Why sciatica comes back and what actually helps

Clinicians, thanks for joining the show. Just to let you know, this is a lay public friendly podcast. This is really not even for you. But if you're looking for a podcast for you, and you want to learn all the tips and tricks that we talk about on this show, subscribe to the premium version of the Restoring Human Movement podcast, and all the stuff that you will want for your own clinical practice is in there. Take advantage, you won't be disappointed. Now on to the show. 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, it's your host, Sebastian, with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is your first time on the show, welcome. You've missed a lot of different shows in the past. I think we're around 200 and almost 90 right now. We've covered various things from sciatica to sports hernias to hip pain to neck pain, nerves, and so on. Many, many, many different things. So, I've had guests on, more guests on in the past, and as of the recent years, I found it easier to just sit in my own little room here and just podcast with myself or some of my associate doctors.

So, I wanted to have on Michael Shacklock about a year ago. I had him on before, but we got lost in communication and email a little bit because he is on the other side of the world. I've been to multiple of his workshops before. They're excellent. I've seen him speak multiple times. Every single person I know, from chiropractor to PT to doctor, or let's say medical doctor, orthopedic that I've ever met who's watched him speak the dang. Everything that he said was missing parts of the puzzle for treating people with sciatica, but I had no idea I didn't know it. I remember one friend, I've had him on the show, Cody D-Mac, before. He said, you have to go to his workshop.

Basically, if you know all the stuff that you know, this is a part that you cannot afford to miss if you're treating people with sciatica. So, I thought we would call this podcast Why Sciatica Comes Back, Tips from Michael Shacklock, Nerve Expert, but gosh, I hope I don't change the name of the podcast. But I want it to be something really catchy and really precise for you guys because here's the thing. I've met a lot of people who have had lower back pain before, just generalized lower back pain, and a lot of them have heard of the McKenzie Method. Robin McKenzie was a famous therapist who put together a methodology that really, really helped a lot of people.

And then for other people who have been experiencing low back disc pain, a lot of you have heard of Stuart McGill. Stuart McGill is an excellent source of information. He's well-researched. He's done a lot of research on his own in his lab, and he's written quite a few books. The books, I think both Robin McKenzie and, or I don't know if Robin actually wrote it, but the McKenzie Institute wrote it, and McGill wrote, for the lay public, I think were excellent. McKenzie's is called Fix Your Own Back. They have Fix Your Own Neck, Fix Your Own Shoulder, and various methods. Stuart McGill has the back mechanic, which I think is excellent as well.

So there's these types of treatment methodologies that are synonymous with these problems. Even, I'm hoping one day to have Jill Cook on for tenanopathies. And then you'd think that everybody who has these problems should probably know about these people and the information that they have come across in order to get themselves better quicker. The sad reality is a lot of us end up having encounters as clinicians with people who have just not been doing the best things at the moment, you know, sadly. And there's a lot of great information out there that we just have to become exposed to. So in this podcast, this is intended for lay public.

My intention is, is I want to coerce Michael one day to write a book almost like Fix Your Own Nerve. You know, like, he doesn't just work with sciatica. He doesn't just talk about sciatica. He talks about the whole nervous system. And so I hope his information today is clean enough and informative enough to help you guys find that there is going to be a solution, even if you tried other things before. And then I'm hoping one day that he actually puts together a provider list of people who have been through his workshops. I think we've talked on email a little bit, and he said that possibly over the next year he's been a little busy.

But I think for my struggle as a clinician, I've met people from different areas, and they say, I have this sciatica. Where should I go? You know, I wish I knew who took that workshop, because I know everybody who's taking that workshop has the relevant information and can probably treat you really well with simple things and get you better faster. Now, if you're compelled in this podcast to think, you know what? I really need that type of care. I need help. I need to get better. I need to know all the things that I should be doing, should not be doing, and how to progress my care. What type of sciatica do I have?

What are the causes? I need some education. You're thinking all that kind of stuff. You should find somebody who's been trained by Michael, if you can't see Michael himself. But certainly see someone who's been trained by Michael or his disciples. So you can go to neurodynamicsolutions.com. Hopefully, very soon he's going to have a provider list up. And find somebody who practices neurodynamics. If that listing's not up, you can certainly ask one of your local providers, hey, do you know anybody? You can even email us. There's a contact in the podcast as well. Just ask us if we know anyone around you, and we'll certainly do our best to find somebody.

So without further ado, let's meet Michael. And he already has to say about all things sciatica. It's morning time, right? Yeah, that's right. It's 9.30 a.m. I thought we'd narrow the topic to sciatica more so than other types of nerve problems. And can you tell everybody why you're so qualified to talk about this topic? Well, that's a really good question. I find it hard to answer because even though I've been studying the area for a long time, yeah, and treating patients, the more you know, the more you realize you need to know. And so people say, you know, do you know a lot? Are you an expert?

Well, maybe. But certainly there's a lot more to know, and, you know, even though we do know a lot. So I'm going to say, yes, I might be an expert, but let's talk about what we don't know as well because we need to learn, you know. Okay. So we're not going to call you a guru or anything, right? Oh, well, just Michael Shacklock. That's all I need. Michael. Okay. So for everybody, just to give context again, this is going to be lay public base. So no big need to talk clinical stuff. If there is clinicians listening, then they should know there's other podcasts. Taylor and Brett interviewed you very well recently, too.

So there's lots of other references, and everybody should go to his course. So can you explain for the lay public, at least in regards to sciatica distribution, what's the difference between something like a neurodynamic problem and something more like, say, a diabetes neuropathy? Because I think those are confused sometimes. Yeah, yeah. First of all, what is sciatica? Sciatica is simply symptoms, and it could be pain or pins and needles or numbness, itching. It could be all sorts of symptoms in the area that it follows the course of the sciatic nerve. So usually it's the back of your buttock, right?

It could be anywhere near the back of your buttock, right down to your foot on the back surface of your leg or your lower limb. That's generally where it is. It can vary a bit because people's anatomy is not completely uniform. And so that's the general description. The next step is, what's it caused by? Because it has many possible causes. You could have a little swelling in your sciatic nerve that can produce sciatica, but that's not the same as low back pain with a pinched nerve root by a disc, for instance, that can produce symptoms in the same area. Because it's a pathway, and if you think of a garden hose and you block the garden hose, you can affect the flow all the way down that hose.

And so part of the issue from defining it for the layperson is, what's the cause? It's a symptom. In the end, sciatica is just a symptom. The next thing is, what's the cause? And that's where the health practitioner enters the picture and tries to establish that so they can plan treatment. And so really, it's symptoms in the area where the sciatic nerve goes. Can I ask a couple of questions on those two? Yeah, of course. Is it allowed to jump? Does it need to travel all the way down your leg in continuity? No, it doesn't. No, no, it doesn't. You could have a buttock pain and a pain in your calf down the bottom of your leg.

Two areas, but it could come from a similar general area. So that's technically a variation on sciatica, but people don't usually call it that because they're not so aware. If someone hasn't looked into the area in detail, they might say, oh, I've got a buttock pain and a calf pain. So what's the cause? Is it two things or is it one and so forth? So it doesn't have to be in continuity, no. Does it have to feel like electricity? Is there other different qualities? No, no. That's a subcategory of sciatica. So if you imagine you have pain and aching down your leg, that could be sciatica. But if you had burning pins and needles or something like that, itching even, that could be a nerve called neuropathic, which means something that's related to a deafening abnormal function of the axons, the little nerve tubules inside your nerve.

But nerves have connective tissues around them as well, and they can cause aching. So different parts of the nerve can produce different types of responses. And from a science or health perspective, we can define them differently. But for the umbrella statement, it's still all sciatica. Different components of it, though, or different types. Okay. And so I know there's this phenomena with sciatica that comes on with movement. You know, when you lay down, it goes away or bend forward or you kick, you know. And that's what I call neurodynamic pain because it's dynamic in the nerve. And so a more umbrella or superficial way of describing it would be movement-related nerve pain.

Okay. And that's reliant on the nerve being centered to force, such as movement, stretch, pressure, and so forth. So there, I know that with some of the patients that I've seen, we've talked about, I describe it as tolerances. So some of the tests that you perform to identify how it is sciatica or not is, or what's causing sciatica and so on. And we talked about the tension. And, like, I know a lot of people who have been down the rabbit hole of looking at things, they think about pinched nerves and where's the pressure at. Should I do nerve flossing? Is that right? Should I stretch my leg? You know, how do you identify which things are good for them?

You know, I sort of, I feel like I'm on thin ice here because I watch, you know, you really watch social media. It's a way of life now. And, unfortunately, there's a lot of junk. And, unfortunately, the layperson is not aware of what is junk and what is accurate. And, unfortunately, junk can be just low-quality good stuff or it can be downright false. And, so, unfortunately, the layperson is vulnerable to misinformation. And, so, if we go to flossing or nerve mobilisation or stretching, as you call it, there's a lot of stuff out there saying, hey, do this for sciatica, do this. It might work and it might not.

But, the key is finding out why it's there and changing the why. And, so, nerve flossing is a possibility. But, it's not always useful. Nerve tensioning and so forth or stretching is also a possibility. But, a lot depends on what kind of problem you have. For example, if you're limping into your health practitioner's clinic because you have severe sciatica, my opinion is give the person pain relief. It's pretty simple. And, because that's what they want. The reason they have lost function is their pain. And, so, why are we applying force to a nerve that's already forced on from a, we know that from a most common diagnosis, dyscania.

So, we are applying force to a nerve that's already forced on and we're supposed to help. Now, over time, that might be true. But, today, I can't sleep, I can't walk, needs help. And, for me, unloading or taking force off the nerve root for pain relief, to me, is really important for us, particularly in the early stage of sciatica. I'm not saying the approach is generally wrong. But, what I am saying is different stages require different needs, have different needs. So, we can do different treatments along a spectrum of different mechanisms, of different ways of treating. And, like you, Sebastian, you know this stuff.

You'll be familiar with, okay, this person needs this type of treatment. Even though it's still sciatica, at different stages, the same medical, same classification, if you will, or label, actually needs different treatments. And, so, that's why I really recommend that people see a health practitioner's skills in the area. Unfortunately, it's not always easy to know who is. Yeah. Well, that's why I want you to make that directory. Oh, yes. I take your point. Yes. But, yeah, you're right. And, since I am on social media, and, you know, we try to provide context to everything that we talk about.

But, the hard thing is, and it's like a common question that we always get is, so, I have sciatica, so what do I do? I don't know. Oh, yes. What do you mean you treat sciatica? Yeah. So, I'm not saying we shouldn't put that stuff on the internet. I'm not saying that. I'm just saying that the certain aspects are important, and you are right, situation, context. Yeah. So, they're all situational, I feel like, and what you mentioned is that person that limps in is maybe different than someone who's fully functional, but they can't do, you know, just a few things, right? Yes, the athletic sciatica can be treated differently from the severe pained sciatica.

And, one is, the top one, the athletic one, is just lost a bit of performance. And, for example, a hurdler or a 100-metre sprinter or a performing artist, a dancer, a football player who's at peak performance, a small problem for them is a big problem for them because their top 2% of their performance can be the difference between winning a competition and losing in the final. And so, for them, what I would, see, I'm no athlete, I'm healthy and reasonably fit, but I'm not an athlete. And so, my top 2% isn't tested, so I would never know if I've got a 98% sciatic nerve. But an athlete would, and that's why they have to be treated differently, and that's why we have to go into performance strategies that are often more complex and more intricate for the athlete.

Okay. So, that actually brings up, I'll tangent around, I know I have a bunch of questions written down here, but let's just say, since you haven't tested your upper limit of your, if you have that 5% sciatica, should you just never try athletic endeavors again and just, you'll be okay? Or is it... You mean for an athlete? Let's just say for you, because... Oh, for me, yeah. Okay. Yeah, unfortunately, I've had experiences with patients where, you know, for example, someone had neck pain or something, I treated them and they did really well. And they said, well, by the way, I've had this achy, breaky sciatica for about 10 years.

It's only achy, breaky. It's not really severe. It doesn't really stop me. But I do notice it when I do something extensive, just occasionally. Can you fix it? So, we did it yesterday and he had a dysconeia and stuff like that. And I said, well, we'll try. Well, unfortunately with him, every time I treated him, it was provoked and it didn't improve in the long term. And he may have had some adhesions or some other pathology or some other pain mechanism going on in his back or his nerve. And after several visits, we disagreed that it's probably safer for him not to push it. And that was partly based on him not needing much function, high function.

But for an athlete whose income, particularly livelihood, is dependent on their performance, then I would be more willing to take it further, but with closer controls, such as different types of examination, neurological, make sure their nerves are okay and so forth. So, I think the decision is based on the person's needs and that's close communication with the sufferer and what they're willing to tolerate and what is safe. Because remember, we're health practitioners, our requirement is to be safe, even though the patient might say, just try it. We still have to say, if we think it's dangerous, that we shouldn't do it.

And so, situation is really important and requirements. So, for me, I don't mind. I don't mind beating over and getting an extra stretch down the back of my leg. I don't care because I'm not going to push my psychic nerve. Can't be bothered. Return on investment is low. Yeah, I remember there was somebody I was managing that they were a really hard case, for me anyways. For the most part, things got better and then, you know, we talked for every month or two and stuff would come back. And the amount of volume that they were doing with their sport was pretty high. They were not a paid athlete. They're recreational and that's really just what they want.

It keeps them sane. And so, I, you know, in so many words says it's assumed risk, you know, like, like, you don't get this isn't your day job. I know you love it. But, like, you're going to have to choose how much, how much you want to deal with because it was just more highly provoked with what she was doing. But, so, but I've had some people too. Yeah, exactly. And for the listener who's not a health practitioner here, unfortunately, licensed health practitioners are bound by law. And that's to protect the public from danger. And even though someone might say, don't worry, I'll take the consequences of something extreme and risky, we're still not allowed to do it if we know that it could place them at significant risk.

And, again, it's a cost-benefit risk analysis and that's between you and the patient. So, even though someone might say, oh, stretch the heck out of my nerve, I don't mind if it wrecks it. Well, we do. And so, there's that very, particularly high performance level, that's where that 2%, 5% puts them into a window of risk in some people, not all, but some. And that's where, you know, the cost-benefit analysis comes through and ethics. Now, you've mentioned the disc quite a few times here. And I know that there's going to be a lot of people who have been told they have disc injuries creating their leg pain or their sciatica.

I know there's other types that you alluded to, that there's, what are the other causes? Can you talk a little bit more about a disc injury and how that affects it versus maybe another type of problem? Yes, exactly. It's a really good question because even though the disc injury, the disc problem, pressing on nerve root, is the most common cause of sciatica, it's not the only one. And if we jump to the assumption that it is disc hernia when it's something else, then things might not go well as you want. Disc hernia presses on the nerve root. It's a bulge in the disc. There are specific terms. We're going to call it a herniation, which is the kind of more official term.

And it's like a bulge in your bicycle tyre and it can press on the nerve root. Now, that nerve root needs blood flow. It's a bit like if I were to put a small tourniquet around my arm, upper part of my arm. It might be okay for a while, but then finally the veins will start bulging. It'll go blue and it may start hurting. And so take the tourniquet off and it will relieve it. And that's kind of what's happening in some nerve root problems, particularly in the early stage. So if you get a lot of pressure, you can get pain, but you can also get loss of function like paralysis or numbness. And unfortunately, there's not a close relationship between the two.

So if you get severe compression early, suddenly, often you don't get much pain and instead you get a weak limb. Your foot might not be doing what it's supposed to or something like that. The other part, the other sword is that it might not be so severe, but it's more irritated and it can be really painful. And so the really painful one doesn't always indicate that it is serious, which is a pain in the neck, not quite literally. But for the sufferer, I've got really severe pain. The problem must be serious, but actually not always. We're actually, as a health practitioner, actually more concerned about whether you're paralyzed.

So if you're paralyzed from a pressure on the nerve root, then particularly early, you might end up, you might need to get a medical consultation or some sort of radiology or something. So for me, there are, again, different kinds. The more severe, more likely cause loss of feeling and loss of movement. But it's not a determinant of pain. Pain is often related to irritation and inflammation and loss of blood flow. So it's, there are different, well, this is why I'm sort of impressing upon the audience here. That type of problem is important. Weighted out. Yeah, the way, I personally find the weighted out approach controversial.

Now, there are two, for the listener, there are different parts. We read research. We learn what the clinical trials show. We, you know, we learn what happens when you don't touch something for a long time. Don't treat it. And a lot of problems are what we call self-limiting. So they, you heal naturally. But unfortunately, and that is common with sciatica, but unfortunately, there's about 10 to 30% of people are still problematic after a year. And it's not very easy to predict who's going to go in that direction and who won't. And so if someone has sciatica early, you could say, don't worry, be happy, just keep moving.

And it might work. Or you might need something quite specific from the health practitioners, such as a chiropractor like yourself and so forth. And it might really help. But there's another group that, if you leave alone, don't. And my opinion is that that's horrible. Because from a political perspective, we health practitioners that are not really doing very much. We're supposed to help people. And if we're told that we can't help you and it doesn't work, then that's a failure as far as I'm concerned. And so my opinion is that partly based on research, partly based on my experience, I would much rather see someone with acute severe sciatica early, figure out as best we can what's going on, and give them the best advice that we can, and give them home treatment strategies and some physical diagnosis and treatment, sometimes with our hands, et cetera, and sometimes with exercise and so forth.

And that is influenced by what the practitioner sees. Are you moving properly? It doesn't look like there's too much pressure on your nerve root. So then we'll show you some positions which can at least transiently reduce that pressure and give you some symptom relief, some pain relief. And then as you're improving your pain, we can then give you training and so forth, exercises and some physical treatment maybe to help optimize your healing. Okay. Actually, one thing that I've had people ask me a bit is, well, that position you gave me, it does feel good when I'm in it. I don't really have a problem.

But it just comes back, so it really doesn't work. So what do you think, you know? Like, what's the point? Yeah, that's exactly. That's where the balance between transient benefit or temporary benefit has to be married with long-term needs. My feeling is if we did a recent pilot study on putting people into this position to relieve pressure on their nerve root in hospital. They arrived at emergency at the hospital with severe pain and we assessed them and so forth. And we found that people who got this position to open their foramen and improve their pressure on their nerve root transiently did much better at a week than the ones who didn't get it.

But that's not long-term, as you say. And so my feeling is keep adding to it like a yo-yo going upstairs and inserting other treatments in the process to address all the problems that relate to that sciatica. Okay. I can't help but talk about that yo-yo going up the stairs. Is that something that you did? Were you a yo-yo man? Mm, mm, mm. Yeah, I was. I mean, in real life. I remember when I was a young kid buying this yo-yo, I thought, whoa, fantastic. My parents probably thought, great, this kid's occupied for hours. Yeah. So, you know, my dad, he, I forgot, I totally forgot. We saw him a couple weeks ago.

And so we watched Tommy Smothers. I guess Tommy Smothers died, I think, recently. But he was the yo-yo man. Oh, wow. We used to watch this yo-yo video when I was younger. So we weren't super- It's amazing what you can do with a ball on a string or a bill on a string. You can. So is there, we talked about that, like, in that step-by-step type of scenario. Does everybody have to do all the steps, like the relieving position and then the exercises? Or can they skip steps? Or can they just, you know, not continue up the steps and they'll be okay? Is there? Yeah, yeah, exactly. I personally think that there are, we say in Australia where there's a lot of horse racing and gambling, you've got to pick the right horse for the right course.

If you get a soft course and it's been raining, then you've got to pick a horse that can run on soft turf. Or if you've got one that is strong on hard surfaces, then you've got to pick a horse that runs well on hard surfaces. So what I feel is that the practitioner has to assess the person, figure out what the dominant problems are and work with those dominant problems. And you might even jump tracks at some point and say, well, actually, you got stronger in this area really well, better than I expected, but this is what's lacking. Forget that for now. Just maintain it with a few exercises and then you're going to add something different because this is the next part that's lacking.

So I'm okay about changing things and jumping steps as long as it's, you know, appropriate for the patient. So for some of these step-by-steps or general things that you give people over time, I don't think I've ever asked you, how long do you usually see somebody from early onset to like, you know what? You don't really need me anymore. How long does that usually take? How frequent is that touch point? Okay. Let's just say someone who limps in with severe pain. I like to see them probably two or three times, about three times in that first week. So we're in utopia where we can do what we want, which is rare, but, you know, we'll say we can.

I like to go to the top and then dial it back if it can't be done. Then I would like to see them at least two or three times that first week so we can give them some pain management strategies, how to unload their nerve root, how to move better and so forth, how to sleep better and so forth, and then move it to a couple of times a week with rehab strategies, some manipulations or manual therapy, whatever, and then develop their understanding of the problem and not be frightened of certain things and then go from there. It could take, I like to see a big improvement in the first one week, first week, and the first one to two weeks.

So I like to see, it doesn't always happen, but I'm willing to then to spread it out after that and you might manage someone intermittently over a year, depending on how they go. Yeah. And so that was, I'm glad you mentioned some of those points in there because I think I've met a lot of people who have said, you know what, I know this is rehab, it's going to take some time and so it's okay that I feel bad for months. Ah, yes, that's really important because we're in a world of velocity these days and people want stuff quick, they want particular improvements. That's fair enough, but there are times, well, for example, just say someone who bends over, like, oh, I've got a back pain, oh, it's not too bad.

Then by tomorrow they have sciatica, it's really bad. That's an incident. Now, that might be managed differently from someone who's been building up, it might be a repetitive task that's been building up, that their pain's been building up. And sometimes we have to explain to the sufferer, look, a process got you here, so a process has to get you out of here. And so you might say, well, you've been bending over a fair bit, you haven't been moving very well over the last five or 10 years, it's been loading you back in a way that we don't think is balanced, and that might be why you've got this problem.

So we're going to have to show you how to move differently or load you back differently. And that takes time for a tissue to change. The disc itself does not generally have a very good blood supply, so it doesn't heal very quickly. We know muscles can heal more quickly because they have good blood supply. We know that in the right situation, nerves have good blood flow, so they can often change quite quickly, sometimes, not always. And so the disc not having very good blood flow means it's going to take time to adapt to new load, heal, and so forth. And so one of my favorite statements to people who've got this problem is, look, remember that a process got you here, so a process has to get you out of here.

And process is about, if you're building a house, you have one brick at a time, one step at a time, finally, you have a house. But it is step by step and piece by piece. I like that. That's good. Process got you here. Process got you out. I know. Did you ever meet Dan John, by chance? He never... Yes, I have, a couple of times, actually. Did you really? Yes. Yes, I do. I thought he said some of your habits, you know, maybe a little bit more brash than yours, but I like it. Yes, habits. I mean, really, a lot of health practice is about changing habits. So we have a few minutes here. Is there anything that you think are important take-homes that we did not hit yet?

I think from the listener's perspective, there's a broad range of services for sciatica and in physical therapy, particularly in the British Commonwealth countries, and it's sort of partly through the US as well, but more in the British Commonwealth countries, a lot of physical therapists are reducing the emphasis on physical function, or not function, physical causes, and they're going into the psychosocial, meaning, look, if you're worried about your pain, then it's going to make your pain worse. Which is kind of true to some extent, but I think you've got to be careful about overdoing either end of the spectrum, physical or the psychological.

And so I really worry that some physical therapists, I can only speak for our profession, are telling people, your disc's not hurting, when maybe it is, and you should test it. So you're entitled to a decent physical examination, a decent interview with your health practitioner. And I get worried when people go to a health practitioner, they get a short time, they don't get a good explanation. The statements given to them about their problem are not tested. They just read some paper, read a research paper and tell a patient what to do. To me, that's not enough because we are paid and we have obligations and responsibilities to the patient, the sufferer, to give them the best we can.

And so I would, number one, be discerning about who you see. I'm not recommending anyone or not recommending anyone, but make sure that you feel that someone's communicated with you well, listened well, tested the ideas with you and negotiated an outcome or a plan with you. And I just worry that a lot of physical therapists are not doing so much physical. And I personally think that the body is important. We know that dysconeas can hurt. We know that the prevalence of dysconeas in people with back pain is higher than those without back pain. But because there are studies that show that some people without back pain have dysconeas, therefore dysconeas are not important.

That's, to some extent, biased. You've got to balance all the information. And hopefully, you come out of the evaluation with your health practitioner that you've got a good balanced view and tested a bunch of ideas with the health practitioner. Yeah. Nice. Thanks. Well said, Michael. God, I want to do this just again and again and again. But Zoom's going to cut us off. Yeah, sure. Thank you. It's a pleasure. It's an absolute pleasure. Thank you, Sebastian. Thank you. Yeah. Well, cool. Thank you for being on. All right. I hope that was helpful to everybody. Unfortunately, in the middle of the podcast, we had an audio glitch.

And I don't pay for Zoom because I don't really use it that much. So it cuts us off in 40 minutes. And that's kind of the way it goes. So we lost a little bit of time there. But I think I want to recap just on a couple things here that he said. And I hope I don't misquote. But I think the takeaway that I thought was interesting is that obviously there's different types of sciatica. You know, there's different variants, if you will. But also, too, in that utopia type of scenario, like how often would we see somebody with this type of problem? And I would echo the same thing because people who have full-blown pain associated to sciatica or the disc or radiculopathy, whatever you want to call it, it really hurts.

And so we can supply some treatment on day one. And it's transient effects. And ideally, we get them to do some things at home. But I think if I were the patient in that scenario, I would just, all things considered equal, I don't have to pay at all. And I just come in and see me for 15, 20, 30 minutes and just make me feel better. You know, and I think Michael's right with that. Two to three days a week would be pretty appropriate because when I've had family members with the same type of thing, there's a lot more in it, you know, because they live really close by. They're not paying me for help.

You know, they contact me on my phone. And there's a lot of questions. There's a lot of concerns. And there's a lot of things that I can do for them in week one. And so hopefully, if you guys are looking for some help, you find somebody who practices in a similar methodology that Michael's talking about. Again, if you're looking for a provider, I don't think at this point he has a certification for the people who have gone to his workshop. It's just educational. They show techniques and methods and so on. But I'm hoping very soon, because I was kind of poking Michael with that, is that it is very hard to find people who are vetted for this type of management style.

We do it here at Performance Place. And if you guys are looking for somebody, we can certainly look around and see if we know anyone around your area. But it'd be really nice to know. I'd love to connect with the people who have taken his workshop because there is some step-by-steps. And to be fair, everybody may do a slightly different treatment as well. There may be someone who does more soft tissue work. There may be someone who does more exercise. There may be someone who does some adjusting. But it's all based upon your unique presentation as well as what is found in your physical examination, like what's found in the assessment.

So I hope that recap was at least enough to highlight the things that I found, you know, interesting in there, amongst many other things. So if you've been suffering for this for a long time and you're not finding any relief, hopefully you find someone who can do a good job with you. So if you guys are looking for help from Michael or someone who's been helped, who's learned from him, again, NeuroDynamicSolutions.com. Subscribe to the podcast for more to come. Take care.