Lower Back Pain Questions: Supports, Exercise, Decompression and More

Clinicians, before we start, I want to draw your attention to the premium version of the podcast that we released back in January. This is where we do case presentations. We do what worked, what didn't work with specific types of scenarios, as well as orthopedic testing and so on. So this is all the stuff that you have been asking for. Many of you have been emailing me and asking, when can we do more case presentations? When can we get a little bit more specific into this and so on? So this podcast is for you. So please take advantage of it. It releases every Monday. It's 15 minutes. It's very, very detailed and stuff that you can actually use or at least consider using when you go back in the clinic on Monday. So this is something you can always cancel if you need to, but I don't think you're going to want to. And everybody in there so far, I think, has liked it. Nobody's complained yet. So I'll see you guys in the real podcast right here, right now. 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, this is Sebastian with the Restoring Human Movement podcast. Thanks for joining the movement movement. This is your first time on the show. Welcome. You've missed a lot. It's been almost 230, 40 different episodes and we've gone to once every two weeks now because you need to catch back up. So Dawne Costantino is on today. She's giving me a thumbs up because I said it right. Are you supposed to pause in the Costantino? Costantino? If you had to say it correctly, I'm okay with the pause. Yeah, it's a hard one. So anyways, we're going to go over lower back pain Q&As today. We've been doing this. I think this is the third or fourth one we did now. But these are common questions that we get from people regarding lower back pain, what they should do. Should they ice? Should they heat?

Should they stretch? Should they do X, Y, and Z? And so we have this big old list we're going through that we're sharing with each other that we're going to play a little bit of doctor patient just to see how each other answers it. So maybe our answers will help you to some degree. At any point, if you feel like you want us to help you, we can. People come see us for back pain all the time of various different types, various different severities. We're in Coast Mesa, California, and we'd love to help you guys out. So just reach out info at p2sportscare.com. Dawne Costantino, you there? Yeah, you just sound pre-recorded.

Yeah, I told you. That's why I don't want to close the show, like I said last time, because I've done it so much. Have you gotten my 4th of July emails, by the way, or audios? The old ones? Yeah. Oh, there were some this year. I guess you just weren't invited. One of my friends is like, are you practicing? I said, no, it just comes to mind. So do you want to be doctor or patient first? I'll be doctor first. Okay. We are on the lumbar support, I think. Yeah. Do you think I should get some lumbar support? You know, actually, I guess depending upon the situation, I'll say commonly, sure, go ahead. But I'd probably make one. Like I wouldn't buy one. I just make one with maybe a shirt or a towel or something of that nature. You can use in your chair. You can probably use in your car a little bit. You can even do like a modified small one, like a folded up towel on your bed below your low back too. Keeping in mind though, that this does not help everybody. Some people actually make them feel worse. But you know, that's the whole point of having someone look at you first is to see whether something's going to be helpful or not. So what do you think?

Yeah. I mean, when I first read this question, I was like, what's, what's different than the back brace question that we just answered on the last one, but I realized there's different. So there's the back brace and then there's the support, like when you're sitting down that little thing behind you to keep you in better posture, right? Lumbar supports. Yeah. They even sell them at the 99 cent store. I think like there's ones there that's like, so. Yeah. Some people have some really cool ones. Um, I, I do exactly what you just said. I tell them, you know, keep a sweater or a towel in your car. Um, and you can always roll it up and you can make it as thick or thin as you want to kind of help support the low back. Um, but I don't recommend this for everybody. This is for your people who respond really well to extension stuff. So we do a cobra pose and it helps them. And this is just very basic way of trying to get you to understand it.

But, um, if they are extension based person, this can help temporarily. Um, some people, some of this has gotten them to the, or the lumbar support on top of some other things has gotten them to our office in the first place. And we actually kind of need to take it away. We need them to be a little slouchy. We need them to do the opposite because they've been doing it too much. So like you said, it's not for everybody. Um, but it can be really beneficial for some. Yeah. I'm slouchy right now. It actually feels good on my back. It's great. Yeah. You're always slouching. Um, uh, also to, uh, I guess side conversation. So we're losing some interns next week. Mary Lou just said, Mary Lou's one of the interns here. You guys have probably heard him on the podcast before. She was like, what am I going to do with my day? I said, you're going to come back here and just probably hang out with us.

So she's over there just hanging out, waiting in the background. Yeah. She's, yeah. She's, uh, she's like, well, she's, she might go local, like Tustin or something like that. So, um, I was like, yeah, she's like, she's like, can I still come to the Tuesday in service? Yeah, sure. Can I still come to do the carry circuits? Yeah, sure. We want you around Mary Lou. Okay. So let's go to the next one. I am the, I'm the asker. So I'm the patient. So should I continue to work out? I'm not sure what bothers it. Uh, I like to go to the gym and do bodybuilding types of lifts because I want to make sure that my triceps are really strong looking and I want to make sure my abs are good and my legs look really cut. So can I do everything? Yes. All of it. Cool.

Thanks. Right now. I am not taking anything away from you. Um, every time we ask these questions, by the way, my mind is always like, this is the first time I'm seeing this person. They're sitting down in front of me. We're getting to know each other. We're taking a history and that's one of their questions or one of their goals of what they're trying to figure out. Right? So in the beginning, if someone's already a super active person, um, based off just that question in the beginning, I'm going to say, yes, continue to do everything that you're already doing. And if anything throughout this visit tells me we need to take certain things away, we will. Um, if we can't find a variation of a squat that works best for you, that's not painful, then maybe we might ask you to not squat for a little bit, but we're going to keep you moving as much as possible.

Um, and I'm probably adding more things in the visit than I am taking away, at least on the first visit. If a few visits go by and you're not where you should be, then we might start asking you to kind of back off a little bit. Um, but at no point am I telling you to not work out or to be on bed rest or anything like that. Yeah. I think bed rest for most people will probably be more detrimental than good. Um, I, we had someone come in here that they had, uh, they were kind of, they were, they weren't super active at that point in time anyways, when they made the decision to just go on more bed rest, but, uh, they, they just said, I'm going to take a spur to three months and just do a bunch of bed rest. And they didn't feel better. Um, in fact, they felt worse and they have to, quite honestly, they have to dig a, they have a whole bigger hole to dig out of for a little bit. Um, but yeah. Um, I had a patient the other day who was a cyclist, um, and he had knee pain, one sided knee pain that only came on at the, what was it? The three hour mark. So he had a full two hours and 59 minutes that was pain free. Um, and then once he reached that three hour mark is when his knee pain would start to come on and the doc he saw before seeing me said, don't ride anymore, just, just rest, just take it away. Um, and the way that I try to explain it to him is why would we take it away when you can do so much pain free? Let's continue to do that and add a couple of other little things in with it. And maybe we can get you to that three hour mark and beyond depending on what your goals are. Um, but too many times do we just tell people to just completely stop what they're doing and just see what happens. I think that there's just a better, more specific way we can guide people into resting or taking things away.

No, I think it's a better idea just to completely decondition this person. Um, maybe, maybe a way to creatively go through that too is like, okay, once you hit the two, uh, two hour and 45 minute mark, can you get off the side, take your water break, eat some of your snacks and then continue again and just see if maybe you can cluster it up. So there's more creative ways you can actually do it versus just saying, don't do it at all. Yeah, absolutely. You can still get that amount of time. If we're using the cycling example, if you want to get three and a half hours in, then we're, we're going to do little micro breaks in between to get you there. We had a cool one the other day that, um, she was, she was really fun to work with. Um, she, um, she was, didn't like the idea that the last person she had seen told her that she couldn't do a certain lift and they regressed her quite a bit to something that, you know, once I tell you the numbers, you're going to realize that this is quite a bit of a regression.

Um, I, she surprised me at the end. I didn't actually think she was going to ask this question nor that she can lift that much weight, but she didn't have any pain doing it either. Um, they, they said that she should stop doing hip thrusters. And I was like, uh, she's like, should I, should you, can you look at my form? I was like, uh, uh, okay. You know, based upon what I saw in the exam, I didn't see any reason to like hip thrusters actually probably be helpful to her. And so she did barbell hip thrusters. And so she's like, well, I'm doing about 300 pounds. I'm like, Oh yeah, let's look at your form then. Cause you know, with that amount of load, you know, stuff can go on. And we took, we took a look at her, at her, uh, form actually pretty good. And they wanted to regress her down to like a five pound weight. I'm like, Oh my gosh, like that's like, they're going to like, you're, you're deloading the entire body for the sake of one thing that you're not even sure of what it is. Um, I mean, I feel good about knowing what it is now, but yeah, I think that was a bad idea. Cause they, and she didn't like the idea that the person had told her to do that. And that was one reason she didn't want to go to them anymore. So I know that's people don't like to be told they can't do anything. A lot of times.

I think there's some trauma situations where you need to need a break of time where you deloaded or take some rest or something like that. But, um, even with trauma or tears or anything like that, um, you still got to be doing some form of movement, just laying down and doing nothing is more detrimental for you. Yeah. I think that's my ambulance this time. Oh, I thought it was me. I think it's coming straight down this side street. Yeah. Where are they going? Well, apparently they're right there because they stopped. Um, yeah, there's, I know we're talking about back pain, but you know, things with like tendinopathies or like jumper's knee, things like that. Like there's a need to deload, to reload, but the deload is not like, you don't have to completely deload the person. Like if it hurts to squat, you don't, you can take part of squatting away, but it doesn't mean to say do nothing. And so you, you take some of the triggering movement away for a couple of days and then you reload it again because it, uh, the body will adapt.

It will, if you don't want to use it and you're not using it, it's just going to say, cool, I'm going to recycle all these proteins and efforts and yeah, I'm going to do something else with it. Cause you know, so I wouldn't want to do that to somebody. That's just me. I mean, even with all this advice too, I wouldn't recommend trying to figure this out on your own either. I'm just thinking like somebody's taking what we're saying and they're like, Oh, okay. And they're going to try to figure it out on their own. It's, it's really hard to do on your own. You just got to work with somebody to figure out, okay, how much do I to rest? How much weight do I add? What movement should I, and shouldn't I do? Just go ask for some help from somebody who's not going to ask you to bed rest. Yeah. So, um, I think that this is probably side conversation, but we had a really, uh, we had a fun case the other day. He was a guy that just, uh, we call these people homies, you know, like they're just good. Like they're just dudes. Like they'll do whatever you ask. They're just easy to work with. Um, do everything you ask to a tee. And, uh, he was in a situation where he really didn't have any program. Uh, he also didn't have any idea of what was going on with his back. And so we evaluated, evaluated it. We gave him exercises to do. We wrote exactly how many times you should do that to what intensity. Uh, and we said, come back in a couple of weeks, you know? And so he's like, I'm going to do it all. I'm gonna do it to the T. If you tell me to do it, I'm going to do it. I said, perfect. Do it right. Exactly as written. I'm going to love that. Right. So I don't, I think, uh, it might be a misconception that people might have that they have to actually continually see somebody to actually do the exercises. You don't need to, but you have to know what to do and you need to have some guidance like Dawne Costantino said. Yeah. That's a good way to put it. Okay. Uh, it's your turn. Oh, should I only do my rehab exercises or is it okay to do other things? Uh, I would like you to do other things if you can. Uh, are you able to do other things? What do you want to do? I want to do, um, I'm an ultra marathon runner, so I'm training for that right now. No, you're not. I heard that you could just run two miles the other day. Yeah. You're just building up. Um, so the ultra marathoners like to eat pizza. You did say you liked, you wanted pizza the other day. So that's part of the training, huh? Um, okay. But yes, there are other things that, uh, that I like to do besides my rehab exercises, but I don't know if I should do them. Is it going to negate anything that we're doing here together? Uh, I don't know. You tell me what, give me an example of things that you want to do. Cause I, I looked at you, right? So I know some things go ahead. It's run, swim, cycle and lift.

Okay. Uh, do any of them bother you? They all do. All of them bother you. Okay. I don't know at what point. Cause there's sometimes where it does and sometimes where it doesn't. Okay. Uh, which one bothers you the least? Swimming. Swimming. Okay. Uh, why don't we, are you okay with keeping swimming in it, but taking the other ones out for about a week? Do I have to? I mean, you don't have to, it's up to you, but it sounds like, so right now you're presenting as somebody who their situation is a little bit more acute. Like it seems like, uh, it's not just one thing. Like, cause some people have like, it hurts to only run past a three hour mark. And then there's other people who are like, it hurts doing everything. So this might be a situation where we just have to narrow, narrow the triggers a little bit. Um, but there is a possibility by the exercises I gave you to do at home that we don't have to completely eliminate things either. But, uh, I think if you want to cleanly do things, you just pick one of those three that you want to do. The other ones we will plug back in as soon as possible. Uh, typically I see people in about a week, but why don't you shoot me an email and tell me how you're feeling? Uh, I think it's fair to say at this point, you can correct me if I'm wrong. Cause I don't know all your history at this point. If it hurts to run, it probably hurt. Does it hurt to walk? No. Can you walk a little bit? Yeah. Okay. Does it hurt to, um, bend over? No. Yeah. But it hurts to lift and cycle.

So it doesn't hurt to do anything really significant throughout the day, like day-to-day task. Is that what you're saying? Okay. Why don't you run it? Maybe run at a different speed. Does it hurt to bike uphill, not downhill and straight? That's a good question. I think I only do straight. Okay. Um, maybe we do hills and maybe we'll raise your stem possibly. So we can raise the stem up a little bit. So, uh, ideally I would just like to like, cause here's the thing that's going to happen. I would imagine with this scenario is you're going to, you might drive yourself a little crazy because things are going to come back a little bit more aggressively temper. It's like a temperamental situation. So we can have the choice to either you cut out a couple of things and have a little bit more something that's controlled. Uh, or you can choose the, you can choose the chaos, which I don't, it doesn't matter to me either way, but we can try to mitigate some risk with that by changing your running speed or distance or, uh, or pace, or we can change the fit of your bike, mainly the stem height, cause that'll dictate how much you've been forward from the back.

Cool. I think I can do that. Okay. Swimming pick a different stroke. Sounds good to me. So I can keep moving. I can keep doing all this stuff. You can keep moving forward. Maybe we just change the way you're moving forward for just a week. All we need is like a window. We need a window of a week to settle things down. After that, I can, I will give you more miles than you ever want to do. Okay. I will crush you, but you need to help me help you. Perfect. I'm into it. Okay. Uh, do you, do you want to add something to that one? Um, I think you hit it pretty well. I think all these questions always make me think of a specific patient. Um, but there's a lot of times people will take what you're doing and they'll be like, I see where you're at, where you're going with this. And then they'll kind of like add their own little twist to it. Um, how do you feel about that when people do that? Uh, by twist, you mean, uh, with like running volume in that case or like your rehab exercises. So you'll give them like this, this, this, and this to do, do this before you go run, before you go cycle, whatever.

And they come back and they're like, I did that, but I also did this and this because you're giving me core work. So I found this little YouTube video where we do this or, you know, they just add their own stuff. Like, Oh, so you're telling me that I just need to do more glute work. Yeah. I haven't, I haven't had that in a long time. Um, but I have had people that have kind of added more. Uh, but I, I, a lot of times I'll tell people, I just want to keep it simple. Like, especially with kids, like, I only want you to do these two things. I'm not saying like cut everything else. You're out of your life, but you know, play basketball, go for a walk, like do all the normal stuff that you're doing. I just need you to change a few things. Okay. Don't add more. It's simple for a reason.

That's it. Okay. Um, but yeah, I don't know. Most people that I find in, in, I'm okay with it is if safe, we suggest that you like five days a week of a core exercise, they're probably not going to do five. So I find it surprising that they'll do five then plus more exercises, but that's just me. So you got a unique one there. Uh, well, I'm like, I actually get that a lot. Really? And I know a lot more with my more active people. They always, um, they just want to add more to it. And we get to a point where it's like, why are you doing 50 different exercises? How do you have that much time in the day? Um, yeah, yeah. I don't really get it too much, but, uh, I'll tell you what, uh, since you're going to ask a question, how about we have a guest on here? Let's just grab Mary Lou to answer this next one. How do you think about that? Hey, Mary Lou. Hey, come over here.

We're going to, we're going to pull in a ringer because I know you're going to leave in a couple minutes. So, okay. So Dawne Costantino is going to ask you a question as if you were the, uh, you were the lead doctor in this case and just answer it. You can hear your feedback on this audio. This is Mary Lou. She's going to be a new doc pretty soon. Congrats. Just another graduation, uh, surprise, right? Right. Welcome. Just get close to go and sit down and get close to that mic. Hey, Dawne Costantino. What's up Mary Lou. All right. I got a question for you as your patient. Okay. I was told I should never lift anything over 25 pounds ever again. Well, um, let's see. Uh, yeah, I don't, I don't think that that's, uh, necessarily the best way to go about it. Right. We want you loading. Um, you know, we, if you think about it, you're probably lifting more than 25 pounds throughout your day, whether you realize it or not, you're carrying groceries inside. You might be picking up your kid. Um, you know, you're, you're probably doing a lot more than 25 pounds throughout your day.

So I wouldn't recommend to not pick up anything over 25 pounds for the rest of your life. That is not the right, right way to go. Yeah. I think it's, it's going to do more harm than, than, uh, than good. Right. So, but it seems like when I'm doing any of my lifting throughout the day, I go over that 25 pound mark is when it hurts. What do you think about that? Um, I think then, you know, we just have to make a couple of changes. We can modify it. We can coach you through how you can lift things safely. So that way you're not having that pain, uh, pop up throughout the day. You know, it might just be a matter of shifting things around just a little bit and only for a short amount of time. And then we can go from there. You know, you just build up strength. So part of exercise, I know a lot of people, you know, just may exercise to exercise, but part of exercise should also be your preparing for life, right. In different ways. So doing any kind of working out should prepare you for your movement throughout the life, throughout your life.

Right. Sounds fair to me. All right. Uh, I think he wants you to hit me again. All right. What else you got? What do you think about decompression? And we're talking low back here, by the way, this is low back podcast. Okay. Um, so for low back decompression, what do I think? I think there's nothing wrong with decompression. Um, in fact, there are times we have people, you know, they like that. So we'll give them a little bit of traction to decompress them before we get them moving. You know, if it feels good, that's okay, but it's not always necessary. Um, and you know, um, I don't think that it's a good long-term strategy. It's kind of like, uh, you know, uh, a massage where it might just feel good for that moment. It might be okay. It might make you feel better momentarily, but it's not going to build up any kind of resilience and it's not going to make it go away long-term.

So I'm sorry. I have scenarios for you then. Okay. Not doing any decompression therapy right now. Do you think I should introduce it in? Uh, I don't think, I think you can get good results without decompression therapy and I don't think you need to add something else into it. Okay. Um, I've been doing decompression for the last 13 weeks, twice a week. Do you think continue? Um, well, you've been doing it for 13 weeks. Do you think you've seen a significant change in using the decompression? Sometimes I noticed there is change, but sometimes I noticed that it doesn't necessarily help. It's hard to say. Okay. Um, are you pairing it with anything else?

No, they always just do the decompression and tell me, come back in a couple of days. Okay. Well then that's where I think you might be, uh, having some, you know, a missing link. You might want to add in some other things and build it. If you really feel like it's helping on some days, cool. Keep it in, but let's add it and build up around that and build some support or do some other things that you can do, not only doing decompression, but throughout the day, um, just to kind of keep that window of pain-free, you know, relief longer. Right on. Good deal. Your voice is so relaxing on the podcast. It's a nice thing.

Thanks. No problem. Yeah. I, I actually, um, when I was doing a massage one time, somebody asked me, do you do voiceovers? And I said, no, why? They're like, you have such a calm, relaxed voice. You should really do voiceovers. And I'm like, all right, whatever. It's a meditation podcast, like guided meditation. Yeah. I wasn't really sure how to take it. I was like, are you trying to be creepy right now? Or is this like, right? Cause this is in the middle of the massage. I'm like, hmm. What's that? What's that? Oh, ASMR. Yeah. So now take your muscle, just tighten it up and now just relax. There's your ASMR, ASMR plug.

I feel, I feel more, I feel more calm now. You feel calm. Good to see you done. Yeah. He's going to jump back in. Okay. Thanks. I thought it'd be fun to have her on since. You like her. What? Okay. Okay. Mrs. doesn't have a mic. Oh, okay. Well, uh, why don't I ask you something then? Because you've already tormented her a little bit. Uh, should I change my workstation? Have you tried to already? Uh, I, have you ever seen whose line is it anyway? Yes. Yeah. I see. There's the game about questions. It's like you, like whoever doesn't ask the question gets out. Should I have you anyways? Well, do you think I have?

Well, have you? Uh, no, I haven't. Okay. We can try it. Okay. You can definitely try it. I think changing workstations, usually it helps because, um, you have been in one position for a very long time and it causes issues. So we can try getting you a different type of setup where maybe you're standing a little bit more. Maybe you're sitting a different way. Maybe the chair you're sitting on isn't very supportive. We can definitely try this if you haven't already tried it. Okay. Cool. I feel like people these days, almost everybody is so educated on this that they've already done it all. They have their standing desk. They have their different chair. They sit in different ways. They sit. They've tried everything. They have the desk that goes up and down. They try to stand at a bar table for a little bit. Like, I just feel like that kind of advice is nothing new than people don't already know.

Yeah, I think so too. And standing desks for the most part are pretty affordable. Uh, I think the only thing they don't really do extremely well is like, and I haven't done it either. This is a desk that can go up. Um, I haven't fit it to myself, but also I don't have a detachable keyboard because I have a laptop. So it's still, I mean, for low back pain, it's probably okay, but even the forward head carriage sometimes is enough load to piss off some people's backs. So maybe changing the eye height and being a little bit more upright, it might help out too. Um, I know we found cases where the mid back, uh, not working well has created lower back pain. So sometimes that looking down will be part of the puzzle, but not with everybody. Yeah. All right. Uh, it's me to you.

Uh, I'm working from home right now and I've been working from the couch. It really hurts. Ouch. Um, let's try to get you a better workstation then. Oh, you're defaulting back to the last conversation. Okay. Oh, sitting on the couch, working from the couch. I honestly, I am a, I'm bad at this too. I'll work from like my bed a lot. I'll just kind of like prop myself up. My legs are out and my laptop on my lap and sitting there for long periods of time will create some issues. Sometimes it doesn't even have to take that long, but it is not a very supportive position. Um, especially if my low back does not like rounding at that time, I put myself in that position and it just pisses it off. So maybe we can change where you're sitting and where you're working from to see if it helps you.

Yeah. Yeah. I know that I was sitting on the couch today because my dog July, I was teaching her to not get on the couch. And so I was forced to the couch and my back was hurting a little bit. I'm like, damn it. I just want to, I don't want to be sitting here anymore. But so in that case, she was the one forcing me to sit there and I realized I could just put her in her kennel and sit wherever I want. So you're in control. Let's choose the couch or the bed. Cause you think you're going to be more comfortable there, right? You're like, Oh, I'm working from home. I love this spot. It's so comfy. I'm going to just work here. And it ends up just pretty more.

Yeah. It sucks. The, and you know, like those pictures where like somebody is in like this, like sprinter van laying on their belly with their laptop and they're on their bed and their legs are crossed. And you're like, that looks so comfortable. It sucks. It's good for like five minutes. It absolutely sucks. More than a couple minutes. And you're just like, Holy shit. Yeah. I spent 150 grand on this, on this, on this sprinter van and I can't even lay comfortably in it. The hell second to take that photo is why, of course, that's why they look so happy. Yeah. They didn't have to pay workers comp on it because that model got hurt doing that for shoot.

Uh, I think we can probably answer the next three in the same breath. So why don't we just do these? Yeah. I think, uh, I was asking you, so you ask me this basically, these are interchangeable, right? Yeah. So I was thinking of doing Pilates, doing chiropractic or getting an injection. What do you think? Uh, maybe, you know, um, I guess in the Pilates situation, if I found in the exam it'd be helpful to them, I would say, so go ahead. Uh, same thing with the chiropractic, uh, adjustment, I guess in this case, using people say chiropractic, they're talking about the specific pop. Uh, in that case of, if I deemed it was helpful, I would help, I would do it for them. Um, and with the injection, usually, uh, I kind of take the route of, if someone's not improving, then we can maybe use it as a way to identify a pain generator by guiding the needle. I mean, I won't do this, but you guide the needle, you can see it hit the structure and all of a sudden the person's pain dissipates. We had a shoulder case that it helped out with this fashion because we weren't sure if it was coming from the neck. Um, but in other situations, it's like, if there's a truly inflammatory, um, thing going on and we have a hard time cooling it down, like there's a lot of fuel in that fire, then maybe an injection might be something helpful. And I never suggested people go out for like sciatica sometimes with this, but it's not very common. Um, but yeah, does that answer your question? It's all dependent really? Yeah, absolutely. Um, I was going to say, so like the, I can put the, I can think of a patient where I can put chiropractic and injection in this same category to answer those questions. Um, someone who came in with very, very, very cute, very high pain level, like mid back and neck pain.

Um, and we couldn't even do anything with him. Like laying him down onto the table was excruciating. Um, getting him up off the table was excruciating, trying to just put him in a timeout position against the wall and like tinkering with where his head was at was really, really hard. So he was coming in for just an adjustment. He thought an adjustment would help him. And the way that we were moving him and trying to do his exam, it was like, there's no way I'm doing any sort of adjustment on your spine at this point. I do not think it would be beneficial for you. I actually think it would make you worse. So let's not on that. Um, and when you think about injection, I've never had to do this before, but with this patient, I recommended it. It's like, I think that you could be a good rehab candidate, but if we can't even move your body, we got to find a way to move your body. Um, so if you want to go ask, you know, I sent him to somebody to just see if he can get something to help with his pain levels so that he can come back and we can do some movement for support. So, um, an injection can be used in a way that if we can't move you, it can help get you to a point where we can move you. Um, doing chiropractic, if you've already tried it and it's not working, maybe not. Uh, we try something different, but if you haven't yet and you think it might help and your exam shows it, sure. Let's try it. Um, the Pilates thing though, um, people think I put like Pilates and yoga in the cat, same category. People think that they need more mobility or they need, um, I don't know. I don't know what goes on in their mind when they think yoga and Pilates, not that I'm against it. I actually absolutely love those two things, but, um, I don't tell people go do this for your pain. There's been times where it's helped.

Um, maybe if they're not moving enough, it helps promote more movement. Um, but when I first started Pilates, I actually had a lot of pain from doing Pilates, um, until I really got the, what I would say core control down and then it wasn't painful. So, um, I don't know where I was going with that. Yeah. I had somebody before that they actually, um, I've had a lot of people who have say you brought up yoga. I've had a lot of people who have done yoga and then there's certain painful movements in their yoga flow into doing a flow that are, I mean, they trigger their problem. And so it's kind of like a dance. And then so it's hard to, uh, say, don't dance with the rest of the group. So I just say, look, you can, you can choose to be kind of an independent in the group and continue, or you can, uh, you know, pause for a week and then go back to it again. Uh, and there's another situation where I had somebody that he was actually a pretty hard case for me. He was had some groin pain and, uh, we tried a bunch of things that typically work. And then all of a sudden he decided to go to hot yoga. And all of a sudden his, all of his groin pain was gone. Uh, I think it helped him. I don't think it was the heat. I think it was just, he was so guarded and stiff and like he was at the point where he needed more movement exposure in his spine. And aside from telling him to dance, this was kind of like a choreographed dance where he had exposure to different movement.

That was my thought with it. But, uh, yeah, I agree with you on that. Have we disagreed on anything yet? There's sometimes where you give like a contract, like a, just a statement that kind of contrasts what I say, but I don't think we ever really disagree. I think you said that Mary Lou sounds better than me. I disagree. So, okay. Here's the last one. This one's kind of, um, well, I guess there's two more on here, but this one, this one's probably an important one. The next one, uh, I've had a bad experience with my old PT, chiropractor, MD, orthopedic, et cetera. You insert the profession. Um, uh, what do I do now? Like, why would I come see you? Um, you know, I like, I feel like a lot of times people will kind of bundle their experience of that profession with their one experience with that one person. So when someone brings up this question to you, is there anything that you talk to them about?

I literally had this conversation on the phone like two weeks ago with somebody. It was, we didn't even get a hello from this person. It was just, hi, my name is so-and-so and I want to know what makes you different than anybody else I've already tried. I was like, all right, then here we go. Um, did you say that you were two chains instead of one chain? No, that was a two chain song. I'm different reference. I didn't get that one either. Your references. I'm terrible at this stuff. Mary Lou's over there grumbling. Like that's terrible. What's that? Yeah. Jared would have got that one. You're right.

Yeah. Anyways. I mean, I think the way it's a hard question to answer, you know, I'd sit here and I can talk all day about what makes us different, um, or what would be different, but the way that I approached it was, well, why don't you first tell me what you've already tried? Cause sometimes going to a DC or a PT or an MD means they were just told to rest. They were given pain medications. They did a lot of passive treatment. Um, maybe they went home with a paper with rehab exercises on it instead of it being individualized for them. So I like to get an idea of what they've already been through before I can answer that question. Um, so then I can, you know, pose, well, this is what we do in here. And that's the way I approached that conversation. I said, well, why don't I just give you like a little rundown of how it would look with you coming in here? And I tell them, you know, the three goals we're trying to accomplish on the first visit, where it would go from there in the future. Um, but at no point am I, you know, sitting here and telling you like, we're going to do this exercise that you haven't done and this exercise that you haven't done, or you don't know until you see somebody, you don't know what you're going to do for a person until, you know, you get to know more about their body and do their exam. I talk about our first aid as a way that kind of sets us out from the rest. You know, maybe you've gone straight into strengthening and corrective exercise and you need to really address the underlying issue first. And no one's done that for you. Maybe nobody's looked somewhere else that the pain could be coming from, but I don't know.

I don't really know how else to answer that question. I think that we're better than a lot of people out there. It sounds, you know, big headed of me to say, but you don't know until you come in and try, just give me one, one visit, just come in, show you what we do. And if it feels like we're any different than anything else that you've tried, then you can continue to come. And if not, you know, I'm not going to keep you around if you don't like it. Yeah. What's a good way to answer it. Yeah. It's a tough question. Cause, um, I mean, I think first off, as you kind of noted that, um, we don't know the experience of the person has had and they can have a same experience that you mentioned, like the piece of paper experience, which actually some people like, I didn't realize that, you know, piece of paper with 10 different stretches on it.

And so they would, they might get that same experience from a physical therapist, a chiropractor and a medical doctor for all we know, you know, cause everybody, just because the piece of paper handing is not specific to the profession. So, um, so everybody might have a very similar treatment with soft tissue work at a physical therapist, uh, a chiropractor or massage therapist or a, uh, um, uh, or, uh, what are the, what are DOs again? Uh, or, um, I forget the pediatric, right? No, no, no. DO is, uh, um, I'm forgetting the name. Um, what are they doing? Osteopath. There you go. She's listening over there. I should just get her a mic kind of like, uh, she's like the producer. Yeah. So the osteopaths, it's like, you might do the same thing. So, uh, I wouldn't bundle your experience of the entire professional degree in with one person. Um, someone asked me this the other day and, uh, I looked at him. I was like, I feel like we're very thorough, you know, like we really pay attention to what's going on with you. We're very thorough with our exam. We take time with you. Uh, and none of the exercises we do should hurt. Like they might've had an extra, uh, exercises that hurt them before. Um, so I just want them to know they're in good hands that would make us different. Like, um, so I, I think a lot of people lack it. Like they don't get enough. There's a not enough, there's not enough information that's gathered before applying care. Like you need to gather information like Sherlock Holmes and you know, like his Watson.

It's like the entire show is about gathering information and then doing, then figuring it out. Like Scooby-Doo is the same thing. Like they didn't figure it out to the very end. So it's a very small part. Get that fly. It's a very small part of the puzzle. So the first interaction should be gathering information, which we spend a lot of time doing that. So I think we are different in that regard. Well, kind of popped up into my head too, is there's times too, where I will ask them. So what have you already tried? And I mean, you get to learn from other people's mistakes too, right? If somebody, if you're the first person, Sebastian, somebody comes to see you're going to try something. It looks like this is going to work, go home with it. They come back. Maybe it didn't work. So you try something different, right? Well, if somebody's seen a bunch of other people already and they come back in and you get a list of things they've already done, well, now you get to learn from that and you can maybe guide them in a different direction as well.

So we get lucky in that sense. Sometimes I think that even happens with you and me sometimes too, when we work with the same patient, it's like, well, uh, I get to look at what you've already done, or you get to look at what I've already done and then choose something different based off of that. And sometimes that person looks like the hero because of it, but you know, you need to give one person enough time to be able to figure it out before you say it's not working. Number one. Um, so that's, that's one thing to think about, but like you said, we're thorough. We individualize care for everybody. Nobody's care looks the same. Um, yeah. Yeah. And I think you mentioned some good there is it. And I'm sure other places do this too. You know, you're testing to see if your treatment helped them. And so if someone doesn't go back to this person, which I know we're talking about, like you said, someone called and then like day one, what makes you different? Like impress me type of thing. It's like, well, really we learn more about you as we see you move and we see what you respond to. If you don't respond to something that is information we're gathering information.

And so you're like a novel, you're like a big book. And we picked you up in the middle and we're starting from a chapter 15, like we're learning as we go. And at some point you're like, Oh, this, this book is about, you know, world war two and there's an ambulance driver and he really likes this girl, miss Catherine, you know? And so did you get the book yet? I think it's world war one actually made that story up, but it was pretty good. Oh, it's a farewell to arms. I'll see you later. Thank you. I can get half that. Um, but so anyways, I think that's what people, people, people need to spend a little bit of time, you know, letting someone have a chance to help them. There is no magic. So there is no quick fix.

Yeah. And if someone tells you that, um, I would disagree. So anything else you want to add, Dawne Costantino? Cause that was the last question we're going to cover for low back in the near future. And we have in the coming podcast at some point, it's another series of me and Dawne Costantino doing hip pain questions, neck pain questions, shoulder pain questions. And then I have no idea what to talk about next after that. I think that honestly though, well, I mean, we could talk about this off the podcast, but I think we should do something about all those crazy things that we've been seeing in the office too. And just kind of educating people on it. I think that'd be a good way, good information for me. Well, um, me and Merlew did do one before about chain, uh, about thorough examination and things that people might be missing if they don't allow someone to for like do a thorough exam, uh, such as those big, bad scaries or like needs for images and so on. So there is a podcast about like about two months back where you guys might find parts of that, but we can do another. Um, I don't know really what else I would add. I think, uh, give us a chance. If you've tried something and it's not working for you, reach out to us. We'd love to answer any questions.

Um, we are the locally world famous. I wanted to add that in. Yeah. We haven't, we got to do more video videos. Um, yeah, we have a YouTube channel. If you guys don't know, we are a trademark local world famous chiropractors. And, uh, so there's a bunch of videos that release all the time. In fact, we can't get the videos done quick enough where me and Dawne Costantino haven't had a really good schedule where we can sit down and do something like this. And so I just replaced her with Merit Lou for like five of the episodes. She was, she was, she was good. She was really good. I think you'll be happy to know that you got a break. Okay. Well, thanks for being part of the movement movement. You can always reach out to us info at P2 sports care.com. We'd love to help you guys out. See you next time. Bye.