The Lifestyle Solution to Chronic Back Pain with Dr Saloni Sharma

Is back pain holding you back from living your best life? 

In this enlightening episode, we sit down with Dr. Saloni Sharma, a distinguished expert in physical medicine and rehabilitation, who shares groundbreaking insights from her book 'The Pain Solution.' 

Dr. Sharma reveals how simple lifestyle modifications can dramatically reduce back pain without heavy reliance on medications. 

You'll discover how your diet choices directly impact inflammation and pain levels, learn practical 'micro-boost' techniques you can implement today, and understand the crucial connection between sleep, stress, and back health. 

Whether you're dealing with chronic pain or want to prevent future issues, this episode offers a fresh, evidence-based approach to back pain management that goes far beyond traditional treatments. 

Dr. Sharma's integrative method combines cutting-edge medical knowledge with practical, everyday solutions that actually work. 

Don't miss this game-changing conversation that could transform your approach to back pain forever.

Connect with Dr Sharma:

Website: https://www.salonisharmamd.com/ 

IG: here

"The Pain Solution" Book on Amazon: here

Podcast Index and Sign up for Weekly Emails: https://www.drorlena.com/blog/index-of-podcasts-and-blog-posts

Looking for support? Book a free call with Dr Orlena: https://bookme.name/drorlena/positively-healthy-chat-with-dr-orlena-fb

Transcript

Dr Orlena (00:01.172)
Hello, hello, hello. Welcome to Fit and Fabulous with me, Dr. Orlena I'm super excited today because we have an amazing guest who's gonna talk about a topic that I'm really interested in, Dr. Saloni Sharma. Welcome, welcome.

Saloni Sharma MD (00:12.514)
Thank you, Dr. Orlena, I'm so glad to be here.

Dr Orlena (00:15.166)
It's an absolute pleasure. Thank you so much for coming. And first of all, do you want to just start by telling people a little bit about who you are and what you do?

Saloni Sharma MD (00:22.926)
Sure, I'm based in the Philadelphia area. I have training as a physician in physical medicine and rehabilitation, and that's especially the helps people function better in their day-to-day life, whether they have back pain or a stroke or spinal cord injury. And then I did a fellowship in pain management. I did another fellowship in integrative medicine. I have training in mindfulness, physician well-being, burnout, a whole bunch of sort of holistic things to really look and help the whole person.

Dr Orlena (00:46.954)
Perfect, I love it, I love it. And I love that you've got mindfulness in there. I was thinking, my goodness, you have so many qualifications and then you pop in mindfulness and I'm like, that's really wonderful because it really is holistic. It's about the whole body and the whole person because obviously we're all connected.

But today we're going to talk about back pain and I'm super excited to find out about back pain, partly because it is such a big topic and it affects loads of people. And personally, I can give you my own history of being an active and fit person. I just turned 50 a few weeks ago. And, but since I think about 40, I've had lumbar back pain, which niggles and niggles. doesn't stop me doing stuff, but it stops me sleeping. And I've been to the doctor who told me I had a scoliosis and I'm like, surely I had the scoliosis.

this always, but does that really account for my back pain? And I think it's really difficult to get answers. And not only is it difficult to get answers, but it's also difficult to know what is best for us to do. So I'm excited to dive in and hear your words of wisdom. So perhaps start at the beginning and tell us why people have back pain.

Saloni Sharma MD (01:55.118)
Sure, so like you mentioned, about 80 % of people will have back pain at some point in their life. So it really is almost a universal problem. Hopefully for most people it's not ongoing, but sometimes it is. There's many causes of back pain. So in the spine there's bones, there's discs, there's nerves, there's muscles, there's ligaments, disc herniation, degenerative disc disease, spinal stenosis. These are common causes of back pain, as well as muscle strains, ligament injuries. These also cause it. And like you said, structural issues like scoliosis. And some scoliosis,

born with and some of you can get as we age. So there's all different kinds of things. They all have so many variables. Like you mentioned, different ages, different things pop up. There's different levels of inflammation and so things that maybe were sort of low level might pop up as we age a little bit more.

Dr Orlena (02:39.424)
That's really interesting actually. Having been a pediatric doctor in a formal life, I've always just thought that scoliosis was there. I didn't really think about acquiring scoliosis. So I guess really, you you've covered the causes. People want to know, well, one, how can I prevent myself from getting back pain? And two, if I have back pain, what can I do about it? So perhaps we should talk about preventative things first, because I suspect that's gonna be a shorter conversation than...

Saloni Sharma MD (03:09.484)
Yeah, wonderful. So, and like you're alluding to, there's a lot of overlap. So the preventative things are keeping your core strong.

So, and that means 360, so your abs, your obliques, your paraspinals, your back muscles all around, that's one key thing. Maintaining a healthy weight for your body type is important. And all the lifestyle medicine factors really come into play in prevention and treatment. So thinking about your diet, thinking about your stress. I actually designed a program called the Relief 5R program. It has a lot of the pillars of lifestyle medicine sort of tailored to pain. The first one is the most important one in a lot of ways, and that's refuel. And that's talking about nutrition.

There's also revitalize, which is more about exercise, recharge, which is out of sleep, refresh, which is stress reduction, mindset, and then relate, which is really relationships with others and with yourself.

Dr Orlena (03:59.764)
What I totally love about, well, partly my podcast, but also about how lifestyle medicine works. I interviewed so many different experts from cardiologists to cancer specialists, and they all basically say the same thing. And it all comes down to this just neat, you know.

eat well, sleep, all of the sort of basics really that I think a lot of us have forgotten how to do. Just taking you back to those exercises and you talked about core and you talked about side and you talked about back. Could you go through some of the exercises because I know not everybody's gonna understand exactly what that means and what that looks like in terms of how many exercises do I have to do? Do I have to do them every single day? Do I just need to do them once a week? A little bit more detail please.

Saloni Sharma MD (04:42.872)
Sure, I think.

Number one, it's meeting people where they are and doing what's comfortable for you. You should always clear any kind of exercise program with your physician. But a lot of it can be easy stuff. So instead of doing sort of a traditional sit-up where you hinge and come up with your knees bent, talk about reverse sit-up so you're laying flat and then you bring your legs upward. You'll still feel that in your core. You can do planks, regular planks, side planks, modified planks. Walking is the best exercise, right? Just staying mobile. And a lot of it comes down to stretching every day. There's been a lot of studies recently about squats and even doing 12 squats

an hour can control blood sugar and inflammation more than doing a one hour of a heavy workout. So it's really sort of doing little steps throughout the day. I call them micro boosts in my book. They're little steps that add up to big relief throughout the day and just making it easy and doable so it works for your life and you'll get it done.

Dr Orlena (05:31.744)
So did you say 12 squats per hour? So when your watch does this annoying little bleep bleep bleep you've been sitting for too long, if you stand up and do 12 squats then, that would be a really useful thing to do.

Saloni Sharma MD (05:42.178)
It would be a great thing to do, especially if you are at a more sedentary job, more of a desk job, that's a great way to do it. You activate your large muscles in your quads, and you can activate your core too if you sort of tighten and engage it, and that can really help with blood sugar control and inflammation control.

Dr Orlena (05:46.154)
Perfect.

Dr Orlena (05:57.216)
Perfect, perfect. Okay, so moving on to I've got back pain. What can I do? How can I fix this? How can I find out what's wrong with me? I think that's a big thing, you know, that...

Conventional medicine, and I'm in Spain, so not in the US, but I think it's the same in a lot of health centers. I know that in the UK, where I'm from, back pain is one of those things where it's really difficult. People just don't really have the resources to be able to diagnose your back pain. So what are the kind of things that we're looking out for and how can we help ourselves if we do have back pain?

Saloni Sharma MD (06:32.173)
Yeah, that's a great question. think there's kind of two parts to it. So the first part is you really want to be mindful of what we call red flag symptoms in the medical world, right? And that's why you want to meet with your physician. If it lasts more than a few weeks, if you have numbness or tingling, loss of bowel or bladder control, weakness where you're dragging your foot or leg, these are things you want to get evaluated right away. You know, if it lingers more than six weeks, I would say without those red flags, I would still see a physician and be checked out. Beyond that, there's really five ways to cheat adrenal, sort of the conventional system, and that's physical therapy, healthy lifestyle,

medications and there's more advanced things like injections and surgery. There's alternative things, acupuncture, medical marijuana, chiropractors, all these other things. So that's sort of the conventional way and that definitely has a role. Unfortunately, you know, I'm in the United States and we have an opioid crisis here and I think it's, you know, not just unique to us, but especially strong here, unfortunately. And that's because we have a pain crisis. And that's really why I wrote a book about a way to empower yourself with tools to prevent and manage back pain.

Dr Orlena (07:32.01)
Perfect, perfect. Now I'd love to hear more about your book, but just as a side note before you move on to that, you mentioned chiropractors. Now I think that chiropractors in the UK are perhaps different from chiropractors in the US, but for me, a chiropractor is somebody who comes along and does this thing on your back where they go chunk, chunk, chunk, chunk, and to be honest, it fills me with the heebie-jeebies because I'm a bit like, wait, that's my spine. I don't want you to do anything like that with my spine. So I don't know if chiropractors are different.

but I don't know that sort of like cracking thing. Do you know what I'm talking about? Is that a good thing or is that a okay thing or am I just scared for nothing?

Saloni Sharma MD (08:10.54)
No, I think you have a healthy dose of skepticism. You know, I advise my patients not to get any what I call fast cracks, and that's where you go, you know, they're real fast. So I think chiropractors are great for soft tissue work, for a tight muscle massage, heat, infrared treatments, things like that. I think they're great for that. I would advise no fast cracks or high velocity manipulations, especially in the neck.

Dr Orlena (08:18.847)
Yeah.

Dr Orlena (08:33.216)
Perfect, perfect. Okay, so let's move on and hear all about your book and what it dives into and tell us some of your secrets from your book and then we'll all go and buy it and read it.

Saloni Sharma MD (08:42.755)
Yeah.

That's so kind. mean, honestly, I wrote it because I'm not as familiar in Spain and UK of the health system, but I can tell you in the United States, know, doctors get in less and less time with patients. Patients are more and more unsatisfied and the care overall has gone down, especially for chronic ongoing conditions like back pain. You know, the whole health care system seems to be designed around acute care, like emergencies, you know, like a broken leg or a heart attack. And thankfully, you know, we handle that well, not perfect, but well. But it's the chronic things, the day to day that bogs

you down, they interfere with your life that really don't get addressed properly. And so I wrote the book because I wanted to tell all these things to my patients and I don't have time for it. And it's everything we want to talk about in lifestyle medicine. know, the book's called The Pain Solution and you know, I have it here, of course, and it's called Five Steps to Relieve and Prevent Back and Also Enjoy Pain Without Medications, right? And so that's the key. There's a role for medications, definitely, especially in, you know, life threatening conditions and even in pain, but it shouldn't really be the mainstay of treatment, right?

And so that's where the book comes in. That's where I talk about what I call micro-boost that I mentioned. They're little steps that add up to big relief. And that's the whole concept is making it practical, making it easy, making it doable. No one has time for more stuff. No one has time for more work. So it's making things that are simple like the squats and adding them to your day. And it's not just exercise. It's improving your sleep, your diet, your stress management. They all impact inflammation, which contributes to more pain.

Dr Orlena (10:09.418)
Yeah, absolutely. And I think I 100 % agree with you in that it needs to fit into people's lives. And this is one of the big things that I'm always trying to teach people is it's really about consolidating those habits, but they have to be the habits that work for you. So you have to enjoy it and think, okay, sometimes there are habits that are more difficult to build up than others, but really it's about...

it being fun and easy as opposed to, my goodness, I have to put in all of this effort and what's the benefit I'm getting. Now, obviously if it's back pain, it might be worth the effort, but often people don't see what the benefit is because it might be a long-term benefit, like preventing back pain, for example. And so what are the, if you had to say to somebody, look, just do three things, these are the three big things that I would recommend you do.

Saloni Sharma MD (10:49.23)
Exactly.

Dr Orlena (10:58.112)
to prevent yourself from back pain, like little habits that you can build in, what would those be?

Saloni Sharma MD (11:03.66)
I would start with nutrition, you know, in sort of the refuel chapter, is

Dr Orlena (11:06.218)
Ready?

Saloni Sharma MD (11:07.95)
it's really staying away from a lot of processed foods, which I know, I'm sure your listeners have heard this before and your viewers have seen it, but the concept is processed food impacts inflammation and pain in so many ways. We're talking about the gut microbiome, we're talking about the gut brain access, we're talking about the way you think. I mean, in the US, one of the red dyes has just been banned. I think the UK and Spain are a little more advanced and ahead of their curve than we are. And there's two other red dyes which are on the docket to be banned in certain states. There's just so many studies.

showing how these processed foods and artificial dyes impact pain and disease across the board, including back pain, but all the way to diabetes and heart disease as well. So that would be a key thing, is the processed foods. And then I actually divide the microboost in the book into level one, level two, sort of to what you were alluding to, to make some that are little more easier and some that are more difficult and more advanced, I should say. And so, you know, one might be just have half your plate with veggies and that's all. That's just like a baby step, right? So

You might still have processed snacks and foods, but at least at dinner every day, half your plate is veggies. And so that's not an onerous task. Yeah, it's not super hard. And you can sort of like check that little box off that you did something good for yourself today. And it's really not punitive. It's sort of about adding things, not taking things away. Changing soda to sparkling water, that's an easy one. So there's lots of little tips like that. I think the second one would be something to do with sleep hygiene. And I talk about the 30-30 rule in my book, and that's 30 minutes

Dr Orlena (12:12.274)
I love it.

Saloni Sharma MD (12:37.74)
before bed and three minutes after you get up, don't look at the screen, any screen. know, a lot of studies say two hours before, but here we go, talking about meeting people where they are. That's not really realistic. It's not realistic for me. I wish I was. I'm a working mom. I'm busy. I have a lot of different hats I wear right now, but 30 minutes can make a difference. And if you are using it, you know, there is some data showing that blue light glasses are helpful, so you might as well give that a try. But if you can really do the 30-30 rule, I think that's really helpful. And then the third one,

would be stress reduction. a simple micro boost is four, seven, eight breathing. Are you familiar with that?

Dr Orlena (13:14.186)
Yeah, but I'd love you to explain it, because not everybody is.

Saloni Sharma MD (13:17.176)
Sure, so it's actually based on yoga and Hindu philosophy, but Dr. Andrew Weill popularized it in the USA, but it is inhaling for a count of four, holding for a count of seven, and exhaling for a count of eight.

And what that does is that longer exhale, it activates the parasympathetic or the relaxation system. And that's really the goal. So don't get caught up on the numbers. Just try to get that long exhale. Another one that I have in the book is called So Calm, and just inhaling for so and exhaling calm, just calm and really just letting it go. Another one that's fun is Teenage Size, and it may be a little ageist, but it was in one of my mindfulness courses.

If you are a teenager, if you have a teenager, if you remember being a teenager, sometimes there can be drama as we're dealing with big emotions and it's really going like this, going, huh, and doing that three times before or after a stressful meeting, a stressful doctor's appointment, that can really just take your sort of over nervous system that's an overdrive down a notch.

Dr Orlena (14:19.806)
perfect, I love that. I have four children, two whom are 12 and the other two are teenagers, but I am going to be implementing that and they're going to find it so annoying.

Saloni Sharma MD (14:29.216)
It's awesome if you do this whole shoulder shrug and release your body with it. I find it to be really helpful. So just to recap, the three I said were decreasing processed foods, maybe doing a plate of half-edges at dinner, focusing on sleep, 30-30, no screens, 30 minutes before bedtime, 30 minutes in the morning, and then focusing on some kind of breathing stress exercise, whatever sort of fits with you, 4-7-8 breathing, teenage size, so calm, whatever works for you.

Dr Orlena (14:53.888)
Perfect. And another question I have, so thinking about inflammation, and we love talking about inflammation on this podcast, and I can hear you basically saying, you know, all of this processed food, what we're doing is we're reducing the inflammation, which is going to impact our, hopefully not getting back pain. But if you have back pain,

Presumably there is some inflammation there and I wonder how dangerous that inflammation is in the scheme of things. Like I don't know if you're eating junk food, is it a little bit of inflammation down here, your back pain, or does it equate with eating junk food? I don't know.

Saloni Sharma MD (15:28.75)
And I think that's really individual. you know, everyone's genetics and factors are different, but in general, yes. The poorer your diet, the higher level of inflammation, and the more pain. I think the easiest analogy is needs, right? And so there's been multiple studies on neosteroarthritis, which is similar to back arthritis in many ways. And they found that if you eat sort of a Mediterranean diet, not only do you have less pain subjectively, on MRI there's less degenerative changes, and they follow people out.

Dr Orlena (15:56.433)
That's really interesting.

Saloni Sharma MD (15:57.804)
Yeah, for several years. So it's not just subjective, it's objective.

Dr Orlena (16:00.628)
That's really interesting, but what I meant was I am that person who's eating a Mediterranean-style diet. Like, I don't eat any processed food. Like, I was adding up today, I was preparing to do some reels, and I'm like, I'm going to show everybody what I eat, and I added it up, and I'm like, my goodness, I have 18 grams of fiber for my breakfast. That's insane.

still have back pain and I wonder if that inflammation, that chronic inflammation that I have that is presumably being generated by whatever process, like I don't understand exactly why I have back pain and perhaps it is scoliosis but my question is if you've got that back pain and that's a chronic inflammation how detrimental to someone's health is that? Is that equivalent to eating badly the whole time or is it just one of those things that actually washes out it's a bit like I don't know cutting your finger and it doesn't really matter?

Saloni Sharma MD (16:47.308)
Yeah, think you're right. I think it could be more of a local issue, especially if it was structural issue like scoliosis, where there's sort of a physical change that's causing or contributing to that inflammation. And especially someone like you who does a great diet, such an incredible diet with 18 grams of fiber and breakfast. But I think also looking at your other factors, right, besides your diet and your stress and your sleep and your relationships and how that's all impacting your inflammation. But yeah, don't think it's something that you should worry about that if you have some back pain and stress that your whole body's on fire and inflamed.

Dr Orlena (17:16.572)
Thank you, that's very reassuring. Okay, and so those are level one examples. What are some of the examples from level two?

Saloni Sharma MD (17:25.138)
should I just like pull them out versus two hands ony? It's so funny because the first chapter, nutrition, nutrition and stress are my longest chapters, just because there's so much to talk about. So a level two microboost, it says, try eating no processed food for 14 days, record your energy activity and pain levels and see if you see improvement. One is replace animal protein with plant protein for four out of five days.

Dr Orlena (17:51.662)
do you want to talk a little bit about that? Yeah, I'd love to talk a little bit about plant and animal protein.

Saloni Sharma MD (17:54.722)
Yeah. And another one is talk about, you know, consider circadian fasting or circadian eating. I like to call it not fasting. Yeah.

Dr Orlena (18:02.89)
So tell us about animal protein. How does that impact your back pain?

Saloni Sharma MD (18:07.79)
So unfortunately, most of the animal protein, especially, I'll speak to the United States, is also very processed. It's not protein that, it's not animals that are fed well. So if you're gonna eat really high level animal protein, then you could do that once or twice a week, or maybe even two or three times a week, and that would be reasonable. But most of the food we're getting here is not that. It's grain. Yeah, so fish, again, so if you can get wild.

Dr Orlena (18:31.252)
And so what about fish then?

Saloni Sharma MD (18:36.002)
fish, that's great as opposed to farm raised. Again, that costs more and there's limited supply. But fish in general is better for you than sort of the red meats.

Dr Orlena (18:45.994)
Perfect. Yeah, well in Spain we have, I mean, I guess if you go to the supermarket, you're getting farmed salmon, but actually it's amazing that in most towns there are fishmongers and here we have like, it's a small town of 30,000 people. There's not heaps, although it is quite touristy. So I think that boosts artificially the numbers, but we have a fish market and there's five or six different stands there. And the vast majority of it is caught fish as opposed to farmed fish.

Saloni Sharma MD (19:13.732)
that's fantastic. And in the United States, I mean, there is wild fish, even in the freezer section. You just have to read it and it will be a little more expensive.

Dr Orlena (19:20.456)
Yeah, perfect. Okay, so animal meat, ideally not if we can help it. What was the second thing you mentioned? yes. Do you want to tell us a bit about that?

Saloni Sharma MD (19:30.894)
So talking about circadian eating.

Yeah, so first of all, it's not fasting, it's eating, right? We're talking about things you can do, not things you can't do. And you want to look at this eating window. There's a lot of data that shows that eating within certain times is better for your body. We know we have a circadian rhythm, and we know that we're sort of designed to eat more during daylight hours. And sort of following that pattern can be helpful for your body in so many ways. It's processing the food, too.

and it's also inflammation. So if you're processing a lot of food, it's to say you have a really heavy late night dinner and then you go back to sleep. It's not just the reflux or indigestion I'm referring to. At night, our body actually does repair work. And if it's too busy processing your food, it's not gonna do that repair work. And you can get these.

Dr Orlena (20:15.326)
Yeah, that's really interesting actually. And I've always advocated, you know, having a window of 12 to 14 hours after you eat. And previously I've thought, it doesn't really matter when you start and when you don't start. But actually I've been listening to Dr. Stacey Sims. I don't know if you know her, but she very much looks at female physiology and she talks about eating in the morning, which is naturally what I do anyhow. But actually, particularly for women, she says that if you can eat...

in the first two thirds of the day rather than the second two thirds, it's much better for you. And that's definitely where Spanish people fall down because they are eating at midnight and all these things. I'm like, it's time for bed, not time for eating. Like my body is saying it's sleepy time now, but all the Spanish people are up eating their supper late at night. So the Mediterranean people aren't all perfect.

Saloni Sharma MD (20:59.148)
Thank

Well, I guess we're all human, that's right.

Dr Orlena (21:06.108)
Exactly, exactly. well, I guess as well, it goes to show that actually having a good nutrition really carries you forwards because, you know, the studies still show that, you know, a lot of Mediterranean people live longer and that being lifestyle. So if they aren't doing some things great, then the nutrition is presumably giving them a lot of benefit.

Perfect. Anything else that you would like to add in terms of how to look after our back and how to avoid back pain?

Saloni Sharma MD (21:38.766)
I think there's a lot more that we can do and we're not empowered to do. And that's really where the book comes in. It starts out with a survey. And I'd ask your listeners and viewers to think about it. Have you ever gone to an orthopedist or a back specialist and have they ever said, how many times a week do we process food? Have they ever given you a script for a nutritionist? mean, unless you're morbidly obese, probably not.

It's looking at all these things we're missing in our healthcare system that's so focused on emergencies and not helping us live day to day. And I think having a survey and just taking it and realizing, wow, these things impact my pain, and then taking them after you make some modifications and seeing the change, that can be really helpful.

Dr Orlena (22:21.364)
Yeah, yeah, and I mean, just going back to healthy eating, and this is what I do, I help people to basically implement a system so that they can eat healthily, because they know they want to do it, they just can't manage to do it. But the vast majority of people, when they start changing the way they eat, they just feel like a new person, and they say, I've got so much more energy, I feel so much better in myself.

And I just feel like I can do all the things that I need to do. And that in itself is amazing. I love, there's a quote as well that I think, I can't remember who it's attributed to, but it goes something like most people don't realize how close they are to feeling good. They just don't realize that they're living in this slightly hungover state, I want to say. Obviously not actually from alcohol, but you know, that just, I just don't feel so good. And actually once they start looking after themselves, they're like, my goodness, I feel so much better.

perfect. Where can people find your book? Is it on Amazon?

Saloni Sharma MD (23:17.174)
It is on Amazon. It's on Target Online Amazon. It looks like this because I think there was a knockoff too. So the one Barcelona Sharma is the one you want. And yeah, I think like you said, maybe you're one or two micro boosts away from being a whole new person and feeling incredibly better.

Dr Orlena (23:32.682)
Perfect, perfect. And would you like to tell people where they can find you and your website?

Saloni Sharma MD (23:37.486)
Sure, my website's name, so it's SoloniSharmaMD, all one word. I'm also the medical director of the Integrative Health Center at Rothman Orthopedics and a spine physician there. So there's information there too.

Dr Orlena (23:50.144)
Perfect. Thank you so much. Thank you so much for coming on. Any last words of wisdom for us? I love it. You can do it. You can do it.

Saloni Sharma MD (23:54.318)
You can do it. I love it.