Episode 27: Do You Really Need That MRI or X-Ray?

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• Joe Gambino
• Joe LaVacca

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Summary
In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca discuss the important topic of when to consider getting an MRI for injuries. They explore the guidelines for imaging, the significance of trauma, and the role of physical therapy in recovery. The conversation emphasizes the importance of understanding pain, the necessity of imaging, and the potential for unnecessary surgeries. The hosts share personal anecdotes and professional insights to guide listeners in making informed decisions about their health and treatment options.

Takeaways
Consider an MRI if there is significant trauma.

Pain does not always correlate with the need for imaging.

Recovery timelines can help determine the need for scans.

MRI is useful for ruling out serious conditions.

Functional loss is a key indicator for imaging.

Not all injuries require immediate imaging.

Consulting a PT can provide clarity before imaging.

Age and history play a role in imaging decisions.

Surgery should be a last resort after conservative care.

Understanding your body is crucial for making health decisions.

Transcript

Joe Gambino (00:01.007)
Welcome back into the Beyond Paint podcast. I am one of your hosts, Joe Gambino, and I am here with the, I don't even have an adjective for you today, Joe. We'll just call you Joe Lavaca today.

Joe LaVacca (00:10.076)
And I was hoping you would say impeccable or something like that. So maybe I'll just throw in my own adjective today.

Joe Gambino (00:14.477)
Yeah, you know, I will call you the impeccable Joe Lavaca. There you go. I like that you you helped me out there. You can find us on Instagram. I'm at Joe Gambino, DPT and the impeccable of over there. He is at strength and motion underscore PT. You can find this podcast on Instagram as well. Beyond pain podcast. And this is also on YouTube. Cups of Joe underscore PT.

And if you are interested in working with either one of us, there is an application form down in the show notes. So feel free to fill that out and one of us will get back to you. And that's it, Joe. How you doing?

Joe LaVacca (00:54.498)
Well, as we were chatting offline, doing pretty well. The Yankees clinched their spot to the championship series. So I think we're both pretty happy about that. was a nice series, hard fought, but I did like the way we pulled it together last night. The judge even got a couple hits, a couple walks. So maybe that's a good sign for us. Garrett Cole looked like he's like in his real aggressive self. I thought he was going to kill somebody when the bench is cleared.

Joe Gambino (01:04.327)
That's right.

Joe Gambino (01:11.786)
Mm-hmm, finally.

Joe Gambino (01:21.767)
Hahaha!

Joe LaVacca (01:24.106)
I just saw him walking over there and I was like, no, don't do it. You're gonna get suspended, don't do it. And I was like, you know what, if he does it, it actually would be probably pretty cool. That's fair. That's fair. That's also fair.

Joe Gambino (01:32.381)
Yeah, well we don't need anyone else to get hurt by throwing some punches either, not at this stage of the game. But after we won game one, and that back and forth game, I was like, this is the game that you needed to win that's gonna set the tone for the series. So I was somewhat confident after that. If we were to lost that game, I would have been very, very nervous. So.

Joe LaVacca (01:45.288)
Of course. I agree.

Joe LaVacca (01:52.524)
Yes, I agree. Now my question to you, have you been able to stay up for these games even with a brand new baby? How are we doing this? How are you managing it? Give us your time management sleep secret.

Joe Gambino (01:59.513)
I stayed up yesterday, yes.

Joe Gambino (02:08.349)
my time management sleep is, a blessing because Jen's insurance plan offers night doula service. So, well, you know, I'm getting, we've been going to bed a little bit on the later side, with me watching some of the games. So I'm getting between six and seven hours of uninterrupted sleep, six of the seven days of the week.

Joe LaVacca (02:17.538)
How beautiful.

Joe LaVacca (02:28.895)
Wow. Wow, I feel like you said that with like a little bit of take that everyone, right?

Joe Gambino (02:33.735)
Yeah, yeah, yeah, it's like one of those like, you know, it's a flex, because yeah, yeah. No, it's awesome, because it's definitely something that we would not be able to do if Jen didn't have it as like a work benefit of hers through Carrot. So we actually had it for Olivia and didn't know, which yeah, we missed out on that.

Joe LaVacca (02:39.746)
It was a bit of a flex. I felt it in your voice, just a touch. Good for you, man. You should be flexing on that. That's awesome.

Joe LaVacca (02:56.13)
Well, amenis.

Uh-huh.

Joe Gambino (03:03.537)
back then. you know. No, yeah, yeah, Lily. Yeah, as you called my daughter like 17 times in the last episode, which you can go back in and edit that out because that episode has not been released. So you could you can fix it if you want.

Joe LaVacca (03:04.652)
Do you mean Lily?

You

Yeah. Well, the context of that...

That's fair. No, no, no. I'll own up to it. So the context of that is Joe and his lovely wife have a dog named Lily. My good, good friend who I spoke to the night before that podcast episode has a daughter named Lily. So I just had Lily all in my mind, all in my mind that day. And I just kept calling.

Joe Gambino (03:37.821)
Yeah, well, we also call Olivia Livy and we have a Lily and it's very easy to so. You know, we do it all the time, so I let slide, but just once Joe, everyone gets one.

Joe LaVacca (03:46.644)
Alright, cool, cool. Well, just don't tell Olivia and we'll be fine.

Joe Gambino (03:51.715)
It's too late for that. All right, let's get into it, Joe. So today we have a question of the day, which I think we're just gonna turn into a full on episode because I think it's an important one. So the question is, when should I get an MRI? So let's dive into it here. Maybe instead of just starting when we should, or let's just leave it at that. Like when should somebody start?

Joe LaVacca (04:04.652)
I think so.

Joe Gambino (04:20.455)
considering an MRI as an option as opposed to just waiting it out or doing nothing or seeing a PT or something like that.

Joe LaVacca (04:27.018)
Right. is it safe to say that we can also say x-ray or MRI or scan? Right.

Joe Gambino (04:31.739)
Yeah, any sort of imaging. anything that we're going to be doing, even if it's like those EMG tests or whatever, anything that we're looking at a deeper look inside the body for something that might be going on.

Joe LaVacca (04:42.914)
Yeah. Well, first and foremost, if you have a trauma, I probably think it's worthwhile to get or lead into your process of recovery or rehab with some sort of a scan. a trauma, I don't necessarily mean, you you were lifting something heavy or you sneezed.

slept wrong, right? All these different things. I'm talking you were on a bike and flipped off the handlebars. I'm talking falling down a flight of stairs. I'm talking, you know, getting hit by a car, being involved in a motor vehicle accident. So something where a lot of force is delivered to your system or tissue in a very, very small period of time. And a lot of times I always kind of think of like this bubble gum analogy.

Me and you could take bubblegum and very slowly pull it apart and it will kind of stretch and maybe leave that weird like one piece of bubblegum that never seems to break. It's like a long hair. But if we delivered a very quick pull of the bubblegum, we can kind of get the snap in half. Right? So now that's not what I'm saying is happening to tissue, but just an idea of what the difference is with accumulation of force over time versus something delivered all at once.

So I would say I'm gonna stop right there and see what you think about the rule of trauma, get a scan, and does that always sort of jive with your thought process.

Joe Gambino (06:22.041)
Yeah, to a there's significant trauma, know, fractures and stuff like that can, can definitely be associated with those things. You know, if you had a fall on your arm, right? Like, I mean, there's different things that can happen that you'd want to, you know, potentially get imaging. So, you know, I think also how you're feeling and things like that can make all the difference. Right. If there's a lot of, if there's bruising or swelling, right, those are other indicators that, you know, after, after some trauma that you might want to get something looked at.

and then outside of that, I also think that, you know, there's all, every injury, right? If you had a fall and there was a, I don't know, you landed on your wrist and it was sore, right? you would imagine, or we know that there's a course, you know, after a few weeks, right? It's just hard to get better, right? But if things continue to be irritated for a longer period of time than we would expect, then if you didn't get the X-ray or imaging upfront, then you're going to probably want to start to consider it at that point. So.

Also, what is the recovery looking like? Is something lingering around? Those will start to hint, you know, maybe it definitely needs to be looked at if you decided not to opt into that at that beginning stages.

Joe LaVacca (07:32.034)
And luckily for us, there are a couple of guidelines, right? I know that there are the Ottawa ankle guidelines, things like the Ottawa neck guidelines. And these are just things that guide me and you and maybe making a decision or pushing people towards some sort of imaging after a trauma. And a lot of that is just like bony tenderness, ability to move. What was the mechanism to your point I think is really, really important. I think the other thought that you had there was, well,

If we do think it's more tissue based, then all of these tissues probably have a recovery time. So muscle heals better than tendon, bone heals a little bit better than maybe nerve does. Right? So we have all these are kind of like classifications. And if we are assessing you or your clinicians assessing you and coming up with an idea of what we think is happening, we should probably be able to give you a timeline.

But then not only a part of the timeline have some sort of objective tests to hold that up. We've talked on the podcast so much that pain is sort of bigger than medicine or bigger than anything we could probably find in the textbook because it's so individual to everyone's experience. However, if we think it is a muscle strain, right, as a simple example,

And maybe there's a little bit of swelling, maybe there's some bruising, you know, maybe there's a little bit of weakness and we do an assessment. then after, you know, maybe a couple of weeks to maybe max a couple of months, I would expect that muscle to recover really well. I would expect the force output to be more normal or symmetrical to the other side. So even if someone comes back, you know, two months later, three months later, and they're saying, Hey Joe, my hamstring is still hurting a little bit.

You know, do you think it's time I should go get a scan? Well, me and you, or hopefully everyone else should hopefully have the ability to fall back on something objective and say, great question. When we tested your hamstring or whatever muscle we were looking at when we first met, we saw a, you know, maybe 20 or 30 % different side to side. Let's retest it. Hey, look with your eight weeks of training, your 12 weeks of rehab, whatever, you know, course you're doing, maybe it is even rest, you know, who knows what some of these soft tissue things, but with.

Joe LaVacca (09:58.144)
that period of time, you're now 5 % different from the other side. You know, you're 10%. So the tissue we can see is responding because the behavior and the quality of that tissue is changing, even though you still have pain. So that's a great point. I don't think like pain necessarily is a reason to go get a scan, but can we tie that into something functional? Can we tie that into something objective? And then that maybe gives us a better.

Joe Gambino (10:29.487)
No, I agree with that. And you know, if we're staying on the topic of like X-rays, know, like when you have something significant to the joints like that, like all movement hurts. and, and, know, like if it's soft tissue or just like maybe joint irritation, you rub it, you give it some rest, you know, you can, you'd feel better. You do some passive movement or probably like stretching it will probably be okay. Right.

But when you have a break those things will all be irritated and when I was I don't know Maybe it was like 13. I was playing football got tackled literally I was like this far away from a touchdown a little shoe string track tackle I was trying to stick keep my balance and I fell and I landed on the back of my hand and I fractured my wrist and I didn't think anything of it I remember being a lot of pain. I was in so much pain. I called my dad. I could pick me up I was literally five blocks from my house Right, so he can't pick me up. We just I hung out for like

three days and I was remember after the next day my wrist was felt okay. If I moved it, hurt but I didn't have pain otherwise. And I remember I was just at like, my sister had a volleyball game and as they were all warming up, I grabbed the volleyball and I was just, it was in the gymnasium of our school. So there was basketball hoops. And I was just, I did a layoff. was like, why does that hurt so much? And then I remember I went to my dad, was like, man, my wrist still hurts. And then one of my friend's moms was there and she looked at me she's like, that shit's broken.

You need to go get that looked at. So I got looked at and lo and behold that a fracture and was casted and all that stuff. but again, right? was like all passive all active movement was painful. If I just rested it, it felt fine. And then if I did easy stuff, right? Like I was like, man, I like, why does that bother me so much? So I think like those are like distinctions. If it was just like a joint issue or I just strained something, you know, it may have still hurt me, but I don't think it wouldn't have been to that extent. So.

There's a little personal story of, I didn't even realize it. I probably wouldn't have get it checked out. was 13 years old. the hell, you know, I was like, yeah, let me go to a doctor. Someone has to tell me to do that at that point.

Joe LaVacca (12:28.876)
Yeah.

Joe LaVacca (12:33.346)
I still think that's impressive, Joe, that you were able to last as long as you did. But the only thing in my mind that I keep hearing is that you didn't score the touchdown, which is really unfortunate. And if you're that close and you're gonna break your wrist doing it, you gotta get the six points, dude. You gotta figure out a way, whatever you need to do. But I still think that that's very impressive that you're able to manage a couple days, because now you're sleeping on that thing.

Joe Gambino (12:34.802)
Cough

Yeah

Joe Gambino (12:42.459)
Yeah.

Joe LaVacca (13:01.012)
Which I imagine could not have been all that comfortable, but I mean, I guess you did it. Maybe you were just so full of like endorphins and just like, you know, energy and vigor at 13 because I, I remember in the playground of sixth grade, I was, you know, running around, running around, running around very similar mechanism, right? Kind of fell on the school yard. My wrist, you know, kind of went in that same motion that you were describing. And I just remember being embarrassed.

Joe Gambino (13:05.605)
Yeah, I don't remember sleep being a problem.

Joe LaVacca (13:30.614)
Right? Like, my God, like I just fell in front of my friends. I was like, my wrist is really hurting though. I was like, but you know what? I'm going to just let these tears like swell up, you know, turn really, really red, these tears away from my face. And then I went inside. remember like holding my arm like against my chest and I remember taking a test. Right? Cause I think we had like some sort of math test or something that I had to take. And then I was like, well, let me try to grab my book bag and see what happens. Right? So my book bag was on the floor. I went to go grab it.

And then I just remember being in the most pain I've ever been. Started crying, raised my hand. I was like, I gotta go to the nurse. So my story is a lot less manly, I guess you could say. I did well on the test, but I wasn't like casually playing basketball with a broken wrist and like coming over the sideline and being like, hey, you know, with my wrist dangling, like, I think my wrist might need a little bit of attention here. No, I was like, no, I need attention now. So I applaud you, brother. I applaud you.

Joe Gambino (14:09.071)
Yeah.

Joe LaVacca (14:28.854)
But I think the other one too, as I think about it now, I think would also be signs of systemic issues. And a few things come to mind. So persistent fever, maybe recent infection. Maybe that also can go with recent hospitalization, right? Depending on the group you work with. Maybe prolonged.

Joe Gambino (14:28.906)
Thank you.

Joe LaVacca (14:56.482)
Corticosteroid use is something that we want to pay attention to here. Again, depending on the population that you're working with. Are we blowing off things that, you know, maybe, you know, a bigger, you know, soft tissue injury or even bony injury because of medications, because of infections. So I would think of also just signs of general feelings of being unwell, right? Things that don't add up orthopedically or clinically.

that would probably be another one where I'd say, Hey, I think maybe we need to go back to your GP. Maybe we need to go back to even a rheumatologist and then dive a little bit deeper. And maybe it's not a scan, but maybe it's blood work. You know, maybe it's a physical. And then you could probably tie in your client's history into that. think that would be also a big, big clue on something that we might want to take a peek at as well from, you know, a scan blood test sort of like

deeper level than just some stuff on the table.

Joe Gambino (15:56.989)
Yeah, I like that for, for, know, when you have pain that's can't figure it out. Sometimes, you know, you have like these things that don't make sense as far as the clinical picture looks. So, but I do want to ask this question here, because this is probably the thing that I hear most, right? As you know, someone, maybe there's no trauma or anything like that, but someone has pain for a while and they, they have this urge to go to the doctor and to go get a looked at and they need an MRI.

And sometimes they need an MRI before they even feel obligated to go see a physical therapist and get it worked on because they need the answer as far as what is going on. Like that's going to, you know, make all the difference, especially, you know, I mean, you and I both know we don't need that to make decisions to help someone rehab and things like that. So when you're looking at an MRI, how are you viewing it as like what it's good for? And at what point in the stage are you saying, okay, you know, you should definitely.

Joe LaVacca (16:29.57)
Mm-hmm.

Joe Gambino (16:52.989)
100 % go get an MRI right

Joe LaVacca (16:55.426)
Yeah. Well, I guess the first part, what would an MRI be good for? For me, it's usually ruling out. I think at this moment in time, being 15 years out, maybe a little bit more, 15 years out now, I'm pretty confident telling people, hey, you're going to have a tear. There's going to be a disc bulge. There's going to be bony changes.

There's going to be loss of joint space. There's going to be this, there's going to be that. So if there is a lot of pushback for testing, and even if I share with people, hey, your prognosis or your outcome with therapy is going to be hurt by unnecessary testing. And I can pretty much tell you how I'm operating. I'm operating under the guide that you have this, this, this, and this.

So even if your MRI comes back and it only has two of those things, well, okay, I'm still going to approach this pretty much the same way. Now, if there is something outside of the realm of my considerations, then sure, the MRI might show us that maybe it would open up a pathway for different types of treatment. But I think then at that point, it's small sort of pushes towards different treatments.

even chatting offline about different therapies like taping or red light or maybe we can throw a PRP in there or maybe we can throw something else in there. And I think if you see something on the scan and we weren't considering it and there is some sort of adjunctive medicine to help with that condition, okay, then wonderful. I don't mind if it's within your financial means, if it's safe to consider that. But what I would say then to your second question of like, when

when would I maybe try to push someone who is maybe reluctant to go get a test? And I would kind of go back to more nerve signs or maybe functional loss. And the things that pop up, and I don't know if we mentioned this in our sciatic episode, but it's worth revisiting. If you have profound muscle loss or function loss, if you have progressive function loss or, you

Joe LaVacca (19:19.368)
muscle loss or weakness, or if you have multi-level function loss or weakness, I think it's probably time to go get a scan. So, whether or not we're thinking of upper body or lower body, maybe just because I brought up sciatica with our other episode, people have some pain down the leg. should I get an MRI? Should I not? I don't know. I've read different things about them. My friend said no. Someone else said yes. What do you think? And we see some

loss of reflex or we see a little bit of loss of strength at the foot. And we're like, yeah, you know, this is pretty typical. We might expect this. why don't we, you know, give it another couple of visits and see what happens. And then all of a sudden they come in and, know, they, they start reporting that their knee is buckling a little bit more. you know, they noticed that the foot is maybe scraping across the floor, right? You know, that would be something that, Hey, now is tacking multiple levels is clearly trending either.

progressively or profoundly in the wrong direction. So, hey, you know what? Maybe it's time to go look at this tissue, make sure there's nothing taking off its blood supply because we don't want it to become ischemic. We don't want things to ourselves to start dying. So I think that would probably be the two things there. What's it good for? I think it's good for ruling out most of the time. And then when would I go the three P's progressive, profound or polymodal or poly level sort of thing.

Joe Gambino (20:45.681)
Yeah, I agree that I think it's definitely for a rule out standpoint. So it's not going to be the first thing that I'm sending somebody for, but definitely motor loss. That's one, know, if there's any sort of radiculopathy plus you've lost, you know, strength, significant amount of strength, or you're noticing that the there's muscle wasting there. You're atrophying the muscles are getting smaller. Like just go get it. Balan bladder falls into that same same.

concept there and there's like a few other ones where like, you know, if someone's getting like a lot of locking of their knee and then I'm suspecting a bucket handle tear, I'm probably going to go get them, send them back to a doctor because my clinical, you know, just from doing it experience is telling me that, you know, those are ones where a conservative care doesn't always do the best, right? Cause there's something actually in pain, the joint space. And another one that just popped into my mind that, you know, the shoulder, if it's like weak and painful, I'm not going to send them right away.

Joe LaVacca (21:22.71)
Mm-hmm.

Joe Gambino (21:42.161)
but if I'm suspecting a rotator cuff tear, nothing's really kind of working, I wanna just rule out that there's not like a really large rotator cuff tear that's really not gonna do well. So there's a couple things that like I know if I see it, I don't know if PT is gonna be the right way for them, so I'm gonna send them, that's probably how I'm gonna do it. Otherwise, as if it's just things don't match up, so there's more pain than I would expect, there's night pain, there's...

you know, for whatever specific area of the body, all the symptoms that they're telling me, I'm sensing there's like a whole lot of things going on. Like it doesn't make sense for one specific diagnosis. I'm probably going to go send them to get ruled out because it doesn't make sense clinically. Like if we're looking at low back pain or sciatica, right? Like it's like very specific things that we look for. And if it's just like very general, they're telling me stuff that I wouldn't expect with things. I'm like, I don't really know here. Let's just.

rule, this is rule everything out. That's maybe impact. So we can just focus. Then we know, okay, hey, we're good. Now we can just work on PT and conservative care and we should be able to find the solution that we're not going to miss anything that way. and then back to your point about, know, you were talking about, Hey, things are just going to pop up on MRIs regardless. You know, I look at MRIs, it's literally just a picture in the moment, right? So you're just going to get a snapshot of what your internal anatomy looks like. And there are plenty of

Research articles these days that show the older that you get, the likelihood of something popping up at any joint is going to be there, right? You're 60 years old and you get an X-ray or an MRI, there's a really high chance that disc degeneration or arthritis or a labral tear or meniscus tear is gonna pop up. it's not a one-to-one ratio, which is why I don't think anyone needs to rush out to get an MRI unless...

pain's maybe been going on for a really long time and you want to rule something out or things don't quite make sense or you have some of these symptoms that, know, hey, maybe PT is really not going to be the best. We want to, you know, rule out all this other stuff and make sure that there's not a better pathway for you to go. So we're not wasting time and wasting insurance dollars and all of that fun stuff.

Joe LaVacca (23:54.676)
Yeah. And I think it probably loops all the way back around to what we started the episode with. Even a bucket handle tear, I would probably assume like when we were going something like that specific with mechanical symptoms at the knee, you're probably not just waking up like that. You're probably not Beyonce-ing that injury. There probably was some sort of like mechanism or trauma. Same thing with the rotator cuff tear. probably have an athlete, you probably have a repetitive stress. You may have a fall.

And even then with even some of the rotator cuff stuff, you know, I kind of operate well, there probably was a tear there before. So, I mean, was there a bigger tear now? So I think age is always a factor when we're thinking about scans. When we sort of like hone in on specific things, like we mentioned the auto ankle rules or the auto neck rules, like there are certain things to even look for at the shoulder for my understanding of external rotation loss, age, even lateral abduction.

strength of the shoulder, so that's moving your arm away from you. If all of those things are sort of like mixing, well then yeah, you might have actually a better outcome with surgery if we do it sooner rather than later. But I think ultimately too, like if we're going to go down the scan road and then accept different outcomes, I think it's also too about knowing what people want to get back to. And you know, I've had plenty of people just be like, hey, look, I don't know.

Even if the scan says whatever it says, I'm not getting surgery, I'm not doing this, I'm not doing that. And as long as it's not life threatening, then I don't know if I'm the right person to be like, well, no, you should go back to playing pickleball and you should go back to playing tennis. I think if you want to, you can, there's no reason to be fearful. But right now I understand your decision as a person going through what you went through.

So if we wanna avoid surgery, if we're really adamant, it doesn't matter to us, it doesn't matter what the scan says, well then hey, we just need to give ourselves time, compassion, patience, consistency, all those other things that we keep talking about, and then see where we are in a few months and then make another decision. When maybe we have a little bit more clarity and less emotions tied to

Joe Gambino (26:05.757)
No, I like that because, know, if it led down the rabbit hole of potential surgeries and stuff like that surgery, I tell people surgery is always an option. You know, it's not, you know, whether you tried to do some PT first, if they're like, hey, I really don't want to do surgery. Well, all right, well, let's see what we what we can do over the next few months. And if nothing changes, then surgery is still the option for you. Right. Like it's not going to disappear off the table. And then in a perfect world, right. Like, hey, you are feeling better and we can push that back or you don't need it. So

Joe LaVacca (26:24.043)
Ahem.

Joe Gambino (26:35.665)
I like what you said there. And I do think that goals, even if it's like, Hey, you have someone who like wants to get back to soccer or running or golf and they have a significant injury. Well, Hey, if you really want to get there, maybe we need to go down this rabbit hole and you can educate and let that, obviously that person needs to make their own decision, right? We're just here to be a guide. That's the last thing I want to mention, with all this, just as like a summary, I mean, like if you're out there and you're wondering if you need an MRI, I would just either.

Probably if you're not, if you're seeing a PT or not seeing a PT or a rehab provider, I mean, go see one and just ask. mean, we're able to give you an idea of what's going on with your body and do you need an MRI or anything like that? So if you're on the fence, I mean, it's, that's going to be less of a time commitment, you know, less, you know, I have to worry about surgery, right? You just go for one assessment, kind of get a plan, figure out what's going on. And then if they're also telling you, Hey, you know,

Maybe you do need an MRI. Well, now it's confirming your bias on what you think you need. And then you can go get one and, you know, it's just kind of educating yourself on your body in a sense and what's going on so that you can go out and make the best decisions for yourself. Cause I see way too many times people just going in for the MRI and the doctor saying you need the surgery and then they get an unnecessary surgery. And if you kind of go through that process of evaluating it, going to talk to a rehab provider about what's kind of going on and do they think that you need an MRI and what the plan should be.

you can skip a whole lot of that stuff. And I think a lot of people are just driven like, the medical field is here to help me. And they are, but at the same time, know, mean, a surgeon might just say, Hey, well, this is what I do. And this is the way I can help you. Right. Versus, and it may not just be the best thing for you at that time. So I think that's my last two cents. And you can follow up with that Joe, if you want, or you can take us home, whatever you like.

Joe LaVacca (28:26.848)
No, I think it gives a good segue to a future episode. When do I need surgery or when should I consider surgery? So it's like a cliffhanger. Ooh, I love it.

Joe Gambino (28:32.518)
Joe Gambino (28:36.293)
I like that. That was unintentional.

Joe LaVacca (28:41.92)
All right, let's do it. So, you me to take us out or you take us out? All right, well, thank you for joining us for another episode of the Beyond Paint podcast, everyone. Joe, I love you. Listeners, we love you. And if you've made it this far, extra love to you. Don't forget to like, subscribe, share this episode with someone who you think it might help. And we'll see you next week.

Joe Gambino (28:43.229)
Yeah, take us home. Take it.

Joe Gambino (29:02.769)
Bam.