[#5] Do Expensive Recovery Treatments Work?

I go over four common treatments used for pain-relief and recovery and whether they are worth the cost of paying out-of-pocket for.

Main topics covered:

• What dry needling is and how it works
• What shockwave therapy is and how it works
• What PRP is and how it works
• What low-level light therapy (LLLT) is and how it works
• Are these treatments worth it?

References:

• Fernández-de-Las-Peñas, C., & Nijs, J. (2019). Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. Journal of pain research, 12, 1899–1911. https://doi.org/10.2147/JPR.S154728 
• Charles, R., Fang, L., Zhu, R., & Wang, J. (2023). The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis. Frontiers in immunology, 14, 1193835. https://doi.org/10.3389/fimmu.2023.1193835
• Speed C. (2014). A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence. British journal of sports medicine, 48(21), 1538–1542. https://doi.org/10.1136/bjsports-2012-091961
• Sax, O. C., Chen, Z., Mont, M. A., & Delanois, R. E. (2022). The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis. The Journal of arthroplasty, 37(11), 2282–2290.e2. https://doi.org/10.1016/j.arth.2022.05.014
• Clijsen, R., Brunner, A., Barbero, M., Clarys, P., & Taeymans, J. (2017). Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. European journal of physical and rehabilitation medicine, 53(4), 603–610. https://doi.org/10.23736/S1973-9087.17.04432-X

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Transcript

SPEAKER_00 0:07

Hello and welcome to Candid Conversations with Dr. Kelsey. I'm your host, Dr. Kelsey, and this is the space where I share my honest thoughts, real experiences, and the no BS conversations I wish more people were having about movement, training, injury recovery, and life as an active human. The goal of this podcast is to help you better understand your body, think more critically about rehab and fitness, and feel more confident making decisions so you can stay active long term. Before we start, a quick reminder. I am a physical therapist, but I am not your physical therapist. Nothing here is medical advice. So if you're dealing with something specific, please reach out to your PT or schedule a session to work with me. Alright, now let's get into today's conversation. So today I wanted to talk about expensive recovery treatments. And before I do, I just want to warn you that I am getting over like some sort of cold or something, so my voice might sound a little bit different, and I'm gonna try my best to edit out any of the coughs. Um but anyway, today's episode was um inspired by um my experience when I went to go tour a wellness spa that was uh trying to find someone to uh rent um space from them. So um it was when I was still kind of looking for uh a space to see in-person uh in-person uh patients or patients in person. And um this wellness spa had some space for me. Um but uh it uh they were mostly interested in me because of my background in pelvic floor physical therapy. Um and that was because I guess the previous the person who was previously renting that space was an OBGYN or something, um and was using some sort of machine. Um I forgot what it was called, but it was basically from what I could tell, just a really, really fancy East M machine for the pelvic floor. Um but the machine had been super expensive, like I guess 200 grand or something. And so since they didn't have anyone who was trained to use the machine, it was just kind of sitting there. And so besides wanting to, you know, rent that space out, they wanted, they thought, oh, they figured that um, you know, if I can use the machine, then it wouldn't be just sitting there, they could still make revenue, uh, make back their revenue from buying the machine or whatever. And um the thing that bothered me the most though was that instead of focusing on like all the benefits to that patients could have with this machine, which uh uh spoiler alert, um, like in my professional opinion, like I said, this machine was kind of like a fancy ESTEM machine, so not necessarily something that could necessarily benefit patients any more than like just a regular standard ESTEM thing for the pelvic floor, or just like good pelvic floor physical therapy focusing on like muscle coordination. But anyway, so instead of like focusing on the benefits that this machine could have on patients, they they like were really trying to convince me to be able to use this machine because I had to like pay for some training or something on the machine specifically. They kept emphasizing the fact that because it's not covered by insurance, like I could charge like $12,000 for like a six-session package or whatever. And as if like that would convince me to use this machine. And it kind of just reminded me of um of an Instagram post that I saw somebody post um of them like using some vibration plate at a physical therapy place um and saying and and saying that it was for recovery. And you know, vibration plates do have their place, like they're actually um used in evidence-based physical therapy, but for like other for like actual conditions, not just for like muscle recovery, like athletic recovery, like and and so I thought, I don't know, I thought it was ridiculous. Um, like hopefully this person did not pay a lot of money just for like the quote unquote perk of that service. Um, but like all of these things put together just kind of made me really think, and I'm just because when when I created when I created my business, I did it out of um, I don't want to say out of the goodness of my heart, because that just sounds so like cliche. But but I did it for a purpose. I did it because I saw like people, like athletic individuals, so like athletes in the clinic who weren't getting the care that they needed, either because of insurance or because like the clinic itself wasn't equipped to help them very well. Um and so I saw that need, and that's why I created my business. And obviously, when you have a business, you need to be able to make money to run the business. Um, but like the main point of the business is to help people that weren't being helped very well, um, the traditional way. And so, like saying these things, like like the wellness spa, which in and of itself, like I'm I don't know, honestly, in my I'm I'm not like a huge fan of of wellness spas, like, or I'm not a huge fan of the ones that say that they have the answers to certain things. Um if you want to go to relax, that's fine. But like, because this particular one was like a one of those IV uh vitamin, IV vitamin spa things. Um and and that other physical therapy place with like advertising the stupid vibration plate, like those types of places I don't agree with. Um and it just kind of made me think, like, am I am I that naive that like I started a business to help people instead of wanting to make money? Um, but yeah, and you know, so many of these types of things exist in like the health and wellness world that I wanted to talk about some some of the most common things that I get questions about as a physical therapist. So today I'm gonna talk about dry needling, shockwave therapy, PRP, and low light level therapy, of which red light therapy is um is part of it. So um red light therapy is low-level light therapy, but um it's just like a specific section of it. Um and I I want to go over what each of these things are and how they work based on the evidence and whether I think they are worth it. Um because I think I think it's important to help people understand like, you know, if something is actually going to benefit them, but it they have to pay out of pocket, like that doesn't necessarily or having to pay out of pocket doesn't necessarily mean it's a scam. Um, but there are definitely ways that things that actually do benefit people can be sold as a scam, if that makes sense. Um but yeah, so first I'm gonna go over dry needling. So the definite um dry needling, as defined by the American Physical Therapy Association, is a skilled intervention using a thin filiform needle to penetrate the skin that stimulates myofascial trigger points, musculature, and connective tissue for the management of neuromuscular skeletal disorders. So dry needling is not to be confused with acupuncture. I know a lot of times people will compare the two or say, like, oh, it's like acupuncture or whatever, because um the majority of people have a general idea of what acupuncture is, and then dry needling just sounds weird. Um, but the biggest thing they have in common is that they both use thin, like thin filiform needles. Um, there are needles that are specifically made for dry needling, but a lot of people who do dry needling will use acupuncture needles. Um, however, that's kind of where the similarities end. Um they dry needling and acupuncture both use different clinical frameworks. So um their use cases are a little bit different, and the clinical reasoning behind the application of dry needling and acupuncture um is also a little bit different. Um so um but basically, so I'm gonna talk about dry needling, I'm not gonna talk about acupuncture. So basically, what dry needling does is or how it works is it resets the function of the muscle along with triggering your body's natural pain relief system. So this works by the like the needle its insertion itself into the muscle, um, and any other like there's uh two different techniques. There's like um you're adding electrical stimulation to the needle, um, and there's also a pistoning technique where your the needle stays um under the skin, but it's like you you pull back and um um bring the needle back and forth um to kind of target different areas of the muscle near the insertion point. Um I personally uh because I am certified in dry needling, I personally prefer to use ESTEM than the pistoning technique because um I just think eSTEM is a little bit more comfortable than the pistoning technique, but it's it just really depends on how the person was trained and and also the patient preference because I do know someone who for some reason she does not respond very well to ESTEM, but she's totally fine with uh pistoning. So but the the actual like the insertion of the needle and whatever technique is used to manipulate the needle is what triggers the biochemical processes in the body that's going to, you know, like trigger that natural pain relief system, uh, maybe create like I think one of the um one of the theories is like it creates like these micro traumas or something, and that's kind of what triggers your body's like um remodeling system and and things like that. But the in the evidence there's definitely an application for pain relief. So it it does help with pain relief. Um, in terms of some of the other stuff, like um I don't know if people usually look at dry needling as um jump starting like a like tissue remodeling or tissue healing. Um I feel like when I've heard people describe that, it's more in the sense that it's going to increase blood flow to the area and it's that blood fl increased blood flow that um improves tissue healing. But um I feel like dry needling doesn't necessarily have um other outlandish claims um beyond like the pain relief and then and maybe like um improving or decreasing like the trigger points and stuff, which that in and of itself has its own like little history. Um but for the sake of this podcast, um yeah, I unfortunately there's not too much uh research evidence on specifically dry needling, um, because a lot of the research that people use to back up dry needling is actually research on acupuncture, of which there are many different kinds of acupuncture, um, from what I've learned. Um but again, even though they're kind of similar, they are not exactly the same. So it's really hard to make claims on dry needling specifically while trying to use evidence from like acupuncture uh techniques uh and stuff. Um I will also say that some dry needling courses will also incorporate some acupuncture technique, like acupuncture-like techniques. Um and I feel like that muddle muddies the water a little bit as well. Um but in practice, so what I've experienced as a clinician and what I have um witnessed from like my coworkers and as someone who's gotten dry needling myself or sought out dry needling for certain things, um, it is something that has really can have really good results, um, and is definitely something that's worth trying um if other things haven't worked yet. So the way I was taught in my dry needling uh course and how I see view dry needling is you know, we're gonna try some other things first, and there's only gonna be very, very few cases where use cases where I'm gonna be where I'm gonna be like this is the first thing we're gonna try before trying other exercise stuff. And what of those is um gonna be dry needling your upper traps if someone's coming in for neck pain. Because I know um because neck pain itself, like that, it's really tricky. Um it's a really tricky thing to treat because of there's so many nerves and things around your neck. Um, but I what I know for sure is that people who usually people who get drag needling in their upper traps will usually at least have some pain relief, and that's that and that's gonna allow them to do the exercises that are going to cause the long-term ch changes to decrease their pain in the long run. So besides that, I typically use um dry needling almost as a last almost as a last resort. Um I say that's a more true as that was more true when I was working in an insurance-based clinic than I am as a cash pay clinician, mostly because uh dry needling is a little, or at least I think it was just the way our clinic was set up. Um it was a little time consuming to set up, and a lot of insurances do not reimburse for dry needling, and so we are essentially like not getting paid for the time that we're doing the dry needling um portion of the session. Um and that's why a lot of times, like even if you're using your insurance to go to physical therapy, um, if they suggest dry needling, they're gonna tell you that, oh, it uh they more than likely will tell you that um it's uh extra cost, like you have to pay, I don't know, like $50 or whatever, or $25 um extra, or some um, yeah, versus cash pay, like you're paying a flat fee anyway, so they're they're gonna include it as part of your treatment without like a second thought, so to speak. So dry needling definitely has a use case for decreasing pain in terms of some other claims that people make for dry needling, um, in terms of like recovery and things like that. Um that might be a little bit more mixed. I mean, yeah, if you're if the reason why you're wanting dry needling for recovery is to decrease like DOMS or something, pain from DOMS or something, I suppose there could be a use case for that. Um, I know in my training to like some people might want to use dry needling as part of their warmup or something, but that's also gonna depend on the person's reaction to dry needling. Um because for some people it's going to kind of inhibit their uh muscle contractions, so it's going to like I don't know, I call it like dead leg. Because um, you know, for example, when I've gotten dry needling, um like it feels like that leg or like I've gotten dry needling on my glutes, for example, and then it feels like that glute is like super, super sore, and like I definitely wouldn't want to do like an important workout right after that, but um I would feel better the next day. So it just really depends if and but some other people aren't as affected by that. So um I think there was at least one study that showed like like low-level evidence that it can help people kind of you know warm up for their event, but I don't know, like if you want to pay out a pocket for that, fine, but um I feel like there's other things that you can do besides dry needling that will also benefit you. Okay, and then so next is shockwave therapy. So shockwave therapy is a use of uh sound waves or acoustic waves um to uh trigger your body's natural healing and pain relief system through a process called mechanotransduction. Um, so this therapy was actually first used um by urologists to help break down kidney stones because the sound waves would kind of break down or fragment um, so to speak, the calcium deposits of the kidney stones. And so I think the one of the first uses of shockweave therapy in the orthopedic side, in the orthopedic world, was for uh calcific tendinitis. So that's when your body starts um or that's when the tendon starts getting calcium deposits. Um, and so the the calcium deposits itself is what causes the inflammation of the tendonitis in in calcific tendinitis, and so you know, logically it helps break down kidney stones, and so it also helps to break down those calcium deposits. Once those deposits are like gone, uh, you know, broken down, reabsorbed by your body, whatever, um, then that that relieves the air like takes away that irritat nothing's irritating the tendon anymore, and so that's kind of how it helps. Um since then, people have um I think it's also been like approved, quote unquote. Um I guess now that I think about it, like I don't know who's approving this, but I don't know if it's like insurance, whatever. But since then it's also been used for like plantar fasciitis, other tendinitis like normal tendinitis, um, and then some other cases, like I think there's research um ongoing for like um uh shin things like shin splits or you know bone stress injuries um and bone regeneration and like varicose veins or something. Um but right now the evidence is mostly showing really good um results for calcific tendinitis, which makes sense, um, and also plantar fasciitis, um but it it's kind of mixed for normal tendinitis, like whether it actually helps um over like doing other things like normal physical therapy. So definitely calcific tendinitis, you're gonna have benefits. Planar fasciitis, you're gonna have benefits using shock weave therapy, but for some of the other stuff like normal tendinitis or just like I don't know, muscle pain or something, like it's you know, it's kind of like eh, like yeah, it's not gonna hurt you necessarily, but um it's probably you're probably not gonna receive much more benefits than if you did something else. So next is PRP injections. So if you don't know what PRP injections are, yes, PRP stands for platelet-rich plasma, and it's a treatment where um so they use your own blood. So they take your blood out and then they spin it down to the concentrated like platelets and other substances that's already in your blood, like growth, like the growth factors and cytokines that help with healing and things like that. Um and then they use that mixture um or that sample and they inject that's what they use to inject into the area. So like your knee or your shoulder or whatever. And um while initially it was thought that PRP could help with actual tissue healing, um like because theoretically, you have all of these um these substances in the blood that help with like that aid with tissue healing. So if we can't theoretically, if you concentrate them and then like inject them where you want there to be more healing, like theoretically that's how it would work. But um, after many clinical trials over the last few years, like people or researchers still haven't been able to prove that it actually helps with like healing tissue or regenerating tissue. But what it does help with is pain. So it does help to decrease like uh that inflammation, it helps to decrease pain in certain areas that weren't responding to anything else. So it does it is helpful, but not with like it it is helpful depending on what your expectations are. Like if you're going for pain relief, like yes, there are studies that show that it helps with pain relief. But if you're going because you think it's gonna regenerate your knee or something, there hasn't been any meaningful studies that actually prove that it will regenerate anything. Um another thing to note is that apparently there's different preparation parameters that may affect the sample, and so that affects so that affects its effectiveness. And so if you go to one particular clinic, um they might have different parameters than uh a different clinic, and so maybe you had really, really good results in at this one clinic, but then you moved away and now you found a different clinic. Maybe you might not get as good of a result from that clinic. So I think that's also why there is variability in the cost. Um, because I know a previous client has told me that in Kentucky she's gotten PRP injections before, and I think she only paid like $500. Versus here in Vegas, I think it's it's pretty common for people to pay like $2,000, and this isn't something that's usually covered by insurance, if at all. Um, so this is something you're gonna have to pay out of pocket. So that's PRP. And then last is low-level laser therapy, of which red light therapy is a subset of. So low-level laser therapy is gonna have like the other wavelengths or whatever, and then red light therapy it's gonna focus on the red light wavelengths. Um, so basically, this works through photon absorption, and like part of your mitochondria absorbs the photons from the um laser therapy, and then that's what triggers um the biochemical response um in the cell. And there is good so similar to um PRP, there is good evidence for pain relief, but poor evidence for actual tissue healing in humans. Um, because I will say there are quite a few positive studies, or um yeah, there are quite a few studies that show that it does act like actually heal tissue, but they're all animal studies. Like if you take the animal studies out and only look at the human studies, it's pretty mixed at best. Um, whether uh laser therapy actually helps to heal tissue beyond just uh pain relief. However, I think I had first heard of light therapy in physical therapy school when we were talking about wound healing. So that's gonna be separate. Um, I think there is actual good evidence in human studies um for light therapy for wound healing, but if you if you think about it, like wounds are typically on your skin, so it's like you know, on the surface of your skin, and so the light is gonna be directly affecting those tissues versus a lot of people will try laser therapy for like their knee or like their shoulder or their back or something. And so if you really think about it, like that light has to penetrate through the skin and then through your fascia and then the muscle and how what depending on how deep uh you want the light to go, like or yeah, that's where depending on like the actual part of your joint or what have you you want the lights to affect, um, you know, the light has to go through all of those layers. And so it's like it's up in the air whether like just um having the light on like your skin is going to cause like those, you know, that is going to trigger those biochemical events that are going to filter down into like the muscle or the joint itself. Um and so, but in terms of like if you have a wound, light therapy is good for that, but I mean it's the thing that you want the light to be affecting is literally getting touched by the light. So um and also there in in a lot of the studies, like it's hard to compare studies because a lot of them had um different parameters like wavelength, dose, and duration. So it looks like there, or it seems like there's not a an established, like, I think there might be an established um established settings or whatever. I can't think of the word right now. But um I guess if you go to like an established business that has like affiliates around the country, um, I know of one that is kind of affiliated with my old clinic or the um my old clinic was is actually what they call a physician-owned uh physical therapy clinic, and so the physician's clinic is associated with this laser therapy clinic. I don't want to say the name of it, um, but like if you go to something like that, obviously there's going to be a little bit more uniformity or consistency, I think that's the word I'm looking for. But in terms of going to different types of clinics or maybe going to like a clinic like that that has a powerful like machine laser thing versus like just buying one like online, I mean they're those are gonna be very different and you're gonna have different results. So, but at the end of the day, good evidence for pain relief. Um, but if you are trying to get this therapy because you want to help with tissue healing, I mean, you it's i it's probably not going to help with the actual tissue healing itself. So after talking about all four of these treatments, are they worth it? Um so like I already kind of alluded to, it really depends on what your expectations are. So a better question to ask is what is the cost of pain relief to you? Um because if you're trying, if you're considering these therapies because you once your like let's say you had surgery and you want your um recovery to go faster, you want your tissue your injury to heal faster, or you want faster tissue healing or whatever, like you will probably be disappointed. Um but if you're going because you are trying to um improve your pain, you're trying to decrease your pain, and like, hey, if it if it does help with tissue healing, cool. If it doesn't, you're just you know, you're like it, you're like whatever. Um as long as it decreases your pain, it's fine. Then I feel like these therapies then would probably be worth considering um for those. And also if you can afford it, because that um I have had a few people ask me because like um I think that the laser clinic that my old clinic is associated with, or you know, the physician practice it's associated with, um, I think it's like $250 for a six sessions, which for some people $250 is like it's a it's an expense, obviously, but it's just kind of like, well, you know, worth trying because I'm in a lot of pain and I can't do anything right now. But for some people, $250 is a lot. It's like, do I pay for like gas for my car or do I pay for this laser treatment? And in that case, like I feel like it's not necessarily as worth it because, yeah, it's gonna decrease your pain. But for example, if you had a knee replacement, if you wait like two weeks, that pain's probably going to get better anyway. Um so those are all things to think about when considering whether these treatments are worth it. Um, some other things to think about are um if somebody, if a healthcare provider suggests these treatments, like are they suggesting the treatment as part of a well-rounded treatment plan? Or are they saying just get this one, you know, get this one treatment, like just get the dry needling or just get the PRP or just get the laser treatment, like like, and then you'll be fine, you know, because there is definitely a difference between treating these things as like a miracle cure or miracle treatment, quote unquote, um, versus as a tool to uh as a tool in a part of a well-rounded treatment plan. Because I do understand like how much pain can affect someone, um, especially in physical therapy. Like if someone like I try my best to choose exercises and things that are not going to irritate that person even more, um, irritate their injury or their pain even more, but you know, sometimes there's just no way around it. It's just that tissue is just way too irritated. So, you know, if one of these therapies, if one of these treatments can decrease their pain enough so that we can focus on their range of motion and their strengthening, then that's definitely worth it. Um and so as part of that, so with that, some red flags when people are advertising these these things are like if they're advertising it as like, oh, this is you need this because it's going to heal tissues, or if they're overpromising on results like that, versus saying, like, hey, I think you know, you would benefit a lot from this treatment. Um, you know, it's up to you if you want it because you're in a lot of pain right now, but you know, maybe this drying needling will help you decrease your pain enough so we can focus on your exercises, then you know, those those are two different things. And again, the being sold as a standalone solution, like none of these are necessarily standalone treatments for the long term. For the short term, obviously, like if, for example, I mean, I'm I don't want to say I'm guilty of it, but I am guilty of this. Like, you know, I know I need to strengthen my calves, improve their endurance, but before my higherx race, like my calves are kind of bothering me, and so I did get shockwave treatment because it's it has helped me in the past before. Um, but that's partially because this was like the week before my high rex race. Like, I'm not gonna improve the endurance of my calves in one week. Um, and so I got the shockwave therapy just to get me through the race, and then after that, my plan was to um incorporate some like calf strengthening and endurance things um so that my running um wouldn't affect me as much for other things like Tathon and Hyrocks in the future. Um but besides those specific use case scenarios, like these treatments um aren't necessarily a standalone solution for um long-term results. However, I will acknowledge that these treatments do make people feel better. And with the exception of PRP, because that's like I feel like that's a little bit more excessive and very expensive. Um, a lot of people will use dry needling, shockwave therapy, and uh light therapy as part of like a maintenance plan, um, almost like getting regular massages because it makes them feel better. Um, or they'll use it kind of like as a maintenance plan, so to speak, um so that they so that they don't get to a point where they're like they feel super, super beat up. Um, this is more for like professional athletes or people who are tray uh like doing high volumes of training, they'll get these therapies to so that they can continue training training at the level that they are. Um because I do acknowledge like if you're training at a certain level, like you know, you try everything else, but or actually I'm gonna c caveat this. So for people who are doing that amount of training, like professional athletes, a lot of them will also have their sleep dialed in, their nutrition dialed in, um, and all of those basic things. And then so the extra is the maintenance therapy to help them like feel better, versus if somebody is maybe not a professional athlete, but they're wanting to work out more or are an aspiring professional athlete or something, like using these treatments as recovery is not an uh is not a substitute for dialing in your nutrition or your sleep habits. So that is the caveat, but but I do acknowledge that people will use these as kind of like a maintenance plan. And so in that situation, I mean, like that's I feel like that's totally fine as long as the person, again, is able to afford it because like I mentioned, these and especially if you're using it as maintenance, like insurance is not gonna pay for maintenance um for like if you don't have like a disease or something. So you're gonna be paying out of pocket for this, and like if you're gonna use it for maintenance, like potentially doing this for long term. So if you're okay with paying out of pocket for it, like and you do you, um, but understand the limitations that these are just like maybe it'll give you that like 1% edge, but only if you have all the like the other basics dialed down or dialed in. Um so technically these like outside of normal like rehab, like outside of injuries or outside of like recovering from something else, like surgery or anything, like these treatments are not necessary if you're otherwise healthy, but I do acknowledge they do make you feel better. So um, so some people will choose to get them regularly as part of a maintenance plan. Um but yeah, so at the end of the day, these treatments are they're called treatments, but they're really tools, they're not like uh individual like standalone solutions. Um for someone recovering from an injury, the thing that's going to um make the difference long term is going to be um loading. So that's the part that's good they will need to that you need to focus on in rehab is loading the tissue and rebuilding its capacity, um, especially for everyday athletes. And um maybe you don't have a range of motion or strength deficit and you're just going for pain relief, you know, like again, you do you if you can afford it, um if you're fine with repeated treatments, like that is definitely your choice. Um, but especially if someone's dealing with like an injury for a long time and because they're dealing with the injury or pain, I mean, um, and avoiding certain movements now their strength has gone down and maybe the pain has affected their range of motion, like um these treatments are not going to be a substitute for rebuilding their strength and range of motion. So yeah. So is it worth it? It might be. It's up to you to decide based on what I went over today. But yeah, that's it for now. Um, if you're listening on Apple Podcasts, I would greatly appreciate a follow and a rating if you enjoy this episode. Thank you for listening, and I'll see you in the next conversation.