Breaking Down Back Pain | Dr. Betsy Grunch

Back pain is one of the most common reasons people seek medical care, yet it remains one of the most misunderstood.

That became increasingly clear during my conversation with Dr. Betsy Grunch, a board-certified neurosurgeon who specializes in complex spine and brain surgery. On social media, millions know her as "Lady Spine Doc." In the operating room, she's known for tackling some of the most challenging spine cases. But what struck me most wasn't the surgeries she performs. It was how much time she spends explaining why a patient might not need surgery at all.

As physicians, we're often asked to fix things. A torn ligament. A fractured bone. A herniated disc.

But Dr. Grunch kept returning to a question that medicine doesn't always spend enough time discussing:

Just because we can operate, should we?

The Problem With "Fixing" Everything

We live in a culture of immediate solutions.

Something hurts, we want it repaired. Something breaks, we want it fixed. That mindset works well for many aspects of modern life, but the human body doesn't always follow the same rules.

Dr. Grunch sees this every day in patients who arrive terrified after being told they have a disc herniation.

The pain can be overwhelming. One moment life feels normal. The next, you're unable to walk comfortably, sleep, work, or think about anything besides the pain shooting down your leg or arm.

The assumption is often that surgery is inevitable. Yet according to Dr. Grunch, the majority of disc herniations improve without surgery.

That reality creates a difficult conversation. Sometimes it takes longer to explain why surgery isn't the best first step than it does to schedule an operation. And that's where medicine gets complicated.

Because healing and fixing are not always the same thing.

What a Disc Herniation Actually Means

One of the things Dr. Grunch does exceptionally well is translate complicated spine pathology into language patients can understand.

The discs between the vertebrae act as shock absorbers for the spine. When one of those discs tears, some of its inner material can push outward and irritate nearby nerves.

The symptoms can be dramatic.

Pain. Weakness. Numbness. Tingling.

But not every herniation requires surgery.

In many cases, inflammation is driving the symptoms as much as the physical compression itself. Time, anti-inflammatory treatment, physical therapy, injections, and carefully guided rehabilitation often allow the body to calm the inflammatory response and heal.

That doesn't mean the process is easy. Pain has a way of shrinking your world. It creates urgency. It creates fear. And fear is often what patients are really bringing into the exam room.

The Long-Term Consequences We Don't Talk About Enough

One of the most fascinating parts of our conversation centered on something patients rarely hear about during those early discussions: what happens after surgery.

Spine surgery can be life-changing when it's truly needed. Dr. Grunch performs these procedures every day. But she also spends significant time helping patients understand that surgery alters anatomy permanently.

A microdiscectomy removes part of a damaged disc. A fusion eliminates motion at a spinal segment. Even when the operation is technically successful, those changes can influence the mechanics of the spine for years to come. The spine functions as a system.

When one segment loses motion, neighboring segments often absorb additional stress. Over time, those areas may begin to degenerate more quickly, a phenomenon known as adjacent segment disease.

It doesn't happen to everyone. But it is part of the conversation.

And it's one of the reasons Dr. Grunch is passionate about preserving motion whenever possible.

The Rise of Motion Preservation

For decades, fusion was often considered the definitive surgical solution for many spine problems.

Today, newer technologies are creating additional options.

Disc replacement has emerged as one of the most exciting developments in spine surgery, particularly for carefully selected patients. Instead of eliminating motion entirely, artificial disc technology aims to preserve it.

The concept is straightforward: remove the damaged disc and replace it with an implant that maintains movement between the vertebrae.

Not every patient is a candidate. Not every spine problem originates from the disc itself. But for the right individual, motion preservation may help reduce stress on neighboring segments and support long-term spinal function.

As with most things in medicine, success depends less on the technology itself and more on selecting the right patient for the right treatment.

How Much Spine Degeneration Is Preventable?

In a world increasingly focused on longevity, this may be one of the most important questions patients ask. Dr. Grunch's answer was surprisingly practical.

While some degree of degeneration is inevitable with aging, many of the factors that accelerate spine problems are modifiable.

The first is nicotine.

This was one of the strongest points she made throughout our conversation.

Most people understand the risks nicotine poses to the heart and lungs. Far fewer understand its impact on spinal health.

Nicotine restricts blood flow, limiting the body's ability to deliver nutrients and repair tissue. Over time, that impaired healing capacity contributes to accelerated degeneration and poorer recovery from injury.

The second factor is strength.

Not endless cardio.

Not chasing a smaller number on the scale.

Strength.

A healthy spine depends on a healthy support system.

The Muscles That Protect Your Spine

When people hear the word "core," they often think about abdominal muscles, but Dr. Grunch defines the core much more broadly. It includes the abdominal wall, obliques, spinal stabilizers, diaphragm, and pelvic floor.Together, these structures create the foundation that supports the spine throughout daily life.

Weakness in any part of that system can increase stress on the spine itself. This becomes particularly important for women.

Pregnancy, postpartum recovery, pelvic floor dysfunction, and hormonal changes all influence spinal stability and movement patterns. Yet these conversations are often missing from traditional discussions about back pain.

As Dr. Grunch pointed out, many women spend years caring for everyone around them while neglecting their own recovery.

The consequences eventually show up in the form of chronic pain, instability, and diminished quality of life.

The Weight Conversation We Need to Have

Perhaps one of the most refreshing parts of our discussion was Dr. Grunch's willingness to talk openly about obesity and weight loss.

Not from a place of judgment, from a place of patient care.

She shared her own experience with postpartum weight gain, disc herniation, chronic pain, and ultimately losing more than 80 pounds through lifestyle changes and medical treatment.

Her perspective was simple. Obesity is one of the most significant contributors to spine pain. Ignoring it doesn't help patients. Addressing it does.

For some individuals, that conversation includes strength training and nutrition. For others, it may include medications such as GLP-1 therapies under appropriate medical supervision.

The goal isn't achieving a particular appearance.

The goal is reducing pain, improving function, and creating conditions where the spine can succeed.

And sometimes, helping a patient lose weight may eliminate the need for surgery altogether.

Pain Is Never Just Physical

One theme surfaced repeatedly throughout our conversation.

Pain doesn't exist in isolation. Every patient arrives carrying far more than imaging findings and physical symptoms. They bring stress, relationships, work pressures, anxiety, fear, past medical experiences, and mental health challenges.

All of it influences how pain is experienced and how recovery unfolds.

As physicians, we weren't always trained to think this way. Many of us entered procedural specialties because we believed the work would be straightforward. Identify the problem. Fix the problem.

But real patients are more complicated than that.

And the best outcomes often depend as much on listening as they do on technical expertise.

What Patients Need to Know

One of Dr. Grunch's biggest frustrations is the anxiety created by imaging findings.

An MRI report can sound terrifying.

Disc degeneration.

Bulging discs.

Arthritis.

Stenosis.

The reality is that many of these findings are incredibly common, even in people without pain.

Images must be interpreted within the context of symptoms, physical examination, and the patient's overall story.

A scan alone rarely determines treatment.

And it certainly doesn't automatically mean surgery.

The Bigger Picture of Resilience

What stayed with me most from this conversation is that resilience isn't about avoiding injury. It's about understanding how to respond when injury happens.

It's recognizing that surgery is sometimes the right answer, but not always the first answer. It's building strength before pain forces you to. It's addressing the habits and risk factors that contribute to degeneration. And it's understanding that recovery involves more than anatomy.

The healthiest spines aren't necessarily the ones with perfect MRI scans.

They're the ones supported by movement, strength, good habits, thoughtful care, and patients who understand their options.

That kind of resilience doesn't happen overnight.

But it's one of the most powerful investments we can make in our long-term health.

Want to Learn More?

Follow Dr. Betsy Grunch, also known as @ladyspinedoc, on social media for educational content on spine health, surgery, recovery, and patient advocacy.

Watch this episode on YouTube right now!

For more conversations like this, subscribe to The Resilience Factor wherever you get your podcasts, and find me @dr.pamelamehta on social media.