Understanding Low Back Pain Diagnoses and How Often They Occur

Hey, clinicians, before we start, I'm going to draw your attention to the premium version of the podcast that we have that we released back in January. It's going very well. It releases once a week and it's all the stuff that you care more about than some of the general conversation you might get in some of these free version podcasts. So it's about 15 minutes long. We do case presentations, all of the stuff that we tried, things that work, things that didn't work, and a little bit more specific to you and the things that you wish might be in there too. It's very affordable. You can quit at any time. There's a link in the description below.

Go check it out. You'll love it. Now onto the podcast. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey guys, it's Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is the first time the show. Welcome. You've missed a lot. Go back in the archives and check some stuff out. You're missing out on some nice, nice topics about low back and hip and shoulder and shoulder blade and ankle and foot. You name it, we've had it on the podcast.

We've had solo ones as well as interviews with industry experts and so on. This is a very user-friendly podcast. This is a lay public targeted podcast. There is more clinical stuff. And as you heard at the beginning, clinicians, if you're listening to this podcast, if you want to go into the nitty gritty stuff, we got stuff in the premium version for you exclusively. But today we're going to cover a really cool topic, which is understanding low back pain diagnosis. I found over the years that people tend to be very confused about their diagnosis. They get scared of their diagnosis. They get hung up on the idea that it's something that won't change.

And so I've written a couple books over the last, I'd say three years or so. One was about my back pain story. That one was called, I will be back pain. That one's available on Amazon actually. And I published about three more. They were a little bit more targeted to, hey, what do I do? Or, hey, what's my diagnosis and what treatments work? And kind of common questions that people tend to ask. It was just a more organized way of putting stuff down together in a nice framework so it can help people understand what they have to do next. The challenging thing with having an injury or having a problem is understanding how to get out of it. And I've had back pain myself. I understand that it's challenging to try to navigate your own recovery, make your own suggestions to yourself, and then convince and coach yourself to do those suggestions as well with only accountability to yourself.

I don't suggest that anybody try to treat their own ache and pain on their own. I really don't. I know I write these books that have a lot of good information in them, but it's also leading you into a point where you just ask someone for help as well. But sometimes people stumble into really good stuff when they just DIY as well. So I'm not going to lie about that. Sometimes magical stretches take things away. However, this podcast is not intended to be medical information today. So if at any point, if you do want to work with us at Performance Place, you can reach out to us. We do virtual or in person. We've had some fantastic people who have, it's gone extremely well. We have not physically touched them or met them in person because of distance or inability to work with them. And it's been perfectly fine. We have some great reviews on our Google page about them. However, we're going to go into the podcast today, mainly covering a diagnosis. The book that is in, and there's a link in the description, uh, currently this topic, uh, the, the title might change, but I kind of like this one at the moment. Uh, it's called low back pain series, part two, understanding lower back diagnosis that had not let Dr. Google lead you towards failure. This is tending to be part two after the part one, which was, um, uh, it was called the map a load framework part three, which is available as well.

That's about treatment options. So, um, I'm not going to be able to go through all the diagnosis today, but I'm going to go through the ones that are, uh, on the list. I have this big list in the book. Um, and I even, but percentages of the time that I typically see people who actually have this problem. Um, we pride ourselves on very accurate working diagnosis and, um, or, uh, or establishing good exam and good history practices to make sure we hit the nail on the head. And I'm surprised how many times people actually don't have the things that they think they have, or they've been given a diagnosis, which is, um, you know, I want to be nice to the other healthcare providers. I said, I said, um, you know, um, in a polite way, I disagree. I think this is what's going on. Here's why. Um, and usually the history and diagnosis will lead us there. So I'm going to go down this list and just give you the percentage of the things that I usually see. Uh, some of the healthcare listeners might disagree with this, but facet syndrome for lower back pain, I'd say of someone who walks in, I know this percentages won't add up to a hundred and that's because people can have multiple diagnoses, but if, if there were a hundred people walking in only 10 people would have facet syndrome, scar tissue, 5%, spondylolisthesis under 5%, uh, uh, spinal or foraminal stenosis about 10%.

Keep in mind, I work with people who are about, you know, 40 to 50 years old or so kind of that middle age type of population. If I worked with older people, uh, I like into the eighties and seventies, I might see more of, of those spinal foraminal stenosis cases too. Muscle strains under 5%. Piriformis syndrome under 5%. SI joint under 5%. Um, being out of alignment, uh, it's not really diagnosis, but under 5%. Uh, one leg is longer than another or uneven hips under 5%. Disc herniations, I'd say easily 60 pinched nerve, uh, or, or radiculopathy, we call it 30%. Uh, spinal fractures under 5% arthritis as being a symptom generator, uh, let's say 10% or so. Um, uh, hereditary family types of back pain under 5%. Age related, which is not really diagnosis either, but people come in talking about it under 5%. Chronic pain or what we would deem as increased sensitivity or some other type of, uh, um, psychosocial aspect associated with it 30%. And then the scary, big, bad, scary stuff, like, you know, tumors, infections, like all the stuff that you don't want that, that a lot of us are scared of. Uh, that's why I call it scary stuff. Um, 3% or less. It's not super, super common, but your practitioner can help you kind of find your way and figure out what to do. Um, now you might be wondering like, how do I get the correct diagnosis for me? Well, um, it's a team approach. It really is a team approach. Um, in the books, I kind of talk about establishing a team. Your team might include a chiropractor, a physical therapist, a medical doctor, an orthopedic surgeon, a massage therapist, a strength coach, a medical exercise specialist, a yoga instructor. It might include all of those or none of those, or sorry, I don't want to say none of those, but you know, only a couple. Um, sometimes people can put on different hats for you. Uh, you might find someone who is a, um, a massage therapist, but also they, um, do personal training. Uh, you might find, uh, an orthopedic surgeon who does really, really well at, at, at screening out all the other type of, um, um, like baseline stuff. Um, so it, it just depends, but I don't suggest you have a team of one. All right. At some point, if you look at this team approach as someone is, as people helping you find your diagnosis, as well as figuring out how to deal with it, um, you can present the problem to your team. You guys can be like Sherlock Holmes and Dr.

Watson, and here's the information. And then you figure out what to do about it. Um, it's as simple as that most of the time, but I'm going to cover a couple of these diagnosis, the ones that are the, um, let's cover the ones that are a little bit more of a, um, let's do controversial ones because, because those are the ones that I'm probably going to get a little backlash on. Um, let's start with scar tissue because, uh, scar tissue of the back to create back pain itself is something that I've kind of battled with over the years. Um, uh, back in the day, I used to do a lot more, a lot more soft tissue work, um, into the areas of the low back, the QL, the, the piriformis, the hip flexors and so on.

Um, and you know, it was funny. Like, I know that like clients would ask me, do you, what do you feel? And I don't know, I really don't. I mean, I've, I've probably spent, I've easily spent, you know, six, seven, eight years doing soft tissue work on a daily basis. I don't think I can feel any, I can't diagnose scar tissue that way. I can't anyways, maybe other people are better at it than me. Um, but it's not extremely, um, common. The reason why I'd say like scar tissue, I know that we talk about microtrauma and so on. I don't want to disregard the whole thing with it, but I think it's overly utilized. And the, the, the trouble I see with, um, considering that you have scar tissue is that there's a, there's kind of like this thing where they say, it's always this need to quote unquote, break it up. Scar tissue in itself is really strong. Uh, it's made of collagen.

Collagen is, is if you did ounce for ounce, uh, it's stronger than steel is strong. It ain't going to break up. Like, I think we'll probably what we're doing a little bit more of is maybe creating a slide amongst adjacent tissues or creating tissue glide. Uh, I think that's a little bit more probable, but I don't think there's actually, there's actually scar tissue that's creating a symptom generator. Now, can you have actual scar tissue? Yes. On my elbow, I got cleated when I was playing in high school baseball. I have granular, I guess, scar tissue there. You can see it. It's different than the other tissues. It doesn't hurt. Scars don't have to hurt. And most scars don't hurt, but there's other things that can happen around scars, which can create pain as well. Um, I guess, uh, adjacent slide can be an issue. Also nerve bundles around the area might become a little bit irritated too. There's other aspects of pain that could be associated with it as well. Uh, however, for the most part, uh, I don't think when you're getting tissue work on what you're really getting the benefit of is the breaking of the scar tissue. I think there's other benefits to it. Um, I don't think we can discount the, the, that scar, that, uh, deep tissue work, uh, and manual therapies help.

They certainly help. But the reason why I'm bringing this topic up today is, and I wrote this in the book is because it, there's certain diagnosis that we give people, uh, and clinicians, I think you should hear, you know, hear this some, cause I, I, I'm sure people have come in and they said, well, I got this scar tissue. And you're like, well, how do you know that? I said, someone told me. And then whether you agree with it or not is a whole different story. But, um, uh, let's just say if you didn't agree with the diagnosis, this belief is ingrained in a lot of people's minds, you know, it's, it's something it's almost like grandma said, put like a piece of steak on your eye when it's, when it's, when you got hit in the head, like it's something that just is hard to break them of that belief system. And sometimes because we only have a certain amount of time in the day, getting the, getting one treatment done in substitution for another is not necessarily, it's not possible. Like they're robbing themselves of time. So I don't tend to tell people I have scar tissue anymore. I used to, um, also to, um, scar tissue. I think if we're talking about an actual intramuscular tear or a tissue disruption, I think a lot of times probably we'd find is, um, we'd find that there was around the time of injury, there was a bruise that formed, right? Cause if there was actual tissue disruption, there was a bruise that formed. Uh, I did a whole podcast back in the day about the, uh, um, uh, it was, there, there was a consensus statement back in 2012, um, of, of muscular injuries. Uh, and they basically started recategorizing things like strains and, um, uh, other types of lower grade, non-visible, um, uh, muscular injuries. And the interesting thing was that, so if, if someone came in with, with sciatica and their hamstring was tight, that is a muscular injury, but it's a, it's a, uh, an injury that is derived from a different area. It's not necessarily, it's not a scar tissue because there's not any tissue disruption. It's just the muscle hurts, but it's referred there. Um, anything above a grade two or something that can be visibly seen on an MRI such, uh, or, or a, um, an ultrasound might have, might develop scar tissue. Yes. If you had a grade two tear and above, you'll probably have some scar tissue formation. Um, in that case, something like a manual therapy or loading the area to increase the resiliency of the tissue as it started to form is, is definitely merited, but let's, let's make sure that we're not too hung up on the idea of scar tissue. Manual therapy can help, but it's, I don't believe it's the scar tissue. And am I, I'm going to reserve the right to change my mind on this, uh, over the years, by the way. But at this point in time, this is kind of what I think what we're, we're dealing with. Now let's move on to, um, another one.

I've done a lot of podcasts on this before we talked about disc herniations. I should probably talk about this one as being, um, I want to talk about it because it's a common one. Uh, I'd say it's easily 60% of the people that we see come in. Um, it's a lot of the classic, uh, I can't bend forward. Um, my QL gets on spasm because I'm bending forward. Sitting too long bothers me and I start to stand up and it starts to hurt. Um, uh, bending forward, like I said, bending backwards is normally okay, but it's not always, um, first thing in the morning, it tends to hurt putting on shoes, getting down to cars, um, coughing, sneezing, bearing down. Um, and it's funny.

There's some of those ones are outliers too. Um, like there's, there's information that the client gives us a lot of times. It gives us an idea of, of how to, um, you're like, it's, it's not a smoking gun necessarily, but it's like, huh, it's interesting. This, this isn't adding up, but this information they gave us is a little bit more heavily weighted than anything else. I'll give an example. Um, usually with, with, uh, ruling out disc herniations, like usually I am, I'm of the thought that we treat it first as a disc, just cause it's so common. Uh, if it doesn't work, it doesn't work. And then, you know, you'll know to go to a different direction, but because it could be, um, we have the responsibility of treating it first. It's just so highly probable. Um, I'd say easily 60% of lower back pain as well as hip pain into the backside of the hip is from some type of disc irritation, whether it be a herniation or protrusion or prolapse or whatever, it's a disc irritation of some type. Um, and not everybody is, is the classic presentation, but, um, we had someone the other day who came in. Um, it was interesting bending forward, no pain, sitting, no pain, bending backwards, sitting bending backwards, uh, you know, um, uh, they had the positive, we'll call Kemp's test and stuff. A lot of, a lot of the backward bending stuff really bothered them. Um, and usually that's not really common with something like a disc. And so, like I said, we treat it like a disc until it's not a disc. And you just see that the outlier information that he had that kept pushing me back that way is he said, when he coughs, it hurts, you know? And I'm like, it's okay. So I got to, it wouldn't be a facet thing. Uh, it wouldn't be a nerve root as much. It wouldn't be scar tissue.

And it went, okay, so let's just see. Cause it's gone. We actually treated him as a disc. Um, uh, and it only took five minutes or so. And he was able to stand up and bend backwards. Like, oh, all the pain is gone. And, uh, it was just surprising because normally if bending backwards was painful, you'd think something a little bit more like a posterior element of the spine, like a facet, um, a pinched nerve or, or something of that nature, but, or even like a stenosis, uh, a foraminal stenosis or something like that. But it wasn't, um, disc herniations are super common. Uh, I know there's the whole thing about, uh, sometimes they hurt, sometimes they don't. Uh, I can tell you my personal experience with them is, is that, uh, uh, it's, there was, um, I was diagnosed with a three millimeter central disc protrusion when I was 15. Uh, this is what my first book was all about.

And I had back pain for probably, I want to say it was three, four months. And then I improved by finally getting the right care. And, um, I didn't have any back pain again until 35. And then I decided to get an image done again, just to see if anything's going on. Because at the time I actually had, um, I had a fever and stuff. Uh, I was much better, but I had a fever and everything. And I'm like, is this, maybe I got an infection or I just want to check. So I just paid, paid cash for my own MRI and guess what it showed? It showed a three millimeter central disc protrusion. It's the same one, same level. It didn't go away. And so we can almost say for the last 20 years, I've had zero back pain because I had the disc herniation because it's been there. You know, it's not very common that people get their images done when they feel good. They get it done when they feel bad, which is, you know, insurance won't give it to you just as curiosity. Uh, that's why I paid out of pocket. But, um, most people that have disc don't need to necessarily have an MRI to confirm it. I was just curious about the infection. Uh, most of them do not require injections or surgeries of any type. Uh, they can, they can be recovered from very easily. And I know it sounds scary to have, but of all the stuff that I already mentioned as the percentages of possible diagnosis, this is kind of the one you want. Like it's, it's the easiest to recover from. Um, it just hurts and it really hurts.

Um, but make sure that if you, we have a big article on, on disc, by the way, and we have a bunch of YouTube videos on it. If you want to learn more, um, or just get this book, this book, uh, covers a little bit more in detail that I'm going to right now, but it's super common and it's really recoverable. Now, the other one, this is highly probable is a pinched nerve. Um, this one is called a radiculopathy. Um, it's not uncommon for people to have more leg pain than they do with their back. Um, it's, uh, typically when we work with someone with a disc or sorry, when we work with someone with back pain, we, we have to establish, uh, is there any nerve involvement? Um, the nerve takes precedence. If we're going to treat, let's just say we had to treat a muscle spasm and then facet syndrome. And then, uh, also a nervous pinch, you have to treat the pinch nerve first, mainly because the only real urgent urgency, other than the big, bad, scary is to have a surgery is going to be to restore function. Like usually surgery is going to be more reserved for like, okay, function is degrading. This person can't go number one or number two. Um, they can't even walk. They can't raise their foot. Uh, they have a visible muscle loss on one side. Um, or they have numbness into the area of their groin area, like where they would wipe when they go to the bathroom. Like there's, there's, there's tingling numbness and not that those are criteria for, for surgeries, but you know, tingling numbness, buzzing, stabbing, shooting, um, and that lightning type of nerve pain, that's the type of stuff you got to get rid of first because the body will continue to use all those muscle spasms to protect the nerve. Your hamstring will continue to be tight if you don't deal with this nerve stuff first. Um, and there is a, um, in the books that I kind of cover a, uh, I call it a map a load framework. I won't go into it too much. Um, cause the book has all the stuff with it. Um, M is, it's an acronym. M is modification of pain. A is activate the support systems. P is patterning movement. And then a load is adding load, which is usually kind of how our rehabilitation completely goes together. Um, the last part is movement variability. Just go back and do stuff that you like and have fun with, but, um, we don't necessarily cover that in the books too much.

Um, the sometimes with things like radiculopathy is if you can't actually get it to reduce with, uh, conservative care, um, doing manual therapies, doing adjustments, doing rehabilitation, um, simple things, simple things tend to work with these things because you're going to know if you start to move your leg, it's going to start to zap you. So you just go into position where it doesn't necessarily hurt. Um, so reducing modifying pain or modifying the nerve symptom is really important and it can't really go on too, too long. You don't want it to go on too long. So there are situations where using something like a surgery might be very adequate, um, M or modification of a pain or modification of symptom with something like a nerve root impingement, if it is advanced or if there is a need, um, in one of the podcasts to come, which is not necessarily releasing yet. Um, we have one where we're talking about a, um, uh, failed back surgeries, like how to recover from failed back surgeries. It's going to be, um, number 256. I have, uh, Dawne Costantino on there with me. Uh, I do some of these out of order by the way.

And so in that podcast, it's actually, uh, I came to a conclusion. I came to a revolution like in my mind, cause we're looking up like, what's the percentages of failed back surgeries and, um, like basically their pain coming back. And one of the stats was about, I think it was around 26% of leg pain will come back after the back surgeries performed, uh, you know, within a year or two. And it was like, well, that's a failed back surgery. They would call it. And we're like, wait a minute, the surgery reduced the symptom, but it came back. So the surgery was successful, but the rehabilitation was not. And so your daily habits and the way you move and treat your body brought it back because the surgery didn't change any of that. The surgery just, um, it just modified the symptom, which there's nothing wrong with. It's perfectly appropriate to do, but how you recover with the remainder, like doing the AP and loading is important.

It's how you treat your body. Good spinal hygiene is Stuart McGill would say. So, um, yeah, so I hope that covers enough with the pinched nerve. Uh, let's see what else is going to be on this list. Uh, I hope you guys are running through your head of what you want to hear about next on this. Uh, I think, let's see, facet syndrome, scar tissue, we covered that. Uh, let's talk about the SI joint. That SI joint one is, uh, one that we do get a lot of, uh, SI joint pain is around. Like they say, it's around kind of like the sacrum where there's the big bumps on your back. Um, 20, most people want to, a lot of people don't actually feel the bumps on their back until they have pain. And then they feel the bump and they think, Oh, well, there's a bump. It might behoove you right now that if that area doesn't hurt right now, just feel and feel what normals are for you on both sides. And then you'll see at some point, if it doesn't become a problem into that area, which is not very uncommon, you'll think, Oh, I already felt that before. It's normal. Like you get to feel what normal anatomy is on yourself and finding bony landmarks. And so this area in the SI joint, uh, it's a really big, uh, concern for people, uh, rightly so, because it is right over the area that hurts. Um, but there are some things that can, um, be kind of oddballs in the area. If you actually do have something that is creating SI joint irritation, um, there's obviously the SI joint sloppiness or kind of, they say the syndrome, but there's also other things like arthritis, which can go in the area. Uh, I think there's ones that are ones you would need blood work to confirm, uh, x-rays can show signs of them as well.

And they're ones that actually would probably not respond extremely well to, um, you know, exercise or movement-based therapies like adjusting and tissue work and all that kind of stuff won't necessarily, uh, help it. Um, because there's other types of inflammatory components within it. Um, probably a lot of you thinking, well, what about turmeric and icing and so on? It's, it's a different process. Um, there's something like, uh, like it doesn't really localize in there, but let's just say rheumatoid arthritis. Rheumatoid arthritis is like a destructive type of arthritis. Like it, it kind of chews away, they call them rat bite erosions within certain joints. It starts to kind of erode the joint almost like, um, kind of like, uh, a river taking grains of sand off the shore. It starts to erode things if you, you know, ignore it. And so there's other ways to manage those types of problems, which could be the reasons for pain in the SI joint or the fingers or wherever. So there's other types of inflammatory arthritis, which can be in the area.

I think there's an interopathic one as well too. So, uh, either way, um, SI joint syndrome or the ones, the people who are, if you're out there thinking, well, maybe it's just because it's not in the right position or so on. Um, or it's actually sloppy or needs to be stabilized. Cause there are things like surgeries that go through and they kind of put pins within the SI joint to stabilize it. Um, now there's a series of, of tests that you can have your practitioner do. It's called Laslett's cluster. It's a five part series of tests or, or a collection of tests, which helps the clinician stress the actual SI joint. Now, what we know from like working with mechanical based low back pain is like to say with the low back disc, normally, if you load the disc in the area that stimulates the irritation or the air kind of, uh, Oh, let's just, let's, let's revert a little bit. If you're, if your hand had a bruise on it and I squeezed your hand, it would hurt more. So there's mechanical base or there's pressure base, uh, or the pressure would increase the pain. Uh, also if you, uh, I know I kind of irritated my thumb. I was diving in baseball a couple of weeks ago and my thumb kind of got bent back. It didn't swell up or anything. It's just kind of sensitive still to certain movements. And so if I move my finger away from my thumb away from the actual webbing of the hand, it still hurts. And so I'm loading the joint because I'm creating some strain on the joint. Now the SI joint or the low back, you can do the same thing with a good examination. Now lads its cluster as a way to stress the SI joint. And normally, which is daily movements, the SI joint would get it. Maybe it's greatest shear with lunging, walking, running or split stance activities. This is why I bring this up because when, um, we have people who come in, they're like, they bend forward and touch your toes. They're like, well, it hurts right on my SI joint when I do this. So I know it's my SI joint. It's like, well, no, because there's not appreciable, um, shear on the SI joint when you're doing that. It has to be more of a split stance. Um, so, um, within an exam, we can go through and test those areas if it's a big concern to the person, but if coughing, sneezing bothers it and bending forward or bending backwards, kind of like with, with not a split stance position, um, I, I, I should regress for a moment because I've had people before. They're like, well, it also hurts when I split my feet and I bend forward too.

Yeah. Yeah. So, but it hurts when your feet are together too. And so that information tells me that this is probably not, or there's other considerations first. And so just be considerate that, uh, even with sitting, there's not really appreciable load on the SI joint. Um, so if it hurts more after sitting, then maybe not. Right. So the SI joint, like I said, it's under 5%. I think I have seen one over my 12 years of practice, um, that popped up positive on all, uh, on a lot of those tests and there were negative with a lot of the other ones. But the cool thing is that you're probably going to rehab it a similar way. You're going to find something that modifies the pain. It could just be as simple as don't do that. Whatever's, whatever's irritating it. Uh, and activating the support systems could be core stuff, glute stuff and, um, patterning movement and loading. It's the same thing. Okay.

So the last one, I think we should maybe go through cause we're about 29 minutes into this podcast is where should we go. We're going to pick one more of these things. Uh, let's see. What do we have again? We have our facet syndrome, but you know, we should go for spine, spinal or foraminal stenosis. I like that one. Now spinal or foraminal stenosis is a first. I should probably note that we can categorize arthritis within this one too. Um, you know what I should know what I should have wrote in here. Degenerative disc disease. Let's do that. Okay. Degenerative disc disease is not going to be too different from your spinal or foraminal stenosis. It's not going to be too different from your arthritis either. It's just a really bad way of describing things. Okay. Degenerative disc disease. Uh, I think they should go backwards in time and rename this thing to, I think you have no problem possibility of recovering from this back pain syndrome. The effects of telling somebody that they have degenerative disc disease. It sounds like they're going to degenerate away and nothing's going to ever make it better. So why try? I don't know how many people I've met who have been told this. And I think it's like the mental effects on them and, um, is it's astounding, especially if they haven't really responded well to, to care. Um, I'm not going to say that, um, foraminal stenosis or spinal stenosis or arthritis and degenerative joint doesn't like, I don't want to say it doesn't exist. Um, there's signs of things, but it's not typically a symptom generator. Um, it can be, it certainly can be. We had somebody with foraminal stenosis, which is a narrowing of the hole that the nerve goes out of one of the nerve was out of in the back of the spine. It created upper glute pain and sacral pain, like kind of pain around the sacrum for her, the SI joint only to have her do was open the foramen by rounding her back.

And she actually was able to run within about a two weeks period of time. Um, for foraminal stenosis or a spinal stenosis, that's a little bit more complicated. Um, I don't have a solid answer for that one now because that one is a problem with the center hole of where the actual spinal cord is. Uh, I know there's ways that you can position yourself to elongate the actual or thin the spinal cord as it goes through a narrower canal, but that one's a little bit more of a, uh, probably off topic for the podcast, but for degenerative disc, God, if you've been told that, uh, I would try to rethink it. I'm not going to say you don't have arthritis findings in this, in the x-rays. I'm not going to say things don't look kind of, uh, different in one area of the spine versus another, but degenerative disc is, is basically a collection of observations within an x-ray. All right. I bet if you're like me, you had back pain say today, and then tomorrow you don't, or it's better. Like there's days and time, there's times of the days and there's days or weeks period of time where you actually feel fine. There's some people who feel fine for a year at a time and then their back pain comes back. So that degenerative finding, or sorry, the arthritic finding that what we call, we tend to call it gray hair of the spine. Since gray hair doesn't hurt. I got about 50 of them right now. They don't hurt. And, um, to think that they do hurt is going to drive you a little bit more, more crazy than you need to. It's just a sign of aging. Okay. I've met people who in their thirties who have been told they have degenerative disc disease and they think it's a death sentence. I've met people in their sixties. Uh, and I met a lot of people, like I said, who have had good and bad days, good times and bad times, and that's not going to, it's the, the actual visual finding on the x-ray will not go away. So why try? Why even bother with that finding? Okay. What you can do is you can find out what movements bother your spine, just like the other, just like the other, um, the other diagnosis I talked about and, um, rehabilitate yourself that way. All right. Or, or get your team member to help you. Um, people we've seen a lot of people with degenerative disc disease in our clinic. It's typically not that hard to rehab them. It's really not. Um, and I don't, I'm not saying that we're doing anything super fancy, but typically if you stabilize the spine, I'll give you a couple of hints, at least that work well for us. Um, hard style planks work really well. I mean, I think, I think if we were to go through a list of the exercises that we most commonly use, um, I'd say 90% of the day is hard style planks, side planks, glute, banded glute bridges, bird dogs, uh, dead lifting, split squatting, um, uh, overhead pull downs, low bears, diagonal sits. You can probably YouTube a lot of these things too. We have videos on a lot of them. Um, a lot of these things are, we call isometric core work or isometric, uh, work of the core to stiffen up. Uh, also a lot of the ball socket work we do is, is it requires stiffness of the core and then movement of the ball socket joint under some load, like pull downs and split squats and dead lifting. Okay. Um, I don't know if there's more to cover on that. I hope that I didn't sound too, too brash on it, but it, it really frustrates me to see how defeated people are when they've been told that they have massive amounts of scar tissue or that they have degeneration of the spine it's, it really doesn't have to be that way. Okay. I believe in diagnosis. I really do.

Like I diagnose people, uh, when I see them, uh, in our clinic, uh, Dawne Costantino diagnosis people as well. We give people diagnoses, but a better way to look at this is figure out what movements your body can't currently tolerate. Hey, you got, uh, you have, uh, let's go with, um, foraminal stenosis. It hurts to bend backwards, but bending forward feels perfectly fine. Do that. And after a couple of weeks, we're going to have you been backwards a little bit more. Does that sound good? Well, or we can say, well, it hurts to walk too far. Well, then it's okay to sit down every once in a while. You know, well, it hurts to do a bird dog exercise. Well, don't do it. How does the side playing feel? It feels fine. How's the hard playing feel? It feels fine. Do those. Um, if you consider what your body is tolerant of at the moment, I think you'll find a lot more freedom in what you can do.

If it feels, if it, if your back hurts to bend forward for like at this point in time, consider yourself not as you can't do that ever again, consider it as you just currently can't do it. And there's nothing wrong with that. Like I, I, there's been times where I go out in the sun. Like I remember one time I went, I went to Mexico and the first day I was there, I got burnt and I had to wear a t-shirt for remainder of the time. Cause I was solar intolerant. The sun was not tolerable on my skin. It doesn't mean don't go out in the sun ever again. It just means this is going to be about a week's period of time that I, I just did too much too soon. Uh, I could have maybe done more sunblock or wear a shirt half the day. Like I, I could have, I don't want to beat myself up about what I could have done better necessarily. But if I look at it as look, this is just a momentary period of time where I can't do a certain thing or certain movement or certain activity. It doesn't mean you can't get it back. It just means currently it's the easiest thing to do is just don't do that and do something else that feels fine. Most of the time people's, most of the time people's spine, regardless of the diagnosis, whether you agree with it or not, is not going to explode.

It's not necessarily going to, it's not going to explode and just all of a sudden, um, get terribly bad and you're going to be physically disabled forever. Okay. I know there are times where you've been forward and right, but if you've had it before, you've probably recognized that it, it does get better. You know, it's not like you're physically disabled forever. Uh, it just, and it gets scary. Like it's scary to do it again. I totally recognize that as well, but, um, the body's pretty resilient. Uh, I've come to realize that over the years of working with people is, um, like there's surprisingly how I am surprised how many things people do that I, that, um, don't hurt their body. Uh, even if I tell them don't do that for a week and they still do it, they still come back fine a lot of times, you know, the body's resilient. Uh, and I think as, as long as you look at yourself that way, you might realize that a lot of these diagnosis, although they might sound very complicated and scary, they don't, it doesn't mean the end of your life and it doesn't mean the end of what you want to do. Um, I've had back pain. I play baseball again. I play baseball again. I run again. I lift again. I sit with bad posture again. Like there's nothing wrong with doing that again. And it's, you want to restore human movement. Uh, I know that you guys know that podcast is called restoring human movement, but, um, think, I want you to think about why it's called that because we're, we're going to remove human movement just for a short period of time. And then we're going to restore human movement, bringing it back. Sometimes the easiest thing to do is don't do that for a little bit and then start to do it again slowly until your body is acceptable of it. Okay. Um, I'll briefly cover just a few more things here because I know I've got a little bit more of a lecture on a few of these things today, but I hope it was helpful to you guys. Um, there are chapters about being out of alignment and one leg being longer and so on. Um, these are under 5% or so, uh, I don't think they're very, I don't think they're very important quite honestly.

Uh, and you'll see the reasons why if you end up buying the book. Uh, but I don't think they're a major reason to concern. And I only bring it up because I've had people who they say, well, like, well, we really want to work with you, but, uh, we can't come see you all the time to get, uh, aligned. And I'm like, you don't need to. Like we've seen a lot of people over the years who we have not actually had to adjust or length or even their hips out to make them feel better. We haven't had to give them anything like, like a, uh, a lift for their shoe to make them feel better. Now, is there a time and place for these things? Sure. There definitely is, but most of the time there's other ways to accomplish the M or modification of, of pain category other than just having just someone work with you. We've done tissue work. We've done adjustments. We've done a lot of things, uh, we've done cupping. We've done a lot of things that help out to modify pain or, um, or reduce people's pain, which is, again, it's very helpful. Um, but at the same time, it's, it's not everything. It's, it's not all the parts of recovery. Um, activating the support system, patterning movement and applying load, making your body work a little bit. It, they don't, the M category treatments of people do to you will not substitute for those categories. Okay. I always think of rehabilitation as like a dojo type of thing. I've never been into karate, but I would imagine the point of karate is self-defense. And so you're practicing in a controlled setting against people that, you know, self-defense. If someone's going to creep up on you and grab you, you learn to defend yourself and I'm sure you don't use it every day, but if someone were to creep up on you in real life, you would automatically go into dojo mode. Like you go into karate mode.

And so learning how to lift weights again, how to move objects, um, and how to move your body in a, in a painless way, uh, even challenging way is the dojo. All right. We're using different implements and tools and weights and backpacks to help you figure out how to navigate loads that you're going to, you're going to find every day. I'm sure when you woke up and, and, uh, you know, picked up, if you, if you cook on cast iron stoves, like me, those things are like 20, 30 pounds, right? A stove is a lot. Some people hurt themselves just by picking up things off the floor. Like everything has load. Everything has mass. Everything has weight. Everything has a load.

They're big objects. They sometimes weigh a little bit. They're little objects that sometimes weigh a lot. And that's the whole point of recovery. Being able to live your life, play your sport and have fun. And these diagnosis, although they are important, uh, they will not necessarily like identifying, like that you have a, uh, that, that, that you have a disc issue is one thing, but how learning how to solve it is something else. All right. I know a lot of smart people who know what their diagnosis is, but how to get out of pain and how to recover is a different story. I was no exception to that. I needed to ask someone for help. Okay. So, um, the big hitters on the diagnosis list, I'll do a rewind here.

The big hitters is, uh, disc herniation. It tops the whole list of about 60%. If I were to fear to put a gun to my head and make me guess 60% are going to be some type of disc irritation. Uh, 30% is going to be pinched nerves. Another 30% is going to be chronic pain. I won't be covering chronic pain in this. I have covered chronic pain in another podcast. Um, there's, it's a lot more complexity to it. Um, so, uh, generally chronic pain is beyond six months of having your problem. There's other aspects that will create pain other than just structural abnormalities or structural, uh, uh, structural driven symptoms.

Okay. It's a little bit more than just pricking your finger anymore. So this is the reason why addressing things very soon is it, it helps things out. It makes it less complicated, not to say chronic pain can't improve. It just makes it just a little bit more challenging. There's other considerations we have to do. So, uh, sooner the better. Uh, I hope you guys liked this podcast. Uh, please subscribe to it. We have a lot more really cool topics to come. Uh, we have understanding hip and groin pain diagnosis next time. Then we have, should I stretch or strengthen my low back? Why does my low back get crooked? Why does my back pain come only in the morning?

My low back pain MRI says it's normal, but I have pain. What the hell? Uh, failed low back surgeries and how to recover. What I mentioned with, uh, Dawne Costantino, uh, posterior, uh, intern posterior tilt. Is it bad? Perfect posture could be creating your pain. And here's how spinal stenosis, non-surgical treatment options. They may work. That'll take us all the way into May. I like to be way ahead of things if I possibly can. Um, and so you guys, if you want to learn more about low back diagnosis, please access the book. It's in the link description. Um, you'll get a PDF and you'll, and yeah, you'll get it. I continue to update all of the literature that I write. Um, if you find any spelling errors, it's actually been spell checked quite a few times and we had a professional editor come through as well. So if you find anything, uh, I'd love to hear your input. I'm, I'm, I'm not, uh, absent of imperfections. Uh, I have imperfections and one of them is grammar and spelling. Darn it. But all these read pretty well for me anyways. So, uh, hope you enjoyed. I'll see you guys next time. Take care.