Episode 102: Is Your Back Pain Serious? 10 Evidence-Based Facts You Should Know

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain Podcast, hosts Joe Gambina and Joe LaVacca celebrate Joe LaVacca's milestone birthday while diving into the complexities of low back pain. They discuss the prevalence of back pain, the role of stress in pain management, and debunk common myths about aging and pain.

The conversation emphasizes that while persistent pain can be distressing, it is rarely associated with serious tissue damage and that recovery is often possible. The hosts encourage listeners to reframe their understanding of pain and stress, highlighting the importance of a holistic approach to health and wellness. 

In this conversation, Joe and Joe LaVacca delve into the complexities of pain, particularly back pain, and the misconceptions surrounding it. They discuss the limitations of imaging in diagnosing pain, the importance of understanding pain in the context of exercise, and the myths surrounding posture and core strength. 

The conversation emphasizes the significance of movement variability and the management of pain flare-ups, while also addressing the role of injections and surgeries in pain management. 

Overall, the discussion provides valuable insights into effective pain management strategies and the importance of a holistic approach to rehabilitation.


Takeaways

Low back pain is a common experience for most people.
540 million people experience low back pain at any given time.
Most people recover from low back pain within 2 to 12 weeks.
90-99% of low back pain cases are nonspecific.
Stress can significantly impact pain perception and recovery.
Getting older is not a direct cause of back pain.
Persistent pain is rarely associated with serious tissue damage.
Pain is a multifactorial experience influenced by various factors.
Exercise can be both a stressor and a healing mechanism.
Understanding the nature of pain can help in managing it effectively. Pain is more complicated than just structural issues.
Scans often do not reveal the true cause of pain.
Most back pain is non-specific and difficult to diagnose.
Experiencing some pain during exercise can be beneficial.
Posture and core strength are not the sole causes of back pain.
Everyday movements do not inherently damage the back.
Pain flare-ups are common and do not indicate damage.
Injections and surgeries are not definitive solutions for pain.
Movement variability is crucial for maintaining back health.
Managing pain requires a comprehensive approach, including emotional awareness.

Transcript

Joe (00:00)
Welcome back into the Beyond Pain Podcast. I am one of your hosts, Joe Gambina. I'm here with our other host, Mr. Joe LaVacca And it is a special, a special episode-ish, because

Joe LaVacca (00:11)
Rule.

Joe (00:12)
coming on to this episode, Joe, you are now in your 40th decade of life. Yes.

Joe LaVacca (00:16)
I am yes. So the listeners can expect a lot more wisdom, a

lot more calm, a lot more patience than I was even delivering before, Joe. So this is gonna be exciting time for me, for you, for them. I am looking forward to it. thank you for everyone who had reached out and sent some messages on social media. it really did mean a lot to me. And it never goes unnoticed that

Whenever my birthday comes around, I I I'll shoot a birthday message to people here and there. But it was really nice to hear from a few people and be kind of in the back of people's mind. And I'm always like, Wow, that was nice. So I do actually look forward to my birthday every year for for that reason. As I joked with Joe offline, 40 was sort of like a really good movie trailer where it was all this build up and anticipation, and you kinda get to the theater and you watch it and you're like, that was it. It's over. All right, I guess I'll just go to work.

Joe (01:12)
Here we are, Ford is

here.

Joe LaVacca (01:14)
guess I'll just go about my normal routine and so it wasn't a letdown. It is exciting, but I feel good and I'm ready to be back and looking forward to the rest of the summer with you and our listeners. So let's hit it, man. What are we talking about today?

Joe (01:30)
Well we will be talking about some back facts. So talk

Joe LaVacca (01:35)
Ooh.

Joe (01:36)
a little bit about lower back pain some facts around it, and I will let you intro us into the idea of it, and we'll dive in.

Joe LaVacca (01:44)
All right,

awesome. This came up this week. I had the pleasure of teaching or leading a little discussion, I should say, at a gym in New York City called Nimbo Fitness. They're a really fantastic group of guys. I probably go in there once a year and we just talk and riff on just different topics. And one of the ideas that we came up with this time around was how can

Joe (02:07)
Ha! Ha!

Joe LaVacca (02:08)
our personal trainers really help out this whole idea of paint?

Particularly low back pain, because it is the most common thing that I think most human beings, regardless of if you're 40 or 50 or young, quote unquote, you have probably dealt with. And that's what the research says is that low back pain at one point or another is going to be experienced by almost everyone. And Joe, right now, this is estimated, of course.

Can you think of how many people it are estimated to be having a low back pain episode or complaint right now at the given moment?

Joe (02:54)
I'm gonna ballpark it to be a million.

Joe LaVacca (02:58)
540 million at any one time. So this is something that creates a community. You are not alone, even though it might feel that way. And I mentioned this in the gym the other day. That my most favorite fact about low back pain is most people recover quickly. It doesn't seem that way because it is so common, and we can all shake our heads at

Remembering what it was like when our back went out, or remembering what it's like to have back pain bending over and getting up out of bed and things like that. But from a true statistical sense of maybe how pain is affecting your lifestyle, do you have to modify workouts? A lot of those windows can be anywhere between two to, let's say, 10 or 12 weeks. My second favorite fact is that even though you might get treatment for it,

That window doesn't really seem to shift all that much. And I think this is a really important point on where we're going to take the episode because so many people have pain. This window typically clears up anywhere between maybe like two weeks and 10 weeks, you know, give or take a few days in either direction. But during that time, if you get care, you're going to be told what caused your back pain. And I think this is where you start getting treatment.

For your weak core, you start getting treatment for stress management or breathing, you start getting treatment for some sort of corrective exercise or hip opener. And then lo and behold, in four weeks, your pain gets better. So, what are you likely to think? I need more core work, I need more hip work, I need more breath work, and that is going to be the reason why I can prevent this pain from returning. But here's the other fun fact, Joe.

throw it at you because I think we've talked about it before. How many cases of low back pain are actually nonspecific? And we're looking for a percentage here.

Joe (05:06)
I think we said like eighty percent or something like that. I can't even remember the numbers.

Joe LaVacca (05:09)
90

to 99%, brother. So we have the most common experience or symptom

Joe (05:17)
Mm-hmm.

Joe LaVacca (05:17)
in the entire world coming to us that's going to typically resolve on its own for most people in two to let's say 12 weeks. And almost 90 plus percent of the time, you or I wouldn't actually be able to specifically label with certainty, with certainty, where the pain is.

Coming from. So I think I'm going to just pause right there. And you being reminded of a couple of these things, or maybe

Joe (05:45)
Mm-hmm.

Joe LaVacca (05:46)
hearing some of these numbers, do you think that this contributes to the sort of like fear-mongering and lack of understanding that we're seeing from clients, especially on the internet and the people that you work with?

Joe (06:01)
Yes, I do. I think if you have pain and you go see somebody whose job is to try to figure out what's going on, well you're going to get some sort of answer. One of the things I hear a lot is w you know, I mean there's a lot of people who come in who nothing's wrong with the memorize, this PT or this carrots that you know, like there's nothing like that they can specifically find but they think

It's this. And then it's usually related again, like what you said, like it's the core, it's the glue, it's not firing, whatever it is. And I think if you cannot say with certainty, and this even goes back to our last episode of, or maybe at this point it'll be two episodes back, of do we need to know exactly where your pain is coming from to help you? Well, sometimes there that's not the answer, right? There is no real specific cause. So we would then need to figure out.

Okay, well what's just happening from a move perspective? What is being irritated? Is it trending in the right direction? What are your goals and what are you trying to accomplish? and sometimes maybe it is a little bit of time and just putting a little bit of good inputs into the body, and maybe we need to be a little bit more specific, especially if it's for those people who have been dealing with pain for much longer than two to twelve weeks, right? but I think the language that

For sure, the way that we speak to our clients and the the language that we use for sure can create like an identity for somebody. And you know, maybe for the person who's only had back pain for the first time and it lasted for four weeks, it's probably really not gonna cause too much of a problem unless it's becoming a recurring problem and they've heard the same thing over and over again. But for the people who have been in pain for a long time to just blame it on this, and especially if they've tried all these other things in the past before, well

Now they're gonna think like nothing's gonna work for me. It's it I think it's gonna set them up for a harder time because they're ex they're not gonna be able to have good expectations for what's gonna happen when you don't have good answers or they're being told the same thing number of times with n with no changes to the outcome.

Joe LaVacca (08:03)
Right. And then when you're being told something specific, and then all of a sudden, you know, like you're saying, like you get better. Well, if my thought process was my core was weak, I shouldn't lift heavy then until I've strengthened my core to a good enough point. Or maybe I just shouldn't lift heavy, or maybe I shouldn't do barbell exercises or dumbbell exercises or kettlebell exercises. And you know what? That could actually be the case for certain people.

I I don't believe that there is a you know specific exercise or modality that you have to do. I think big picture wise, if you're building muscle mass, if you're building bone density, if you're managing your weight, I don't care how you do it with a treadmill and two pairs of sneakers, with a pool, with a kettlebell with resistance bands. And you know, I think we've talked about that here. It's more about the keeping the goals the goals rather than what specific

process is the best way to do that because I think that'll be really individual. The things that are I think are worth looking at if if you and I on average are going to have a pretty hard time pinpointing down to it being a facet joint, a a specific muscle, a joint, a you know, and maybe with some certainty we can talk about, you know, disc pain, but that's a kind of a separate beast, so we can maybe push that one aside. This is more of the back pain that's staying above your knee.

the back pain that's on one side, the back pain that's kind of feels like it's in your hip, or you know, that little spot that you press your thumb into. I think these are the more common patterns we're talking about. But I think the thing that gets sweeped under the rug a little bit is kind of filtering the people who have high pain intensity, so who are reporting maybe seven, eights, and nines, or maybe even higher, right? These people who are saying, you know, help me, this is this is really serious. People who are

Demonstrating some psychological stress. Now, I read recently, and this is my new filter question for stress: is your stress creating conflict? Is your stress creating isolation? Or is your stress creating a loss of identity? If one of those three are met, then yes, I do think your body can be responding unfavorably to that experience. If you're like,

well, I'm really stressed out because I have to get my kids to school in the morning. I'm really stressed out because you know, I I read about something that I read about Brian Johnson's gastric intestinal disease and it's really worrying me because I took all of his pills and everything else. Like like all of these just general worries about work and relationships and whatever, we all have them. I can't do anything about those. And guess what? If you didn't have them, that's also a stress. So if you were

Didn't have a boyfriend, girlfriend, spouse, kids, that's a stress. If you didn't have a job, that's a stress, right? But all of them are different. So I filter it now with those three things. And actually, since I've been asking that question, it's been a lot more insightful with clients because I asked one person the other day who was feeling really fatigued and she has fibromyalgia. And I asked her that question specifically, and she was like, No, nothing like that. I just think it's the heat. Perfect. So we're able to.

Pace ourselves at the gym, come up with strategies at home. I asked a client that this morning who I was working with, and he paused, got a little teary-eyed, and said, Yes, I feel completely isolated. And then that just put us into a direction of, hey, you know what? Well, there's probably not gonna be too many exercises that are gonna help you with isolation, short of leaving your laptop at home this week, going to see some friends, call on a family member because he's from he's from France. You know.

calling up some family members from back home and just talking about the World Cup or whatever. So I'm gonna pause again. This idea of stress being the culprit for pain, what are your thoughts on that? Do you like this like kind of screening bucket of more specificity on how it's impacting the person?

Joe (12:08)
I do. I think that's a important and probably underlooked thing and probably something I don't necessarily scream for enough. you know, I think throughout my conversations and just have it like with the the nature of how in depth I get, like sometimes those things surface, but I think there's also times where I wonder, like, based on how they're presenting or when things reflare up or something like that, like like

Trying to find sometimes there are thoughts in my mind, like I wonder if there's more of a stressful situation going on in their life that is, you know, unforeseen by me. And I think screening that out is is a very smart thing because in cases of people being, I mean, we talked about it in the we were just talking about the bigger bucket episode that we did. It was like s episode seven or eight, where, you know, pain is not just what is on your MRIs or your imaging or like one specific tissue, right? It is a

multifactorial thing where all sorts of str our bodies just see stress as stress. It doesn't really matter if it's physical or emotional or whatever else. So if there's just so much stress coming into the system that's always overflow in the bucket. Well, if there is a way to decrease someone's stress, I don't know if that's always what we can do, right? But maybe we can point them in the right direction to to maybe help that process. we can find ways to help them recover better, right? Like

That will also help the process of helping increase the size of their bucket to tolerate more stress. If we can slowly get them to move more and get stronger and things like that, where their body can tolerate more stress, it tells us we're building a bigger bucket. so I think that is a very smart way to to go about things. and I especially for people who have been dealing with pain for a long time. Or I think I've talked about the story about an old

Personal trending client of mine who we worked together for a long time, was moving really good, started to have pain one day and like his movement reverted back to normal. And every time that happened, it always correlated with significant stress at work for him. Right.

So it was like like that was the first time and that was before I even knew all this stuff that I r started to even see the pattern of how stress in someone's life can just like really impact how they move, how they feel, pain, all that stuff.

Joe LaVacca (14:27)
Yeah. Yeah. And once you see it, it's almost kind of hard to unsee it or maybe not think, is this gonna be something that affects every single person? Right. And I think I fall into that trap of spending too much time there. Like, are you sure that you don't have any stress at home? Are are you sure that you like your job? Are you sure that you love your kids? Right. And I think when you

kind of overemphasize those ideas, that's where I think people feel even like a little bit more stuck, right? Because it's not practical to think, well, I'm gonna get rid of all your stress. It's just impossible. Exercise is stress. So if I think that stress is causing your pain, why would I add to your stress list to help you cope with it? If I think that you're in a vulnerable state and you might need let's say

Soothing or sparing techniques over stressing techniques, then you know, why wouldn't we give you that? and then vice versa. Well, when people just say no, I just move on now. Well, you're the expert in your life. I'm asking you a question. If you say no, great, cool, let's move on. In the event I pick up on something or or you know, we pick up on something on visit three, four, five, six, you know, when you actually get to know somebody.

Maybe you pick up on an inflection. Maybe you pick up on a sort of facial expression or pause or you know just their demeanor coming off the elevator or coming into your clinic or showing up on Zoom. But I think it takes a little bit of time to know somebody. So that first question, if you feel stressed, okay, cool, let me know. Let's talk about it. What kind of stress? Is it those ones that, like I'm saying now, are making you feel conflicted, isolated, or maybe kind of questioning yourself a little bit? Then cool.

Do you have someone to manage that with, or do you want to talk about some strategies together? And I think I keep offering those branches, right? Because I tell people a lot of the times with this behavioral stuff, I know enough to be dangerous, but I'm not a licensed like behavioral health specialist, right? So I can give you some tactics. Do those seem appealing? No? Okay, great. Well, if this keeps recurring, I'm going to suggest that you go see somebody that can give you even more tactics than the ones that I know.

So I think maybe that's been a little deviation for me as well. But we got 10 facts. I don't want to turn this too much into a stress conversation because I think people are like, well, where are the facts? and we got 10 of these, buddy, and I and I wanna we'll go one by one. You you wanna take number one and we can comment on it if we like and kind of just keep

Joe (17:09)
I will.

Joe LaVacca (17:10)
moving through this list.

Joe (17:11)
Yeah, I think this is this is good, especially for people with I feel like I mean and maybe it's just social media, but I feel like the spine in itself is something that is perceived as it's so fragile, right? And even from a provider standpoint, how we talk about or how they talk about.

Much we can load it, only neutral, fear of flexion, fear of extension, fear of rotation, fear of just movement in general, right? so I I kind of like this one here, and this actually probably ties into a few of these on this list. but the first one here is persistent pain, back pain can be scary, but is rarely dangerous.

Joe LaVacca (17:48)
Mm-hmm.

Joe (17:49)
And I like this one because and and the the note here is it's it's it really is you know it can be distressing, it can be disabling.

But it's not life threatening and it will you know you're not gonna end up in a in a wheelchair as a result, right? So I think it's it is good. I think we talked about, you know, how many people in the world have pain, right? And I

Joe LaVacca (18:08)
Yeah.

Joe (18:08)
think the the statistic is at some point and someone like 80% of people at one point in their life is gonna have lower back pain at some point or another. So I think it you know it comes down to is like pain is a normal experience, right? We talked about this a number of times.

yes, especially if you've been dealing with it for a long time, maybe you don't have the answers, that it can become a stressful thing. You're not sure if you're gonna get better. but I think reframing it this way, like, hey, you know, if you can still do the things that you want to, maybe you have to reserve or you have to take some rest recovery, you have to think about, okay, maybe I can't like guard in on this day and then work out the next day and then go play golf on the next day, right? Like, maybe you have like plan your weeks. You know, I hear people talk about that. I used to have to do that myself.

kind of plan how I'm structuring all my activities. but I think it'll be kind of ref like reframing it like, okay, pain is normal. It's not always dangerous. it may be impacting my life, and then trying to figure out how we navigate it from there.

Joe LaVacca (19:07)
Amen, brother. number two is a good one for me. getting older is not a cause of back pain. So, yes, we have a lot of common sayings, I'm just getting

Joe (19:18)
Mm-hmm.

Joe LaVacca (19:18)
old, or this is what happens when you turn 40, 50, 60. fortunately, the evidence doesn't necessarily always support that. So, I think hanging on to just you getting older or age as being a little bit of a crutch for your pain, we can probably

Joe (19:39)
Yeah, I agree. I I

Joe LaVacca (19:39)
What do we got for?

Joe (19:40)
the the only thing I'll say there is, and I was thinking about this when I read it earlier, is that I think a lot of people, one reason why when we get older we start to feel it is because there's just more time for repetitive stress to act in our bodies. So, you know, if it's not gonna happen when we're fifteen or twenty, you know, usually around it seems like late twenties, early thirties is when it tends to kind of pop up. but I would probably say that's more so gonna be

lifestyle related, how hard or little you've trained, the injuries that you've had in the past, how active you are or not active you are, all those things will kind of build up and present in a certain way. And we do know that there's gonna just be an age-related decline. We see it with you know, power loss and strength loss over time. If you're not doing it right, there can be a pretty stark decrease over the course of our decades after we turn f once we, you know, get past our third decade. So when we're Joe's age and forward

Joe LaVacca (20:31)
Yeah.

Joe (20:35)
and you know, you know, I think that also plays into, you know, pain and movement, all these things also popping up over time. But I think those things are also, you know, if you start to do things about them or you start to train a certain way, the same way we can, you know, prevent these strength and power losses from declining significantly over a course of a life, we can do the same thing with mobility, with pain, with all these other factors as well. So I'll leave that there.

Joe LaVacca (20:56)
Yeah. Heck yeah. What do you got for number three?

Joe (20:59)
Number three, persistent back pain is rarely associated with serious tissue damage. And I think we've hinted on that today a number of times. You know, you can go. I've even had two people I've talked to this week, one for the neck, one for the back. both have some some numbness that's happening. but all their MRIs are clear. Nothing has popped up, no hernia discs, you know, maybe some light disc degeneration, but nothing that doctors have said that correlate with their their symptoms.

So, you know, this is that whole back and forth and talking about how pain can can come in a number of different ways. but what you see in an MRI or an x-ray does not always match what you see or from a pain perspective or how someone's feeling. And that can go both ways, right? Two people with symptoms that aren't correlating what's happening on imaging. So what's happening here? How do we find an answer to that? And it can be the opposite way. You can have these things that pop up on imaging, but no pain. And why is that for some people? So I think this just really starts to

Tell us that pain is a little bit more complicated and we need to look outside of just imaging and where specifically or what structures are being irritated to figure out how to help somebody.

Joe LaVacca (22:09)
Yeah. And this

bleeds right into number four. And my comment kind of blends in with what you were just saying and with number four. So number four, scans rarely show the cause of back pain. We were just kind of saying that before that ninety to ninety-nine percent of most back pain will be what we call non specific, meaning that we cannot with 100% accuracy accuracy tell you why you have pain or what's the main driver of your pain. Now the the one little thing that I might just sort of caveat here.

That tissue healing occurs within three months and that scans can't show your cause of pain. Maybe if you are having leg pain more than back pain, and specifically leg pain that goes below the knee, leading to any sort of signs of weakness and numbness, that might be one of those things where, hey, we'd want to get a scan to better understand or make sure the nerve itself is okay and not getting suffocated.

Or not getting damaged, but just becoming irritated. So that might be one of those like little things where hey, a scan can tell us a lot. A scan might even give us options on monitoring your symptoms because we have a baseline. But a lot of your degeneration and stuff that you mentioned, it's gonna happen in adolescence. That that was the most interesting research I read at the end of last year. Was like when you repeatedly scan people between the ages of like 19 and 30, like that's when most of the degeneration happens. It's not until

They get 40, 50, 60 when they start to have like their first episode of pain potentially, where

Joe (23:40)
Mm-hmm.

Joe LaVacca (23:41)
they're like, my God, look at all this stuff. But you've been with that for maybe 10, 20, 30 years at this point, from what we're finding out. So that would be the only little caveat I'd add to number three or four. But I love number five and I love the rest of them. So what do you got for us at number five?

Joe (23:55)
I do. I think number five is probably a

a big one for a lot of people listening here. And I feel like I talk about this a lot, often with clients and stuff like that. But pain with exercise and movement doesn't mean that you're doing harm. and I will I will frame it around, you know, like if you do have pain and we are working together and we're trying to get you out of pain, you we do have to do a dance around.

Pain to get you over the hump, right? I think a avoidance of pain in movements is going to leave you stuck because you're not putting enough load into the tissue to make changes to make your body say, okay, maybe I could tolerate this stimulus and I need to reassess, you know, my pain gauge, right? So that we can, you know, okay, I can set this bar higher now and you can do more before I'm going to stop this pain response.

so that's kind of where I think I want to talk about, you know, like you do need to experience some pain depending on how we're rehabbing and and the scenarios, not always. but I think we do need to, you know, if you're always avoiding pain, I don't think you're gonna really move the needle forward. so I'll that's where I'm gonna frame it. And if you want to frame it in a different way, go for it.

Joe LaVacca (25:11)
Yeah, no, I think that the the stuff that I've read currently has some short-term favorability for experiencing pain with your movements and with your rehab and with your loading. Again, I think the the caveat there is keeping it tolerable, right? and I think there

Joe (25:28)
Great.

Joe LaVacca (25:29)
are some research articles in the works from podcasts that I've listened to this week sort of

Trying to question or elaborate on this idea of how much pain should you have with rehab? You know, is more pain better? Is less pain better? And I think that's sort of where we're at this crossroads, right? Because we all can kind of agree that, hey, for tendons, you really need to load into pain. Maybe for rewiring your nervous system response, you want to push into pain and become almost desensitized to the signal a little bit.

Joe (26:03)
Mm-hmm.

Joe LaVacca (26:04)
But how much is too much?

How little is too little? I think those are the questions that we still have to figure out. So right now, I think the best filter I offer clients is keep it tolerable and then monitor symptoms 12 or 24 hours later to see if there's any change in your daily function or behavior.

Joe (26:22)
Exactly. I don't know if we'll ever gonna get like a this is the number because I think everyone

Joe LaVacca (26:25)
Probably not.

Joe (26:26)
responds differently and everyone's has more tolerance to pain or less tolerance to pain based on them. but I think the the response afterwards is what I'm looking for. And I did have somebody I was working with a while back. we use this this rule, you know, I'm I you know, no more than a four, you know, nothing that flares up twenty four, forty eight hours later. And he would do his workouts, it was shoulder pain, and he checked that box every single time.

But what we started to see is that after doing that for like three, four weeks, is that his overall pain started to increase.

Joe LaVacca (27:00)
Mm.

Joe (27:01)
So now we're talking about okay, you're still you're following these pain rules, like like there's nothing here that's a red flag, but now we're seeing your pain get a little bit worse. So then we had to have a conversation. Maybe these pain rules, we have to, you know, come up with some exceptions here. And now what we're gonna do is we're going to try.

To find entry points into all these exercises, that's really not an irritator right now. Like let's just see. And then all of a sudden, his pain came way down. We were able to start to load it more and more. And then we started to space out the stimuli a little bit more. And that's what was successful for that person. So again, I think, you know, sure, we have these general rules, we need to experience a little bit of pain. We need to kind of push through some of the tissue so we can make some adaptations, but the responses on the other end let us know if we're moving in the right direction. Are we just staying the same? Are we getting better? Are we getting worse?

And then based on that information, we refigure out what we need to do from here. So I think we need just need to take information from multiple points to make decisions versus saying it's it's black and white, you have to experience pain or you don't experience pain or this or that.

Joe LaVacca (28:04)
Right, right. I'm going to combine number six and number seven, because I think they're kind of a related conversation. Back pain is not caused by poor posture, and back pain is not caused by a weak core. Now, if you are listening as driving, I hope you're still on the road.

Joe (28:23)
Yeah.

Joe LaVacca (28:24)
if you are listening at home, I hope you haven't fallen off your chair. But yes, this is the case. We see very, very weak correlations to posture.

A lot of these things come up with the idea of force on the spine. But force on the spine doesn't necessarily mean you're going to have more pain in those positions. It doesn't necessarily mean that those positions are bad. And when we actually just watch people lift, there does seem to be this kind of slightly flexed, stooping posture behavior that is actually more efficient for you to be lifting things because it prevents overgoing.

Guarding, it prevents over muscle contraction or energy usage. And I think this kind of goes into this idea of the weak core. Why do people kind of tolerate core exercises because they're isometrics, they're the same static position and you're not moving? Why do people typically not do well with core exercises in pain? Well, because you're in pain. One of the things

Joe (29:27)
Mm-hmm.

Joe LaVacca (29:27)
for muscle to do.

I'm sorry, for pain to do to muscle in the presence of pain is inhibited. So I think we're getting too many false positives when it comes to this idea of weak cores, because pain inhibits muscle production

Joe (29:42)
Mm-hmm.

Joe LaVacca (29:43)
or force in an area. That's what it's supposed to do. It's supposed to guard you. And I think you hit it on the head a few episodes back, or probably more than a few episodes back at this point, that just because a position is sensitive,

doesn't mean that that is a position that we need to avoid or that some opposite end of the spectrum or flexion, extension, or slouched or upright is then all of a sudden ideal.

Joe (30:06)
Mm-hmm.

Joe LaVacca (30:07)
So I think six and seven is still ones I battle in the clinic regularly with clients, especially if they've

Joe (30:13)
Mm.

Joe LaVacca (30:14)
come from other providers or come off of watching Instagram videos on their way

Joe (30:19)
Mm-hmm.

Joe LaVacca (30:20)
in. but the literature just does not support those ideas.

Joe (30:25)
Yeah, I think eight falls very much into it, so we'll touch on it very quickly. But bags do not wear out with everyday loading and bending. again, you know, I think it comes down to how much you're doing. Obviously, with anything like repetitive strain over time, can cause problems. It doesn't matter if it's sitting, if it's standing, if it's good posture, bad posture, or if it's bending, if it's not bending, right? you can you can have issues with that stuff. but what also Richard shows is that if you do

Bending and loading of your spine, that it will also adapt favorably. So we can use that to our advantage to make a more robust human being and make sure that your spine is able to segment well enough to disperse forces. That's what its job is. It does a very, very good job at that. And typically the people who have problems with loading and bending are the ones that over time they have lost the ability to segment their spine, disperse force. They are the ones who maybe have had pain a few times in the past and they're.

Core doesn't fire as well because they are dealing with some issues over time. they may have other things from other areas in the chain that are causing things to be loaded in a different way. So it's not necessarily the loading or the bending that's the problem. It's more so of the other factors that might play in stresses, other lifestyle things that have led you up to that point. So I think we need to get away from blaming the movements, the weak cores, the postures, the bending itself.

And trying to figure out, okay, what might be causing this? How can we build you up to the point where you can tolerate those things better? Because we're all like, if I sit on my computer eight hours a day, I can't stay in one position. I'm gonna end up with poorer posture, quote unquote. If you're not watching this on video, I'm doing air quotes.

Joe LaVacca (32:07)
Mm-hmm.

Joe (32:07)
we need to be able to tolerate different stimuli. And the best thing that we've learned even earlier on in our careers, and it's still true to this day, is

Movement variability. The more we explore things and the more we change our positions, the the better things are going to be. And probably to me, in my opinion, more so than any of these positions, when they become painful, that I that's less of the problem. It's it to me, it's the loss of access of other positions that become more common. We always blame anterior public tilt for all these things. It's the death sentence, but everyone has anterior public tilt. So why do we still say that way?

But the problem is what happens when people really struggle to get out of anterior pelvic tilt when they're doing things, right? They don't have access to a

Joe LaVacca (32:48)
Right. Right.

Joe (32:48)
posterior tilt or a very hard time bringing their ribs down and creating like a more neutral position. Well, if you can't do that and you're always in these positions, is you know, to me, right, to us, it's a it's obvious that, you know, issues can happen down the line. So it I think is more the loss of movement over time that becomes the issue than the things that we just talked about.

Joe LaVacca (33:09)
Right, right, for sure. And one thing I always give a little example to for clients is well, if we need to limit everyday loading, moving, bending, how are your hands and fingers doing? How's your jaw doing?

Joe (33:24)
Mm-hmm.

Joe LaVacca (33:25)
How's your elbows doing? Do you think that those things are maybe getting the most motion between eating and talking and everything else all day long and writing and texting and keyboarding?

Joe (33:36)
Mm-hmm.

Joe LaVacca (33:37)
Yet

You don't have any pain degeneration breakdown there that we know of, but we have to spare your back. Like, you know, again, why is that? Make sense

Joe (33:46)
Mm-hmm.

Joe LaVacca (33:46)
of it. And that's always like a nice little exercise for people to do that maybe, okay, everyday things aren't breaking me down because I don't have pain anywhere else in my body, and I'm not thinking about sparing those things. So maybe I'm just sensitive, maybe this will pass, and it absolutely will. Which brings us to number nine.

Pain flare-ups do not mean you're damaging yourself or losing progress. Up to 89% of clients with low back pain experience a flare in their pain, particularly within the first three months of getting treated. And when you do not know this, when you are not armed with this information, both you and your provider might have a negative reaction because.

It was unexpected. But yet the data shows it's not unexpected. We know it's likely going to happen. So let's create, and I might have said this in the podcast before: a flump plan, a flare-up management plan, a flare-up management procedure because we know it's likely to happen. So when it does, you message me, we have our soothing, safe exercises to go to. We have our graded exposure.

We can cut back on volume. We can cut back on intensity, but we're not going to stop. We're not going to turn the dial off. We're just going to turn the dial down on the things that we do. And then guess what? We don't need maybe a whole six week reintegration reprogression. Once the flare goes away, we'll build you right back up to where we were. Where was our starting point? Or where did we end up? Right there. you know, bench pressing a hundred pounds, cool. That's what we're gonna go to.

Deadlifting 100 pounds, cool. That's what we're going to go to. As long as you weren't completely unable to do anything for more than three or four weeks, I'm not anticipating that you're losing strength, losing too much power, losing too much aerobic fitness. We make a quick modification and then we keep you moving forward.

Joe (35:50)
Perfect. And I'll just reframe that just one step further for because we do know that the number one predictor of injury is having that injury. So if we're looking down the line for somebody and they experience a flare-up, it's it it it's normal. and I think that it shouldn't be necessarily, you know, I mean, sure it can be, you know, you can be frustrated around it, you can be disappointed, you can be, you know, a little scared about it. I I I always tell people, you know, feel your feelings around it because I think they're they're valid.

But it doesn't mean that you've damaged yourself, you've really set yourself back. I think it's it's more of you know, like these things happen. and typically what I've seen with people who I've worked with in the past, when these flare-ups happen down the line, they recovery times are shorter. Like those are all still really

Joe LaVacca (36:34)
Mm-hmm.

Joe (36:35)
good signs that like all the work you've put in in the past is still helping. and you just may need to, you know, use your flump pan plan right at that moment to get yourself over the hump and you get right back into things.

because flare-ups happen, right? And we've talked about it here, right? Like there are, I think, red flag triggers, you know, like ball and bladder, you know, if you have an issues with that, if you have like significant motor loss, like all of a sudden like drop foot things within

Joe LaVacca (37:00)
Mm-hmm.

Joe (37:01)
that nature that say, okay, like night pain that doesn't go away no matter how you move, like those are things you need to go see your doctor right away. Like those are the ones that are more dangerous from a red flag perspective. But if you're not having those things, it's very likely not dangerous. And we need to, you know, you can figure out how to write the ship, whether that's by yourself or

With your PT, Cairo, one of us, however that looks like for that person.

Joe LaVacca (37:24)
Exactly. Feel your feelings might be the most Italian thing you've ever said on the on the podcast show.

Joe (37:28)
There

you go. I gotta you know, they come out every now and again.

Joe LaVacca (37:34)
man.

All right. Take us home. What's number ten?

Joe (37:36)
Number 10, injections, surgeries, and strong j drugs usually are not a cure. My perspective on them is they are the thing that is the helps us get over the road bump. If someone's having a really bad, a really hard time getting over the pain hump with movement in general, sometimes these things can be the thing that get us over that hump so we can actually get you moving and get, you know.

stronger and do all the things that we need to do from a rehab and movement perspective and even a strength and fitness perspective that you weren't able to do before. So my experience of talking to people and even with someone who I talked with recently, I kind of have a feeling that he was thinking that like once I like if these injections work, I'm gonna be good going forward. and sure you might be, but there's I think that's also the opportunity where you can now really do the heavy hitting work that you wanted to do previously to get yourself

in a really good place at that point in time to make sure that it doesn't happen because, you know, people who usually do injections and stuff like that, they tend to do multiple over the course of time. And you are limited how many you can do in a given year anyway, based on, you know, the side effects and stuff like that. So get moving,

Joe LaVacca (38:46)
Sure.

Joe (38:46)
even if you're doing those things.

Joe LaVacca (38:48)
Exactly. We can always change your position, your load, your frequency, your duration, the activity. We can't change an injection surgery. And then we definitely can't change, well, we can, but it's much more difficult. becoming dependent on something like an opioid or other drug.

Joe (39:05)
Mm-hmm.

Joe LaVacca (39:05)
So yes, continue to find a way. Joe brought up red flags before. If you missed them, go back and take a little listen to that. Those are gonna be the things we really wanna rule out.

Those are gonna be the things that are kind of scary, but short of those things, give it time, give it hope, give it opportunity, and you will see, I think, major, major improvement, particularly in that kind of first two to twelve weeks, hopefully, as long as it doesn't shift into some more of a chronic pattern. But again, that would be a a d slightly different beast.

Joe (39:37)
Mm, perfect. All right, well that was the ten. Unless you have any other thoughts, let's let's take

Joe LaVacca (39:40)
Top 10. No.

Joe (39:43)
it home.

Joe LaVacca (39:43)
No. Joe, we love you. Listeners, we love you. Thank you again for making the 40th week of my or 40th year of my life an enjoyable one. And I look forward to many, many more. So don't forget to tune in next week for another exciting episode of the Beyond Pain Podcast.