Five Sciatica Myths and the Five Steps of Real Recovery

I don't really, I don't need to take the insurance. I don't even like, like an EPO, I don't even need to look it up. I just know it's not going to cover because I've looked them up enough. And I know HMOs and Kaisers won't help me help them, but at least financially, but that's a nice touch point. It's a nice way to build an interaction between you and a potential patient who you just want to help. And I just want to help them. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales.

Hey everyone, I'm Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the movement movement. If this is your first time to show, welcome. This is about a 45 minutes to an hour long format where we basically go over how to become a better clinician. We do improve our communication between doctor and patient with some common terms. And oftentimes throughout the show, you're going to find that some of it is a little bit more catered towards helping a clinician like yourself improve your business, improve your clinical skills, and improve your knowledge base. But other ones are based upon digesting things down simply for some of our patients to really understand what's going on. So a lot of these are patient-friendly. Honestly, the podcast started as a more patient-friendly show, but I think as I started to find it, you know, 100 and whatever we're at right now, I feel like I'm running out of topics, you know, which is the challenging thing. So I just ended up going through what we're kind of going through.

And so I thought, well, first off, let me mention that if you were at the movement meetup this weekend, thank you so much for coming. I met some really amazing people. And so for all the listeners who have not heard the movement meetup was, um, this far into the show, a hundred and I think we're about 60 now. Um, I haven't, I mean, I've met some listeners, but I have not truly had a meetup, you know, like I kind of just want to meet people and see who's out there and what they thought of the show and, uh, just bro down really. I, I, I kind of miss just seeing other clinicians that, um, are like-minded and you can echo ideas off of and just learn from. Um, and so I learned things as well. And so thanks to everybody for coming out. Thanks for the strength coaches for coming out.

Um, thanks for everybody of other, um, non chiropractors come out too. So it's always, it's always nice. Now, uh, I thought what we cover, uh, today is a little recap of not necessarily just on insurance of what we covered last week with Sam Collins and the prior week, but we're going to cover, um, I'm going to cover just like an onboarding process that I feel is a nice upgrade that we've had in the office here. And it has, I think it's going to have a better, um, uh, a better outcome where patients tend to understand better, where they feel better about their choices, where there's less dropout, where they're, uh, hopefully where they're, um, where they feel better quicker and also too, where they don't have a relapse. And so over the years, I think what I've tended to notice is that, um, some people are just in it to reduce pain. And I totally understand that. That's their goal.

Um, but I don't think that's the real end all goal. And I don't think I've done a good job of uncovering what their end all goal is. So what I'll cover today is, is a little bit of a flow. It won't be complete just because we're still developing it here. Um, I'm going to share some audio with you that is part of the, the onboarding, um, in a little bit, but I'll give you a rough breakdown of, of what the goal is and why, why we're revamping the system here. So first off, as we've gone through, um, you know what, I can't do that yet. I have to share the personal story. So we'll get on the first personal story first, and then we'll get right onto the show.

Now, this is a, this is a live, uh, personal story. Um, actually yesterday, I keep forgetting how important the glutes are. Okay. And so I was standing up, guys will probably can test this. I don't know if girls can test it, but if you stand up and pee and squeeze your butt cheeks, like you're trying to, like you're trying to break a cord into five nickels, you'll stop your urine stream. Okay. And so it just reminds me of like, you know how we just end up doing like these small exercises, um, that aren't always very useful for everybody, but they might be used in a certain point in time. Like if you squeeze your butt cheeks together, you do a kegel. And so aren't we kind of doing part of pelvic floor too? So I think that, that, that whole contraction around the area, I think we can get more out of actually, um, you know, stopping you, like contracting your cheeks.

So anyways, give that a try. Just, um, you know, stand up, take a pee, see what happens. You might be surprised. Now getting into the actual, uh, information here is number one is, is when, when, when we got all that information last week about insurances, how do we use that? Um, I know for me personally, I, I will go into, um, uh, some new updates of what we're, how we're going to use insurance over the next couple of weeks. But for the most part, I'm not married to the idea of, of taking insurance, but I do like Sam's idea of, of diversifying a little bit, but more so I think it was, it was interesting takeaway was how much I didn't know, you know, um, how much I didn't know about insurance options for people. Um, and as my dad kind of told me that, um, this probably, this probably not verbatim, but this is what I heard. I guess every son kind of hears what they want to hear, but, um, he's had some good wisdom over the years. One of them was don't diagnose someone's pocketbook because you don't know what's in it. Um, this one was, uh, our job's not really to take their insurance, but our job is to inform them about what their options are. And so as a clinician, we're guiding. So he's a dentist. He guides them into figuring out if their insurance is an option. If it's not an option, then he tells them. Um, and then they have something called care credit or something like that, that they might do in their office. Or in our case, we might offer them some type of prompt pay discount or they just pay per time or whatever else you want to do. So, um, the way I'm kind of taking that information is just learning what the insurance options are and giving them a realistic, um, outlook of, of what they could be paying.

Um, because I think at this point we, we kind of, I don't really, I don't need to take the insurance. I don't even like, like an EPO. I don't even need to look it up. I just know it's not going to cover because I've looked them up enough. And I know HMOs and Kaisers won't help me help them, but at least financially. But that's a nice touch point. It's a nice way to build an interaction between you and a potential patient who you just want to help. And I just want to help them. So our touch points here is that I talked to our intern, Michael yesterday about, he's like, you know, how do you, like, how do you get patients? Like, what is one way to get patients?

And I think, I'm like, I think it's just touch points, man. It's building the relationship. You have to build that relationship up. And if you're not able to actually see that same person all the time, you might, um, create some other touch points, some other ways where they can interact with you and be familiar with you and the skills that you might have to actually help them. So the system that we're kind of going through here is based upon a couple principles. Number one is that we took some of the information from Sam Collins. Um, we took some of the information from some colleagues about using Ovality, um, as a option to check out insurances to streamline the process.

Uh, and we also took some information from a book called, um, uh, F insurance. You'd spell it out, look it up. It's by Danny Mata. I think I got it next to me over here. Cause I'm going to read excerpt from it. Uh, Danny Mata, M A T T A. Um, so that's an interest. It's a really good book. You just take a listen or take a look. Uh, and the last part is a lot of stuff that I've learned through, um, some other social media sources and, um, uh, the evidence-based chiropractor, Jeff Leggman is a good place to, um, interact with some of this stuff too. And it's just about creations of touch points. And so the first off is that when people tend to call us, um, when they call us, they are, they might ask a simple question like, do you take my insurance? By the way, there is a podcast I did back in the, um, back about, I want to say three, four months ago called the ring ring game, which is, which was a rough version of kind of what this is, but I think I can still improve on that. So the phone call, they're asking about their insurance. They're asking about, Hey, do you do a quick adjustment? Hey, do you do this and this and that? But really, I think when you get down into it and you ask about their problem, they probably don't even, they're not married to the idea. Some people will pay any amount to actually get better. Um, and we just don't know that yet because we're just simply asking their question. We're not getting to the deep part of why their question is being asked. Um, I remember I had a patient that we were just, uh, we're bullshitting around one day and he had, uh, he had a, he had an ankle problem. He had Achilles problem. He was younger.

He was like 25 or so. And so I was like, if I could take this away right now at the snap of the fingers, what, how much would you pay? If I can, I'll guarantee it for 10 years, you'll feel good. And he said, I'd pay every, every penny I have. And I was shocked by the answer because like, uh, I know you got a bit of money. Number two is wow. You know, um, he said, he's like, I feel confident I can make more, but he's like, I would just, I would easily just take it away because it's such a burden on my life. I can't do X, Y, and Z. So that was, we got deep into the reasons why with him. But sometimes on the phone, we don't necessarily do that because it's a really quick interaction. So in the book, uh, F insurance, by the way, I'm choosing not to use the explicit because, uh, I'm trying to do better at net necessarily cussing. Um, but probably as you guys saw at the, uh, at the movement thing, uh, at the movement meeting this weekend, movement meetup, uh, I cuss quite a bit. So I think it's in context. It's, it's, it's like exclamation points.

So this is a, this is an excerpt from the book. Uh, I'll just read it to you guys. And hopefully I remember how to do that popcorn game, like in school. So, um, caller, uh, Hey, I was calling because I hurt my knee and I saw that you guys have a lot of good reviews online. I wanted to call and see if you take my insurance staff. Hey, thanks for so much for calling. Can I, uh, I can help you with this? The answer to your question is a little bit more complex than yes or no. Uh, do you mind if I get some more information about you first so I can better answer that? Caller. Yes. Staff. Great. First, my name is Claire. Do you mind if I ask you, uh, ask your name and why you're seeking help for your injury at this point, like right now? So the point is you kind of get into the, you're, you're getting into their problem and figuring out more about them before you actually quote numbers.

You quote numbers. They'll go away real quick. Uh, caller. I'm calling right now because many has been begun bugging me because it's stopped me from running staff. Oh, that's too bad. Um, now mad living. Sorry. Um, and are you training for anything particular color? No, I run B I run when I go to orange theory and now it's gotten so bad. I have to stop going staff. That's too bad. Orange series. Awesome. Uh, how long you been training there in any for anything in particular? Sorry, just getting over a cold color. Well, I'm getting married about six months. I've been going in to lose weight. So, uh, so I can, uh, before my wedding staff, oh, congrats. Where are you getting married? Conversation continues. And so at this point, you kind of go a little bit further. Um, uh, you, you did kind of deep build a rapport and so on.

Um, but after, when you get to the insurance question, staff, now going back to your insurance question, what we consider, what are we, what we're considered as out of network. And this would include me for most cases too. What this means is we don't have any direct contacts with insurance, which is a really good thing for you. All of our doctors make decisions based upon what's best for you. They spend a full hour in our case, 30 minutes with you every single time you come in and we have full, uh, complete transparency about what you pay. You won't get one of those frustrating bills from one of the three months later saying that you owe $500 from one of the doctors. Um, our fees are anywhere from blah, blah, blah. Uh, depending upon, uh, if you do a single session with us or purchase a package. Now, a good percentage of our patients do get reimbursed by their insurance for their visits with us. It really depends on if you met a deductible, what your benefits are. I'd be happy to check those for you, uh, to give you a clear picture of what you could potentially be reimbursed. Uh, would you like me to do that? Yeah, that'd be great.

Um, and so it kind of goes down that route. So it's really building the relationship first and then you get to, um, uh, you, you get to be the informant. And so like my dad said, is your, your job is to part of your job is to inform them about their insurance options and you can build a relationship from that. Now, um, it's, they suggest you put someone, you say, Hey, let me put you in the books while we check on this. And you call them back. Um, we've been trying to do that. Um, it hasn't gone a hundred percent yet because we're still working on the system. However, um, I implemented a system a little bit while, a while ago where I said, uh, every caller or email should be suggested number one to come in or number two, a virtual option. The virtual option is a touch point. And like I told Michael, a touch point is, uh, a way to get the, get in front of the person every day just for a little bit, or at least every couple of days. So when they finally get to the point where they start, where they want help, where the pain point is so extreme that they'll come see you. Uh, I have a friend who actually, he, um, he bought a watch. And so what he did, what he did was, uh, I mean, he researched the watch and then the watch company retargeted him, meaning that they sent him ads on Facebook and Instagram and blah, blah, blah. Right. And so he's like, I don't know how many times I saw that watch ad, but one day I bought the watch and I don't know what it was. It was just that I felt like I wanted the watch at that point. You know, maybe he was drunk and he decided he wanted to buy a watch, you know, but it could have been the 20th touch point. So whatever reason he was not ready in the beginning to get that watch, but they kept in front of him.

And that's kind of what we're doing here. So when I suggest people, uh, uh, some type of, uh, digital product, it could be free or it could be paid. It does. To me, it doesn't matter really. Um, but it depends where they're at. And so what we have is, is basically if, if we get them on the books and say, Hey, um, by the way, this will retract a little bit with, um, I'm going to show you the audio in a second here that me and Dawne Costantino created for sciatica. Um, she said that it would be really nice if people kind of came in and knew what to expect. Cause sometimes they come in and they're like, yeah, I don't, I, I, I didn't wear the right clothes and I had no idea. So what was going to happen. And so partly through this audio, we dress a little bit of that, but also debunk some myths and some common things that might be stopping people from coming in. So when they call and say, Hey, in the meantime, uh, would you like access to an audio that we created? Uh, it kind of tells you what to expect when you come in, as well as, uh, five myths about sciatica that are a stopping point for a lot of people. Uh, a lot of people are very surprised by the things that are on the audio.

Um, and they're actually very happy. They learned them because they found out that, that they've actually been creating some of their own problem. Is that something you're interested in, in listening to? And if they say, yeah, that'd be great. Um, we send them, it's an opt-in link. It's not a, it's not a website. It's an opt-in link, which will take them to my website, uh, which will have an audio on it. And so the opt-in link creates, uh, the start of a drip. It's an email drip, which email is a, it's, I own the real estate in email. It's not like Instagram where you have to like Instagram can dump one day and then all of a sudden you lose them. So in the email drip, they might get, they're going to get more touch points. It won't be all the time, but it's just going to be enough just to get them to the point where they, where they feel like, Hey, I might trust that person because there's a potential. This person doesn't book today because their insurance didn't cover it all. And they legitimately don't have the money right now, but they might have the money next week. So those touch points could be various things. And so I prefer at this point to diversify and spread. So it goes to Instagram videos that I've already created. It goes to YouTube videos I've created, um, articles, um, and other call to actions like, Hey, this, this week you could actually do a 10 minute phone call with one of our doctors for $10, which would be, uh, me or Dawne Costantino at the K in that case. And so they, they have potential to act on those if they want. And there's some urgency within them. So, um, obviously we could do free phone calls, but, um, if you, if you label it as free, it's not worth anything, you know, like I don't, you can't call, uh, you can't call a surgeon's office and get them on the phone for 10 minutes, you know? So that's it. Time is money. And I think people need to realize that. So, um, what, what this basically is, it creates a experience for the person. It is a way for them to experience you and what you could possibly do for them.

Now, um, the other option of things that we give them is that if they just, if they're a ways away and they want, like, they don't want to come in, they just call because they're interested, but they're not really that interested or, um, say they don't want the audio, but they, they're like, I really can't afford it with insurance. And basically I looked at, I look at this, like, it's a problem that they don't know what we can do for them. And so it's our responsibility to show them what we could do for them. And so I, I have, um, I have video guides, which basically outline, it's about 15, 20 pages, 15, 20 pages that outline why the things they've tried maybe not have worked. Um, and why the, why the, the methodology we might use might work for them. And here's a bunch of videos of the things that we will probably do. But by the way, there's a huge disclaimer in this as this is your, like, we are not managing you. There's a, uh, I had an attorney make all this whole disclaimer on it where it's basically use, use or beware. It's a self-help book, you know? And so I know I've said in the past, I don't think people should manage people virtually, you know, like one-to-one because that's it's, you haven't done really a full exam.

And so I, I prefer to make this like, uh, Stu McGill has back mechanic book. McKenzie has fix your own back. There's, there's a lot of things out there that it's just basically a, like you're just reading a book and these are the things that we read as clinicians, but patients can read them too. Now, uh, is there anything about how to adjust your own neck? No, there's not stuff like that. Um, there's movement based corrections in there. And, um, basically it's, it's in that conversation too. I don't try to paint like a, I don't try to paint like a picture, like, Hey, you're going to fix yourself. It's like, Hey, you weren't ready to come in to see somebody. So we're meeting you where you're at. And this is what this guide is. And through this guide, I'm going to tell you, I call it the big boy, big girl conversation. Do not expect to fully get better because you have not taken the responsibility of finding someone one-on-one. And here's a whole list of people who I know personally who do a really good job and they might be right around your area.

And so I have a list of people across the country. And, uh, I say, look, you know, like I heard like when I had back pain, I went to Cody, Cody saw me a handful of times. And then I went to Brennan and Brennan was with me for like three months for two, two times a week to do strength conditioning. I did the big boy, big, big girl thing. And so I don't believe in that, that I, I don't, I don't try to paint the picture that, that people are going to solve their own problem. Like, especially people have had this stuff for a long time. They, they tend to be fearful, like, sure. It might work on some people. They might find this magic stretch. They find that they find the McKinsey book works for them. They might find that, you know, like doing a little bit of like, um, leg stretching might work. They might find some of that stuff works, but it's, it's incomplete in my opinion. So they find, I think they find a little bit of non lasting relief and they, they just follow down the rabbit hole a little bit the other way. So I don't want to be part of that problem personally, but that is, that is, that is part of the drip right there. Another thing that we've been working on, um, actually, you know, I'll get to that odd. Let me get to that audio right now. Um, we'll get to the audio about sciatica. It's about 15 minutes long and then we'll come right back into this. Hey everybody. I am Sebastian and this is Dawne Costantino. Hello. We are chiropractors at Huntington Beach and we thought we would cover some of the myths, the five myths that, um, a lot of people have heard about sciatica, um, because that is a lot, it's a lot of times a, uh, uh, like a thought barrier to people. Like they're not always doing the right thing to solve their problem because, uh, they're still kind of stuck on these concepts. So, um, what would you like to start with? How about, uh, how about stretching? Stretching is a pretty good myth. That stretching is going to help with the sciatica. Yeah. Is that a myth? That's a myth. I think when it comes to sciatica, I actually think that's stretching should be contraindicated in that instance. I think it's the complete opposite. So explain that to me. Like say I have sciatica or by the way, I think we should figure out first sciatica. By the way, everybody, I've noticed sciatica is a very overused term. They say, oh my sciatica and they mean buttocks. It's not actually sciatica.

Sciatica is a posterior or backside of the thigh, like hamstring region pain that goes past the knee to the calf part of the foot. Okay. If you do a, if you do a buttocks pain that it could still kind of fall towards this category, but it's generally not actually sciatica. It could be driven from something else like a, like a low back disc, but sciatica is typically nerve. It's typically nerve based. So stretching a nerve in this case, let's say we have right-sided sciatica. How do you feel about stretching the right leg? Um, so I think a lot of times people are told to like stretch their hamstrings in that instance because that's where the pain is coming from in the first place. Um, and for us specifically, the one way that we evaluate what's causing that is actually putting that nerve under tension and basically what it looks like, um, because we're on audio is stretching the hamstring. Um, and if we can light that up even more than that was, that's kind of what cues us in on what's causing it. And so that would be something that we need to actually not do. And so when people are told that they need to stretch the hamstring, cause that's where they're feeling their pain, I just don't necessarily think that's the right thing for them.

Yeah, I would agree. I think there's, uh, nerves are a lot of times they're, when they're irritated, they're really intolerant towards stretch. Um, normally they can tolerate stretch and it does look very much like a hamstring stretch to do it. But if you imagine kind of sitting in a chair and then putting your leg up that has leg pain into another chair, that is basically the positive test that Dawne Costantino's talking about. And you're putting your nerve at tension, you're prolonging your problem. Um, simply put, if we just take that stretch away, you'll probably feel better very quickly already. Although there's other stepping stones to cover in this case. Um, how about stretching the back?

Do you have any problem with that at all or stretching the upper back or the, or the glutes or the hip? Um, kind of depends on what stretch exactly. I think when it comes to stretching the low back, people tend to go into like this rounding position. And a lot of times, depending on what's causing the sciatica, that actually could drive the symptoms even more as well. Mm-hmm. The, I think a good, probably a good way to assess or like a self-assessment on this is any stretch you do should not create your problem. Um, simply put you, you cool it down and we build it up later. Um, so like if you stretched your shoulder, it wouldn't create your leg pain. If you stretch your mid back, it wouldn't create your leg pain. If you rounded your back, it might, or if you arch back, it might, but at least we can use pain as a good indication of it's whether it's good or bad for you. Uh, the second, uh, myth is going to be MRIs. And a lot of people will search to figure out why they have sciatica by, by using x-rays and MRIs. Um, do you have thoughts on that, Dawne Costantino? Um, I don't think you can diagnose sciatica through x-ray only. Sciatica is usually caused from, um, soft tissue related things. You really can only see it in MRI, but I always have trouble with the way to word this. Um, a lot of times though, when you find something on an MRI or on imaging, it doesn't necessarily mean that that's what's driving your symptom. We find positive things on MRIs and imaging all the time. Um, and people have no pain, right? I've, I've noticed a lot of people that have come in with ongoing sciatica there. They really want to see, they want to see what it is. They want to see what is creating the problem. And so I personally understand it. They want to see hip MRIs. They want to see MRIs and they want a low back one. And so they want all these images because they want to know what it is. Um, usually the indication for an MRI is someone not getting better after six weeks of good care. Um, or they have red flag questions like they have numbness into their groin area, or they're, they're kind of get trying to get all their urine out, but they can't, or they're having bowel or bowel bladder changes, or they're slapping their foot. They walked in the hallway, they have strength loss. So those are things where like the red flag questions, or we're looking for infections, um, infections. And so MRIs are, they're, they're nice to have as extra information, but they certainly don't put all the information together. We can have people with no MRI findings and have sciatica, and we can have people with horrible looking MRI findings and have no sciatica. And so it's just useful information for your clinician to put together.

Agreed. Good. Okay. Um, the third one is, I feel like there is a muscle that is creating my problem, creating my sciatica. Um, this is one thing I kind of struggled with coming out of school too. You go over sciatica and I think it wasn't until recently that I really understood what the heck it even means. Um, but I did always have a lot of patients going through the program that would come in and tell me, you know, my sciatica is acting up and I just need this certain muscle in my butt rubbed out for it to feel better. Um, and I think that isn't really what is driving their symptom in the first place.

We learn in school that, you know, the sciatic nerve runs through this muscle, um, in the booty area called the piriformis. And so if it goes through it or under it or on top of it, that is what can be driving your symptom. Um, but a lot of times too, if, if you're under the understanding that that's what it's coming from, then you may neglect looking at the low back and seeing if it's coming from that in the first place. And I think too, probably on that note is that the, by, I think what you meant by looking at the low back is not imaging again, we're talking about like an actual good evaluation with it. Um, I know we, we had put a video together about a good way to kind of test before if we're, if, um, leg pain is coming from the piriformis or not. And so one way is, and this is just an example of, of like what an exam would look like is that someone might have you slouch in a chair only. And then if it shoots off the leg pain, really, um, there's no change to the piriformis muscle, not much. I mean, like there's more to the back. And certainly if you kind of sit up in good posture, it goes away. And so if you've only affected the lower back, how come when you say it's the piriformis or the hip flexor or whatever, you know? So there's, there's other considerations and there's certain testing that we can do in person. Um, funny, actually, I told you, I got a phone call one time where someone said, well, what do you mean by testing? Like, like they didn't know I meant putting my hands on them and moving them. And so when we, when we're talking about testing, we're actually talking about being in office with you and working with you in the exam and asking you what hurts, what doesn't in what position. And it gets the information we need. It's not a certain zappy test or an MRI or anything like that. So we can gather a lot of information for that and we can rule out muscle injuries.

And actually not saying that the piriformis couldn't be causing it because that's true. And we will test for that, but it's, we just don't see that as often. Yeah. I think, um, there's, it's very, it's lower. It's a lower percentage. Um, if we were to, if we're at a gamble for gambling people, um, I'd say well under 10% of the time is it ever the piriformis or ever the hamstring that is creating the problem. You might have tightness there, but if those, those aren't the thing primarily creating the problem. Okay. Let's go to, um, let's see, we covered stretching MRI. We didn't cover surgery actually. We should do that. So surgery and injections, a lot of people with static have been told you're probably going to be surgery, a surgery case. What do you think about that?

I think that you should make sure you should try a conservative care first before you jump to that extreme, to be honest, and making sure it's good conservative care. I think unfortunately there's not a lot of good care out there. And so people say they have tried it. And so, you know, they've tried it all. They've tried PT, they've tried Cairo, they've tried massage and it didn't work for them. So now the only option is surgery. I think that, you know, it is hard to find good care, but as long as you're, I think it's important to make sure that you go out there and you, and you just figure out what the best care is before you jump to that extreme.

Right. Uh, I think too, like just on the note of, of, of good care, uh, I think expectations of what people have sometimes they're not, um, I guess we're not always clear about it. And so sometimes they'll think, Oh, well, I've had this for, you know, I've had this for a couple months. It's going to take a couple months to feel better. Not necessarily. Um, we taught, we expect about a 30% change within a single session and you keeping that change is really what gets you out of the hole. Um, we've had people with sciatica, we've had a complete reduction out of the foot and you want it to go up like a thermometer, comes out of the foot, out of the calf, out of the thigh, and then into the back. And then you result from the back. Um, we've had people complete reductions out of the foot and the calf within less than three days. Um, we had a guy that came in last week that he had sciatica and, um, now his, now he can bend over and touch his toes within a week.

So it can happen very quickly, but you actually have to have good care and good direction. If you don't have that, uh, in your, in your provider that you're, you're, you've been working with, can't make that change within a couple, at least give them a week or so. If you're not getting that change, then maybe ask him why, like give them the chance, give him, her the chance to prove themselves that they can help you. But if you've gone months and months and months and they want to do more, I think you've given them a shot. That. And I think like, how do we know that it's good care? I think if they're giving you type of treatments where you have to be relying on them, that's probably not the good care for you. Um, and another thing too, is really hold yourself accountable in a sense of, are you doing the work that you should be doing at home on your own or out of the office?

That's the most important thing. And so people are really looking for these treatments that are, you know, just going to be the end all be all. Cause they don't want to put in the work. Like you got to be willing to put in the work if you want to get out of pain. And that's the hardest thing to convince people of. Yeah. You know, sometimes they have actually something called a virtual surgery. Uh, I know that we had brought up the myth of surgery. Surgery is helpful in certain cases, by the way. And, uh, we're not, we're not poo-pooing on surgery necessarily, but, um, surgery as, as an overall go-to is, it's not an end all solution. People come out with having the same pain they did.

And so, um, someone came up with the idea, I think it was Stuart McGill came up with the idea of the virtual surgery. Dawne Costantino, you had a surgery today. What are you going to, what, what am I going to recommend you for the next week? Are you going to go to work? No, they're going to tell you to stay in bed. Or stay, stay in bed. And they're going to ask you to do your rehab exercises daily. They're going to send you to PT or some type of, um, uh, rehab place five days a week or something like that. And they're going to ask you to, to comply. And you're probably going to do it because you had a very real situation. Now let's not do the surgery and let's just do the stuff. Most people will probably get better from that, but you have to take it seriously.

Now part of the last myth here is a common one is, um, age. People tend to lean on the idea that they have an age related problem and that is very defeating. Have you seen people, um, of various ages with sciatica, Dawne Costantino? Absolutely. Okay. Have you seen older people, let's just say everyone over the age of 50. Have you seen them get better from sciatica too? Yes. Okay. Um, so do you think it's age dependent? No. Okay. Tell me more. Um, I, I think a lot of people use just age as an excuse most of the time. And I really just kind of always tailors back into how much movement are you doing throughout the day? How much are you willing to put into your own health? And so, um, age is, it's something that a lot of people use as an excuse, even doctors out there too. You're getting old. Sometimes they just have somebody walk into the office. I've actually noticed this myself, um, doing some shadowing lately is that somebody walks in and they're, you can tell that they're a little older and without even doing any sort of examination or seeing any sort of imaging, they just go straight to, well, you're old and you're arthritic. How do you know that? You know?

So I, I think it's just one of those things that people just tend to just like blame it on. And I don't just don't think it's the right thing. Yeah. There was actually, there's, um, um, I've, I've seen quite a few people that have come in and they say that I'm just thinking about a knee case right now. And they come in and say, yeah, I've bad knees. I have arthritis. And like, that's just this kind of the end of it. And so it's interesting when you flip them on their back and you put their knee through range of motion, deep enough range of motion with the knee to where they could possibly squat to the floor, like, but to go put to the butt to the ground type of thing. And so it's, they're always kind of blown away when you say, look, you have enough knee bend to allow a squat.

You just can't do it when gravity's there. So is that age or is that inability? Is that deconditioning basically, you know? And so don't get married to the idea that you're older, you know? Yeah. There's, there's, um, arthritis. We call it gray hair of the spine. Gray hair does not hurt. Wrinkles of the face does not hurt. It's just, it's just signs. That's it. They don't really mean much. Another thing too, though, is like if you're older and you're having pain, but you also haven't really been very healthy or athletic or moving a whole lot, like then sure, that could be like age can play a role. Absolutely. And so we will take into consideration that like, if age is a fear, like a fear thing for you, we'll slowly introduce you back into it. Like we're going to, we're not going to just say like, oh, you're older. And so, you know, this isn't a reason to blame it for it. Like we'll take, I don't know what I'm trying to say here.

There's, there's, there's, there's considerations. It's like, uh, rehab is scalable. Um, movements are scalable. If you can't, uh, I forget, we're talking about sciatica still. So like, um, even you can probably tolerate a certain amount of hamstring stretch, but you can't tolerate a lot. And so they're all scalable. Um, so just realize that when you're asked to, when you're suggested to do certain activities or certain rehab, it's, it's not because, um, like we did have one lady before. She's like, you're don't, I don't want to become an athlete. I'm not an athlete. Don't make me do athletic things. I just want to feel good. And it's like, right. Bird dogs or side planks or some of these things, they're, they're things that make people feel better. Some athletes do them, but we're not trying to make you athletic. We're trying to make you into what you want to be.

So it's case dependent. So, um, those are the five myths we thought we'd cover. And so if you guys are interested in seeing us anyways, um, I am Sebastian, this is Dawne Costantino. We work in Huntington Beach, California. Uh, we have a clinic here and, um, this does sound cocky, but I think we're pretty good at what we do. So, uh, we're not going to BS you. If you, if you have any questions, feel free to contact us. The website is P to sportscare.com. That is P the letter to the number sports is plural care.com. Just email us and just let us know you're interested. Also too, for the, there are people that out there that, that they've, um, have, they're like, I don't, I'm not live close. Uh, there is video guides that we have. And actually too, um, by law, you're not supposed to manage people, um, virtually unless you've seen them. And so this is a nice place to vacation. You can come in, we can examine you and we can manage you virtually for about a month or so. Um, there's nothing wrong with that, but we should be seeing you once a month just to see if you're feeling better. Um, and usually we find enough information the first time to guide you. Um, lastly is if you are coming in, you've already booked an appointment. Um, what should they wear?

It's an athletic clothing. Cause you're going to sweat. Yeah, you're going to, you're going to sweat. What should they expect? What should they expect? Expect to move. Don't expect to do us, have us do the work for you. You're going to have to put in the work. Okay. Um, what would be, um, how long, how long should it take? Um, is it going to be too hard for them? No, I think that, like you said, we're going to scale it back to what they're comfortable with. A lot of times too, we feel we have people come in who are just fearful of movement cause they've been in pain for so long. Um, so Sebastian always says we're looking to find a 30% improvement within the first visit. And we usually find that pretty often. Um, and then, I don't know, you chime in here.

Yeah, I think just, just, um, I mean, if you're really in need and you go, you got nowhere to go, I think you just need a guide. You need someone to help you through it. Um, and, and honestly, any place that you go and there's, there's other places around that are, that are good. You just have to find them. Um, they kind of the same mentality. So there are really good, um, knowledgeable, um, providers out there that can help you. They can be a chiropractor or PT or even, um, even a lot of times just, um, like strength coaches can be helpful with general movement, general physical preparedness. There's a lot of things that can help, but I think, uh, starting with step one and figuring out your diagnosis with a movement based exam, uh, is probably going to be useful. Step one. Step two is make sure that you, uh, we know what desensitizes your structure. In this case, your nerve. Um, it might be from the disc. It might be from the nerve, but you have to trial to figure out if the care is the right care. If we know it's the right care, if we suspect that we're on the right path, you'll have a 30% change in the same day. What you might find too, is that you find a 50% change within a week. And that means that it's working pretty well. Third is you need to build some endurance within the belly as well as the hips and you need to build some strength in the hips is number four. So there's parts to this puzzle. Number five is going into the movements that you've been avoiding. So if you're looking for a good solution, allow us to take you through it. That's what, that's what separates us apart from other clinics.

We just don't hand you a piece of paper and then let you go. There's parts to it. We have to help you through it. It doesn't take that long to feel good, but it takes a long time to build a buffer. You should feel good after a couple of weeks if you found the right place. Thanks for listening. Talk to you guys later. Now, the last part here is I tried to do a better job of laying out a foundation and a workflow of what is expected to get them to where they want to be. This is, I really need to get better at this part. And I've, I've been thinking about it for a long time and I didn't like the idea of first doing it, but I understand it because people, people need a roadmap and with, uh, I read a book called, um, uh, I think it was built to sell. Thanks Phillip for the suggestion. Um, really nice read, uh, easy. And so the moral or the story in that was basically this guy had this multimedia company and so they were just struggling and always looking to, um, uh, kind of keep, keep above water. And so what they're really good at there was logos. And so basically the, as a storyline went, there was the owner and there was this friend who helped him out. And so the owner of the company said, we're really good at logos. And the friend's like, Hey, why don't you just do logos? And he's like, well, I can't just do logos. And it's like, sure you can. And so what does it take to make a logo, a good logo that works for somebody? And he's like, well, first we have to figure out what the company's name. And like the person has to give us all of their, you know, what are they trying to do? What's their company about? Like all the specifics of that. That's step one. Step two is create drafts. Step three is send the drafts to the person. Step four is finalize a draft. Step five is whatever it might be. And then at the end you have a logo that works and people are satisfied with that product when they complete the five step process.

Now I want to share with you guys a break. We're going to do a break and I want to share with you guys a webinar series that I put together. I'm extremely proud of it. And I'm going to continue to promote this thing to death because I think it'd be a huge mistake to have made it such as I did and did put 15 hours into it of recorded content and then nobody finds it. So if I was talking to my five, um, not five year old self, I guess myself that was in practice for five years or even a couple of years ago, I would say, if you do not get this, it's a complete waste of your money to go to any other CEU, uh, unless it's on my CEU list that I listed in the workshop. So I believe in it that strongly. It will help guide you into what CEUs are going to be useful and ways to organize the content that you guys get at some of the CEUs. How do things like FRC plug into plug into here? How do things like DNS plug into here? How do you things like, um, uh, Dan Johns plug into here? I cover all this stuff. I don't go through all of the parts, the nuances of those, but I'll tell you where they plug in for sure. And I'll show you the steps that I take to make people feel better with hips and shoulders and low backs and cervical spines and referred symptoms, uh, IT bands, um, thing, uh, hip FAIs, things of that nature.

And so I'm going to share with you one of the testimonials or at least part of an email that I got from one of my students that was in there. And so I won't spare you, uh, I won't go through the entire thing, but basically they were working with someone with hip and they didn't feel comfortable with hip people until we did the hip course. And so this was just the next week after we did the hip course. And so they said they missed a few steps in the exam and treatment, but felt they felt way better and more comfortable than ever dealing with a hip complaint. I can't wait to master this and mess around with more. And so they have, they had a really good experience in it. I guess that's not the best testimonial, but, uh, I don't want to reveal all too many of the details that they said, because it might get too much into, uh, uh, personal stuff. Either way, they felt comfortable mastering, um, or dealing with hips. And so if you're having trouble dealing with hips, I encourage you to go through the first course I have, which is one of six, which is on the P2 sportscare.com slash products page. Uh, it's one of six hip complaints. Go through there. It's the best money you'll ever spend. Again, I don't make money on the podcast, but if you want to know what I really think about how to treat people, it's in there. See you on the other side. Now back into the show.

And so I was thinking about this, how do, how could we really improve our patient outcome? How can I prove my patient outcome at performance place by using something that works in a different profession? And so I, I tend to find that I'm very wishy-washy about what I expect from them. And, and I've, I've told people before too, I have probably done a better job at this in some cases more than others. But, um, I say, look, why did you come to me? I'm like, Oh, I just, I'm suffering with this. I can't figure it out. Okay. You're hiring me to be your helper. You got to listen to me. Okay. So you came in today for an exam and I gave you one thing to do, two things to do. Your job is to come back a second time so we can, we can figure out what to do next and then what to do next and what to do next. And what this sounds like is ongoing treatment, you know? And, um, I always feel very touchy about that. I don't like the idea of really maintenance care, at least with a, with a passive approach. I know everybody packs a little bit differently. I don't feel good about it because that's not what my biases are. I do feel really good though about, about having them do some strength work, working on form with, um, I call it the Dan John model into bucket three. If you're not familiar with my bucket system, I made a whole podcast about it in the past. So bucket one is first aid. Bucket two is corrective exercise. Bucket three is Dan Johnning. Bucket four is movement variability. And so I feel very comfortable at block three with people and that could take months, you know, cause we're just, we're just exploring different exercises that they, um, that they could be doing at the gym. And I think it builds a very well-rounded human.

Um, I don't feel comfortable doing ongoing corrective exercise or ongoing, um, uh, ongoing first aid. It just doesn't work well for me. So with this being said, what I've been trying to work on doing is creating a, uh, a step, uh, a five step process of, let's just say back pain or a piriformis syndrome or a shoulder or whatever it might be. And, and again, this is still in a work in process, but I'm sharing with you guys and see if you have ideas. I thought number one, and I don't want to make this complicated because it's, it should be simple. I want them to understand this is what needs to happen. Step one, proper diagnosis. Step two, uh, what did I call it? Um, desensitizing. Step three, building endurance. Step four, building strength. Step five, exploring movement. And so, um, breaking this down into a day by day process to them. So they say they came in for a single session, an exam, and I gave them a first aid. And so, um, in that case we did number one. Uh, so, Hey John, you came in, we did step one today, by the way, I want you to realize that low back pain recovery is a five step process. I want to, I want to work. I want to help you through that. And I think the reason why you've not succeeded with your other rehab is because they hand you a piece of paper and let you go. Now I could do that, but we wouldn't be any different than them. So I think they were on the right track, but they didn't lay out a good, uh, framework and a good roadmap for you. And so if you, you came in today to pay me to be your guide in this. And so I know it's going to sound like I'm trying to sell you a bunch of, a bunch of sessions, but really, uh, hear me out here. Okay. We did number one today. We did proper diagnosis and number two, you're doing it this week. You're going to be desensitizing by doing the first aid that I gave you to do. Okay. The next time you come in, we're going to start working on steps three, step three, and maybe a little bit of four. Step three is building endurance. Step five is building strength. Now I'll tell you that it's very, it's negligent of me to tell you to stop now. Like you'll be fine. I think it is because I, I 10 years of practice, I've seen people have flare ups of the same damn thing over and over again. All right. Now you're going to be feeling pretty good within a week or so. Hopefully if I did my job right and you did your job, right. And we're on the same team with this, but if correct me if I'm wrong earlier, you said your goal is to lose weight, go to orange series. You can lose weight to look good for your wedding. Reduction of pain does not get you back into doing that other thing.

It doesn't get you to the goal that you asked me to put you through. So if you're looking to get to your goal, we need to, uh, we need to go through step five. It's not going to be a quick process, but it doesn't mean it has to be an ongoing long-term painful process. And it certainly doesn't have to be super expensive. Um, now what I would propose is about a three month program. Okay. If you hear me out with this, if you agree with me on this, it'll cost you, I'm going to make up a number. It's going to cost you under $2,000, but it's certainly going to be over a thousand. Okay. But what we're hoping to solve with this is reoccurrence. And so here's what this might look like for you. So today you came in and we did step one. You also, you're working on step two on your own. Step three, building endurance. I think we all know that you don't get strong overnight. You don't build endurance overnight. This takes time. So what we're going to do is I'm going to suggest certain exercises for you for this week and maybe next week. So you might not see me for two weeks.

I want you to work on them and then come back and I need to change them because the body will start to adapt. And the exercises that I give you right now is extremely incomplete and so baseline that, that I would feel like an asshole if I left you with this. And this is all you're doing throughout the time because I've met people who do the same exercises forever and it's stupid. Okay. So you might come in and see me once every two weeks for, for probably about a month or two months or sorry, a month and a month or a month and a half before we really fully get into step four, which is building strength. The cool thing with step four is it looks like you're just doing a workout. Um, I saw Craig Levinson posted something recently where he said, uh, rehab is working out while you're injured.

So if you kind of think of it like that, then we're basically just, I'm showing you the workouts I want you to do because I know your problem really well. It, I'm not going to say you, you can't do this on your own cause you certainly can do it on your own. However, to have you figure out the exercises on your own and show it on a, show it on a video, I think it's kind of stupid again. It's just, it's, it's, it's, you can have better results if I just show you. So what you might see is we call it, we call this the workout of the week or the workout of every two weeks or the workout of the month. Um, so I'll give you one workout and exercises to do. It'll take no, no more than 20, 30 minutes. And I want you to do it twice to three times a week. It's totally your call of how, if you want to go, um, two or three, but I want you to come back and I'm going to change them for you. And by the end of this, you're going to feel like you have the ability to program your own exercises. You still might want a strength coach. They're pretty darn cool. I've hired one myself, but this puts you through step four. Step five is where people tend to kind of not remember what it was to be a child. And that's just exploring movement. There's no weights involved.

You just swing bats, go run around, go play on the ground, hang out with a dog, you know, try to grab a ball from a dog. That's pretty darn variable. And so what this does, it exposes your body to some of the movements that it, that it's, it's been fearful of. So that would be the five step process. So step one is a proper diagnosis. And it sounds like when you came in, uh, you had not had a proper diagnosis. And so we did that for you. Number two is desensitize. You're working on that. Step three, let me help you build some endurance. You can do a lot at home. Step five builds or four is build strength. Step five is experience the world. And so this will take you to roughly about three to four months. You don't need to see me all the time, but for the price of under $2,000 or whatever, um, I will help you through it. Everyone's gonna be a little different in this, but that's kind of where I imagine this going, because I don't know about you guys or like, I, I, I've tried to be the hero before and I'm like, you'll be one session, you'll be fine, you know, type of guy. And I realized that I'm talking about pain. I think it's ridiculous to have someone come in and say they had a fracture, you know, osteoporotic fracture, a compression fracture. You know, I'm going to get you out of pain. You'll be, you'll be fine. Just, just do this one. You'll be fine. You don't have to do anything else. I didn't even tell him to build up any bone density. Like that's like, you can have me do water aerobics and then water aerobics turn into some type of weighted buoyed water aerobics. And then you can have them go on to the pool deck and do some squats. You can have them go for walks and to say the body is going to be able to do this almost immediately is ludicrous. It takes time. I call this the long game for people. And so I would like to build my practice, um, or, um, uh, say me and Dawne Costantino's practice at this point, because I think Dawne Costantino is, uh, Dawne Costantino, uh, Costantino is his now come on. Um, you heard her on that. And, uh, I'm, I'm happy to have an, an associate doctor. Um, uh, uh, it's, it's exciting experience. Now we're part of a team here. So, um, I'm excited to have her on. And I think we can build something, uh, very, very comprehensive because there's a lot of people out there who have really, um, suffered by having incomplete care. They felt good. People make them feel good. We, we make them feel good with percussing guns and adjustments and stretching and massaging. We make them feel good. But I think to have a complete care is, is, is, is more challenging because they don't always want to do it and they don't understand why. And so I'm trying to improve that. So the onboarding process is phone, phone call, get to know them, um, offer them to check their, their insurance, build some rapport, offer a touch point, uh, or offer an audio. They'll get through a little bit of a drip.

They might experience, um, Instagram, YouTube articles, more call to actions. And when they're ready to come in, they might, or we could call them back if we really need to. Um, I don't personally like doing that because I want them to, I don't want to feel like we're hounding them, but they're certainly experiencing us. They're like, wow, they, hopefully they really know what they're talking about. I think they can help me. I decided they're the ones. And so that's the experience. I hope that they're getting to come in as they exit. I hope they feel like they, they can control their symptoms.

And also too, they have a lot of tools to decrease possibility of reflare up or what we'd call is building a buffer. And that's sort of the five step process that I hope that I'll be very good at talking about here soon. And obviously that'll increase, um, some retention, but I think it'll really be helpful. I think for all the people who have, who have come in that I'm like, you know, like I, like I've known you since middle school, don't just come in once you need to come in a couple of times, you know, like you need to come. And so when you really care about somebody, like, I think you start recommending the, the mom, dad type of recommendations of care, you don't just recommend what you think their pocketbook will, will afford. And that's your, that's my dad's, uh, don't diagnose their pocket pocketbook thing. So, um, that's what we're working on. Um, and hopefully it works out well. I hope it didn't offend. I don't think I offended anybody with that, but, um, that's, that's what we're working towards. I want to celebrate the successes that people have. Um, and, and, and I don't, I don't personally like seeing people in pain all the time. Like I, I know that I'd spoken to Ali about sometimes we just need to, you know, decompress. And it's, it's, our, our job is hard cause we're a sponge. We're a sponge for people's problems. Uh, and I know it's not always, uh, like I don't, I don't always take it home, but, um, it, you're a, you're a, uh, I think Dan John had said you're a, you're a sum of your habits. And so I think if we can sprinkle in much more of our, um, patients who have successes, like they come in, they're excited about stuff. Um, you know, they went and ran their marathon, they had no pain whatsoever. And now they're just, we're just getting into it. We're just getting down with it. We're just going to do some, some, some bucket three, some strength conditioning or step four stuff. Um, it's exciting. It's fun. They become friends, you know? Um, and so that's what I would like my practice to be a little bit more of. And so hope that was helpful to everybody.

Um, thank you again for coming to the movement meetup. I'm sure I'll have another one at some point soon. Um, do I plan to have it in different cities? Not really. Um, I feel like if I can't get people to come, uh, here, and this is a nice place and nice in the winter, uh, then I'd rather not, uh, spend the time and effort to go to a different city and hopefully people come there. By the way, I can see where the location of the viewership is. There's a lot of people in Southern California, so I'm just going to hang. By the way, um, uh, I, I don't know if I mentioned, uh, I don't know, I don't know what, what, uh, sponsorship I'll do in here, but I, I, I am going to have a workshop, um, for students is number one. There's one in, um, there's going to be one for, uh, students only, which is going to be, I think I'm going to have to scroll around here.

So there's a student workshop. The early bird is February 1st. So you're getting very close to the deadline. February 1st, um, students only, uh, ideally if you've been past the sixth or seventh term where you start to learn orthopedics, hip orthopedics, I think that'd be a good time to come to me in Huntington Beach on May 30th. It is, uh, from nine to 12 and one to one to four. I'll feed you guys barbecue. We're going to do tomahawk steak, tomahawk steaks. We'll have some beer and whatnot. And so it'll be, um, very useful. And, uh, I think we're going to have, I think we can fit around 20, 22 people. So, um, it won't, there won't be unlimited spots. Just let you know, full price is two 50. Um, and so I really want you guys to sign up early. I don't want two 50 from you. I want you to know. It's just that we know that people don't buy unless there's some urgency. I'd rather you fill the spots right now so I can plan better, uh, rather than just last minute, all of a sudden everyone signs up and then I, and then I got to make sure that everything's planned well. I want to make sure it's a good experience for everybody. And so it's 175 again, it's going to be at my clinic in Huntington Beach. Um, I'm basically going to put all the pieces together for you that you're wondering, well, when should I do this exercise or that one, or how do I get people from this point to that point?

Um, I think a lot of the interns that have come in and they've been very, they've been very happy about their experience of shadowing because it lay, I lay out basically the block, the block system, how to, uh, reduce people's problems, um, using corrective exercise, um, for, for specific cases. So I think it'll be helpful for everybody. There's also going to be a doctor workshop too. This is CEUs are available and this is April 25th and 26th. Um, I changed the date once. I don't know if I mentioned that, but it's April 25th, 26th. It's in my office again. It's Saturday from eight to 12 and also one to five. Uh, it's nine hours long on that day and it's, it's nine to 12 on the other day.

So we get three hours again, barbecue on Saturday night. Come to my, come to my garage. Early bird is before February 1st. If I get it February 1st, it's too late. You can pay me on Venmo. That is three 50 late bird, which is a block of time where it's February 1st to April 1st. April fool's day is 450 full price after that is 500. It was much cheaper last year. And I had a couple of people tell me you should charge more because it was very useful information. Um, so please reach out to me. Um, and my Venmo, if you want to come right now, that is at S Gonzales, that's G O N Z A L E S six, S Gonzales six on Venmo. And that's how we're collecting it. And so just make sure you notate student or doctor and then I'll put you in there right, uh, right there. Thanks for listening to everybody and thanks for being part of the movement. See you next week.