A five-step roadmap for low back pain recovery

Hey guys, before we start the show today, I want to introduce the premium version of the podcast. If this is your first time listening to the show, you're probably not going to be interested in this, but if you've listened to a lot of the podcasts before and you love all the content that's been coming out, you like the interviews, you like the case studies, just know I've done more. Okay, I've done more, but I have not done them in a long format. They're about 15, 20 minutes or so. I'm doing the case studies right as I come out of the exam room or as I'm on my drive home. The audio is a little different than these ones, obviously, because this is on a big podcast mic.

But in the light of getting things super fresh and getting things closer to the moment where I interacted with a patient, this is the format it's got to be. But these aren't things that everyone's going to want to hear. This is only going to be the people who really, really, really want to learn more about this style of care. So for the clinicians out there who are interested in the premium subscription, scroll down and become a member. There's going to be something released every week, and I know you're going to love it. Now let's get into the show. For all the people out there thinking, well, pinched nerves, it sounds pretty serious.

It can be serious. Disc herniations. Yeah, it can be serious. And I don't want to discount that it's not painful. It is painful. I've had disc herniations. I've had pinched nerves. And they hurt. They suck. It's a lot of pain. But also the way to overcome it is actually pretty simple. It's not complicated. It's just effort. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. I'm Sebastian, your host for the Restoring Human Movement podcast.

Thanks for joining the Movement Movement. This is your first time on the show. Welcome. You've missed a lot. You've gone about 220 episodes through. Imagine you missed that many episodes of Modern Family. And you're like, you know, I'm just going to start in the middle. Can't do that. Got to go way, way, way, way, way, way back. So go into the archives and look at all the interviews and the solo podcasts that I've done. And I feel like I've done some original content. But at the same time, I feel like I'm just trying to clarify some of the things that are already out there that we as healthcare providers would like to share with our patients, with our clients, and help you guys get better quicker than you ever thought possible.

Now, the whole point of this podcast is, again, to improve our patient outcome and helping you guys get to the point where you feel like you're in control. Because a lot of times people feel like, well, they're out of control. They can't get over their pain, over their issue, when a lot of times they've been through all these treatments that don't work. And as I always say, there's a treatment that works when you pick the right solution to your problem. If you pick the wrong solution to your problem, then you'll end up with no change. And this is what I think happens to a lot of people throughout their recovery process.

So this one in particular, this podcast today, is going to be a solo one. It is on the topic of lower back pain and how to create a roadmap for recovery. I'm doing this one for the Wellness Week. I was asked to do this one by Bean Pod. Sorry, Podbean Tech. So I am being a terrible job. Anyways, I was asked to do it by Podbean. And I thought I would just push it over to my podcast as well. So I believe in doing, killing many birds with one stone, if we possibly can. So I thought you guys, the regular listeners, would love this one as well today. So as always, I try to do a good job of letting you into who I am as your host.

So hopefully you like me as a host. And you can follow along with all the podcasts and learn it on the journey that I've taken as well by sharing a short story. And I'm going to go with the one today, which is the story that I think it goes well when people ask me to tell a story that makes people laugh, that gets a giggle out of them. It's usually this one. And this is the default. So if you've already heard, I apologize. So back in the day, I went to Vegas by myself. And I was there for an event. And I had nothing to do, you know, at nighttime, in the afternoon, because most of the event was during the daytime.

And so I thought, you know what, I wonder if I can, people go to Vegas for nightclubs, why don't I go to a nightclub? And so I walked around and I found, it was around like four o'clock or so, so there's no lines, nothing like that. And so I'd ask the bouncer out front of one of the nightclubs, I said, hey man, can, the way I'm dressed right now, I didn't bring anything else. Can I get in like this? And so I was wearing like a V-neck, you know, there was no, like it was just plain color, no like logos and stuff like that on it. And I had jeans on and I had Jack Parcell shoes with some laces and so on, you know, black and white, standard color, things like that, nice blue bottoms.

And so he's like, no, no, no, you can't, you can't do it. I said, why not? He says, because of your shoes. I said, what's wrong with, what's wrong with my shoes? He's like, they got laces in them. And I said, that's the lacest. Ha ha, lacism. Anyways, that's when I realized lacism was real. So that's the only joke I got for today. But we're going to go into the concept of lower back pain and how to create a roadmap for recovery today. So I thought I would probably first start today with what is wellness and because this is wellness week. And I thought I would first cover what I think wellness is because I think there's many different concepts of it.

And obviously everybody has their own goals and what they believe wellness is. I tend to think it's more so being physically capable and enjoying your life. And I think there's a lot of people out there who are very physically in shape and they might not enjoy that process at all. And there's people who are in pain and there's people who are in pain who are not physically capable. Obviously, there's nutritional aspects, there's mental aspects, there's many different aspects of wellness. But I think for the most part, I think we're all meant to be here to enjoy our life to some degree. You know, I think that would be fair to say.

And I think being physically capable is helpful in the enjoyment process because I don't think anyone likes feeling like they're not able to do something and they need assistance. And so I would say being physically capable. I have a friend who he put it really well. He says he doesn't if there was a tornado that hit, he doesn't want to be a liability. He doesn't want someone that someone has to be rescuing. He wants to be someone who can rescue somebody. And so I thought, oh, that's a pretty good way of going about it. So I like that. Now you have to enjoy getting to that point, I feel like. So now when we're going at low over lower back pain today, I thought we should first start with something that everybody usually does when they have lower back pain.

And they go straight to the Internet and they think, Dr. Google, what's up, man? Like, what's going on with my back? And so they start Googling all this stuff. And first, I thought we'd start with this because this is a lot of things that, like when I see patients come in, I like to get into their head a little bit and debunk some of the things that they've been thinking about. Because the fact of the matter is, is the solution to their problem, again, might not be what they think it is. And so if they think it's one of these problems that maybe Dr. Google suggests to them, this is one of like they think one of their problems is one of those problems.

And the solution is rest, ice, heat, whatever it might be, if they have no results from that, it's, again, it's because it wasn't their problem. And so I find that Dr. Google needs to update their stuff, to be honest with you. There are a lot of good things on the Internet I've found, but they're buried under and they're written by a lot of people who don't know how to rank their stuff, including myself. Or I know that it's very hard to rank pages and what I believe to be good information, at least that I write. It's tough. I mean, it's a full-time job. Other companies have a lot of money. I think we all, hopefully we all realize right now that places like WebMD and, you know, and Google and all these places that they have, they have a lot of money to be at the top of the ranking.

And so people might not see the more updated information. And so Dr. Google mentions that if you have lower back pain, you, number one thing was muscle spasm or ligament strain. I'll cover each one of these in turn, by the way. There's also bulging or ruptured disc, they say. I'm going to say they, they, you know, the Internet, they. Arthritis, osteoporosis, sciatica. Other considerations that you might find is hip flexor tightness, weak glutes, scar tissue, adhesions, and tension. That could be stress or just like tension within muscles, as they kind of say. I'd say from my personal experience, a lot of these are actually, I don't want to say they're incorrect, but they're, they're not the easiest wins in the book.

And I will come back to this concept here in a few moments, but I'll go to each one in turn, actually, in a couple moments. But let me first tell you my experience with low back pain as I've found I've gotten better at treating it over the years or helping people find a solution for it. I'd say easily over half the people that come in have a low back disc. I'm going to say issue at this point as the primary generator of their pain. And can it be that they have tight hip flexors and hamstrings and, you know, pinching of the hip and all that kind of stuff? Yeah, yeah, that goes along with this typically.

There's, there's kind of related symptoms that happen similar to a heart attack. If you're having a heart issue, it's you start sweating, you have arm pain. Sometimes your face gets a little tingly, you know, things like that. So there's associated symptoms that occur, but if you chase those associated symptoms, you never really have a big solution. So in my experience, over half the people are really just have a disc issue. And I should probably start right now by saying that most people, most people, and I'm going to start making up stats again, because I, you know, like everyone say, where'd you get these stats?

Well, I'm going to make them up based upon what I see clinically, at least with the population that I treat. I treat people who are fairly athletic. They're not professional athletes, but they're also not couch potatoes either. So I'd say easily, easily, 95% of them do not need medications, surgeries, or injections to solve their disc issue. And I will go over disc issues, bulging, ruptured disc here in a couple minutes, because Dr. Google did touch on them. But what I tell most of my patients on day one is, hey, we're dealing with a disc issue here. I want to give you one piece of advice. Do not Google any of that that I just said.

And they laugh and I'm like, no, no, really. It's going to scare the shit out of you. Because the way they're suggesting managing it, at least from the older documents, it freaks people out. And all I really need them to do is what I'm suggesting that they do the first couple weeks. And they're going to feel dramatically better. And later on, hopefully, I mean, they're not going to Google anymore if they are already feeling better. So I'd say over half the people, let's say 50% plus, are disc issues of some type, because there's many different types of disc issues. I'd say another 25% are pinched nerves to some degree.

Now, is that sciatica? Is it radiculopathy? Is it, you know, whatever? Yeah. Yes. So I'm going to say 25% are roughly that. So that only leaves us about another 25% for the remainder, which would be, I'd say, you know, your overuse, your arthritis, your strains, and things like that. And so, yeah, there are other considerations like facet syndrome and all those scar tissue, muscle strains, things like that. There's a bunch of those things that could be it, but they're not the majority. Okay. They're not the majority. And I'll probably say this over and over again today because I think it is the biggest piece of information I can possibly give you is don't treat yourself like an exception to the rule.

Don't think that you're out of the realm of the percentages. Most people need to be treated just really good for the 75% here, the disc and the pinched nerves, and most of their problems are going to go away. Most of them. Now, there might be a little residual stuff that happens a lot of times for people, and it's because they've left it alone too long. They let it kind of fester. They had it for months to years at a time. And so, this is what we call a compensation or adaptation. The muscles, the ligaments, the body, even bones and so on will adapt. Part of the theory with arthritis is the body is adapting and creating more bone to stabilize.

It's not necessarily age-related or familial, like meaning it doesn't necessarily run in the family, at least not osteo, which is the more common type. It's the old age type. So, there's adaptations that occur. Later, as you wait too long, I don't want to say, I don't think too long is ever too long. It just makes it more challenging. There's more hurdles to go over because when we get people who are super fresh, they're pretty simple, to be honest with you. And we have countless amounts of testimonials on our website of people who have had really good experiences just by doing the simple stuff, doing the stuff that works, doing the stuff that feels good.

And these people, again, do not need medications, surgeries, injections. Granted, can people need those? Yeah, sure they can. It's in the right situations. And also, too, we usually rule out red flags with people. If you're wondering about what the red flags of back pain are, these are the ones that you kind of got to worry a little bit more. I think the estimation is about 3% of people will have a red flag and need to get more urgent intervention for these. And so, just Google red flags of lower back pain. As I've looked around for Google references on that, they seem to be pretty good and consistent.

So, there's about three of them in there, but there's certainly other ones, too. Now, for all the people out there thinking, well, pinched nerves, it sounds pretty serious, it can be serious, disc herniations. Yeah, it can be serious. And I don't want to discount that it's not painful. It is painful. I've had disc herniations. I've had pinched nerves. And they hurt. They suck. It's a lot of pain. But also, the way to overcome it is actually pretty simple. It's not complicated. It's just effort. And I think we all can agree here that simple is different than effortful. And so, it does require work on your part.

It requires you to do something for yourself. It requires you to do some homework. But not necessarily even a lot. It's just a little bit of habit changes, a little bit of work that you can do at home, usually under the right direction of a good examination. Now, probably a lot of you are wondering, well, you're talking about the right thing to do. I'm dealing with back pain right now. What do I do? The answer is it depends. I think that we all kind of know that the problem that we're looking at in front of us requires a little bit of evaluation, typically, to have a pinpoint strategic attack on it.

Now, as I'm sitting here doing a podcast, I see that there is an issue with my plant. Actually, there's not an issue with the plant. It looks pretty good. But let's just say this house plant here is withered. Now, is the issue that it has no water? Or is it that the soil has no nitrogen in it? Or is it because they didn't put it in the sun? So, all those three problems make the plant start to slowly die in this case. Now, the intervention is dramatically different. Now, I could shotgun approach it and do all three. I could give it some water, put some new soil in it, or put some nitrogen in the soil, maybe some fertilizer, and put it right by the sun.

Hopefully, it takes, and it probably will. It's just more to do. In this case, I'm requiring, I guess the plant doesn't really have to do the work. I have to do the work, and then I see what the results are. And when it comes to back pain, it's the same thing. And so, with a thorough examination, with someone looking at you, watching you move, taking a history, stress testing your spine, ruling in and out, diagnosis are really important. And then they can pinpoint, strategically attack what's going on. Usually giving homework, sometimes hands-on care is needed, too. Now, you might wonder, what does a good exam look like?

Well, usually they have to watch you move, and they have to put their hands directly on you. Do you need an MRI or an x-ray? No, you typically don't. In some cases, they're helpful to see extra information, but those types of images are not needed in majority of cases of pain. It's also important to note, too, that a lot of people can feel better just doing something like general physical movement and more so kind of taking that shotgun approach, like I mentioned with my houseplant here. But they have to be willing to try. They have to be willing to risk some things, because I could be wrong here, and the plant could die.

I mean, you're probably not going to die from doing movements. But sometimes what I've noticed with a lot of people, or with some people, is they refuse to do anything, try anything. Like, even like if you said, go for a walk, and they're like, no, no, no, no, no, I don't know. Is that right for my diagnosis? What's my diagnosis? Well, I don't know your diagnosis right now. I haven't examined you, but here's what's the important part is, too. And I talked to an urgent care doctor about this as well, and we were talking about giving antibiotics. And so she was saying, well, you know, sometimes we don't know the exact diagnosis, and most times we don't know the exact diagnosis, but we know what it's not.

And we can treat based upon what we know, if we know that it's not something else. And I said, oh, we got the same thing here. Like, so we know what it's not, and we know how to take a nice, high-reward, low-risk approach to the things that it probably is. And something like walking, low-risk, high-reward. And something like some of the exercises that we suggest very early on to people without really even, maybe if we really don't know what's going on, we'll give them an extremely low-risk, high-reward activity to do. And then we see where things go from there. And I only bring this up because sometimes people get so married to this idea of knowing the exact diagnosis where they burn all their money on x-rays and images and specialists, and everyone's kind of confused about what the right diagnosis is.

One guy says this, someone else says that, and someone else says, ah, they're both full of crap. And then we see this image, and maybe we get an ultrasound done, and it's like, dude, you just burnt, like, 10 grand on all this stuff, and you didn't even start one thing. You could have maybe just felt better just by walking around a little bit more. I think we all kind of know that back pain, like, it hurts when a lot of times when you're sitting. So just do the opposite, right? Doing the opposite is important. So I guess I shouldn't get too far away from Dr. Google here that I started in the beginning.

Sorry. Sometimes a podcast full of jumps around a little bit, but I hope you like the conversational tone. So let me explain the major things that Dr. Google at least brought up here. Muscle ligament strains. Now, this is something that comes up very often that people have questions on. I like the question, and I think if we take a logical stab at it, I think we're all going to figure out where we're at in this case. Now, in the past, there was three types of muscle injuries. There was one, two, and three. Now, it's much more expanded. Back in 2012, they created a muscle injury consensus statement, and they broadened the category slightly.

However, let's just still call it one, two, and three with subcategories. And so muscle injuries two and three, threes are completely muscle ripped off of the bone. Not a fun thing. You'd know it because you'd bruise up and you wouldn't be moving anything. Number two, sorry, category two is a partial tear. Still, fiber disruption, muscles tend to, kind of like when you have a piece of meat, when you tear it, it bleeds. And so you'll find a bruise here, too. And so, again, you see the consistent thing is bruising. Also, too, you'll have positive imaging. You'll have a definitive answer on an ultrasound or an MRI that there was a definitive muscle ligament tear.

That's the important thing here. So if your MRI or your ultrasound doesn't show anything in the muscle, then it's probably not. Well, could it be trigger points and all that stuff? Yeah, sure. But, I mean, I think those images are pretty sensitive. They're really, really sensitive. They can see things. And so if they're not seeing anything, stop looking. Stop looking at that structure anyways. And, again, based upon the percentages that I talked about earlier, you know, the strains, arthritis, overuse, all those things, those ones are way lower. They're, like, under the 25% realm. Like, so let's just look at something, a higher percentage there for you, okay?

And you can have strains, grade one, that do not have positive imaging findings. And the largest category in there is a 2A, 2B. Or, sorry, I take that back. I guess I shouldn't reference back. It was actually grades. It was 2, 3, and 4, I think, is what was actually on the consensus statement. So I think it was 2A, 2B was the category of a strain. It used to be category one. Either way, these are the things that don't have positive images associated. And they don't have bruising either. And so interesting, the things that they patched in there that they didn't have before was reciprocal inhibition types of injuries.

Or, hey, this muscle's off, so this one works harder, so it makes it painful. So lower back type because the glutes are off type of thing. Now that's in there. And there's also the spinal-related muscle injuries, too. An example would be your hamstrings are tight because your spine is telling it to be tight. An example would be maybe sciatica, too. So these ones are the most common things. Again, these do not have positive images. Although your hamstring hurts or your hip flexor hurts or your low back hurts, they will not have positive images, at least in regards to finding muscle injuries. So that's the first thing.

Don't get married to the idea of the muscle-ligament thing because you probably won't find it. Dis bulges, herniations, I'll come back to that because I think this is the largest one on the list. Arthritis. Arthritis is not very much related to pain. There was an interesting paper that came out a while back where they were kind of relating that most people's back pain is around the age of 30, 40, roughly. Let's just call it early middle age. And so when they got older, they definitely had some back pain. People had back pain, but there's significantly less. And I think if we can take the logical thought process here is, well, when you get older, you get the arthritis, right?

Because it's the old age arthritis. So you should have more back pain. And that's incorrect. And so we can, in this case, one plus one doesn't equal two. And so, yeah, you could have arthritis, but it does not mean you have pain. Probably on the same note, scoliosis, too. A lot of people have been told that they have scoliosis problems in their spine that are causing their problem. That's not necessarily the case. The images such as x-rays that usually see those, I mean, I can twist my spine in the x-ray actively, like on purpose, and it'll show some type of rotation and bend. And if your muscles are in spasm because of a disc or a nerve, because, again, that's a secondary problem, it's going to show spinal positions that have changed.

Normal. Okay, that happens. So I would not worry about scoliosis for the most part, unless maybe you're in the subcategory where you're an adolescent female, usually middle school age. And those are the ones we got to worry about, but a little bit more about with, like, thoracic scoliosis. That's a whole other topic for a different podcast, and I won't be covering that one today. Probably the people listening to this podcast are going to be in their 30s, 40s, and 50s. I don't think teenagers even listen to podcasts, really. So osteoporosis, which is on the list, that is the bones of the spine in this case, but it can be the pelvis, hips, and so on.

Usually, weight-bearing joints and bones, they lose their density. And so the way this usually happens is not doing anything. It's inactivity. And so we usually find this more so on people who have been inactive. Now, I would imagine, and I don't know for sure, that people who have longstanding back pain, say 20 years of back pain, are probably going to find osteoporosis more so than others because they're not doing anything. They're just, like, a lot of those people are very afraid, and I know that it's, like, I've had back pain, too. I get it. I totally understand. But when you find the right thing to do, we can offset this thing, right?

You don't want to get to the point where you have osteoporosis because then you're running the risk of having possible fractures with things like stepping off curbs and so on. Your bones become a little bit more fragile, and it's harder to come back from in that case. But generally, having osteoporosis, I'm not familiar with that actually being associated with low back pain, but I wouldn't discount the possibility that people who don't move are probably those people who are in pain a little bit more so than others because if you're not in pain, you probably want to be active a little bit, you know, be adventurous, go hiking and swimming and things like that.

But most of the time, like, I don't remember the last person that came in that said that their back pain is from osteoporosis, nor have I ever told anybody in years that their back pain is from osteoporosis. So I would discount that one pretty quickly. And then there's sciatica in here. We'll come back to sciatica as well one more time, too. And so before I move on from the other ones, there's weak glutes, tight hip flexors, scar tissue adhesion and tension. So hip flexors and weak glutes, yeah, they go hand in hand. Again, those are their associated problems that come along with back pain. And it's kind of a saying that, like, when people have their first issue of back pain, sometimes a lot of times the back pain will shut down the glutes.

And then they end up having more back pain later after it settles because their glutes are off, or at least someone's told them, or their hip flexors are tight, which, again, go hand in hand. And so it creates this dumb cycle. It's this cycle that happens. So you have back pain, shut your glutes down, but then you have back pain because your glutes are shut down. By the way, they never really shut down. They just become a little lazy. So there's a saying that you can probably look up online called glute amnesia. I think they're nice little write-ups. It's a cool little coin term that someone gave.

But that's a really common thing with super people. And a lot of times when you jumpstart those glutes, you get them kicking. Oh, man, people's back pain goes away so quick. You get the ab wall working a little bit, not via the means of sit-ups necessarily, but just getting to do some planks and side planks and bird dogs, a little bit of rolling on the ground. Like, it makes them feel good. You know, it makes people feel generally good. If it doesn't make them good, there's a possibility we need to move backwards and do what we call first aid process, which I will eventually explain a little bit here because I have a five-step system I like to go through when people are going through issues and back pain and shoulder blade and whatever they have as a good way to explain things to them because I know people have tried a lot of things and it has not gotten better.

And so breaking down maybe the reasons why things have and haven't worked for them might be helpful to digest it down. And it gives them a nice control system. But before we get into that five-step process, I'll come back into the disc bulges and sciatica conversation because those are pretty relevant here. So disc bulges, ruptures, and so on. Their herniated disc is probably the most common one or let's just say bulging in that case. I believe that's the slang term that most people use. Bulging discs are, you know, they're scary. They're really scary. They hurt. There are a lot of times those things where people are stuck on the ground and their back hurts so bad they can't get back up.

It's usually worse in the morning time. A lot of times for the first hour and they can't bend forward. They can't tie their shoes. They have trouble getting out of cars. They can't put their pants on. They have to roll back into the bed to put their pants on. I feel really bad for the yogis out there who wear the yoga pants because I know you guys jump to get in your pants because I've seen it before. People do it too. I don't know how you get those leggings all the way up. You almost have to wear baggy pants at those times. And a lot of times these people wear actually flip-flops too as I learned because it's hard to put the shoes on.

And so those disc issues, the disc bulges that people have or the disc herniations, yeah, they can be really painful. However, they will settle themselves and they will feel better. And I like to tell people it's kind of like a sunburn. Don't think of your spine as being damaged in this case. Your spine is not damaged and it's not like it won't get better. You're not going to have a bad back forever unless you want to or unless you decide to do nothing about it. But if you take a good approach to rehabbing this thing, you're going to feel like I go out and get a sunburn. Yeah, it hurts for a couple of days.

I get out of the sun for a little bit and I go back in the sun. And this time I'm a little bit more responsible by putting sunblock on or I maybe step in the shade every once in a while. And that's basically what happens to a lot of the people who have disc issues is they end up having just too much exposure at one time. I know a lot of people through quarantine period end up having disc issues because they sat at home. They didn't go outside. Some people didn't exercise. Some people did. They brought their work home. They had terrible ergonomics, different chairs. Some people sat up and tried to do their work in bed.

And there's a lot of low back rounding that happens with that. And that usually pisses off disc. So discs are very easy to manage if you're good at managing them. Again, surgery is not required typically. And injections and medications are not required either. You just have to do something that feels really good. A really good first aid that lasts about, you know, five to ten days or so because first aids don't last forever. And you stabilize the spine a little bit. You do a little bit of hip work. Walk around. You feel good. I am surprised actually by how quickly people get better. I used to be really bad at working with low back disc.

I'll be honest with you. Probably about like five, six years ago, I was terrible. I was terrible at it. I would just, um, I would tissue work people with them and they would not necessarily get better. They would have a hard time getting up off the table afterwards. And I feel it always felt so bad. And I thought, what else can I do for this person? And I realized that, you know, uh, finally at some point I asked, you know, some colleagues about what I can do to, to get better at this. And they directed me to some information and, and, uh, I got way better at treating them. And so now though, seeing how quickly they can get better is astounding.

Uh, you can have some people 50% better within a day, you know, sometimes even more, uh, like when we're talking to people on the phone, I'm, I'm always hesitant to give these claims because it always feels like it's just, it's, it's found, sounds like we're just lying about it. But, um, I remember, I remember this one lady that she had, she had back pain. She's even crooked. She did the Reiner dimension, the right first aid, 75% better within a week. She was no longer crooked. She would, she can sit for more than 15 minutes and drive to work. Previously, all she could do is maybe like one time around the block and she'd walk in the office, just super crooked, by the way, usually crooked is a disc.

It's not, it's not a hip flexor. And, um, I was amazed by how quickly she got better. And previously I'd given her the wrong first aid to do. And she just kept, kept, it kept hurting, you know? And, uh, I've been, I've been honest with people that come into my office and they say, you know, I say, look, I might pick the wrong thing. If I pick the wrong thing or you don't do the right thing, they say, I picked the right thing, then, then this won't have the results that I'm expecting. But I feel very confident with, with disc issues, um, at least most of them that you can predict a good timeline.

You can get, you can get them to feel really, really good within about a week and a half. And then it starts to slow down and I'm okay with it slowing down. They have to know that there's a little bit more work entailed into getting to that point. And, um, that's just the way it is. Um, some people are, it's like a magic, you know, they get better and it's great. Um, but not everybody's like that. So, uh, I know I've given a lot of examples and I've dodged around a little bit. Now, now let me lay out the, the five step system that I, I, I kind of break down for these people here. Um, and, and, and you guys included just so you can understand that when you're recovering from stuff and low back is just one of the things, uh, I'm sure that, you know, nutrition has the same type of thing, dietary changes, mental health.

Um, and, uh, you know, sciatica does shoulder blade, neck pain, wrist pain. And it kind of, they, they, uh, I, I created this, this categorization system mainly to help people understand when is an appropriate time to do certain things because it's not always the right time, right time to do glute work for low backs. Sometimes you just have to chill it down a little bit, you know? And so I break this down into, into five steps and everybody's very different of, of, you know, when they start encountering, you know, the, the third, fourth and fifth step, but at least it's a good categorization system.

Um, so usually the first step or the first step should be diagnosing or creating a working diagnosis, taking a history and doing a physical exam. Okay. I know that people at home can't do this necessarily because they, uh, I mean, I didn't, I didn't go to school to do my taxes. I know I can fiddle around with it, but I'm going to suck at it. Uh, and I'm probably going to pay more or get audited. I'm not quite sure which, but, um, either way it's not going to go well. So when people try to self-examine themselves, it's not a good thing to be honest with you. Um, I, I don't suggest people do it.

Uh, we do put out some self-tests a lot of times for people to play around just to challenge your thinking, but it's not necessarily up to them to put all the tests together to formulate a working diagnosis. Now, uh, I've had questions from people before who've said, well, what, what one test would dictate that I'm dealing with the pinched nerve or a little back or whatever, right? There is no one test. There's a cluster of tests and the, it's a broad picture. We're looking at a big picture. What does this picture start to look like as we start to do all these tests, uh, ruling in and ruling out things and what it seems to look like the most.

Oh, it looks like a sailboat. Now that picture looks like a sailboat. Then we start treating it like a sailboat, but if it starts to look like a skull and crossbones, then, you know, like we, we treat it like a skull and crossbones. And so the same thing happens with disc and nerve and arthritis and strains and so on. And so having someone who's skilled at doing that is very valuable and it's worth a lot of money to be honest with you to start in the right direction. And so step one is knowing which direction to take and having a working diagnosis. Again, this also rules things out to like your things that, uh, that, that Google searches freak out about like cancers and, you know, rheumatoid arthritis and all these other things that it could be.

Um, but that's step number one. Step two is doing a first aid. Step three is doing, uh, supportive work or corrective work. As we kind of say, don't worry, I'll go into each one of these in turn. Step four is doing some basic strength training. Step five is exploring the world, being playful, moving again. And each one of these steps I think is important to fully recover. Not everybody who goes through our type of, um, care necessarily goes through all those steps. And sometimes it takes them a couple bouts with back pain to really, um, take to heart the reason why they're suggested. And just as if, um, I'm, we don't try to prepare people for a goal of just getting out of pain.

We try to, we try to encourage them to find a goal that is just, uh, living well, feeling well, aging well, moving well, um, and being happy. And it's, it's when you're only looking at reducing pain as, as the goal, you're not going to get to the points. It's kind of like, um, if you were just going for the goal of being able to deadlift 200 pounds, you get there and you're done now, what, you know, most people in general don't have, they shouldn't have a definitive timeline goal of reaching a certain physical mental, uh, goal. It's just, it's just a process, you know, a, a nice, sustainable, habitual process that gets us where we need to go over the long haul because we have our entire lives, you know, to reach or to continually get better.

And so when you look at it like a single goal, it's going to happen over six weeks. Um, you're probably going to end up stopping once you hit that goal. And then you might not have hit steps, you know, four and five. So anyways, step two, first aid, first aid is only meant to happen for about five to 10 days. Um, generally with low back pain, usually bending forward or bending backwards is a really good first aid or even bending to the side. I know it seems really silly, but whatever direction feels better, do that. Sometimes we use something like a position of comfort. And so, uh, well, I'll, we'll usually ask people on day one, what position makes your pain go away completely.

And if there are subacute case, not necessarily an acute one, but a subacute, a subacute case will say, look, it only hurts when I sit down and when I bend over, when I start walking, it goes away within like a minute. Good. Walk more. First aid, walk more. My girlfriend had a, she had that exact scenario. She said, well, I've been trying like, you know, all these exercises and so on. I said, well, it feels good. She's walking. I said, walk more. And then it started to dissipate away. Um, first aid is first aid because it's first aid. You don't have to necessarily do it forever. Um, and there's a lot of different things that can be plugged in as first aid.

And a lot of you probably know them, you know, adjusting massage, like ice heat, um, doing yoga, doing, um, the, I know McKenzie is something I use quite a bit. Um, even corrective exercises like core work can be first aid, uh, laying curled up in a ball in a fetal position, being on the ground, not sleeping on your crummy bed, uh, changing chairs, changing habits. All this can be first aid, even things like back braces. And I know with knees, a lot of times with unstable knees, I'll just give them the first aid of an extension check brace because it's helpful. It stabilizes the area and it lets it heal up.

It's first aid. There's nothing wrong with first aid, but if you do first aid forever, you're going to be in for a rude wake up call because first aid only does first aid. It doesn't make you stronger. It doesn't make you more capable and it makes you a human liability. As I mentioned earlier, um, if you want to be well, I think you should be physically capable and enjoy your life. And if your goal is to only reduce pain and you use that first aid forever because your pain keeps coming back, then you're not going to be well, to be honest with you. And that's a tough love talking. So I hope that resonates well with you guys.

And so if you think you have a bad back and it keeps coming back over and over again, then you're just not physically prepared. So let's get you beyond the first aid and we'll get you into stuff that's more productive, a better long-term strategy. So steps three, steps three is, uh, um, it was, it was corrective work. And so this might look like a lot of times things that you, if you watch Instagram or YouTube, you see people doing funny things on the ground and these yoga moves and maybe these ones with bands and balls and so on. You follow this nice physical therapist who always got these cool exercises or whatever.

Um, and I use all these by the way, so I don't want to sound like I'm bashing them, but it's, uh, you know why they call it corrective exercise because it's intended to correct something. It's not intended to do more corrective later. You correct something. If the problem is spinal endurance or your glute is off or whatever, correct it and then go beyond it and that's why you go into step four, which is strength training, building strength within the body. Strength is a nice foundation for recovery. And so I'm okay with everybody doing correctives, but correctives are correctives. So how long should you do a corrective?

In my opinion, I think four to six weeks is pretty fair. You know, they should be challenging and I know that some people are able to talk through their correctives. Like say right now, I'm doing my correctives and I'm doing this podcast with you guys. That is not challenging enough. It has to be effortful. Remember how earlier I said it would be simple, but effortful. This is it. Your rehab should be challenging. It should challenge you. Now, what I do for myself versus what I would do for someone who's 70 years old and has it lifted a day in their life and has not been outside their house for, you know, six months is very different, but it's challenging for them because what we want over time is want the body to adapt favorably.

Remember I said, this is a long game. And if you're trying to improve yourself every day, we want to make sure that your body has a stimulus to adapt to, I know we talked about osteoporosis earlier. Well, the way to improve osteoporosis, they say, in addition to some of the supplements is to do weight bearing exercise. You'll hear this over and over again from your, from your MD probably. Well, I think you should start walking a little bit and maybe doing some, you know, stuff into a pool first and then get out of the pool and do some weight training. It's because the bone responds to the stimulus of gravity or external load, which is the weight.

It's just the way it is. Now, do I want to put someone under on a hack press right away who has never squatted, squatted with weight? No, I don't, but I would certainly have them walk. And I think if I recall, marathon runners have really good bone density and they're, all they're doing is body weight exercise most of the time. So, um, corrective is corrective because it's corrective. Don't make it a long-term plan. Most of the time when people start getting into weight training and I know this is going to be a, probably a large topic, but let's just say, let's just start with weight training.

Um, they start to feel much better, more capable, more, I guess, in my definition, they feel more well. Um, and it don't feel as fragile. And that is a good place to be in my opinion. Like you want to be able to feel like, okay, so I got to carry it like a big bag of books downstairs. And then, you know, shoot, I got to pick up this, this, you know, there's a, there's a package at the bottom of the stairwell. I got to pick that thing up and walk into my car as well. And so you're carrying stuff, you know, you're picking up stuff, you're bending over to pick them up and it's nice to be physically capable and not think that your body's going to fall apart if you just pick up something more than five pounds.

And so weight training is basically training your body within a controlled environment to do things well, to be able to, um, navigate external loads, external weights, and then adapt to them as well. If you do it on a chronic basis, I know I said chronic chronic sounds bad, sounds bad. It's not chronic just means over time. Okay. It means a long time. And so weight training happens over a long period of time. Adaptation happens over a long period of time. You don't get strong over two weeks. You don't get strong over the course of your eight week rehab program. It happens after. And so we encourage people to usually after they start feeling good, they got the correctives about them.

We show them proper form with lifting. We say, Hey, what's your lifting goal? And they say, Oh, I don't want to get too bulky. And I said, it's fine. So pick up these weights, do it, you know, two, three times a week. And by the way, now's a good time where you should probably talk with a strength coach. If you're really serious about making some changes, they're probably the ones to go to and see, you see how this handoff happens. It's you go from back pain to being really capable and doing a lot of stuff with some weights. The cool thing is that people who have never experienced this before tend to think, holy crap, I feel better in my fifties than I did in my forties.

How's that possible? Like I said earlier, this is not age related for most people. And in your forties, or at least this person, this example, in your forties, you just weren't physically capable. You let your body kind of rot itself away without doing the right first aid, without doing some correctives to correct what needed to be corrected and without challenging yourself. Okay. And I know we all get busy. You know, I'm, I'm 38. I get busy, you know, um, I still live three, four, uh, or three, four days a week right now, but you know, on a slow week, one to two, you know, I go on a walk a couple, a couple days a week for about 20, 30 minutes.

Um, when at all possible, I try to do something physical. Uh, I love playing baseball on Sundays. Uh, I've had two disc herniations. I still play baseball. I have zero problems whatsoever. Um, I can deadlift, I can squat, I can swim, I can run no problems whatsoever. Now, am I just a lucky person? No, I put in work and it's, I enjoy it. I enjoy it now. I enjoy the way it makes me feel. I enjoy that. I'm not physically a liability. Uh, and I feel, I feel it feels nice to be capable, you know, not having to worry that you're going to step off a curb and that your back's going to hurt or that you bend over and pick up something wrong.

It's going to stiffen up. And I think a lot of you can get to that as well. And so that step forward is a critical point in there, but it does come at a cost. Everything comes at a cost here. There's a reward and a, uh, there's a, there's a benefit and a detriment to everything. And there is one that comes along weightlifting. I see is that people tend to move like robots. They're now all of a sudden there becomes a quote unquote perfect way of squatting down or a perfect way of bending over. And so that is not the case. That is just the case when it comes to high loads. Okay. Now, if I'm picking up a, you know, a hundred pound dog and I need to put in a car, yeah, there's, there's a optimal form.

But if I'm bending over to pick up a dirty rag, I should be able to do a very, a variety of different ways. And there's what we call movement, um, variability and there's no optimal way to swing a baseball bat. Um, there's no perfect way of squatting down. If you're going to pick up something, uh, you can use your legs, you can do it sloppily. You can bend your back. You can bend at the hips. You can do it with one knee down. You can fall on the ground and do a burpee back up. It doesn't, it shouldn't matter because all those are very low loads. All you're doing is navigating your own body weight.

And a lot of times people struggle to get back to this because they're afraid to get out of perfect form. Now, when you're not in perfect form, um, if you haven't exposed your body to it in a while, what do you think is going to happen then? It's just unprepared again. So this is why doing things like weight training a little bit and getting out and just hiking, swimming, playing, playing with friends, doing freeze tag, you know, playing like a kid again is helpful. Do things with bad posture and have a good time, have fun. So that is the five step system that I see it, at least in regards to back pain.

You have your, uh, your working diagnosis exam. Most of you need somebody to do that with you. Um, your first days can be strategically pinpointed if you've done the exam well. And that's where most of our first day stuff happens. Uh, the supportive stuff or the corrective exercises, we say that can also be done within one day. Um, if you go to the right person and they're very efficient, uh, you can also get into step four. Sometimes on day one, uh, we had a lady the other day who came in, who she had a disc injury and we found the first aid very quickly. After the exam, we had her do two corrective exercises to correct for something.

And we had her deadlifting from a block within the first day. And she's like, Oh my God, it doesn't hurt anymore. So it can happen very quickly. Step five is go out and do something fun, you know? And so these are the parts that I think a lot of people forget when they go through a, uh, the rehabilitation process and they wonder, well, what should I be doing? Well, where are you at? You know, where are you at in your recovery? Do you need a first aid? If you're finding that you're doing corrective exercises and nothing sticking, then you probably need a first aid. If you're doing weight training and, uh, things keep bothering you with your squat and deadlift or you're, say you're running, there's something that bothers you through your activity, then maybe you need a, uh, uh, a corrective or a first aid or both, or maybe an exam.

And so it's a, it's a nice step-by-step process that if it does not need to be a slow one and rehab does not need to take months. Okay. It should only take probably, let's say weeks. And I might go out on a limb to say this, but two to three weeks to feel pretty damn good pain wise, pain level wise. Now that's where your journey starts. Okay. That's where you got to tell yourself, what's my goal? What do I see success looking like? Um, and if you fall in the category, which I mentioned earlier, where things are more so that you don't want to feel like you're unable to do stuff, then your journey starting, it's going to be a good time and you're going to feel good, look good.

Uh, you're going to age well, you're going to be able to do a lot of things you never thought you'd be able to do again, like pick up soccer and basketball. So, um, next time you're going through a rehab process or you start with somebody, ask yourself, is this the type of, uh, rough approach you're taking? It doesn't have to be exact. You know, I don't expect everybody to practice exactly this way, but I think the thought process should be there. Uh, there should be a thought process of how to get you out of pain and then get you back into function. Okay. And I, I also believe too, that I know that people are quick to jump the gun when they go to a healthcare provider or rehab place.

Um, don't be so quick to jump the gun. Uh, I I've, I've screwed up a lot of times with people and I've, I feel like, uh, if they would have just gave me one more session, you know, they gave me like one time, give me one more session. I would have figured this thing out because you're like a book. I'm just picking it up right in the middle. So sometimes you go the wrong direction, it happens, you know, and, um, but generally speaking, if you give someone the chance to see you one to two times a week for a couple of weeks, they should be able to get this right. And you should be feeling significant, better, significantly better within that time.

So give them at least that chance before you start jumping the gun. And I know a lot of people have this story where they're like, I've seen 15 different doctors and they didn't know what they're talking about. And you're my 16th one. And so it's like, I, I got a feeling I'm going to be the 16th one. And like, I have to tell you, don't like give me a chance because, uh, everybody, everybody needs a little bit of a chance to help you. And if you keep jumping doctors, you know, no one's going to have a handle on you. And I mean that the nicest way. Okay. Just give them a chance, hear what they have to say.

It's hard to believe that you're going to go through 16 doctors and one of them would not have gotten you to feel better. Okay. There might've just been some miscommunication along the way, some misinterpretation of information. Maybe they gave you, uh, or maybe, um, maybe they, they didn't pick the right corrective or first aid right away. And that's okay. You know, everybody's human. So I hope this was helpful to everybody, at least understanding, uh, at least the, the mindset and the recovery process for lower back pain. Obviously I didn't go through, um, all the exact steps, but, but again, there's, there's a lot of different ways to, to, to do this.

And I think it's more important to understand where you're going before you start off on the road. Uh, if you're interested in getting the, uh, I have a book that I put together on this. Uh, it is, it's not for clinicians cause I know a lot of clinicians do listen to this podcast, but this is mainly, this is mainly for patients. Uh, if you go to my website and go to p2sportscare.com and you go on to low back six or you, you're probably gonna have to Google search that actually, cause there's a couple of hyphens. So it's p2sportscare.com slash low, um, hyphen that little dash thing back hyphen six.

You type that in. It's going to take you to, uh, I have a free book. Uh, you just pay the shipping and, uh, you'll get at least the six exercises that I like the most to plug in at least for the first, uh, steps for the steps two and three. Obviously there's no exam. There's no examination and diagnosis in this, but it's gives you a couple examples of things that I would like to really use on steps two and three with the first aid and the correctives, at least in the very beginning here. So, um, within that book too, it talks a lot about road mapping, such as we talked about in this podcast. So if you've liked what I've mentioned in here, it's a little bit more formatted cause I took the liberty to actually be able to write that and not go, you know, ad lib, uh, such as in this podcast.

So, uh, I encourage you to get it. It's a really good deal. It doesn't cost you a thing for the book. Again, it's, uh, it's, uh, I think right now it's seven bucks for shipping and handling, but, uh, we're, we're figuring out what our exact cost was for that shipping and handling. Cause, uh, funny, I didn't realize that shipping is different than handling cause handling is also the gas and the material and whatever. So we're trying to make it a net result zero basically. So we don't lose money on the, on the thing, but, um, take advantage of it. I will have a link in the description below as well.

So check out that book and I think you'll like it. So if you like this podcast, subscribe to the podcast. I go through a variety of different topics. Um, we go through hips and shoulders and knees and feet and back and whatever. We also go through, um, more complicated topics such as, um, I've interviewed, um, Stuart McGill, um, Michael Shacklock, Richard Ohm, Cody DMACC, uh, who else do we do? Greg Lehman, Phillip Snell, a lot of people, a lot of people. I apologize if I didn't mention everybody, but, um, I've learned a lot through doing this podcast and being able to ask these experts, a lot of, um, one-on-one information that I don't think a lot of people get the opportunity to actually do a workshop.

So I feel like I've learned a lot and my patient care has gotten much better over the years. And I think my, uh, communication and instruction to patients have gotten better too. And hopefully, um, this podcast was a reflection of that, but usually I show a picture. So I didn't get the opportunity to show a picture. So anyways, subscribe to the podcast. Um, my, uh, email address, if you need it, actually, let's just go with it. There's a contact form. Screw it. I'll leave it in the show notes. Okay. Thanks for being part of the movement. See you guys next time.