The Myth of Core Stability in Chronic Lower Back Pain

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You're listening to the restoring human movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey everyone, I'm Sebastian, your host with the restoring human movement podcast. Thanks for joining the movement movement. The title of this podcast is the myth of core stability in regards to chronic low back pain recovery. I know it's a probably a hot topic, probably strike something in the wrong way. Um, I'm going to cover the pros and cons of both today because fact better is a lot of people will report to a, their medical doctor, their chiropractor, their physical therapist, their trainer, and you're going to get a bunch of different concerns.

Inflicting information, which is really, really challenging. I've always told my staff that it's very hard to be a patient because patients don't know what to do. And they've been told all these different things to do and different diagnosis and so on. And so being able to sift through the information and see what's relevant to you is going to be very important moving forward and figure out the best starting point for you. If you have not heard this podcast before, welcome. It's your first time. And I invite you to go backwards into the archives. There's 200, I think 64 different episodes now. Um, I think they've gotten better over the years.

They're very, very user friendly, late public friendly. And we have, uh, interviewed people like some of the industry experts, experts on the show, as well as other people. We think it would give good value to you guys. We've covered low back, neck, shoulder, shoulder blade, hip, low back. Uh, we said low back SI joint hamstrings. We've covered, covered so much stuff. Um, so please go backwards. So I think all of the ones that came about three months ago was the most relevant in regards to lower back pain today. So we are going to first start with the idea that you need to have core stability that is measurably better than before to get better from lower back pain.

I think this is incorrect. I don't think we need to necessarily measure to see. We don't need to see that things have actually dramatically improved. In fact, probably a lot of you, if you measured from day one to, you know, day 16 or whatever of your, uh, core exercise program to see if you're actually getting better core stability, um, or better core endurance or better core strength or whatever attribute you're going to measure. I'm going to gamble and say, you probably don't, you're probably not, but I don't think there's a good relationship necessarily between people getting, uh, stronger and people feeling better.

I'll tell you the reasons why here. First off, uh, I should probably a full disclosure. There's, there's competing research claims in both camps. Core stability is important. And then core stability has, uh, no benefit over, over just general physical exercise. Uh, I'll cover that a little bit later. Um, but there's people in both camps that may be listening to this podcast and I'm going to tread the line the best I can to say it's all comes down to what you need. Uh, we have a saying that it comes down to, um, uh, N is one or the subject is one. You're one unique person. Uh, N is the amount of people in a research study when there could be a thousand, but really you're your own unique research study.

And finding a practitioner in a team to work with you as that single individual unique person with chronic lower back pain is very important. And that's where the magic started to happen. So, uh, I'll tell you this much, at least when we were talking, when I don't think you don't, I don't think you need to have a measurable increase in core stability, strength or endurance really, because we've seen people who have gotten better, literally like 50% better or more sometimes in a week. I know it sounds dramatic. It sounds like I'm lying to you. I'm not. We've had people actually call on the phone before where they said, well, we think you're kind of full of it. Like people get better that quickly. Sometimes they do.

Um, and a lot of you have experienced that before or probably way back in the day when you remember your first time having lower back pain, it probably generally went away with over the, over the course of about a week or so. That's super, super common. It's not perfect, but it's much, much better. Now, the reason why I don't think, uh, having any measurable change is required to get better or feel better is because over the course of a week, you're not going to get stronger. Really, you're not going to get more endurance. It's just the exercise itself itself or the timeframe that's passed and let, let the, the area that's creating the symptom relax and chill out.

There's not going to be any measurable strength change. Okay. I know that, uh, I've had this discussion sometimes when people have some apprehension of doing any weight training in their life at all. They say, no, no, no, no. You know, you don't understand when I lift, like even for like a week, I get really, really big. So you're saying that you're physiologically different than the rest of us in that you can grow muscle over the course of a week. No, it's, it's not going to happen. The reason why I don't think people really need to have an increase of core stability, core endurance, uh, core strength really, uh, to feel better is because the adaptation has not occurred.

Many times that when we see people at performance plays, they do feel better. Most of them feel better over the course of maybe a month. They're not going to really have a big measurable change in, uh, core, core function at that point in time, or at least I'm, I'm not aware of any measurement that would change. Really. They'll feel better, but it doesn't change anything. Okay. The second thing I think we should cover on this is, um, tensing your core. Um, I've heard this described in a really nice way before they said that, uh, clenching your core, um, after a back injury is similar to clenching your fists after spraining your wrist.

And I would agree with that. Um, but there are some circumstances actually, uh, quite a few where a little bit of a brace, not an actual brace around your back, but a brace as in creating like a little bit of a stiffness brace, like knowingly can actually be helpful when you're dealing with back pain. A lot of people have experienced this when they feel like they're having to get off the floor or they're going to bend over. They go, or they hold their breath a little bit and they tense up and they say, oh, well, that's the only way I can get out of a car or put my shoes on is if I brace a little bit.

Yeah. And that's okay. That's okay to do. It's not okay to do, in my opinion, over a long, long period of time. And so you might notice that sometimes, uh, actually, if you do a gut check right now, do you feel yourself sucking your stomach in? Are you like hollowing your stomach and pulling your belly button towards your spine? Or at any given time throughout the day, if you did a mental check-in, is your stomach ready for a gut punch? Like you're kind of like, it's like you saw someone come in for a punch and you stiffened up. If you're acting that way and you've had back pain for a long time, uh, actually I would venture to you and say even probably for a lot of people, uh, if you've been dealing with it this way, if this is your management plan, knowingly or unknowingly stiffening your core.

Um, and it has been over about a month and a half, two months or so, I think you're missing a really, some really easy stuff to do. Tensing the core is, is a, um, habit change. A lot of people will adopt as they start to improve and manage their own low back pain. And it's not a bad thing, but it's just a bad thing over the course of a long time. Um, I've worked with a lot of people who, when you tell them to take a deep breath in, they just suck their stomach in. Uh, and we can argue back and forth about what's the right way to breathe. But overall, that's a really abnormal one. If we're just asking them to take a deep breath.

Now that might be a normal one for something like do a hiccup, you know, it's a hiccup breath, which sucks the stomach in, which again, right for a hiccup, but probably not right for just general breathing patterns. Um, a lot of times, uh, or if you looked up breathing, uh, compensations recently, there's probably a lot of articles out there that say that accessory breathing muscles can help out in altered breathing function. Like some of the neck muscles, which may or may not explain the, why, why some people, after they have low back pain, end up having neck pain too. And sometimes they have numbness tingling down into the arm.

It's these, these muscles really helping out up there to create altered breathing patterns. Altered breathing patterns can be seen as almost like a, um, like a limp. Um, oh, it's okay for a little bit of time, but after that, it's not okay. Uh, unless there's still something in your foot. In that case, it's probably okay, but we should probably get rid of that thing out of your foot. It's been, you know, two months. Why don't we get rid of that thing out of your foot? Which comes down to good care. Now, tensing your stomach can create a lot of different, um, other problems. Uh, I don't want to say I'm predicting anybody's future with this, but I'll just give you some general things that we've seen over the years.

Um, a lot of people, number one is they become neurotic about it. They say, yeah, you know, like, I feel like if I don't tense my core all the time, then my back's going to hurt. So I tense it all the time and say, how do you feel about that? Well, I mean, I thought I had to do it. You don't have to do it. And just relax. Just, just let it hang out. Act like no one's in the room. I want you to, to show everyone, like all the guts, just let them spread out into your stomach. Oh, that feels okay. I feel okay. You know, they don't realize they're holding so much tension, so much tension in their body because they're guarded.

Now, sometimes people end up having groin pain after, uh, managing lower back pain in this way. Sometimes their hip flexors will get really tight. Sometimes they have upper glute pain, which they may call a trigger point or a, um, uh, my, like, uh, more of a piriformis syndrome. Sometimes their back gets stiff and tired, but not really painful in the same way. These are, uh, compensations and, uh, it's, it's, I, I find it's pretty common, um, but also it's very reducible as well. Now, your core does not need to be stiff to necessarily feel better. Uh, I already mentioned that some people feel that their lower back feels better when they tense, but that's not everybody.

Sometimes all you have to do is just get up and move around a little bit, get up, take a walk, get out of the position that's creating your lower back pain. Uh, as, as I'm doing this podcast, mine's a little achy right now. I should probably get up and do a standing version of the podcast, but I got the notes on my computer and I just want to make sure that I'm hitting some line items. So I'm going to hang out here a little bit, but it doesn't mean I can't reposition just as I did in the chair and let the backrest do the job. So my core doesn't need to be stiff all the time. You can actually let things like the backrest do the work.

And when you're walking, if it makes you feel any better or more, more safe is that when you walk and swing your arms, you should get an automatic inherent low level brace. It's just enough to not let your body just fall apart or have really any pain. That's why a lot of people have no pain when they walk, but they do when they sit or go into a stationary position. The pure act of walking is almost like greasing up the joints. It really helps out to build some protection for the low back with the form of the anterior sling. It goes across the abdominal area. It also gets the glutes and the hips and the shoulders working really well, which helps out, which I'll talk about a little bit later.

So you don't need to be stiff all the time. If you're overall convinced that you need to be stiff, consider maybe going on the ground, laying on your back, put your heels to your butt or legs up on a chair and just relax. You're going to notice that sometimes just being on the ground and just relaxing feels better than standing and bracing. If you want to use that strategy and you feel like, well, that really made a good change of me, the next step might be sitting on a chair, finding a position of, quote unquote, good posture by dialing your hips forward and backwards and forward and backwards and find the middle.

And then just take a breath and relax. You might notice in that position, you may not have any low back pain again. And what it really prods the idea of is if you don't have core stiffness, you can still feel good. Okay. Your core doesn't have to be stiff and stable all the time. Now, exercises that tend to not work, by the way, I've seen a lot of people add exercises to the programs that we give them. By the way, I should tell you, we do give core stability exercises and I'll tell you the reasons why later. But a lot of times people add their own core work, which they can do it if they want to.

But at the same time, it makes the situation of having temperamental low back pain, chronic low back pain and acute low back pain really challenging sometimes, especially. Well, actually, I take that back. It makes it challenging, especially if the person is really worried about their back because it adds more variables to the equation. It's like eating a taco and you're worried that you're allergic to things in the taco, but then, you know, put hot sauce on it and then you end up having acid reflux. You're like, well, what's the taco with the hot sauce? I really don't know. And so the exercises that move the spine while in the exercise are the ones that I generally would not pick.

That would include things like pikes, sit-ups, crunches, supermans, probably reverse hypers. And whether those side tilt ones people do, they stand and they kind of lean side to side or they go on their side and they try to hit their obliques. Those are ones that I probably would not do. Even ones hanging from bars when you're hanging and you bring your knees to your chest like chin tucks or there's one where people leave their legs up and knees tucks and they almost do a Russian twist while they're up there too. Those would also be included in this category that I think would be less useful than you think, at least for managing and helping people with lower back pain.

But it doesn't mean you can't do them later if you want to. After questioning, a lot of times we ask people, like, are you married to the idea of doing that exercise or is it just something that you kind of learned in men's health or something like that or women's health? And they're like, well, I've just seen it before. People are doing it at the gym, so I thought I would give it a shot. So you're okay if we take that out at the moment? Yeah, I'm totally okay with that. Great, let's take those things out. If you feel like you want to go back to them later, you certainly can. But at this point, why don't we just leave them out at this point?

The other thing that people tend to do when they start using exercises is they tend to go too long. So they go beyond their own physical capacity. So in this scenario, using core stability exercises is not really going to be too helpful because you're going to go to the point where your body is starting to fall apart and it goes through movement because you can't hold a single position in the exercise itself. And so that would be something like a plank, like the plank exercise generally, I think, is a very good and very valid exercise to use with people with chronic and acute and subacute lower back pain of various different diagnosis.

I'll cover all that later, but using it too long as the public uses it is a little bit of a problem. It's like they have these plank challenges that are all over the place now. It's like, who can hold like an eight hour plank? Like, let's get in a group and then figure out who can hold the longest plank. I don't care if it looks bad or if it feels bad. Just hold a long time. And a lot of times when we have people test to see that it's all hurts to do a plank. Can you show us your plank? Ooh, that's a, that looks pretty good. And wait a minute, it's starting to go downhill now. How do you feel now?

Oh, it hurts now. How did it feel when you started? It felt pretty good. So only do the ones that are making it. So you feel good. On that same token, it's super, super common for people to have the problem of low back pain, try core exercise at a rehab facility, a physical therapist's office, a chiropractor's, a gym, wherever they're starting to do their core exercise, whether it's the quote unquote right ones or the quote unquote wrong ones, like I just mentioned, for the, per the scenario. Either way, people tend to have a very common story of I've tried that. It didn't work. It didn't help me.

Well, how did it, how did it not help you? In what way? What was your experience with it? Well, it hurt to do. So did you push through it or do you just stop? Well, I pushed through it and actually it made me feel a lot worse. Okay. Other scenario. I pushed through it or did you push through it? No, I didn't. I stopped. Well, so this in, in my opinion is a problem. There's a few things that could be happening in this scenario. Number one is the exercises are poor, a poor choice for this person's type of back pain. Because remember, not all back pain is created equal. We covered this in some of the podcasts previously of different diagnosis and different tolerances that people's backs will have.

So the exercise selection may be poor. Also, the way it's coached may be poor. Just as I mentioned earlier with the plank, there's nothing wrong with the plank in that scenario, but the way that it was coached in the beginning was probably okay. And if the coaching changed the way it was after when the person got tired, then that would create pain for the person. Right. It's, it's kind of like, uh, I mean, if you're teaching someone to drive a car, like, yeah, you can say, jump in and just drive the car, but you know, there's right and wrong side of the road. There's a way that'll get you in trouble and there's a way that you'll go perfectly fine.

And the same goes for corrective exercises when used when, and when that comes to planks or various different exercises, even some of the exercises that I said, I don't know if I'd really pick those. There's probably ways you can get away with that. Um, while having lower back pain as well, if you do it in a certain way, because a lot of times lower back pain, it's not just all of a sudden it's, it's just, it's not just in your head. Like there's things that your body likes and doesn't like and so on. Um, we should probably know that the, so again, the exercises is one thing that could be wrong.

Uh, coaching is another thing that could be wrong. Uh, also to how long you're holding it, as I mentioned before, it could be wrong. Uh, and I'm saying it's wrong for you. So these exercises should generally feel hard, but not painful. If it feels painful in the area that you have any of your aches and pains, then it's probably coached wrong, the wrong exercise for you or holding it too long. And yes, you can pick an exercise that is curated to you. This is why coaches have regressions and progressions. Even a simple plank can go from your elbows and knees. It can go from the elbows and feet. It can go from the feet and the hands.

Uh, and it can even go from the point of where you're barely up off the floor, kind of like your face down sniffing the floor and you're starting to get up, get up into a plank position. There's a plank that will work for you generally. Now, let me divert a little bit into a devil's advocate with, uh, this would be like the other camp of, uh, believers. I personally believe corrective exercise has a good value. Um, and there is some notes, um, some references where people say that core exercises is core stability exercise is no better than general exercise. Um, so why should they be used basically?

And, and just as I mentioned before, some people will feel that core exercise is a way to challenge their body and, uh, without any pain. And this is a good thing. Other people really suffer through it. In that case, don't bother with it. Uh, I had a friend recently that he had, um, lower back pain. He was sitting around for a couple of weeks. He ended up, he got sick and, uh, he didn't have to do any core exercises. He just went and walked around. Uh, other people will have lower back pain continually until they start to reintegrate into back and back into the activity that they were, that they like doing.

Uh, I'm a good example of that. Uh, I did do a spurt of core exercise. I did a spurt of the, uh, McGill spinal hygiene type of approach. Um, and I deadlifted and I squatted and so on, but I still felt some back pain until somebody told me, you know what, you're, well, you're good. Like everything, everything seems good on the exam. It doesn't look like your spine is really in danger of exploding. When you go try some stuff, go out and do anything you want. So I'm, I'm good to go sprint. Yeah. Uh, diving in baseball. Yeah. Can you, can I hit? Yeah. You could do all that. Once I was able to do all that stuff.

And once I tried to do all that stuff over the course of a couple of months, I felt way better. It was almost like, um, as I went through my standardization of rehabilitation, as I mentioned prior, I felt about 80% better, but at the very tail end, there was that tensing core thing, which is why I want to cover this topic today, tensing the core and just being so aware that you may hurt your back again, doing something. So you just brace after realizing that I'm a full go and I could just do some stuff. I tried it. I dabbled with it. I had some successes. I had a little aches and pains here and there.

I remember diving forward. Um, well, I, I had some back pain when I hit the ground, when I was, uh, diving in baseball and I was kind of hesitant to swing hard, but I was okay with swinging the opposite direction and bunting and sprinting and all that felt okay. So the last, you know, 20% or so came down to just reintegrating back into something that I like doing. And so I think for a lot of you could end up being the same. So going back on the idea, the devil's advocate of core exercise, core stability exercises, nobody do in general exercise. I think it depends on the scenario because in the beginning when I was feeling pretty bad with my low back, core stability exercise was a way for me to feel physically able and challenged with zero back pain while doing so.

And so it gives me a nice idea of that, you know, I'm not broken. I don't need to guard this thing completely. You know, I can do things. I can still go to the gym. I can still do stuff. And I mentally feel better about that because a lot of people who have chronic low back pain, they have no idea why they have low back pain. Uh, they've been told that, you know, they should do X, Y, and Z. And, uh, by someone else, they said, they say maybe you should do H, J, Q, you know, all these different things that are so conflicting and all of a sudden people just stop and pause and I don't know what to do.

I'm not going to do anything. I wonder if I'll get better on its own. And some people do, but doing core stability exercise is a really great way, low risk, high reward way to feel mentally better, feel physically better, and then get into the exercises and activities that you want to do. But ideally, you should go back towards an exercise that's pleasurable to you or an activity that's pleasurable to you. I only bring this up because I know that after questioning a lot of people working with them, I say, why are you here? And they say, well, I want to get out of pain. What is pain stopping you from doing?

Uh, well, I can't do the dishes and I can't put my shoes on and, uh, you know, I can't, uh, uh, you know, pick up the dog and okay, that's all good. I think we can help you with that. What do you want to do? Well, what do you mean? Uh, what do you want to get back to? Well, I can't do those things. We have a, is your, is your passion alive for washing dishes and picking up dogs? Well, I used to play soccer, but, but I'm too old for that. Do you want to play soccer again? You know, I hope you guys get my point. Like you're never too old to have a pleasurable physical hobby and it's advised that you do.

Um, some of the, some of the nicest people, uh, mentally, like they were just seem mentally there. They just loved it. They were people who are part of like the Sierra club. Um, they just hiked around and had groups of hiking friends and out in nature and they just loved it. And they didn't have to do any core stability exercise to feel normal. They didn't have any problems, at least that was stopping them from living their life and doing what they want to do. They, uh, just did general physical exercise, but there's a time and place. Some people will not be able to do general physical exercise and get away with it.

Other people can, as I mentioned, my friend, he just needs to get off the couch and walk around a little bit. It's fine. I was also in that scenario towards the latter part of my, uh, last back pain incident. Other people I've, I've had them come in and physically lay on the floor and they do not get up for an hour. Uh, we do the history taking process there. We do part of the exam as much as we can on the ground and we coach them into what, uh, what to do. I can tell them to go to jumping jacks, but it ain't going to help them. What's going to help them at this point is giving them suggestions of physically challenging things that will make them feel like they're not broken.

Or like their back is bad and so on. And so in this scenario, core stability exercises are very helpful, but in this other scenario, they might not have any difference. Either way, um, I suggest most, uh, most people that we see do core stability exercise and then also do general physical exercise. It's, it's, they're, they're not, uh, they don't interchange for each other all the time. They're not a one-to-one relationship. It's not like you get a taco or a burrito. It's like you can get both and you should get both. They actually compliment each other. Core stability exercise or weight training and, um, exercise that doesn't require any weights like you're hiking in baseball and soccer are all very, very helpful and complimentary to, uh, helping people with back pain.

Uh, another thing to consider is that when you are sucking in your stomach and creating the core stiffness and the sucking in the stomach is, uh, something that we've gone away from, at least when we're coaching, uh, people with back pain. And, uh, the reason is because it was, I think it was based upon like one study way, way, way back when, when they were trying to stimulate the transverse abdominus, which it held value there. But at the same time, there's other, um, uh, bracing techniques and stability coaching techniques that can be way more helpful, uh, and have been shown to be so on research.

And so typically what we do in performance place is we teach people to do, to find high tension and then to dial it back. A lot of times, even like finding perfect posture, it's hard to find neutral or different variations of posture if you don't know the ends of the ranges. And so if you sit up nice and tall, that's your, that's your top of posture. And then you have your sloppy sloppy, which is like, if you just fell asleep at your sloppy posture, and then you have somewhere in the middle, the magic is in the middle. Usually with this, we teach a brace bracing technique because most people aren't aware that they can find pain relief while doing so when they're in a certain stage, but we want them to come back.

We want them to come back so we can make sure that we tell them to not use the brace and just relax. Because in some scenarios, they need the brace, um, again, this is not a back brace. It is a bracing, uh, act activity. Um, a lot of times we need to teach them to fine tune the brace or the stability based upon the task at hand. Eventually this comes naturally just as you, before you ever had back pain, you didn't have to think about it. It just happened and you felt fine. Um, but some people need to be retaught and the whole thing surrounding, uh, rehabilitation of, of the spinal problem like chronic low back pain is that you need to sometimes reteach a pattern or we call it, uh, rewiring.

Uh, rewiring is not something that you need to do forever. It's just you, uh, I always tell the people I work with, like you learned to tie your shoe at one point. You know, it has been sometimes probably like so young that you, you don't even remember. I don't remember when I learned to tie my shoe, but I'm pretty sure showing a kid to tie a shoe. It's just mind numbing how much attention you have to put to it and how much attention they need to put to it too. Well, I want you to loop and now swoop, you know, and so you're teaching them. And so it takes 30 minutes probably to teach them and do it.

And then they forget the next day. And so it takes a little bit of diligence to get that back. And the same thing happens when people have low back pain. Sometimes you need to rewire a pattern, get them to do it frequently. And then it'll come automatically. You don't need to think about how to tie your shoes. I can do it while I'm on this podcast right now. It comes automatically. It's a software program. So it has nothing to do with stiffness. It has nothing to do with stability, strength, or endurance. And maybe that is the reason why a core stability exercises work because you're rewiring something versus building strength over the course of that week or two week period of time.

Now, when you get back into activity, typically, ideally, you want to push people or we like to push people to foot on ground activities, which can include weight training, but also it can include like just generally moving around. Typically what happens, and if you watch some of the, you watch runners or people, actually you can watch volleyball, you watch baseball, you can watch so many different sports. You see this gross, large amount of movement coming from a ball and socket joint, such as a hip and a shoulder, like a baseball pitcher, like they push off the mound. They got their legs kind of cocked into all these positions and their arms cocked back into position.

If you look at their, their torso, it's generally not any different than like maybe, um, I don't want to say like a water we need. Let's just say it's like, it's almost like there's some stiffness there, like a football or like a ball that's been blown up. You know, it does deform, but it doesn't crumple. And so this is a good demonstration of creating power from the joints, the, the ball and socket joints versus deformity from the spine, which in, in our scenario, we call it a power leak. Um, a lot of times we see power leaks with people, uh, in the spine when a lot of the energy goes into the spine and then they have having a problem, which could be disc herniation.

It could be a parse fracture. It could be many things. Um, a lot of times people who bend predominantly at their spine versus at their ball and socket joints, or they have a lack of movement in their ball and socket joints because of, uh, arthritis or because they never really got it back, um, tend to have more, uh, back pain than, than those who have more freedom and range in there. By the way, uh, it's going to sound real stupid to say this podcast is called restoring human movement. If you have a hip problem and it physically can get back into extension again, but it doesn't stay there maybe, or you have a little bit of arthritis, but not a lot.

And you're, you, you notice that your hip doesn't really work that well, or people have been telling you that your hip flexed, hip flexors tight and so on. It's good practice to restore the movement that you had lost. I'll say it again. It's good practice to restore the movement that you've lost because if you get that movement back and you create that wiring pattern, then you'll be able to get back into your sport that you want to do, which then makes you happy because this whole thing is about, you know, it's, it's nice to not be in pain, but get happy, be happy. You know, that's all what it really comes down to is, is finding an exercise or an activity or rehabilitation or whatever you want to call it that makes people feel physically better and mentally better.

And core stability is not the only way. It's just one of the ways. All right, guys, thanks for joining me on this podcast. And I hope you enjoyed as much as I did. If you're looking for resources about lower back pain and how to improve, I wrote four eBooks myself, which are super affordable. And I think they'll serve you guys very well. It's a four part series versus six powerful exercises to reduce lower back pain. And the second one is understanding lower back pain for the lay public. The third is lower back pain treatments that work. And the fourth is all about weight training after lower back and a groin injury.

These are all in the links below the podcast player. We also have online programs for lower back that reveals all the exercises and methodologies that we use in our opposite performance place. Lastly is if you want to work with us virtually or in person, we do offer virtuals and in-person services. Check our Google five-star reviews to see how virtuals work and how successful they actually can be. There's a little bit of a disbelief sometimes when people say, ah, I got to go in person. You don't have to, but if you certainly have the means to be in person, you certainly should. We will talk to you guys next time.

And thanks for joining the movement movement.