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 Episode 7 - Sports and Spine with Jake Beamon, PTA

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Episode Summary
Very often you hear this saying in the fitness world and athletic arena, “No pain, no gain”. It’s as if pain should be expected when you do exercise or undergo training for a sport and if you don’t, whatever you’re doing isn’t going to be effective. This kind of misinformation that exists in this field is one of the main reasons why injuries, particularly on the back, are prevalent among athletes. Because the truth is, the most you should feel while training is a little soreness or muscular discomfort.
 
Today’s guest on Back Talk Doc is Jake Beamon, PTA, a physical therapy assistant at Carolina Neurosurgery & Spine Associates and avid CrossFit enthusiast. He discusses the many causes of back injuries among athletes, with one of the main reasons is a lack of understanding of the importance of core strengthening. Another is muscle asymmetry, which is often in the case in those who play golf, baseball and basketball.
 
Injuries also occur when there is lack of warm-up or excessive non-essential training. Jake is a believer of adopting functional sports-specific training and working your body out as a whole unit, and not separating certain muscle groups.
 
Jake also dives into how you can protect your back if you’re into athletics, or even as an ordinary person who’s into fitness programs like CrossFit. Besides strengthening your core and improving mobility, you must maintain functional body movements of hip hinging, squatting and jumping/walking/running regardless of age and fitness level.
 
Always consult your doctor or expert before embarking on any sport or training regimen. Additionally, putting good nutrition in your body should be of priority as well. The benefits will only be seen when you incorporate a healthy balanced diet in your everyday routine. 

Key Moments In The Episode
  • Reasons athletes tend to injure their back - 06:05
  • The body's core muscle system - 07:56
  • Pelvic muscles in healthy spinal movements - 09:34
  • Characteristics of a strong core - 10:26
  • Breathing and core stability - 11:49
  • Effects of yoga - 14:28
  • Sports that create the most muscle asymmetry - 15:07
  • Excessive non-essential training - 17:34
  • Kettlebell swings as alternatives to deadlifts - 19:17
  • Weight training for sports - 20:18
  • Increasing muscle bulk from weight training to prevent back injuries - 21:49
  • Ideal exercise program for people with varying levels of fitness - 31:41
  • Back injury prevention for golfers - 32:50
  • How to tell you're physically fit for CrossFit - 35:15
  • Health habits to follow - 38:31
  • Favorite apps, books or other tools - 39:20

Every episode of Back Talk Doc includes a Health Matters segment intended to provide actionable health information you can immediately put into practice in your life. This week, Dr. Lakhia talks provides insight into the nutritional content of dairy and other plant-based milk alternatives. While cow’s milk is a great source of calcium, many are unable to consume this due to lactose intolerance or allergy to casein. Almond milk, coconut milk, oat milk, pea mil, rice milk, soy milk and hemp milk or some of his recommended alternatives, which not only provide the calcium you need but are also infused with the right vitamins and minerals that your body needs. 

Links Mentioned In The Episode
  • Glute power with Ryan Klomparens, PT
  • Becoming a Supple Leopard by Kelly Starrett
  • Diaphragmatic breathing technique
  • Golf specific training for hip mobility
  • Carolina Neurosurgery & Spine Golf rehab program
  • MobilityWOD
  • Plant -based milk alternatives
​
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
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 and Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years. Now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk doc, Dr Sanjiv Lakhia.

Sanjiv Lakhia: 00:35 Growing up in Cincinnati, Ohio, I played a ton of basketball. I love playing basketball and I got to tell you, I wish I had our guest today. I wish I had him around when I was younger to help me stay healthy and protect my back. I remember growing up, dealing with low back pain after practices, taking charges, getting run over. I remember my dad taking me to get shots in my back and I really didn't have any understanding about low back pain when I was in high school and on the varsity basketball team.

Sanjiv Lakhia: 01:10 In fact, I remember our training really was focused on basic strength training, sprints, and stretches and there was no science discussed. There was no nutritional science. There was no exercise science. Today I'm very pleased to bring to our listeners an interview with Jake Beamon, who's a Physical Therapy Assistant at Carolina Neurosurgery and Spine Associates.

Sanjiv Lakhia: 01:30 Jake works in our Concord office. Jake has been fully licensed for about four years. He's certified in Kinesio tape, Graston level one, with experience as well in Tai Chi for rehabilitation. Part of that, he was a personal trainer, a collegiate wrestler at Appalachian state and for four years of Brazilian jujitsu and mixed martial art assistant coach.

Sanjiv Lakhia: 01:55 Currently, he's an avid CrossFitter with plans on becoming a level one certified CrossFit coach. Today, Jake is going to enlighten us on really how to protect your back if you're into athletics at any age. But if you're in the teenage up through 20s and 30s range or even just a weekend warrior, I think you're going to learn quite a bit today. Jake, thank you for being here and welcome to the show.

Jake Beamon: 02:20 Thank you for having me. It's awesome to be here.

Sanjiv Lakhia: 02:23 I always like to begin the interviews giving our listeners kind of a personal experience or a sense as to what drove you into the world of spine care that you're in. Can you give us just a little bit of history and help the listeners get to know a little more about you?

Jake Beamon: 02:38 Yeah, for sure. I originally went to Upstate, I wrestled there and I was going to college for civil engineering and I did an internship in which I shadowed somebody who worked for the county up there near Upstate. I began to see that all they did was review site plans on a computer, put a rubber stamp on it, and then go to the next one. I realized that in my head, I was going to be out in the field and supervising these highways being built and these great things being done and realizing that that was not what was going to happen. That led me to kind of stumble around a bit for a year, just doing some general education stuff. I was fortunate enough to have a great aunt who was an Assistant to the Director of Foresight Memorial Hospital in Winston-Salem.

Jake Beamon: 03:26 She knew I was big into fitness and with wrestling and she said, "Come down, I want you to shadow a physical therapist for a day and see what you think." And I said, "Okay." I go down there and I got really lucky. I got to shadow a couple of therapists that day and watching them being able to heal people through movement and exercise was so beautiful. They made it so cool. It was so human to use your own body to heal your own body, which is what I loved about it.

Jake Beamon: 03:56 I became drawn to that field and realized the best way for me to get into the field is as quick as possible and to get my hands on patients in the practice was to be an assistant. I applied to Central Piedmont right here in Charlotte and I went through their program, graduated from there, and then I've been practicing ever since.

Sanjiv Lakhia: 04:14 Describe to our listeners, kind of your typical day at our offices.

Jake Beamon: 04:19 Usually I see anywhere from 12 to 15 patients, 30 minutes, 45 minutes slots. We see a pretty good variety, but obviously mostly spinal focus, so post ops cervical fusions, post-op lumbar fusions, microdiscectomies, laminectomies, things like that. But I also am fortunate enough to get a decent amount of athletes who come to us with low back pain, neck pain.

Jake Beamon: 04:48 I also get a lot of patients from physiatrists like yourself for patients who are lumbar strains, neck injuries that are seeking to not go the route of surgery in which I'm definitely really poised to make sure we can make a difference there.

Sanjiv Lakhia: 05:05 I met with you at our recent holiday party and that was really the first time I got to know you and you came up to me with passion in your eyes and you're basically are like, "Listen, I got to get on the air and share with people my story, my passion." You really emphasized to me then that if people had enough information you could prevent back injuries of front and you notice a lot of mis-training going on in the fitness world. And you're really just chomping at the bit to correct some misinformation that's out there in the fitness field and in the athletic arena.

Sanjiv Lakhia: 05:42 Number one, I want to thank you for reaching out to me and really excited here to share your information and your story. With your background, you tend to suggest that most athletes do not train correctly with respect to their spine. What are some of the reasons athletes tend to injure your back? I know you had kind of three specific categories, so why don't we kind of tick these off one by one for our listeners?

Jake Beamon: 06:05 Yeah, of course. The main thing I think is just lack of understanding of what core strengthening is, how the core is involved in training in general, and in human movement, and within sports in itself. Also, I think one of the big things that people tend to not have is they have a lot of asymmetries. People playing your sport typically makes you one side dominant. Then throughout your life, you're usually one side dominant. You start adding these dominance, and leg, and pelvis position or a dominance to drive off of one leg versus another whenever you're sprinting.

Jake Beamon: 06:43 For instance in football, when you're charging for a ball or trying to jump for a catch and you start to get shifts in your pelvis, shifts in your thoracic spine, your lumbar spine and those muscles start getting not aligned and symmetrical anymore. Then that leads to mechanical breakdowns once you start putting repetitive stress on those tissues. Then last, I think that it's starting to change.

Jake Beamon: 07:09 I think there's a little bit of a revolution starting to happen in the fitness industry where people are taking mobility seriously, starting to actually grasp what core is and we're getting away from this, "No pain, no gain" axiom, which I hate. I'm not a fan of that. Whenever patients come to me and I'm training and they're like, "Oh, this should hurt." And I'm like, "No, a little bit of soreness, muscular discomfort maybe, but there should be no pain with your training."

Sanjiv Lakhia: 07:32 My mission on Back Talk Doc is to educate mostly non-medical personnel and arm them with information on how to protect their back and protect their spine or treat their injuries. Let's break down a little bit some of what you just went through. Number one, there's people out there are probably saying, "What is the core?" I myself, I've read multiple definitions of this, but what do you consider to be the core muscle system of our body?

Jake Beamon: 07:56 Basically, you can break down the core in anatomical muscles since we can point to specific muscles and go, "This is the core." But I like to think of the core and a lot of the literature I kind of read and like to think of the core as this. It's keeping your trunk, specifically your trunk, stable while you can manipulate specifically in athletic field, manipulate forces around your trunk. While it can provide a stable platform for you to be able to conduct these forces like running, jumping, squatting without having unwanted motions or movements that translate into your spine.

Sanjiv Lakhia: 08:34 Anatomically, I like to tell patients that if you put the spine in a box that the size of the box essentially represent the core muscle system. Correct me if you think I'm wrong, but I think we look at the abdominal muscles in the front, so the rectus abdominis muscles. The transverse abdominis is extremely important. It goes kind of side to side. Then you have the angled muscles, the obliques, and then of course the gluteal muscles, which Ryan Klomparens talked in great detail about on, I think, our second episode, and we can link to that in the show notes as well.

Sanjiv Lakhia: 09:05 Then from the posterior or the back of the body, we have the strap muscles and then deeper to the strap muscles, we have very small muscles that help rotate the spine called the multifidi. Then on top of the box, I would say, is your diaphragm, which is basically the main muscle for breathing and respiration and then the floor of the core. Do you consider the pelvic muscles as playing an integral role in supporting healthy and safe spinal movements?

Jake Beamon: 09:34 I do, and I would also lump in there. They get overlooked, but I really think, especially when you're making torque on a barbell, for instance, if you are an avid strength trainer or a powerlifter, the lats provide a secondary function where they do create a lot of stability, especially when you're doing back squats or front squats or even deadlifts.

Sanjiv Lakhia: 09:55 Those are the big muscles that give the bodybuilders kind of that V-shaped look, correct?

Jake Beamon: 10:00 Yeah.

Sanjiv Lakhia: 10:00 Then also we'll see them in swimmers.

Jake Beamon: 10:03 Yes.

Sanjiv Lakhia: 10:04 Like Michael Phelps, huge lats. That's a really good point. That muscle essentially runs from your arm to your spine and down to your pelvis. I mean, it covers a massive amount of geography of the spine. Thanks for including that. Okay. If you're an athlete at home, a weekend warrior and you're sitting around and listening to this podcast, how do you know is your core strong?

Jake Beamon: 10:26 The way I kind of define a core being strong is, can you perform the functional movements in day-to-day life such as in squatting, hip hinging, jumping and while you're doing these motions, maintain a stable trunk? You're not lopsided when you jump. When you squat, you're not going to one side, your trunk is not leaning.

Sanjiv Lakhia: 10:49 Is there a specific test that someone can do that's very simple to just determine how stable their core is? Is there something like a doctor can use in the office and tell a patient, "Hey, stand on one leg for 10 seconds," or anything that comes to mind that can be a really quick check for an individual to know do they need work or need to work with a physical therapist?

Jake Beamon: 11:09 Yeah, you could do... starting supine's easy. Having a patient lay on their back and then queuing them to tighten their abdominals and then just seeing if they can pick both knees up off the table and bring them towards their chest and down. Or even having them straighten one leg and lift that leg up and come down and maintain core integrity.

Jake Beamon: 11:29 When you're feeling on their stomach, it's not given out. They're able to keep tension in their stomach and that's relatively a simple move. Typically, for athletes, my go-to would be plank possibly or something along those lines to see how long they could hold or how they could tolerate being in that position.

Sanjiv Lakhia: 11:45 Does how you breathe affect the stability of your core?

Jake Beamon: 11:49 Yes, very much so. Diaphragmatic breathing specifically has been shown in studies to stimulate the multifidi and several muscles in the core. I do think it's great to learn that method of breathing in general and stop being a chest breather. But another thing that I found that I think it's important that no one ever taught me was when you're doing a heavy lift. There are sports that I'll go into later that I do still think require heavy strength training specifically if you want to be a powerlifter or if you want to be a football player or if you want to be an Olympic lifter, then you're going to need to heavyweight train.

Jake Beamon: 12:23 There is a maneuver that you need to be able to perform, which is the ability to... some people call it Valsalva maneuver but I think it's something similar to that but not quite the same. It's the ability to intake a bunch of air, filling up your stomach with air, and then you have to be able to contract your abdominals while doing this. I like to compare it to, if you take an empty soda can, you stand on one leg, crushes.

Sanjiv Lakhia: 12:46 Yes.

Jake Beamon: 12:46 If you feel your diaphragm and everything up there, you contract, that's a full soda can you haven't opened yet. You stand on it, you've got plenty of strength in it and plenty of resistance in that can and so you liken that to a lifter. They have done studies that people's one rep max on their back squat, their dead lift, and even their bench press has increased by using this method.

Jake Beamon: 13:08 Now granted you are holding your breath, so the rep scheme should be one to three reps. You don't want to lock that thing down and go try to hit 10 reps. You know what I mean? You're going to end up hurting yourself. But I was always taught you breathe in on the way down and out on the way up and that's great if you're doing pretty moderate weight. But once you start getting to heavy weight, you need to be able to fill your abdominal wall with air and contract and really make yourself nice and stable and that helps.

Sanjiv Lakhia: 13:32 Does this breathing technique have a name to it?

Jake Beamon: 13:34 I want to say this, just call the Valsalva maneuver. They just referenced it as that. That's kind of the tricky part of it. I don't ever remember anyone ever giving me a name and I managed to bumble all the way up into a college level lifting program before luckily had a coach walk over and tell me that and I was in my second year of wrestling.

Sanjiv Lakhia: 13:52 Great. We're going to dub that, the beam and breathing method.

Jake Beamon: 13:56 Oh, yeah.

Sanjiv Lakhia: 13:56 We'll see if we can put a link to that in the show notes. Now, I appreciate that. Listen, if you're out there, please try this only under the supervision of a physical therapist or personal trainer, someone who knows what they're doing. I don't want you going to the gym tomorrow, putting on heavy stacks of weights and trying this method, this pretty high level stuff that he's sharing with you. Okay.

Sanjiv Lakhia: 14:15 The second element that you discussed earlier about reasons why athletes tend to injure their back is muscle symmetry or asymmetry. A couple questions followup to that. Do you think an exercise like yoga can help people feel more balanced in their muscle tone?

Jake Beamon: 14:28 I want to answer that is yes and no. The reasons I want to say that, yes yoga does, because certainly it helps with allowing yourself to have symmetrical mobility obviously because that's one of its main focuses is making you more mobile throughout your body. But something awesome that yoga does do is static holds and different positions that does help build core strength and just overall ability to stay more stable.

Jake Beamon: 14:51 But where yoga kind of falls a little bit short and where I would have an athlete do more than just yoga or a weekend warrior is there is no dynamic movement. We're not getting side to side, we're not getting multi-directional. You're typically on a mat or standing in one position and you're just doing these holds in those positions. You're not doing movements with it.

Sanjiv Lakhia: 15:07 What sport do you feel like creates the most muscle asymmetry and the biggest problems?

Jake Beamon: 15:12 I want to start off by saying pretty much any sport, but the two that I see in clinic that I can personally vouch for. I actually have really three but I wrote two here, but I'm going to go with three. Golf, which I know we're going to touch on later. Baseball, specifically pitchers, the one arm throwing action or doing a lot of torque that or body that way. Then last, I tend to see it a lot and recently I've been graced to be lucky enough to work with a young athlete, a seven foot basketball player who repeatedly dunks on the same side over and over and over. That caused him some asymmetries.

Sanjiv Lakhia: 15:44 Okay. Elaborate on golf because that's probably the most popular sport in this area, at least in terms of the reason why men come to the office because they can no longer swing a golf club their back hurts.

Jake Beamon: 15:56 Actually me and another therapist in my clinic, we always kind of go back and forth. But I would almost, and this was just from what I've seen that golf is really one of the hardest things on your back. You need to have a lot of rotational force. You need to have a lot of coordination in your body. A lot of times, these guys, these weekend warriors, most of the time or they're playing golf, they don't have the thoracic mobility. They're not really warming up. It's considered a casual fun game to go outside and play with.

Jake Beamon: 16:22 There's a lot of mobility and coordination. You need to swing that club. If you're not warmed up and ready and you go out there, definitely high chance to injure yourself.

Sanjiv Lakhia: 16:31 What about runners? Do you feel like running can help or hinder this problem?

Jake Beamon: 16:36 I think running would probably hinder. It would hinder it to a degree and this is why. When you run, you can think about your form and running and heel strike and keeping good pattern and that's all great. Once you start to fatigue, the body likes to seek and find the path of least resistance. It's going to go with what's the laziest easiest way that Jake can run this 5K or Jake can run this mile today. Once that happens, we're immediately going to fall back into where our asymmetries are.

Jake Beamon: 17:02 If I'm more locked down in my right glute and my right leg is more dominant than I'm going to start running with that leg more, I'm going to spend less time on my left leg. I'm not going hit heel strike properly with my left leg. Actually running is going to reinforce that, I think.

Sanjiv Lakhia: 17:15 Once again, I think these points really illustrate how someone could benefit from working with an expert before they start a specific sport training program. Then the third point you mentioned about why people injure their back or why athletes injure their back is the excessive non-essential training. Let's go ahead and get into that a little more. Do you want to elaborate on that?

Jake Beamon: 17:34 Yeah. Stuart McGill, who's one of my favorite guys, he's a professor in Waterloo at a university out there in Canada and he wrote just tons of books on the back specifically because he injured his back earlier in his life and has rehabbed some famous power lifters and Olympic lifters and a lot of people who deal with massive amounts of weight on a regular basis through their spine and has brought them back to their careers. He talks about how bodybuilding, not on purpose, but polluted its way into our methodology of training here in the US. For instance like you've probably heard of the obligatory chest day, back day, leg day, things like that.

Jake Beamon: 18:13 Well, when you go to pick up something off the floor, do you just use your leg that day? Do you just use your chest that day? No. You use your total body as a unit. This ideology of you need a chest day, a back day, and a leg day has separated us from training functional motions and training in a way that utilizes your whole body together and has relied more on heavyweight and breaking your body parts up, which doesn't link your neural systems together and doesn't let you move properly.

Sanjiv Lakhia: 18:40 Yeah. A simple example that illustrates that even taking it out of the sports arena is for the average person who has to bend over and make their bed. You have to be able to hinge at the hips properly. You have to have an engaged core, you have to have some flexibility in your hamstrings. If your shoulders are in a properly retracted position, you're going to tilt forward a little too much and compress your disk.

Sanjiv Lakhia: 19:01 I would totally agree with that. Going into the gym and just knocking out a hundred knee extensions and bicep curls is not likely to promote that safe movement pattern. I think that's a terrific point. What are your thoughts on things like kettlebell swings as an alternative to deadlifts?

Jake Beamon: 19:17 I like kettlebell swings and I do think that... So again, kind of another example of bodybuilding polluting itself into the training realm. If you pretty much pulled any strength and conditioning coach from probably the last 10 years back or 20 years back, they're going to go bread and butter every day. What should you do? You need to bench every week. You need to squat every week, you need to deadlift every week. I'm sure that you and me, when I came out, that's what you did. I mean, you had a deadlift week, you had a bench week, you had different... They constantly were harping on these three things.

Jake Beamon: 19:44 But I think that the kettlebell swing in combination with an RDL with lighter weight or combination with some other hip hinging exercises can eliminate the need for a heavy deadlift completely. I think the...

Sanjiv Lakhia: 19:59 RDL, Romanian Deadlift?

Jake Beamon: 20:00 Yes.

Sanjiv Lakhia: 20:00 Okay. I think we actually have a good YouTube clip of some of these exercises from our second episode that, again, we'll link to when we talked with Ryan as he talked about a few of these. You answered some of this a little bit, but are you against deadlifts only or weight training in general for sports such as volleyball and basketball?

Jake Beamon: 20:18 I want to start with saying that for instance, I look at you, you're a very tall man, right? My seven foot athlete that I'm working with now, putting a bar bell on his back or your back in the distance that you guys need to cover to get to parallel and back, and strapping tons of weight on there when the sport that you played and also my current patient athlete plays, requires you never to dip below a quarter squat. I mean, when you jump, you're not squatting all the way to the floor and then jumping up. What is the purpose for strapping you down with all this weight and then making you go to the floor and up when this could be achieved with the high box squat? This could be achieved with possibly hang power cleans. This could be achieved with just band resistance jumping squats.

Jake Beamon: 20:59 There are so many other things we can do that's going to protect your back as a basketball player specifically or a volleyball player or soccer player. People who are more cardio based in their sports, the need for a heavy deadlift or heavy weight lifting for them, I just don't see the purpose. I would go a step further to reference one of the probably greatest NFL players of all time, even though I wish he didn't play for the Patriots and play for the Panthers is Tom Brady.

Jake Beamon: 21:25 If you look at Tom Brady and you follow his exercise regimen, he does very little weight training at all. He has resistance bands, plyo core work. I don't think you could argue that his resume shows that that doesn't work.

Sanjiv Lakhia: 21:36 It sounds like you're very much in favor of functional sports-specific training versus cookbook style of weight training. Do you think increasing muscle bulk from weight training will help prevent back injuries?

Jake Beamon: 21:49 No. I used to believe this. I used to believe that if you had a pair of spinals and a big thick back, that you're guaranteed you are insulating yourself away from back injury. But as I've seen patients, I've treated powerlifters, I've seen crossfitters in my gym, these guys with massive backs and stuff and they're getting hurt just as much as people that are smaller or have smaller backs. It's all about core stability, being symmetrical, and having good pelvis control. I've seen dead lifters on YouTube, herniated disc picking up 500 pounds and their back was big around that I can put my hands around.

Sanjiv Lakhia: 22:23 Well, you covered a lot of the potential pitfalls in terms of exercise programs and back injuries and I want to shift into what you think an ideal exercise program would actually look like to promote a healthy spine. We're going to get to that topic right after this break.

Sanjiv Lakhia: 22:42 I often recommend a Mediterranean diet to my patients to promote their health and wellness. One of the questions that comes up a lot is the idea of calcium intake, promoting healthy bones in a particular their relationship with dairy products. Through the years I've read a lot of different information on dairy products and on today's health matters segment, I want to do a brief review and nutritional comparison of dairy and the numerous plant-based milk alternatives that are out there.

Sanjiv Lakhia: 23:13 I was at Trader Joe's recently and I looked on the shelf and there's at least half a dozen different types of "milk alternatives" that are available. I think it's important that before you reach for those, you have a general understanding of the nutritional content of these food options and where they can play a role in your diet. Starting out just with a simple a cup of cow's milk that's going to have about a hundred calories in it, and I will tell you right up front, I'm not a big believer in calorie counting. I don't think the literature supports, there's any real useful role in watching your calories with respect to weight.

Sanjiv Lakhia: 23:49 But a cup of cow's milk has about a hundred calories, about 13 grams of carbs, and one thing you should know is there's about 13 grams of natural sugars. There's eight grams or protein and a little bit of saturated fat. You do get about 300 milligrams of calcium which satisfies about 30% of your daily requirement and there is certainly some potassium in there.

Sanjiv Lakhia: 24:11 The big issue I see with cow's milk is twofold. Number one, there is a very high number of people who have lactose intolerance and really can't tolerate dairy products and then there are some who have allergies to the casein which is the main protein in dairy and that can trigger a whole host of problems such as respiratory issues with increased mucus production and a fair number of gastrointestinal symptoms.

Sanjiv Lakhia: 24:39 The literature is somewhat mixed with regards to the inflammatory reaction that dairy products can produce. There are some evidence that suggests it increases inflammation in our body and there's even some evidence that suggests the opposite way. I think there is enough issues with dairy products and cow's milk that is reasonable to look at alternatives.

Sanjiv Lakhia: 24:58 Additionally, a lot of the milk that's sold in this country has added hormones, antibiotics, and other chemicals that just aren't healthy for you. The one plant-based milk alternative I use quite a bit is almond milk. Now, almond milk is very low calorie, about 30 calories in a cup of almond milk. It lacks a fair amount of protein, so you really don't want to count on that for your protein needs. But as you'll find, most of these plant-based alternatives are fortified with calcium, potassium, and fat soluble vitamins. You can get a fair number of your fat soluble vitamins through drinking these products.

Sanjiv Lakhia: 25:39 On the milk is typically pretty bland, but you can use it and really any recipe, put it in your smoothies. It has a low-glycemic index, which can be a challenge from dairy milk or cow's milk. Cow's milk has definitely been shown to increase your insulin or cause an insulin spike after you drink it and you don't see that with the almond milk. It's one of my favorites. Again, I think you should always look at unsweetened products. Stay away from the added sugar. Almond milk is quite easy to make on your own at home. There's multiple recipes on YouTube where you can buy raw almonds and blend them and pretty much just train it with a cheese cloth and have some fresh almond milk available.

Sanjiv Lakhia: 26:21 Another popular milk alternative is coconut milk. Coconut milk is a little higher in the fat content, particularly the saturated fat content, which for some is not a problem and for others it can be depending on your lipid metabolism and your genetics. You may or may not want to entertain coconut milk. It has less sugar than cow's milk, but it doesn't really have much protein. In fact, it has almost no protein, so keep that in mind as well. Coconut is really not a nut, quite safe for people with nut allergies and it's a good vegan alternative if that's your food plan.

Sanjiv Lakhia: 26:58 Another milk product that you can buy is oat milk. Now, oat milk is about 130 calories per cup and is somewhat in between in terms of the carbohydrate intake of rice, milk, and dairy mill. Oat milk has about 24 grams of carbs per cup and five grams of sugar with four grams of protein. You can easily make this by soaking steel-cut oats or whole oats in water and then straining them.

Sanjiv Lakhia: 27:28 It is higher though in the carbohydrate intake and fiber than most milks, but it's low in fat, contains numerous B vitamins, and trace minerals like magnesium and phosphorus. Again, it's likely fortified with fat soluble vitamins. Oat milk also is vegan if that's important and a part of your plan and it's really a great option for those who are allergic or sensitive to soy or dairy milk.

Sanjiv Lakhia: 27:50 Pea milk, that's P-E-A. Pea milk is another alternative made from split yellow peas and it's a newer plant-based option that's on the market. If you drink a cup of unsweetened pea milk, it's low in calories at about 70 calories per cup and it does have eight grams of protein, which is nice. It's similar to potassium content and has fortification typically again with vitamins A, D, and calcium and oftentimes with Omega three fatty acids. It's another good alternative if you have lactose intolerance.

Sanjiv Lakhia: 28:23 Rice milk, maybe one of the more popular alternatives, and I typically try and stay away from rice milk simply because it has much higher level of carbohydrate and take per cup, so about 23 grams of carbs for cup, which for many of us who are trying to watch carbs to keep our blood sugars in a proper range, this can be problematic.

Sanjiv Lakhia: 28:42 In fact, if you have a bowl of oatmeal with rice milk, that can create quite insulin spike. However, it is enjoyed by many people. Rice milk though has very little protein. It has about two and a half grams of saturated fat and is really high in the carbs and sugar, so be careful how much rice milk that you are drinking, but again, it's another good alternative if you have allergies to dairy, soy or nuts.

Sanjiv Lakhia: 29:09 That leads us to soy milk, which gives you about 80 calories per cup, four grams about a gram of sugar, but it does give you a pretty good punch with seven grams of protein and there is about half a gram of saturated fat. If you're going to drink soy milk, make sure it's a whole soy product and not an alternative product that's fortification of soy.

Sanjiv Lakhia: 29:33 There are some research questioning the safety of soy product intake in terms of the effects on your hormones. I think some of that though, you can just take with a grain of salt. If you have soy milk, don't have it every day. It's okay to have periodically if you want as a replacement to dairy.

Sanjiv Lakhia: 29:50 Soy milk is cholesterol free and low in saturated fat and can make a good alternative to dairy for some people. The last milk product that I think is popular or becoming more popular is hemp milk. Hemp milk does come from the hemp seeds. And no, if you drink hemp milk, you're not going to test positive for marijuana on a urine drug screen. Hemp milk is a good option. It's higher in fat content in particular Omega fatty acids which do have some cardiovascular protective effect. It's a bit creamier and does have a bit of a unique taste and I found hemp milk to be slightly more expensive, so there you go.

Sanjiv Lakhia: 30:27 There's a low down on the milk alternatives if you're looking for options other than dairy due to allergy or other medical issues. I really like the almond milk as a primary alternative, but any of these can make for a great replacement product and it's really not a bad idea to alternate these and even try and make some of these on your own. Again, I hope these tips help you to stay healthy and stay out of the doctor's office because as you know, your health definitely matters.

Sanjiv Lakhia: 31:00 We're back here with Jake Beamon, Physical Therapy Assistant with Carolina Neurosurgery and Spine Associates and he's breaking down the whole topic of back injuries in sports and really correcting some misinformation that's out there in the fitness world. We're going to move on now. Jake, what do you consider an ideal exercise program that promotes a healthy spine for, let's break it down into different groups of people, weekend warriors versus amateur athletes and then also we see a lot of seniors who people are living longer and they want to play pickleball. They want to golf, they still want to run, they don't want to be sitting around watching TV. What are some key elements in an ideal exercise program?

Jake Beamon: 31:41 I think that with any exercise program, we need to take into account that regardless of your age, you still need to hip hinge, you still to be able to squat to some degree, you still need to be able to walk/run. All that being said, we need to take into account that if you're doing an exercise program, you want to make sure you preserve and maintain these important functional body movements. To me, what would vary between a youth athlete, an elderly person, a weekend warrior is going to be the intensity and the exercise selection, but we are going to hit these same systems of the body with various different training exercises.

Sanjiv Lakhia: 32:20 Say those three again.

Jake Beamon: 32:21 Hip hinging, squatting, and for athletes, jumping. I would say as a weekend warrior and elderly people, jumping maybe we could exclude that, but definitely walking or running.

Sanjiv Lakhia:  32:37 You set that as your foundation and then you gear exercises to maintain those functional abilities?

Jake Beamon: 32:41 Yes.

Sanjiv Lakhia: 32:42 Okay, very good. Then with golfers, again, we touched on a little bit. Do you have any simple things that golfers can do just to protect their back?

Jake Beamon: 
32:50 Yes. I want to start off by saying that there's a specific Titleist back program for golfers and Graham, who is the head of PT here, is certified in that. I do also believe there's a therapist, Jackson, I believe, who is out and Matthews who's certified in this. Now, I have treated golfers and I understand the gist of what they need. I'm going to share with you that today, which worked with golfers that have worked. But if people want to seek further and get more specific in details of like a golf swing and things like that, I would turn them on to Graham and Jackson.

Jake Beamon: 33:20 A lot of anti-rotational core exercises. You want to train your body to be able to resist a little bit of that back rotation you're getting off the club. So that club's generating feedback when you swing and you need to be able to resist that throughout your core. Next, I would look at your mobility, mobility. I get golfers that come in, they're like, "Oh yeah, I swing like this." Then I test them thoracically and they don't have it. They're at a desk throughout the week and then they're going to go during all this tour, through all these stiffened muscles. That's a lot of their problem there.

Jake Beamon: 33:51 Then last I would go with hip stability. Again, talking about being asymmetrical, you're constantly doing hip extension, hip extension, hip extension on one side of your swing phase, when you're swinging that club and the other side, you're not getting it. A lot of these golfers pelvises get torqued. Doing hip stability exercises like single leg glute bridges and things like that, some of the stuff Ryan touched on is going to help realign on you. You should almost integrate that like, "Okay, I played golf. Now when I get home, I'm going to do these 30 minutes of hip stability, mobility exercises." Or, "Before I go play, I'm definitely going to do the mobility. And then after I get done, I'm going to kind of treat myself with the stability and the core exercises," to kind of cancel out what you did with the golfing.

Sanjiv Lakhia: 34:34 I think the take home point there is, if you're a golfer and you're listening, don't just golf.

Jake Beamon: 34:38 Yes.

Sanjiv Lakhia: 34:38 Don't just get out of bed, make your tee time, play 18 holes because then you will eventually end up on my schedule or someone quite similar. Really integrate focus flexibility programs using a foam roller, doing some hip work. There's a lot of literature out there. As always, I recommend that you seek help and guidance with an expert. There's no substitute for one-on-one attention.

Sanjiv Lakhia: 35:01 You mentioned before your interest in CrossFit. I consider this personally to be very high level exercise with significant safety concerns. I see a lot of patients coming in with injuries from CrossFit. How can someone tell that they're physically ready to handle a program such as CrossFit?

Jake Beamon: 35:15 I'll be remiss to go without doing a little defensive CrossFit before I go into how you could tell. In defense of CrossFit, so CrossFit's design is to be universally scalable. For instance, if the exercise is a snatch, which - for listeners who don't know that it's taking a barbell from the floor to your hip crease and then generating it overhead, very quickly and you have an athlete who cannot do that.

Jake Beamon: 35:40 I mean, obviously that's a very... I consider a snatch, probably one of the most complex tier three movement. It's one of the most complex movements you could do. I'm not going to ask someone who comes in right away to be able to snatch. What we'll have them do is the way CrossFit structures are educated is you take that exercise down the chain of exercises that may lead to them just holding an empty rod over their head and squatting down and coming back up to try to mimic a snatch. As they progress, you can add these different exercises, so they can still do the same workouts as everyone else, but it's been scaled down.

Jake Beamon: 36:11 Also, there was a comprehensive study done with personal trainers, certified strength conditioning coaches, and some sports med doctors that found CrossFit to be no more dangerous than marathon running. If you look at those two sports, you're looking at the same injury rate or issues, that's what they found. But I do agree with you that CrossFit takes a certain skill because it is high intensity. You can't go in there and not know how to control your core. You can't go in there and just throw a barbell around. You're going to end up on our schedules.

Sanjiv Lakhia: 36:41 Yeah.

Jake Beamon: 
36:41 I think that how you can avoid that is most good CrossFit gyms will have a foundations program that they should take you through and they should walk you through all these complex motions and educate you and teach you about these. Then when you're in a class setting, that coach should be watching you more than anyone else because you're new and you want to make sure that you're landing these movements and you're not getting pain. That was how I would think that you could do CrossFit safely.

Sanjiv Lakhia: 37:10 My advice for any exercise program, whether it's CrossFit or Orange Theory or if you're getting into yoga, I always tell individuals, start where you are and compete with yourself, not the person next to you. I think I see injuries occur when individuals try and do something that they're not ready for and it's for the wrong reasons, whether it's to impress someone or they feel somewhat ashamed or embarrassed that they're not as strong as they want to be.

Sanjiv Lakhia:  37:34 I think if you get a good coach and you have reasonable expectations, you can do quite well in these types of activities. All right. You've done a great job today, breaking down this topic. I'm going to close with just a few kind of personal questions that I know our listeners love. Can you share with our listeners your typical weekly exercise program?

Jake Beamon:  37:52 Yes. As you kind of alluded to before, I am kind of a CrossFit junkie, so I do CrossFit typically four to five days a week. I've got to give a shout to CrossFit North Lake. That's where I go. But anyways, so they do a good job programming. We hit a lot of stuff. What I usually reserve is Saturdays. I reserve that for whatever. I kind of look at the workouts they put me through throughout the week and say, "We didn't touch on running." Or, "We didn't touch on some unilateral or side to side motions." Then I kind of go and I just build myself a little custom body weight or kettlebell workout that will address what I didn't get to do on Saturday. That's kind of my week.

Sanjiv Lakhia: 38:26 Do you have any other health habits that you want to share with our listeners that you think are successful and other people could adopt?

Jake Beamon: 38:31 Yeah, I would say right away and probably the best advice I ever got from my wrestling coaches, you cannot out train a bad diet. You can train as hard as you want, as long as you want, as much as you want it, as high intensity as you want. You will see no physical benefits. You will see no changes unless your diet is dialed in. I definitely control my eating. I live off an 80, 20 rule, which is Monday through Friday. I have five to six meals a day. I eat pretty strict and then Saturday I let it hang out a little bit and I have a burger or something or beer too, and then I tighten it back up Sunday and then I back through the next week.

Sanjiv Lakhia: 39:03 Well, if you've heard any of my other episodes, you know that that is music to my ears. I really feel like you've got to put good nutrition, good fuel in your body if you want to have optimal results. Then lastly, do you have any favorite apps, books or other tools that you want to share with our listeners that they could benefit from?

Jake Beamon: 39:20 Yeah, so one of them I really like... If you are a CrossFitter that was catching onto this, there's a really cool Instagram page called MobilityWOD, which is mobility workout of the day. It's just different mobility techniques you can do, different stretches and things like that. Also, I want to put a plug in, Ryan referenced him on one of the other shows. Kelly Starrett has a book that I call it the Plumbing Manual to the Body. It breaks down with all the lifts, all the complex motions you can do in training and shows you, "Okay, if you're having pain here, go back to this appendix here, do these mobilization exercises here." It's kind of like a broken down simplistic version of how to physical therapy yourself if there was such a book and it's called Becoming a Supple Leopard.

Sanjiv Lakhia: 40:05 All right. Well, we will put links to those tools in our show notes for sure. I hope you guys who are listening get a chance to check some of this stuff out and hope you enjoyed today's interview with Jake Beamon. He really went into a deep dive on how to prevent back injuries during your athletic training, regardless of the sport. He gave us some terrific tips here. We'll have all of this in the show notes and I hope you take some time to review this and implement some of these tips into your own life.

Sanjiv Lakhia:  40:32 Thank you, Jake. I really enjoyed the interview.

Jake Beamon:  40:37 Thank you. Thank you for having me here.

Outro: 40:37 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and 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.
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Dr. Sanjiv Lakhia is a board certified physiatrist with Carolina Neurosurgery & Spine Associates, one of the oldest and largest private neurosurgical practices in the country. The practice has offices in North Carolina and South Carolina, and offers comprehensive diagnosis and treatment of spine injuries and disorders. To learn more or schedule an appointment, call 1-800-344-6716, or visit cnsa.com.

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