Failed Lower Back Surgery and How to Recover

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Go check it out. You'll love it. Now onto the podcast. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey everyone, I'm Sebastian, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time, you've missed a lot. You need to go backwards. There's lots of great episodes, topics about low backs and hips and groins and shoulders. And gosh, you name it. We have it on here too.

We release once every two weeks at this point. And this is about a 30, 40 minute show. We have someone on here today. This is Dawne Costantino. Hello, hello. She's going to help us out with the topic that I know that everybody really cares about is failed back surgery and how to recover from it. If you can't at all, because I'm sure this is a hot topic for people. Yeah. Why don't we start with, we're just going to volley this a little bit here. We don't have any pre-planned agenda or anything like that. No questions. I am looking up Dr. Google, by the way, Dawne Costantino. I know you love that. What do you first think about when someone, I guess, hears that they have, that they've had a back surgery and they still have pain? Like, have you seen people like that before? Yeah, I would say, I mean, I was thinking about that before we even started this podcast too, because thinking about things to talk about and whatnot.

And my first thought was when you, because what you see all the time is when people get a surgery and it doesn't change any of their pain. Was the surgery done in the right area? You know, that was my first thought. Maybe we can go through that. Another thing being, oh my gosh, I just had a brain fart. Well, that's the first thing I think about. Did it stink? That would be hilarious if that was a thing. What is that? Did you fart? It was my brain. I wonder how far ahead we are, how close we are to being able to share smells through technology now too. Forget emojis, like that poo emoji is going to go away. It's just like, it's just through the phone. Just share a fart with you via Zoom.

Anyways, that was my first thought. There was something else that popped in my head as I was talking that it kind of went away, but I'm sure it'll come back as we speak. Okay. The first thing, was it the right area? Or maybe it was in the correct area. Maybe there was a temporary change of pain. And then the pain comes back, which then I start to go down the route of thinking, well, we didn't change anything about habits and lifestyle choices and what led you up to the surgery in the first place. So first couple of topics there. Yeah. When I was here of someone, at least debating, like kind of volleying the idea of back surgery, like, I feel like it's really an emotional one. Like they're like, if this doesn't work, then I'm just going to go for the surgery. It's like, it's kind of like a last ditch Hail Mary type of thing. And now I don't, I don't know if it's like, you know, if this doesn't work, I'm going to go back to Nantucket. You know, it's like, you're probably not going to move.

Like you're just going to, like, you're just talking about it. So I don't know if a lot of people actually go through it with it, uh, unless they're really in a lot of pain because they got to, they want to do something to, to reduce their pain and nothing else has really done that. Yeah. Um, I remembered what my brain fart was. Oh, okay. Silent, but deadly. Exactly. Those are the best ones. Um, so the, the thought of, well, maybe we got a surgery based off of an image, right? And we always talk about how, um, imaging is just another data point. So maybe we, we did surgery on something we found on an image and that wasn't your actual pain generator.

So that's another kind of route I think about when somebody fails back surgery. Yeah. Yeah. There's a, I'm sorry. I was reading something too, but I agree with what you said. So if you want to elaborate further, I was reading something. Cause I want to pull up a couple points. What did I just say, Sam? What did you say? You said, yeah, symptom generator. It's probably wasn't it. There you go. Which is a big thing. Like, cause if you, I mean, gosh, we had a, um, I remember seeing this guy, like I was back in, like I was in my internship. And so he was, um, he was, uh, he was a power lifter. He was a lifter. He was a bodybuilder, a power lifter. He was something like he was a strong dude and he was about, I want to say about 50 years old.

And so he came in and he, he wasn't really in for back pain. He's for something. I think he's in for hip pain or something like that. And so, um, he told me a story about his, his back procedure. And he eventually brought in a bunch, a bunch of x-rays to show what his spine looked like at that point. And, uh, I mean, that's the first time I really known anybody that's had a back surgery and like, there was, you know, rods and screws and like, you can see it. Like it was like looking at it. I was thinking, dude, how do you not have any back pain? And he's like, why I don't, you know? So I guess in that scenario, he probably the surgeon or the surgery addressed the symptom generator, right. Because it helped him. Yeah, definitely. I mean, so I had a guy come in the other day who, um, the first thing he handed me was his imaging report and his CD. And he wanted to know if we were going to look at it and had a bunch of questions about it and all that stuff. And, you know, if there's people out there who maybe don't try rehab or try other, you know, conservative care before they get surgery, which is okay. There, I mean, there's, you know, everybody has choices here. Um, but ultimately I, the biggest thing that he thought was very interesting was the fact that what we found that one disc that showed up at L5S1 on his lumbar spine, um, me telling him this may not be the actual pain generator. And if I treat you based off your image, we may be missing something there. Um, he was shocked. He kind of was silent for a second that big. So, um, some people may not realize that that's even a thing. So it's important to kind of go over that. Yeah. Well, even too, I know that the idea of just the idea of seeing like a disc on your, like you've been told like your, your thing is a disc, right? And so sometimes people really hang onto that idea. And over the course of 20 years, they say, I'm not going to bend forward. I might, you know, my spine might explode type of thing. Uh, I know I've had people, there was the gentleman that came in a couple, couple months ago, I think it was. And so just interacting with him initially, he, there's something that he said or did, or like made me kind of think about like, so I just asked him, I said, look, if today your back pain can reduce, but it meant you had to round your back. Are you okay with that? And, uh, he's like, yeah, I'm totally fine with it. You know, why do you ask? And so I just explained myself because it's kind of a long question when I meet someone for, you know, 10 minutes. Um, and lo and behold, at the very end, that actually is what helped him because I mean, his, his image showed that it should be a disc, but it was actually something else. Uh, and I said, remember back in the beginning when we talked about that, this is the reason why I'm asking because not everybody's open to the suggestion. They might think their spinal disc is going to ooze out and explode if they round their back at all. It's like, they think they're super fragile, you know? Yeah. Well, it's interesting that you bring that up. Cause, um, there was somebody the other day, um, I was just giving a hype him in my hypothetical just, Oh, well, you may respond with a disc issue. You may respond better to a little bit of extension. You may have been told to avoid flexion. Maybe that's what helps you in your past with, uh, before surgery or after surgery or whatever it may be. And he goes, let's actually quite the opposite. I actually respond, responded better to rounding than to extension. So based on this and what we're talking about and people listening, it's super important to not just treat what we see on the image. You treat the person in front of you and the symptoms that you see, because if I, you know, based the guy who came in with his image with a very big disc showing up on there, um, treated him with just that and told him, you need to extend, you need to extend and didn't chase his pain or his symptoms or test anything afterwards. He may have been worse when he came back the second time. So when you, when you say chase his pain, what do you mean by that?

So chasing pain using outcome measures. So, um, very basic thing I use all the time is, uh, it hurts when you squat. Maybe when you get past 90, um, that hurts really bad. So we chase that chasing pain means doing something that provokes your pain that maybe you want to get back to and creating a program and some exercises around that. So anytime you respond well to something we do and we go back to that squatting and it reduced your pain, then that's us chasing the pain and, uh, you know, building a program for you. So you're not really concerned of the image of the disc you're chasing what he says. Nope. Only thing on the image I'm concerned of is big, bad, and scary in a, so when we think about categories, big, bad, and scary is, is this disc so big?

It's pressing on spinal cord. It's creating bowel and bladder dysfunction in you. It's creating balance issues. There's a whole list of things. Um, that's what I would want to know. Um, and also big, bad, and scary being maybe there's some tumors or some inflammatory processes going on there. Again, a list of things we can go through, but big, bad, and scary is what we want to know on an image. Um, not necessarily the fact that we see a disc. That's not something that we're like, oh my gosh, this is scary. So, so all this, um, I'm going to ask you a couple, targeted questions just to make sure that like we're kind of chopping because that was a lot of information there. So you're saying a low back disc herniation or another, I know that people have different types of disc injuries like protrusions and prolapse and sequestrations. Are you saying these don't need surgeries?

No, not all of them. Okay. Um, and big, bad, and scary is, do they need surgeries? Oh, that's a good question. Maybe. Um, I would say that's probably, I mean, I would say maybe and not all do some might. It really depends on what it is. And I'd say out of, that maybe is a little bit out of my expertise. Maybe if you know more about that, you could answer that one, but not all of them do. Um, but that's something in a sense that maybe we need, uh, information from a different specialist who knows more about this to tell us, Hey, um, this is okay to treat conservatively or not. I can give an example. So I have the, the, um, lady who's coming in, she's got a lot of things going on, but we found on image that she's myelopathic. So that means that in her history, she's got things that aren't normal. She can't pick things up or hold things very much, uh, difficulty with typing and texting some balance things. And on her image, we found that there's some spinal cord compression going on. Um, and so she was sent out and she came back and based on that specialist, he said, you know, I don't think it's, it's an emergency at this point. I think maybe we can see if it just gets better on its own. So, you know, that's something where you get a second opinion and this guy is really good at what he does. So, you know, not everything needs surgery, even if it is big, bad, and scary. Yeah. I think the big, bad, and scary, at least for me is like, okay, I like they shouldn't be in our office, at least not co-managed, uh, and not being, uh, like someone else needs to take a further look, you know, it's like, like I can do my own plumbing, but at some point it's like, okay, I need someone else that knows a little bit more about plumbing to tell me if this is right or not. You know, uh, maybe an example is an infection. I don't know if that needs a surgery right away, you know, but you probably, they might get, um, some other type of antibiotic type of treatment or they might get something else, you know? So, but there's things, there's a bunch of things that can happen in the spine that can, can create pain. Um, gosh, um, like meningitis is one for neck pain, headaches, right? It's like, you probably don't treat someone with meningitis here. You just refer them out, probably the ER, right? Yeah. Um, surgery, that's like, I mean, I don't know that, uh, the route of how they treat that, but I think there's definitely more like, um, medical, um, like things that are prescribed to you that you take or, you know, things like that. Yeah. The only, the only thing I'd like to add that you were mentioning earlier about chasing pain is that, um, the, a lot of times like people, when they come in, like they'll present, they'll present a lot of information to you and they'll, and they'll tell you what hurts and what doesn't hurt. And a lot of people probably listen to this podcast can probably resonate well with us that as soon as they do stuff like standing or walking around, their back hurts, but they lay down and they feel perfectly normal, you know? And so that's, that's good information. And it means that pain fluctuates and it's transient, it's circumstantial. Uh, and so we can use a good clinician can use pain as a way to reverse engineer your problem almost and, uh, figure out what you should and shouldn't be doing at least for a period of time and create like a customized program for you to follow, give you recommendations of things you can do throughout the day, how to modify things like washing dishes or, you know, sitting in a car and, you know, realistic things that can make your life a lot easier. Um, but if you only look at the image, the image, it does give good information, but it doesn't, it's not a smoking gun a lot of times for a procedure. Um, but there's different types of disc issues that we won't go into necessarily, but herniations are one that is kind of like the oddball. It's like, there's a lot of people that have them that don't need surgeries, but the larger versions might, and that's where we might suggest let's get a better plumber, you know? So, uh, I, so I was, the thing is why I wasn't listening to you for part of the time is cause I was reading this thing. It was a, there was a, a PubMed article. This is from, uh, this is the first thing popped up. So I haven't done a lot of big research on this, but I'm just kind of going with an overview of what are some things that are common threads that are coming up on some of the Dr. Google searches. So one of them was, uh, this was called failed back surgery syndrome, a review article. Interesting. 2018. Yeah. Uh, so I'll just read a couple of line items. So low back pain has been estimated to have a lifetime prevalence of 60, 80% amongst global populations, make it one of the most common health complaints. Approximately 8% of individuals suffering with low back pain will have symptoms that persist, persist longer than three months. As a consequence, a large majority or a large number of these patients with low back pain who have sought treatment a substantial increase will go undergo surgery. Um, uh, though on there and over going, uh, going through surgery between 98 and 2008, uh, lumbar fusion surgeries in the U S increased, uh, like about threefold. And the, the yearly cost of spinal fusion is $16 billion in 2004. Whereas the overall failure rate of the few of the lumbar spine surgery was estimated to be about 10 to 46%. Uh, so that was interesting. Uh, the primary sure, although prime more than 50% of primary surgeries are successful, no more than 30, 15 and 5% of patients experience, uh, patients experience a successful outcome after the second, third and fourth surgery. So they're basically saying the possibility of an improving goes significantly down. Um, but in my book, 50% is not very good in the first place.

That's shocking. That percentage, just getting back surgery, you have a 50% chance of this actually working for you. Yeah. Here's another one. This is a, this is just a, this is an article, but the American society of anesthesiologists estimate 20 to 40% of back surgeries fail. And so, um, patients having repeated back surgeries have a much higher chance of failure. One study found 30% of back surgeries are, uh, second back surgeries are successful. So although these numbers are a little bit all over the place, and I'm sure if you guys do your own research on Dr. Google and Google Scholar, you're going to find that there's, um, there's fallout is why we're doing this podcast. There's fallout. But as Dawne Costantino mentioned before is if you can identify the correct symptom generator, then the surgery rate in theory would go up. Um, like the gentleman I mentioned before, he probably needed it. He had a lot of hardware, but he felt perfectly fine and was perfectly functional. Yeah. Well, I wonder how much that percentage would even go up if you said, um, got, get the right pain symptom or get the right symptom generator number one. And then when surgery is over, pair that with rehab and lifestyle choices as well. Cause not everybody who does surgery actually ends up going to someone afterwards or sticks to it or goes to a good one. Somebody who's going to help you through that afterwards. So, yeah, I'm glad you brought that up. Go ahead.

I want to throw out there really quick. We're not against surgery whatsoever. So we want to make sure that we're not making anybody think that, uh, we're, you know, we're against it. We don't think anybody should get it. That's not true at all. We just, you know, we've just seen a lot out there and failed ones, ones where maybe they were successful and other things came up afterwards. You know, there's tons of things that we could talk about, but we're not against, we're just, there's a lot of information we can go over with it. Oh, totally. And we've heard, we've referred people to, uh, surgeons and other, uh, neurologists and so on. We've referred people. We have like a slew of people who come in that I think Dawne Costantino collects people who require referrals. I don't know what's going on. Um, a chiropractor who's referring to other people. I mean, yeah, she, she, I think half of your day is writing reports to help these people find, uh, a solution with, that is not you.

Right. And it's not because I can't help them in a sense that like, I don't know what to do. It's more just like, this is insane. How many people I have coming in that they should not be seeing me. They should be seeing somebody else. Like a chiropractor will not fix this or a PT will not fix this. This is something that a specialist needs to see. So yeah, that was, that was a crazy couple of months there. Yeah. Uh, here's a, here's a, here's a couple other, um, numbers on here. I'm just kind of pulling out numbers randomly. This is from, uh, uh, failed back surgery syndrome, current perspectives from journal of pain. And, uh, let's see, what is a resume? Uh, J pain res.

Uh, this was from 2016. Uh, this is a quote in another one. This said five to 36% of reoccurring pain, uh, rate of back and leg pain two years after disectomy for disc herniation. Uh, another one says, uh, 29% of patients with same or increased pain to two or sorry, 12 months after surgical laminectomy for lumbar stenosis, secondary to degenerative changes. Uh, let's see. The other ones are a little bit more oddball, but, um, interesting, right? Um, a summary of, Ooh, I like this a summary of factors leading to failed back surgery syndrome. Hmm. I think we should go through this, uh, or at least a little bit, uh, smoking, obesity, litigation, um, depression or anxiety and, uh, past back pain. Greater with foraminal stenosis and disc, disc herniation.

Any of those you want to touch on? Oh, um, sorry. I was, are you, are you Dr. Googling too? By the way? Yeah, I could. So the smoke, the smoking one's interesting to me because I have heard, uh, actually a couple, a couple surgeons say like, I won't even operate on anybody if they're smoking because they're just recovery. It's just not that great. And so that case, uh, that, that makes sense. Obesity. I would imagine because it's, it probably surrounds the idea that there's some type of metabolic recovery disorder like diabetes or something of that nature. Um, I'm not quite sure about depression, anxiety, other than the fact that we can go, uh, psychological route with that a little bit. Same thing probably with the litigation, um, history of back pain. I think that's the one we can probably key up on a little bit more here, at least from what we see in our office.

Which one? Yeah, we'll go down that one. What do you mean by that? So, uh, history of back pain, uh, is like the surgery is helpful to reduce symptom generating structures if that is needed, but it doesn't change how you use your back, how you use your body. Uh, you mentioned earlier, it's like, well, are they going back to the same things that created their pain in the first place? And so, you know, the, usually a history of back pain, if we kind of trace that back a little bit, uh, you can figure out the mechanics or the daily activities, the way they've been treating their back or their body over the years that might have been good clues into rehab the area and prevent the surgery in the first place, possibly.

Yeah, absolutely. I mean, I feel like that should be something that's required. I know you can't force people to do something that they don't want to do, but I mean, even just a simple education afterwards, you know, there's a huge component to education of like, Hey, based on your history, based on what you do for a job, what you do outside of your job, um, even just simple education on, you know, this is maybe these things is what led up to this in the first place. Maybe we can stay away from those things, or maybe we can modify those things and just simple education stuff can be super beneficial for people after surgery and helping them and figuring out what caused it in the first place. Um, but trying to navigate that on your own is kind of hard because then you can, you can create fear avoidance kind of like with your, your disc people who avoid flexion.

There's fear into introducing those things back in. Um, I'm trying to think of like an, like a, um, like an extreme example of somebody doing something crazy that they probably shouldn't ever do again in their life. But I feel like you should have freedom of movement and you should be able to, to slowly introduce things back in that maybe brought you here in the first place and showing you how to do it better. Um, maybe you can help me with like an extreme example. I don't know. Um, maybe, well, I mean, I, I always tell people it's, it's their choice obviously, but, um, I, I had someone who they came in, they've come in on and off for the last couple years and they improve. They do have back stuff and hip stuff and knee stuff that just kind of comes and goes.

And then, you know, there's periods of six months where they feel great. And then they're like, and finally they emailed me and they said, uh, so I really want to figure out why this keeps happening. And like, what's wrong with me? Should I, you know, should I stop doing what I'm doing? Um, her, her, her activity of choice is a lot. I mean, a lot of, of weightlifting, Olympic lifting, and I'm not blaming anything about, you know, the Olympic lifts or weightlifting, but this is what you're choosing. Like, like at least from a rehabilitative relative rehabilitative perspective. Um, if we're going to build strength with somebody or, or what you program and what you add to a rehabilitation program is based upon what the person's goals are. And so if this individual wanted to go back to playing, you know, rec league soccer, um, playing volleyball, running, uh, weightlifting two days a week versus, you know, 15 doing doubles and stuff like, so there's, we, we have to get a little bit higher. Like the way I explained it to her was like, so there was a movie Ford vs. Ferrari. I don't know if you ever saw it done.

I didn't. You were missing out. It is fantastic. I wanted to see it. I will now. It was one of the few movies that I paid for, uh, uh, when like you pay for it at home, it's like, okay, I'm going to, I'm going to see this. And, and so, uh, the, the, the basics of the story is, is, uh, Ford one, but they created a car that was so fine tuned, uh, that it was winning already. And so towards the end, there was the last lap that the, um, I don't remember if he made it. Uh, I think he made the car. So he kind of knew the inner workings of the car, but he optimized everything. He's he was going to win the race already. And he said, screw it. I'm going to red line the shit out of this thing. And so he just took it like well beyond what it was supposed to do or what it could do based upon the red line. And he finished the race. He made the fastest lap of all the laps, but he didn't need to, but to be able to red line things like that, like with your car, with your body, you kind of need to be optimized. I would imagine. And there, there's, it carries an inherent risk like it did with him in the car. And so if you're, if you're choosing to do 15 Olympic lifting sessions a week, you're kind of redlining. So this is totally your choice. And so when you bring up the extreme things of like, it's, it's kind of extreme, it's a lot, you know, like three, four or five days, generally it's not going to red line quite as much as that many. Right. Yeah, absolutely. So basically like you're pro athletes, there's just, there's risks to being a pro athlete or there's risks to working out 15 times a week. And if that's something that you want to do, maybe there's something that we can do to give you a higher threshold to tolerate that stuff. But you, at some point you're asking too much of your body. So there, there's definitely extreme examples. And that's where that education piece comes in. Like, Hey, you're probably going to be seeing me more often because this is something that you're willing to risk your, your body for. Um, but that's not the case with most people, you know what I mean? And so there's always just those education aspects of, of, uh, you can do these things again, you can work out three to five days a week. You know, your pain does not have to stop you from doing this altogether. So. Yeah. Yeah.

There's, um, uh, I know that with the race cars, don't they change the tires like four or five times a race? Like, I'm pretty sure I can go about a year and a half without changing my tires. If I just drove my forerunner the way I do, you know, so it's, it's, it is totally your choice in the programming and the care for the vehicle in this case is dependent upon what you're asking of it and what your, what your goals are. Um, and if it makes you happy to do, um, do that, that's fine. But if you are just comfortable being a really cool average, uh, and I say average above average human being, that you just have a happy life and you move well and feel well and look good, like you don't need to do so much, you know, you won't, it won't require quite as much.

I like your car analogy. That's probably one of my favorite analogies of yours. I actually understood that one. Oh, Oh, stop it. Well, some of your analogies, I'm like, where are you going with this? I don't think I get the connection here. It's only because I stole it from someone else's existing storyline. Um, so probably what we should cover too, uh, is, so this topic is obviously the whole podcast is based upon, you know, failed back surgeries and can you recover from it? So I guess we should cross that bridge here pretty soon because we're going to end up closing at some point here. Uh, in your opinion, do you feel someone can recover from, uh, at least in the case of, we're talking about those preoperative factors of you had back pain before multiple times and you got the back surgery cause it kept coming back. Do you think you can, most people can get better after that? I would say yes. I mean, I don't, I can't think of any reason in my head that I would say no. So I'm going to say yes. Um, I go, I go to, my mind goes all over the place. I'm thinking about what I want to say in this one, but I'm thinking about Ford versus Ferrari and how you're going to make this analogy even better.

No, there's no way you did a great job. Um, ultimately I just think to myself, I would want to know, like say, say someone came in, I haven't seen them before their surgery. They got their surgery done. A good amount of time has gone by and their pain is still there. And now they're in our office. I want to know what they did before. What did you do before your surgery? Um, and there's, you know, there's a bunch of categories you can put them in of the people who maybe didn't try very much. You know, we just kind of diddly daddly here and there and they wanted the surgery. So they just kind of waited it out and did what they needed to do to be approved for it. And now they got their surgery and now they're not feeling better. So those types of people would probably do really well in our office. Cause now we can dabble in, Hey, maybe some, you know, the type of rehab that we give and the type of programming that we do, um, could probably work really well for them.

Then there's those that maybe did try. I mean, we see these in our office all the time to the people who I've tried everything. Um, and it's like, well, maybe you just haven't tried us yet. So I think about, I feel like I'm just advertising us now and I'm not trying to, but Yeah. You just sound like a snob right now. Cause I'm wondering, I'm listening. I'm like, what, what do you do? That's so different. Besides talk about Ford versus Ferrari and stuff. If I didn't say it, you would say it at some point in this. So I'm saying it for you. Probably. I've always said Dawne Costantino has a nice way of saying screw you, but it doesn't sound bad, you know? So it probably didn't sound self-promoting at that moment anyways.

Yep. Yep. But I mean, you can just take a list of things. What have you tried and let's, let's do the things that you haven't tried or give me the list of things that you've done. And I can probably show you and educate you the things that you haven't done yet. Um, but yeah, I don't know. That's where my mind's going with this. I think that anybody who walks in after surgery and they're not better, um, I'm maybe at that point, I want to see your image before and after. Um, and you know, let's just try some things and see what goes from there. Yeah. I always like to see that number one, has your surgeon cleared them to do stuff?

You know, are they like, it's almost like, uh, I mean, I've never been pregnant, but at some point, like your OBG at YN says, okay, you're good. You know, even though you're like, I'm not good. And they're like, no, you don't need to come back type of thing. You know, like, cause there's nothing, nothing really, really bad. It's just don't feel great yet. You know? And so, uh, surgeons at some point after the procedure, they'll say the same thing. And you've probably gone through rehabilitation maybe hopefully. Um, but I'm, I think the same way you do with it. Um, try to organize what they've tried, what's worked and what hasn't worked. Um, obviously the things that haven't worked, we need to figure out if they were done well. Number one, if they weren't done well or done often enough, we might revisit that. Um, or we just don't use it at all. Uh, a good example of that possibly is like, we've heard people say, ah, I've tried rehab. What'd you do?

Oh, I just did a, I did a glute bridge like three times a day for two weeks. He's like, well, that's, it's not really enough, you know? So the dosage is wrong. Um, we watch them do it. It's, it's a poor, it's poor form or poor intensity or whatever it is. In that case, we might deem, well, I think we give it a shot again. You know, it's, it's a really reasonable way to go. Um, but if you've tried things like a bunch of stretching and, um, muscle stem and massage and ice and heat and so on, it just means you've done a lot of passive care, which there's nothing wrong with reducing pain with passive care, but it doesn't change how you're using your body either. It doesn't change support systems. It doesn't change movement patterns and do any of that stuff. And so we might then take more of the other approach on the flip side.

Sometimes people have never even tried like just tissue work rounding their back. Like they haven't tried any of that stuff. So there's so many different avenues we could take or a good clinician could take, a good coach could take just to show you what to do. It's just, um, but, uh, I remember that book that we both read Dawne Costantino, the medical exercise specialist. Did you get to the, do you remember the part about cardiology where it said that I think there was, it was in the gray area. It said that I want to say, I want to say the number is ridiculous. It was like, it was like, after having heart surgery under like 10% of people ever did cardiac rehab. I was like, I was like, you gotta be kidding me. Like it was so bloody low, you know? And, um, it was so bloody low. It was so bloody low. It was so low, you know, and I'm going to, I think low back is probably the same. It's going to be so low. Oh, bloody low.

Absolutely. My mind's kind of going in a, in a way of two, maybe we don't, not everybody is considered failed back surgery too. Cause there's people, I mean, I can think of a few of people on my schedule right now that have had fusions and I'm not just talking about fusions here, but these ones specifically are fusions and they had a really good amount of time that they were actually pain-free. And then at some point their pain started to come back. Um, maybe it's not the same type of back pain. Maybe it's not the same area, things like that. Um, with me specifically, what I see with fusion people is it's those that the areas that weren't fused that start to get, they don't start to find a little bit more movement through them. And those ones end up becoming the pain generators after a time of being pain-free. Um, so maybe not everybody listening to this. If there's a time in your, after surgery that you were pain-free, I wouldn't call that a failed back surgery. Um, there's just different types of modifications that you need to think about afterwards to help you move a little bit better, to help you become more informed about, you know, what's happening in your spine once you've been fused or discectomy or whatever it may be.

Yeah, that's a good point. Uh, I'm glad you brought that up. So going back to that number that five to 36% of reoccurring rate of leg and back pain two years after discectomy for a disc herniation, perhaps at that point, the surgery did address the disc herniation, but there's other reasons for leg pain, like, uh, um, I call it like a primary radiculopathy. It's like the nerve root is just impinged. And so that can happen. Um, if your body is trying to get away from something, like Dawne Costantino said, it's like the, uh, let's just say, uh, this is discectomy is an effusion, but let's just say it was fused the other around, uh, other areas around it. We'll start to move a little bit more to help out with general movement compensation. Um, but yeah, so that is a really good point. I wouldn't, I wouldn't say that it's a failed surgery. Most of the time I'd say it's a failed recovery. Yeah, absolutely. Do you think it's important at all to go through like different areas, maybe for people who aren't super familiar with the anatomy of the spine, like different areas that could be pain generators just so they, they know based off of their surgery, would you say that's kind of off topic? Um, let's, uh, let's, I'll let you lead that conversation a little bit. We'll see if it, if it goes too far because it can be, well, actually before we go too far, um, let's, can we, can we line on them a couple of things that generally work for people in this situation? Just some simple exercises, a simple, like, let's just say a simple treatment plan. What does it look like?

How many days a week they should be doing stuff? How many hours that should take during the day? And so on, like, what are some general things so they're not leaving this podcast thinking, well, they just talked about how cool they were and then Ford and Ferrari and so on. So what do you think? Yeah, absolutely. Um, so I would say for timeline of things, mainly when pain levels are maybe at their highest or, um, when it said it's the kind of biggest consistency, things like that in the beginning phases of healing when there's pain involved and it's, um, it's pretty much taken over a lot of your life. Um, we ask you to do things kind of throughout the day and that sounds a little overwhelming. People sometimes look at us like we're crazy when we ask them to do something hourly.

Um, but the hourly thing, I've been using the bank account analogy a lot and I think that that would be helpful in this moment. How many things are you doing that deposit into your bank account throughout the day that make you feel better? And then how much are you doing that withdrawal from your bank account that make you feel worse? So the reason we dose out high volume in the very beginning is because we need you to deposit a little bit more because you've been in the negative for quite some time now. So we start to build up that nice little money cushion there. Um, so in the beginning phases, maybe we ask you to do things hourly to just keep depositing, but we slowly tailor that back. It shouldn't take up your whole life forever. Um, and some things like specifically that pop into my head, especially after surgery, people love, um, or at least people I've seen have responded really well to like self decompression, not a passive version, but an active version. So like learning to breathe into the diaphragm and around 360 around the spine works really well for some people. It creates an active decompression of the spine. Um, and then maybe a more active version of that is, um, some ways to coordinate those movements, like, um, learning to activate the front wall kind of in the, you know, the six pack area, the side walls, like your obliques, the back walls, kind of like your, your glute bridges or some form of glutes, things to just help build up the 360 support around the spines. Really nice. We should probably mention too. These are people who have been, we see that have been cleared, right? Yes. Okay. These aren't post-op people. Yeah. Yeah. Um, that's actually a good point. Yeah. So, um, start you there, but as quickly as possible, we want to get you into a route of things look more functional. So, um, being able to get up and out of a chair safely for you, being able to pick things up off the floor or carry things. So we need to go over modifications of squatting and hinging and carrying like that to help you become educated and, um, know what areas should be working well, uh, in those movements because you do those all throughout the day. Um, is that what you were asking you said? Yeah. Just, just giving them a basic idea, you know, cause it sounds like you're doing, um, some things that make you feel good for the first few weeks and, you know, and then after that you're doing some core stuff and some hip stuff and, you know, like stuff, you know, but challenging stuff. Uh, I like to have people walk, um, or do find some activity they like to do that doesn't hurt. And then my chains for everybody, some people like to garden, some people like to, um, go swim and it's just whatever you like to do. If they don't like to do it, they're not going to do it. Um, so something to at least get them moving, you know?

Uh, the, the only other thing I'd probably address on this too, is that, uh, I think Dawne Costantino had already said, it's not really easy to do on your own. It's really not. Um, there are, there are some psychological aspects associated with having pain and especially ongoing pain and failed procedures or whatever you want to call it. Um, most of the time it requires someone just, uh, someone reassuring you it's okay to do that. You know, like, are you sure this is okay to do this bridge for my back? Well, yeah, we tested you out. Things look good. And yeah, let's just try it and see, does it hurt? No, it doesn't. Well, let's do a couple more, you know? So the reassurance is more valuable than the exercises, quite honestly, because people scare themselves out of doing things and rightly so they've had a lot of pain in their past. And so you need to have, like, if you're avoiding doing things or have some hesitation because you feel like it's not good for you, you need to be working with somebody, you know, two, three days a week. And we sometimes, you know, they, you need to be doing things, uh, and doing the right things for you. Yeah, that's a good point. I mean, I had someone the other day, she's a knee, knee pain, but I think it's a good story to bring in what you just said. Um, she had knee pain and she was just avoiding all of these things. She lived in a, in a place that had stairs. And, uh, when she first had her knee pain, stairs was really provoking for her.

She stopped Pilates, even though that was something that she loved and it used to help her in the past. And so when she came in and we did her exam and I gave her an idea of what was going on and what's safe for her and some things to stay away from, we went outside and we walked upstairs and she's like, we haven't done anything. Why is it that I'm not having pain on the stairs anymore? She was shocked. So it's that reassurance factor is huge. I mean, exactly what you're saying. It's, it's really important for you to like, for most people to just know, like, Hey, you're not hurting yourself doing these things. This is okay. Maybe we can modify it for the time being, but, um, you, at some point you're going to have to do them again. And then going back to what you were saying before that, um, so, or something you were, you, sorry, pain in a way gets you to move in interesting ways that you may not know about. And so say, for example, the list of things I said, like glute bridges and core work in breathing and squatting, I'm already doing that. Like they're not giving me any new information you may not doing. You may not, may not be doing it right for you though. So I've had a lot of people come in where if I took a video of them deadlifting, most people on the internet could look at it and be like, that looks like a great, like great form, but it was painful for her. And so we did a, like a simple little tweak and now it wasn't painful for her anymore. Most people don't know how to find those tweaks or how to find those cues on their own. So it's important to find the right way to deadlift for you, the right way to squat for you.

And you need someone to look at you to be able to, to help you through that. Yeah, I totally agree. There's, um, there's a big value in, in, in having someone that knows how to guide you and coach you well. Um, I've always said it over and over again, I can try to do my taxes, but there's a fine line in there somewhere, you know, like there's like someone telling you that's okay to do. Oh, you need to get a different credit card for that. Or you need to whatever, keep your receipts, you know, like these are all important steps. Um, and I would imagine that most people that have had a back procedure and there's a period of time where they feel pretty good. Um, they're probably, they can recover. I would agree with you. Um, I can't imagine. Oh, there's a dog back there. Yeah. Sorry. It's his toenails. Okay. Um, yeah, we're not in the same room.

So yeah, I would imagine they could get better. I don't see any reason why they can't. Um, but I would imagine though, that there's a lot of hesitation that people have. They feel like they've tried everything. Um, things aren't getting better and it's just, there's a lot of other aspects. Yeah. You go away, dog. So anyways, did, um, you were mentioning earlier about like things that might change. I think we can cover that for a couple minutes here and then we'll close up. Um, the, the symptoms that might change. Is that where you're going to, you were going to cover? Yeah. Well, I don't even know if, I mean, we could go over it and in my mind, I have a specific person. Mary Lou was one of her people that she was working with that, um, she had, it's knee pain, but this will come back into what we're talking about. It's knee pain and she had surgery for her knee pain and then pain was still there afterwards. And she ended up finding out that pain was referring from her spine. And so pain generator was not correct in that one. That was based off of an image.

She needed a knee replacement, got the knee replacement. Pain is still there. Treated the low back and now she's feeling better. So, um, you know, when there's a surgery done to a specific area and it's not feeling like it's, it's, uh, helping you at all. I think it's important for people who maybe have gone through it to know maybe some other areas that could be contributing to it. Um, so I mean, there's the disc that's a pain generator, right? There is the joints in the spine called the facets, the facets. I think some people call them facets. He always makes fun of me, the facets. Um, and those ones, like if you guys were to extend backwards in your spine, trying to like do a back bend, they, they prevent a lot of that motion. So those ones can be provoking for some people. Um, and then there is also nerve root pain as well. So say you got a discectomy and it's, and it's, you know, it's still painful for you. Did any of these, were any of these other areas mentioned to you? Um, have you been treated for any of these other areas? And if anybody doesn't know this already, there is, there's diagnostic, um, things that you can do beforehand too, to see if it's the right area that they're going to be, um, doing surgery on. Like you can do a medial branch block to see if it's the facet. And if that changes your pain, you know, it's that, um, I don't know if they do that for other areas of the spine too, but there's some diagnostic stuff you can know beforehand that you can ask your surgeon about to see if that's a possibility for you before you decide to make that decision. Yeah. I do have one thing on that is that, so I call it the identifying the symptom generator game. And so, but people tend to look at the injections and things like that as, as different tools. They, they kind of use it for a different purpose. And so I've had, I've had patients come in that have said, uh, so they injected the facet, my pain went away, but it came back. And then a couple of days that didn't work. I said, what do you, what do you mean? It didn't work. And they said, well, it came back. I said, yeah, but it, like they, they hit the spot, right?

Yeah. And it made you feel better, right? Yeah. So that's probably the symptom generator. It's just the way you're moving keeps pissing it off and you know, your movement compensate, like this is how you probably got in this situation in the first place. So whether you decide to actually decrease the symptom by addressing the facet or change your movement or change your, um, strength or stability or endurance, whatever, um, it'll probably continue, but it does help with identification of what the symptom generator is. So there's nothing wrong with that. Right. I mean, so I agree with you. I think that's, that's just where that education piece comes in for people. Just know that this isn't treatment. This is just diagnostic purposes. Yep. Yep. Uh, anything else you want to add before we start to close any gems that you saved to the very end? I can tell you got real worked up cause you took that third jacket off. Uh, I can't think of anything off the top of my head. Um, any gems or anything? I think that was pretty good, but ultimately I think to myself, I know in the end of these podcasts, you always ask, how can we help people? Right. So if you want me to get into that, I can, but I'll leave it for you to see if you have any gems left first. Uh, I think the only gem I would say is, you know, like, don't beat yourself up. Like there's help out there if you want it, like ask someone for help. Um, and if you're finding that someone that you're working with, isn't giving you the attention that you're wanting, isn't listening to what you're talking about, isn't getting the results you're looking for, just no harm, no foul. I think you should all communicate with that person and say, look, this thing, this isn't working for me. And here's the reasons why. Um, I've know that I've met a lot of clients that they like, I've told them on day one, cause I can see on the list, it's like doctor number 15, you know, it's like, and so I tell them, look, you owe it to yourself to keep someone in your life as a game, as a quarterback, no matter if you decide to come work with us or work with someone else. It doesn't matter if you cancel your next appointment, you need to call us or email us and just tell us that way we can give you some feedback. That's it. And I've met a lot of people that they don't do that, you know? And so you need to have someone help you because every single person that picks up your book, that is your back pain and your recovery is starting from page one. And so it'd be nice if, if everybody can kind of get through a little bit before you kind of decide that it's a, it's a bad book. Right. So it's just my only word of advice. Very well said. And if you failed back surgery, it does not mean that you can't be helped. So just keep that in mind. That doesn't mean that this is going to be the rest of your life. Um, have some patients, keep searching, give someone enough time to say whether or not they can or can't help you and go from there. But I don't think anybody at any point in their life should think that they're just helpless. There's help out there for you.

Just keep searching. Yep. So if people were to look for us, Dawne Costantino, where would they look? Okay. So ultimately, I mean, are we comfortable working with people who have failed back surgeries? I'd say if you're cleared to do some exercise, heck yeah, we can. So, um, you can reach out to us. I think email is always the best if you'd like to, um, emailing, we can, we can respond to you really well. We got a YouTube page. If you don't already know that, check it out. There's tons of things that you can go through on there. Um, and, and phone calls. I mean, if you guys just have questions, want to know if we're the right one for you, or maybe somewhere else that you should try, uh, we're happy to kind of help you help you seek through all of this information. So reach out.

Please reach out. A phone call doesn't cost anything. So, uh, yeah. So if you guys want to listen to more podcasts, we have more coming. Uh, I did a bunch of, uh, line items here of what some other topics are coming. Uh, so let me just see what we have up in the queue here coming. Uh, I know that there, me and Dawne Costantino are going to talk about, um, uh, anterior, posterior pelvic tilt. And is it bad? Cause everyone thinks it's bad. I know this is going to be perfect posture. One could it be creating your pain as well as spinal stenosis treatments, uh, non-circle surgical treatments that work. So we're going to focus on the hips and lower back for a little bit here. And if you didn't listen to the past podcast, there's ones on lower back diagnosis, understanding it, lower, uh, understanding hip groin pain diagnosis. Should I stretch or strengthen my low back?

Why does my below back keep getting crooked? What is my back only come back pain only come in the morning and so on. So there's going to be a lot of back and hip and kind of that region stuff that you should definitely listen to. Um, and we try to be non-biased with the stuff that we're talking about, but obviously we have things that we've found that works and hasn't worked and so on. So we're just going to try to be as brutally honest with you guys as we can and just listen to the podcast. You'll love it. So thanks for being part of the movement movement. You can reach out to us to info at p2sportscare.com. And there's always a link in the description of the podcast. Say bye, Dawne Costantino. Bye.