The Beyond Pain Podcast

Episode 14: The Most Common Type of Low Back Pain

• Par Four Performance • Episode 14

Share episode

Send us a text

DM Us! We love chatting with our audience, please feel free to do so on Instagram and say what's up!

Want to work with us? Apply here!

Watch on YouTube here.

Summary
In this episode of the Beyond Pain podcast, Joe Gambino and Joe LaVacca discuss non-specific low back pain. They emphasize the importance of ruling out serious conditions and educating clients about the nature of non-specific pain. They also highlight the role of movement and staying active in managing low back pain. The hosts provide tips for clients, including not panicking, staying optimistic, and listening to their bodies. They also discuss the fluctuating nature of pain and the importance of gradually reintroducing activities to avoid flare-ups.

Takeaways
Non-specific low back pain refers to pain that cannot be attributed to a specific anatomical structure.

Ruling out serious conditions and educating clients about their pain can help alleviate fear and anxiety.

Staying active and gradually reintroducing activities that feel good can aid in recovery.

Pain may fluctuate during the recovery process, but this does not necessarily indicate setbacks.

Listening to the body and avoiding overexertion can help prevent flare-ups.

Joe Gambino (00:00)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino. You can find me on Instagram at Joe Gambino, DPT. And Joe, if you're watching this on YouTube, Joe did an early wave because I have not introduced him yet. But Joe Lavaca, that's right. I'm here with the lovely Joe Lavaca. You can find him on Instagram at Strength in Motion, underscore PT.

Joe LaVacca (00:17)
You threw off the cadence.

Joe Gambino (00:29)
We throw that out there just, I mean, yes, please give us a follow if you don't already, but we do love to connect with the audience. So please shoot us a DM. Even if you just DM us the word podcast, we're more than happy to take the conversation from there if that's easier for you. On that note, this podcast does have its own Instagram channel, at beyond pain podcasts, right Joe? I always forget that one, perfect.

Joe LaVacca (00:53)
That's correct.

Joe Gambino (00:55)
And this is live on YouTube as well. if you're, want to check us out there as well, that is cups of Joe underscore P T on YouTube. And I think that is everything. And there's an application form in the show notes as well. So if anyone is, wants to talk to us deeper, as far as what may be going on with them or you rather, you can fill that out and one of us will get back to you, Joe, how you doing?

Joe LaVacca (01:22)
I'm doing good. It's nice to have you back, buddy. Running through that intro, I know you were away last week. Yeah, we had Dr. Michael Ray on. He was wonderful. So we'll be dropping that episode in a couple of weeks. yeah, the stress of the intro, because we were rolling there for a little bit, you were doing the intro really, and even the outro, I was realizing as I was editing everything. And it was a lot of stress.

Joe Gambino (01:25)
Thank you, thank you. I I missed the show last week.

Joe LaVacca (01:50)
I didn't want to mess it up. You had your flow, your rhythm. And then that's why I was like, because you had your flow, your rhythm, for those watching on YouTube, you'll notice that early wave because you changed it up. I didn't know you were going to change it up today. So I'm already on my toes, but I'm happy to have

Joe Gambino (02:04)
How was that? That's my goal Joe, keep you on your toes. Keep you on your toes. What kind of coffee you drinking there today?

Joe LaVacca (02:12)
No, regular, just what I got, Lavaza. Yeah, well, that was the real reason why I picked up the bag back in the day. I was like, Lavaza, Lavaca, close enough. honestly, just where I go grocery shopping, I like this kind of mild blend that they have, and it is always on sale for like $6 .99, right? So I love

Joe Gambino (02:17)
Lavaca? You got some Lavaca coffee over there?

Hahaha

There you go.

Joe LaVacca (02:42)
Occasionally I'll treat myself to some Illy. You know, the nice coffee in the metal can. I do like a good Illy, but it's hard to when you pick up one of those cans of Illy and they're $16 .99 and the Lavazza, which is just for me, is $6 .99. And I'm like, I mean, I can't afford to just treat myself like that every week. I gotta make it special. So what about you? I see you're drinking one

Joe Gambino (02:45)
Mm -hmm.

Mm -hmm. Yeah, you need to if you're gonna if you're gonna spend $16 .99, you need to find a good coffee shop near you and if you like their coffee get their beans So we have a coffee shop here called common grounds. I will take you there Joe when you when you come visit in August But they have good coffee I've been buying my coffee beans from them and getting some espresso beans and so I have the espresso machine and so I have a ice latte here for

Joe LaVacca (03:12)
Yes, yes.

very good. Can't wait.

Joe Gambino (03:32)
my enjoyment today. Yes, yes, they're finally coming together. I go between, do, right now it's either this or I do homemade cold brew. So that's, those are the two things I've been, I drink almost every day now at this point in the occasional treatment amount.

Joe LaVacca (03:32)
That's right, I forgot you were getting into the ice lattes. That's right, that's right.

No, I'm hoping that the recipe is perfected over the next like four weeks.

Joe Gambino (03:51)
For which one? Lattes or for...cobra? I mean the cobra has been perfected for years.

Joe LaVacca (03:54)
I mean, whatever, whatever. I'm just excited to come, well, I'm just excited to come see you and sample whatever coffee brews and espressos that you have for us as we maybe do our first couple live, live together sessions.

Joe Gambino (04:00)
Yes.

That's right. You can do a coffee review live on this podcast.

Joe LaVacca (04:14)
Wow, that'll be an extra soad, extra soad for the deep, deep fans.

Joe Gambino (04:19)
Yes, let me ask a question here, Joe.

Joe LaVacca (04:21)
Throw it at

Joe Gambino (04:23)
When you take, when you drink coffee, do you have a cutoff time for when you need to stop drinking coffee because it impacts sleep or something like that?

Joe LaVacca (04:30)
Great question. I personally haven't felt that coffee keeps me up at night. Although I'd probably say the latest I tend to drink it is maybe like around a four o 'clock cutoff. But that's also just because of my schedule most of the time. For instance, if I'm in the city, I might have like a quick minute or two to sneak out, run across the

around like that 3 .30, four o 'clock time to grab a cup of coffee and just kind of power me through the day. But if I don't, then I'm running up to Penn Station, right? And you've done this song and dance in the city, right? I got to get to the train by a certain period of time or else I'm stuck waiting at Penn Station for 30 to 45 minutes. I don't want to do that. By the time I get home, well, I mean, it's just like nine, nine fifteen. I'm usually making dinner at that time.

cup of coffee then doesn't really seem to do it for me. Now, my parents drink coffee after dinner almost every night and they don't seem to have any issue with it either, at least from what they tell me. So it does not seem to bother me. I know that that may be individual from different people, has some different effects, I guess, depending on your receptors. But what about you? Is this a specific, like I can only have two lattes in the morning or some jittery or what's going on over there in the Gambino

Joe Gambino (05:56)
Yeah. So I only ask because, right before we got on, had made myself a iced latte and Jen dropped off Olivia daycare and she's, I were at a vice coffee now. She finished it this morning and she comes home and she's like, I need a, I need another coffee. I'm the coffee maker of the house. and I was like, well, I literally had just made one. So was like, here you go. take me. like, no, I don't want your coffee made it for you. was like, listen, she.

is highly affected by caffeine. Like if she has it afternoon, like she won't sleep at night. So it's like I could have literally I can drink one of these at like 10 o 'clock at night and fall asleep like a baby afterwards. Like there's nothing better for me when I go out for a nice dinner to get a cappuccino afterwards. That's like boom hits the spot every time and I can go home and I'll say there's probably a couple of occasions where it might have impacted sleep where I stayed up a little bit longer,

Joe LaVacca (06:37)
fall asleep,

Mmm, very nice.

Joe Gambino (06:54)
95 % of the time it does not. So I was like, here, take it. I can drink one of these later. And then I had time to make myself another one anyway, so it all worked out well.

Joe LaVacca (07:03)
That's perfect. mean, that's actually interesting because I'm thinking about my nights out and I do agree with you, right? Like if I'm going out, I sometimes like to have an espresso martini first because I'm like, let's get the job, let's get the energy flowing, right? A little shot of espresso. I know it doesn't work like this, but you know, a little shot of espresso, you know, a little martini. Hey, this is great. Cause I don't want to be doing it later on. However, I think it just depends on the night. I know we're going to be out

Joe Gambino (07:17)
Mm -hmm.

Joe LaVacca (07:33)
know, Courtney or a few of my friends, like an espresso martini first, I think sets me in this mindset that it's going to be a late night. As opposed to if I was out at a nice restaurant, perhaps, you know, with yourself, I get some espresso. I'd love a little Zambuca in that espresso. I love just like a little, you know, a little flavor to the coffee, which I feel like will settle me down, whether that's a Jameson or like a Galliano or a Amaretto. Right. So there is something that's weird

Joe Gambino (07:48)
Mm -hmm.

Joe LaVacca (08:02)
me finishing a night, like a calm night with a hot coffee and a Zambuca, Galliano or Amaretto versus an espresso martini that gets me amped up for the night. That has to be psychological, I'm thinking right now.

Joe Gambino (08:13)
I was just gonna say, I feel like now like this is actually, and I know this isn't even really where our conversation was going today. But this is almost like, I mean, think about pain now, right? Like we already know that it's so multifactorial and.

your experience when pain happens and a whole lot of other factors and stress, right. Can all layer on top of it. And I think these are some of those things that start to tell us like how pain, right. Is not just pain, right. It can be impacted by so many factors. There's something like how you respond to coffee. I mean, we've seen how many studies where like they've taken like white wine put

red dye in it, they give it to like sommeliers and they can't tell the difference between it being white or red, right? Because your brain, right? I mean, the way it perceives information, right? Is going to, it can almost play, play tricks on you. So I think that's, that's interesting. I think it's nice. I figured something we can talk about maybe to start this bad boy off, even though we are going to be talking about low back pain, specifically non -specific back pain where there's no real, you know,

rationale for why you have it and our eyes are clean and all that fun stuff. So I think these two things will blend together. So why don't we start there and you can give your thoughts on

Joe LaVacca (09:31)
I love that transition because we talk about that a lot in the show. And I think even some guests have brought that out. That context matters. And I think this is so key. The same ingredients for me, espresso and alcohol, can either get me into a mindset of ramping up my night or espresso and alcohol can get me into a mindset of ramping down my night and getting ready for bed.

It's probably really funny because it depends on who I'm with, what my expectations are. And that's a beautiful segue, Joe, because I think pain will obviously do the same thing to us, right? When you're having some pain with your training, are you anticipating an event on the weekend? Right? Maybe there's a run or a marathon coming up. Maybe you have a lift coming up. that back pain that you would normally get after your deadlifts or that knee pain that you kind of occasionally get after your run.

Joe Gambino (10:07)
Thank you. Thank you. you. Thank you.

Joe LaVacca (10:28)
is just simply magnified, right? Or just given a whole different meaning because you have a different sort of connotation to look forward to. So, man, that was a nice segue. I think we should make a coffee connection to pain in every episode if we could.

Joe Gambino (10:44)
Well, mean, that was a, mean, usually you gave me, feel like it was, you gave me the layup unintentionally, right? Like that was a, was, that was a, you know, just hit me. was like, wow, you know, we're talking about perceptions, right? And how it changes things and one can empty up and one can calm you down. And I think it's a, it's very similar. And I have some, some clients that I'm working with now

Joe LaVacca (10:50)
Hahaha

Joe Gambino (11:07)
they are, they become fearful of movement over time because of how long they've had pain. Right. And when now when we become fearful of things and you know, there's this whole, you're almost expecting to have pain when you do a movement, right? Like, I feel like things like that will, will have a good opportunity to increase that pain response for somebody. So definitely, I think it's a good point here, but let's, let's dive into,

I think where this conversation should start for low back pain, because we're talking about nonspecific, is guess like, what would you say, how would you define nonspecific low back pain, and how would that compare to other diagnoses that might pop up? I know we recently talked about sattica and stuff like

Joe LaVacca (11:54)
Yeah, I think that would probably be the easiest or freshest in clients minds or listeners minds because we did the sciatica episode last week. Non -specific back pain is not a fun definition, I think, for clients. think especially as we start off a lot of assessments, most clients will tell me part of their goals is I want to figure out what exactly is causing my pain or what is the

cause of my pain. And as a clinician sometimes I'm like, boy, they are not going to probably like what I tell them after this assessment because they're already shining a light that this is probably going to be non -specific in nature. Now let's clarify what non -specific means. Non -specific means that just from a clinical assessment, I cannot reliably pin down one specific structure that's causing your back pain.

So I can't necessarily say it's a bulging disc versus a facet joint versus muscle versus tendon versus anything else anatomically that we want to name around the low back. So what I tell clients is that while I can't necessarily rule one thing in the great thing about your assessment and your story is what we were able to rule out. So we talked about nerve root issues last week.

you know, with the sort of umbrella of sciatica kind of like attached to it. So we know that you don't have leg pain that's worse than back pain. We know that you don't have, let's say loss of sensation, reflexes, strength. Being that we can pair that now with your mechanism. And I think I've given you the Beyonce definition. We just woke up like this sometimes, right? Yeah. It's one of my favorite, you know, diagnoses to give people the Beyonce coding,

Joe Gambino (13:44)
Mm -hmm.

Joe LaVacca (13:52)
That can also be a little frustrating and I get that because people do want answers. So when you are explaining this again virtually, because I think maybe there's an advantage for some of us doing in person because you can maybe put your hands on people and you can do these like tests and retests and it might be just easier to form that bond with someone that, hey, this is okay.

and let me explain to you why it's okay. So maybe we can dive into that a little bit. How do you do that virtually with your clients to sort of ease them into this idea that nonspecific back pain doesn't mean that we have to be nonspecific in our treatments or maybe even cause for concern.

Joe Gambino (14:27)
Mm -hmm.

Yeah.

Yeah, so there's a couple of things. mean, in a virtual environment, yeah, I can't put my hands on them, but I can still test and retest movement. So part of the goal during an assessment is playing with some movement and seeing if we can make some sort of changes to things. The other thing, and I think you've kind of, you know, part of it, right, is what can you rule out? I think that's a great way to kind of put it as far as, hey, we can rule out any sort of major issues that are.

to go get MRIs or see other physicians or really have any sort of concern over things. And then those are things that I educate on and let them know. then I shift them towards, know, because even in like physical therapy, right, like our goal is not to give someone a medical diagnosis, where we give them a movement diagnosis. So then it's really how are they presenting from a movement perspective? What

things are irritating, what things make them feel better, where's their mobility limitations, where they have strength stability limitations, active and passive range of motion differences, right? So now we can almost start to paint a picture like, hey, well, you have these issues going on from a Moomer perspective, these things are irritating, these are, and now you can almost start to formulate a pathway back forward, especially if you've given deeply into their goals. Here's what you want to accomplish, here's what you look like today.

These are the first stepping stones to start to move things down the line. We'll know very, very quickly if we're on the right track or wrong track, because we should see some sort of change, right? Even if it's temporary, very, very quickly within the first couple of weeks. And if we're not seeing those changes, then we need to reevaluate. need to change the plan. We need to move forward from here in whatever way, shape or form. But, and then if really nothing is changing and this is just not acting in a way that we would suspect.

Then even if nothing popped up in our assessment that would tell me they need to go get this checked out at that point I'm like, okay Well, maybe we really do need to get something checked out to just make sure that there's nothing that we're missing and we rule out some of these other things that can potentially be impacting our planet care, which is Honestly doesn't happen too often, but it has happened, right?

Joe LaVacca (16:52)
Yeah, you remind me of a few things there, Joe, which I think are worth maybe revisiting. With all the tests and things that we do, and I know that I always highlight that you're virtual, I mean, my dream would be to go all virtual as well, but honestly, it strike the motion. I think the power of virtual appointments is wonderful, and maybe we could do a whole episode on that one day too. But I think from a standpoint

All the tests that I can offer someone, a straight leg raise test, a this test, a shear test, the SIJ tests, or the sacroiliac joint test, should say, I learned a long time ago that the patient -specific test is probably the one that matters most. So for instance, I had a client come in this week who was sort of presenting like she might have some leg pain.

wasn't quite sure of the mechanism, did some sort of like weird, you know, step back reach maneuver while she was running. Cause she went to go like, kind of try to find, you know, her glasses while they were falling. And, you know, she was worried obviously about sciatica. She was worried about all these things that she had read about. But there was a lot of things in her sort of description that didn't match sciatica. And it was sort of this more pain to the hip, not necessarily down the leg. It was coming and going.

And her main thing was, for the last two weeks or three weeks, I haven't been able to bend forward or touch my toes. And I said, okay, great. That's what I think that we should focus on because this girl also did yoga and she was sort of just dabbling and running because her family had done it and she wanted to join the family bucket list. You know, her husband ran a marathon last year. Her kids ran marathons the year before that. So now she's like, Hey, I'm the only one that hasn't done

and two, three weeks in, my glasses fall, I do this weird thing, right? So that's all we really focused on was I know her running coach, I know her running coach is excellent. She was already active. It seemed like she had a good supportive family who were all kind of like pushing each other and maybe that could be a good thing or a bad thing eventually, but the way she was describing it was good. And all we did was focus on flexion or just getting her down to sort of touch her toes. And that's all we did was that test, retest, and then what do you

By the end of the session, she was touching her toes and she was just so thrilled to realize, hey, that there's a pathway here. And I think that that PT diagnosis that you mentioned is maybe something that we should be giving clients a little bit more of. And for clients listening, a PT diagnosis would basically be, hey, my client comes in with an inability to touch her toes due to low back pain associated with weakness of the

pour this, pour that. But then that gives you and I a plan forward. And I don't really think I've really pushed a PT diagnosis on clients in a long time. So thank you for reminding me of that, because I've been so sort of interested in ruling big things out. But I do think that that's a nice plan forward for people to hear that. So I think that's a really good reminder. So good stuff there, my friend.

Joe Gambino (19:58)
wow. Thank you. And I think that's, mean, I do think it right. High importance of being able to those things out and educate, right. Because I think a lot of people find some of these diagnoses, potential diagnosis scary, right. or they believe this is going to happen because of whatever reason, right. They saw it on Google. Another doctor told them that, whatever it may be. So, but great. I think that's a, that's a great thing, but I do think that, I mean, I've never really, you know,

Joe LaVacca (20:11)
Mm

Joe Gambino (20:27)
It's not going to change my plan of care or how I'm going to help somebody if I was like, this was, I don't know, a facet joint issue versus just like, I don't know, whatever else. Right. Like unless there's like something very, very clear, like nerve tissue versus anything else or, you know, how, like if they have a, like if for a shoulder, if we're talking about, right, I want to know if there's like a full on

really, really bad rotator cuff tear, right? And like, how can I look for signs of that? So I need to know if I can rule them out. Cause I know PT at that point is probably not going to be the best outcome for them. Or with the knee, right? It's like meniscus tears do well, but do they have signs and symptoms of like a bucket handle tear, which we know won't quite respond to conservative care as well. So little things like that, right? Those are the things I really want to start to try to rule out, like you said, but I also want to, you know, other than that.

little nuances and structures are probably not going to change the way that I treat. It's going to be more of how they're presenting. And that's how I always try to educate

Joe LaVacca (21:30)
Right. And I think the scary thing is important for us to touch on because scary doesn't mean dangerous. Right. And you mentioned it earlier in the episode that a lot of the people who present to us with low back pain, it may be most pain in general, a lot of their MRIs or x -rays are, let's use the word normal or sort of expected, because I think after the age of 20, 30, 40, we're going to see adaptations

on x -rays and MRIs. And that's what people want to talk to me about. but this said this and this said this and this said this. And I understand that, but you've also been alive and moving and participating in activity or not, or doing just different things. Why would we expect the inside of our body, the skeleton tissue, the tendons of this, that to not look different, but we expect the outside of our body to look different. And we're okay with

Right? Because that just happens gradually over time. So look at a picture of yourself when you're 20. Look at a picture of yourself when you're 30, when you're 40, when you're 50. You're like, wow, I look different. And that was gradual and expected. So when clients present with these MRIs and these x -rays, I kind of tell them that would basically be the same rules we want to apply to this picture. If we took a picture of your spine or your disc or anything we're trying to talk about every day.

for the 20, 30 years, you'd be like, look at that, look that little thing. Oh, look at that. It's like a little gray hair, a little bump there. Oh, that's cool. Oh, wow, that happened so slowly. I can see how that maybe wouldn't be dangerous for me. And it's just sort of an adaptation. So as a reminder, those scans, show us your anatomy, but they don't show us your pain. And that's another important thing for clients. And as we were saying too, all these structures refer so much to the similar patterns.

facets and discs and tendons and muscles, they all refer very similarly. So I think that, you these like big takeaways for people to mitigate fear is important. And one of the first ways that I try to mitigate fear with people, and maybe we could put together some takeaways, is that this will get better on its own. Non -specific back pain, right, when we rule out all these other serious and sinister things, typically lasts about six to eight weeks.

Now know it's not wonderful news, but it's better than thinking that this is going to last potentially the rest of your life. The caveat or the back and forth of that is that recurrence is common for a lot of people and we don't necessarily know why, but we do see that people who maintain activity levels, who have better active coping strategies versus passive, and maybe kind of prioritize relationships socially.

they seem to do a little bit better. So why not focus on the fact that, you're safe. We know this is scary. It doesn't need to be dangerous. But what can we do to keep you moving over the next six to eight weeks and then keep all these positive attributes going forward? Would you say that those are decent takeaways? What would you add to those takeaways for your clients with back pain?

Joe Gambino (24:47)
I think those are great takeaways and maybe my question to you Joe and I'll let you kind of take it home here. If you had to give someone three tips, just general tips, know, lower back pain doesn't have to be anything specific. What were the three specific things that you would, you know, if it was a client sitting in front of you, you tell them to do to reduce pain, feel better, build more confidence.

Joe LaVacca (25:15)
Yeah, well, first off, I probably tell them, don't panic. Everything we found out today and everything in your story leads me to believe that you are going to be able to recover from this. And I say that rather confidently because I know I have so much data on my side. The other big thing is that I want you to stay moving. Now, initially, when you first get the back pain and if people are listening or maybe day one or day two of back pain, it is okay to rest.

It's okay to just take it easy for a day or two, but then after that day or two, start just doing anything that feels good. So if bending forward feels good, do more bending forward throughout the day. If extending backwards feels good, do more of that. If you were a runner, but you can walk, walk. If you were a walker, but now you can't walk, try to bike, try to swim, right? And just know that any sort

lateralization or substitution that we make will be temporary at best. The last one that I usually would tell them is just stay optimistic. Know that you will get better like I know you will get better and know that it won't be necessarily 100 % linear. So I think we talked about the Toblerone of recovery like this kind of like up and down, up and down, up and down. You'll have a couple of good days. You'll have a bad day quote unquote. It doesn't mean you're setting yourself back.

you are moving forward, that day, if you were able to run the day before, might be a walk day. That day, if you were able to do a heavy deadlift the day before, might be arm day at the gym. So I think it's just remaining optimistic and accepting the day to day and where you're

Joe Gambino (27:05)
I that Joe. The only thing I would add in here would be listen to your body. Because especially as you start to feel better, we know that even if you decide not to see PT, chances are things are going to start to feel better three weeks in, four weeks in, five weeks in, so on and so forth. As you start to reintegrate yourself back into the activities, make sure you're just not doing too much too fast because we do know that the tissues right under when they're injured.

They're just not going to, or there's pain, they're just not going to be able to accept or tolerate as much stress as they did prior to it. So you may need to just proceed with some caution. So you want to keep doing the things that feel good, remove the things that feel bad. And then you want to slowly dose in those things that felt bad as you start to feel better to make sure that you're just not flaring anything up in the meantime, because I feel like that's always, and I think I've talked about it multiple times in this podcast, but that's like that

point when you start to feel better, where I feel like flare ups tend to happen the most because now people are starting to go explore movement more because they're feeling better and then they do something too much and then they have more pain. like, my goodness. I'm, you know, I can't do this now. really it's not that you can't do it. You probably just took it a little too far. so I think that kind of like slow, steady build up back into the gym or back into running or back out onto the golf course or whatever it is that you're trying to do. that that's really the one thing I'd say.

Joe LaVacca (28:28)
Yeah, yeah, absolutely. And sometimes even when you do everything right, you're still gonna get a flare just because, hey, that's just the course of this stuff. And then it goes back to, hey, don't panic, stay moving, remain optimistic.

Joe Gambino (28:34)
It happens.

That's right. That's right. And I, been trying to, especially more, I would say this is probably something I've done in the last couple of years is I try to give my clients like a test, a movement test. So if we're working on specific qualities, I have somebody out that he has, anterior shoulder pain. When we started, he couldn't even move his arm past like his side into extension without pain. And he couldn't reach across his body with pain and pressing movements or the both painful things. It makes a hole in the sense,

Um, so he was doing really good pain came down. He's getting back at the pressing with no pain. had a flare up just like you said, and it started like he got really nervous about it. He realized after about four or five days, it started to get significantly better against who's recovering. And then when we got on the call, we're looking at movement and he has like 50 degrees of shoulder extension. Like I'm like, listen, even though you have all this pain coming on, like the objective things, like the test that I gave you.

These are the things that we were trying to improve so you can get back into pressing, right? You need shoulder extension and shoulder internal rotation to do pushups and bench press and things like this. We're getting there. That's why you started to feel better. Flare ups happen. So how can we now let pain come back down? Now we have new tests that we're working on to continue to build up on. whether pain goes up or pain goes down, these are the things that we want to see get better over the next

three, four weeks. And if those days are getting better, even if pain staying roughly the same or is up and down, we're going to be in good shape because we're building up better capacity at that shoulder and this is going to allow you to tolerate to do more and more. So just stay the course and you know, we were pretty good. He's, he was in a good mind space because things started to come down pretty quickly. But if he was staying elevated in pain, I think we would have had a whole deeper, deeper conversation there.

Joe LaVacca (30:30)
Amen, man. It's like inception. You got to have that token to come back to, know if you're dreaming or not. So what's your token? Just keep coming back there.

Joe Gambino (30:37)
That's it. That's it. All right, man. Well, I this is great. I think there's a lot of key takeaways here. We brought in some some really nice crossovers between coffee and pain, which, yeah, right. You know, I called you the philosopher, but I'm slowly coming, coming, coming for your title. I know. It's all this espresso I'm But, you know, as always, Joe, I love

Joe LaVacca (30:49)
man, that's beautiful.

The last couple weeks, the last couple weeks you're coming, you're coming for it.

Joe Gambino (31:07)
Listeners, I love you and if you stayed and are listening to these words at the very end, extra love for you.

Joe LaVacca (31:07)
Love you too, man.