Ultimate Mark: “I Just Love Playing Too Much!”
Our Experts
Dr. Mohamad Bydon, M.D
Faculty Page, linkedin, Google Scholar
Relevant Publication: Lumbar Fusion Versus Nonoperative Management for Treatment of Discogenic Low Back Pain
Dr. Mark Stoutenberg PhD
In My Body Odyssey’s first full episode we meet Ultimate Mark– an uber competitive weekend warrior in many sports but most frequently Ultimate Disc (formerly Ultimate Frisbee).
Mark hurls himself on the ultimate field just as he once did as an aspiring soccer goalie. Problem is Mark today has a fully fused spine dating back to severe scoliosis in high school. And that lack of spinal flexibility, along with his love of competition and high pain tolerance, puts him at risk for frequent injuries and possibly another major surgery.
“There’s something called adjacent segment disease,” explains Mayo Clinic Neurosurgeon Mohamad Bydon, one of two experts providing insights into Mark’s Body Odyssey. “It's not inforeseeable that as, as the years go by, he'll begin to develop problems and a decision will have to be made on extending that fusion.”
Meanwhile, Ultimate Mark continues to play at high intensity. “I'm extremely competitive and I want to win at all costs, he tell us. “Like I, I do what I can to win and if it hurts me, but it helps the team, it's worth it in my mind.”
Our second expert guest, Dr. Mark Stoutenberg of Temple University and the NGO Exercise is Medicine, has led numerous studies and programs on the benefits of sport and exercise. Still, Dr. Stoutenberg sounds a cautionary note on Ultimate Mark’s love of intense competition with a fully fused spine. “I don't think our younger selves really understand what being 50 and having chronic back pain is like,” says Dr. Stoutenberg. “ I just hope people at that point would say, you know what, I gotta change my lifestyle.
Does Ultimate Mark love sport too much? Mark finds the tradeoff acceptable for the social and behavioral benefits he gets from Ultimate Disc. Tune in to learn more about Mark’s highly intentional sacrifice of bodily injury for a healthier mind on this first episode of My Body Odyssey, a podcast about the rewards and challenges of an active lifestyle.
Original music by Ryan Adair Rooney.
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Mark (athlete)
And then just in the past few years, I’ve broken my wrists. I have multiple sprains on my ankles I'm playing on right now, broken a few fingers, multiple concussions, a broken elbow… It’d be easier for me to name something I haven't injured.
Valerie Wencis (co-host)
To say Mark is a ‘weekend warrior’ is an understatement. You name it; Mark plays it. Soccer, Tennis, Ultimate Disc - as in Ultimate Frisbee. In fact, you could call Mark the ‘ultimate weekend warrior’, competing through all those injuries.
Mark (athlete)
… I will admit I've not been great at following the medical advice about how to take the best care of my body. Not because I disagree with what the doctors have to say, cuz I know they're right, but because I just love playing too much.
Valerie Wencis (co-host)
The psychological rewards, but physical challenges, of the uber weekend warrior on this episode of My Body Odyssey. On this show, we track the wellness journeys of our protagonists, such as Ultimate Mark, over months and seasons and years. I’m Valerie Wencis.
Robert Pease (co-host)
And I’m Robert Pease, with a lot of questions in mind this episode. First off: Why does an athletic guy like Mark get hurt so often, and so seriously?
Valerie Wencis (co-host)
And why does a smart guy like Mark continue to rehab, but then compete again, same intensity, injury after injury?
Robert Pease (co-host)
Interesting, isn’t it? Professionally, Mark’s a sustainability scientist.. And maybe needs to analyze his own sustainability…
Valerie Wencis (co-host)
Which we’ll get to. But, let’s start where we met Mark.
<Event noise (voices, wind)>
Valerie Wencis (co-host)
First leg on this Odyssey, A sunny, but windy, summer day at the Boston Ultimate Disc Invite Tournament, back in 2019.
Robert Pease (co-host)
Picture a hundred teams competing, or waiting to compete, around a dozen fields in Devens, Massachusetts. Over a thousand participants.
Valerie Wencis (co-host)
But not many as competitive as Mark…
Mark (athlete)
I'm extremely competitive, and I want to win at all costs. I do what I can to win and if it hurts me, but it helps the team, it's worth it in my mind.
Robert Pease (co-host)
Problem is, Mark has real physical limitations dating back to injuries in high school, when his scoliosis, or curvature of his spine, suddenly became a lot worse. The average person has a curvature of less than 10 degrees. And initially Mark’s scoliosis was only a bit more than that…
Mark (athlete)
I had like a 12, 13 degree curve, which is more than average, but it's not that bad. And then when I was in high school, I fractured a vertebra in my back, kind of below the bad part of my scoliosis. And then things just kind of started growing super fast, right? So things kind of, so I went from a straight-ish spine to, I think I had like a 62 degree curve on the top and like a 55 degree curve on the bottom. Think about a 60 degree angle on a triangle. That's almost what my spine looked like, right?
Valerie Wencis (co-host)
But Mark’s desire to keep playing and competing never wavered, so he decided to have a very major corrective surgery.
Mark (athlete)
So after my, my freshman year of college, when I was 18, I got a spinal fusion from the vertebrae T1, which is like, basically the top of your back, right before you hit your neck, all the way down to L3, which is like, almost to the, almost to the, to the base of your back where your back touches your butt. And I think there's like 14 or 15 screws in there now, fully fused. You know, it was a six to eight month recovery.
Valerie Wencis (co-host)
And here’s where that tendency to not follow the medical advice does kick in…
Mark (athlete)
Being the total masochist, apparently that I am, after two months, I begged my parents to drive me to the high school track nearby. And I tried running, and I went maybe 20 feet and then collapsed on the track in pain.
Robert Pease (co-host)
Let’s try and put that in perspective. UCSF Health recommends lifting nothing heavier than a dinner plate in the first 6 months after a spinal fusion surgery. But Mark, after two months, he goes out for a run.
Valerie Wencis (co-host)
Okay. So, we know a bit about college-aged Mark. But let’s move this odyssey forward a decade, to Mark today. Same drive to compete. Same tendency to get injured – often – and sometimes seriously.
Robert Pease (co-host)
And we’re wondering: could the inflexibility of that fused spine, which allows him to compete, have something to do with those injuries he gets while competing?
Valerie Wencis (co-host)
We consulted a real expert on the subject: Dr. Mohamad Bydon, a neurosurgeon at Mayo Clinic in Rochester, Minnesota.
Dr. Mohamad Bydon, MD (expert)
Neurosurgeons operate throughout the body. So we do surgeries on the brain, on the spine up and down, on the peripheral nerves. So we're really sort of throughout. Our approaches are anterior, they can be posterior… we have a really sort of diversified array of options that we can offer to patients.
Valerie Wencis (co-host)
And he told us about the three different categories of spinal surgeries.
Dr. Mohamad Bydon, MD (expert)
There's a category of instability of the spine, where if somebody has that, you have to stabilize the spine, meaning put in screws and rods to hold it together, cuz it's unstable. There's a category of compression, where the nerves are being compressed.
Scoliosis is an alignment issue. And it sounds like in Mark's case, he had scoliosis as a child, continued to progress, progress, progress, ultimately requiring surgery. And many people go through those things for many months and years to try to put off surgery, and that's fine. Surgery should be a last resort.
Robert Pease (co-host)
A last resort. But very often, miraculous improvements are made to patients like Mark with severe scoliosis. Yet there are other risks associated with an extensive spinal fusion. Again, Dr. Bydon:
Dr. Mohamad Bydon, MD (expert)
Now, the other thing that people should be aware of is there's something called adjacent segment disease, where people can develop problems at the lower or upper levels. It's not unforeseeable that as, as the years go by, he'll begin to develop problems, and a decision will have to be made on extending that fusion.
Valerie Wencis (co-host)
So is that because of his scoliosis, or is it the fusion that’s contributing to potential problems?
Dr. Mohamad Bydon, MD (expert)
Right. So it's a good question. The fusion that he had certainly is a part of that. Now, the other end of that becomes exactly as you're saying, which is, there's a natural history, meaning as we age, we get problems anyway in the lower back. And so, biomechanically, that could create more strain, in fact, does create more strain at L3, L4, L5 and L5S1. And so that could set him up for bigger issues, faster, at those segments.
Valerie Wencis (co-host)
And Mark is all about that strain, which, according to Dr. Bydon, could mean another major spinal surgery. And in Mark’s case, possibly sooner rather than later.
Mark (athlete)
How do I put this… My pain tolerance is, like, through the roof. For example, one time I broke my wrist on my throwing hand, and then I played for five more weeks, not knowing that it was broken until I finally thought I should probably go to the doctor and get this sprain looked at. And then I was in a cast for two months.
Robert Pease (co-host)
We also discussed Ultimate Mark’s issues with another Mark, let’s call him ‘Expert Mark’, Dr. Mark Stoutenberg, a Kinesiologist at Temple University. He had back issues himself growing up in Canada playing football, and yes that’s American football.
Mark Stoutenberg, PhD, MSPH (expert)
I worked at the University of Miami and had the great honor of being part of some football teams there. But at the same time, I was taking classes in, in the, in the discipline of, of exercise physiology. It was just fascinating. And it just was, you know, I, I fell in love.
Valerie Wencis (co-host)
Dr. Stoutenberg is a huge proponent of the benefits of exercise. It’s his life’s calling in many ways, as a researcher at Temple. He’s also a program director for “Exercise is Medicine” – an NGO that helps medical professionals help patients to exercise, not only to regain health, but keep their health.
Robert Pease (co-host)
But Expert Mark also recognizes that competitive sports can get the better of us. And that so often seems the case with Ultimate Mark.
Mark Stoutenberg, PhD, MSPH (expert)
And, and so it's kind of a trade off. And I don't think our younger selves really understand what being 50 and having chronic back pain is like… 18 years old, massive spinal fusion, you know, I, I just hope people at that point would say, you know what, I gotta change my lifestyle. We don't want to, but I think we have to change our lifestyle, get in the pool, do low impact exercises, find other ways and understand that our path in life is changed. And, and we have to adjust to that. And it's hard to do, really hard to do.
Valerie Wencis (co-host)
But Mark didn’t make that major lifestyle change. Instead, he played a lot less soccer, and a lot more ultimate. But same intensity, while working even harder to stay on the field..
Mark (athlete)
I'm in a lot of pain now, but I go to physical therapy multiple times a week, I do a lot of medication, I stretch every single day. I basically live on my foam roller when I'm watching TV. As much as I can do to like, get as flexible as possible. Since I can't really stretch any muscles in my upper back, I have to do as much as I can to get my lower back and my legs as stretched as possible.
Valerie Wencis (co-host)
And there are few players on the ultimate field, perhaps on any athletic field, who so passionately play through pain and injury.
Mark (athlete)
Yeah, so when I first started playing the sport, people would like, see me get hurt on the field, and they would say, oh no, like he can't go back on. This is horrible. This is horrible, right? Over time, I kind of just developed this persona as the person who will get hurt multiple times per game. And it's cuz I mean, I just throw my body around when I play.
Robert Pease (co-host)
But aren’t those injuries trying to tell us something about what we’re asking our bodies to do? Again, Dr. Bydon on that clear and present danger:
Dr. Mohamad Bydon, MD (expert)
It's important not to play injured. It's important to, and, and again, if you're a professional athlete, that's just part of your job and they, and they do that. But it's important to try to avoid playing injured, because small injuries can beget bigger injuries and they can, it can really, you know, get out of hand very quickly.
Valerie Wencis (co-host)
And Dr. Stoutenberg on the steep long term trade offs:
Mark Stoutenberg, PhD, MSPH (expert)
Anything we do in life to the extreme, we're gonna pay the price for, you know? If you played 15 years of basketball in your life, you're probably gonna have knee pain later in life. You know, if you played professional football, there's a good chance, you know, you're gonna suffer joint pain and replacements and different things.
Valerie Wencis (co-host)
Yet… back in Devens, at the tournament where we first met him, no one was having more fun than Mark, despite his painful past, and maybe a painful future too. In Mark’s calculation, it’s worth it. Not just for the competition, but for the camaraderie.
Mark (athlete)
I dare you to find a better community of athletes anywhere in the world than the ultimate Frisbee community. Seriously. Every single person here is friendly. I'm, we're playing in a tournament with 12 other mixed teams and I've already run into probably 30 or 40 people that I know from other teams.
Valerie Wencis (co-host)
With that in mind, we met with Mark again…
Robert Pease (co-host)
Odyssey part two.
Valerie Wencis (co-host)
A remote interview late in winter of 2022, wondering how he was doing.
Robert Pease (co-host)
And was he planning to play Ultimate Disc again this summer season?
Mark (athlete)
I should I, you know, being totally upfront like a couple months ago, you know, when I, or maybe 10 months ago when I tried to get back into ultimate like post or, you know, ‘post COVID’, like still in COVID, but the seasons had started back up. you know, I had fractured a bunch of bones in my back without realizing it…
Robert Pease (co-host)
Okay, Mark, you have a PhD in engineering… And then if we understand your job description, you're measuring the consequences, the health effects, of global warming?
Mark (athlete)
Yeah, I mean, very, very close. Yeah. So my role at my current company is I am, what's called a sustainability scientist. I look at the climate change potential of the human health impacts and the water impacts of various, like, consumer products.
Robert Pease (co-host)
Well, let's say for discussion's sake that Mark, you are the planet. Can you apply your sustainability analysis to yourself, and question some of these activities that you throw yourself into?
Mark (athlete)
You know, I think that's actually a really good way to put it, like, you know, for, for every, no, seriously, like for everybody, you know, you always hear that thing, like, Hey, your body's a temple. take care of it. But for me, I think that my body… I know I've seen the x-rays. I know that my body is, is not as much of a temple as it is, a slowly, devolving, you know, Aztec-looking pyramid, that's falling apart over time.
So for me, this ‘body's a temple’ thing is, is a valuable lesson for most people, but at the same time, so is the mind, right? And if I didn't have competition, if I didn't try to be bettering myself on the field or on the pavement or wherever I was gonna be trying to play a sport or improve my energy levels or improve my physique, I don't know if my mental health would be as strong as it is.
Valerie Wencis (co-host)
Okay. So yet Another reason Mark subjects himself to physical injury. Not just love of competition, not just the community, but the behavioral benefit from all of the above. But still… There are other sports, other activities with communities…
Mark (athlete)
I did try yoga. I can't do yoga. You know, almost my entire back is fused together. It's all one piece, right? So I can't even tie my shoes, like in a normal way. So the idea of doing downward facing dog, and then trying to bend over and touch my ankle is, it actually gives me night terrors. I could not do that.
Robert Pease (co-host)
Well what about, you know, hiking?
Mark (athlete)
I love hiking! So I, I will say, I will say, yeah, those are the sports I play that are team sports, but I actually, I, I hike as much as I can. I don't know if, if you've ever heard of disc golf? I play a ton of disc golf. My post-ultimate career retirement plan for sports is competitive disc golf.
Valerie Wencis (co-host)
Yeah, I love your retirement analogy too. Like most people it's just normal golf, but for Frisbee players, it's, it's disc golf. so speaking of, though, have you been able to go back to Frisbee at all? I mean, maybe not with your current, latest injury, but did you sneak any Frisbee in during the pandemic?
Mark (athlete)
I played for the first time since April of last year, this week, actually.
Valerie Wencis (co-host)
Congratulations.
Mark (athlete)
I'm horrible now. I, the amount of the, the rust that was coming off, I, I looked like, I looked like a, like a 1950s old car. Like just every single step I took, you could physically see the trails of rust coming off of me. It was, it was wild.
Valerie Wencis (co-host)
And will you continue with it?
Mark (athlete)
I'm, I'm pumped.
Robert Pease (co-host)
Ultimate Mark. Pumped for another season. And that kinda concerned us... Honestly, I had been hoping Mark might find something other than sports to absorb his angst and energy… Just for his own sustainability.
Valerie Wencis (co-host)
Exactly. In the arts possibly. No scorekeeping. No wins and losses.
Robert Pease (co-host)
No hurling the body onto the field…
Valerie Wencis (co-host)
And it turns out, Mark does have an artistic side
Mark (athlete)
Recently I started picking up neon bending. So like, you basically, you know, you stand over a flame with like glass tubing, and you make neon signs by hand. And it's awesome. And, my girlfriend and I have turned that into a little bit of a competition. So the competitive nature doesn't leave there either, because we're always down to see who can make the better 90 degree bend relative to the other, so that doesn't leave as a result, I can stay competitive there.
Robert Pease (co-host)
Yeah. Well, it's always good to compete intensely around flames… what could go wrong?
Mark (athlete)
Oh my god, it’s the best. I'm sweating. I have burns all over my fingers. It's so worth it. My 90 degree bends are like, they're like 95 degrees. They're not great, but they're getting there. So, so, you know, it's, it's little improvements every day, even if it's not in sports, it's important.
Valerie Wencis (co-host)
Oh my gosh.
Robert Pease (co-host)
Ultimate Mark’s Body Odyssey. His mind very happily goes to competition in anything he does. But his body faces really steep challenges on the field…
Valerie Wencis (co-host)
And severe burns in the studio. Still… you have to love that spirit.
Robert Pease (co-host)
Exactly. Maybe spirit will endure, if bone and skin do not.
Valerie Wencis (co-host)
But next time with Mark we’ll discuss more of that Mind Odyssey, meaning those huge behavioral benefits he gets from Ultimate and other sports.
Mark (athlete)
So I am trading off a little bit of my own body's health in exchange for what I perceive as more happiness and a better mental health. And I think that's just as important as making sure your body feels good, you know?
Valerie Wencis (co-host)
How about your Body Odyssey? Do you have a story to tell about the rewards and challenges of your active lifestyle? If so, we’d love to hear from you via our website, mybodyodyssey.com, or on social media.
Robert Pease (co-host)
My Body Odyssey follows the wellness journeys of protagonists over the months and seasons and years. Next up, we’ll meet Diane, an avid, if amateur, triathlete with type one diabetes, who’s constantly balancing on a blood sugar balance beam.
Diane (athlete)
Next thing you know, I’m inside an ambulance…
Robert Pease (co-host)
We’re going to learn a lot about the unique challenges of diabetes and exercise next time. One in ten Americans have diabetes, many more are pre-diabetic.
Valerie Wencis (co-host)
More Odysseys coming soon on all major apps.
Robert Pease (co-host)
My Body Odyssey is a Fluent Knowledge production. Original music by Ryan Adair Rooney.