19 Dec Boston Panel Part 3: What Experience Has (and Hasn’t) Changed About How We Understand the Spine
Article Rundown
- Fundamentals of spine health haven’t changed — precision has
- Pain must be identified by mechanism, not labels
- Experience refines when to stabilize, mobilize, or do nothing
- Progress comes from evidence, not trends
What I Haven’t Changed My Mind On — and Why That Matters
One of the questions that came up during our Boston panel was simple on the surface, but deep in practice: What have you changed your mind on when it comes to the spine, and what have you doubled down on even more?
For me, the honest answer is that I haven’t changed my mind all that much on the fundamentals — and that’s not stubbornness. That’s respect for evidence. Everything I do is grounded in what Dr. McGill has always called the six pillars of evidence: experimental research, clinical trials, real-world case outcomes, diagnostic imaging, biomechanical plausibility, and practitioner expertise. When all of those line up, you don’t chase trends — you refine execution.
What has evolved is my ability to apply those fundamentals with greater precision. Finding someone’s pain mechanism, confirming it by increasing and decreasing symptoms, teaching them how to calm it down, and then building them back up strategically — that process hasn’t changed. What’s improved is how accurately and efficiently we can do it.
Precision Matters More Than Ever
The biggest mistake I still see in the industry is treating “back pain” as a diagnosis. It isn’t. Pain has a mechanism, and if you don’t identify it precisely, you’re guessing.
Through years of working alongside Dr. McGill in both the lab and the clinic, we were able to match what we saw on MRI with what the patient actually felt — distinguishing between active pain generators and old, burned-out scars that weren’t the problem anymore. That level of confirmation changes everything. Once you know what you’re dealing with, you can teach the patient how to wind pain down instead of constantly flaring it up.
That approach applies whether you’re helping a 72-year-old who just wants to stay independent at home, or a three-time Olympian who wants one more shot at the podium. The principles don’t change — the application does.
Experience Separates Theory From Reality
A lot of young clinicians believe they’re effective because they can keep high school athletes on the field. That’s not the test. The real test is taking a 15-year NHL veteran, someone with mileage, injuries, and scar tissue, and extending their career without breaking them down further.
That takes creativity, restraint, and judgment. It also takes humility — knowing when to stabilize, when to mobilize, and when to do absolutely nothing. I’m still learning, still refining tools, and still improving how I sequence interventions. But I’m not quick to listen to someone on YouTube who claims they’ve found “the secret.”
Learning From the Right Sources
Staying open-minded doesn’t mean listening to everyone. It means learning from the right people. That’s why weekends like this one — working alongside experts like Michael Shacklock in neurodynamics — matter. If I want to understand neurodynamics, I’m not going to social media. I’m going to the people who built the field.
That mindset came up again as Dr. Steve Roman shared how regenerative medicine has changed his own clinical trajectory.
Regenerative Medicine and Extending Healthspan
Dr. Roman made a powerful distinction during the discussion: it’s not just about extending lifespan — it’s about extending healthspan. Movement is youth. The ability to stay active, independent, and capable as we age is the real goal.
He spoke about how newer intradiscal procedures, including DiscSeal, have shifted his practice. These weren’t techniques he embraced early on due to concerns around safety and efficacy, but with better data and improved protocols, he’s seen patients regain function and quality of life in ways that simply weren’t possible before. That kind of evolution — careful, evidence-driven, and patient-centered — is exactly how progress should happen.
Rethinking Soft Tissue and Microcurrent Work
Dr. Joe Camisa offered another important perspective — one I personally relate to. Like many clinicians, Joe was trained in a traditional medical model that downplayed soft tissue, fascial work, and frequency-based therapies. Over time, experience challenged that bias.
What Joe described wasn’t abandoning joint mobilization — it was understanding its place. Soft tissue and fascial changes often need to happen first. He also spoke about doubling down on frequency-specific microcurrent, not as a standalone magic tool, but as something that enhances everything else: needling, exercise, motor control, and muscle activation.
That kind of integration requires investment — financially and intellectually — but the results have justified it.
The More You Learn, the More You Realize You Don’t Know
One of the moments that resonated most with me was the acknowledgment that there may never be a true “spine master.” The field is too broad. The tools are evolving too fast. That’s why collaboration matters.
We need specialists — surgical revision experts, regenerative medicine physicians, microcurrent specialists — and we need to know when to lean on them. The deeper I get into this work, the more I’m reminded of how much there still is to learn.
Ironically, that realization hasn’t made me less confident — it’s made me more disciplined. It’s reinforced the importance of fundamentals, precision, humility, and surrounding yourself with people who challenge your assumptions rather than reinforce your ego.
Sorry, the comment form is closed at this time.