Lower Back Pain Relief – Success Stories

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Welcome to the Back Pain Solutions Podcast – Lower Back Pain Relief – Success Stories

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Introducing Lower Back Pain Relief – Success Stories

Should a 75-year-old patient expect to get better from an episode of back pain whilst experiencing an improvement in their fitness, as part of a rehabilitation program? And just how important is it that you stop doing exercises that you’re undertaking to lose weight if they’re having a negative influence on your back health?

In this episode we introduce some case studies in order to put some of the theory discussed to date into context whilst discussing the additional benefits you can experience when taking an active based approach to back rehabilitation.

Patient number one was an elderly lady aged 75 who’d had a fall. She presented with kyphotic posture (rounded posture), and was in a lot of pain. Previously she’d been diagnosed with a compression fracture of the T12 vertebrae in the middle of her back. Supporting the back and neck gave her relief, which was the starting point on her recovery – easing discomfort. During history taking she also communicated a history of fatigue and was eating a lot of grain, consuming little water, and feeling very bloated daily. As part of the discussions a paleo-based diet was introduced, and a lot more water consumed throughout the day, to help influence energy levels.

With these initial changes in place the next focus was to introduce the bracing technique in order to engage key muscles required to support the spine. A focus was placed on targeting the posterior chain, including the gluts, in order to help her with simple daily activities such as getting out of a chair without bending through the back.

Within a couple of sessions there was some immediate relief which she hadn’t experienced having seen a physiotherapist previously. The lady also experienced some weight loss in the early stages of her treatment, and recovery, which was an additional benefit. One of the inspiring things about this story is the confidence, and fitness, the patient gained by taking an active based approach.

Over a period of 2 years this patient has been on a journey not only to eliminate her back pain but she has continued to improve her core strength with a progressive exercise program which has had a hugely beneficial impact on her posture, outlook and overall health.

Patient number two was a sportswoman who was actively participating in an online exercise program. She was suffering from bilateral knee pain and had a history of low back disc herniation. She had been to see a few different therapists who had failed to successfully diagnose, and treat, her pain.

History, and examination, revealed muscle weakness in one leg and a very tender lumbar spine when palpated. She also had a lot of tension in the muscles of the lower back and a lot of weakness in the posterior chain, which was resulting in a lot of movement through the spine, exacerbating her herniated lumbar disc.

Focus was initially placed on engaging the muscles of the posterior chain with exercises designed to help facilitate activation as there was a failure to control the muscles successfully. As with all patients, bracing techniques and hip hinging was incorporated into the rehabilitation program to ensure the spine was kept in neutral.

This case study was a classic example of a patient suffering back pain due to a disc herniation, and was performing exercises that were having a negative effect on her spine health. Introducing a regimen that helped educate the patient understand her back health, and learn movements that are designed to support the spine helped her take back control of her back pain. Importantly, she was open to a different approach and implemented the advice that was given to her, staying committed to her own recovery.

Show Highlights. Lower Back Pain Relief – Success Stories

This episode demonstrates that despite your age, and despite the clinical presentation, it is possible to find lower back pain relief and move to a pain free back.

As is always the case, back pain has a cause and a good examination, followed by a movement based approach to rehabilitation can ensure a successful outcome.

Interview Transcription for Lower Back Pain Relief – Success Stories

Ben James 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. Somewhere along the line, we’ve developed poor habits and become more vulnerable to back pain, smart, strong features, evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better health. So join us as we demystify some of the commonly held beliefs about back pain. build your confidence to a stronger bank, the smart Welcome back to the smart strong podcast. Everybody. This is Ben James and I’m with my co host as always, Jacob stay morning, Jacob. Good morning. So today we’ve discussed a lot of topics we’ve introduced the podcast we’ve talked a lot about where people are going wrong, some of the lack of education and awareness around the back and particularly a lack of movement with regards to back health, without core strength and awareness of some of these simple bracing to techniques as we’ve discussed today, it’s going to be very, very difficult to manage back pain, you might get some immediate relief. But as soon as you leave that therapists office, you’re going to go back to those activities that are causing the problem with us desk, work, driving, etc. And we’ve talked a lot today about introducing movement, introducing, walking, introducing exercise in general, to aid back recovery, and educate our audience in terms of their back house and how they can take back control. And what we wanted to do today was introduced some case studies. To put some of this information into context. Because we talk a lot about theory, we talk a lot about some of the things that we can be doing. But we thought that it’d be a great idea to bring in a few case studies talk the background of the patient, some of their beliefs, some of the things they’ve maybe done today that we’re helping or we’re not helping, and the journey they took in terms of their recovery. So I’m going to talk to Jacob interview. In some of the case studies, he’s seen some of the patients he’s seen. So we can bring that to life a little bit more, and put it into context for you guys. So Jacob, I think we, we’ve got a few maybe patients in mind, we’ll see how the podcast goes in terms of time, because you know what it’s like we get into the detail and we get into the depth. And suddenly, we could be talking for a long period of time about one to patients so that we don’t put any pressure on ourselves to talk too much. We want to give the listeners the detail around some of these key customers that patients that you’ve seen that helps to put context around some of the topics that we’ve discussed today. So on that note, is there anyone specifically that we could start off focusing on in terms of a patient that you’ve seen the problems they faced and, and the way they presented to you in the in the clinic?

Jacob Steyn 2:56
Yeah, I want to start with this lady that I saw She, she 75 policeman she came in, that’s two years ago. And she had a fall. And she came to see me very cathartic and back pain. And in the beginning, it was very difficult for her because she couldn’t. She couldn’t even go on to her hands and knees. It was very painful. Okay, I won’t be found that lying on her back with a lot of support, even though she’s very hunched over in the upper back.

Ben James 3:32
So that’s like the rounded back

Jacob Steyn 3:33
that we’ve discussed and touched on before. Exactly. A very, very rounded head protruding forwards, you know, very difficult to look straight ahead, mostly mostly want to look down towards the floor. And we found that lying on the back with a lot of support. And I mean, a lot of support under the upper back and head was actually relieving was made a spine feel good in that position. And so What we did with her was, at least what I did with her was giving him this exercise three times a day. And then I obviously asked them what what how’s it going with her energy and she said, well then energy is very low. And you know, she’s got some bloating in her belly, and she was eating a lot of grain, a lot of bread two times two to three times a day. She had two glasses of water a day, three coffees a day. And what we did then was we we changed that to diet that’s going one direction of a sort of has a base of a paleo diet, more water. And I said you know, for now let’s eat coffee. And so we added some pre and bro biotics and l glutamine for the gut and We looked at some breathing techniques and I taught her how to stand up out of a chair using the glutes in the post to chain. So these wind, strong bracing and get up out chair and the next time she came in, she felt a lot better. She had more energy. She was standing much taller, and before and she, she just felt better. She started losing weight as well. Okay, it was important for her and she was a little bit overweight.

Ben James 5:37
Okay, and so she just kind of taking a step back I guess she came to see you She said she’d seen anybody before had any advice before or she just kind of presented with that mid back pain. What was the onset? How long was she had it?

Jacob Steyn 5:53
She she was she went to a physio to see to see a physio As part of a rehabilitation process after the fall, generally, people in the Netherlands they go to a GP and then they get to refer they get referred to a physio. So I did I didn’t know down what was done before with the physio I know she was there. And yeah, and she came to one of my workshops and that’s how I got to know her and that’s, that’s what got her to come to me because you know, she shared it was difficult for her to, to trust anybody starting and the workshop. It made it easier for her to actually come in.

Ben James 6:36
And this is a workshop you do your clinic or local gym.

Jacob Steyn 6:42
It’s at the clinic we in the reception, we just we put some chairs down, we have a presentation, we do it. It’s a presentation mixed with a sort of work on hands on workshop, doing exercises, testing people in these exercises, muscle strength, these sort of things to Give the give themselves a little bit of a better idea of how they function.

Ben James 7:05
Exactly. Yeah, I understand. And I think you know, for the listeners, that’s something that is worth looking out for because people, you know, like yourself, Jacob, that are prepared to put on these kind of educational events and these open evenings as it were, to do a little bit of an educational session that is that is free presumably, it helps to raise awareness for you obviously, as a practitioner, but it gives people a little bit of insight that that helps give them some sense of trust in what you’re doing, and a bit of understanding so when they’re making an investment to get some treatment, they already know you and your approach, which I think is is important because you know some people that are let’s say walking in off the street with with serious back pain, they want a bit of reassurance of friends, and that’s clearly a beneficial thing to do. As a side note to the podcast.

Jacob Steyn 7:59
Yeah. Absolutely and and I think that’s a big deal. That’s the big thing that people get to see what, what your approaches and then if they feel that’s something they would like to try it, then they will try it. And usually, you know, it usually works very well at showing people what you’re doing and actually people coming in and allowing me to help them.

Ben James 8:24
Absolutely. And so this lady comes in to see you on the back of this, this opening evening and she’s got my back pain she’s she’s obviously been receiving some nutritional advice from us you fairly open to that at the beginning. Is that something that you discuss with all your patients at the outset because obviously, this is something that we think is important around overall health and back health and particularly pain, which is a number of subjects there that we’re going to touch on in in subsequent podcasts. But just to touch base on it today in terms of the case studies, Was this something that was you felt pretty particularly important for this patient or is this something that you would you would always do generally with with patient.

Jacob Steyn 9:06
I, I’d like to do it, I do it as much as I can. But I have to be a little bit careful because some people are less open to it than other people. I in the workshops, I spend a little bit of time just talking about how your diet has a massive influence on things like degeneration of the joints, how it aids massively in the healing and the recovery process of any disc injury. And also how it just plays a big part in day to day recovery in your normal day life and and a lot of people who come in with problems especially if it’s chronic, they have a lack of energy, you know, they are they are they have some chronic fatigue going on. And a big part of that is because of diet. If not the biggest part. Yeah. And so so your ability to heal is directly related to your energy. And so I make I make this very clear. And we talked about if and if people have heard this in the presentation and in the workshop, then they’re more likely. And they actually asked, Well, can we look at my diet when they come in for the, for the treatment? Yeah. And, and in this case, this lady had a, when she had a fall before she came, she had a compression fracture at 12. That’s a compression fracture of a vertebrae in the spine around just below the mid back. Yeah, and we saw this on on the X ray and she had you know, she’s getting older associated degeneration of the, the discs in the vertebrae in the low back. And so I explained to her how if we work on a anti inflammatory diet, how this is going to be slow down How the healing of this compression fracture will be sped up. So she was very interested in.

Ben James 11:06
Yeah, so in this case, he kind of almost formed the baseline for your treatment approach. And I guess, you know, for a lot of patients, that’s going to be something new at least mentioned or discussed, because as you say, and again, we’ll discuss in a future podcast, diet, nutrition, can have a huge influence on inflammation and therefore potential for chronic pain, etc, etc. So it’s got to be something that we we consider as part of our treatment approach.

Jacob Steyn 11:36
Yes. And I saw her the end of 2017 for the first time and I still see her every eight weeks. And she’s now lost almost 10 kilograms. And every time she comes in, she’s very happy. She taps her belly, and she says, I’m down a little bit more, you know.

Ben James 11:56
Yeah, so this has been Yeah.

Jacob Steyn 12:00
symmetric, very good about

Ben James 12:03
well, and I was going to touch on that because there seems to be a perception often when you speak to, to certain people and again, going to be very individual, but as we age, there’s this perception that we can’t do as much, and maybe we’re limited etc. And actually the, the human potential even at 92, to put on muscle mass and to be stronger is is certainly there the potentials absolutely there. So I think this is sometimes again, something that we we have to do is to inspire and encourage these these people and she was obviously somebody that that not only wanting to get out of pain, but she maybe had a realization from the workshop that she could she could do more had she lead an active life prior to this injury or was she just somebody that had had been fairly sedentary but was inspired to to improve your overall health as part of this journey?

Jacob Steyn 12:56
Yes, I don’t know too much about that. But About her previous the previous part of her life, but she I think she was quite an entry. She’s now more active, and she does her exercises. And I think, you know, probably at a stage where she thought, Okay, this is it, it’s not going to improve. And when she saw the improvement, she got motivated to do more.

Ben James 13:21
Yeah. Great. Great. And so she came in to see you, which she surprised by the approach you took because we’ve talked a lot about doing an in depth examination and testing muscle strength and testing muscle strength through some exercises, maybe that’s the kind of plank type exercise which again, you may modify, depending on the age of the patient. Is that something that you did as your first examination to test some of this muscle strength to look at some of these movement habits as we discussed and was there something that she was surprised about and was not expecting it?

Jacob Steyn 14:01
Yes, I yeah, you know, when she when when when somebody is this age I’m never sure what they expect. I think they’re not expecting what I’m going to give them for sure. Yes. And her exercises at the moment she’s doing the glute bridge. She’s doing the clam shells. So mainly working on the glutes and the and the big buttock muscles and the smaller ones to the side so that she could be a little bit stronger in the posterior chain because they get very anterior chain quad dominant as people age because they start leaning forward and you know, they catch everything with the quads. And then the table hanging exercise I also gave away she’s just with her arms outstretched hanging on a table where the hips towards her hands which means she’s getting the the extension and distraction in our spine. She’s doing that a couple of times a day, which means she’s, you know, she’s she’s more upright. So, yeah, I think she probably never thought she was going to do these sort of things. And when she started doing them, she noticed that it helps a lot. And yeah, she’s been doing it.

Ben James 15:17
Now it’s good, it’s good that she’s had the motivation and the determination to to persist with the exercises for quite a period of time, it seems and that’s, that’s always positive as a practitioner, because it’s can be frustrating when people maybe feel they don’t have the time to do the exercises we’ve kind of alluded to in the past. The table hanging exercise, obviously is is one that that we haven’t discussed in the past to date. So as always, we’ll have some links into in the show notes to the to the website and we’ll have a video on that. And just so that you can visualize that and put it into practice. If you feel it, it could be appropriate to you and your your back pain for those that are listening So did you do any direct kind of hands on treatment with this lady or was it very much as exercise based approach because it sounds like she’s got this rounded posture and when she’s walking she’s she’s almost in this slouch slumped posture and there’s obviously been a lot of focus for you to to strengthen their posterior chain and kind of bring a more upright and focus on that. That posture.

Jacob Steyn 16:25
Yeah, I did do a nice little do a lot of soft tissue work around the neck and the shoulders because of the the the the slouched position, you know, hanging forward with his shoulder. So she gets she has a lot of tension there. And I don’t think that’s going to change because it’s, I think that’s, you know, you’ve got your limit to how much you can improve that in terms of getting more upright. So she has a she has a lot of tension there and I always lose in that for her and what I also do as I do sometimes Do some chiropractic drops a technique where you loosen the low back a little bit, but basically stays in a very neutral position lying flat on the tummy. So those are the main things I do hands on.

Ben James 17:12
Okay. And how was her brace her general strength when she came in? Did she have any awareness of those things when she came into the clinic?

Jacob Steyn 17:23
Now we can we can we can honestly say that you have no awareness of those things. Of course, you know. Yeah. And so that’s always very nice when you can teach people how to activate, for example, the brace. And when you even a 75 if you test the glute meet when they lie on their side, you know, and you show them Oh, well, you know, there’s there’s no power there. You get them to line you on the back and you compare to quad strength. And actually they have a fair bit of clustering. You explain to them you know, actually, we’d like it to be at least the same or maybe even stronger. Yeah, so people get that.

Ben James 18:10
Yes, absolutely. Yeah. So how long is it now that she’s been to see you should come in with this mid back pain and it was obvious weaknesses there. And there was some dietary issues potentially that were that were not helping. She’s now been to see you. How many treatments potentially

Jacob Steyn 18:27
nearly nearly two years meeting and yeah, I see your every eight weeks now. And then we’ll discuss maybe some dietary things. Yes. Usually got some some questions for me. And I’ll be working, like I said, on the soft tissue areas, especially around the shoulders and the neck, maybe in the low back a little bit. And then we just we revised her exercises tonight. I always check some of the exercises. And you know that that’s good for her because then it brings her back doing it properly as well. actually standing out of getting up out of a chair. People quite often fall back to doing it in the old way, or they think they’re doing it properly. But actually, especially at that age, they, you know, they, they changed the technique. Yes,

Ben James 19:14
yes. So you’re kind of constantly reviewing the exercises she’s doing maybe adding a little bit of progress, but at the very least, just checking the, the quality of the technique to just make sure that she’s doing it right. Not developing poor habits and ensuring that you’re doing all you can to kind of maintain what she’s now got. And is a posture improved?

Jacob Steyn 19:40
Yes. Oh, yes. She’s, you know, I mean, she’ll, she’ll never get off right? Of course. Yeah. But she’s, she’s a lot more upright than before. And with the improvement of a posture, she’s not having this pain anymore. The pain went over in a few weeks. And she had for quite a while before that,

Ben James 20:02
and what’s been what’s been your kind of observation on how she comes into the clinic in terms of, I guess her mood and her general outlook, have you noticed a difference in terms of more positivity, more happiness as a result? Absolutely.

Jacob Steyn 20:23
You know, a little bit more, but when she came in and well worth, when people come in here, they have hope.

Unknown Speaker 20:32
Yeah.

Jacob Steyn 20:34
You know, and then it’s what you do with it. And, I mean, she’s, she’s in a much better place right now. She was before. But, you know, going for a walk and doing stuff like that, which was very difficult before. Now, just something she does regularly. And she has a lot of appreciation for that. I mean, that’s clear, she shows that

Ben James 20:54
great. I mean, that’s a positive story. I’m conscious that as As alluded to at the beginning of the podcast, sometimes these discussions going away with us. So we’re already up to 20 minutes on there on one patient. And so, in terms of getting through a number of different case studies, maybe we maybe we’ll, we’ll do another episode after this to introduce a few more, but moving on from that patient. I wanted to discuss is there a patient you can think of that’s come into the clinic that maybe is younger, that’s felt that they shouldn’t have back pain because they’re, they’re doing a lot of sport because that’s another kind of classic those people that are exercising their so they feel they shouldn’t have a problem. Or maybe a patient that is doing some exercise maybe that isn’t necessarily an elite sports person, but but they feel they’re doing the right thing as it were for their back pain.

Jacob Steyn 21:54
Yes, I have a I have a lady. Let me see the Age. So I can think of this as one person 31 year old lady who has had one child came in with bilateral, so both left more than right knee pain and swelling, not able to rest on the knees. And history of a low back hernia. And that was two years prior to when i saw i she was doing a lot of exercises. She was following a program online which involves all kinds of you know, from verbis to Yeah, extreme set up movements going through the spine.

Ben James 22:54
So this was like a sports space program rather than it was a kind of rehab based program or was it

Jacob Steyn 22:59
yes Hundred percent sports based program not a rehab program been to see a few other therapists and yeah, I’m not exactly sure why, who or how she got to me but she came to me and so I investigated her and we had a, it was a long investigation because there was a lot of information. And so just to break it down a little bit, the main points were muscle weakness on the leg where she had the old hernia been a very tender lumbar spine, you know, if you push on the vertebrae, the muscles absolutely cramped up in the low back. The core not strong and all those theory chain very weak. Nice if you look at the range of motion of the nice, very tender if you Going to full flexion and then she had raised inflammatory markers, but not raised enough for the doctors to do anything about it, but it was raised.

Ben James 24:14
So this was a blood test that was done by a doctors

Jacob Steyn 24:17
but test Yes, exactly.

Ben James 24:19
And this was done because of this particular problem she was experiencing with their back or knees or was this just a general health clinic check.

Jacob Steyn 24:28
General Well, I’m not sure exactly why they did this. But it was a general health check and you know, something more like that. That was like yeah, and she she does you know, she wouldn’t wake arrest that she’d be fatigued. Then her got wasn’t good. A lot of wind and going to the loo would not be constant you know sometimes should be debated sometimes diarrhea. And then yeah, she vitamin D was low also on the blood test. Okay. supplementing with candy. And yeah, so then we we started with very basic stabilization exercise or something like the bird dog and hands and knees was very difficult for her. But also because the knees were a little bit painful, we made sure that she had padding underneath the knee so that it was possible and we worked a lot on the posterior chain. We built it up slowly, you know, just to get the communication between the brain and these muscles in the beginning because it was very weak, to be honest. And then we did stuff like the dead bug, clamshells Glute Bridge. You know, just doing the basic hip hinge learning how to bend through the hips. Keeping the spine straight. And we we went, or we went back to a sort of paleo diet as a base again, trying to get the gut better. We looked at a B complex vitamin B complex vitamin D l glutamine. Yeah, we’ve stayed on that sort of approach for about eight weeks. Because I explained to her this, this will take time, you know, and she was actually still breastfeeding. So she was she was afraid of losing weight, you know, if we would remove especially grain like bread and these sort of substances. And she was closely monitoring her weight and she was actually losing a little bit of weight. And so I suggested you know, just up the fat with your meals, and she would have a lot of vegetables and fat with some, obviously somebody chicken or fish and I wanted to try and do three meals a day, which ended up doing it was possible so we really got control of her insulin. And yeah, she gradually improved and she made a very good recovery had a blood tested at some point later, inflammatory markers were down her gut was much better she going to the to the loo was a good experience for her. She did mention that you had to go to three times a day now. And that she wasn’t used to it, but it was it was all good. So this is kind of a classic

Ben James 27:45
patient that we’ve, I suppose been been talking about throughout these podcasts today. They’ve got this disc herniation and they’re doing some exercise Is the following some programs probably assuming that they’re doing a good thing for themselves and for their body and hopefully for their back pain, but actually moving incorrectly because it sounds like her awareness in terms of posture in terms of neutral spine in terms of using those muscles, the anterior abdominal wall, posterior chain, to resist movement around the spine. It sounds like she’s been doing a lot of exercises that were creating movement in the spine for a disc problem that we know is going to be exacerbated by all those things.

Jacob Steyn 28:38
Yes, yes. And she was she was quite driven. And, you know, listening to her, she would do her exercises from this program that she bought on a regular basis. And I just knew that, you know, it was like you say it wasn’t contributing to getting stronger in a good way.

Ben James 28:58
So there was a there was there was a positive In your mind that she’s committed to exercising, therefore that’s going to be a great potential for her to adopt what you’re saying and, and ensure that she’s going to see improvement, but at the same time, you had to break some habits because it sounds like she’s doing maybe one of these intensity based workouts to try and lose weight after giving birth. And maybe there’s this other factor there that she’s wanting to lose weight and get back into shape. But actually, it’s trying to make her aware that yes, that’s that’s the goal you want. But unless we get the baseline right and get the movement patterns, right. The backs going to suffer as a result. Is that fair to say?

Jacob Steyn 29:51
Yeah, in her case, she she didn’t want to lose by DJ actually had a problem keeping on the way because she was still But, I mean, you’re right with saying that she, she will, you know, she wanted to get back into shape obviously after the pregnancy that was her goal. Okay. And that’s why she was so phonetically driven to do this program. But yes, I and there was some habits to break, but she was very open because she was already. She already went to a couple of therapists and you know, she wasn’t getting better that that was said her motivation was very big. She was very motivated to get better. And, you know, everything we discussed, she really took at heart and she really went for it. And with the knees, the knees were very irritated, both of them. And so I explained to her, you know, this is going to take some time and she knew that and, I mean, at some point because of her her left knee that was it was worse than the ride needs to get swollen at least twice a week and At some point, she just told me, oh, my knee hasn’t been swelling for a couple of weeks. You know, and I knew Okay, bodies making taking turn there. And then she weighed 56 kilograms. And then she said, you know what I weighed myself and I’m, I’m on 58 minutes. So, actually, the day is going very well. And she, you know, energy came back and she was very fatigued. And I think she was she was out of, you know, she stopped working for a little while. So she made a dramatic improvement on all those basis and I think that’s what she needed. She needed to to improve more than one thing and if you just have one approach, or one aspect that you try to improve, it wouldn’t have been enough. And I had a strong feeling that we we have to go this direction and she was she was very good in following it up.

Ben James 31:57
Yeah, she was obviously a little bit desperate and And prepared to listen, which is obviously important. And I think that’s maybe a good place for us to, to summarize this particular episode, and as I say, you know, we’ll, we’ll perhaps do another episode next with a couple more case studies because I think they’re really valuable. But there’s obviously some background here and some, some support in terms of exercise and exercise based approach, which we’ve, we’ve discussed and we certainly believe in that movement is important, but actually, holistically there are other factors, such as nutrition that also need to be considered which, again, we’ll, we’ll touch on in in subsequent podcasts, but it sounds like there’s a couple of patients here that first and foremost had the desire to improve on what prepare to listen. And I think that’s the first thing. If you’ve be prepared, I think to challenge your practitioners we said before, because if you’re not getting this overall holistic advice and this movement based advice, you really are going to struggle to see significant improvement. So you’ve got to be prepared to challenge and prepare to find that right practitioner and what once you found them, be prepared to listen. Because in both cases that we’ve discussed today, the patients followed the advice that you gave them. They remained committed to that advice. And as a result, they’ve seen improvement. And so often, we see people that are desperate that are trying to do numerous different things at any one time. And it’s very difficult to establish what’s creating the problem or or exacerbating the problem, and what he’s actually helping in certain period. So I think it’s very important to be prepared to make some sacrifices, and particularly the second patient, she had to make some sacrifices, sacrifices in terms of what she was currently doing in order to make that progress. I think For those listening, that have back pain, and that are doing different things, you’ve got to start to think Well, okay, I’ve got to create a base and I’ve got to stop all these different things and then make it much more clear. When you get in the right advice, how and where that progress and that improvement is coming from, because otherwise it is, it can be complicated and can be exacerbating the problem. But certainly, as demonstrated today, a movement based approach is going to be beneficial in terms of back health, but not just improving back health and back pain, overall health, weight loss, and state of mind, which we know, experience and evidence is telling us is hugely beneficial, in terms of our mental health, not just our physical health. So, Jacob, once again, thank you very much for your input. And, as discussed will, will maybe cover another couple of case studies next time. And bring some of this information to life. Again, refer to the show notes, we’ll have some link for the the table hanging exercise back to the website. So you can see that exercise and see some of the other exercise we’ve talked about in the past to help with with your health and starting on the journey to better back health. So, once again, thanks for listening, as always take the opportunity to head over to iTunes and give us a rating. It just helps to raise awareness and get the podcast out to the masses as we continue our own journey to improve back health for more people. So thanks again for listening guys, and Jacob. I’ll speak to you soon.

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