Lower Back X-Rays and Why They Don't Explain Your Pain

Before we start the show clinicians, I want to invite you to take advantage of the premium version of the podcast that we have specifically for you. It was created for you. This podcast you're going to hear today is lay public friendly and it's intended to be so all of the stuff that you wish we would have covered more of like, Hmm, I wonder what the underlying biomechanics are of that. What's the clinical reasoning process? What positive orthopedics tests are there? I wish they would do more case presentations on X, Y, and Z. We're covering all of that in the premium version. And we have been for the past two years. So take advantage of it, scroll all the way down, click on it and listen to it. It releases every Monday for about 15 minutes. You're going to love it. See you guys in the show. Here we go.

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, your host with the restoring human movement podcast. Thank you for joining the movement movement. This is your first time in the show. Welcome. You have missed a lot of episodes. This is episode almost, I think around 260. This show has changed its focus a little bit over the years and gone a little bit from being very clinically based and very technical to user friendly and lay public friendly, which is kind of what we're sitting right here for probably a little bit of time.

I really enjoy breaking things down in a simple way if we possibly can. Obviously, we could make things super technical if we wanted to, but really, who cares? I don't even know. Most people who have problems, who have back pain and hip pain, they only care about specific anatomy because they want to get better. They don't necessarily care about the actual interlinkings of the joints and tendons and so on. And so I'm going to do my very best today to make things very simple and we're going to cover a topic which is going to be lower back x-rays and why they don't matter. I know it's a topic that you probably have run into before and you thought, well, maybe I should get x-rays done.

This person says that I have this finding on my x-ray and how much does that matter? You know, and should I get an MRI or so on? And so we're going to cover that topic today with four major key points. We're going to try to keep this podcast under 40 minutes, hopefully today, but there's a lot of very intricate information that we could add, but I'm going to really attempt not to. By the way, if you haven't subscribed to the podcast, please do so. And any clinician who's listening to this and wants to know all the intricate nitty gritty stuff, we have a premium podcast for you, which is available down at the bottom of your podcast player.

If any of you want help from me or my associate doctor or any of my team, just reach out to p2sportscare.com and we can help you out. Link is in the description. So the first thing I think we need to cover with the idea of lower back pain and x-rays is they don't see everything that you think they would. All right. So a lot of people will get x-rays done kind of as like a last, maybe not a last ditch, but they're like, they're really concerned. My back hurts. I wonder why I think I need to see it. Let's get an x-ray. The fact of the matter is a lot of the times when people get x-rays done, they don't see the things that they're actually concerned about.

Maybe it's cancer. Maybe it's a low back disc herniation. Maybe it's a pinched nerve. In fact, x-rays see like they'll see signs of things like cancer, but it's really not the best image for the problem. If you're looking for a low back disc herniation, it's not the best image for the problem. And same thing with pinched nerve and all the big, bad, scary things you could possibly have. X-rays are good for some things. But again, if you're looking for soft tissue problems such as scar tissue or adhesions or bursitis or muscle strains, disc herniations, disc protrusions, Cotty Aquinas syndrome is another big one that you guys might not be aware of, but it's kind of on the red flag list.

They're really not going to be seen very well on this. So that first part of understanding of what an x-ray is for is really important because I don't want you to put all your chips into the idea of, you know what, I'm going to figure out what it is. Let's get an x-ray and just figure out exactly what it is. You're not going to find very much. And you're not actually going to rule out very much either. You will rule out some things, which is helpful, but generally it doesn't tell us any more about what to do with you than maybe a thorough examination. Maybe I should backtrack just a moment to first give you some insight of what a good thorough examination for a back would be.

This would include sciatica, hip impingement, SI joints, piriformis syndrome, all different types of back pain. Should start with a thorough history. And what I mean by thorough history is somebody actually listens to you and they hear you out and they figure out what makes you feel better, what makes you feel worse, what time of day are you better, what time of day are you worse. Do you have any pain when you're sitting there right now talking to me? Why are you pacing the room? Does that make you feel better? Are you standing up because it makes you feel better? Does it hurt to tie your shoes?

Do you hurt at all times of the day and not just 100% of the time of the day? Or is it only like 5%? Does it bother you when you golf 18 holes but not 16 holes? So there's a lot of intricate details associated with taking a thorough history. I remember one of my teachers in school, I thought it was kind of too much information at one time. But once I came out of the examination room, this is almost 15 years ago now, they said, well, what created their pain? Like, when is it most painful with their back? It was a back case. And they said, well, it hurts when I, I said, well, it hurts when they sit.

And she said, how long? In what kind of chair? You know, and it really didn't make a lot of sense to me until recent years because you can really learn the mechanics of what's going on with the person internally as well as what their tolerances are if you figure out more information. I've said over recent years that your clinician, your doctor, your orthopedic, your MD, your chiropractor, your PT, your trainer, they're part of a team. They're part of a team that's trying to figure out information that's going to help you find a solution. And in that case, not asking questions leads to not having information.

And so there has to be a lot of question and a lot of team building, basically. You hold all the clues because you have all the answers and someone has to help you extract those answers, which is what a thorough history is. The second part of figuring out exactly what to do is a physical examination. Figuring out that actually bending forward does bother you or bending backwards bothers you or twisting. Or maybe we're going to put a golf club in your hand and make you swing 10 times and watch you. Movement evaluation is very important as well as a good orthopedic examination. By the way, an orthopedic examination does not need to be done by an orthopedic doctor.

Physical therapists, chiropractors, medical doctors are all familiar with how to do, should be, I take that back, should be familiar with how to do a thorough orthopedic neurological examination of people with low back and hip pain. Even sciatica, like you don't need to have NCVs and EMGs and all these expensive tests to figure out why. You need a history and a good examination to start with. Now, back onto the idea of x-rays of, you know, maybe when would they be needed? Well, they'd be needed to find extra information to figure out why you have what you have. If the indications within the history exam show that there is a need for the image.

I'll give you an example. So generally people who are, let's just say, 18 years old and have back pain and it's not all the time. And it happened with an incident, like they slipped and fell or they hit a baseball and all of a sudden their back started to hurt. Like this would be something that maybe we don't need to have, um, well, I take back the slip and fall. Um, maybe you don't need to have imaging on immediately or at all. The slip and fall would insinuate a possibility of, of trauma or fracture. And so you need to look to see if there's something like a fracture. Uh, and also, uh, maybe a scenario where the person's 80 years old, they had slow onset of back pain.

It feels like a deep within the bone and it's, uh, worse at nighttime. They've been losing weight. Uh, and all these, uh, we call them red flag questionnaires. Then we might want to see if there's maybe something else going on, like, uh, some type of cancer. We really don't know. Now, I don't say that to scare you guys, but there is a true, the reality is that I think the estimation is around 3% of people with back pain can have some bad thing like that. Which is the whole point of a thorough examination. Uh, I had someone call actually, uh, recently and they said, uh, you know, can you just give me some exercises to do?

And I said, well, I think we should probably examine you and make you move around and watch you a little bit. Uh, and they said, well, how come? And we talked about this. She said, well, there's, we got to figure out if we can actually help you. Well, can't you just suggest a stretch? Well, yeah, but what if, I mean, what if you had a fracture? Is that, is that what you want to do? You know, we, we're not necessarily doing the examination and history taking for, uh, like he was saying, well, I, you got to cover yourself. I get it. I'm like, no, that's not just it. The fact that I might give you something that is not helpful to you is the part that you should be concerned about.

Not just that we're like, oh, we have to do this because our industry dictates it. No, but it is important to figure out more information. If we need information, we need to, we need to find out how to get the information. In that case, do an examination. A history taking process is, it does take time. It can't take five minutes. It normally takes over 30. Uh, and then you give suggestions based upon what you find. X-rays can be helpful. Again, trauma is important to maybe use X-rays with car accidents would be important to use X-rays with. And people, uh, of older age, like geriatric populations might be first starting points just to make sure that we're rolling out things that could be there because it would dramatically change the game plan.

So this brings us on to number two, uh, the reasons why, uh, uh, that actually, I don't know if I should title this one, uh, lower back X-rays and why they don't matter. Uh, they do matter sometimes. I guess I should re, uh, reverse a little bit on that. They do matter. And in this scenario, which I'll mention next, they, they do matter. And so when I went through a course, uh, this was years and years ago, someone put it a very good way. Uh, the instructor said, the main reason why we use X-rays is to figure out if there's been a fracture of cortical bone and to see if there's actually, uh, I hate to say alignment issues, but we'll say alignment issues.

Mainly in the, in the fact of is something physically in a place where it shouldn't be like it's dislocated, like a hip is grossly at a socket. Like you jam your finger against a baseball base. And then you see that it actually fractured part of the cortical bone, which I'll mention in a moment. And it's actually displaced from outside the joint area. Now I'm not talking about the whole idea of what you might think about when, when, so when people go to a chiropractor, sometimes they use a stereotype of alignment. I'm not talking about that at all. Uh, they're, they're talking about the, uh, idea of a sub luxation, which is, uh, below a luxation, which luxation is a dislocation.

And so a lot of times in imaging, we're going to look for the luxations because those are important. And those can be very, uh, a very strong indicator that you're going to have pain associated with it and be a little bit more of a smoking gun. Like if someone came in and they had their shoulder completely dislocated at a socket or lux that a socket and they're having shoulder pain, that would make, that make pretty good sense to me. You know, um, the also too, if you have the cortical fracture, which I'll mention about what it is in a couple of minutes. Um, if you had a fracture in your humerus or in the bone of your shoulder, they look brand new and you had a shoulder pain.

That makes complete sense to me too. It's a little bit more of a smoking gun and it would make it so all the tissue work that you might do won't help. Uh, it would probably mean all the Theragun and the CBD, it's not going to help. It might help with a little bit of pain management, but it's not going to solve any problems for you. And we're all here to solve problems. Everybody wants to feel better. I would assume. And it's not just to be managing the pain. Now, cortical fractures are something that, um, uh, this is something that, that in the information might've changed since I learned last.

Uh, I think it's, it was about five, six years ago where, um, I had this discussion with somebody. And so cortical fractures are like, if you imagine like drywall, like right now I'm looking and I don't know if you guys can tell there's a little bit of an echo in this room. Uh, so I'm, I moved our podcast studio into a separate bedroom in my house and, uh, the room is vacant right now. All there is, is carpet on the floor. So there might be a little bit echo until we get some stuff in here. Um, overall fantastic view when we're doing the podcast. So I like that better than better than the closet, but the acoustics might not be quite as as good.

Anyways, I'm looking at drywall right here. And so we just painted this drywall. It's got its, uh, you know, texture on it and everything. And then underneath the drywall, I don't really know what's going on in there. I have no idea if there's any insulation. I don't know if there's a rat behind it. Uh, I don't know if there's termites. I have no idea what's in there. Now, basically this is a scenario of, of the x-ray. The x-ray can see parts of the inside of the wall or inside of the bone, which you call medullary bone. It's like the hollowness in the, in the spongy part of the bone, the part that's not the outside.

Like if you're visually looking at a skeleton, it's the inside of the bone. And so the insides of the bone sometimes have problems like bone density. Sometimes there's actually, uh, lesions or cancers in there. There's, um, there's, uh, compression fractures that happen in there or compaction fractures. Um, uh, it actually happens on vertebrae sometimes or backs is when people compact their bone. Um, sometimes it happens up into the mid back a little bit more than the low back, but it does happen. And usually trauma-based if I had to guess, I don't see a bunch of those in our office, but it does happen.

Anyways, the point is, um, I remember learning that in school, the medullary bone or the inside of the bone that you see on x-ray, you can only see that if the bone density has decreased when it actually has hit halfway. So half of the bone has to kind of melt away before you see any indications, any indications there's anything going on in there at all. And this is why I know I mentioned bone density. This is why something like a DEXA scan is a better image for bone density because x-ray is not good at it. There's a reason why people don't suggest x-rays to investigate bone densities because it's not good at it.

Just like it's not good at other things like soft tissues and discs and nerves and strained muscles. It's not good at any of that stuff, but it is very good at looking at the side of the drywall, which I just mentioned. I see right now our paint job looks, it looks great, but I'd be able to tell the x-ray if I had missed a spot, I'd be able to see if there's a crack in the drywall and I needed to actually repair it. So I can see those things on x-rays. So you can see a luxations or a slight slash dislocations. And you can also see a cortical fractures too. Don't worry, I'll get to the alignment part at the very end here.

So we'll come back to that whole thing again. The third thing to consider, and this is why x-rays don't matter as much as you think, is that you can see signs of how you treated your body, but you can't, x-rays can't see how you feel. I know it seems very woo woo, but at the same time, you ever have a sunburn and the sunburn just really hurts. If you shot an x-ray of that, you will see no change. The reason why is because not just that it's not very good at investigating a skin because skin is too soft. The x-rays blow right through it. That's why you see the skeleton and the bones. But you, it doesn't actually show how you feel.

It doesn't show emotion. I don't know if you guys have ever met anyone who says, oh, I got a high pain tolerance. Things like that don't bother me. I mean, I know one guy who actually requested that he can have a root canal done with no anesthesia because he wanted to feel it. He's like, I can, I can tolerate it. So someone like that versus someone like me who I don't want to tolerate at all. That's a, like a tolerance or an emotion, right? X-rays don't see happiness. X-rays don't see sadness. They don't see pain. It's all an emotion. And the way your body interprets pain is different how other people's body interprets pain too.

And the reason why images are nice to see some things of, of, uh, structure and alterations from quote unquote normal is mainly because they can show how you've been treating your body. So we can show loading patterns and wear patterns. Um, the alignment of a car might be a possibly good analogy in this situation because you can see how the tread starts to wear over the course of a 10,000 miles. You can see if you've neglected to put any air in the tires, this does not mean that you slip off the road. It doesn't mean your tires pop. It doesn't mean they're not around. It doesn't mean they don't work.

It just shows some wear, wear doesn't necessarily hurt, but at some point you might get to the point where it can hurt. And that's why, uh, there was a, one doctor, his name was, uh, Brendan Murray. He, he gave me some good advice. Uh, we talked about the idea of stenosis or, or arthritis. I said, should I be worried about stenosis with some, uh, with this case? I brought up a case to him. He said, well, stenosis isn't a problem unless it's a problem. And I thought, genius is genius. Your tread's not a problem until it's a problem. Your alignment's not a problem until it's a problem, right? It just shows signs of wear.

And so some of those big fancy words that you find on x-rays, like, uh, spondylolisthesis, um, bone spurs and thesophytes, um, degeneration, by the way, which is, we should have a whole other podcast on degeneration, which you guys should not be scared of at all. It's just signs of, of how you've been treating your body. Um, they're just signs of what you've been doing. Okay. Now I'm not going to say that these things shouldn't be taken into consideration, but they don't indicate that you're in pain either. Um, a lot of times when people have shown signs of how they've used their body, it's a good way, it's a good way to, um, good extra information to figure out if they're still using their body in that fashion, um, their body bodies compensate there for all we know that you're, let's just say your left hip was broken for a whole year and you were in a, like, uh, uh, uh, you were ambulating or walking on and all of a sudden your right hip starts to show some wear patterns.

Well, you've been using the right hip a lot more than the left, left one might look like it had a sign of a fracture, but at the same time, it might, it has no signs of degeneration because you haven't been using it. It's like a, it's like a smooth baby's behind type of type of thing. Hasn't been, hasn't been rubbed up by pants or anything yet. Right. Cause they wear diapers. Actually, I guess they get diaper rash, don't they? So anyways, um, seeing the signs on the image, the findings on the image, give you information about how you've been using your body. If you see lots of findings and optopathies and osuses and things like that at L5S1, then there's a chance that you've been using that segment a lot and it might start to hurt.

But in rehabilitation, it's a, it's a pretty, uh, easy, um, logical approach that you can take. If you've been using that area a lot, give it a break. I'm not saying take, take a break, like take some rest, but perhaps get the rest of the spine to work a little bit more. Get the core to work a little bit more to support it. The body has all of the support systems that it needs built in by God or, um, by Darwinism, whichever one you believe in, um, it has all of its systems built in that it can support itself and decompress itself. You just have to reeducate it sometimes to do that. Also to the, the glutes and the hips do help a lot.

Um, it might seem very kind of, um, like a broken record. I've heard a lot of people say, well, someone told me I had weak glutes. And so, uh, you know, I've heard that from everybody and you know, it's just not helping. Um, yeah, you know, there's a reason why a lot of the, uh, research over the years has shown that the glutes have a high association with, uh, or weakness or a lack of function of the hips have a high association with people with back pain. It's just even observationally, you can see people who don't use their hips well, tend to use their back more. And so if you can get your hips to work better, you can deload the segment like L5 is one.

And so a lot of things that come along with that, like lower back pain, disc pain, um, disc herniations, sciatica, stuff in the back of the calf, stuff to the back, uh, back of the thigh, uh, the foot pain, numbness, tingling. Then a lot of times comes along with this, uh, you can deload it. You can deload the area and give it a break. You can get the areas to other areas to do some work. Now, the last part I'm going to cover is the alignment one. And, um, I think there's been a movement, probably not a movement movement, but a movement of people considering that alignment does not really matter.

Perfect alignment does not matter. There is no perfect posture. There is no perfect alignment. And if you start to pop your, uh, bones a little bit, whether by yourself or, or with some assistance, if you move around a little bit or go play golf afterwards, it's not going to put your bone back where, where it was before. All right. I'd, I'd love to say, you know, that, that the body is, um, actually it'd make our business probably easier if we just could say that, you know, you need to, you need to be put back in place, but the reality is that you see people on with x-rays, x-rays can, um, it's funny.

Actually, uh, I have, uh, an old intern that he did a really good, uh, thing, at least to prove a point. And, um, so he took some x-rays, uh, or he had some x-rays that he actually, uh, showed and it was of somebody who had a straight neck. There was, um, no real curvature in it. Uh, and so he kind of posed the idea of, of what, what, what's wrong with this person? Do you think they're in pain? And, uh, after so much debate, uh, you know, people would say, yeah, this person looks like they're in pain. Uh, he said, uh, it's me. I did an x-ray when I didn't have any pain, just so I can prove a point.

And, uh, that's not the common scenario. People won't generally have x-rays performed when they're not in pain. So how do you know what your normal is if you only take the image when you're in pain? So this gentleman took the image when he wasn't in pain. So now if he ever develops neck pain from, or maybe not from that curvature alignment issue, then you could, uh, you can beg the question of, is it his alignment or is it something else? Because his alignment was like that anyways. Did he need to be put back into place to feel better? He was already feeling better. So alignment really doesn't matter.

And I know I might ruffle some feathers by saying that, but I would take it this way. Your body's more resilient than you think. Okay. I've met a lot of people who have had, um, uh, surgeries that look like you just threw a bunch of hardware in their spine. And I'm not going to, I'm not demonizing the surgery per se, but they had a lot of abnormalities and you ask them, Hey, do you have any pain? And they say, no, I remember one gentleman, uh, he had, uh, he had knee replacements. He was about 70 years old. He can squat deeper than anybody I've seen. Um, there's a lot of people who have normal function, no pain, who have bad alignment.

All right. Visually or via x-ray, it does not matter. Um, personally, I actually had an image done. It wasn't an x-ray necessarily. I, I, I had an MRI done. Uh, it's, this is within the book that I wrote, by the way, I will be back pain. It's on Amazon in case you guys want to take advantage of it. Um, so there's a section in there where I talk about this back issue that I had about five years ago and this back issue, I never really had x-rays done on it, but I had an MRI done on it. So this should kind of just prove a point again. Um, at some point I started to feel better. Like I started feeling way better.

Uh, I was about probably 90% better, but I happened to develop a fever and it was, you know, sweating at night and stuff like that. And so, uh, me being from, you know, a medical education, I started thinking, what if it's like tuberculosis in my spine or something? And this isn't some odd thing, some really, really odd thing. I thought, you know what? I'm just going to get an MRI done. I'll pay some cash for it. I just want to know, you know, uh, I probably could have got other testing done too, but I kind of wanted to see, you know, just like a lot of you, you want to see, see what's wrong. You know, although you don't always see what's wrong.

Um, I had the image done. It didn't, it didn't end up finding anything like that. Uh, it, it just showed a, uh, a small disc issue, which was about three millimeters centrally located in my low back. And so, um, my mother is very, uh, organized. I'll say that. And so when I was 15, I also had, I had about an eight month period where I had low back pain. Uh, I actually had to stop playing baseball for quite a few months because of it. I eventually fully recovered and perfectly fine now. Um, but it was pretty bad at the time. I couldn't sleep in my bed. Um, I had, it was, it was, it was pretty terrible.

Um, swinging a baseball bat was like murder. And anyways, so I had an image done then and guess what it was. It was an MRI. I also had a bone scan and x-rays done then. Uh, I had the reports for those as well, but I compared these MRI reports side to side and, uh, lo and behold, they had the exact same reading, exact same thing. Didn't look any, didn't look any different. This is the MRI report anyways. And so let's think of this timeline here again, because normally people don't have images done when they're not in pain. And so I was 15 and let's just say reasonably, I felt better by 16. I didn't have any back pain until I was 35.

And at 35, I had a couple months where the back pain, and then I had the image done and now I'm even older and I don't have any back pain. So does that mean over the course of those 20, was that, uh, uh, one at 25, 35, so over 20 years over that course of time, when I have that disc herniation that was sitting there the whole time, does that mean that it was a pain generator and a, and a problem for me? Cause it was there. It was, it was still there. It never went away. It just went dormant. So every year after year, I probably could have done an image and found the exact same thing. If I had to guess, obviously I didn't do it.

If I had to guess, it was going to be the exact same thing. So all of the imaging findings, the alignment and all that jazz, it can be, it can be helpful as extra information, but it is not a smoking gun at all. At all. It's just extra information. So when you guys are attempting to recover from your lower back pain or any of the musculoskeletal problems that you might have, remember that x-rays can be helpful, but they sometimes matter less than you think. They see some things, but not the things that you're concerned about. Normally there's other tests that are better for it. If we're really trying to rule things out and it all starts with a good exam and a history taking process.

Somebody who's going to help figure you out, figure out the information that you have deep with inside you, all the information you have, uh, and organize it to figure out what is the next best logical step. Do you need that x-ray? Do you need an MRI, CT, PET scan, a lot of work? What do you need? If anything at all, um, also know that they're only mainly used for cortical fractures, uh, and luxations or dislocations to figure out it, uh, that they would act, those things would actually change the process of your treatment plan. If you had a fracture, you'd probably be in a cast, at least what we're talking about the arm.

You wouldn't be doing, uh, stretches. You would be in a cast. You'd be stabilizing it, a soft or hard cast. The treatment plan dramatically changes. Uh, the other thing is, uh, remember that the x-rays, although, um, it sounds like I'm bashing on them. I don't want to say they're useless. They do have good information in them, but don't overthink it too much. Uh, it helps you see signs of how you treated your body, but it does not have to tell you how you feel. Just like I mentioned in, in my MRI, uh, and alignment does not matter. Uh, maybe I'm going to eat my words in like 10 years, but I'm pretty sure that over time after time of all these cases that we've seen at performance place, I don't think alignment matters.

I really don't, you know, um, people have us look at it. People have us like we've been forward. They say that they're curved that way, not the other. Generally, it doesn't matter, except there is a scenario where those 15 year old girls or teenage or middle middle school girls that are having like the mid back curvature kind of happen. It's very common with, uh, dancers. Uh, they call it a scoliosis. And so it's not that a scoliosis is always important, but generally at a younger age, if you find something like that, it might still be changing. And some people have a very dramatic one. And at some point there's like a critical point where it actually matters a lot.

But most of the time, if you have to, uh, like if, if you have to point out to someone in your family, you're like, Hey, look at my spine. Can't you see? It's kinda, it's kinda like moved over here. If you have to point it out to them cause they don't see, Whoa, what's going on there? Generally, it's probably not that big of a deal. Obviously this is not medical information cause I don't know you guys. I'd like to know you guys, you can come on in, but, uh, just know that generally the big scoliosis is that matter are the ones that are like, they're, they're getting pretty dramatic by the time someone catches them.

Not to say there's not something that these people can't do. But again, just like I mentioned, uh, with all the other things today, you're what you, the information you find and gather, or that your team helps you find might change your treatment plan. There is no simple stretch for, uh, that works for every single person with low back pain. There's no one simple exercise, no one simple day, habit, daily habit change. Everybody is different than you in their unique way, which is a good thing. Uh, and most people do get better. Most people get better without surgery, injections, or medication. Although there's a time and place for all of it.

Okay. If you guys are looking for help, please reach out. Uh, I'm Sebastian at performance place. We have all of our links below. We also have, uh, online, um, eBooks, which cover things like, um, low back diagnosis, which you guys might not be familiar with as much, but I always, it's, it's troubling to me that a lot of people will go online and they'll read information. That's about 10 years old. Uh, this stuff that I'm putting on there is, was just created within the last year. Uh, it was very research-based and it's as simple as it can possibly be for a reason. Uh, I continue to update these things over the course of every, every year.

Um, as we start to do research updates, there's also another book called, um, low back pain treatments that work. And it gives you general context of what, let's just say stretching. When would stretching work in what scenarios and what diagnosis? And this is just based upon what we see at performance place. And we do see a ton of low back hip people, a ton of them. Uh, and there's also this one last book that we created. Me and Dawne Costantino wrote it, uh, partially together. And when people go back into weight training, sometimes they wonder what they can safely do. And so this is usually for, this book was written for people who are a little bit afraid, afraid of going back into weight training.

And that's something they want to do to develop some muscles and be physically active again when they've been dealing with low back pain. And it gives them an idea of things that are high reward, low risk exercises, as well as, um, variations to the movements like a deadlift. If you don't want a deadlift, what are other versions of a hip hinge that you can actually create benefit by getting the hips involved to spare the back? So we've written all that for you. And that's in the link description. Uh, and, uh, I love that you guys, uh, listen to the show. Please subscribe to the podcast. I'm going to keep it going as best I can.

And don't worry if there's an echo too much in this version, I, we're going to get this thing filled a little bit and it was going to be bomb pretty soon, if not right now. So we'll see you guys next time.