Is Low Back Rounding Bad? Common Back Pain Recovery Questions

Is lumbar spine rounding the devil? And the reason why I think I get it quite a bit is because at some point, people do have pain with bending forward with their back. Maybe it creates leg pain. Maybe it creates TFL, pseudo-TFL-like symptoms. Maybe it creates hamstring tightness. Maybe it creates radiculopathy, sciatica, foot pain, and so on. And I know where the idea comes from, and I make sure that I frame it really easily in the beginning for people. 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. It's Dr. Sebastian Gonzales, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time, welcome. This podcast is targeted at improving the communication between patients, clinicians, and getting our message across in both regards. Imagine like we are at a bar having a beer. Maybe you're drinking a Miller Lite. I don't know where you are. And I'm drinking a Mongo IPA, double IPA. And then our friend, who is a—I can't go with nurse. Let's go with trash man. He's asking about what we're talking about.

So I don't think it's really fair to really keep him out of conversation. And I don't think it's fair if he talks about only trash stuff and we don't understand what he talks about. And so I think improving our communication between patient and clinician is really helpful for getting people to actually do what they need to do to get better. And so we have—we are guilty in the medical profession of making things too complicated and making our own language. Maybe we shouldn't do that. So as we go through this podcast, we're going to go over some communication that I typically do with patients with some of the common questions that I get.

And so I'm going to go over a handful of questions that I just formulated because I tend to hear them a lot. So the first one is, should your low back round ever again? Or is spinal rounding the devil, basically? Also, we go over, can I run again? Can I ride a horse again? Can I do X, Y, and Z again? Is it—am I actually getting better because it hurts more in this place versus another? I've been doing rehab exercise for about three months. Should I continue? And I feel pretty good. Should I come back? And these are typically questions that I get from patients that I thought I would answer in podcast format.

So if you guys like it and you have patients asking the same questions and you resonate well, please share it with them. Now, before we get into the actual bulk of the podcast, just know if this is your first time, I'd like to share a little bit about myself. So you can get to know me as your host via story format, via rant, and so on. And so I'll get into that real quickly first and go straight into the content. So if you know me, I grew up in Boy Scouts. Obviously, there's the end of the podcast where I talk about Eagle Scouts because I am an Eagle Scout. By the way, once you're an Eagle Scout, you're always an Eagle Scout.

It's a lifetime membership. So we would spend a lot of time out in the woods or at least every summer we'd go on a handful of trips. And so I've actually gone up Mount Whitney twice. And if you don't know what Mount Whitney is, it's the highest mountain in the continental United States. I think it's about 14,784 feet, I think. And so I've gone up there a couple times. And it's funny, both times there was thunderstorms when you're up there. And there's this little shack that is made of metal, which seems like a terrible idea because it's amongst a bunch of kind of slate rocks up there. There's nothing up there.

There's no trees. There's just that little hut which you can sign in on. And so we went up there and there was – we did a multi-day trip. Some people do single-day trips. They would just pound up there, start at midnight and just go up. But we decided to take our time. And so we went up there and I went one year. This was the second year it was with – or sorry, the second time it was with a couple of my friends. The first time was just with my dad and uncle and a couple of their friends. And the second time, though, we took some of my friends because we were – I think we were probably about 21 years old, 25 years old, something like that.

And so one of my friends – this is Larry. Larry went up there. Larry didn't make it, by the way. He got to Ridgecrest, but it was a little bit hard to get up to the top. And so we stopped at this little lake. It was called Lone Pine Lake, and we ate lunch there. And so we usually bring, like, gouda cheese, salami, French rolls for the first day because French rolls aren't getting bad then. And it was good. You know, like the gouda cheese, it stays preserved a little bit within the wax covering and so on. And so we're just sitting there on this log just slicing this cheese up. And as you know, like the cheese is like – you don't get a lot of it up there, and so it's kind of a rarity.

And so I was slicing the cheese. He's sitting next to me, and so I sliced a piece off and I had my buck knife, and the cheese fell. And so I had a cheese in one hand, like the whole cheese. I couldn't drop that, and I had my knife in the other. And so I lunged down and tried to catch the cheese before I hit the ground with my knife in my hand. I actually stabbed him in the shin. So that's the time I stabbed my friend. It wasn't big. It was like a pinhole. But I did stab him. So I'm sure my scout leader would be upset at that because I probably should have lost my totenship at that point. But anyways, that is a little story about me.

Hopefully, you get to know me a little bit better. And let's get on to the content now, okay? Okay, so as we get into the first question here that I get from patients a bit, or at least I'll frame it as I kind of see this. Number one, is flexing the devil. Is lumbar spine rounding the devil? And the reason why I think I get it quite a bit is because at some point, people do have pain with bending forward with their back. Maybe it creates leg pain. Maybe it creates TFL, pseudo-TFL-like symptoms. Maybe it creates hamstring tightness. Maybe it creates radiculopathy, sciatica, foot pain, so on. And I know where the idea comes from, and I make sure that I frame it really easily in the beginning for people.

Because we talk about first aid. And so I actually had people recently come in who have been exposed to McGill's work, which I love McGill's work. But I tell them, like, look, keep in mind that we're talking about a disc at that point, you know? At some point, your body is resilient and it's going to heal. And at a certain point, rounding forward should be minimized or at least modified. And that's why we talk about hip hinging and loading from the hips, especially when we're integrating someone back into just a normal daily activity with flexion-tolerant back pain or discogenic types of symptoms or sciatica, is because we want the hinge and load to come ideally through the hips, even with mundane daily activities.

But, you know, I think there's a big conversation here that needs to be talked about because I think when people tend to go through this disc-based condition, they go through usually McKenzie extension exercises or endurance loading and extension or Cobras, whatever you want to call it. You go into the arching exercises and it makes people feel better, right? It makes them feel really good oftentimes. I'd say a good strong 75% of the time, people feel really good with that and it's surprising. And so, thinking about the mental aspect of going through and having this condition in myself personally, I tell them, look, it's comfortable, it's easy, but at the same time, too much of that is not appropriate either.

And just like you cut yourself in the arm, you start rinsing and lathering and putting Neosporin on and a Band-Aid and you don't do that beyond like five days or so. And at some point, I know that I've had cuts on my arm like road rash style from baseball where I literally shred the arm like skin almost like pretty much off. It's just a big old road rash or raspberry. And if I cover it up too much, it never really scabs up. And so, there's different things you want at different points of your care. And at some point, rounding is going to be picking that scab. All right? We want the scab to heal.

We want literally the spine scab to heal. And we want it to become resilient again. But I oftentimes try to retract and reel people back from those exercises like arching backwards and having perfect posture and things of that nature, usually within about a week or so. And usually after the first week, I'll test them and see, are you truly responding like someone who has an active disc or not right now? Because the symptoms change a little bit. And so, I had someone the other day that she came in and she had an active disc. She did it, dead lifting with a deficit. And so, she had all the qualifications, including the testing to merit probably having a discogenic type of symptom.

And she bent forward and it was painful. Bending backward was comfortable, but not really – it was comfortable, but not pain-free. And so, we've established that bending backwards is going to be a really good first aid in her process. And so, we did that for about a week and she came back and we tested again and lo and behold, she feels pretty much better. And so, what we found though – and by the way, she was doing all the McGill work at the time, the bird dogs, the side plank, the modified curl up, walking, stuff like that. And so, I advised her to do all that stuff. And so, we – when she came back, I took her into a buddy squat.

And that's just me holding her hand and dropping – we dropped down on a squat together and I say, how's that feel? And she's like, well, it doesn't feel like the last time. And I said, great, cool. What's it feel like then? And she's like, well, it's not stabbing anymore. Now, it just feels tight in the back. And so, I can reflect on back what I felt like when I had months of really staying out of flexion just because it was a fearful thing for me. Rounding my spine was fearful. And what occurs is that typically the back muscles get – they just get overworked, you know. At some point, the guarding in the beginning is a protective mechanism, but it's – I always explain to people kind of like there's a sniper in the jungle in the Korean War.

And, you know, years and years later, decades later, we got to go find the guy because he lost his radio. And he still thinks he's fighting a good fight. And so, I tell him that, look, although that was appropriate at one point to have those muscles guard up and to stay out of that rounded position, especially in the loads, then it's not always appropriate anymore. And so, usually in the second day, I'll take him into a little bit more of a rounding progression, but not in a passive way. And so, what does this look like? Good question. I tend to take him through a doorjamb squat, a goblet squat, a quadruped rock, DNS work in a face-up position.

We do rolling. We do quite a bit of things of that nature. And when I take him to the goblet squat, consider the goblet squat as a movement, not an exercise at this point. And so, I just hand him about a 25-pound kettlebell, and I say, go ahead and sink down on the floor. And usually, they'll have a lot of tension, and they'll be very attentive at their spine. And I say, look, you're going to be down there for like a minute, so just relax. Let your hips drop down towards the floor, sit between your heels, and push your elbows between your knees, and just let them lock in and sit there. And I do it with them, and we just have a conversation.

And so, when we do this, I keep asking them to breathe deep into the hips or try to spread the yoga pants. And so, what this does is it calms the nervous system down a little bit and makes this into basically a therapeutic exercise, in my opinion. And so, usually, when they stand up and move around, they're like, wow, that feels a lot better. And so, what I mention to people with this is that although I will take them through loaded exercises, resistance training, a single leg hinging or deadlifting or squatting, double leg split stance, all this kind of stuff. The stuff that you'd see people doing in the gym, you know, but in a more regimented way.

I've been clear with them that when weight goes up, your spinal round will go away, all right? And that's just kind of the nature of the beast. And I'm proposing that you're able to do this like you're sitting down there smoking, right? Taking your 10-minute break, just having a really long, like you've got a Virginia Slim, like it's a long, like imagine Cruella de Vil, right? A long cigarette. And it's just, just be down there and relax. And you can break it up, take a little walk, come back and do it. But I had heard back in the day, I think it was Kelly Starrett had the 10-minute squat rule.

And I'm not saying squat for 10 minutes, but I'm just saying break them up into bits, you know? 30 seconds here, 30 seconds there, and just kind of settle into that position. The reason for this is, I mean, obviously, we can go into more of a, like a seated, rounded position or try to get it in more of a passive way. But in my opinion, when the feet are on the ground, the hips are active in it, and there's an effort involved. And you still have to support yourself against gravity. And so, with doing this, the hips help buttress and protect the spine in that rounded position, even in the early stages here.

And when you breathe deep, you build a buttressing effect from the inner wall of, or the inner cavity of the abdominal area. And so, in DNS, they would call this intra-abdominal pressure. And so, I think this is helpful to do that and just let people know that it's okay to have spinal flexion. It's actually advised, in my opinion, usually about two, three weeks into their care. But doing it too early is going to pick that scab off. And so, this is why I like people to come back for the second time, show me what they're doing, tell me what's going on. Are you afraid to round? Because people, some people are afraid to round too.

And so, just realize that when a round is a natural human movement in the spine, you should be able to do it. Now, there is too much of a good thing, and that's how some people get this way. And when the load goes up, when we're talking about lifting heavy weights, or we're talking about saving a baby from under a truck, then we are going to be locked and loaded with the spine, and we're not going to be rounding anymore. Okay? So, two different skill sets in that. There's normal unloaded activities, daily movement stuff, non-repetitive, just stuff randomly here and there, right? I sat on the beach this morning into like a deep squat right there and just read a book, you know?

And then I went into Indian style, if that is a, can you still say that? Cross-legged, cross-legged, criss-cross applesauce. I went into that position and read a book. And sorry if I offend anyone on that. I guess I never know what's appropriate anymore. And so, those are all okay to do. And also, I went into a cobra position, read a book kind of like a therapeutic one for the first week of care, like a McKinsey model. And so, all those are okay. And as people start to come away from that active disc injury, the flexion intolerance, then we have to expose them to the other ranges. And so, that is typically what I tell people in a shorter way, because this is a podcast which people can reference, and I try to be a little bit more detailed.

So, by the way, share this with your patients if they have this question. This is what I tell them when they seem fearful of it, because I did have a guy, he recently came in, and he comes in and out of care like, you know, one and a half months, two months at a time. And so, when he came back, he's like, dude, my back is so tight. And so, he was having some leg symptoms then, you know? He didn't have leg symptoms before. I said, what's been going on? And he's like, so, those exercises you gave me made me feel better. So, I did a lot of them, and then I started to stay in a perfect posture position, perfect posture, quote-unquote, all day.

And now, that area is just really tight. And so, we also went into a goblet squat position, and he felt way better, and his symptoms went away. And so, people drive their own symptoms sometimes just by going through that thought process that that one thing that we're given for about a five-day to seven-day period of time is going to be the most useful thing for them throughout the end of time, and it's not. And so, this is the scaled approach to getting someone back into what they want to do. And so, if you are a patient and you're listening to this, then just realize that there is a process that most of us have in mind.

And we're trying to guide you through it. We can obviously talk about our life dreams with you, you know, on the first date. And I want to own a house, and I want to have two kids and get a pony. But it's kind of frightening to people. And so, I personally don't expose all those things. I allude to them. But there's no point in talking about them too much in detail because it's too much at the time. But when you come back, we will talk about that a little bit more. And I'm just going to put you through the ringer with it. And you'll feel good. And you're going to feel empowered. Now, the next thing that I get people tend to ask is, especially with runners, can I run again?

I had a lady one time, she asked about one thing she wanted to do was ride a horse. Can I ride a horse again? And basically, can I do X, Y, and Z again? And most of my answer is probably, like more than likely yes. I say 95% yes, and I'm like, I would tell you. I would tell you if I didn't think it was good for you. Now, someone that has, like, say, a PARS defect or some type of moving, instabilizing the spine, maybe we don't want to make that person a gymnast or at least we should have that conversation with them because they can do it, but it's just going to be challenging along the way. You know, someone who had a massive herniation who wanted to do Jefferson curls, maybe that's not something we want to really have them do.

You know, it's like they can do it, but there's high reward, low risk, in my opinion. And if they're looking to, when you finally get down into goals, it's like, what do you want? Well, I want to ride a horse because I do it with my wife, and we go out in this ranch every year, and we reenact the Oregon Trail, you know? And it's the best time of our life. We do it every single year. We look forward to it. Then, yes, yes, you can, right? But if it's like, I want to ride a horse because I thought chicks would think it was cool, and I want to get a date, it's like, then no. How about I just tell you how to listen better, you know?

And so I think it's dependent upon the goal. Most of the time, though, I don't shy people away if they're really – I have a conversation about it with them, but I don't shy them away from what they really want if they really want it. And so usually I give the caveat of, look, here's your reward and risk on this. There's other ways to get to the goals that you're looking for, but if this is the way you want to do it, I'll help you along, okay? But I want you to understand this. Understand this one thing because the major reason why I'm in business is because people can't manage their loads, all right?

They don't know how to scale things appropriately, and they like jump back in. And so I had a lady one time, actually, she had some sciatica, and we had talked about the just integration of certain things, like going for walks. And she went out and walked like 10 miles that next day. And she's like, well, I was so sore. And I was like, yeah, you walked 10 miles. Like you haven't walked more than a mile in a long time. Like you walked 10 miles. Like if I ran 10 miles and I have never run in my life, I'd be sore. I remember when I was a kid, when I was 14, me and my buddy, like we, so he lived about four miles from the beach.

And so we ran to the beach and back with like crappy shoes, no training whatsoever. So we ran eight miles. Dude, I couldn't move for a week. And so I think that being said, it's like I could have managed it better. You know, I've had people go from zero to 100 with running mileage. They've gone to like, they're like, hey, I've only, you know, run once over the past six months. I've tried things here and there, but never really going for a long, slow run. And so I went with my buddies and they went eight miles the other day. You know, how'd you feel? Well, I'm a little concerned because it got a little achy again.

Well, right. You know, right. It makes sense. With weight training and loading, it's like you haven't deadlifted in six months. Then maybe we go like 20, 25 reps with like 30, 40, 50% of effort, you know, and then live to strive another day. Like no one started just deadlifting like 135 with no background training, right? And it's kind of like, although your mind is there, like you could do it again and you should do it again, but it doesn't mean your body's physically capable currently. And your body adapts to loads with running, with weight training, with horseback riding, all this stuff. But it also deloads when you don't do it.

And so it's an efficiency machine. And it basically just says, hey, look, you're going to use these proteins and all these materials over here to build these muscles and build these support systems for riding a horse. Great. Cool. Let's do it. You know, ride the horse like three times a week for about, you know, 20, 30 minutes at a time. And you do it for six months, your body's going to be conditioned for it. But when you don't do it for six months, then your body's going to become deconditioned for it. So you need to responsibly go back slowly and just see how it goes. And in another setting, if that is someone who's afraid of hurting themselves with doing it again, but they want to do it again, I think this is a little bit of a different scaled approach.

With these people, I tend to get them a little bit more of, I give them a percentage based of, of not exertion, but, but success. If you can do 80% of your, of your reps with no symptoms, no flare ups, no spikes, no alarms going off, then we can do it the next day or, or the following day. And so with the one, with the thing I want least with these people is I'm like, look, like I, like I had a, I had a girl the other day and I said, look, I think it's fair to say, that I want to load you up today with a, with a deadlift because that's, that's what, that's what you're asking for. And I, and I want to do it.

I want to help you through it. I think you should be deadlifting in your rehab. But we're going to do so we're going to scale it. We're going to put it on blocks. Is that okay? Yeah. And we had this conversation about, I know, should we do it from the deck? And I said, look, you know, like the thing that I would want least from this experience today is that you leave here feeling anxious or tomorrow you're, you have a spike of, of symptoms, whether it's a true symptom or not, just an alarm system going off. The worst thing I want is that to happen. And then I've scared you out of doing that exercise and I've done you a poor service.

And so I think what we should do is consider it like getting into a cold bucket of water. You know, it's a slow progression. You could jump in, but it might scare that, scare the shit out of you. Right? Like, and I'm not saying it will freeze to death. You won't die from it, but it's a freak experience. And people don't like having freak experiences. And so when managing someone like that, then I like to scale them a little bit differently. Someone who is afraid of doing that, I don't like to nurture them being afraid, but I like them to realize what's harmful and what's not and not push them any further than they want to go.

And I usually, usually use, I'm going to use this a handful of times is the red, yellow, green system. You know, it does, if it hurts severely, like it's that stabbing, shooting pain you've been having, then that's a red flag. Okay. If it's a yellow, it's just like, it's like, hmm, I wonder how that's going to feel. That was a little bit weird. I'm not sure. I'm a little anxious. That's a yellow. So just pause then, take a breath, walk around, feel it out, wait the next day maybe to see how you feel. Green is like, dude, I could do this all day. This is great. Full go. Right? That's green. And so, yes, you can probably do these things again with the caveat that there's a possibility that there's certain things that are high reward, or sorry, high risk, low reward.

But for the most things that everybody wants to do is they're high reward, low risk, in my opinion. And it's the only way they make them high risk is poor load management or poor volume control, whether that be weekly or daily. So I think it's an important thing when it gets into building back someone's activity or their main goal. Because if they don't have success with it, they're going to think they're old and they're fragile and so on. And I don't think that's the way it should go. Look, we're pretty resilient, I think, as humans. We just don't realize it until we've overcome the thing. Every person that comes in your office, a lot of people that come in your office, they have some type of fear of not getting better.

And that's why they're there. Right? If they were going to get better, like, they'd be that guy who's just sitting at home. He's like, dude, I'll stress this off for a couple days. I'll be fine. You know? There's that guy who doesn't go to the doctor when they have an infection in their eye. You know? It's like, oh, it's fine. I'll get better. And so if they're fearful about it, they're going to come in. You know, and I don't believe in selling fear, but the reality is they're fearful about something. They're anxious about something. They have a problem they can't solve. And so just make sure that when you do communicate this kind of stuff to them, that you're clear about their risk-reward so they understand what their part is in this process.

Now, another question that I typically get from people, it actually doesn't happen all the time, but it does happen, and it's a conversation point. Hey, how are you feeling today? Well, I think I'm getting worse. Well, why is that? Well, so my back just really hurts, or my neck just really hurts. You know, it's just tight all the time, and now I got like a little bit of like an ache right there and so on. I'm like, well, how's your hip? You know, how's your leg? How's your foot? How's your arm? How's your numbness? Oh, that's much better. You know, and so the concept of centralization, I think, is challenging to people, and even the workshop I recently did, we talked about this, is because centralization, like their symptoms should come up like a thermometer.

And I tell patients that when we have this conversation, I say, look, I know it's a concern. I get it. But we did talk about this last time, and so this is a very common thing to happen, and I explain it again, is that the symptoms should come out of the arm or the leg first, or the hip or the knee or the foot or the hand or the shoulder or the shoulder blade. It should come out of there first. It's going to come out of there first. If you're getting better, it's going to come out of there first. Now, there's a possibility that it starts to localize. It's kind of like it clusters right amongst the spine, and the muscles around the spine say, dude, this sucks, you know?

And I'm like, that is, I know it's uncomfortable, but it's not an indication that you're getting worse, all right? So trust in the process here. Remember how I said last time we have this thing that we're going to do for about five, six, seven days, and then we're going to start removing it. That's what we're going to do today. And so this conversation does a lot of times go hand in hand with those people who have been avoiding rounding, you know, or the people who believe that their arm symptoms are only going to be kept away by keeping their double chin intact or keeping perfect posture or sitting upright.

And so a lot of times we just have to reduce these symptoms just in a little different way. And so I just make sure that they're comfortable with understanding that. And I say, look, just email me if you have a problem with this. But I know, I'm like, I've been through this personally. I've done this before with myself and many people. It's very common. What your experience is common. And it's almost required to, in some cases, to get you through this. So just, here's what we're going to do now. And just understand that as we go through this, it's probably going to get better from here and things are changing, okay?

Now, what we're really doing with this beginning of care, at least with the end range loading, is that I tend to collect data points, right? I tell people, look, we can't solve a problem unless we collect all the data points or at least as many data points as it looks like it's needed to form a pattern, right? If we have on the left over here, we have like two data points. On the right, we have like 50 of them throughout your examination and what you've told me in your history and so on, and what we do with treatment, if you're still clustering to those 50 data points, and that looks like a clear path of benefit, right?

The other direction looks like it's unlikely that you have X, Y, and Z, and it's unlikely that X, Y, and Z will help you. And so we're pushing towards those 50 data points, and throughout the process of you doing what you're doing at home, sometimes you'll get confirmation that these data points are correct, you know, and that I did my job, and that you're doing your job of doing your homework. In this case, the, this, this, excuse me, man, in this case, the, the stiffness you're getting around the spine is a confirmation of these data points in combination with the, with the symptoms coming out of your arms, legs, feet, shoulders, whatever it might be, okay?

And so you're confirming what I need to know to do what you do, do something else with you next. Pretty soon you'll be done with me, but just let me guide you through this process, okay? It's not that I'm going to be fixing you at any point in time, you're fixing yourself. And by what you're doing with these exercises is you're giving me the information to guide you to the next step, okay? If you do these exercises, you will have an improvement or there will be no change, all right? In regards to arm, leg, shoulder blade, hip, piriformis, IT band, all these symptoms can centralize, all right? Perfectly normal, all right?

If you tend to get worse and it gets further down the leg, but your back gets better or your neck gets better, then I think we need to have a conversation. But all this information helps me help you, gets the right quote-unquote fix for you, okay? Another question I get from people is, or at least it's a conversation that we typically have, is that when they have some type of extremity-based symptom that is a, it's probably coming from a neurological compromise somehow, not a bad one. It's just, imagine pseudo-IT band syndrome, right? Pain localized in the knee, it's really not, or it's reduced with postural changes, it's worse in the morning, first step out of bed, morning runs are a little bit iffy until they get about a mile in or so, and then it starts to warm itself up, quote-unquote, and then it goes away.

They sit throughout the day, their knee gets worse, they stand up, walk around, it gets better. After a couple minutes, in the afternoon, usually their afternoon runs are much better after they warm up appropriately. So this is more of like a pseudo-IT band syndrome, and so the patient comes in and they're like, look, I got knee pain, right? And so I'm having this conversation with them about, you know, what we're going to do and the reason why I'm implementing what we're implementing and the data points and maybe it's, you know, neurologically related and blah, blah, blah. And so a lot of times they still have the question of like, but can I run on the knee?

And I'm like, well, look, okay, I know that you're concerned with your knee, but I'm telling you it's a referred symptom to your knee. But here's what we're going to do. I'm going to test the knee aggressively, you know, and I'm going to stress test it. And I won't try to break it in half, but I'm going to subject it to more strain than it will get with running. And let's just see how it fares. And so we do that, and we do all the orthopedic tests and so on, but more so the resisted range of motion testing, I think, is telling to the person because they can see, wow, you were laying in there, you're all sweating, and it didn't break in half.

Like, you didn't just crumple your knee. And so I tell them, look, we stress tested the heck out of the thing. To me, it looks like a stable joint, which is the only reason why I wouldn't tell you to at least apply some type of gravity-based load to it. Running, walking, running at different speeds, sand running. And so I let them know that, look, we stress tested the heck out of this thing. I think the symptoms are coming for us. Do you have any questions or concerns? Good. Now, you're probably going to go home and look up IT band syndrome, and literally everything you read on the internet is going to be wrong for you.

All right? They're talking about an actual friction-based syndrome. You have one, you have a condition that looks very much like IT band syndrome. So I'm calling it phantom, it's calling it pseudo. It's kind of like, it's iffy. It's not really IT band syndrome, but everything you read on it is going to be about what to do if you had the actual friction syndrome. And so just know, I checked you for that. I checked you for meniscal tears. I checked you for conure-like patella, runner's knee, patella femoral pain syndrome. All the stuff you're going to look at when you look up knee pain with running, I checked you out for, you don't have it.

Okay? And so usually this stops the thought until sometimes later on down the line, if they're not getting better, sometimes they'll have the thought that they need to look in the knee with an MRI. And that's a whole different conversation there. But I think that's a helpful one in the beginning for me to get people to do the things that I need them to do to collect all those data points to help them out. And I think it's a real concern they have, and it's a valid concern. But I think communicating in this way and showing them that the knee is not fragile, then I think I think I get better retention out of what I need them to do.

There's less fallout. There's less of them going to like a therapist later and someone rubbed on their IT band. They're like, ooh, that's the tightest one that I've ever felt. By the way, don't tell people that. I don't think I've told someone that one time. She still remembers it, you know, and not to IT band, but for a different area of the body. And I don't think we should tell them that. Ooh, that's the tightest. And so I don't know how much you guys, but how many people have you had come into your office like, dude, I went to this doctor or massage therapist or physical therapist or my friend that we did groups, couples massage, whatever the heck you do.

By the way, nothing against those professions. I'm just saying some of you, some of you say this, please don't say it anymore. You have the tightest upper trap I've ever seen. You have so many knots in the shoulder blade. You have the tightest IT band or TFL that I've ever seen. Like these things are people, I don't think they take pride in this thing, but they tend to remember that, all right? And that gravitates them towards structural based problems. And they also think it feels, they told me it's tight. They don't think, well, why is it tight? What's driving this tightness to occur? Because that could be neurological too.

It could be an easy win if they just do the stuff that they're being asked to do. But they, but it makes sense. It's like there's a hammer and a nail and there's a piece of wood, let's hammer it, right? And so when I, when I hear tight, I think stretch or massage or rub or deep tissue, right? And there's an appropriate time for that stuff. But when it becomes the only thing that you're doing and you're not getting any result from it, I think that's a big problem. And that also comes with, you know, hey, this, your spine's not moving. Maybe we, like, I think you have the most immovable spine I've ever seen.

It doesn't move, right? Should we be adjusting it all the time? Maybe, maybe there's a reason why it's like that, right? Maybe we give them a little bit more focal homework. You know, maybe we reduce the central threat. So there's a lot of different things we can do with this person. But when they only have one tool in their toolbox because they see the problem is the tightness or the stuckness or the mobility issue-ness, then I think it handcuffs us as clinicians to do what we want to do. Because these people are going to call your office again. They're going to be like, hey, do you do this for this?

And it's like, well, probably not, you know, but you come in and I can take a look at you and just see what you, you know, see what we got to do with it. I don't know, I'm looking for someone to do this. And there's probably a reason this person's still having symptoms because they keep looking for that. So just consider that. I know we got a tangent topic there. And I'll go into the next common thing in next. And we have, this is one that actually started a little email thread with some of my patients on just to, to give them a little bit of a newsletter, because I think what's expected of them long term, I think is what's, what's different than we talked about in the beginning.

And so I've, I've done a bad job of this in the past and telling people what's really expected of them long term for their health. And I've gotten much better at it over the years. As you heard, I did a podcast about what's the exit plan to, to, to treatment is, is resistance training, at least in my book. And so, uh, in the past people would be like, cool, I feel better. I'll see you later. Right. Pain is gone. I will see you later. And so now I, I ask him up front a little bit more. I say, Hey, you're probably going to feel good after this amount of time. Here's what you probably should be doing later.

Right. We'll talk about that bridge when, when we, when we, when we go over it. But, um, I had a lady the other day too, that she, um, I, I managed her, I think I, I, I think I managed her better than, than I initially thought. And so she felt better with, it's funny. She had a shoulder condition. We, she were actually, she originally came in with a knee condition, a knee condition while running that, uh, was able to become, it was completely reduced, uh, at least for, you know, that day with hip loading. We had to run around the parking lot. She felt better. All right. She came back and, and, uh, there were still, uh, some knee issues there and we had to scale some running and so on.

That's a whole different side story. But for the most part, she's feeling better on that with, she had a shoulder condition that she'd been doing the same rehab exercises for about three months. Um, and she had no change and she still lost her shoulder range of motion. We reduced it with some focal neck treatment and she can now reach overhead, pick up a 10 pound weight on top of a refrigerator and bring it down. There's no symptoms whatsoever. And as we started to go through stuff and she was, uh, we, she'd come three times and we started to take her through more of a loading process and scale her away from the first day, scale her away from the corrective exercise and started getting into a real resistance training program and a load.

And so she is, uh, she was, she was going to be gone for a little bit. And so, uh, she, I, we went through a standard push, pull, carry, squat hinge scaled to what she could do. Uh, that's the Dan John principles, by the way. Uh, if you have not heard the other podcast where I talk about exit to resistance training, uh, I talk about Dan John's principles in there quite a bit and it's just simple stuff. And so, um, if you have questions on that, please go back to the podcast. So, uh, we scaled her appropriately with that. And so she had a lot of questions with a couple of them. She did the carry really well.

She did the, um, uh, uh, she does split squat really well. She did a crawling really well. And when it came to a single arm pull and a, uh, an, an SLDL or a single leg deadlift with just a minimal weight, she had a bit of questions. And so she's like, I'm going to be leaving town next week. Do you think I'll be fine? I'm like, yeah, you'll be, you'll be good. Just, just do these when you're at home, um, for a little bit, if you have a problem before you leave or if you question, just, just let me know and book a book a time. And so I emailed her later that day and I said, look, I, I see your hesitation on some of the things that we were doing.

So please come back and I'll coach you through it. And so I think in the past I've given people a little bit more, um, credit to what they can do on their own. And I, I think I've said it many times before. I can try to do my taxes, but I suck, you know, and it's not really, I don't want a CPA to say, Oh, you could do this on your own. I don't want to do it on my own. I had a web designer one time that like he was, he was great for a lot of things, but then he, I would say, Hey, I got this problem. Can you solve it? And so he'd send me an article on stuff. I'm like, dude, I don't just, can you please, can you please help me through?

Just, just tell me what to do. Like, I don't necessarily want to do it, but if you want me to do it, just tell me what to do. I don't want to read anything. I just want to do it for now because this is more of an urgent thing. I'll learn about it, you know, as time goes on, but, but please just tell me what to do. And so, um, with this lady, I want to do the same thing. Just, just show me what to do. And so I think I managed her a little bit better in that. And so her retention going on her trip was going to be much better. And so I guess this falls back to the question of, should I be, I feel better because she felt better.

Should I be coming back? Why should I come back? Um, what should I be doing next? And so I really think people should manage their, may be able to manage their systems by, uh, or symptoms by having a little bit of a first aid process in their back pocket just in case, because things sometimes come back, right? I had a guy that came in three times with the same, for the same neck issue and the same thing worked on all three. And he's like, I get it now. And I'm like, good. Next time it starts, start with that first and to manage your symptoms, then we'll get a little bit more aggressive when you come in.

And so, uh, I also want to have to have a little bit of a, of a corrective exercise approach in their back pocket. Maybe that's part of their warmup for their, for their actual resistance training. But when they do resistance training, they, they, um, they should feel good. Um, it should make them, I mean, they should make them feel better afterwards and during it. It shouldn't be painful. It should be effortful, but it shouldn't be painful. And so when people say, what should I do next? Should I come back after pain? I say, dude, you, you probably should, but you don't have to. What's your goal?

And so when they tell me their goals, it's for, it's, if it's for running a marathon, then the answer's yes. Because what are you, what are you guys doing on your own right now? Um, I do, I do like a little bit of squats and lunges here, uh, before I go run and that's kind of it. By the way, what should I do for a warmup? You know, should I be doing these other exercises that you gave me, um, uh, all the time? Well, you can do them for about six weeks, but after that you should be changing them. And so I lead them a little bit more into, you should come back for exercise programming if you're not going to go with a strength coach or a trainer, right?

And I completely understand not wanting to go somewhere else because, um, I've had, I've had quite a few people that they're like, you just know my, you know, you know, my symptoms or my case really well. And I just feel comfortable with you. Great, cool. Come in. Like I can, I'll tell you when I have no more value for you, but, um, I have a lot of value I can provide for resistance training and I think it's only going to benefit you guys. Um, I've heard of the, the gym, uh, the hybrid gym clinic model. Um, and I've been, I've been kind of doing that model for a long time. I don't necessarily ask membership of people, but for the most part, they, they come in, they get their thing addressed.

They tend to stay for a little bit of, uh, exercise resistance training programming and just guidance overall with life. I like to send them out in the wild to do a lot of this stuff. I don't necessarily need them to be here unless they want to be here and they like being here. And so the, uh, there was a, uh, there was a girl that came in the other day that she had never really experienced tension cueing, you know, crush the, crush the bird, right? Or bend the bar or drive the feet through the floor, turn the floor, all this stuff. And so it really changed how she was doing her lifting. And so she's like, dude, all these cues are money.

Like, good. I like them. And so we'd only gone through a couple of sessions and she's, so she's like, I feel much better. Should I come back? And I said, look, I did a whole 12 hour workshop on this kind of stuff like last weekend. So I've only spent really only about 30, 45 minutes doing this stuff with you. I can spend more time if you want. And if you think it's valuable and you trust me, I'll, I'll go through the process with you and just show you what I like. And we'll figure out all the holes in your programming. And then I'll release you the while. And you just got to trust me that I'm going to say that, that there's no more value for you here.

Okay. I'm not going to keep you on necessarily, but at the same time, if you're only in interested in reducing pain, you're probably going to be in pain again, you know, and it might not be immediately, but you're going to be very frustrated by this thing coming back. And because there's probably a, there's a process that drove this to be, all right, you weren't just fragile. It, something drove it to be this way, whether it be sitting too much, whether it be lifting poorly, whether it be poor programming, incomplete programming, holes in your program, or just, um, you know, just, just being, um, well, I guess that's all I got there.

But for the most part, people drive their own symptoms somehow, some way, and we have to unravel the, the why of why it occurred, right? It's like a murder mystery. Why did they do that? What's their motive? You know, was, was there a motive? Were they in the right place at the right time for that? And so we, we start to unravel the mystery that is their quote unquote overuse injury. And we figure out how to get them to a more, um, to a happy longer life. And obviously the, the whole concept of prevention is kind of like washed out by now. I think, I think it's kind of a, like, I don't think patients really care about prevention until they've had something significant and they're fearful that it'll come back.

And I know providers talk a lot about, uh, talk about prevention a lot, but they're speaking to people who don't really care about prevention. I don't care about prevention of the Quervin syndrome because I'd never had it. I don't really care about it. Right. I don't care about prevention of, um, a stress fracture in my foot because I've never had it. Right. I do care about back prevention and shoulder prevention because I've had those too. And so, but I think as you just take people through a process of molding their life a little bit, formulating habits, getting good tension in, in their, in their, uh, lifting and, and just exposing them to movement variability, then I think they're going to be overall prevented without you having to even talk about prevention.

Just build a better human. And by the way, movement variability is, I like to, I, I know there's things like FRC out there. I know there's things like yoga and, um, Tai Chi and so on. And I'm not, I'm not going to bash on them, but for the most part, I don't think we have to make things super complicated and regimented. Right. I play baseball, I go to the batting cages, there's a pitch that's high. I, I try to swing at it and I pause because it's a high pitch, right? I'm reacting to a ball that's high. My position of hitting is different at that point than it is if it's straight down, straight down the pipe, right?

An outside pitch is different. An inside pitch is different. Bunting is different. Catching butterflies and going for the high ones and low ones. And I remember when I was a kid, we used to chase sparrows in the, in the, in the field at school. The sparrows would go literally everywhere. They're the fastest birds you've ever seen in your life. Chase sparrows, you know, play with your dog, go run on rocks and the rocks will move and react. The reactive posture, uh, is what I'm looking for with that movement variability and being able to be exposed to it. So the people who have, uh, have had ankle turns and they've been bracing up their ankle forever, they're not going to be exposed to that movement variability.

So, and the people who do only resistance training and move like robots will not be exposed to the movement variability. I think it's another part that we're missing with people. And a lot of times you'll get it with some cardiovascular and just go out and play and have a good time. Do what kids used to go do. Go play in jungle gyms. Go hang on a bunk monkey bar, do different things, you know? And so I, I get it though. I get it. Um, resistance training at some point feels safe to people. Running feels safe to people. But if this is the type of guidance that I'm talking about, it's like, do you have pain?

No. Is there more things I can teach you? Yes. And so this is, it's, it's overwhelming to people sometimes to, uh, to talk about this stuff. Again, I call it white picket fence syndrome. It's like, you go on a date and they're like, they just want to, they just want to have a good time and talk to you. Right. And you get to know you and you start telling them about like how much you want in your 401k and what year you want to retire and, and you want a house, you know, with two ponies in the back and one cat and picket fence all around. And it's like, oh my God, this person is like already dreaming of their white wedding before we even like have their first, have our first conversation, you know?

And, and I don't like doing that to people, but alluding to it, it's like, I think we should have that conversation at some point if this is going to be a fruitful relationship for both of us. Right. At some point, you're going to want to know if that person's having, want to have kids or not. At some point, this person wants to know what else you're going to do with them. And you allude to the conversation, talk about it a little bit and say, don't worry. We'll talk about it more when we get there. Don't worry. Trust me. Okay. I got you through this. Trust me. I'm not going to burn through your pocketbook.

Trust me and we'll go through it together. So I hope this was helpful to everybody and, and just kind of learning the ways I at least communicate with people. I know that with my, my interns have come in, they've said, wow, your communication skills are, are pretty good. And so I'm not trying to toot my own horn, my own horn, but I'm trying to spread that the, the communication is important. And I think that people, unless they've sat in on examinations and patient interactions with, with real people, it's all hearsay. You know, I would definitely go suggest shadow somebody who is a good, uh, communicator and just see what they do because it's really what they do or how they interact with that person is different, uh, than the next person, even with the exact same condition.

So you have to navigate the relationship a little bit to get the person to that goal. All right. Um, thanks so much for joining me on this podcast, everybody. And, um, thank you for spending a good hour of your time, uh, listening to me rant about stuff. And so hopefully it's agreeable at least, or at least stimulating to your thoughts and, um, last house cleaning here. And so this is the last, uh, really the last podcast before the workshop occurs. And so I decided, um, way back, um, probably about six months ago to put on a workshop. If you didn't hear it already, uh, it was based upon how to offload musculoskeletal neurological, uh, pain generators and basically how to use active and active exercise or active, um, uh, suggestions versus passive, uh, and loading strategies to get people to feel really good within a short amount of time and actually get them to feel super empowered versus just putting your hands on them.

And so I go through a lot of that stuff, um, in this workshop and it, it does cost more now. I'm a man of my word and there was an early bird discount. You just missed it. So there won't be, uh, any CEs, CEs involved. I did CEs in the past with the other workshop and honestly it was a bottleneck. And so I think most of the people who came, they really didn't care about the CEs anyways. They just, they walked away with clinical nuggets and I'd say, uh, probably more than half of them walked away with a good four plus clinical nuggets and it will literally change the way they practice. All right.

I've already texted a couple of them and they said, dude, this stuff is good. And so I want to share what I, what I have. And hopefully if some of you come that know exactly what I know, um, you might just reaffirm the things that you think anyways. So, um, please come. I would like, I love to share the information with anybody who's, who's willing to listen. And as I typically say, um, keep money in the family and I know it costs money to come to this and I did raise the price from the other workshop, but like I would all day, I would pay the optometrist, which I like as a friend and a doctor, I would pay her cash all day versus going to someone else who costs less.

And so please do that. Keep money in the family. All right. I would pay you guys the same. And I hopefully you, you understand that I do got to collect money for it to pay my bills too. So this podcast doesn't generate me any money. Okay. I don't get any money for doing these. And so if you want to pay it forward, please do it that way. And I'll, and I'll share all the clinical goal that I have with you. So, um, by the way, I don't know everything. I'll just share what I know. Um, as always leave people better how you found them. If you're dating, dating Eagle Scout and I'll see you guys later.

Peace.