Art of Wellness #8 – Why Most Back Pain Treatments FAIL (What Actually Works!)

But I think of all of them, I’ve heard the least good about back procedures. Yeah. Yeah. Other than maybe, like, super high athlete, like Right. Like an all Jermaine Sterling getting, like, I think he got his disc actually replaced.

That was his neck. Right? I believe so. Yeah. Neck.

And that was a game changer for him. Mhmm. But other than that, average Joe who’s just aging and their back’s hurting more and more, I I’ve never I don’t think I’ve heard one success. That’s what I’m saying. There you know, there’s a time and place for these things.

But, again, if if outcomes are showing that they’re not even as effective as, like, sham treatments or PT, we might as well what’s a sham treatment? As in, like, in a research study, they just give you, like, a placebo or, like, a a nothing Okay. Group or whatever, you know, comparing it to the actual treatment itself or intervention. Yeah. And then the research shows that, you know, the fake treatment was just as effective.

You see it all the time in science, but, especially nowadays with back pain and stuff. Even, like, knee, pain, like, meniscus stuff, same thing. Which you’re very familiar with too. So two very two topics we’re gonna be talking about today, meniscus and and back, besides our outline that I gave you, which I’ll pull up right now. But You’re like, I brought this broken trainer on.

That’s his claim to fame. I mean, I love having you on. But it’s you know what, though? I’ve always been it’s always just about how you choose to look at things. Right?

I could be sore about the fact that I’ve had some knee issues and some injuries. Yep. My dad has six joint replacements. Like, all of them. All major joints.

Shoulders, hips, knees. They’re all replaced. Right? And, again, I could be sore about that, but I choose to look at it as I am in the profession of helping people through exercise, through nutrition, through just being active, living better. And I can use those experiences that that I’ve had not only to help other people, but also it’s been a huge source of motivation for me to research, get answers, whether or not that be, you know, reading books, taking certifications, or working with pros like you who can see further than I can.

Yeah. I mean, I’m a research nerd, and when this popped up on my social media feed I figured me and you can talk about it because it’s very relevant to us, how back pain is I mean, it’s it’s everywhere in modern society. Yeah. Like and well, let me welcome the podcast first. It’s Art of Wellness, episode eight.

First is Art of Wellness episode eight. Thank you for listening. Thank you for subscribing. I got Danny here again. What’s up, guys?

Yeah. We’re talking back pain, a bunch of other stuff. But again, this is kind of something I wanna talk about because, again, we love well, I love talking about back pain and treating it, and we both kinda had back pain, before. But the article itself is titled can you make it bigger, Brian? Please?

It’s called it’s in the it’s published in the British Medical Journal. It’s a systematic review and meta analysis. And for those who don’t know, it’s the highest level of evidence in science. So the article is titled commonly used interventional procedures for noncancer chronic spine pain, a clinical practice guideline. Essentially, it’s talking about back pain that lasts longer than three months.

Okay. In respect to spinal injections. Things like, cortisone injections, steroid shots, ablation procedures. Essentially, the whole thing is saying that there’s very low to minimal evidence on on these actually helping people. Do you think everyone knows the things you just mentioned?

What questions do you have? No. Just do you think everyone do you think it would be beneficial at all for your viewers just for a brief summary of cortisone injections, ablations? Well, yeah. I mean, I could just touch on it really quick.

I mean, the cortisone injections are mainly for the inflammation process to kinda, you know, help with that. And then also, ablation procedures are essentially cutting off sections of nerves to disrupt the pain signals going to the the painful area. I had a I had a older client get one of those and Yeah. How are they doing? Didn’t help.

Yeah. And we’ve heard that I’ve heard that a billion times in practice. And what was sad is she was really thinking that would be her Yeah. You know, the thing. Right.

And, again, this article is saying essentially how you know, when you read something like there’s low to minimal evidence on these procedures that are just done willy nilly these days is is extremely eye opening. So let me read you some Yeah. Some oops, some stats on that I have on the article that I highlighted on my phone here. Okay. And we can kinda get your your take on it too, Danny.

But so there’s there’s been a well, the first sentence that I kinda highlighted was despite limited evidence of benefit, these procedures remain incredibly common. The numbers tell the story. Between 1994 and 02/2001, there’s been a two hundred and seventy one percent increase in epidural steroid injections. There’s been a two hundred and thirty one percent increase in facet injections in the same period. Joint interventions increased from four hundred twenty five thousand to two point two million from February the year February to 02/2013.

So I wanna get your just reaction to that, first of all. As in, like, the increase is immense. Significant. It’s very significant. It’s at least 50%, almost every category.

Yeah. Some of those are, like I think one of those was several % increase Yeah. Or more. Mhmm. That’s pretty wild.

It’s insane. And, again, so one of the questions the article was was asking is, why the disconnect? The guideline offers a stark insight. Interventional procedures for chronic pain or long standing back pain, are often well reimbursed. In some places, pain clinic physicians average over $700,000 a year in billings.

This creates a troubling ethical conflict where financial incentives may outweigh evidence based practice. That sentence, like, hits me in the chest. Because And you feel very strongly about that kind of pride myself on being evidence based as should all physical therapists. And the fact that these interventions, like like pain pills, steroid injections, even back surgeries that are not the outcomes are poor, are just thrown out there like nothing, instead of people just trying physical therapy or movement or exercise first. Like, why why do people jump to this right away, you think?

Why do people jump to this? Or why is this so, like, prevalent? Has the modern spine just completely eroded over the years? Like, I don’t understand, you know? Well, it’s most it’s definitely multifaceted.

There’s a few things that come to mind. Right? If you if you consider what the modern spine is. Right? Yep.

We’re really just End quotes there. Yeah. We’re we’re we’re really just talking about people are more sedentary and sit a lot more. Yeah. Right?

And so what that’s doing to the spine, well, we know it’s not good. Not good. Right? Nope. So so that’s one thing.

Right? There’s also the over monetization of the medical system. Mhmm. Right? That’s one thing.

Historically, people have really relied on doctors to guide them with their pain, with their discomfort, but and this isn’t to to disc doctors because, obviously, we need doctors like MDs. Right. Right? Yeah. But they’re only limited to their scope of practice, and and they only have so much time in a day.

Yep. They can’t be a physical therapist, a nutritionist, Everything. Everything. They just can’t. And so so I think sometimes they have this pressure on them to to kind of go outside their scope when really they they they don’t really know that much about nutrition.

They don’t always know that much about the musculoskeletal system and how the human body interacts with physical therapy, exercise, etcetera. Right? Mhmm. And so there’s that. Right?

Yep. And there’s also probably one of the most important things is we’re in the microwave age. Microwave. People just want results. Oh, yeah.

Right? You know, it’s like thirty Yeah. You’re cooking something for thirty seconds, and even then, it’s like, come on. It’s like, just chill. Right?

And I’ve done that. We I’m sure we all done that. Right? Unfortunately, yeah, we have. That’s part of it too is if people can hear that they can have the easy way out, the quick fix, oftentimes, you know, relative to their busy life, quote, unquote, that’s what they’re gonna choose.

Even though you and I both know, gosh, the the side effects or consequences of just exercising or getting physical therapy or eating better or sleeping more at night, etcetera, there’s almost none. Right? As long as you’re doing it the right way and you’re with the right pro or under the right program. Whereas, the side effects to surgery, medicine, etcetera. This stuff where the the article touches on, like, the potential potential harms of these needles going into places.

Again, like, you see all the I can’t read that, but all the x’s right there. It’s just talking about how Lots of red. Lots of red and how not, you know, indicated they are anymore. Yet, they’re still done, like I said, at a whopping zillion percent increase over the years. For what?

You know? Which I think we know the answer for what, you know? But it is what it is. That’s the age we live in, I guess. Like, the quick fix society, like you said.

Which it shouldn’t be applied to the human body because that we’re not robots, like I always say. We’re human beings with feelings and emotions, and we react to our environment constantly. We’re not just mechanical things, you know. So it we need time to heal. Yeah.

Mentally and physically, not just, here’s an injection, you’re fine. Here’s a pill, you’re fine. How many times have we heard that that doesn’t work? I see people all the time with back pain. They’ve had injections.

They’ve taken pills. They’re essentially just Band Aids, and they say it themselves. My dad just got his last knee replaced. Mhmm. Right.

I say last knee because all the major joints are taken care of now. Right? Hips, knees, shoulders. And there has obviously been scenarios, many probably, where joint replacements were necessary and and saved people and from Sure. Chronic pain.

Mhmm. But there’s just as many stories Mhmm. Where people are really disappointed at the result. Yep. Right?

And he’s in that situation right now where even his first knee replacement, they did have to go in again six months, a year later to clean up scar tissue and Oh, yeah. Do something else. I can’t really remember. Mhmm. And it that one’s functioning much better now, but the one he just got replaced eight eight, nine months ago, it’s not good.

He’s hobbling downstairs. He’s just in a lot of discomfort, and he’s in this situation now where this was supposed to be it. This was supposed to be the thing that was gonna fix it and Yeah. Help me get out of pain, make me more functional. Easy.

And here we are. It’s never that easy. And, you know, again, as a PT, you know, we’re at the forefront of when they get surgery, I see them right away after not anymore because I don’t treat that population really. But, you know, my old jobs that I used to have, you know, I would get a zillion knee replacements All the time, that’s the knees and hips Yeah. Replaced.

And like you said, it’s never that easy to wear because they need PT right away. They need movement right away. You just don’t get the joint replaced, and then you’re fine. Yeah. You know, we’re the the health care providers that actually do the exercises with the patient afterwards.

You know? No one else is doing that. That’s our job as physical therapists is we are the ones guiding them through the rehab, doing the exercises with them, showing them the progressions, all that stuff. No other healthcare provider does that. So keep that in mind.

And then also, again, with joint replacements, like you said, I’ve seen a billion to where, like, I’m trying to do range of motion work with them. It doesn’t budge. You know, it’s it’s impossible. Like, we’ve done everything. And then at that point, they need to go back, see the surgeon, get the manipulation done, get the scar tissue out, all that stuff.

That’s a great point because I’ve actually wondered about that. So, for example, you know, if I were to identify that someone’s missing some range of motion in their hip. Right? Like a Faber test, for example, external rotation test. Mhmm.

I would have my normal protocols from there. Right? Mhmm. Foam roll the hip. Some I’ve learned from you.

Mhmm. Joint mobilization, you know, doing joint mobilization, pigeon pose or something like that. Right? My dad’s external rotation I trained my dad. My dad’s extra road external rotation is terrible.

Terrible. It always has been. Mhmm. But, obviously, that’s not helping things with his knees. And I had that thought of, okay.

I’ve identified that your hips are super tight, but you have fake hips. So would a joint mobilization even work? And so I just decided not to try because I go, I don’t even know if that applies to an artificial hip, like, how how those techniques work. Mhmm. Well, how I mean, you can I mean, obviously, what if if you’re scared of, like, popping the joint out, it takes a ton of force to pop it out?

So I wouldn’t worry about that. Okay. If anything, just giving input to the body to stretch it and mobilize it a little bit, and it’s completely fine. Okay. So joint replacements can respond and and A little bit more fast.

Stretching. Yeah. To to mobe technique? Like stretching to it. Yeah.

Interesting. But again, well, it’d be super hard to pop it out. Yeah. As in, like, unless you’re just, even then, I it’s it’s they’re very well if the surgeon did it correctly, which I’m hoping they did. It should have been pretty good.

Fine. But all that other stuff should be enough, if you’re teaching him the correct, like, self soft tissue stuff, range of motion stuff, stretching things for him to do. It should be fine, you know. You shouldn’t need that on top of that. My dad’s a good sample size of kinda I don’t quite wanna put throw him into the category of wanting the magic pill.

Mhmm. He’s, he’s now in a much better place than he was before because he he realizes that that paradigm can only take him so far. Right? Just always looking for the shot or the surgery, etcetera. And he’s training with me now.

He’s coming around to the benefits of exercise. He was a power lifter back in the day, so he he was super strong and jacked, but that’s a whole different style of exercise. Right? It’s not so much the quality of life, you know, get through your day Yeah. Age gracefully Right.

Type of exercise. Right? And so now that he’s finally coming around, he’s open to it more than he ever was. But even still, he did some physical therapy and was having some success. Mhmm.

And now I I just the other day, I he says, oh, I gotta go to back to the doctor. And I said, dad, how much better was your knee after doing physical therapy? Mhmm. He goes, it was a lot better. I said, I’m like, compared to now.

Right? He goes, yeah. It was a lot better. Okay. And I go, so maybe you need to go back.

Maybe you just didn’t transition out properly. Right? Maybe there was a just something didn’t quite connect. Right? There it’s not unheard of to need to go back to the drawing board a little bit.

Right? And if you have that experience of it was effective, right, and you were more functional, Why give up on it now? But what was he saying that was troubling him still? Like, he’s having difficulty going down the stairs or just, you know, just just kind of discomfort throughout that whole conversation. He should be telling his physical therapist that.

So I’m not sure why he didn’t practice doing stairs or getting stronger with single leg stability type stuff. When he did it, it was good. Decentric work. Yeah. When he did it, it was good.

Okay. But now that’s been, like, maybe six months since he been doing his exercise. Version of it. Oh, the classic, yeah, fix myself. I don’t need anybody.

Yeah. His own version of it. And he and he always kinda wanted me to stay away from it as his trainer, so we must, like, just do our body. Our dead’s generation. Like, I don’t need that.

I got it. Oh, yeah. I was just teasing, no offense to baby boomer men out there, but, they are the most pig headed Yeah. Oh, yeah. You know, population when it comes to fitness.

It’s like, at least from my pers I don’t know how it is for you as a physical therapist. For but for me, it’s like, hey. I want you to help me, but within the parameters that I’m willing to allow you to help me. Oh, yeah. It’s that’s like, oh, okay.

I see it all the time. Like, whatever. Yeah. But, just the other day, I had him just do, like, a isometric Okay. Quad raise.

Mhmm. Right? Just lifted it slightly off. Just said, hey. Don’t don’t let me push you.

Yep. The knee that’s not hurting, fight. Mhmm. It’s right there. Right?

Mhmm. The knee that is hurting Yeah. Right. So, dad dad, are you still doing, like, leg raises or anything like that? Are you doing quad stuff?

Yeah. Like, didn’t I know your physical therapist gave you Oh. Quad stuff. They should’ve. I don’t know.

Okay. Good. He he did. So, but somewhere along the line, obviously, it got goofed. Yeah.

I love sending people super long emails with their home exercises, tips, tricks, all that stuff. Again, we go the extra mile because I don’t work for corporate health care, thankfully, anymore. But, yeah. Hopefully, they gave him, you know, exercises, progressions, milestones to hit, you know. I think you and I both know that one thing that is often missing in physical therapy, and you’re so much better about this because you can do your own thing.

You’re not beholden to a system. You you can do what you want. Yeah. Right? But a lot of physical therapists, maybe similar to the doctor example earlier, have their hands tied to an extent.

Oh, yeah. Right? Yeah. And their workload’s quite significant. And, really, you get them functional, and you accomplish whatever goal you wanted to with insurance, right, to say, hey.

They reached these benchmarks. But the time but then it’s time to leave, and I feel like too often, it’s just keep doing these things. Yep. It’s not, hey, to really take this full circle or to take it to where you need to be to be functional and strong Mhmm. You need to progress.

Yep. The best way to bulletproof is take these principles and build on them and continue to get stronger. Mhmm. But most of the most of the time I’ve seen it, it’s yeah. Just keep doing these things.

Right. And I remember doing that. Again, the the usual physical therapy clinic is and I worked for those companies, is just, like you said, it’s hustle and bustle. I see three people at a time, three patients at a time. I don’t have time to go, I know.

And it yeah. And that’s where I got back pain from, was that job. Twisting your spine, looking at your hand. And that’s how I we’ll talk we can talk about that too. Like, I Yeah.

Well, we’ll get to that in a second. But the usual PT clinic is super busy. We love in they love insurance. Just like these injection people do, reimbursement stuff, all that stuff. It’s you don’t have time to go that extra mile for somebody.

And like you said, I remember being like, oh, yeah. Just keep doing them. Here’s a big packet. Just do them. And I hated doing that because I I just it was impossible for me to keep up with somebody.

But now, you know, I could email them, like, a month later. Hey, you still doing your stuff? Here’s a progression to this. Or, I send them some stuff. Hey, try this out.

Let me know in a couple weeks how it feels. I do it all the time. Absolutely. But I wanna get back to this article really quick. There’s something else that, was, towards the end of the article.

And I wanna read these two paragraphs again, the the one about the evidence based practice, just to kind of, you know, reinforce this. The paragraph was I have it on my phone, but it was it says, this creates a troubling ethical conflict where financial incentives may outweigh evidence based practice. The top ten percent of interventionalists perform nine times more procedures per patient than the bottom ten percent. As healthcare professionals, we must ask ourselves, are we prioritizing patient outcomes or procedure revenue? When the evident isn’t that just like a such a bullshit question to be asking in healthcare?

Exactly. I hate that so much. That is even a question at all. Right? Yeah.

Again, oh, healthcare is a business. No. It’s not. It’s about helping people. It just is.

And again It says. If you wanna talk about, like, a business, yeah, I have to make money with my my clinic and stuff. But, again, on the spectrum of helping people and making money, it should still be more on the making or the I was gonna say making money. I’m turning into them. On the helping people side of the spectrum.

Yeah. And you can still make money doing that, you know. If you can’t figure that out, then you suck as a health care provider. Something I heard once upon a time that I think is a good kind of litmus test for where your heart’s at in business Mhmm. Is if you are doing if you are making it your goal to provide a great service or create a wonderful product or whatever it is, like, your your focus is offering the thing as well as you can possibly offer it.

And that thing translates to you making money. Mhmm. Then fine. That’s great. Yeah.

Right? But if your motivation is first to make money and secondary to then figure out how to do the product or the service around Yep. The money making part first, then your your philosophy is jacked from the start. Right. Right?

And I think that’s where these big medical corporations, insurance companies, etcetera, that’s where they’re sort of damned from the beginning because the goal is first and foremost to make money and not first and foremost to provide the best source of care. It’s almost like, hey. Let’s make as much money as possible. And then from there, let’s see how great our care can be from there. Right.

And thanks for talking about this with me because I get really mad about and you know I do. Like, this fires me up a lot. The other question that the article was saying or asking was, when the evidence doesn’t support our interventions, what’s driving our clinical decisions? In other words, like, the evidence isn’t showing that these injections are helping much. And, again, we know we’ve I’ve said this.

We’ve said this plenty of times. Like, what’s driving these interventions then? Money. I mean, what else is it? Oh, I don’t know.

I mean, again, maybe the quick fix modern society, our thinking as well, that we think, you know, oh, well, this person could just fix us. Yeah. Man, if I could just fix someone in one visit, I’d have the magic bullet and be a gazillionaire. Yep. Yep.

Exactly. Because you could just make someone super strong. Pain free, like a Jedi. You are pain free. Back pain?

Nope. So it just it hurts my heart even, like, seeing these things, these these statistics. And we we know this as as PTs, as physical therapists. Like, we’ve heard and we’ve seen patients that they get injections, they’re they’re taking, muscle relaxants, stuff like that, And they still have a lot of pain, and it’s not taking the pain away. And and we’re the ones, again, at the forefront having to explain to them why it’s not working.

And no one else is doing that. It’s it’s us. We’re the first point of contact after the surgery, after the these interventions. Yeah. So I can’t think of who else it would be.

No. And again, that’s why I call us the doctors of movement and exercise because we’re the ones actually doing these rehab stuff with the patient. No one else is doing that. I’m with them every day for an hour and a half, hour fifteen minutes. I mean, you’ve been with me.

Like, we’re doing exercises together. Yeah. Yeah. And in some ways, that kinda positions you in some scenarios to have to be the bear the bad guy, the bearer of bad news. Right.

Right? Because you’re the one removing the illusion Mhmm. Of that they had of, oh, well, I’d Right. I was under the impression if I was just on these meds or if I got this surgery or if I took this shot Yep. I would have been good.

And here you are having to That’s a great point though too, because the general population doesn’t know any better. And they’re thinking that this stuff will just help them right away. And I think, again, it’s our job as physical therapists to, you know, tell the public that there’s other ways to manage back pain. And I say back pain because back pain, again, is, like, is by far the most I this thing I treat the most. Yeah.

It’s not even close. Back and neck pain, spine stuff. So, like, it’s up to us to tell people, like, yeah. I mean, well, do I even say this stuff has a time and place anymore? Like, this is again, this article It’s pretty damning.

It’s pretty damning, you know? A lot of them are too. So and again, maybe it’s not the job of this article to be, like, to talk about physical therapy, but I see no mention of exercise rehab intervention in this article at all. Like, why doesn’t it say, like, what else can we do? What else can we refer to?

It should be like, oh, maybe try referring to physical therapists. I don’t see that anywhere in this article. Maybe, again, it’s not the job, maybe, of this particular article. But, well, I guess it kind of is too. Like, what other interventions are there?

Exercise and rehab, physical therapy. And then once they get more functional and we’ll talk about this too right now. Once they get more functional, I could be like, hey. Here’s Danny. He’s a good trainer.

Keep going with him, you know, once he’s pain free. But they don’t again, a lot of these health care professionals don’t even refer to physical therapy still. Yeah. And that’s why a lot of people are cynical about there’s a lot of people I feel like, especially since COVID in 2020, it’s sort of increased. A lot of people are a bit more skeptical than they’ve ever been.

And, you know, I think the reason why that’s the case is we’re we we’re realizing that the the lens at which this research is being looked at and and how the medical community has been operating has been a very narrow lens. Yep. Right? And and the question I think and you’re asking is, why is it so narrow? Why aren’t we considering all of the options?

Right? If there’s all these different ways that we could be helping people. And again, I think it always goes back to money. Money. Right?

And again, I’m not saying physical therapy is a cure for everything either. I’m just saying if data is showing that some of these interventions don’t even do anything, why not try physical therapy first? You’d be surprised how much rehab and exercise can decrease your pain. Yeah. I think in some ways, it’s almost like an epidemic of busyness.

That yep. Right? Because, you know, we’re talking about the doctors being too busy and the physical therapists in the in the bigger, establishments being too busy. And then people go, okay. Well, I’m too busy.

So exercising and getting physical therapy, that’s that’s a lot to ask of me. So why can’t I just take a pill or get a shot? That that’s really whether it’s true actual busyness, because we know a lot of busyness is it’s your own perception of your busyness. It’s just how you manage anxiety and stress. But bottom line is there’s a lot of human beings running around stressed out, busy, and that’s a big part for that’s a big huge part a huge aspect of this.

And, you know, I always tell people too, like, you know, physical therapy is therapy. Therapy is a process. Process requires work. And people don’t like to hear that getting out of pain requires work. Yeah.

And that’s our job to guide them through the exercises to get them stronger, more mobile, more flexible, reinforcing the painful area. But again, that’s a process. It there’s no, like, magic bullet to make your muscles stronger and more flexible in certain positions, less afraid of certain positions. That’s all physical therapy. And through greater exposure and through strengthening exercises, stuff like that, we do that with the client and the patient.

So, I always tell PT students, don’t don’t undermine our importance in health care. Because if anything, the more health care evolves, the more we’ll be more readily more readily used. Yeah. Because people, I think, are and this isn’t skeptics. This is data.

This is science telling you that the prevalence of these things are going up, and they’ve been going up. Yet the evidence is it says right there, low or very low certainty evidence. Like, that’s Yeah. And this is the British Medical Journal. It’s not 4chan.

Right? This is legit. This isn’t some YouTube guy saying, which I guess I’m that YouTube guy now. But I’m trying to I was about to say, man. Don’t hate on those YouTube guys.

We’re both YouTube guys now. But I’m trying to back it up with science here. And there’s plenty of these articles I’ve seen over the years, even in PT school, even in practice now. It’s I see these all the time. But this one, it just came up on my feed yesterday.

Yeah. And I was like, I have to mention it. I I think you’re a good person to kinda riff off of to talk about back pain and, these interventions and things like that. But so Well, one other thing you’ve helped me with, and I think this is an important thing that physical therapists offer and even can be reinforced when you begin strength training in a more, you know, you’re you’re in your healthier phase. Mhmm.

Right? Mhmm. Is pain is a message. Right? And so you could look at that in another way is your body, your brain, your central nervous system is trying to talk to you.

Oh, yeah. And just like any relationship, it’s reinforced and becomes stronger, better when the communication is better. Yep. And understanding that message and not necessarily always looking at that message in terms of black and white, like, I’m feeling some discomfort, Stop everything. Mhmm.

Right? Yep. That’s how a lot of people are because they’re so deconditioned. They’re not as aware of their body. They’re not as that that relationship has withered over time Oh, yeah.

Between themselves and their bodies. And so you’ve helped me with that personally when I’ve when I’ve worked with you in that I’ll be doing something, like, I’ve gone to you for my knees, my shoulders, my lower back, and you’ve helped me Everything. Everything. Right? You should tell them.

I’m like, well, let me tell you what’s next, Sherry. But And I’m glad to help you. You could text me whenever you want. So Yeah. Yeah.

And you’ve helped me at times when I’ve felt a little discomfort doing something, and then you helped me qualify it. Right? Well, what what are you feeling? Talk to me through it. On a one to 10, where’s it at?

Mhmm. And oftentimes well, one thing I like about you is you let me trust my intuition. Mhmm. But once you give me that information, we can collaborate from there Yep. And make that decision together of, okay.

Actually, this it’s not so bad. Right? And more often than not, when we did that collaborative effort, I the next day, the day after, it wasn’t like I was hobbled from that. Right. Right?

It was a what you call a functional level of discomfort. Mhmm. Right? And that’s the that sweet spot where you’re working your body or muscles hard enough to build muscle Yep. Get that synovial fluid through the joints.

And, yeah, there’s a little stress, but it’s not so much that it’s gonna debilitate you. Right. Because the alternative is just let all your muscles muscles atrophy, let your joints get super dry Yep. And become super fatigued. Yeah.

And it’s gonna get way worse. Pain shoots up even more. And So pain is not black and white. Right. Never.

And you’ve really helped me understand that. The thing we say in PT now is, hopefully, they’re saying this in school. That’s what we learned. This pain is a complex experience. It’s not just pain doesn’t equal tissue damage or stop.

I think when people exercise and they feel some pain, they think, like, oh, if I keep going, it’s just gonna hurt more, and I’m gonna damage myself even more. Yeah. When a lot of times, sometimes they need more strengthening and more exercise. And if they work through it, they’re like, oh, the pain’s gone. Yep.

Like, what the heck? Yep. And that’s a good thing. And we’ll talk about that too, in a second here about, like, you know, pain being something that is telling you, like, hey. Just change some stuff.

And you you’re very well versed in these things too. That’s why I trust your intuition of, like, you know, what’s going on with your knee. Then you can kinda modify it yourself. And then you’re like, oh, hey. It worked itself out.

It feels fine now. Yeah. Exactly. There’s been so many times where we’d talk through it, and, you know, I end up doing the thing you asked me to do. And then every once in a while, I’d say, Garrett, this is not the one I’ve been.

And and you would respect that. Right? I we I mean, that’s what a Yeah. A health care person should do. You know what I mean?

Is if, like, if of course, if someone’s being like, oh, this is, like, a 10 out of 10 pain. I can’t do this right now. Alright. We’ll try something else. We’ll come back to that.

That’s okay. But there’s something really important in that process though that I wanna discuss is I was taking ownership in that process. Mhmm. Right? And that’s where you see the best results.

Mhmm. When when people go to health care professionals, whether or not it’s a physical therapist, a a doctor Yeah. A personal trainer, whoever, if you’re not ready to take some ownership in the process, your your results will be very limited. Very yeah. You have to take you have to advocate for yourself.

You have to take ownership over this. And, again, that goes back to the busy thing a lot. I think a lot of the times, people just wanna go turn their brains off, be told what to do. And, yeah, you could see some results doing that, but you’re gonna see the best results if you’re ready to take some ownership and collaborate with your competitor. I always tell people we’re a team.

I told someone that yesterday, a new person. I was like, we’re a team. We’re doing this together. You know? Like, you tell me what’s going on, what you feel.

I’m gonna give you these exercises. I’ll work on you a little bit. Tell me how you feel next week. Yeah. You know?

If you feel a little bit worse, we’ll modify some things. It doesn’t mean you’re broken. Yeah. It just means we stress you a little bit too much. And that’s okay.

Your body’s not fragile. It’s not gonna just, like, it’s not gonna just go out of alignment instantly, or, like, your pelvis is gonna go out of alignment or whatever, like, people like to think these days. Yeah. Your body is very resilient. And so it’s good to make it more resilient.

And that’s our job. That’s where we come in, to help them build tolerance to not have any pain episodes in the future. But again, people, for whatever reason, maybe it’s just conditioning this way that society has kinda drawn us to these injections and pills and stuff like that. But I think more now more than ever, physical therapy and exercise is gonna be much more prevalent. Hopefully.

I’m hoping. I’m trying, to and like you said, like, nowadays, people are doing their own research for the good or bad. Yeah. But It’s a mixed bag. But this is again, this is data.

I’m not bullshitting you guys. And I’m trying to, just reinforce. And I think a lot of people do realize nowadays that exercise and movement is much more important than taking a pill or red light therapy or something. Well and you work I think a lot of the times I’ve come into your clinic that you’ve been working with younger people, and I think I’ve seen that too. I think the younger generations are viewing it this way.

I think I hope so. I really believe it. I I think I’ve seen it for myself. I I think no again no offense. I’m not calling boomers out.

I’m just saying it how I see it. You know? That generation, I think, was more prone to just say, hey. Fix me. Don’t, you know, give me that thing.

Yep. Just fix where I think people in their twenties, thirties, or and even forties, right, are starting to realize they saw the results of that. Mhmm. Right? And realized it wasn’t a magic fix.

Right? That there’s major consequences to that sometimes. It doesn’t always go well. And I think they’ve learned from their parents, their uncles, their grandparents, etcetera, and realized, you know what? There’s other things to look at here.

And I so I do think I we’re we’re gonna see more of that in the in the coming years. Yeah. Yeah. At least that’s my hope. I believe it all.

I think so too. I see it in the PT students that I get and the younger people that I work with, like, clients and patients, that they’re more well versed in, like, at least, like, knowing that movement is medicine. Exercise is medicine. So hopefully that translates into less this stuff and more, like you said, taking ownership and seeking out the help of a professional who’s, you know, well versed in exercise and movement to get them over that hump of back pain or hip pain or knee pain, whatever it is pain. So that’s my hope for the future.

Even though, like, Gen z, we like to rip on them all the time. But because Just because they’re online too much. Because we’re millennials. So, of course. Now we’re the ones that Well, Those damn kids.

Well, if anything, we’re hyping them up. We’re being like, yeah. You guys can, like, change it and be Care the torch, guys. Yeah. Don’t sit on TikTok all day or whatever.

But, yeah, that was a big portion of the podcast that that Well, speaking of which is good. Well well, speaking of the TikTok, I think, just in general, there’s so much TikTok. There’s just so much information online. Yes. Right?

And so you’re seeing all these people on Instagram and YouTube and TikTok Mhmm. Advocating for more of the movement based side of medicine. Mhmm. Right? And I like anything else, it’s a mixed bag.

But I think if you’ve got I think historically, it’s been too far this way. Mhmm. Right? Like, all Mhmm. You know, allopathic medicine Yep.

Yep. You know, shots, etcetera. And now we have a lot of this this messaging going on here. Right? And like anything else, you get a little bit of both.

Yep. You find the balance somewhere in between. Yep. And yeah. Hopefully, again, it shifts more towards like you said, the movement is is medicine, program here.

And as PTs, like, we’re at the forefront of it. Like, we’re the ones doing the movements with the patient. No one else is doing that. I keep saying that because it’s the truth. Yeah.

Well, another PT plug, you know, why not? Sure. Is in this age of so much information, that’s another benefit of working with a personal trainer or physical therapist, any qualified professional, is to be sort of a liaison to this information. Right? We can be the first line of defense sometimes to call out bullshit.

That’s what we’re doing right now, my friend. But but on the other side of it too. Right? If if this guy comes in and your client comes in and says, hey. You know, I I just heard that if I do sissy squats, that’s the cure all for my knees.

Right? And it’s like, well, maybe, but probably part of a comprehensive strategy and maybe not for you too. Yeah. Right? And so that’s where you we can come in and just say, hey.

Let’s make sense of whatever TikTok video you saw or whatever article you read or whatever. Let’s make sense of it together. Let me add my 2¢. Right? And this is a good point because and we’ll talk about this right now.

In terms of, like, PT, personal training versus physical therapy, we want to see which one. But I think, especially us as physical therapists, pain throws everything off. You can’t just go online and be like, oh, let me just start doing knees over toes or whatever. Whatever protocol people throw out these days, if you’re having pain, especially pain higher than a five out of 10, some of that stuff can irritate you even more. So it’s important to see somebody, you know, in person would be best to customize the plan for you.

Because some of those exercises can really aggravate it a little bit more, flare it up a little bit more. You might need to back off from some things first. Maybe in the future, you can do those things. But if your pain is just everywhere, it’s gonna throw everything off. And you can’t just do whatever someone says on the Internet.

Oh, try the top three exercises for your knee or your back if you’re just in crazy pain. Yeah. You should go see somebody. And let’s talk about that right now, actually. So, like, when when to see a PT versus when to see versus when training modifications are enough.

So, like, you as a personal trainer and I’ll give you my take on it. It’s like, when do you think modifying their training isn’t enough and you refer to us? That’s a great question, and I think it’s a nuanced answer. And so as not to take a ton of time trying to work through that This might take up the whole podcast. But What did you say?

I said this might take up the whole pot. The rest of it I mean, we just spent, like, what, forty five minutes on this article. So but this it’s fine. This is classic us. This is very important, though, to talk about because people wanna know the difference of when should they see you.

And then when they’re seeing you, when is pain too much Yeah. To come see us. Well, I would say a qualified professional is going to understand their scope of practice. Mhmm. And I would say also that you’re gonna know when you’re guinea pigging.

Mhmm. Right? And so I have enough experience. I’ll I’ll use knees for an example. Sure.

Right? Because I would say I probably encounter knee pain more than I encounter back pain Okay. As a personal trainer. Mhmm. And so let’s say, for example, someone’s squatting, and they’re just feeling general knee stiffness.

Mhmm. And they say, oh, well, my knees are bugging me. And I say, okay. Well, let’s just do something basic, like foam roll the quads, the IT bands. And they get on a foam roll, and they’re like I’m like, okay.

Well, this may not be the only thing, but this is a part of the piece of the puzzle. Right? You’re holding on to a significant amount of tension. Right? And then they go back, and it’s okay.

Right? That would be an example of a an easy modification, right Yep. That didn’t take an exorbitant amount of time Yep. Was within my scope of practice. Yep.

Okay. Or, for example, let’s say I have someone who’s talking about knee arthritis and maybe for whatever reason, they’re not keen on going down the physical therapy process at that point in time. Right? Well, they don’t like doing squats. Well, I might have them do a TRX squat where they can offload some of that pressure onto the knees and put it into the back of the legs.

Or maybe, hey, they wanna lift heavy. Squats are out of the picks, or lunges are out of the mix. Maybe I can have them do heavier hip thrusts because hip mechanics tend to be a little bit safer for the knees. Mhmm. Right?

It’s just by definition, it’s more hip based than knees based. Up on your knees too. Yep. Yep. Exactly.

There’s a lot of lot coming out on that and just engaging your glutes just being so good for everything. The whole chain. Kind of bringing it all full circle to the modern spine. Right? Mhmm.

What about the modern glutes? Yeah. Yeah. Right? There’s a problem there too.

So a short answer would just be, I would say, when a a qualified professional is going to be able to know when they’re outside their scope of practice or realizing they’ve gone through their sort of go tos, their bag of tricks, and as a personal trainer, I’ll say. And if those things aren’t working, you have to know when it’s time to say, hey. We’re guinea pigging now. Yeah. This isn’t okay.

Yep. This isn’t within the things that I’ve done that have helped people in the past Right. Or are based on what I’ve read, what I’ve researched, what I’ve learned through certifications, etcetera, through experience. This is now we’re just trying to throw shit at a wall and see what sticks. Yep.

In the moment I’m even in in that ballpark at all, that’s when I’m starting to have those conversations of Agreed. Hey, listen. We it’s time to talk to somebody else. We gotta bring another person into the mix, another professional. And and most Yep.

And most of the time, my first line of defense is physical therapy. Yep. And we do the same thing. You know, a big part of the our DPT title is, differential diagnoses. Like, again, if if someone’s exhibiting red flags of pain, I’m gonna text the ortho that I know right away.

Like, hey. This guy is this is out of my scope. You take a look at him, see if he needs surgery or imaging or something. Yeah. And we’re very well versed in that too.

Like, if they have back pain and they’re exhibiting red flag signs, then they need to go to the ER or go somewhere else, you know. Yeah. They, like, scream from doing the posterior talk. I can’t exercise it isn’t gonna help that. You know what I mean?

If they have, like, you know, a red flag classic red flag sign of back pain is like saddle anesthesia. Meaning, like, they have, like or paresthesia. They have pins and needles feelings in their in their genital area and in their inner thigh. That’s a sign of more nerve damage, and I can help with exercise, you know. Then I’ll be, alright.

Go to the ER. Or if they’re having, like, bowel and bladder problems with their back pain, or if they have a fever, chills, nighttime pain, That’s all stuff outside of my scope of practice. That is go see go to the ER, go see your ortho, your primary care. That’s you know, make sure to get that checked out. Some practical things that I I wrote down and I I was thinking about yesterday about, like, when you should refer to PT is when someone has, like, sharp, radiating nerve type pain.

Mhmm. Like, numbness, tingling, shooting down their arms, down their legs. That’s usually, like, alright. Go see your physical therapist. I never touch nerve stuff.

Yep. So Anytime there’s nerve stuff, I’m like, nope. So that’s more our stuff, our job. Pain that gets worse with movement too. As in, like, like, when you’re trying to modify something and you keep modifying it and the pain is still there, I would say that’s more like rehab world, like our world.

Yeah. As in, like, it’s not working itself out like we talked about earlier. Like, the pain is staying constant or getting worse with all the modifications you’re throwing at at them. Yeah. So like the TRX example.

Squats hurt my knees. Okay. Offload with a TRX squat. Mhmm. No.

That really hurts too. Yep. Let’s try glute bridges. No. That really hurts too.

Yep. It’s like, okay. Yep. So nerve pain, pain that gets worse with activity, visual changes too. Things like, let’s say you see some swelling, some bruising, some redness, stuff like that.

Refer to physical therapy or medical professional. And the last thing I would say is, like, the person has pain with ADLs or activities of daily living. Like, they have pain with, like, their normal daily stuff, like getting up from a chair, walking down the stairs, going to the bathroom, walking, sitting. Because that’s a sign it’s pretty far progressed. That’s a sign that it’s interfering with your daily life, and you need to see a physical therapist first.

And then we’ll catch any red flag signs that they need to see an MD after that. But, yeah. So nerve pain, pain that gets worse with movement, visual changes, and, like I said, pain that’s interfering with your life is when I would refer to a physical therapist, on your end, at least. I I agree. That makes sense.

I agree with everything. That’s kinda how I summarize it in my head yesterday. I was trying to think about it. I’m like, what well, how can I, you know, say this to Danny tomorrow? Because I tried to, like, summarize it in three or four points, but that made the most sense to me.

I I I think it’s spot on. Okay. Anything else you wanna add about that? About, like, I don’t know, recent stories about maybe you had to refer somebody out or it was, like, too much and you’re, like, alright. This is not getting any better.

Well, my dad’s a perfect example. Oh, yeah. Yeah. We just had that conversation where I said, dad, were you better when you were seeing a physical therapist? Yes.

Okay. Well, just because you saw a physical therapist and then you went through life and did your thing, and now the results are it doesn’t mean that wasn’t effective because you’ve sort of gone downhill from there. Yeah. Right? It’s just what what was missing?

Where where in the transition plan did we fall short? Yeah. Right? Yeah. And so yeah, I’m I’m advocating for that right now because he is in that situation where it’s yeah.

You’re you’re having trouble walking downstairs. Yep. That, you know, that just it’s intuitive for me as a trainer to say, alright. If you’re having trouble walking down stairs, I mean, what am I really gonna be able to do as far as modifying squats and lunges and this and that? You can’t even do basic stuff.

Yep. Right? Yep. And Agreed. It’s just a much better use of your time working with someone who’s that’s their bread and butter.

Yeah. Yeah. Super agree. Completely agree. And one important point and that I’d also add is I think the best results are when we all work as a team.

Oh, oh, yes. You know, when when you know, I don’t see as much with physical therapists, but more cash based businesses, right, like massage therapists, personal trainers. I’m cash based. Well, yeah. Yeah.

That’s true. That’s true. Right? Yeah. It but, you know, when I think a lot of the times you see that, oh, no.

Don’t go to them because that’s taking away from me. Don’t you know, no. No. No. Right?

The massage therapist doesn’t they wanna be the one to fix your knee or they you know, the personal trainer wants to be the one to Yeah. Do it. Right? No. Your client pay it forward.

Your clients will thank you and trust you more if you do right by them. Right? And maybe that temporarily loses you a client maybe forever. Yeah. But you did the right thing.

You made a difference. That’s what’s most important. And I also believe it will come back to you. But it you shouldn’t lose the client though because we’re all different scopes. Like Sure.

I love having people that I could text like you, massage therapist people I know, the orthos I know, the MDs that I know that I can text. We’re all collaborating, and we all have different scopes. So, like, if anything, the client should benefit from all of us in our own way. You know what I mean? Absolutely.

I have massage therapists sending me people all the time. Yeah. Because, you know, mostly they’re passive, massage therapy type stuff. Like, they’re not really doing the exercises with the patient, the client that much, as much as we are. Yeah.

So yeah. While soft tissue work helps a little bit, decreases the pain and all that stuff, they might need further intervention, which is us, prescription of exercise. I’m happy to hear that because that’s a pet peeve of mine. Yeah. I think I have two there’s two massage therapists in my in my place and Really?

They’re and they’re awesome. I love both of them. I’ve known both of them for years. They’re actually just really cool dudes in general. Yeah.

For sure. Right? Oh. And My leg is already Yep. Yep.

And it’s not so much a pet peeve that I have with them. It’s just this thought that runs through my head when I see someone who’s, let’s say, three hundred pounds walking into the massage room. Mhmm. And I overhear the back pain conversations and things like that. And I wonder sometimes, you know, I’ve I’ve I’ve maybe talked to them about the years, but probably not as much as I should have.

Yep. Right? Because every once in a while, I wanna just go up to the massage therapist and say, dude, when are you gonna just tell them they need to lose weight? If you’re three hundred fifty pounds and you have lower back pain, nothing you can do is really gonna help you all that much until you offload that tremendous amount of stress you’re putting on your back. Yeah.

You could tell me whether this is some bolt, some sort of BS stat, but I heard I think I read in an article that when you’re after a certain point of being overweight, it’s an extra four pounds of pressure on the joint for every pound. I mean, it makes sense. Yeah. Mhmm. So think about that.

Right? Someone goes in, oh, my back hurts. I’m three hundred fifty pounds. I’m not making fun or teasing anyone for being overweight. I’m just saying if we’re talking about the whole kind of theme of this is what really works.

Yeah. Right? And when to kind of look at something different. And so if you are significantly overweight and you go in to get massage therapy and your back hurts now it’s one thing if you’re just trying to get some relief. But if that’s what you’re doing week in, week out, every other week, without the other pieces of the puzzle, you’re not gonna that weight’s not gonna no one’s hands can and I hate saying this, but it’s the truth.

No one’s hands can, like, magically take the weight off of you. No. Just like no one’s hands can magically make your muscles stronger and more flexible or Yeah. Or put you back into alignment or something like that. You know?

That’s not how the human body works. No. Especially with bones, you need so much so many pounds of pressure to actually move bones. But that’s a whole another thing we could talk about next time. But Bottom line, nothing happens in a vacuum.

Right? It’s all multifaceted. Yes. But another question I had was I thought it would be kind of a fun one to end it on since I’m pretty sure we’re running low on time. But is how did our training or, like, me and you personally working out, how did it differ now that in our we’re in our thirties as opposed to in our twenties?

Like, how have we changed our our training, structure now that we’re old men? How didn’t it change? That’s actually a better question. And all right? Well, I mean, when I was in my twenties, late late teens, that’s when I got really into lifting.

Mhmm. I mean, even just right off the top of my head, thinking about what I was doing. The amount of volume I was doing, the I mean, I didn’t take days off. Right? There was a good couple years where I worked out seven days a week.

I just did this chest try, back buy, shoulder trap, leg split. Yep. And I just keep going. I had the energy, the testosterone, the youth to just go as I just would just keep going. You don’t have to test anymore, bro?

Oh, I mean, maybe. I don’t know what’s changed, but I can’t I can’t do that crazy crap anymore. But, I remember back in the day, my now part of this is just being uneducated. It’s not so much about age, but I remember my dad when he was working for the Naperville Police. Mhmm.

There’s a fitness guy or one of the cops was responsible for helping with the fitness side of things. And and so my dad asked him to do a masala and invent my program, and the guy just laughed when he saw it because it was, like, three sets of flat bench, three sets of incline bench, three sets of decline bench, three sets of dumbbell chest press, three sets of incline dumbbell chest press, three sets of decline dumbbell chest Sounds great to me. Three sets of chest fly, decline chest fly, incline chest fly. So every time I hit chest and tries It looked like this. Dude, I was doing, like, 30 sets of chest every single time.

Right? So no wonder my Everybody’s chested. No wonder my labrum’s a little torn on one shoulder and, you know for use injuries. So it’s yeah. Just working out stupid, you know, just, you know, the way higher frequency, way higher volume.

Stupid. So, yeah, higher volume, higher frequency. What else? Yeah. So significant amounts of volume.

Right? I I’ve become much more strategic with that over time, not only with myself, but with my clients, realizing you don’t have to do a significant amount of volume to be effective. Yep. Right? There’s places for that at given times, but you have to do it the right way.

You have to do it progressively. I’m of the opinion now, especially now that I am older, 35. Mhmm. If you can accomplish the same result Mhmm. With less work, why wouldn’t you?

Especially bringing all full circle to this busy world we’re in. Yep. Right? Busy. Hell, yeah.

Right? Yeah. You know, they’re why wouldn’t you wanna do that? So if you can see great results with building your triceps, let’s say, with just adding having six sets instead of Yep. Why wouldn’t you?

The minimal effective dose. Yep. The minimal effective dose. Right? To say it succinctly.

Mhmm. Thank you, Jerry. Of course. Right? And so that would be one volume for sure.

Yeah. Oh, yeah. Rest. Rest. Rest is huge.

Oh, man. Back in the day, I could I remember just being out drinking and partying. Right? Getting, like, three hours of sleep. Mhmm.

My workout buddy, I’m like, dude, we’ll be fine. Just slam some n o explode in the morning. Oh, that’s cool. Is that classic pre workout. That’s still a thing.

I don’t know if it is still a thing, but that’s what it was. Right? Or c four. C four. Yeah.

You know, it’s like That gave me diarrhea once. Yeah. Did it really? Mhmm. Yeah.

Probably gave me diarrhea and I don’t know. So just The old school one. Yeah. Oh, well, but they had to change the formula because I’m pretty sure it was, like, it got recalled. Yeah.

Her heart palpitations or killing people. I don’t know. But so so that right? The way I prioritize recovery is so much different. I mean, I I wanna sleep.

You know, I I gotta make sure I’m getting sufficient sleep, at least six hours. I try to get more like seven. Mhmm. You know, even eating healthier. Right?

Like, I could just eat whatever I wanted back then. I’m a little bit more selective about what I put into my body. I try to practice that idea of, you know, you are what you eat. Right? So if you’re eating a bunch of processed foods, sugar, etcetera, you know, it’s low fiber foods.

Right? It’s only gonna take you so far. So I would say those are probably the three biggest things. It’s just the minimal effective dose. Yep.

Right? Considering that, really prioritizing rest, prioritizing how I eat, and also prioritizing probably the last point would be prioritizing my priorities. Right? So, like, what is truly important to me? Right?

I can’t have everything at once. I can’t be the best at this and the best at this and the best at that. So what am I really trying to accomplish when I’m in the gym? Right? Yes.

You can’t have 10 priorities. You can have one or two maybe. Right? Yep. So keeping that in mind, like, now at my in my life, I do jujitsu.

I wanna be able to play with my kids. I do like the idea of looking muscular. So how do I program for that? Yeah. Right?

And it’s not always easy to figure that out because sometimes one priority feels here today and and then it feels this tomorrow. But Yep. You know, just having to have that honest conversation with myself of, I only have so much time. I can’t be the best at everything. So what’s what is my priorities in this lifts and program accordingly?

Agreed. Yeah. I mean, especially with all the studies coming out about how much little exercise you need to make a change, especially in the general population, the untrained population. You don’t need 30 sets to grow your chest? Well, when you’re 18, you do.

But yeah. I mean, it doesn’t require that much exercise to make a big difference, or what studies are showing now. Same thing with me. I mean, especially mid thirties, we’re the same age, 35. Recovery is much more important now than actually working out to me, honestly.

Because, like you said, we’re we’re doing stuff throughout the day. Like, I only have so much time to get a one hour workout in or something. That’s what I do. One hour, I gotta go back and see some people or or work on something else. And then at night, my ass is back in bed, like, at, you know, try try to be 09:30, ten ish.

That’s me too. But it’s hard sometimes too. But because then I realized, like, I was talking to Romy about this the last podcast is, like, if I don’t sleep great for, like, one day, it throws off the next day a lot now. Sleep hangover. Mhmm.

Well, like you said, like, in our twenties, like, you know, in college or whatever, I used to work out, like, at midnight sometimes. Same. I can’t even imagine doing that now. Get, like, a BFC monster can. Do you remember those?

A big effing can. Those things were crazy. It was like a quart of mustard. That’ll kill you. That’ll kill you.

But those are wild. Yeah. I mean, yeah. Even working out at just saying it out loud is like, what was I why was I doing that? Well, I I know why because I was, like, studying all day and I was like, oh, let me go work out.

I probably should’ve just slept and then worked out the next morning at least, you know? But Plus, don’t you think part of that is I used to stay up late all the time. Yeah. And I think part of that is just the routines become a little bit more rigid over time. Mhmm.

Right? And so you you’ve got your schedule. You kinda know how it works. You know what makes it effective, efficient. Yep.

Whereas when you’re younger, you’re kinda like, I’ll take every day as it comes. Right? Yeah. And you wanna lose the moment. Yeah.

And that’s a there’s a balance to that. Right? Because there is something to that. Getting too rigid is not necessarily great for your soul. Right?

Agreed. Because you kinda get bored and that can be not not a joyful life as much. No. So there is that balance of not being overly that with you, but we can do that next time. But being too, like, structured and rigid with your training and stuff because it could definitely make you more stressed.

Oh, yeah. You know, if you miss a day or Yeah. We’ve seen both sides of the spectrum, especially now when I work with athletes. They’re they’re like especially when they have an injury, it throws everything off for them. They can’t train like they used to.

Yeah. They get frustrated. They get angry. They get, you know, stressed with that as well. But, we’ll talk about that next time.

Couple last things is, simple tips or practical tips that people can take away now in terms of, like, training? What are some quick tips you could give somebody, about training, nutrition, whatever, that that they could implement right now in their life? Yeah. So I would just say, take a moment, maybe more than a moment, because this isn’t always easy to do Yep. To reflect on what you really want for your life, the type of person you wanna be.

Oh, we’re getting deep. Okay. I personally believe that we all kind of know who who we wanna be. Right? What where our conscience is telling us.

Right? Jiminy Cricket, you know, who whatever. We have that internal compass. Mhmm. And so whatever that’s telling you about the kind of person you wanna be, start taking small steps towards that.

Right? If you wanna be a more active person, maybe that starts with just walking your dog. Right? I like saying that. You know your dog wants to walk?

Come on. Go walk your dog. Yeah. They wanna walk. You know?

You know? Or or maybe that’s I wanna eat healthier. Right? And that’s that’s hard for you because you’re busy and there’s a lot going on. Maybe that just starts with eating fruit.

Right? Maybe have a piece of fruit after dinner. If it’s working out, right, maybe maybe it’s doing push ups at your house. Right? Like, maybe you don’t have the time to go to the gym right now.

Maybe just do some push ups at your house. Yep. Do something that can start to reinforce the type of person you wanna be. Right? Because I heard once that our habits are actually just a reflection of our identity.

They’re affirmations of our identity. Right? So healthy people make healthy decisions. Active people make active decision decisions. Right?

Educated people make educated decisions. The list goes on. Right? So try to keep those things in mind that those tiny little disciplines that you can implement in your day, however small, will add up over time if that endeavor you’re aiming at is truly worthwhile. Yeah.

Okay. I like it. That was a lot deeper than I thought. I was just gonna say, like, I was gonna say, I get a lot of people that work from home. Right?

And they’re sitting on their computer in their home office for, like, hours working. And, you know, when I get a new person and they they do that, and I tell them, like, how often do you get up from sitting? They’re like, oh, well, I sit there for, like, two, three hours. I’m like, well, that’s not good. Yeah.

Yeah. So I call them movement check ins. Like, I’ll give them exercise to do, like, every twenty, thirty minutes. I tell them to set a timer every twenty, thirty minutes to get up. Like you said, maybe do some push ups if they can do it.

Some stretches that I give them, some mobility stuff. I give them a TheraBand. They can do some TheraBand exercises. Things that take, like, two, three minutes just to break up the monotony and the the static positioning of sitting. Yeah.

Because your body needs blood flow. It needs movement. You know, motion is lotion, as we always say. Motion is lotion. So that’s one, like, thing that people can implement now is just, like, check-in with yourself.

Have you moved after sitting for two hours? You haven’t. So you should probably check-in with yourself, do the stuff that your physical therapist gave you. You’ll feel a lot better. And the beauty of that is your brain will kind of reinforce those things.

Mhmm. If you’re eating healthier or you’re moving more or you’re doing your exercises Gain momentum. Yeah. You’ll have little subtle cues like, oh, I have more energy. I was sitting for four hours, and I got up to move around a little bit and do some of my PT exercises.

All of a sudden, I have more energy. I have more mental acuity. Right? Yep. Or I had a nice meal.

Right? My stomach doesn’t feel as heavy as when I eat more a more processed meal. Right? Your body will give you those subtle cues if you’re willing to listen to it. Yep.

Completely agree. There was one thing I wanted to read off of, a post that I made on on threads because I don’t have Twitter. I should probably just post it on Twitter too. But What is threads? The Instagram version of Twitter.

Oh, okay. I like it just because I already had it. I’m just too lazy to download Twitter, but very similar. Or maybe not. I’m not really sure.

I’ve never been on Twitter before. So I probably only go on Twitter for I don’t really tweet, but I go on Twitter for like, Google even integrates what people are saying on Twitter. Okay. Or maybe that’s because I’m on Twitter and it Google does that. Who know?

I don’t know. I don’t know how that all works. But those posts people seem to like is again, reinforcing that your body is isn’t fragile. It’s it could be reinforced. It’s very adaptable.

It’s highly adaptable. So I just posted, your body isn’t fragile. You don’t throw out your back. You don’t slip a disc. You don’t sleep wrong and get out of alignment.

Words matter in health care. Change the narrative. I’m essentially saying that those things those things that have been ingrained in society were, like, you know, we think it’s so easy that things just get, like, thrown off, your bones move, your muscles atrophy super fast, like and then you get pain right away. All that stuff, it’s not that simple. Like, your body just doesn’t, like, slip away, and your bones just, like, move out of formation instantly.

Pain is not just that. Pain is very different than just tissue and structural damage. So, I’m just trying to get people to to realize that your body isn’t fragile. It’s very adaptable. And, just as easily as you get into pain, you could get out of pain.

But, of course, it’s a process too. So, don’t expect any quick fixes either, which is the whole theme of this podcast, I would say. But, Well, which straw boat broke the camel’s back? Yeah. All of them.

Yep. Mhmm. Right? And that’s the thing. Right?

Like you said with pain, pain is a signal for change sometimes. I mean, most of the time, like, I remember when I had really bad back pain. Like, I was going through a lot of stressful times before that even happened. And then I twisted at work, and then pain trigger. My back was just gone after that.

But But that was compounding over time. It was again, like you said, that was the straw that broke the my back. Yeah. Well, if your pill well, if your if your pillow’s like this and you sleep like that Yeah. For six months, you’ve been getting away with it.

Yeah. And then one day, you wake up and you’re just like, I can’t move my head. Well, it’s like, no. To your point, you didn’t sleep wrong. You’ve been sleeping wrong.

And I’m And now your body’s finally Right. Rejecting it. And on top of that, there’s probably other things you were doing that you weren’t, you know, doing some strengthening work for your upper back, your neck stuff. You were probably stressed out. And then, like you said, that last sleeping wrong episode triggered the pain, and now you’re stuck.

Yeah. I’m sure you see that all the time in physical therapy. Like, I don’t understand. Why is my knee hurt? I’ve been doing these things my whole life.

Right? It’s like a heart attack. I don’t understand. I’ve been eating fried foods my whole life. It’s like, well, now your body’s sick of it.

Yep. Right? Yep. There there is these breaking points, but to your point, it doesn’t happen overnight. Yes, sir.

Things you wanna plug? Website, podcast? Dannygustinfitness.com is my website. What’s what’s his name? Brian?

Brian. Yeah. Brian. Brian. I knew it.

I should’ve just I should’ve just said it. Forgot. I should’ve just said it. Way to go. Brian has told me that I don’t have a podcast, that I actually have a a show expert on that.

Okay, Brian. I refer to him on those things. But I, Danny Guston Fitness Podcast on YouTube. And, yeah, Jerry, thank you so much for having me, man. Anytime.

Anytime. It’s always a pleasure. Website? Dannygustonfitness.com. Yes.

And my website is artofpt.com. If you need to contact me, you could just fill out the little form. I could give you a free online consult. You’re not active on Instagram or Facebook that much. Right?

I’m trying to push you on Instagram. I’m trying. I’m trying. Actually, I my digital marketing people, it’s that’s that’s a goal of 2025. Because I actually I I admire what you’ve been able to do in the sense that you you naturally are a little bit more involved and engaged.

And maybe not naturally, but that’s something it’s a habit and discipline you’ve built over time Yep. To where you’re pretty involved on Instagram. Thank you, sir. And I know it’s something that’s worthwhile for me. So I I’ll make some headway on it this year.

I’ll make you proud, Jerry. Yeah. I’ll I’ll keep you a comment on it. But, my Instagram is at a p t doctor g. You could also just, send me a message on there.

I send out a a newsletter biweekly. It’s called the PT Handbook. It’s just, like, daily PT tips, physical therapy tips that you could implement into your life. That’s it, man. Thanks for coming.

Absolutely. We’ll see you guys next time. Thanks, guys. This camera. Peace.

Which camera? This one, I believe. Adios. Just look at all of them. Awesome.

That was a great one, man. Yeah. I think it’s the best yet.