Lower back pain questions: surgery, ice, yoga, walking and stretching

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Thanks for joining the movement movement. This is your first time to show. Welcome. You've missed a lot and you should probably go back and listen to all the ones in the archives. Today is going to be a little bit more patient friendly. This podcast is intended not just for patients and clients and lay public, but also to, for clinicians to really improve their ability to treat people, get really nice outcomes and get people to feel better. And so we thought we'd cover something today, which is a bunch of just general questions that we kind of get from some topics. And I apologize for the echo.

Usually when we do a dual podcast, I, since we moved offices, I got rid of the podcast room. And so Dawne Costantino is here with me. Hello. And so we're going to do the best that we can with the audio that we have. So we're going to cover low back pain today and we're within the next 30, 40 minutes, we're going to get through as many questions as we have heard. And we might even make some up on the fly. I have a whole laundry list of so many questions you get with low back pain that hopefully by the end of this single part or two part series, all of your questions are answered. Okay. Do you want to start first, Dawne Costantino?

Sure. Okay. So, um, do you want to be the, do you want to be the, we can role play by the way. That's fine. Okay. So you want to be the patient or the doctor first? Uh, I'll be the patient first. Okay. Do it. Cool. Hey, Seb, um, do you think I should get an inversion table? Uh, so I'm guessing you don't have an inversion table, do you? Like me as Dawne Costantino and me as the patient. No, you, you're, you're, you're always the, you're the patient. Okay. Gotcha. No, I don't. Okay. You don't have one. So, uh, why do you think you need an inversion table? I'm just curious. Um, I've just heard that, you know, in compression in your back, sometimes it's gravity that's taking a role and I heard that just doing inversion can really help.

Okay. Um, yeah, you know, we don't actually have an inversion tables here. Uh, and I've never personally suggested an inversion table to anybody. Uh, so yeah, I mean, I wouldn't personally. Um, but if you are looking for an inversion table, I know Costco has them. They're pretty cheap. And the cool thing is you don't like it. You could probably return it. Right. Um, I actually had a neighbor one time who had, it was an inversion table, but it was something where he was kind of hanging from his feet in a doorway. It's probably another type of anti-gravity. Well, I don't think so. He was a, he was a Marine.

He could just take it, you know, he's like, he's like, I'm not afraid of this stuff. And so, um, anyways, uh, one day I went over there and, uh, he, he had just been off of the machine and his wife had called me. And so we went down there and so he was fine when he was in the hanging thing. Cause he was in the anti-gravity, but doing the sit up to get out of it created so much pain. He was on the floor. He couldn't leave the ground. So, um, I would question with an inversion table, then if you do feel good doing it, by all means you can do it, but, um, maybe consider when you get out of it, how you're going to feel and how you get out of it.

I like that. Okay. Do you think it would make me worse at all? Um, I mean, in this case it did with that guy. Sure. You know, there's always a possibility. Everything's got kind of a risk reward. Um, yeah, it could make you feel better, but there is a possibility it makes you feel worse. And that goes along with any type of treatment that you get. There is no magic bullet. Can I add to that? Sure. Doctor, literally the patient who just left asked me about this. He had already ordered one. And then he said, do you think that I should do it? And I said, I don't think it's going to hurt you based off of, you know, him and working with him and knowing his symptoms and what's going on.

So I don't think it's going to make you worse. Um, but I don't think it's one of these things that's going to be just like this magic pill that you take and everything goes away. It's a very passive, um, you know, modality that you can use. Um, it could feel good while you're in the position. Um, but I don't think it's going to be something that will give you long-term benefits. Okay. Yeah. I think that a part that people kind of forget when they're using things like these passive things or, uh, inversion decompression is that it actually can help with things like, you know, numbness of the feet, low back pain, the general compression that we're kind of talking about.

Um, but there's other ways the body can decompress itself and the inversion table doesn't improve your, uh, spinal stiffness. It doesn't improve your, uh, hip strength. It doesn't improve all the things that can also help out with keeping you from needing the inversion table. So yeah, if it feels good, that's cool. If it takes your numbness away, cool. Um, but there's other things you need to be doing. So I'm just curious. I don't even know how often when people use inversion tables, how often do they do it? Is it a daily thing? I think it's a daily thing. And honestly, I've gotten in one before and I can't even, I mean, does it feel good on your low back?

Sure. But my head feels heavy while I'm hanging in it. Like, I just don't like it. So I think that's probably, it probably says it on the box too, but like if you have a history of high blood pressure or headaches, like you don't want to do it. I don't think so. Uh, that's the, that's the, that's the, there's the cost benefit. Your back feels good, but your headaches are terrible. So, um, but yeah, anything. So before we move on to the next question, do you want to add anything or, cause I want to make sure these topics are generally done. Yeah. Um, well, I think where you were heading with the question where I would just add a reiterate on this is the question of, uh, do you, do they do it every day?

I think people are using this in a way to just decrease symptoms. Um, but we want to make sure that you don't have to on a daily basis, um, be doing something that gives you all of this temporary relief, you know? So, um, what am I trying to say with that? If it's something that you're using on a constant basis all throughout the day to reduce symptoms, then, um, maybe we should try to do something a little, little harder, a little less passive that can help improve symptoms throughout the day. Yeah. There's a, it's funny, like when, I don't know, I, I know the inversion tables are on the same thread, but I'm sure a lot of the other things we're talking, going to talk about on this list are too, but when you, when you say like, Oh, how is your back pain doing?

Oh, good. Like I, I found something that works, but what's working in inversion table, how often you do it every day for the last year? Why do you need, if it's working, why you need it so much? You know, it's like, uh, if you, you know, learn to shoot, you don't need to go back to shooting class. So like at least part a, you know, like you kind of, it's something that you've already gotten through. Um, and so maybe that, I guess that comes down to people's success type of, um, measurement tool. Is there a success getting out of pain or just actually being independent again? You know? So you want to go on to the next one?

Sure. Okay. So I'm the patient with this. I have back pain. It hurts. Do I need surgery? Um, I know these are generic, but these are probably, there's just so much to dive into it. That one, um, we can keep going. No, it's great. So I think the, here would be, I would follow that up with more questions. What have we tried? Is surgery the first thing that we're coming to when this lower back pain has come on? Probably not. Actually, most likely not. Um, most of the time things with lower back pain, we don't need surgery. It really just comes down to, um, finding the right program, um, the right type of rehab for you, um, and being consistent with it.

That can really help. I think surgery should be the absolute last thing that we consider. Um, as long as you don't have anything that's progressively getting worse, your function is, you know, decreasing rapidly. Um, you have inability to use your foot. You can't pee, things like that. Um, if you don't have any of that stuff going on, let's give, let's give rehab and loading and all of that, uh, a fair chance before we say surgery is the first thing to do. Okay. But I've tried everything. I've tried sit-ups. I've tried supermans. I've tried walking. I've tried injections. I've been stretching.

I tried yoga. Uh, nothing helps. Yeah. I hear that a lot. Yeah. Well, those are the first go-to. We definitely hear that a lot here. I think a lot of times too, is what I hear is I've definitely, I've already done PT for this long. Um, and then when we dive deeper into what the PT considers or what it consists of, it's certain things that I probably tell people to stay away from more than anything or to not rely on. So, um, was your PT and rehab challenging enough? Did we give, uh, did we challenge your body? Was it things that really improved pain? Um, was it individualized for you? These are all things to consider.

Um, when we do this laundry list of things that you have tried. Yeah. The, let's see. Well, I, um, I, I, I went every day. I went three days a week and, uh, yeah, it didn't help. I just don't get it. Do I need surgery still? I did. I did what they told me to do. I'm literally thinking in my head right now. Give us a chance. There's, and, uh, it's, I always, I've thought about it like a lot that, you know, like we always hear the bad stories, you know, when people come in and they're like, well, I've tried physical therapy. I've tried, um, you know, acupuncture. I've tried chiropractic. I've tried all these things, you know, and to be fair, there's other clinics that said, well, I've tried you guys, you know, and you guys suck.

Like I didn't get better. And so everybody gets his, gets everybody else's failed cases because it didn't work for them. And so I'm sure there's a lot of people that, that are not thinking that surgery thing because what they did in their rehab was good and right for them. But just because you tried a program doesn't mean that program was the right program for you. Um, and, uh, Superman is not right for everybody. Uh, and a sit-up is not right for everybody. How do you know it's the right program for you? If there's people out there right now, they're currently in a program. Um, what would be like top three things you would say to them for them to consider?

Does this feel like this is the right program for me or not? Um, I think the first thing is that I, I think people should give the program or the director of the program a chance. Um, you know, it's really common for people to do like a, you know, I went in one time and it didn't help. And that's not a program. That's a magic show, you know? And so give the, like, do the work, whatever they say, I want you to five days, stand on your head, whatever, do it, do it as many times as they say, and your job should be not to necessarily be like, you know, to try to prove them wrong, but prove them wrong, you know, do the work and prove that it doesn't work and give them three weeks.

Three weeks is fair, right? To feel like you'll like, you'll know, like there's light at the end of the tunnel. It's like, huh, things are getting better. I'm optimistic. I feel like I can do X, Y, and Z a little better, you know? And yeah, I liked it. That's, that should be fair. Um, now if you've done everything to the T and you don't, you're not having that experience, try another program, you know? And I think we've told that to people here, right? Just give us a, like you said, just give us a shot. Like it's a, but it ain't no magic show. Yeah. Um, something I was going to add to that too, considering surgery, um, say you do go through with the surgery, you are still going to have to rehab afterwards.

So you might as well give rehab a shot in the beginning before we decide to, to go down that route. Yeah. Um, I don't think actually, so there might be some, some, uh, some back and forth on this a little bit, cause I don't think some of the old time like surgeons, I think if I recall, I've heard stories, they don't always, always suggest rehab after. So there's a possibility they might not get that recommendation too. Um, but either way, uh, there is the idea of the virtual surgery, which I think Stu Miguel came up with, which is a good idea, which you're kind of alluding to, right? You were going to, you had to do the rehab anyways.

You might as well just do it minus the surgery, see how you feel, dedicate yourself to it. And if it doesn't work, yeah, you, you've kind of earned your right to maybe try surgery. You know, uh, I'm sure a lot of, there's a lot of surgeons out there now in their head like, yeah, do your work, but there's time and place for surgery as always. We kind of say, right. 100%. Um, okay. Anything else you want to add to that before we continue? We will not come back to surgery again. I just think that I think it's more just a little cherry on top of what we just were saying is that, um, surgery, can it help fix the problem in the pain?

Sure. But what really caused some of these things that was creating your pain in the first place is usually having to do with needing to load your body, needing to find the right movement patterns, whatever you want to say about it. Um, there are still things to be fixed so that this isn't something where you have to constantly go back to surgery over and over throughout the rest of your life. So, um, consider doing the hard work now. Okay. Do the hard work now. Dawne Costantino said so. Okay. So we're going to move on to the next question and I'm just curious with time. We've been almost eight to 10 minutes doing this podcast and we're only to question three.

This is going to be a very long series. I realized there was more after that. Oh no. I had, so I had listed down for hip questions, neck questions, shoulder questions. And so if you guys aren't subscribers to this podcast, there's a lot more to come. Um, and, and obviously when we do these Q and A's and stuff, it's not to sound like we're making fun of any of those questions. These are just questions that a lot of people have. And, uh, it's everybody's, a lot of times people's first rodeo with these problems and they have the same starting point. What should I do? Okay. So let's move on to the next one then, which is, uh, you, wait, you're, I'm patient.

You're patient. Okay. Go ahead and ask me. Shoot. Hey doc, should I use ice or heat? Well, so which one, which one do you like? Which one do you like? Sometimes ice helps. Sometimes heat helps. Okay. Do you use them in combination? Sometimes I use them one after another, you know, cause I've been told like 20 minutes of ice and then do 20 minutes of heat right after. And you know, it helps a little bit. Okay, cool. Do you ever use a heated blanket? Those are pretty bomb. No, I haven't. There you go. Yeah. The heated blanket is the answer. So, uh, well, I, so I usually tell people with the ice and heat thing that whatever one feels better is fine.

You know, some people have a preference. I like heat. Do you think I should do ice? No, I just do the one that feels good. Um, I don't personally think there's a big appreciable difference between the two from a therapeutic value at this point. I'm sure I might change my mind one day. Uh, and I think, didn't you say the, didn't you, you said when you came from Dr. Murray's office, the, did the internship there, he really likes ice for acute low backs, right? So, uh, in that case, yeah, I think what was the idea is that the, he's trying to stop the infiltration of the nerve with the vessel as it moves into the outer, outer third of the meniscus, right?

Or sorry, um, outer third of the, the, the desk, the interval disc. So I'm okay with that, but I haven't really had to force it too much. Uh, I did have a patient the other day that had a really hot neck, uh, and I told them to do some ice just mainly based upon that same premise. And, uh, but yeah, I don't, I don't know if he, they say he heats for like what chronic pain or something. What's the, do you have any idea? So I know that the idea behind ice is to very simple terms to decrease blood flow to the area, right? Decrease inflammation and he is the opposite. So if you wanted to still stay pretty simple, um, ice in the very beginning, like when you first get injured, do we want to use it?

Could it help? Sure. But the thing is, is you have your natural healing process that needs to occur anyways. You don't necessarily want to stop that. Um, but when it becomes too much, when it's too much inflammation or too much blood flow to the area, it can help. Sure. Um, heat on the other hand, I do believe you want to, I don't think that you want to promote more blood flow to an acute injury with heat because that actually could, um, be bringing in, I guess, for lack of a better way to say it too much inflammation into that area. Um, all in all, I think with anything that we're going to talk about, whatever feels good, do it.

Never once have I told somebody to do ice or to do heat alone. Um, and that was the answer to their problems. So whatever one feels better. Yeah. You know, when you were saying that I was, uh, look, trying to look up, there was something I saw years ago, which was, uh, I forget who came up with the rest. I see Dr. Nice. Someone with an, I want to say Milnick, Mernick, somebody like that. Anyways, I, I, if I recall, if you look at his website, I think there was like about five years ago where he came out and said, look, 25 years ago, I created this thing. I'm so sorry. Like, please stop, you know, type of type of thing, or at least for some parts, you know, I think mainly ice was, I think on the agenda in that conversation.

But, uh, it was, uh, it was kind of interesting to see that, that the person that was promoting it kind of changed their mind, you know, cause they were learning some stuff, I guess. And, uh, obviously it's circumstantial, as you kind of said. So, but at this point in time, I think it's so ingrained in culture that it's, you know, it hurts, put ice or heat on it, you know? So yeah, whatever, whatever you like. Um, I think the, the, I, the old way of thinking is rest as in don't move it, ice it, elevate it. All of those things have kind of been disproven at this point. So rest being more active rest, depending on where you are in your healing journey, um, and loading it, using it in a pain-free way is really what it all comes down to at this point.

So use ice or heat if it feels good, but I wouldn't hang my hat on that being the only thing that's going to help you. Yeah. Um, the only other thing I kind of come up with when people talk about the ice and heat is I know they're going to be laying there, you know? And if, so if I've asked them to do something else, like I need you to go on walks and they're like, well, I don't really have time because I'm icing. Then that would be an absolute, let's pull the plug on that thing. Uh, unless they can figure out how to get the ice on their back when they're walking. But if it's robbing them of the other, of the time that we're asking them to do something else, then, uh, then I'll remove it.

If not, go ahead. By all means. Okay. I'm apparently the patient here and I really want to do yoga because my friend, their back pain really was better with yoga. So do you think I should do yoga? Um, that's a hard one. I wouldn't say it's hard, but do I need to do yoga? Do I need to do, well, let's start with this. Do you want to do yoga? Uh, I, I, I, me, I don't, I really don't. If it's a goal of yours, we could get you to it. But if you're thinking like, do I need to do yoga to help with my back pain, but I hate yoga, then no. Okay. So, cause some people obviously might've been told that yoga is there supposed to be the thing that they're doing, right?

Um, but yeah, there's, I don't really want to do yoga. I really don't, I don't want something else to do. I just want to play baseball. I don't want to do yoga. So in this case, don't do yoga. Don't do yoga. So you're saying I can get better by not doing yoga. Okay. But it's, but yoga could help. It could. Okay. So maybe in what scenario then would, uh, so now let's change the scenario. I want to do yoga. Yoga is my passion. Okay. Can we do yoga? Let's, uh, and you're not already doing yoga. It's something you want to introduce in. No, I've been doing yoga. I'm just, I haven't been doing it for a while because I'm really, um, cause some positions bother me.

So let's explore the positions that feel good and explore the positions that don't feel good. We'll stay away from the ones for now that don't feel good or see if we can modify them. Um, and then continue to do the ones that feel good. As long as yoga is something that you still want to do, I'm not going to take it away from you at the time being. Okay. So we just modify some of the positions that hurt. Uh, so can you coach me through all that? I thought you were a yoga instructor. Yeah, totally. Okay. I get what you're going here. Um, all of it. No, but let's, we'll find like a general, uh, what we usually do is we find, um, general things to stay away from and general things that we want to promote.

Right. So for example, low back pain, somebody really hurts when they round their low back. So any positions that you feel like are putting your low back into a rounding position, we're going to modify those. Okay. I want you to try to bend your knees or just try to stay away from it for the time being. These are the little things that we'll kind of just discuss. We won't like sit and go through all positions, but giving people, um, kind of this umbrella idea of what to kind of focus on as they continue through it. If we notice you're not getting better than maybe we need to dive deeper into this or take yoga away for the time being.

But for now, we don't want you to round your low back. We want you to extend more. So let's try to do that while we're doing yoga. So, but, but I actually hurt doing both directions though. You're not, you weren't being easy on me. I know, you're totally right. Um, okay. So then are there positions in yoga that you can do that are pain-free? Corpse pose. Is it just laying flat dead? Yeah, I can do corpse and I could do, um, I can do a war. Warrior one. Okay. So let's only do those for now. But how do I flow between those? I like it even flows. Okay. So then if this is a, if this is a rude, real true, like patient interaction at this point, and probably I'm going to now be like, let's just take it away.

It seems to be complicated, right? I don't want to take it away from you for too long. I know that this is something you love. Let's pick a couple of positions that feel good. You flow through those positions. Okay. But for now we're taking you away from it. Okay. So, cause I know a lot of people, there's kind of like this thing where, uh, certain communities, they're like, you know why we go to Dr. So-and-so? Cause he doesn't, they don't tell us to stop. And so you just created the thing where you just told them to stop. And so me as my, I, uh, have a pastor for do yoga patient. I don't really want to come back to you.

Why? Like, why, why are you taking my yoga away again? I know. Well, cause you made it difficult for me at this point. No, I get you. And we are not like, I, I think I mentioned this to almost every new patient when they walk in the door, at no point am I trying to take away anything away from you. Um, if anything, I'm going to ask you to do more is really all it is. But if we are noticing that you are not improving, then maybe we need to dive deeper into taking some things away that could be continually scat, scratching the scab off of this injury. Um, but in the very first visit, I usually don't take people away from things.

Yeah. Most of the time I don't have to. Yeah. Okay. I'll leave you alone then. Well, I think with the yoga one too, what I noticed is that because there's certain positions in here that we use as first aids, right? Which look like yoga positions, happy baby child's pose, whatever. Um, cobra pose. Frogs. Yeah. So like all of these things we, we use in here. And so people look at us like, Oh, I knew I should be doing more yoga. That's not necessarily what we're trying to say here. Um, there's reasons why we're choosing these things. It's a certain position that we're trying to accomplish with your low back and seeing how you respond.

Um, but yeah, we're not trying to promote yoga in your life at all. I'm scratching my leg. I thought you were about to hit a fruit fly or something. Using my elbow to scratch my leg. Yeah. Just, so just because, yeah, I guess we're using something and you might be suggested some things by your healthcare provider or your trainer or whatever. They generally feel good and they might seem like a yoga pose or they might not be whatever. Uh, but it's, it's a, yeah, I guess I think of it kind of like, you know, like say, say my back hurts to playing baseball. Uh, it really hurts to maybe throw like my back actually hurt to throw high.

So I'd be in the outfield and like, you'd be warm up and you throw to the other fielder. And sometimes you're like, Oh, just throw it high, you know, simulate us fly ball. And so when I threw a high, I actually hurt like stung in my low back. Uh, when I throw it low or straight fine. Right. And sliding wise, I could not dive head first, but I can slide feet first. And so I chose to remove those from my, uh, luckily that didn't really affect me playing. If throwing straight was a problem, then that'd be a different story. But it doesn't mean I can't play. It just means I have to acknowledge what bothers me and remove it for a little bit.

I now dive head first and I can throw high as I want. So, but that comes back after a little period of time. Yeah. 100%. I think too, like when we find certain things in here that work for people, we tell them, Hey, sorry. We don't get distracted. And so she's spinning her phone right now and just looking away. Like, did you expect like a Pokemon to come out of that phone? Sometimes I really feel like we're just having a conversation. Um, what was I trying to say? So we find things in here as far as movements, positions, or some corrective exercises that kind of help with your pain. We say, do this before you go do those painful things again.

So if there's positions in yoga, try to do these things and then see if it helps you. Um, sometimes it does. And then sometimes it doesn't. So then continue to use these things. We know that work today. Stay away from the things that don't feel good for now. We'll get you back there. It's a goal. Yeah. I think at some point it just comes down to like trust with it. It's like, I feel like sometimes there's, there's misunderstanding of, well, you see, you don't want me to do yoga anymore. No, I didn't say that. I'm just saying, can you stop for a week? Find something else you like, you know? Uh, and, and we'll get you back into it.

It's not going to be a big deal. You might pull your hair out a little bit more, figuring out how to change your yoga flow to make it feel okay on you while you're trying to recover from something. And maybe it's just easier just to focus on your recovery at this point versus trying to, you know, do many things at once. So, um, just make it easy on yourself. Just pull the plug on it for a week. If it really are, if you are someone who like warrior one inch corpse, that's it. But if you're like, it bothers everything, everything good, except for a yoga, a warrior one, then skip that one. That's an easy plugin, right?

So different scenarios. Okay. So you are the doctor now and wait, no, you're the patient. Okay. Go ahead and ask away. Is walking. Okay. Well, does walking feel good? Sometimes it does. And sometimes it doesn't. I feel like you've told a lot of people that story already. Like you don't feel, I don't feel like it's very, there's no, there's no pazao behind you saying that, right? Sometimes it does. Sometimes it doesn't. You know, I feel like you're just tired of this questioning series already. So, okay. No, but seriously, sometimes it does. And sometimes it doesn't. Okay. Well, when doesn't, when doesn't it?

I think sometimes if it's my back isn't feeling good, I go for a walk and it doesn't feel like it just doesn't feel good to walk. Sometimes I have the ability to walk for a short distance or time before the pain comes on. So I just don't know if walking is okay. Okay. Well, that's a good question then. So you made it a little bit more complicated, right? So we'll answer the complicated scenario at this point. Um, I think the, the general thing that you would maybe want to follow is perhaps walk to your tolerance. Okay. Um, one of the easiest wins and like at least a nice milestone that we can have with people with back pain is when they can get to the point where they can walk without pain.

It's a really good because then we can, they're not triggering their problem over and over again. So if you can only walk, you know, for five minutes, maybe just walk for four and a half, take a little break, uh, cool it down. However, that might look, I'm sure we would have gone through some first aid exercises for you already here. So use that first aid and then walk a little bit more. Uh, in my opinion, you probably figured it out already that if you sometimes can get 20 minutes walking, sometimes five, you might not want to go walk to the grocery store and back, right? So maybe consider it like, uh, uh, there's a little route by the house you might take or by the beach or wherever, and just don't leave yourself hanging out to dry.

Like you're stuck there and you're like, you're, you're stuck on the floor type of thing. Right. Um, also too, do you walk by yourself with a friend or with a dog? You want me to actually enter that? Um, with a dog. I figure. I can't wait to hear. How do you walk your dog around my waist, around your waist when you're reading a book? Right. I heard this before. Totally. I was walking, walking my dog and reading a book. What? My favorite way to walk my dog. So it's around your waist and he just, does he pull you? He pulls me. And so is part, perhaps is the pulling creating some of your pain too?

I didn't really think about it that way, but maybe. So why don't you try to walk maybe without your dog? Like I'm, I'm not saying don't walk your dog, but maybe walk on your own as your own time without your dog and just see if that makes it. So you're walking the pain free. Okay. Um, I walk him while holding it in one hand. Okay. Maybe switch hands, perhaps. Uh, maybe the way they kind of pull and turn you that one direction might create pain and the other way doesn't. Uh, also too, I know that people sometimes have pain when they walk your dog, not when they're walking their dog, but when they pick up the poo.

So perhaps if your dog is easy to navigate, maybe you steer them towards the edge of the grass by the curb and you don't have to lean down so far to get it. And you can step off into the street. If only it was that easy. Oh, obviously seven doesn't have a dog. You guys look, I can control say no, no, don't do it there. Put my finger up with their nose. Poo over there. Okay. Um, I walk with somebody. You said that. Okay. You walk with somebody. Uh, are they, are they kind of like you guys are power walking? That's like your exercise. Yeah. I feel like I'm always trying to keep up with them. Yeah.

So then just, can you ask that, tell them your situation, say, look, it's okay. If I walk slow, maybe, maybe slow is better for you perhaps. Uh, and their pace is making it so you hurt. So you want to work with, walk with them a little bit, but you want to make sure that you feel good too. So perhaps they either scale back their walking pace or they walk out ahead of you in return in kind of like a frisbee type of thing. If you will, you know, what else you got? You make the, can you keep making this hard? Um, walking downhill only hurts. Oh, so do you live only on a hill? I mean, some, a lot of the streets near me.

Yes. Have some Hills. Okay. Um, can you find a flat area to walk maybe for a little bit just while we're doing a little bit of rehab on it? Possibly. Okay. Does that hurt to do that? I don't think so. Okay. Let's do that. Okay. Sweet. What is going on now? Is there like banging happening somewhere or is there a thunder outside? Dumpster time. Oh, is it done? Oh, okay. I thought it was thunder. Okay. There's a lot of things to consider with walking. I think before we take walking away, um, I've had people only walk uphill and it feels better. I've had people only walk downhill and it feels better.

I have people walk faster and it feels better. I have people walk slower and it feels better. Um, I have people walk with a weight pulled into their belly and it feels better. There's a lot of different things in ways that we can still get you to walk. You have to walk. It's something that you need to do in your life. Um, but depending on how cute you are, how flared up you are, maybe we just need you to rest in your first aid position and do that for a little bit. Um, but walking might be a part of your rehab too. So a lot of ways we can modify this. So try these modifications. There's also two, um, I know that, um, I've had a few people do this is that you really do have trouble walking.

Like they just can't get to that milestone. And so sometimes they use a back brace and that'll help them get over the hump to walk. And you, now you've created some independence. They're not stuck on their floor anymore, you know? So that's a good thing to try, but it's always about my vocation. I don't know why that came out like that. You were probably thinking, what else should I say here? You're buying time. You're trying to buy time. Okay. So, uh, who is the patient now again? Uh, I'm the patient. I'm the patient. I love this one. You're going to, you're going to get hammered on this one.

Okay. So I didn't do anything. Why did this happen? That's all I can. That's all I'm worried about right now. Why? Why did it happen? And there was like no one specific event that you felt it. I didn't do anything. It just started on and it happened. I didn't do anything. Nothing different. It happened. I don't get it. What's going on? I think a lot of times people want a specific answer to that too. And most of the time I can't really give you the answer because usually things like this happen as an accumulation over time. Um, faulty movement patterns here and there and here and there that kind of accumulate.

And then all of a sudden there's just a day where you either wake up with it, you pick your keys up off your table, whatever it may be. And boom, it just, it blows out on you. So, um, that's my answer usually to things like that. It's usually an accumulation of stuff over time. So then, but I was told that there is probably a single reason it's my tight psoas. I mean, someone else told me there's a definitive answer. So, how do you not know? Like, what do you, why, how do you not know? Like, I'm just trying to, you know, um, why, why would you, why would I have you treat me if you have no idea?

It's a good question. Well, probably then probably the least reversing this is why it happened is different than your diagnosis. They're not the same thing. 100%. Okay. Um, I don't know how to answer this one besides what I just said. That's literally the only way that I, most people are okay with the way, what I said. They're usually good with that. Well, I'm trying to be, be the person who is distrusting of like, or focus, just focusing on why, like they want the why answer. And because I know I've had people who are, they, as I kind of think of it is that they're more focused on the why versus how do I get rid of it?

You know? And I don't know, I don't know why either, you know, uh, sometimes it, they just focus on it, you know? And so I'm trying to be that person as well. What would you tell me if I just won't like, this is an hour into our first session here and you just, you won't tell me why. And so I'm, I'm not willing to go forward because I need some type of reason to trust you. Yeah. Um, so I think in the history, we would probably pick up on certain things that have probably contributed to this. So I would be able to maybe give them, oh, it could be an accumulation of, I don't know, sitting for long periods of time.

I'm literally just pulling this out of my butt right now, but sitting for long periods of time, then sitting in your car for even longer, not moving as much. Um, I don't know, you didn't, uh, you haven't been doing any activity for a really long time and then all of a sudden you just increased your activity, um, or the opposite. You've been really active and then you stopped doing activity. Like it really is, it's hard to give a definite answer, but when you get to know the person, when you, um, have worked with them a little bit, or you, um, ask more stuff in the history, you start to figure out, ah, here's a contributing factor.

Here's a contributing factor. If it wasn't trauma, it usually is an accumulation of things over time. And in your first visit, we try to kind of pull that out of you. And that's why we ask questions. Yeah. Does that sound better? No, that sounds good. I just want to make sure you didn't ignore my question. Why? Totally right. I'm sorry. Why did this happen to me? Um, yeah. So yeah, you're right though. You'd like, you get some stuff out of the history and like, and so on. And, and like, I personally don't like telling people too much stuff is damaged or that. I mean, I think when you, when you kind of, sometimes you go the route of talking about, Oh, you've created this problem over time, I know I've just thrashed my body over time and I shouldn't expect to feel any better.

It's like, well, crap. Like that, you don't really give a lot of options to make you feel better if you really trash yourself. Um, so I don't think looking at that way is necessarily a good thing, but, uh, maybe we flip the script. Why do you think it happened? What do you, maybe some of the ideas, I mean, you know, your body and your habits better than I do. So why do you think this happened? Well, I've been sitting more and I started this exercise program at the house that could have been in. I'm sure they've had thoughts of what it is. And so at this point in time, uh, what they say is obviously important, but why it happened is not as important as how to get rid of it.

So just kind of getting beyond that question. Yeah. Okay. You got the hard one. Uh, you're the patient. Is it an injury? Is your low back an injury? Well, uh, it's a good question. Do you think it's injury? Feels like it. It's very painful. Yeah. But I didn't do anything that's an injury. Um, yeah, you know, uh, I would consider this as a little hiccup, I guess. And maybe I'm downplaying this. And the reason I bring this up is because you might've met somebody. One of your friends who maybe they slipped and fell. And that is what they call a quote unquote injury. But you didn't do anything to create this, right?

This is just kind of happened. So is it injury? Yeah. I know it's painful, but is it an injury? I don't know. It doesn't matter. Like, does it matter? So, uh, injury usually will come with the notion of trauma. It doesn't sound like he had trauma. So no, maybe it's not an injury. I don't know. I like that. You know, so it doesn't really matter. That's good to hear. It's not an injury. Yeah. It's funny you say that. So I'm not damaged? Yeah. You're not damaged. Okay. Yeah. Even if you had an injury, though, are you really damaged? Not necessarily. Okay. Well, what if I, what if I threw my back out?

It sounds like, am I going to have, oh, now we're, now we're going to get in. Not on the list, but, uh, what if I threw my back out? I feel like I'm supposed to, like, I have a week back. That's just my, like, it's my week back. Oh, so I'm the doctor now. Now you're the doctor. Yeah. Um, I mean, sure. I think let's treat it like it is. Okay. Let's treat it like it is an injury. How do we treat an injury? You know, we find things that feel good. We promote that for a little while. Um, and then we start to build back over time or build up over time. Um, so that we can one promote healing of this injury and to prevent it from continually occurring.

So in the beginning, let's treat it like an injury, but most of the time you're not really truly damaged. Um, it's a lot of just more dysfunction that we need to. Kind of, uh, what am I saying here? Yeah. You're right. Yeah. We're not, you're, I think the injury comes along with the notion of being damaged and irreversible. And I think we've all probably met someone who's had a fracture, a quote unquote injury because there's enough, uh, force to actually break a bone and they've returned back to full function. Like I have a friend who tore his tricep off his, uh, elbow and he returned back to full function.

Like those are, those are incidences. Like he was sliding into a base. And yeah, full function. Fine. No big deal. I know one of my, one of my friends, he has a finger removed. He's still, uh, he still throws a baseball hits. No problem. You know, that's an injury full function. So just different function. Yeah. Okay. And, uh, are you, I forget who's the patient. Cause you're jumping around. I think you were doctor on the last one. Okay. So, uh, you're doctor on this one. So I'm a patient. So to address my little back pain, do I just need to stretch more? I feel like I've been told I need to stretch more by a lot of my friends and it's just not working, but do you think I need to do it more maybe?

So you've been stretching already? I've been trying. Yeah. I just, it just seems like it's not sticking. Okay. So then since we've already tried that, let's try something different. Oh, how so? So if you already tried stretching and it doesn't seem to be something that's sticking, then maybe we need to try something besides stretching. So you mean there's more than just stretching to do? Yes. Oh, okay. So, um, so do, should I keep stretching? Does it hurt? Uh, it doesn't, it hurts when I'm doing it, but it doesn't, it feels better after it feels better for an hour or so. Okay. I think I'm okay with it.

And as we go through your appointment today, if there's certain stretches, I think that we need to stay away from for certain reasons. I'll explain that to you, but if it's something that feels good while doing it or gives you some relief afterwards, you can continue to do it, but there's more that we need to do than just stretch. Good to know, but I really like stretching. So then stretch. The thing about stretching though, um, I think that I, we actually talk about this a lot with people is because it's this feeling of tightness and it's an, the way that we understand tightness is we need to stretch it.

Right. And a lot of times what we see, I mean, a lot of times, yes, most of the time, um, the things that we see in here, stretching could actually make you worse in the very beginning than it could make you feel better. So, um, we might ask you to stay away from it for a little bit or stretch the other things that we need you to, that are okay to stretch, like stretching your hamstrings, for example. Like I tell people all the time, let's, let's try to stop doing that for a little bit. Um, but stretch all the other areas around it. That's totally okay with me for now. You know? So we try not to take certain things away, but stretching can be bad.

It can. It can be. So, uh, we've gone probably about 45 minutes here and we covered one, two, three, four, five, six, seven, eight, plus a mystery question that was in there. We've covered nine questions and there's a whole, we're only a third through this list. So, uh, I think over time we're going to keep addressing these things because people do have a lot of questions associated with back pain, hip, neck, shoulder blade, all that kind of thing, those things. And, um, sometimes there are hangup points for people or there's, as we kind of mentioned earlier, there's things that people are doing that are actually making their problem a little worse circumstantially.

And so hopefully you guys take this as a way to just learn a little bit more about what's going on with you. If you're clinicians and you resonate with what we're talking about, hopefully maybe just share it with your clients. Um, these are tools that we share with our clients too, to help them better understand and kind of, I guess, stop some hangup points, you know, like, uh, kind of like the whole ice thing. Like, well, I'm icing, so I can't walk. Well, so let's get rid of the ice. You know, like, um, is there anything you want to add, Dawne Costantino, or if anyone, if there's any lay public listening and they want to reach us, how would they reach us?

Well, I think that while you were talking right now, I was thinking to myself, like the way we answer some of these questions is almost so nonchalant. Like it may seem like we may not be taking these questions seriously, but we really truly are. We're kind of shooting in the dark with answering these questions based off of, we don't really know what's actually going on with you. So these are the best ways that we can answer it, at least over a podcast. Um, it can definitely be answered a little bit better if we were to see you in person, know what's going on with you, um, get a diagnosis, see how you move, things like that is when we can get, definitely give you more definitive answers to these questions.

So, um, if that's something that you guys are interested in, we can do that in person or we can do it virtually. Um, we've seen a lot of progress with both these days. So absolutely would love to kind of help, uh, dive deeper into that if you're interested. Yeah. And the worst case scenario, just give us a few weeks. I think we'll do a good job or not. And then we'll release you. Yeah. So, uh, as always, thanks for being in part of the movement movement and we'll see you guys next time.