Episode 8 - Exercise recovery with Josh Kollman, DC and Bridgette Kelly, PT
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Episode Summary
You don’t need to be a professional athlete to know that it’s important to give your body the rest and recovery it needs after a grueling workout or training session. Some people forget this and push themselves beyond their limit, increasing the risk of sustaining serious injuries. Even those who regularly exercise, no matter the age group, are as susceptible to getting injuries as an elite athlete.
This episode of Back Talk Doc features Dr. Joshua Kollman, chiropractor at Carolina Sports Clinic and physical therapist Bridget Kelly, experts on the topic of recovery from physical exertion. They talk about the different recovery tools and strategies available not only to athletes, but to anyone who is taking up sports casually or exercising regularly. Pain and injuries are typically caused by what you do or don’t do prior to and after a physical activity, rather than the activity itself.
For Dr. Kollman, the best approaches are multidisciplinary and involve not just doing something after a workout, but even before starting. He stresses the importance of doing functional specific warm-up exercises prior and static stretching towards the end of a warm-down. He also talks about what you should do on rest days, which should also involve doing light mobility work.
Both Dr. Kollman and Bridget share the variety of tools and programs that they use in their own practice. These include state-of-the-art machines that conduct cryotherapy and thermogenesis, to simple massage therapies and acupuncture. Additionally, it’s important that you support these tools by giving your body the proper nutrition, hydration and quality sleep it needs.
They also stress the necessity of consulting with an expert team of medical practitioners before trying out any recovery equipment or procedures. Sometimes, they can detect things like movement patterns and behaviors better than any machine could.
Key Moments In The Episode
Links Mentioned In The Episode
You don’t need to be a professional athlete to know that it’s important to give your body the rest and recovery it needs after a grueling workout or training session. Some people forget this and push themselves beyond their limit, increasing the risk of sustaining serious injuries. Even those who regularly exercise, no matter the age group, are as susceptible to getting injuries as an elite athlete.
This episode of Back Talk Doc features Dr. Joshua Kollman, chiropractor at Carolina Sports Clinic and physical therapist Bridget Kelly, experts on the topic of recovery from physical exertion. They talk about the different recovery tools and strategies available not only to athletes, but to anyone who is taking up sports casually or exercising regularly. Pain and injuries are typically caused by what you do or don’t do prior to and after a physical activity, rather than the activity itself.
For Dr. Kollman, the best approaches are multidisciplinary and involve not just doing something after a workout, but even before starting. He stresses the importance of doing functional specific warm-up exercises prior and static stretching towards the end of a warm-down. He also talks about what you should do on rest days, which should also involve doing light mobility work.
Both Dr. Kollman and Bridget share the variety of tools and programs that they use in their own practice. These include state-of-the-art machines that conduct cryotherapy and thermogenesis, to simple massage therapies and acupuncture. Additionally, it’s important that you support these tools by giving your body the proper nutrition, hydration and quality sleep it needs.
They also stress the necessity of consulting with an expert team of medical practitioners before trying out any recovery equipment or procedures. Sometimes, they can detect things like movement patterns and behaviors better than any machine could.
Key Moments In The Episode
- Definition of an athlete - 10:44
- What to do before and after exercise - 14:08
- What to do on days off - 18:35
- Fascial stretch therapy or massage therapy - 20:09
- On cryotherapy and thermogenesis as recovery tools - 24:39
- Compression therapy - 29:36
- New technology as an alternative to manual therapy - 32:47
- The importance of personal medical evaluation - 35:11
- Using nutritional supplements for recovery - 37:27
- Supplement recommendations - 40:04
- Protocol to prevent back pain - 45:23
- Dr. Kollman's nutrition and exercise strategies - 49:00
- Bridget's nutrition and exercise strategies - 51:29
- Recommended apps or books - 52:22
Links Mentioned In The Episode
- Carolina Sports Clinic
- NormaTec
- Marc Pro
- TENS
- Compex
- Game Ready
- Theragun
- Hypervolt by Hyperice
- NAD IV therapy
- Boundless: Upgrade Your Brain, Optimize Your Body & Defy Aging by Ben Greenfield
- The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph by Ryan Holiday
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Intro (00:01):
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates where providing personalized, highly-skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here is your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia (00:35):
Welcome to episode eight of Back Talk Doc. I am your host, Dr. Sanjiv Lakhia, a board certified physiatrist, specialist in physical medicine and rehabilitation. I work at Carolina Neurosurgery & Spine Associates with offices in Charlotte, North Carolina and Rock Hill, South Carolina, and the Greater Carolina area.
Sanjiv Lakhia (00:54):
If you had a chance to listen to our previous episodes, we have gone over quite a bit of information regarding ways to help prevent low back pain and low back injuries. If you haven't had a chance to download our second episode with Ryan Klomparens, it's a great episode where he reviewed how to strengthen your glutes to protect your spine. And then our most recent episode, which was just released, was interview with Jake Beamnon, physical therapy assistant who is an avid CrossFit enthusiast, and we really broke down different aspects of how to train appropriately if you're an athlete and not injure your back. So I hope you have time to listen to those and protect your back.
Sanjiv Lakhia (01:33):
Today though, we're going to shift gears, and I really want to focus on a topic that I think is underrated in the world of athletics and day-to-day activities, and that is recovery from physical exertion, physical exercise, and sports in particular. I'm very excited to have today with me two individuals who I think are very well qualified to educate my listeners on the topic. That is Dr. Josh Kollman, chiropractor in Charlotte, North Carolina at the Carolina Sports Clinic, and he's accompanied by Bridget Kelly, one of their physical therapists who has expertise in dance and works in the South Park area. So Josh and Bridget, welcome to the show.
Bridget Kelly (02:13):
Thank you.
Joshua Kollman (02:13):
Thanks, Doc. We appreciate you having us out.
Sanjiv Lakhia (02:15):
All right, Josh. I want to educate the listeners a little bit about your background and why I think they should listen to what you have to say about the topic. Just briefly, for those of you who know me, I've been here in Charlotte about five years. When I first started working here, I had a chance to meet Josh and just kind of exchange our information professionally, and through the years we have collaborated on patient care. Your group does a terrific job of keeping people active and mobile. And then sometimes when things go south, we're able to provide the services that are needed like injections or surgery or what have you. So we've got a real good synergistic working relationship, and we really appreciate that.
Joshua Kollman (02:52):
Absolutely.
Sanjiv Lakhia (02:54):
Josh's background is extensive. We were joking about it when he first showed up this afternoon. A couple of things I want to highlight, and you can certainly learn more if you go to his company's website, but from a manual perspective, he's not just a chiropractor. He's got expertise in numerous modalities including dry needling, acupuncture, Graston Technique. He has certification in strength and conditioning. And Josh, I found your educational background to be interesting. You have your Doctor of Chiropractic degree from New York Chiropractic College, but you also have a Master's Degree in Performance Enhancement and Injury Prevention, as well as a Bachelor's Degree in Kinesiology. So it looks to me like you've had a passion, for most of your life, to learn about how to help people exercise and stay healthy and stay out of harm's way.
Joshua Kollman (03:43):
Yes, sir. Yes.
Sanjiv Lakhia (03:44):
I know currently in addition to treating the weekend warriors, you are involved in some professional endeavors with professional sports teams, professional golfers. So every time I try and reach out to you, you're either traveling or you're busy saving the world in the Charlotte community, but I appreciate you taking the time to talk with us today. And then, Bridget, you have a background in dance and I know you went through PT school at University of Kentucky. Is there anything you'd like to add so the listeners may know a little more about your educational background and training?
Bridget Kelly (04:14):
Yeah. So I was majoring in dance, and when a professional dance career was not going to be physically possible, I started getting more into the preventative medicine side. So when I treat injuries both with dancers and all the other types of athletes that I see, I like to really focus on, of course, getting better the one problem that they're in for and making sure that all of these future injuries are preventable, that we can stop what future injuries might be happening before they do. And that's where a lot of their recovery tools can be pulled in.
Sanjiv Lakhia (04:46):
I think it's interesting how many of us in the health and fitness world, particularly the medical side, bring to the table our own personal injury, our own personal background. I've shared with my listeners before that I hurt my back playing basketball growing up, and I just feel like the more we share with people, the more they can relate and we can learn from each other.
Sanjiv Lakhia (05:05):
Josh, tell us how the Carolina Sports Clinic came to birth, kind of what your vision has been for your chiropractic group. I know you have offices throughout the Charlotte area and you're kind of a destination spot for athletes in the region.
Joshua Kollman (05:20):
Yes sir. Yeah, we have three locations. We're at Blakeney, we're down here in Baxter Village, and also, doc, up at SouthPark. And the ticket for me, I was a little bit different in this sense of, it wasn't necessarily an injury that drove me towards the sports medicine world. It was more of - I know so many of our listeners can probably really relate - I couldn't sit still. Even now talking to you, it's hard to sit still. So basketball was a huge passion of mine, and I played DII at Penn State. Doc, sitting still, the academic side, was hard for me. And so I'm studying exercise science and going through school, and finally I got into a cadaver lab at Penn State, and it just started to click. Anatomy was something I could put my hands on. It was something that I could visualize, I could touch, I could feel. And being an athlete, I think that lent itself to seeking out a profession that I didn't have to sit behind a desk or I could be up and be involved in health and wellness.
Joshua Kollman (06:23):
I was fortunate enough to, at a young age, I had a strength and conditioning mentor that led me to the National Academy of Sports Medicine. So doc, I'm 19 years old and I had an opportunity to go study with the NASM and get my certified personal training certification. I felt like that helped me to engage with somebody one-on-one at an early age. You come to me with a set of goals, and here I was at an early age trying to figure out how to get you to those goals. And doc, sometimes you might come to me back then as a personal training client, you had some low back pain. My knowledge at that point in time was so limited. I didn't know what to do besides maybe some strength exercises.
Joshua Kollman (07:10):
So it's saying, I mean, doc, I'm old. I've got a lot of grays. So this is 20 years ago. And so I would send my athlete or my client to another health care provider, and the answers that I was getting back was just, it didn't satisfy my ability to help my client. Usually, it was just rest. You'd go to the orthopedic world and they'd say, "Hey, take some time off, take some over the counter NSAIDs or whatnot, and then go back to your activity if you can." And so for my athletes and my clients, that wasn't good enough. And so for me, I needed to find something that I could immerse myself into that I could have the tools, so that when that client, patient, friend, whoever it was, sought me out for help, I had that knowledge to help them.
Joshua Kollman (08:00):
So from that, that's where the concept of Carolina Sports Clinic - and I want to be so respectful to... If there's any chiropractors out there that are listening to me, please don't take it the chiropractic profession is so important to me as a chiropractor. But I really feel that the chiro hat is a tool in my toolbox, and I really don't define myself within those chiropractic principles of, you're going to come into the clinic and it's going to be a quick, maybe rack and crack adjustment, you're in and out of my office. I, from an early age, in this profession. I wanted to take the movement sciences from Penn State, from my graduate program, from my personal training background, and see how I could apply that, so when I'm working with an athlete or a patient, I had those tools to really make a change and a difference, so that that athlete or patient didn't have to constantly come back and me.
Sanjiv Lakhia (08:55):
Yeah. No, that's excellent. And I want to address that too as an osteopathic physician, which I am, and then a board-certified physiatrist, I do get a lot of questions about chiropractic care in general. And I will share with my listeners, I feel like spinal manipulation can be a very valuable tool in the toolbox, but being dependent upon it doesn't always lead to long-term success. So the best approaches are multidisciplinary and I feel like you have to have multiple players that can help patients navigate their injuries through different stages of the process. Certainly, there's the end point where if everything is not working, you have surgical intervention that can be offered, which our group does so well, and then everything in between.
Sanjiv Lakhia (09:40):
Let's jump into kind of the topic of the day today, which is recovery from athletics, recovery from injury, which I think your group really sets itself apart with. Our patient population at Carolina Neurosurgery & Spine ranges from young athletes to middle-aged weekend warriors, and then we have a lot of active seniors. Let's kind of organize this and get your thoughts on, based upon these demographic groups, when it comes to recovery and activities, how would you organize or advise a listener today to organize their activities? Let's say, for example, someone in their 60s has gone through the weekend, they played some pickleball, they played a round a golf and it's Sunday night and their back is pretty sore. They're having some pain in their calf muscles and they want to stay active the rest of the week and not have to take a week off. We exchanged some show notes and I've kind of broken it down to certain categories from exercise to manual recovery, another intervention. So I'd like to let you kind of jump in and give me your thoughts on that.
Joshua Kollman (10:44):
Absolutely, doc. I appreciate that. Listeners, think about this for a second. Yeah, I think it's so important that we first define when we talk about an athlete. And in the clinic, it's imperative that we define an athlete as anybody that wakes up in the morning and moves and breathes. So it was always my goal with Carolina Sports Clinic, was to create a practice that... For me, I'm very fortunate. This is my ninth year as the team chiropractor for the Carolina Panthers. This is my 11th year out on the PGA Tour, traveling with those guys on the sports medicine team. I'm able to be, a lot of times, a fly on the wall. I'm there as the chiropractor, but I get to see the DO and the MD and the ortho and the different disciplinaries, and I get to see how they assess, approach and treat elite athletes.
Joshua Kollman (11:33):
So it was always my vision and goal of taking elite athletic care and taking that to my athletic population, which is defined in my clinic as everybody. It could be an elite athlete. It could be that 67-year-old playing pickleball. It could be that mom of four that's just trying to get through her day with so many - she feels like the mama bus, the taxi, driving all of her kids to the different programs throughout the day. So it's our goal to take our recovery efforts and our treatment efforts and actually apply that to all of our athletes, which is being defined as anybody that wakes up and moves and breathes is an athlete in my ballpark.
Sanjiv Lakhia (12:13):
I like that definition. I feel like teaching healthcare, these are full-contact sports. I mean, I did an episode recently on back injuries at work, and statistically, nurses have a very high risk of injuring their back throughout the work day. So almost anyone who's out trying to make a living is in part going to use their physical skills to help accomplish that day-to-day task. So that's a good definition.
Sanjiv Lakhia (12:38):
Bridget, do you kind of see it the same way in terms of, you have to almost approach everyone with the same level of need?
Bridget Kelly (12:45):
Absolutely. I've had a lot of patients who are older who always talk down on, "Oh, I'm just running a couple miles a day," acting like that's no big deal. But when you are active throughout the day, whatever that activity is, whether your goal is getting on and off the couch independently, or if your goal is running a marathon, you still need to be active enough to accomplish whatever those goals are.
Sanjiv Lakhia (13:07):
Yeah, it's paramount of importance.
Joshua Kollman (13:10):
Let me tell you, you guys are going to like this quick story. I do a lot of work with Sun City right off 521, a huge retirement community. I have so many athletes from Sun City that come in during their softball tournament or pickleball tournament. And they'll come in and they'll say, "Hey, Josh, I know my buddy Richard's coming in later on today. Take his knee out, man." I mean, these are 60, 70 and 80-year old athletes that are still so competitive. So I love that we're bringing in everybody because I do feel that all of us has an inner athlete inside that's just looking to excel in whatever activity that we're trying to accomplish and compete every day.
Sanjiv Lakhia (13:56):
All right, let's get specific.
Joshua Kollman (13:57):
Shoot.
Sanjiv Lakhia (13:57):
In terms of exercise, what are your thoughts in terms of post-exercise stretching versus mobility work versus taking days off if you're just sore? What do you typically advise your patients?
Joshua Kollman (14:08):
Absolutely. All right, doc. So think about this, gang, listeners, with exercise and stretching. The pendulum swings on this every single day. If we go and look at some evidence-based practices today, the pendulum is at a point of suggesting that static stretching could, before activity, decrease performance. There's still unclear research-wise on what static stretching has the ability to do post exercise.
Joshua Kollman (14:37):
Here's what we've done at the clinic, is our stance is we try to look at all the literature that's currently out there and clinically what has worked for us in the past. Right now, I'd love to have our listeners really engage in dynamic movement patterns before, and we break down dynamic as patterns that you're in motion. You're moving, and they want to be specific. You and I are basketball players, doc. So let's say you and I are going to go hoop. We don't want to go throw a baseball before we go play basketball. So we want to do specific movement patterns for that exercise. You had a great podcast with the CrossFit. Let's say we're going to do some barbell type activities, or maybe we want to warm up some of that rotator cuff with a PVC pipe before we jump into the barbell movement patterns.
Sanjiv Lakhia (15:25):
So more functional specific warm up.
Joshua Kollman (15:27):
Yes, sir.
Sanjiv Lakhia (15:27):
Yup.
Joshua Kollman (15:28):
I definitely don't want to discount the ability of static stretching. So for our listeners that are jamming into this podcast, if we're going to do our static stretching, I don't have an issue with it. Let's put it at the end of our movement patterns, use it as part of the warm down, right? I like that term warm down instead of cool down. I want that warm down to be active. So many times our warm down tends to be a cool down, which is very passive after a hard bout of exercise. I see a lot of my athletes just go kind of just grab a seat and not do a whole lot of movement, right? If our goal is going back to that older athlete playing pickleball, on Sunday night, he has or she has some back pain, it could be due to not necessarily the activity itself, but what did we do after the activity, right?
Sanjiv Lakhia (16:19):
Yeah, that makes sense. I've done martial arts off and on throughout my life. And in the martial arts arena, they practice what you just said. So it's dynamic warmups, some brief sprints, some dynamic leg swings, some stretches, and then at the end is when you're doing more of the static stretching after you've kind of mobilized the tissues, improved the circulation. Miraculously, you think you would be at higher risk for pulling your hamstring or doing these crazy kicks, and for years of practicing martial arts, I never had anything like that happen.
Joshua Kollman (16:53):
Yeah. And hey, doc, for our science geeks out there, and I love science and I tried to dive into it a little bit, I just went to a fascia manipulation seminar and this doc out from Italy, the Stecco Method, they were talking about hyaluronic acid and how, when we look at fascia, how fascia moves, that it's increase in temperature. So when we increase, everybody is like, "Man, when I start moving, that Achilles tendon or that knee pain or that elbow pain tends to decrease in irritation or what I perceive as pain. Why is that?" As we warm tissue up, tissue becomes more elastic, and that elasticity and increased blood flow makes a change with the hyaluronic acid, and it really prepares us for motion. So I love that dynamic warm up, we prepare for motion, and then we have a nice warm down post activity.
Sanjiv Lakhia (17:43):
Bridget, is that how you typically start off your patients with a little bit of a cardio piece to get the blood flowing and get them moving?
Bridget Kelly (17:50):
Absolutely. I'd say big time education-wise for those athletes, that certain populations like runners and golfers are historically known for wanting to dive right into their activity and then hop back in the car and head out after. So really educating patients on how to warm up, warm down, get everything ready to go.
Sanjiv Lakhia (18:10):
Josh, you touched briefly here on the fascial stretch, and that's kind of my second category, is in terms of recovery, there's all sorts of options out there for manual recovery from massage therapy, dry needling, acupuncture, and you have a terrific background in many of these. How do you intellectually organize these treatment options for your patients when they come in, in terms of deciding when to go to which tool?
Joshua Kollman (18:35):
You'll like this, doc. Watch this, you and I can do some blending here. So you'd asked earlier about taking days off. This is a cool spin. So days off can be active recovery days. I like to call it the arc, right? So it's an active recovery day on our day off, and that could look like, you and I are marathon runners, so we're running a half marathon. And so our active recovery day could be a pool swim. The hydrostatic pressure of the water, great for our joints. We're unloaded. We're in a different movement pattern. So that would be a day off in essence, and the ability to do some mobility work, a chance for us to check in with ourselves and see how am I feeling? Do I need to do some extra foam rolling on some different tissue, or do I need to do some different dynamic mobility patterns because I feel like my hips are starting to tighten up?
Joshua Kollman (19:26):
So I really want our listeners that are going to tune into this podcast to understand, a day off typically doesn't necessarily mean I'm not going to do anything that day. If we're really looking to have optimal function of our soft tissue, it's really going to behoove ourselves to engage into some light activities throughout that day off. I know a lot of us do have those jobs that require us to sit. When we're sitting, blood's pulling. When we're sitting, we're not in a great hip position, we're loading the low back. And so getting active on those days off could reduce some of that soreness that we were talking about. It could really set the tone for our next workout even.
Joshua Kollman (20:09):
Let's go to the question, massage therapy versus fascial stretch therapy versus acupuncture. The cool thing here, doc, is you see a lot of massage therapists are actually certified in FST as well, fascial stretch therapy. I love to use massage therapy as if, doc, you're coming to me saying, "Josh, man, you're my massage therapist and my left hip, I tell you, I just feel like it's restricted, my range of motion is limited. I really need you to focus on that soft tissue in that area." We'll pan out along that line a little bit. I can use it. I know your job is super stressful as a doc. I can help to increase some of that parasympathetic nervous system, right? Decrease that sympathetic drive. Massage therapy is phenomenal with that.
Joshua Kollman (20:59):
Fascial stretch therapy, I want all of us to think as... let's think about a big net like Spiderman net. I want you to think of the body in the fascial covering. You probably remember it from medical school.
Sanjiv Lakhia (21:11):
It's not just the stuff we cut through to get to the good stuff [crosstalk 00:21:14]. The secret sauce is the-
Joshua Kollman (21:16):
Secret sauce. We have superficial fascia, we have deep fascia. You know it has a huge supply of innovation. And so with fascial stretch therapy, it's not passive. You're going to be on the table. I'm a level three certified medical fascial stretch therapist. What I do with you on the table is about an hour long dance with your joint structures. A lot of it is passive, me moving you through that fascial layers with a lot of contract-relax. So you are getting active. You're getting some activities, some activation of the fascial tissue while we're working through that system. So it's different with massage.
Joshua Kollman (21:56):
I need everybody to think about this for a second. This is huge for me. I think of ballparks. And for you, doc, if you're on my table and I take you through either a massage or FST, I'm looking at the fascial nets, the joints, the soft tissue. I'm preparing the system for motion. I'm fixing the tissue. A lot of people get into this rut, follow me for a second. They go get a massage. The massage therapist works the tissue while the athlete, the client's on the table. It's a very passive. They get off the table, they feel better for five, 10 minutes, a half hour, a day. That pain comes back, hip pain comes back. What just happened? I had a massage yesterday. I had a massage this morning. Why do I still feel some of that tightness that I went in for the massage?
Joshua Kollman (22:48):
What we need to start teaching people is that once you have FST, once you have a massage, now we need to put the body through motion. We need to give the body some stability. We just made a change to the system, and then we just asked our client or our patient just to plug back into their environment without any engagement into that new-found range of motion that we just delivered them. They don't know how to play in it. So in our clinic, when we say mobility work, we're really trying to make a shoulder work like a shoulder. My soft tissue work is going to really increase range of motion and work on the joint, the soft tissue surrounding the joint, the neurology with the joint, and then we want to load it. We want to neurally groove that joint, that pattern, so now you can own that new range of motion and you can go play in it and you're not going to reverberate back to what you had done before the treatment or the massage ever happened.
Sanjiv Lakhia (23:48):
That's excellent. It's really combining modalities, manual work with therapeutic exercise.
Joshua Kollman (23:54):
Absolutely.
Sanjiv Lakhia (23:54):
That's purposeful. I really like that. Thanks for sharing that.
Joshua Kollman (23:57):
Yes, sir.
Sanjiv Lakhia (23:58):
Another category that I encounter, I get questions about a lot from my patients, is the whole heat versus cold. And I think the modern day version of that is sauna therapy, cryotherapy. Now, I've talked with my listeners and I did a segment on the benefits of far-infrared sauna. I own a far-infrared sauna and I've used it off and on for years predominantly for stress relaxation, but also I've found it to be very helpful with back tightness and pain. Certainly, now cryotherapy is in vogue. You hear a lot of the professional athletes use it. I think your group offers services for that.
Joshua Kollman (24:32):
We do.
Sanjiv Lakhia (24:32):
Can you walk us through a little bit about the cryotherapy and just your thoughts on thermogenesis as a recovery tool?
Joshua Kollman (24:39):
Absolutely, doc. Great question. We do. We have cryotank at the clinic. We've also experimented with some spot cryotherapy that you're going to see as a new form of cryotherapy that we can use that the athlete or patient doesn't have to be fully immersed in the tank. You're seeing in the NFL a lot of our centers are creating whole body cryo to where these require the cryotherapy room, if you will, you actually put on that beanie, gloves, hopefully. You see some of our NFL athletes forget to put the feet booties on and they end up with some pretty bad burns from that. But if you're protected properly, cryotherapy is actually a super safe recovery tool. It's something that we've used in the clinic for the past two years. Our tank is a whole body tank, and doc, we use it for our athletes. We call it a freeze and squeeze.
Joshua Kollman (25:33):
So our athletes' post activity, you want to make sure that the skin is dry. We have a shower at the facility that can shower up after a run, a [inaudible 00:25:42], a hard workout, CrossFit. They'll shower up. After the shower, they'll dry off. It's a three-minute recovery system in our cryo tank. Basically, what we're looking to do is, is we're looking to take this athlete, we're trying to increase muscle oxygenation. We're trying to look at something called creatine kinase. We're trying to decrease the body's metabolic waste post hard exercise. And so we do have a lot of literature that looks at three minutes in the cryotherapy chamber has the ability to significantly decrease a lot of that metabolic waste that's out there that can cause a lot of the irritation post induced onset muscle soreness from exercise.
Joshua Kollman (26:29):
We know that after a hard bout of exercise, it's a lot of the fluid within tissue that pushes up against some nerve endings that are exposed, right? A lot of people used to think that was lactic acid that was the reason why you were sore after a workout. We now know that's not the case. And so cryotherapy has the ability to calm that tissue down. You think of systemic vasoconstriction is the goal of cryotherapy. I know there's a lot of claims out there with some other - decrease in heart rate. We look at Wim Hof and a lot of the methods that they're looking at as far as... I don't know, doc, if you've seen any of his material that's out there.
Sanjiv Lakhia (27:10):
He's wild.
Joshua Kollman (27:11):
Wild. Wow. Do you cold shower at all?
Sanjiv Lakhia (27:15):
I do, yeah.
Joshua Kollman (27:18):
Doc, it is invigorating.
Sanjiv Lakhia (27:20):
It is, yeah. It's a slap in the face.
Joshua Kollman (27:22):
When I get out of the cryotank, I do, I feel refreshed. It is that great slap in the face, and I'm in there for three minutes and it feels fantastic.
Sanjiv Lakhia (27:32):
Okay. Let's say I send you a patient who's herniated disc. We've done a couple epidurals. They've rehabbed. They're doing pretty good. They have some residual pain and inflammation. Logistically, for someone who knows nothing about it-
Joshua Kollman (27:45):
Yes, sir.
Sanjiv Lakhia (27:45):
... walk it back a little bit. You define cryotherapy as, is there a certain temperature cutoff, or what is the degree of coldness that someone can expect?
Joshua Kollman (27:54):
Basically, somebody can expect with that is -275 degrees.
Sanjiv Lakhia (27:59):
And how is that accomplished in the tank?
Joshua Kollman (28:00):
With nitrogen.
Sanjiv Lakhia (28:01):
With nitrogen. Okay.
Joshua Kollman (28:02):
Yes, sir. That is right.
Sanjiv Lakhia (28:03):
What does a patient feel when they're in the tank?
Joshua Kollman (28:05):
They feel a slap-in-the-face cold.
Sanjiv Lakhia (28:08):
Very, very cold.
Joshua Kollman (28:09):
It is cold.
Sanjiv Lakhia (28:10):
Okay.
Joshua Kollman (28:10):
We have a certified technician that is running the tank, and that technician is talking you through the whole time. We'll actually rotate you while you're in the tank. Again, your head is above the tank. So some people tend to feel claustrophobic in some units. So we have your head elevated above the tank, you have gloves on, you have booties on, and we're rotating you halfway through just talking you through the whole system while you see, obviously, the nitrogen. It looks like a really cool Batman movie in the clinic while the nitrogen is flowing.
Sanjiv Lakhia (28:44):
Okay, very good. Are you using a lot of cold therapy, Bridget, with your patients in PT, or is it more traditional cold packs and standard things that are done
Bridget Kelly (28:55):
In our location in SouthPark, we don't have the cryotherapy unit yet, so we are doing more of the traditional cold and heat therapies, but hopefully that'll be a new thing that we'll be getting in more of the clinics.
Sanjiv Lakhia (29:06):
Right. All right, so we've touched on exercise, we've touched on manual recovery techniques, we broke down cryotherapy and thermogenesis. There's a few other miscellaneous techniques for recovery that I noticed your group is recommending to patients that I wanted to get your take on. You mentioned on your website the NormaTec recovery sleeves. This is compression therapy.
Joshua Kollman (29:28):
Absolutely.
Sanjiv Lakhia (29:28):
I assume this is a form of helping to move lymphatic fluid and kind of decongested tissues after exercise. Can you elaborate on that?
Joshua Kollman (29:36):
Okay. Yes, sir. There's some literature too when we talk about compression. When we walk into an NFL locker room, you're going to see a cryotherapy chamber. You're going to see spot cryo. You'll see something, we'll talk about in a second, called a Marc Pro. You'll also see potentially a Compex unit. You'll definitely see NormaTec, and you'll see Game Ready. So those systems are typically a lot of our recovery tools that we'll utilize with our elite athletes. The freeze and squeeze that I alluded to that I talked about earlier in the segment, basically we use the freeze is our cryotherapy and our squeeze is the compression.
Joshua Kollman (30:17):
So we can go through a bout of... I like to use the NormalTecs first and then we'll go into the cryotherapy unit. So it's anywhere from a 20 to 30 minute treatment, doc, with, a lot of my patients call them the moon boots. So we have boots that goes from your toes all the way up to your hip. They are sectioned off in chambers, and basically, you can create this pneumatic squeeze for the lymphatic system. You are in a zero-gravity chair, so we have your legs elevated, and then for 25 to 30 minutes post activity, post exercise, that is a great way to start recovering the system. So we have a decrease in exercise soreness, so we can prepare the tissue for its next bout of exercise.
Joshua Kollman (31:02):
Let's take the Mark Pro. A lot of people are familiar with the old school TENS units. Remember TENS units was a current that we could use for that disc patient to create some white noise for the nervous system, so they'd had a decrease in their perception of pain. That's a TENS unit. So we've taken that technology and we've enhanced it, and we can use these units, they're wireless units - the Compex unit, the Marc Pro. These units, it looks like a TENS unit. The current is a designer current, and we use this on a low frequency to create a pump. So this can create some muscular contractions like a pump to help flush out the tissue post exercise. Doc, we can use the Marc Pro, we can put that on the tissue first, then we can put the sleeve on, so now we have a really effective way.
Joshua Kollman (31:56):
Think about this. Another way I could achieve a recovery like that, we talked about it earlier, I could use some dry needling. So post exercise, this is really cool, guys. I can actually do some superficial needling into the tissues that were just used, elevate the tissue, do some cupping, I call it cupping a river, so I'm given a little bit of space underneath the tissue. I'm going to hook up the needles with some stem to get some contraction, elevate the extremity. Voila, I've just created a scenario where I can do some amazing post exercise, high intensity recovery.
Sanjiv Lakhia (32:32):
And that's going to really accelerate the...
Joshua Kollman (32:34):
Yes, sir.
Sanjiv Lakhia (32:35):
... removal of the lymphatics and congested tissues and accrue the blood flow almost like... Can you do that in lieu of massage? Can you get similar, or would you consider it to be a little more powerful effect than manual?
Joshua Kollman (32:47):
Doc, that's awesome question. I love the ability to... You and I, before we started, we were talking about some recovery tools. Let's say you and I, we're triathletes and we've trained hard for this Ironman that's coming up-
Sanjiv Lakhia (33:01):
That would be more you than me, by the way. I'll accept that.
Joshua Kollman (33:05):
We were going on this journey together. You and I are going to take advantage, and let's say for us, we are utilizing Carolina Sports Clinic, and we have some massage and acupuncture, dry needling, physical therapy, cryo, the recovery center, cryotherapy and NormaTecs. So it's cool to have the ability to use that, but you and I might be, we're on the road or we're traveling to an event. The tools - the Marc Pro, the NormaTec, the Game Ready even - those are portable. I know a lot of the recovery tools can be expensive. When you purchase a NormaTec, it's a one-time purchase. You and I could have it at home, we could use it after every workout. Massage therapy, those sessions, they could get a little expensive.
Joshua Kollman (33:50):
So I love the question. I think a lot of times it's utilizing both of those, guys. Scheduling yourself with your massage therapist, getting some recovery treatment with your physical therapist or your chiro, that's part of it because those guys could potentially... In our clinic, when you come to me, doc, I'm looking at your movement patterns. NormaTec can't really look at your movement patterns, right?
Sanjiv Lakhia (34:14):
Right.
Joshua Kollman (34:14):
So maybe I can pick up on that potential Achilles, knee tendonitis, hip bursitis issue, and we can knock it out before it becomes an issue. That's our goal. It's all about prehab. I don't want to see you when your tissue is flared up. If I'm on my game, I'm not your, "Hey, I have an issue. I need to go see Josh and Bridget." It's like, "Josh and Bridget, here I am. I feel great. I'm using recovery tools at home, I'm utilizing your services, but keep me moving well so I can keep doing the things that I love to do."
Sanjiv Lakhia (34:49):
Yeah. I think that's where our training comes into play, where this is a field where you have to have customized, personalized care.
Joshua Kollman (34:57):
Absolutely.
Sanjiv Lakhia (34:57):
And then you have the tools that you can identify that will help an individual patient, but there's no substitute for a personal evaluation and that personal touch. I think there's still a lot of value to hands-on a patient to help understand what they're going through.
Joshua Kollman (35:11):
And doc, think about this. If you come into the clinic and I pick up on that hip issue, you're like, "Hey, Josh, I'm just here for... I haven't seen you in three, four weeks. My training volume has ticked up. I want you to check through my systems to see how I'm moving." So we go through our assessment. We see that, "Hey, doc, I think you're putting a lot of load to this right hip. Let's make some changes in maybe your running cadence or bike fit or maybe it's some rehab exercises on Bridget's. And to give you a little bit more, that podcast, strengthening your glutes, what we've just done is, is we've hopefully prevented an injury that: a) takes you out from what you're training for, and visits with us.
Joshua Kollman (35:54):
Bridget and I don't have the philosophy of, "I want to see you three times a week. I want to see you 50 times a year." If I can fix that in one visit, because we preemptively picked it up in our movement screen, now I've saved you a ton of copays. You can go buy a NormaTec for the house, and everybody is happy.
Sanjiv Lakhia (36:13):
That makes a lot of sense.
Bridget Kelly (36:14):
I think that's the biggest benefit of the collaborative care of being able to have one location that has these multiple services, is that we can... When they come in, I'm treating them from a physical therapy standpoint, but I think, hey, I think the massage therapy would be really beneficial for one session, so that we can work through more of this widespread muscular tension and then dive back into rehab exercises versus if they need NormaTec and cryotherapy as a recovery tool. We also just point people in the right direction of what's going to help the most at the time.
Sanjiv Lakhia (36:44):
Oh, absolutely. Absolutely. All right, we're coming to the end here. You've covered a lot of material. I really appreciate. One question I get a ton is about supplementation. So nutritional supplements are all over the market in terms of recovery from exercise, recovery from athletics, creatine, there's protein powders and such. Do you have a couple that you think have pretty good research that you recommend or could be recommended to a wide population? And again, if you're listening, this is for informational purposes only. Please speak with your physician, your medical provider before you start any sort of nutritional product. Just because it's not a prescription drug doesn't mean it will affect your physiology.
Joshua Kollman (37:27):
Absolutely, doc. That's a great point. I want to elaborate on that. There's two things that, doc, I think you'll love. Number one, gang, I want all of us to really... We talk about supplementation, I think we get confused a little bit. I want us to remember that our best source of nutrition comes from what? Whole foods.
Sanjiv Lakhia (37:43):
Absolutely.
Joshua Kollman (37:44):
So I really want to hammer home here that when we talk about supplementation, we want to do our best to... I have three kids, three locations. Obviously, we're super busy. I'm training for a century ride up in the mountains at Mount Mitchell currently. And so I know how hard it can be to properly utilize whole foods as your only source of nutrition. That's a challenge. So that's where supplementation can come into play. And fortunately for us, we live in a world where, oh my goodness, you open up your email or your Instagram or whatever it might be, and I'm constantly getting bombarded by Viking Waffles or all kinds of different supplementation that's out there on the market.
Joshua Kollman (38:26):
And so remember that, guys, when you can, first and foremost, whole foods is the ticket. Number two, or doc alluded to, whether it be your primary healthcare physician, we have in the greater Charlotte, Fort Mill, Rock Hill area, we have some phenomenal family physicians that are doing some concierge care where you can check in with them and say, "Hey, look, we actually have some at the clinic. We use a couple of labs." Instead of just throwing a dart, doc, at some massive wall and trying to hit bullseye, let's do a panel, let's do a blood panel. Let's take a look at your body's chemistry and let's see what is or is not working for you. I love that.
Sanjiv Lakhia (39:09):
That makes sense versus shotgunning approach.
Joshua Kollman (39:11):
Oh, doc.
Sanjiv Lakhia (39:12):
I mean, nowadays, the level of sophistication from a lab perspective is quite high. You can check your omega fatty acid profile, you can run hormone panels, you can look at your micronutrient status. There's a wide variety that's available. Now, I will say though that some of that is compartmentalized to people who can pay for it out of pocket because not a lot of the insurance payers cover some of the nontraditional testing. But if you do have the resources, it can be worthwhile. And I always tell patients, to your point, if you are limited with funds, I'd rather you spend your money on good, healthy organic food than on capsules and tablets. I think you have to start there. That's your foundation, and the supplements are just to kind of fill in the gaps. But are there anything that you recommend that's specific for, let's say, back muscle soreness after working out the gym, or how do you kind of approach that? Are there nutritionals that you could recommend to people?
Joshua Kollman (40:04):
I do. Yes, sir. So one thing that we're seeing right now, an uptick of is magnesium. So that's a big one that I think has been around for a long time. You're seeing magnesium being used in a lot of different creams and sprays. I was just out on the PGA Tour at the Phoenix open this past week and we had a nice product on the trailer that had magnesium in it and we could actually spray it on top of our kinesio tape.
Joshua Kollman (40:29):
So we had a couple of our athletes that woke up... These guys sleep in a different bed every week, and so sometimes they're in a bed that's not conducive to supporting their system. They wake up, they're a little bit sore, maybe they didn't play well, they hit a [inaudible 00:40:45], hit some bad shots. And so we'll do some soft tissue treatment, we'll tape them up, we'll use some of the magnesium. As it gets into the hotter months, for a lot of us endurance athletes, I think magnesium can be a great way to help us maintain as we get that high sweat rate to try to decrease some of that muscle cramping and muscle soreness.
Sanjiv Lakhia (41:05):
Yeah. So magnesium, for those listening, it's a natural muscle relaxer. It down regulates glutamate, which is excitatory neurotoxin on the body. So there are applications for cognitive issues and for pain in general. Our food is really deficient in magnesium. The soil is deficient in magnesium. Most people are deficient in magnesium. It's also a natural laxative. So there's a lot of good benefits [crosstalk 00:41:30] for magnesium and it's really hard to take too much magnesium because the limiting factor would be loose stool, similar to vitamin C. So that's a real good one. Any others you want to toss out there, Josh?
Joshua Kollman (41:42):
Yeah, doc. I want to ask you a question. I think a lot of our listeners are familiar, so I'm going to breeze over this one quick. We do use a lot with our athletes, we go into some like branched chain amino acids. Let me jump into this for a second, doc. Are you familiar with NAD?
Sanjiv Lakhia (41:55):
A little bit. I've read a little bit on it as kind of the newest anti-aging molecule, but you can certainly enlighten me.
Joshua Kollman (42:01):
Yes, sir. So let me take a few minutes. There's an athlete that I work with on the gridiron that has utilized NAD significantly throughout this past season and has seen a really nice improvement. We're really looking at this for recovery, for cellular regeneration. This is a substance that some people... We actually make it, doc. And as we get older, i.e myself, obviously, most of my internal system starts to decrease in production. And so the cool thing with this, some people stay away from it because it can be something that if administered not properly, it's not comfortable.
Sanjiv Lakhia (42:39):
So backing up, NAD, correct me if I'm wrong, it's a byproduct of the Krebs cycle in our formation of ATP. So if you're listening, you're saying, "What on earth are they talking about?" I would think of it as somewhat of an energy molecule.
Joshua Kollman (42:53):
Yes, sir.
Sanjiv Lakhia (42:54):
Is that a kind of a simplistic way to describe it?
Joshua Kollman (42:56):
Absolutely.
Sanjiv Lakhia (42:56):
Okay, go ahead.
Joshua Kollman (42:57):
Absolutely. And so the most common form with administering NAD is IV, intravenous. So you'll see a lot of times, we have a doc, we have an ER doc in the clinic that companies call revive. And so he's in the clinic with one of his nurses and they provide IV bags to our athletes, and they're putting the branched chains in there. They're loading it up with vitamin C. They have NAD that they're putting in the bag. And that drip, doc, is going to work a lot slower with the NAD versus like, "Hey, guys, I've had a hard training cycle. I'm looking to hydrate. I feel like I'm getting a little bit of a cold, so I want my B12 or my B-complex, my branched chains." This bag with the NAD is going to be a slower drip, and with that slower drip, you still might have some achy type symptoms with the administration of NAD.
Joshua Kollman (43:53):
A lot of times they'll tell you if you're coming in with a knee injury or a knee issue that you're training through, a lot of my athletes tell me that they feel an increase in achiness wherever that part is that they had come in that they had a problem with. And so the NAD treatments, they'll do two to three a week for a couple of weeks. So you almost have a dosing period of NAD. And we are reporting a lot of our athletes are feeling like their recovery processes are definitely increased and enhanced with the NAD through the IV.
Sanjiv Lakhia (44:29):
Well, we'll have to keep an eye on the research as that evolves.
Joshua Kollman (44:32):
Absolutely. For sure.
Sanjiv Lakhia (44:33):
That's very interesting. Bridget, do you use any or have any go-to supplement recommendations for your patients?
Bridget Kelly (44:38):
That I always like to defer to the experts that we have one chiropractor in clinic who is our supplement expert and always will refer patients whenever that might be the best fit for them, so we can make sure that we have our experts in all the different areas tailoring to them.
Sanjiv Lakhia (44:56):
Yeah, that's fine. It all, hey, I always like to stay in my lane. So that's great to have a team that you can rely upon. And then as we've covered a lot of stuff here, Josh, of the things we discussed today, what do you find to be the most useful for low back pain, for athletes who have low back pain that they've rehabbed, they're doing well, they're performing, but you want them to stay on top and not have back pain recurrence? Is there a little protocol that you recommend or some go-tos of this list that we've covered today?
Joshua Kollman (45:23):
Yes, sir. Movement is life, absolutely. So loading, we can go through different progressions, whether it be a dowel, right? I need to work with a strong foundation. That is critical. So when I have that strong foundation through some proper loading patterns, proper movement patterns, that's where I've got to start, because your magnesium, your kinesio tape, your chiro, whatever it might be, I just don't think it's going to be as effective if I don't start with that solid foundation of movement patterns. So doc, I'm going to have them move first, and I'm going to teach them some proper loading patterns, I'm going to use a dowel or a rod and-
Sanjiv Lakhia (46:01):
Like hip hinging.
Joshua Kollman (46:02):
Yes, sir.
Sanjiv Lakhia (46:03):
Okay.
Joshua Kollman (46:03):
Absolutely. And then we can progress to some different movement patterns, almost go into like even a dead lift to getting that back nice and strong that it can handle what our day-to-day activities throw at it, what we talked about earlier, using some magnesium, our recovery tools, we discussed using a Theragun, a Hypervolt. This company, Hyperice, creates some beautiful products that we used on the PGA Tour to warm up some of our backs while the guys were going through some dynamic movement patterns before the round. It's basically, doc, a wrap that goes around the low back. We have one for the shoulder. We have a sleeve that we can use for a thigh or for an arm. That wrap is going to provide heat and vibration. So that heat and vibration is a fantastic tool to calm down that back that might be a little tight.
Joshua Kollman (46:57):
Everybody right now, I think listening, might be familiar with a Theragun or the Hypervolt. Those tools are excellent, again, to provide some vibration/percussion to the tissue to increase some blood flow, to create a break of that nervous system, that spastic tissue. I'm looking to put an input into it, and a Theragun can be a really nice way to do that, or the Hypervolt.
Sanjiv Lakhia (47:21):
How about you, Bridget, do you have some go-tos you think for the back?
Bridget Kelly (47:24):
I would say the biggest thing that we haven't touched on yet today, when we were talking recovery, we've talked about all these different fancy tools, some of which are more expensive, but number one thing that everybody can do and can probably do more of is sleep. I never want to brush over the importance of sleep when it comes to recovery, especially for something like back pain when you have been far more active and need to calm that down. So I always like to address that, and then like Josh touched on with the movement of how can we get things moving and how can we keep things moving well as we progress into the loading, strengthening and everything.
Sanjiv Lakhia (47:59):
I'm very happy you said that. I'm almost embarrassed that I haven't brought that up. I mean, that as a fabulous tip. Sleep is really the only time our body repairs itself.
Bridget Kelly (48:09):
Absolutely.
Sanjiv Lakhia (48:10):
I wrote a patient education booklet, and in the back, I have a whole bunch of sleep tips and I've done a mini segment on one of the podcast before, but Bridget, you're absolutely right. If you are not having a good sleep routine at night, a consistent sleep-wake schedule, getting consistent amount of deep sleep, restorative sleep, then you're basically fighting uphill battle as your body tries to recover during the daytime. So I really appreciate you sharing that.
Sanjiv Lakhia (48:37):
All right, so we're going to close. I always like to close my interviews with a little more of a personal twist, bring people on the show that are wildly successful both professionally and personally. So I think it's always good to share our success strategies with each other. So Josh, can you share with our listeners your personal strategies for nutrition and what your typical weekly exercise program looks like? Just hit on some highlights for us.
Joshua Kollman (49:00):
Absolutely, doc. I agree with Bridget. With three kids and the intensity that goes through my day, if my wife sees me start to lay down, she's like, "Honey, don't lay down." I mean, when my head hits the pillow, I am out. And so I do, I think that has to be such a foundation of what we do. Hydration, I think that's something else that... A lot of what we talked today, we try to really hammer through what are some of these things that we're seeing a lot of our elite athletes do that we can bring to the everyday population, right? And so I definitely don't want to undermine, because I agree, sleep, proper hydration, water, is critical for that foundation for success that we can build on it.
Joshua Kollman (49:45):
Doc, pretty much I set the alarm at 4:15 every day and I get up. I'm training for Mount Mitchell right now, so I'm riding between 100 and 125 miles a week. Most of those rods are indoors on the trainer right now. I have a fitness facility that's close to the clinic there in Blakeney and I spend most of my time at. And so it could be three or four days a week. I'll do two a day. I'll get a workout in the morning, and then I'll hit the clinic running. And then for a little boost at lunch, I'll grab another workout, and that workout is typically like a lift session so I can get a good lift at the clinic. Once I'm done, I coach basketball, my girls' basketball in the evening and crush it at home, and it's off to bed.
Sanjiv Lakhia (50:30):
Any specific dietary strategies you follow? Are you on any keto or any sort of plan, or just more whole foods, plant based and healthy?
Joshua Kollman (50:38):
Whole food, plant-based and healthy, doc. I can't stress that enough. I do use some of the supplements that we talked about, and I don't think I could lay it down as hard as I do without having... I utilize the team that we've built at the clinic. I utilize our recovery services. I try to sneak them home at night and use them and bring them back to the clinic. And so I can't stress that enough. I feel like as active as I am, I have to practice. I can't be that plumber that you go over to his house to watch the game, and all of his faucets are leaky. So I definitely...
Sanjiv Lakhia (51:15):
Like practice what you preach.
Joshua Kollman (51:15):
Yes, sir. I got to keep it together.
Sanjiv Lakhia (51:17):
All right, 4:15 wake up. When is the bed time?
Joshua Kollman (51:18):
Bed time is at nine o'clock.
Sanjiv Lakhia (51:20):
Very good. Folks, that's a disciplined man right there. He is...
Joshua Kollman (51:24):
Critical.
Sanjiv Lakhia (51:24):
He's getting in the sleep that he needs. Do you have any secrets you want to share, Bridget?
Bridget Kelly (51:29):
I would say no matter what different athletic endeavors, at first, I was in a professional dance training program. Over the years I've done sprint triathlons, half marathons, different fitness routines. But throughout that, I try and stay consistent with taking at least one yoga class a week, one Pilates class a week to really maintain kind of that core hip foundation that we talk about so often and doing more of the active recovery with yoga and dynamic stretches like we had talked about earlier. Just making sure to, no matter what the athletic endeavor is at the time, that I have that good foundation, which of course is supplemented with the nutrition as well.
Sanjiv Lakhia (52:09):
That's great. And I think the three of us probably need to go take a yoga class after sitting here...
Joshua Kollman (52:13):
Yeah, absolutely.
Sanjiv Lakhia (52:13):
... talking for about an hour. Wrapping up, Josh, do you have any apps or books that really inspire you that utilize that listeners might benefit from?
Joshua Kollman (52:22):
Yes, sir. I think you and I probably jumped to a lot of the... I know Greenfield came out with a new book, the Boundless book.
Sanjiv Lakhia (52:27):
Yes.
Joshua Kollman (52:28):
I just got the copy of it. I didn't realize that it was five pounds. The book is thick.
Sanjiv Lakhia (52:35):
Yes.
Joshua Kollman (52:36):
Tim Ferriss, Ben Greenfield, all those guys are fantastic. I love to read on the plane; Ryan Holiday, The Obstacle Is the Way. Those things keep me fired up. I have so much more to learn. I feel like I'm just scratching the surface. And so those materials, I can't say enough good things about what they're putting out and their content. They're pushing the envelope. Some of it might be a little extreme, but I think, again, as that pendulum swings back and forth, you find that happy medium and grab it and run with it.
Sanjiv Lakhia (53:11):
Yeah. And I listen to a lot of podcasts and I've read a lot with Ben Greenfield, and I think one thing I would say, is for anyone, it can just create an awareness about your health. And if that's all that happens as a result of listening to the gurus in the field and the experts and the elite people, that's a victory. Not all of us have to spend $20,000 a year on our performance or on recovery. But if you sleep better, hydrate better, better food, integrate some mobility into your lifestyle, you're going to feel better, and that doesn't cost a whole lot.
Sanjiv Lakhia (53:41):
All right, guys, I've really enjoyed the interview. Josh, if listeners want to get in touch with you or want to learn more about some of the stuff you've talked about, do you have any way you can share that, social media or contact info?
Joshua Kollman (53:52):
Yes, sir, yeah. Doc, you mean so much to us and I can't tell you how much I thank you for what you do and the services that you provide. I know the listeners already know this, but I have to put this out there, that so many patients that I send your way when I hit that roadblock, and they can't wait to come back into the clinic or call me up and say, "Josh, that was one of the best visits I've ever had with a physician, with a doc." And so I can't thank you enough for your knowledge and you constantly pushing the envelope. What you do and how well you do it is amazing. So keep up the great work, and I appreciate you so much.
Joshua Kollman (54:34):
Listeners, if you have any questions for us, carolinasportsclinic.com is where you can go and you'll find all of our contact information there and social media posts.
Sanjiv Lakhia (54:44):
Yeah. We'll put links to that in the show notes. I'll try and link to some of the information on some of these supplements and some of the resources he mentioned. I really appreciate you sharing that feedback. Listeners, that was not a paid advertisement.
Joshua Kollman (54:57):
My pocket is open.
Sanjiv Lakhia (54:59):
I'll gladly accept it. So thank you, guys. Bridget, Josh, I really appreciate your time.
Joshua Kollman (55:04):
Thank you, doc.
Bridget Kelly (55:04):
Thank you so much for having us.
Outro (55:07):
Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery & Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates where providing personalized, highly-skilled and compassionate spine care has been our specialty for over 75 years. And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here is your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia (00:35):
Welcome to episode eight of Back Talk Doc. I am your host, Dr. Sanjiv Lakhia, a board certified physiatrist, specialist in physical medicine and rehabilitation. I work at Carolina Neurosurgery & Spine Associates with offices in Charlotte, North Carolina and Rock Hill, South Carolina, and the Greater Carolina area.
Sanjiv Lakhia (00:54):
If you had a chance to listen to our previous episodes, we have gone over quite a bit of information regarding ways to help prevent low back pain and low back injuries. If you haven't had a chance to download our second episode with Ryan Klomparens, it's a great episode where he reviewed how to strengthen your glutes to protect your spine. And then our most recent episode, which was just released, was interview with Jake Beamnon, physical therapy assistant who is an avid CrossFit enthusiast, and we really broke down different aspects of how to train appropriately if you're an athlete and not injure your back. So I hope you have time to listen to those and protect your back.
Sanjiv Lakhia (01:33):
Today though, we're going to shift gears, and I really want to focus on a topic that I think is underrated in the world of athletics and day-to-day activities, and that is recovery from physical exertion, physical exercise, and sports in particular. I'm very excited to have today with me two individuals who I think are very well qualified to educate my listeners on the topic. That is Dr. Josh Kollman, chiropractor in Charlotte, North Carolina at the Carolina Sports Clinic, and he's accompanied by Bridget Kelly, one of their physical therapists who has expertise in dance and works in the South Park area. So Josh and Bridget, welcome to the show.
Bridget Kelly (02:13):
Thank you.
Joshua Kollman (02:13):
Thanks, Doc. We appreciate you having us out.
Sanjiv Lakhia (02:15):
All right, Josh. I want to educate the listeners a little bit about your background and why I think they should listen to what you have to say about the topic. Just briefly, for those of you who know me, I've been here in Charlotte about five years. When I first started working here, I had a chance to meet Josh and just kind of exchange our information professionally, and through the years we have collaborated on patient care. Your group does a terrific job of keeping people active and mobile. And then sometimes when things go south, we're able to provide the services that are needed like injections or surgery or what have you. So we've got a real good synergistic working relationship, and we really appreciate that.
Joshua Kollman (02:52):
Absolutely.
Sanjiv Lakhia (02:54):
Josh's background is extensive. We were joking about it when he first showed up this afternoon. A couple of things I want to highlight, and you can certainly learn more if you go to his company's website, but from a manual perspective, he's not just a chiropractor. He's got expertise in numerous modalities including dry needling, acupuncture, Graston Technique. He has certification in strength and conditioning. And Josh, I found your educational background to be interesting. You have your Doctor of Chiropractic degree from New York Chiropractic College, but you also have a Master's Degree in Performance Enhancement and Injury Prevention, as well as a Bachelor's Degree in Kinesiology. So it looks to me like you've had a passion, for most of your life, to learn about how to help people exercise and stay healthy and stay out of harm's way.
Joshua Kollman (03:43):
Yes, sir. Yes.
Sanjiv Lakhia (03:44):
I know currently in addition to treating the weekend warriors, you are involved in some professional endeavors with professional sports teams, professional golfers. So every time I try and reach out to you, you're either traveling or you're busy saving the world in the Charlotte community, but I appreciate you taking the time to talk with us today. And then, Bridget, you have a background in dance and I know you went through PT school at University of Kentucky. Is there anything you'd like to add so the listeners may know a little more about your educational background and training?
Bridget Kelly (04:14):
Yeah. So I was majoring in dance, and when a professional dance career was not going to be physically possible, I started getting more into the preventative medicine side. So when I treat injuries both with dancers and all the other types of athletes that I see, I like to really focus on, of course, getting better the one problem that they're in for and making sure that all of these future injuries are preventable, that we can stop what future injuries might be happening before they do. And that's where a lot of their recovery tools can be pulled in.
Sanjiv Lakhia (04:46):
I think it's interesting how many of us in the health and fitness world, particularly the medical side, bring to the table our own personal injury, our own personal background. I've shared with my listeners before that I hurt my back playing basketball growing up, and I just feel like the more we share with people, the more they can relate and we can learn from each other.
Sanjiv Lakhia (05:05):
Josh, tell us how the Carolina Sports Clinic came to birth, kind of what your vision has been for your chiropractic group. I know you have offices throughout the Charlotte area and you're kind of a destination spot for athletes in the region.
Joshua Kollman (05:20):
Yes sir. Yeah, we have three locations. We're at Blakeney, we're down here in Baxter Village, and also, doc, up at SouthPark. And the ticket for me, I was a little bit different in this sense of, it wasn't necessarily an injury that drove me towards the sports medicine world. It was more of - I know so many of our listeners can probably really relate - I couldn't sit still. Even now talking to you, it's hard to sit still. So basketball was a huge passion of mine, and I played DII at Penn State. Doc, sitting still, the academic side, was hard for me. And so I'm studying exercise science and going through school, and finally I got into a cadaver lab at Penn State, and it just started to click. Anatomy was something I could put my hands on. It was something that I could visualize, I could touch, I could feel. And being an athlete, I think that lent itself to seeking out a profession that I didn't have to sit behind a desk or I could be up and be involved in health and wellness.
Joshua Kollman (06:23):
I was fortunate enough to, at a young age, I had a strength and conditioning mentor that led me to the National Academy of Sports Medicine. So doc, I'm 19 years old and I had an opportunity to go study with the NASM and get my certified personal training certification. I felt like that helped me to engage with somebody one-on-one at an early age. You come to me with a set of goals, and here I was at an early age trying to figure out how to get you to those goals. And doc, sometimes you might come to me back then as a personal training client, you had some low back pain. My knowledge at that point in time was so limited. I didn't know what to do besides maybe some strength exercises.
Joshua Kollman (07:10):
So it's saying, I mean, doc, I'm old. I've got a lot of grays. So this is 20 years ago. And so I would send my athlete or my client to another health care provider, and the answers that I was getting back was just, it didn't satisfy my ability to help my client. Usually, it was just rest. You'd go to the orthopedic world and they'd say, "Hey, take some time off, take some over the counter NSAIDs or whatnot, and then go back to your activity if you can." And so for my athletes and my clients, that wasn't good enough. And so for me, I needed to find something that I could immerse myself into that I could have the tools, so that when that client, patient, friend, whoever it was, sought me out for help, I had that knowledge to help them.
Joshua Kollman (08:00):
So from that, that's where the concept of Carolina Sports Clinic - and I want to be so respectful to... If there's any chiropractors out there that are listening to me, please don't take it the chiropractic profession is so important to me as a chiropractor. But I really feel that the chiro hat is a tool in my toolbox, and I really don't define myself within those chiropractic principles of, you're going to come into the clinic and it's going to be a quick, maybe rack and crack adjustment, you're in and out of my office. I, from an early age, in this profession. I wanted to take the movement sciences from Penn State, from my graduate program, from my personal training background, and see how I could apply that, so when I'm working with an athlete or a patient, I had those tools to really make a change and a difference, so that that athlete or patient didn't have to constantly come back and me.
Sanjiv Lakhia (08:55):
Yeah. No, that's excellent. And I want to address that too as an osteopathic physician, which I am, and then a board-certified physiatrist, I do get a lot of questions about chiropractic care in general. And I will share with my listeners, I feel like spinal manipulation can be a very valuable tool in the toolbox, but being dependent upon it doesn't always lead to long-term success. So the best approaches are multidisciplinary and I feel like you have to have multiple players that can help patients navigate their injuries through different stages of the process. Certainly, there's the end point where if everything is not working, you have surgical intervention that can be offered, which our group does so well, and then everything in between.
Sanjiv Lakhia (09:40):
Let's jump into kind of the topic of the day today, which is recovery from athletics, recovery from injury, which I think your group really sets itself apart with. Our patient population at Carolina Neurosurgery & Spine ranges from young athletes to middle-aged weekend warriors, and then we have a lot of active seniors. Let's kind of organize this and get your thoughts on, based upon these demographic groups, when it comes to recovery and activities, how would you organize or advise a listener today to organize their activities? Let's say, for example, someone in their 60s has gone through the weekend, they played some pickleball, they played a round a golf and it's Sunday night and their back is pretty sore. They're having some pain in their calf muscles and they want to stay active the rest of the week and not have to take a week off. We exchanged some show notes and I've kind of broken it down to certain categories from exercise to manual recovery, another intervention. So I'd like to let you kind of jump in and give me your thoughts on that.
Joshua Kollman (10:44):
Absolutely, doc. I appreciate that. Listeners, think about this for a second. Yeah, I think it's so important that we first define when we talk about an athlete. And in the clinic, it's imperative that we define an athlete as anybody that wakes up in the morning and moves and breathes. So it was always my goal with Carolina Sports Clinic, was to create a practice that... For me, I'm very fortunate. This is my ninth year as the team chiropractor for the Carolina Panthers. This is my 11th year out on the PGA Tour, traveling with those guys on the sports medicine team. I'm able to be, a lot of times, a fly on the wall. I'm there as the chiropractor, but I get to see the DO and the MD and the ortho and the different disciplinaries, and I get to see how they assess, approach and treat elite athletes.
Joshua Kollman (11:33):
So it was always my vision and goal of taking elite athletic care and taking that to my athletic population, which is defined in my clinic as everybody. It could be an elite athlete. It could be that 67-year-old playing pickleball. It could be that mom of four that's just trying to get through her day with so many - she feels like the mama bus, the taxi, driving all of her kids to the different programs throughout the day. So it's our goal to take our recovery efforts and our treatment efforts and actually apply that to all of our athletes, which is being defined as anybody that wakes up and moves and breathes is an athlete in my ballpark.
Sanjiv Lakhia (12:13):
I like that definition. I feel like teaching healthcare, these are full-contact sports. I mean, I did an episode recently on back injuries at work, and statistically, nurses have a very high risk of injuring their back throughout the work day. So almost anyone who's out trying to make a living is in part going to use their physical skills to help accomplish that day-to-day task. So that's a good definition.
Sanjiv Lakhia (12:38):
Bridget, do you kind of see it the same way in terms of, you have to almost approach everyone with the same level of need?
Bridget Kelly (12:45):
Absolutely. I've had a lot of patients who are older who always talk down on, "Oh, I'm just running a couple miles a day," acting like that's no big deal. But when you are active throughout the day, whatever that activity is, whether your goal is getting on and off the couch independently, or if your goal is running a marathon, you still need to be active enough to accomplish whatever those goals are.
Sanjiv Lakhia (13:07):
Yeah, it's paramount of importance.
Joshua Kollman (13:10):
Let me tell you, you guys are going to like this quick story. I do a lot of work with Sun City right off 521, a huge retirement community. I have so many athletes from Sun City that come in during their softball tournament or pickleball tournament. And they'll come in and they'll say, "Hey, Josh, I know my buddy Richard's coming in later on today. Take his knee out, man." I mean, these are 60, 70 and 80-year old athletes that are still so competitive. So I love that we're bringing in everybody because I do feel that all of us has an inner athlete inside that's just looking to excel in whatever activity that we're trying to accomplish and compete every day.
Sanjiv Lakhia (13:56):
All right, let's get specific.
Joshua Kollman (13:57):
Shoot.
Sanjiv Lakhia (13:57):
In terms of exercise, what are your thoughts in terms of post-exercise stretching versus mobility work versus taking days off if you're just sore? What do you typically advise your patients?
Joshua Kollman (14:08):
Absolutely. All right, doc. So think about this, gang, listeners, with exercise and stretching. The pendulum swings on this every single day. If we go and look at some evidence-based practices today, the pendulum is at a point of suggesting that static stretching could, before activity, decrease performance. There's still unclear research-wise on what static stretching has the ability to do post exercise.
Joshua Kollman (14:37):
Here's what we've done at the clinic, is our stance is we try to look at all the literature that's currently out there and clinically what has worked for us in the past. Right now, I'd love to have our listeners really engage in dynamic movement patterns before, and we break down dynamic as patterns that you're in motion. You're moving, and they want to be specific. You and I are basketball players, doc. So let's say you and I are going to go hoop. We don't want to go throw a baseball before we go play basketball. So we want to do specific movement patterns for that exercise. You had a great podcast with the CrossFit. Let's say we're going to do some barbell type activities, or maybe we want to warm up some of that rotator cuff with a PVC pipe before we jump into the barbell movement patterns.
Sanjiv Lakhia (15:25):
So more functional specific warm up.
Joshua Kollman (15:27):
Yes, sir.
Sanjiv Lakhia (15:27):
Yup.
Joshua Kollman (15:28):
I definitely don't want to discount the ability of static stretching. So for our listeners that are jamming into this podcast, if we're going to do our static stretching, I don't have an issue with it. Let's put it at the end of our movement patterns, use it as part of the warm down, right? I like that term warm down instead of cool down. I want that warm down to be active. So many times our warm down tends to be a cool down, which is very passive after a hard bout of exercise. I see a lot of my athletes just go kind of just grab a seat and not do a whole lot of movement, right? If our goal is going back to that older athlete playing pickleball, on Sunday night, he has or she has some back pain, it could be due to not necessarily the activity itself, but what did we do after the activity, right?
Sanjiv Lakhia (16:19):
Yeah, that makes sense. I've done martial arts off and on throughout my life. And in the martial arts arena, they practice what you just said. So it's dynamic warmups, some brief sprints, some dynamic leg swings, some stretches, and then at the end is when you're doing more of the static stretching after you've kind of mobilized the tissues, improved the circulation. Miraculously, you think you would be at higher risk for pulling your hamstring or doing these crazy kicks, and for years of practicing martial arts, I never had anything like that happen.
Joshua Kollman (16:53):
Yeah. And hey, doc, for our science geeks out there, and I love science and I tried to dive into it a little bit, I just went to a fascia manipulation seminar and this doc out from Italy, the Stecco Method, they were talking about hyaluronic acid and how, when we look at fascia, how fascia moves, that it's increase in temperature. So when we increase, everybody is like, "Man, when I start moving, that Achilles tendon or that knee pain or that elbow pain tends to decrease in irritation or what I perceive as pain. Why is that?" As we warm tissue up, tissue becomes more elastic, and that elasticity and increased blood flow makes a change with the hyaluronic acid, and it really prepares us for motion. So I love that dynamic warm up, we prepare for motion, and then we have a nice warm down post activity.
Sanjiv Lakhia (17:43):
Bridget, is that how you typically start off your patients with a little bit of a cardio piece to get the blood flowing and get them moving?
Bridget Kelly (17:50):
Absolutely. I'd say big time education-wise for those athletes, that certain populations like runners and golfers are historically known for wanting to dive right into their activity and then hop back in the car and head out after. So really educating patients on how to warm up, warm down, get everything ready to go.
Sanjiv Lakhia (18:10):
Josh, you touched briefly here on the fascial stretch, and that's kind of my second category, is in terms of recovery, there's all sorts of options out there for manual recovery from massage therapy, dry needling, acupuncture, and you have a terrific background in many of these. How do you intellectually organize these treatment options for your patients when they come in, in terms of deciding when to go to which tool?
Joshua Kollman (18:35):
You'll like this, doc. Watch this, you and I can do some blending here. So you'd asked earlier about taking days off. This is a cool spin. So days off can be active recovery days. I like to call it the arc, right? So it's an active recovery day on our day off, and that could look like, you and I are marathon runners, so we're running a half marathon. And so our active recovery day could be a pool swim. The hydrostatic pressure of the water, great for our joints. We're unloaded. We're in a different movement pattern. So that would be a day off in essence, and the ability to do some mobility work, a chance for us to check in with ourselves and see how am I feeling? Do I need to do some extra foam rolling on some different tissue, or do I need to do some different dynamic mobility patterns because I feel like my hips are starting to tighten up?
Joshua Kollman (19:26):
So I really want our listeners that are going to tune into this podcast to understand, a day off typically doesn't necessarily mean I'm not going to do anything that day. If we're really looking to have optimal function of our soft tissue, it's really going to behoove ourselves to engage into some light activities throughout that day off. I know a lot of us do have those jobs that require us to sit. When we're sitting, blood's pulling. When we're sitting, we're not in a great hip position, we're loading the low back. And so getting active on those days off could reduce some of that soreness that we were talking about. It could really set the tone for our next workout even.
Joshua Kollman (20:09):
Let's go to the question, massage therapy versus fascial stretch therapy versus acupuncture. The cool thing here, doc, is you see a lot of massage therapists are actually certified in FST as well, fascial stretch therapy. I love to use massage therapy as if, doc, you're coming to me saying, "Josh, man, you're my massage therapist and my left hip, I tell you, I just feel like it's restricted, my range of motion is limited. I really need you to focus on that soft tissue in that area." We'll pan out along that line a little bit. I can use it. I know your job is super stressful as a doc. I can help to increase some of that parasympathetic nervous system, right? Decrease that sympathetic drive. Massage therapy is phenomenal with that.
Joshua Kollman (20:59):
Fascial stretch therapy, I want all of us to think as... let's think about a big net like Spiderman net. I want you to think of the body in the fascial covering. You probably remember it from medical school.
Sanjiv Lakhia (21:11):
It's not just the stuff we cut through to get to the good stuff [crosstalk 00:21:14]. The secret sauce is the-
Joshua Kollman (21:16):
Secret sauce. We have superficial fascia, we have deep fascia. You know it has a huge supply of innovation. And so with fascial stretch therapy, it's not passive. You're going to be on the table. I'm a level three certified medical fascial stretch therapist. What I do with you on the table is about an hour long dance with your joint structures. A lot of it is passive, me moving you through that fascial layers with a lot of contract-relax. So you are getting active. You're getting some activities, some activation of the fascial tissue while we're working through that system. So it's different with massage.
Joshua Kollman (21:56):
I need everybody to think about this for a second. This is huge for me. I think of ballparks. And for you, doc, if you're on my table and I take you through either a massage or FST, I'm looking at the fascial nets, the joints, the soft tissue. I'm preparing the system for motion. I'm fixing the tissue. A lot of people get into this rut, follow me for a second. They go get a massage. The massage therapist works the tissue while the athlete, the client's on the table. It's a very passive. They get off the table, they feel better for five, 10 minutes, a half hour, a day. That pain comes back, hip pain comes back. What just happened? I had a massage yesterday. I had a massage this morning. Why do I still feel some of that tightness that I went in for the massage?
Joshua Kollman (22:48):
What we need to start teaching people is that once you have FST, once you have a massage, now we need to put the body through motion. We need to give the body some stability. We just made a change to the system, and then we just asked our client or our patient just to plug back into their environment without any engagement into that new-found range of motion that we just delivered them. They don't know how to play in it. So in our clinic, when we say mobility work, we're really trying to make a shoulder work like a shoulder. My soft tissue work is going to really increase range of motion and work on the joint, the soft tissue surrounding the joint, the neurology with the joint, and then we want to load it. We want to neurally groove that joint, that pattern, so now you can own that new range of motion and you can go play in it and you're not going to reverberate back to what you had done before the treatment or the massage ever happened.
Sanjiv Lakhia (23:48):
That's excellent. It's really combining modalities, manual work with therapeutic exercise.
Joshua Kollman (23:54):
Absolutely.
Sanjiv Lakhia (23:54):
That's purposeful. I really like that. Thanks for sharing that.
Joshua Kollman (23:57):
Yes, sir.
Sanjiv Lakhia (23:58):
Another category that I encounter, I get questions about a lot from my patients, is the whole heat versus cold. And I think the modern day version of that is sauna therapy, cryotherapy. Now, I've talked with my listeners and I did a segment on the benefits of far-infrared sauna. I own a far-infrared sauna and I've used it off and on for years predominantly for stress relaxation, but also I've found it to be very helpful with back tightness and pain. Certainly, now cryotherapy is in vogue. You hear a lot of the professional athletes use it. I think your group offers services for that.
Joshua Kollman (24:32):
We do.
Sanjiv Lakhia (24:32):
Can you walk us through a little bit about the cryotherapy and just your thoughts on thermogenesis as a recovery tool?
Joshua Kollman (24:39):
Absolutely, doc. Great question. We do. We have cryotank at the clinic. We've also experimented with some spot cryotherapy that you're going to see as a new form of cryotherapy that we can use that the athlete or patient doesn't have to be fully immersed in the tank. You're seeing in the NFL a lot of our centers are creating whole body cryo to where these require the cryotherapy room, if you will, you actually put on that beanie, gloves, hopefully. You see some of our NFL athletes forget to put the feet booties on and they end up with some pretty bad burns from that. But if you're protected properly, cryotherapy is actually a super safe recovery tool. It's something that we've used in the clinic for the past two years. Our tank is a whole body tank, and doc, we use it for our athletes. We call it a freeze and squeeze.
Joshua Kollman (25:33):
So our athletes' post activity, you want to make sure that the skin is dry. We have a shower at the facility that can shower up after a run, a [inaudible 00:25:42], a hard workout, CrossFit. They'll shower up. After the shower, they'll dry off. It's a three-minute recovery system in our cryo tank. Basically, what we're looking to do is, is we're looking to take this athlete, we're trying to increase muscle oxygenation. We're trying to look at something called creatine kinase. We're trying to decrease the body's metabolic waste post hard exercise. And so we do have a lot of literature that looks at three minutes in the cryotherapy chamber has the ability to significantly decrease a lot of that metabolic waste that's out there that can cause a lot of the irritation post induced onset muscle soreness from exercise.
Joshua Kollman (26:29):
We know that after a hard bout of exercise, it's a lot of the fluid within tissue that pushes up against some nerve endings that are exposed, right? A lot of people used to think that was lactic acid that was the reason why you were sore after a workout. We now know that's not the case. And so cryotherapy has the ability to calm that tissue down. You think of systemic vasoconstriction is the goal of cryotherapy. I know there's a lot of claims out there with some other - decrease in heart rate. We look at Wim Hof and a lot of the methods that they're looking at as far as... I don't know, doc, if you've seen any of his material that's out there.
Sanjiv Lakhia (27:10):
He's wild.
Joshua Kollman (27:11):
Wild. Wow. Do you cold shower at all?
Sanjiv Lakhia (27:15):
I do, yeah.
Joshua Kollman (27:18):
Doc, it is invigorating.
Sanjiv Lakhia (27:20):
It is, yeah. It's a slap in the face.
Joshua Kollman (27:22):
When I get out of the cryotank, I do, I feel refreshed. It is that great slap in the face, and I'm in there for three minutes and it feels fantastic.
Sanjiv Lakhia (27:32):
Okay. Let's say I send you a patient who's herniated disc. We've done a couple epidurals. They've rehabbed. They're doing pretty good. They have some residual pain and inflammation. Logistically, for someone who knows nothing about it-
Joshua Kollman (27:45):
Yes, sir.
Sanjiv Lakhia (27:45):
... walk it back a little bit. You define cryotherapy as, is there a certain temperature cutoff, or what is the degree of coldness that someone can expect?
Joshua Kollman (27:54):
Basically, somebody can expect with that is -275 degrees.
Sanjiv Lakhia (27:59):
And how is that accomplished in the tank?
Joshua Kollman (28:00):
With nitrogen.
Sanjiv Lakhia (28:01):
With nitrogen. Okay.
Joshua Kollman (28:02):
Yes, sir. That is right.
Sanjiv Lakhia (28:03):
What does a patient feel when they're in the tank?
Joshua Kollman (28:05):
They feel a slap-in-the-face cold.
Sanjiv Lakhia (28:08):
Very, very cold.
Joshua Kollman (28:09):
It is cold.
Sanjiv Lakhia (28:10):
Okay.
Joshua Kollman (28:10):
We have a certified technician that is running the tank, and that technician is talking you through the whole time. We'll actually rotate you while you're in the tank. Again, your head is above the tank. So some people tend to feel claustrophobic in some units. So we have your head elevated above the tank, you have gloves on, you have booties on, and we're rotating you halfway through just talking you through the whole system while you see, obviously, the nitrogen. It looks like a really cool Batman movie in the clinic while the nitrogen is flowing.
Sanjiv Lakhia (28:44):
Okay, very good. Are you using a lot of cold therapy, Bridget, with your patients in PT, or is it more traditional cold packs and standard things that are done
Bridget Kelly (28:55):
In our location in SouthPark, we don't have the cryotherapy unit yet, so we are doing more of the traditional cold and heat therapies, but hopefully that'll be a new thing that we'll be getting in more of the clinics.
Sanjiv Lakhia (29:06):
Right. All right, so we've touched on exercise, we've touched on manual recovery techniques, we broke down cryotherapy and thermogenesis. There's a few other miscellaneous techniques for recovery that I noticed your group is recommending to patients that I wanted to get your take on. You mentioned on your website the NormaTec recovery sleeves. This is compression therapy.
Joshua Kollman (29:28):
Absolutely.
Sanjiv Lakhia (29:28):
I assume this is a form of helping to move lymphatic fluid and kind of decongested tissues after exercise. Can you elaborate on that?
Joshua Kollman (29:36):
Okay. Yes, sir. There's some literature too when we talk about compression. When we walk into an NFL locker room, you're going to see a cryotherapy chamber. You're going to see spot cryo. You'll see something, we'll talk about in a second, called a Marc Pro. You'll also see potentially a Compex unit. You'll definitely see NormaTec, and you'll see Game Ready. So those systems are typically a lot of our recovery tools that we'll utilize with our elite athletes. The freeze and squeeze that I alluded to that I talked about earlier in the segment, basically we use the freeze is our cryotherapy and our squeeze is the compression.
Joshua Kollman (30:17):
So we can go through a bout of... I like to use the NormalTecs first and then we'll go into the cryotherapy unit. So it's anywhere from a 20 to 30 minute treatment, doc, with, a lot of my patients call them the moon boots. So we have boots that goes from your toes all the way up to your hip. They are sectioned off in chambers, and basically, you can create this pneumatic squeeze for the lymphatic system. You are in a zero-gravity chair, so we have your legs elevated, and then for 25 to 30 minutes post activity, post exercise, that is a great way to start recovering the system. So we have a decrease in exercise soreness, so we can prepare the tissue for its next bout of exercise.
Joshua Kollman (31:02):
Let's take the Mark Pro. A lot of people are familiar with the old school TENS units. Remember TENS units was a current that we could use for that disc patient to create some white noise for the nervous system, so they'd had a decrease in their perception of pain. That's a TENS unit. So we've taken that technology and we've enhanced it, and we can use these units, they're wireless units - the Compex unit, the Marc Pro. These units, it looks like a TENS unit. The current is a designer current, and we use this on a low frequency to create a pump. So this can create some muscular contractions like a pump to help flush out the tissue post exercise. Doc, we can use the Marc Pro, we can put that on the tissue first, then we can put the sleeve on, so now we have a really effective way.
Joshua Kollman (31:56):
Think about this. Another way I could achieve a recovery like that, we talked about it earlier, I could use some dry needling. So post exercise, this is really cool, guys. I can actually do some superficial needling into the tissues that were just used, elevate the tissue, do some cupping, I call it cupping a river, so I'm given a little bit of space underneath the tissue. I'm going to hook up the needles with some stem to get some contraction, elevate the extremity. Voila, I've just created a scenario where I can do some amazing post exercise, high intensity recovery.
Sanjiv Lakhia (32:32):
And that's going to really accelerate the...
Joshua Kollman (32:34):
Yes, sir.
Sanjiv Lakhia (32:35):
... removal of the lymphatics and congested tissues and accrue the blood flow almost like... Can you do that in lieu of massage? Can you get similar, or would you consider it to be a little more powerful effect than manual?
Joshua Kollman (32:47):
Doc, that's awesome question. I love the ability to... You and I, before we started, we were talking about some recovery tools. Let's say you and I, we're triathletes and we've trained hard for this Ironman that's coming up-
Sanjiv Lakhia (33:01):
That would be more you than me, by the way. I'll accept that.
Joshua Kollman (33:05):
We were going on this journey together. You and I are going to take advantage, and let's say for us, we are utilizing Carolina Sports Clinic, and we have some massage and acupuncture, dry needling, physical therapy, cryo, the recovery center, cryotherapy and NormaTecs. So it's cool to have the ability to use that, but you and I might be, we're on the road or we're traveling to an event. The tools - the Marc Pro, the NormaTec, the Game Ready even - those are portable. I know a lot of the recovery tools can be expensive. When you purchase a NormaTec, it's a one-time purchase. You and I could have it at home, we could use it after every workout. Massage therapy, those sessions, they could get a little expensive.
Joshua Kollman (33:50):
So I love the question. I think a lot of times it's utilizing both of those, guys. Scheduling yourself with your massage therapist, getting some recovery treatment with your physical therapist or your chiro, that's part of it because those guys could potentially... In our clinic, when you come to me, doc, I'm looking at your movement patterns. NormaTec can't really look at your movement patterns, right?
Sanjiv Lakhia (34:14):
Right.
Joshua Kollman (34:14):
So maybe I can pick up on that potential Achilles, knee tendonitis, hip bursitis issue, and we can knock it out before it becomes an issue. That's our goal. It's all about prehab. I don't want to see you when your tissue is flared up. If I'm on my game, I'm not your, "Hey, I have an issue. I need to go see Josh and Bridget." It's like, "Josh and Bridget, here I am. I feel great. I'm using recovery tools at home, I'm utilizing your services, but keep me moving well so I can keep doing the things that I love to do."
Sanjiv Lakhia (34:49):
Yeah. I think that's where our training comes into play, where this is a field where you have to have customized, personalized care.
Joshua Kollman (34:57):
Absolutely.
Sanjiv Lakhia (34:57):
And then you have the tools that you can identify that will help an individual patient, but there's no substitute for a personal evaluation and that personal touch. I think there's still a lot of value to hands-on a patient to help understand what they're going through.
Joshua Kollman (35:11):
And doc, think about this. If you come into the clinic and I pick up on that hip issue, you're like, "Hey, Josh, I'm just here for... I haven't seen you in three, four weeks. My training volume has ticked up. I want you to check through my systems to see how I'm moving." So we go through our assessment. We see that, "Hey, doc, I think you're putting a lot of load to this right hip. Let's make some changes in maybe your running cadence or bike fit or maybe it's some rehab exercises on Bridget's. And to give you a little bit more, that podcast, strengthening your glutes, what we've just done is, is we've hopefully prevented an injury that: a) takes you out from what you're training for, and visits with us.
Joshua Kollman (35:54):
Bridget and I don't have the philosophy of, "I want to see you three times a week. I want to see you 50 times a year." If I can fix that in one visit, because we preemptively picked it up in our movement screen, now I've saved you a ton of copays. You can go buy a NormaTec for the house, and everybody is happy.
Sanjiv Lakhia (36:13):
That makes a lot of sense.
Bridget Kelly (36:14):
I think that's the biggest benefit of the collaborative care of being able to have one location that has these multiple services, is that we can... When they come in, I'm treating them from a physical therapy standpoint, but I think, hey, I think the massage therapy would be really beneficial for one session, so that we can work through more of this widespread muscular tension and then dive back into rehab exercises versus if they need NormaTec and cryotherapy as a recovery tool. We also just point people in the right direction of what's going to help the most at the time.
Sanjiv Lakhia (36:44):
Oh, absolutely. Absolutely. All right, we're coming to the end here. You've covered a lot of material. I really appreciate. One question I get a ton is about supplementation. So nutritional supplements are all over the market in terms of recovery from exercise, recovery from athletics, creatine, there's protein powders and such. Do you have a couple that you think have pretty good research that you recommend or could be recommended to a wide population? And again, if you're listening, this is for informational purposes only. Please speak with your physician, your medical provider before you start any sort of nutritional product. Just because it's not a prescription drug doesn't mean it will affect your physiology.
Joshua Kollman (37:27):
Absolutely, doc. That's a great point. I want to elaborate on that. There's two things that, doc, I think you'll love. Number one, gang, I want all of us to really... We talk about supplementation, I think we get confused a little bit. I want us to remember that our best source of nutrition comes from what? Whole foods.
Sanjiv Lakhia (37:43):
Absolutely.
Joshua Kollman (37:44):
So I really want to hammer home here that when we talk about supplementation, we want to do our best to... I have three kids, three locations. Obviously, we're super busy. I'm training for a century ride up in the mountains at Mount Mitchell currently. And so I know how hard it can be to properly utilize whole foods as your only source of nutrition. That's a challenge. So that's where supplementation can come into play. And fortunately for us, we live in a world where, oh my goodness, you open up your email or your Instagram or whatever it might be, and I'm constantly getting bombarded by Viking Waffles or all kinds of different supplementation that's out there on the market.
Joshua Kollman (38:26):
And so remember that, guys, when you can, first and foremost, whole foods is the ticket. Number two, or doc alluded to, whether it be your primary healthcare physician, we have in the greater Charlotte, Fort Mill, Rock Hill area, we have some phenomenal family physicians that are doing some concierge care where you can check in with them and say, "Hey, look, we actually have some at the clinic. We use a couple of labs." Instead of just throwing a dart, doc, at some massive wall and trying to hit bullseye, let's do a panel, let's do a blood panel. Let's take a look at your body's chemistry and let's see what is or is not working for you. I love that.
Sanjiv Lakhia (39:09):
That makes sense versus shotgunning approach.
Joshua Kollman (39:11):
Oh, doc.
Sanjiv Lakhia (39:12):
I mean, nowadays, the level of sophistication from a lab perspective is quite high. You can check your omega fatty acid profile, you can run hormone panels, you can look at your micronutrient status. There's a wide variety that's available. Now, I will say though that some of that is compartmentalized to people who can pay for it out of pocket because not a lot of the insurance payers cover some of the nontraditional testing. But if you do have the resources, it can be worthwhile. And I always tell patients, to your point, if you are limited with funds, I'd rather you spend your money on good, healthy organic food than on capsules and tablets. I think you have to start there. That's your foundation, and the supplements are just to kind of fill in the gaps. But are there anything that you recommend that's specific for, let's say, back muscle soreness after working out the gym, or how do you kind of approach that? Are there nutritionals that you could recommend to people?
Joshua Kollman (40:04):
I do. Yes, sir. So one thing that we're seeing right now, an uptick of is magnesium. So that's a big one that I think has been around for a long time. You're seeing magnesium being used in a lot of different creams and sprays. I was just out on the PGA Tour at the Phoenix open this past week and we had a nice product on the trailer that had magnesium in it and we could actually spray it on top of our kinesio tape.
Joshua Kollman (40:29):
So we had a couple of our athletes that woke up... These guys sleep in a different bed every week, and so sometimes they're in a bed that's not conducive to supporting their system. They wake up, they're a little bit sore, maybe they didn't play well, they hit a [inaudible 00:40:45], hit some bad shots. And so we'll do some soft tissue treatment, we'll tape them up, we'll use some of the magnesium. As it gets into the hotter months, for a lot of us endurance athletes, I think magnesium can be a great way to help us maintain as we get that high sweat rate to try to decrease some of that muscle cramping and muscle soreness.
Sanjiv Lakhia (41:05):
Yeah. So magnesium, for those listening, it's a natural muscle relaxer. It down regulates glutamate, which is excitatory neurotoxin on the body. So there are applications for cognitive issues and for pain in general. Our food is really deficient in magnesium. The soil is deficient in magnesium. Most people are deficient in magnesium. It's also a natural laxative. So there's a lot of good benefits [crosstalk 00:41:30] for magnesium and it's really hard to take too much magnesium because the limiting factor would be loose stool, similar to vitamin C. So that's a real good one. Any others you want to toss out there, Josh?
Joshua Kollman (41:42):
Yeah, doc. I want to ask you a question. I think a lot of our listeners are familiar, so I'm going to breeze over this one quick. We do use a lot with our athletes, we go into some like branched chain amino acids. Let me jump into this for a second, doc. Are you familiar with NAD?
Sanjiv Lakhia (41:55):
A little bit. I've read a little bit on it as kind of the newest anti-aging molecule, but you can certainly enlighten me.
Joshua Kollman (42:01):
Yes, sir. So let me take a few minutes. There's an athlete that I work with on the gridiron that has utilized NAD significantly throughout this past season and has seen a really nice improvement. We're really looking at this for recovery, for cellular regeneration. This is a substance that some people... We actually make it, doc. And as we get older, i.e myself, obviously, most of my internal system starts to decrease in production. And so the cool thing with this, some people stay away from it because it can be something that if administered not properly, it's not comfortable.
Sanjiv Lakhia (42:39):
So backing up, NAD, correct me if I'm wrong, it's a byproduct of the Krebs cycle in our formation of ATP. So if you're listening, you're saying, "What on earth are they talking about?" I would think of it as somewhat of an energy molecule.
Joshua Kollman (42:53):
Yes, sir.
Sanjiv Lakhia (42:54):
Is that a kind of a simplistic way to describe it?
Joshua Kollman (42:56):
Absolutely.
Sanjiv Lakhia (42:56):
Okay, go ahead.
Joshua Kollman (42:57):
Absolutely. And so the most common form with administering NAD is IV, intravenous. So you'll see a lot of times, we have a doc, we have an ER doc in the clinic that companies call revive. And so he's in the clinic with one of his nurses and they provide IV bags to our athletes, and they're putting the branched chains in there. They're loading it up with vitamin C. They have NAD that they're putting in the bag. And that drip, doc, is going to work a lot slower with the NAD versus like, "Hey, guys, I've had a hard training cycle. I'm looking to hydrate. I feel like I'm getting a little bit of a cold, so I want my B12 or my B-complex, my branched chains." This bag with the NAD is going to be a slower drip, and with that slower drip, you still might have some achy type symptoms with the administration of NAD.
Joshua Kollman (43:53):
A lot of times they'll tell you if you're coming in with a knee injury or a knee issue that you're training through, a lot of my athletes tell me that they feel an increase in achiness wherever that part is that they had come in that they had a problem with. And so the NAD treatments, they'll do two to three a week for a couple of weeks. So you almost have a dosing period of NAD. And we are reporting a lot of our athletes are feeling like their recovery processes are definitely increased and enhanced with the NAD through the IV.
Sanjiv Lakhia (44:29):
Well, we'll have to keep an eye on the research as that evolves.
Joshua Kollman (44:32):
Absolutely. For sure.
Sanjiv Lakhia (44:33):
That's very interesting. Bridget, do you use any or have any go-to supplement recommendations for your patients?
Bridget Kelly (44:38):
That I always like to defer to the experts that we have one chiropractor in clinic who is our supplement expert and always will refer patients whenever that might be the best fit for them, so we can make sure that we have our experts in all the different areas tailoring to them.
Sanjiv Lakhia (44:56):
Yeah, that's fine. It all, hey, I always like to stay in my lane. So that's great to have a team that you can rely upon. And then as we've covered a lot of stuff here, Josh, of the things we discussed today, what do you find to be the most useful for low back pain, for athletes who have low back pain that they've rehabbed, they're doing well, they're performing, but you want them to stay on top and not have back pain recurrence? Is there a little protocol that you recommend or some go-tos of this list that we've covered today?
Joshua Kollman (45:23):
Yes, sir. Movement is life, absolutely. So loading, we can go through different progressions, whether it be a dowel, right? I need to work with a strong foundation. That is critical. So when I have that strong foundation through some proper loading patterns, proper movement patterns, that's where I've got to start, because your magnesium, your kinesio tape, your chiro, whatever it might be, I just don't think it's going to be as effective if I don't start with that solid foundation of movement patterns. So doc, I'm going to have them move first, and I'm going to teach them some proper loading patterns, I'm going to use a dowel or a rod and-
Sanjiv Lakhia (46:01):
Like hip hinging.
Joshua Kollman (46:02):
Yes, sir.
Sanjiv Lakhia (46:03):
Okay.
Joshua Kollman (46:03):
Absolutely. And then we can progress to some different movement patterns, almost go into like even a dead lift to getting that back nice and strong that it can handle what our day-to-day activities throw at it, what we talked about earlier, using some magnesium, our recovery tools, we discussed using a Theragun, a Hypervolt. This company, Hyperice, creates some beautiful products that we used on the PGA Tour to warm up some of our backs while the guys were going through some dynamic movement patterns before the round. It's basically, doc, a wrap that goes around the low back. We have one for the shoulder. We have a sleeve that we can use for a thigh or for an arm. That wrap is going to provide heat and vibration. So that heat and vibration is a fantastic tool to calm down that back that might be a little tight.
Joshua Kollman (46:57):
Everybody right now, I think listening, might be familiar with a Theragun or the Hypervolt. Those tools are excellent, again, to provide some vibration/percussion to the tissue to increase some blood flow, to create a break of that nervous system, that spastic tissue. I'm looking to put an input into it, and a Theragun can be a really nice way to do that, or the Hypervolt.
Sanjiv Lakhia (47:21):
How about you, Bridget, do you have some go-tos you think for the back?
Bridget Kelly (47:24):
I would say the biggest thing that we haven't touched on yet today, when we were talking recovery, we've talked about all these different fancy tools, some of which are more expensive, but number one thing that everybody can do and can probably do more of is sleep. I never want to brush over the importance of sleep when it comes to recovery, especially for something like back pain when you have been far more active and need to calm that down. So I always like to address that, and then like Josh touched on with the movement of how can we get things moving and how can we keep things moving well as we progress into the loading, strengthening and everything.
Sanjiv Lakhia (47:59):
I'm very happy you said that. I'm almost embarrassed that I haven't brought that up. I mean, that as a fabulous tip. Sleep is really the only time our body repairs itself.
Bridget Kelly (48:09):
Absolutely.
Sanjiv Lakhia (48:10):
I wrote a patient education booklet, and in the back, I have a whole bunch of sleep tips and I've done a mini segment on one of the podcast before, but Bridget, you're absolutely right. If you are not having a good sleep routine at night, a consistent sleep-wake schedule, getting consistent amount of deep sleep, restorative sleep, then you're basically fighting uphill battle as your body tries to recover during the daytime. So I really appreciate you sharing that.
Sanjiv Lakhia (48:37):
All right, so we're going to close. I always like to close my interviews with a little more of a personal twist, bring people on the show that are wildly successful both professionally and personally. So I think it's always good to share our success strategies with each other. So Josh, can you share with our listeners your personal strategies for nutrition and what your typical weekly exercise program looks like? Just hit on some highlights for us.
Joshua Kollman (49:00):
Absolutely, doc. I agree with Bridget. With three kids and the intensity that goes through my day, if my wife sees me start to lay down, she's like, "Honey, don't lay down." I mean, when my head hits the pillow, I am out. And so I do, I think that has to be such a foundation of what we do. Hydration, I think that's something else that... A lot of what we talked today, we try to really hammer through what are some of these things that we're seeing a lot of our elite athletes do that we can bring to the everyday population, right? And so I definitely don't want to undermine, because I agree, sleep, proper hydration, water, is critical for that foundation for success that we can build on it.
Joshua Kollman (49:45):
Doc, pretty much I set the alarm at 4:15 every day and I get up. I'm training for Mount Mitchell right now, so I'm riding between 100 and 125 miles a week. Most of those rods are indoors on the trainer right now. I have a fitness facility that's close to the clinic there in Blakeney and I spend most of my time at. And so it could be three or four days a week. I'll do two a day. I'll get a workout in the morning, and then I'll hit the clinic running. And then for a little boost at lunch, I'll grab another workout, and that workout is typically like a lift session so I can get a good lift at the clinic. Once I'm done, I coach basketball, my girls' basketball in the evening and crush it at home, and it's off to bed.
Sanjiv Lakhia (50:30):
Any specific dietary strategies you follow? Are you on any keto or any sort of plan, or just more whole foods, plant based and healthy?
Joshua Kollman (50:38):
Whole food, plant-based and healthy, doc. I can't stress that enough. I do use some of the supplements that we talked about, and I don't think I could lay it down as hard as I do without having... I utilize the team that we've built at the clinic. I utilize our recovery services. I try to sneak them home at night and use them and bring them back to the clinic. And so I can't stress that enough. I feel like as active as I am, I have to practice. I can't be that plumber that you go over to his house to watch the game, and all of his faucets are leaky. So I definitely...
Sanjiv Lakhia (51:15):
Like practice what you preach.
Joshua Kollman (51:15):
Yes, sir. I got to keep it together.
Sanjiv Lakhia (51:17):
All right, 4:15 wake up. When is the bed time?
Joshua Kollman (51:18):
Bed time is at nine o'clock.
Sanjiv Lakhia (51:20):
Very good. Folks, that's a disciplined man right there. He is...
Joshua Kollman (51:24):
Critical.
Sanjiv Lakhia (51:24):
He's getting in the sleep that he needs. Do you have any secrets you want to share, Bridget?
Bridget Kelly (51:29):
I would say no matter what different athletic endeavors, at first, I was in a professional dance training program. Over the years I've done sprint triathlons, half marathons, different fitness routines. But throughout that, I try and stay consistent with taking at least one yoga class a week, one Pilates class a week to really maintain kind of that core hip foundation that we talk about so often and doing more of the active recovery with yoga and dynamic stretches like we had talked about earlier. Just making sure to, no matter what the athletic endeavor is at the time, that I have that good foundation, which of course is supplemented with the nutrition as well.
Sanjiv Lakhia (52:09):
That's great. And I think the three of us probably need to go take a yoga class after sitting here...
Joshua Kollman (52:13):
Yeah, absolutely.
Sanjiv Lakhia (52:13):
... talking for about an hour. Wrapping up, Josh, do you have any apps or books that really inspire you that utilize that listeners might benefit from?
Joshua Kollman (52:22):
Yes, sir. I think you and I probably jumped to a lot of the... I know Greenfield came out with a new book, the Boundless book.
Sanjiv Lakhia (52:27):
Yes.
Joshua Kollman (52:28):
I just got the copy of it. I didn't realize that it was five pounds. The book is thick.
Sanjiv Lakhia (52:35):
Yes.
Joshua Kollman (52:36):
Tim Ferriss, Ben Greenfield, all those guys are fantastic. I love to read on the plane; Ryan Holiday, The Obstacle Is the Way. Those things keep me fired up. I have so much more to learn. I feel like I'm just scratching the surface. And so those materials, I can't say enough good things about what they're putting out and their content. They're pushing the envelope. Some of it might be a little extreme, but I think, again, as that pendulum swings back and forth, you find that happy medium and grab it and run with it.
Sanjiv Lakhia (53:11):
Yeah. And I listen to a lot of podcasts and I've read a lot with Ben Greenfield, and I think one thing I would say, is for anyone, it can just create an awareness about your health. And if that's all that happens as a result of listening to the gurus in the field and the experts and the elite people, that's a victory. Not all of us have to spend $20,000 a year on our performance or on recovery. But if you sleep better, hydrate better, better food, integrate some mobility into your lifestyle, you're going to feel better, and that doesn't cost a whole lot.
Sanjiv Lakhia (53:41):
All right, guys, I've really enjoyed the interview. Josh, if listeners want to get in touch with you or want to learn more about some of the stuff you've talked about, do you have any way you can share that, social media or contact info?
Joshua Kollman (53:52):
Yes, sir, yeah. Doc, you mean so much to us and I can't tell you how much I thank you for what you do and the services that you provide. I know the listeners already know this, but I have to put this out there, that so many patients that I send your way when I hit that roadblock, and they can't wait to come back into the clinic or call me up and say, "Josh, that was one of the best visits I've ever had with a physician, with a doc." And so I can't thank you enough for your knowledge and you constantly pushing the envelope. What you do and how well you do it is amazing. So keep up the great work, and I appreciate you so much.
Joshua Kollman (54:34):
Listeners, if you have any questions for us, carolinasportsclinic.com is where you can go and you'll find all of our contact information there and social media posts.
Sanjiv Lakhia (54:44):
Yeah. We'll put links to that in the show notes. I'll try and link to some of the information on some of these supplements and some of the resources he mentioned. I really appreciate you sharing that feedback. Listeners, that was not a paid advertisement.
Joshua Kollman (54:57):
My pocket is open.
Sanjiv Lakhia (54:59):
I'll gladly accept it. So thank you, guys. Bridget, Josh, I really appreciate your time.
Joshua Kollman (55:04):
Thank you, doc.
Bridget Kelly (55:04):
Thank you so much for having us.
Outro (55:07):
Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery & Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.