24 Dec The Full Boston Panel: Precision, Principles, and the Future of Spine Care
Article Rundown
- Real progress comes from identifying the pain mechanism, not chasing symptoms
- Movement quality depends on the whole system, not isolated joints
- Regenerative tools work best when they support sound fundamentals, not replace them
- Long-term results come from principles, precision, and smart load management
Precision, Principles, and the Future of Spine Care
I sat down with Dr. Stuart McGill, Dr. Joe Camisa, and Dr. Steve Roman for a wide-ranging discussion on spine health, movement, and where modern care is headed. What stood out immediately was that despite very different backgrounds, we kept coming back to the same idea: real progress doesn’t come from chasing trends — it comes from understanding mechanisms, respecting fundamentals, and applying the right tools at the right time.
This conversation wasn’t about selling a single method. It was about how experienced professionals think when cases are complex and when simple answers aren’t enough.
Dr. Stuart McGill: Fundamentals, Mentorship, and Precision
One of the most powerful parts of this panel was hearing more about how Dr. McGill’s career trajectory was shaped by mentors and key moments. Early in his life, others had written him off, pushing him toward a path that looked very different from where he ultimately ended up. The presence of the right mentors at the right time changed everything.
That theme shows up in his work today. Dr. McGill’s approach is rooted in precision. He doesn’t guess. He identifies the exact pain mechanism, proves what increases it and what reduces it, and then teaches the individual how to wind the pain down. Only after that does he begin rebuilding capacity.
What has not changed for him are the fundamental rules of how the spine behaves under load. Those rules are supported by decades of experimental research, clinical experience, and imaging confirmation. What continues to evolve is how tools are refined and applied, especially when dealing with higher speeds, elasticity, and more complex movement demands.
Dr. Joe Camisa: From “Back Specialist” to Movement Specialist
Dr. Camisa explained that his growth as a clinician came from stepping away from being a “one-joint” specialist and instead becoming a true movement specialist. He described learning a system of rules that governs how the body is supposed to function, then filtering everything he learned through those rules.
A key principle discussed was the relationship between mobility and stability throughout the body. When a joint that should be mobile becomes stiff, or when a joint that should be stable loses control, the body compensates. Over time, those compensations create stress concentrations that show up as pain or injury somewhere else.
This is why three people can have the same underlying limitation — such as poor pelvic stability — but present with completely different problems. One person develops low-back pain. Another develops hip issues. Another ends up with knee pain. The location changes, but the root problem often does not.
Dr. Camisa also highlighted the difference between “software” problems and “hardware” problems. Some movement issues can be coached away. Others require restoring mobility or tissue quality first before better movement strategies are even possible. Understanding that distinction changes how you assess and how you intervene.
Dr. Steve Roman: Regenerative Medicine and Extending Healthspan
Dr. Roman brought a regenerative medicine perspective to the discussion, emphasizing that the goal isn’t simply living longer — it’s extending healthspan. Staying active, resilient, and capable later in life matters more than just adding years.
He explained how advances in regenerative medicine have created new options for people who previously faced limited choices. Where the conversation once jumped quickly to surgery or long-term medication use, there are now non-surgical approaches that may help reduce pain and support tissue health when applied appropriately.
We also discussed epidural injections and how regenerative alternatives like platelet-rich plasma differ from traditional steroid approaches. Steroids are often used to reduce inflammation, but they can be catabolic and come with risks. Regenerative approaches aim to create a more favorable environment for healing and nerve health rather than simply suppressing symptoms.
As with everything else discussed, Dr. Roman emphasized that these tools are not shortcuts. They are options that require careful patient selection, sound clinical reasoning, and realistic expectations.
What Changed, What Didn’t, and Why That Matters
Toward the end of the panel, we asked a simple but important question: what have you changed your mind on, and what have you doubled down on?
Dr. McGill noted that the core principles guiding spine assessment and load management remain the same, but he continues refining how speed, elasticity, and slack factor into injury risk and performance. Staying open to learning, without chasing unproven ideas, is part of that process.
Dr. Roman shared that he has expanded his use of certain intradiscal regenerative procedures as outcomes and safety profiles have improved, which has influenced how he approaches specific cases.
Dr. Camisa spoke about how experience forced him to rethink some of what he was taught early on. As he worked with more complex cases, he placed greater value on soft tissue and fascial work, as well as tools like frequency-specific microcurrent, integrating them with movement and loading strategies rather than using them in isolation.
For me, this reinforced an important lesson: fundamentals still matter most, but sometimes people need the right support to access those fundamentals. The assessment always comes first. The strategy always matters. Tools only work when they serve the system, not replace it.
The Big Takeaway
There is no single exercise, procedure, or modality that fixes everyone. The best outcomes come from a system built on clear principles:
- Identify the true pain mechanism
- Remove the driver and calm the system
- Restore movement and stability where they belong
- Build capacity with intelligent load management
- Stay open to learning, but learn from proven sources
That is what this panel was really about — and it’s the mindset that leads to durable results, whether you’re an athlete, a clinician, or someone just trying to move better without pain.
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