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Jerar Lahoud: Fighting Back Against Bad Back Pain Advice
95 Plays29 days ago
In this episode, Lachlan talks with Jerar (@thepainillusion), an Exercise Physiologist who used to deal with long-term back pain. He shares what he learned from his own struggles and why pain doesn’t always mean something is badly wrong.
They talk about why scan findings can be unnecessarily alarming, how some advice from health professionals can actually hinder recovery and why getting stronger doesn’t always mean your pain will go away.
If you’ve ever had pain that won’t go away - or want to help someone who does - this conversation will help you see pain in a new light.
What you’ll hear:
- Why pain isn’t always a sign of damage
- What “The Pain Illusion” really means
- Why scans and back problems don’t always match up
- How to think differently about strength and movement
Links & Resources:
Recommended
Transcript
A Spine-Chilling Experience
00:00:00
Speaker
The scans showed I had, you know, scoliosis and at the time I'm yeah, wow, I didn't even know that. then she pulls out this sculpture. The further down on the sculpture you go the more degenerated and in black this sculpture looked.
00:00:12
Speaker
And she said to me, if I didn't come in twice a week for the next four weeks, this is what would happen to my spine over time. Like the sculpture just looked so scary, you know, like this disc was just black and the vertebra above and below were almost like touching with all these spurs on it. now I relate a lot to getting unhelpful advice that seems helpful at the time.
00:00:32
Speaker
Imagine we blamed having a headache because of the amount of grey hair that you have on your head. I want to be the devil's advocate. Are you telling me that disc bulges can never cause pain?
Meet Gerard Lahoud
00:00:45
Speaker
Today on Pain Coach, we're joined by Gerard Lahoud, exercise physiologist and founder of The Pain Illusion. His passion for pain education comes from personal experience after receiving poor advice during his own battle with low back pain.
00:01:01
Speaker
Now Gerard applies evidence-based strategies to help people overcome persistent pain and move with confidence.
00:01:10
Speaker
This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
00:01:29
Speaker
Gerard, thanks for coming on. want you to explain to me what's the reasoning or the meaning behind your Instagram name, The Pain and Illusion.
What is 'The Pain Illusion'?
00:01:40
Speaker
To be honest, this is not a question I thought would come up, but it's a question that's come up a lot in the past.
00:01:45
Speaker
I guess lot of people have different ideas as to what it might mean. i think at face value, it's like, you know, it's not real or it's, you know, it's not there, but you're made to believe it's there or something like that. But I guess by definition, illusion meaning sort of relating to perception in terms of, you know, things might appear to be a certain way when they might not be.
00:02:08
Speaker
And so in the context of pain, that might be, you know pain means damage or pain means something's wrong. Whereas I guess in the context of an illusion, might seem to be that way, but there might not actually be damage, anything necessarily wrong.
00:02:24
Speaker
And that's sort of like the context around the pain illusion. Oh, that makes sense.
Social Media Conversations on Pain
00:02:30
Speaker
because Because I'm just thinking of listeners, people that are in pain, feel that they might have this like, oh, is he saying that it's not real or that it's not...
00:02:41
Speaker
yeah, it's my experience isn't in real and my suffering isn't real. Is that just speak to that for me? Yeah, it's definitely a tough, maybe like a tough concept to grasp, especially if you have pain, because ah chances are, if you've experienced pain, you've probably run into a situation where you're probably made to feel like you're not believed, like you are making it up.
Perception of Pain vs. Optical Illusions
00:03:09
Speaker
And so, I guess don't try to necessarily use that language much at all because of these notions around what the word means. But at the same time, guess behind social media, you know, we're having this conversation because of, I guess, the name. And so at least sparks conversation, but it also gets people thinking about it further, hopefully. Because, yeah, it starts conversations and brings up questions.
00:03:36
Speaker
Yeah, for sure. Oh, that's for sure. Because straight away when I hear it, I'm thinking, oh, I wonder, like, i kind of have a feel of what you're probably meaning behind it, but I just thought I'd ask you directly. And so I think, yeah, the idea of pain being a subjective experience or an experience that's very personal um and the way we perceive what's going on can be can be accurate or inaccurate depending on our understanding. Um, and everyone would experience it different, just like those, I'm just thinking of those classic illusions where you look and you see one thing, but someone else will look at it and they'll see a completely different thing.
00:04:17
Speaker
And, and I guess both are, both are true and real in the eye of the person looking at that picture. So that makes sense. Yeah. And I guess on the point of illusions, like optical illusions, I think they're a great analogy for pain too, because you might look at a picture and it might seem like two of these boxes are different colors.
00:04:37
Speaker
But even once you're told that they're the same color, you still can't unsee it. You know, it's not as simple as just thinking differently about it. It's not just as simply as, you know, learning more about the illusion or learning more about pain, but there's a lot more going on that we aren't necessarily in control of.
00:04:53
Speaker
So yeah, that there's another layer to the pain illusion itself too. Yeah, for sure. Do you know Daniel Harvey by any chance? He's a pain researcher. I know he's got some research around this area. you know him and are you familiar with his work?
00:05:08
Speaker
I was actually on a call with him two days ago. we spoke for the first time a couple of days ago and yeah, guess I got put in contact with him and but Maybe this will come back to a conversation we'll have very, very soon.
00:05:23
Speaker
um But maybe by the time that this this podcast is released, I guess we might have the answer to this. But I guess he's like he's someone I might sort of be looking forward to working with in the future. So, yeah, the timing of this question is incredible.
00:05:40
Speaker
Yeah, wow. Yeah, no, I actually did a little bit of research assistant work and it was, when I say a little bit, it was a tiny little bit with Dan when he was at Gold Coast, well, Griffith on the Gold Coast.
00:05:54
Speaker
I was about to say Gold Coast University Hospital, but that's not exactly right. mean And yeah, I just know that he has some things around this and um some research that he's done and this is an interesting area for of his. So,
00:06:10
Speaker
I'm glad that you've been in kind contact with him because it sounds like you guys would align on on many things. Yeah, we haven't actually, we touched on the topic a little bit at the Instagram page, but um obviously see the call wasn't about that.
00:06:23
Speaker
guess I don't know too much of the background with that, but I'm keen to talk to a bit more about it. So that'll be interesting. Yeah, for sure.
Gerard's Back Pain Journey
00:06:31
Speaker
So, mate, you told me that you experienced back pain or you've had experience with persistent back pain that's largely recovered now, from all accounts, you may have a different perspective on that. But I'd love you to just explain that time and just sort of retrace that period of your life so that listeners can understand um that you've been through this. And you're not just someone that knows a lot about pain, but you also experienced it, which gives you this level of expertise that you can only have through experience.
00:07:04
Speaker
Tell us a little bit about that journey.
00:07:08
Speaker
Well, I guess my journey probably with back pain started six, seven years ago. it was working at Woolies at the time and there was no sort of instant moment where my back started hurting. It just sort of gradually just started coming on.
00:07:26
Speaker
It's confused. I didn't know why. was training at the time, but there was no sort of one experience I could point out where it started, but it gradually of worsened. And I just dropped a comment to one of my managers at the time at Woolies.
00:07:41
Speaker
And guess Woolies has this program where they give you sessions to see healthcare professional. And ah similar to like, I guess, Medicare, but obviously no GAPV.
00:07:53
Speaker
what he pays for it. And I saw a health professional. They weren't the only person that I saw. It was sort of my gateway to seeing somebody because I guess at the time it was just, I didn't really do much for it.
00:08:05
Speaker
And so started working with this person, at five sessions together. Interestingly enough, i was a bit concerned that going through that experience that maybe I'd lose some hours working at Woolies.
00:08:18
Speaker
And so almost felt like ah no one put this pressure on me at all, but I felt like, you know, I need to basically say that I'm okay and can do everything because was concerned that I wasn't going to be able to work.
00:08:33
Speaker
but They weren't the only sort of person that I saw. went and i saw a few other people. These, i guess the sessions I had with them at the time, probably like 16, 17, 18, maybe.
Critical Reflection on Advice
00:08:43
Speaker
mean, they, they helped in, in the very short term, but there were sort of no noticeable differences over time. Like you sort of just kept coming back and I'd see them and they would, you know,
00:08:57
Speaker
sort of, you hand on treatment, very passive. Every session after that, I'd come in and ask how it was. I'd say, you know, it felt good for a couple of days and it just came back and there was no further questioning into that.
00:09:10
Speaker
At the time, I didn't really but think much about thought, you know, it must be part of the process, must be normal. I was sort of taking a lot of the advice they were giving me, didn't really do much.
00:09:20
Speaker
And at the time, Everything that they were saying made sense. But i think my own experience maybe led me to where I am today. It's hard to say.
00:09:34
Speaker
But think more I learn, the more I reflect on my own experiences and think to myself, that advice I got was not that good at all. And think if I wasn't maybe as curious as I am as a person, I i maybe wouldn't have been critical of the information. and I don't know where I would have been today because of it So think a big part of my sort of journey to where I am now and and wanting to help people with chronic low back pain specifically, because that was sort of my experience. I'm not sure if we've actually clarified that, but it's sort of, know, I relate a lot to getting unhelpful advice that seems helpful at the time. Yeah.
00:10:17
Speaker
And for a lot of people, this advice changes a lot of things for them and not for the better. And so I guess with my own experiences of getting this unhelpful advice, i sort of want to help people sort of get better advice.
00:10:32
Speaker
Yeah. And positively influence their life, even if they have pain and it seemed like, you know never getting better. know, it's been a year, been two years and nothing's changing.
00:10:44
Speaker
So yeah, that's sort of, i think that's where, think that's why I'm here I am. It's hard to say, obviously, like if I didn't go through that experience, would I be doing what I'm doing? Who knows? But yeah, I'm glad to, I guess, in hindsight, it's weird to say, but I think I'm glad I went through what I went through because I guess it gives me a bit of an insight to be able to relate to people.
00:11:07
Speaker
and For sure. Yeah. Tell me, were you like, so you're an exercise physiologist. We studying at the time you finished, where were you at in that sort of career pathway?
00:11:22
Speaker
Hmm. Oh, I'm trying to just forget the timeline right, but yeah if I'm not wrong, it would have, I guess I would have had a bit of back pain at end of high school too. So probably going into making the decision of what it was that I wanted to do.
00:11:38
Speaker
um And obviously like a lot of people in the healthcare industry, I was massive on sports and so yeah. Yeah. Yeah. Now, obviously you haven't named names, so I would love you to be able to delve into some of the bad advice that you got.
00:11:57
Speaker
um Some of the bad advice I've gotten and actually, um I've made a couple of videos and skits about on my page. Yeah.
00:12:08
Speaker
I guess with my pain, there was a few people I saw, but there was this one person, they sort told me about my back. I got scans. The scans showed I had, you know, scoliosis.
00:12:22
Speaker
And at the time, i'm like, yeah, wow, I didn't even know that. Like, she's like, you know, this shoulder is so much higher than this one. And you can see it on the scan. It's really, really evident. And, you know, if we don't do anything about it, and then she pulls out this sculpture.
00:12:36
Speaker
this low back sculpture and it's got, you know, discs where the further down on the sculpture you go, the more degenerated and black this sculpture looked. And she said to me, if i didn't come in you know twice a week for the next four weeks,
00:12:52
Speaker
this is what would happen to my spine over time. And at the time, I'm just like looking at the sculpture thinking, yeah, like, wow, that looks bad, you know? um And obviously I had a bit of trust. I just obviously, you know,
00:13:08
Speaker
She knows more than me about the topic. And so ah did come back, but coming back to the point at which I was questioning things and i sort of just stopped going in the entire. I don't remember a particular point in time where I stopped, but I don't remember going for very long. I think it might've been another three or four sessions.
00:13:29
Speaker
noticed not much was's changing was changing. like, you know, is this really worth my time? guess I didn't really attach to, know, this explanation that was given to me. I think I'm glad didn't because like the sculpture just looked so scary, you know, like this disc was just black and, and the vertebrae above and below were almost like touching with all these spurs on it. And it just, it just didn't look great. You know, like I could only imagine how someone who didn't have a medical background would look at something like that and think, yeah, wow, that must be bad. My back must be really bad, you know?
00:14:01
Speaker
So yeah, like the sad thing is I, I have worked with people even after, guess, working in clinic who have said the same things to me.
00:14:13
Speaker
And, like, when I hear it, I sort of just – it's such a weird experience to hear it from somebody else because big part of me is just like, oh, my God, I can't believe this is, like, way more normal than just the experience I had. and But hearing that as well at the same time is sort of ah glimmer of hope because – there's so much that we can talk about and so much that we can change and learn from where we are at the moment.
00:14:42
Speaker
So, yeah. Yeah, it's something that I can definitely relate to. And I feel like it might be good business advice to scare the crap out of people, but it's definitely not good treatment advice.
00:14:54
Speaker
And obviously in the long term, and people hopefully start to understand that. Because, you know, you scare someone and say, come back to me twice a week for however long.
00:15:06
Speaker
And obviously, yeah, that can, it can, I think sometimes people make up, this is just clinicians, I feel like they make up these problems so that they can justify these treatments that don't have any good particular evidence.
00:15:24
Speaker
um And I find it as a small business owner, I find it this, Ethical thing all the time that I just hear other people that come and see me and what they've experienced and I just like so wrong.
00:15:41
Speaker
But I can also see how it can sort of lock people in to these sort of programs or whatever the treatment looks like because they create enough fear and they create a need for the clinician and therefore hopefully in their mind maybe I don't know, I toss between the idea of they corrupt or ignorant? I don't know. hope that most of them are ignorant, honestly.
00:16:08
Speaker
Yeah. It's a question I always ask myself, right? Because like you said, if you're sure yeah if you' running in a business, if you're working as part of a business, obviously the more people you see, the more money you make.
00:16:19
Speaker
But sometimes in healthcare, the more you see someone, the less or the worse the outcome. And so it's trying to find this line between how much am I actually helping this person, right? A big part of me questions whether these people actually, honestly, I hope that that they truly believe that that is helpful advice because, you know, yeah.
00:16:45
Speaker
And, you know, I make jokes, you know, I'm sarcastic about some of these things on my page and I've had comments on some of these posts saying, you know, things like, you know, like half of these are true. Like I go to, I go to a top chiro school.
00:17:02
Speaker
And so when I say things like that, it almost makes me feel like, but better about the fact that this information is being spread because the intent is still, it's still right. You know, like the thing is, if you and I got taught that, and we truly believe that by spreading that information, we're trying to help people, but whether that actually is helping people or not is an entirely different, entirely different story.
00:17:26
Speaker
Yeah. Yeah, no, that's, that's exactly right. And I sort of toss between the two. Sometimes I'm just like, oh, they're just corrupt. And other times i'm like, no, maybe they just aren't up to date. And look, there's areas ah that ah you kind of feel like there's a little bit arrogance to saying this, but I think there'll be areas where I'm probably got the same blind spots, you know?
00:17:49
Speaker
where, you know, I might not accurately understand a particular area and you know enough to be dangerous and you share that information, but perhaps it's not exactly correct.
Questioning Scoliosis Treatment Narratives
00:18:02
Speaker
Yeah, that's interesting. So your advice is basically that you have scoliosis, which you obviously had from a very young age and hadn't been a concern for you. And then...
00:18:15
Speaker
that you needed these treatments to sort of align that scoliosis. but What was the reasoning behind it?
00:18:23
Speaker
It was essentially that, like it was, I don't know if I'm making the memory up now, it was probably four or five years ago, little longer, but it essentially revolved around alignment because of what scoliosis would have done to the discs.
00:18:36
Speaker
Yeah. And there was no other options, you know, like that was the only option I was given. So what else was I meant to do, i guess, you know? This would be a very common story. So for those that are listening and have heard this advice about their particular back problem, what would you say to them? How would you sort of, because I find it very challenging sometimes to shift someone's paradigm differently.
00:19:04
Speaker
completely in a different direction and obviously it takes time it takes trust it takes a lot of different things but if you were to just speak straight for a second what would you say to someone that has been told ah this
00:19:22
Speaker
i think you have to be open to learning
00:19:27
Speaker
I think it's really hard based on your own experiences, your own expectations, what you've heard from other people, what you've seen other people with similar conditions go through. And things might appear to be a certain way, but it's...
00:19:43
Speaker
it's
00:19:46
Speaker
Sort of reflecting on your own beliefs. Like where do these beliefs come from? Why do I have these beliefs? And what sort of maybe, you know, what would be a really good question to ask yourself?
00:19:58
Speaker
What piece of information would I need to receive in order to change my mind about this? And I think that opens the doors for possibilities that you might even imagine. You know, like for me, if I heard something like, you know,
00:20:15
Speaker
you've got back pain because you have scoliosis. It's like, I don't know a world where don't have scoliosis. I don't have a world where... Sorry, that's... My mate's dog is just... It doesn't take long and he'll settle back down.
00:20:31
Speaker
No, he's just excited. But yeah, like it's like in my own experience, have scoliosis and I have pain. So it makes logical sense.
00:20:43
Speaker
But just because it makes logical sense doesn't automatically make it true, you know, because there's many people out there that have scoliosis and don't have pain. And, you know, just learning a little bit more about the fact that you probably had scoliosis from when you were born. Like,
00:20:58
Speaker
it's genetic factors play huge roles in whether you have scoliosis, right? And for me, maybe getting that piece of information where it's like, well, true, you know, if I've always had scoliosis, but I haven't always had pain, that might be enough information to maybe change my mind. Or, you know, scoliosis was truly the cause of my pain, why does it feel better sometimes?
00:21:20
Speaker
You know, why is it just not constant like my scoliosis is? And so guess first maybe being curious, right? asking questions and I guess the want to learn because it's really hard to maybe change your mind about something if you're not open to it yeah for sure for sure if someone's not open uh as a young physio I would have still had a crack but but nowadays I'm I'm way less
00:21:53
Speaker
confrontational about it because it is tricky and and they need to build trust in you before you can sort of lead them into that.
Public Understanding and Critical Analysis
00:22:00
Speaker
And they, like you say, they need to be open. Sort of transition to something I wanted to talk to you about because I know you're going into research or you're sort of like thinking about that research pathway.
00:22:11
Speaker
You're on the journey already, which we'll talk about a little bit later. But do you think it's important for the general public to sort of have some sort of ideas around research and the scientific method and how to analyse things that come their way? Like how do we know that something is factual or true?
00:22:36
Speaker
you have some advice?
00:22:40
Speaker
so yeah I'd probably be asking the same questions. I think research, the skills behind research is exactly that. It's a skill. It's something that you will get better over time with, if you put the effort and the time towards doing.
00:22:59
Speaker
i thought I knew research until I started doing a bit more research. And i guess for the general public, if it's hard for clinicians to even have the time to look at research,
00:23:13
Speaker
which is going into exactly what they're doing as a profession, it's really difficult to expect the general public to, you know, have any time or desire. Like, you know, that's what, you know, healthcare professionals are for, right?
00:23:26
Speaker
But at the same time, guess it's, we sort of live in a society where some healthcare professionals have power and there's a sort of a power imbalance where it's like what they say must be true. It's really hard to,
00:23:42
Speaker
ask questions. But if there's any maybe advice around the research and sort of questions to ask and analyze is you're you're allowed to ask, you're allowed to ask questions.
00:23:55
Speaker
I think if if you're asking questions, because you're something just doesn't make sense, or you've heard different, I guess that's a big part of a health professional's job is to to help answer as many questions.
00:24:08
Speaker
So If you're almost made to feel like you shouldn't be asking questions, probably not the right person to help you, maybe, generally speaking. um But, yeah, it's really difficult. You don't know what you don't know.
00:24:24
Speaker
and if you haven't been exposed to a potential opposite scenario, how you meant to know what questions to ask? It's difficult. It is really difficult. I just say, maybe it should always be open-minded to the possibility that something might not be true. And the same goes for healthcare professionals. If there's healthcare professionals listening to it's a few things I could probably name off that I've changed my mind about with new information I was given. And I know it's hard.
00:24:55
Speaker
know it's really hard to change your mind about something, even if you've been given new information, but yeah, I guess research and learning is asking questions is a skill, but it also takes time and effort.
00:25:10
Speaker
Yeah, I think everyone should have sort of like a baseline understanding though. And I agree with you in terms of like the research and it's something that I haven't particularly gone down that pathway. And I agree that, you know, the more someone learns about something, the more they realise they don't know. And that includes the scientific method itself and how that all works.
00:25:32
Speaker
um I do think that there are, you know, some things that people can learn to try to understand how research is done and why it's important.
00:25:44
Speaker
um And I think one, and I'll just mention this briefly, but I think one of those things is as clinicians, if we choose a particular treatment method, the privilege of looking and going, okay, well, what if we did nothing?
00:26:03
Speaker
Or what if we did, some alternate treatment option. And what the research does, it does that. It looks at the different options. Whereas a clinician and a patient, when you're coming into treatment environment and and you get offered these options and you choose a particular option, you don't really know whether you chose the right option because you don't know what the outcome would have been if you did something else.
00:26:30
Speaker
So I think that that's what research does. It answers the questions of, hey, out of these different options, which one of them could be doing nothing at all, which is the best option, which is superior? and And it's something that we don't as clinicians have the ability to do unless we go down the research pathway like you're planning to, um and as patients as well. And so there's this uncertainty um around the treatment option. That's why i always think that what treatments we choose um as a clinician and as a patient should always be guided by a body of research. And obviously, yes, you're dealing with an individual in front of you. And so that needs to to shape your decision as well and see what research sort of matches their particular situation.
00:27:18
Speaker
But we can't base it off clinical experience over some of this large body of research. I could talk more about that, but let's not say for the sake of time. What I wanted to, unless you have some comments on that, Jo?
00:27:35
Speaker
Yeah. For the sake of time. No, I think for the sake of time, there is a ah really good paper. If there's anyone that wants to read through, it's a really easy read and it's very sort of lay.
00:27:47
Speaker
Like I said, the majority of it is nice lay terms. I believe it's called Why ah Ineffective Treatments Seem Helpful. There's a few things that come up in that paper, things like by Hartman 2012 maybe, but it lists off a few different things as to what may be helpful.
00:28:07
Speaker
Sorry, not what may be helpful, things that appear to be helpful and why they may appear to be helpful. So yeah, why do ineffective treatments seem helpful? And I think for me, that paper laid the foundation to ask further questions about is what is happening right now actually what I think is happening?
00:28:27
Speaker
Or is there something else going on at the same time? and Which sort of comes back to, you know, how much does experience truly matter when the evidence actually says something else?
00:28:38
Speaker
So yeah, that paper I highly recommend. I'll put it in the show notes. I've written it down here and i'll I'll get you to send me the link just so that I can attach that so that if someone wants to check it out, they can.
00:28:50
Speaker
We could probably speak ah the full hour on that, but we'll move. I wanted to know, did you have any imaging on your back? Was there, what did that suggest? Obviously you did, well, I'm assuming you did from the scoliosis, but were there any other findings and how were they explained to you?
00:29:09
Speaker
yeah had imaging on, well, to to face show the scoliosis. It's one of the first photos I actually have in my phone, which is,
00:29:20
Speaker
really convenient because when ah see someone who tells me about their scoliosis, it's like, well, you know, here's something that I relate to on and I can find it straight away. Right. Um, but yeah, that was almost all the information i was given. Like I wasn't told much else. i Just this is why. And here, let's just try to modify the symptoms.
00:29:39
Speaker
It wasn't nothing that I could do outside, nothing, I can implement, try, just this is what it is and you to come in and got to fix it.
00:29:52
Speaker
So you haven't had follow-up imaging since then, like MRIs or anything like that?
00:29:59
Speaker
No, I haven't. And this is a really good point because think for a lot of people listening, imaging is something that people always, I guess, are referred for. you know Let's get imaging, let's just find the problem,
00:30:17
Speaker
And let's see what we need to do to fix that problem. But very rarely is imaging actually done afterwards. It's sort of like we have pain. Let's get imaging.
00:30:29
Speaker
Let's fix the pain and let's not worry about the imaging anymore. So like if we just took the imaging part out of the storyline, the rest still makes sense. Like you have pain.
00:30:41
Speaker
Let's deal with this pain. The imaging doesn't even fit into that puzzle. it would fit if you needed to get one before or after, or if, you know, we suspected something serious going on, which happens in less than like 5% of cases, and that's being conservative.
00:30:59
Speaker
But yeah, it's an interesting point. Like if it truly was important, let's get imaging after to make sure we know we've fixed the problem. But we never got imaging to see if my scoliosis was aligned again, or and even though my pain is much more improved now, so it is.
Role of Imaging in Back Pain Treatment
00:31:15
Speaker
particular parts is less sort of persistent, but it's not like, you know, we've gotten scans to see that we've corrected anything or that the treatment that we've done actually solved the problem, which comes back to what we were just talking about. You know, a like we can to apply assumptions to these treatments, but how we actually test them to see if they're true or not is a whole nother. That's where the sort of the research comes in. Yeah.
00:31:39
Speaker
Mind you, you know, I do see some people that go through their chiropractic treatment and they do do follow-up scans and they do try to ah say, look, see, we've realigned your spine here, here and here, um which is a whole interesting discussion.
00:31:57
Speaker
um And there's obviously it's a snapshot in time and so muscle spasming and things like that can make some changes in the curvature of your spine, but they may not be...
00:32:08
Speaker
um persistent or relevant as you're suggesting i want to read look i thought this was your article and i was like this is a doozy but it's a shout out to your mate what's his name he's oliver davis his grand page is chronically fit yeah it's the we've got one of his one of his articles in one of his blogs in in my um bio on my page Yeah, he is, Oliver, you are a wordsmith. Like it is really well written and I'll attach it to the show notes as well.
00:32:41
Speaker
I'll need to remember that. Sometimes I say that I'll do it and I never do. But I want to read it because I think it's really good. want to read just a little section.
00:32:53
Speaker
hard to know which section I'll pick. I'll go down and I'll talk about something that you've sort of already mentioned slightly. He says, because he's using the, you know, and you know, because you've seen it, but he's using this horror film and um MRI findings and um this sort of illustration.
00:33:12
Speaker
And he says, the vast majority of back pain falls into the shadowy realm of non-specific low back pain. This isn't caused by a clear-cut villain like an infection, a tumour, fracture, inflammatory disorders, or corderoquina syndrome, which is when, yeah, we won't bother. Yeah.
00:33:32
Speaker
Instead, it's the work of an elusive phantom, a blend of factors that when combined create the sensation of pain. This phantom lurks in the background, makes it difficult to pin down treat with a single solution.
00:33:47
Speaker
It's like trying to catch smoke with your bare hands, always shifting and blending into the shadows, yet undeniably present, much like the hidden traps in a haunted house.
00:33:59
Speaker
It's a great article. I think he's absolutely nailed it. But I want to talk about, well, he mentions that non-specific lower back pain, this idea that we can't really sort of pin it down to a singular structure that's causing it.
00:34:12
Speaker
And like you said a little bit earlier, it depends what research you look at, but, you know, anywhere from...
00:34:22
Speaker
80 to 95% of back pain sort of fits into this non-specific where we can't see a particular or we can't tell the particular structure that's causing it.
00:34:36
Speaker
What is the reason behind this? If structure all. Yeah. What is the reason behind this? Just for listeners to sort of have a way in into understanding this. The term non-specific?
00:34:49
Speaker
Yeah, well, why do we, I guess the question that I'm asking is what we see. So there's this, sta and you you'll know it And he actually, in the article, for those that go and read it, he does discuss it.
00:35:04
Speaker
where they do a whole bunch of MRIs on people that have no back pain. And I think it's a massive study. I think it's about, from memory, it's about 30 that they do these MRI ah studies on.
00:35:16
Speaker
I'm just scrolling to see if I can find the particular image because he's got the stats here. So, for instance, our age, well, I'm assuming, I'm about, I'm 32.
00:35:28
Speaker
you know, you'll give or take. You probably, you might be younger. But in our age group... yeah i I don't know if I should be offended or... one No, I'm kidding. i don't know I don't know how old you are, so I don't know whether I'm going up or down.
00:35:44
Speaker
but What's your guess? oh My guess would be like ah high 20s, maybe early 30s.
00:35:57
Speaker
I'm turning 24. Okay. Cool. okay cool I wasn't far off. High I gave you a few years. Hopefully, I don't know if you hit the age where that becomes offensive or not, but if you were 70 60 or 70, it would definitely be offensive. But right now, you might be okay with that.
00:36:17
Speaker
It's almost a compliment, I feel. Some of my age, being told that, looks I don't know, 30 just looks a bit more mature. 24 seems young to me. ah Yeah. Well, I'm glad. I'm glad I could compliment you.
00:36:29
Speaker
Well, so let's go my age group, just to keep it simple. So for those people that are in my age group, Around this disc bulge, which a lot of people talk about when they have experienced back pain, about 40% of people my age have these findings on an MRI and have absolutely no pain whatsoever.
00:36:50
Speaker
So what does that tell us about back pain? What is the role of imaging um for those that are listening?
00:36:58
Speaker
I think when people get given this information, ah face value might seem like You know, there is this problem in your spine, but you just can't feel it. um But at the same time, but you know, we used to think that this was a problem.
00:37:20
Speaker
You know, we you'd have back pain, we'd get imaging, and we'd see these things, right? We'd find things like disc bulges. It's very easy to pinpoint or blame something that just doesn't look right.
00:37:34
Speaker
And we thought that for a long time. Until we did, you know, scans or images of people who didn't have back pain and the same things come up. And it's almost analogous to wrinkles or gray hair.
00:37:51
Speaker
Imagine we blamed having a headache because of the amount of gray hair that you have on your head. Like you'd never do that because you have enough experience to be like, I know a lot of people who have gray hairs and I've never mentioned anything about a headache.
00:38:05
Speaker
It's easy to dispel. It's not really easy to dispel something that looks really bad on imaging and we've been told is really bad. It's really hard to say that that's actually not necessarily a bad thing.
00:38:19
Speaker
It's just the same as wrinkles or gray hairs just on the inside. And it's really hard to change the notion around disc bulges, especially when we've thought that for a very long time.
00:38:34
Speaker
but it can sometimes pave the way for change belief and behavioral responses and emotional responses for what it means and what you can do because simply just understanding it differently can really sort of pave the way for what you can do in turn, what happens to you long-term because of what behavior you start to implement, you know, like,
00:39:04
Speaker
If you get imaging and you see a disc bulge and you think my back's compromised or it's damaged or something's wrong, Like you said, it's really hard to know what you would have done or could have done because, you know, it's only one person in this situation.
00:39:17
Speaker
But it's very likely just when we look at trends of how people behave when they have these beliefs, they move less and they have a lot more fear around their back. And their belief around how they think they can manage it themselves is a lot lower.
00:39:31
Speaker
And, you know, simply changing these beliefs or learning a little bit more about it can change the responses that we have for when we do get pain. We can almost dissociate the, not dissociate, sorry, but the pain that we do experience may not be because of that disc bulge. There might be another reason.
00:39:53
Speaker
And if it is another reason and this disc bulge is thing that came up on imaging isn't actually a problem, maybe if I move, I'm not worsening this disc bulge because that isn't actually the problem, you know? And And I guess that's recommendations now are to avoid imaging.
00:40:11
Speaker
you know The best advice is to not get imaging unless we suspect something serious. Once upon a time when we thought disc bulges were a problem, we would get imaging done on a lot of cases of back pain.
00:40:23
Speaker
And we thought, you know, what's the harm? Let's get imaging. Let's see if there's anything. And if there isn't, no harm done. So we started to see the harms that imaging do for people. And now the recommendation is unless we suspect something serious, let's actually avoid imaging.
00:40:40
Speaker
But it's really hard to sort of translate that research into the real world. Like it is a bit of a time gap between, it comes back to what were talking about earlier. It's really hard to unlearn something that just makes sense and is logical. It's almost like saying,
00:40:55
Speaker
the the way that you've just made sense about your pain with this disc bulge might not actually be something else. It's really hard to go i haven't my answer you don't actually have your answer.
00:41:09
Speaker
there's a lot of barriers around, yeah, what images tell you, what they mean and how they influence everything really. Yeah. And they feel invalidated. I think it's a really good point to, to point out the fact that in most cases, uh, imaging shouldn't be done unless there's some serious pathology um,
00:41:28
Speaker
some neurological findings which basically means for those that are listening there's there's some weakness in a particular limb or something like that where they think there's some serious nerve pathology going on but and there are clinical guidelines on the internet that the government have put out to explain what is back the treatment or what is the best advice for for back pain? And I think it's it's good to have a look at um for those if they're listening and they are experiencing back pain to look at those because I i see many clinicians that I do not follow this advice.
00:42:07
Speaker
um So yeah, and that's that's important. I want to be the devil's advocate.
Disc Bulges: A Piece of the Puzzle
00:42:14
Speaker
Are you telling me that disc bulges can never cause pain?
00:42:19
Speaker
No.
00:42:22
Speaker
but they could.
00:42:27
Speaker
I think the, I guess, important part about the whole conversation is what does knowing for sure change about what we're going to do?
00:42:40
Speaker
Because whether it is a disclosure, the treatment options don't change based off what we know now. So it could be, it might not be, but I think the possibility that It isn't is a lot more valuable than you've got a disc bulge this is why. Yeah.
00:43:03
Speaker
I agree with your answer. And I, and I would say that it's, it's the disc bulge is one piece of a very complex puzzle, which is pain and it can be a contributing factor and.
00:43:17
Speaker
It obviously can also in some situations be something that's, that's kind of irrelevant to your presentation or what you're experiencing because they just lay, I guess, dormant and they don't cause any problems.
00:43:31
Speaker
Um, but yeah, I, I, I have this wrestle a lot because I've, I've done and I've gone and done the, um, professor in pain science with Lorimer and those guys down there. And I think it's super, super helpful.
00:43:43
Speaker
Um, but I also like I just am mindful that I feel like we don't need to check the baby out with the bathwater and the bodies can still have a role to play um in this complex pain problem.
00:44:00
Speaker
And I think they do that. um But I think when you find yourself in a camp, you can sort of go so far into that sort of like the nervous system side of things and the mind and the thoughts and feelings and those kinds of things that you sort of lose sight of the fact that the body still is the part of this puzzle and it still is an important part of this puzzle and really when you delve into it you can see that there's just really isn't this separation between mind and body it's just this it's a one thing but yeah we'll i go move on because you're an expert um in exercise as an exercise physiologist i want to ask you a question what do you think of the importance of technique for injury prevention
00:44:43
Speaker
or because we were talking about it for someone with a disc bulge. um I think we can be confident that the technique itself has a lot of context behind it.
00:45:00
Speaker
So there is no sort of blanket rule around this technique is the technique that you should be using if you have X problem. Yeah.
00:45:15
Speaker
There's many people who have back pain who find a lot of relief in rounding their back. And there's a lot of people who have back pain who find no relief in rounding their back.
00:45:27
Speaker
And so technique, if we put technique on a pedestal, we're assuming that technique is causative of pain.
00:45:38
Speaker
And so guess the role of technique around injury prevention and pain is that the body is like, we know the body is great at adapting. It can adapt to absolutely anything.
00:45:50
Speaker
And when it comes to technique or injury,
00:45:56
Speaker
They're likely to occur if we do something that we're not prepared for. And I think the body's really good ah stopping itself from doing something that it can't do. And we've probably all experienced something like, you know, rolling our ankle and just not being able to walk properly for like the next five or 10 minutes.
00:46:16
Speaker
The technique in the walking changes, but in that context, it's helpful. Uh, There are so many factors that play a role into technique.
00:46:27
Speaker
In terms of injury prevention, yeah, I think it's simply just whatever technique we use, if we do something too much too soon after doing too much for too long, after too long, it's likely that we'll hurt ourselves. But I guess that in itself, we can be reassured.
00:46:47
Speaker
even the chances of something like that happening is low because our body's got really good protective mechanisms. If you roll your ankle, you've probably hurt your ankle and your body makes you limp so that you don't continue to hurt it.
00:46:59
Speaker
So in the context of what technique to use, if you're using the technique and you can move with that technique, it's probably safe. There's probably many other things I can influence whether it hurts or not. And one technique might feel fine today and it doesn't hurt tomorrow, it's,
00:47:16
Speaker
tomorrow was a lot stressful of a day and you didn't really sleep that well and you worked overtime at work and you barely ate. You'll use the exact same technique where the experience is entirely different. So when it comes to exercise, we can't really blame the technique when there's all these other things factoring into the experience you have with that technique.
Technique vs. Form in Exercise
00:47:40
Speaker
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00:47:52
Speaker
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00:48:03
Speaker
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00:48:15
Speaker
Link is in the description.
00:48:19
Speaker
So yeah, I think when it comes to technique and exercise in general, if it's relevant to what you want to do find some way that you can do it regardless of the technique, sometimes the things that you want to do need an ugly technique.
00:48:35
Speaker
Find where you are at that, regardless of what the technique is, and just build up over time. You don't have to perfect your deadlift technique before gradually building up. If you can lift that weight with that technique you're using, you're probably strong enough to do so.
00:48:50
Speaker
As long as you keep the technique consistent and you build up over time, all technique can adapt to anything really. I love that answer and I think it will be surprising to many people listening because, you know, there's a lot of experts in quotation marks on um on social media and things like that that that would argue the opposite.
00:49:11
Speaker
um I happen to think they're wrong and your R's wrong. Yeah. But that's because I think you're supportive of our whole body of research. I always say to people that out of out of load,
00:49:26
Speaker
and technique load always is is the more likely culprit for injury. And it's because it's a load that you're not accustomed to rather than a particular technique being the problem. And I think you're spot on in terms of like, let's prepare people for life because life doesn't look like a perfect squat or a perfect, perfect. And I'm putting, I should put them in quote marks as well.
00:49:50
Speaker
Life doesn't look like squat or ah a a perfect, uh, deadlift. It just doesn't. Like, you know, I treat from time to time, I've had some concreters come in.
00:50:02
Speaker
And but if you've ever seen concreters do their job, they cannot, um with the trowel or whatever it's called, they cannot literally do their job without some lumbar flexion involved or actually a lot of lumbar flexion involved at many times. And so there's no point in training them for something that they don't have to do from day-to-day life But I think there's a lot of sense in trying to build their capacity in these what would call awkward movements, sort of non-common
00:50:37
Speaker
techniques, I might say.
00:50:40
Speaker
it is an interesting sort of conversation, this one, because
00:50:47
Speaker
it's It's very plausible to just train these perfect or textbook techniques, but you're still training the muscle groups that are required for those movements.
00:50:58
Speaker
So even if you do a task that doesn't look like something you've prepared for, your muscles are still strong enough to do that task as well. So i guess, you know, reflecting how I even maybe speak about it,
00:51:11
Speaker
You don't have to be prepared for absolutely everything. Like if you are generally stronger, you will be able to handle tasks, even if they don't look like something that you wouldn't normally do.
00:51:22
Speaker
yeah Because talking about topics where people swing a certain way in terms of the way they go about doing things, yeah then all they start to focus on is these techniques that seem different, that aren't the the gym related techniques to prepare for those just in case.
00:51:38
Speaker
And, you know, if if you're just training the gym, you're not really strong enough to do anything else. You're just strong enough to lift weights in the gym. But yeah the muscles still work the same and they ah contract the same and they go about the same movements, the same. And so even if you didn't necessarily prepare for rounding your back a lot, you'll still be able to handle tasks that require rounding if the muscles are generally strong, whether the movement looks like that or not.
00:52:04
Speaker
Yeah. Thanks for providing some nuance to my ah statement before, but it just shows like for listeners, the complexity and the nuance around this. And so like these simple explanations usually never do justice um to the reality, but it's yeah it's a cool conversation to have. And um I think a lot of people would be intrigued and probably lot of people will be surprised by some of the comments.
00:52:34
Speaker
from an exercise expert, but I'm not going to box you into that because I know there's a lot more that you guys can do than just exercise. You mentioned a while back that there's some things that you've changed your mind on in this area, and I'd love to hear it.
Does Strength Equal Less Pain?
00:52:50
Speaker
What have you changed your mind on in, say, the last five years when it comes to pain of any sort? I know I'm putting on the spot, but... No, no, no. There's definitely one that stands out and it probably links back nicely to what we were just talking about.
00:53:08
Speaker
If you were to ask me this question two years or if you were to ask me about this topic two years ago, ah would have said that surely the stronger you are, the less pain you have. And so when i used to work with people who'd come in have pain, see the way that they might move, the things that are challenging now,
00:53:30
Speaker
ah Things that will look like, you know, my back hurts and lifting this box is way harder now. And like, I can't lift as much as I used to. And so it just made sense to me sounds logical.
00:53:43
Speaker
You get stronger, your pain should reduce because, you know, pain is protective mechanism. And we will experience pain before we hurt ourselves. And if our tolerance is higher, it must mean that where we experience pain as a protective mechanism is also higher.
00:53:59
Speaker
It sounds logical, right?
00:54:03
Speaker
But then you start to think like really strong athletes get pain. And, you know, there's many people that don't exercise and don't get stronger and their pain still improves too.
00:54:15
Speaker
But at the time, when I started getting that information, it was really, was really weird because that was like the approach to take, like people can get stronger and sorry, we know how to make people stronger. And the assumption is that if they got stronger, their pain improves.
00:54:34
Speaker
Now you're telling me that it's not actually the strength component that is making them stronger. What am I meant to do now? Like my, I guess, as the title says, exercise physiologists, it's all about exercise.
00:54:48
Speaker
i thought getting stronger was the important thing about pain improvements. Now, a year or two later, I've had a lot of time obviously easy to think about it, but the fact that I'm learning more about the fact that strength might not be as important as we think.
00:55:08
Speaker
At first I thought, what am I meant to do now? Now I realize this actually allows a lot more options than just strength training. You like... exercise does actually help but it might not be the strength component of exercise because we look at research and walking programs don't ah sorry structured exercise programs don't do better than walking programs and bodyweight exercises don't do better than powerlifting programs and resistance training programs don't do better than aerobic exercise but all of them help improve pain the same
00:55:42
Speaker
Why some of these exercise programs help improve strength, but others don't. So there might be something else going on. And I think at first I thought it was, you know, a punch in the stomach, you know, like I, I've got nothing to do now, but now it's like, I have so much more option.
00:56:01
Speaker
It's like, what do you enjoy? Do you not enjoy strength training? That's okay. We don't have to. Cause I think for a lot of people, They have pain. They get told you have to do this thing and then they don't end up doing it.
00:56:14
Speaker
And then they get blamed for not doing it when the problem might have never been in the person not doing it, but the exercise that they were given. Yeah, i wonder if it's, again, a piece of the puzzle, but not something that we can blanket rule put across everything. i just want like I agree with what you're saying. i think it's spot on.
00:56:35
Speaker
I also am happy clinically to go, like I have a Tindex machine, which is a, it's like a European climbing device that they measure sort of grip strength and different holds and those kinds of things in climbing. And I think it's a really good tool that I use sometimes with people to track progress with particular injury.
00:56:56
Speaker
But also sometimes I do make this assumption that And I'm not saying when I see a client that that assumption is always correct, but I'm saying, so we're assuming here that if we, there seems to be compared to your left side or whatever, this particular, say it's external rotation of the shoulder.
00:57:13
Speaker
There's a deficit here compared to the other side. Now that just may be normal. It may be something that you've lived with pain-free and it's not contributing, but let's just assume it is. And now we're going to try to strengthen it And then we're going to see if it reduces your pain over time.
00:57:30
Speaker
and And I sort of leave it open because it's like sometimes, and I've seen this, that measure improves and their pain stays the same.
00:57:40
Speaker
But I think it's, you know, yeah, I love what you're saying. And I also see, guess this, this degree of nuance that sometimes it can be used. um I'm just trying to make this practical for people listening as well, because I think we are going into the weeds a little bit that a lot of people probably don't even think about these things.
00:58:01
Speaker
But I think it is really good to have, it's not language that they won't understand. It's just probably the concepts they probably haven't thought of. And I think it's still super helpful to see this conversation happening.
00:58:15
Speaker
I think what might be helpful on this topic is that We see strength reduction when you do have pain. Like you feel weaker, you can't lift as much.
00:58:26
Speaker
For sure. But what if, you know, it was the fact that you have pain that you can't actually, you know, lift as much because the pain is limiting you from pushing that much.
00:58:38
Speaker
Chicken or... Yeah. But the most thing important part about it is what happens when the pain comes back later is it because you're weak again?
00:58:49
Speaker
And what happens maybe in the past where you try to get stronger, the pain improved. And then the next time you get pain, you try to strengthen the area and it doesn't improve. Then what? So it's sort of was it truly the strength, I guess, change that mitigated, sorry, that,
00:59:05
Speaker
The pain improvement, yeah. Or was it the other way around? we We as professionals that study this stuff, we live in this like this this level of uncertainty. But the tricky thing is then i find is that people want, and I understand that they want this, they want real simple practical advice. And so it can become really complex in my mind because I'm like, am I telling them the truth? And I really want to tell them as as as accurately as I can the truth.
00:59:32
Speaker
And yeah, and sometimes... you know I have a client right now, she's strengthening her knee, especially in knee extension, and we've seen an improvement and her pain is reduced. and So the assumption we make, which I think is better than not testing at all, is that maybe that had a part to play in her pain reduction.
00:59:49
Speaker
But like you're saying, there's so many other variables at play here that could also be partly having that effect on her. So, yeah, it's an interesting one and it's complex. i want you to sort of rattle off.
01:00:04
Speaker
a few of the common misconceptions that people have when it comes to back pain. Ooh. Hmm. That it's really hard to know what is actually common thought, but I'll name a few that is the first few that come to my mind that you should wait until pain goes away before engaging in what it is that you want to do That, you know, that there is something,
01:00:34
Speaker
seriously wrong if you do experience pain. I mean, like we we can think about back pain almost like a headache sometimes where it's like, you know, probably didn't drink that much water today and I've been watching TV all the time and I didn't really get that much sleep.
01:00:50
Speaker
I'll just, you know, I'll be fine. know, I'll be okay. Other misconceptions that maybe posture, the way that you're sitting, the way you slept is what was the cause of it.
01:01:06
Speaker
I'll jump in one that I hear a lot. You've nailed a few of them, but one of the ones that I hear a lot is that I just need a stronger core. but If I get stronger in my core, all of these problems, which is kind of go back to our strength assumptions that we were talking about.
01:01:22
Speaker
If I just get stronger in my core, my back pain is going to be gone. and The majority of the time it's like, Have you measured that? No, but ive but I was told. Yeah, yeah.
01:01:37
Speaker
So you like that I measure. You like that I measure. That's good. That's good. Yeah, if you measure it, it's all right. Then it must be the core strength.
01:01:45
Speaker
Now, another one that's crossed my mind now is that the back pain is caused by repetitive movements over time and like, you know, cumulative stress over time. think it's a very common one. People think, you know,
01:01:59
Speaker
rounding your back even though it might not hurt now if you keep doing it it'll hurt that's something that i think is common advice and it seems logical because it's like you round your back and it doesn't hurt but there's still fear associated to it because it's almost delayed consequences um at the same time the advice given to those people is strengthen your core or get stronger which repetitive movement at the spine which is like yeah Same thing that's been told is the cause is also now the solution, you know, so it's probably another common one. They're probably the main ones that come to my mind now.
01:02:35
Speaker
i want to switch
Living Life with Pain
01:02:36
Speaker
gears because i think I think I can hear someone yelling at the podcast. Well, then what should I do? like you've told us what we shouldn't do. Some like complex things around. What should I do if I have, say, let's just say I've got persistent back pain.
01:02:53
Speaker
What should I do?
01:02:56
Speaker
I think if we know for sure that there isn't anything serious going on and, you know, there's no red flags, nothing sinister, There's many things that I guess persistent pain takes us away from doing.
01:03:11
Speaker
And lot of the time, pain has this relationship with behavior and behavior has this relationship with pain where they both influence each other. I guess some questions to ask yourself is, how would things be different if it weren't for my pain?
01:03:30
Speaker
And that will sort of give you a general idea of what it is that the sort of the pain is barrier. And then you can start to devise a plan of how can I get there?
01:03:43
Speaker
Generally, we know with time, pain can improve and pain can change. we don't actually have to wait for pain to go away before doing these things. You know like you said, pain can still be present, but you can still get stronger at the same time.
01:03:57
Speaker
And so if you knew that your pain would be very different in 12 months time, how different would your behaviors be or what you engage in be different over the next 12 months?
01:04:11
Speaker
And I guess like the hard thing with persistent pain is there's a lot of things that it's in terms of it makes challenging but doesn't always completely eliminate you from doing and so if you can find way to do it um if you can't i think that's where working with someone can be helpful and for that guidance i guess the coaching throughout the journey but If you can find a way to do something and then build it up over time, it might actually be reengaging with the things that you want to be doing that would actually be most beneficial to your pain long term.
01:04:51
Speaker
So I think a lot of the times when we have pain, especially persistent pain, we try to figure out how can we make if this is life, this circle and pain takes up a lot of it, how do we make this circle of pain a lot smaller?
01:05:05
Speaker
Whereas we also have the option of making life, the circle of life sort of bigger too. I've seen this in Cormac and I think it makes a lot of sense. I think at first it might seem like, you know, don't worry about the pain, just do what it is that you want to do But it's not as simple as sort of ignoring it, but <unk> it's the experience of going about doing the things that you want to be doing generally will make you happier and generally will make you healthier.
01:05:31
Speaker
And it's usually those factors that can help reduce pain. A lot of time we get knuckled down in how can we get rid of the pain before re-engaging with this stuff when we can start to re-engage in this stuff that the pain has stopped us from doing that we want to do and do, you know, I guess do as much as we can and gradually build up over time. And it's the side effects of doing that that could probably help the pain long term.
01:05:57
Speaker
Yeah. Yeah. Great advice. i think that's really nice, simple, great advice that you've given there. And i yeah, there's some questions surrounding that. Obviously one that I'm sure some listeners will have, but how do i know whether I'm doing damage and those kinds of things?
01:06:14
Speaker
We won't tackle that. You know, that's where a clinician can come in and help to understand, to reassure. And there are some key clinical things that we look for that determines for me whether this might be because of some structural thing that's going wrong or whether this is yeah just a ah flare-up that many people experience with pain great advice I want I want to finish on the question that I ask everyone that comes onto the show it's a bit of a tradition if someone is listening and they're experiencing pain of any sort but let's say back pain because we've talked about it a lot
01:06:58
Speaker
that's just debilitating, they're feeling helpless, they don't know who to trust, they've tried all of these different approaches and they've sort of been left feeling helpless, what would your advice to them be?
01:07:12
Speaker
know that's tricky because you probably just gave those people advice, but do you have have something for them? I think when you've tried a lot of different things and the outcome hasn't been as expected, it's very easy to lose hope.
01:07:29
Speaker
I don't know how much value this has, but think change inevitable and change will happen. It just needs the right environment for it.
01:07:43
Speaker
So regardless, I guess, of how many things you've tried and how hopeless you feel, there is always... Always hope, i guess you just by the way we're designed, you know, the body is great at adapting and changing. It just, um heard this analogy from David Butler.
01:08:04
Speaker
It's like, it's almost like a cake. There's ingredients that will make up this cake, but it needs to sort of be made in the right process. You might have tried things, that might not have worked, but you might have just, you know, baked this cake in the wrong order. So um guess there's always hope and change is inevitable, really.
01:08:27
Speaker
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