Treatment Options for Low Back Pain and How to Choose Them

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 everyone, this is Sebastian, your host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is your first time to show. Welcome. It's been a lot of episodes so far. I think we're on 250 plus or minus 10. I don't know anymore. We're releasing once every two weeks at this point because life did get busy for me. This show is very user friendly. It's very lay public friendly. It's to help you guys find the right care for your problems, your mental, not mental problems. We're going to go with mainly musculoskeletal problems. There is a mental aspect to recovery for a lot of people, so there's obviously that part in it too. In the past, we've interviewed industry experts. We've gone over some simple things that you can do. And for various parts of the body, we've gone through low back, hip, shoulder, knee, ankle. We've done pretty much everything here. And so scroll back into the archives and find what you want to listen to and check it out. Today is going to be a solo podcast. That's just me. And we're going to cover something simple.

Which is going to be treatment options for lower back pain. I know a lot of people do suffer from lower back pain. And I'm not going to go into full detail with all the options, but these are a lot of the ones that we hear about at Performance Place. And I did write actually a pretty long book on this. It's a, I don't want to say book. It's a, it's an ebook that we offer on the website as well. And we do have a lot of people ask us about lower back pain. And so, uh, there's a, uh, the current title of that book is called understanding low back treatments of what works for most people. Uh, understanding that actually low back pain is different for some people versus others is a good starting point because what's some people respond to, uh, other people won't. And what, uh, sometimes what makes some people feel better can make people, other people feel worse. And so that's like the conundrum that you end up seeing. Like if you go through on, you know, all these forums online, it's like, well, all I had to do was stretch and I feel better. And then you see someone else comment where they're like, well, I stretched and it felt worse. And they're like, well, I tried ART and that worked. And someone else's why I did that. And I went to 30 sessions. It didn't help. And I tried an adjustment and that works. And no one's like, well, adjustments made me feel worse. So how do you know what to do? Because there's a lot of disarray. There's a lot of difference of opinion, you know, what works for your friend might not work for you and vice versa. Um, the first, uh, first advice I can give you on this is that, uh, treatment options are best selected when you know what's going on with you. And so that comes with in the form of having someone actually help you figure out what's going on with you. Self-diagnosis does not count. Um, it actually might make you pick the wrong treatment option for you. And so typically someone will need to spend about 30 to 40 minutes helping you figure things out. Uh, I like to consider this like a Sherlock Holmes and Dr. Watson type of approach. Your Dr. Watson, whoever helps you figure things out is Sherlock Holmes. And so I know with that show, uh, and Scooby doo, it's like most of the time they're figuring stuff out before they actually figure out what's going on. It's only the last, probably 10% of the show where they're like, oh my gosh, there's the villain, you know, and then they start to figure out how to solve that problem.

Most of the time they're collecting clues and figuring out what they should do. They're strategizing. And so it's basically what you pay a professional for. Um, the professional should be willing to listen to you. The professional should be willing to brainstorm with you and discuss things with you. Uh, they should be able to tell you what's going on and what might not be going on. And by the way, images are extra information with this whole process. X-rays, MRIs, uh, CTs, um, NCVs, EMGs, all these ones are extra things that can give Sherlock Holmes and Dr. Watson information, but they're not a smoking gun. Okay. So, so some of the things we might cover today, I'm just going to look over the list that I have on the, the, the ebook that I have is we have deep tissue work, corrective exercise, foam rolling, stretching, acupuncture, chiropractic adjustments, physical therapy, yoga, personal training, heat, ice, medications, um, uh, nutritional changes, surgeries.

And then that's kind of all I have on there. Um, I have another book as well, which is available, which is about diagnosing, uh, or diagnoses. And that one is also available on the website. You can check it out at p2sportscare.com. Just search low back and the search function is called understanding low back diagnosis and hadn't a lot, not let Dr. Google's lead you to failure because that's what typically happens. Okay. And so I'll probably do another, do another podcast on that topic as well, if I haven't already. So the first one we're going to go into is, is deep tissue massage. Um, there's many different types of deep tissue massage. I should probably start with that.

Um, you know, there's, there's Rolfine, there's Stecco, there's fashion manipulation, there's active release, there's, um, just general deep tissue work. There's, there's so many, there's so many. Um, I had a intern who was, she went to massage therapy school. And so she informed me of all these different types of massages and techniques that were used. Um, and so she actually came to find that some conditions like say acute low back pain where you can't actually get off the floor, didn't actually respond super well to things like soft tissue work. And so she was kind of at a, at a loss of, I don't know what to do with these people. When she found out later, there's other, either other actual treatments that work better for these people. Um, a lot of times people will get deep tissue work to your quadratus, the borne muscle, their paraspinous muscle, their, um, piriformis, their glutes, uh, upper back. And all the, although these things can help, it doesn't mean they're necessarily the only part of the puzzle you need to address.

In the books that I write, uh, I talk about the MAPA load framework. So it's MAPA. No, MAP is all capital A and then load framework. And the way I describe this is, uh, M is modification of pain. And so some of these treatment options that you maybe have found do address modification of pain. And there's nothing wrong with that. This process of finding something that will reduce your pain and modify your pain is actually a good thing. And a lot of people do need it. But the problem is when people find treatments that they do, uh, uh, they might find five treatments that they're, that they're using it at this point in time. And all of them address them, the M category, the M category. If it's full, it's full. Don't add more to it.

The second category is a, which is activate the support systems. And this typically requires some work on your, on your part, which is like isometric core work, something that's challenging glute work, um, glute primers, um, uh, patterning exercises are coming next, which is the P P is patterning movements. Some people need to learn to move in a way that doesn't hurt them. Um, not to say there's a perfect way to move or bend over and pick something up. But when your body is in pain and you have lower back pain, sometimes rounding your back to look, to pick something up off the floor is something you want to avoid for a little bit. So sometimes people need to be patterned or coached into doing things in a way that they're going to experience every day that doesn't, uh, trigger their problem. And the last one is adding a load, which is the, a load section. Loading is usually something in the form of weights or simulation of weights that you'll find throughout the day. Uh, I know that people are like, well, I don't weight lift. Well, you pick up a kid and kids 30 pounds, you move their car stuff in, in and out of the car, which are big and bulky and 20 pounds. And I've seen diaper bags. Holy crap. I've seen diaper bags. Those things are big. And considering that somebody who just gave birth is carrying around all of these, lugging all these things around. Yeah, there's loads involved in it. Gravity is a load. Your body weights a load. Um, things, things are loads. Okay. Dog food, um, dogs in and out of cars. Um, everything, everything has a load unless you're on it. Even on a different planet, things have loads to them. They're just big or small really. And so at some point you'll need to encounter loading and it's best to do that in a format where you are in like a, let's just say a dojo. Okay. If you are anticipating not getting attacked one day, or at least to stall off an attack and, you know, um, get rid of the attacker. No, a lot of times that you would simulate the attack. And then that way, when, if an attack happens, you can just navigate it without having to think about it. And that's the whole point of a rehabilitation process with loading is you add load.

So when load comes at you and loads around your body knows how to navigate load in a subconscious way, you don't have to think about it or worry about it even because a lot of times people with low back pain, they'll just, you know, uh, I can't, I can't touch that. It's a, it's, it's just too heavy for me. It's 10 pounds. Like just like, this is something that can easily be done in a rehabilitation setting. Most rehab places will have 10 pounds. And if they teach you how to move the 10 pounds, they're doing you a big service. And that can be done as simple, as soon as like day one or day two. A lot of times, um, we've had people who have acute low back pain or just like really stabby low back pain who we have picking up, uh, 10, 20 pound weights on day one. And it feels good to them.

And they're thankful for it because now they can move the laundry around and big laundry basket. So, um, that is the map a load framework, which I go full in detail, uh, in the books as well. But a lot of these things will fall into the M, A, P or L category. And I'll mention it when we get there. And so the deep tissue massage, again, nothing wrong with it. It is helpful in some cases, but it addresses the M portion of the category. The next thing is corrective exercises. And I like to add corrective exercises to a lot of people because I find that most people, quite honestly, they fill their M category with way too much stuff and they don't really add the, a category, which corrective exercises fall into because you're activating a support system, a support system. So the spine doesn't have to work so darn hard in the area that's actually creating the pain, such as a nerve root, a disc, um, even a fracture doesn't have to become triggered so often with just daily activities.

Now, people who are generally deconditioned or inactive overall, they might have to get to the point of what we call GPP, which is general physical preparedness. In my eyes, general physical preparedness is something that everybody should be able to attain, whether they're young, old, or whatever. Um, because at some point, if you are in a burning building, you should be able to save yourself. If you were walking across the street in a car turned in front of you, you should be able to scurry out of the way a little bit. You know, you don't need to be quote unquote athletic. You just have to be able to be not, um, it would be self-sufficient. Basically, everybody should be able to walk up and downstairs, um, a flight of stairs without being winded. Everybody should be able to get on and off the toilet. Um, everybody should be able to get down to the ground and back up without grunting. Um, and so there's a lot of things that people, a lot of people should be able to do generally.

And now I know that if some of you can't, and it's because you're in pain, I feel you, I got it. But once you modify pain, you will probably want to get back to general physical preparedness because that is the way that you should be, that you should, you'll be independent in life, right? Nobody wants to typically have someone, um, have to caretake for them too soon in life. So, um, for athletes, they might have to do a little bit more stuff, but corrective exercises is an early entry point for activating the body's support system. So the A category. Now, the funny thing is, I know I've said this many times to people, but I said, you know why they call it a corrective exercise? And they said, no, I said, because you're correcting something.

It doesn't mean you do it forever. I mean, you correct it and then you move away from it. Like you get people out of the corrective exercise category as soon as humanly possible, which could be as soon as one week, two weeks, a month and a half. It just depends on where the person's starting point is, uh, how much their pain modification is helping them. Uh, and sometimes corrective exercise in the form of people who are lack general physical preparedness, it can be as, as, um, it can reduce more pain than things like injection to medication sometimes because you're supporting the spine. Now, usually when you move away from corrective exercise, you're moving into the patterning and loading process, which is where you want to be. Uh, corrective exercises can be done, um, in physical therapy clinics, chiropractic clinics, personal trainers, and strength coaches.

Oftentimes we'll use these things as a warmup. It's just the semantics of how you word it. A plank is a plank is a plank. So it doesn't matter who shows it to you as long as it feels like it's challenging and it's not painful. Okay. Now the next one is foam rolling. Um, I know I'm blowing going through these, but we're already 13 minutes in this podcast and we're only going to spend about 30 minutes. So, uh, I don't know how many we'll get through, but foam rolling. Uh, I think foam rolling is a great tool for things around the low back, but not necessarily on the low back. And so usually, um, adding it to the hips and mid backs and upper backs and, and, um, quads and so on.

It's good. I think it's fine, but it also falls into the M category. M is great. It's needed, but a lot of times I've met people who go on to their foam roller and they try to get back back up and they're just hot mess. Like their back just is screaming at them, but they've been told by a friend that they need to use it. So they use it. And then they get up screaming thinking that, well, I, uh, I got to suffer through this because my friend told me to help them. Well, it helps your friend doesn't mean it helps you. You might find a better M category than they did for you. Okay. You might find that deep tissue work works better for your, for your M category.

You might find that adjustments work better or ice or heat or something else. And so it doesn't matter how you fill the M category, but generally, um, if the back doesn't like the foam rolling, then you might want, might not want to do the foam rolling. Now, stretching is the same thing. It's an M category and it kind of falls into the same pretenses as foam rolling foam rolling. If it doesn't feel good, don't do the foam rolling. If stretching doesn't feel good, don't do the stretching. We've met a lot of people over the years that, that their low back pain also has an aspect we call neural tension with it. Usually people will call this sciatica where it shoots down their leg into their calf, into their foot, or their foot gets numb at some point, or they noticed that there's a lot of tightnesses below the knee. Stretching this area typically does not go well for these people. And we've met a lot of people actually over the years where if they stretch, they actually increase their pain.

And we simply to give them one suggestion is don't stretch. And all of a sudden over the course of a week, most of their pain goes away. It's phenomenal the way it works. The body knows the body knows that if it's does, if it's not good for it, then it'll tell you that it's in pain. And if it's better for it, it'll tell you that you feel better. And so if stretching is the M category that you've chosen and it's not working for you, you might want to find a new M category. Considering the reason why muscles get tight in the first place, if you need to go backwards into one of the podcasts called the mobility stability continuum, it might be useful for you. I think I did it about a couple months ago.

And so that one describes why certain muscles get tight and what you might want to consider to reduce the amount of tightness or spasm in that muscle. The fact of the matter is that muscles are protective or muscle spasms are protective at some, uh, for a lot of the time, they're just pawns in the game of chess. They're trying to guard the queen and the king. And so if in the court, in the situation of sciatica, if your hamstring is tight, it's tight because it's trying to stop you from stretching the heck out of the sciatic nerve because the sciatic nerve is just irritated and pissed because that happens sometimes when people have back pain, but it doesn't always. Um, by the way, it's probably important to note that people with lower back pain, uh, that have sciatica, sciatica is technically the pain below the knee. And so a lot of people call it my sciatica area, which is the hip. They usually deem it as the area of the hip in the back on the buttocks is not indicative of sciatica.

It's the leg pain that is the sciatica. So, uh, the glute pain is, is be something else, but, um, it, if you're looking at treatment options, sciatica is clinically not, not that. So, um, it might help your journey at least with some point. Now, acupuncture is the next one. Uh, again, I think this is an M category. I'm not an expert in this. Uh, we did receive some, we shadowed a little bit in school with some acupuncturists in our, in our school experience. And so I do have some experience, um, talking to quite a few acupuncturists about what's going on, but I would deem it as a little bit more of an M category. Um, I don't feel like it's effortful. And so usually things like A, P and L category use, it takes a little bit of thoughtfulness and effort and coaching. Um, but typically things that people are doing to you versus for, uh, you doing the thing for you is if they're doing it to you, it's usually an M category. So they're putting needles in you and you're, uh, either, or they're cupping you or they're doing things to you. And so those things are M category. Again, nothing wrong with M category. You just figure out what your M category needs to be. Uh, and I've met a lot of people where acupuncture has helped their low back. Um, but again, you need to fill the other categories. Rest is something that is, uh, it's the next category. It's quite, quite honestly, it's overused. Uh, I've met a lot of people who have just abused this quote unquote rest category. Um, but I've met a lot of people who use it to the advantage to their advantage, which, um, is perfect because it's a great M category, um, treatment. Uh, they find out that if they lay on their belly or their back for like even a minute or so at a time, it rejuvenates them to the point where they have absolutely zero pain. I felt this way when I had some pain in my, in my low back with, uh, walking when I was, uh, on the vacation. And I would lay down literally no more than about 30 seconds to a minute. And I would pain would be gone. It's like hitting a reset button where I can have another 30 minutes of pain-free movement. And so that's okay to do. However, things that are really beyond using, you know, 20 minutes a day of extra off your feet time, um, uh, other than just like a good night's sleep, uh, usually doesn't go well for people. Uh, they tend to have their body deload itself excessively. They end up getting weaker. Um, their core gets weaker, their hips get weaker. Uh, I think the estimation that I'd seen is that for every day of quote unquote bed rest that you do, it takes four days to recover. And so if we're considering that the map a load framework works for people, which I found that it does the a P and L category have now become harder for you.

Okay. But if bed rest is helpful, I'm always okay with three to five days of people just kind of taken an easy, we'll say, but that doesn't mean they're not doing stuff around the house. Um, I know people who have been laid up, like they can't get off the floor. They still crawl to the bathroom. They still try to get their own food and water. It's uncomfortable. Um, but it's, it's a good starting point for them. Um, they might find ways around the house that feel better. Um, actually crawling is one rehabilitation exercise that we use a corrective exercise. Um, but some exercises are done too soon sometimes. And, uh, crawling is a perfect example of if we go back into the corrective exercises of how should they feel when you're doing them, um, corrective exercises shouldn't necessarily hurt your area when you're doing them. It should feel challenging. And so crawling, the people that I've met who have been laid up on the floor, crawling forward to get to where they're going is painful. Crawling backwards isn't crazy, right? And so that's a regression of the exercise. It's not always that way for everybody, but it's certainly surprising when you find out that, huh, crawling backwards doesn't bother me. I can, I'm totally liberated right now. I can go out of the bedroom and into the bathroom. And if I can get back, I get on the toilet, then I can actually go to the restroom by myself. All of a sudden you're an independent being. And so crawling is a regressed form of a corrective exercise. Um, but it's a starting point, you know, the body knows like the body knows it has needs. You got to go to the bathroom. You got to get water. You got to get food.

And so if your partner or your spouse or whoever's with you is able to give you some independence, a lot of times that drive will get you to do things automatically where you won't have to spend all day on in the bed because that usually won't help long-term. Um, now the next one is chiropractic adjustments. Uh, I found that this one is actually, it's, it's something near, near and dear to my heart because we get a lot of phone calls in our office because we have chiropractors in our office. Um, people think that this is a quick fix. It's, uh, it's crazy. Um, and not the crazy that it can't help people, but it's like, it's like the stereotypical quick fix, you know, um, chiropractic adjustments can help some people in some situations. I've met a lot of people where they have an adjustment done. They're like, wow, that like, it didn't come back for three weeks. That is the perfect example of a, of a great M category thing, but it doesn't feel a P and L. And, um, usually a good first aid or sorry, a good M category exercise usually will have, usually will work within the same day, within two days. Like you'll know, like it'll feel like a magic show. And so if you feel like that hasn't been working for you with one of your M categories, you might want to move away from it. Uh, an adjustment just to, to, uh, the reason why it's near and dear to my heart is because so many people call about it. Uh, and it's mainly cause they, cause we have chiropractors here. It's like, it's like the assumption of the only thing that we do. And, um, we do a lot, much more. And so everything that we covered so far from manual therapy to corrective exercise, to stretching recommendations and, uh, personal training, things like that, we can do all that. Um, but just the adjustment is the thing that people think that it's the only thing we do. Uh, I have a good friend who says a good chiropractor knows how, when to adjust and when to not. Uh, and I think that's a really good statement. Uh, I, I, I think there's a value to it, but also I think it's, uh, used too much sometimes, but also to, to be fair, a lot of times, uh, uh, people calling do ask for it and that's what they want. That's what they're willing to pay for. So, but it is a great M category activity. It doesn't feel a P or L. So if you find that you're actually feeling good from something like an adjustment, then you might want to choose to stabilize right after that, activate the support system, do some patterning, and then maybe load the body as soon as possible, or at least go through the dojo type of thing with it. Physical therapy is another thing near and dear to my heart because it's, it's when people say things like, well, do you do physical therapy? Well, like, what are you asking for? Well, I wanted to make sure to do exercises. Okay. So you're talking about corrective exercises. You're not talking about physical therapy per se, physical therapy, uh, or physical therapists. I'm sure they get the same phone call we do, but the other way it's like, so they can do mobilizations too, you know, but when people say, Oh, I need someone to mobilize or crack me, they think call the chiropractor. And when they think exercise or, or stretches or STEM or ultrasound or all these other things, they think the physical therapist. And, um, so I'm sure they have the same phone calls, which near and dear to their heart. But, um, yeah, there's, there's great things in physical therapy that can be done. They, a good physical therapist, therapists can perform, uh, just like a good chiropractor can help you find an M, A, P and L. They can help you with all of them, but it really depends if they're going to apply those techniques or not. Physical therapy is a general category of, um, healthcare provider. We can provide a lot of silver services that I just mentioned too, but not all of them will. So that way, that way, when you call a physical therapy or chiropractor's office, either one ask them, what will my treatment look like? And if you hear things from all four categories, then I think you might've found a good place. So if they say, well, we might do a little bit of soft tissue work on you, and then we're going to give you some core exercises, and then we're going to help you do a hip hinge, which is a pattern one. And then we're going to show you how to actually use a little bit of weight training so you can navigate, uh, loads throughout your life. This, they filled all four categories. They might not do that on day one, but they are addressing all of the parts, at least in my opinion. Um, I have a joke that, uh, I made it up. I, I feel like it's funny, but you never know. What do you call, what do you call a bridge exercise when a physical therapist shows you and it's physical therapy? What do you call when someone, when, uh, when you, what do you call a bridge exercise when a physiotherapist shows you?

It's called physiotherapy. What do you call a bridge exercise when a strength coach or trainer shows you? It's called a bridge. A bridge is a bridge is a bridge. A plank is a plank is a plank. Um, chiropractors can do physiotherapy, but they can't technically do physical therapy. Um, and trainers can't show you physio or physical, but all of them can show you a bridge. Anyways, the whole thing is semantics. Um, yoga, yoga, we should cover next. This one is a one that, uh, I, I would, I would probably put it into the A category, but the problem is, is that yoga as a whole, um, you, you experience a lot of movements, a lot of movement variability, which can be good for some people, but some people might find that, um, just doing yoga worked for their friend, but not for them because a forward fold just pisses their back off while their friend is like, oh, it's just like the best feeling in the world. And so, yeah, uh, you might have to find that you'll have to modify parts of yoga to make sure that you're not irritating the back, or you might need to double backwards a little bit and figure out what M category exercise might cool things down. So you can do part of the category in yoga. Um, it also helps out with some of the P category, like patterning. I've noticed there's a lot of hip hinge movements that come into yoga, but there's not a lot of L there's not a lot of loading unless we're considering body weight. People who are deconditioned or don't have a lot of experience doing, um, uh, jet daily, uh, daily fitness or activity or movement. It's going to be amount, uh, good, good amount of activity for them. It's going to be a good amount of load because their body is the load. Their gravity helps out with that, but there's usually not more load. Um, loading is something that it's, it's something temperamental sometimes for people because they feel like body weight training is enough for them. And if you've spoken to a good doctor about, uh, things like osteoporosis, they're going to say body weight exercise is a good starting point, but you need to do a little bit more of probably weight training too, because the body will adapt to what loads you put at it and the bones will adapt to. You can actually build some of the trabeculae in the bone, the architecture, the little slings in the bone. If you challenge the body more than it has been in the past. And so if body weight is enough for you and it's challenging for you, it's fine. But if it's not, you need to move upwards a little bit into something like personal training or weight training, which is the next one. Personal training. Uh, I, I love it when people see trainers or strength coaches that know really well what they're doing, that have a good goal that helped them set goals that helped them use like a form of, uh, exercise programming that I love called push, pull, carry, squat, hinge.

It's developed. It was created by Dan John, who has a great podcast as well. By the way, you should check that one out. Um, I don't include hits training in this. I don't love people doing hits training if they're recovering from back issues, but generally hits training is not bad for everybody. Um, and I'm not telling you that everybody has to go to strong man or CrossFit or anything like that. Just good old fashioned weight training or even some, some bodybuilding methods can help, uh, can work really well for people, but we don't really have to go for the aesthetic muscles. You just have to go for loaded movements. The push, pull, carry, squat, hinge is enough. And in a lot of good, uh, personal trainers and strength coaches know how to do this and just ask them what my, what my, my program look like. And if they mentioned a little bit of deadlifting, some squatting and some loaded carries, pulling and pushing exercises, then yeah, that's kind of probably what most people should be doing. In my opinion, uh, the, the missing link that I see a lot of people not doing is the loaded carries. And to me, when I talked to at least a train coach or a trainer, if they don't mention the loaded carry, then I know that we're probably on a different page because the loaded carry is, is a missing link for a lot of people. And it helps out to build a lot of the support systems of the spine. And it's supported by some, uh, a lot of evidence about lower back pain recovery as well. So the loaded carry is something that could be very much helpful to you if you're not doing it already. Um, now, uh, personal training again, it's, it, it, it can cover part of the ache or part of the M category, but certainly part of the A part of the P and then into the L. And so you're going to notice that not all these things, these treatments, uh, are inclusive of all categories. Um, so you might have to pick one M one a, and then do a little bit of weight training and some, and, um, in a perfect world, I, I would love people to see us by the way, if you like what I'm saying so far, just contact us P two sports care.com, um, or info at P two sports care.com. We can help you virtually or in person and, uh, see us. We can help you get through the M a and P. And then ideally you go to a, uh, strength coach to help you out with the lifelong journey of just being physically, mentally, uh, active and the load changes based upon your goals. And as you start to feel better, your goals might change. Well, I might, your goal, first goal might be just to be able to walk, uh, up and down the street. That's a good goal. What if you want to go golf? What if you want to hike a mountain? What if you wanted to do triathlon? What if you want to be part of a, uh, bodybuilding competition? Like your goals might change. And so with that, the training goals change to the loading changes slightly.

Now, um, because we're going to run out of time here, I'm not going to go too much into the other parts, but there's heat ice medication. All of these ones are, um, aspects of the M category. I don't love the heat. I don't love the ice and the medications. I don't really love them either. Um, I'm not going to say they're not useful for you. There's a time and place for things like ice heat medication. I have hope. I have whole parts of this in the book as well. Um, but there is a time and place and there's times where we have to co-manage people with pain management specialists or, um, uh, with their medical doctors who are helping them with some medicated, medicated M category as well, but it certainly doesn't feel the AP or L category. Um, the surgery is, uh, sorry, nutrition is one that is a large discussion. I have a larger section in the book about that. Um, there is, I'd say for most people with back pain, it's not the first starting point I would take, but there are some very useful aspects to it. Um, it's just some easy things that you could do every day. Drink, drink a cup of water every morning, the largest cup in your kitchen, identify your worst meal and make it a little bit better. Uh, make energy drinks and sweet drinks. So weekly treat, not a daily beverage, throw away all bags of chips and things in packages.

Stop eating two hours before bedtime. Substitute cookies with fruit. Consider substituting your dressings with olive oil, salt, and pepper. And if you drink alcohol, substitute beers and cocktails for hard alcohol, or just cut out alcohol altogether. And those are just some basic rules that I like. I personally do things like meal prep. So it's not like I'm just, um, say what I do, not what I do or, uh, do what I say, not what I do. I follow this pretty well as well. And I feel very good for it. Surgeries are, um, it's interesting. Uh, I'll cover this very, uh, briefly cause we will have to close here. Um, surgery is something that it's, it's funny. It's just, it's a part of life that people will, um, very much take their recovery seriously. And so, um, there's a thing that, uh, I think Stuart McGill brought it up. He called it the virtual surgery. And so you wave your hand, you say, you've had the surgery. Now let's do the rehab. And so a lot of times people will actually improve just by doing the rehabilitation that is required after the procedure. I'm not saying there's not a time and place for surgery because there is, and there's a lot of things that we will ask people on day one and examine them for to see if they actually have an urgent need for surgery. But pain itself is not necessarily a requirement of surgery. It's function we're looking at. If your function is degraded or you have red flags in your history, then we might consider sending you out a little bit more aggressively. But the first thing you need to do is consider that a good rehabilitation process needs to be covered. And I think the estimation is that only 3% of people ever engage in a formal low back rehabilitation process, which is absurd because if you want to get better, you need to earn your surgery. And I do mean that the nicest way. I had a friend tell me that years ago, he said, we just have people do the rehab that they're supposed to do first. And if they fail it, we suggest the surgery a little bit more, um, with our whole heart. But if you didn't do the rehab and you didn't put any effort in, uh, you shouldn't do the surgery, uh, at least in most situations.

And in my opinion, um, obviously time and place, but it's, uh, the support, the MAPA load system, uh, works. It works very well. And, um, if you follow it, then you might find that there's some amazing success on the other end for you. You might find that a lot of your aches and pains and tightnesses and fearfulness and movements all go away and, um, you'll get your life back. So we specialize in helping people with lower back pain, sciatica and hip pain at performance place. So we'd love to work with you. Um, we can help you virtually or in person, just reach out to us. There's a link in the, uh, little, um, podcasts part below. And if you're a clinician and you're wondering like, what do they do actually at that place that, that, uh, might help me in my clinical practice with helping people. Um, there's the premium version of the podcast for that. We also do have workshops where we teach other clinicians too. Um, so those are all available to you. There's links in the description as well. So thanks for being part of the movement movement. I hope this didn't sound like I was a know-it-all with these things, but I, I feel confident in a lot of the information I'm sharing with you, but obviously the information is relative to your situation.

Um, and I don't know your situation. So these are just general things that we come across and just trying to share some of the, um, in my experiences over time. So, um, get, get access to the books. Uh, I think you'll like them, especially the other one about diagnosis. It'll help you out with understanding, um, the probability of things, um, and having a good, um, conversation with your clinician, your doctor and your therapist, uh, about what you feel is going on with you and it might help them in their journey as well. And so I'll see you guys next time.