Muscle Knots with Christine Koth

“Tight actually means that either the muscle will not lengthen to its proper length;it’s unable to fully lengthen (usually because the brain tells it not to) or there’s actual contraction inside the muscle itself, a part of the muscle that’s contracted. We would commonly call that a muscle knot, a section of the muscle that is not letting go.”

Christine K

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Muscle Knots

– Read More

Muscle knots are a common causes of tight muscles

So says long time physical therapist and author of Tight Hip, Twisted Core: The Key To Unresolved Pain, Christine Koth.

In today’s episode, she explains what a muscle knot actually is, as well as how to treat tight muscles.

Pregnancy Back Pain

Christine explains how very flexible people can suffer from joint instability.

Hyper mobility can be a cause of back pain for this reason.

The high levels of the hormone relaxin found during pregnancy cause ligaments to relax. Joints become looser and less stable.

This is a common cause pregnancy back pain, specifically SI joint and tail bone problems.

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With former chronic back pain sufferer, and

host of the Back Pain Liberation Podcast, Iain Barker

About Me

 

 

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.

 

Anterior Pelvic Tilt Test

 

We talk about anterior pelvic tilt as a common cause of chronic back pain and other musculoskeletal conditions.

Chrisitine explains the procedure for an anterior pelvic tilt test that you can do yourself.

 

QUOTE OF THE DAY

 

Which Canadian poet, writer and filmmaker. Recipient of multiple literary awards including the Booker Prize, said: 

“We all have an old knot in the heart we wish to untie.”

Answer at the end of today’s show.

Listen on the player on this page, iTunes or wherever you like to listen to podcasts.

 

Full Episode Transcript

 

Click for episode transcript - BPL42
Iain Barker

People often say that they they feel tight or they say ‘I’m so tight.’ But then you, you kind of imply that’s not always an accurate description of what, what people are actually going through tightness in the muscle.

Christine Koth

Right? Yeah, this is something I’ve discovered as a physical therapists over the years, you know, people are like, Oh, I need to, can you teach me a stretch because I feel so tight in my shoulder, I feel so tight in my hip or something. And, and this word is something that’s used for a lot of different reasons that aren’t necessarily accurate. And, you know, I chose to put this in the book, because I’m talking a lot about what a tight hip is. Yeah, I want it to be really clear what it means to be tight, you know, tight does not mean pinch, it does not mean pain, it does not mean you know that you feel a stress, a stretching sensation. Tight actually means that either the muscle will not lengthen to its proper length. Like, yeah, it just is, you know, unable to fully lengthen, and usually, because the brain tells it not to, yeah, um, or there’s actual contraction inside the muscle itself, a part of the muscle that’s contracted. And we would kind of, you know, commonly call that a muscle knot, you know, or section of the muscle that is contracted that is not letting go. Yeah, those two are really the, you know, the proper definitions for what it means to be tight. And when I talk about the hip being tight, and the iliacus being tight, in particular, that’s what I’m referring to, is having muscle tension that is not not letting go. I use the example when I’m working with clients, and I lie them down on a table, you know, so they’re completely relaxed. They have nothing else to do except just lie there. Yeah. And in that position, there’s no muscle that should be working. Yeah, you know, but if I go and I touch the iliacus, for example, or the quad, for example. And there’s tension in that muscle. Yeah, that’s tightness.

Iain Barker

Yeah. Yeah, makes sense. So I guess we’ve already covered, we’ve already touched on this, but you know, if if a muscle is tight, what can we do about it.

Christine Koth

So stretching is the common thing that we go to first. And stretching is actually a great tool, it helps to kind of integrate the brain with the idea that this muscle can lengthen nice and long and can then you know, go back to its baseline length. And stretching also is great for increasing circulation, we everything in our in our body needs really good blood supply and circulation, which helps to bring nutrients to the area helps to clear out toxins and waste. You know, so it’s a really great tool, also really great for when you have created, you know, like, if you really worked out hard and you want your healing of that muscle to occur in a proper way, stretching helps the muscle fibers to orientate in the proper direction, so that those muscle fibers can be the most effective as they rebuild themselves. So stretching is, you know, is one tool that kind of, you know, in some small ways will help with tightness. But it’s oftentimes not enough. And we talked earlier about prolonged pressure and the importance of prolonged pressure, we’re experiencing month muscle tension or like a muscle not are part of the muscle that is contracted. Stretching oftentimes isn’t enough to get that to go away. Most of the time. It’s not, it’s a good adjunct, but not enough. And that’s where the prolonged pressure comes in. really being able to find the spot that’s tight, putting prolonged pressure on it, so we can change the the holding pattern basically, what our brain is choosing to to do on that particular area muscle.

Iain Barker

Yeah, a lot of these things, they kind of come down to habit. Yeah.

Christine Koth

Absolutely, absolutely. You know, we want people to have the right habits or the habits that are effective, like you, you know, we, like we talked about our lives are super busy. We’ve got a lot going on. You know, for me, as a physical therapist, I only give people the things they absolutely have to do and the most efficient, you know, kills many birds with one stone type of Yeah, yeah, we’re gonna give you the results that that are long lasting, not just temporary, you know, this is a perfect example of that using, you know, stretching versus prolonged pressure. It’s like, you get Much more bang for your buck. When you can find that muscle knot hold it, you know for that 90 seconds, will give you so much more than, you know, month and

Iain Barker

you can check your emails at the same time.

Christine Koth

Exactly. catch up on, catch up on, you know listening to your podcast. That’s what people.

Iain Barker

Everyone should listen to podcasts. Yeah, definitely. It’s all about priorities, especially this one. So part two of the book, why is my hip so tight? So what causes this problem in the first place? I guess.

Christine Koth

So we alluded to this a little bit about sitting, right? We live in this world where we sit way too long. So you can that’s driving sitting at your desk, sitting and watching television, whatever the case may be. There’s lots of examples in our lives of sitting. Driving in particular can be even more Yeah, because we use our hip flexor on this the leg that we’re you know, right leg. Yeah, we’re using our so

Iain Barker

I used to really we struggle with driving, actually, for exactly that reason. And also, depending on where you’re driving, it can be quite stressful can’t it? So you kind of you get a little bit of tension from that as well.

Christine Koth

Yeah, yeah. And the pelvic area is an area that a lot of people hold tension in. It’s either that or it could be the base of the skull and the neck, those tend to be whee fight or flight. Yeah, will cause tension. So you know, stress is a big component trauma in that area can cause tightness in the hip. Any kind of issues with the, the organs, you know, so digestive issues, reproductive issues, urinary issues can also contribute to tightness in that area, because your body just wants to protect you. Yeah, there’s something that’s inflamed or irritated. Your brain just says like, I want to, I want to kind of keep this safe and tightness is one of the things that chooses to do. Yeah, so those are, you know, some common examples. Other things when you look at athletic pursuits, you know, if you are someone who is using overusing, the the psoas and the iliacus, when you overuse a muscle, that’s another example of how it can choose to get tight. So certain sports like running, cycling, cycling, puts the muscle into a shortened position. Running uses a hip flexor lats, kicking sports, of course, you know, you’re using your hip flexor quite a bit there. Lots of heavy lifting, if you’re in a CrossFit athlete, or you’re, you know, a gym rat, and you’re doing a lot of deep squats that the iliacus and the psoas, its job is to really stabilize, yeah, connection between the spine and the hips. And when you’re putting a lot of strain on it, where that stability, you know, is threatened, it can cause those muscles to decide to contract and stay on for good. Yeah, you know, so the athletic population, you know, I’ve seen so many people with that are, you know, really intense athletes that end up with tightness in their hips for that reason? Yeah. And then last but not least, is the hyper mobile population.

Iain Barker

Well this kind of interests me? Because I’m a bit of a stiffy? You know, I want to be, you know, you mentioned yoga later on in the book. Yeah. If I do yoga, I’m the person who can’t sort of get into the pose. Yeah, some people, I did a quite a lot of Tai Chi, and mostly you on your feet, but some things who kind of sitting down on the floor, with like legs stretched out in front of you. And some people will they can do that, and then sort of lean forward and almost get their forehead on the, the the floor, I find it uncomfortable to just try and …it’s as much as I can do to sit upright, with my legs out in front of me. You know, I’m I’m not flexible. I’m quite stiff. So it was kind of interesting to me to read your book, from someone who’s completely, you know, come from a completely opposite sort of end of the spectrum. Because I understand you’re, you’re very flexible, almost hyper mobile, your issues if anything would come from the other, the other side as it were

Christine Koth

Exactly, exactly. Well, you know, we’re all i the ideal situation is that we’re in balance. Yeah. So for you doing more stretching and more flexibility. Yeah, to me is is going to bring you into better balance, you know, where your where your stability and your mobility are in balance, because you probably have more stability than you do mobility. Yes. Whereas someone who is the person who can bring their forehead to the floor when they’re well in a forward fold, they need more stability. They do not need more stretching at all. Yeah,

Iain Barker

What, I didn’t really get and You can maybe explain to me now is if someone’s hyper mobile like that, Mm hmm. How is it that they’re also tight in the iliacus?

Christine Koth

I know, isn’t it? Isn’t it an amazing oxymoron? Yeah. So it’s such a mystery, and it’s so common. So, um, people can, there’s a difference between being able to lengthen a muscle, and whether or not, at rest the muscles holding tension. Yeah. So using that using the hip flexors, the iliacus. And the psoas, as an example, you could go into a really deep lunge, lunge pose, and really be, you know, quote, stretching the iliacus. And psoas, and maybe even deep into that lunge pose, you don’t even feel a stretch this is how a lot of people who are very mobile can be, yeah, so their range of motion is really good, you know, the muscle is able to lengthen really long. But then if that same person lies down on their mat, and savasana, and you know, someone were to come up to them and touch that iliacus or psoas there would be muscle knots in that muscle, then there would be tension in that muscle. That’s interesting. Yeah. So there’s, you know, just because you can stretch a lot, you know, through a decent range of motion does not mean that you don’t aren’t holding tension in the muscle. Okay. And this is the thing that a lot of Yogi’s and dancers and people who are, you know, gymnasts… people who are very mobile, end up experiencing, because what happens is, when, when you’re good at something, right? Like, if you are just naturally, someone who’s flexible, you’re gonna tend to sign up for yoga classes or become a dancer, ballet dancer or something like that. And those professions or those activities end up creating, you know, more and more flexibility always working, I guess, deeper into your splits. Yeah. And that creates more and more instability, you know, and pretty soon, you’re not just stretching muscles, you’re stretching ligaments, and you’re stretching joint capsules, and you’re creating more and more looseness to your body. Yes, so then iliacus. And psoas you know, because their job is to hold the top half of your bodies in the bottom half of your body together, those muscles are going to say, Okay, we have a really tough job to do. We need to you know, this body keeps getting more and more mobile, you we have to get more and more tight to hold it together. And that’s where

Iain Barker

the compensating for the excess mobility elsewhere.

Christine Koth

Exactly, yeah. So this underlying tension is going you know, it’s there. And it’s, it’s, it’s, you know, every day as you’re moving and walking in just doing normal things is pulling on you and tugging on you. And then people end up with back pain or tailbone pain or knee pain or Yeah, case maybe. Yeah,

Iain Barker

yeah that makes, I sense. You mentioned pregnancy, that obviously has effects on on the body and joints tend to sort of relax a little bit more. So it’s kind of ties into the, to a similar sort of idea, I suppose.

Christine Koth

Yes, the hyper mobile body is you know, anyone who has had a child who’s carried a child, your body releases relaxing, which causes the pelvis to become more mobile. You know, this is part of what allows us to to give birth to a child. And because of that, that creates instability and similarly causes tightness in that iliacus. And so as it tries to stabilize, it’s very common for for women who are pregnant to have tailbone problems, SI joint problems, low back problems.

Iain Barker

Well, obviously, I knew about back pain but didn’t know particularly SI joint problems and tailbone.

Christine Koth

Yeah, very common. And then those things oftentimes persist after they have the child because that weakness has been developed. And those muscles have, you know, kind of been Yeah, traumatized. Yes,

Iain Barker

yeah. Yeah. Well, chronic pains is kind of strange beast, isn’t it? It kind of commits itself to memory in some ways, isn’t it?

Christine Koth

Yeah, there’s definitely the neurological, you know, effects of having any kind of instance, even if it’s an injury that was caused by some sort of trauma or something that accumulates over time. You know, this is the neuroscience behind how our brain is connected to our muscles and our pursuit of pain. You know, so, so ultimately, we want you know, the way that you want to ways to get out of pain is to really understand why why it’s happening in the first place and to give our brains a really clear understanding, you know of what to do and why it’s there and how to move forward. So that the fear that we’re holding on into, you know, in the reptilian parts of our brain. Yeah, enter down a bit.

Iain Barker

Yeah, yeah. makes total sense. So part three of the book, a tight hip, twist the core. And he talked about, well, we sort of mentioned a little bit earlier, but everything’s everything being connected.

Christine Koth

Correct, Yes. So when that iliacus is tight, or the psoas or both that tension pulls on the pelvic bone where it’s decided it’s tight, and causes what what could be called an anterior rotation or forward rotation of that side of the pelvis relative to the other side, or relative to the tailbone? Yeah, that forward rotation puts strain where the tailbone meets the pelvis. It also causes a rotation in the spine and compression shortening of the muscles on that side of the spine. Yeah. Which can irritate any underlying disc issue or a facet joint issue or nerve issue, muscle issues happening in the spine can even work its way up to contribute to scoliosis, and, you know, shoulder imbalances. And even headache and things. Yeah. And then that that same rotation, the pelvis changes, really the orientation of how the ball fits into the socket in the hip, because the socket of the hip is a part of the pelvic bone. Yeah, and when that socket is not fitting well into the hip joint, that can be, you know, create a predisposition for the hip joint rubbing the wrong way. You know, arthritis developing in the hip for labrum problems. snapping hip pinching in the hip. Groin problems, all of those can be origination originated from that rotation of the pelvis, and then working its way down.

Iain Barker

Yeah. And you saying that it tends to be on one side? Or is it more pronounced on one side? How does it work?

Christine Koth

You know, it’s actually if you if you end up having tightness in both of your iliacus equally you’re better off?

Iain Barker

Yeah. Well, I can imagine that. Yeah. The hit the pelvis being rotated forwards is obviously not good. But for it to be sort of rotated forwards just on one side and come completely out of sort of balance in that plane as well. Right. would be worse, wouldn’t it?

Christine Koth

Yeah. And that’s where you get the twisting, you know, the the

Iain Barker

Yeah,exactly.

Christine Koth

Yeah. Yeah, yep. And, you know, in my practice, I have seen maybe one or two people that have symmetrical tightness, but most people have tightness on one side versus the other.

Iain Barker

Yeah. Yeah. Isn’t that strange?

Christine Koth

It is really strange. And actually, it’s interesting. And I don’t know, if it’s a geographical thing or not. But many people, most people have tightness on the right side versus the left side. Really? Because I don’t really, you know, I’d love to figure out it’s like a question I’ve been asking for my whole career. why that is, I want to know why.

Iain Barker

Most people the dominant leg is the right leg, isn’t it? As is for most people the right hand, the dominant hand,

Christine Koth

right? Well, there has been, there was one study that was done, because there’s been more right hip replacements than left. And there was one study that that looked at whether it was handedness, whether people who are right footed, you know, had a higher chance of having a right hip replacement versus left footed. And they, they did not find a correlation. Okay, that study, you know, but I think there’s a lot more research to be done. And I kind of feel like, if we could answer that question, you know, that maybe there’s a there’s an answer to why hip replacements are so prevalent in our, in our society, because it’s, you know, there’s a high percentage of people that will end up having a hip replacement in their lifetime.

Iain Barker

Well, it’s become pretty much a straightforward standard procedure these days isn’t a hip replacement, but I think it’s like a really big deal anymore. Right? In, get it done. And out and off you go, you’re done.

Christine Koth

Right, right. But my thing is, like, why do we, you know, why do we even have to have surgery in the first place? You know, what I are we doing, in our lives that are creating? Yeah,

Iain Barker

absolutely. Yeah. Even though that operation’s been perfected, and has been done, you know, countless times, of course, it would be better if we didn’t have to do it.

Christine Koth

Exactly,

Iain Barker

if we could figure out, Okay, well, what’s going wrong here? You know, how could we make? How can we change what we do so that that join lasts throughout our lives instead of having to be replaced? Yeah.

Christine Koth

Well, and I don’t know if there’s a correlation, but I am really curious of whether or not tightness in the iliacus is a cause of hip arthritis. You know, I know, many people who have had lots of symptoms in their hips, lots of you know, hip arthritis type pain, who have had their iliacus release feel better, you know, I think the hip fits better into the socket, and it you know, some of that rubbing is eliminated. So, you know, if we all had Happy iliacus muscles, maybe, maybe we would end up with without a hip replacement. Hypothesis worth exploring. That’s for sure,

Iain Barker

Of course, it is. I mean, when you think about the treatments that people have, you know, this particular example, if you could replace hip replacement surgery, with pressure.

Christine Koth

Exactly. Yeah.

Yeah. Here’s a device that costs you know, $140, you can use it for the rest of your life. Yeah, you know, it, you know, released your iliacus every time it gets tight, and you’ve been sitting too long on that airplane. or whatever That’s a much better investment in health care dollars, then, you know,

Iain Barker

well, yeah. Not just that, you know, the person, the individual. It’s got to be a better, better treatment option. Yes.

Christine Koth

Yeah, exactly. Yeah.

Iain Barker

So was there anything else from from that? That part of your book that, that we would need to cover or move on to the soften the hip to solve your pain bit?

Christine Koth

Well, I guess I just would want to mention to that with that rotation of the pelvis forward and changing the orientation of where the ball fits into its socket. Yeah. I think that, you know, it’s really important to understand how that changes the mechanics of the leg. Yeah, well, that causes that rotation of that leg, inwards strains the knee and the inside of the knee compresses the knee on the outside. Also, more pronation more flat foot on that side, and also lead to more Bunion on that side.

Iain Barker

Yeah, Bunion, this is where the toe kind of points in, isn’t it? Exactly. Yeah. big toe points into the other toes. Yeah.

Christine Koth

Yeah. So you know, really, you may not know that your hip tightness is causing these things. Maybe your symptom is plantar fasciitis or knee pain. Yeah. But if you’re noticing that one of your legs is different than the other in this way, it’s worth investigating whether the tight hip is part of what’s contributing to that.

Iain Barker

Well, certainly, isn’t it? Yeah. Kind of, if you were to have one or more of those problems, that would be a bit of a health disaster, wouldn’t it? You could perhaps fix fairly easily.

Christine Koth

Exactly. Yeah. And this is what I’ve seen in my practice. And this is why I ended up writing this book, because there was this pattern that just continued to show show itself. People come in, they’ve been they’ve tried all these different practitioners, they’ve done all these things. Nothing has worked. And when I assess them, like, okay, their quad strength is good. They’re their core, they’ve been working on their core, they’ve been, you know, going to the chiropractor, they’ve been, you know, doing their physical therapy exercises. And, you know, all these ducks are in a row, except they’re still having pain. Yeah, well, is missing. And, you know, these people who have done everything, yeah. So many times have come to me and found that, you know, really, it’s the missing link has been iliacus.

Iain Barker

Yeah. So you, you have a quiz in the book, whereby the reader can decide whether they actually do have a tight iliacus. Mm hmm. Although it seems fairly complicated, I’m not sure. I’m not sure it’s something we could. So can we give an overview of it now? Or is it something you’d have to read in a book?

Christine Koth

Well, there’s certain signs that are that are commonly associated with tightness in the iliacus. And I’ll just give a couple examples. Please do Yeah. Great. You know, so for example, if you are lying on your back and you bring your knee up to your chest and you feel a little bit of a pinch inside your groin or in your hip. Yeah, that is a sign that your pelvis is possibly rotated, especially if you feel it on one side and not the other. Okay? Another example would be If you are lying on your back and you have one leg up in the air and you go to lower it down to the ground and you feel pop or click in your hip, often, that is a indication that there’s tension that muscle is slipping over the bone or the orientation of the hip joint is, is creating that pop. Okay, that’s another kind of test that you can do. Some of the symptoms that we mentioned, you know, earlier, when we’re talking about what happens when the pelvis gets rotated, whether you have SI joint pain on one side, you have low back pain on one side, knee pain, bottom of the foot pain, Bunion, knee pain, all of those things are indications of posture, the hip is possibly involved. You know, another thing that sometimes isn’t super easy to figure out in yourself, but if you have a practitioner to look at, when you go from lying down to sitting up, if one leg gets shorter, when you go from lying down to sitting up, that is an indication it’s a very strong indication of a of an anterior rotation, which would be caused by tight iliacus.

Iain Barker

Yeah, that makes sense. Yeah. That would be quite hard to spot on yourself, wouldn’t it? Yeah.

Christine Koth

Yeah. You can cut if it’s pretty if it’s a drastic imbalance, you can see it, you know, you see, okay, well, one leg is shorter. But oftentimes, you need someone kind of looking at your

Iain Barker

Yeah.

Your head’s in the wrong place where it isn’t it.

Christine Koth

So these are all, you know, examples of things that would be indicators that potentially this is a problem. Yeah, you know, groin pain, when you’re like when maybe when you are sitting for a long period of time, and you go to sit up, stand up, and you feel it a little bit in your hip? Yep. Take a few steps before you feel normal. That’s another indicator. Yeah, that makes sense. Yeah.

Iain Barker

And so having done the quiz, and decided, Okay, I think I do have a tight iliacus. So then you mentioned three steps that you can take to kind of approach that problem.

Christine Koth

Yes. You know, I’m all like I said earlier, I’m all about efficiency, like, I want you to get the absolute most important things done, and, you know, take away all the fluff, take away all the extra things. And that’s why I broke it down into these, these three steps, these three things are the most essential pieces of the puzzle. And without doing all three, the results, you know, are not going to happen. Or if you choose to, you know, these, just these three things are really, really important. Yeah, the first thing is to release the front of the hip. And this is what we talked about releasing the iliacus. Yeah, in the book, I give three ways to do that, you can use the hip hook, which will be available in a few months, and you can pre order soon. Okay, you could also use a three and a half inch to four inch ball. Now this is not as effective as a hip hook because they can’t put pressure in towards iliacus. But indirectly by pulling on the fascia does do does release a little bit of the psoas an iliacus, so it’s definitely if you don’t have the hip hook, or you don’t have access to that it’s still an effective tool and will give you a good a good amount of relief. Yeah. And then the other option would be to have someone do it, release it for you. So whether you take your book, you know, into your physical therapist, or your massage therapist or chiropractor and say, Can you do this technique on me? That’s one suggestion. I also, you know, have had many people use their partners or friends or, you know, people that could, you know, come over and, and deliver that technique

Iain Barker

to so you can’t do your own fingers on your own person.

Christine Koth

You know, you can’t really because it’s awkward, you know, you have to put Yeah, okay. Yeah. And inside your pelvis, you can get at it a little bit. But yeah, you can tired pretty quick, because you’re not Yeah, you don’t have the right leverage. The right Yeah, well, it’s definitely worth poking in there, you know.

Iain Barker

But so as a lay person, then say, if you wanted to get your partner to do it, it could would they be able to find it with with their, with their fingers and put pressure on it?

Christine Koth

Yeah. Well, part of it is, you know, it’s a communication between you as the person receiving the treatment and the person delivering the treatment, right. So, I talked about in the book, you know, you Okay, on the front of the pelvis, and you know, if you put your hands on your hips and you have your fingertips at the tip of your pelvis the front of your pelvic bone. Yeah, that bony prominences sticks out. Yes. Yeah, that’s your as is it’s called. And inside that right inside that bone is where the iliac is lives. Yeah. So that is right where you want to be pressing and if

Transcribed by https://otter.ai

 

THANKS FOR LISTENING

 

Thanks for joining me for episode 42 of the Back Pain Liberation Podcast.

More from author of Tight Hip Twisted Core and inventor of the ‘Hip Hook’, Christine Koth

If you find the show helpful don’t forget to rate, review and share with anyone else you know who has back problems.

All the best

Iain

Music courtesy: Jahzzar www.betterwithmusic.com/

Photos by Ricardo Gomez Angel and David Pennington on Unsplash

This website is for your information only. Consult your own doctor for medical advice.

Any guests express their own views and no endorsement  by the Back Pain Liberation Podcast is implied.

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Music courtesy: Jahzzar www.betterwithmusic.com/

Photos by Ricardo Gomez Angel and David Pennington on Unsplash

This website is for your information only. Consult your own doctor for medical advice.

Any guests express their own views and no endorsement  by the Back Pain Liberation Podcast is implied.

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