July 17, 2025 • 19 mins
Tired of the cycle of lower back pain, rest, temporary improvement, then pain again? In this enlightening episode, Dr. Kyle breaks down what's really happening with lumbar spine pain and mobility issues that plague active individuals.
Your lower back consists of five lumbar vertebrae designed for bending forward and backward—not rotation. Yet when your hips below or thoracic spine above lack proper movement, your lumbar spine takes the brunt of compensation. This creates a domino effect where certain segments become hypermobile while others restrict, leading to joint irritation, muscle guarding, and those shooting pains down your leg commonly mislabeled simply as "sciatica."
What most people miss is that the muscle tension and spasms aren't the actual problem—they're just your body's fire alarm signaling underlying joint dysfunction. That's why massage alone rarely provides lasting relief. The nerves exiting through irritated facet joints become hypersensitive, creating referred pain patterns that tell a story about which segments are involved and how severe the problem has become.
The solution requires a three-part approach: manual therapy to address joint mobility disparities, strategic soft tissue work to calm inflammation, and corrective exercises that solidify improvements by fixing the movement patterns that caused the problem initially. This comprehensive strategy explains why the specialists at Driven Athlete see consistent success treating chronic back issues that other approaches haven't resolved.
Whether you're a weekend warrior, competitive athlete, or simply someone who wants to live an active life without pain, understanding the true mechanics behind your back pain is the first step toward lasting relief. Reach out to us at 561-899-8725 if you're ready to break the cycle and get back to doing what you love.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up y'all?
It's your man, dr Kyle.
Driven Athlete Podcast.
Back at you.
Today we're talking about lumbarspine and joint mobility and
(00:24):
pain referral patterns from thelumbar spine.
So this is a super common thingwe see patients with.
So I'm like man.
I want to educate people and atleast bring some insights from
the lens in which we wouldperceive this and how we would
treat it and the approach wewould have, and some
explanations on where does itcome from in the first place,
like where does pain come fromwith this?
So to begin with, a little bitof an anatomy breakdown and I'm
(00:45):
not trying to insult anyone'sintelligence, just make sure
we're on the same page.
The lumbar spine is the lowerpart of the back of the spine.
That's the last five vertebraethat connects to your tailbone.
All right, so, and they'renumbered One, two, three, four,
(01:11):
five.
So L for lumbar one, l2, l3, l4, l5.
Some cases it's more rare thannot is an L6.
It could be like a sixth lumbarvertebrae and it could be a
lumbarized sacral vertebrae or asacralized lumbar vertebrae if
they're more articulated orfused with either side, but
anyway.
But the lower five vertebrae isthe lumbar spine.
They're bigger, they're stout,they're built for more stability
and the orientation of theirjoints that work together are
built more for bending downforward and bending up backwards
(01:35):
, so flexion would be bendingdown, extension would be bending
up backwards.
So lumbar flexion and lumbarextension, that's how the joint
orientations of the lumbarvertebrae facet joints are
positioned.
That's kind of the architecture.
So, with that being said,they're really not made for
rotation.
Not much rotation mobilitycomes from the lower lumbar
(01:59):
vertebrae.
But we see people and athletesand active individuals.
They compensate by rotatingthrough the lumbar spine because
other joints above the lumbarspine or below the lumbar spine
aren't rotating like they shouldand that would be like your hip
joint below.
So imagine like rotatingthrough your hips with a tennis
(02:19):
swing or a baseball swing or areally commonly down here in
Florida is a golf swing.
Or above the lumbar spine, inyour thoracic spine, the
thoracic region of yourvertebrae, of your spine.
If somebody is lacking rotationrange of motion in their
thoracic spine, what right belowit is going to overcompensate
to make up for that the lumbarspine.
(02:40):
So with biomechanicalcompensation patterns, the
lumbar spine will take the bruntof some of those movements, all
right, and that can lead todisparities in mobility, all
right.
So every vertebrae, from L1 to2 to 3 to 4 to 5, to S1, s1
would be sacral vertebrae numberone, all the way up to T12,
(03:03):
which would be thoracicvertebrae number 12.
That's the lowest thoracicvertebrae.
There's 12 of them, all right.
So T12 is the lowest one, andthat articulates with L1, which
articulates with L2, whicharticulates to L3, to L4, to L5,
down the chain to S1.
So that kinematic chain ofthose lower lumbar vertebrae,
those lumbar vertebrae, thoselumbar vertebrae, they all work
(03:25):
together right, and they move.
At every segment.
Every segment has its ownsegmental mobility.
But if some segments move moreextraneously than the neighbors
above or below, those mobilitydisparities can cause problems.
And those segments that maybemove extra compared to their
(03:45):
neighbors above or below, wewould call those segments that
move extra, those would behypermobile segments,
hypermobilities.
And another common thing withthat too is if the sacroiliac
joint, the SI joint, can getdysfunctional too to compensate
for lumbar mobility disparitiesor a lack of hip range of motion
(04:06):
, below in the pelvis, or above,with thoracic spine rotation,
mobility disparities or a lackthereof.
So the compensation patterns cancome and go in different ways
for different people.
That's what we have toinvestigate.
Be like where's thecompensation pattern happening?
Where's it coming from?
What's causing the pain Like?
What's the pain generator?
Why did it happen in the firstplace?
(04:27):
How do we fix it?
And then how do we prevent itfrom coming back?
The how do we fix it part is arecipe of manual therapy, soft
tissue work, correctiveexercises.
But we have to have anunderlying diagnosis of what's
going on first to actually get agood, clear diagnosis and
treatment pattern, because thattotally changes the treatment
trajectory.
So the lens in which weperceive this as movement based
(04:50):
professionals and clinicians,we're going to diagnose it off
of a movement based problem.
Right and biomechanically,compensation patterns can lead
to segmental hypermobilities andalso segmental hypomobilities,
so they're not moving enoughright.
That makes sense If thedisparity in the relationship
(05:10):
one's moving too much, the otherone's not moving enough.
There's a disparity andimbalance in mobility between
those two segments or threesegments or four segments and
very often the painful siteactually I'll take that back
almost all the time we diagnoseoff of the painful site being
hypermobile.
So if we push and palpate onsome of the vertebrae in your
(05:34):
back and some are really tenderand like sensitive and hurt, and
other ones really aren't tenderand sensitive, don't hurt as
much.
Very, I mean almost all thetime.
The hypermobile segments arethe tender, more sensitive
vertebrae.
All right, and that just cluesus in to hone in on a diagnosis
and figure out what's going on,because then we know what's
(05:54):
going on, we can treat it betterand we're going to work on
treatment stuff and treatmentinterventions to help fix the
problem.
But the underlying root causeusually comes from a combination
of movement system impairment,compensation patterns, global
compensation patterns.
It's a recipe of like the hipisn't moving good because the
(06:15):
glutes aren't recruited wellenough.
Maybe they have psoas guardingpsoas.
Weakness can be a common one alack of core stability in
recruitment and a lack ofthoracic spine rotation mobility
.
That is a really common recipeof body mechanics, mechanical
compensation patterns, and thatleads to back pain.
That we see All right.
(06:36):
So, with that being said, thosesegmental mobility disparities,
what do you think is happeningat the painful site that there's
a hypermobility and it's tender, it hurts to touch in your low
back and you have a ton ofmuscles that connect all over
the place, from your pelvis toyour tailbone, to your hip joint
and your glutes, your hipflexors, your quads, your back
(06:58):
muscles, your abdominals.
Your diaphragm connects up inthere too.
What do you think the musclesthat connect to those vertebrae
that are dysfunctional andhypermobile are going to be?
Like?
They're really guarded andtense and spasming right, that's
usually where muscle spasmscome from from underlying joint
hypermobility that's beenchronic in a long, long time of
(07:21):
repetitive microtrauma, fromthese compensation patterns of
the joint that lead to a lot ofpain and irritation, local
inflammation.
And then the muscles thatconnect to those joints are
going to be guarded and on highalert and they're going to be
strong and they're going to bespastic, spasm, and they're
(07:42):
really sensitive and tender.
All right, that's what themuscles look like when they're
connected to those, and thosemuscles are usually in your low
back, that they're in protectionmode.
They're defense mechanism,protection, guarding mechanism
and really spastic.
And those muscles are yourerector groups.
All right, it's going to be thelongissimus, the iliocostalis,
(08:05):
the multifidus, the spinalis aretiny little muscles that
connect between every singlevertebrae attachment in the
lumbar spine.
The quadratus lumborum also is akey player with muscle guarding
and spasm and tenderness andpain.
And then the psoas is also akey player.
Those muscles are the ones thatusually get very guarded and
tense.
So we have to work on those,you know, and that makes sense
(08:26):
that they're all lit up.
If we just do, if a person justgets massaged over and over and
over again, they just massageout their low back.
Usually we find that peopledon't get better.
It's because the muscleguarding and the muscle spasming
that's just a tertiary problem.
That's not the problem.
The muscles usually follow suitbecause of underlying joint
(08:47):
irritation and compensationpatterns biomechanically and the
muscles that are being overusedchronically they will get
guarded, intense and tender andlit up and irritated and on
defense mode and super guarded.
And that's the tertiary problem.
If we just work on that thesuperficial muscle guarding
people don't get better.
We have to work on solving theunderlying root problem which
(09:12):
for this situation, is amovement system impairment.
There's a recipe of severalthings all playing together that
led to this pain and it's arepetitive microtrauma of issues
that lead up and accumulateover a long period of time,
where finally the straw thatbuilt the camel's back comes out
(09:33):
for the chickens to roost nopun intended with the straw that
built the camel's back.
So, with that being said, one ofthem you can't leave out of
this talk is you got bones, yougot ligaments, you got tendons,
you got muscles, but you gothurt.
Discs are in there which we'vehad.
We've at length to talk aboutherniated discs.
So we can check out thatpodcast.
I've did before and I'll sendit to you if you want.
(09:54):
But the last thing we got,that's probably the most
important, because you also havenerves.
You have nerves everywhere.
Nerves innervate all over theplace.
You have trillions of nervesall over the place and they're
super aware, alert, and they'resensitive and they're ready to
send signals.
And when somebody's in pain,those nerves are going to be
hypervigilant and they're goingto be ready to send signals back
oh, don't do that, oh, becareful, oh, I'm nervous, right,
(10:17):
all that stuff.
So there's nerves, nerve roots,that exit from the spinal cord
through every vertebrae, atevery facet joint in the lumbar
spine, throughout your wholespinal cord or your spinal
column, your vertebrae, everysingle vertebral segment joint,
all the way down and throughyour sacrum.
There's nerve roots that exitfrom the spinal cord through
(10:38):
those facet joints and so theypass right through the joints
and imagine what do you thinkthe nerves are going to be like
when the joints that they passthrough are very irritated and
inflamed and lit up.
They're going to be supersensitive and they're going to
be ready to send signals andthose signals would be referred
pain, referred pain or painpatterns.
And those signals would bereferred pain, referred pain or
(10:59):
pain patterns.
And the trashcan term ofincluding all that as it relates
to back pain is sciatica.
All right.
So sciatica is a trashcan termthat collects.
There is an issue with thepathway of the large nerve
called the sciatic nerve thatpasses from a collection of
nerves through the nerve rootsin your lumbar spine and your
sacrum as it passes down theback of your butt and your glute
(11:20):
region down your hamstring.
So that would a large nerve iscalled your sciatic nerve.
So sciatica would be like apathology of the sciatic nerve.
All right, that gets involved.
The question is is like it's notalways.
It doesn't paint a good picture.
It just represents referredpain down the glutes and the
hamstring region, the back ofthe thigh right.
It's a super common area forreferred neural pain, all right.
(11:44):
So really, what educate peopleis?
Like it's just nerves that aresending signals down the leg
that um is informing everybodythat they're in, they're lit up,
right, and they're, they're, uh, sensitive and they're getting
some danger signals and, uh, andthey want to let you know.
Right, that's just a fire alarmto let you know there's a
problem, all right.
(12:05):
So that referred pain and painreferral pattern that tells us a
story.
It lets us know, maybe, whatsegments are involved, the
severity of the problem andmaybe when imaging might be, you
know, advised, right, it's notalways just straight up sciatica
and it's not alwaysrepresentation of a herniated
(12:26):
disc causing the referred pain.
It's actually I mean, this iscontroversial to say according
to the literature and theresearch it's usually not the
disc.
There's a whole other podcaston that prior, previously, that
you can check out about herniadisc and referred pain and
neural pain patterns.
But anyway, it's just referredpain and a classic sign for that
(12:47):
is down the glute, down thehamstring, the posterior thigh,
the back of the thigh region,and that just reflects referred
nerve pain Because the joints inthe lumbar spine that they
passed from originally, thosejoints are very irritated and
they're inflamed and they're litup and all the muscles that
connect to those joints are alsoguarded and tense and very
(13:09):
spastic, all right.
So the question is, it's is whydid it happen in the first place
?
And that's how we're going tofix it.
Does that make sense?
So that's just a little bit ofeducation on before I land this
plane because I wanted to bequick.
I just wanted to introduce thisreal fast like a short, concise
information on low back,segmental mobility, muscle
guarding, referred pain.
But the recipe for how we fixthat is a combination of manual
(13:35):
therapy to improve thedisparities in joint mobility of
the lumbar spine, the hips,maybe the SI joint, the
sacroiliac joint and thethoracic spine.
So manual therapy to interveneand improve the mobility
disparities of those joints andthose segments, followed by some
soft tissue work to get thingsto settle down, bring some blood
(13:55):
flow for sure, stimulate somehyaluronic acid and blood flow,
some synovial fluid in the jointspaces.
And that could be achieved withjust straight stripping,
cupping I'm not really a fan ofGraston, I don't really do that
much and then dry needling canbe really helpful too.
Dry needling is super helpfulfor this, maybe not right away
at the acute stage on the sitebecause it's going to be tender
(14:16):
and it's going to be sensitive,but neighboring it can be really
helpful.
It also helps with nerve or furpain too.
So dry needling it's a reallyeffective soft tissue of effect.
Neural nerve and soft tissueintervention that followed up
with corrective exercises.
The corrective exercises iswhat solidifies the changes
we're looking for.
(14:36):
The manual therapy sets it upfor success so that things are
moving better and they feel alittle bit better right now.
And then the correctiveexercises lock it in place and
solidify the changes that we'relooking for.
But we ultimately have to fixthe compensation patterns, the
recipe of biomechanicalcompensation patterns that led
to the problem in the firstplace.
If we don't, then things aren'tgoing to get better.
And that's when people come seeus because they've been doing it
(14:56):
for a long time, battling thispain.
I had to rest for a little bit.
I try to just back it down, Iice it, I rest, I take some
Advil, I feel a little bitbetter.
Then I get back into myactivity If it's exercising golf
, tennis, lifting weights,whatever.
If it's exercising golf, tennis, lifting weights, whatever.
And then it comes back again.
And then I had to rest and thenI'd try to go back into my
exercises again, my workouts andmy golf and it comes, my pain
(15:18):
comes, returns again, and thatcyclical rollercoaster of like
it hurts and I rest, it hurtsand I rest.
That's when people come see us,because we're the specialists
that are going to take care ofit.
And we're only saying that inconfidence, because we've done
it a thousand times and we'vehad a good track record, right.
You don't see all thosefive-star Google reviews just
from.
They're not fake, right.
But that's the high fivemoments we get when people stick
(15:52):
to a plan of care and we'reable to progress things
appropriately, with goodintention and communication
through the process over acouple weeks, a handful of weeks
.
At the end of that, in the highfive moments that we get,
that's the Google reviews wehave, right, and the
testimonials and stuff.
But the corrective exercises iswhat solidifies the changes,
because the pain, the problem,that is the underlying root
cause of the problem, which thepain won't resolve unless that
root cause problem is fixed.
And then, guess what?
The muscles will follow suitwith feeling better too.
(16:14):
So even if we didn't do anysoft tissue work which is common
oftentimes, we just focus onthe joint manual therapy we
don't even do soft tissue worklike stripping dry, needling,
cupping or whatever.
We'll just do manual therapy inthe joints and then we'll do
corrective exercises and supercommon, people leave and they
feel a lot better, they feellooser, they feel good and I'm
(16:35):
like we didn't even touch yoursoft tissue, we didn't even
touch your low back muscles andlike work them out Right.
Um, it's because once we getthings feeling better in the
joint level and fixedcompensation patterns, the
muscles will follow suit.
So the muscles aren't theproblem, the muscles pain and
the spasms.
It's not the the problem, it'sjust a fire alarm.
But we have to fix it, onlycause, otherwise it's going to
keep coming back.
So a thing that we have likethat we judge, we um I don't
(16:57):
want to say that a thing that weum grade the clinicians that
come mentor with us, with me.
Well, in the fellowship programfor continuing education we
have a lot of mentor menteesthat come in the physical
therapist docs that are tryingto improve their level up their
clinical game.
They come mentor with me andone of the things I ask is, when
(17:17):
you work with an athlete andit's been a couple of sessions
they should be feeling better.
Several sessions later, acouple of weeks later, and
they're like hey, you're good togo back to your sport or your
activity, 100%.
What's the likelihood of thatpain returning?
If the pain comes back, thatmeans you didn't solve the
problem.
That's the bottom line.
My pain came back and they'redoing everything you're telling
them to do.
They're not doing anythingoutside of, out of system that
(17:39):
they shouldn't be, that they'renot telling you which that
doesn't really happen.
That often People don't comesee us unless we, unless they're
like motivated, like let's justfix this fricking thing.
'm going to do everything youtell me.
Perfect, let's get after it.
If the pain doesn't come back,that means you solved the
problem.
If they return to their sportand the pain returns, that means
you didn't solve the actualunderlying cause of the problem,
which means the diagnosiswasn't accurate and the whole
(18:01):
trajectory of treatment alsowasn't as best as it could be.
That's kind of how these piecesall fit together.
So anyway, that is the bestrecipe for actually solving this
problem.
I wanted this to be super quickand short.
Just a concise info on lumbarspine, biomechanics, segmental
mobility, pain, referred pain,neural referred issues and then
(18:21):
muscle pain and the recipe onhow to fix it.
This is what that was about.
If you have any questions,don't hesitate to reach out.
You can check back all theother podcasts we've done,
especially on herniated discs,because we did that before too
at length, and we're always opento questions, comments,
concerns, conflicting opinionsand if y'all want to come on the
podcast, let me know.
I'm always open to ideas.
And if you have any pain orthings that you want to get
(18:42):
fixed, don't hesitate to reachout.
We can at least talk on thephone and figure out what the
best direction for care for youis.
If it's not with us, it'ssomebody else, so at least we
can point in the right direction.
So at least give us a call.
We can at least talk on thephone.
The best number to reach us onis 561-899-8725.
We're located here in West Palmbeach, just East of I-95, next
(19:03):
to the Palm beach outlet mall,the Tanger outlet mall.
We're right here and we workwith active, athletic
individuals that are motivatedto get improved, their situation
All right, and they'reenthusiastic about wanting to
get better.
If they're 85 years old or ifthey're 11 years old, we've
worked with both.
We've actually worked with a 95year old before it.
Just if you have a body andyou're active, right, you're an
(19:24):
athlete, what we would say, andwe just work with people that
are active and they want toimprove their life and improve,
decrease their discomfort andimprove their functionality, and
it gets some answers.
That's who we treat and that'swhat we work with and that's
what we have the best resultswith, so don't hesitate to reach
out.
We'll catch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up y'all?
It's your man, dr Kyle.
Driven Athlete Podcast.
Back at you.
Today we're talking about lumbarspine and joint mobility and
(00:24):
pain referral patterns from thelumbar spine.
So this is a super common thingwe see patients with.
So I'm like man.
I want to educate people and atleast bring some insights from
the lens in which we wouldperceive this and how we would
treat it and the approach wewould have, and some
explanations on where does itcome from in the first place,
like where does pain come fromwith this?
So to begin with, a little bitof an anatomy breakdown and I'm
(00:45):
not trying to insult anyone'sintelligence, just make sure
we're on the same page.
The lumbar spine is the lowerpart of the back of the spine.
That's the last five vertebraethat connects to your tailbone.
All right, so, and they'renumbered One, two, three, four,
(01:11):
five.
So L for lumbar one, l2, l3, l4, l5.
Some cases it's more rare thannot is an L6.
It could be like a sixth lumbarvertebrae and it could be a
lumbarized sacral vertebrae or asacralized lumbar vertebrae if
they're more articulated orfused with either side, but
anyway.
But the lower five vertebrae isthe lumbar spine.
They're bigger, they're stout,they're built for more stability
and the orientation of theirjoints that work together are
built more for bending downforward and bending up backwards
(01:35):
, so flexion would be bendingdown, extension would be bending
up backwards.
So lumbar flexion and lumbarextension, that's how the joint
orientations of the lumbarvertebrae facet joints are
positioned.
That's kind of the architecture.
So, with that being said,they're really not made for
rotation.
Not much rotation mobilitycomes from the lower lumbar
(01:59):
vertebrae.
But we see people and athletesand active individuals.
They compensate by rotatingthrough the lumbar spine because
other joints above the lumbarspine or below the lumbar spine
aren't rotating like they shouldand that would be like your hip
joint below.
So imagine like rotatingthrough your hips with a tennis
(02:19):
swing or a baseball swing or areally commonly down here in
Florida is a golf swing.
Or above the lumbar spine, inyour thoracic spine, the
thoracic region of yourvertebrae, of your spine.
If somebody is lacking rotationrange of motion in their
thoracic spine, what right belowit is going to overcompensate
to make up for that the lumbarspine.
(02:40):
So with biomechanicalcompensation patterns, the
lumbar spine will take the bruntof some of those movements, all
right, and that can lead todisparities in mobility, all
right.
So every vertebrae, from L1 to2 to 3 to 4 to 5, to S1, s1
would be sacral vertebrae numberone, all the way up to T12,
(03:03):
which would be thoracicvertebrae number 12.
That's the lowest thoracicvertebrae.
There's 12 of them, all right.
So T12 is the lowest one, andthat articulates with L1, which
articulates with L2, whicharticulates to L3, to L4, to L5,
down the chain to S1.
So that kinematic chain ofthose lower lumbar vertebrae,
those lumbar vertebrae, thoselumbar vertebrae, they all work
(03:25):
together right, and they move.
At every segment.
Every segment has its ownsegmental mobility.
But if some segments move moreextraneously than the neighbors
above or below, those mobilitydisparities can cause problems.
And those segments that maybemove extra compared to their
(03:45):
neighbors above or below, wewould call those segments that
move extra, those would behypermobile segments,
hypermobilities.
And another common thing withthat too is if the sacroiliac
joint, the SI joint, can getdysfunctional too to compensate
for lumbar mobility disparitiesor a lack of hip range of motion
(04:06):
, below in the pelvis, or above,with thoracic spine rotation,
mobility disparities or a lackthereof.
So the compensation patterns cancome and go in different ways
for different people.
That's what we have toinvestigate.
Be like where's thecompensation pattern happening?
Where's it coming from?
What's causing the pain Like?
What's the pain generator?
Why did it happen in the firstplace?
(04:27):
How do we fix it?
And then how do we prevent itfrom coming back?
The how do we fix it part is arecipe of manual therapy, soft
tissue work, correctiveexercises.
But we have to have anunderlying diagnosis of what's
going on first to actually get agood, clear diagnosis and
treatment pattern, because thattotally changes the treatment
trajectory.
So the lens in which weperceive this as movement based
(04:50):
professionals and clinicians,we're going to diagnose it off
of a movement based problem.
Right and biomechanically,compensation patterns can lead
to segmental hypermobilities andalso segmental hypomobilities,
so they're not moving enoughright.
That makes sense If thedisparity in the relationship
(05:10):
one's moving too much, the otherone's not moving enough.
There's a disparity andimbalance in mobility between
those two segments or threesegments or four segments and
very often the painful siteactually I'll take that back
almost all the time we diagnoseoff of the painful site being
hypermobile.
So if we push and palpate onsome of the vertebrae in your
(05:34):
back and some are really tenderand like sensitive and hurt, and
other ones really aren't tenderand sensitive, don't hurt as
much.
Very, I mean almost all thetime.
The hypermobile segments arethe tender, more sensitive
vertebrae.
All right, and that just cluesus in to hone in on a diagnosis
and figure out what's going on,because then we know what's
(05:54):
going on, we can treat it betterand we're going to work on
treatment stuff and treatmentinterventions to help fix the
problem.
But the underlying root causeusually comes from a combination
of movement system impairment,compensation patterns, global
compensation patterns.
It's a recipe of like the hipisn't moving good because the
(06:15):
glutes aren't recruited wellenough.
Maybe they have psoas guardingpsoas.
Weakness can be a common one alack of core stability in
recruitment and a lack ofthoracic spine rotation mobility
.
That is a really common recipeof body mechanics, mechanical
compensation patterns, and thatleads to back pain.
That we see All right.
(06:36):
So, with that being said, thosesegmental mobility disparities,
what do you think is happeningat the painful site that there's
a hypermobility and it's tender, it hurts to touch in your low
back and you have a ton ofmuscles that connect all over
the place, from your pelvis toyour tailbone, to your hip joint
and your glutes, your hipflexors, your quads, your back
(06:58):
muscles, your abdominals.
Your diaphragm connects up inthere too.
What do you think the musclesthat connect to those vertebrae
that are dysfunctional andhypermobile are going to be?
Like?
They're really guarded andtense and spasming right, that's
usually where muscle spasmscome from from underlying joint
hypermobility that's beenchronic in a long, long time of
(07:21):
repetitive microtrauma, fromthese compensation patterns of
the joint that lead to a lot ofpain and irritation, local
inflammation.
And then the muscles thatconnect to those joints are
going to be guarded and on highalert and they're going to be
strong and they're going to bespastic, spasm, and they're
(07:42):
really sensitive and tender.
All right, that's what themuscles look like when they're
connected to those, and thosemuscles are usually in your low
back, that they're in protectionmode.
They're defense mechanism,protection, guarding mechanism
and really spastic.
And those muscles are yourerector groups.
All right, it's going to be thelongissimus, the iliocostalis,
(08:05):
the multifidus, the spinalis aretiny little muscles that
connect between every singlevertebrae attachment in the
lumbar spine.
The quadratus lumborum also is akey player with muscle guarding
and spasm and tenderness andpain.
And then the psoas is also akey player.
Those muscles are the ones thatusually get very guarded and
tense.
So we have to work on those,you know, and that makes sense
(08:26):
that they're all lit up.
If we just do, if a person justgets massaged over and over and
over again, they just massageout their low back.
Usually we find that peopledon't get better.
It's because the muscleguarding and the muscle spasming
that's just a tertiary problem.
That's not the problem.
The muscles usually follow suitbecause of underlying joint
(08:47):
irritation and compensationpatterns biomechanically and the
muscles that are being overusedchronically they will get
guarded, intense and tender andlit up and irritated and on
defense mode and super guarded.
And that's the tertiary problem.
If we just work on that thesuperficial muscle guarding
people don't get better.
We have to work on solving theunderlying root problem which
(09:12):
for this situation, is amovement system impairment.
There's a recipe of severalthings all playing together that
led to this pain and it's arepetitive microtrauma of issues
that lead up and accumulateover a long period of time,
where finally the straw thatbuilt the camel's back comes out
(09:33):
for the chickens to roost nopun intended with the straw that
built the camel's back.
So, with that being said, one ofthem you can't leave out of
this talk is you got bones, yougot ligaments, you got tendons,
you got muscles, but you gothurt.
Discs are in there which we'vehad.
We've at length to talk aboutherniated discs.
So we can check out thatpodcast.
I've did before and I'll sendit to you if you want.
(09:54):
But the last thing we got,that's probably the most
important, because you also havenerves.
You have nerves everywhere.
Nerves innervate all over theplace.
You have trillions of nervesall over the place and they're
super aware, alert, and they'resensitive and they're ready to
send signals.
And when somebody's in pain,those nerves are going to be
hypervigilant and they're goingto be ready to send signals back
oh, don't do that, oh, becareful, oh, I'm nervous, right,
(10:17):
all that stuff.
So there's nerves, nerve roots,that exit from the spinal cord
through every vertebrae, atevery facet joint in the lumbar
spine, throughout your wholespinal cord or your spinal
column, your vertebrae, everysingle vertebral segment joint,
all the way down and throughyour sacrum.
There's nerve roots that exitfrom the spinal cord through
(10:38):
those facet joints and so theypass right through the joints
and imagine what do you thinkthe nerves are going to be like
when the joints that they passthrough are very irritated and
inflamed and lit up.
They're going to be supersensitive and they're going to
be ready to send signals andthose signals would be referred
pain, referred pain or painpatterns.
And those signals would bereferred pain, referred pain or
(10:59):
pain patterns.
And the trashcan term ofincluding all that as it relates
to back pain is sciatica.
All right.
So sciatica is a trashcan termthat collects.
There is an issue with thepathway of the large nerve
called the sciatic nerve thatpasses from a collection of
nerves through the nerve rootsin your lumbar spine and your
sacrum as it passes down theback of your butt and your glute
(11:20):
region down your hamstring.
So that would a large nerve iscalled your sciatic nerve.
So sciatica would be like apathology of the sciatic nerve.
All right, that gets involved.
The question is is like it's notalways.
It doesn't paint a good picture.
It just represents referredpain down the glutes and the
hamstring region, the back ofthe thigh right.
It's a super common area forreferred neural pain, all right.
(11:44):
So really, what educate peopleis?
Like it's just nerves that aresending signals down the leg
that um is informing everybodythat they're in, they're lit up,
right, and they're, they're, uh, sensitive and they're getting
some danger signals and, uh, andthey want to let you know.
Right, that's just a fire alarmto let you know there's a
problem, all right.
(12:05):
So that referred pain and painreferral pattern that tells us a
story.
It lets us know, maybe, whatsegments are involved, the
severity of the problem andmaybe when imaging might be, you
know, advised, right, it's notalways just straight up sciatica
and it's not alwaysrepresentation of a herniated
(12:26):
disc causing the referred pain.
It's actually I mean, this iscontroversial to say according
to the literature and theresearch it's usually not the
disc.
There's a whole other podcaston that prior, previously, that
you can check out about herniadisc and referred pain and
neural pain patterns.
But anyway, it's just referredpain and a classic sign for that
(12:47):
is down the glute, down thehamstring, the posterior thigh,
the back of the thigh region,and that just reflects referred
nerve pain Because the joints inthe lumbar spine that they
passed from originally, thosejoints are very irritated and
they're inflamed and they're litup and all the muscles that
connect to those joints are alsoguarded and tense and very
(13:09):
spastic, all right.
So the question is, it's is whydid it happen in the first place
?
And that's how we're going tofix it.
Does that make sense?
So that's just a little bit ofeducation on before I land this
plane because I wanted to bequick.
I just wanted to introduce thisreal fast like a short, concise
information on low back,segmental mobility, muscle
guarding, referred pain.
But the recipe for how we fixthat is a combination of manual
(13:35):
therapy to improve thedisparities in joint mobility of
the lumbar spine, the hips,maybe the SI joint, the
sacroiliac joint and thethoracic spine.
So manual therapy to interveneand improve the mobility
disparities of those joints andthose segments, followed by some
soft tissue work to get thingsto settle down, bring some blood
(13:55):
flow for sure, stimulate somehyaluronic acid and blood flow,
some synovial fluid in the jointspaces.
And that could be achieved withjust straight stripping,
cupping I'm not really a fan ofGraston, I don't really do that
much and then dry needling canbe really helpful too.
Dry needling is super helpfulfor this, maybe not right away
at the acute stage on the sitebecause it's going to be tender
(14:16):
and it's going to be sensitive,but neighboring it can be really
helpful.
It also helps with nerve or furpain too.
So dry needling it's a reallyeffective soft tissue of effect.
Neural nerve and soft tissueintervention that followed up
with corrective exercises.
The corrective exercises iswhat solidifies the changes
we're looking for.
(14:36):
The manual therapy sets it upfor success so that things are
moving better and they feel alittle bit better right now.
And then the correctiveexercises lock it in place and
solidify the changes that we'relooking for.
But we ultimately have to fixthe compensation patterns, the
recipe of biomechanicalcompensation patterns that led
to the problem in the firstplace.
If we don't, then things aren'tgoing to get better.
And that's when people come seeus because they've been doing it
(14:56):
for a long time, battling thispain.
I had to rest for a little bit.
I try to just back it down, Iice it, I rest, I take some
Advil, I feel a little bitbetter.
Then I get back into myactivity If it's exercising golf
, tennis, lifting weights,whatever.
If it's exercising golf, tennis, lifting weights, whatever.
And then it comes back again.
And then I had to rest and thenI'd try to go back into my
exercises again, my workouts andmy golf and it comes, my pain
(15:18):
comes, returns again, and thatcyclical rollercoaster of like
it hurts and I rest, it hurtsand I rest.
That's when people come see us,because we're the specialists
that are going to take care ofit.
And we're only saying that inconfidence, because we've done
it a thousand times and we'vehad a good track record, right.
You don't see all thosefive-star Google reviews just
from.
They're not fake, right.
But that's the high fivemoments we get when people stick
(15:52):
to a plan of care and we'reable to progress things
appropriately, with goodintention and communication
through the process over acouple weeks, a handful of weeks
.
At the end of that, in the highfive moments that we get,
that's the Google reviews wehave, right, and the
testimonials and stuff.
But the corrective exercises iswhat solidifies the changes,
because the pain, the problem,that is the underlying root
cause of the problem, which thepain won't resolve unless that
root cause problem is fixed.
And then, guess what?
The muscles will follow suitwith feeling better too.
(16:14):
So even if we didn't do anysoft tissue work which is common
oftentimes, we just focus onthe joint manual therapy we
don't even do soft tissue worklike stripping dry, needling,
cupping or whatever.
We'll just do manual therapy inthe joints and then we'll do
corrective exercises and supercommon, people leave and they
feel a lot better, they feellooser, they feel good and I'm
(16:35):
like we didn't even touch yoursoft tissue, we didn't even
touch your low back muscles andlike work them out Right.
Um, it's because once we getthings feeling better in the
joint level and fixedcompensation patterns, the
muscles will follow suit.
So the muscles aren't theproblem, the muscles pain and
the spasms.
It's not the the problem, it'sjust a fire alarm.
But we have to fix it, onlycause, otherwise it's going to
keep coming back.
So a thing that we have likethat we judge, we um I don't
(16:57):
want to say that a thing that weum grade the clinicians that
come mentor with us, with me.
Well, in the fellowship programfor continuing education we
have a lot of mentor menteesthat come in the physical
therapist docs that are tryingto improve their level up their
clinical game.
They come mentor with me andone of the things I ask is, when
(17:17):
you work with an athlete andit's been a couple of sessions
they should be feeling better.
Several sessions later, acouple of weeks later, and
they're like hey, you're good togo back to your sport or your
activity, 100%.
What's the likelihood of thatpain returning?
If the pain comes back, thatmeans you didn't solve the
problem.
That's the bottom line.
My pain came back and they'redoing everything you're telling
them to do.
They're not doing anythingoutside of, out of system that
(17:39):
they shouldn't be, that they'renot telling you which that
doesn't really happen.
That often People don't comesee us unless we, unless they're
like motivated, like let's justfix this fricking thing.
'm going to do everything youtell me.
Perfect, let's get after it.
If the pain doesn't come back,that means you solved the
problem.
If they return to their sportand the pain returns, that means
you didn't solve the actualunderlying cause of the problem,
which means the diagnosiswasn't accurate and the whole
(18:01):
trajectory of treatment alsowasn't as best as it could be.
That's kind of how these piecesall fit together.
So anyway, that is the bestrecipe for actually solving this
problem.
I wanted this to be super quickand short.
Just a concise info on lumbarspine, biomechanics, segmental
mobility, pain, referred pain,neural referred issues and then
(18:21):
muscle pain and the recipe onhow to fix it.
This is what that was about.
If you have any questions,don't hesitate to reach out.
You can check back all theother podcasts we've done,
especially on herniated discs,because we did that before too
at length, and we're always opento questions, comments,
concerns, conflicting opinionsand if y'all want to come on the
podcast, let me know.
I'm always open to ideas.
And if you have any pain orthings that you want to get
(18:42):
fixed, don't hesitate to reachout.
We can at least talk on thephone and figure out what the
best direction for care for youis.
If it's not with us, it'ssomebody else, so at least we
can point in the right direction.
So at least give us a call.
We can at least talk on thephone.
The best number to reach us onis 561-899-8725.
We're located here in West Palmbeach, just East of I-95, next
(19:03):
to the Palm beach outlet mall,the Tanger outlet mall.
We're right here and we workwith active, athletic
individuals that are motivatedto get improved, their situation
All right, and they'reenthusiastic about wanting to
get better.
If they're 85 years old or ifthey're 11 years old, we've
worked with both.
We've actually worked with a 95year old before it.
Just if you have a body andyou're active, right, you're an
(19:24):
athlete, what we would say, andwe just work with people that
are active and they want toimprove their life and improve,
decrease their discomfort andimprove their functionality, and
it gets some answers.
That's who we treat and that'swhat we work with and that's
what we have the best resultswith, so don't hesitate to reach
out.
We'll catch y'all next time.
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