EFR 888: Sciatica and Back Pain Myths, plus How to Strengthen & Pain-Proof Your Back At Any Age with Grant Elliott

00:00 - Chase (Host) The following is an Operation Podcast production. You believe, quote everything we've been told about back pain is completely wrong.

00:08 - Grant (Guest) Why I could go on for days about all the myths that are still pushed and still mainstream, and not only the entire health space, the back pain space as a whole, but largely, to summarize this, what everyone's basically told with back pain is just that Rest it. This is a cause for concern. You'll likely need surgery. Don't load your spine. If you put weight on your back, it just means you're compressing your discs over time and then there's going to be nothing there and then it's bone on bone and literally none of that is true. Yeah, those are the main reasons why movement just makes us feel better and for any musculoskeletal injury, but primarily low back pain, we want to continue to explore as much movement as we can within our capabilities, Because back pain is a movement-based problem and it needs a movement-based solution. Hi everyone, my name is Dr Grant Elliott, founder of RehabFix. Welcome to EverForward Radio.

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02:48 - Grant (Guest) Well, the first thing I'm going to latch onto is saying what qualifies someone to do anything is the results that they can produce. Nothing on paper qualifies anyone of anything uh, the results and having a massive proof of evidence that they can accomplish what they say they can. Nothing qualifies anyone more than that does.

03:08 - Chase (Host) Have you been asked that question before? That just rolled off so easily. That was so-. I'm just good baby.

03:11 - Grant (Guest) I live and breathe this stuff, but that's what I believe. That's what I believe. So regards to back pain and why they should listen to me regarding this, Well, back pain is the number one disability in the world. When I was in high school, I had back pain, went to a traditional old school Cairo that totally failed me. That was inspired by meeting a good Cairo that actually helped teach people how to fix themselves. So I said that's what I want to do. I want to be one of the good guys. So then spent a bunch of time, a bunch of money, to be the best I possibly could, and then invested even more time, even more money into growing the biggest audience that I can. And now I have over 3 million followers dedicated just to helping people with back pain and we're the number one online program in the world. So I guess that's my pitch.

03:49 - Chase (Host) And 30 seconds. Perfect, exactly. All right, man. So before we get into how to fix back pain, let's talk about what got us there in the first place. What do you think is the biggest modern contributing factor to humans injuring their backs and or developing chronic back pain?

04:03 - Grant (Guest) That's a really big question and I'll answer as concisely as I can. There is not one singular thing that results in back pain. 90% of low back pain is deemed nonspecific, meaning you cannot trace it back to one specific origin.

04:20 - Chase (Host) Not like an acute injury or something like that.

04:22 - Grant (Guest) Well, not necessarily. There might be an acute incident where that person's back pain began, but that doesn't mean that that was the only thing that contributed to it. So here's my example. I was just talking to someone the other day and they said I ruptured my disc at the end of a flight, long flight. I got up out of my seat, I felt a pop pain shooting down my leg very classic presentation. So the plane ride, that was when I did it and the response is that's when the injury manifested, that's when you felt it, that's when the pain began.

04:55 But it's impossible to say that that is what caused it. More than likely this was developing in the background over time due to a combination of multiple things, mainly tracking back to poor movement, not enough good movement, too much bad movement, then potentially additional stressors in one's life, whether it's work, stress, emotional stress, relationship stress, social stress, poor diet, poor sleep. These things can stack and stack and build, and then that incident on the plane could have been the straw that broke the camel's back. So yes, literally.

05:30 So back pain and pain in general is multifactorial. There's many, many different layers of pain because pain is an experience. So there isn't any one thing but to still provide a comprehensive answer. What is the main contributor? The only answer I could possibly provide is not enough movement, and not enough movement in variable ways, meaning multiple different ways. Too many people moving within certain ranges, not exploring more ranges, and you're going to be susceptible to injury in ranges that you don't expose your body to. So not enough movement, not movement in enough ways, and then poor belief systems regarding pain and back pain Belief systems.

06:13 - Chase (Host) You wouldn't really expect somebody to talk about belief systems when we're talking about back pain, a mental component to a physical ailment physical ailment.

06:30 - Grant (Guest) Yep, where does that one come from, huge? This is probably more important than any of the physical, mechanical strength mobility components. Largely, the reason most of the time individuals find themselves in chronic pain is not because the injury is not healing, but because their mind and their nervous system that has learned that injury is not healing, but because their mind and their nervous system that has learned that injury is not healing, huge. I'm not saying the pain is in your head, I'm not saying that all pain is real, but all pain is created in the brain. So what I mean is if, let's say, the last 20 years, any association I've ever had with the word back pain has been incredibly scary, incredibly negative. Oh, my aunt, she had back pain and she's been in a with a Walker for 20 years. Oh, my cousin, he, you know, bulged a disc and I heard that his doctor said you can't ever heal, that it's not possible. Uh, this is it for the rest of your life.

07:24 And I have all these negative associations with back pain, which is true. That's the societal narrative and the medical narrative of back pain. So now that establishes my belief system. So then let's say we've all slept wrong before. We've all woken up with a kink in your neck or your shoulder, weird, your hand a little bit numb, let's say. You sleep a little funky and your little back's a little sore. If that was your elbow, hey, I woke up with a little elbow pain. Oh, I don't care, I'll go on with the rest of my day. I'm sure it'll be gone.

07:54 But that same scenario happens with their back and their belief system is oh my gosh, this is a death sentence. Because of everything I've known regarding back pain. What does that do psychologically? It screws you psychologically. So now you believe I hurt my back, something is damaged, something is injured. This won't heal. I'm probably going to go on disability, I'm probably going to need surgery. You start spiraling into this mental panic, catastrophizing yeah, absolutely catastrophizing, that's the appropriate word. And then you find yourself in vastly more pain than you ever would have been, in rushing to imaging prematurely, rushing to injections prematurely, when in reality, if you had a proper belief system, hey, I felt some pain, but I didn't have an extreme motor vehicle accident yesterday. I didn't get in a hit, I'm not wounded. I just woke up with this, I'm probably going to be fine. And you forgot about it and you went out with your day. Normally that would probably be gone within 24 to 48 hours.

08:57 - Chase (Host) But isn't it just something unique about back pain that gets people? If I wake up and I've got elbow pain, yeah, more likely than not, I'm kind of just going out of my elbow, but with back pain it's just immediate, Like it get in our way more of our day. Why are we so less likely to want to endure or renegotiate that relationship to back pain than any other kind of pain?

09:20 - Grant (Guest) Although I drew a parallel between waking up with elbow pain and not being concerned, but waking up with back pain and being concerned although I still stand firm to the parallel that if one doesn't worry you, then the other one shouldn't I don't want to discount the very true reality that back pain affects you more than elbow pain. If my elbow hurts, just as the simple example, I can use my other arm. It's not a big deal. If your low back hurts, you use your low back for everything.

09:46 - Chase (Host) I can't use my other back.

09:48 - Grant (Guest) Yeah, you use your low back for absolutely everything, so I'm not dismissing the fact that it is absolutely a greater impact on your life. There's nothing you use more than your lower back, so that is why low back pain is the number one disability in the world and perpetuates into these cycles. So that is a factual component for sure. But there's just more of these beliefs, belief systems and connotations and poor education surrounding it.

10:10 - Chase (Host) I've heard you say that you believe quote everything we've been told about back pain is completely wrong.

10:16 - Grant (Guest) Why? Yeah, I could go on for days about all the myths that are still pushed and still mainstream, and not only the entire health space, the back pain space as a whole, but largely, to summarize this, what everyone's basically told with back pain is just that Rest it. This is a cause for concern. You'll likely need surgery. Don't load your spine. If you put weight on your back, it just means you're compressing your discs over time and then there's going to be nothing there and then it's bone on bone, and literally none of that is true, but that is 99.9% of what's circulated in healthcare. So that's the quick blast of the most important concepts.

10:59 - Chase (Host) Why back pain? What, what? What about back pain? You said you had it, uh, in high school, I think it was. But you know what about back pain that made you just kind of go like this is the hill I will die on.

11:08 - Grant (Guest) Yeah, so a little bit of a backstory there. Um, I was a competitive cross country mountain biker. I loved it, I was good at it, I was climbing the ranks very quickly, I had scholarship opportunities to get school paid for. And then my last year, the most important year I started getting back pain because my races got more intense for longer and I didn't know what to do. And so we went to just oh, just go to a chiropractor. Right, they're the number one source to help with back pain, which is true, they're the most trained in back pain. Um, but who we saw was just a I didn't know this at the time a more traditional old school. So x-rays first. Your spine's crooked. We need to see you three times a week until your spine's straight again.

11:50 - Chase (Host) And uh obviously quick snap crackle pop here yeah.

11:53 - Grant (Guest) Obviously, at the time I did not know cookie cutter kind of treatment.

11:56 Absolutely, and I'm young and my dad didn't know any better. And so that's what we did and nothing changed. And then my races got worse and worse and worse, so that I stopped racing, lost my scholarship opportunities. And well, what do I do with my drive? So I said I'll just get into working out.

12:10 So I just got to the gym working out, saw someone there warming up one day. He's doing some cool warmup movements, some cool like mobility movements. What's that about? Stroke a conversation? He's a chiropractor. What you him? He's a chiropractor where you're doing completely different than, like my association. Can I shout at you? Shout at him. This is sick.

12:31 You're doing rehab, teaching people how to fix themselves. I didn't know that this is what it should be. So that experience with back pain myself is there's a personal component to it. But then the second layer of that is, as I was going through school, um, I realized and this is back in 2017, I realized I need to post on social media. I haven't graduated yet, but I know that I need a digital portfolio so that wherever I go, I have some degree of evidence of this is what I'm about. This is my mission. These are all the different things I'm into to have immediate authority. So I just started posting on social media like once a week and started growing a little bit. And I'm someone who's addicted to growth. I love to work, I'm addicted to hard things. I just want growth. It doesn't matter what it is Like. If I'm going to mow my lawn, I want it to be the best cut.

13:17 - Chase (Host) I'm going to do it the best way, yeah.

13:20 - Grant (Guest) So I had no intention of creating an online program, making any money online zero intention. My only goal was just to have a portfolio. But then, when it started growing, my number one mission just became let me just see how many posts I can make, let me see how good I can make them, let me see how many views I can get, how many followers I can get for no end goal other than just that, just kind of like gamifying it for yourself. Let me, yeah, just let me see followers I can get for no end goal other than just that.

13:45 - Chase (Host) It's kind of like gamifying it for yourself. Let me, yeah, just let me see how.

13:47 - Grant (Guest) I can grow this. So I started posting about um a little over halfway through school. So I posted more and more and more and more. And then I listened to a podcast that said hey, if you want to, if you really want to grow your social media, you got to post every single day.

14:00 - Chase (Host) I was like okay, it's like Gary Vee by chance, it was not Gary, it was not Gary but he for sure resonates with that.

14:11 - Grant (Guest) So I said, okay, and even though in Cairo school we have anywhere from 35 to 45 credit hours per trimester very heavy load If we can remember back to college, it's usually 15 credit hours as a normal schedule. So we were at 35 to 45 is pretty stacked. I was like, all right, I'm going to film something, I'm going to edit something, I'm going to post something every day, and I said I'm going to do that for the next year. So I did that for a year straight, had over a hundred thousand followers before I graduated, and then I started seeing the types of videos that were getting the most traction, the types of questions I was getting the most, and it was always back pain, my low back pain posts, my sciatica posts, my disc herniation posts were always the highest views, the highest questions, everything I was like.

14:53 Well, I'm super good at helping people with back pain and this is what my audience is already telling me I should gear towards. So once I started understanding that I that creating an online program, that helping people digitally, even existed, then I started to learn more about business and systems and processes and I said, okay, this is going to be very difficult to help as many people as I can. If I'm a mixture of all these things, yeah, I need to. I need to pick something. I'm the best in the world of back pain, so I'm going to be that damn. All right, that's what I went to. All right, I'm the best in the world at back pain, so I'm going to be that and that's what I went to All right man.

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16:28 I've been rocking state and Liberty for years, whether that's a casual jacket, t-shirts, more formal wear I actually have two of their tuxedos Anytime I'm a groomsman or going to a wedding. I look my best, feel my best and I'm not sweating through it Like I know a lot of the other guys are. State Liberty is built for athletes made to perform. Stateandlibertycom checkout code EVERFORWARD 00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00,00. Pain. I feel like when we talk about back pain it's always low, is there for sure?

17:22 - Grant (Guest) Mid back, high back, and why?

17:23 - Chase (Host) low back. Is it so popular?

17:24 - Grant (Guest) Yeah, cause it's just the main leverage point of your body. Once again, like you sit, what's the, what's the main focal point? The leverage point? It's, it's the low back. You bend over to pick something up. You bend over to pick something up, it's the low back. That's the main lever arm because it's directly to your hips. You hinge through your hips, so the low back is the primary, really lever arm. So yes, of course there's mid back pain, there's neck pain. Neck pain's very common as well, but low back pain number one disability in the world. 80% of people alive will experience low back pain at some point in their life.

17:53 - Chase (Host) It sucks. I've been in and out of it a lot my life. It sucks. I've been in and out of it a lot my life. Uh, it's like when you have it you just want to get out of it, and when you're out of it you never want to have it again. Yeah, it's awful. I've heard you talk about weak glutes as being one of the myths to back pain, and I see a lot of people talk about you know we need, in order to get rid of back pain or strengthen your back, we got to work everything else around it and look at you know all the other muscle groups coming right up there. We'll see bridges, we'll see hip thrusters, glute thrusters, all this stuff. Are we wasting our time there, or are weak glutes really a thing when it comes to low back pain?

18:26 - Grant (Guest) Not wasting your time focusing on the wrong thing. Weak glutes are a myth because there's no evidence to substantiate this. So whenever I can answer a question without my personal opinion, I always will. So, instead of me forming my own opinion, to tell you how about I look at the hundreds and thousands of evidence-backed research papers to do the talking for me, because that's much more credible than what comes out of my mouth. So if we look at the current evidence, there's no substantiated research to support weak glutes cause back pain. A lot of people like that concept because people love a very mechanistic explanation of low back pain. So people like the the reason for your back pain is weak glutes. Okay, so the only thing I need to do is strengthen my glutes and I'm done. And then I do 10,000 glute bridges and their back still hurts, or?

19:20 - Chase (Host) we got a great button now. Yeah, yeah.

19:21 - Grant (Guest) Yeah, we glued our tight tight hip flexor. These are very, very basic, very superficial explanations for why someone would have back pain, when early in the show I gave you the response what causes back pain? There's so many layers and so to discount all of that, like I'm going on a bit of a tangent here I know shorter answers are usually better for snippets- and things like that Podcast, but along for that yeah, it's all good.

19:43 But let's say someone comes to me and they're depressed. They know 10 people who had back pain and surgeries. So they have a terrible belief system around it. They're in an abusive relationship, they hate their job, they're deconditioned, they haven't moved for 10 years. They've been told not to move. They're afraid to move.

20:02 That person comes to me and I go oh, cause, your glutes are weak. I'm completely dismissing and undercutting what's truly going to make the difference in that person's life and pain. It's. It's so disrespectful to what we know to be true about treating someone with pain as an entity. So to just undercut all of that and go well, my mechanistic explanations are you, you have weak glutes and so all right. Well, anyone who isn't working out is going to have weaker glutes. It doesn't make any sense. And we'll get elite level power lifters, elite level CrossFitters who come to us and like yeah, I've been in PT for six months. Okay, what have you been doing? Yeah, they told me, my core is weak and glutes weak. Don't you squat 500 pounds? Yeah, you don't have a weak core or weak glutes.

20:51 - Chase (Host) But what do weak glutes? What does that even mean? What does that look like? What does that feel like? How can we even go? Yeah, you have weak glutes. I don't know what's the test for that. I don't know, I don't know, chase. So, realistically, is there a testing to determine that?

21:10 - Grant (Guest) from an individual from one side to the other. Yeah, you can test that. You're like looking at which muscle groups are firing versus not. Okay. And I said, okay, give me equal pressure. So I pushed down on one. I felt the strength of one bicep. I pushed down on the other. That could give me a determination within you If you have one arm stronger than the other. But there's no way for me to just determine like I don't have a control to compare it to. So could you test one person's right glute versus left or right glute med versus left and determine if one side is is weaker than the other? Yes, but pain causes weakness too.

21:39 - Chase (Host) Yeah, yeah, exactly yeah.

21:41 - Grant (Guest) Someone had back pain on the right side and then you did a strength test on my right leg and I'm afraid of doing anything with my right side. I'm afraid of flexing my glute, I'm afraid of flexing my low back because it hurts. Then that glutes not going to fire, purely from a nervous system level. My brain's going to go don't fire this, like we're trying to avoid loading this area, so it's going to seem weaker. So then let's say for that person you say, all right, we're going to do glute bridges. And I've been afraid to do any exercises for six months. Now I feel comforted. I've been told that there is a movement I can do safely.

22:16 - Chase (Host) I believe this is the solution.

22:17 - Grant (Guest) I believe this is the solution and I also have not been moving. So now you give me something and you've instilled belief in me that this is the solution. That also gets me moving. So then I feel better and then I go oh, it's because my glutes were weak. When that's not it. It's because you established a positive belief system towards movement. That's what made me better, Not because my glutes are magically stronger.

22:42 - Chase (Host) That's so well said, man. That's so I mean. The power of belief is truly like immeasurable. I mean, especially when you look at things like the placebo effect, when we look at, um, phantom limb pain people who, like you're missing an arm, but then all of a sudden, you put like a mirror down next to it and the brain sees another, or your arm is there and you believe what you see, right, and then all of a sudden, your pain goes away.

23:03 - Grant (Guest) Yeah, you're, you're. You've brought up good words and good examples. You're educated on this topic.

23:08 - Chase (Host) Yeah, it's been a minute, I've been out of clinic for a minute, but you know I've been there and not just from like oh I'm sore from this plane ride, kind of thing. But you know when you're in it you will do anything you can to get out of it. Yeah, and that means developing, in my experience at least, a better understanding of what's really going on so that you can almost kind of cheat the system and your brain being the system. Yep, belief will take you anywhere man, belief will take you anywhere. Tight hips it definitely can contribute to low back limitations, right, low back pain.

23:49 - Grant (Guest) walk us through the correlation and or causation of tight hips and back pain easiest way I can connect this for everyone listening is uh, imagine if you were trying to squat in the tightest pants, uh, the tightest leather jeans that have no elasticity to them. It's not going to work, so something's going to have to give you can. You can envision that feeling of wearing like these really tight jeans that don't move at all. You'll total, squat down. You can just tell like you're going to be going up on your toes, your back's going to be rounding a whole bunch. You're going to have to find other areas in your body to be able to do it. That's the same concept of having tight hips. That's what it is restricting.

24:26 So a way that I like to phrase it is the low back and the hips. They're like best friends. If one's a little cranky and upset, then the other one starts to get too. But if one's happy, then, generally speaking, the other one can be happy too. They kind of kind of be together. So if your hips are not moving optimally, then that will carry over to the forces that are placed on your lower back too. Hence the example of the tight jeans. So if I'm someone who's really passionate about fitness and exercising or running or whatever it is, um, and I'm performing tasks where I need adequate hip mobility to perform them proficiently, but I don't have adequate hip mobility, then there's going to be non-preferred forces that are repetitively done on my lower back over time, which then can develop to something later. So if one area is not moving well, then the other area has to overcompensate, which is the low back.

25:22 - Chase (Host) Tight hips. Just the word alone, tight, makes me think. I'm sure a lot of people would think if they're tight, I just need to loosen them up. So how do we loosen up tight hips?

25:31 - Grant (Guest) Yeah, so there's. I post a lot of exercises showing hip specific movements to do. How do you loosen up tight hips? Well, through various movements. Two main categories would be a, I would say, mobility. Some people use the word stretch and there's connotations for stretch. Some people say everything I post is stretches and that's fine. I don't technically show stretches, I technically post mobility exercises. So when you say stretch, most people think like static movements, like no hurdle stretch or whatever. Not the case. So there's going to be a mobility category and then you should first have a strengthening category. So a good one is actually this is great.

26:08 Hip flexors oh, my hip flexors always tight. A tight muscle is commonly a weak muscle because if your nervous system once again can tell this does not have good stability, it doesn't allow that region to move more, it tells it to move less because it doesn't want you to go out of its range of control. So when I post videos showing to to strengthen your hip flexors more than you're stretching them, I get all these comments that's going to make it tighter. When you strengthen muscle, it gets tighter. Not true at all.

26:35 Evidence is the. When you strengthen muscle, it gets tighter. Not true at all. Evidence is the opposite when you strengthen a muscle, it gets looser, so that goes the same for other regions of the hip too. So we should be performing mobility movements that help the hip explore all of its ranges of motion. So just think what are the directions it can go. It can go forward, it can go back, it can go out, it can go in and it can rotate. So you want to perform any and all movements that explore the entire motion of the hip and then also strengthening movements that explore every motion and rotation of the hip. That's going to expand the ability, the range that it has, and then strengthening it, loading the joint and loading the tissue will then maintain your ability to stay within that range.

27:20 - Chase (Host) Let's talk about also, for a second, working through and despite being in pain. What I mean by that is a lot of times I've been in pain it's my back, I have back pain, I've hit pain, whatever. Uh, and I will do. Let's say you know, I have back pain, I have hip pain, whatever.

27:39 - Grant (Guest) And I will do.

27:39 - Chase (Host) Let's say a back squat or a deadlift and I will feel better after that. What is going on there? How can I work out something that is currently causing me pain, specifically targeting that area In this example, strength training, load-bearing exercises that actually then makes me feel better afterwards.

27:56 - Grant (Guest) Yeah, actually, I would say three. I'd say three main things there. One of them my memory will not serve to me sound like an expert on this, but one is movement. Exercise in general produces anti-inflammatory mediators. Your body will reduce inflammation as a result of exercise. Now you might think, okay, if you develop a sore muscle, you break down tissue, then that creates inflammation within the tissue. Yes, but systemically your body releases anti-inflammatory cytokines Cytokines, yeah, yeah, that reduce that as a whole.

28:27 So that alone is healing. Getting blood flow and more fluid through the region is healing. But then also going back to, hey, I'm moving is healing. But then also going back to, hey, I'm moving, okay, I'm doing this thing that I thought I was going to be afraid of, but I'm doing it, I'm feeling okay. There's a mental component to it as well. So, yeah, those are the main reasons why movement just makes us feel better. And for any musculoskeletal injury, but primarily low back pain, we want to continue to explore as much movement as we can with our capabilities, because back pain is a movement-based problem and it needs a movement-based solution. So almost everyone feels better.

29:00 - Chase (Host) Moving movement's a part of the solution yeah, part of the world of back pain that I really saw got flipped on its head over the years was like when I was going through injuries and rehabilitation it was if you're in pain, don't do anything, rest, recover, immobilize, you know rice basically Nowadays, and over the years it's like okay, whatever you can do that doesn't cause more pain or can at least keep that pain consistent, then you're good to go. Why this differentiation? And why are we now saying actually, if you can work through pain and it doesn't make it worse, then you're actually doing your body a service.

29:34 - Grant (Guest) Yeah, so the rice guy actually attempted to redact those statements a few years later, but that was not published and you know circulating but rice itself still is, which has its place-ish.

29:48 - Chase (Host) Maybe not for back pain, but yeah, not for back pain for very specific injuries.

29:53 - Grant (Guest) But what does the evidence show? I always go back to the evidence when I can and pull my opinion out of it. The evidence is very clear that rest is not good for low back pain. It is not good. It chronifies pain, it creates fear, avoidance behaviors, it delays healing, it reduces the rate of recovery All negatives. Now, of course, could someone in the comment section find one specific reason why rest could be a good thing for one situation? Duh, but we're talking about the masses. Generally speaking, rest is not good for low back pain. And then, when they started actually encouraging more movement for all the reasons I stated earlier, so wow, all of a sudden, rate of recovery is significantly improved. And then we're actually finding these scientific explanations for that.

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31:23 All right, let me get to the free part. I know you like Chase. Just tell me how to get the goods. So they're hooking it up to give you a multi-day sample pack of their gummies. All you have to do is head to timelinecom slash ever forward sample to get your free three day sample pack. That's T I M E L I N Ecom slash ever forward sample to get the goods. To highlight the importance of continuing to always look at the science Um, I mean, how many times in the exercise, fitness, wellness, nutrition world do we say that this is God's honest truth of what works for the human body and then, 10 years later, it's like oh, actually it's a complete opposite kind of thing.

32:03 - Grant (Guest) Yeah.

32:03 - Chase (Host) Yeah, and just to clarify Rice, for those of you who don't know rest, ice compression elevation Yep, right, okay, it's been a little minute, but you keep bringing up fear.

32:14 You keep bringing up you know that this, you know belief system approach and I really want the listener to hone in on that, because I think this is probably the trickiest part for somebody to get on board with. It'd be easy for me to have low back pain, have an injury, and I go to you, or I go to my doctor or my therapist or whoever a trusted resource, trusted resource and it's like, okay, I trust this person and they're going to give me the plan to execute, but it's the fear that is keeping me from actually taking action. I don't know your doctor, but I bet the doctor's not going to go through a fear counseling program or they're not going to walk you through like getting over it or like how to develop the courage or the mental fortitude to actually take action on this thing. They know it was going to work for you. How do we actually work through fear before we can start taking physical action?

33:01 - Grant (Guest) So the doctor should be doing that. But that doesn't mean that your first appointment should be all about addressing your mindset and fear, because the majority of individuals truly won't resonate with that Because, hey, I hurt my back, give me the exercises for my back and we do that. But we integrate mindset, fear, pain education into the program as a collective piece of it. You need to have both. So I want to make sure I'm clear in this stance that, although I've talked a lot about fear and mindset, that's not the only thing that causes pain. There absolutely can be a mechanistic reason for it, so sure. So the example I gave of the last person I talked to on the plane like okay for that person, I analyze their lifestyle. They're just doing tons of flexion all the time. They're sitting all day. They're doing forward-based movements. They're not doing any movements to counteract that stress. So did we give them a very structured exercise, movement-based plan to fix the disc, reduce the disc, get it off the nerve, get their mobility back? Absolutely, but it's not a matter of like if someone has a fear or mental component. It's just a matter of how much. Everybody has a component. It's just a matter of how much they have of it and some people have more than others, so it needs to be a component.

34:18 So one simple way that you can help reduce someone's fear while also giving them what they feel they need, which is the exercise, is by helping them find a safe exercise that they're currently capable of doing and simply doing it with them and encouraging them to do it and being that guide, because they're looking for us to be the savior, and we love to be that. But even though they might see a movement on my page, on my thousands of videos, and go, that looks like a great one. I want to try that, but I'm afraid. And then, if we just simply get on a call with them, we say, hey, we're going to do this one because this sounds appropriate for you. Okay, there's my green light to try it. Yeah, you've given me the courage to try this.

35:00 Or or hey, a grant, or whoever's on my staff talking to them hey, is it like okay to walk? Can I do that? Yes, okay, great, like I've been afraid to do so. Can I still go to the gym and do these exercises Actually? Yes, you can continue to do that. Stay within your limits. Oh, my gosh, thanks so much. So simply talking through that with who you deem to be your professional at the time and feeling like you now have the permission and confidence to do that. That's what eliminates the fear. So you need to, you need to give them both. Yeah.

35:29 - Chase (Host) My healthcare, no matter how your skin in it, it has to be both sided. You know both people need to be on board. The participant, the patient, has to be equally invested in the plan as well as the person giving it, or else we're not going to be adherent and we're not going to have this belief system attached to it that we really, truly need for actual healing.

35:48 - Grant (Guest) Yeah, I have absolutely no problem saying this for all of my audience to hear. There are some people that we get out of pain, not because our plan was the right one, not because the exercises we gave them were the perfect ones. They were missing. Not any of that. It's because we were just the best cheerleaders.

36:03 - Chase (Host) Yeah, yeah, you could actually sit there and be a human with them for a moment.

36:06 - Grant (Guest) Yeah, yeah, yeah, just like the movements we gave them and maybe we discovered this after the fact. It's not that, oh, that was the fix and that loosened up that hip flexor and now they're better. It's that they were just afraid to do any movement and we were the first person to give them adequate time as opposed to a two minute GP visit and sit with them and hear their concerns and talk through all these variables that affect pain, understand the movements they were afraid of, and then give them slow steps to be able to do that again. And the next thing they know they don't even realize it. Oh, my gosh, I'm doing this exercise that I was afraid of doing. I feel invigorated with hope now that I can do this, and if we give that to someone, that can be the thing that fixes them, not the exercise itself. So sometimes we're just the best cheerleader.

36:52 - Chase (Host) And that's healing. Like I said, that's that's long lasting, real healing for sure. I want to get to a couple different categories that I go to when I think of of healing um, back pain and like, probably where I think a lot of people go to try to treat it, um, is one of these better than the other?

37:08 - Grant (Guest) basically, okay, rehab or prehab well, that's a tough I would. I would have to say rehab. Why? Because it's very, it's very difficult to have a concrete depictor of of pain and of preventing it, like if we had a solid, concrete solution that, hey, if you do this plan, you keep these movements, you're going to avoid pain, then, like, like, no one would get injured. So if I had to pick one or the other, I would not do rehab because it's there's no solid predictor of pain. But if someone does injure themselves and they don't do rehab, the consequence of that is significantly greater than someone who is not doing prehab. Okay, so if you forced my hand, I would, I would pick that one.

37:58 - Chase (Host) I am this or that? Static stretching or dynamic stretching? Why? Evidence that's it All right? Load bearing exercises versus body weight Load why?

38:11 - Grant (Guest) Because our body is not enough. Yeah, our body's not enough weight.

38:15 - Chase (Host) Go deeper there for me, please. I think a lot of people are hell bent on not doing load bearing, especially when we're dealing with pain and injury. You know why should I consider load bearing for getting out of low back pain?

38:26 - Grant (Guest) Yeah. So you need enough external stimulus to provide a progressive adaptive responses in your body. This is especially more important later in your elite, later in your years, when muscle atrophy and bone mineral density loss are significantly accelerated. So if you've been surviving on just body weight movements, hey, that's great. Some movements better than no movement, some load is better than no load, for sure. But that's not enough to sustain the adequate amount of bone, bone mineral density and muscle mass into your later years that will keep you independent and optimal living. So it's I mean, simply put, it's just it's not enough. Like, going back to evidence, we know that like we need adequate load to stimulate the response in both of these areas.

39:16 - Chase (Host) You kind of just hit on it, but I wanted to ask you this question directly Lifting doesn't damage your spine. Rest does.

39:21 - Grant (Guest) Absolutely yeah. There is no lift that could harm your spine more than resting it, for For sure.

39:29 - Chase (Host) No questions asked Whether we're trying to navigate just daily living or navigating an injury.

39:37 - Grant (Guest) Daily living? Yeah for sure, because if someone said I have an injury, then there could definitely be paths where it's like okay, this scenario would not be appropriate to load right now, like, like okay, we have a 10 millimeter disc bulge. That is symptomatic, that is encroaching on a nerve, like they have severe radiculopathy down the leg. We don't want this to progress. I'm not going to put a squat bar on that guy's back. But yeah, daily living. Once again the evidence couch potatoes. Their spines are way less healthy than the meatheads in the gym who are deadlifting and squatting as much as they can every week.

40:11 - Chase (Host) Let me kind of flip the the fear limitation on its head here. I don't want to say this that example you were just giving of someone with, like, the herniated disc right, and you say you know, with these, you know symptoms. I wouldn't put them under the squat bar. But what if that person knew, like they? Maybe this is a lot of identity, a lot of identity wrapped up under maybe their professional power lifter. Or maybe they just know that I feel my best. I just love the feeling that I get when I'm under the squat bar and I want to get back to that and can I work through those symptoms and through that pain and kind of maybe against the recommendations to go kind of the back door of fear to like I know if I can do this, if I can prove to myself I can do this, and I feel like that's going to empower me to like actually get better If so, yes, doing the thing they want to be able to do will be incredibly empowering and healing.

41:04 - Grant (Guest) But if they have a legitimate injury and they're symptomatic, and let's say they're flexion tolerant, meaning they're still to the point where, hey, when I bend over to put my socks and shoes on, like my low back hurts, I get fire shooting down my leg. But I really want to squat because it would make me feel better, I would say, uh, nah, you gotta at least give me a little bit of time to fix the issue, so then you can safely go back into that full board. If they want to just do something in the gym and they said, hey, if I just have the bar on with like a plate each side, that does not cause me pain, can I do that? I'd say sure, okay, I'd say sure.

41:41 But it would be dumb if there was a legitimate problem that I could resolve and I said, okay, okay, instead of me actually giving you the right exercises and the right steps to fix that, just go squat until you feel more confident. Yeah, that'd be very negligent. So in that example I'd say, all right, if there's a certain amount that you can do, that you feel okay, do that within moderation, don't go overboard. But let's actually just fix your back, let's fix your disc, let's get it off the nerve and then slowly grade you back in. So then you know you can be a hundred percent confident in that, because you're actually recovered even better yeah, yeah, absolutely.

42:15 - Chase (Host) Another thing that comes up when we're looking at back pain, and especially low back pain, is sciatica, and I saw you have this quote on one of your posts about how sciatica is not forever. It's a symptom of low back issue. It's a symptom of a low back issue, not a leg problem. Can you explain more there please?

42:30 - Grant (Guest) Yep. So sciatica is a general term that's defined as pain rating on the back of the leg following the track of the sciatic nerve. Your sciatic nerve is the biggest nerve in your body, with a diameter of up to two centimeters, and it is comprised of the nerve roots from your lower back. So when someone has sciatica it's going to represent as pain in their leg, most commonly the glute or hamstring. It can absolutely radiate to the calf or to the foot or toes and cause numbness and tingling, a tight pulling sensation or burning or electric shock like sensation. So when someone feels a tight burning in their hamstring, their instinct is to stretch that. But that can absolutely make it worse. A sensitive nerve does not want to be stretched because being impacted by something.

43:17 So if you imagine a hose, if I put a rock on a hose and I slide the hose back and forth, it's sliding under a rock. That's like a herniation on a disc, herniation on a nerve, and so if you're trying to just stretch the nerve, let me loosen that up because it feels tight. That's what it's doing Instead. Get the rock off the hose and then move it. That should be the process. So if someone has pain in their hamstring and they're stretching it, or they're going to a low quality doc and they're just doing oh, let's do hamstring stretches, let's scrape it, let's needle it, let's use a shock wave on it, let's do all these things on your hamstring. It's it's being referred from the lower back. There's no problem with your hamstring at all. That's just where the pain is located, because if something's going on the back hitting the sciatic nerve, it can radiate anywhere in the leg. That's just where the pain is being referred to damn the body man is.

44:13 - Chase (Host) It is a tricky, fickle thing. Um, we can get better if we just learn how to pay attention to it.

44:17 - Grant (Guest) Absolutely, absolutely and like I want to rewind one short second. When you ask the question of like hey, power lifter, that's their identity, they love it. Like, should they just just work through that? A lot of people phrase questions like that and a lot of people think like that because initially the thought is like okay, do they either do it or don't do it, because they assume that fixing it and getting back to 100% of their goal is not an easy option and it is so.

44:45 So many people who come to us who have been told from their general provider that's not qualified to help with back pain at all, by the way, but that's where everybody goes for back pain. It's like going to a dentist with an eye problem. It makes no sense. They're told yeah, you got to rest, you got to stop exercising, stop running. Some of our clients are told to stop their job because it's too much for them. Yeah, absolutely. Are told to stop their job because it's too much for them. Yeah, absolutely. We've told people who were told to quit their job and go on bed rest for three years because they were 62 and their yeah, their Medicaid would.

45:13 Their Medicare would kick in in three years. Oh my God, yeah, it's. It's wild man. So in in in these options where people are like, okay, do I just do it or don't? It's well, just fix the problem and then you can do it whatever you want. And it's well, just fix the problem and then you can do it whatever you want. Yeah, and it's like what, I can fix this. Like I can get back to squatting 100? Yeah, I can get back to running a marathon. Yeah, just fix it. Some people don't even know that's an option.

45:37 - Chase (Host) What a novel idea, yeah yeah, let's just fix the problem.

45:40 - Grant (Guest) Oh okay, yeah, yeah should I just modify, work around it or stop none of those?

45:45 - Chase (Host) just fix it and then you can do it, which kind of leads me to a point of talking about the spine. You, uh, you bring up how our spine is actually so much stronger than we think, um, and how we've been talking about fear is the enemy of recovery quite a bit. But is our spine really as fragile as a lot of us are led to believe?

46:01 - Grant (Guest) yeah, this is what we started to call the glass back syndrome, where everyone thinks their back is made of glass.

46:06 - Chase (Host) Yeah, glass man.

46:07 - Grant (Guest) Yeah, glass man. Yeah, just the wrong movement, right? Our spine is so freaking strong. There's no area in your body that is more densely packed with connected tissue and bone than your spine. It is so supported Like that thing's, like a steel beam that's just able to move because our body is just designed by our creator so magnificently Like. Your spine is not weak. Your spine is so freaking strong. But it's these perpetuated narratives in the medical system, in society, in your friends and neighbors, that have this sense that you got this glass back and so that's what you believe.

46:42 - Chase (Host) In past experiences. You know we throw our back out because we think it was just a slightly move wrong. No it was like everything else leading up to it.

46:49 - Grant (Guest) Like I said before, yeah, oh, it's so easy for me to throw my back out. No, it's so easy for you to experience pain, but it's extremely difficult for you to throw your back out. That's a difficult thing to do.

46:59 - Chase (Host) What a great rephrase right there. Yeah, that's so good.

47:03 - Grant (Guest) It's huge and these conversations, like a lot of these topics, like I know you've been asking great questions. I know just talking through these questions, this alone is going to help so many people because when we have these conversations with our clients, real time for our consultations around the world, you can see the light bulbs just going off all the time and that alone is like, oh my gosh, like that makes me feel so much better.

47:25 - Chase (Host) Just getting a glimpse of hope alone is enough for people to like, actually, I think, be in less pain If you think you're stuck like this or it's never getting any better, but like someone tells you oh no, actually here's a way that's like a drop in the bucket of hope and that's when your pain begins to start to go away For sure Big time. When we talk about spine, we talk about low back, pain, back. You know everything. I think a lot of people automatically go to posture as well and I know this is another big area that you like to cover and actually you say that perfect posture is over rated, why sitting up straight won't save our back, you say. And the real secret to spine health is how you move, not how you sit. So should we just get rid of perfect posture? Should we get back to slouching? I mean, what's the deal with posture here?

48:10 - Grant (Guest) Yeah, you should throw away perfect posture for good. And my explanation for that is this is I always use my elbows. I talk about elbows a lot, I guess.

48:20 - Chase (Host) I saw a video here. Yeah, okay, so you know, that's where.

48:23 - Grant (Guest) I'm going. So I'm going to do it anyway, cause I haven't done it here.

48:25 - Chase (Host) So if I held my elbow lock straight for eight, hours you guys got to watch the video for this one for sure.

48:30 - Grant (Guest) Yeah. So just envision with me if I, if I had my elbow straight for eight hours, would it feel good or bad, bad, bad. Okay, now I have it bent for eight hours.

48:43 - Chase (Host) Would it feel good, or bad.

48:45 - Grant (Guest) Also bad is no position that I could hold my body in any joint in one position for a prolonged period of time where it would feel good. So now with my back, if I had my back slouched forward, looking like a shrimp, like a banana bad posture. Would that feel good for eight hours? No, because it's bad posture. But wait, if I sit perfectly tall with a lumbar support, with my shoulders back, looking pretty, for eight hours straight, that's going to feel just you also can't keep that up for eight hours.

49:13 No, that's also going to feel bad. So the difference is that the best posture is the one you're in for the next five minutes, cause your body wants movement, it wants fluid to move, it does not want to be stagnant. So the mistake of coaching people on posture is convincing them that something that isn't a problem now is so if someone's experiencing back pain and they have all these other areas in their life that need to be addressed in movements. But now you convince them.

49:43 Oh, the reason for this is because of this superficial explanation. I'm going to give you the mechanistic reason it's because you're not sitting straight. Now they have a new frame belief system I have to sit like a robot in order to feel better. And then they do that for a year and they're not better. And now they believe I can't get better because the reason I had pain was my posture. But I've been focusing on my posture for a year but I'm not better, so I can't heal. So it's. It's focusing people on these just dumb explanations that are not helpful, that are just making them spend all their time and energy into the wrong place. So the best thing to tell people who are obsessed about their posture is to stop obsessing about your posture. Sit however feels good to you. Just move in different positions as much as you can.

50:32 - Chase (Host) That's it the best thing I found from my posture. And who can say posture and not automatically just like try to sit up straight, you just can't not do it. Uh, I love getting horizontal. The best posture for me is being on the floor. Sweet, what's that about? Is there something about getting horizontal that actually is good for the back, other than just maybe just it just feels better to me yeah.

50:55 - Grant (Guest) So the potential reason for that is this is that if you analyze the position that your body is in for the majority of the day, then doing things that are the opposite of that will feel good. There we go that why? So other people might hear your question and go, oh, it's because you're decompressing your spine. That's why you're not decompressing your spine that much when you're laying flat on the ground. But what you are doing is you're getting your spine out of around a position and your hips out of a flex position. So most people listening we sit most of the day.

51:25 There's nothing inherently wrong with sitting. Sitting is not going to break you. Sitting is not the new smoking. Sitting too much and not moving, not exercising. Eating bad is the new smoking, but not sitting itself. You can undo the stresses of sitting with movement breaks, movement snacks and also exercising the recommended amount throughout the week At the gym, at least three, four days a week. Sitting is not going to be a big issue in your life. So, minute amount throughout the week At the gym, at least three, four days a week. Sitting is not going to be a big issue in your life. So likely for you and likely the reason for many others is that when we're sitting, we inherently are going to be in a rounded position most of the time, because that's the direction we're working. Your hips are up, flexed, so that if you get in a position where, oh, I'm no longer in that position, there's going to be a degree of relief with that, absolutely.

52:06 - Chase (Host) Yeah, I want to walk through a couple other modalities that I think are now pretty common for a lot of people, especially if we're exhausting treatment options. I'm in back pain and or I'm in that kind of prehab rehab place and I'm trying to just navigate, avoiding future back pain, or I'm having a flare-up Things like cupping, acupuncture, acupressure, massage therapy. I'm going to throw them out and let me get your take on it in terms of, like treating back pain. Okay, cupping, yeah, man, all right, I recently started cupping. I love it great. It loosens up my low, my low back.

52:42 - Grant (Guest) You should do it your belief.

52:44 - Chase (Host) I had no belief, something going into it. I thought it was freaking weird and I'm like I'm great, I'm gonna have these giant like octopus suction cups on my back for a week or two weeks. I was not trying to have that happen but my therapist was like let's give it a shot. And I was like, all right, cool and I love it. So what's going on with what? Why? Why do you think I love cupping, uh for treating low back pain, and why did someone else not? I don know, just totally personal preference, or is there anything going on really in there?

53:10 - Grant (Guest) Yeah, I have no idea. Maybe for you something is Damn, you got it. I need that hard-hitting answer. I know you want it. So here's okay, let me answer the question for cupping and probably anything else you're going to ask me, or even any evidence based on cupping, yeah yeah.

53:23 So think about it like this Imagine there's a big bubble okay, and that has the solution for back pain. Within that bubble is a small bubble. The small bubble is titled 10% and everything outside of it is 90%. 90% of your plan to resolve back pain is gonna encompass movement, movement, rehab, movement-based solutions. 10% can be focused on passive therapies. So active therapy, passive therapy. The evidence clearly shows that active therapy will outperform passive therapy any day of the week. Am I saying that there is not some degree of efficacy and place for passive therapies? No, I'm saying it's not nearly as important. So if there's someone that has that 90% down and they're looking for an additional layer to stack on it and they resonate with cupping that makes them feel good, they have a good belief with it, then great, okay, then do it. But if the question is framed as an isolated point is this good for this? The answer is meh. If they said, is this a good thing to add to my active therapy routine?

54:37 - Chase (Host) If their active routine is solid and they asked me the question should I add this to it, then I would say sure, okay, it would change the answer yeah I also will say I think any good uh, therapist, trainer, coach will also preface it by saying you know, it depends, and I think if we can choose it, like if it was my choice to explore this modality and it wasn't like him saying, hey, yes, do this and it will solve your problem yeah, we're kind of getting back to the whole belief system aspect yeah, for sure, for sure.

55:03 It helps remove that factor yeah, which reminds me I'm definitely due for a session. Acupuncture slash, acupressure.

55:11 - Grant (Guest) Yeah, there's some pretty good evidence behind acupuncture and dry kneeling. There is, there's a lot of that. I wrote a giant paper on carpal tunnel syndrome and acupuncture.

55:25 - Chase (Host) Yeah there's some solid evidence behind that, some solid results behind that too. Would you ever recommend is there anything that kind of presents with low back pain that you would go? Oh yes, absolutely. You should go get acupuncture, acupressure, dry needling.

55:33 - Grant (Guest) So generally speaking, people who have been in low back pain for longer that have way worse body awareness and control around their lower back. What do you mean by that? So let's take someone who has um, had low back pain for six months. They are movement aware. We're asking them to perform movements with their lower back and hips and they're relatively able to do it from an understanding standpoint. I'm not saying they're able to do it because they don't have any pain. Maybe they're restricted from a pain standpoint, but they understand how to do it and they can move their body the way we want them to. Now let's take someone who's been in pain for three years. They're extremely stiff, both from a physiological and mental standpoint, and we're trying to talk them through movements and they're just like rigid, like I don't know how to do that with my hips. It's hard for me to do that with my low back. They have poor kinesthetic awareness, poor mechanoreception. That is someone who could definitely benefit from acupuncture, because a significant benefit that acupuncture has is not just doing some weird thing in the muscle with the needles, but stimulating the nervous system and what we refer to as cortical mapping, to relearn how to control the area.

56:48 I haven't heard that word in a minute. So the concept here is cortical smudging. So we all have something called a homunculus you might have seen this where there's more nerve endings, more nerve receptors, in certain regions of our body than others, and that's by design. If, going back to movement, if there's an area of your body that you stop moving, then your brain starts to blur that map of it. It gets fuzzy because it's like, okay, we're used to using these joints and using their muscles and now we're not really using any of it. So now we don't really know where these areas are. When that happens, that's cortical smudging. We lose control of these regions of the muscles and of the joints.

57:27 When that happens, our nervous system up-regulates to try to find it. So it's almost like, let's say, I'm using my eyes, I'm using my hands to feel around space. I'm going to adapt to this. Of course, if I close my eyes, then my ears got to go hypersensitive and now I'm feeling a bunch more. If my hearing goes, then I'm very acutely aware of what my hands are feeling. That's what your nervous system does from a pain standpoint when cortical smudging begins. So now, something that normally wouldn't have triggered pain in your low back does, because your nervous system is redlining. So if this is normally the stimulus for those listening, let's say I'm drawing a line along my eyebrows here If this is normally the stimulus that you need to get to, to trip the wire, to experience pain, and let's say for those listening about my chest, so I got a line on my eyebrows, line up my chest.

58:16 He's so thoughtful, everybody, if you have so thoughtful, what will happen if you are not moving an area, you lose control. Cortical smudging begins. That baseline that's around my chest now goes to my jaw line. So now a stimulus where, if I'm down on my chest it would have only bumped me up to here, didn't cause pain. If my baseline is my jaw now, it's triggering pain.

58:38 So what acupuncture does, wrapping about to acupuncture is having those very finite points of sensation and stimulus throughout your lower back. It sends feedback to your brain to begin remapping and understanding where that area is again. So as that blurriness starts to go away, your nervous sensitivity starts to go down and your control of the area starts to go up. And that's why it can be very beneficial for back pain, given that there's an active rehab plan component, because if you start to improve this area, you start to regain that awareness. You need to use the awareness. If you then just go home and lay down and you're still in rest mode, you're going to undo it. So you've got to have that movement-based plan.

59:25 - Chase (Host) I've got to say man've had um acupuncturists and acupressurists and chinese medicine doctors on the show before and I've never heard an explanation as good as that one sick. That was fucking epic, that was.

59:37 - Grant (Guest) That was spot on we're good at what we do, bro, so good man, that was so good.

59:41 - Chase (Host) Um, no shade to any past guests. Of course, maybe they were just cutting it for time, but what about? Foam rolling and I kind of always throw in a lacrosse ball with foam rolling. Maybe that's just how I was taught, but anytime I've worked with you know deep tissue, myofascial, myofascial release therapists or chiropractors I've always had those two kind of thrown together for working through pain foam rolling and lacrosse ball. What place do they hold for low back pain?

01:00:09 - Grant (Guest) yeah, they provide evidence-based answer. They provide a temporary improvement in range of motion but have not been shown to like change any tissue adaptation or movement patterns to be able to be some degree of cure for back pain so why is that?

01:00:26 - Chase (Host) sorry to cut you off, but I think that's just an important concept. We can even ourselves much less go to a therapist or medical provider and we can get improved range of motion and we think that that's improvement. But I'm hearing you say that that's not actually correct. It's just kind of an acute experience and not actual reflection of any real healing going on.

01:00:46 - Grant (Guest) Okay, Well, to to your point. Now. Here's where we have to add a caveat, where if someone does something and then immediately after they see an acute change in the range of motion, does that then stimulus?

01:00:57 - Chase (Host) system.

01:00:57 - Grant (Guest) Yeah, Then does that does that tell them, oh my gosh, I'm better, I'm going to go to the gym now.

01:01:02 - Chase (Host) I didn't think I couldn't move my back that way. Now I can't.

01:01:12 - Grant (Guest) Now I back that way. Now I can, now I can't. And now they go to the gym and now they start exercising in in conquering all of that, start moving their body, regain the mobility, and then they go foam rolling fix me. Yeah, so to that point, could foam rolling have fixed that person's pain?

01:01:18 - Chase (Host) yes, yeah, as much as it pains me to say it, and the belief that I can.

01:01:22 - Grant (Guest) Yes, yes, exactly, exactly. But once again this goes back to more of a passive therapy, like is following my glutes gonna fix chronic back pain and like all these other things associated Direct relationship no, not as a direct relationship. One counter to this is you asked about sciatica earlier. If someone has sciatica and their glute is inflamed and their hamstring is inflamed because the nerve is inflamed, their hamstring is inflamed because the nerve is inflamed that's going through their body. If they use a foam roller or lacrosse ball in those areas nine times out of 10, that will make them worse because you're taking inflamed nerve. That's like just imagine this like hot, like hose. That's like, oh, like we're on fire. We don't like this. The biggest things that nerves do not like are stretch and compression. That they do not like. So if you have a hot nerve going through your leg and you stretch it, no, but now compression, what would putting a lacrosse ball, any object of any kind, directly into the tissue to get where that nerve is irritated, what would that do?

01:02:29 it would create compression on it so that can flare them up so if you got a pinched nerve, compressed nerve, I mean pinching it, compressing it even more exactly, exactly my, yeah, my nervous pinched so I'm gonna get a little cross ball and sit on it and, you know, throw 500 pounds on my back to compress it even more, like not the direction you want to go, so that could potentially flare them up and we hear this a ton that that. Hey, I tried these movements and you're right. Stretching made me worse, fulming made me worse. I think it's sciatica.

01:02:56 - Chase (Host) Bingo. What are some other tools and modalities that you're actually really a fan of right now? Is there anything new, a new tool? New uh rehab rehab tools, or have they, you know, sliced tool? New, uh, rehab rehab tools? Or have they, you know, sliced bread any different way? When it comes to these, these little tools and gadgets.

01:03:12 - Grant (Guest) So, yeah, I'll, I'll be honest and I don't want to be used as a paid endorsement. I probably will be. But in regards to most things that have been out the last you know, 15, 20 years, uh, if you had asked me this question six months ago, I would say no, I would say like it's kind of all the same. It's all that passive therapy category, that 10% category. Once again, to clear this up, anything that's not making you do the work is a passive therapy and that's so low on the total pull. But recently, truthfully, shockwave has really shown some very promising benefits. What's shockwave? Yeah, I'm not the person to ask, because I never. I never use it.

01:03:52 - Chase (Host) Okay I never use it. Is that a brand or is that a it's?

01:03:55 - Grant (Guest) it's think of it like shockwave it's a, it's a modality, it's a tool, that's it's think of it like a pulsing tool on a particular tissue. That is shockwave and um kind of like like some ultrasound therapy sure, that's a that's a great visualization.

01:04:08 Imagine ultrasound therapy they're holding a tool on a body part to treat that part. It's just doing a different treatment approach than uh, than ultrasound, so that's, that's a good connotation. So, uh, I know some really evidence-based providers that would be saying very similar things to me throughout this entire show and they've started to jump on the shockwave bandwagon and they're like yep, there's some things that like movements not helping and this does. So I'm not putting like a complete stamp of like I'll buy a shockwave, cause like we can get people better without that expense for sure.

01:04:40 But if I had to say anything like genuinely, I've been hearing some stuff about that.

01:04:44 - Chase (Host) Well, I think to be honestly about that. Well, thanks for being honest on that. Yeah, for sure, I'm always curious, especially people that are in more of their areas of expertise than me. I'm always curious what are the things that they see that maybe we don't, that we should be looking at? Yep, it all boils down to, I think, for a lot of people, back pain, doing things to not only get out of pain but to get their life back, to get their identity back, but to also avoid surgery back, but to also avoid surgery. Yes, when should we actually be looking at surgery as the proper course of action?

01:05:13 - Grant (Guest) Thank, you for your questions. So there is a clinical criteria for surgery. It's very clear If steps one, two, three are done, then this is a candidate for surgery. But for some reason it seems like a lot of surgeons don't know this the clinical criteria for surgery. It's crazy.

01:05:34 - Chase (Host) I don't know why that is but it seems to be the case. The surgeons, their hammers and everything's a nail.

01:05:39 - Grant (Guest) It's so like we're the one, the conservative people, not all of them. I'm not speaking for everybody, Certainly not. I know the clinical criteria for surgery, but it seems like most surgeons don't. I don't know. That's not supposed to be my specialty as a specialist, but apparently it is.

01:05:55 - Chase (Host) I got to get a surgeon in here. Next time We'll do a follow-up.

01:05:57 - Grant (Guest) My gosh. So let me give you an extreme example, then I'll go through this criteria. So disc herniations very, very, very strong belief in all areas that that has to be cut out in order to be fixed. Massive study in 2020, 280,000 people so large sample size, large population yeah, 280,000 people with lumbar disc herniations 97% fully resolved no surgery, 97%. That's huge. Then the question is how many people do you think every year are referred to surgery?

01:06:33 - Chase (Host) 97%, yeah, 97%, a lot more than three Same stat, but different group yeah, completely flipped.

01:06:39 - Grant (Guest) So back pain in general, highly recoverable Surgery can be avoided for sure. Disc herniations, something that has a high association with surgery 97% recovery rate, wild. So when is surgery needed? It can be boiled down to three main things. One is neurological deficits, progressive neurological deficits. So what does that mean? We've all slept on our arm weird and woken up and our hand was a little bit fuzzy. That same process can happen with low back issues.

01:07:12 When a disc is hitting a nerve or other tissue is hitting a nerve or spinal cord and causing compromise of the nerves or these sensations. So an example would be if I developed a back issue and I woke up one day and some of my toes were numb, okay, that inherently is not a big deal. We talk to people every day who have numbness in their foot or calf or around their lower back. Numbness, no big deal. It doesn't inherently mean nerve damage, it doesn't mean something's severely wrong, it's the context of it. So someone comes to us hey, my toes are numb, no big deal. We fix this all day long. If they say yesterday my toes were not numb, today they are. And then let's say tomorrow my whole foot is numb. The next day, my toes to my knee are numb. You get the concept Rapidly progressive neurological deficits.

01:08:02 That is one indicator for potential for surgery. The other one is progressive motor deficits. So that is strength. So we said your foot's getting numb, okay, now it's your foot's getting weak. So, hey, my, my toes are kind of weak. I don't know if they've been like that, oh, for like three months. Okay, that's not getting worse. Nope, okay, no cause for concern. Hey, my toes are kind of weak. When did that start? Yesterday? Start yesterday. Okay, let's monitor this next day. Way more weak next day. Now, my foot's weak next day. Yeah, my foot's starting to kind of drag on the ground a little bit. Oh shit, rapidly progressive, and we've had clients in these exact scenarios. Sometimes we can pull them back and still save them. Sometimes we make the appropriate to surgery when necessary. So those are rapidly progressive motor deficits.

01:08:47 And the third main one would be cauda equina-like symptoms. Cauda equina syndrome is a surgical emergency that is characterized by a few different things and once again, for anyone listening, please understand that it needs to be evaluated and it's encompassing multiple of these symptoms, not just one. Some people have one of these symptoms and they can freak out if you say this to them. So understand it is a combination of things. The context matters. So what can create cauda equina syndrome?

01:09:16 Significant encroachment on the spinal cord where permanent function could be altered or to the extent of paralysis. So what are warning signs that this is coming? Rapid, progressive neurological symptoms in both legs. So all of a sudden I have radiating symptoms down both of my legs. That's one. Another one is alterations in bowel or bladder function. So the nerves that exit your lower back, they control everything below your lower back. That includes bowel and bladder function. So what can sometimes happen is someone could have a disc injury causing sciatica, and then all of a sudden they are accidentally wetting their pants when they do not intend to Grown individuals. They start to not be able to control their bowel function.

01:10:06 - Chase (Host) Is this like a regular thing? Semi-regular, Like how often should we be going? Oh, like I leaked a little bit, Exactly.

01:10:13 - Grant (Guest) So context this is very important. Context matters. So we have had clients who said hey, I'm extremely concerned. I've looked up cauda equina syndrome. Like I'm starting to urinate when I don't intend to Like. Do I need to go to surgery? Intend to like, do I need to go to surgery? The we need to ask the right questions. How long has that been going on? Has the extent that you're leaking been increasing? If they say this is extremely new but it's not increasing, then this is a monitor and this is also a.

01:10:41 Okay, let's check these other symptoms now. Do you have progressive neurological deficits in the leg? I see no, I see. Do you have progressive neurological deficits in the leg? I see no. Do you have motor deficits? No. Do you have changes in bowel function? No, okay, so you just have one, we're okay. Good, yeah, if it remains stable, then we're stable, okay.

01:10:57 So all these this is why it's a criteria Okay, because the number of these that you have increases the likelihood that you need to have surgery. So bowel and bladder function are a big one. And then saddle paresthesia, so numbness in between your groins. So if you imagine you're sitting on a bike seat anywhere between your legs that the bike seat is touching, if you start to experience numbness in that region, that is another sign of cauda equina syndrome. So if someone has certain components of cauda equina syndrome and they're small and not neurological or motor deficits, they don't need to be concerned. They need to be working with a professional, they need to be monitored, they need to have a plan, but that is not responsive to our rehab plan, that is not responsive to oral or injectable steroids, then that is becoming a surgical case.

01:11:57 So it's a mixture, it's one or the other, it's the severity and how long they've been going on that dictates these things. But on paper, these are the main things that you need to evaluate to determine if someone is a surgical case. The frustrating part is we will get people come to us every single day. We have over 200 consultations every week. Every single day, we have people come to us. They have none of these, zero and they're yep, I have a surgical consult next week. I just wanted to see if I could avoid this. And we're like okay, well, let's go through these questions. We go through all these questions and they're like nope, nope, nope, nope, nope, nope, nope, nope, come on, and we're just going.

01:12:36 - Chase (Host) And they're scheduled for surgery.

01:12:37 - Grant (Guest) And they're scheduled for surgery Every day, every day. That's terrifying, every terrifying every day. And so we're just going, hey like. And this is where it's tough, because maybe they love their surgeon, maybe they've heard amazing things about their surgeon, they're bought into their surgeon or their aunt had the same surgeon, the best friend right.

01:12:55 They did amazing work for my, you know whoever and we have to tip to a very careful line here, because if we call out the obvious malpractice that's taking place, then they're going to be personally offended and they're not going to want to listen to us. So we have to say, okay, has your surgeon gone over the clinical criteria for surgery?

01:13:15 - Chase (Host) with you.

01:13:16 - Grant (Guest) No, would you like me to go through that with you? Yes, okay, let's go through this together. Here is the clinical criteria for surgery. Not our opinion. None of this is our opinion. This is our criteria, and then we can. Let's go through this together. Here is the clinical criteria for surgery. Not our opinion. None of this is our opinion. This is their criteria. And then we can start to go through it. And then we have to suggest okay, well, this is the criteria for surgery.

01:13:36 Since you're stating you're not experiencing any of these, is surgery something you would like to avoid? Well, yes, okay. So if there's a way that we could help you avoid that, that's something you would want to explore. Yes, okay, we're getting them to our side of the fence instead of combating their belief. We have to be delicate about it. But that's what's? That's what the most infuriating thing, man, is just so many people being pushed to things that they do not need prematurely, and then, on the flip side of that, there's also a massive number of people that come to us every week who have had surgery within the last six to nine months.

01:14:09 - Chase (Host) And they're in the same position or worse.

01:14:13 - Grant (Guest) So it's like, oh my gosh, we could be saving so many people from surgery so many.

01:14:18 - Chase (Host) I hear people like. The woes of people after back surgery are, I think, even more than I hear of people considering back surgery. It's like I wish I never did it. Or, yeah, I think, even more than I hear with people considering back surgery. It's like I wish I never did it. Or, yeah, I might have solved one problem, but now I've got this other problem.

01:14:30 - Grant (Guest) Yep, there is a really cool video where this was a bit of a polarizing scenario, where I don't remember the name, so forgive me, but there was a particular speaker, a particular guest at an orthopedic surgeon conference, so I think there were maybe multiple hundred thousand orthopedic surgeons in the conference and basically the question was how many of you in here are doing fusions, lumbar fusions, on a weekly basis? Pretty much everybody raised their hand, okay. And then the next question was how many of you would accept a lumbar fusion? And I think maybe one person raised their hand. Oh, that's not good. So there was a. There was a video of this. It was extremely polarizing. It like went viral like the twitter health space. There you go like people who are doing the surgeries they don't want them that's super high, I'm sure with insurance yeah, oh my gosh yeah for sure, 100k.

01:15:23 - Chase (Host) Baby you're like no, I'm good thanks yeah, yeah, for sure.

01:15:27 - Grant (Guest) So that's that's what You're like. No, I'm good. Thanks, yeah, yeah, for sure. So that's that's what we're here to help people avoid.

01:15:31 So we we deliver two things to our clients around the world who are stuck, who have been in pain, who have been told all the myths and all these lies and have this belief that no one can help them and they have to. They have to pack their bags and they got to try to get their hopes up one more time. To give us a shot and that's a tough part is that people who have been in pain for so long they feel very let down, they feel jaded, they feel skeptical, and it's difficult for them to get their hopes up in fear of another disappointment, because that sinks them lower in their mentality. So we respect it when people who are in tough mental places, they still reach out to us because we recognize that they're getting their hopes up one more time and they don't want to be let down. But what's really tough is when they're in this situation and they're being told all the time that's you know, you need surgery, you need this, you need that, and it's not at all the case, and what we love is being able to help people.

01:16:22 We've canceled thousands of surgeries, thousands of surgeries. So what we're providing them is not only the avoidance of a of a procedure that is irreversible, that could potentially have deleterious effects to the rest of their life, but then we're also giving them is the actual solution and the ability to get back to their life pain-free, which then unlocks everything else after that, which is now I can get in shape, now I can play with my kids, now I can pursue that career, now I can whatever. It unlocks everything beyond that too. So we're giving people the avoidance of something that can be avoided and should be avoided if, if, possible, but then giving the solution at the same time, and it's so rewarding.

01:17:05 - Chase (Host) Rewarding is an understatement. When you're dealing with people's happiness and livelihood, You're giving people their life back and their future self that they probably don't even know if they are going to be around for or if they even deserve in some capacity. Man well, to put it technically, you know your shit. This has been an incredibly eye-opening conversation and one that I know is going to help so many people in my audience, and whoever sees this hears it. But to bring it home, before I ask my final question, I want to ask what can we revisit maybe that you already talked about or we haven't said that you want the audience member to, without a doubt, walk away from this conversation knowing they can do to change their back pain.

01:17:51 - Grant (Guest) Yeah, so the of course we post daily exercises. We give the movement fixes for people to put some of these steps into action, to try our things out. If you see benefit, great work with us. We provide a fully tailored rehab plan to get you where you need to be with a structure, specific approach. So I want people to explore movement and exercise and do these things, but without being able to say specifics to a mass audience, the overcompassing messages. You're not fragile. Back pain, although being highly common, it is highly recoverable. Movement is the answer. It should be a majority of what you're spending your time in Passive therapies and things like that can have a place but are not even a fraction as important as movement is. So this is a movement-based solution. It's a movement-based problem. You need a movement-based solution. Do not be afraid of movement. Motion is lotion, rest is rust and you need to move.

01:18:49 - Chase (Host) Amen, brother, amen. Well, I mean, I think, quite literally, this is going to help me and my audience move forward in life and to keep living a life ever forward. Those two words, man, what do they mean to you? How do you live a life ever forward?

01:19:01 - Grant (Guest) The immediate connotation to me is just always living in a pursuit of growth. So I've talked a lot about being stagnant with movement, but I would never want to be stagnant in my life either, and that's any area where the potential of growth is there. So, whether that's in my relationship with my wife or with my kids, or developing a better balance in my life, better mental fortitude, growth in my business, growth in my physicality, whatever it might be, what I immediately think of Everford is whatever that area is, I need to move forward in it always, and if I'm not, then I'm losing. That's my thought.

01:19:46 - Chase (Host) Never a right or wrong answer, man, I always appreciate everyone's interpretation. So thank you for that. This has been great. I love just being in the presence of people that again know their shit but also just are so passionate about the greater good, and it's so apparent that that's both for you, man. So this has been a real treat for me. Thank you, thank you.

01:20:05 - Grant (Guest) Where can?

01:20:05 - Chase (Host) my audience go to connect with you. Of course it will be in the video description box and show notes, but where can they go right now to learn more about what you got? Going on and maybe quite literally save their back.

01:20:14 - Grant (Guest) Yeah, rehab fix on all platforms. Instagram would be the number one, because not only do you get insights into my life and what I'm doing, but I post daily videos. Long format videos are on YouTube, but Instagram is really the place to be. But at Rehab Fix on all platforms. And if you DM me the word podcast on Instagram, I will immediately provide your audience a very in-depth video that is not available anywhere on my social media. It's not a lead magnet anywhere else, it is only available to podcast listeners. It is a I think it's like a full 20 minute process of me going through the exact evaluation that we provide our clients to help them real time diagnose what is causing their pain and, in the initial movement steps that they should do. I walk them through it Exactly. Tons of value worth a few grand alone, and I'll provide it for free. Just message me the word podcast on Instagram and it'll be set right to you.

01:21:15 - Chase (Host) Too easy, baby, too easy. I'll make sure to put that in the show notes for everybody. Again, so good, and this is just a reminder, another reason why I love having people on like yourself on the show. It's a reminder of um things that I I want to get back into and reminder of the bigger reason why, like I just had a kid Right and so, like I, working out and being active has always been a part of my life for the past like 20 years, but, like through your lens, of the specialty of back pain and just reminded me of, like, how simple something could just go unnoticed for you know, days, weeks, months, and next thing I know I'm blowing my back out and then I can't pick up my kid. So, like, this is just as much as it is for my audience, is always for me, and so this is going to help me move forward in my life. So thank you.

01:21:57 - Grant (Guest) I want to add one thing to that. Now you have the opportunity to instill movement based habits into your kid's life. So I take my kids on a morning walk and evening walk. Every day. I get them barefoot in the yard. They see me working out in our home gym and that's playtime for them. Daddy, can I work?

01:22:14 - Chase (Host) out with you. They're like the extra weight on the cable.

01:22:16 - Grant (Guest) Yes, yes, so we are instilling movement based lifestyles into our kids. That is going to change the trajectory of their future in regards to their understanding, their education, their happiness, the optimal living that they now have access to and without it's, without even thinking, it's ingrained in them and now they get to pass it on to their kids and their kids and their kids.

01:22:39 - Chase (Host) Oh, trust me, my son is already going to know these behaviors he's. He knows morning sunlight, he knows morning walk, evening walk. He knows this stuff before he even can walk, before he can even say dad. It's just a part of our lifestyle. So we're in good company there. Love it For sure, man. For more information on everything you just heard, make sure to check this episode's show notes or head to everforwardradio.com