Three Days of Intensive Rehab for Postpartum Back Pain

Hey guys, before we start into the podcast today, special announcement for the clinicians within California area, and also Utah, by the way. I have a workshop, and it's credentialed through CEs, for DCs mainly, not PTs, but PTs are welcome, students are welcome, people who don't need CEs also are welcome. So if you'd like to come, it's on June 8th and June 9th. It's basically all of the stuff that I've learned and kind of packaged together in the way that I treat, that I've learned throughout the podcast and working with different people over the last couple of years. And I always tell my patients that there's, they're like, what makes treatment with you a little different?

And I say, well, you know, like honestly, with your case, I might not have done a good job with it about five years ago. And so I feel like I've really developed a lot more over the past couple of years as a clinician, and I want to share that with you guys. So I want to help open Pandora's box. I'm not saying I know everything, and I'm also looking that other people are willing to share their experiences of things that we might not know already. So think of it kind of like a group of really good, open-minded clinicians who are getting together. And by the way, we're going to have some beer after and tomahawk steak.

So it is open to students, and I strongly suggest it to students, okay? I strongly urge you, if you don't know what you're going to do through clinical practice or you feel like there's missing parts, this will help you a ton, okay? It is also for DCs. Like I said, California easiest because, gosh, I know I could show you guys a lot of stuff, but I'm very self-conscious about having you fly in for this. I don't know why, but I'm confident I'm going to show you a lot of things. But a couple of buddies in Utah got that credentialed. So Utah and California, if you guys need details, please email me, info at p2sportscare.com, and I'll send you everything you need.

Let's get to the podcast. This is my first time really experiencing that, and it was interesting. Like I said, the out-of-towners that I've worked with before, I've worked with them, but it's like they'll come two days in a row, and I don't talk to them in between. You know, they're free to go throughout their day, and I don't get to answer all their questions and direct them as you go walk down the street and have dinner. And so this person in particular came with a – I'd worked with her in the past a little bit with giving her some guidance on things to try, but she hit some sticking points.

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. It's Dr. Sebastian Gonzales, again, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time, welcome. This is a podcast where I'm attempting to blend the line between clinician and patient, and kind of think of it like if you were at a bar with two docs, and the docs are talking a little bit technical, and you're like, what's that mean?

And they're like, oh, well, let me explain that a little bit more to you. And so we try to break down the terminology a little bit more to make sure that it's friendly to everybody, because this is really where the magic happens, is where you understand what's going on in your body, or you understand what's going on with your rehab, rather, or your treatment. And a lot of times, we do find that people who tend to not understand, and understand that they're going to get better, or understand what's expected of them, a lot of times don't comply with their care. And so when I'm going through this today, I actually had a unique situation over the weekend where I had a friend fly in from another state to work with me.

And so the interesting part is that, so they basically were a live-in. They were here for about three days, and we basically worked on her back. We worked with her back condition. And so I had originally kind of given her a little bit of guidance, and that seemed to work, but she kept hitting some sticking points. And so I thought today it'd be an interesting thing to go through, and just there were some things I learned throughout the course of the weekend, and things that I think would help my treatment overall in working with people. And so clinicians out there, hopefully you're going to learn something from this in regards to patient care.

And also, what it would be like to actually work with a patient if they lived with you. Because not all of us, I think the general rule is that if you don't treat friends and family, if you're a clinician, because it's really tough, they don't always listen to you, but sometimes they're really good. And sometimes we put our guards down. We don't tend to do everything that we need to do. And so, again, this is your first time. We're going to go through about 45 minutes to an hour or so, typically. By the way, if you have not gone backwards already, go backwards. It's not serial. You don't have to follow along each time and do each one in sequential order.

But there's different topics at hand. And so, one thing that actually iTunes changed just very recently, if you've already been listening to the podcast for quite a few weeks, you probably realize at some point I mentioned episode numbers. iTunes started making it so they don't, they're like, if you put episode numbers, like numbers on your podcast, then we're going to penalize you. And so, I stopped doing that. And so, a lot of the ones that I referenced back in the past, you can still find the show notes as well as references on the website, p2sportscare.com, and just type in the episode number that I mentioned.

But when you go on iTunes, we're making a good effort to go back and start removing those numbers. So, at some point, those numbers are going to be dumped. So, if there are episode numbers that you want to find, now is the time to probably do it because they're going to be harder to find. You should scroll back. Some ones that you would probably get a lot of information from if you're a clinician is, there's one with Michael Shacklock, I think it's number 91, and there was also one with Dr. Stuart McGill, 67, which is probably going to be removed very quickly from iTunes because they only go up to about 100 episodes.

There was one with Dan John, I think it was 63, and there was also one with Tom Michaud, number 94. Also, too, if you are not, if you're not really good with corrective exercise or loading, then you're going to get a lot of information from the ones I do with Cody D-Mac, who is a serial co-host. I think there's a great one around like 122, 123, around there. So, if you're a patient, just type up whatever, just go with whatever you feel. There's shoulders, there's hips, there's knees, and so on. So, as we go through this also, last thing, house cleaning-wise, before we actually get to the stories that I learned, was that through each episode, I try to give you a little bit of insight into who I am.

And so, I'll do a little bit of a short story about something I like, something that happened, some gripes, who knows. So, we're going to get into that right now, and then we'll get into the content. So, back in the day growing up, I didn't really have, I didn't have a ton of money. Like, we weren't poor or anything, and we definitely had enough money to survive, but I never really asked my parents for a lot of money. And so, I wasn't taken care of that way, although my dad might tell you different. He's like, they were spoiled brats, but I never really asked them for money and said, hey dad, give me 200 bucks, you know, type of thing.

So, anyways, I was, I grew up kind of frugal. And so, one thing that I thought was kind of was a waste of money was greeting cards, or especially like Valentine's Day cards, birthday cards, and so on. So, there was one time that I bought a card for somebody, and I took a piece of paper, and I wrote in on the paper, and put it in the envelope, and didn't seal the envelope, and put it in the card. And so, when they got the card, they read the piece of paper, and the card was blank. And I said, here's the gift that keeps on giving. You can just return that and get about five bucks back. So, it was kind of like, you know, it served its purpose, but you don't really need to write on the card.

I wasn't going to keep the card. They weren't going to keep the card. It was just going to be a toss and throw away. And also, too, back in the day, I used to draw cards. Me and a friend used to actually, for his, I think it was his birthday, maybe it was Christmas, I forget. But you'd do a wrap in the card. And I would draw my own card. Again, I'd just do it on paper, because I like drawing, as you've seen, probably. But anyways, so we do these wraps. So, if I could find one, I'll actually do one on air. He might have some, but I thought they were pretty clever. They were probably about, like, 30-second wraps.

Real cool. All right, now onto the content. Okay, so we did have someone come in just recently, and she was with us for, it was Friday morning all the way to Sunday, or Sunday night. And I was able to work with her three times throughout the weekend. And I have worked with people from out-of-towners before, but it wasn't to the extent of this. And I started thinking about all of the other things that some people do extensive things with, you know, where you get them every day. And I think about yoga retreats, you know, or people spend, you know, thousands of dollars to go spend a week with someone to learn to eat better, you know.

And I actually, there was a guy that I know that he was a personal trainer that he said he had patients or clients fly in that just really wanted to make sure that he was helping them develop their habits throughout the week and making healthy meals and meal prep and going for walks throughout the day and so on, or whatever it was that he was going to have them do. And so, this was my first time really experiencing that. And it was interesting. Like I said, the out-of-towners that I've worked with before, I've worked with him, but it's like they'll come two days in a row and I don't talk to them in between.

You know, they're free to go throughout their day and I don't get to answer all their questions and direct them as you go walk down the street and have dinner. And so, this person in particular came with a, I'd worked with her in the past a little bit with giving her some guidance on things to try, but she hit some sticking points. And so, prior, I'll give you a little bit of history with her is that she had a baby and when she started having her pregnancy, she had some back pain develop. And I didn't talk to her much at that point about it, but we talked after and she wasn't really convinced that she wanted to have a baby, another baby yet.

Like, they want to have another baby. And she wasn't really sure that she wanted to go through that again. Like, especially if she hasn't recovered from the first baby. And this is actually an interesting thing to me is because I've heard a lot of ladies who have been pregnant who just have kind of thought, like, this is what it is the sacrifice I make as a mother to have kids. And this is just the way it is. Like, the baby wrecked my body. I've heard some people say that, you know. And it's just not going to be the same. And I don't think that's completely true. And I think there's a lot of things that you can do to prep yourself really well to having a baby.

You have to be conditioned, I think, to have a baby. And I might not be the perfect one to speak about all this stuff since I don't have kids and I have not been pregnant. But this is just my thought. I think that the human body was really meant to have a baby. So, but at the same time, people who are, people are meant to run too. But sometimes when people run, they don't fare very well. And they're the same humans. They might not take it as well as the other human. But for the most part, it shouldn't disable you for the rest of your life. And so, she was really confused about what to do. And she really couldn't figure out what was triggering her symptoms.

It seemed to happen haphazardly. She had really no rhyme or reason, no direction anymore. Originally, I had coached her into some McGill-based principles and some McKinsey's, as well as a little bit of loading into a hip hinge, a carry, and a pull. But it was like, I only seen her for like an hour. You know, it was quick. And so, it was really, I would say, incomplete. And this is what I have experienced throughout my own patient care. When I was the patient is sometimes you have questions. And sometimes the lack of ability to put things together just because you're not, maybe you're not in that industry.

Or maybe you don't have a good understanding about what's going on. Or maybe you're just scared. And you don't know where to go next. And there are sticking points in there for a lot of people. And that's why my personal second round of care or my second interaction with care is typically just question and answer as well as retention and show me what we did last time. And so, I didn't really have this potential with her. But she did have some good success over those first couple months. But then it started to revert back. And some things she had tried throughout her time there is she had a friend who was a PT who was doing some adjusting into some tissue work as well as some, I'll call it, tool-assisted.

Because I don't know exactly the methodology she was trying. She had, she said she had some really good hope for this one guy who, he said it was about eight weeks or so of care and, or sorry, eight sessions of care or so. And he was very comprehensive. He took the time. He answered questions. And she was very, she was, she was hoping that was going to be the thing. And she said she really liked the guy. It just didn't tend to work out very well. But for the most part, he was nice. He was a great doc. And he took the time. He just, he just didn't succeed or help her through that last little bit.

But it did help out quite a bit. And so the last thing that she was suggested was injections into the SI joint. And they were, everyone was really convinced there was an SI joint issue. And so I'm not going to say it or it is, or it is, or it isn't. By the way, we did videotape her examination and some of her initial care on day one when she stayed with me here. And we didn't do the stuff on day two, but I, day two and day three, but I can tell you about that stuff as well. And so by the time she left, we had a couple days of nearly no back symptoms. And she, when she was triggering, or when her symptoms did trigger, we just cued her and do some movement, some cleaned up some movement, and then it went away.

And so I feel very confident that I think what her major thing was, was that when we need to get her to the point where she developed her hip hinge again versus her spinal hinge. And she had two symptoms really driving her to the confusion, was that number one, there was a right-sided symptom right around the area of the SI joint. So that's why everyone, I think, was saying SI joint. It happened mainly in the morning. We did trigger it through the exam with sit-ups, as well as a SI joint shear test, which could have been another type of symptom generator as well, because I didn't go through the entire laslitz on her.

But for the most part, we were able to reduce her symptoms. There was also a left-sided, higher lumbar flank pain. And so it was kind of around the area where you reach behind your back and try to put some block on, but you can't really reach high enough to get to your shoulder blade. It was kind of around there. And so there were unique, different symptoms, and they came different times of the day. And so the left, or the right-sided, lower right-sided symptom around the SI joint tend to come a little bit more in the morning, as well as walking. Washing dishes tended to happen a little bit. And the upper left-sided flank area stuff tended to happen more with, like, say, carrying a baby, since she had a baby.

And prolonged standing tended to do it. And over the course of the remainder of the day, it seemed like that was the one that seemed like it was the thing that, if she had to stop, she would stop and address that one. She wouldn't necessarily address the lower one. It was more of just kind of like a dull ache tightness. The upper one was kind of like a cramping. So she felt like she had to stretch it out. And so there was two different types of symptoms there. And I wanted to trigger them differently and uniquely. And they were a little bit tough because she was kind of like a car when you got into the mechanic.

You just couldn't trigger it really, really well. We did eventually do some stress testing, like I said, into the SI joint, as well as some sit-ups or some flexion-based movements. We were able to generate some symptoms. But the cool thing was that when she was finally, we're all said and done with that day of videotaping and just showing what we do with that type of case. Like, so we went into dinner later that night. And she triggered it, the upper flank stuff, just with walking. And so it was nice to have someone around just to, I was still troubleshooting. But as I learned, when I was going through that over the next day or so, she's like, so you've told me to do all these different things.

I don't know which one to do. It's confusing. And so I had to really reel back with my communication or my, I did frame it well. I said, look, not everyone, I have the opportunity to at least troubleshoot their stuff. And I just want to make sure I get it right because you're not going to be in town very long. And then I'll be a little bit more shooting from the hip. But for now, I just, I'm just collecting data really. And I just want to see what helps and doesn't help. And typically with patients, I play the game better or worse the same. And so with her, it's the same thing. I'm like, I'm like, I'm going to suggest a couple of things while we're walking here.

I just want to see. So just, just try and let's just see. And it gave me a lot of good data throughout the day. So I'll share some of that stuff with you as we get into it. So her lifestyle though, overall wasn't bad. I mean, she did rather regular mother stuff, I'd call it, you know, like, but her and her husband did a really good job of like every morning they'll get up and they'll, they'll, they'll do five days a week of gym work. There was weight training in there. There was biking. There was that kind of stuff, but they would, they would kind of switch it up. So one, one would be with the baby one hour, one would be the baby the other hour.

And by the way, I don't see a lot of parents doing this. A lot of times they'll let their own health go down because they have a baby and the baby comes first type of thing. But she was very active. She biked, she danced, she did weight training and motherly stuff. So that was all really cool. And so through the exam, my main goal with being able to figure out my data points and being able to suggest to her was that I wanted to see number one, if we could trigger the symptoms with some type of specific testing and figure out a directional preference maybe for the spine, but also too, to see if we can offload some of the pain generating structures.

And so just by what, by the way, to clarify with offloading, I did mention at the beginning of this podcast that we would, that I have a seminar coming up and the seminar is mainly about this offloading of symptoms. And I think that's confusing to a lot of people. So I'll clarify this. And this was helpful, I think, in explanation to her about resiliency of the body and all that kind of jazz. So offloading is basically, in my opinion, it's finding what will actually decrease pain or the alarm system of the pain generating structure. Let's just reel it back into stuff that you guys might be familiar with.

So disc injuries usually don't like to go forward with flexion or bending forward or arching the back or sorry, rounding the back. And extending it will give it a chance to recover. You just give a structure a chance. With nerve-based conditions, a lot of times with, let's just say, a straight leg raise or sciatica, a straight leg raise with dorsiflexion or toes back towards the head might light them up. But also, too, if you do the other side, according to Clinical Neurodynamics by Michael Shacklock, and by the way, listen to that episode, then the other side into a straight leg raise will reduce their symptoms significantly.

And so this is all about offloading the structure of interest. And as we went to dinner one night, she said, you know, she told me a story about the one doc who really did, she felt very comfortable with and he was very open to questions. And she felt like he diagnosed her correctly. And she's like, I really wish he was able to do some of this stuff with me when I'm at home because I really like him. And I said, look, you know, like I think our profession has, we have different, there's different skill sets for different things. And some people are really good at diagnosis of things, which is great because we need to be able to diagnose things.

But at the same time, learning what the diagnosis is, it takes a very detailed exam, which it sounds like he did with you. But at the same time, knowing what the diagnosis is, it has nothing to do with what we know will decrease the symptom. I don't think. I mean, it gives us theories to test, but the application of being able to test the theories is a whole different skill set. And so I think in that case, maybe he did a really good job of diagnosing, but the treatment was just, there was just something a little bit lacking. It sounded like he had good, some good first aid in there because it helped to reduce her symptoms, but it wasn't able to completely get it away.

And in this, again, this is not me tooting my own horn. I'm just saying from a offloading standpoint is that if someone bent their finger back words and it pissed off the joint capsule, then you can say, oh, well, that stress testing shows that there's an issue with the joint capsule, right? It doesn't tell us anything to do with it. Now, you might tape it out of that range of motion and then get people into maybe doing some sand grabs or some rice grabs or something like that, maybe do some basic loading of the hand, then maybe that makes their symptoms reduce. And so they're different skill sets, and I think we should all be good at both of them.

So in regards to her examination, typically what I look for is I look to identify the actual diagnosis, and then we look to see what actually, what entry points we can have into her care. And sometimes the triggers will give us clues of what to do. By the way, carrying a baby, to me, that means there's a possibility that loaded carries are going to be a dominant thing in her future. And in regards to offloading, we found that I had her do, I wasn't quite sure if there was a directional preference to her spine because she had, we couldn't really duplicate it with some of the stress testing, which I could have made a little sloppy.

And so finally I said, look, can you just do a partial sit-up? Because I know this will usually irritate a little bit of the disc. And so she said, yeah, that's my pelvic pain. That's my SI joint pain. And so I said, okay, let's go down and come up again. She said, yeah, that's it. That's it. So Michael Shacklock has a good saying. He says that one time is an incidence, two times is a coincidence, three times is a pattern. And so I'm looking for patterns on things. And so she was able to trigger it very frequently with rounding her spine. And so I took that as the possibility that we are still looking at a little bit of a flexion tolerance with the disc.

So I wanted her to do some McKinsey extension just around that area. I won't keep her doing it too long, but I thought it would be a good starting point. And now the exam of that, I don't like her doing things that are triggering her symptoms too long, but I wanted to see what we can do to decrease her symptoms overall. Because again, if I don't really know what's going to decrease the symptom of the disc or these, I suspect she had a spinal hinge into extension of the mid lumbar as well, is that I feel like, so when I, when I, when I went through the unloading process, a lot of times the first thing I'll do there is I'll, I'll check intra-abdominal pressure or pressure cueing or, uh, bracing cueing.

And I think breathing and bracing are different, uh, they're different skills, but for the most part, I'll do a try a couple of things. And so I'll have her try a little bit of a sit up. And so she came from a dance background. So she was a little bit more of a, of a skinnier, like she just attempted to get skinny. And so I just put my hand on her belly. I said, look, don't, I'm going to, I'm going to lean on you, right? Don't let me force your guts out of your mouth. I want you to fight back a little bit with your guts. And she did a sit up like that and it didn't help. So I tried the sides, the finger poking that Dr. McGill does.

And that seemed to help. Okay. And so she said it helped on the way up and on the way down. So on the way down, oh, I noticed that she was losing tension in there again. So I said, look, all the way down, I might, I might have you do a sit up again really quickly from whatever point you're going down from. So I want you to be ready to go really, really slow. And so at that point, she was able to reduce her symptoms by keeping some protection in her spine, in her lumbar spine while she was having flexion. And so to be clear, I don't think there's anything wrong with having some flexion, but in people who have this type of symptom generating condition, then maybe adding a lot of flexion back in early is probably not the best idea unless you have some support with it, which I will talk about later.

Also too, something that helped was that, and this doesn't always help, is that, so I just took, I raised the table up and I physically tried to pull her pelvis ring, her pelvic ring together, like compressing it together. Imagine like stabilizing the ring via compression at the pubic symphysis as well as the SI joints. And so at this point, she was also able to do some sit ups. And so I concluded that there's a possibility that let's just, let's just say we're going to go off of theories here. Maybe we're looking at intra-abdominal pressure. Maybe, as a problem. Maybe we're looking at the co-contraction of the abdominal wall, front, back, side, top, bottom.

Maybe. Or maybe we just strengthen the muscles that are, or increase the tone of the muscles crossing the SI joint that would help her out with single leg stance or gait that would stabilize the SI joint. Maybe. I don't know. So we eventually went into a, I like to take people originally through a rehab process first and just see if we can get some things that will reduce their symptom. I do attempt to do some of the McKinsey stuff first just to see directional preference. And then we'll start to do some loading just to see if we can reduce the symptom just with increasing tone of the area. And I know we did a podcast back, I think it was 122, with Cody D-Mac about loading, about how we should load our patients.

And in this case, loading came in the, it came as manual. And so I started her off into a high diagonal sit, or let's just say a downside clamshell. And we got the glute medius involved. And I looked originally, and I saw that she was sliding side to side a little bit. She was offloading the left side, I will leave in the video. And I started with the left side. It reduced her symptoms a little bit, but not completely. And then eventually, when she started walking after, she said, well, it hurts my right leg, which is the other side. The right leg hits, it's when I'm standing on it, and it hurts into the SI joint area, again, that same side.

And so I concluded there's a possibility that maybe we need to address that hip too. And so we did, and to a single leg stance, I just improved her single leg stance for that time. I think of it as reducing the threat. And so I just put her into a position called a frozen skater for me, which is kind of like a bowling, you just get them to load and find that hip area, or the gluteal area, and you just stay. And so this is kind of building that brain muscle connection, I'd say, or the motor pattern. And then she was able to walk without having a symptom at all. And so she asked me, she's like, I don't, I thought we're looking at the left hip, the other hip.

And I said, yeah, I know we were, but I'm going off what you're telling me now. And so this is the benefit of having a long exam process, is that I tell people all the time that I get things wrong a lot of times too. And so I'm picking up a book halfway through, and I'm reading your novel, and I'm just learning more about you every single time we have this interaction. And so in that case, she's like, well, maybe should I do that left-sided thing, that thing on the ground we did, that high diagonal sit, should I do it on the other side too? I'm like, well, there's nothing wrong to do it on both sides, but I do want you to get up to foot on ground stuff, which is now into our loading process.

And so that day, I took her through a hip hinge from a block with a lighter kettlebell, a lighter than that kettlebell to set her tension. And then I went into a heavier kettlebell. And so my goal was, is since I had her the second day, was that, number one, the first day I was going to build the hinge, and also to just make sure that we had the correct diagnosis and theory going forward. The second day, she woke up, and she felt a lot better. And so her hips really, her hip pain, or her SI joint pain, really didn't seem like a thing, but both of her hips were really sore. And she's like, I don't know, I can't tell if it's better, both hips are really sore.

And I said, well, it's both sides down, they feel very equal, right? And she's like, yeah. And I'm like, great. I'm like, it's normal to feel this tightness. It's the change of tone, and you just made some of the muscles work in there. And so we're sitting down there drinking coffee. She was able to sleep on a futon or a roll-out mattress without a problem. And it's not the firmest of the mattresses, so that was enlightening to see. And so her morning time pain was no longer there at that point. So after that, I really wanted to see, with her walking, what was she doing during her walking to create these symptoms?

And I wanted to go for a walk with her and just have a conversation. So we got up that morning. I got my cup of coffee. She didn't get any, but we went for a walk. We went for about a 20, 30-minute walk. And so through that, she didn't really have that lower SI joint symptom trigger, but after about 10 minutes, she did have the flank area first come. And so the way I describe it is that she, just to clarify what I, the premise I was working on with her is that I believe a lot of people with this low back disc-based pain originally or piriformis pain or sciatica type of stuff. A lot of times they have a protective mechanism which occurs.

And I've been describing it to people as the sniper in the Korean jungle. And so say we have this Korean war occurring and this sniper out there, he's out there just waiting, okay? And he loses his radio and he's just waiting and he's trying to fight the good fire for 50 years, right? Or whenever the Korean war stopped. And so you go out there and you finally find the gun. You're trying to convince him that the Korean war is over. And he says, no, man, like it's not. It's real. I've been fighting this thing. I know. And so you show him pictures of the surrender and you show this and this and that.

And it takes a little while to build a relationship, you know? And so I believe these people who have this problem with first the lumbar spine disc issue, according to McGill's observations is the gluteal areas turn off. According to Yanda's work, the low back muscles tighten, the hip flexors tighten, the belly wall loses its tone or the front belly wall loses its tone. I guess we can say the TA and the oblique and the gluteal region loses its tone. And I think that's the areas where people have been traditionally told that things aren't turning on, you know? And so this is the good fight, I'd say, you know?

I'm like, and at some point, the good fight needs to just cool down, you know? And not everyone tends to work on this over the course of time. I like people really fresh when they have a disc injury. I like them to get the cheeks going again and to reduce the potential. The spinal hinge, not the hip hinge, but the spinal hinge, the extension from becoming a thing. According to Dr. Snell's work, he would kind of categorize this as like your mains syndrome, your flank pain, which becomes a symptom found with that mid-lumbar extension. You'll also find groin pain come from that. You'll find hip bursitis type of pain.

You'll find inner groin problems or thigh issues, sometimes inner knee issues, sometimes saphenous nerve contribution issues. So you'll find a lot of these things which are the secondary result of that back flexion intolerance and tendency to be an extension. And so I'm also a fault of that too. And a lot of us are, I think. You're going to see a lot of people who tend to not want to bend forward that much. Although bending forward is not really painful anymore, the body subconsciously, that sniper, has not really been told to stop yet. And I personally use a lot of Guido van Reisigen's attractor state work to reduce this stuff here.

So anyways, we went on the walk and we had this conversation. And throughout that, she had a little bit of pain in the flank. And so I just asked her, we did a little bit of arm swing cueing with walking, the McGill stuff. And so that reduced the symptom. She was also already doing some dermal traction or pulling up on the skin in the area, which reduced the symptom. And so I found actually a lot of people, especially dancers, tend to have this mid-spinal hinge which occurs, or sorry, mid-lumbar hinge which occurs. But also too, they seem to trigger it with some rotation. And when you put them down into like a buttress plank, the buttress plank seems like even the remedial one from the knees, it tends to get them, you see this big sag, this goli occur around like L2, L3 area.

And it tends to sag and it changes very quickly with them removing a hand. And so they're not very stable right there. And I say the spine is just kind of shimming around. And it just pisses off the little nerves when they go through. And so for her, they seem like two different conditions. But I believe that we're looking at mainly just one large situation. And I don't like to break it down as simply as this because it makes it seem like we can do a bunch of exercises, which I wouldn't really love, but you think about the things that people want, things that people are like, oh, that's really attractive.

They want abs, they want glutes, okay? And so I guess if we can tie those two together, we're basically rotating the pelvis a little bit posteriorly or to neutral, and we're giving the belly wall a chance. And so just to clarify too, because she was asking about some extensions. She's like, so should I not be an extension? I'm like, no, extension is fine. Flexion is fine. You just need the protection to do both. And I think it's normal for the spine to do normal things, but at the same time, you're just not giving your stuff a chance to desensitize and chill down. So that was the basics of the first day.

We went for that 20, 30-minute walk. We had a good conversation. I got to know her even more. And we got to figure out also too the game plan for later that day. And so that was actually the time where I learned that when she carries her baby, typically that's when we have the flank pain type of stuff. And so I'm learning more every time again. And just from an overall spending the whole weekend standpoint, this was really interesting to see. And before I go into the next day, I'll just tell you that we did go to dinner that night, and so she was sitting on a bar stool. And I said, look, I know we're all just hanging, just having a good time at the same time.

Tell me when you're feeling stuff because I do want to keep giving some suggestions. And we'll just see. I'm still testing. And so she said, well, I'm feeling it right now. And I said, okay. So she was just kind of leaning forward, leaning onto the table. And I guess it wasn't a bar stool, it was a chair. And so I said, let's just see if we can increase the symptoms. I said, can you poke your ribs out or make like a big proud chest? And she said, yeah, that increased the symptoms a little bit. And it took a little time to get there. And so, because we had to wait for it to kind of set in. And I said, great, can you reverse that now and just get rid of that?

And I said, from the bottom half right there from your pelvis, can you just kind of push your pubic bones forward? Like you have your sit bones just, you're going to lean a little bit more into your sit bones or you're going to perch off the end of the chair. I tend to have people IQ it as dial your pelvis forward. And so she's correcting for the bottom half now versus the rib lift or the chest lift. And she's like, oh, yeah, it went away. And so throughout that night, she was – I don't like people getting super neurotic about this stuff. But at the same time, I want to set them up for success so we don't keep picking the scab.

And so she's like, every time I dialed my pelvis forward, I was able to reduce the symptom. And so I said, great, cool. So we're looking at – we're looking at it still that there's a lot of things we can improve on, okay? And so I know it seems like this whole thing is very – it's very mysterious. Like we can't tell what's going on and you haven't been able to find anyone to help you so far. You get through the tail end of this thing. But for the most part, I don't think it's as mysterious as we think. And so on to day two, we went into the office and we just did a morning workout. So on day two – actually, let me recap real quick.

Day one. So day one, we went through the exam. We confirmed what direction we were going. We created some theories and we've confirmed the diagnosis that we're working with. And so day one, in regards to strength conditioning, we went over mainly the hinge and some crawling patterns because of the mid-spinal hinge. And so day two, I wanted to give her some other options of things. And typically, this is where I get into the weeds with care a little bit is that when I am giving options of things to try, people tend to get overwhelmed a little bit with the options. And so I believe that some people – I give them the option.

I say, look, number one is that I can – do you want me to make this so you can – do you want me to help you through to get you kind of into your own routine? Like you can develop your own routine. You want to understand it or you just want to do it? And some people say they want to do it. In this case, she's not going to be here. So I want her to understand it. And she was on board with understanding it. And so the second day, I went into some DNS face-down, face-up stuff. Honestly, I've been to one DNS course. I've used it quite a bit in regards to the exercises. And I went to theory. I don't know the months.

I don't have a baby. I don't know the months. I'll be completely honest with you. But we tend to go into some crawling patterns as well as kind of the baby get-up kind of stuff. And so I took her from a face-down, face-up approach. And we went through about five minutes or so of that. I said, look, we're going to go through this little flow right here. And the attempt of this is to decrease the potential of that spinal hinge and keep that pressure involved as you're loading into the ball socket joints, the shoulder as well as the hip. And so I said, remember that exercise we did the other day where I kind of leaned on you, which was the high diagonal seat?

I'm like, this is in that series right there. So I'm like, I'll tell you what. I'll give you everything here that is an option of just a nice little flow thing to do so you can have a little something to do and kind of have a plan in the morning. But I don't want you to get married to the idea. And the whole point of a corrective exercise is to get you off the ground at some point and load you. And so these things are a good starting point. And if you feel like there's one area of this flow that you're really suffering with, it's really challenging to do, then start there. You don't have to do the other parts, okay?

So we found that one of the most challenging things for her was being into a crawling position and being able to keep that mid-lumbar area really supported. And so I suggested that's a good area to start with you. And that's why on day one I went through some crawling because I thought it was going to be a thing for her. And so we scaled that back into a remedial thing. I gave her some cueing just to make sure she was getting it. And so I do plan on videotaping some stuff for her as well just because she's out of town. And so in the strength conditioning part, I tried to be very clear with what I wanted.

And if you've already heard the episode that I did on loading and strength conditioning as an exit plan to care, which was probably about, I don't know how many episodes that was, but it was going to release, I think, on May 10th or May 3rd. So, or sorry, March 10th or March 3rd. And so that one I go into more of the Dan John model of the push-pull-carry squat hinge, not in that order, and just some basics of things to do in there. And now some of you might think, well, there's other exercises, I know, but general categorization, we'll stick with that. And I know there's arguably the lunge as well as twisting or rotation, which is within your categories.

It doesn't matter to me right now, okay? Like I'm trying to make things simple, the simplest of people that we can. And I'll tell you how I typically add into that is I usually have people do a reactionary sport. And rather than the twisting and so on within their strength conditioning, I just want them to go catch butterflies or, you know, go to the batting cage and just hit softballs or play pickleball. Or it's a reactionary sport where we start to expose ourselves slowly to the range of motion that is typically not within our strength conditioning program. We're not moving like robots anymore, moving like actual humans.

And so you do it without just kind of lollygag through it for a while, and eventually as you get more comfortable, you start to increase your pace. So you pick pickleball. And I said, good, do both sides. Great, cool. You know, like, and those are things where you start to explore the range of motion, the ranges that you're not exposed to within strength conditioning. And also in really not much of a loaded fashion. I just want to get people to build their brakes before they really go into that kind of stuff. So on day two, I wanted to give her something of each grouping with single-sided options since she said she was having issues with gait.

Also, two, it tended, it seemed like when we were getting into a double leg pattern or standing, she tended to extend a little bit, which is what I wanted to get away from. Because I believe that life happens when you're doing single-sided stuff, like we're not bunnies. I do like that analogy that we don't hop around like bunnies, so we have to make sure that we're loading a single side per side. And most times when people hurt themselves or they have a trigger, they're reaching somewhere to get a pen with one hand. They're not two-handed lifting a pen. And so exposing them to those types of movements and using the weights as a tool to improve the ability to tolerate them throughout life is really my goal.

And so we went through a single leg variety of a deadlift, which is a SLDL, a single leg deadlift. Interesting, on day one, we found that she had been copying people doing deadlifting, so she went for the straight knee variety. And so I said, look, I don't teach the straight knee variety. I teach a soft knee, but don't lock the knee on me, you know. And same thing with the single leg one. She was having trouble finding her cheeks to assist. She was finding a lot of thigh. And so I just had her find it over and over again until she found it. Also, too, we went through a single leg variety of squats, which we went through split squats, which keeps them a little bit more upright, and axial loading the spine versus using the spine as a lever.

We also did a mixed carry. I had her do a rack and a suitcase opposite sides because I was not quite sure we can do a single-sided carry really aggressively with her yet because she was triggering herself with her baby carrying, which is probably, she said, about 30 pounds, 25 pounds. And I think that's what she said. And so I had her do about 20 pounds on the rack carry and about, I think it was 40 on the other side, on the lower one, the suitcase. We also did a single arm pressing option and a single arm rowing option as cued how we do in the Pro Chiropractic Online course. Focus on your floor contacts and you can only move with high quality if you have a fixed point of contact.

And so we went through a single arm dumbbell press or a kettlebell press as well as a single arm horizontal pull. And so it was interesting going through these. Actually, that was the day, that entire rest of the day and into the next day, she really didn't have any symptoms at all. And so because she had so much success on that day, I'd probably stick to a single leg variety program to her for a while or single arm single leg variety program and just work on high tension. Because she even mentioned that she was really struggling to have someone cue her in the way that she really responded to.

And she's like, we only went through five reps of this stuff with similar weight to what she was doing at the gym. And she's like, usually at the gym, I can talk through this and I'm doing 15 reps and I'm barely sweating. But we're doing just five reps or so here and I'm just like leaking from every pore of my body. And we took breaks and everything. And so she's just, I think, lacking in tension, just similarly how on day one we had the sit-up that was lacking in tension on the way down. And she created a symptom with that. And so I would like her to improve her ability to create a dimmer switch.

And so we want 10 out of 10 tension, although we're not going to use 10 out of 10 through all of our movements through life. It's just not possible. And so I just want her to get a feel for what tension is so she can turn it on and off and have that skill built. I told her, honestly, I don't know what the possibility is, but I said, look, you live right by Dan John. Go up there. And I'm like, he created half the stuff that we use or more than half the stuff that we use and even use a very similar cues. And so I bet it's a very good benefit to go see somebody like him or someone who like learned with that style.

And so I reminded her that it's very common for people to get stuck in this thing and get very confused. And I reminded her that when I went through my back rehab recently that I had someone manage my care. And I had someone, I had Brandon Gassamia come in two times a week as we started to load because I noticed that I was a little bit fearful of loading. And so he came in a couple times a week for a few months. And then he came in one time a week for a few months. And then we stopped and I can load on my own now and I feel good and great. And so it's useful to do that. And if she's having problems finding somebody to cue her through that and she's not keeping the cueing, then maybe she needs a little bit of reminders here and there.

And I understand trainers or coaches and one-on-one help or even like probably like two, three-on-one help would be fine with this too. It's expensive. I get it, you know. But at the same time, it's like if you're not getting results, you need to pay for it, you know. And I went back into the idea of the yoga retreats. Like people go and pay $3,000, $4,000 for these retreats. And people spend money typically on things that are luxurious. And I'm not saying that yoga is only luxury. But for the most part, you don't need to do this down in Tahiti, you know. And you don't need to buy your Gucci bag.

You don't need to buy a high-end Lexus or a BMW, you know. Like people spend money on things that they want to spend money on. And I think if health is an important thing to you, hire someone that is going to coach you through it effectively. And I believe that at some point, you should be managing your own symptoms. You shouldn't be managing or your symptoms shouldn't be there anymore, but you should be able to program for yourself. And this is why I like programming people in this fashion and directing them to Dan John's thing, which I did mention in that podcast. Go buy interventions, right?

So I tell almost every patient that has the question about strength and conditioning to go buy interventions. It's just a good starting point. And so all these questions you're asking are going to be formatted very well in there without – not to say I don't want to share with them. But at the same time, it's going to be easier if they can go back to it a couple times, you know. So on day two, like I said, we – she didn't really have any symptoms. And so we progressed into day three. In day three, it was interesting. She woke up. She did her – she did some DNS to start the day. She also did some McKinsey extension.

We went for a walk again and went to the beach and just hung out, right? Laying in the sand and just chilling, had no problems there at all, rode bikes, no problems. And so those were all big wins, I think, for her, you know, and showing that you could challenge your body pretty well because we had really challenged it a bit through that workout and really not have any symptoms at all. So it kind of breaks the aspect of the fragile nature that people think they have with back issues or injuries in general. And so I asked her that day. I said, what's sore on? And she said, really, the glutes are sore.

Mainly the glutes are sore. And so I concluded that we could probably amp stuff up a little bit the next day if we wanted to. And so I reminded her that what I would expect is that – I'm like, there's probably the beginning here because we're doing a little bit of a shock factor. You know, we're unbiasing certain exercises to get certain movement or getting certain muscle groupings into the movement because I want you to utilize them. But I think the shock factor is going to go away pretty quickly. And tomorrow we're going to do a little bit more of loading and we'll just change it up slightly.

By the way, any questions you have throughout the entire day, let's just answer these things. So we went on to day three. And day three, again, we started with something that was familiar to her. We went through DNS again. She went through the flow. She had good retention. It was great. Then we went through only three exercises. And I said, look, we have five movements that we can go through today. But since we spent a little bit more time with a single leg deadlift variety the other day, let's go into something different. I typically explain my programming as an entree platter. All right. You got two or three major entrees.

You have chicken or entree highlights, I'd say, if you're a meat eater. You have chicken. You have beef. You have lamb. You have veal. So you have different things where they're your starting point. And I said, what's our meat today? And I said, well, we're going to goblet squat. So our major meat today is squatting. Build around that. Build the other parts of the meal around that. And so the prior day was mainly hinge. And so the thing I built around that because coupling with the inability to control the spinal hinge is I like to add mid-back extension and rotation. You want to make sure the extension and rotation is preserved at the mid-back.

And so for that, I picked a little bit of, again, DNS stuff. I like to use it with that. There's also other things you can do. I did do one thing different. It's like a sideline, make a big rainbow, keep your knee attached to a yoga block type of thing, or fingertip drag along the ground. I forget what you call it. But for the most part, it's big rainbows when you're laying on your side with your arm. So we did that. We did a non-DNS-based thing. And then we did DNS. And then we went into a kettlebell arm bar as the strength and stabilization component with that to drive the mid-back rotation.

And so we did a squat that day. We did a pressing variety, which is the kettlebell arm bar. And I took her pretty heavy on that. So she did about 35 pounds, treating it like it was 500 pounds. And then we did an aspect of a pull. We did a front lever just hanging from a bar. And so those three, in particular, it was interesting to see that actually she had a little bit of a symptom after that. And so I would conclude that the, actually with the hanging, she extended a little bit more than I would want. And that was just an issue, I think, with endurance and strength there. And so I might scale her back a little bit accordingly.

Take her to more of like an ab wheel or something like that. Or the crawl would also work. Or like a TRX rowing would also work. Or a horizontal pull. And the goblet squat, I think she did an okay job with that. But I'll probably scale her back a little bit to a split squat or something like that. And so that was kind of like the whole thing that we did throughout the weekend. And the very last thing that we did, I guess, was the very last night. We sat there and we just talked. And you said that she still had questions about programming. This is kind of when I went more into like, I really think you should watch Dan John's intervention.

I can explain it to you. But at the same time, it's going to get very complicated with all these things. But I break them into four parts in regards to what we did. Number one is the scab picking mentality. I don't think she's super sensitive to the scab picking. But perhaps if we improve her ability to carry your child. And just make sure that when she was washing dishes, she had a little bit of an issue. I said, don't be afraid of getting your shirt wet. Lean on the counter. Get in there, right? Rather than hanging back. And so I think if we take those scab picking things away and just clean them up a little bit.

The very few she had, she'll be in good shape. And second is that we have the first aid. She was using some dermal traction, which worked dialing the pelvis a little bit to reduce the scab picking in phase one with sitting. And also, too, I gave her some sideline shack lock openers as well as McKinsey unrange loading and extension. And so those are all things that would help decrease her sensitivity very quickly. And I said, look, other stuff, which is like your, let's say it's endurance-based floor stuff or quote-unquote core things. You got your DNS there. We got a bunch of other things that we've done over the course of time or that she's tried that would fall into that category.

And then you got your loading. Okay, a lot of those things we did on day two and day three were loading or your strength. And that's going to be more of the falling into the Dan John principles. So go ahead and just download that and check it out. And I'll tell you what, after that, if you have more questions, just tell me. And the last part, like I said in the beginning, was that I think there's a very big gap between moving like a weightlifter and moving like an athlete or a human. And I don't think they always carry over. So I like those reactional sports and just doing something. She's like, oh, I like biking.

I said, that's a good thing for cardiovascular fitness. Let's keep that. And she said, pickleball. I like pickleball. I said, great, do pickleball. That's it. And so it was kind of like a lag of conversation there. And she's like, oh, anything else you want to add? I'm like, well, you already picked pickleball. And that's fine with me. And so we can overcomplicate these things. But for the most part, I would watch that last thing. I would watch the Dan John intervention. I would add a little bit of reactional-based movements in there and just a sport. And then we're just kind of off the races there.

And so her plan was to go through that for about six weeks and just kind of recap with me. And I thought that was going to be a good thing to try. So I think the last part we'll go through this is I'll go through my takeaways of what I learned over the weekend. Number one, I don't think I should overcomplicate things. I have a tendency of thinking that a lot of people want to know all these little parts about their thing. And I don't try to make it too complicated on purpose. I just, as I understand it, they ask a very complicated question and want a very simple answer with it. And it's not always possible.

And so I tend to, now I realize that it's really important to ask them what they want out of the experience. And do they want to understand the mechanics, what's going on? Do they want just some suggestions? And if they want some suggestions, are they okay with just returning after a couple weeks and saying, what next? And being okay with just asking with what's next because there's typically things I like them to do later on. Not to say that care goes forever, but like I said in the episode where we talked about resistance training as an exit plan, is that if they're not under some type of programming by somebody, they're going to want to change their programming a little bit.

Especially if they haven't wanted to take the time to understand the aspects of programming, which I don't think is too complicated, but also, too, they have different skill sets than I do and other people do. So the other thing I like to ask is, do they feel in control? And don't feel dumb about asking questions that seem very basic because that's why they're here. And so also, too, I did learn that, and I've learned this a couple months ago, just reiterated it again, was that I like to clarify with people as we start through the exam, is that everything that we're doing is not going to be stuff that they need to know about.

But I do need the information from them. And so I'll play the game better, worse, the same, but I keep reiterating that, look, I know we did a lot of stuff, but I'm only asking you to do a few. So don't be overwhelmed by the other stuff. Also, too, I like to tell them that they're going to be fine. If I think they're going to be fine, I try to leave them with, you'll be fine and you're resilient and you will get better. And because I think the mental mindset of this part is really huge, and if they think they're broken inside or they're going to be like that forever, then I think that you reap what you sow on that kind of thing.

I tell them to not overthink things too much unless they really want to get into the weeds of things, and in that case, they're going to be doing a lot of reading. And also, too, don't avoid motions and activities forever. That first aid process in the beginning, we might avoid certain things, and for her case, she really didn't have a lot of things I wanted her to avoid. I just wanted her to clean a couple things up for a little bit of time. But for the most part, you want to bring life back kind of how you were. And if you look around and you see all these people doing things, sitting and walking, quote, unquote, in the wrong way, and they probably don't have any problems.

And some people who are very attentive about their posture and their walking and there's the correct way of doing things, they develop more symptoms than the other people. So I think there's a lot of variables with this, obviously. But for the most part, I wouldn't overthink this too much and don't think that you can't do things again. I remember I met a guy at Home Depot, and he saw me with a baseball jersey on because I was just coming from a game. And he was talking about, we're talking about adult league baseball, and he's like, I don't know, like, yeah, I can't do that. I'm old. And he was like 45, and I'm like, damn, I'm like 10 years younger than you.

Yeah, you can. We have older people than you on my team. And he's like, no, no, no, my days of that are over. And it's like, okay, if you say they're over, they're over, you know. And that's your choice. So you've kind of sealed your own destiny in that. So I would encourage you guys that if you have not already gone through this type of intensive care with someone, just try it. And I think you'll learn something along the way, just like I did, is that I think she was a perfect one to do it with me because she didn't overanalyze this stuff, and she didn't overask, and she retained things really well.

And so I think that she'll have a very good, I think she has a good success rate, and I think she'll do perfectly fine. And I would venture to say probably over the next couple weeks that she won't even realize the symptoms anymore at all. But it was nice to take her through the part of resiliency. And if you guys tend to use corrective exercise or loading and weight training as part of your care, this is probably the most menacing part for people. Like laying there and having someone do something to you and treat you, like that's the easiest part. They just got to show up. And being able to incorporate these parts into their life as a means to just overall being healthy and being resilient is a little bit more complicated than we think.

And so I do think that a lot of times personal trainers and coaches have a better, they have a better ability to make a dent in someone's life for the better than we do as clinicians because we don't see them all the time. And so I think implementing those systems is really helpful. And I think you'll find that when you take someone through this kind of thing, like I was surprised by it, like she was working hard. She didn't have any symptoms that popped up really. And then on that last day, we had a little bit. But it's a really good opportunity for me to refine things with her and just make sure to clarify what I wanted out of her strength conditioning for the first couple weeks.

And so I feel good that she felt good, that she felt safe, and that she'll continue to do it. Because I think we all know that over the course of time that is your age, you just want to have some mobility and you want to have some strength to get off the toilet, and to be able to walk, to be able to live on your own. And there's that gradual decline that we say happens after the age, I think it's 28 or so. You got to start with a lot, you know. So just make sure that you're fighting the aging process. And the best way to do it, I think, is just being active and being strong. And so I think that strength conditioning is probably one of the best things we can give our patients and showing them that it is safe and it's not the stereotype that they're thinking it is, the Arnold stuff.

And just so it doesn't have to be crazy. It's just simple stuff over the course of time building volume. She left feeling fresh every single time we did it. And it wasn't too much, but it was challenging. That's all I would ask for. And so I think I'll leave it at that for today. But if you guys have suggestions of more topics for me to do, I'm looking to expand the topic base a little bit more over the course of this year. I think we covered a lot. We covered a lot of back-based things. We covered a lot of loading this year. We covered a lot of the educational stuff for the Pro Chiropractic Online, which is if it – I don't know when this one will release specifically.

It might be the one before that whole series starts or it might be just after. The date of release of that curriculum is a little bit more of a moving target just because we have some accreditation things just to address. But I hope this is opening Pandora's box for you, and I hope you start to explore different types of corrections and implementations with people because I know I sound like I'm always like a Debbie Downer in manual therapy. I do manual therapy and adjustments on people every day. I just think it's a very small part of the puzzle, and it's very helpful for getting people out of symptoms.

But for the most part, I think the resiliency over time is the target for me, and I make sure that my communication with patients is like that. The resiliency is important. Like weak people, they tend to fall apart more in my opinion. So, again, if you have not subscribed to this podcast, please do it, okay? All you got to do is scroll down, hit the little subscribe button, and give me a review. I just want a review telling me how I'm doing. Tell me if this inspired you in any way. And by the way, if you think a fellow clinician or a patient would benefit from this or if you are a patient and you have a friend dealing with a back type of condition and you think this information is valuable for them, please share it.

The only way the information gets around is through viral share, okay? Like I'd love to say that promotions on Facebook and Instagram and all that kind of stuff works, but for the most part, I think you sharing is the most powerful tool because the people you're sharing with really trust you, and hopefully you guys trust me by now. I mean, this has been 150-something episodes now. I hope you guys trust me by now. So, I'm not trying to screw you on anything. So, share it. And I'm learning more every day, and if you want to be part of this journey, please share it with your fellow clinicians and subscribe to the podcast with me.

As always, leave people better in how you found them, and if you're dating an Eagle Scout, and if you are still in the California area before June 8th and 9th, please come to the workshop. If there's still spots available, we're going to cook tomahawk steaks. As you've seen them on Instagram, you don't have to pay a thing for that part. We're just going to hang out in my garage and just cook those steaks after and just bro down and just meet other great, like-minded, open clinicians. Talk to you guys next time.