Vijay Vad, BACK RX

Vijay Vad, BACK RX

“I wanted to be in a medical specialty where I restore people’s quality of life. I don’t save lives going to work every day, but hopefully, I save their quality of life. That’s what life is worth living for.” Zibby talks with renowned orthopedist at the Hospital for Special Surgery, Dr. Vijay Vad, about his book, Back Rx, and the practices he has developed to help his patients (including Zibby’s own family) live their lives to the fullest.


Zibby Owens: Welcome, Dr. Vad. Thank you so much for coming on “Moms Don’t Have Time to Read Books” to discuss Back Rx: A Proven Integration Program for Staying Pain Free.

Dr. Vijay Vad: Thanks for having me, Zibby, and that trillion-dollar smile that can probably cure most back pain.

Zibby: That’d be nice. I have to say that your book was an unexpected benefit when I brought Kyle in for a recent appointment with you for his ankle. Next thing you know, we’re chatting about your book. Here it is. It’s been amazing. We couldn’t live without you, so I’m delighted that I can repay all of the pain-free help you’ve given my whole family by a little podcast.

Vijay: That’s sweet. I’m happy to be here.

Zibby: This book was great because I wasn’t expecting you to be talking about your life too. I thought it would be more clinical with just advice and self-help, but you brought in so much of your own background. You talked about your grandparents in India and how they cured pain and things like that. Tell me a little bit about writing this book and when on earth you found time to do it.

Vijay: Those are very good questions. I think every time you write a book you have to have a message that is important and compelling for your readers. It can’t just be a bunch of scientific information thrown on paper. When originally I started my clinical practice and a couple of my patients from Penguin wanted me to write a book on back pain, I was like, I don’t really want to write a book on back pain. I’m doing my practice. I’m too busy. Lo and behold, a few years went by. I was in California visiting my aunt. She was doing these exercises that was ancient wisdom on the East and scientific principles of the West. I was like, wow, that’s a combination of rehabilitation and yoga. I said, “Where’d you learn that?” She goes, “When I had your cousin forty years ago and somebody wanted to fuse my back, a yogi told me, do these exercises fifteen minutes every day and you’ll never have back pain. In the last forty years, I’ve never missed a day, cold, sick. I’ve never had back pain.” I put this program together, gave it a more scientific name, Back Rx, but it’s really yoga, Pilates, and medical rehabilitation. The clinical trial results were astonishing. To this day, I get letters from patients saying, the breath part of that book saved my life and made a huge difference. The clinical trial showed reduction in pain, reduction in recurrence of back pain — we don’t want to fix you, you come back a year later — and big decrease in . By the way, we proved this once. Then we did a beta app clinical trial with the same exact results. That app is going to be out hopefully by May.

Zibby: That’s exciting. The main principles of your plan — first of all, you also include psychological elements to back pain, which I thought was fascinating. Not only do you prescribe antidepressants for back pain occasionally, but you delve into what could be going on with the private life of your patients that might be causing the stress that could cause the back pain. Part of the solution is figuring out this whole mind-body piece of back pain. Tell me a little more about that part of the Back Rx.

Vijay: I call back pain the laboratory, ideal situation that exemplifies the mind-body connection. I mention in the book after 9/11 I saw a huge spike in people — either it was just in their mind — that’s only ten percent, the John Sarno phenomenon. Ninety percent, they blew their disks out because they were so stressed out. By the way, now in this pandemic I’m seeing the same kind of thing, what I call the pandemic within the pandemic. There’s the psychological stress of being in a pandemic. You combine that with really bad ergonomics. You’re sitting at a kitchen table for ten hours. You’re sitting in your bed doing your work. To me, that stress of the pandemic and that ergonomics, there’s a gigantic spike I’ve seen in people blowing their disks and back pain.

Zibby: Wow. I was so struck by that. I’m glad you brought it up. Can you just spontaneously rupture a disk not even doing anything to make that happen? I always thought you’d have to lift something wrong or something would have to precipitate it, that it couldn’t just be stress, but it can?

Vijay: We say you bend down and pick up a hundred pounds, and you blew your disk out. Now, that can happen. More commonly, your disk comes out just spontaneously, putting on socks. You’re getting up out of bed. You went to grab a towel or something, and boom. It was the straw that broke the camel’s back. My favorite example I say to third-year medical students, the dean wants to talk to me about academic performance. The loans are due. My girlfriend dumped me. My disk blew out. That’s the mind-body connection.

Zibby: Got it. You’re so funny in your book talking about the one patient on his honeymoon who says he couldn’t get out of bed. You’re like, isn’t that the whole point? So funny.

Vijay: Poor guy. He’s like, you don’t understand what’s going on here. I’m bedridden.

Zibby: You’re like, great, I’m jealous. You have the stressful part of our whole psyche affecting our bodies, but you also bring in all this stuff that I hear about night and day with self-care and how this is really the crux of the whole thing. We should be eating with a Mediterranean diet. We should be getting regular exercise and sitting better at our desks and doing these exercises and sleeping. All of these things will affect our back in addition to the rest of our health. How important is all of that stuff relative to — is that really the secret, that we have to just live healthy and then everything will be okay?

Vijay: Good genes help. I believe in simple solutions to stay active. I think healthcare should only be there in extreme circumstances. It’s your lifestyle. My whole mission has been, last twenty-three years now I’ve been in practice — who’s counting? — is inventing simple solutions to stay active that are cheap, simple, and effective because we can’t keep doing business as usual. Healthcare costs will be astronomical. I say to patients, you want to avoid recurrence of back pain? I call it thirty on thirty. Every thirty minutes, you get up. You put your arms back and do five or ten deep breaths and then sit back down. Something as simple as that could avoid so much back pain.

Zibby: Maybe you have to do this in private, though. I was even reading your book standing up at the kitchen. Maybe I shouldn’t do that.

Vijay: You could get up in the middle of a board meeting and set a new trend, the Zibby Owens thirty on thirty.

Zibby: I’ll see if that catches on. Moms don’t have time to sit down. Tell me more about the importance of the anti-inflammatory diet. I know this. I’ve tried it. Yet it’s so easy to slip into eating bad stuff again. Remind me why it’s so critical.

Vijay: Look, if you have ice cream once a week, it’s not anything bad. If you have a steak once a month, I’m not going to — there’s this old Sanskrit proverb from five thousand, six thousand years ago. You are what you eat. The medical world is finally catching on to, hey, good food as medicine has impact on your brain, your back, your heart, your mind, your body. It’s important to eat good food daily and a little bit of exercise daily. It doesn’t mean you can’t splurge every once in a while.

Zibby: Does walking count as exercise, or not?

Vijay: My favorite saying when I did a PBS special on back pain is walking thirty minutes a day keeps the doctor away. If somebody had told me you only had one medicine for human health, what would it be? I would say walking thirty minutes daily.

Zibby: Really? I feel like that doesn’t even count. I feel like when I walk the dog for thirty minutes or something, it certainly doesn’t feel like a workout. What about the workout versus just exercise? Tell me more about that.

Vijay: It all depends on your fitness level. I’m talking about maintaining basic health. If you look at my personal life example, my mom who is super smart, smartest person in our family, had a heart attack when she was fifty-four, genetics with triglycerides and this and that. She was not an athlete by any means. As soon as she finished her cardiac rehab — that was back in 1996. From 1996 to 2021, however many years that is, she has not missed one day where she doesn’t walk minimum three miles, three to six miles daily. She’s seventy-eight years old and vigorous. Walking has, in her life, been the key thing that has kept her healthy.

Zibby: Okay. All right, I’ll put it back on the list.

Vijay: You’re young, Zibby. You could run. Running is the ultimate brain preserver.

Zibby: Just getting away from my desk is a victory. I feel like just getting and doing anything is probably better.

Vijay: I think for you, a twenty-minute run. With four kids, all these enterprises, Kyle, you got your hands full. A twenty-minute run for you daily would be perfect.

Zibby: It would be a lot, but okay, I’ll try.

Vijay: Ten minutes.

Zibby: Ten minutes. It’s actually easier for me to do a walk because then I could drop my kids and walk back. I guess I could run. I don’t know.

Vijay: Don’t underestimate the potency of thirty minutes walking daily.

Zibby: Good. Thank you. You made me feel better. With the other exercises in the book, let’s talk about strengthening your core. I feel like so often with back pain people are told to do physical therapy. They go a couple times. Then they don’t do the exercises at home or they stop the physical therapy. Tell me about the importance of sticking to that.

Vijay: Physical therapy is formal. You could do it for a month after acute back pain, but then we call it post-rehab. It’s really up to you. Back Rx is literally fifteen minutes three times a week. Has a potent impact on reducing back pain and recurrence of back pain. It’s just fifteen exercises you do three times a week. Soon, it’ll be in an app. You could put it on your computer. It’ll give you all the information about your pain, your medication use, your time off of work, how happy you are with your life. When we did the beta app trial, patients loved it. There’s a virtual coach. I didn’t even know what a virtual coach was until the Cornell Tech people told me. These are messages we send to humans, and they react to them. Zibby, it’s time for you to do your exercise. Zibby’s like, oh, cool. My iPhone just gave me a message I want to exercise.

Zibby: It works. My kids have Fitbits. It’ll tell them, it’s time to stand up. It’s time to walk around.

Vijay: There you go. These new generations, they love their machines sometimes more than their mom motivating them.

Zibby: Oh, yeah. I have to drag them out of the house kicking and screaming. If the Fitbit buzzes, they’re out of their chair like a rocket.

Vijay: Boom!

Zibby: Whatever. We need a parenting Fitbit of sorts. What made you become a doctor to begin with? How did you end up a doctor? How did you end up in this specialty? I know you did so much with tennis players for a long time. How did that all happen?

Vijay: I was actually interested in politics and diplomacy early on. I grew up in Oklahoma. I actually worked for my congressman in Washington who was head of the House Intelligence Committee at the time. Very much interested in international relations and diplomacy. Then the more I looked at it more, I realized it was very political and bureaucratic. I come from a long line of physicians. You could almost call, it was a profession that was because I couldn’t find anything else better to do, if you can say that. Had somebody told me how gratifying it would be practicing it, I probably would’ve been less grumpy as a medical student. Sports medicine, I was an athlete. Was injured, had a stress fracture. The doctor that took care of me got me back on track. I wanted to be in a medical specialty where I restore people’s quality of life. I don’t save lives going to work every day, but hopefully I save their quality of life. That’s what life is worth living about, with some decent amount of quality.

Zibby: I think there’s not enough written or talked about athletes who are no longer playing their sport anymore, the transition from being a professional athlete or even just an athlete when it’s such a part of your identity and then you stop doing it. I feel like there aren’t a lot of supports for that particular group of people. You must see those people all the time.

Vijay: I see those people all the time. It’s very, very difficult on them in many ways. By the way, the least of it is financially too because they don’t save money, a lot of them. You may think every professional athlete makes a lot of money. The top one or two percent do, but the rest of them — and their bodies, depending on what you play — I take care of some ex-NFL and NBA guys. Their bodies are wrecked by the time they’re thirty-five, forty.

Zibby: They’ve lost their livelihood and their bodies. God willing, there’s a lot of life left after thirty-five, forty. If your body is already in so much pain, what do you do then? Should people not even do the sports to begin with? It’s a trade-off, right, that maybe people don’t understand so much when they’re younger? I don’t know.

Vijay: When you’re twenty, you don’t think forty. NFL and NBA and even the ATP, the tennis player’s association, has done a lot of work telling players, look, there is life after tennis. How many professional tennis players are well-known? Very few. The rest of them, they slug it out on the tour, or even NFL for that matter. These player councils have done a great job of telling players, look, this is not going to be forever. You need to figure out a way to have the life after and adjust to the life after. Some of them have gone on to do incredible things.

Zibby: I know firsthand watching Kyle’s transition from when he was twelve years of on the court every day to suddenly not, it was such a blow for who he felt like he was. Not to be airing his dirty laundry. I just think if there had been some supports or that people talked about it more it might have made it easier.

Vijay: The ATP is much better now than when Kyle was twelve, fifteen, twenty, or when he transitioned out of it. It’s a huge change in your identity. You’re on a court six hours a day to not doing that, and the whole going to tournaments and going city to city. That’s why you look at guy like Roger Federer who is thirty-nine or something, he doesn’t want to give it up. He’s like, I’m still a top-five player in the world. I may not win any Grand Slams, but I’m having fun doing this. What am I going to do after this? Academy and coach little kids? He goes, I’m not ready for that.

Zibby: We were just watching him yesterday. Didn’t he just play? I feel like we’ve had him on. This week, he was playing. He’s back at it. Unbelievable.

Vijay: That’s the other thing gratifying with what I do. I can help on one spectrum, the eighty-four-year-old grandmother who wants to walk a mile with her grandkids. On the other spectrum, we have these athletes that are thirty-five-plus. We’re keeping them at the top of their game, the top in the world using modern sports medicine principles. It’s a very exciting time to be in sports medicine, frankly, because of both ends. We can keep the eighty-four-year-old grandmother and the thirty-five-year-old elite athlete active.

Zibby: Wow. Do you have any inside information on what’s going on with Tiger Woods, by the way?

Vijay: I do, but it’s HIPAA stuff, so I can’t say much about it. One thing I can say about superstars, they got there because of a very different mindset. They’re driven to the core. All I can say is don’t count him out. He could make a comeback despite all that.

Zibby: Oh, my gosh, unbelievable. In terms of writing this book — then I know you rewrote it twenty years later. You said you had lots of different things that have come up over time that you wanted to integrate and basically did it all again. What was that like? How long did it take to write? What’s your process like for writing?

Vijay: From the time we decide — let’s say I speak to Penguin. I’m fortunate enough I can just call Megan at Penguin. I say, “Megan, it’s time to do a book, don’t you think?” She’s like, “Great idea. Let’s do it.” I’m lucky in that sense. From the time we get the contract done — I’m extremely lucky to have a writer, Peter Occhiogrosso, who truly — we’ve done many projects together now — who can bring my voice out. There are times I throw sixty-eight pages out. I said, ” Peter, that sounds way too much like you, the granola kids from Woodstock. This is not me.” He’s like, “You just threw all sixty-eight pages out.” I said, “We got to start over and write the chapter all over again. It’s got to sound like me.” It’s a process. It takes about eighteen months from start to finish per book. I’ll tell you, it’s so gratifying when you see the final product. The people at Penguin are phenomenal, editing job. I was at my friend Chris Godek’s who reads as a consumer and has a lot of input. This doesn’t make any sense. It’s a process that I’ve been lucky to be doing it for almost twenty years and six books. I’ve loved every single one of those projects.

Zibby: What advice would you have for aspiring authors?

Vijay: If you see a lot of sea of red on your initial manuscript, don’t panic. It just means your book is going to be an amazing book when the final product is done. I just feel like if you have an idea that you think that people would listen to and would add to their life — I’m a big believer in storytelling. I think your book has to have some type of storytelling. I always say these great epics that are so successful over thousands of years, Iliad, Odyssey, or the Bhagavad Gita or Ramayana, Mahabharata, they’re stories. They’re powerful stories. Every story in my book is a real-life example of real patients and what they did to overcome their back pain in this case.

Zibby: And made it very entertaining — not entertaining, that’s the wrong word — engaging to read because you want to see what happens. I love how you bring John full circle to the end. It was great.

Vijay: I’m privileged to have him in my life. His story of where he started in Florida at an opiate clinic, fifty, seventy pounds overweight, and to see where he is today as a software security expert with a thriving business, it’s really gratifying that I could make a positive difference in one human’s life.

Zibby: That’s amazing. All in a day’s work. Thank you. Thanks for coming on to talk about this book. Fantastic, excellent life tips. Even if your back is fine, honestly, this is a better way to live than most people are living anyway. Highly relatable and very user-friendly and fun to read at the same time. Thank you for my copy.

Vijay: Of course, Zibby. My pleasure being on your podcast. You’re doing very good stuff with your podcast and your idea of “Moms Don’t Have Time to Read” concept.

Zibby: Thank you. I hope I won’t see you in person soon, but I have a feeling I probably will.

Vijay: I’m glad Kyle is standing on his two feet.

Zibby: Yes. Today’s a good day. Thank you.

Vijay: Great being with you.

Zibby: Thank you. You too. Buh-bye.

Vijay: Buh-bye.

Back RX by Vijay Vad

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