Degenerative disc disease: what it is and how to treat it

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 is 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. Covered degenerative disc disease today, as well as some parts that I think you're really going to want to know about. For all you watching on YouTube, you can see the slide right here. We have in this video, we're going to cover what current research says, how it happens, treatments that work, prevention, and also for the people on YouTube, there's going to be two of my favorite exercises. It's not going to be in the podcast. There is a podcast version of this. It's called Restoring Human Movement. If you're listening on that, you can always go over into YouTube.

Just search in Performance Place Sports Care and you'll search degenerative disc disease and you'll find it here. So, I'm going to do my best to entertain both audiences today, but we're going to go through some really great information that's going to give you some insight about what's going on with it. Now, degenerative disc disease, as you see by the picture here, some of you do, is you see all the stars all over this person's back. And so, a lot of you may experience tightness into the side of the lower back, into what you might call the QL muscle. You might also feel it into the area of the kind of the bony parts of the spine, right along the middle.

It may go all the way up into like the bra line region, down to the SI joint region, down to the sacrum, tailbone, and so on. A lot of you will actually experience correlated hamstring tightness, sit bone tightness, piriformis muscle gluteal tightness right around the crest of the hip where her hands are on this picture. Like, if you're mad, you'd put your fingers there, your thumb would land there, hip flexor tightness, and so on. And so, the feeling of tightness associated with this, whether it be restricted to movement or not, is a completely different story, but it's super common. So, we're going to go over, again, current research says how this happens, how degenerative joint disease happens, degenerative disc disease happens, treatments that work, prevention, and two of my favorite exercises.

So, the first thing I pulled, this is a study from 2019, and I just took a screenshot of a certain section, down to the second line that says there's no single definition was used in the majority of publications, and most frequently the term was used without any definition provided, which was in 30%. In other cases, degenerative disc disease specifically included radiculopathy or myelopathy, radiculopathy is a pinched nerve, myelopathy is cord compression in 14%, or only back or neck pain, which was 5%. So, this term was thrown around a lot, and this was over the course of this research article, this was level 4 evidence, it was talking about 402 publications.

It's interesting how much is just thrown around, you know, and there's no consistency really about what we're even talking about, whether the research is investigating treatments, you know, who it's specifically in, and so on. Like, all this information we get about them, it's kind of haphazard. It says, In conclusion, degenerative disc disease represents an underdeveloped concept with greatly varying definitions documented. Such inconsistencies, challenges clear, accurate communication in medical and science, creates confusion and misconceptions amongst clinicians, patients, and others, and hinders the advancement of the related knowledge.

Interesting, right? So, all the things that Dr. Google says is not necessarily correct, and obviously, in this podcast, or in this YouTube video, you might say, well, you might be spreading the wrong information, too. I'm going to do my best to try to keep things as wishy-washy, but also as concise as I possibly can, because there's different terminology thrown around all the time. Now, the mechanism of injury is usually slow onset. It doesn't happen overnight, although some of you may feel more in when you start to get up, or one day after a certain activity. Perhaps you went golfing yesterday, and all of a sudden, you feel it more today.

It's kind of like the day where it peaks. But a lot of people can't really identify when it started. It just started to come on over time. Usually, there's no trauma or accident. It's not like you fell golfing. It's just you went golfing. Also, there is adaptation over time, which I'll describe the picture on the left. And there's also a thought that it's hereditary. Hereditary, I think we should touch on that first, is I would question how accurate that is. There's obviously things associated with the body, which is obviously hereditary. It's familial. It runs in family lines. And that happens, like rheumatoid arthritis is a type of arthritis, which can affect the spine, can affect other joints as well.

But it does happen more consistently with hereditary. But there's a lot of other factors, too. Are you sleeping well? How do you treat your body? How do you eat? I'm sure a lot of you, some of you may have heard of the term epigenetics. It's kind of like selective gene expression. So although you may have the gene for it, your genes may say you're supposed to have it, or you may have it. It doesn't express in everybody. Like you have it, but your sister doesn't. So with that being said, there's a lot of other variables associated with what's going on. It's not only physical, but also chemical, too.

How you treat your body, what you put in it, and sleep, stress, and so on. So there's a lot of different factors. If you look at the picture on the left, here's a couple different phenomenas and problems that happen in the spine. And so you see on the left on the top, it's a normal intervertebral disc, they say. The second one down is a quote-unquote degenerative disc, where it seems like it's more macerated. There's splitting in the sides, and there's less disc space. The third one down is a disc bulge, and then there's a disc herniation, and then a thinning of the disc, which is often said to be correlated with degenerative disc disease.

And a lot of times you'll find arthritic formation, which the fifth one down is disc generation with osteophyte formation. Osteophyte can be called spurring, like fish slipping on x-rays. A lot of times you'll find it, or you can just generally call it arthritis, osteoarthritis, and so on. So there's a lot of different words for it. But generally speaking, it's a change that happens between the vertebral bodies in the space of the disc that usually happens over time. It's an adaptation over time. In the next slide, I think this is how I usually explain things to people when we're talking about degenerative disc disease, as well as degenerative joint disease.

And they wonder why they have arthritis maybe in one hip and not another, and so on. It's really about how you treat your body over time. Again, some of it can be hereditary, yes. But at the same time, there is something called Wolf's Law. Wolf's Law is something that we learned about in, I think, probably the first year of chiropractic school. I'm sure that physical therapists, medical doctors, osteopaths, physiotherapists, they all should be generally familiar with it. The recommendation for walking or doing white marion exercise if you are osteoporotic in regard to building bone density comes down to allowing the bone to remodel in a favorable way based upon how you treat it over time.

With that being said, osteoarthritis, or sorry, so osteoporosis or bone thinning won't go away overnight. It is a process to remodel the bone in a favorable way. Under that same thought process, though, it does not happen overnight. It comes over time as you don't treat your body to a little bit of load. So in the picture on the left, this shows a femur, and this is a compressive load downward. And you can see with this particular picture on the left side of the bone, there's less compressive force than on the right side of the bone. And so you take that bone over time, and you take a look at it in the middle, and it shows on the side where more compressive load is, new bone will add there, while on the left side of the bone, new bone or bone will be removed from there.

This is called osteoclastic activity. The bone remodels. It's a naturally occurring thing. And what you have at the end of it all is a bone which can tolerate the compressive force that you put upon it. So bone is not a tissue that doesn't change. Bone is a dynamic tissue, meaning it does change. So this slide says, Wolf's Law holds that bone will grow and remodel in response to the forces or demands placed upon it. And this says examine the bone on the left. So this makes complete sense to me, and this is a type of, the femur here, the thigh bone is something that we would be considered of when people are, want to make sure they don't have, get broken femurs when they fall, when they get older.

So that's why we want to have people generally active, active throughout their lifetime is because gravity supplies the compressive load in that case. Now, this picture is one with, it's a man stand, man or woman standing, and it shows what we can call good posture, bad posture. So, like, it doesn't really, let's not focus on the posture associated with it, really. The person on the left has, quote unquote, ideal alignment. And then there's kyphotic, lordotic posture, which is kind of, if you know what, the side of a spine, like if you play Mortal Kombat, there's the, you know, spine that comes out and the finishing part of the thing or the, I guess we can go with Halloween skeleton.

There's a zig and a zag of the spine. And so, as the zig and zag increases or decreases, sometimes, if it's like that over time, then you get more load on certain regions of the spine. And so, this is a representation of four different general types. There's also, if you flip this person around forward, you'll see that there's like the scoliosis type. By the way, scoliosis is not curved deformity forward and backwards. It's curved deformity side to side. And that also adapts over time, too. But if you look at this line, just as in the last picture, the line that intersects the femur with compressive load, you can do the same thing here.

There's a line drawn through the human from the head to the hips to the feet. And that's generally, we can figure out where compressive forces may be a little bit more so. And so, if you allow your body to be subjected to vertical load over time like that, then it will remodel and say, hey, I'm just trying to help you out because I'm a dynamic structure. I'm just like muscle. I remodel according to what you ask of me. And that can be favorable or unfavorable if you're trying to decrease, if your goal is to decrease the amount of bone formation in a region because you have degenerative joint disease or so on.

And so, how you allow your body to adapt over time is important. Like, no one wakes up with arthritis. It happens over time. It happens over years and years and years. And I want to say it was back in the 80s or 90s or something like that. I think it was 80s or 90s. They realized that with, you can't really reverse the, what happens to, you can't reverse arthritis. But I think the thought is that you can prevent it from happening or you can prevent the progression possibly. The idea was based upon girls with knee problems with ACL tears. And so, they found that within those joints, within those knees, the people who had the ACL tears generally had more arthritic findings over time.

Like, within five years, they had arthritic findings, degenerative joint disease in that case, over those five years. So, it was how your body loads that region. Trauma or past injury is something that may make you load differently over time. So, a lot of times, that's why rehabilitation is required. It's to get your body to load better. So, you don't have things like this pop up over time. In this slide, I wrote down posture matters over time. And this one was an interesting one. I just pulled this study right before we did the presentation here. It references down on the right side. And so, this is an MRI.

This is a flexion extension MRI. And this is regarding disc movement. And so, the common thought is that if you round your back forward, the disc will move back in towards this disc herniations and protrusions will move back towards the spinal cord and maybe create a little pressure on it and create symptoms. In this case, you see that the extension actually increased the disc material moving back into the spinal cord region, creating some cord compression. In this case, it said spinal flexion had 3.3 millimeters of movement into the spinal column. And in extension, it had 8.9. I would imagine that would be part of the annulus of the disc, not the disc nuclear material, which is common too.

And so, everybody's spine moves a little bit different. Their symptoms are a little bit different. And what your problem or your pain generator is might be a little bit different than everybody else's too. And so, posture does matter in this case because your spine, just like the bone, moves, okay? Or actually, it's dynamic. It moves around. Now, I'm going to cover Yana's lower cross syndrome. If you guys haven't read anything about it, I did do a write-up in my book, which I'll put in the link description. Actually, there might be a card that comes up on the side here. But if you guys listen to the podcast, then you just go in your podcast player links.

But Yana's lower cross syndrome is, I think, a really good idea. It's a good ideal theoretical model. And actually, it's a pretty good observational too. This is a lot of times what we see with people. People on the left with tightness, chronic tightness of the erector spinae, iliopsoas, and erector femoris. Those are called tonic muscles, which I'll cover in a second. Generally have more compressive aspects in the backside of the spine. It's usually these people don't have really good movement patterns, okay? They can move without pain, pain most of the time, but a lot of times these people have an anterior tilt to the pelvis.

Their booty will be sticking out. You'll see that there'll be like a big gully in the middle of their back between their back muscles that look really tight most of the time. It almost looks like you can put a carrot between their lower back muscles. And then the person on the right is the opposite. It's a posterior tilt. And so there's the rectus abdominis, the external oblique are helping out with the matter, the glute max in the hamstring, and so on. And so neither one of these positions is like the one you should stay in or be in, but when all these muscles work together, they create what we call co-contraction.

It helps out to create decompressive efforts of the spine. It helps spare your spine from abnormal loading strategies. Now, the tonic phasic muscles, if you go in and look up Yanda's muscular imbalance syndromes, you're going to find upper cross and lower cross. I think these are really good starting points for understanding of not only that your diagnosis, your disc degeneration, your disc herniation, your pinched nerve, and so on, aren't the only problem. Like this gives a better idea, a better understanding of why those things keep maybe popping up. And so these are areas of the body or muscles of the body that tend to dominate movement because they have better energy systems.

So tonic muscle groups are the ones that are typically facilitated in this picture. Facilitated, at least in the lower cross syndrome, it says rectus femoris and alial psoas on the front side. And the backside, the muscles that are facilitated or pretty hyperactive are the thoracolumbar extensor group. So like maybe even the QL would be in there too. The muscles that are a little bit dormant would be abdominals, glute medius, glute minimus, maximus, and medius. So all the glutes. And so there's other muscles in this scenario as well. But generally speaking, a lot of times people will go in because their back hurts and they notice that their low back muscles are tight.

And their rectus femoris and iliopsoas or hip flexors are tight. And then if they went to a trainer or a strength coach, you'd say, well, the abdominals and glute muscles are kind of weak or inhibited in this case. And so the muscles aren't really doing their job. They're not really helping each other. They're not creating co-contraction and making a good ecosystem for the spine to survive. Over time, if you allow this to occur, in theory, abnormal loading strategies happen and then you end up having adaptation of the bone, which creates degenerative disc disease. 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. Now, if you look up in the upper cross syndrome, the facilitated muscles are the sternocleidomastoid and the pecs, the upper trap and levator. I mean, how many times do you guys go to massage therapists and they're like, oh, yeah, your upper trap and levator are the tightest that I've ever seen. Right? Nobody ever says in the other group or category, the inhibited ones, the deep neck flexors. Your deep neck flexors are the tightest that I've ever seen. No, because they're usually dormant. They're just not working well. Lower traps, retus anterior is also in that category.

And does anyone ever go to a therapist or a clinic and say, and they get told their abdominals or glute max are way too strong? They're way too active. It's not super common. And so my point is that the energy systems of these muscles are different. And so the ones that are facilitated, the tonic group, the ones that are helping tend to help out longer. And then over time, they will create abnormal loading strategies. Now, here's a picture of DNS, open scissor. DNS is dynamic neuromuscular stabilization. This one ties into that same one with the Yanda's lower cross, upper cross type of syndrome.

It's just a different strategy, a different painting picture, if you will. And so in this one, it describes a little bit more about how diaphragmatic breathing and internal pressure within the abdominal cavity matters in keeping you in an optimal position to have better load sharing amongst the spine and other parts of the body too. If you look at the picture on the left, you have the diaphragm and the thoracic and pelvic diaphragm or the pelvic floor, generally horizontal to each other. And you can see that everything is, it looks like it's a more compressive system. It's like a Coke can with a horizontal top and horizontal bottom.

You look at the other picture and it's like a can that's kind of been tilted at the top and tilted in the bottom, like an open pair of scissors. So what the theory is, is this abnormal loading strategy creates a scenario where there's poor internal pressure, internal pressure within the cavity. If you want to look this up, you can, or just trust me. Better intra-abdominal pressure helps to decompress the spine. It helps support it. It helps support the spine. It also helps out to improve glute function and it helps or a glute activity. It also helps to facilitate more abdominal wall activity, which was what we went backwards into the tonic phasic group.

It's, it's what the ones that needed some help. That's why a lot of times rehabilitation of a hip or a back or a knee starts at the core. It's not a six pack or eight pack or 12 pack. It just can the core function. I've seen people who are overweight have a perfectly functioning core. Okay. It has nothing to do with aesthetics, but as you can see in the picture on the right, it says the spine is extended. The pelvic is tilted forward. Like they're taking an Instagram picture. The diaphragm is oblique. There's a suboptimal distribution of pressure. And then there's incoordination of stabilizer groups of muscles.

And then there's more compressive overload, overloading of the lumbar disc and joints. Okay. Now here's a picture that shows, this one's actually pretty common that we find mainly with squatting patterns. I do see it with deadlifting patterns too. These are pictures of the same person doing a deadlift, but two very different low back strategies or stabilizing strategies. The person on the left, the bar is still in generally the same position. The logo of the shirt looks really good. It looks up. So it looks like they are not dumping at the low back, they're not rounding at the low back, but they're extending at the low back.

You can see that there's a dramatic arch. It's like a sway back. And this is something that may load the backside of the spine more than the front. And it's just inadequate load sharing. They're an open scissors presentation, more compressive load on the spine. The person on the right, although they look like they may not be paying much attention, this person is paying more attention to a bracing strategy or a pressurizing strategy than the person on the left. And so over the short term, the person on the left can get away with this. Okay. This, this works for a very long time. The person on the right, I think they'll succeed better over time.

And if the goal is to lift weights, I think, or lift heavy weights, the person on the right is going to even do better. Okay. But posture with lifting really does matter. We see it a lot with squatting. People who have actually hip pain with squatting or low back pain with squatting, they tend to have a strategy where they're really extended on the left. It's almost like they're scared to actually look over the cliff or allow their chest to go a little bit forward because you got to have a forward backward displacement. Like you got to have, you got to allow the chest to go a little bit forward unless you have a counterbalance like a goblet squat.

But as they extend their back more, their back hurts more. And so essentially they're using their back as a hinge point versus their hips as a hinge point. Correct me if I'm wrong, but a deadlift is a hip hinge. You're supposed to get the drive from the hip, not the spine. And so that's why the spine is going to take more load over time. And at some point it may develop degenerative disc disease or other types of disc problems. Now, this is a great picture of how posture matters with sitting. So there's lifting and sitting. And those are the two most common ones for people. Obviously, there's sport, but that's there's various different sports.

With sitting, though, this is a picture of a cog wheel type of scenario. And if you can see the guy on the left, the cog wheels really aren't in alignment. Cog wheel guy on the right shows that he mainly just corrected his lower cog and the rest of the cogs fell in line with it. And so normally, so if you guys are sitting there right now, like a really better strategy for sitting is not to raise your chest as grandmother told you to do, because that'll essentially make you like the girl on the left with lifting. She's just arching her she's bringing her chest up tall chest, proud chest, if you will, which is really not a great cue for lifting person on the right here with sitting is not doing a proud chest cue because they're not shoving their ribs into the person in front of them.

They're just dialing the pelvis forward so you can grab your pelvis, dial it forward, dial it backwards as if you're like you like you have a clock dial. You're dialing it forward and backwards and just find the middle. It doesn't have to be at either extreme. It's going to be in the middle that feels better to you. And so sitting with posture does with better posture over time does matter. But if you have neurotically better posture, it's not going to help you either. Okay, because it's really hard to find a better pressure strategy from within if you're extended all the time. Actually, when we teach it at performance place, it's actually easier to teach while the person's in neutral or even rounding like the guy on the left with bad posture.

And similarly, we actually do have some people into their 70s where they actually for quote unquote, their better posture, it hurts their body more like their back hurts more to have better posture. And if you see people walk around with walkers like rounding their back feels better. They've been doing it probably for a very long time and their body adapted over time to create bony formation. And now there's just obstructions. There's movement obstructions. Okay. Treatment. I think there's a few categories of treatment or parts of treatment which are important. The specific type of treatment, I can talk about those a little bit in turn here in a moment.

But generally speaking, there should be some assessment to figure out what to do first. Assessment to figure out what areas of the body may be contributing to the excessive load on the spine in the first place. An example would be if you had a hip replacement or you had a hip injury and you never really recovered from it. It seems like it's never been the same. At some point, that load that's been taken away, the work that's been taken away from your hip will go somewhere. It's going to go to your knee or your back. It's going to go to a neighboring joint somewhere or even the opposite hip. Work, it's like Newton's laws.

You can't, I'm trying to think of one that would relate to this really well. But generally speaking, you can't create or destroy energy, right? It's going to go somewhere or matter. You can't just create or destroy matter. But I remember the pool ball analogy. You hit one ball on another ball and then one slows and the other one takes extra energy. The same thing happens here. Load is the same. So you need to make sure your other areas of the body are working well to spare the area from progressing further with degenerative disc disease. Now, assessment of movement is important. You can even do these virtually.

I'm sure you guys have seen a lot of our videos where you see us moving because you're watching us move. Essentially, doing things on video and watching people, you can see what movement looks like. I mean, we've all watched movies and TV and we see people move. We see people do things. You can see facial expressions and so on. So there's a lot of things you can pick up on video or having a trained eye look at you. Again, in person, they can put their hands on you, but it's not always needed. A lot of things that we actually do as movement providers comes down to not only talking to you, watching you, but then also doing some assessment to confirm what we found.

A lot of times, doing a treatment like an exercise or a stretch or watching you do other things that were suggested is helpful because if we pick the right thing, you generally can do it. If we pick the wrong thing, then you feel worse. And that's a confirming test to see that maybe we pick the wrong. We need to go back and observe the movements a little bit more. Also, assessments of habits is important. If you sit very poorly or you sit very neurotically or if you lift as the person left it, as we mentioned before, then you may have load over time. And so we can give you as much tissue work and adjusting and mobilizing and medication that we want to.

But if you don't change your habits, this is going to probably continue. All right. So we have a few things there. How do you move? What are your habits? And what are areas of the body that may be contributing to your back as well? Another part is assessing chronic programming or sport. All right. Some people, it's interesting. You talk to them a little bit more and you learn what's going on with their life. And you say, well, what do you do for fun? Well, I like to hit my head against the wall. And you're here for headaches? Yeah. Why? You know, it's like, well, part of your daily ritual is hitting your head against the wall.

You know, now that might seem ridiculous to say, but, you know, people who have back pain may be doing things chronically in their day-to-day program, weight training, or sport that triggers their problem. And they have no idea they're doing it. They have no idea that it has a part into it. And we don't have to necessarily take that activity away. Like we don't have to take a back squat completely away, but you may decide to coach it differently or you may decide to give them a different version of a squat to make it so the body feels better. And then you go back to the back squat later and then build it up from there.

You don't have to take it out forever, but essentially you, you as the client are in complete control. Okay. I always tell people all this time, I remember there was a, I watched a show called Better Call Saul and I thought it was a really good scenario. If you guys have seen it, basically the attorney gave the banker advice, the banker kept ignoring the advice. And finally the banker said, well, I don't know if I want to work with you guys because you know, every, uh, things aren't going well. And the attorney came back and said, look, I've been, my job is to advise you. You can do whatever you want, but I'm advising you.

We advised you to not do that. So you decide what to do. And so you guys are all under your own control. The, but you may need advice. If you need advice, you need to seek someone with education and experience working with something like this. Ideally, you need to restore human movement as well. You need to restore the movement. If you have lost hip rotation and you need hip rotation to, to spare the spine, but you can get it back, then you need to do so. If you can't get it back because you have arthritis in the hip where it's been replaced or so on, then that's a whole different story. But if you can get it back, you need to get it back.

And sometimes that requires you to go to somebody for some help. Also, you may need to increase function where you need it to say you had a hip replacement in the hip has full range of motion and it just never fully trusted again. It hasn't worked really well, but it's theoretically, it's good. You need to restore function and that's going to require you to do some corrective exercises or some patterning exercises under the supervision of somebody typically. Now, this picture here is, this is one that describes a little bit more of like the process that people go through sometimes and what choices they take really does matter, um, based upon, uh, you know, their overall, like how they fare with an injury.

And so we see in the middle here, people have an injury and they have an experience with pain. How they decide to, to work with it from there is totally up to them. Some people will have back pain and decide I'm never doing that ever again. And in that case, they, next time back swatting comes up, they're like, I don't want to do that. And they become fearful of the movement. And then if they do it again, they become really scared about what may happen if they do it, or they just avoid the thing completely. And eventually one day they may become disabled and depressed and the body doesn't really, it's not as strong anymore.

But eventually they're going to have to help someone move. And then they pick up a couch with them and then they have pain and then they worry about it and so on. And what feeds further to the cycle is essentially bad information. Your back is, your back is a bad back. It'll never be the same again. Never lift over 20 pounds ever again. You're going to need surgery one day. It's a, it's a matter of time. Just come back when you're ready. Most of this is just complete BS. Some of it may have some truth to it. Obviously, you know, lifting a certain amount for, you know, some people at a period of time in their life is completely appropriate.

But the way things are said is really important. I'm sure many of you probably can recall something. If you like back in high school, you remember a moment with your coach where it's like, this should have been forgotten years ago, but it's not. I remember one time that I was, I tried to extend a single into a double. And at that moment, I got thrown out at second and I, and we ended the game and the coach came out and just reamed me on the bases, you know, and I haven't forgot that. There's a lot of other things that I completely forgot, you know, situation games. I never remember any again. I know one lady who was told by a physical therapist that she worked with that her ankle was the weakest ankle that she's ever seen before.

And she should never play soccer again to this day. This is 15 years ago. This girl is so afraid of using her ankle. She literally has nightmares about turning her ankle. It's her biggest fear. So installing fear in people and bad information is, it's, it's, it's a bad thing. Now, the way this can be navigated by healthcare professional and to have better verbiage is like your ankle seems like it needs some stabilization. Don't worry. You can work with that. If you decide to play soccer right now, you might have a little bit of mishap and turn it, but don't worry. We can, we can settle that down if it does happen, which is the truth.

Like last thing you want to do is say, you're the whole, you're the worst person I've ever met in life. You know, you're ugly, you know? And essentially that's kind of what we're doing, but to their other parts of their body. Now, the other scenario that you could take is the person has injury. They have an experience with pain and then they get helped out of the pain. They have less fear of movement. They're basically, they're, they're confronting their problems and they recover. Seems like a way better, way easier way to go. And that's typically what happens when you're under the guidance of somebody who can help you.

Okay. You need someone to be on your side. This happens. We, we, we see this a lot with people that with reoccurring injuries or different things that come up, um, I remember had someone recently that they got hurt while deadlifting and we're talking about it a little bit because her back had recently recovered really well. And they said, well, I got hurt, but I'm really glad this happened now because I feel like if it didn't happen with you or if it didn't happen with you, then it was going to happen at some point anyways. And I would deal with it poorly then. And I said, that's a really great way of looking at it.

You know, like normal things that are normal circumstances don't hurt. So I'm not going to say that your, your body's broken or anything. Let's just, it's not tolerant of that movement at the moment. Let's scale that back a little bit. And then we're going to reintroduce it again in a little bit. And so that's confronting it at some point in your body. Well, thank you for that over time. Now there is, I missed one of the slides here, but there's there back into the, those muscles that work a lot, the tonic phasic groups I've had, I've had people ask me recently, like, why, why do those ones always work so much?

And so one thought is that we call the lower irritability, lower irritability threshold. And so in this picture, I put a Jeep on there that is rock crawling. I've seen people do this that don't have lockers on their, on their cars. And you see one wheel spin and the other wheels don't really spin. They're just not moving because the other wheel that's spinning a lot is taking up all the, all the, all the juice. And so hypertonic muscles disrupt force coupling and normal joint mechanics in a few ways. But the first is via the lower, lower irritability threshold, meaning they don't really require much electrical impulse to contract, AKA the tire spins.

So something like, say you're doing a back squat when you really want to work your legs, but the only thing that works is your back, then usually those muscles have a lower irritability threshold. So there's a few ways to address this, but that's probably the easiest thought process with it. A couple of exercises that I'll show you a few that I like here in a few moments, and I'll take this mic off. And then we'll, we'll let the podcast people go is we're going to cover two of these side planks, planks, squats, lunges, walking, and pull-ups. I'm not going to do pull-ups today, but I thought I put that in because on there, because you got to question the idea of why, why would a pull-up her help degenerative disc disease?

Well, it's because the body works as one big unit. You ever see someone doing pull-ups and they just hyper extend their back when they're pulling up. That's because their abdominal wall may be inhibited. We went back into that lower cross syndrome, the abdominal wall is inhibited. And so essentially they're compressing their spine when they're pulling up because the rest of their body's not helping. Now you can use the pull-up as a really great corrective exercise because you can challenge them to only pull up as well, as long as essentially you, like we usually, we slap them in the stomach. Don't let me, don't let me slap you stiffen up so I can't slap in and hurt you.

And so that's the only goal that matters. The pull-up itself really doesn't matter too much. It's can they keep stiff and then pull up as well. Okay. Some prevention that you guys may or may not be familiar with is number one is movement snacks. I consider these prevention because although movement snacks can be really helpful for people who are having pain too, it may be too general to actually solve the problem or the pain that they're in. Movement snacks is simple. You snack throughout the day with, you know, certain chips and stuff that you like. Same thing with movement. Just get up and do some movement snacks.

And that might be lunging, walking more, crawling on the ground, changing postures, just something different. Snack throughout the day. It may help you. The second thing is exposing yourself to relative heaviness. I used to call this strength, but now I'm calling it relative heaviness, mainly because your body doesn't necessarily always need to be strong. I don't think. I think it just needs to be exposed to a challenge. As I mentioned before, that person who is avoiding back squats, at some point, they make someone, they help someone move a couch and they hurt themselves. The thought is that that's, they're just generally unprepared.

So exposing your body to some relative heaviness periodically would help you. So at any point in time, your body has been prepared to encounter the tasks that it may be asked to do, such as helping someone with the couch. I was asked to just earlier bring a dresser out of my dad's truck. I didn't know it was going to be that big, but I'm really thankful that I've exposed myself to some heaviness over the last few months to where my body is now ready for it. It's a preparedness issue. The third thing is picking up a few physical activities. These shouldn't be really heavy, but it should be more of just like generally being physically active running, sprinting, jumping, hanging, hitting, something like that.

Pickleball is a good choice. I prefer baseball and sprinting. Those are just my things I like, but it doesn't have to be cardiovascular fitness. It can literally be as silly as chasing squirrels and chasing dogs. The fourth thing is prevention is you want to have an assessment of chronic programming in sport. Like I mentioned earlier, sometimes the best prevention is just filling a void. If you don't do hip hinging movements in your program, because you were scared of it years ago, perhaps you add it and that may just help you condition your hip to hinge better, which will spare your spine in the future.

Now, this is, these are a few excerpts from my book. We'll put a link in the description for those of you people up, actually for the people doing the YouTube, you may find a link that comes up on the side, but pain's not here to punish you. Pain's here to protect you. Just like when you hit a touch of a hot pan, pain tells you that you're doing something that's not right for your body. For this reason, paying attention to what your pain can, what your pain can be. I can't, what, man, I wrote this and I'm having trouble reading it right now. Paying attention to your pain can be an asset as you work on recovery.

What makes your pain increase or decrease? What positions do you have no pain in? What positions do you have a lot of pain in? Can you use pain to find control over your situation? Pain truly can be an asset to your recovery if you allow it to be. This is why numbing pain with medication, ice, and heat can slow your process because it removes your body's alarm system. Next is, we have the, we call this the, I call this the map-a-load framework. This is something I developed, it's based upon a few strategies I've used over the years, but I thought the acronym would work really well. And so, M means modification of pain, A means activate the support system of the body, P means patterning movement, and A is applying load or relative heaviness when ready.

And so, this is something we cover in that book a little bit, as well as some of the other books, but this is generally how we program at Performance Place for various different types of problems, such as degenerative disc disease, to help out. And so, modifying pain is a really, really simple way to make it so your body can move well and you can sleep well and recover, but it does not create any adaptation in regards to changing how you move. It doesn't facilitate muscles that are off or dormant, and it doesn't deactivate muscles that are hyperactive. It doesn't change low irritability threshold.

It just makes you feel more comfortable. And so, activating the support system, patterning movement, and adding load are really the ways to go about with that. So, now I'm going to go into a couple exercises I thought I'd share with degenerative disc disease, and these are the favorite ones that I have that really reduce pain really well. For that, I'm going to switch over, actually, into the headphones here. And so, if you guys pause for a moment, we're going to do that. And for all you on the podcast, I want you to subscribe to the podcast and listen to the next one, but also go to the YouTube channel and check this stuff out.

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.