Fear of bending forward after a healed disc herniation

And so when I eventually started squatting deep, even without weight, just as a movement, my back felt way better. It was crazy. So that yellow I had avoided for a while was, I think, the thing driving my problem. And so I want to make sure that your program is well-rounded so you don't have a different type of problem come along the lines. 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 Dr. Sebastian Gonzales, your host with the Restoring Human Movement podcast.

Thanks for joining the Movement Movement. If this is your first time, welcome. You are way behind. We are way into about the 100 and probably 70s now. And so I do encourage you, if you're a clinician, especially to go back in the archives, I've learned a lot over those, over the years of actually doing podcasting. And I want you to follow along the journey with me to help improve yourself as well as improve your patient outcomes so we can just get better as a profession. I had someone recently, it was Jesse. Jesse Macedo said, he said, you know, the cool thing of how to improve a profession is to share what we know as, let's say, seasoned clinicians with the younger group.

And so they can then capitalize on that and then become way better than we were. So I'm hoping that everybody is doing that and learning from the podcast as we go along here. So the format of this podcast is conversational, and the whole point is to improve clinician communication as well as patient outcome. Think of it as in common terms, like we're going to go to a bar, and I decided to get a Mongo from Port. You decided to get, you as a clinician decided to get a martini. And we have a friend there who is a, he works in a machine shop today. The machine shop technician decided to get a water because he's our DT. What a responsible guy. We're just having a conversation about healthcare related stuff and how to overcome certain types of injuries.

Now, in the archives, there is a lot of great things. I've interviewed Stuart McGill. I've done Michael Shacklock and Brett Winchester and Richard Ulm and Cody DMACC and a bunch of people. And there's also some great episodes in there which are, they're more patient friendly. This podcast first started as kind of a patient educational tool, but I started to get, I don't want to say bored with the topics, but I just, I kind of wanted a little bit more. I wanted to learn some more. So it became naturally a little bit more of what I was interested in versus just only disseminating information. And so there are some great ones like the one today, which is a good tool to send your patients so they understand where things are going in their care. And so today's is going to be based upon the patients with lower back pain who are more fearful and they have a lot of extension or arching tendencies. And so part of their problem, uh, ongoing problem might be due to the fact because is that their avoidance of certain activities, they're fearful of bending forward. They've had a past disc herniation, which has been resolved, but now they have a different type of back pain. They're just really struggling with. And so this is a audio that I decided to make for my patients who have this.

Hopefully you'll resonate with the same type of message so they can, as they can understand, um, that we're on the same team, that we're communicating that I've examined and checked out all of the big, bad, scary things. And that I, I, I'm deeming the care that they have here as, as very well, we're very well-rounded, low risk, high reward, and try to get them to their goal, uh, or whatever that might be, um, and what the steps are in play. And so, um, hopefully this is something helpful to those patients. Now, as every podcast, um, of mine, anyways, I try to start with a little bit about myself with short story format. So you understand, uh, who your host is and hopefully like me. Uh, so you follow along with me. I mean, I don't like watching Oprah, but I certainly do watch, um, Mary with Children. So I just like Al Bundy better than Oprah. Nothing wrong with Oprah. I just resonate better. So I want to hope, hopefully you resonate well with me and that you become part of the movement and we can get going on improving the profession together. Let's do that, um, little short story here and we'll get right into the audio.

Now, recently I purchased a boat and if you've been listening to the podcast, you'll realize I do like boating and that we had an RIP Glastron Mercury around, uh, December, November of 2019. Sad thing is it, it, um, went for auction on eBay. I didn't realize. And so we donated it. And so it ended up getting sold for $98. Sad. And so, um, got a video of it driving away and so on. So this is the start of a new era. And so I've been looking for a boat, nothing fancy, just something that is, you know, that I can fit, you know, more than four people on this time because that last one was 15 foot or it was tiny. Um, 18 feet, I think is something pretty solid. And I ended up finding something and I got it, got it for a good price and got it from a good person. And so I've been through figuring out who to buy from because I've been instructed, be confident with the person you're buying from because they might screw you. And so we went and visited quite a few people. And then finally we encountered this guy who had an amazing looking boat at a good price. And so, um, after investigating it for a little bit, I asked him about him and we met, we started talking about Boy Scouts and lo and behold, he's an Eagle Scout. And I said, I'm an Eagle Scout. And he turned around and shook hands. And I was like, wow, that's, that's rare. It's rare now. You don't find many Eagle Scouts. And knowing what, I guess what we probably know as the unspoken rule of Eagle Scouts is you don't screw each other. You don't screw people. You're just an honest person, hopefully. And the scout law was kind of, um, uh, around that, you know, it just, hopefully I know it could be wrong.

The stereotyping Boy Scouts could be bad. Eagle Scouts could be bad people, but either way, um, I'm going to stereotype and say this guy was a good guy. So we ended up doing the deal and I felt so much better about it knowing that he was an Eagle Scout. So I'm going to be biased and say, buy all your boats from Eagle Scouts. So, um, I haven't found a problem with the boat yet and he know it found a good home. So let's get onto the podcast and get in there. So recently I became an uncle and, um, it's a uncle of, I guess, twins. So my sister had some twins and so I started helping to babysit her, her husband and went back to work. And so it's kind of challenging to do twins.

Apparently it's harder than doing a single baby. And so all the things that you can do with a single baby, such as put them down and walk away, um, all of a sudden there's a second baby who kind of wants your attention here sometimes. So, uh, I've been going over to, to help, help her out and, uh, help out with the babies. And so I started learning something there is that, uh, capital letters when typing while holding a baby are really hard. And so I started responding people to people via email from my computer. And then, so I realized I would have to hit shift and then the, the letter to get it. So it's a uppercase letter. And so I started thinking, well, I can't, I can't respond professionally to some people. I can just respond quickly to others, but there should be a general understanding that people can't, uh, if they have a baby in their hand, they should not be expected to follow the same grammar rules as everybody else.

So I'm going to say that, um, capital letters should be off the list, um, as well as, um, anything that relate, uh, that requires a shift button to be hit. So think about that. Uh, next time you get an email from someone who does not have capital letters. Now onto the show. Hey, I'm Dr. Sebastian Gonzales. And you're, if you're listening to this audio, it's because I've either sent it to you, my office has sent it to you, or you've already seen me in person, or you've asked me for this type of information. And the reason why I wanted to make this today actually is for, there's certain situations where, um, the communication between doctor and patient are, have to be a little bit more clear and the situation that you're in, or at least the, based upon the examination I did on you is the, the situation has to be a little bit more clear. We have to have good communication because for your type of back pain, at least what I found with the exam is that part of your, part of your condition is there's, there's some fearfulness and hesitation. Okay. And I want to make sure that I'm treading lightly on, on the idea of fearfulness on this, because first off, I just want to let you know that, that I'm not saying this is your fault. I'm not saying this is your, um, knowingly that you've, you've done this. And, um, I've actually had this type of back pain as well, where I thought that what I was doing was going to be helpful, but in fact, it was actually creating more of a problem. So with the examination, what we, what we kind of went through on this is that, um, you've had a past, uh, disc herniation or a past active one is what I like to call it. Uh, active disc herniations are ones that the ones that you're familiar with, the ones where you're on, on the ground for a couple of days, or the ones where you, you can't bend for because there's a stab in the spine and it even could shoot down your leg.

Now, um, I've had that as well. And so I've had a, just a smaller herniation, a two millimeter. You might have a different size one. Uh, it's okay. Um, my, my girlfriend's had a, a larger one as well. But, um, one thing you got to understand is that the body will heal itself. Okay. The body's pretty resilient. Just like when you have a cut on your hand, it will heal itself. Uh, and it typically does on most people. However, there are situations where we're not really making it easy for our body to do some of the healing. Um, and part of the medication that we've once gave it for healing no longer is a helpful medication. So within the examination, what I typically look for is I rule out all the big, bad, scary things. Um, and I also rule out things that you might be concerned of. And so usually in the exam, I'll tell people that, and by the way, I'm apologize if this is repeat, but I want to make sure that I do cover all basis on this for you because, um, this is going to be a little bit more of a long game. Uh, and I want to make sure that, that, that you know that I've covered a lot of the basis. So I've looked for active disc herniations. I've looked for nerve impingement. I've looked for a facet impingement or, um, compression of the joints in the back of the spine. Um, I've looked for SI joint strains and sprains. I've looked for muscle spasms and piriform syndrome and tight hip flexors. I've looked for all that stuff and I've looked for hip impingement as well. And so going through that, part of the major thing I want to relate to you is that, uh, if you're hearing this audio, it's because I've found that your disc is really not seemingly the driver of the condition or what you're feeling. And so usually in the examination process, I'll cluster information together and think of it kind of like we're just creating, um, we're claiming, we're creating, uh, data points or plots. And so say there's four possible diagnosis or probable ones and say one is a disc herniation, an active one, then there's a pinched nerve and then there's, um, SI joint sprain and then there's hip impingement or whatever we want to say is in that cluster.

And so most of the information that we're gathering might not land in the cluster of the disc herniation. And that's kind of what, if you're hearing this audio, that's, that's what I've found is that the disc once was active and no longer is active. And so by bending forward and rounding your spine a little bit progressively, we're not going to necessarily make the disc explode. Okay. And so yes, rounding can provoke a problem when a disc is active. However, if the disc is not active currently, rounding is a normal human movement. Now there's going to be a situation where, um, I want to make sure that I'm clear on this is that when I, when I ask you to round your back some, or when we start implementing a little bit of a round, I don't like to tend to have people do it in two ways.

I don't necessarily like to have them do it in a, in a sloppy posture seated, like non-active position. And I really don't like them to do it, um, with weight on their back. And so typically when we're going, we're talking about weight training, because some of you might have hurt yourself with squatting or deadlifting and you had poor form quote unquote, and you end up having, um, this disc herniation that first started and then it became settled is that you probably had a little bit of a round in your back and the weight was there. Now, if you've noticed me walk around the office and help you through this stuff is I'll squat down and I'll round my back. Um, and so I'm rounding with really just body weight, um, or just normal daily human movements. You can actually round it with, you know, say we pick up a kettlebell, um, like a 25 pound one or so, like it's okay to round it a little bit. And if you look around at most people throughout life, they can, they can round their back and they really have no major problem. Now there is a situation again, where the disc was once active, where rounding might be the thing that is driving the problem. In this case, if I did the exam and I found that rounding the spine created that stabbing type of thing, then I would probably take rounding away for about a week. And I might give you, um, some arching exercises to do, which help the disc nice, uh, settle and scar up and feel nice and happy. However, if I found that that's not really a thing, I'm not going to necessarily take rounding away from you. Okay. Rounding can actually be very therapeutic, um, based upon the type of back pain you have. And in this case, I think the back pain that you have is something where we have to add a little bit of rounding. We're going to do this in a nice safe way. Okay. Again, I want you to understand this is completely normal. Okay. I've had a herniation as well. I've actually had two. I've had one at 15, one at 35. And, um, I didn't want to round my back just because it was seemingly, seemingly was like, um, uh, yeah, it's, it's, it's kind of like upper, I'm apprehensive about it. Um, and actually extending and arching my back was actually driving more of my problem. And so it's a normal thing. It's very hard to deal with on your own. Um, I try to be honest with people when they come in about it is that I want to give you the benefit of the doubt and say that you can do all of this on your own, but when there's fearfulness or avoidance of certain movements in play, I don't think you should. And I, I paid or I offered to pay one of my friends to work with me. He did it for free. Luckily, luckily, um, he worked with me for about a month or so on and off, just helping me guide me through what to do next. And then to be able to actually get my body strong again and not feel like my back is weak and fragile all the time.

I, I hired a strength coach to come in twice a week for about, I think it was two to three months. So I did what I'm telling you to do. And I'm telling you, you, you need guidance with this and you need some one-on-one or, or two-on-one or some direct attention just to make sure that, that you feel comfortable adding these things in because it could be very menacing. And, and, and again, I, I, I know most people can handle a sprained ankle on their own. They can just, you know, uh, stay off of it and limp it off and so on. But when it comes to these, uh, I try to be very clear with people who come in is that we're on the same team and we're communicating. Okay. We, we should communicate. All right. If you feel by any, it, it, say we, you, you come in this, come in the second time. And then after the third time, you're like, I don't like the way you smell, you know, I'm just going to leave or, Hey, that thing we did, it, it scared me a little bit. And it made me feel like maybe I was getting that I'm going to get worse. You need to call an email or email me because it's very, it's very easy to jump ship.

Um, but to be honest with you, the more people you go to and the more failures that you have with this, if you have failures, uh, the harder it gets for you to recover. Okay. And the, the less time you spend with someone, including not just including myself, but whoever it might be that you select to work with you is that you don't give them a chance to learn. Um, usually when people come in the first time, I've, I'm, I'm testing to see where we're kind of at now today, not necessarily where you're at with the active disc, but where we're at today. And so when I figure out where we're at today, I'm, I'm making a judgment call based upon a high reward, low risk type of assumption. And I want to see what that does. I want to see if it makes you feel better. And so when you come in the second time, I'm basically figuring out where we're at again. Okay. And so by figuring this out, you're helping me learn your owner's manual. Basically you have an owner's manual. I haven't read it yet. I'm only getting parts of it every time you come in. So the more that you come in, um, and help, let me help you through this and communicate with me, the better I'm going to understand what's going on with you and how to help you. Now I want to be, I want to be clear about this again, is that the kind of avoidance of movement and, uh, the not wanting to bend forward or touch your toes around your back.

It's just typically a subconscious thing for a lot of people. Um, sometimes I'll ask people in an exam to how far can you, can you bend forward? And they say, Nope, don't want to do it, you know, or they flatten their back a lot. This is what, what I kind of call the elephant in the room. Uh, so this happens with various different types of conditions as well. Um, when someone comes in with a really acute low back or like a, uh, uh, an active disc, typically they'll try a little bit to bend forward or like say a subacute one, one that's been going on for a long time, they'll try to bend forward. And I'm, I noticed a girl the other day, she kind of bent forward. She can't get that far and it hurt a little bit. Um, actually hurt quite a bit. And then she would crawl with her fingertips to try to get further. And so this just told me that she's not afraid of bending forward. Um, and there's, there's not a big white elephant in the room. Now, if someone's afraid of bending forward or rounding their back, then that's a little bit more of a white elephant. Um, typically I'll do, um, I'll explain this, uh, in one situation, uh, where it can happen three ways. And so there, there was a, there was a, not a fairy tale. There was a, uh, fable maybe there was a lice, the, the, um, mouse and the lion, I think it was where the, when the lion had a, uh, a thorn in his foot and the mouse took it out. I think the whole point of that one is to build trust, but either way I usually use the tack in a foot. And so I say this typically happens three ways where say I step on a tack, the tack falls out, but it hurt me. And so I limp for about five days or so. And then I slowly start to put weight on that foot. And then I eventually just kind of come out of it. Okay.

That's the best situation. It's the easiest. It's the, it's the self-resolving ones. Cause you, I'm sure you've met a lot of people who had back pain and it's self-resolving. You're like, dude, what, why are you so lucky? They're the situation. They're just situation one is all situation two is where a little bit more of the mouse and the lion. And so the tack, you step on it and it stays in your foot and say it stays in your foot for months. And so you're still limping. And so this problem keeps ongoing. And so the answer to this one is typically take the tack out like the mouse did, and then help to put, sometimes people put weight back on their foot. Sometimes they don't and they need a little bit more coaching. Then there's a third situation where you step on a tack, the tack falls out of your foot. So there's no tack anymore. You don't need the mouse and you limp for months still. So when these three situations, um, what's happening in the third situation is that there's still a perceived threat or there's, uh, something else driving that movement compensation. Perhaps in your situation, there's a subconscious threat happening. And I do mean subconscious because, uh, think of it kind of like if I put you in my office and I shut all the lights off and I put a blindfold over your face and I said, go ahead and walk to the bathroom. And you probably put your hands up because there's, there's, it's, you don't really think of, I'm not afraid of the dark, but you, it's, there's kind of on guard.

And so that on guard that happens there sometimes is that subconscious movement compensation that we just have to expose the body to say, look, it's okay. I know where the bathroom's at. We're just going to go. And even if you hit the wall, it's okay. It's not going to hurt that much. Right? So just imagine that tack and the lion, you're, you're, I don't, I wouldn't, I wouldn't say this is an active thing. Like you're wanting to feel bad because I know some people will, will say that it's all in your head and I don't think it's in your head, but just know there's a subconscious thing driving this. And that's the, that's the nervous system.

That's the body. It's just like a car alarm. It's just a little bit more sensitive. It's like it's going off the wind. So we need to fine tune that car alarm here. Now, probably on the, on the note of, should I be doing the things that I'm, that I was doing? Some people come in and they say, I've been arching my back for a very long time and I've been having proper posture. I don't understand why this thing is still here. What do I do? Should I keep doing those things? And so I just kind of play that, let's play logic here. Were those things working? And a lot of people will say, well, yeah, it helped for like the first month or the first couple of weeks. And then it started to not help. Well, then I think we take the assumption that your medication, which worked for the first week or so, has now become a poison. And so usually in life, there is too much of a good thing. And when it comes to movement, sometimes too much of one thing could become the driver of the condition. I've met a lot of people who have said, well, sitting in my chair in my desk job and it just kills me. Like it's, it's going to be the death of me and it hurts my back and my hip and all that stuff. Right. And then if you go to Costco and you see people standing by the door, the greeters or the checkout people, they're standing there and notice, look down next time, they stand on little black squares or octagons. This is because they've had workers comp injuries from standing too much. Does that make sense? I mean, one thing, they're standing all day. The other people are sitting all day. And some people who sit all day, they're like, well, I need to see the standing desk. That's my answer, the standing desk. It's not necessarily one or the other. It's going to be a combination of all. And so the easiest solution that I have for most people, if I didn't have to do anything else, is if you sit too much or whatever the white elephant movement is that you're doing too much of, do a little bit of the other. And it might be very daunting to do the other at first, but when you start to get into doing it, eventually, your body's alarm system or its subconscious kind of says, oh, that's okay. That's fine. I could do that. You know, the first little bit is like jumping into a pool. It's just kind of, it's not frightening, just shocking, right? But sometimes you just need a little bit of help to get into that.

So just know that movement overall can be a medication for this, but too much of one movement could just be a poison. And that's why it's nice to have someone on your team to be able to guide you through this, to figure out what you need to do. Because I've said it before, because I've been a patient, it's really hard to be a patient. I think it's underestimated, in fact. And the amount of things that especially a lot of analytical people will think as patients of what's going on, it's too much to think about. Like I paid somebody to make it simple for me. I paid somebody to make it simple for me because I didn't want to overthink this thing. And I even knew, again, cocky, confident, I guess, I knew more than you did about how to resolve my problem. And I still couldn't do it. So just think about that. Because this is going to be a little bit more of a long game. All right. I try to make this clear to people, but I want you to listen to this podcast or this audio a couple times just to understand it is that the way you feel today is not how you're going to feel in a couple weeks. And I really hope on the grand scheme of things that within a couple weeks, you feel 50% better, at least 25. You feel like you're in control, like you can make it so your symptoms go away at will. And you can find a zero out of 10 in regards to your discomfort in some type of position. So you have that control system. Now, pain is the first thing to go and the last thing to come. So I don't want you to focus on pain as being your end goal. And I know it's very easy to think, I just want to be out of this pain and I'll be fine. I won't do anything else the rest of my life. If I don't want to walk or cycle or jump rope or whatever, I'm fine with that. I just don't want to be in this pain. It's very easy to think that way. But I want you to think about what life would be like if this pain was gone again. What are the things you could do again? Because the things that you want to do, in my case, I wanted to play baseball again. The things I wanted to do would help guide what type of corrective exercise or what type of rehab I should do. Because the rehab for someone who just wants to walk is a little bit different than someone who wants to play basketball or run or whatever. And so whatever your goal is, I'm not going to choose it for you. I want you to choose it for yourself because I want you to have a good life, a fulfilled, happy life, feeling like you can do the things that you want to do. So the long game here is don't focus on pain as being the end result.

But within a couple weeks, I'm hoping we can get the symptoms down significantly. But don't think that's going to be the end of the road. And so again, just to kind of give you a look into my head about when I'm guiding you with this stuff is that I want you to first off, just know I'm honest with this, with this type of thing. Okay. And I know that it's probably not commonplace to, you know, necessarily take people through face value anymore. And I don't know when that became a thing. And I don't know when people started to distrust their doctor and say, oh, my doctor doesn't know anything. And, you know, he doesn't understand. And like, I remember back at probably back in the day, like, you know, when there was the townsfolk, I was watching Deadwood.

Deadwood's a good show, by the way. Lots of cussing in it, though. They're like, Doc, what do you do for this? Doc, what do you do for this? And they would do it. I mean, they would kind of be surly to the guy because that's how they were, at least what I think they might have been back then. But they would take his judgment. And so when this is, trust me when I say this is going to be a long game for you, okay? And it's not going to be as quick as like, hey, there's a quick fix with this thing. I want to go someplace two times and that's it. It's not going to be like that. There are situations where it's like that, but it's not going to be like that for you because you have a little bit more of stuff to unravel here. When I talk to parents or people who need images because I'm looking for something, they don't always do it. But when I want them to understand, I guess this side conversation, I want them to understand that I don't often refer for images. I'm looking for something in particular. And so they're like, God, you know, I just put it off for weeks. I said, no, look, listen, I don't often refer for images. But when I do, I'm serious about it. I want you to do it. And not everybody does it because maybe they got this recommendation from someone else who was a little bit haphazard and just does it with everybody. It's not the case with me, okay? And so when I say this is going to be a long game and we're going to be on a team approach, I do mean it. Now, a long game doesn't necessarily mean high frequency. So what I want you to understand is typically here's how we'll go in a really good situation. You come in once, I get to figure out what your diagnosis is and what's creating your problem or the elephant in the room. That's step one. I'll also put together a good first aid for you or a movement-based first aid so you can help have a good control system. So you can get down to that zero, that's step two. A lot of times we'll address that in day one. And so day two, when you come back, I want to see if that step two and step one were correct by you reporting back and saying, okay, I felt like I was 25 to 30, 50% better. I was able to get my pain down by doing this one thing you told me to do. And what else do I do? That is a good second interaction. That's perfect. And what that tells me is I'm on the right track. I don't need to investigate any further at this point in time and that you have a good control system so I can take a little bit more risk with you. Not a big risk, but enough risk to where we can start making a better long-term solution.

Because if you stayed at step two, that would not be a good long-term solution. That's what you've been doing already, probably. And this is the situation you're in because no one ever took you or you didn't go through steps three and four and five. Step three is usually building a nice floor-based program, what we call corrective exercise. And corrective exercise is, in fact, corrective. Or it's a platform to build on some deficiencies that you might have in your body. Maybe it's strength. Maybe it's endurance. Maybe it's, well, crap, I'll stick with those too. And so there's deficiencies. And the whole point of a corrective exercise, similar to a first aid, is to be removed at some point. You might use it as a warm-up at some point, but I don't want it to be your long-term program. A lot of corrective exercise is on the floor. And you'll know that it's a corrective exercise when it looks like, hmm, this looks like kind of an exercise I would do at a PT's office. Nothing against the PTs, by the way. I'm just saying that's the general public's. It's like, huh, that looks like a PT exercise. So you might have bands. You might be on the ground. You might be doing silly movements. These are corrective in an attempt to use them as a stepping stone to get to something that doesn't look corrective anymore. How do you know a non, sorry, that's step three, the corrective exercise. Corrective exercise, you can use the same ones for probably about a month. But at some point, the body will adapt and it'll say, hey, these things are easy. I don't need to, I'm not challenged anymore. Let's, let's, I'm just going to pause until you give me something else to learn. And so the, kind of on that same analogy is that if I played the same song on my harmonica, you know, for a month and I got really good at it, that I kept playing it, I'm not learning any new skills. I'm not building upon that base.

So building upon that base usually is a little bit more of, of lightweight training or aggressive if you want to. It doesn't need to be super aggressive, but it'll look like you're just pumping a couple of weights here and there. So this will usually have the foot on ground type of approach or closed chained, what we call it. And this is where things tend to get a little bit more fun. And so let me retract one second just to give you a good timeline of, again, how this would be as a long game approach with a, just a general overview. I've seen you once for two weeks, once a week for two weeks. I've given you a step two, which is first aid. I've given you corrective exercise, which you can do at home again for four weeks if you want to. However, since you're, you're a little bit more into the weeds than some cases, then I kind of want to keep an eye on you make sure that these things are going well. So I might see you once in the third week, or I might see you, um, I might see you once two weeks later. It just depends how we interact on, on that second day. So based upon what you're showing me, I'm making the recommendations. It's not a standard template. Okay. Now, if you've got a good handle on stuff, I want you to just give the body time to do what it's going to do. It doesn't adapt overnight. It just needs a little bit of volume. And so you just have to do it, you know, three, four, five days a week. If you went five days a week, but didn't go for broke and you felt like, Hey, it's challenging, but I can do it again the next day. That's perfect.

So the step step, that's all the way to step three. Step four is where things tend to kind of spread out a little bit after the initial burst. Now say we've gone through that kind of stuff over a couple months and now we're into step three or sorry, step four. Step four is a little bit more of that weight training. And so say the first thing I give you for weight training is a squat, but you've been hurt with a squat, but I might give you a squat first as a movement. And then I might give you a squat with then a little weight or a backpack or something that you might encounter normally throughout the day. So this is called a reintroduction of activities of daily living. So I'm reintroducing things that will, that you're going to encounter anyway. So you might as well be really good with good about it. And so with this, if you're, if you're hesitant, I probably need to see you again the next week or that same week to help you through it. You see where I'm going with this? This is why it's a little bit more of a long game, long game in a communication is because there's skills that we got to build to get you back to the point where you feel whole again. So if I introduce that squat and you feel really good about it, you have no problems, you report back the next day via email that you feel good and you're very confident you're going to get over this thing. And I see that you see there's a lot at the end of the tunnel. We can wait a week or two maybe, but I need to start building in a program of movements that complement each other. And so the squat is just one of them that I might choose, but I might choose a hip hinge. I might choose a carry. I might choose an overhead press. I might choose a pull, a pulling exercise like a row. I might choose a lot of things.

It's all based upon your goals and the weights are going to be based upon your goals too. Now, I did have a person one time saying, I don't want to do that. And I said, why not? And they said, I'm not an athlete. I'm just a normal person. I'm not trying to be an athlete. And so I said, have you had any experience doing any weight training at all? And they said, no. And I said, great. So I want you to just look at these as things that you're going to encounter on the house. And so I ended up using buckets and backpacks with some weight in it and balls and stuff that she might use elsewhere. And so at that point, it was better for her because she wasn't really wanting to do it because she felt that it wasn't something that was needed for her goal.

But if we kind of show that these are loads and weights in different shapes and sizes are things you're going to encounter throughout your life, then you might kind of see that these are, I'm just training you to encounter these when you encounter these well and not hurt yourself when you move them. Now, I don't think most people are going to hurt themselves with moving general stuff around the house, but it does happen sometimes. So that's step four. And step four, again, the cool thing with step four is that you're just building a little arsenal of exercises that you could do at home or at the gym. And then the cool thing is you can do them for weeks at a time.

I've had people within step four not come for a month or two months. And so it's based upon their ability to do their own homework. And so now all of a sudden, this long game that we're talking about, it's not like this standard rehab facility long game where it's like, I need to see you three times a week for the next three months. It's I need to see you maybe five, six times over a two, three month period. And then I need to see you once a month for another year. Okay. And let's think of it kind of a little bit more programming. Now we can take this another way. And at that point, if there's a strength coach or a trainer that you really like, I might delegate step four to them or part of it to them. And so now it's what I really want is, is some contact points and some exposure. Step five, by the way, we won't cover it too much in this, but step five is just going out and having a good time as a human, like catching butterflies and crawling on the ground. And it's basically all the things that you're thinking, I'm too old for that. And so I don't need them to be extreme, but if there's a certain thing that you're avoiding, like I know a lot of people of older age, they tend to not want to go on the ground because they're like, I can't get back up. One of the best things we can do for them is get them on the ground so they get back up in case they fall. But also that builds strength without having to really go through a bunch of silly programming and weight training exercises.

It's just a general movement and it exposes your body to a lot of different ranges of motion and you get mobility and flexibility and strength and endurance and all that stuff, but just by doing normal stuff. Okay. So normal human related stuff or relate, um, think of it as returning to playful movement, things that you might've done in your youth that are just fun. You're the whole point of life is to just have purpose and have fun. Right? So that's the, that's step five. Now, when we start encountering some of these things, probably a good plan of attack is to do something called the green, yellow, red approach. Now the green, yellow, red is say, I asked you to do that squat in step four and you're like, mm, that didn't feel good. And I said, okay, so green means full go. Like that's perfect. Like when you walked in here, you felt fine or you weren't afraid of walking. Yellow means cautionary. It's like, nah, I'm not quite sure. Red means, dude, that like lit me up. Like I'm on the floor. It shot down my leg. That's a red. Okay. So the green, yellow, red approach, it kind of helps cluster the threat level that happens with certain movements or certain weights. Yellow, what I tell people to do is, why don't you just do it a couple of times today and then tomorrow, see how you feel.

See if it created any long-term damage or it just kind of was a car alarm going off and you just shut it down. The more yellows that you encountered, actually, it's not a bad thing. It's actually a good thing. And it helps you fine tune that car alarm and it helps you kind of get those movement compensations that you've been experiencing to be gone. Reds are things where there might still be things that are kind of being pressured in there and irritated and sensitive. And so I'm going to help you through those reds too, but reds aren't like, hey, no pain, no gain, push through. First, what we do is we encounter the greens and then we encounter some yellows and then we address the reds. And this is why it's again, a long game. What I've personally experienced is, and again, this is based upon theory, but this is my observation with myself as well as other people, is when I reintroduced step four or some weight training, some normal stuff throughout life, I noticed that I would deadlift fine. I'd push and pull and carry fine. I was kind of hesitant to squat, especially deep. And so when I eventually started squatting deep, even without weight, just as a movement, my back felt way better. It was crazy. So that yellow I had avoided for a while was, I think, the thing driving my problem. And so I want to make sure that your program is well rounded so you don't have a different type of problem come along the lines. Now, probably the last thing here to address is, um, what can you expect in regards to should recovery be a hundred percent upwards and always positive? No, it's not realistic. The communication aspect that we're talking about here is that I want you to feel that, um, that you're on the right path, that you're still moving upward, but there's a couple of hiccups here and there. It's not uncommon. I've had hiccups.

Everybody has a couple of hiccups and, um, there is, there's ways around them. However, that communication is going to be helpful to avoid, not necessarily avoid, but we'll navigate around those hiccups. And some of the things that you might experience along the course of the way here is you might notice mid-back tightness or groin tension or groin pain. You might notice adductor or thigh kind of strain stuff. You might notice knee stuff. You might notice hamstring tightness. You might notice even some, some neck pain or shoulder pain. So these things are, they sometimes go along with the territory. They're not a big deal. Okay. They're expected. And I've seen them in cases like yours happen very frequently. So just tell me when they happen and then allow me to do my job to investigate, to see if there's an actual threat there, if there's actually attack there, we'll remove that attack and we'll get you back on the right path again. The hard part when, when things, um, kind of fall apart is when people panic or they start spiraling the drain mentally thinking, Oh, this is like first that, and now this, and now I don't know why this is happening to me.

Okay. It's, it's not uncommon to feel that way, but allow me to help you. Now, if you feel like you're really starting to feel that way and it's, and it's a big mental challenge for you, uh, I'm, I'm not, I'm going to be honest with you. This doesn't happen all the time, but sometimes people need professional, um, uh, psychiatric help. They need it. They need a therapist. And so it's, it's not super common, but my part of my job is to help you through this and make sure that we're on the same team and make sure we're going in the right direction. But if there's other mental barriers, um, I'm not professionally trained as a psychologist. And so part of that mental game and figuring out where the barriers are mentally, if there is any might be better if you actually see someone else in combination with, so that would be a co-management case. So it's not a bad thing.

It's just making sure that, that when there's, if there's a problem there, we need to make sure that problem's addressed. So the barrier or that threat can go away. And so we can just make sure we're on the right path to get you to the goal that you want. Now, do you guys have any questions or you, if you have any questions along this path to again, just let me know. I'm more accessible via email. I'll do my best to get back to you. If you have a very large question or concern, it's best to, best to be done in person. Um, I've had people over the course of time email me after say, um, so they haven't been in for like two months and they said, well, you know, a month ago, my back really started hurting again. And so now I don't know what to do. Um, I need an MRI and, and I say, look, it's, it's been two months. I need to look at you again. Status has changed. Like our, our profession or a medical profession, we're required to look every month or so. And so I need to see if things have changed because things can change dramatically over a week. And I want to make sure I'm not giving the wrong recommendation to you. And by the way, on the note of the MRIs, uh, a lot of times people don't need MRIs. They don't always need x-rays either. And so if you feel like you need them because you want to see what's going on or if there's anything, anything seriously wrong in there, you can certainly do it. But, uh, just as a, uh, as a, as a good framework for MRIs, um, x-rays, by the way, you can get them a little bit more, more easily. But MRIs, I've called on behalf of people to get MRIs for their insurance company. It's not easy. And I'm not going to, I'm not saying like, Hey, it's, it's the, what was me type of thing. But this is typically what happens if you're trying to get the MRI covered. By the way, if you want to, if you want to get it done, I got one done for me and I just paid cash straight up. It wasn't that expensive because I didn't want this barrier. And I just wanted to know. There's nothing wrong with knowing or wanting to know and looking because it gives me more information too. But I want you to understand that the criteria of someone else paying for it, such as your insurance doesn't necessarily, uh, it doesn't necessarily go that same way. So you're going to, they're going to ask me a couple of things. Does the patient have any motor loss? Like, are they weak in the feet? Like they can't pick their foot up? Well, no, they walked in perfectly fine. Do they have any numbness into the groin area? No, they didn't mention anything like that. Do they have any change of bowel or bladder function? No, they don't have, they don't have that either. Well, have they come in for six weeks of physician or, or, um, clinician directed rehab? Well, no, they came in like three times, uh, three times over the last couple months. And then I just got an email from the patient or they called and they wanted to get an MRI. Okay. Well, that's not going to be approved. And so I want you to understand the things I said there is that there's three major criteria for investigation, at least of the lower back, um, to figure out if we need to look at an MRI. There's other ones, but those are the big, big three. And the other part is notice that I said, uh, clinician directed rehab, like in person. And so this is the part that a lot of people tend to forget is they said, well, I've been doing everything. Well, where you've been doing it at home. Okay. So the reason why, again, in the beginning, I said this is that you shouldn't do this on your own. And it's really easy for people, especially in the situation, in some situations to not do things. Well, I don't do my own taxes because I know I'm going to mess them up. And so just the recognition that you need some help and being able to have someone to help you, you'll start to meet that six week criteria. So if you really do want that MRI, you're starting to meet the criteria that is needed because now for me to fail with you after six weeks, it's not very common. And after six weeks, you hopefully you'll think I don't need the MRI.

So that's what, that's what the, that's what the thought is on imaging anyways. So, but if you guys have any questions, the email's the quickest way. Um, but if you have a long, um, a very, uh, like if you want more than a couple minutes, uh, I think an in-person thing is a little bit easier. And if you have any concerns about your body or want me to investigate something, it's easier just to do it in person. Okay. I'm on your team. Let's get this thing. I think you'll be perfectly fine. A lot of people do get better. Um, your body's pretty resilient and it's just looking to recover. Uh, we just have to give it a chance and, and let it know how to do it is all. So let's get this thing. Thank you for listening to that. And hopefully you're able to share it with your patients and just let them know what parts, uh, resonate well with what works well in your practice. And as we go on here, I think we're going to, I'm going to close up the podcast here, but I, I would really like to do it. Another nice call to action. I didn't, I didn't put a advertisement or a commercial in the middle of this because I do want patients to listen to that.

Um, but I do have some workshops coming and I know that from, I want to, I want to help everybody. I want to help all the clinicians improve their skills. And I do have, um, some classmates that were able to come last year to the workshops. And I think they got a lot of good information from the workshop that I put on, but also they got, um, I got some good feedback of how I can improve. And so clustering that information with what my interns have said and all my interns so far, um, you've heard from some of them, you've heard from Kyle Hemsley, you've heard from Sara Van Dyke. Um, Dawne Costantino will be on very soon. Jeremy Dinkins was on as well. Um, Nathan, I think he wasn't on officially. He was on as a ring ring game, but, um, all of them had said that they needed better, um, organization of information. And so I started creating something which was more case specific.

And so we started doing the, the box system of, of how to recommend to people and the search, the strategy behind it. And so you notice that in this podcast today, we talked about level one, two, three, four, five, and so on. And so level three is actually level two and level three and level four actually confusing to a lot of people. We're very good at most of the time level two. We're good at first aid, but for a hip impingement, for a hip FAI, like actually one where there's truly a FAI and you've done the test to figure out that it's a hip impingement. What is one corrective exercise you can do to actually take that person's symptoms away completely within one session? And so it doesn't have to be a first aid. A lot of times it can be a corrective exercise or a step three. And step four is to double down on that. And based upon the information you know, information in what you found that was working in the step three, you can now prescribe exercises, which has a low reward or low risk, high reward. So what I want to share in my workshop is basically if someone comes in with a, with a fearfulness of bending forward, such as in this case, what are some things that we can do for first aid as well as corrective, as well as loading to get this person where they need to go. This, the other ones we're going to cover is hip FAI.

We're going to cover actually disc related issues. We're going to cover shoulders and necks and knees, runner's knees and so on. We're going to do various different parts of the body kind of as a case presentation model. We're also going to do some examination in case you feel like, I don't know when to choose those tools, which is the feedback that I got from the first workshop. They said, that was cool, but how do I know when to use it? And so I'm hoping that with this, I'm able to give everyone a good look into what an intern experience would be. And hopefully you can walk away with feeling like, Hey, hip cases, impingement cases. I got this. I know it. And so I want you guys to message me, email me. That is seb at p2sportscare.com. And just let me know if you're, if you want to come to the workshop, there's a student one, which is May 30th. And that one's on the cheap. There's only limited spots, 20 spots or so. And that's mainly for people who are still in school. Okay. For clinicians, there is a CE based one. That one's a two day one. It's 12 hours. It's coming. It's going to cover all the stuff in California that you really need history taking and physical exam are going to be, um, if things go well, we're going to be four hours in that. And so that's a category that is a must fill that people are not typically familiar with, especially new clinicians. And they start scrambling later to get those things. So we're going to hopefully get those, um, and CE's in California, but I can expand a little bit more if you know, let me know ahead of time. Um, it's going to be cheaper than most workshops that you go to, and you're certainly going to know more. I've been through a lot of workshops personally, and I can tell you that, um, the information they give you is, um, it's good, but it's hard to know when to use it. So I'm going to show you when to use certain things. And so hopefully, hopefully you walk away feeling like you're, um, you've leveled up.

I'm also going to feed you steak and beer and wine and so on. So please come. It'll be a good time. Just message me. That is Seb, S-E-B at p2sportscare.com. Looking forward to seeing you. And thanks for being part of the movement. See you next week.