Description Low back pain and sciatica are some of the most common injuries in both athletes and everyday high performers. Yet most back pain is misunderstood, over-medicalized, and managed with fear. In Episode 60 of The Vitality Collective Podcast with Dr. Jeremy Bettle, Dr. Jeremy sits down with Dr. Brian Wolfe to break down what is actually happening when your back "goes out." They discuss: • What disc injuries are and how they really behave • Why MRI findings often do not match your symptoms • The difference between muscular soreness and nerve pain • How fear of movement turns acute back pain into chronic pain • Why sitting and poor load management drive flare-ups • When rest, injections, or surgery may have a role • How progressive strength training builds a resilient spine Back pain is complex. But it is also trainable. If you have ever been told you "have a bad back," this conversation will challenge that narrative and give you a smarter path forward. Listen now to learn how to reduce low back pain, manage sciatica, and build long-term spine resilience. Guest Bio Dr. Brian Wolfe, DPT, is a co-founder and owner of Evolution Physical Therapy and a recognized leader in sports medicine, focusing on injury prevention, rehabilitation, and performance enhancement. He holds a Doctorate in Physical Therapy from Ithaca College and is a board-certified Orthopedic Clinical Specialist. With a robust background in professional sports, Dr. Wolfe served as a physical therapist for the Premier Lacrosse League from 2019 to 2021 and currently works with New York City Football Club. Overseeing Evolution Physical Therapy's East Coast operations, he leads a distinguished practice with locations in Greenwich, Darien, Stamford, Norwalk, CT, and Farmingdale, Long Island. An engaging speaker, Dr. Wolfe shares his deep expertise in pain management, mobility, and wellness, empowering audiences to pursue lifelong health and vitality. Links Evolution Physical Therapy: evolutionphysicaltherapy.com Physio Growth (mentorship): physio-growth.com Brian on Instagram: @BTWolf02 Evolution PT on Instagram: @evolutionPTfit (main), @evolutionPTfit_CT Brian Wolfe, PT, DPT, OCS on LinkedIn Three Actionable Takeaways Build a simple, condensed yoga or mobility routine into your day. You don't need a full 60-minute class. Focus on warrior poses, triangle poses, cobras, prayer stretches, and basic vinyasa flows to move your spine through multiple planes of motion. Even five minutes of this can make a meaningful difference in how your back feels. Work with a qualified practitioner in physical medicine who can guide your movement. Whether that is a physical therapist, a chiropractor, or a strength coach, having someone who understands your mechanics and can program specifically for you is one of the best investments you can make in your spinal health. When you have a back pain episode, choose motion over rest. Your spine responds better to movement than it does to lying still, medication, or jumping straight to surgery. Build a plan that includes what you do daily for prevention, what you do when a flare-up hits, and who you see when you need professional help. Key Insights The spine is a complex, multi-joint structure that moves in three planes (flexion/extension, rotation, side bending) across cervical, thoracic, lumbar, and sacral regions, making it far harder to assess than a single joint like the shoulder. Discs are highly innervated structures, and discogenic problems can manifest as back pain, hamstring soreness, calf tightness, hip flexor issues, or shooting pain down the leg, all from the same underlying cause. MRI findings often do not correlate with pain levels. Many people have disc bulges with no symptoms, and others have severe pain with clean imaging, so imaging alone should not dictate treatment. The legs are the true shock absorbers of the body, not the discs. As we lose muscle strength, our joints absorb more force, which increases injury risk. Sitting is one of the highest-risk activities for the spine because of the sustained compressive load it places on the discs. Prolonged sitting followed by heavy loading is a recipe for injury. The pain cycle works like a stereo dial. After an injury, the nervous system can stay turned up to a seven or eight, meaning you feel pain faster, more intensely, and for longer than you should. Breaking that cycle requires intentional movement, not avoidance. Unilateral symptoms (one-sided soreness in the back, hamstring, or glute) are often a warning sign of a discogenic issue, while symmetrical post-exercise soreness is typically muscular. Rehab should follow a clear continuum: address pain first, then fix the underlying problem, then build injury prevention through strength, and finally progress to performance training. The gap between physical therapy and performance training is where many people get reinjured. Communication between practitioners (physicians, PTs, trainers) is essential and often lacking. A subsequent back injury should be treated as a new injury, not a re-injury. Framing it as new helps psychologically break the chronic pain cycle and reinforces that the original tissue has healed.
