Training.
What I do,
and what I’ve learned.
Goal is 5–7 days a week. Reality ranges from zero to seven depending on what the OR schedule looks like. Consistency over time matters more than any individual session — and training smart matters more than training heavy. I learned the second part the hard way.
Train to keep going.
Not to prove something.
In residency I was in the best shape of my life. I ran, I lifted heavy, I pushed hard. I also ruptured my tricep tendon going too heavy without a spotter. That injury changed how I think about training — not because it scared me away from the gym, but because it made the risk-reward calculation visible in a way that is hard to ignore when you spend your days operating on people who made similar miscalculations.
I am a spine surgeon. I know exactly what a ruptured disc looks like. I know what degenerative changes look like at 45, 55, 65. I know what happens to the spine when you load it heavily and repeatedly with poor mechanics over decades. This shapes every exercise decision I make. I do not squat heavy anymore. I do not deadlift heavy anymore. I do not go to muscular failure without a spotter. I train to maintain strength, cardiovascular health, and longevity — not to find out what my maximum is on any given day.
What I do instead is train consistently, stay in a rep range that allows full control of the movement, listen to what my tendons and joints are telling me on any given day, and choose exercises that deliver the training stimulus without the spinal load. The goal is to be able to do this for the next 40 years.
“I ruptured my tricep in residency going too heavy without a spotter. That was the last time I needed to learn that lesson. Training should add years to your life — not subtract them.”
“Listen to your body. Listen to your age. Listen to your symptoms. Those three things will tell you more about what you should be doing in the gym on any given day than any program or protocol.”
How a session is built —
every time.
Every session follows the same structure. Cardio first, weights second, traction daily. The order is not arbitrary — cardiovascular warmup before loading joints reduces injury risk meaningfully, and traction is something I do regardless of whether the full session happens.
Walk or run to the gym, or start on the treadmill. Incline walk, flat run, or combination. In peak shape during residency, the goal was 400–600 calories on cardio alone before lifting. Now the target is 200–300 calories — a deliberate reduction that reflects both time constraints and the understanding that cardiovascular benefit accumulates without requiring maximal effort every session. Walking on an incline treadmill while answering messages counts. Getting there matters more than how hard you get there.
Four muscle group pairings rotated across sessions: chest/back, biceps/triceps, legs, shoulders/traps. Minimum 4–6 reps on the heaviest sets — never attempting a true 1RM without a spotter, which I rarely have. Most working sets are in the 8–12 rep range at a weight that allows full control of the movement throughout. No grinding reps. No ignoring joint pain to finish a set.
Hang from a pull-up bar. Ten seconds. Several sets. Done. This is the one thing I do every single day regardless of what else happens — whether I made it to the gym or not, whether I have time for a full session or five minutes. As a spine surgeon I understand the mechanism: gravity-assisted spinal decompression, intervertebral disc hydration, paraspinal muscle lengthening. It does not have to be heroic to be useful. Dead hang, slight lat engagement, relax the spine. Ten seconds. Repeat.
Planks, extension exercises, leg raises. This is the area I am most honest about neglecting. I know the evidence on core stability and lumbar health. I know the anatomy. I still do not do this consistently. It is on the list to fix. The exercises that make the most sense for spine health are low-load, stability-focused: planks and side planks, bird-dogs, extension work, and hanging leg raises.
Cardio first —
then and now.
The approach has changed between residency and now. The principle has not: cardiovascular work before lifting, every session.
Walking on an incline burns significantly more calories than walking flat — in some cases approaching the caloric cost of running at the same speed, without the impact load on the joints. It also allows you to do actual work: answer emails, return messages, review charts, take calls. You cannot safely do any of that while running. If I need to get cardio in and I have things to handle on my phone, incline walking is the answer. It is not a compromise — at meaningful incline and moderate speed, it is genuinely taxing. The calorie numbers bear this out.
Walking to and from the gym follows the same logic. It is not wasted time. It is steps accumulated, phone calls handled, and a warmup completed before arriving. Getting the steps in while taking care of things is not multitasking as a shortcut — it is recognizing that movement does not require dedicated uninterrupted time to count.
The 4-day split —
what I actually do in the gym.
Four muscle group pairings. Rotated across however many sessions happen in a given week. Bodyweight movements highlighted — they build real-world strength without joint-loading risk, and they travel well. Struck-through exercises are ones I have retired for specific reasons.
Minimum 4–6 reps on the heaviest set — and that set is rarely attempted. Most working sets are 8–12 reps at a weight that allows complete control of the movement from start to finish. No grinding reps. No half reps to move more weight. No ignoring what a joint is telling you to finish a set. I ruptured my tricep once. That is enough to internalize the rule permanently.
The practical corollary: I do not go to the gym to find out what my maximum is. I go to accumulate training volume, cardiovascular benefit, and stimulus for muscle maintenance. Those goals do not require near-maximal loading. They require showing up consistently and doing quality work at moderate intensity.
Warm-up sets before working sets on every compound movement. A few progressively heavier sets before reaching working weight — particularly important for chest, shoulders, and triceps given the injury history. Never going straight to working weight cold. The warm-up sets are also when I assess how the joint feels that day and decide whether to adjust the plan.
Rest periods vary entirely by context. A quick session — 30 minutes total — means minimal rest between sets, moving efficiently from one exercise to the next. A full session with sauna, cardio, and lifting can run 90 minutes with normal rest between heavier compound sets. On call days when the phone rings between sets, rest periods extend naturally. The session adapts to what the day allows. A 30-minute workout that actually happens beats a 90-minute plan that does not.
Daily traction —
the one non-negotiable.
This is the one thing I do regardless of whether I made it to the gym. Whether it was a clinic day, an OR day, a travel day, a day where nothing else happened. Dead hang from a pull-up bar for ten seconds. Several sets. Done.
As a spine surgeon I understand exactly what this does mechanically. Gravity-assisted axial distraction of the intervertebral disc spaces. The disc is a hydrophilic structure — it is designed to absorb water when unloaded and express it when loaded. During a day of standing, sitting, and operating, the discs are under compressive load. Hanging decompresses that load, allows the disc to rehydrate, and lengthens the paraspinal muscles that tighten around a spine that has been held in one position for hours. It does not have to be heroic to work.
Ten seconds of relaxed dead hang. Brief pause on the ground. Repeat three to five times. The whole thing is two minutes. The barrier to doing this every day is psychological, not physical — there is no equipment requirement beyond a bar. I have one in my house. I use it at the gym. I have hung from door frames. The daily habit matters more than any individual session length or intensity.
Core —
the honest part.
I am a spine surgeon. I know the evidence on core stability and lumbar health better than most people. I still do not do this consistently. I am working on it. Here is where I am and where I want to be.
Stretching —
the honest part, part two.
I cannot touch my toes. I am a spine surgeon who knows better, and I cannot touch my toes. This is the flexibility equivalent of the core section above — I know what I should be doing, I am not doing it consistently, and it matters.
Flexibility is not a vanity metric. Posterior chain tightness affects movement quality, exercise mechanics, and how the body compensates during daily activity. For someone who stands in a flexed-forward posture for hours operating, mobility deficits in the hamstrings, hip flexors, and thoracic spine compound over time and limit what you can do in and out of the gym. I know I should be doing more flexibility work. I am not doing enough of it. That is the honest answer. Including it here because it is a real gap — and because the transparency is the point.
Can’t train because
your spine is in the way?
Back pain or nerve symptoms that limit your ability to exercise are worth addressing. Not to optimize your numbers — because movement is one of the most important things you can do for long-term health, and losing access to it has consequences that compound over time.
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