BPL19: MRI for Back Pain

by | Mar 13, 2019

 

SHOW NOTES

MRI for back pain.

It is a common misconception that you need an x-ray and MRI scan for back pain diagnosis.

In today’s episode, Dr. Sebastian Gonzales tells us how he uses MRI scans sparingly.

As a still image, of the structures of the back, it can be a useful diagnostic tool.

It won’t, however, show the cause of back problems in most cases.

“In an X-ray, an MRI, you can’t see pain, you see structure”

 

Excerpts from the Show

As well as merits and limitations of MRI scans for back pain, we cover myths and misconceptions in a number of other areas.

This is the third of 4 episodes with Dr. Sebastian.

Look out for a chance to win an audiobook copy of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery in the next episode.

Today’s Guest

Founder of Performance Place sports injury specialists, and author of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery, Dr Sebastian Gonzales.

Live Pain-free Eliminate Chronic Pain without Drugs or Surgery

If you click the above link and buy on Amazon I will (probably) make a small commission at no cost to you. Check back next episode for a chance to win a copy of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery.

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BPL19: MRI for Back Pain

MRI for Back Pain. Dr. Sebastian Gonzales explains the merits and limitations of MRI scans for back pain diagnosis. Podcast show notes.

Anxiety and Back Pain [Book Giveaway]

Anxiety and Back Pain. How to improve your emotional state. Gut health, chronic pain and depression – Heather Pearsons go-to recipe. Book Giveaway | BPL29

Spine Surgery [Don’t Make a Terrible Mistake]

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Click the play button to listen to this episode now

MRI for Back Pain

MRI scans often have findings which worry the patient – and have no bearing on the pain they are experiencing.

Worst case scenario they can misleading.

  • In an X-ray, an MRI, you can’t see pain, you see structure
  • Something to take note of – that’s all that people should use MRIs for – and obviously, we’re looking for things that would change the course of care
  • Oftentimes, it’s not even a good image to see complete nerve health either
  • So, it’s not the end all that people tend to think
  • Okay, we’re going to figure out really, what’s wrong. Now, we’re going to do an MRI.’  that’s far from the truth
  • I hardly recommend anyone for an MRI … I want to see that they’re improving, if not I’ll suggest it, just to see
  • I think it’s overly utilized
  • (If the mri result) is negative …. it doesn’t mean that it’s not painful. It just means that it’s not what you think it is
  • It should be used only when needed
  • I tend to use it when people are not responding. If they’re doing the things asked, and they’ve been screened out, and everything looks good. There are no red flags
  • It’s like a timeout in a football game. Don’t use it early. If you use it early, you might not get another one
  • Especially when you consider insurances, they’ll do one, but after that…..
  • if you’re waiting on that MRI to be cleared, it could take you months and all the way you could have just been better the entire time

 

Hi, I’m Iain Barker creator of Back Pain Liberation.

I got back pain young and it got worse over time. Like many others in this situation, I saw plenty of doctors and therapists – all to no avail.

In the end self-help worked best – it often does for bad backs. Now I train regularly, focus on what works, and don’t get back pain.

My goal is to share what I learned. To help you find a more effective way when treatment doesn’t hit the spot.

 

Core Stability

Training core stability is essential for back pain rehabilitation.

This doesn’t necessarily mean core-specific exercises.

Rather, training core stability is part of everything we do.

  • The core is actually not the six-pack
  • You could be chubby and still have a solid core
  • That’s why I started talking about the keg system – because that keg with that pressure in there and with the sidewalls and top … it has the ability to protect the spine
  • The spine is unique in its biomechanics and its abilities – the core is a critical part of this
  • (The core) can be as flexible as a fishing rod when you want it to be….In contrast, it has to have the ability to become an I-beam and solid as a rock … when needed
  • That happens through this through this fine guide wire system that is the core and which is intra-abdominal pressure too
  • When people come in with back problems…you don’t have to teach almost any core exercise at all, but you tell them to do a brace which helps out with stiffening their torso a little bit to protect the spine and their symptoms cut in half a lot of time
  • Then it just becomes teaching them how to do it on their own
  • So the core is really important, but not in the way that most people would think of it
  • Everyone says, ‘Yeah, yeah, yeah, the core is important.’ But it really is.

Back Pain Keeps Coming Back

  • Back pain will come back – it’s just the way life is
  • If we’re very keen to the movement based corrections and just knowing when to implement certain strategies, then we’re gonna be just fine
  • Avoiding stuff will only get you so far

 Is Back Pain Genetic?

  • I think there’s more nurture versus nature
  • If I did guesstimate I’d say a strong 90% or more people, their back pain is … either they did it to themselves or they were they were part of an incident. The other people then might be grouped into those oddball ones. And one is familial, or hereditary
  • there’s this whole concept of epigenetics, which is you have a genetic disposition for rheumatoid arthritis, but some people don’t get it, you know, and so there’s always little markers, and I know this whole thing with 23andme. And people like to do that stuff and see what genes they have. And they’re not always expressed.
  • I want to make sure to be very clear about not allowing people to think that it’s familial, although there’s a small percentage, because, again, that’s something you can’t change. And worst case is those people take that and run with it, and then they don’t try anything.

Thanks for Listening!

 

Was an MRI scan helpful for your back problem or not? To share your experience, leave a comment below.

To help out the show, click a link to iTunes, Stitcher or TuneIn:

  • Subscribe.
  • Leave an honest review.

Thanks to Dr Sebastian Gonzales for joining me this time and explaining how the chiropractic profession has evolved; as well as all the other good stuff he shared with us.

Best,

Iain

 

 

Photo by Ken Treloar on Unsplash

More Podcast Episodes

BPL8: Moving Stretch with Suzanne Wylde

Moving Stretch creator Suzanne Wylde on back pain self care and stretching for less flexible people, A must-listen if you have an inflexible back. Can emotional stress cause back pain?

BPL19: MRI for Back Pain

MRI for Back Pain. Dr. Sebastian Gonzales explains the merits and limitations of MRI scans for back pain diagnosis. Podcast show notes.

BPL3: Myofascial Release Exercises with Chris Kidawski

Find out how to end back pain forever, second half of the podcast interview with Chris Kidawski. In his new book he explains his myofascial release process.

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BPL18: Lower Back Pain after Deadlifting

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Full Transcript of BPL 19: MRI for Back Pain

Iain Barker

Welcome to episode 19 of the BPL Podcast, I’m Iain Barker

Today I’m talking to Dr. Sebastian Gonzales about MRI scans.

People often think of MRIs as the ultimate test, where you get to really see everything that’s going on inside and finally get to the root cause of your back problem but it doesn’t really work like this.

Dr. Sebastian tells us how he uses MRI scans sparingly.

As a still image, of the structures of the back, it can be a useful diagnostic tool.

In most cases, though, it won’t show the cause of back problems

As well as merits and limitations of MRI scans for back pain, we cover myths and misconceptions in a number of other areas.

• Core Stability
• Back Pain Keeps Coming Back
• Is Back Pain Genetic?

This is the third of 4 episodes with Dr. Sebastian.

Look out for a chance to win a copy of his new book I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery, in audiobook format, next episode.

Let’s get into the interview now
Okay, so Myth number three core training is just a fad.

Sebastian Gonzales

Yeah, so I know there’s ups and downs of these things. And, you know, everyone says, Yeah, yeah, yeah, the core is important. But it really is. And actually going through my clinical experience. I went through phases. I went through the first part, I thought, well, the core is important. And then I kind of dropped off that bandwagon. And then it was a couple years went by where I focused on other things and then I realized oh the core’s important again and the core is is a bigger I wrote a big article on this because at the thought of the core is actually … it’s very watered down at this point but it’s not a six pack … you could you could be chubby and still have a solid core and that’s why I started talking about the keg system because that keg with that pressure in there and with the sidewalls and top … it has the ability to protect the spine imagine just the spine sitting in there it’s protected

Dr. Stuart MacGill has a very good analogy with this he says the spine is unique in its biomechanics and its abilities and the core is a critical part in this so number one is he said that can it be as flexible as a fishing rod when you want it to be and that’s how you get your your yoga and how you get your dancing and stuff like that right? In contrast it has to have the ability to become an I-beam and solid as a rock when cued to, when needed, and that happens through this fine guide wire system that is the core and which is intra abdominal pressure too, or the breath part so he calls it a brace and bracing is is a skill. I’m very surprised when people come in with back problems that you don’t have to teach almost any core exercise at all, but you tell them to do a brace which helps out with stiffening their torso a little bit to protect the spine and their symptoms cut in half a lot of times and then it just becomes teaching them how to do it on their own. So the core is really important, but not in the way that most people would would think of it

Iain Barker

So often people will think about holding the abs really tight when they think about it bracing with the core

Sebastian Gonzales

Right the bracing is … there’s a paper that came out years ago where they they compared … the hollowing was on it and bracing was on it too. Bracing just kicked hollowing’s *ss. Like just plain and simple. Just the the activity the core just completely spiked. And the hollowing thought is that in the sucking in and forceful contraction from a single site. I always tell people, it’s kind of like you take keg and you just dent it. And no one wants to buy a dented keg, you know. So you gotta keep the walls broad. And the wider base of support there is, just like with when you’re standing….if you’re standing two feet together….someone comes to push you over, you’re probably going to go over. But if you widen your feet, and you take that same hit, you’re probably going to stay relatively stable. So if you widen your contact points on your pelvis and give it a chance … then you’re going to have a better resiliency there.

Iain Barker

So it’s not about looking good on the beach…being nice and slim, then, unfortunately, is it

Sebastian Gonzales

No. But I mean, to be fair, though, that’s if that’s someone’s goal, we have to get them there. But it’s a separate goal from feeling good. They’re completely different things. But yeah, I want that goal too

Iain Barker

Don’t we all but, personally, being pain free is much higher on my agenda. Yeah,

Myth number 4. Once back pain is gone. It’s gone forever.

Sebastian Gonzales

So this is kind of back, we were talking a little bit about keeping a little bit of your programming. And…I tend to find that people … they’ll stick with phase 1 and 2. They’ll get rid of the scab picking, they’ll keep the first aid. And they’ll feel pretty good in there. But stuff tends to come back sometimes. And I know that I am at the point mentally, where I know back pain will come back. It’s just the way of life. And it’s just the lifestyle that we’re in. And we’re stupid and make wierd goals and it’s just how it is. But I think if we’re very keen to the movement based corrections and just knowing when to implement certain strategies, then we’re gonna be just fine. But I think a lot of people think that once you have that little ache and pain, it’s it’s the end of the world. And I know for me personally, when I got my second one, I thought ‘I’m getting old…this is from getting old’ So and I don’t think that’s the case. You just happen to have it when you got to a certain age where you’re thinking that.

Iain Barker

Well, I had my 50th birthday last year and I have no back pain now. But I started getting back problems in my mid 20s. So like, in my sort of mid to late 20s, it was causing me all kinds of trouble, you know, I’d throw my back out, and I’d be unable to do anything for, you know, maybe a week. So it’s not age basically, is my experience. It’s something else

Sebastian Gonzales

In that book in that book. I put a little graph in there.

Iain Barker

I saw that. Yeah, yeah, it’s the corellation…. Was this about arthritis? Or was something else?

Sebastian Gonzales

Yeah, that was relationship to kind of debunk the idea of arthritis being the main cause of back pain. Because, that’s a big hang up for people. But yeah, so if you look at that graph, like it’s the back pain prevalence spikes in like 20s and 30s.

And then arthritis is a slow, it’s a slow increase. Almost linear. And they don’t match. So I know why people think that…or I guess I know why people think that. And I know you’ll get to this myth later. But I’ll probably hit it now since I’m talking about,

I believe that people think like, you never know, like most people when they come in with whatever area they’re talking about. say it’s a knee, they’re, like, I got this muscle problem here. And so they never say vein they never say artery. They never. They almost never say fascia, they never say nerve. All the little thing that are not touchable, they don’t say, They think joint muscle cartilage. So I think it’s easy when you see an x ray, and you think is that me? What are those little things? Oh, my God, that must be the problem. But it’s not. It’s not the case. I’d say a strong majority of the time. But if you believe that, that’s a big, that’s a big hindrance. Because if it’s not going to get better, you know. So that’s done. I got ahead of you on that one.

Iain Barker

Yeah, that’s okay…Myth five, the next one, we’ve already really done. Dead lifting is bad for your back, we’ve already pretty much covered that.

You have to be careful, I guess with dead lifting, don’t you? As you say, maybe not lift too much. And not too soon. And if you’ve developed ways of moving whereby you can pick stuff up without injuring yourself, then maybe you can do your dead lifting. But as you say, to start off with you, you don’t want to pick the scab and you want to be in the kind of first aid way of thinking and maybe move on to picking up heavy weights a little bit later.

Sebastian Gonzales

Well, I think it’s I think it’s important to note on that one, too, that people, when you say deadlift, think tons of weight. Dead lifting can be 10 pounds. So it’s a graded exposure, and it’s a movement … it is called a hinge. I personally teach people from blocks, I elevate it about six to nine inches off the ground, because most people don’t have the anatomy to get down there safely. Most things you pick up, most people hurt themselves when they pick up pennies off the ground. So it’s not the weight it’s the depth of the way they did it

Iain Barker

They should have left that penny where it was!

Sebastian Gonzales

I know the funny thing is when the penny is actually glued to the floor.

But so i think i think dead lifting is a foundational point and you’ll find your sorry, I’ll take it back. hinging is a foundational point, and like through Qi Gong and Tai Chi and yoga, and you’ll find hinging all over the place. But it doesn’t look like it doesn’t look like dead lifting. It just it’s just a hinge with a little weight

I think it’s foundational for building the engine honestly. But I know a lot of people shy away.

side story. I know this is a tangent topic, there’s actually a thought if you guys want to read up on something Mike Boyle, he’s a strength coach. He wrote an article on no more back squats. And so he describes the spine used as a lever versus vertical compression. It’s interesting because … we do get that story that people hurt themselves deadlifting and back squatting. So you can actually take that out and still be a very athletic, fast, quick person without actually doing that stuff anyways. But I think us as a society, we’re kind of married to a barbell or that movement, but it’s a double leg movement. And we’re not bunnies we don’t hop around all day. So single sided movements are actually a little bit safer.

Iain Barker

Okay, that’s interesting. I’ve thrown my back out getting out of a car, or one of my kids fell off a stool that she was standing on. I reached out and caught her as she fell and I threw my back out doing that. We can’t avoid doing all these things. We should be able to do them. We should be able to pick stuff up off the floor. If we can’t do that, then there’s a problem. So the answer I would suggest is to do what you can to fix the problem. Rather than avoid, you know, normal activities like picking stuff up, you should be able to do really

Sebastian Gonzales

Avoiding stuff will only get you so far really At some point, you’re going to see it.

Iain Barker

We don’t really want that restriction in our lives,do we?

Sebastian Gonzales

I don’t think so. Although spiders. I’m okay. With avoiding spiders

Iain Barker

Are there spiders … your’re in California aren’t you?

Sebastian Gonzales

They’re not big. Well, the biggest ones, we have these little, these little, they’re like red green tree spiders. They’re, they’re very menacing little guys, they, they’re about the size of the body is about the size of your thumb. And then they like to hang out in doorways. They just love to spin their web really quickly there. And then, like they could be not there one hour then the next one you’re like ‘Oh, god, there’s a whole big spider web right here. And then you just so there’s times will walk up to the house and we’ll just start waving our arms or we’ll let the other person walk in front…and they don’t know

Iain Barker

Let someone else take the hit. Yeah…

Sebastian Gonzales

they don’t hurt you. But there’s definitely a time of the year where it starts to get a warm, warm or you like, I’m gonna, I’m not gonna walk in front.

Iain Barker

And the worst thing is when you get the spider web in the face, isn’t it? That’s so unpleasant.

Sebastian Gonzales

I wonder if the spider ever thinks like ‘I want to get away from this situation’. Or if they’re like, ‘oh, here’s an opportunity to get in their shirt.’

Iain Barker

I don’t know. Anyway, Myth six, how you use your back has nothing to do with an injury? What I’ve written here is quality of motion is more important than flexibility. And you’re talking about the hips and the human engine that we that we kind of touched on earlier.

Sebastian Gonzales

Right. It’s I know that this blends with another topic we’ll hit later which is the, ‘my mom or dad had back pain. So so will, I’ type of thing and it is about quality of movement. But there are people that they they are a little bit fearful of bending forward. So they might interpret this as you need to have a flat back at all times. And that’s not true. But it is quality of movement. Remember how I said we’re kind of stupid, we just like to do like, funny things and activities. And I’m no different. It’s just, we, we like to challenge ourself. That’s just how we are we like we get bored. So there’s certain activities that have a higher risk, then then I’m willing to take and it’s, it’s if you’re going to do those, you have to just take care and be able to be able to load appropriately. So you spare your spine really. So yeah, it is how you use it. A lot of people are sloppy, and I’ve been there too.

Iain Barker

well, human beings we do tend to be lazy Don’t we?

Sebastian Gonzales

We do yeah, we Yeah, we do. It’s a there was a guy that came in. He was he was a fun guy to play with. He had a knee problem and he was he was in the belief that was a inner medial meniscus issue. And so he walks around an office most of the day, and he’s a fitness guru… junkie just loves it. So he won’t take the elevator he’ll take the stairs he runs up the stairs he’s like it’s the funniest thing when I run up the stairs or run down the stairs it feels fine but when I go walking down the hall and then I have to turn around and get something that hurts and I said okay do that movement he’s like yeah that hurts and I say okay now do it act like you’re going to like you’re like you’re playing basketball now like the plant and go and he’s like yeah doesn’t hurt at all

so there’s the thing when we’re doing an attentive movement, sometimes more tension is protective over over some issues so …. the back’s no different on that

Iain Barker

So, Myth number seven My back is weak or I have a bad back. So you talk about some tough love in this section

Sebastian Gonzales

yeah …. luckily I write it in there and like no one’s on the other side to like argue with me when it like hopefully they go through this book before they start hating me

but i think it’s a very defeated mentality … I tell people all the time … if they say something the reason for their problem is something that’s not changeable…. Don’t worry about it you know and like if you think it’s arthritis it’s not going to go away like if you think you have a damaged a ‘weak back’ and you think it’s never getting better then it’s not going to get better … so I have found very few people that were not able to get better … there are some people though that they they still do have that belief they have the weak back and those are the ones who typically they’ll come in for

I say they come in when they’re hot and I tried to tell them like look i don’t know i don’t want to have a long treatment plan…I want to be your guide in this I’ll treat you when your hot, but it’s it’s like having like you’re in a pool …the water’s really muddy you can’t get down to the real root cause of why that things happened until the water clears. And so once that water clears, then there’s a solid game plan but they tend to they tend to flare it up and then they then they get better and then they just avoid and they think they have a weak back and then it flares up again. Yeah, I mean, it might be months in between but they’re they’re not willing to take the next step into into engine building

Iain Barker

that’s no life, is it to have, you know, throw your back out. So you have acute back problems , a few times a year and have, nagging kind of discomfort and worry all the time in between times. I’ve been there and that’s, that’s no good.

Sebastian Gonzales

I’ve a friend who says ‘It’s very tiring to walk around the city thinking clowns are going to jump out around every corner and you’re gonna hurt your back.’

Iain Barker

Yes that sounds exhausting.

Your whole book, the premise is that your the mindset, your mindset as a back pain sufferer is the most important thing. And for me, this this point this

changing the belief that you know, there’s something serious there must be something seriously wrong with my back to cause all this pain. And, you know, to be told, well, for me, it was a surgeon, to be told ‘there is nothing structurally wrong with your back’. And to actually believe that this was a huge turning point for me to be almost given permission ‘If you want to go and do some training, that’s not going to hurt you – do it, it might help you’. And lo and behold, you know it, my life changed mainly from getting away from this what you call Myth number seven. I have a bad back.

Sebastian Gonzales

Yeah,it’s really tough . And quite honestly, not not everybody has their their clinician or their guide is going to give them good communication. And, and I’ve been at fault for this many times. And some people, they hear what they want to hear. So over the last week, I’ve tried to be very clear with people. And I had a shadowing doctor with me. So one lady came in with an elbow problem. I tend to stress test the area. And so I know if there’s a big risk to the person. And so the weak back, I would stress test the area. And so when they when they tend to come back on that whole like, well, it’s weak and I shouldn’t I don’t think I should be doing that. I’ll say, look, if you trust my testing, which I hope you do, I know we just met. But if you’re here for my guidance, and I’ve stress tested all of the ranges and structures of your back. I see no reason you cannot simply go for a walk. Or you know, like maybe not hit a baseball, but this lady was a golfer, she didn’t want to play golf. She was afraid. Which is fine. So I said, ‘Look, why don’t you go to the short game, just putt, and she’s like ‘can I putt? I said ‘Yeah, you can putt’ I stress tested your elbow it’s not going to explode. And the forces I put on it in that exam are much greater than you’re going to get with putting a golf ball. Yeah. And so she she wasn’t completely convinced. So I handed her a club and we did it in there

and getting people back to activity. Because motion is lotion is a critical point in their recovery. And it takes that mental mindset change or else it’s not going to happen. So it will probably require some support to I don’t know … Did you have a friend or your spouse help you through it or

Iain Barker

not so much? No, in fact that this kind of meeting with the, with this orthopedic surgeon I left feeling pretty angry because I just thought he wasn’t taking my my problem seriously. You know, he basically sent me away with the feeling I was kind of wasting his time kind of thing. You know, there’s nothing wrong with you. Your problem is bad posture. And it took me a while to kind of digest that and, you know, try different forms of exercise. But yeah, I suppose the the kind of the help I got was more from you know, the people who trained me in different kinds of mindful exercise, I would say

Sebastian Gonzales

yeah, well I always say that the solution is ready for you and when you’re when you’re looking for it

Iain Barker

I think there’s a lot of truth in that in all areas of life actually

Sebastian Gonzales

I do too actually but that’s a whole other tangent topic

Iain Barker

It really is.

COMMENTARY

So the solution is ready for you, when you look for it.

The solution to your back pain is not listening to this podcast.

Or reading blog posts.

Or hanging out on Facebook groups.

All these things may help to point you in the right direction, or to inspire you. Hopefully both of these things. But just getting the information will not help your back.

You have to take action.

For Dr. Sebastian, and for me and for many, many people, the course of action which did solve their back problems was regular training.

It was finding a way to train that worked for them and sticking with it.

Often this involves a lot of trial and error, over a long time.

Time after time my guests on this podcast have told a similar story of a very long and winding road to recovery.

And, all the time, the solution was, to a great extent, in their own power.

They just needed to understand this and decide to make it happen.

If you are ready to look for the solution then, in my view, rehabiltation through exercise is the first place to start – after you’ve been checked out by your GP of course (common sense applies).

What I would want to do is to help you to cut out the trial and error process. To get you started straight away on improving posture, relaxation and movement through a practical training method.

If you want to give it a try then you can book a 30 minute taster session with me, 1-2-1 via Skype video call at no cost to you.

Go to backpainpersonaltrainer.com

that’s

www.backpainpersonaltrianer.com and book a free taster session there.

More from Dr. Sebastian now.

RETURN TO INTERVIEW

I’ll carry on going through to myths, although we kind of touched on them already. Myth number eight. My mom or dad has a bad back. So I will, too.

Sebastian Gonzales

Yeah, when I wrote that actually there I should have added a couple of addendums to that. There is a little bit of correlation with familial but it’s more structure. If I did guesstimate I’d say a strong 90% or more people, their back pain is because they did it to themselves. Either they did it to themselves or they were they were part of an incident. The other people then might be grouped into those oddball ones. And one is familial, or hereditary. And there’s, there’s this whole concept of epigenetics, which is you have a genetic disposition for rheumatoid arthritis, but some people don’t get it, you know, and so there’s always little markers, and I know this whole thing with 23andme. And people like to do that stuff and see what genes they have. And they’re not always expressed. So there’s other variables of why and with spines, one of the logical ones is biomechanics and loading process. So there, there’s, so there’s a little bit to that. But I’m going to rewrite that section one day, and I want to make sure to be very clear about not allowing people to think that it’s familial, although there’s a small percentage, because, again, that’s something you can’t change. And worst case is those people take that and run with it, and then they don’t try anything.

Iain Barker

Even if it were the case that they had inherited a genetic disposition towards back problems. My mother had back problems, I remember as a child, could it be that, they can adopt a positive mindset and sort of deal with that problem successfully? themselves? In any case?

Sebastian Gonzales

Yeah, I think they can. I mean, I think there’s, I think there’s more nurture versus nature, like attributes that can come from just, I mean, you see all the time when people eating, like, if, if the mother and father eat fast food, the kid will, too and the kids get overweight. And so then, yeah, there’s so there’s, I mean my dad taught me a lot of woodworking and he had a really bad habit of he would always take the safety’s off. So I was very mindful when the saw’s down because there’s no safeguards on it. but also, he told me certain things to do when cutting. So I think some of those attributes and can be learned from the family, if it makes sense.

Iain Barker

It does. Yeah. Okay. Myth number nine, this is what we’re talking about x rays and MRIs. The myth being that, that you have to have these things for diagnosing the cause of back pain.

Sebastian Gonzales

This is a great one, I could spend hours on this one

Iain Barker

Maybe you could summarize a little bit, I’m gonna run out run out of storage on my voice recorder…

Sebastian Gonzales

I’ll tell you the typical story because this happens a lot. And I just had a kid in the other day… I’m all down for an MRI and X ray just just to peek and see. But so actually, I’ll start back there was a guy that came in, he’s been with me for a little bit of time. And he suddenly developed this neck pain he hasn’t had before and with a certain age group and you want to look for certain things. And at that point, I told him, ‘I’m gonna recommend you for an x-ray because I want to see what it’s not’. I wanted to see that something’s not there. And I was looking for, like, cancer or something weird, you know? And I said ‘Be very clear, though, we’re gonna get this image back. And it’s going to have a lot of scary words on it. And unless I say, so, do not freak.And they’re just normal stuff. And so we got it back. And he says, ‘Spondylolisthesis’

Iain Barker

I was trying to pronounce that when I read that in your book.

Sebastian Gonzales

well, there’s actually three of them in school that we learned … I always get jammed up too …. there’s spondylosis, spondylolysis and spondylolisthesis, and it just, I don’t even care, we get hooked up on this terminology now. But it’s scary to the patient, you see moderate this and severe that and we talked for 30 minutes about this. And I said, ‘Look, I I’m okay, talking about this. But I’m telling you, it has nothing to do with what’s going on right now.’ And people tend to have a very quick default to that. And I had a I had a patient that he he responded very well to care. He got over 50% better within within the first day and continued to get better. And so since he’s a kid, he had the mindset of … the parents want to check sorry I got distracted, the parents wanted to check to make sure it’s nothing else. So they took him to his GP and his GP said you should go to orthopaedic…orthopaedic is going to do an x-ray, an MRI and I emailed them. I said, ‘Look, you’re going to get a lot of information from that thing. And it’s going to look very scary’ because very quickly, they will see remember I said, ‘arthritis doesn’t really have a big relationship.’ They’re going to see that stuff. And all of a sudden, whatever was working, they’re going to visually see it. And change their mind. And it’s a I have a friend that said that in an X ray, an MRI, you can’t see pain, you see structure. And I have another friend he described this very well. He put up a slide of someone laying on a railroad track and a trains behind him about like 100 yards. And so he said, ‘Is this is this dangerous?’ And the answer is, we don’t know. It’s a still shot. We don’t know if that person’s grew up around train tracks. We don’t know if the trains moving. We don’t know if he’s asleep. We don’t know if we don’t know anything. Yeah, we just see that there’s something take note of . So that’s all that people should kind of use those MRIs for. And obviously, we’re looking for things that would change the course of care, like space occupied lesion or things like that. And oftentimes, it’s not even a good image to see complete nerve health either. So it’s, it’s not the end all and people tend to think, I think that the MRI is ‘Okay, we’re going to figure out really, what’s wrong. Now, we’re going to do an MRI. that’s far from the truth.’ I hardly recommend anyone for an MRI … I want to see that they’re improving, if not I’ll suggest it, just to see. but I think it’s overly utilized.

Iain Barker

So you could have some of these scary findings on your MRI, which are nothing to do with back problems. And they could be someone who has no back pain at all who, who has these findings on their MRI, despite the fact that not causing any problems?

Sebastian Gonzales

Yeah, and there’s things become like a bruising, like I could, actually. So I’ll, um, yeah, well, we’ll go with will go with delayed onset muscle soreness, probably easiest, you know, probably everyone’s experience, maybe not heard of the correct or the terminology, delayed onset muscle soreness, or? Dom so it’s going to work out and you saw, right?

that’s, that is technically a muscular injury, have some type of grouping, it’s been classified, it just hasn’t hit the point where there’s anything positive on an image. And so when people go in, and like say, we’re assessing a muscle injury or tendon or joint, and they’re like ‘this thing really hurts. Why is this thing negative?’ It’s, well, it’s because you haven’t, you don’t have the criteria to show that as positive. So in that instance, a muscle tear grade two and above would then reveal itself, but everything else is negative. And it doesn’t mean that it’s not painful. just means that it’s not what you think it is. So it’s, it should be used only when needed. And I think people need to be very considerate of this too, is that I again, I tend to use it when people are not responding. If they’re doing the things asked, and they’ve been screened out, and everything looks good. There’s no red flags, we, we will use it if needed. It’s like, it’s like a timeout in a football game. Don’t use it early. If you use it early, you might not get another one.

So it especially when you consider insurances, like they’ll do like one, but after that, even get one is a pain in the b*tt. And if you’re waiting on that MRI to be cleared, it could take you months and all the way you could have just been better the entire way. So it’s, it’s a confounding thing. And I understand it. And that’s why I included my I included 2 of my MRIs in that book, just to show you, the findings were basically the same.

Iain Barker

And that kind of leads into Myth number 10, which is, if there are findings on an MRI or some other imaging technique, which can’t be cured, there’s no hope for me.

Sebastian Gonzales

Yeah, that kind of falls into that arthritis. And somebody will say disc, bulges won’t go away, and things like that. Like, they, they kind of get that mindset, they’re, they’re stuck with it. And that’s how it’s going to be …and all throughout that book. It’s I’m trying to debunk all of these stall points for people and I’m okay with them ….I totally understand them, having them. And I’ve met a lot of people that have the stall points and the beliefs but at some point it’s like, the belief is okay, and I wouldn’t fight you on every belief that you have, like, I don’t care if you like lemonade vs. Orange juice, it doesn’t hinder what’s going to happen with your back recovery. But if you’re telling me the reason why you’re not going to get better when you walk in the first day, is because you have arthritis on your X ray, I’ll tell you straight up ‘That x ray’s not or that the arthritis is not going to change. So can you get better?’And if your answer is ‘no’ then we need to really discuss whether the arthritis is the root cause your pain or not and then we need to go through all the reasons and I typically give people a couple choices on this and it usually takes a few times before we get to this point. And I get a feel that they know that I have their best interests at heart because I sound kind of like an *sshole and I say

so because so there is I started doing this one this one guy came in. And so I would I would attempt to do a corrective exercise which I wanted to do, which was helping him or what I believed to be helping him and so he asked me ‘why are we doing this again?’ and at first I would explain it and all the reasons why and blah blah blah and then so we did it and so we went to the next thing because sometimes they get two or three and it was next thing and he asks ‘why we do this again?’ And so finally in the third time I was I stopped and I said ‘Look, do you really care what this is doing? Or are you just nervous and I’m like I’m okay you’re nervous. But or if you really want to understand I’ll share every single piece of information that I’ve ever gotten about this one exercise in correlation to what you have I will educate the heck you. You can have everything I read and then we can sit down and have coffee or dinner and we’ll talk about this I love it I love talking about this or second option is you just trust me’ and most people take the second and they’re like ‘yeah I didn’t really want to know anyways … I just didn’t know if it was right’ and so people get nervous they start asking questions and talking which is ok but if we’re if we’re trying to get to the bottom of it and get you better you have the two choices you can fully wholeheartedly understand why or second is you trust

Iain Barker

yeah

Sebastian Gonzales

because this understanding I’m down … and probably long term it’s going to be better. But it’s gonna take you a long time to read all that stuff

Iain Barker

My guest today was the Dr. Sebastian Gonzales of Performance Place clinic.

Next week is the fourth and final episode with him so as usual there will be a giveaway.

Stay tuned for a chance to win the audiobook version of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery

All the links for Sebastian are, as always on the blog.

Just go to www.backpainliberation.com/blog and look for episode number 19.

If you are interested in training 1-2-1 with me you can book a taster session at backpainpersonaltrainer.com

That’s www.backpainpersoanltrainer.com

I’m Iain Barker, thanks for listening to the Back Pain Liberation Podcast.

BPL19: MRI for Back Pain

by | Mar 13, 2019

 

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Should I go to the doctor for back pain? Should we treat back pain as a medical problem, to be dealt with by medical professionals? Alternatively, should we try to tackle the problem ourselves? Avoid frustration by having a more concrete idea of what your doctor can actually do for you.

MRI for back pain.

It is a common misconception that you need an x-ray and MRI scan for back pain diagnosis.

In today’s episode, Dr. Sebastian Gonzales tells us how he uses MRI scans sparingly.

As a still image, of the structures of the back, it can be a useful diagnostic tool.

It won’t, however, show the cause of back problems in most cases.

“In an X-ray, an MRI, you can’t see pain, you see structure”

 

Excerpts from the Show

As well as merits and limitations of MRI scans for back pain, we cover myths and misconceptions in a number of other areas.

This is the third of 4 episodes with Dr. Sebastian.

Look out for a chance to win an audiobook copy of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery in the next episode.

Today’s Guest

Founder of Performance Place sports injury specialists, and author of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery, Dr Sebastian Gonzales.

Live Pain-free Eliminate Chronic Pain without Drugs or Surgery

If you click the above link and buy on Amazon I will (probably) make a small commission at no cost to you. Check back to later episodes for a chance to win a copy of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery.

Click the play button to listen to this episode now

MRI for Back Pain

MRI scans often have findings which worry the patient – and have no bearing on the pain they are experiencing.

Worst case scenario they can misleading.

  • In an X-ray, an MRI, you can’t see pain, you see structure
  • Something to take note of – that’s all that people should use MRIs for – and obviously, we’re looking for things that would change the course of care
  • Oftentimes, it’s not even a good image to see complete nerve health either
  • So, it’s not the end all that people tend to think
  • Okay, we’re going to figure out really, what’s wrong. Now, we’re going to do an MRI.’  that’s far from the truth
  • I hardly recommend anyone for an MRI … I want to see that they’re improving, if not I’ll suggest it, just to see
  • I think it’s overly utilized
  • (If the mri result) is negative …. it doesn’t mean that it’s not painful. It just means that it’s not what you think it is
  • It should be used only when needed
  • I tend to use it when people are not responding. If they’re doing the things asked, and they’ve been screened out, and everything looks good. There are no red flags
  • It’s like a timeout in a football game. Don’t use it early. If you use it early, you might not get another one
  • Especially when you consider insurances, they’ll do one, but after that…..
  • if you’re waiting on that MRI to be cleared, it could take you months and all the way you could have just been better the entire time

Core Stability

Training core stability is essential for back pain rehabilitation.

This doesn’t necessarily mean core-specific exercises.

Rather, training core stability is part of everything we do.

  • The core is actually not the six-pack
  • You could be chubby and still have a solid core
  • That’s why I started talking about the keg system – because that keg with that pressure in there and with the sidewalls and top … it has the ability to protect the spine
  • The spine is unique in its biomechanics and its abilities – the core is a critical part of this
  • (The core) can be as flexible as a fishing rod when you want it to be….In contrast, it has to have the ability to become an I-beam and solid as a rock … when needed
  • That happens through this through this fine guide wire system that is the core and which is intra-abdominal pressure too
  • When people come in with back problems…you don’t have to teach almost any core exercise at all, but you tell them to do a brace which helps out with stiffening their torso a little bit to protect the spine and their symptoms cut in half a lot of time
  • Then it just becomes teaching them how to do it on their own
  • So the core is really important, but not in the way that most people would think of it
  • Everyone says, ‘Yeah, yeah, yeah, the core is important.’ But it really is.

 

Hi, I’m Iain Barker creator of Back Pain Liberation.

I got back pain young and it got worse over time. Like many others in this situation, I saw plenty of doctors and therapists – all to no avail.

In the end self-help worked best – it often does for bad backs. Now I train regularly, focus on what works, and don’t get back pain.

My goal is to share what I learned. To help you find a more effective way when treatment doesn’t hit the spot.

 

Back Pain Keeps Coming Back

  • Back pain will come back – it’s just the way life is
  • If we’re very keen to the movement based corrections and just knowing when to implement certain strategies, then we’re gonna be just fine
  • Avoiding stuff will only get you so far

 Is Back Pain Genetic?

  • I think there’s more nurture versus nature
  • If I did guesstimate I’d say a strong 90% or more people, their back pain is … either they did it to themselves or they were they were part of an incident. The other people then might be grouped into those oddball ones. And one is familial, or hereditary
  • there’s this whole concept of epigenetics, which is you have a genetic disposition for rheumatoid arthritis, but some people don’t get it, you know, and so there’s always little markers, and I know this whole thing with 23andme. And people like to do that stuff and see what genes they have. And they’re not always expressed.
  • I want to make sure to be very clear about not allowing people to think that it’s familial, although there’s a small percentage, because, again, that’s something you can’t change. And worst case is those people take that and run with it, and then they don’t try anything.

Thanks for Listening!

 

Was a chiropractor helpful for your back problem? To share your experience, leave a comment below.

To help out the show, click a link to iTunes, Stitcher or TuneIn:

  • Subscribe.
  • Leave an honest review.

Thanks to Dr Sebastian Gonzales for joining me this time and explaining how the chiropractic profession has evolved; as well as all the other good stuff he shared with us.

Best,

Iain

 

 

 

 

Find more episodes of the Back Pain Liberation Podcast here

BPL11: Should I Go to the Doctor for Back Pain

Should I go to the doctor for back pain? Should we treat back pain as a medical problem, to be dealt with by medical professionals? Alternatively, should we try to tackle the problem ourselves? Avoid frustration by having a more concrete idea of what your doctor can actually do for you.

How to Handle Stress [for Back Pain Relief]

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BPL20: When “Correcting” Posture Causes Pain

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Spine Surgery [Don’t Make a Terrible Mistake]

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BPL6: Outwitting the Crooked Back Pain Industry

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BPL2: End Back Pain Forever with Chris Kidawski

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BPL22: Can a Rib out of Place Cause Back Pain?

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Causes of Chronic Back Pain [Book Giveaway]

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BPL8: Moving Stretch with Suzanne Wylde

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BPL3: Myofascial Release Exercises with Chris Kidawski

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BPL:10 Listen to Your Body with Suzanne Wylde

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BPL12: Live Pain-Free with Lee Albert

SHOW NOTES Live Pain-Free: Eliminate Chronic Pain without Drugs or Surgery.   Find more episodes here Lee Albert was a newly-qualified massage therapist when, over 30 years ago, a car accident left him suffering frequent migraine headaches. For 3 years he sought help...

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BPL18: Lower Back Pain after Deadlifting

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BPL9: Lack of Motivation to Exercise

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BPL1: Pilates for Back Pain with Gillian Greenwood

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BPL17: What Does a Chiropractor Do?

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BPL7: How Cathryn Jakobson Ramin Trains to Beat Back Pain

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Taming Chronic Pain with Amy Orr [Book Giveaway]

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Intentional Living

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BPL16: Back Pain Trigger Points

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BPL4: Sacroiliac Joint Release with Karen Gabler

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BPL14: How to Fix a Thrown out Back with Dr Jeremy James

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BPL19: MRI for Back Pain

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Full Transcript of BPL 19: MRI for Back Pain

Iain Barker

Welcome to episode 19 of the BPL Podcast, I’m Iain Barker

Today I’m talking to Dr. Sebastian Gonzales about MRI scans.

People often think of MRIs as the ultimate test, where you get to really see everything that’s going on inside and finally get to the root cause of your back problem but it doesn’t really work like this.

Dr. Sebastian tells us how he uses MRI scans sparingly.

As a still image, of the structures of the back, it can be a useful diagnostic tool.

In most cases, though, it won’t show the cause of back problems

As well as merits and limitations of MRI scans for back pain, we cover myths and misconceptions in a number of other areas.

• Core Stability
• Back Pain Keeps Coming Back
• Is Back Pain Genetic?

This is the third of 4 episodes with Dr. Sebastian.

Look out for a chance to win a copy of his new book I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery, in audiobook format, next episode.

Let’s get into the interview now
Okay, so Myth number three core training is just a fad.

Sebastian Gonzales

Yeah, so I know there’s ups and downs of these things. And, you know, everyone says, Yeah, yeah, yeah, the core is important. But it really is. And actually going through my clinical experience. I went through phases. I went through the first part, I thought, well, the core is important. And then I kind of dropped off that bandwagon. And then it was a couple years went by where I focused on other things and then I realized oh the core’s important again and the core is is a bigger I wrote a big article on this because at the thought of the core is actually … it’s very watered down at this point but it’s not a six pack … you could you could be chubby and still have a solid core and that’s why I started talking about the keg system because that keg with that pressure in there and with the sidewalls and top … it has the ability to protect the spine imagine just the spine sitting in there it’s protected

Dr. Stuart MacGill has a very good analogy with this he says the spine is unique in its biomechanics and its abilities and the core is a critical part in this so number one is he said that can it be as flexible as a fishing rod when you want it to be and that’s how you get your your yoga and how you get your dancing and stuff like that right? In contrast it has to have the ability to become an I-beam and solid as a rock when cued to, when needed, and that happens through this fine guide wire system that is the core and which is intra abdominal pressure too, or the breath part so he calls it a brace and bracing is is a skill. I’m very surprised when people come in with back problems that you don’t have to teach almost any core exercise at all, but you tell them to do a brace which helps out with stiffening their torso a little bit to protect the spine and their symptoms cut in half a lot of times and then it just becomes teaching them how to do it on their own. So the core is really important, but not in the way that most people would would think of it

Iain Barker

So often people will think about holding the abs really tight when they think about it bracing with the core

Sebastian Gonzales

Right the bracing is … there’s a paper that came out years ago where they they compared … the hollowing was on it and bracing was on it too. Bracing just kicked hollowing’s *ss. Like just plain and simple. Just the the activity the core just completely spiked. And the hollowing thought is that in the sucking in and forceful contraction from a single site. I always tell people, it’s kind of like you take keg and you just dent it. And no one wants to buy a dented keg, you know. So you gotta keep the walls broad. And the wider base of support there is, just like with when you’re standing….if you’re standing two feet together….someone comes to push you over, you’re probably going to go over. But if you widen your feet, and you take that same hit, you’re probably going to stay relatively stable. So if you widen your contact points on your pelvis and give it a chance … then you’re going to have a better resiliency there.

Iain Barker

So it’s not about looking good on the beach…being nice and slim, then, unfortunately, is it

Sebastian Gonzales

No. But I mean, to be fair, though, that’s if that’s someone’s goal, we have to get them there. But it’s a separate goal from feeling good. They’re completely different things. But yeah, I want that goal too

Iain Barker

Don’t we all but, personally, being pain free is much higher on my agenda. Yeah,

Myth number 4. Once back pain is gone. It’s gone forever.

Sebastian Gonzales

So this is kind of back, we were talking a little bit about keeping a little bit of your programming. And…I tend to find that people … they’ll stick with phase 1 and 2. They’ll get rid of the scab picking, they’ll keep the first aid. And they’ll feel pretty good in there. But stuff tends to come back sometimes. And I know that I am at the point mentally, where I know back pain will come back. It’s just the way of life. And it’s just the lifestyle that we’re in. And we’re stupid and make wierd goals and it’s just how it is. But I think if we’re very keen to the movement based corrections and just knowing when to implement certain strategies, then we’re gonna be just fine. But I think a lot of people think that once you have that little ache and pain, it’s it’s the end of the world. And I know for me personally, when I got my second one, I thought ‘I’m getting old…this is from getting old’ So and I don’t think that’s the case. You just happen to have it when you got to a certain age where you’re thinking that.

Iain Barker

Well, I had my 50th birthday last year and I have no back pain now. But I started getting back problems in my mid 20s. So like, in my sort of mid to late 20s, it was causing me all kinds of trouble, you know, I’d throw my back out, and I’d be unable to do anything for, you know, maybe a week. So it’s not age basically, is my experience. It’s something else

Sebastian Gonzales

In that book in that book. I put a little graph in there.

Iain Barker

I saw that. Yeah, yeah, it’s the corellation…. Was this about arthritis? Or was something else?

Sebastian Gonzales

Yeah, that was relationship to kind of debunk the idea of arthritis being the main cause of back pain. Because, that’s a big hang up for people. But yeah, so if you look at that graph, like it’s the back pain prevalence spikes in like 20s and 30s.

And then arthritis is a slow, it’s a slow increase. Almost linear. And they don’t match. So I know why people think that…or I guess I know why people think that. And I know you’ll get to this myth later. But I’ll probably hit it now since I’m talking about,

I believe that people think like, you never know, like most people when they come in with whatever area they’re talking about. say it’s a knee, they’re, like, I got this muscle problem here. And so they never say vein they never say artery. They never. They almost never say fascia, they never say nerve. All the little thing that are not touchable, they don’t say, They think joint muscle cartilage. So I think it’s easy when you see an x ray, and you think is that me? What are those little things? Oh, my God, that must be the problem. But it’s not. It’s not the case. I’d say a strong majority of the time. But if you believe that, that’s a big, that’s a big hindrance. Because if it’s not going to get better, you know. So that’s done. I got ahead of you on that one.

Iain Barker

Yeah, that’s okay…Myth five, the next one, we’ve already really done. Dead lifting is bad for your back, we’ve already pretty much covered that.

You have to be careful, I guess with dead lifting, don’t you? As you say, maybe not lift too much. And not too soon. And if you’ve developed ways of moving whereby you can pick stuff up without injuring yourself, then maybe you can do your dead lifting. But as you say, to start off with you, you don’t want to pick the scab and you want to be in the kind of first aid way of thinking and maybe move on to picking up heavy weights a little bit later.

Sebastian Gonzales

Well, I think it’s I think it’s important to note on that one, too, that people, when you say deadlift, think tons of weight. Dead lifting can be 10 pounds. So it’s a graded exposure, and it’s a movement … it is called a hinge. I personally teach people from blocks, I elevate it about six to nine inches off the ground, because most people don’t have the anatomy to get down there safely. Most things you pick up, most people hurt themselves when they pick up pennies off the ground. So it’s not the weight it’s the depth of the way they did it

Iain Barker

They should have left that penny where it was!

Sebastian Gonzales

I know the funny thing is when the penny is actually glued to the floor.

But so i think i think dead lifting is a foundational point and you’ll find your sorry, I’ll take it back. hinging is a foundational point, and like through Qi Gong and Tai Chi and yoga, and you’ll find hinging all over the place. But it doesn’t look like it doesn’t look like dead lifting. It just it’s just a hinge with a little weight

I think it’s foundational for building the engine honestly. But I know a lot of people shy away.

side story. I know this is a tangent topic, there’s actually a thought if you guys want to read up on something Mike Boyle, he’s a strength coach. He wrote an article on no more back squats. And so he describes the spine used as a lever versus vertical compression. It’s interesting because … we do get that story that people hurt themselves deadlifting and back squatting. So you can actually take that out and still be a very athletic, fast, quick person without actually doing that stuff anyways. But I think us as a society, we’re kind of married to a barbell or that movement, but it’s a double leg movement. And we’re not bunnies we don’t hop around all day. So single sided movements are actually a little bit safer.

Iain Barker

Okay, that’s interesting. I’ve thrown my back out getting out of a car, or one of my kids fell off a stool that she was standing on. I reached out and caught her as she fell and I threw my back out doing that. We can’t avoid doing all these things. We should be able to do them. We should be able to pick stuff up off the floor. If we can’t do that, then there’s a problem. So the answer I would suggest is to do what you can to fix the problem. Rather than avoid, you know, normal activities like picking stuff up, you should be able to do really

Sebastian Gonzales

Avoiding stuff will only get you so far really At some point, you’re going to see it.

Iain Barker

We don’t really want that restriction in our lives,do we?

Sebastian Gonzales

I don’t think so. Although spiders. I’m okay. With avoiding spiders

Iain Barker

Are there spiders … your’re in California aren’t you?

Sebastian Gonzales

They’re not big. Well, the biggest ones, we have these little, these little, they’re like red green tree spiders. They’re, they’re very menacing little guys, they, they’re about the size of the body is about the size of your thumb. And then they like to hang out in doorways. They just love to spin their web really quickly there. And then, like they could be not there one hour then the next one you’re like ‘Oh, god, there’s a whole big spider web right here. And then you just so there’s times will walk up to the house and we’ll just start waving our arms or we’ll let the other person walk in front…and they don’t know

Iain Barker

Let someone else take the hit. Yeah…

Sebastian Gonzales

they don’t hurt you. But there’s definitely a time of the year where it starts to get a warm, warm or you like, I’m gonna, I’m not gonna walk in front.

Iain Barker

And the worst thing is when you get the spider web in the face, isn’t it? That’s so unpleasant.

Sebastian Gonzales

I wonder if the spider ever thinks like ‘I want to get away from this situation’. Or if they’re like, ‘oh, here’s an opportunity to get in their shirt.’

Iain Barker

I don’t know. Anyway, Myth six, how you use your back has nothing to do with an injury? What I’ve written here is quality of motion is more important than flexibility. And you’re talking about the hips and the human engine that we that we kind of touched on earlier.

Sebastian Gonzales

Right. It’s I know that this blends with another topic we’ll hit later which is the, ‘my mom or dad had back pain. So so will, I’ type of thing and it is about quality of movement. But there are people that they they are a little bit fearful of bending forward. So they might interpret this as you need to have a flat back at all times. And that’s not true. But it is quality of movement. Remember how I said we’re kind of stupid, we just like to do like, funny things and activities. And I’m no different. It’s just, we, we like to challenge ourself. That’s just how we are we like we get bored. So there’s certain activities that have a higher risk, then then I’m willing to take and it’s, it’s if you’re going to do those, you have to just take care and be able to be able to load appropriately. So you spare your spine really. So yeah, it is how you use it. A lot of people are sloppy, and I’ve been there too.

Iain Barker

well, human beings we do tend to be lazy Don’t we?

Sebastian Gonzales

We do yeah, we Yeah, we do. It’s a there was a guy that came in. He was he was a fun guy to play with. He had a knee problem and he was he was in the belief that was a inner medial meniscus issue. And so he walks around an office most of the day, and he’s a fitness guru… junkie just loves it. So he won’t take the elevator he’ll take the stairs he runs up the stairs he’s like it’s the funniest thing when I run up the stairs or run down the stairs it feels fine but when I go walking down the hall and then I have to turn around and get something that hurts and I said okay do that movement he’s like yeah that hurts and I say okay now do it act like you’re going to like you’re like you’re playing basketball now like the plant and go and he’s like yeah doesn’t hurt at all

so there’s the thing when we’re doing an attentive movement, sometimes more tension is protective over over some issues so …. the back’s no different on that

Iain Barker

So, Myth number seven My back is weak or I have a bad back. So you talk about some tough love in this section

Sebastian Gonzales

yeah …. luckily I write it in there and like no one’s on the other side to like argue with me when it like hopefully they go through this book before they start hating me

but i think it’s a very defeated mentality … I tell people all the time … if they say something the reason for their problem is something that’s not changeable…. Don’t worry about it you know and like if you think it’s arthritis it’s not going to go away like if you think you have a damaged a ‘weak back’ and you think it’s never getting better then it’s not going to get better … so I have found very few people that were not able to get better … there are some people though that they they still do have that belief they have the weak back and those are the ones who typically they’ll come in for

I say they come in when they’re hot and I tried to tell them like look i don’t know i don’t want to have a long treatment plan…I want to be your guide in this I’ll treat you when your hot, but it’s it’s like having like you’re in a pool …the water’s really muddy you can’t get down to the real root cause of why that things happened until the water clears. And so once that water clears, then there’s a solid game plan but they tend to they tend to flare it up and then they then they get better and then they just avoid and they think they have a weak back and then it flares up again. Yeah, I mean, it might be months in between but they’re they’re not willing to take the next step into into engine building

Iain Barker

that’s no life, is it to have, you know, throw your back out. So you have acute back problems , a few times a year and have, nagging kind of discomfort and worry all the time in between times. I’ve been there and that’s, that’s no good.

Sebastian Gonzales

I’ve a friend who says ‘It’s very tiring to walk around the city thinking clowns are going to jump out around every corner and you’re gonna hurt your back.’

Iain Barker

Yes that sounds exhausting.

Your whole book, the premise is that your the mindset, your mindset as a back pain sufferer is the most important thing. And for me, this this point this

changing the belief that you know, there’s something serious there must be something seriously wrong with my back to cause all this pain. And, you know, to be told, well, for me, it was a surgeon, to be told ‘there is nothing structurally wrong with your back’. And to actually believe that this was a huge turning point for me to be almost given permission ‘If you want to go and do some training, that’s not going to hurt you – do it, it might help you’. And lo and behold, you know it, my life changed mainly from getting away from this what you call Myth number seven. I have a bad back.

Sebastian Gonzales

Yeah,it’s really tough . And quite honestly, not not everybody has their their clinician or their guide is going to give them good communication. And, and I’ve been at fault for this many times. And some people, they hear what they want to hear. So over the last week, I’ve tried to be very clear with people. And I had a shadowing doctor with me. So one lady came in with an elbow problem. I tend to stress test the area. And so I know if there’s a big risk to the person. And so the weak back, I would stress test the area. And so when they when they tend to come back on that whole like, well, it’s weak and I shouldn’t I don’t think I should be doing that. I’ll say, look, if you trust my testing, which I hope you do, I know we just met. But if you’re here for my guidance, and I’ve stress tested all of the ranges and structures of your back. I see no reason you cannot simply go for a walk. Or you know, like maybe not hit a baseball, but this lady was a golfer, she didn’t want to play golf. She was afraid. Which is fine. So I said, ‘Look, why don’t you go to the short game, just putt, and she’s like ‘can I putt? I said ‘Yeah, you can putt’ I stress tested your elbow it’s not going to explode. And the forces I put on it in that exam are much greater than you’re going to get with putting a golf ball. Yeah. And so she she wasn’t completely convinced. So I handed her a club and we did it in there

and getting people back to activity. Because motion is lotion is a critical point in their recovery. And it takes that mental mindset change or else it’s not going to happen. So it will probably require some support to I don’t know … Did you have a friend or your spouse help you through it or

Iain Barker

not so much? No, in fact that this kind of meeting with the, with this orthopedic surgeon I left feeling pretty angry because I just thought he wasn’t taking my my problem seriously. You know, he basically sent me away with the feeling I was kind of wasting his time kind of thing. You know, there’s nothing wrong with you. Your problem is bad posture. And it took me a while to kind of digest that and, you know, try different forms of exercise. But yeah, I suppose the the kind of the help I got was more from you know, the people who trained me in different kinds of mindful exercise, I would say

Sebastian Gonzales

yeah, well I always say that the solution is ready for you and when you’re when you’re looking for it

Iain Barker

I think there’s a lot of truth in that in all areas of life actually

Sebastian Gonzales

I do too actually but that’s a whole other tangent topic

Iain Barker

It really is.

COMMENTARY

So the solution is ready for you, when you look for it.

The solution to your back pain is not listening to this podcast.

Or reading blog posts.

Or hanging out on Facebook groups.

All these things may help to point you in the right direction, or to inspire you. Hopefully both of these things. But just getting the information will not help your back.

You have to take action.

For Dr. Sebastian, and for me and for many, many people, the course of action which did solve their back problems was regular training.

It was finding a way to train that worked for them and sticking with it.

Often this involves a lot of trial and error, over a long time.

Time after time my guests on this podcast have told a similar story of a very long and winding road to recovery.

And, all the time, the solution was, to a great extent, in their own power.

They just needed to understand this and decide to make it happen.

If you are ready to look for the solution then, in my view, rehabiltation through exercise is the first place to start – after you’ve been checked out by your GP of course (common sense applies).

What I would want to do is to help you to cut out the trial and error process. To get you started straight away on improving posture, relaxation and movement through a practical training method.

If you want to give it a try then you can book a 30 minute taster session with me, 1-2-1 via Skype video call at no cost to you.

Go to backpainpersonaltrainer.com

that’s

www.backpainpersonaltrianer.com and book a free taster session there.

More from Dr. Sebastian now.

RETURN TO INTERVIEW

I’ll carry on going through to myths, although we kind of touched on them already. Myth number eight. My mom or dad has a bad back. So I will, too.

Sebastian Gonzales

Yeah, when I wrote that actually there I should have added a couple of addendums to that. There is a little bit of correlation with familial but it’s more structure. If I did guesstimate I’d say a strong 90% or more people, their back pain is because they did it to themselves. Either they did it to themselves or they were they were part of an incident. The other people then might be grouped into those oddball ones. And one is familial, or hereditary. And there’s, there’s this whole concept of epigenetics, which is you have a genetic disposition for rheumatoid arthritis, but some people don’t get it, you know, and so there’s always little markers, and I know this whole thing with 23andme. And people like to do that stuff and see what genes they have. And they’re not always expressed. So there’s other variables of why and with spines, one of the logical ones is biomechanics and loading process. So there, there’s, so there’s a little bit to that. But I’m going to rewrite that section one day, and I want to make sure to be very clear about not allowing people to think that it’s familial, although there’s a small percentage, because, again, that’s something you can’t change. And worst case is those people take that and run with it, and then they don’t try anything.

Iain Barker

Even if it were the case that they had inherited a genetic disposition towards back problems. My mother had back problems, I remember as a child, could it be that, they can adopt a positive mindset and sort of deal with that problem successfully? themselves? In any case?

Sebastian Gonzales

Yeah, I think they can. I mean, I think there’s, I think there’s more nurture versus nature, like attributes that can come from just, I mean, you see all the time when people eating, like, if, if the mother and father eat fast food, the kid will, too and the kids get overweight. And so then, yeah, there’s so there’s, I mean my dad taught me a lot of woodworking and he had a really bad habit of he would always take the safety’s off. So I was very mindful when the saw’s down because there’s no safeguards on it. but also, he told me certain things to do when cutting. So I think some of those attributes and can be learned from the family, if it makes sense.

Iain Barker

It does. Yeah. Okay. Myth number nine, this is what we’re talking about x rays and MRIs. The myth being that, that you have to have these things for diagnosing the cause of back pain.

Sebastian Gonzales

This is a great one, I could spend hours on this one

Iain Barker

Maybe you could summarize a little bit, I’m gonna run out run out of storage on my voice recorder…

Sebastian Gonzales

I’ll tell you the typical story because this happens a lot. And I just had a kid in the other day… I’m all down for an MRI and X ray just just to peek and see. But so actually, I’ll start back there was a guy that came in, he’s been with me for a little bit of time. And he suddenly developed this neck pain he hasn’t had before and with a certain age group and you want to look for certain things. And at that point, I told him, ‘I’m gonna recommend you for an x-ray because I want to see what it’s not’. I wanted to see that something’s not there. And I was looking for, like, cancer or something weird, you know? And I said ‘Be very clear, though, we’re gonna get this image back. And it’s going to have a lot of scary words on it. And unless I say, so, do not freak.And they’re just normal stuff. And so we got it back. And he says, ‘Spondylolisthesis’

Iain Barker

I was trying to pronounce that when I read that in your book.

Sebastian Gonzales

well, there’s actually three of them in school that we learned … I always get jammed up too …. there’s spondylosis, spondylolysis and spondylolisthesis, and it just, I don’t even care, we get hooked up on this terminology now. But it’s scary to the patient, you see moderate this and severe that and we talked for 30 minutes about this. And I said, ‘Look, I I’m okay, talking about this. But I’m telling you, it has nothing to do with what’s going on right now.’ And people tend to have a very quick default to that. And I had a I had a patient that he he responded very well to care. He got over 50% better within within the first day and continued to get better. And so since he’s a kid, he had the mindset of … the parents want to check sorry I got distracted, the parents wanted to check to make sure it’s nothing else. So they took him to his GP and his GP said you should go to orthopaedic…orthopaedic is going to do an x-ray, an MRI and I emailed them. I said, ‘Look, you’re going to get a lot of information from that thing. And it’s going to look very scary’ because very quickly, they will see remember I said, ‘arthritis doesn’t really have a big relationship.’ They’re going to see that stuff. And all of a sudden, whatever was working, they’re going to visually see it. And change their mind. And it’s a I have a friend that said that in an X ray, an MRI, you can’t see pain, you see structure. And I have another friend he described this very well. He put up a slide of someone laying on a railroad track and a trains behind him about like 100 yards. And so he said, ‘Is this is this dangerous?’ And the answer is, we don’t know. It’s a still shot. We don’t know if that person’s grew up around train tracks. We don’t know if the trains moving. We don’t know if he’s asleep. We don’t know if we don’t know anything. Yeah, we just see that there’s something take note of . So that’s all that people should kind of use those MRIs for. And obviously, we’re looking for things that would change the course of care, like space occupied lesion or things like that. And oftentimes, it’s not even a good image to see complete nerve health either. So it’s, it’s not the end all and people tend to think, I think that the MRI is ‘Okay, we’re going to figure out really, what’s wrong. Now, we’re going to do an MRI. that’s far from the truth.’ I hardly recommend anyone for an MRI … I want to see that they’re improving, if not I’ll suggest it, just to see. but I think it’s overly utilized.

Iain Barker

So you could have some of these scary findings on your MRI, which are nothing to do with back problems. And they could be someone who has no back pain at all who, who has these findings on their MRI, despite the fact that not causing any problems?

Sebastian Gonzales

Yeah, and there’s things become like a bruising, like I could, actually. So I’ll, um, yeah, well, we’ll go with will go with delayed onset muscle soreness, probably easiest, you know, probably everyone’s experience, maybe not heard of the correct or the terminology, delayed onset muscle soreness, or? Dom so it’s going to work out and you saw, right?

that’s, that is technically a muscular injury, have some type of grouping, it’s been classified, it just hasn’t hit the point where there’s anything positive on an image. And so when people go in, and like say, we’re assessing a muscle injury or tendon or joint, and they’re like ‘this thing really hurts. Why is this thing negative?’ It’s, well, it’s because you haven’t, you don’t have the criteria to show that as positive. So in that instance, a muscle tear grade two and above would then reveal itself, but everything else is negative. And it doesn’t mean that it’s not painful. just means that it’s not what you think it is. So it’s, it should be used only when needed. And I think people need to be very considerate of this too, is that I again, I tend to use it when people are not responding. If they’re doing the things asked, and they’ve been screened out, and everything looks good. There’s no red flags, we, we will use it if needed. It’s like, it’s like a timeout in a football game. Don’t use it early. If you use it early, you might not get another one.

So it especially when you consider insurances, like they’ll do like one, but after that, even get one is a pain in the b*tt. And if you’re waiting on that MRI to be cleared, it could take you months and all the way you could have just been better the entire way. So it’s, it’s a confounding thing. And I understand it. And that’s why I included my I included 2 of my MRIs in that book, just to show you, the findings were basically the same.

Iain Barker

And that kind of leads into Myth number 10, which is, if there are findings on an MRI or some other imaging technique, which can’t be cured, there’s no hope for me.

Sebastian Gonzales

Yeah, that kind of falls into that arthritis. And somebody will say disc, bulges won’t go away, and things like that. Like, they, they kind of get that mindset, they’re, they’re stuck with it. And that’s how it’s going to be …and all throughout that book. It’s I’m trying to debunk all of these stall points for people and I’m okay with them ….I totally understand them, having them. And I’ve met a lot of people that have the stall points and the beliefs but at some point it’s like, the belief is okay, and I wouldn’t fight you on every belief that you have, like, I don’t care if you like lemonade vs. Orange juice, it doesn’t hinder what’s going to happen with your back recovery. But if you’re telling me the reason why you’re not going to get better when you walk in the first day, is because you have arthritis on your X ray, I’ll tell you straight up ‘That x ray’s not or that the arthritis is not going to change. So can you get better?’And if your answer is ‘no’ then we need to really discuss whether the arthritis is the root cause your pain or not and then we need to go through all the reasons and I typically give people a couple choices on this and it usually takes a few times before we get to this point. And I get a feel that they know that I have their best interests at heart because I sound kind of like an *sshole and I say

so because so there is I started doing this one this one guy came in. And so I would I would attempt to do a corrective exercise which I wanted to do, which was helping him or what I believed to be helping him and so he asked me ‘why are we doing this again?’ and at first I would explain it and all the reasons why and blah blah blah and then so we did it and so we went to the next thing because sometimes they get two or three and it was next thing and he asks ‘why we do this again?’ And so finally in the third time I was I stopped and I said ‘Look, do you really care what this is doing? Or are you just nervous and I’m like I’m okay you’re nervous. But or if you really want to understand I’ll share every single piece of information that I’ve ever gotten about this one exercise in correlation to what you have I will educate the heck you. You can have everything I read and then we can sit down and have coffee or dinner and we’ll talk about this I love it I love talking about this or second option is you just trust me’ and most people take the second and they’re like ‘yeah I didn’t really want to know anyways … I just didn’t know if it was right’ and so people get nervous they start asking questions and talking which is ok but if we’re if we’re trying to get to the bottom of it and get you better you have the two choices you can fully wholeheartedly understand why or second is you trust

Iain Barker

yeah

Sebastian Gonzales

because this understanding I’m down … and probably long term it’s going to be better. But it’s gonna take you a long time to read all that stuff

Iain Barker

My guest today was the Dr. Sebastian Gonzales of Performance Place clinic.

Next week is the fourth and final episode with him so as usual there will be a giveaway.

Stay tuned for a chance to win the audiobook version of I Will Beat Back Pain: Getting Into A Winning Mindset For Recovery

All the links for Sebastian are, as always on the blog.

Just go to www.backpainliberation.com/blog and look for episode number 19.

If you are interested in training 1-2-1 with me you can book a taster session at backpainpersonaltrainer.com

That’s www.backpainpersoanltrainer.com

I’m Iain Barker, thanks for listening to the Back Pain Liberation Podcast.

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