Dr. Google Is In: We Answer the 10 Most Googled Pain Questions

[0:00] Jason: Hey, Kathy. Have you ever Googled your symptoms?

Kathy: Of course. Last week, I had a headache, and Google said I was either dehydrated or possessed by a Victorian ghost.

[0:11] Jason: That’s actually a pretty narrow differential diagnosis. Then I searched, why why does my knee hurt when I squat? And somehow, I ended up on a forum where a guy was recommending elk cartilage and moonlight stretching.

Kathy: Alright. Well, that is the beauty of the Internet. You can start with back pain and end up buying supplements from a guy named Steve.

Jason: Good old Steve.

[0:31] Kathy: So we’re answering the 10 most googled questions about musculoskeletal pain before Steve gets to

Jason: Yes. This is the PTCH.

[0:40] Kathy: What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Chiropractors and physical therapists don’t like each other.

Jason: Oh, think again.

Kathy: I’m doctor Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m doctor Jason. I’m an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH podcast. Remember, there’s no I in PTCH.

[1:05] Jason: Oh, no. Everybody hold on. The PTCH podcast is back. I’m doctor Jason Young.

Kathy: And I’m doctor Kathy Lynch.

Jason: Okay. And we’re the PTCH podcast.

Kathy: Yeah.

Jason: We got Raul over in the booth.

Kathy: Yes.

Jason: So hi, Raul. And, you know, can we send another shout out to somebody who is not in the studio, but we’re in their room, like, often

Kathy: We are with her. Yes.

Jason: At all times.

Kathy: Yes. Enchanted Beauty.

Jason: Mhmm. Our good friend, Karen. She’s listening.

Kathy: She’s listening, and, you know, she’s probably doing somebody’s eyebrows right now.

Jason: Absolutely. Maybe a good bikini wax.

[1:39] Jason: And, you know, hopefully, I’m not messing things up by, like

Kathy: Hold steady, Karen. Hold steady. No laughing.

Jason: But how cool is it? A

Kathy: Yeah.

Jason: A, a aesthetic salon that is listening to the PTCH podcast.

Kathy: Absolutely. Yes. Making people more beautiful

[1:54] Jason: and just a little bit smarter.

Kathy: Just a touch smarter or depending on the episode. Could possibly be dumber.

Jason: Yes. Could be dumber.

[2:02] Jason: I don’t know, though. This this this episode could go either way. This could could go either. Yes. Kathy, what what are we talking about today?

Kathy: Well, you know, we were brainstorming ideas for the podcast, and I thought, well, what did people wanna know?

Jason: Yeah. Let’s give the people what they want.

Kathy: Give the people what they want.

Jason: Yes. Show me the money. Yes. We are a podcast of the people, for the people, by a couple of people.

[2:31] Kathy: So we thought, hey. Let’s try to answer, in one episode, the top 10 most googled questions about musculoskeletal.

[2:42] Jason: Doing all 10?

Kathy: All we’re gonna try.

Jason: We’re gonna have to, like, steamroll this.

Kathy: We will. I promise. We’re gonna try to get this done in an hour.

Jason: Man, we might need, like, a flag or something in case the rants start getting too ranty. It’s like, shut up.

Kathy: We’re guaranteed to go on tangents.

Jason: Definitely go on tangents. We’ll try to see if we can

Kathy: What? On this podcast.

[3:04] Kathy: So Alright. What you got? Let’s start off. Numero uno. Number one, maybe you can answer this one. Number one most Googled question, about musculoskeletal pain is why does my back hurt?

Jason: Oh, that’s easy. Probably because of sin. Yeah. You’ve offended God, and so now now your back hurts, and you deserve it.

Kathy: I thought it was blue Gatorade. Next question.

Jason: No. That’s a really great question, though.

[3:37] Jason: I’ve heard lots of crazy reasons why people think that their back hurts.

Kathy: Yeah.

Jason: But, back pain and by this, I’m guessing they mean lower back pain.

Kathy: Yeah.

Jason: The most common type of back pain out there. But, there is a statistic out there that eighty five percent of people, and by people, of course, they mean Americans.

Kathy: That’s right.

Jason: Yeah. Eighty five percent of people will have at least one significant episode of lower back pain during their lifetime.

[4:07] Kathy: Oh, that that’s eighty five percent? Eighty five percent. Say, I would

Jason: I would call up to about a hundred percent. Yeah. Right? Well and it’s weird because it’s like, that makes sense to most people. But every once in a while, you’ll find somebody who’s never experienced it. Kind of like you’ll find somebody who’s never had a headache, which I I still think that those people, their condition is called lying. Right? Everybody’s had a headache. Right? If if not, just come hang out with me for a while. You’ll get one.

[4:38] Kathy: Yeah. The Google tells us that back pain is, the leading cause of disability worldwide.

Jason: Worldwide. Yes. I believe that. There is there are more days of work lost to lower back pain than any other condition, which is amazing. Mhmm. So, not surprised at all that it is the number one most Googled question. People are out there looking for answers. The reason your back hurts is because you’re not getting adjusted on a regular basis. That’s what the research said. Not really.

[5:11] Kathy: There’s we’ve we I think we’ve already we’ve had one whole episode on this. We talked about, back pain a a lot, but I think the thing that’s scary about back pain is, there are a lot of there are a lot of nerves back there. I mean, your spinal cord is back there. It’s where it lives. Yeah. And so there’s a lot of fear when it when you get back pain. Totally. My back went out last night Mhmm.

[5:36] Jason: To the club. Yeah. I know. Exact did it come back by morning? Yeah.

[5:40] Jason: Yeah. And the good news is is that most types of back pain are fairly benign. Mhmm. Most types of back pain will resolve on its own Mhmm. Which, you know, some people are like, that’s blasphemy, and all those people saying that are other chiropractors. But it’s it’s true. Most people’s, episodes of back pain are transient. They will get better on their own. There are some that are definitely worth treating, and, there’s, fortunately, a lot of treatment options. Unfortunately, for most people, they all work about the same.

[6:14] Jason: So Right. It’s a it’s a tricky it’s a tricky area to research, but it’s one that there is, some pretty intense questions because back pain can be debilitating.

Kathy: Yes. No doubt. And I think that there’s a lot of, a lot of what goes along with it is psychological and, like because you worry about, oh, no. Mhmm. My back’s gone out Yes. To the club with your back. And, and so what do you do about that?

[6:44] Jason: I think some of the leading causes that I see of back pain are people like to say postural stress, but postural stress can also be called inactivity.

Kathy: Yeah.

Jason: So a sedentary lifestyle not moving, not taking care of the the postural muscles, the endurance muscles there, that’s a major cause. And then you have your more garden variety causes like strain. So, lifting something heavy, lifting something that you’re not prepared to lift,

[7:15] Jason: those kinds of things, and some of it’s genetic. Right? There’s some people that have a genetic propensity towards some back pain, but, don’t I I think that gets overblown too, and people are like, my uncle had had a slipped disc. I hate that term. So I’m going to also

[7:34] Kathy: no. Not hereditary. Not hereditary. Debunked.

[7:38] Jason: Debunked thoroughly. But it’s I think one thing that’s interesting, though, is it’s also cultural, which is something we don’t really understand well because Americans get more lower back pain than other cultures. And there are cultures where they have virtually no lower back pain

[7:55] Jason: and, like, they’re lifting heavy things and sleeping in huts or I don’t know.

Kathy: Yeah. But, yeah. They’re not sitting sitting as much. I guess.

Jason: But, yeah, we, Americans, we love our back pain

Kathy: We do. And the constitution and the flag.

[8:13] Kathy: We sure do. What is the second most googled

[8:19] Jason: question? That’s a great question. I’m gonna look on your computer because for some reason, I don’t have that pulled up. Oh, yes. This is a great one. Uh-huh. And people are asking, not only Google this, but they’re asking their providers this.

[8:30] Jason: Don’t I need an MRI? Or, like, how would I know if I need an MRI? Let’s answer that one together. Ready? One, two, three. Yes. No. No. Definitely no. Usually no. Do you get this question, Kathy? People come in, like, why don’t they just do full body MRIs for everybody? I see. Yeah. Yeah. And it’s I I think intellectually seems like a good idea, but from a practical standpoint, why if let’s pretend MRIs are free. Yes. Why wouldn’t everybody want an MRI?

[9:05] Kathy: The things we see on an MRI, what the pic the picture doesn’t correlate a lot of times with the pain. Yeah. The picture is one moment in time. It’s usually unless you get a functional MRI, it’s not when you’re moving. It’s you are laying down in one position. So it is not always gonna give you the answer that you want. And then it’s also gonna give you things you don’t want to see, and you cannot unsee it. And then you walk around thinking

[9:36] Kathy: you got disc bulges all over your spine, and you should never leave your bed. Yeah. Yeah. Yeah. I’ve,

[9:42] Jason: I’ve had a series of, old men. I think that’s how I describe them coming into the clinic lately, and, it’s a really interesting thing. About half of them that I’ve that I’ve had come in, their doctors have jumped to early on, let’s do some X rays. Mhmm. And then the other half have not had that. Guess which half got better quickly? The ones that didn’t get the X rays. Ones that didn’t have the X rays. Because the ones that did, they saw they they saw the,

[10:13] Jason: the arthritis or actually, arthrosis is what is what I should say because you can’t see the inflammation on the on the, on the X-ray. But those guys, they saw those results, and they decided, well, I’m done golfing. I can’t go for a run anymore. And they just they disabled themselves Mhmm. By seeing too much of what was there. The guys who couldn’t see that, they they wanna get back to golf. They wanna get back to all these things that,

[10:42] Kathy: and and guess who gets the results? Mhmm. It’s not the dudes who decide that Sudoku is their new sport. No. That is the truth. Yeah. And we know we know from research that imaging doesn’t necessarily mean we’re gonna get better outcomes.

[10:57] Kathy: Mhmm. And I think I heard this, I think, from you several times, but I think you’ve said oh, gosh. Now I can’t think about it. The only reason

[11:12] Jason: the only what what is it you always say about surgery? I only say two or three things. Surgery about MRI. Well, yeah. Well, I I have said that the that the main reason Can’t Now I can’t think of it. My brain. No. It’s, like, it’s the leading cause of surgery

[11:28] Jason: is an MRI. Yeah. Because I come up with that. Yeah. And so My my brain just went on a Okay. Okay. And we’re good. Take takeaways for this episode. I don’t know if I don’t know if we can get the other eight. We’re struggling it too. Wow. Okay. Yeah. But yeah. Who’s the leading cause of surgery is an MRI? And, there’s a piece of me that when I’m working with patients, I almost want to reserve the MRI Mhmm. For when I’m referring somebody to a neurosurgeon. Because,

[11:58] Jason: when we’ve done all the conservative stuff that we can and it’s time for you to take it to the next level Mhmm. They’re they’re who needs that MRI Yeah. Clinician. Do you need MRI information? Really. Yeah. I don’t really either. Right? It’s it’s not too tough to figure out through an orthopedic test Yeah. What is probably going on with somebody. So I don’t need an MRI. Mm-mm. People who need the MRI are the people who are gonna cut you open and save the day. Yes.

[12:23] Kathy: Well, if if conservative conservative treatment hasn’t worked, that’s when I’m like, you know what? It might be time for imaging. So they obviously serve a great purpose.

[12:32] Kathy: Right. Early on in pain and early on in an injury, unless, you know, it’s a knee or ankle.

[12:38] Jason: But you you generally don’t need an MRI. Right. In fact, I’m I’m looking this up because I I’m trying to think of the study where I saw this, and I I don’t think that that’s my saying. I think that it is something that that is confirmed. It’s literally the leading cause. Yeah. Here it is. Early MRI for low back pain is associated with substantially higher odds of spinal surgery. In an elderly Medicare Advantage population,

[13:05] Jason: early imaging was associated with an adjusted odds ratio of three point four for spinal surgery, compared to those with early imaging. So you are many times more likely to have surgery Dang. If you have an early MRI. Early MRI. Okay. Early MRI. K. So yeah. Don’t do it. Do I need an MRI? I think you could swap want for knee. Do you want an MRI? Right. Do you want surgery? Correct. And it’s not to say the surgery is not necessary Right. Ever. Yes. But,

[13:41] Jason: you are probably according to the to the studies Mhmm. You’re probably more likely to get an unnecessary or an an or an avoidable surgery if you have an early MRI.

[13:54] Kathy: Let’s avoid those surgeries if if we can.

[13:58] Jason: Yeah. I mean, I think it sounds good. Alright. Don’t but just really quickly, and we’ll get on to numbers. You have people that come in and they’re like, I don’t know what’s wrong with this. I just wanna get whatever surgery it is.

Kathy: Yes. Yeah. That’s that’s so weird to me.

Jason: There’s some people that come in there, like, just do the surgery and let’s fix it.

Kathy: Yeah. Yeah. I mean, it no. Yeah. And I had a patient

[14:21] Kathy: recently. It’s like, well, my doctor said that we gotta jump through hoops, so that’s why I hear physical therapy so that I can get the MRI. Yeah. And finally, I get my MRI scheduled next week. Yeah. And then We gotta just we just gotta check this PT box so I can get my surgery. I take a deep breath and a swig of whiskey.

[14:42] Jason: If you ever go to Encore Physical Therapy, PT is so good, you’re gonna want more. Uh-huh. Check out doctor Kathy Lynch’s, hip flask that she’s carried around with her. And if you see her reach for the hip flask or flask, you probably just said something real stupid. Yeah. Oh, she’s going for the flask. I’ll retract that statement. I’m so sorry. I’ll do my I’ll do my squats. Yeah. Yeah. Just Alright.

[15:20] Kathy: Okay. Question three. Question three. Top number three most Googled we should’ve gotten backwards. Anyway Mhmm. Number three most Googled, question. Is my sciatica serious?

[15:36] Jason: First I know that’s The first the first question is, is it seriously sciatica? Usually not. Yeah. So this sciatica is a term that gets, like, kicked around all the time, like, literally. Not not like literally kicked around all the time sciatica. But kicked around like the word literally Yeah. Which now people use for things that they are intentionally saying is not literal. Like, literally, every time you blah blah blah blah no. That is not how it’s used. Right? So sciatica gets overused a lot. And I’ve seen it used to mean everything from really, really, really bad lower back pain or mild lower back pain to full blown sciatica where people have foot drop and numbness and tingling and Can’t get away from the pain. Searing pain down your leg. Yeah. But it’s only one of those things. Mhmm. It’s and it’s not the first thing. I’ll just say this. If you’re googling it,

[16:36] Kathy: it’s probably not because if it’s serious sciatica Mhmm. You are going to urgent care or the ER. That’s the pain is that bad. Yeah. So and

[16:47] Jason: so just so people know, sciatica is it happens in one place in your body and one place only. One. That’s in your lumbar spine. K? And in order for you to have sciatica, you need at your lumbar spine, where the nerves are exiting, you need some sort of compressive force, whether that is a disc pushing on that nerve root or it could be, that the, that there’s a mass in there or that there is a bone pushing on there, and that is the order of the likelihood of those things. Disc, mass, bone. Okay? And, so it only happens up there in in your back, and you will feel it radiating down past your knee. Mhmm. Past your knee. Not to your knee. Not north of your knee. Past your knee. South. Also, you’re gonna feel it in the back of your leg. Mhmm. So if you have, if you have these, these, sensations in the front of your leg and the front of your thigh, that’s not sciatica. It’s probably a femoral nerve problem. Mhmm. The femoral nerve is not the same as your sciatic nerve. It’s not. And it’ll cause numbness, tingling, muscle weakness, or shooting pain down past your knee. Mhmm. Down past your knee. Fast. Yes. And if you don’t have that, you don’t have sciatica. Also, sciatica is typically just gonna be one side, not both. Right. So, if you just have hip pain, that’s not sciatica. Even if your medical doctor told you you’ve got sciatica because there’s some medical doctors who don’t have a lot of background in musculoskeletal things who they they just think anything that refers to a part any part of the leg is sciatica, and the difference matters because the treatment is different for sciatic problems than for other types of problems. Like, you could have an actual leg problem. Mhmm. Right? And, if we’re just treating your back and not your leg, how’s your leg gonna get better? Yeah. Yeah. Acupuncture.

[18:45] Jason: Absolutely. No. I don’t know. Craniosacral therapy? Craniosacral therapy. Right? No doubt. Perimenopause? I’m just I feel like we’re just going through old episodes. Plastic surgery. We are.

[18:55] Kathy: We are. Because the next most Googled question is, should I rest or keep moving? Oh, you take this. We just did a little episode on this one. Mhmm. Likely,

[19:06] Kathy: just keep moving unless it’s a broken bone, it’s a heart attack, or you’re having a stroke. Yeah. Or you’re bleeding out. Yes. Don’t just keep moving.

[19:16] Jason: I mean, if you keep moving, keep moving to the ER. Yeah. It’s like, it’s like Dory. Right? Just keep swimming. Yes. I don’t like swimming. Yeah.

[19:24] Kathy: Yeah. We we did a probably a month ago, a whole episode on rest. Mhmm. When rest is good, when rest is when you need to do rest and when you shouldn’t rest. Especially back pain, do not just rest. Gentle movement, short walks, getting up, stretching your legs, moving around every hour,

[19:47] Jason: Just keep moving. Yeah. And appropriate loading. Yeah. Right? So Appropriate loading. We keep hitting certain themes. So appropriate loading, blood flow to areas, movement, all those things. And so that’s an easy one. I I wish that we could just hard code it into Google that it always said, nah. Keep going. Keep moving.

[20:07] Kathy: Yeah. Likely just keep going. 95% confident you can keep moving a little bit. Totally. Absolutely.

[20:13] Jason: So

[20:15] Kathy: Okay. Alright. Question number five. Why does my neck hurt? Okay. So back was number one. Yes.

[20:24] Jason: Neck, number five. Neck is number five. Alright. Well, let’s let’s talk about probably one of the most, pervasive and controversial made up conditions that that circulate on social media. My people are guilty of of spreading the word on this, and, that is a condition called tech neck. Have you heard of this?

Kathy: I’ve heard of tech neck.

Jason: Yeah. So, I mean, bless their hearts. Yeah. They mean well, the people who talk about Tech Neck. Mhmm. But, Tech Neck is not really a thing. It’s this idea that everybody in our culture has neck pain because we’re looking down at our phones. Mhmm. Can you get neck pain from this?

[21:18] Kathy: Sure. Mhmm.

[21:20] Jason: Does it change the curve in your neck?

[21:23] Jason: No. Is it the main driver of neck pain in our society? Also, no. Like, there’s there’s really no evidence to support that, and there’s lots of research. So the same kind of things that would bother your neck, would probably bother the rest of you. The tech neck thing is probably more associated with a lack of movement in general Mhmm. That, it’s I’ll put it this way.

[21:53] Jason: It is more harmful to your spine that you’re being sedentary than that you’re looking down. Yes. Necks are made to look down really very pretty well. Do you think people, while searching Google, are looking down

[22:07] Kathy: and texting, why does my neck hurt? Yeah.

[22:11] Jason: Ironically, yes. Well and I’ve I’ve told people I tell people this less, but early career, I would tell people if you don’t look like an idiot when you’re using your phone, you’re not doing it right. Yeah. So I tell them, yeah. You wanna have it up here. But you know what? You cannot do that for too long either. And maybe that’s the only reason my advice worked was it’s like, eventually, you’re just gonna give up because this looks stupid, and it feels even worse.

[22:35] Jason: So, so I don’t know how pockets work. I can’t put my phone in my pocket now. And here’s the other thing too is when you look at the way that bodies are designed, the the eye part of your head is built different than the non eye part of your head.

Kathy: You mean the front of your head?

Jason: Yes. Okay. That’s exactly what I’m talking about. And so because this is where our eyes are, we’re also pretty well designed to do things that are in front of us. Right?

Kathy: Gotcha.

[23:07] Jason: So what was the question again?

Kathy: Why does my neck hurt? Yeah.

Jason: Yeah. So the some of the most common reasons I see that people’s neck hurts besides not moving enough, people’s beds Yeah. Hurt their necks. Like, if you got a weird pillow situation, like, you got six or seven pillows, and so you’re sleeping, like, all curled up, and you wake up in the morning and your neck is all stiff.

[23:30] Kathy: It’s a really common reason. Not found the perfect pillow yet. Do you have pillow recommendations?

[23:35] Jason: I do. We’re looking for sponsors. Okay. So,

[23:39] Jason: what I recommend is the MyPillow. It’s a great politically

[23:45] Kathy: politically, it has to be the worst, but that’s

[23:50] Jason: Raul’s over there dying. Yeah. Nobody nobody should buy MyPillow. It’s the worst pillow, and I’m not just talking politics. It’s just it’s not a good pillow. My my pillow speech goes like this. If you’re a side sleeper, which people come in, they’re like, I’m a side sleeper, so that’s why I have lots of people sleep on your side. It’s fine to sleep on your side.

[24:14] Jason: But you need a pillow that’s gonna fill the space in between your AC joint, which is that kinda knobby space of your shoulder and the and the neck. Okay. And it’s gotta be firm enough so that overnight, it’s not compressing to where you’re in a weird position. You also don’t want something that’s gonna push you too far the other way. Mhmm. And, you’re gonna have to change pillows from time to time. Yeah. I think it’s time. Yeah. So sometimes the pillows change. Sometimes your situation changes. Mhmm. Your mattress is changing softness. So it’s it’s okay to have to change it up sometimes. I know some people who, they do really well with a rolled up towel Oh. Behind their neck. So your position matters.

[24:51] Jason: Your the condition of your mattress matters, but pillows are fun. Usually, when people are getting hurt, it’s because they have too many pillows, not because they have not enough. That’s what at least that’s what I see. Yeah. They’re all No evidence to be backed up. Okay. K. Alright.

[25:07] Kathy: K. We’re breezing through these. Okay. Alright. Question number six. Is arthritis causing my pain?

Jason: I don’t know.

[25:21] Jason: Sounds like a personal problem.

[25:25] Kathy: So, usually, if arthritis is causing your pain, the things that we hear listen for in, when we’re taking history for the patient is it takes me thirty minutes in the morning to get warmed up. Mhmm. Once I’m moving around, I feel a lot better. Yeah. Or I’ve been sitting in my car and I get out of my car and my knee is really stiff. Mhmm. Usually, that’s one of the first clues where I think, this is probably arthritis. So Yeah.

Jason: But, Kathy, what if they’re bone on bone? What if their bones are on their bones?

Kathy: Then there’s definitely arthritis.

Jason: Well and I think it’s really important to differentiate between arthritis and arthrosis. Yeah. It bugs me to no end when people come in and they they have their X-ray, and they’re like, oh, according to my X-ray, I’ve got arthritis. Mhmm. It’s like, are you having any pain? No. Are you having any joint inflammation? No. But I’ve got arthritis. K. No. We don’t. You have arthrosis. Mhmm. And, I don’t blame people for not knowing the difference. I do blame their doctor for using the wrong word.

Kathy: Well, yeah, when I read the the the reports that come back, the radiologist report, they say arthritis.

[26:36] Jason: Yeah. Yeah. And it’s like, how are you seeing the inflammation on the X-ray? Right? You could see so, technically, the changes that are made in the bones are there’s inflammation involved in that process. Yeah. But unless there’s an active inflammatory process, that person has arthrosis, which is just a change in the shape of the bone. And one of the things that we know and has been acknowledged more and more lately, especially in the literature, is that arthrosis is normal and it’s natural. Mhmm. It’s a badge of honor. It is. Right. Getting gray hair. It is. It is gray hair of the spine. Mhmm. And it is poorly associated

[27:16] Jason: with symptoms, meaning that they’ve done studies where they’ve taken a 100 people off the street. They stick them in an MRI machine, which we’ve just discussed. It’s so unwise. But for the sake of science Why not? All those people are dead now. They’re all dead. They they had surgery and died. Oh, this is a good time for the disclaimer. Yeah. None of this none of this is true. No. This is for entertainment purposes only. Yeah. We’re not we’re not giving medical advice. No. No. Not today. No. Maybe next week. Yes.

[27:47] Jason: But no. The so they take a 100 healthy people, stick them in an MRI, and they find, like, bulging discs. They find, collapsed vertebrae. They find arthrosis all over the place. And the only way that these people got into the study is they didn’t have symptoms. And so you see these these findings, but they don’t have any symptoms, and they’re out there just leading normal lives. And so what it tells us is that the presence of those things doesn’t necessarily mean that you’re going to have a problem or that your problem is related to them. Right.

[28:23] Jason: That being said, those things are associated with pain. Mhmm. So that’s kind of a weird thing. It’s like, I just I thought you just said that they that they weren’t. So people who if they would have taken a 100 people with, like, back pain Mhmm. They would have found probably even more people with with those conditions. And so there’s more of an association there, but it’s not automatic that if you have these changes that you’re gonna be in pain. The other thing too is that those people that they took with back pain and they scan them,

[28:54] Jason: those people aren’t always gonna have back pain for the rest of their life. And so these things come and go. You can have a flare up of arthritis, which if you have a flare up of arthritis, it does cause pain. But if you have arthrosis, you’re probably just gonna be fine until you die, which we all do. You’re gonna die with arthrosis, not from it. There’s only one way out of this life.

Kathy: Yeah. I beat arthrosis to the grave. Let’s do it.

Jason: It’s like, yeah, I’m taking you with me, arthrosis.

[29:24] Jason: Alright. What’s next?

[29:26] Kathy: Alright. Question number seven. What exercises help pain?

[29:31] Jason: Ridiculous.

[29:32] Kathy: People constantly search for the best exercises for back pain.

[29:37] Jason: Man, there is back pain again. There it is. Yeah. Yeah. Well, could we skip back pain for a second? Yeah. And I you have a lot to say on this, so I’ll just say one short little thing. One of the best treatments for pain after exercise is exercise.

[29:56] Kathy: Right.

[29:57] Jason: That’s all I gotta say about it.

Kathy: Yeah. Just keep on going. Mhmm. Circulation.

[30:02] Jason: Yes. If you are sore after a marathon, one of the best things you could do Mhmm. Is go for a little run. Yeah. A little Not another marathon. No. But little run. Little recovery run. Yeah. Yeah. So what do you think? What exercises help with pain?

Kathy: Well, it’s funny because people do come in and they’ve are you know, they’ve already researched. They’ve Googled. I’ve been doing exercises is what they tell me. And the exercises that they come in are actually good exercises.

[30:27] Kathy: However, they may have gotten their diagnosis wrong. Mhmm. So they’re doing exercises for back pain Mhmm. But their back pain wasn’t caused by a certain thing that this exercise is gonna help them with.

Jason: Right.

Kathy: So, any exercise is great. Mhmm. However, if you’re having pain when you bend over in your back and then you’re doing extension exercises, lumbar extension exercises, that’s not gonna help. If you’re doing bridges Surprise. If you’re doing bridges Yeah. That’s the opposite of what you need.

Jason: Right. So

[31:06] Jason: So specificity of those exercises can matter. So it’s a good question for people to Google.

Kathy: It is. It is, but at the same time, they’re just gonna get generalized.

[31:16] Jason: Yes. Yeah. So you gotta be careful. Like and we both had the patient who’s come in and said, I tried doing the exercises on YouTube. Yeah. You know, the exercises on YouTube. Bob and Brad. Yeah. And, what I tell people is exercise is good for back pain. Yeah. I I do a lot of back pain. So,

[31:37] Jason: exercise is good for back pain. Mhmm. But, medicine is also good for back pain. Mhmm. So if you go out there and you’re taking birth control Yeah. That’s a really good point. That’s exactly Yeah. Which which is medicine. It is medicine. Birth control is not gonna fix your back pain. No. I mean, unless, like, you’re trying to beat, like, pregnancy related back pain, which I’m not too worried about. So yeah. So Yes. Some specificity

[32:09] Jason: Yes. Is good. Yes. Let me ask you this, though. What would you say are maybe some of your best general exercises, like your your your high value ones that are maybe gonna hit a bunch of targets? Mhmm. Right? Outside of, like, you know, you’ve you’ve kind of alluded to directional loading where it’s like, oh, does it hurt with flexion or extension? Like, what is an exercise that you would recommend to anybody if you didn’t have any information about

[32:41] Jason: what’s causing their pain. Know what joint or what Yeah. What’s gonna be, like, a high value exercise that way?

Kathy: Well, I always go with the squat.

Jason: Okay. Squat’s good. Yeah. The squat. I mean, it’s Fix your headache? Yep. Absolutely. Hey. Maybe you maybe you have a headache because you’ve been sedentary, and you need to get some blood flow into the brain. Yeah. You know, maybe your neck is stiff Mhmm. Because you’ve been sitting around. Mhmm. You know, get some blood into those neck muscles.

[33:07] Jason: I like it. And I think psychologically, that’s a good that’s a good one too because if you can squat, first of all, getting feeling that power in your legs, it’s it’s like it’s a confidence builder. Right? For me, I would say walking. Yeah. Right?

[33:21] Jason: There’s, I mean, sometimes if I don’t know what to do, I just tell people, go take a walk. Yeah. Just walk until it feels better. Yeah. Yeah.

Kathy: And calf raises, we’ve we’ve talked about how the calf muscle is the the heart of the lower body because it helps pump the blood back into back up into the heart and through the rest of your body. So Yeah. I love heel raises.

[33:45] Jason: So if you I’ll I’ll I’ll give you another one dancing. I think dancing is Oh. I think dancing is very good exercise. Yes. Psychologically,

[33:53] Jason: cardiovascularly. Mhmm. And, one of the best things about dancing is it’s not just a sagittal plane movement Yeah. Where your treadmills, your ellipticals, your rowing machines, they all happen in a hallway, in an alleyway Mhmm. Where, like, you you’re doing everything forward and back. Dancing is, you know, if you’re doing it right, you should be moving side to side, maybe twisting. There’s some rotational elements. So I think that that’s an excellent exercise. What about walking like an Egyptian?

[34:30] Jason: Oh, hey. Oh, do you think hear me out, what do you think the chances are that we get the Bengals that come on the pitch black guys? Are they alive? I think they are. Okay. Let’s do it. Would there be value in that, though? Like, do they know anything about health while I guess they’re alive all these years later? Yeah. Yeah. Talk about clicks. Alright. I’m gonna give you that homework assignment. If you could get a bangle on this show

Kathy: Is that Belinda Carlisle? I don’t know. Okay. Yeah. I was so young then.

Jason: Only one of us was really young then.

[35:03] Jason: Yeah. Let’s see. Okay. Let’s make a bet. If, if you could get one of the Bengals to come on the show, even for just, like, a quick cameo, it doesn’t have to be a whole episode. If you can get one of the Bengals to come on, I will I will let’s see. What should what do you want? What what could I get you that would make that bet worthwhile?

[35:24] Kathy: What you could get me is Neil Ivy, the women’s basketball coach at Notre Dame to come on. Okay. Alright.

[35:30] Jason: Let’s shoot for the stars. Okay. Neil Ivy. Okay. Coming on. You get you get one of the Bengals, I’ll get Neil Ivy. Alright. We’re gonna reach out. Neil, if you’re listening, like usual,

[35:41] Jason: have your agent reach

[35:44] Kathy: out. Alright. We should get to number eight. Okay. Number eight. How do I know if it’s serious? Okay. I had to tell you, I’m on a tangent right now, but I just started getting on threads, You know? Social media threads. I hadn’t been on it before. Mhmm. And I don’t know why it is different than Twitter. I don’t know. But it I I found this hilarious, not hilarious thread of people posting pictures of injuries slash

[36:11] Kathy: things going on with their body. Rashes. And yes. How many asking people on threads, should I go to the emergency room? Oh, okay. This girl posted a picture of a quote, unquote rash. She’s like, what is this rash? And immediately people are like, RN here, MD here. Yeah. Get to the hot this is cellulitis. Yeah. This is going to kill you. Oh my god. And one guy just one guy just posted,

[36:43] Kathy: HOPODIL. He forgot to put the s, and so he just he meant to write hospital.

[36:48] Jason: Nothing else. He was in he was in such a hurry to get her there. He just didn’t even use all the letters. Hospital. Get to the hospital.

[36:55] Kathy: Get to the hospital now. And and, of course, she updated us. Yeah. She did go, and she was in the hospital for, like, two days because she was about to become septic. Been there. Done that. Yeah. And the The was not fun. No. Yeah. And the worst part is the narrative that this is what American health care is like. Yeah.

[37:17] Kathy: The nobody wants to go to urgent care or emergency room because they’re gonna be there all day long. Mhmm. And so they’re just I’m gonna ask all these random people out there for some medical advice instead.

[37:28] Jason: Man, that’s great. You know, next time you see one of those threads, tag me. K. Because me and, Nano Banana, the, the AI image generator Yeah. We’re gonna have some fun. K. Guys done. Guys, do you think this is serious? It’ll be like a a second head growing out of my collarbone.

[37:48] Jason: Should I have this looked at? Hopital. Get you the hopital now, man, before you gotta start brushing that thing’s teeth.

[37:58] Kathy: Oh, okay. That is the question number eight. Okay. Most googled. How do I know if it’s serious? Know if it’s serious. I guess the big question is

[38:07] Jason: what’s serious. But here’s here are the biggest things. First of all, if you have fever Yes. If you have nausea, dizziness, ringing in the ears,

[38:20] Jason: cognition problems, difficulty breathing Slurring speech. Slurring speech, get to the hospital. Waste no time. Get to the hospital. Alright? Like, palpitations, those kinds of things, chest pain. Yes. Like, do not wait. I have a very good friend who, thank god, is alive today because he was driving to work. Mhmm. He had, like, a twenty minute commute. Mhmm. And no. Actually, it’s it’s about thirty minutes. He was, driving, like, through Philomath and had to go to Monmouth or something like that. And just as he’s driving past the hospital, he’s like, man, my chest hurts.

[38:59] Jason: It’s like, jeez. This is really, really tough. And he just took himself to the hospital. Stop, buddy. Because he was having a heart attack. Oh god. Right? And so people think I’m having a heart attack. It’s like, it’s gonna, like, really punch me in the chest. No. It’s like just those are the important things. So those are the really, really serious things. Also, what’s the impact that it’s having on your life, your ability to do things? If you now can’t walk or you can’t sit or you can’t speak or whatever. Right. Control your bladder. Yeah. Get some help. Go go to the hospital. You know, just really quickly. Yes.

[39:36] Jason: There, there is this thing with chiropractic where people are like, oh, if you get your neck adjusted, you’re gonna have a stroke. Yep. So, happens very rarely, but it happens. And, there are some kinda telltale signs that somebody is at higher risk. So they have hypermobility. Typically, it’s a female. Typically, it’s gonna be, like, you know, under under 40, I mean, migraine headache history. And you will have, like, a thunderclap headache, which is, like, all of a sudden, boom, worst headache you’ve ever had, nausea, dizziness, neck pain, those kinds of things,

[40:13] Jason: those are signs that you could be having an artery dissection. And so those are things that people go to the chiropractor with or they’ll go to, you know, their the the ER with and things like that. If any of those, you know, characteristics, the hypermobility of the female, the age thing, the types of headaches, if any of those things fit, go to the ER. If you want an adjustment, that’s fine. Get that after Yes. You go to the ER. But, I have that conversation with people the same way that, you know, somebody would have a conversation about somebody who’s at high risk for a heart attack. Right?

[40:48] Jason: We should be able to recognize some of the signs of something really serious and get to the hospital. Yeah. We’re gonna have to make a T shirt now. I’m telling you. Get to the hospital. Find that thread again. I’ll send it to you. Yes. Who would buy a T shirt that said get to the hospital? Pitch podcast.

[41:06] Kathy: Oh, yeah. 100%.

[41:08] Jason: O p I t a l. There and remember, there’s no s in hockey.

[41:21] Jason: I’m gonna make it happen. It’s coming it’s coming to the PTCH podcast. Yes. So if you go to ptchpodcast.shop/swag, that’s where you could get a like, get your NARD shirt, get your get to the hospital shirt. Outstanding. Alright. What’s next? Number nine. Why does it keep coming back? Is this about in laws? I thought we were talking about musculoskeletal. What is it?

Kathy: No. Shout out to my in laws. They’re great.

Jason: Yeah. I hope they’re in coming back now.

Kathy: My in laws are amazing. I hit the jackpot.

Jason: Oh. Okay. Why does what does the body keep coming back? What’s the answer to that?

[41:57] Kathy: Recurrence is common. Yeah. It does.

[42:00] Jason: If you’re living life right You’ve stayed alive long enough. That’s why it came back. That’s true.

[42:04] Kathy: That’s true. If you’re living life right, you’re probably gonna have some pain. Yeah. Yeah. And if you’re living wrong, you’re probably having a lot of pain too. So you might as well have fun. Get out there.

[42:15] Jason: And sometimes it’s just like a a freak thing. Right? Like, you can, stub your toe twice. Mhmm. Right? And I think sometimes, though, it’s because you haven’t changed your habits. You haven’t changed what you you do. You’re doing the same things over and over,

[42:32] Jason: and, that can be one of the leading cause of recurring pain. It’s not because you have a bad back or a bad knee or anything like that. A lot of times, it’s just because you haven’t found the right habits and doing those long term. People are like, am I gonna have to exercise? If you wanna feel good and stay alive. Yeah? Forever? Yeah. Yes. Or people are like, chiropractic adjustments are temporary. Yeah. Everything’s temporary. Mhmm. You know what else is temporary? Nutrition. You have to eat every day. Every day. Right? Hydration,

[43:03] Jason: Temporary. Mhmm. You will die if you don’t do it. Right? A really good point. So it’s like, yeah, it probably keeps coming back because you haven’t identified the habits that that are leading to it. Mhmm. Some of those habits might be like, I don’t know, rugby or pickleball. No. I’m just kidding. Those are fine. Alright. Last but not least. We made it to number 10. Here we go. We sped through these. Then I’ve got a good game for you. Okay. Excellent.

[43:30] Kathy: Okay. Top tenth most googled question.

[43:35] Jason: Will I need surgery? Probably. Did you have an MRI? Yeah. Right. Get your MRI. Get your surgery. Yeah. Good to hear you. Why is that even a question? That’s not number one. Yeah. I think here’s what I would tell people about surgery. I would say don’t worry about surgery until it’s time to worry about surgery. Yeah. You can always have surgery. Mhmm. Right? And if you need an emergency surgery, guess what? You get to the hospital. You’re gonna get that emergency surgery if you need I I need to stop. For say the correct word again for the rest of my life.

[44:10] Jason: Crap. You ruined me.

[44:13] Kathy: Yeah. Okay.

[44:16] Jason: Yeah. I mean, don’t you think? I I totally agree. I mean, you get you gotta do six weeks of PT anyway. It’s it’s one of those things you gotta check off the list. Check it off the list. Uh-huh. They’ll teach you how to jump through hoops. I I wonder if there’s people out there that ever come in and they’re like, could you just write down that I did six weeks of PT so that I could go ahead and get my surgery?

[44:37] Kathy: I’ve had people wanted to want I think they need, like, six visits, so they wanted to get them all in one week or I’ve had that happen for sure. Like, oh, they and they said I need six visits. Mhmm. So I’m like

Jason: This is like our default patient voice.

Kathy: I know. Hey. I guess it’s all the old men that come in and we’re like, yeah.

[44:54] Jason: Yeah. We’re You know when some lady comes in and she’s stalking like this, it’s like, oh, I know who you are. I know who you are. Right? Yeah. It’s somebody’s listening. They’re like, oh, it’s my uncle Dan. He’s the one with all the problems. Oh my goodness. Alright. K. Let’s go. We made it through. Yeah. We did. Cool. It’s the Cliff’s notes. So I just hope people feel like a fool if they ever Google any of those. Right? I guess we should check again in maybe six months and see if the list has changed. Yeah. See how much the the PTCH podcast is moving Moving the needle. Alright, PTCH-es.

[45:28] Jason: Do do your thing. Right? Okay. You wanna play a game? Yeah. Alright. This is called the MSK Google game. Real or fake? So people type the strangest things into Google at 2AM, and in each round, you’re going to be given three searches or conditions, that people might look for. Two are fake. One is real. A documented thing that people actually Google. Right? Okay. Now, we’ve already revealed the answers on, like, maybe one or two of these, but,

[46:00] Jason: I’m gonna read all three conditions, and then you’re gonna lock in the one that you think is real. Just one of them is real before I reveal, and the rest of this does not rhyme. Okay. I I just felt like I was on a roll. K? Alright. So round one, thumb trouble. Thumb problems caused by a condition called Venmo wrist, WhatsApp it is,

[46:31] Jason: or FaceTime finger. I’ll repeat them. A, Venmo wrist, b, WhatsApp it is, or c, FaceTime finger.

[46:45] Kathy: WhatsApp it is.

[46:47] Jason: That is correct. Oh. Yes. WhatsApp it is. A real repetitive strain injury named after the app first described in The Lancet. Really? Yes. The journal in 2014 after a doctor logged six plus hours of messaging,

[47:03] Jason: wrecked her thumbs. It’s de Quervain’s tenosynovitis wearing a hoodie.

[47:07] Kathy: Okay. What? Was she doing for six hours?

Jason: I don’t know. Right. Chart notes on WhatsApp.

Kathy: On WhatsApp?

Jason: Alright. Round two. Bend the elbow. Okay. Anthony. Which one of these is real? A, drone elbow, b, karaoke elbow, or c, SelfieElbow?

[47:31] Kathy: Oh, SelfieElbow.

[47:33] Jason: Final answer?

Kathy: Final answer.

Jason: Alright. You are correct. Ah. Two for two. K. Selfie elbow is real and is really just lateral epicondylitis. So, it’s tennis elbow. So it’s caused by extending, locking your arm to frame the perfect selfie, same tendon, dumber cause. I think that right now, Kathy, we should see if we’re going to get it. Can I get it? Let’s get a selfie. Alright. That will be posted nowhere ever. Okay. Round three.

[48:04] Jason: Pain in the neck. K. Is it, a, tech neck, b, binge watch neck, or, c, sunroof neck?

[48:14] Kathy: Oh, roof neck? Yeah. That sounds really painful. Yeah. You already know the answer.

Jason: Tech neck. Yes. Tech neck. Tech neck, AKA, text neck, real and heavily Googled.

Kathy: Real. Okay.

Jason: Quote, unquote. The further your head tilts forward over a screen, the more effective load it puts on your cervical spine and shoulders. And there is something to that. Like, for every inch forward that your head is, it is more pounds of pressure.

[48:42] Jason: But, yeah, it’s no difference than no different though than, you know, reading a book

Kathy: Reading a book.

Jason: Or cooking dinner

Kathy: Quilting.

Jason: Quilting, crocheting,

[48:55] Kathy: needlepoint. The original Tech Neck.

[48:58] Jason: Alright. Round four, the 2AM search bar. Okay. These are phrased the way that people actually type them. K? Can you sneeze a disc out of place? That’s a. B,

[49:13] Jason: why does my spine sound like a glow stick? Or, c, lower back pain and tingling in my butt. Should I worry?

[49:23] Kathy: That one. Definitely.

[49:26] Jason: You are correct. Hospital. Yes. So this is this is a genuinely documented real world search, And, it isn’t just funny because back pain plus saddle numbness and tingling around the groin and buttocks and any bowel or bladder changes is a red flag for

[49:47] Kathy: Cauda equina.

Jason: Cauda equina, which is a surgical emergency. Very

Kathy: Skip the MRI. Serious.

Jason: I so they they tell us in chiropractic school, you will probably see around one case of cauda equina syndrome

Kathy: Mhmm.

Jason: On average per chiropractor. I saw mine when I was in chiropractic school.

Kathy: Wow.

Jason: Yeah. The lady came in. I can no longer feel when I wipe. So we sent her up to OHSU. She had decompressive surgery that very day.

Kathy: Yes.

Jason: That it’s it’s that emergent.

Kathy: Yes.

Jason: So those things. Okay.

[50:18] Jason: Round five, final round. Man, we shoulda had some exciting music for this part. The this is this round is called the hands full. Is it a, trackpad wrist, b, text claw, or c, stylus knuckle?

[50:36] Kathy: Oh, stylus knuckle.

[50:38] Jason: Oh, okay. No shots. The real one was

[50:41] Kathy: Phone a friend. Raul?

[50:43] Jason: Phone a friend. Raul, you this is your chance to steal for all the points. Trackpad wrist, text claw, or stylus knuckle. If you say stylus knuckle, you’re the biggest loser

[50:54] Jason: because she already said it, and it was wrong. So you get a fifty fifty chance. Text claw. Text claw. That is correct. Oh. Yes. It’s a real term for cramping, aching, and fatigue in the fingers, wrist, and forearm from gripping and scrolling a phone all day long. People. The take home mirror is phones are great for business.

Kathy: Right.

Jason: So, yes, it often travels upward towards cell phone elbow, which is ulnar nerve irritation

[51:26] Jason: in the cubital tunnel. You hold that, arm bent. The cure for this, of course, though, is every once in a while, yep, you give it the selfie elbow. Right? If you go from text claw to selfie elbow, text claw to selfie elbow, That’s good exercise. Right? Do it while you’re taking a walk. Alright. Kathy, takeaways for me. Ways.

[51:53] Kathy: People are turning to the Internet for medical advice.

[51:56] Jason: What a disaster. Should I go? Well, you know, the great irony is we’re being experienced mostly on the Internet

Kathy: Yes.

Jason: for this show. It is good. Yes. This this life saving information.

[52:08] Kathy: So For entertainment purposes only.

Jason: Yeah.

[52:12] Jason: My, I my takeaway is I’m really glad that we’re doing this episode, that we did this episode because we’re pretty much done now. I’m sure everybody’s thrilled about that.

Kathy: Yes.

Jason: But, this is gonna be a great one to share with patients.

Kathy: It is.

Jason: It’s gonna save me so much time. Like, somebody’s gonna ask me a question. I’m gonna be like, okay. Listen. I’m just gonna send you an email. Just hit play. Put it on double speed.

[52:33] Jason: Yeah. Yeah. Get to the hospital. Yeah. Alright. So, oh, let’s let’s do, let’s talk about our sponsors. K. I’ll talk about my favorite chiropractic clinic in here.

Kathy: Tell me.

Jason: Body of Health Chiropractic and Wellness Center.

Kathy: Yes.

Jason: One of our gracious sponsors.

Kathy: Mhmm.

Jason: I may also be the founder and owner of that of that establishment, but, hey. I think it’s pretty great.

Kathy: Mhmm.

Jason: What about your Kathy? Good things about it. Yeah. What’s oh, what’s that on your shirt?

Kathy: Oh, oh, yes. Encore Physical Therapy.

Jason: Oh, PT is so good. You’re gonna want more.

Kathy: Yeah. No doubt about it. Mhmm.

Jason: Where is it at?

[53:10] Kathy: We’re in Corvallis, Oregon, Corner Of 9th And Walnut

Jason: Okay.

Kathy: Across from the green store.

[53:17] Jason: Yes. Get your weed and then get the exercise you need at Encore Physical Therapy. Weed first. Yeah. Then rehab. Oh my gosh. Now I’m gonna say that there’s, one more thing to remember, and it’s not about the hospitals. Right? There is no s in the hospital, but there’s also no I in pitch.