Non-surgical spinal stenosis treatment options that work

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Non-surgical spinal stenosis treatment options that may just work.

We have Dawne Costantino on today. Hello. She is going to be a good resource on this topic. If you haven't listened to the other podcasts already, the last 10 have been pretty much about low back and groin pain, going all the way from diagnosis to should I stretch? Why am I getting crooked? Why is it hurt in the morning? MRI is normal, but what do I do? Failed back surgeries, anterior posterior tilt, perfect posture, and so on. So we got a bunch of things. Next week is coming rehabilitation options for low back too. So make sure you subscribe so you get all these when they come out. So we're going to go through the famous Dr. Google first and just give some ideas of what information you guys are getting and just figure out maybe if we can shed some light on some things.

So Dr. Google's first suggestion is steroid injections. What do you think, Dawne Costantino? I think that it's pretty common for that to be suggested. I think people sometimes even try that out before rehab. From what I've heard, I would say this has really thrown me off. I can't hear myself so well. It's like you're on Jiminy Cricket. Anyways, from what I've heard, I'd say most steroid injections are some temporary relief, but even temporary relief can be incredible for some people, especially with how much pain they're in. Yeah, I would agree. I think that it's like any way that you can find a reduction in pain, I think is a good entry point into full recovery.

But I don't think the steroid injections are going to be a long-term thing. Even Dr. Google says, let's see, what do they say about it? Epidural steroid injections are commonly used to provide long-term pain relief. I guess I disagree with that unless you do a bunch of them. These injections consist of anti-inflammatory steroid, sometimes a local anesthetic, and can last for many months depending upon your condition. So yeah, it can supply, what do they mean by long-term? Many months or like years? Yeah, honestly. I mean, most of the time, it's probably like within three or six months, right? Yeah.

Well, I've met a lot of people who have actually done the steroid injections. They say, it'll work for about a week and then it stopped. Or I did my first two and it helped and then the third one didn't. I don't quite get it. So they're kind of thrown off that it first starts working and then it doesn't work anymore. Yeah. I mean, it's all over the place with the way that people respond to this. But steroid injections can be wonderful when, you know, maybe just activities of daily living are so hard for you because pain levels are so high. They can help you get into a rehab program of some sort.

So pain relief is pain relief, you know. But are we fixing the real true root cause of what's causing your pain? Not necessarily with a steroid injection, but it can be helpful. Yeah. So I think everybody should probably be aware that at some point, again, we're kind of dividing the line a little bit on these treatments that we're going to talk about as pain management and then rehabilitation. They're technically different. You can probably, most of you can probably just lay in your back and put your legs up in the air and up on a chair or on the bed or put a pillow under your legs. And all of a sudden your pain just goes away completely.

So it's much safer than a steroid injection and less cost less. And you can just lay there as long as you want to, but it doesn't provide any long-term rehabilitation. DRX9000, the Cadillac of all spinal decompression. In Dr. Google, it says, in some cases, disc herniation, spondylolisthesis, and less severe stenosis cases, a non-surgical decompression can be effective at reducing the pain associated with stenosis by gently stretching the spine to reduce pressure on the disc adjacent nerves, allowing the structure to heal with time. What do you think? First, that name was throwing me off. It reminded me of the, there was one time I was looking through all the different types of hot Cheetos or just Cheetos they've made out there.

And it was like a Cheeto one that was like DRX9 squared something, something. So did it, did it, did you eat it? No, I haven't even tried it yet, to be honest. Just because you were scared. There's too many. Yeah, it's weird. To the ninth power. I have never seen spinal decompression named that before, but. You ever seen square root Cheetos, square root of 50 Cheetos? I don't. I've seen that name. I would have believed it, to be honest. Yeah, actually the DRX, I remember I worked at a clinic in undergrad that had a DRX and everybody went on the DRX, man. Like, I remember they would start and stop movies because like they'd be on it for 10 minutes or so and like they're watching 10 minutes of Nemo and then they would go back and watch 10 more minutes of Nemo because they were coming back in this week.

Multiple, multiple months and sessions of the DRX9000. I don't recall the outcome of that, but I remember that they were in quite a bit. Yeah, I mean, from what I've heard from spinal decompression, there's like packaging a lot of times that they'll offer, right? Because they know you're coming in multiple times a week for however many weeks. So it can be pricey, but you can walk out of there feeling pretty good from some spinal decompression. It's a, you know, machine that's kind of pulling and tugging on you and doing the work for you and you just lay there and maybe you notice some, some relief and maybe you don't, but it can be, can be super helpful.

Again, you'll always hear me say though, it's not really addressing root cause or fixing maybe what got you here in the first place. Doesn't really change anything about your movement patterns. I sound like a broken record sometimes, but- I think you probably say that in your sleep too. I say it all the time. Well, how does this Cheeto taste? Well, it's okay, but it doesn't change the movie pattern. It's true though, because I think a lot of people just think, you know, I'm going to get on this table and that's going to be, you know, this is going to be what helps me. And that's not always the case sometimes.

And so just kind of explaining why maybe that wouldn't be an end all be all for you. It's super important to get people to understand. Well, you know, it's funny when I, when I've talked to people about decompressing their spine and I'm mainly referencing it with, in the format of exercises, because there's specific exercises you can do that will naturally decompress your spine. Your spine can be decompressed by using its general support system, which it has access to, which it's not using right, right away. And as soon as you say the word decompression, all they say, all of a sudden they typically say, do you think that's good?

Do you think I should go do that? It's like, I wasn't talking about the machine, I'm talking about using your body to decompress the spine. And then if you do have less pain after doing a spinal decompressor machine, it would really help to make the body decompress your spine throughout the whole day and it's a lot cheaper and it'll provide better results in the longterm. Yeah. I don't think a lot of people know that. Can you maybe explain one or two things maybe you use in the office that- Of exercise? Yeah. Like a normal way or natural way that they can do it on their own. So there's probably one of the easiest ones is, so there's a, there's a technique called DNS, which is dynamic neuromuscular stabilization, which is, it's a whole form of exercise coaching, basically.

It's rehabilitative exercise. The reason I'm bringing this one up specifically is because they, they really focus on the idea of diaphragm and internal pressure. And if you imagine like your lungs, that it's hollow. And if you tap on yourself, you can hear that it's hollow in there. And if you slap on your stomach, it's not hollow anymore. There's things in there, there's water, there's organs and so on. But as your diaphragm, your thoracic diaphragm compresses downward with the breath, it actually compresses the water bolus with the organs. And so if you imagine a water balloon, if you push the water balloon down, you squash it between your hands, it will create outward pressure.

And so the outward pressure, it actually is supportive. It's almost like as you push harder, it actually fights your hands if it's within a contained system. And so now if you imagine that water bolus inside your body, say now your core muscles, your front abs, your side abs, your back abs, they're all keeping some stiffness, but your diaphragm's pushing down. It's fighting back too. Like the water bolus is fighting back. And so we call that intra-abdominal pressure. And so it naturally puckers the spine up and it decompresses automatically. And so normally going through that exercise as a protocol in a way to reduce pain and produce some support in the area typically helps.

And that's what I mean by decompression on your own. That's a great description. Yeah. You like that? Okay. I've never heard of you describe it like that before. I think that was a great, just like, what's the word? Illustration of it. I'm going to go on analogy. How would you describe it? I know that you probably describe it in certain ways to your people. I think I go to like a really simple explanation. I think I probably took it from somewhere. I'm not exactly sure where, but as you breathe and learn to breathe into those muscles and 360 around the spine and also will activate small stabilizing muscles up throughout the spine that can also help to decompress or pull or create space or whatever you want to say.

But I mean, it's short and sweet. That's my description of it. I mean, I think yours sounds better. I feel like I sacrificed part of my intra-abdominal pressure just saying it. So anyways, decompression can be helpful, but it doesn't need to be machine-based. And quite honestly, I don't think I would. Would you say it's an entry point or would you say that's like a, oh yeah, just decompress all throughout the day and you're probably fine? Oh, you mean have the machine at home or do the exercises at home? Let's say they come in the office and they, not that it's this office, but say they do a machine decompression.

They also learn how to decompress on their own. Are they just decompressing the rest of their life or do you think there's more to it? No, I think that's a good question. I'm sure you know the answer, what I would say. Let's see if I can say it in a different analogy for you. Okay. So there was this dog one time. I'm just, I'm just joking. So no, you're right. So you'd start off with a couple of weeks of learning decompression, learning how to decompress. And it's kind of like tying your shoes. You don't need to keep learning it and you just kind of do it. It just happens on a natural occurrence.

Eventually you do regular activities such as walking and a baseball or swimming or whatever you want. And usually the skillset stays. Like the analogy I usually give the clients I work with is, do you have to, do you have to focus anymore when you tie your shoes? No, no, it's just, it's automatic now. So just because you're spending a little bit of time focusing on how to use things properly down there, it doesn't mean it'll be forever. It's usually just like hammer for a couple of weeks and then automatically the skillset stays. It's called a motor Engram. It's a, it's like a software program, like, like matrix.

You just kind of upload it and then it tends to stick until you get hurt again and then it goes away and then you got to learn it again sometimes. So like we can do a whole podcast on decompression. I mean, we could, I mean, next week, tune in. There you go. Medication is number three. Because spinal stenosis is currently incurable, your doctor may prescribe pain management. By the way, this is not me. This is Dr. Google. Medication such as NSAIDs and opioids on a case-by-case basis. You may even be prescribed antidepressants to manage the mental health issues associated with chronic pain. This is a very hard sentence, isn't it?

It's really sad to listen to. What do you think? I mean, it kind of just falls in the same category as everything else. I'm sure it can be helpful in reducing pain, but that becomes something that you're relying on all throughout the day. And I mean, I've even heard people take it as a preventative. Like they wake up first thing in the morning, just take it because they don't even want to know what the rest of the day would feel like or what it would feel like for their pain to come on. So, you know, taking medication can be one of those preventative things. Again, it can be helpful, but hopefully you wouldn't want to fall into the category of taking medication forever, right?

No. Yeah. And it's a way to manage pain just like everything else. But like you said, there's some people that just like, I don't want to deal with it. Like it's, my pain's gone now, but I'm going to keep on this medication. And it's not our job to remove people from medication, but like I'm sure you've had clients that come in. I've had a few that come in that they just, they've been on gabapentin for five plus years. And one lady in particular, she stopped eventually. And the only reason she stopped is because she ran out of the medication and then she didn't have it. And so she stopped and she's like, holy shit, I feel okay.

And it just says she stopped taking it. But that was her choice. I didn't tell her to. But yeah, it's a, I don't know, like do you end up seeing people that need to be on medication for a long period of time? That need to be? No, not necessarily. How about people that are? Yeah. I mean, by the time they, sometimes by the time they get here, they've been on it for so long and they're just looking for, you know, something different than what they've known up until this point. But I mean, most medication, I feel like there's some, you know, healthcare providers out there that do a really good job of this and some, unfortunately that don't.

But anytime a medication is prescribed, it should be an entry point and some sort of steps afterwards to get you, to be able to get you off of that medication, depending upon what we're talking about. But yeah, if you're prescribed a medication and there's no, you know, step-by-step process afterwards of what to do about this condition, maybe ask for a second opinion there. Yeah. I think with the antidepressant in here, I think if you're, if you're going down the route of where you feel like you need antidepressants or you're like mentally kind of spiraling because of your ongoing back pain or associated symptoms, I think now would be a really good time to, to seek help if you're not already.

And I'm not just talking about the help of a psychologist or anything, but you should like, you should seek professional rebuild, rebuild help. Some people just only watch YouTube videos or like go, go look at online, like stuff online. And that's really not a good way to manage this condition nor recover from it. And this whole incurable thing on there, I think we need to address this right now. Spinal stenosis is not always painful. Arthritis is not always painful. Degenerative disc disease is not always painful. They're just signs of aging in the way you've treated your spine. And so this whole incurable thing, I'm not going to say it's a curable thing, but let's not associate the having findings on an image to how you feel because they're technically different in animals.

So if you want to feel better, I think there's a lot of ways where you can, but if you're trying to secure that imaging finding, the answer is probably, I mean, I'd say Dr. Google might be right in this case. Yeah. Your stenosis is not going anywhere. Your pain can change though. Yep. And number four is physical therapy. The natural reaction to back pain is to lessen physical activity because you might think it might worsen your symptoms. This is not me. It is Dr. Google, by the way, again. However, a physical therapist can help you, uh, help teach you exercises, strengthen your back muscles, and actually lessen your pain by increasing your flexibility.

I think this is the most true thing I've heard Dr. Google say in a while. Ever. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. I don't know about the flexibility part. I don't want to focus so much on flexibility, but I think that that first sentence there, less physical activity because you think you might worsen your symptoms, or maybe somebody's told you you need to stop doing certain things. Yeah, that's what we're here for. We're here to teach you what you can and can't do with your body and what your goals are and what you can and can't get back to within reason. And so, if there's a little therapy, do it if you haven't yet.

Yeah, I think that's right. I think that in probably some of the depression association is like, it's hard to not do anything. Like, you're scared of doing stuff. So, it gets to the point where you can do stuff and it comes to doing some physical therapy to do so, then it might be the right route to take. Yeah. What else do you want to add to that? Anything? You like it? I do. I think you explained it well. Well, what don't you like about the flexibility thing? Let's go back to that. Well, I think, so let's, maybe let me read it again here. So, I like the strengthening part. Strengthening certain areas and actually lessen your pain by increasing your flexibility.

Oh, you don't? You know, that just sounds like sometimes, I don't know. This is where my mind goes with flexibility. I think a lot of people's minds go with this. It's like, oh, so I get to just stretch more or something like that or increase my mobility or blah, blah, blah. Stretching is always the answer. Always. But yeah, not necessarily about increasing flexibility. I think it's, we're strengthening, we're educating, we're decreasing pain, and we're restoring function. I think there's more to it than just, you're going to see a change in your flexibility and you're going to feel better. Yeah.

I think the flexibility part is kind of like the same as that imaging finding. It's like, don't relate the way you feel to how flexible you'll be. There won't be a one-to-one relationship. You might increase some motion and get some mobility in there, but it's not like you're going to, you don't need to touch your toes to feel better. So it just, can you touch your toes, by the way? Oof, yeah. Not easy, though. I can't really either. So, but I feel okay. Yeah. Correcting posture. Learning how to sit. Again, Dr. Google, I want to make sure no one quotes me on these. Learning how to sit and stand correctly can ease, help ease your pain.

In addition to teaching you strength exercises, your physical therapist can show you how to care for your spine by simply positioning it correctly. I don't like a couple parts in there, but you step in first if you want. Okay. I don't know. I just don't think that there's any correct posture. To be honest, everybody's a little different. So saying finding correct posture to decrease your symptoms, I mean, there's probably a correct for you. And when I think stenosis, I think sometimes when we tell people to be sloppy, allow yourself to round your spine, allow yourself to lean forward, they actually feel better.

And so if they read this sentence on Dr. Google and don't know better, and they think good posture is sitting up straight and, you know, always just looking kind of like a statue of some sort, real tall, it might hurt. I look terrible right now, but it feels good. But yeah, I mean, if they think that that's correct posture and they do it and they have spinal stenosis and they have pain, then it probably wouldn't feel so good for them. So hard to say that there's a correct, but there is a correct for you. And you can, I mean, there's people out there that can help educate you on that. Yeah. I think that there is, yeah, the perfect posture, I think you're right.

It's just what feels good to you now. And it's not to say that bad posture would make you feel better forever because it might make you hurt too. The name of the game would be to allow, like find a position that's comfortable and make it so you don't need your, all your other types of more invasive pain management strategies. Just let movement be your medication if you can. And then at some point, once the pain settles, you can work with somebody to reintroduce the movement that was once painful. I know that some people, when they have walkers, it's probably because you feel good when you lean forward.

But it doesn't mean we can't, we shouldn't get you upright again. It's just maybe not right now, maybe in a week or two. But normally, exploring those past painful movements can be scary for some people. And also, it might make pain return. And so maybe working with someone one-on-one might be helpful. The last part on that is you don't have to work with a physical therapist only. I know they're mentioning physical therapists in here as like the go-to. It's basically anyone who can help you with movement coaching. And that can be a physiotherapist. It can be a sports chiropractor, a chiropractor, a personal trainer, a physical therapist, even MDs, everybody who can coach movement.

Obviously, if you're looking for diagnosis and now working through your pain, then you need to work with someone with a medical license. But if you're just learning how to move your body doesn't mean it has to be only a physical therapist. So if you don't have a good physical therapist around you, call some of the officers around and see if they do movement coaching or corrective exercise or physiotherapy. And then maybe you find more options available to you if they're not just readily available. Nicely said. You heard talking about walking with a cane or walking with that. What is it? The walker.

I was at a Beach Boys tribute concert at the LA Fair the other day. And the section just like of the areas where people need like scooters and walkers. And, you know, it's just a nice little. That's called the mosh pit. It was just so filled. It was incredible to see. But I just, you have your nerdy moments when you're out in public and you're not working and you just see people walk a certain way or certain things that they do. And I'm just thinking to myself like, oh, I can't help people. Just go hand out a bunch of business cards to them right now. John, stop staring at their hips. But their hips don't lie.

Seriously. Yeah, I know. It's fine. So I went to roller skating a while back and it'd been a lot of years. And so there was like almost these assisted, there were walkers with wheels on them basically. And so it wasn't all geriatric people using them. It was everybody who hadn't skated in a while. Oh, nice. And so it was just, it just looked like, like 50 walkers on the roller rink while these kids are just zipping around, like almost knocking them out. Yeah. So what did they open with? Oh, God. Wouldn't it be nice? No, I think that was song number like three. They played like 40 songs. Keep going.

It's like all the ones you're saying, they definitely played. I don't even remember what they opened with, though. Did they do round, round, get around? Uh-huh. John Stamos was there. Of course he was. Was Flight of the Navigator there? He was all over the place. Okay, next thing is permanent lifestyle changes. Weight can play a role in severity of pain. So your doctor may prescribe exercise, weight loss, and more to lessen strain on your spine. Sure. Yeah, I think that's fair. I would say that's, I mean, that's just one part. One part for sure. I wouldn't say weight loss is the, you know, the end all be all in this.

And it's just one part to the equation if it is something to discuss at all. But, you know, strengthening and working out and all that stuff can be helpful. Yeah, I don't know. What do you think about that? I think it's fair. I think lifestyle changes can be, although it doesn't need to be specific things, it's just kind of different than what you're doing. And I probably, I imagine there's some simplicity and truth to you didn't get this way on accident. You got this way as a sum of your old habits. And so just change something, whether that be what you think might be weight loss, might be walking stairs or crawling on, you know, bubble fights.

Like, just do something else. It doesn't really matter. So you might just feel better just from doing something else. Yeah. I mean, lifestyle changes can be anything more than just weight loss too, right? So it's things that you do all throughout the day that could be contributing to your pain. Could be posture. Could be, I mean, a bunch of different things. So it could be the way that you're picking up, you know, certain things. If you have a, you know, like a job that you have to do a lot of lifting, a lot of moving around, things of that sort. So, I mean, this is a general category of lifestyle changes.

It's not always just about weight loss. Yeah. And I mean, for all we know, this lifestyle change might be doing less. Maybe you're somebody who runs 100 miles in a weekend, which I admit a guy like that. And maybe you just do less. 100 miles in a weekend? Yeah, he worked during the week, and so he had to get his miles in. So he would run multiple marathons in a weekend. Yeah, I don't know how he did it. Good for him. Yeah, he liked it. Why don't you read the next one? Okay. You're so nice. Fawcett blocks. I got real close to the microphone there. The Fawcett block. Fawcett blocks are similar to epidural steroid injections in that they contain a corticosteroid and an anesthetic.

However, they are inserted in a different section of the spine depending on the location of the pinched nerve in question. You made me read that one because I used to pronounce that word improperly. I really don't know if it was improper or not. You know how, like, you ever read anything, like, papers out of Australia or, like, Britain area, and they don't say mobilization, they said mobilesis or something like that. There's an S instead of a Z. For all we know, you're right. Do you want to cover this first? Yeah, I think that Fawcett blocks, in a way, I think are a good kind of diagnostic tool as well.

I think they fall into the category of steroid injections because they can be temporary relief. Again, it's not changing anything about the way you move or what's actually going on in your body. It can just block the pain. But if you get a Fawcett block and it helps you, then we know kind of the true pain generator here, and that can also help guide rehab a little bit better. Yeah, I think so. I think as long as we use this as a diagnostic tool, I think there's nothing wrong with it. If you lean on it as a crutch and it's like your only way to survive in life, then I think maybe that water bolus might be a better option for you.

But yeah, there's a lot of different ways to remedy this in case it does work, but it doesn't stick. A radiofrequency ablation. Your doctor may also recommend radiofrequency ablation, which is the ablating or burning off a part of your nerve. This stops pain signals from reaching your brain by removing the nerve completely. Pain relief lasts for a year on average. That sounds scary. Also, it says it stops the pain signals from reaching your brain, but doesn't it also stop the signals from going to the areas that it supplies to? Well, I think this is a sensory branch. I don't think it's a motor branch.

Oh, God. So, and I think that it's a, I think it's a sensory branch that goes around the faucet or the zygomatic, those are zygomatic joints. So there, but I think it's, it's, imagine it's probably getting something like a stereosis, a stereognosis or arthro, joint, joint position, just getting like joint position. So, I mean, the simplest way is I'm pretty sure that nerve does something for you. Yeah, taking it out sounds a little scary and who knows what kind of effects that might have. Well, yeah, I, I, I mean, I've heard of people doing this and like some people it helps for a while, but at the same time, like, I think if, if, if the faucet block was the, you know, original starting point and that worked for you, I think we just, you, you can, you can derive a rehabilitation program, which can help elongate the process or the effects of the faucet block.

Like, I don't think you have to go through and just burn off the nerve. Like you, using, using the faucet block as a diagnostic tool is, is really good information and it, it helps us figure out what to do. It's like, it's not like it, like the way I kind of see it from a logical perspective is let's just say we're trying to have you lose weight and I feed you broccoli and you lose 10 pounds immediately. It's not like, wow, that worked. Let's cut your stomach out. Yeah. You know, it's like, let's just keep on what we're doing. And maybe instead of giving you faucet blocks, we, we build some support around the area so it can further decompress those faucets.

Yeah. I mean, yeah. I don't know if I've had anybody who's had this done, so I don't have a whole lot of, you know, an opinion on this one, but. It's not as common. I haven't, at least I haven't seen it a bunch when they come in here, so they haven't gotten that far. Yeah. But I have seen a handful of them over the years. I think a lot of these things overall, I mean, besides the physical therapy and correcting posture and lifestyle changes, I think a lot of these things can be used here and there. I think that they should not be first. I think that depending upon how severe it is and what your goals are and things of that sort, like it can be a part of your journey, but it doesn't have to be, you know, these don't have to all be the answers.

But, you know, I hope that this kind of helps shed some light on all that. Yeah. Well, if you had, if you had the opportunity to make a program for someone with spinal stenosis that you had to gamble on, just a general program, lifestyle change, stuff like that, what would you, what are some things that you might pick at the first go? Like specific exercises? Well, just like, because we kind of alluded to, you know, things they can do instead of those things. Like, what are some basic recommendations that tend to work for people that you've seen with with stenosis or spinal stenosis? Well, we always talk about just like general, like more movement overall.

So if you're not, like if say if walking hurts or makes your symptoms worse, you can go walk uphill. I think that sometimes can help people get some movement in and it won't be as provoking. You can start with some simple like core and glute exercises, things like planking or stretches like bending forward to touch your toes while you're seated. Just anything that kind of rounds and opens up the spine can be super helpful. Yeah, I'm starting there, but I'm going, I'm going abs. I'm going some sort of uphill like movement if they want to walk and get around and some sort of, you know, rounding of the spine to just get things to open up.

Okay. I like that. I think if they're starting, if your starting point was from bed rest, then it, I, I, simple suggestion I would make is you can do anything. Like it doesn't even matter the exercise, as long as it feels okay and a little challenging, you can do it, um, anything's better than nothing and bed rest will just decondition your body even further and makes it hard for it to do its supportive decompression. But I think you're right. Glutes, legs, abs. I think working the legs actually are very important because it spares the spine and all these, a lot of these suggestions that we covered in here, such as, uh, steroid injections, the decompression medication to set blocks and so on.

Like these ones are all, these are treating the spine because the spine is a generator of symptoms. But why is it generating the symptoms in the first place? Probably because you're abusing it with some movements or activities that you're doing. So maybe an easier way is just to make the rest of your body do some work, such as your legs and hips. Like they're supposed to do the job to spread the spine. So maybe just deflecting a little bit away from the spine might help you more than, more than just simply doing pain management on the spine. So what if it was a different starting point, not bed rest, but somebody who's already trying to do those things?

Are they generally a active person or are they pretty, are they just, they're kind of like, like they sit around the house a lot. Let's say it's an already active person. An active person. So we can look at triggers. So if we figure out a few activities that trigger your problem, I would imagine if you're active, simple things like walking, you know, getting up out of a chair, sleeping, like not everything bothers you. It's probably just a couple of things here and there. And so those things can be changed or modified slightly. Like if running a certain pace bothers you, change the pace. If running on hills bother you run on flats or this is going to sound stupid.

Go backwards. You know, it's like, it's still just a different version of human locomotion. And it's not like you're running backwards in marathons forever. It's just that you're just changing something for a short period of time to build, to keep your physical activity level up, but also, but also to, to not trigger the area. Um, some people are doing stretches that actually hurt and removing that might be one of the easiest wins in the book, but most people have been given clamshells and bridges. And like planks and side planks, they've been given some of the basic stuffs and there might be different ways where we can coach you through a version of that, that actually makes you feel better because those exercises sometimes make you feel the symptom too.

And so the rehabilitation becomes this trigger if they're not taught right and performed well. What do you think? Very well said. I agree. Well, what do you want to add? We're going to, we're going to finish up here pretty soon. So I think we are a good, how far are we near this podcast here about? It's so easy when you're here. 33 minutes. Give me some, give me some good stuff done. Tell me a story. Do you have any, any good, uh, client stories you want to share? Ooh, stenosis types. Um, I wouldn't say anybody specifics popping into my head right away, but I would say generally, like you have a lot of people who come in and, and they've already pretty much tried like the conservative care rehab route.

And, you know, they're really trying to avoid these like surgical or extreme options or some, maybe some of the things that we talked about today. And, you know, just the way that you know that you're in the right place and you're headed in the right direction is because you're actually seeing results. If you're not seeing results within a certain amount of time, I'd say at least within a month, some sort of results go somewhere else. Um, but general, general thing here is we do see a lot of active people. We've seen, you know, some, some of them maybe on that bed rest route or they've stopped activity because they're, they're fearful or something of that.

But the general trend is the more active people, they seem to be provoking it. And they're trying all these things that the internet's telling them what to do. Um, and it just doesn't seem to be helping. So getting guidance is super important. Having people watch you, having people build a program for you, you know, we're not the type of place that's going to take you away from all the things that you love, but can help modify so that you can do the things you love. And eventually the end goal is now we have less pain. Yeah. There's, I think there's a lot of truth to like just more is, you know, more is not always better.

More is just more. And you mentioned like finding things on YouTube. I don't know if I told you a story. There's someone that we saw recently and, uh, they were given three exercises specifically to do on day one, which is typically what we ended up doing three to four exercises that, and there's a reason why you'd pick certain ones, right? So based upon the history exam, how you see them move and so on. And so those three were picked. And so they called later and said, so I saw you guys on YouTube and you showed all these different exercises. Should I do those too? And I said, no, we're baking a cake.

Like you just decide, like, if you do those, you're deciding to put in salt and more pepper. And then how about molasses? And like, you just throw more ingredients in. Maybe all we have to do if this doesn't work for you is change the temperature. Like we don't change the ingredients. So sometimes the dosage of the exercise is important when they're done and to what intensity, or maybe you just change like one ingredient and things will go really well. Um, but anyways, adding more is not always the answer. Sometimes just refining the exercises are better. I would completely agree with you. I agree with a lot of things you're saying.

This is Dawne Costantino's way of saying, I don't need to respond to that. I have nothing to add. It was very well said. So now I remember actually the old podcast used to say things better after I said them once terribly. Well, you're doing a good job today. If anything in today's episode resonated with you, visit the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links, and a link for a free discovery call with us. We're licensed to work with our outdoor active people via telehealth across many states in the U.S. at this point. In fact, we cover almost half of the population in the U.S.

and we add more states every year. Thanks for listening. Subscribe to the show and we'll see you in the next one.