Lower back pain treatments: what works for which problem

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show is for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Now, we're going to cover today some effective rehabilitation strategies for low back pain. We're probably going to cover other topics pretty soon as we start to move away from low back pain in this podcast in the coming months, but I think we should do some final touches on things because you guys have, if you've listened to all these podcasts, you've probably learned a lot by now, a lot to be dangerous.

The fact of the matter is that a lot of people know about why their back pain is occurring, but how to solve the problem is a whole different scenario because there's a lot of different options of things that could work, but are they going to work for you? So, I'm going to make some references today out of a book that I wrote about low back pain treatments as part of the four-part lower back series that I put together. The first book is on six powerful exercises for low back pain as well as a structured framework. Book number two is about diagnosis and how to not let Dr. Gould confuse you. Number three is about lower back pain treatments that tend to work for people in certain scenarios.

Four is reintroduction to weight training and physical activity without triggering your back and making it worse overall. So, we're going to make some references today of different exercises or stretches or treatments and ultrasounds and things like that have been used for low back pain and maybe in what scenario they might actually work for. So, if you are wondering of what type of lower back pain you have, you should probably get booked too or maybe listen to some of the previous podcasts or just generally you can come in and get examined by us. The sad thing about lower back pain, at least when you're dealing with it on your own, is it is very hard.

I don't suggest anybody try to do this all on their own. It's hard to be the mechanic as well as the driver. It's easiest to have someone help you through this stuff. Now, some of the topics we're going to cover today is deep tissue work, corrective exercise, foam rolling, stretching, acupuncture, chiropractic adjustments, physical therapy, yoga, personal training, heat, ice, medication, nutritional changes, surgery, and so on. I'm going to do my best to cover as many as I possibly can in the time that we have. So, I might not actually hit all of these, but we're going to try to make this about a 30-minute podcast or so for you.

So, let's start first into deep tissue massage. A lot of these treatments, I think we first need to cover them in, position them in the light that they're supposed to be intended for. Some of these are passive therapies and are supposedly supposed to be used more for pain management strategies. And there's nothing wrong with pain management strategies. It's just a pain management strategy. There was someone that I recently saw that we discussed about she had lower back pain for I think it's about three years or so now. And she was given medications to manage some of her pain. And she's like, I don't want to take these medications.

I'm not in pain all the time. And she would describe that she can actually lay on her back with her legs in the air and feel perfectly normal for as long as she laid there. And I kind of said, you know, I think you found that in a very adequate form of pain management, obviously, it's no way to live. And nor is pain management strategies like it's just it's supposed to be as intended. It's to decrease pain at a moment's notice. So she was on board with me with that. She's like, I don't want to live that way, but I can certainly see how it's useful. And I said, yeah. So some of these exercises or sorry, some of these treatments are pain management strategies.

And although I won't be probably saying that they're all really helpful, they're helpful in certain scenarios. So basically the strategy or the framework that I put together to understand these is I call it the map a load system. I've referenced it in other other podcasts that I've done. It's an acronym. Aim is M is modification of pain, which is pain management. A is activation of the support systems. P is patterning movement. And then load is putting your body through load, which tends to if you go through a process like this, it tends to work very well. Stopping somewhere along the way and just deciding, you know what, I'm just going to lay on my back forever.

I'm going to just avoid pain, manage the pain is really not a true solution. If you're looking to go back to golfing or swimming or biking or whatever you want to do. So deep tissue massage, in my opinion, I think it's more of an M strategy. It's a modification of pain strategies. It's pain management strategy. I used to do a bunch of tissue work for a lot of years. I've done things like, like grassing type of work. I've done active release. I've done cross friction massage. Some of my interns have done things like fascial distortion. There's nothing wrong with these. I think the, the thought years ago was that it would break up scar tissue.

But the fact of the matter is, I don't think that the more and more research I see, there's conflicting information about what we're actually doing. Um, I think one method says we're breaking, uh, we're kind of heating up hyaluronic acid and letting it dissipate throughout the levels. Letting the fascia move better. Other ones will say that you're, you know, uh, increasing the amount of activity of cells that actually produce more tendons and muscles and so on. Other ones say you're breaking, you're breaking up scar tissue, facilitating slide between tissues and so on. So I don't know if we actually know what it does.

We can't, can't discount the value and how good people can feel after doing manual therapy like this, deep tissue massage, some type of manual myofascial release and so on. By the way, I should probably note that at least in my book, manual care, deep tissue work, active release, myofascial release, cross fiction massage. To me, it's all very much in the same category. Yes. The theories of why they work and so on are different. The, the way you're taught to how to manage someone's pain, we using the strategies are different. Their certifications are different. To me, it's, it's, it's the same.

We're addressing muscular tissue or fascial tissue or soft tissue. So soft tissue management. I think it's really good to use, especially when people have more chronic pain, like in scenarios like spinal or foraminal stenosis cases for low back pain, it would generally work pretty well. People who have arthritic change or have had back pain for a very long time. Like I mentioned, chronic pain, it tends to work very well with, mainly because there's more time for the tissue to adapt. I remember I was working at a vet with somebody and someone turned their ankle and they started doing some tissue work on it.

And I said, how come you're generally interested in like, how come you're doing tissue work on the air? And they said, well, to break up the scar tissue, I said, it didn't have time to develop, you know? So I think as long as we use logic with it and the longer the person has a problem, I think personally, I think the more successful this strategy will be for it. But I'm not discounting the possibility it works with things like more acute pain, you're flushing some of the lymphatic drainage away or whatever we're doing, right? I think there's value in it, but I think there's a higher probability of doing it when something's a little older and at least when you've had something longer.

If there really, truly is scar tissue, I think something like this would be very useful or even something like if you've been diagnosed with like a Bissett syndrome, I think it'd be useful as well. The things I think it won't be very useful for, and all these diagnoses, by the way, these are in book two. So these are the main ones that I cover. Spondylolisthesis, piriformis syndrome, SI joint syndrome or SI joint sprain, lumbar disc herniation, lumbar radiculopathy or a pinched nerve, as we say. Sciatica, which is pain down the leg past the knee. Spinal fracture or muscle strain, I don't think these are actually very, I don't think it's the first thing I would pick, at least in regards to something to reduce pain and restore function.

Now, the next thing we should probably cover is corrective exercise. Again, this can be a wide range of things. Some people call this physical therapy, but generally physical therapy is like physical, it can be physical medicine. Physical therapy generally is a degree. That person can also do deep tissue work on you. As I mentioned prior, exercises or corrective exercises can be done by a chiropractor, a strength coach, personal trainer. They can all be done by someone who is very good at coaching. I even know coaches at high schools like track coaches who use corrective exercise as part of their warmup.

So it's really, it's a, it's a general category of, it's a tool. It's not a degree, it's a tool. All right. Physical therapy, chiropractic, medical doctor, orthopedic surgeon. These are degrees, but it doesn't mean they can't show the tool. So I think things like a corrective exercise can be very useful for a lot of things. I'm probably biased in this because I have, I use this primarily in our office. Dawne Costantino uses this in our office as well. Something like low back disc herniation works really well with something like this strategy, especially when things like tissue work and deep tissue massage or any of those types of strategies we just prior mentioned don't work.

Something very simple like a buttress plank, a side plank, and a bird dog seem to work very well, but there's other different types of corrective exercises you can use at different dosages that work very well. I think a lot of times people don't quite understand how to use these and what they, how much power they can hold. I've met so many people when they have acute lower back pain, and if you just get them to do a bird dog and a side plank and go for a walk, it's more powerful than any medication that they, that they've taken. It's better than any tissue work that they've ever done. Actually, a lot of times their ability to touch your toes sometimes comes back in subacute scenarios where it's not just like happening that morning or it didn't just start that morning.

So this is our version of a medication. A lot of times this is a movement medication, which does require dosage. It does require picking the strategic medication. A bird dog is not the right exercise for everybody's low back pain. It's just one that works in a certain scenario. So a lot of times an assessment to figure out what your actual problem is, is useful to figuring out what exercises will work well for you. High probability of filling the activation of the support system category for this. By the way, I guess I didn't mention, this can work for modification of pain, as I just mentioned, and the M category, but also it is intended to work for the A category, which is activation of the support systems.

Generally, if someone is not physically able to support their spine very well due to past injury or deconditioning, an A category exercise, like activation of the support system or corrective exercise, works very well to double as a pain management strategy too. So it's really cool. So this works well for people that have spinal or foraminal stenosis, arthritic findings from x-rays, chronic pain, scar tissue, facet syndrome, spinal lobosthesis, piriformis syndrome, SI joint sprain or strain or syndrome, lumbar disc injury, lumbar radiculopathy or pinched nerve, sciatica, spinal, well, spinal fractures.

I think I should take this one off the list there. I don't know why I have it in that list. So that one is not, a spinal fracture is managed a very different way unless we're talking about something like a pars fracture, which is actually can be managed with this type of strategy because you got to support the area. So it starts to heal itself and muscle strains, it works very well too. The things that won't work well with is the big, bad, scary things like the sinister pathology, which, you know, tumors, infections, and so on, it won't work. And so this is the value of obviously being assessed.

Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity. The link's in the description.

It only takes a few minutes to fill out the form. Okay, back to the show. Foam rolling is the next one, which I won't spend too much time on this, but this is a nice version of doing a self-myofascial release or self-tissue work. I remember one client I worked with, she was having some neck pain and she decided to use a foam roller on her mid-back. The reason why she chose the mid-back is, I'll discuss that in a second, but she worked away from the area of the symptom generator and she came back and said, I can't believe I didn't find this thing five years ago. This thing is life-changing. Working around the area with a foam roller can help out to deload the area of the symptom.

If we're dealing with lower back pain, something like foam rolling the lower back specifically, in my opinion, is not worth your time, in fact, it could make you feel worse, although some people might make you feel better, it's always circumstantial, I would go foam roll on the mid-back or around the hip. Generally, something called the joint-by-joint approach to the body or the regional interdependence model is what we follow at performance place here, and a lot of offices will follow the same thing if they're suggesting exercises. Generally, the thing with the lower back is that the lower back is an area where stability is required or stiffness is required for it to function well and for it to not hurt.

The areas surrounding it, such as the mid-back or the hip, will have more usefulness with some movement. And so mobilizing those areas with something like a foam roller or doing a general mobility exercise can help out more so than actually targeting the low back itself. The body is one big unit, it does work together, and sometimes it's better to support the area versus mobilize it more. Things that it will help well with, with high probability of filling the modification of pain category, is in areas when you're doing it in areas of no pain but dysfunction. Let me explain that for a moment. If your hip does not hurt, but it feels like it's stiff, this is better to use on the hip because it's not painful, but it's dysfunctional, and that helps deload your low back.

Same thing with mid-back. It's things that it does help out with if you use it in this format is spinal or foraminal stenosis, arthritis, chronic pain, scar tissue, facet syndrome, spondylolisthesis, piriformis syndrome, and muscle strains. The things I don't think it works very well with is SI joint sprain strains, lumbar disc injuries, pinched nerves of the low back, sciatica, or spinal fractures. I'm not saying it won't work, but it's a lower probability if I had to go gamble in Vegas. Now, the next one, stretching. There's a lot of people that stretch their low backs and hips, and it's funny.

I think the people that we end up seeing in our office are people that it doesn't work for, but I've read on a lot of forums where people say, oh, just stretch the hip flexor. It'll go away, and lo and behold, it worked for them. You know, stretch your hamstrings. It'll go away. It could. But for the people it doesn't work for, this is where it falls into the category that I'm talking about now where it might not work for you because there's a possibility that your muscle spasms are actually protective. If your low back QL muscle is in spasm, it might be because it's trying to stop you from doing something that stretches it further, which might actually increase the symptom coming from a different region.

I'll give you an example. A lot of times people that have low back disc injuries or discogenic pain or pinched nerves in the back, their body is actually telling them via the tightnesses they have to not stretch. A perfect example of this is if you have sciatica or pain down into the hamstring or calf, you should not probably be stretching this at the first go. Every time people do stretch it, a lot of times it does just come back immediately or it hurts like hell to do it. I remember one gentleman emailed us, he saw one of our videos on YouTube and I think the general criteria we gave was if you have sciatica, stop stretching it.

And he said, you know, I really took that to heart and I didn't change anything else. I just stopped stretching. I can't believe how much better I feel. Thank you for this video. And sometimes people are just producing their own problem unknowingly because they're trying to stretch that tightness away. So you might consider consider what is stretching doing for you? Is it helping typically the right treatment and we're covering a bunch of treatment options here, obviously with different categories, MAP or loading generally the, the, if the treatment is correct, you'll know it within two weeks.

Most of the time, I'm not going to say things will be perfect. I'm not going to say you'll be the peak of health in two weeks, but you should be like, hmm, I'm way better in these now than I was two weeks ago. I know things are getting better. It's not perfect, but I'm on the road to recovery. Generally, if you pick the right thing, you'll have that experience. But if you have chronic pain or some other type of thing going on and there's a more parts to your puzzle, it might take a little bit longer or you might be playing chess with the thing, you know, like pawns are in the way you have to move pawns to get to the queen.

But generally, not triggering the problem is one of the easiest ones in the book. And so if stretching is making you feel worse, then you might consider not using it. The things that stretching has a higher probability of working with, in my opinion, is spinal or foraminal stenosis, arthritis, chronic pain, and scar tissue. The things that it has a lower probability with is all the scary stuff, the SI joint syndrome, sprains or strains, lumbar disc injuries for sure, lumbar radiculopathies for sure, or pinched nerves, sciatica for sure as well. Although people have been given sometimes flossing or nerve glide stretches.

I'm not going to say these are wrong, but if you do them differently than shown, then you will actually be stretching the nerve, putting it on tension, which then will increase your problem. I'm not going to say we don't show these at Performance Place, but we don't show them in the first session. It's not the first bridge we'll cross. It's not the low-hanging fruit for most people. Normally, something else like taking pressure off the nerve or taking pressure off the disc is the easiest thing, and usually doing some supportive exercise is usually better. Spinal fractures, it won't work well with.

Muscle strains, for the reasons why I mentioned earlier. Piriformis syndrome, usually it'll have very short-lived reduction of pain, but it'll come right back. Spinal anesthesis, stretching an area that has more motion than it needs to, does not make any sense to me. And Pisset syndrome, that will actually have a higher probability than the remainder of the stuff on the low probability list. Um, normally for people who actually have the set compression, stretching their back will help more than in other scenarios, but sometimes stretching your hamstring won't help. So there's going to be certain situations where stretching certain areas will help and other areas will trigger.

Generally speaking, if you have nerve pain or if you have shooting, stabbing stuff below your knee or into the foot, I wouldn't stretch the hamstrings or calves at all for a little bit of time, uh, just as a first go. And that's typically something we take away in the first week at performance place in lieu of introducing it later. I put acupuncture on here. I think that's a very adequate form of M modification of pain. Unless my education is serving me different, at least in my school that I went to, we had a acupuncture program as a, as a neighboring, neighboring program. So we were required to take a little bit of a rotation through there and see what they're doing.

I didn't see any coaching of movement or exercise in there. If there was, I apologize. I didn't see it, but generally to cover the A and P category, which is activation of the support systems, patterning movement, and then loading the body. It's going to require some coaching and some sweating and some movement on the patient's part. Um, I didn't see any, there's needles, cupping, even tissue work, things like that. So there's, this is a form of pain modification for me that actually, um, I, from what I recall, actually worked pretty well. I don't quite understand all the nuances of it, but generally it worked well for things for modification for a lot of the things on the list.

But for stuff that I've noticed that doesn't really work well with is pinched nerves at a low back, low back disc fractures and the scary stuff. So for rest, the rest of the stuff actually worked fairly well from what I recall. Again, my knowledge on this is, is going to be very limited, but I remember there was one of our classmates who was, it was, it was interesting. It wasn't blow back necessarily related, but they were going down to run a race. They were going to do a marathon. And so driving down, they had knee pain in the car. They had one acupuncture treatment, one needle in a specific area, and they were able to run the whole race without really any knee pain.

And so I don't think there's any reason for them to lie to me about that story, but it was interesting. And I think that from what I had heard on some Google searches, you can search this if you like open heart surgery. I think in China back in the day was, uh, anesthesia was provided with some of these, uh, kneeling procedures. Um, I looked it up on Google. I saw on, it was depicted on the eight cent stamp. So in getting an acupuncture as anesthesia for open heart surgery, I don't know how well that went, but to me, if that can take pain away, certainly use it. But I don't know all the details of that.

Rest, I think is, I think it's one of the biggest waste of times you can do. I think is if we consider rest as bed rest, uh, bed rest is one of the ways you can decondition your body the quickest. And there's no point in deconditioning the entire body for the sake of letting one single area or one region of your body recover. It's almost like a scenario where you broke your wrist and you're like, you know what? I'm just not going to move for eight weeks as this wrist recovers and this cast comes off. It doesn't make any sense. Now I know it's, I know it's painful to move when you have back pain, but I think a lot of you will find that a lot of your movements won't actually hurt.

Uh, it'll just be a few of them. In that case, those activities are considered red light activities. Maybe that's walking, maybe it's running, maybe it's washing dishes, maybe it's putting your shoes on, you know, but that doesn't mean you can't walk outside without your shoes. And that should generally feel okay. Typically movement is a very good medicine for stuff like back pain. And the longer you're doing bed rest, the harder it is to recover in the longterm. When it comes to overall bed rest as, as it may be productivity or like considering like a framework where it might work, I think three to five days is probably most, I would say, go ahead and take it easy.

But again, this is taking it easy. This isn't just laying in bed and just hanging out, even though you feel okay, try to get around. Don't get a bell by your bed and have some weight on you. Get up and go to the bathroom on your own. If you can go make your own food, if you can go outside, go to the store, if you can do your normal daily activity, but maybe don't go through and, you know, go run a marathon. If that's what bothers you, don't even deadlift. That's what, if that's what bothers you, you might have to be coached into a better movement strategy for deadlifting. Cause for all we know, this deadlifting is what did this to you.

Um, overall though, I can't think of one thing that prolonged bed rest can help out. I really don't like, it's not that I'm a hater on bed rest. It's just, maybe I am a hater on bed rest, but for the most part, I don't see that it's a good, adequate long-term pain management strategy for anything that we have on this list. So it's just, it's inadequate. Chiropractic adjustments. This is one of those things where I think we got to default back to the chiropractor as a license, not a tool, although the chiropractic adjustment is called a tool. Physical therapy, which is coming next on the list again, is a degree that they have.

They can use many tools. And so make sure that when you were looking around for someone to work with, that you're considering the license does not dictate the tools they will use. A chiropractor can do, can correct coach exercises as we do. They can adjust you. They can diagnose you. They can do soft tissue work. They can do everything, a lot of things that you're going to want, except for suggest medication or break the skin. But whether that tool should be used for your scenario or not is a different story. It's up to the practitioner to decide at that point. Adjustments though, overall, if I'm going to cover the idea of an adjustment, there's five grades of adjustments or five grades of mobilization.

The adjustment, as long as a lot of you will probably understand it, is the quote unquote crack or the pop. And that's just one version of the five grades of adjustments or joint mobilizations rather. I tend to find that it doesn't need to be that one crack that makes any significant difference. Sometimes just doing lower grades of mobilization can help out somebody if mobilization is needed. I bring this up because some people are afraid to go to a chiropractor because they're like, I don't want to be cracked. You don't have to be. But we actually have quite a few of our patients that come in that we don't actually need to adjust or crack at all to make them feel better.

We see people virtually, which we physically can't touch them to perform a crack. And they still get better if we suggest the right tools to them. All right. So we're by degree chiropractors, but it doesn't mean we can't coach exercises as well. The adjustment itself is really an adequate form of pain management if it works for you. I find that it works for things like pinched nerves a little bit more so, SI joint syndromes, arthritis is, foraminal response gnosis, chronic pain it can work for as well as facet syndrome. I don't find it really works super well for low back disc injuries, although a lot of you who are listening, you've been to a chiropractor and you say, oh, it works for me.

That's fine. You know, I'm saying lower probability. It's not first on my list. I certainly wouldn't adjust a fracture. I wouldn't adjust scar tissue. I probably wouldn't adjust a true sciatica and muscle strains, periformis syndrome, spondylolisthesis. Personally, I'm on the fence a little bit with the pinched nerves and the lumbar radiculopathy, as I mentioned earlier. We, we found that, that a lot of times putting people in a position that reduces their pain completely, such as putting legs up on a chair and laying on their back is actually what a better form of pain management than the actual adjustment itself, mainly because they can supply more dosage throughout the day.

If the goal is to take pressure off the nerve, then why not let the person do it at home more for longer? It's like you're taking a tourniquet off of your arm. It just, it's momentary one when you're in at the office and you get adjusted. But then if you can supplement that with more time that you don't have any pressure on the nerve, that's creating symptoms, that might be better over long-term. But yeah, I have no real problems with the chiropractic adjustment. I think it's overly utilized a lot of times. And I think people ask for it sometimes like that. It's like, this is what I want. We've had a lot of people come in our office and say, this is what I think I need.

But in reality, if we go through the exam and the history, it's not really what they need. It's what they're asking for. And so even though we have all these other tools we can use, I think being open to which tool might be more productive for you, I think is an asset if you were a patient. But obviously you can suggest what you want. You know, you're, you are the customer and unless it's really going to harm you or create some more pain with you, there's no real problem with doing it. We have told people in our office, we prefer not to do it for the specific condition you have because we don't feel like it'll help you.

And also it takes time away from other things that other tools that we think will work a little bit better in this, at least in this scenario today, for all we know, in three weeks after we've worked with you and you feel like 90% better, an adjustment is going to be a valid tool for that day. The, the, the system changes, the program changes. And as long as you're aware that your, your program is specific to your problem today, it opens up a lot of possibilities of different things that have worked in the past, but not might not work today. So things change. Things can change very quickly as you probably found with a turned ankle.

It's like by the end of the week, you're walking on it again. So the things that you can do change a lot over the course that week. And the same thing goes with all these different back conditions too. Physical therapy. I've never been in physical therapy school. Again, it's a license. I kind of have a joke that I tell people that call because it's a, it's a semantics thing. I think for the lay public, although everyone in the professions know that the physical therapy is the degree. Um, uh, I say when you have a bridge, when someone tells you to do a bridge and it's a, and it's a physical therapist, what do you call it?

And you call it physical therapy. What if a chiropractor or physiotherapist shows you to do a bridge? Well, it's called physiotherapy, right? It's the same thing. It's a bridge. And then when you have a strength coach or a coach tell you to do a bridge called a bridge. So a bridge is a bridge, but sometimes the semantics about what it's called are a little bit different. Obviously, uh, I'm not going to say physiotherapists and physical therapists and strength coaches and chiropractors all have the same education. They don't, but a lot of times, and I'm sure a lot of people listening to this in the profession are probably going to agree that a lot of things that you learn about what to do in certain situations and even how to coach things improve after you leave school.

So a lot of times people will go into workshops like the FMS, like some of the like CrossFit certifications and so on. Like there's different provider types, different degree types that go through and learn different coaching strategies. I'm not going to say one coaching strategy is better than any other at this point in time. But what I'm mentioning is what I want you to realize is that the education comes a little bit later. The degree is not that important. Um, a bridge is a bridge is a bridge. So physical therapy though, as a profession, they can really help you just as chiropractors, they can offer different parts, different types, different tools of M, A, P, and even load.

And so someone like this can really help you out with figuring out what to do first and what to do today. Uh, as I mentioned, the very beginning, it's very hard to figure out your own problem and also coach yourself through your own problem and knowing to change the program. It's very hard. So it's, it's easiest to have someone in your team and somebody who's had the problem before someone who's had a lot of experience in getting people help with the problem too. Um, and I know there's stereotypes that go around with physical therapists and chiropractors and MDs and orthos and so on. And we all know them, you know, and it's funny.

I was, uh, I was at a workshop one day. This is a true story. And I was having lunch with a couple of physical therapists who were there. Um, we all, we were all learning something called DNS, which is dynamic neuromuscular education, or it's, it's a type of, uh, sorry, dynamic neuromuscular. What am I, why am I losing it? DNS. D, um, anyways, dynamic neuromuscular stabilization. I don't know why I'm losing my mind with it. Anyways, it's a, it's a tool. It's a form of coaching, like corrective exercises and loading. And so we went, I think I was one of the only two chiropractors there. There's probably like 30 of us.

And so I was eating lunch with a couple of physical therapists and, uh, after eating for a while, we're just, you know, shooting the shit and talking and stuff. And, and he, and they said, uh, so I don't want to be rude, but how do you plan on using this? I said, what do you mean? And he's like, well, why don't you, don't you guys, don't you only like take five minutes per person? And I said, no. And I explained, and I said, no, we, we spend 30 to 45 minutes with people. Like we mainly coach exercises, just another exercise variation. And then you would too. And, uh, I always want to expand education and see what other types of coaching strategies I can adopt and use for people.

And so I was just being facetious. But after that, I said, so how are you going to use this? And they said, what do you mean? I said, don't you just stretch and eat nice and stem and, and they laughed and they said, ah, I get your point. You know, we all have our stereotypes of what a lot of the offices in these professions will do or what they've historically done. And so not every, not every PT office just does passive modalities. Not every chiropractic office does adjustments only and spends five minutes. It's very different. And so if you call each place, if you're wondering about which place you'll go to call each place and see what, see what they do, see what they offer, see how long they spend.

It's not always about how much time they spend, by the way, it's, it's about the tools that they'll give you. And I always, I know it sounds like I'm probably talking down about these types. It's, it's not that at all. The last thing I want is, is someone to come into our office. Who's expecting ice, heat, stem, ultrasound, stretching, or so on. I don't even want someone to come in our office. Who's expecting five minutes and just an adjustment because they're going to be disappointed and misled about what may happen here. And same thing happens with those physical therapy offices. If they're doing something like DNS exercise and they're expecting ice, heat, stem, and ultrasound, they're going to be severely disappointed, uh, and vice versa.

Someone goes in looking for DNS exercise and all they get is ice, heat, stem, and ultrasound. They're gonna be disappointed too. So it's all about setting expectations. Um, physical therapists though, as a profession, if they have the right tools, they'll help you with all of these things. Every single thing I have on the list, except for the scary stuff. The scary stuff are things that professionals like physical therapists, chiropractors, MDs need to be screening for, so they can refer out for, and it's not that anything that they've not that, not that you can't go there and get examined because there's signs and symptoms that may allude to even history findings.

There's things that will allude to the possibility that you may have something going on, which is we're, we're basically triaging you at that point. We're figuring out where you need to go. So physical therapists, chiropractors, great additions to your, to your recovery team. Yoga is probably the last one I'll cover just because of time. I think yoga can be helpful for certain things, uh, like spinal stenosis, foraminal stenosis, arthritis, chronic pain, facet syndrome. I don't think it's helpful for some of the other ones. And I've already gone through the big old list of things, but I'll go through one more time.

Scar tissue, muscle strain, spinal fracture, pinched nerves of various types, lumbar discs, side joint syndrome, piriformis syndrome, spinal dysthesis, and all the scary stuff. Uh, the reason I don't think it's helpful mainly is because yoga is not a single exercise. It's not a single position and there's a lot of variety. It's not that the, a yoga instructor can't identify which, which exercises might be off the board for this client. But if there's a class of 50 people and there's one person, or even a class of 10 people, one person, it's really not fair to the remainder of the class for the yoga instructor to only focus on that one person.

So you might find that a forward fold bothers your back, but yoga, but warrior poses are fine, but then up dog is not. And then so on. So there's a lot of different variety of movements that may or may not work for you. And for all we know, 90% of what is in the yoga class may be helpful, but the 10% is too much for you. Um, and that's not like it won't help today or help later, but it might not help today based upon your certain presentation today. So normally people who aren't either don't have one-on-one yoga instruction or are not very in tune with their body about what to avoid for a week or two while the spine settles itself.

Um, a lot of times if they're not in those scenarios where they can be managed and recognize what's going on, I'll just take yoga away for a week or two. And again, it's not because I hate yoga. It's just because there's too much variety at the moment. There's too many variables. And so, but we'll put it right back in. I remember there was a gentleman that came in. He was 90% better with his low back. He had seen us. I want to say it was a couple months to get that far. The last 10% was really challenging for us. And so we did corrective exercise and soft tissue work and stretching and foam rolling and all that kind of stuff.

And everything we mentioned on the board so far, we tried to some varying degree and we still couldn't get that last 10%. He took it upon his own decision to go to hot yoga and he went and he came back the next week. He said, I can't believe how much that helped. And so in that scenario, yoga was not only a man, a pain management strategy. It was also activating the support systems because it took some effort and it also patterned some movements for him. I wouldn't say it's a specific amount of load unless you're deconditioned because it's only body weight and it's for a sustained hold, but it is load to some degree.

And so in this situation, yoga was a perfect scenario for him, but for a lot of people in the beginning stages, it's not the first low hanging fruit that we'd pick. As I clean up on this and we start to close, I just want to mention the other things that were on the list that I won't cover. Personal training, heat, ice, medication, nutritional changes in surgery. Just consider what you would think I would say about those. I know that surgery is not the first answer for people and it shouldn't be. By far, there's even things called failed back surgery syndrome, FBSS. There's been a couple of papers on them.

And a lot of times pain can come back. As I mentioned with the podcast we did with Dawne Costantino about a couple months ago, it's not that surgery can't help out with reducing pain, but it doesn't address the other parts of the formula. It doesn't do AP and bloating. And so it's Dawne Costantino brought up a good point. She said, maybe that the surgery did his part. It reduced pain, but it was the person's inadequate recovery process or their inadequate rehabilitation, which brought their pain back. And I said, that's a good point. And I really thought of it that way. So if you guys are on the fence about surgery, just consider it doesn't cover all the parts.

None of these things, none of these treatments cover all the parts. Even the ones that I really liked, like physical therapy, which is a lot of different tools within physical therapy, corrective exercise, which I said, it'll pretty much help for all of the ones. It's not, it doesn't, it doesn't necessarily load the body significantly either. And so it is missing parts of the puzzle. You need an M part, an A, a P and a loading strategy. And usually that'll get you to the returning back into the activities you want to do. So if you don't have a way to manage pain, if you don't have a way to activate the support systems and you don't have a way to pattern movement and then load the body to hit the save button on your progress, you're going to miss out on a lot of easy wins.

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