Piriformis Pain and Tightness: Treat the Back First

Hey guys, quick message before we start the show today. I want to introduce the premium subscription to the podcast, which is something that I've been working on for a very long time. It is case study heavy. It's for clinicians. It's not for lay public and it is once a week, short format, digestible. I'm keeping it real in there. If you think I remember holding back on things, it's, uh, I won't be holding back on things in there. And so we're just going to get super raw and make it. And so obviously it's going to be, uh, um, there will be patient privacy and no one will be able to tell who's who in someone. But I know that a lot of people who have come in as interns or shadowers, they want to learn why we're doing what we're doing.

And so that comes down to clinical reasoning as well as examination, as well as we've, what we figured out works in the past. And so we're going to be discussing that. And through case studies, I think you guys will learn how at least my clinical reasoning works. And I hope it's helpful in your clinical practice too. Take advantage of it. It's super affordable. Go on to the, become a member, scroll down on your podcast player. It should be super easy to sign up. Now get, let's get back into the show. We have had a lot of people with puriformis, regional pain, buttocks pain, back pain, say, well, you know, uh, I'm, I'm, I'm, my back's better. My puriformis is better, but my hip flexor is now tight. I don't know if I'm getting better. Yeah. Why is it tight? Or they'll come in in a different way. They'll say, well, the puriformis is tight as well as a hip flexor. And so is my T-band and my adductor is too. And then my back is tight. Can we, can I have a stretch for all those? Well, no, if we, if we address the central threat, the central reason why this is happening, much of that will go away on its own.

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 guys, I'm Sebastian, your host for the restoring human movement podcast. Thanks for joining the movement movement. This is your first time show. Welcome. Welcome. You've missed a lot. Please go back in the archives and check out everything that we have to offer. This is a grassroots podcast. No, I do all the editing myself and we do all the admin stuff ourselves. So we don't pay the big bucks for advertising. Again, if you'd like what you hear, please share it with other people. Now we're going to cover something called puriformis regional pain and tightness today. This is a part two of a, I didn't know it was going to be a two part series, but I decided it should be. Part one is way back.

So look at that first. The general format of this podcast, typically a solo podcast or an interview style one. We try to keep information and terminology friendly enough to healthcare providers as well as patients. But this one is a little bit more of what we call our patient care series. And so if you're a healthcare provider out there listening, then just know some of the general terminology that I'm going to be using is intended because obviously the way that we speak to our patients and get them to understand what's going on and what's expected of them is a little bit different than we might talk to our colleagues. So we all have that little language split. So in this podcast, uh, again, I thought there was a need to go back and generally understand some of the concepts and major points associated with puriformis regional pain and tightness, because it's, it's crazy. It's, it's crazy.

How many people come in or ask questions at least to my office who don't clearly understand, or at least I'd actually, I, I don't think everyone has to necessarily understand when they have this problem. They have to at least number one, trust somebody enough to do what they say to do. Or a second is understand enough so that they feel it is a logical thought process of how do you get rid of this? And so, uh, this patient information series is intended on shedding some light on maybe some mistakes that you might be making or, um, maybe build some trust. You know, uh, I, I always ask the patients that come in to see me, if they ask a lot of questions, I'll freely answer any of the questions that they have, but I'll let them know that, that their, their understanding fully technical aspects of this problem is not necessarily needed. We just have to do what we have to do.

And you have to let me examine you and dictate care a little bit and coach you through movement and so on. So I thought I would circle into some of the three, the three things I want to, to go backwards on from the last, the part one, by the way, again, if you did not hear the part one, you probably should. And also, um, three new major points that I thought we should hit. So six points today. Um, the first one being number one is let's just don't consider yourself a unicorn. Uh, what I mean by that is, um, I know that in school we used to have the saying where when you hear horses or sorry, when you hear hoofs beat, think horses, not zebras. And you'll be right most of the time. And then that's it, no one's, no one's surprised, you know, it's going to be horses unless you live in a place where the zebras, mainly not horses. And this would flip flop, you know, but when it comes to just general presentation of having buttocks pain in the back that people will oftentimes deem as the piriformis muscle being the problem, we should probably consider the horse beat or the, uh, the hoof beat or the, uh, zebra analogy with this. And don't consider yourself a unicorn. Don't consider yourself a zebra. Let's just do the things that are more likely to be, uh, do the things that are more likely to reduce your problem from a diagnostic standpoint, from, from clinical reasoning, at least I found with the patients to come in to see me. This is generally people who are, I don't want to, they're not, they're not athletes, athletes, they're recreational athletes. They're just normal people, probably like you who want to be physically capable. They like, I play recreational baseball. You know, we have people come in like that. We have runners that come in, we have lifters that come in. Um, and I do mean lifters and runners as recreational. These people aren't getting paid for this. It's just how they want to, you know, be outdoors and feel good and look good and, you know, challenge your body a little bit.

And so I can only speak for, I guess, my population and it's safe to say, at least for me, that over half of these people that come in their low back disc irritation of some type, which is creating their piriformis pain. I know it sounds ridiculous. And, and I know a lot of you have probably heard that, um, your back could be related, but because you feel that the pain is in the buttocks area and the piriformis area, that it's the piriformis. I understand. And that's still a common presentation of people who have disc related referral to the area. Now is it just herniation or a protrusion or a prolapse or something like that? Maybe, maybe, you know, um, and do you have to have a positive MRI to have disc irritation that refers to the piriformis area? The answer is no. Um, it's not always related. Sometimes it is, it's good information to have if you already have it, but I wouldn't go run out and get it. Um, the other 20 or another 25% is coming from a quote unquote pinched nerve. I know this is slang term. I'm using it on purpose because it paints a picture. All right. Pinching something doesn't mean it's damaged. And it also doesn't mean it, it, it means it can generally just feel better if you just don't pinch it. And so 25% of people roughly who come in and see me are nerve based piriformis referrals. And again, that's usually spinal basis from the spine. Now I should retract a little bit. Do, does the disc or the nerve require surgery or medication or injections? No, most of the time not. And I know when I say that to some of my patients that come in, they're like, Oh gosh, thank you. I was really worried about that. And they read all these terrible things online that are old, old, old information, or to be honest with you, written by people who might not know what's going on, you know, because they've never been able to successfully reduce a disc or a nerve pinching without that procedure. Most people don't require that procedure. So we've, we've covered 50% plus 25% of the people who come in with piriformis regional pain already from a spinal component. Okay. Roughly. And these numbers are super rough.

Obviously I'm going to make up all of the percentages on here. I'm just eyeballing things. Now, can I back up some of this with, um, some, some research? Yeah, probably I could find something, you know, we can all find research that validates probably our opinion. Um, but this is just what I generally see. And the reason why I know that this is what is happening is because when we treat these piriformis cases as a disc or a nerve, they get better, right? Proofs in the pudding. I know when people call and they're like, well, it sounds interesting. Yeah. No one checked my back yet. Uh, how do I know it's coming from my back when it works? Well, how can I be sure that it's safe to start? Well, you can stand, right? You can walk. I mean, you can do general stuff day to day throughout your life. It's circumstantial pain or it increases when you sit. Yeah. Yeah. You can start. The only reason you really can't start is because you have something urgent like an infection or, you know, um, degrade of the functionality of, you know, of the bound bladder or of the feet.

You know, there's, there's, there's things that we call red flags, which you can certainly look up. Um, but again, this covers 75% when you, when you treat from a spinal component roughly. So already, we know right now that if you have been dealing with piriformis, regional pain and tightness, and nobody's really helped you from a spinal component, you can, you can find some super easy wins. Like that's exciting. It's really exciting because they're, when people are treated, uh, effectively in this way, you can find a dramatic change, not perfect, but dramatic change within a two weeks, three week period of time. Sometimes even sooner than that, based upon, you know, how long you've had it and, you know, your daily activity and so on. So there's a lot of other things that would, would muddy the water a little bit, but generally speaking, this is a good thing.

Let's just deal with it this way. It'll be super easy. Now the other 25% covers all the other things that you probably read about, including your piriformis syndrome, uh, SI joint, sprains and strains, pelvic floor, being out of alignment, leg length discrepancies, um, problems associated with degenerative disc, uh, of the, of the spine. By the way, I think that term is super archaic. So please, um, do not think that your spine's withering away. I think that's a bad job by our healthcare profession to name that. Um, and oftentimes that does not hurt by the way. And so that's your, your, your last 25% in there. Now, obviously that's a, I'm, I'm categories that categorizing that as a big chunk. Um, but if no, let's go backwards again, think of it this way. If you have not been treated effectively as a low back disc type of presentation or a pinched nerve, there's so much, so much you can do.

And that usually leads into some spinal stiffness, some core work, some isometric core work, um, some hip mobility type of thing and so on. And so that's, that's number one here. And I guess, I guess I should read, you see how organized I usually am with these podcasts. I just spitball a lot of things and I hope you guys can follow. Um, but I'm going to go, I'll go back and I'll outline it. I did outline the major six points that I'm going to cover. Number one is the 50% disc, 25% nerve, 25% other principle, or don't act like you're a unicorn. Uh, number two is, um, the category of why this is happening. Number three is X, Y, and Z muscles are tight or feel tight. Why? Uh, I also talk about birds nesting in the, in this, uh, in that portion. Uh, and that's a little recap on the, on the last podcast, by the way, you should go back into that other one and listen to it first. If you're having questions, I won't go into full detail on all these things today. Now, uh, the last three points is associated symptoms, common associated symptoms, which is your TFL, IT band, pectinus, glute, um, low back, sciatica, knee pain, things like that. Number two is, uh, you have to trust your doc, PT or doctor and give them at least two weeks. Number three is ask questions. Okay. So I will go through all of these rest of the five now, and I'll probably recap at the end too. Um, by the way, um, it stayed at the very end because, um, there is stuff you can do on your own. Okay. And, and I'm going to put some links in there of things. So, um, number two is why is this happening? The reason why I put this in here is because it's really confusing to a lot of people. Why, um, why things are happening or what their actual diagnosis is versus, you know, what they need to work on and so on. And, um, I've had people come in and say, you know, you know why, uh, you know what's going on? You know, you know why my pure form is tight? Well, it's because my hip flexor is tight. I'll say, oh, okay, so what are you going to do? And they're like, well, I need to release my hip flexor. Okay.

So what's your diagnosis? I don't know. Tight hip flexor. That's not a diagnosis. Um, and if you're looking for the diagnosis, it would be in, in part one, uh, that number one bullet point that we talked about, which is like a disc herniation, uh, radiculopathy, pure form syndrome, SI joint strain, um, things of that nature, by the way, out of alignment is not necessarily diagnosis. I guess it is diagnosis either. There's a, there's the color M99 codes code. So those are in there. Um, but the, why is this happening is probably what a lot of people are drawn to when they're, what they read articles about. Uh, I have poor core stiffness. Uh, my hip mobility is low.

Uh, my hip flexor is tight. Um, my hamstring is shortened. I have leg length discrepancies, um, things like that. I have an anterior tilt. So, um, a lot of times these things are associated and this is going to blend into that part, the fourth point that we'll cover, which is associated symptoms. And, um, yes, there can be muscular imbalances and things like that, that, that, you know, um, are part of the problem, but you have to ask yourself, why are these happening? Why do you feel like, why is your hip have low mobility? Did you, um, did you have an impact on it years ago? Why do you take weight off? Why does your left glute not work? You know, why is that happening? Is it because you've shifted weight off of that left glute, that left side, because you had a left ankle sprain years ago. So there's, there's a lot of other whys, which, uh, could be part of what's going on. And they are a good part. They are an important part to, uh, for your healthcare provider or someone designing a program for you to address, because what we know is pain reduces quicker than a function is restored. And so pain can reduce very quickly. We know that because, uh, probably a lot of you who are dealing with pure forms pain, you have, uh, it's increased when you sit or when you bend forward and you lay in your back and it goes away or vice versa. And you walk and it goes away or not, you know? And so these are circumstantial pain and pain can be reduced as simple as by saying, don't do that. But I think we all really don't want to not do that, especially if we're, we want to get back to an activity. So I think it's human nature to kind of test it a little bit. I know I did when I had my hamstring tear and I ran out to the mailbox every day and, uh, just want to feel what it felt like. I just want to feel that it was better or not. And, uh, it wasn't for a while and then it was, you know, but we can easily just say, don't do that. But the reason why I bring this example up is because reducing pain is not the same as restoring function. It's not the same of addressing your muscular imbalances. It's not the same as getting mobility back. It's not the same as getting endurance, spinal endurance, or cardiovascular endurance or strength. It's not the same. And so your body has spent a lot of time, especially the longer you've had this reverse adapting to the situation. Uh, an example would be, uh, if I had to, um, if I had cut my hand and the hand never healed, I would spend a lot of time using my other hand. And so over time, so this is like a two year process, that hand will start to become weaker. The whole limb, the whole limb that has the hand effect, uh, the affected hand on it will become weaker. The shoulder will become weaker. And actually the core, uh, that, that helps out with stabilizing prior to using that hand will actually weaken too. So you'll develop even muscular imbalances or asymmetries from the center line, from the core, from the torso. And the same thing happens when people have had things for a long time. So you taught, you turned, turned an ankle two years ago and you never fully recovered on it. It still hurts a little bit here and there, especially when you put full weight on it and so on, whatever the thing might be an old ACL tear. Um, a lot of times people will spend time, uh, rehabbing their knee for a two month period of time. And then they stop, but they never really put full weight back on it and they deem it through bad leg.

And so that bad leg will eventually chew away at, um, having a symmetrical adaptation, having normal muscle on both sides. Now, can you reverse engineer this thing? Yeah. That's the whole point of having a program. That's the whole point of re, uh, reducing pain first and then applying enough load and challenges for your body to adapt. That's what it's all about. However, I bring this up, this long winded thing up because do not confuse reducing pain with restoring function. They're different timelines. And that's why a lot of times we, at least in my office, we'll talk about first aids. First aids will very much so reduce your pain. And when you find the right first aid, it's a game changer. You can sleep well at night. You know, you can find positions that are completely pain-free when you previously couldn't. Um, you now no longer have any piriformis pain with day-to-day activity.

But you still do when you sprint. So we haven't built up that resiliency, that resilience leads to the body, um, yet. So we can't do those advanced things in life yet. But the first aids are great. Um, they are very helpful for reducing pain very quickly. Um, but exercises, corrective exercises, or a good, good old fashioned resistance training program is the other part. And so make sure that you don't confuse some of the quote unquote, why are things happening? Like the core, like the low core stiffness, the low core endurance, the hip mobility and things. Um, don't always, you don't always have to throw corrective exercise at it or strength training exercises at it. You might need a precursor of a first aid. That's what the first aids are used for. The first aid is the first aid because it's the first aid. Sometimes over coaching of the, of the corrective exercise doesn't need to happen when you do right first aid. Okay. So number three, this brings us into why is X, Y, and Z muscle tight and, or why is it feeling tight? And we have had a lot of people with piriformis, regional pain, buttocks pain, back pain, say, well, you know, uh, I'm, I'm, I'm, my back's better. My piriformis is better, but my hip flexor is now tight. I don't know if I'm getting better. Yeah. Why is it tight? Or they'll come in in a different way. They'll say, well, the piriformis is tight as well as a hip flexor. And so is my T band and my adductor is too. And then my back is tight. Can we, can I have a stretch for all those?

Well, no, if we, if we address the central threat, the central reason why this is happening, much of that will go away on its own. And so when it doesn't go away fully on its own, then there's a need to tinker a little bit. I call this the, um, muddy cup analogy. A lot of times when there's something going on centrally, especially like the pinched nerve, the disc, something with the nervous system, uh, or even something that is still a current threat, like, um, attacking your foot, you know, um, or it's the, uh, what's the, what's the old thing? The, uh, the mouse and the line with the line had the thorn in his foot. You know, there's a very real thing going on right there, which needs to be reduced. Um, you can reduce the disc irritation. You can reduce the nerve pinching. You can take the thorn out of the foot and then being able to, uh, all the tightnesses that you end up feeling because they were protecting against using that area of the body, uh, will dramatically reduce on its own. Especially if you just started to have this problem. If you've had this for 10 years, this is a different story and we might need a little bit more, um, a little bit more, uh, corrective exercise or even tissue work to address that kind of thing. But a lot of times that tightness that you're feeling is protective, the hamstring will become tight because it's protecting against the central threat, the problem, the 75% or if you will, the disc or the nerve or the other 25%, which is the SI pelvic floor. All those are the things. Okay. So it's protective a lot of times. So hip flexor, it can be protective. The ab wall can be protective. The lower back tension that you feel can be protective. All of that can be protective. Even ones that I mentioned, not mentioning can be protective. And the confusing things a lot of times for people is one thing when one thing goes away and the other thing stays. And so I call this bird nesting.

I know I've got a lot of probably dumb analogies, but I'm hoping that the pictures in your mind help you help you. And I guess this probably work for people who have watched people fish, who are not good at fishing or have fished themselves and they learned. And so a bird's nest is, I learned my first bird's nest when I was first fishing and you cast the line out or you've been trolling and it's such a tangle itself up. It makes like a little, you know, big old knot. It's a bird's nest. And so we don't really want to cut the line. You know, I don't want to put all that other stuff back on. Plus you lose maybe the lure or whatever you have on the other side. So I don't necessarily want to do that because it takes longer to do that than it would be just to untangle this fishing line real quickly. And so sometimes you get through this bird's nest, you get halfway through it in like a minute. You're like, Oh yes, yes, yes. Ah, there's another one. And then you do it again. You're like, Oh, I got, I got the rest there. There's another one. You know, it's, there's a lot of emotional ups and downs with taking bird's nest out of fishing lines. And the same thing goes with your, um, reduction of your piriformis regional pain too. And all the other associated symptoms with it, you're going to have periods where one thing increases and something else decreases. But as long as you generally see an upward trajectory of how you're doing, if you feel like you're getting better and you can do things throughout the day that it, that are general mundane things that, that no longer bother you, those are good things. And so I'll give you an analogy. I'll give you a situation that we had someone who came in with, um, some groin pain in the front as well as piriformis regional pain in the back. And, um, we, I had to remind him a little bit of where he came from because he always felt the groin pain and he felt the stuff in the backside every once in a while.

And so he was obviously in more concerned about the groin. And so we reduced it, but he also had not had a reduction in this pain in years. And so he was always at a constant, like low level ache in the area. And even when I asked like, what can you do to make this go away? And he says, nothing. It's always there, whether I'm sleeping, uh, or I wake up with it, I'm walking around with it. I'm sitting with it as always there. And so within a week's worth of doing something, he said there was about a 30 minute period of time where he felt absolutely nothing there. And I said, that's great. It's a, that's amazing. You know, that's good stuff. And so over the course of a couple of weeks, we reduced it very dramatically out of the hip, but also it started to localize a little bit more into the piriformis area. And so we would talk about this a little bit and it's like, he's like, I don't know if, I don't know if this is working. Well, how come? Well, because it's still there. Where is it? What's in the piriformis area, but how's the hip? Oh, it's been good. This is a bird's nest. It's a prime example of a bird's nest. And so as long as you're getting it, getting rid of it and it keeps going that way, you're doing something productive and the longer you've had it, the more bird's nest there will be. And this is completely expected. So don't freak out. I know that when I get part of a bird's nest, done, done, and I hit another one, it's mentally frustrating. And I just think maybe I should cut the line at first and it wasn't working. But once you work its way out and you realize the things that you could do now that you couldn't do before, especially mundane things throughout the day, you'll mentally be on the right path again, which is super important because people tend to ditch things that are working because they're confused about what the full outcome looks like. Like maybe they thought it was completely going to get better over the course of three weeks, no ups and downs at all. When in reality, we all have our ups and downs. We all have our bird's nests that we're addressing. You just need to have a little bit of help getting rid of it. Now onto the new stuff here is we have our three bullet points, associated symptoms, trust your doctor, your Dr. PT or chiropractor and ask them questions. And so the associated symptoms I kind of hit on a little bit here, as we talked about bird's nesting is that the TFL, IT band, pectineas, glutes, and sciatica will be very much part of the puzzle for many of you.

And sometimes you'll experience pain into the calf, sometimes the foot, sometimes the hamstring and all of these are the same thing. And the reason I bring this up is because a lot of times when I see people in person for the first time, I'm kind of track, I'm tracking all of it and I'm building a, I'm building a case. I'm building a case to see what is the most relevant thing, what manual testing and stress testing indicated, what looks like it's the most relevant threat. And basically, how do we knock all these birds off with as few stones as possible? How do we get rid of most of this bird's nest, which is to couple fell swoops. And so that's what we're looking at here. And so sometimes we'll give people, like they said, they came in with hamstring issues as well as a tight glute and a TFL and then a foot thing. And so we ended up giving them just maybe a spinal stiffness exercise because we deemed that this was a disc problem. And they say, well, do I need anything for my foot too? Well, it's, it's, it's the same thing. Okay. Okay. I got it. Uh, what about my hamstring? So I stretched that hamstring? No, everything you're doing is within those exercises we give you, we gave you. Oh, okay. So I'm a little confused. So my hip pain in the front, the pectineus, so I should stop stretching that too. Yes. And so I think a lot of people, because of the articles that are out there and I've written articles like this years ago, so I don't, I don't blame them, uh, is that everybody focuses thinking that they have multiple syndromes, multiple problems when usually they don't, usually they're all parts of the same thing.

You know, it's like, if you didn't have any money, it's like, well, you, if someone went in your house, they're like, well, the, the, you know, the stucco needs to be changed. Uh, you need to redo that stucco. Yeah, I know I'm planning on it, but I just don't have any money right now. Okay. And they walk into your house and you're eating rice or pasta, you know, really go, go with this pasta is, uh, is maybe some meatballs. Oh, I don't have any money for meat. You know, it's kind of the same thing. It's the same. Um, it's the same central cause that will, um, create all these other problems. And so a lot of times when you reduce the central cause, a lot of these other problems will just fall off, but sometimes they won't. There are situations where let's just say somebody comes in and we're reducing some of the backside pure forms pain. And as we're doing so, some of the groin pain will increase momentarily. You know, it's not the new normal, but it's, it just is what it is. And so a lot of times we have to keep moving first aids a little bit or changing the corrective exercise. And this is why I like to see people once a week for a couple, at least a handful of weeks because we're tinkering. Um, we had a gentleman actually who came into, you know, I'll probably mention his, uh, his situation a couple of times cause it was interesting. You know, um, he didn't have pure formless regional pain, but he had, um, he had an elbow. And so we deemed that it was from, it was, it was, it was, sorry, it was a quote unquote diagnosis of a golfer's elbow or, uh, sorry, tennis elbows, the tennis elbows, the outer side. And so we kind of deemed this as a neck related. We, we said it was a cervical disc and so we treated it like a cervical disc within a week. He was about 25% better. And then as usually as we learn that we plug in some corrective exercises, which are complimentary, complimentary to the diagnosis and the way that we're reducing it with the first aid.

And so we did that. And the second time, or sorry, the first time we also gave him a corrective too, a supplemental exercise. And so the it's, that's the, uh, super glue, if you will, to the first day. And so the second time we, we went through the same stuff we went through to see how his homework was doing. And we did a little bit of, um, a little bit of loading. We, I think we do have him do a farmer's carry. And he's like, yeah, this, uh, this elbow, this elbow is coming back. We're like, okay, so, um, do that thing that we told you to do, um, with your neck a couple of times as your first aid. And then, and then let's do it again. And he did it. And, uh, he's like, nope, still there. It's like, huh? Okay. So maybe we're wrong. And so we actually changed the first aid on him, which is actually a first aid, which was 180 degrees, the other direction. And that reduced it, that reduced it with the farmer's carry. And so it was really cool. It was easy. It was simple.

And so the next time he came in, um, he was still getting better, still not perfect, but getting better. And so we did this, did a similar workout. We keep things consistent, at least with the farmer's care. And we did a couple other things too. Not really that important. The point is that he had pain with the farmer's care again. And so we said, okay, so do that second first aid we gave you and let's try the farmer's care again. Cause now the farmer's care was our, we call an outcome measure. We're testing to see, uh, if it was, uh, if our first aid is still relevant. And so he did the first aid and he's like, nope, still there. And so we added a third first aid. We changed his first aid again. And this one just knocked it out. And so now he's back into, uh, golfing and doing what he wants. And so it took him three first aids over the course of about three to four weeks really to unravel his bird's nest. Cause he had a couple of birds nests that were going on because he's had it for a long time. And so the same thing happens for you guys with your piriformis area. What a lot of you will probably experience is the, as the backside reduces, the front side might increase that the hip flexor tension might increase. The hamstrings might increase, but I want to caution you. Do not think this is the new normal. Okay. Once you get the first bird's nest out and you're looking down at your reel, you don't have to keep that bird's nest there. I know it's easy to think that I'm never going to get this thing out after that, because you tried so hard with the first one. It's, it's not true. Okay. Most people will get back to a normal, a better normal than they ever thought possible.

If they're able to go through a couple of first aids in a guided way and then put some glue onto it. So, um, try not to go down that mental well that, uh, people do. I've done that too. And I've been surprised how much better it gets when you just are open to trying another intervention. All right. We don't always get the first intervention, right? We like, we would like to think that we do, but we don't. And we don't always. And, uh, when we do, it looks like a magic show. Everyone's happy. I feel good about myself. Dawne Costantino feels good about herself. The interns feel good and that's it. Right. It's like a slam dunk case. The other times it's like, you know, we get a phone call in the next week and it's like, ah, that didn't work. I don't know if it's going to work. Well, that was only intervention one of probably three or four that we're going to try. So we treated you like a 50% disc. You still got a 25% chance that we didn't even address you as a nerve yet. Let's do that.

You know, let's do that. Cause you still got a lot of easy wins that we could do, but just be open to, to, to knowing that the failure of a first treatment is not a bad thing. It just gathers information and basically disproves that it's probably not that. Okay. So your associated symptoms are common. Don't expect to have just pure form is pain and nothing else. You're going to probably have a lot of these things too. It's probably part of the same thing. Don't worry. Just treat the central threat, which is your 50, 25%ers. And then we're probably good. If you need help with this, you know where to find us, by the way, number two or sorry, number five is trust your doctor, PT or chiropractor, ATC, whoever's working with you, just trust them for a bit. And I bring this up because, and I mean this in the nicest way I want everyone to understand, um, where there's a fallout in healthcare and in rehab. And we've noticed that there's a, that there's a, there's, there's people who have been to 15, 17, 35 doctors and they've gotten a lot of opinions. They've been told a lot of things. And because they're now at our office or your office, uh, whoever's office there at now, there's like an inherent distrust. And I totally get it. I understand they've been jerked around. Um, they've been giving treatment plans that haven't worked. Um, and they probably lost a lot of money, a lot of time. I totally get it. But to be fair, if you're, if you're going to work with somebody, let them work with you for a little bit. I usually think about two weeks or three weeks is a fair amount of time to work with somebody. Um, they might say one time a week, two times a week, three times a week, whatever they say, it doesn't matter.

Allow them a couple of weeks, mainly because the body is, uh, it has the ability to heal itself. Just like a cut, it will heal itself. You'll notice a difference within two to three weeks. If they hit the nail on the head, if they miss the first intervention, yeah, you're going to have some lag. Um, there might be a potential that, um, they didn't identify. They weren't able to identify what was driving the problem. Maybe you came in with your piriformis hurting when you're sitting and, um, it's worse maybe when you're driving the car. And so they gave you the right intervention to do, but then you drove to Las Vegas, which is a four hour drive back and forth.

And you sat at the casinos and you're up all night, you know, so there's something that kind of took away from the effectiveness where we're adding basically with a first aid, we're adding some positives. And there was a bunch of negatives that happened and addressing that. Maybe I'm not saying it was the patient's fault or the client's fault, but the practitioner maybe could have identified that. And I've missed this many times too, or I haven't stressed enough that maybe, you know, let's just not drive or go ahead and drive. And, but just fully expect, you might have to do a little bit more of the, of the bonus of the first aids or the, or the other exercise they gave you to kind of offset what's going on. If you're driving more, sitting more than normal. And, uh, so that's something that is, again, it's something that's found, um, after the first intervention, cause you just kind of find, or the first interaction, cause you just kind of find that this was, there was something missing there. And so usually doing the right style of care for the right thing will provide the results that you want. Um, but everybody is a little different. Uh, and that's part of the puzzle that is working with people. So give your person a couple of weeks. If you like what they have to say in there, they proposed a, proposed a reasonable plan of attack. They've manually tested you. And I do mean manually tested you, or at least spent some time watching you. I know virtuals now are a little different, but make sure they've watched you move and taken an interest of what your body's doing.

They can't just merely listen to you or, you know, for a couple of minutes and say, Oh, this is what you have. This is what we should do. There's more to it than that. They need to be able to be interested in what's going on with you. They need to be asking questions and you should kind of, when you look at them in your, in your working with them, you should genuinely see that they're trying to figure something out by what they're, by how they're communicating with you. You know, if they're just talking about the weather or they're like, you know what, you know, it's going to work with you this. And they don't even talk to you about anything else. You should find somebody else. But if you find, if you find someone who generally is trying to figure it out and you can tell, give them a chance. It's only fair.

It's only fair to yourself, your body, as well as them too. Okay. Manually testing, by the way, I should bring that up one more time is that you don't need an MRI and x-ray to start care. I know I've said it over and over again in some of the podcasts that I've done about various different things. And I really do mean it because it stalls care on people as well as the things that you see in the image that are not even relevant. They'll freak the hell out of you. All right. Because there's big words and they look different than what you're normal to seeing. And someone's going to identify that you got gray hair in the spine and that you got this osteo whatever, which doesn't have any part of what's going on with you. And so it'll provide what we call as, as a distractor. And so make sure that someone's manually testing you. If you see them in person, meaning they're going to touch you, move you, tell you what to do and stress test different parts of your spine, as well as your hip, because these are important to do. You gather, we gather information that way to be able to guide you. Now in virtuals, can you do that? There's ways to creatively get the person or get you, get the patient to manually test things. And, um, there, there, there are certainly things that, that, um, that, that they can do. It's not as, it's not as thorough. It doesn't substitute for an in-person exam and there are things missing, but a lot of times it's enough information to at least proceed forward for a little bit of time while you're maybe not, can't see them in person. You know, the last thing probably is, um, uh, your doctor should be doing what we call a slumps test or a straight leg test. And so this, these are called neural tension test.

And the reason I bring them up, bring them up is because it definitively, uh, gives us information that your problem is not in the 25%, the SI joint, the pelvic floor, all that kind of stuff. Um, or the piriformis. It just means it's more from the nervous system, the spine, the disc and something like that. And so slumps test, if you guys are interested, you can look that up. Uh, if you're not interested, don't, but at least you can, if you, when you talk to your doc or your PT or whoever's working with your chiropractor, just ask them, uh, you know, I heard about these things called slumps tests or neural tension test or straight leg test. Um, what did mine show? And they, they should be able to answer that for you or they test you right then and there and that's okay. And so just make sure that, that you're getting enough information because that test is super relevant. And for me, anyways, when I see it in my practice, it really makes me think, should I treat this person as a hip case or should I treat them as a spine case in some way, shape or fashion? If it's negative, maybe I want to treat them more like a hip case possibly. Um, but if it's positive, I'm certainly, I'm on high alert that we should be looking at some spinal, uh, based, uh, interventions, by the way, when I say that, I don't mean surgery, medication, all that kind of stuff.

Just remember that. Okay. Number three is ask questions. I want you to ask questions to your doctor or your PT or a therapist or your ATC or your trainer or whoever's working with you. There's nothing wrong with asking questions, but remember when you do ask questions, there's a chance that they might say that, um, it's not important. And I know that the wording might be a little harsh to say it that way, but there's things that people ask that I know that I, like, I just picked up a car engine, probably the things that I asked the guy were not really that important. And, um, maybe if he would have said, well, you know, I know what you're, I know what you're asking there with this engine, but I think what you're really is what you're trying to ask this. Are you trying to figure this out? And I'd say, yes. And he'd say, well, okay, so here's how we know, uh, that this is that and so on. It's, it's not what you're kind of talking about. So, um, in this case, if someone comes in and ask about their hamstring and piriformis and IT van and TFL and all those things, we can spend time talking about those things, but it's going to take away from other things. However, I'm okay with people asking the questions. And I do encourage you to ask the questions because this gives me or your practitioner the ability to figure out what's going on in your head. And so I might say, you know, all those things are important, but just let you know, everything we're doing today is to also address those two. They might not go away at the exact same time, but yes, they are. They are in this treatment plan. Remember that.

Okay. So part of what we just did there, what I just did was I'm committee communicating to you as a healthcare provider, but I don't know what you're thinking unless you say something. And this is why I want you to ask the questions and open the line of communication because communication is so important when you're working on a team to get rid of something. And you guys are certainly working on a team and you need to make sure that the other person knows or, uh, where your mindset is, or you just blindly trust them. There's, there's a couple of things you can do there. If you blindly trust them and you do what they say, you'll probably get better. However, if you're not doing the things or you have concerns of the things or you think that the person's not listening to you, you need to say something. And so that's a simple conversation that can happen over the course of a couple minutes and you can get a feel of it.

If the person has your best interest in mind, um, if they're listening to your concerns, if they've, if maybe they didn't hear you. Um, and so just talk about it. There's nothing wrong with that. But the last part of this, uh, bracket is going to be about, you know, I've, I've noticed that I don't know if this is a new thing or I just started to notice it, but I think there's a, I I've noticed that some people have a distrust for medical and they'll, they kind of come in with their guard up sometimes, sometimes not everybody, but, uh, these are, these are hard situations, um, for us, uh, on the medical side, mainly because, um, the suggestion that we're going to give you might be relevant in based upon the exam and everything else, but there's just already distrust. And I know this happens with, um, like, I kind of feel it when I, you know, if I find a new car mechanic, I just kind of like, you know, it's like, I'm not sure because I don't know anything about an engine really, or a car or the, or the car too much. And so I could easily be swindled and it's just, you know, I don't know. And, uh, I don't know when that became maybe to be that, be that way for me for car mechanics.

Um, but I think it started in healthcare too. And so if you do have a distrust for the people that you're going to talk to maybe think about, you know, think about it to yourself, why, what, what do you need to hear from this person to trust that they're doing the right thing for you? And, uh, I asked this recently with, uh, I, I, I'm, I'm, we're getting something called a Japanese domestic motor. And so, um, my, my car had a, it, the engine basically ate itself, you know, prematurely. And so we decided to put a Japanese domestic motor in it. The theory with these engines is that, um, you get them from Japan and you can just put them into your car with, um, they say that over in Japan, the emissions laws will, what is it that they, you know, they encourage people to get rid of their, their vehicle or their engine before 60,000 miles or else it's taxed heavily or whatever. So anyways, these engines that, that I would really be interested in, um, that came from Japan would have 60,000 miles. And I mean, that's great for me because I mean, shoot, you go in over here, you know, it might be 300,000 miles. And so I asked somebody, I said, look, um, I asked all the questions about warranties and things like that. But finally at the bottom, at the bottom, when I was talking in the very end, I said, look, um, this is going to seem very rude, but I want to be up front. There's, I have a concern that, you know, I've heard that some of these engines are not really from Japan under 60,000 miles. And they're just from junkyards in America. Um, do you have something that will, um, mitigate this concern for me? And they just said, sorry, good luck in your hunt.

And like, I, like, I'm not trying to be in it. I would appreciate if a patient said this to me, like if I have my concern is this, that way I can help them with that. And so my response, the person was, uh, look, I'm, I look, I'm looking to buy your engine, but do you have anything that will help me with my concern? I said, basically that, uh, and they really didn't have anything, you know, and, or, or, um, the first, the first response seemed like they were upset that I even asked. And so again, this is all part of communication. I don't think there's anything wrong with asking, you know, uh, asking about what your concern is because it helps us understand, uh, what's going on with you and what will be a really good buy-in method. Like what will create the buy-in that you need to be able to create the success that you want? And, um, so those are the three, uh, six parts that I mainly, so there's number one, 50% and, uh, sorry, the 50, 25, 25 rule, or don't assume your unicorn. Uh, why is this happening? Which is all your, you know, um, uh, muscular imbalances, core mobility, blah, blah, blah, things you probably read.

Number three is why do X, Y, and Z muscles feel tight? Number four is associated symptoms such as TFL, IT band, pectinia, sciatica, glutes, all those things. Number five is trust your doctor PT and give them at least a couple of weeks. Number three is ask questions, or sorry, I guess I wrote number three in my ledger. So number six is ask questions. So these are the basic parts. Um, I encourage you guys to reach out to us if you have any questions on this. We're in Coast Mesa, California. Uh, we also do have guides online too. Uh, we have ways to virtually help people. Uh, as Dawne Costantino says, there's really no excuse to not get at least some type of free advice nowadays, at least on our website, because we have webinars that are free. We have audios that are free. We have this podcast. Um, and we have virtual guides. We have the ability to work with people virtually too with, we have telehealth we have in person. We're an essential, uh, profession so we can help people in person still too. And so there's a lot of things that we can do. It just depends what you want to do. Now, if you want to work with someone in person and you're in a different state, uh, yeah, we can help you find somebody. So we're just asking that you trust in us enough to talk to us so we can help you find the help that you're looking for. And so, um, again, if you have concerns or questions or distrust or whatever, just, just that's fine. Talk to us about that too. I don't think there's any hard feelings. It's just kind of meeting you guys where you're at. Um, but we'd love to help you out. Um, we are very good at working with buttocks pain as well as back and all the associated, associated symptoms that I discussed. Um, if you have concerns with us and you don't know if we can help you go look at all of our Google reviews and Yelp reviews, even the ones that are hidden and not suggested, Ooh, not those bad ones. You know, those ones are, uh, you know, uh, of course, probably better than the ones that are, they're shown. Um, I think we only have like one five-star review. Uh, go ahead and read that one. That one's kind of actually pretty funny too. So, um, but we'd love to work with you guys. Um, there's no need to think you're a unicorn and have all these dramatic things done to you, especially when there's very easy things that you can still do things that you can do from home.

There's easy, easy things. So, uh, sorry, they're, they're simple things there. I don't want to say they're easy. They're simple. The process is simple. It's not easy. It just takes work on your part. Okay. And we'd love to help you through that and guide you what to do. So talk to you guys next week, subscribe to the podcast and share this with anybody who you think would benefit from it. Talk to you guys soon. See you next time. Thanks for being part of the movement.