Lower Back Pain Treatment

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Welcome to the Back Pain Solutions Podcast – Lower Back Pain Treatment

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Introducing Lower Back Pain Treatment

Back pain is the second most common cause of complaint in GP practices and the global incidence of back pain is on the rise. It’s now estimated that 80% of the global population will experience an episode of low back pain at some point in their lives! So why is it that the incidence of back pain is on the rise? Should we be concerned about the sedentary nature of our lives? And what can we do to avoid it?

In this episode we discuss the key reasons why back pain is on the rise, and how sitting is having a major impact on our back health. We also discuss the impact that the sedentary nature of our lives is having on the different tissues within the body.

Back Pain Exercises

A large percentage of the population now do office work, following the industrial revolution, and subsequent technological developments. As a result, many people find themselves sitting for long periods of the day. The problem with sitting is that there is no perfect seated posture and, as a result, we find the tissues in our low backs can start to creep over time. That is to say they elongate, without any increased strain having been applied. This results in reduced stability around the joints and persistent pressure on passive tissue such as the intervertebral discs. Over time we see a decline in tissue function with resultant injury, and pain.

Almost all of the work that we do now involves repetitive movements, which we are simply not designed to perform. Whether a carpenter, bricklayer, hairdresser, office worker, repetitive actions can lead to tissue creep and so its no surprise that we’re seeing an increase in the incidence of back pain due to the lives that we lead.

In order to manage back pain, and help to avoid it, we need to become more aware of the things that are having a negative impact on back health, and learn strategies that can help us to manage them. If you’re sitting down for long periods of the day then simply taking a walk during your breaks can have a hugely positive effect. There are always things that we can do, as a first step, to give us some stability to support the spine. This is what’s required to help reduce the incidence of back pain.

We also discuss how working on stability is important, because people must be careful if they’re working all day and then heading to the gym because you could be at greater risk of back pain, and injury if you’re doing the wrong things. If you’re not making a consideration for the exercises that you’re performing then you are even more vulnerable than those who choose to avoid it. Making the right choices about exercise prescription is fundamentally important to back health.

One thing we should all be aware of is what happens to our backs over night, and what should we be aware of when we wake? What are the things that you could be doing should be doing, first thing in the morning that are impacting your back health each day. And how can taking a walk in the morning, and staying hydrated help you?

Finally, we discuss how we all should learn to brace our core properly, and how we keep a neutral spine in order to protect it. Learning to build the core, and generating power here helps reduce risk as the support structure is in place to resist injury.

Show Highlights …..

People need to understand the risks regarding their back health, and must appreciate that they need to be involved in managing pain, and building resilience in the long term. This episode will help to give you some initial direction in taking back control of your spine health.

Interview Transcription for …..

Ben James 0:00
When we’re young, we move in 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 and build your confidence, to a stronger back the smart.

Okay, so Welcome back, everybody to the smartstrong podcast. So this is Episode Three, Jacob and I are back today and you can want to keep listening in because we’re talking today really about why we’re seeing so much back pain. understanding why they should become such a big epidemic and in the UK, is the second common cause of GP complaint after the common cold. So let’s understand why these issues are occurring. Let’s talk a little bit about why it’s important to diagnose the Problems properly. And a little bit then around Personal Training, and back pain and some of the approaches that Cindy Jacobs taken over in Holland to approach these issues with some of these patients. So welcome back, Jacob.How’s things over there?

Jacob Steyn 1:18
Very good. Thank you. Yeah. A little rainy. But otherwise, it’s going really well here on on.

Ben James 1:24
Good, good, good, good.

So we talked a lot about your issues and your experience with back pain, and how you’ve kind of come out the other side, we haven’t really focused so much today on the bigger picture of back pain. And like I say, it’s one of those complaints that we’re seeing more and more and more, and it’s becoming a bit of an epidemic. And there’s been a lot on the news, certainly over here in the UK recently about sitting and the sidenote to nature of kind of work, that’s potentially having an impact. What are your thoughts on that?

Jacob Steyn 2:04
I think, of course, it’s not only in the UK, I think it’s in most westernized countries where we have a sedentary job. And we said lots of whether you’re driving or sitting behind a computer. And I think it’s, it’s, yeah, that’s, you know, if we want to get to the root cause of the problem, I think we have to look at that. And we have to address that. And I think that that’s, I think that’s a much bigger problem than we realize. And I think we’re going to see that more and more and we see it also more and more in students and younger children who are not moving enough. So I think that we, I don’t think we really understand the know what’s heading our way. But I hope we get ahead of this problem. And I hope that from a central point, also from the, you know, from governments and institutions, there will be a way of looking at it in a different way, and addressing the seriousness of it?

Ben James 3:01
Yeah, no, absolutely. I mean, we’ve certainly seen I guess, some positive change we you see on the market now, these movable desks for example. So there are some companies that are taking the kind of occupational health approach and in terms of workstations and how those workstations should be set up to help prevent these issues, etc. And I guess the big question is will will Weiss, sitting in that kind of posture specifically, such a big issue? Are we really focusing in on spine flexion?

Jacob Steyn 3:41
Yeah, spine flexion especially in the low back, but also the loss of flexion extension or movement mobility in the upper back. We have something and I’m sure you know, this term, it’s called the car WP the creep effect. We heard from the research and that’s We know that when the when you’re sitting, or you’re in a posture for too long, you know, the, for example, in this case, the discs in the low back will actually start losing its natural shape. And that’s if it happens for too long period, say half an hour or two an hour sitting of moving in a position which is not natural for your lower back as you lose that natural position when you sit compared to when you stand, you actually go into the screep effect and if you do that on a regular basis, you will have you will have a situation where the tissue in your low back will start getting irritated you’ll have an inflammatory response and from there you’ll have maybe scar tissue developing and you lose the movement and things will stiffen up and you know the brain lose the the understanding of the of the potential movement, which you should be having. And if you do that for a few years, then you’re heading down the wrong way.

So I think that’s where it goes wrong. And I think making people aware of that, just that aspect, you know that if we, if we, if I look at patients and I look at people who are in the situation, usually, they think because they don’t feel anything in their low back, they don’t have any pain. They think it’s okay. But they do not understand that they have lost a lot of mobility, there’s different up have some scar tissue. If I look up in ranges of motion in the low back, they will also they’ll also feel pain, but they generally don’t look that up. So they don’t know that and I think it’s okay. But the underlying problem there is the fact that they’re exposing themselves to a massive injury, that one time in the beginning of the spring when they pick up something from the floor or they’re busy in the garden, and they go through their back, and that’s what we want to try and avoid.

Ben James 5:56
Yeah, no, I know. I think coming back to something you said because I think there’s a difference For the guys listening, there’s kind of two, there’s two elements to this because there’s, there’s the prevention and how we stop those issues or the stop that serious episode of back pain and help people to be stronger and more in control. And there’s also the element of okay. We’re potentially developing some scar tissue. We’re getting that laxity. We’re getting that creep. How do I reverse that? Can I reverse that? Am I in a more vulnerable position? If I’ve been doing that for a couple of years, but it’s fair to say a lot of people will be listening with back pain will say, well, I’ve been sat desk for two, three years, and now I’m starting to get some back pain. Am I down a path that I can never reverse that are Can I at least controller and prevent them You know?

Jacob Steyn 7:01
Yeah, so there’s always light at the end of the tunnel. I mean, we can always improve things you can imagine if you’re sitting a lot, and you let’s say you make a drastic change in your life and you quit your job, and you hit a completely different direction. Let’s say you don’t need or you have the financial means to do it. Of course it’s going to go better with your back. So that just shows that there there are always there is always potential to improve your situation. So let’s say you don’t have the financial means and you are not going to quit your job. Small changes will already make a big difference. You know, if you go for a walk every lunchtime and you go for a walk after work, you are resetting your posture, which you have been let’s say you’ve been in a posture all day or you’ve got a very busy job while you’re sitting in a car or, or you know your delivery man. Your body is not Really getting the stimulation it means in terms of mobility and stability training. So, by going for a half an hour walk at lunch and another half an hour walk after work, you’re actually resetting that poor posture throughout the day and your brain is now turning on certain muscles which are giving you the the necessary stability. Again, you know, that’s just a small example. But there, there’s always light at the end of the tunnel, there’s always there are always things that you can do to get back, which we discussed previously, in the podcast before this one first, as a first step, some stability and then moving towards regaining some of the mobility.

Ben James 8:44
Yeah, absolutely. Let’s talk a little bit more in depth about the prevention and those guys that are doing these repetitive jobs. Because what we’re really saying for these guys is okay, you may have noticed a little bit of back discomfort which is no doubt was drawn you to listening to the podcast and you may have had an episode of severe back pain which is gone away, but you’ve got a little bit of a concern moving forward. What we’re really saying to these guys, is, let’s look at developing some healthy habits around the work and the role that you do. That’s just going to help to prevent this continued kind of creep and this continued deconditioning of some of those soft tissues that are going to potentially result in a more serious issue or more serious episode about pain. let’s develop some habits that are going to help you prevent that and help you understand how you can be a little bit more healthier in in how you treat your spine at work.

Jacob Steyn 9:46
That’s it, those healthy habits, you know, they’re a good point and I think there are a lot of people who might have a job that’s asking a lot of their body, but they’re still going to the gym. So then we haven’t Extra possibility to work with their body and they can use those gym sessions to actually strengthen their body for what they’re doing. But the thing The thing is, in general, I think a lot of people would be going to the gym, for example, thinking about losing weight or getting the heart rate up or doing cardio instead of actually working on creating more stability that’s going to protect their, their core, for example.

Ben James 10:25
Yeah, so there’s a risk here with the guys that are sat all day or they’re doing repetitive work as a carpenter or whatever that might be. That is contributing to a potentially more serious or significant back issue. These guys are not developing healthy habits at work or not aware of what they could be doing to help support themselves at work and then they’re potentially been going to the gym for different reasons, like you say to lose weight or just put on muscle mass and look bigger or whatever that might be. They’re already in a state of vulnerability. And then if they’re not taking consideration, then then they’re real, really more serious risk.

Jacob Steyn 11:15
Certainly, I think the main focus and awareness should be, you know, decreasing that vulnerability to get injured. And that’s also depending on the type of job. If you have an office job, it’s going to be different to when you’re actually a carpenter, for example. I know a lot I have some friends and I know some patients quite closely work with their bodies. So you know, they might be professional handyman or they do all sorts of physical jobs. And I know at the end of the day, usually they are not you know, they’re not up for any physical training. They’ve had their physical training for the day. He’s that’s how they feel. So then they want to relax and recover and the next day, you know, they have another physical day at work. So, for them, it would be much better to actually think about how they do their job. You know, I mean half kneeling, teaching teaching them the bracing technique. Making sure that when they’re in an awkward position that they’re not compromising anything in their body. But if you’re somebody who sits behind the desk, then we are looking more at the creep effect, which we discussed, you know, that’s prolonged position holding off whichever part of your spine whether it’s hanging with your head and shoulders forward or you know, just the fact that you’re sitting and not using your core so you lose all the older muscle protection and your low back so then you get that creep effect. So that person needs to do something different to make sure that they decrease the vulnerability of getting injured.

Ben James 12:49
Okay, and I guess for the for the guys listening where there’s going to be a lot of variability and work and things like we know back pain isn’t is not a simple solution for Everybody, there’s not a simple solution for every issue in terms of prevention initially, and we’ll come on to the diagnosis, patients that have got a more serious or significant episode of back pain for those guys, that might be saying desk or there’s the carpenter or there’s the delivery driver, whatever that might be other there’s some common things that these guys could all be doing. That’s going to contribute to back health and injury prevention. Rather than a say, Well, okay, specific jobs needs specific things, if that makes sense, just to try and give some overall support and advice, I guess.

Jacob Steyn 13:44
Yeah. You know, I’m much more keen on going on the specific advice, but I think if you if you think of general advice might be different than what we think I think the first thing would be. The first thing would be to drink enough water You know, I, I have a lot of patients who I have a blaster and I know you know, he doesn’t drink enough water when I tell him he says he’s gonna do it. But if you’re dehydrated the whole day working with your body, that’s not a good idea. drinking enough water, and, for example, drinking less coffee, that would make a lot of sense to start.

Ben James 14:23
And how’s that going to help everybody? what’s the what’s the impact of that? Are we saying that the hydration is impacting individual discs impacting muscles? what’s the what’s the key rationale for the guys listening?

Jacob Steyn 14:37
Yeah, so the first thing you mentioned there is if you want to hydrate the disc, you need to have enough fluid in your body. We know that there’s research on that. So that’s important that you make sure you have enough fluid in your body to hydrate the disc. Secondly, the lymphatic system is very important and that’s especially important if you want to recover faster and the lymphatics it works with The muscle pump system, unlike the heart, so when you use a muscle you push the limp onwards, when you’re dehydrated that’s, that’s going to go slower than usual. So if you’re somebody who works with your body all day, you need the recovery from day to day. So you need to try and have enough fluid in your body to help the lymphatic system drain quicker and so you’re going to recover better for the next day.

Ben James 15:26
Okay, so hydration was saying is a is a key thing for for anybody in any role. And what about waking up in the morning we know that when we sleep we get some impact on desk because we’re not putting pressure on the desk for example. So when we’re getting up in the morning and those first activities those first eight minutes of the day are contributing to a reduction and despite which will all experience once we we get out of bed is the advice we can give them first thing in the morning. Try not get straight in the car where you’re sitting down, or those simple tasks, those simple activities first thing in the morning that could be having a detrimental impact that we want to be aware of.

Jacob Steyn 16:16
Absolutely. So let’s just back up there for a moment. And let’s explain what happens with the spine when you For example, sleep overnight. After you’ve had a busy day, you know, I mean, even if you go for a hard workout, you’ve done some squats or lifting or you’ve carried sandbags, you put a lot of strain on the spine. Obviously, the first the first thing that has to happen off the bat is the recovery process. So usually you’ll wake up the next day with a stiffer back because you’ve used your back a lot the previous day. You know that when you work in a garden or read on something physical usually, if you don’t work with your body and you’ve had a physical day doing stuff the next day, you will feel it You know, you’ll be stiffened up a little bit. So then if we look at somebody who works for their body, you know they have a physical job there, they’re going to have that quite often they’re going to have different tasks every day and the next day, they’re going to wake up and they’re going to be stiffer in one part of their body. So let’s say that’s the back, we’ve been lifting stuff we’ve been we’ve been using our back to them to do our job. So a part of the process and the recovery process there is sometimes you get a little bit of swelling at the tissues, you can have that at the desk or the muscles or the tendons along the spine. And so when you go to bed, there will be fluid building up around the spine around the discs and the muscles. Which means that you know, that’s that’s the recovery process, but you are lying horizontal so there’s no pressure on the on the actual spine. Which means it’s okay you know, you’re moving in bed with this fluid in these places, build up And it’s not necessarily a problem. But because you’ve not been moving for seven or eight hours when you stand up in the morning. That accumulated fluid is now on the way when you go from horizontal to vertical, so you get the pressure on the tissues on the discs and the discuss week it’s worth mentioning the discs are also accumulating more fluid, that’s what they’re trying to do the whole time when you horizontal they’re able to do that. But when you stand up in the morning, that little bit of swelling which is part of the recovery process together with the fluid in your discs will come on the pressure and you will feel that and you will feel stiffness and you may feel a little bit of pain and it wasn’t restrict movement. So the first thing you need to do is actually move in an upright manner you know, just walking, for example, do you think so that you can for the first 30 minutes, maybe sometimes it will take more 45 minutes you got to pump away the fluid again to The lymphatic system by using your muscles, you know, you might be twisting your body a little bit, just standing in the kitchen preparing breakfast, that should be enough. And after 3045 minutes, you’ll have most of your range of motion, the freedom to move, you’ll have that back. If you would, for example, get up in the morning, and you know, maybe your shower the night before quickly get dressed in the morning of the waking up and you get in a car within 10 minutes, you will still have a lot of accumulated fluid and you’ll be sitting in a car with your low back slouching to a certain degree, hopefully not too much. With all the fluid accumulated along the spine and then your discs, you will have extra pressure and that will make you more vulnerable. tissue damage and irritation. Maybe already have a little bit of irritation. So that’s a very good point. I think you need to take care and in the morning, you need to Listen to your body. Maybe you’ve had a busy day, previous, the previous day was a very physical day and your spine needs to recover. So in the morning, you need to move and get those fluids pumped away before you get in a car and or do something physical.

Ben James 20:16
Yeah, yeah. So really what we’re saying to people is is a good I guess healthy morning habit would be to get up and rather than go straight to the kettle, have a cup of coffee and then jump in the car was saying, get a bit of hydration and get some water in early and try and take the opportunity to have a walk or at least not get straight in the car within the first 30 minutes of the day. You know, yes, they’ll be really healthy habits that everybody could do. And they’ll be a lot of people say at the time and so set the alarm a little bit earlier. You know, if if, if your health and your health is important, then These are very simple things that actually could make a big difference.

Jacob Steyn 21:03
Absolutely, absolutely. And especially if you have a little bit of back irritation, that’s exactly what you want to do. Make a little bit of time for a short 1015 minute walk. I mean, you do that and you will feel a massive difference. That was your eBay. People who have a have a dog will tell you how good it is when they take the dog for a walk in the morning before they leave for work.

Ben James 21:24
Yeah. And, and the ideal then is to With that in mind, and with those two factors considered, how can we introduce some of that throughout the day. So we’re going into work, having had a walk and given ourselves 30 minutes, we’ve had some hydration, we’re taking some water to work. So we’re going to be conscious of that throughout the day. Yeah, you might have a lot of meetings or you might be laying flooring or whatever you’re doing. But let’s try and between those transitions at work. Let’s say you’re moving from one meeting to another or You’re, you’re on your lunch break, trying to walk again, trying to reset that posture, trying to be mindful of that posture and give yourself those micro breaks throughout the day, again, are all going to contribute to a much more healthy back throughout the day.

Jacob Steyn 22:17
Exactly. Yeah. Now, just to reiterate, the point of before, you know, you asked for possible specific adjustments that somebody could make to be less vulnerable for injury. And that’s exactly what I said, the typical desk person would want to walk more, maybe lunchtime, or after work, to get more movement and to pump away a little bit of accumulated swelling from sitting still and to, you know, to get rid of the creep effect. tissues changing form in the spine, for example. And you’re your guy who works physical I think he the first objective there would be to help him become aware of how to brace how to use these core. If he would bend through his back, how he can lock the core in the bent, low back position, so he doesn’t actually damage this. And if he would go to the gym and train, maybe we should look at training the posterior chain, the glutes and the hamstrings, so that when he bends over picking things up or doing something in a strange position, that is not actually getting the power from his back but actually getting the power from gluten hamstring.

Ben James 23:40
Absolutely. Absolutely. And back to the water discussion. How much water are we saying because the the evidence kind of varies or the guidelines or recommendations vary, but I think it’s fair to say from the conversations, I’ve With people were drinking Far, far too little. And actually, some of the advice is really we should be drinking around two liters per day. How many people are honestly and can honestly say that they’re doing and committing to that amount?

Jacob Steyn 24:16
Probably very little. Not a lot. And I think another thing is water retention.There’s very conflicting evidence and things of Yeah, information when we speak about salt for example. I forget the name right of this. I think it’s Dr. James Dean Nicola de Nicola to the researcher who wrote the salt pics recently. He was also interviewed by Rob Wolf, very good podcast. And, well basically what he says is that you need to Get enough salt in your body if you want to lose water attention, you want to get rid of water retention. And I think a lot of people because I hear a lot of patients say when they when they get told to drink more water that if they drink more water they have to go more often to the toilet at night. And I think that has to do with with water retention. So my suggestion there would be and this is also my finding when I work with patients who have that is to try and have some salt, have a little bit more salt, good quality salt, you know, a Celtic sea salt or something like that. opposed to a normal table salt and see what that does. If if that helps you to lose some of the water retention. And the other tip I would give there is to have the two liters of water or liter and a half pending on the size of your body before five o’clock and you know not trying not not forget that you’re not forget to Waterman trying to make up for me.

Ben James 26:03
Yes, yeah, exactly. Don’t just suddenly try and drink two liters at seven o’clock at night. Because actually we need it consistently throughout the day. And just to clear up You, you, you mentioned about water retention preventing water retention he saying preventing preventing water retention issues, because surely world we’re trying to retain more water and that’s what salts doing

Jacob Steyn 26:27
Actually salt helps to get rid of water retention. Okay. And then and then I’m talking about water retention and tissues where we don’t want it. So you will see that a lot of people will have water retention their legs and especially women around their period. And especially some of the older people will also have water attention and I think that has to do with poor digestion and maybe they got an awkward high insulin And, you know, we’re opening up a completely different conversation here. But yeah, that would go more into also looking at somebody dying.

Ben James 27:10
Yes. And I was going to say that that’s certainly going to be something more focused on in in another episode and the the impact on the wider impact of nutrition as a whole, as opposed to just the water and with it salt debate. And so to get clear at the point when we’re talking water attention, and where we want to retain water, because a lot of people are going to say, Well, if I drink two liters of water, I’m going to just be going to the toilet every day. Actually, what we want to do is some some additional salt and diet is going to help us to retain the water within the body, but it’s not going to be distributed in the wrong areas.

Jacob Steyn 27:47
Exactly, exactly.And the wrong tissues.

Ben James 27:51
Okay, well, that makes a lot of sense. I mean, there’s there’s some key golden nuggets for people to develop and to uses habits really day to day that could contribute to better overall back health, which is great, which is what people want to hear. And then I guess moving on then to the people that have had a serious issue or have a serious issue with back pain currently, or that they certainly perceive as being a serious issue. These advice, if you like, that we’ve we’ve been given could help. But in terms of that diagnosis and and getting an accurate diagnosis, what is it that you’re finding that you’re doing? That is so important and what some of the other practitioners out there and maybe missing, which gives the guys listening an opportunity to challenge the practitioners they may be seeing or maybe looking to see? To to ensure that they’re going to make an improvement?

Jacob Steyn 28:56
Yes.

I think. Yeah, that we discussed this little bit in a previous podcast also, it’s a very good question. I think that, you know, as a patient, you should not want to be after a quick fix. I mean, sometimes it’s easy to want to have a quick fix because you’re in pain. And of course, a lot of sense, you know, I want to be I want to get out of pain, and that’s your, that’s that that’s the primary goal. But then when we dig a little bit deeper, there’s obviously a cause and we want to take care of that cause and, you know, for some people, it would be a pain they’ve had numerous times in the same place, which means that the cause isn’t really being taken care of. And I think that’s what people should want to see in a in a practitioner or a therapist, somebody that is looking for the cause of the problem, especially when they make a diagnosis. You know, when you go to practitioner you want to be aware of what they are testing. And even if you have to ask a few questions to find out what exactly they’re after or what they’re finding, and you should expect to have a little explanation of what the problem is and what what causes the problem, I always try my best to make them as aware as possible of the cause I try not to do with not to give too much of a explanation because sometimes you’ll lose them in the explanation or discussion but as long as they get the main reason for why they have a problem and why it keeps coming back. And they get it and when they get it i think that just increases the the strength of the healing process because I you know, you I want them to be actively part of the recovery and Whether that’s following a few tips or guidelines that I suggest they follow, like what we just discussed today, or whether it’s actually, you know, enrolling on a on a personal training program where we’re really changing things in their body and in their mindset. But I think that’s the main thing that they gotta look for is to see if they get that explanation and that understanding of why the problem keeps coming back. And then, you know, you gotta be listening for what is what exactly is this person’s plan with me? And doesn’t make sense?

Ben James 31:39
Yeah, and I think that’s, we mentioned before, how increasingly important is sitting in this age where we’ve got so much knowledge at our fingertips that people want to have a better understanding of what’s going on what they want to be invested in, their rehabilitation. They want to understand And kind of contribute to that, which I think we’d agree is actually essential, given that if you’re going to improve over the long term and show consistent gains and show consistent resilience to further issues, then you have to be involved in it because there’s an active element of treatment. That is so important.

Jacob Steyn 32:27
Absolutely, I think active physically, but also active mentally. If people are actively busy with it in their head and their attitude towards getting better, the outcomes just going to be better.

Ben James 32:41
Absolutely. And it’s probably a good point, and a good time to discuss the role you’re playing over in Nijmegen with regards to the personal training element that isn’t a part of your work and Not just as a chiropractor specifically, but with the local CrossFit gym where I think we both agree. There’s some fantastic opportunities in terms of fitness but there’s also some real risks with some of the things that we’ve seen in that CrossFit environment.

Jacob Steyn 33:20
Yeah, so exactly that that’s those are there are two things there. The one is the aspect of rehabilitation of patients in the in the gym, which I do through personal training. And the second thing is the the actual athletes that I work with people who train in the CrossFit gym. So those are two completely different things. And I’ll just speak about the first one so the patients I see in the in the gym, you know, I would generally treat them a few times and and already, start with basic exercises to get good communication between the brain and the muscle groups that are needed to recover and get that going, and then when they’re ready, depending on their own goal, because will always go according to what they have in store for themselves in terms of improvement. And then we’ll go to the gym and we’ll do a one on one hour session and then we’ll work on those drills and quite often we’ll use some of the equipment in the gym to start strengthening the parts of the body that’s probably been weak for quite a long time. And sometimes people will stay on and keep training at the gym, and sometimes they you know, that would have been enough for them. But I think the important thing there, for me at least is to open up their to make their world a little bit bigger in terms of seeing what is possible, because quite a lot of them would never have associated with a CrossFit gym or You know, doing the sort of exercises that we do using a kettlebell or getting on a GHD doing a sauce on hold or a hip thruster or stuff like that. So I think that’s very good because all of a sudden day, they’ve entered a world in a, in a safe process, without scaring them and where they’re getting, you know, when they get the feeling that this is absolutely not me, they’ve tried it, and maybe they will continue with it. Because they would have generally gotten good results. So that’s the one side of it. The other side of it is the suggested.

Ben James 35:38
So Jacob just to jump in there’s a, there’s a, there’s an added benefit there from a social point of view that we’re saying that, you know, some people that previously may have not felt that these environments were accessible, accessible, suddenly become that little bit less daunting. And actually there’s there’s a little bit of science and behind the benefits to the But the great thing for those guys that do transition into maybe doing the CrossFit or go into the gym is that they’ve had the treatment from you. And they’ve kind of had that continuum of care to give them the foundation. That means when they go on to train, they’re going to be in a far better position. And let’s face it, a lot of the guys that are just going straight into training, and then themselves getting issues.

Jacob Steyn 36:26
Exactly, yeah, absolutely. Absolutely. And often I have in because I work in collaboration with the owners of the CrossFit gym. If they have somebody doing the on ramp, you know, the first the starting program of exposing the the movements to people that they do for the first month before they actually start doing the ones at the CrossFit gym. If they notice that somebody’s got an injury, long term injury or you know, it’s not good, then generally they would send that person to me and so I’ve worked with a few people like that also. Then maybe we’ll take six months if it was radiating nerve issue down the leg, or maybe we’ll take shorter, but then I would prepare these people in a way that would make it will give them the feeling that it’s a lot more safe to start doing CrossFit now, instead of just going and you know, going all out and getting injured again. But for what I wanted to say is for a lot of people and the I think it’s a real benefit that they they enter this environment with the idea that it’s safe and with the comfort or the reassurance that I’m actually guiding them. And I think that’s a big deal. And I would really, I wish I could see a lot more of that where you know, somebody who’s not just in general Somebody who’s generally not very strong or never thought that they would actually touch weights now go into a gym and do these sort of exercises in a very controlled manner, of course, but I wish I could see a lot more of that happen.

Ben James 38:13
Yeah, I was gonna say you, you guys over in in Nijmegen in the CrossFit gym you particularly work have have clearly had the foresight to see the benefits of what you can offer at the beginning of that journey for a lot of their potential clients. Do you think that’s a negative for an area of CrossFit that isn’t considered because you see a lot of these gyms popping up which is great for getting people into exercise and giving people the option to, to exercise in a different way because there are going to be people that don’t just want to go to a more traditional gym should we say and, and therefore CrossFit is really appealing and really beneficial to those guys, but are we saying that potentially there isn’t enough of a focus on the foundations of movement within those gyms, and therefore, people can be put up unnecessary risk if they’re just going into the kind of CrossFit workout of the day. situation.

Jacob Steyn 39:18
Yeah, absolutely. I’ll give you an example. I have a friend here in Holland, he’s a chiropractor, and you know, a fair bit about movement, quality and so on. And he started a CrossFit gym. Never he’s never he has never done something like that before. He’s done a little bit of calisthenics and things like that, but started at a CrossFit gym a few months ago, and after a couple of months, he ended up leaving because he was getting injured himself. And simply because he went with the flow of things and having discussions with some of the trainers didn’t go well. And My my impression there was that these people were not open to some of the things that he was, he was telling them and in the end he got injured. And he left. And I think there is a big discrepancy and a big room of for improvement in this field and I think there are a lot of gems that can actually look for somebody actually make some effort, find somebody who has a different understanding to them coming from a different perspective to help them filter through the people that maybe need more attention before they actually go on this very quite, quite often very intensive training experience called CrossFit. Yeah. And you know, because let’s be honest, if I look at the people starting at the CrossFit gym, where I am, more than half of them or maybe even 75% or even more, does not come from a very Good quality movement background, you know, quite often they they sit behind a desk, you know, they have a job that’s already been for a few years that has already been robbing them from the quality of movement, which they have built up from the childhood, maybe they were not that fortunate and they didn’t do that many sports or didn’t have the freedom to do it. And so they haven’t developed very well in terms of movement. And now they get into a CrossFit gym. And we’re doing very, very technical movements with weight and against time. So if you think about it, it can be it’s the ideal recipe for disaster. And if you don’t identify certain things that needs to be in place before you start doing this, then that recipe just becomes even stronger. So having a little screening process of checking whether these people are actually able to move properly stabilize, or have the mobility is essential actually. So, I think a lot of gyms have, actually, especially CrossFit gyms, they, it’s their responsibility to find somebody with the expertise to assist them in that. And, you know, I think quite often they see it as a, they might see it as a fit, you know, because it’s their gym and, you know, I would they get somebody like a chiropractor or a movement specialist to help them out with this, but, in fact, my experience is that it actually just, it only strengthens the whole whatever they’re offering.

Ben James 42:38
Yeah, I mean, you know, it’s, it’s, again, having that bigger vision of taking that responsibility and being conscious of the the individuals that are going to be attending and not just looking at the business side of all we want to get people into our gym. Let’s look after the people that come into our gym because actually, over the longer term, they’re gonna Going to be more resilient to injury and therefore, they’re going to more likely continue with a membership over the longer term. And sometimes, business owners in many industries don’t take consideration of these kind of factors today so And to be clear, we’re not we’re not knocking CrossFit, we’ve both done activities and fitness at CrossFit gym, some of the activities we, we absolutely support some of them that we would advise against, but I think it it certainly makes fitness very much accessible for a lot of people in a different way that is really beneficial for for certain types of individuals and personalities. But what we’re seeing is, we’re seeing a number of injuries as a result of some of this pretty intense work and therefore, just be careful at the outset that that you’re aware of some of these movement patterns that are so important in terms of resilience to injury and particularly when you’re somebody that may be is a desk all day and has taken consideration of what we’re saying about the potential tissue creep, etc. to then go into that environment, you are putting yourself at risk if you don’t have some foundations in place or knowledge in place to help support that journey.

Jacob Steyn 44:16
Certainly, yeah. Yeah. Coming back to the financial issue at our gym, for example, we have a very low rate of injury. And I’m very proud to say that actually, you know, I know about across regions where people get injured a lot more simply because of what we’ve just spoken about. And at our gym, we have and I’m very proud of the guys and their, the fact that they’re so open, especially the honest to this kind of approach and the influence I’ve had on them and, you know, the fact that they’re so open to the seminars that I’ve suggested, we go to And so they’ve applied a lot of these things, and you see it the whole time throughout the workouts and the lessons that they give. It’s very much focused on the core and, you know, working in a neutral and, and, and staying away from things are actually, you know, just wearing joints more than it should, especially if people are not stable. So, yes, it also identifying Who’s Who are the people that you work with? And, you know, not not trying to build people that’s going to compete at the European Championships. When you have, you know, your general office people and general people training in a gym.

Ben James 45:46
Yes, yeah, absolutely. And, you know, as we kind of indicated at the outset, starting these podcasts, that’s really where we want to take this a little bit further and become a little bit more specific in terms of some of these exercises and some of the Things that we can advise, and they’re going to help people a little bit further. But, you know, to summarize today, really what we’re saying is, you know, some key nuggets of information that can help in terms of resilience, keeping hydrated, being conscious of that movement in the first 30 minutes of the day, taking those micro breaks throughout the day. And then for the guys that have been in pain and discomfort, and maybe you’ve seen a practitioner and you’ve got a discomfort you’ve got out of pain. Look at that continuation of care in terms of your movement in terms of the overall core strength. And in doing so, you’re going to be far, far more resilient, and far, far healthier. You’re going to feel in much more control, moving forward, much more confident. And as a result, you know, that can only be that can only be a beneficial thing. So thanks again, Jacob. And, you know, we’ll see you all again on the podcast and future podcasts and We continue, take the opportunity to like and comment on, on the podcast on iTunes that’s only going to help to get other people aware of what we’re doing aware of what we’re trying to trying to achieve and overall, you know, help a lot more people with with back health and plug some of those gaps that we see are missing out there that that will help far more people in the population. So thanks again, Jacob. And we’ll catch you again soon.

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