Podcast Summary: Your Back Pain Isn’t What You Think, Dr. Amir Reveals the REAL Cause

Kreatures Of Habit Podcast – Michael Chernow with Dr. Armin Tehrany
December 10, 2025

Episode Overview

In this engaging conversation, Michael Chernow sits down with Dr. Armin Tehrany, a board-certified neurosurgeon, chief of surgery, and entrepreneur, to challenge and reframe common assumptions about back pain. Their discussion blends medical insights, personal stories, and practical advice, emphasizing a holistic, science-driven yet open-minded approach to spinal health. Key themes include the psychological and physiological roots of back pain, recovery routines, the promise of artificial disc replacement, and the profound roles of habits and mindset in overall health.

Key Discussion Points & Insights

1. Dr. Tehrany’s Holistic Approach to Spine Health

• Three-Pronged Model: Dr. Tehrany stresses the importance of viewing spinal health through the lens of anatomy, physiology, and psychology—“We've ignored this three pronged approach to spinal care.” (00:08)
• Mental health, exercise, sleep, and nutrition are as critical as medical intervention in treating and preventing back pain.
• The “whole person” approach extends to alternative therapies and the inclusion of supplements and recovery rituals.

2. The Anatomy and Healing of Disc Injuries

• Discs are “basically a protein basket, which inside has a soft jelly called nucleus pulposus. Literally feels like soft like shrimp.” (09:53)
• Conservative versus surgical treatment is dictated more by patient symptoms and quality of life than MRI results alone.
• Chernow’s personal story reflects variability in recovery—even with serious MRI findings, non-surgical approaches can work if the patient’s function improves.

3. Physical vs. Emotional Trauma and Their Impact on Pain

• Discogenic Pain’s Emotional Toll:
  • “Discogenic pain does something to the brain that's completely different... it brings up this hopelessness in many patients.” (14:32)
  • Unaddressed pain can fuel the opioid epidemic; holistic care is vital.
• The Mind-Body Connection:
  • Psychological stress or life events can trigger or worsen symptoms (“recurrent sciatica after a divorce or after a real estate deal gone bad”). (16:25)

4. The Role of Habits and Rituals in Health

• Chernow emphasizes the transformative power of morning rituals such as early riser hunting and digital disconnection for mental clarity and CNS regulation.
• Dr. Tehrany endorses intentional routines for brain health:
  • “Your ritual is absolutely beautiful... the attention economy is robbing us of our lives.” (20:14)
  • He describes his own dual-mode mornings: “Clinic mode and surgery mode,” and shares his practice of inverted meditation.

5. Modern Life, Devices, and the ‘Attention Economy’

• Both speakers voice concern over the detrimental effects of constant digital distraction on brain health, energy management, and sleep.
• Early mornings and late nights are “when the brain needs its own purging of information and calm transitions.” (20:14)
• Movement and nature, like qigong or Tai Chi, are highlighted as cultural antidotes.

6. Central Nervous System (CNS) and Cognitive Fitness

• The CNS’s role in overall health is underappreciated; Dr. Tehrany calls it “the final frontier” for research and personal optimization.
• Four “horsemen” for future neurological health challenges: trauma (including microtrauma of daily living), dementia, chronic pain, and depression.
  • “We're going to have an epidemic of crazy disorders that all have to do with some form of neurologic disorder.” (24:26)

7. Recovery Routines & Practical Recommendations

• Every day should be treated as a “training day or a recovery day.” For aging populations, recovery takes priority.
• Concrete strategies: gentle walking, breathwork, foundation exercises (planks, squats, gentle yoga), ice/heat therapy, massage, cold plunge.
  • “Definitely ice for acute injury, heat for chronic injury. But I think ice at least once a week to just bring the inflammatory markers down.” (50:46)
• Importance of sleep hygiene—especially fasting before sleep to optimize “glymphatic” brain cleansing.

8. Artificial Disc Replacement: Myths, Evidence, and Candidacy

• Cervical disc replacement is now a “total success story”; lumbar disc replacement has advanced after earlier setbacks.
  • “The lumbar devices that are approved now have undergone rigorous testing... and it works.” (57:05)
• Recovery can be rapid: “You should be at 100 in three months... it's one of my favorite things to do.” (60:10)
• Patient selection is crucial; sometimes hybrid solutions (fusion plus disc) are best.

9. Alternative and Experimental Therapies

• Tehrany is open to integrating alternative medicine—energy work, acupuncture, psychedelics—into patient care when evidence supports it.
  • “Everyone's nervous system has a corridor through which we can biohack... There are many other alternative paths.” (33:33)
• He’s founded the Neurovella Brain Spa, offering both research-based and novel adjuncts like ketamine-assisted therapy.

10. Mindset, Addiction, and Habit Change

• Michael shares his recovery journey: “Habits will make you or break you. My habits nearly killed me.” (70:40)
• The key to sustainable change is stacking small wins and adopting positive identity-based behaviors, not merely seeking external “fixes.”

Notable Quotes and Moments

• On the limitations of MRI:
  “The MRI doesn't necessarily tell the story.” – Michael Chernow (08:55)
• On psychological pain and trauma:
  “Discogenic pain does something to the brain... it brings up this hopelessness.” – Dr. Tehrany (14:32)
• On rituals and technology:
  “Right now the attention economy is robbing us... ritualistically, that's when the brain needs its own purging.” – Dr. Tehrany (20:14)
• On alternative therapies:
  “Our cognition really has a very powerful impact on manifestation of pain–manifestation of relief in pain.” – Michael Chernow (32:53)
• On disc replacement progress:
  “Cervical [disc]... totally success story. It works so well. It's my absolute favorite thing to do for my patients.” – Dr. Tehrany (57:05)
• On recovery priorities:
  “As we get older, recovery becomes so much more important than training.” – Dr. Tehrany (46:45)
• On piriformis syndrome:
  “[It’s] controversial... there is such a thing as performance-related pain... but not necessarily [from] pinching.” – Dr. Tehrany (62:47)
• On choices and agency:
  “Every single human has the ability to make a choice... the more wins I stack in the morning, the better chance I have...” – Michael Chernow (72:58)

Timestamps for Major Segments

| Time | Segment/Topic | |---------|------------------| | 00:08 | Psychological component of discogenic pain—holistic approach | | 04:01 | Advances in artificial disc replacement—and hybrid procedures | | 09:53 | Disc anatomy explained; grading disc degeneration | | 14:32 | Emotional and psychological burden of discogenic pain | | 20:14 | Rituals vs. technology; the “attention economy” | | 21:37 | Dr. Tehrany’s morning routine: inverted meditation | | 24:26 | The future epidemic of neurological disorders (“four horsemen”) | | 40:23 | Psychedelics and the rewiring of neural pathways; ketamine therapy | | 46:45 | Recovery routines for athletes and non-athletes alike | | 50:46 | Ice, heat, and movement for acute vs. chronic injuries | | 57:05 | Fact vs. myth: artificial disc replacement—outcomes and patient selection | | 62:47 | Piriformis syndrome and atypical sciatica—diagnosis and management | | 70:40 | Michael’s journey: from addiction to building positive habits |

Practical Takeaways

For Those with Back Pain:

• Focus on holistic care—address mind, body, and environment, not just injury.
• Conservative management is often warranted; MRIs don’t tell the full story.
• Exercise smarter, not necessarily heavier.
• Cultivate morning and recovery rituals that combine movement, nature, and deliberate disconnection.
• Don’t underestimate the role of mental health in persistent pain.

For the Health-Inspired:

• Stack small positive habits, especially early in the day, for cascading effects.
• Consider nontraditional therapies, but seek those with oversight, evidence, and credible practitioners.

For Medical Professionals:

• Expand the dialogue about spinal health to include trauma, lifestyle, and emotional context.
• Embrace patient individuality in both treatment planning and recovery pacing.
• Keep abreast of recent advances in surgical/artificial disc technologies and holistic adjuncts.

End Note:
This episode bridges hard science with open-minded health innovation, giving both clinical knowledge and daily life wisdom. Dr. Tehrany and Michael Chernow offer a compelling blueprint for navigating back pain, aging, recovery, and peak health in our modern, distracted era—reminding us that healing is as much about mindset and ritual as it is about medicine.