Back Pain Lies vs. Science | The Art of Wellness Podcast #13

Speaker: What’s up? It’s doctor Gerry, and today I want to talk about why you still have back pain. The epidemic of back pain, as I call it. It’s everywhere. And nobody seems to care about back pain. And this podcast will give you a better idea for treatments and for how to navigate your back pain, low back pain, upper back pain, any type of back pain really. But a couple housekeeping things. First I want to talk about is I do have a free e-book on back pain. It’s called Rethinking Back Pain, mainly about, again, a modern, a more modern take on back pain and how to better go about treating your back pain. It’s free. It’s in the YouTube description. Hopefully I put it in there, but it’s there. You can click on it, email, put your email in there and then it’ll be sent directly to your inbox. Second thing is I am very active on threads, which I know is like kind of like Twitter, but I never made a Twitter, so I made a threads and it’s the same as my Instagram username. It’s apt. Again, I post a lot of things like, you know, modern rehab science takes things on injury prevention, a lot of stuff on back pain too. So quick tips, couple sentences and I’m very active on threads, so check me out on threads. But to start today’s podcast is I want to start with something a little bit more relatable, because I’m sure we’ve all heard this before. It’s, you know, from friends from family members from loved ones boyfriend, girlfriend, you name it. Someone bends over. Someone twists to grab something. You know, I’ve heard this countless times. Bend over to pick up a pencil. Bend over to pick up a sock. Bend over to pick up a, you know, a laundry basket, a heavy laundry basket. They bend over. And what do they always say? They say, my back went out. My back gave out. My back feels out of place. Some iteration of those. Those sentences that I just said. You know my back is it feels weird. Afterwards it went out is the main one I usually hear. And something so benign turns into a vicious cycle and it can be vicious. It happened to me. I remember I did the same thing working in corporate healthcare, physical therapy. I twisted to grab something for a patient, and I had terrible back pain for about a year and a half I had spasms. Spasms in my back all the time. I would wake up in pain. I had sciatic pain, which if you don’t know what that is, it’s nerve pain. Down to your leg. Down to your foot. I had sciatica down to my big toe and my left leg for about a year and a half, like I said. And again, it turns into a vicious cycle. And I’ve. I see it every day as a clinician, as a physical therapist. It’s something that it’s near and dear to my heart because again, it happened to me. And I don’t like to see people in pain like this. And, you know, I’ve had the scary thing is I’ve had people tell me that their pain that they had when they bent over to pick up their phone or their sock and their back went out. I’ve heard them tell me that that pain is worse than their pregnancy pain, or it’s worse than their kidney stones that they had. And again, it’s it it it messes with them mentally because they’re so afraid to do that movement again, like bend over again to pick up something or to arch back and grab something, because that fear is now instilled into them and their nervous system holds on to it. So anyway, it it’s a vicious cycle. It happened to me. I see it every day in patients and clients, and oftentimes it’s not as scary as you think. So it’s mostly just the initial shock that people get, again, very fearful of doing that again. And what happens? Their nervous system upregulates. They get super tense. They get afraid. They get more stressed, and it magnifies their pain. Happened to me and I see it every day as a as a physical therapist. So and again, it’s never as scary as you think. And that’s what I’ll kind of talk about more in this podcast. So the structure of today’s podcast is I want to talk a little bit first about some common, my favorite common myths and misconceptions on back pain and just terrible advice that I still see when it comes to back pain. And, you know, whether it’s from primary care people or other parts. And it’s just like, why are we still doing this? Why are we still talking about people to go, you know, get these quick fix treatments that don’t work. And then they come to me and they’re like, why does my back still hurt? I tried this. It doesn’t it didn’t help at all. It’s amazing how many times I’ve heard that from people. But so again, first is some myths misconceptions on on back pain. And then the second part of this podcast is I’ll talk about more treatments and a more modern take on how to heal your back pain. So, you know, before I get into the into the myths, like I said, it’s still very weird to me how normal evidence based advice on back pain and healing your back pain is still extremely rare and hard to find in the mainstream, whether it’s, you know, YouTube videos or podcasts or, you know, anywhere in the mainstream. And you know, that good advice that combines modern pain science and rehab science rather than, like I said, simple, quick fix, Band-Aid type treatments. But and that’s what I’ll kind of divulge today or talk about today. But anyway, to start off with, I have a bunch of stats here I want to give you guys, but the first stat I have here is it’s again, these are all very eye opening to me. Maybe because again, I’m a little biased. I’m a PT, but these are all just again to me they’re just like they signal that like, why don’t we talk more about this? And I’ve talked to so many people who are in pain, you know, with low back pain. And these stats will kind of open your eyes as well on how prevalent this is. But. The first step is low. Back pain is the leading cause of disability worldwide. So this is in the whole world, not just here in the US. And again, it’s everywhere. I see it every day. It’s the number one thing as I treat as a doctor of PT is is low back pain. I see teenagers with it. I’ve seen, you know, middle aged office workers with it, um, older lifters with it. It’s it’s everywhere. And it’s just it’s still amazes me to this day. The second stat I have here is up to eighty percent of adults will experience low back pain at some point in their lives. Eighty percent. Like that’s a huge number. You know, I’ve had it. A lot of my friends and loved ones have had it. It’s it’s all over the place. And, you know, maybe again, I’m biased, but I think it’s probably more than eighty percent. The third step I have written here is that back pain accounts for the third highest amount of spending in the United States. You know, MRIs, painkillers, muscle relaxers, office visits to your primary care, all that stuff costs a lot of money in today’s healthcare system. So again, very high amounts of spending when it comes to back pain. The fourth stat I have here, and this is my favorite stat to talk about and I think it’s again mind blowing. Is that roughly up to ninety percent of low back pain cases are considered nonspecific. Now what do you think nonspecific means? Nonspecific means whether it’s an MRI, they take an x ray. Whatever scan they take, they can’t really find anything structural going on and this that. It can be scary. It could also be very empowering because you could look at it the way as like, well then what’s wrong with me? Right. Like, why am I having this crazy pain? You know, I’ll speak from my own personal experience, but again, like, this was me as a, you know, younger PT days when I just started working, I didn’t know any better. I didn’t need an MRI, but I went to go get one because my pain was so intense and I had sciatica nerve pain down my leg. I went to get an MRI. Again, looking back on it now, I didn’t need it. There was no red flag signs of that. I had something else going on. But, you know, I. I got the MRI, you know, it didn’t really show anything. Nothing was going on. I had a mild bulge. The ortho told me, and it, you know, and he’s like, I’m not going to do surgery or give you pills for that. And again, in my head I’m like, oh, okay. Like I know this. Like, I know I didn’t need an MRI, but again, the pain was so intense it felt like something was really wrong. But you know, again, nothing crazy going on and my pain eventually subsided. And I’ll get into that later. But you know, again ninety percent of pain is considered non non-specific. Ninety percent of back pain that is. And again you know I’ll talk about this later. It’s in my book too. It’s called again rethinking back pain. If your primary care or your your doctor if PT doesn’t screen out these red flags. I mean, we all should. We do. If they don’t see any red flags in your back pain. Meaning there’s no like, you know, crazy weakness in your legs. There’s no crazy neurological things going on, no bowel and bladder issues, no signs of a tumor or crazy fracture. That means your back pain can be rehabbed. you know. So why? Why jump to crazy conclusions of, you know, I need surgery, or I need these pills to make me feel better when nothing really crazy is going on. So if you don’t have those things, your back can be rehabbed and healed through physical therapy. So, you know, and again, looking at it from the other side of, you know, the other side of this is, you know, then what’s going on with me? Why do I have, you know, like, for me, for example, like, why was I having that bad of back pain? You know, the reality is, is back pain isn’t just structural. I mean, pain in general isn’t just structural. It’s multidimensional. It’s multifaceted. You know, hopefully you heard my other podcast before this one, but I say it all the time. It pain is influenced by stress, by sleep, by mindset, by activity levels. We’re not just, you know, bones and muscles. We have stressors and we’re constantly, you know, getting things thrown upon us in our environment. So we react to these things and they could influence our back pain, our pain in general, really. So it’s not just looking at it, you know, it’s just, you know, everything is wrong in here. Because again, for me, nothing structurally was going on here, you know. So and that’s the case for ninety percent of people, which again, crazy stat I know. But you know, the more effective approach is addressing the whole person and modifying things and not just looking at it just from, you know, a strict biomechanical perspective, which, again, you know, crazy coming from me, the PT, but take the whole person approach, not just a you have a disc bulge. That’s why you have pain. That’s not how pain works. And we have to stop looking at it that way. All right. So my favorite myths about back pain, my favorite misconceptions about back pain is the first one Is resting is recovery. So let’s say you, you know, you bent over to grab something and your back went out. You know, what are you supposed to do? Let’s say you go to your primary care and they’re like, oh, just. And I’ve heard this still from from patients that I get that their primary care told them just, oh, just lie down and the pain will go away or do nothing and the pain will go away. Right. Terrible advice. And essentially, that person is telling whoever it was that told you, that is telling you to avoid everything, right? They’re telling you to essentially fear your back pain. You know, in terms of research and recovery, on recovery and healing, remember that, you know, having a positive mindset helps. There’s research on that. But also remember that research shows that prolonged bed rest or doing nothing doesn’t help. And research shows that it increases stiffness, it increases weakness, and it prolongs recovery. It essentially makes things worse because, again, the human body is meant to just you’re not meant to just lay down and be afraid and do nothing all day. When you do have pain, you’re supposed to move. You’re supposed to get up and get some circulation going, get your joints lubricated. That all helps whatever pain you’re having. Really. And again, plenty of research on all this stuff and I’ll link some of them in the YouTube description. But and again we tend to forget that. And that’s our job as RTS is to remind you guys that this is, you know, our natural pain reliever to you is exercise and movement. So, you know, when we exercise there’s natural endorphins and chemicals that get released that your body likes. And they’re good feel good. Chemicals and pain decreases especially with back pain. So remember, it’s it’s our job as physical therapists to get you mobile and strong again. And you know, the big thing I’ve seen with, with any injury really is getting you over that fear of re-injuring yourself or having a flare up. People are so afraid of those things. And, you know, it’s it’s a big mindfuck to them. And I don’t mean to swear, but it’s, you know, I see it in people’s eyes. They’re so afraid to to bend over again, to pick up a barbell, to deadlift, to pick up a pencil from the floor, because that’s how they originally hurt their back. So again, it’s in their mind, it’s it’s trauma. You know, just like any trauma in the body, your body holds on to it, right? I don’t care if it’s mental trauma, physical trauma. You don’t just get over it. There’s no quick fix for that. Right? So, you know, that’s why I love our profession as physical therapy is we’re also a therapy. Therapy is therapy. As I always say. Therapy is it’s a process. It’s not just like, you know, something terrible happened to me. And the next day I feel great. Like it’s an up and down process. You know, some days you feel more anxious than others. Some days you feel more depressed than others. Some days you have more pain than others physical pain. It’s the same thing. It’s an analogous comparison, right? It’s the same thing. So it’s an up and down journey, but it’s nothing that you can’t overcome. The second myth I have here is. It’s these are all so, so good. I love these, but I love talking about them because I talk about them with patients every day. But pain equals damage. No it doesn’t. Pain doesn’t always equal damage. Again, I keep referring to myself here, but I had nothing. Nothing was damaged really in my body. You know, why was I having such bad pain. And I see it with patients all the time. They go get an MRI and x ray. They come back to me. They’re like, I mean, nothing crazy is going on. Like, why am I having terrible spasms and sciatic pain down my leg? Right. And again, the the reality of the situation is, is pain is a protective alarm system. Your nervous system is king when it comes to pain. It’s not always a sign of damage or damaged tissues. And I’m not saying tissues don’t come into play. I’m not saying that either. I’m not saying it’s all in your mind. Don’t get me wrong, everything is a combination of everything. But you know, the reality is back pain isn’t just structural. Again, it’s multidimensional. It’s multifaceted. It’s influenced by stress, sleep, mindset, activity levels, all that stuff. And, you know, I want to kind of hammer this one home, but like, people can’t seem to grasp, the concept of pain doesn’t always equal damage. I mean, yeah, of course, if you get in a bad car accident or something, you have a lot of fractures or something, which is are people that I’ve seen before as a physical therapist. Yeah. I mean, that’s probably where your pain is coming from. But like, I mean, someone who just bends over to grab something. Like you’re not going to break your back, you know, and it feels like you broke your back, but it’s not what happened. You know, think of it this way. A different way of reframing it or a different concept of pain is like, you know, say you have a little paper cut in your whatever finger, your index finger, ring finger. And again, it’s just a little a little slit, a little tear in your skin. Right. Is it really that damaged? No. But again the pain can turn diffuse and it can turn general into your whole finger. Right. And you start to feel more pain. And again, that little tear can turn into something, you know, bigger than it is. And again, nervous system is king when it comes to to pain. But let me go back to MRIs again for a second because all my my PT friends watching this are going to know exactly what I’m going to say next. But there’s a lot of MRI studies showing that many people with disc bulges or degeneration. Two of my favorite words I hear as a healthcare person, as a physical therapist, because people get so afraid of, you know, we have our list of words that people are afraid of. We have bulges, disc bulges, right? We have arthritis, we have osteoporosis, we have degeneration. There’s more that people, when their primary care tells them that they become so entrenched in that diagnosis, they’re like, oh my God, I’m broken now. Like, oh my God, I can’t do anything anymore. I have a disc bulge. I can’t bend over. I have a bulge in my back. I can’t do squats, I have arthritis. That’s the dumbest shit I ever heard in my life. And I don’t mean to swear again, but it’s true. Um, and again, I don’t know why people are still saying these things to patients that are trying to get better to overcome their knee pain, their back pain, whatever pain. Like don’t squat. You have arthritis. Like, come on man. Like do better than that. Um, there’s ways to modify things. There’s ways to exercise around these, these issues that are not really that big of an issue in the first place. It’s just again, these are all think of it this way. They’re all wrinkles in our body. They’re like normal age changes, you know. And as you get older this stuff is going to happen. You’re going to get more arthritic. You’re going to get some more some bulges in your back. You’re going to get some degeneration. Like your body isn’t going to be perfect your whole life. It’s impossible. Um, so, you know, again, the stat that I have here and you can look it up on Google, but again, I’ll put it in the description here is in adults, over forty, up to sixty percent of people have disc bulges on an MRI and they have no symptoms. And there’s probably a lot more things than disc bulges on those MRIs. They probably have degeneration. They probably have arthritis, yet they have no pain and they function perfectly fine, you know. So again, pain is very weird when it comes to that stuff. Imaging isn’t always the end all be all. So I’m not saying that, you know, scans are bad or MRIs are bad or X-rays are bad. I’m just saying don’t jump to conclusions. Especially when it comes to back pain. Again, if there’s no red flag signs of back pain, you know, screened out by your physical therapist, then you should do physical therapy and take and be very consistent with it and take it very seriously, because that’ll get you better. Of course, if the PT is, you know, not seeing you as much as they should or they’re stressed out at their clinic or, you know, they’re seeing three patients at once like I used to at my old corporate job, you know, Maybe that’s why you think PT sucks or you don’t believe in PT, but find a good physical therapist. You know, we’re here to help you, and we’re here to actually assess you and give you a proper rehab plan to help desensitize and downregulate your pain and your nervous system and all that stuff, because exercise does all that. It doesn’t mean we’re going to start doing some deadlifts at three fifteen or doing anything too crazy. It just means we need some. Again, it’s our pill to you guys. That is our prescription to you. Are these rehab movements and exercises to get your pain lower and lower desensitizing and eventually you’re not afraid to bend over again. So, you know, that’s kind of my my practical advice on that is that that movement retrains the the alarm system, your nervous system, it calms everything down. It downregulates it. It desensitizes everything. You know, that’s the other side of exercise that doesn’t get talked about is it helps regulate pain, right? Of course, it needs to be done in a in a smart manner, not just again, start deadlifting four hundred pounds. But you know, that’s our job as Pts to prescribe these exercises to you. Um, so that’s what we do. It’s a it’s a, it’s a fun job. But you know, and a lot of people always talk about, you know, well, what if PT hurts me more. Or what if I, you know, what if I have a flare up. You know, and flare ups happen. They happen all the time. I see it every, you know, every week with people again. The journey of whatever pain you’re going through, mental or physical, is not just a linear progression. It takes time and your body sometimes will remind you of that pain of like, oh well, today I feel worse, or today I have a bad day. That’s all right. You know, you’re not going to you know, it’s you’re not broken, as I always say, but something, maybe something else is off that we could adjust for and account for. So we’ll do that. And then we’ll let you know if it’s something that you need to worry about too. If again, let’s say your back pain flares up a little bit for a couple days or a day, you know, I’ll tell you as your as your physical therapist, let’s go, you know, see a specialist, let’s go get an MRI or whatever. But most of the time it’s, it’s just that initial fear, that trauma of it happening in the beginning creeping back up in your mind. And when you have that flare up, you’re like, oh my God, it’s going to happen again. I’m screwed. When in reality, most of the time that’s not the case. All right. I love these. The third myth I have here is I’m gonna get so many people mad at me over these. Posture is the problem, right? Posture. Posture causes back pain, right? We’ve heard this a billion times. People still still think that slouching will give you back pain. When I mean, yeah, you don’t want to be slouching all the time. Even me. Right now I’m slouching too much. But you just look like a weirdo if you slouch too much. But you know, if you want to take it in a more scientific approach when it comes to posture. Studies. And these are good studies. Systematic reviews show that there’s no strong link between posture and long term back pain. Again, systematic reviews, which is the highest level of scientific evidence? Here’s a better take on all this posture stuff. It’s more so about variety of movement and low tolerance right in your spine and your back. Meaning if you’re stuck in one position all day, like me, sitting down right here for probably another twenty minutes or fifteen minutes, maybe I’ll be a little stiff as I get up. I haven’t really moved my body. I’m trying to move a little bit, but you know, what I tell people is, if you have an office job, if you have a, you know, you work from home and you sit there for two hours not moving your body. That’s the worst part, is just sitting there doing nothing. Brian’s pointing to himself over there. But I mean, you know, and maybe I told you this, Brian, but like I tell people all the time is like. Set a timer, thirty, forty five minutes. Press start on the timer. When that goes off, get up and walk around. Get up and do your rehab exercises at your PT that like I prescribed to people that you know that I can give you Brian or whatever. You know, these are our pill to you guys is to get up, walk around so you don’t feel stiff so you don’t have that pain again. Um, throughout the day, if you sit for two hours, even if you stand for two hours, it’s like, you know, of course you’re gonna have stiffness and pain because you haven’t moved your body. There’s no circulation, there’s no joint lubrication, there’s no movement in your body. We’re meant to move. We’re meant to, you know, walk and and run and jump and stuff. So if you’re sitting all day, it’s not going to feel good. Of course, even if you’re slouched or if you’re sitting like this with, you know, quote unquote perfect posture, I’m still going to feel not great sitting here for two hours. You know, I don’t care if I have a lumbar roll behind me. Like it helps a little bit just to kind of, you know, decompress some of that stuff, I guess. But best thing to do. Bottom line is to get up and move. I say every thirty minutes would be best. Um, so stop that posture nonsense. All right. Last one I have here I love again. I keep saying it. I love talking about these. Last one is MRI. You need an MRI to know what’s going on. Essentially, you need a scan or an x ray MRI to know what’s going on with your back. No you don’t. So imaging again it’s it’s going to show some abnormalities in your body Most of the time an MRI will catch something. Is that the cause of your pain? Probably not. But again, as I said before, you know, the older you get, the more you kind of have these normal age changes, as I call them. You’re going to get older, you’re going to have some arthritis, you’re going to have some, you know, degeneration in your spine. You’re going to have a slight bulge coming out your, you know, of your discs or whatever. It doesn’t mean you’re going to be, you know, in crazy pain or have terrible pain the rest of your life, you know, and vice versa. You know, there’s people with, you know, on these MRIs that you see all these, you know, crazy things and they have no pain. So it’s like we need a bigger conversation on pain here than just like, you know, MRI, you have this. That’s why you have pain. That’s such lazy healthcare. And again, it’s going back to what I’ve heard a billion times. Patients tell me is, you know, I can’t bend over because I have a bulge in my back. I can’t do squats because I have arthritis, I can’t. Oh man, just so many things where people say they can’t do something, they can’t run because they have tendonitis, that doesn’t mean you’re gonna just like, fully rupture everything or just like, you know, the second you start running, it’s going to tear your ACL or whatever, or your tendon or quad tendon or your patellar tendon. All that means, and if you have pain with it, it just means to modify some stuff. You need to modify your things. And that’s our job is to to give you these modifications and exercises to help work around these things. I shouldn’t even say work around them. I should say, you know, this stuff is there, so don’t be afraid of it. Uh, some more stats. I have over fifty percent of people in their thirties and 40s already show disc degeneration or disc bulges. Again, on an MRI without symptoms. You know, my back is probably all messed up, you know, messed up. Quote unquote. If they took an MRI again. But I feel great, I feel fine, I have no pain. I’m good. I could twist, I could, you know, run, do squats, deadlift. With or without that stuff. So again remember my favorite stat. My top stat when it comes to all this stuff is ninety percent of back pain cases are considered nonspecific. No clear anatomical cause. So you know, overuse of MRIs can fuel fear. It can increase, you know, surgeries that aren’t needed and slow recovery because, you know, all that stuff costs a lot of money. You you schedule the MRI like a week, zillion weeks out, you’re still waiting on it. You’re like, oh, well, I can’t do PT before I get the MRI. Yeah, you can like, why? Why can’t you do it? Especially again if the ortho or primary care. You see they didn’t find anything. Any red flag signs that you need to, you know, you need intervention. Now go see a a good PT first and we can assess you and figure out like if you again you need more intervention or most of the time, like I said, ninety percent of the time you could just start doing physical therapy right away. Um, you know, again, red flag signs when we catch those neurological things, crazy neurological things like muscle weakness and dragging your leg or whatever. Um, and again, they’re in my book. So a big long list of those. But, you know, things like that, bowel or bladder issues, you know, signs of a fracture, those things. Yeah. I mean, get an MRI for that. Um, we could screen those out. But again, most of the time you don’t need, um, an x ray or an MRI because they’re not really reliable when it comes to pain in these cases. So I would argue just go getting physical therapy first and it could reduce your costs again. You don’t need to go through all that like MRI scheduling and, you know, paying for one and possibly getting prescribed pills or whatever. Like just go see a PT, a good PT, and we’ll kind of let you know what to do from there. Analogy that I have for people is like, think of an MRI as looking under the hood of a car. You’re going to find some wear and tear. That doesn’t mean it won’t drive. Well, it doesn’t mean you can’t still move well, because you have some wear and tear, because wear and tear in the body is normal. And nobody has a perfect no degenerative degeneration, no bulge in their back, no whatever. You know, we’re going to have some wrinkles and age changes in our body. That’s just the way the human body works. So what actually helps back pain. And so I want to put a little disclaimer here first, because I don’t want to just give you specific advice on pain and your back pain because everybody’s different. You know, my pain is different than this other person’s pain. Some people have pain with arching back rotation with most of the time it’s flexion or bending over. Sometimes people need different things. So like trying to paint broad strokes of this is the best stretch for back pain or this is the best. Whatever exercise rehab, rehab, exercise for back pain is not. I wouldn’t be doing good healthcare if I just told that to you guys. So this all is under the umbrella of working with a good physical therapist first to, you know, again assess you and give you your own tailored rehab plan for you, for your pain. And you know, I get people that come in here, come into my practice and they say, um, this happened a few times over the years, but. You know, they’ve tried PT or they don’t. They don’t believe in PT, right. And that’s such a strange statement to me because if you’re saying you don’t believe in physical therapy, then essentially you’re telling me that you don’t believe in exercise when exercise is the most researched thing. I mean, what’s the tagline in healthcare and medicine these days? Exercise is medicine, right? And physical therapy. Again, people still think we’re massage therapists or whatever, but most of my physical therapy is eighty percent of it. Ninety percent of it is just prescribing rehab exercises and feel good movements, as I call them to the patient, where movement experts or exercise experts, you know, and again, movement and exercise is a natural pain reliever. It’s not going to damage you any further, especially if you have a good PT, like, yeah, if your PT sucks and they’re not paying attention to you and they’re giving you these random exercises that aren’t helping you, then yeah, leave. Go find somebody else. But physical therapy is exercise. It’s rehab. Exercise. It’s it’s movement. So it’s the most researched thing we have. Exercise. Right. So again movement helps back pain. Plenty of research on this. Again movement is medicine. Everybody says it. And who are the ones actually doing the movements with the patients all the time. Who’s the one rehabbing someone with an ACL tear or with crazy back pain? That’s us. We’re the ones actually with the patient doing them all the time. And you know, just today I had three people earlier with back pain. I’m the one showing them how to exercise and move again. And yeah, we do some some manual stuff. You know, we do some, you know, soft tissue work, massage type things. I can crack your back. I can do, you know, dry needling, cupping, whatever. That stuff is all well and good. Maybe we need a little bit of that to get over that hump. But once you feel better and that stuff makes you, makes you feel a little bit better. We need to start moving and exercising, because laying on the treatment table is all just passive treatments and meaning the patient isn’t active and we need them to move and to move their body and gain confidence and to get over that, that hump of being afraid of their back pain. So movement helps. Exercise. Pain is a natural pain reliever. Gradual loading of your spine in your back, meaning getting stronger. You know, muscle gaining muscle, getting muscle helps everything. Um. Start small with your physical therapist. Build tolerance. Your back adapts just like any other tissue so it can get stronger and your pain will decrease the more muscle you have as the more you know of your own natural back brace, right? You’re not going to get that with, you know, red light therapy or whatever. That’s not going to make your muscles bigger. You know, a massage isn’t going to make your muscles bigger. You need to gradually load your back and to get stronger in a smart manner, of course. Um, what else helps is your mindset, you know? And again, I think one of the biggest things I see is working as a physical therapist is people are afraid of re-injury of hurting themselves again. And, you know, research shows that confidence and having a good positive mindset helps overcome pain and injury. So fear can slow that down. There’s plenty of research showing, you know, again all this this positive positivity. And you know good mindset helps. And and again you know that’s not my wheelhouse mainly. But you know the thing that I’ve seen as a PT I see it from the other side, right. Is let’s say someone is afraid to bend over and and grab something. And, you know, we start working on flexion, more on bending over more, gradually loading it, you know, doing other things, and once they kind of see that they can do that with less pain or being pain free. Their confidence goes up. They start to become themselves again. You can see their, you know, their smile coming back. They’re not as sad anymore because they’re not afraid of that, that, you know, debilitating back pain and they start to turn into themselves again. Vice versa is also true. If you have a good mindset on these things, it’ll help you with the exercises so they go hand in hand. But I’ve had countless examples over the years where patients get stronger, they get more confident, they get stronger with their deadlifts with and again, maybe they hurt themselves bending over. And what’s a deadlift? You’re bending over and you’re picking something up extremely heavy. You know we work on deadlifts. We work on Jefferson curls. If you don’t know what that is, you know, it’s it’s something you can search over on, on YouTube. But it’s essentially like rounding your spine and bending over and building tolerance into flexion and bending over. And you could load that too with kettlebells, with dumbbells. It’s a great exercise. Once you’re at that point of once your PT actually assesses you and you kind of hit that milestone of going into Jefferson curls or deadlifts because you can’t just, again, just jump a bunch of steps. But again, people get stronger and the more we expose them to these movements that they were initially afraid of, you know, greater exposure, if you want to call it that. You know, along with strength training. It’s something that I love to see. And working with these people, I see their back pain go down, their confidence go up, and it’s the best feeling in the world. So. All right. But recapping the four myths that are my favorite, favorite things to talk about when it comes to back pain is resting is not recovery for back pain, don’t rest. Movement helps everything get active earlier. That’ll help your healing, your recovery. Pain does not always equal damage. Your posture is not the problem. We could throw an alignment in there too, because that’s again, science does not back those up. And the last one is you don’t need an MRI or x ray to know to know what’s going on. Ninety percent of the time, again, the stat is ninety percent of low back pain is considered nonspecific ninety percent up to ninety percent. Lastly, remember your back is strong. It’s adaptable. It could it it can be rebuilt through strength training and physical therapy, just like any other tissue you’re built to move. Don’t fear your back pain. Don’t be afraid of bending over or extending back or rotating again, because that fearful mindset keeps you stuck and it keeps you fearful. And that’s what happened to me. You know, I remember I was, you know, when I rotated and my back felt like it blew up. It’s, um, I was afraid to to rotate again and to bend over again, but, I mean, now it’s just like I haven’t had that pain in forever. And maybe, you know, looking back on it now is, you know, I was overstressed. I wasn’t exercising regularly. I was not eating well, I wasn’t sleeping well. I hated my job. So that stuff probably magnified my my pain, when again, there was nothing really bad on the MRI that I got. And lo and behold, when I quit that job and I got back to being me again and exercising regularly and rehabbing my own back haven’t had an issue since. But if you have a similar story, which I know a lot of you do in the YouTube comments, uh, you know, put it below, drop it in the comments. And, you know, maybe you bent over to pick up, you know, a piece of gum and whatever. And your back blew up like mine. Or you bent over to you dropped your phone, and then you’re like, your back went out and then you went to the E.R. or something. I’ve heard, you know, some iteration of that a zillion times as a PT, but I want to know your story, so comment it below. Make sure to subscribe to the YouTube channel. Follow me on threads on Instagram at Apter G. Again, the free book is called Rethinking Back Pain. Just click on the link, put your email in and the book. It’s free, so why not get it right? It’s like twelve pages I think twelve, thirteen pages. Um, it goes a little bit deeper into all these things. I was talking about a little bit more stats to back these things up and a little bit more dense than today’s podcast, but it’s a quick read, I promise. That’s it. I’ll talk to you guys next time. Peace.