Herniated Discs: Scary Name, Not a Life Sentence

balance between the two of those. And the disc is kind of one of the structures that tries to do that.

[0:00] Jason: True or false? If you herniate a disc, you’re no longer allowed to sneeze without risking full spinal collapse.

Kathy: Okay, that’s false. Unless you’re trying to make a lawsuit out of it.

Jason: This is the PTCH where we answer the questions your doctor didn’t, your friend misunderstood, and ChatGPT got wrong.

Kathy: Yes. And today we’re going to talk about disc herniations — those misunderstood spine pancakes that sound way scarier than they really are. And later we’ll play “Who Herniated It?” where I challenge Kathy to guess which celebrities bent

[0:32] too far and paid the price.

Kathy: We’re here to give you the health info you didn’t know you needed and make you laugh hard enough to use your core muscles.

Jason: This is the PTCH Podcast. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast?

Kathy: But chiropractors and physical therapists don’t like each other.

Jason: Oh, think again.

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

Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the

[1:02] PTCH Podcast. Remember, there’s no “I” in PTCH. Today, we’re diving deep into the back. Literally — if you’ve ever been told you have a herniated disc, or you’ve felt that mystery pain shoot down your leg, this episode’s for you. We’re busting myths, explaining what actually happens when a disc herniates, and giving you the no-BS truth on how to treat it without panicking. Okay, Kathy, I’m so excited about this episode. You’ve been juiced all day.

Kathy: I know. I’ve been thinking about this and it just makes me feel like a real

[1:33] nerd, because I’m like, “Yes, let’s talk about disc herniations.”

Jason: So where do we start? Tell me and I’ll go there.

Kathy: What is a disc?

Jason: What is a disc? Okay. So let’s do a little bit of spinal anatomy. Now, some people don’t know this, but this is a video podcast, right? So you can see it. Some of you are just listening and you’re really missing out, because you’re going to miss — I’m going to give a visual aid here. So you can

[2:04] watch us on YouTube or Spotify. All right. So this is what a disc looks like. Okay? So you have a spinal segment. Your whole spine is made up of this. You have a vertebra, a disc, vertebra, disc, vertebra, disc — repeats all throughout the spine. This is the spinal cord and everything. And discs are squishy.

Kathy: They’re like the shock absorber of the spine. Okay. And sometimes what’ll happen is they will bulge. Right. Now if you’re just in your car, you’re like, “What’s happening?

[2:35] What’s happening?” I’ll tell you what’s happening.

Kathy: You need to watch this.

Jason: All heck is breaking loose in this spine. So yeah. So that disc will bulge out and it’ll pinch the little nerve. Oh, there’s the little nerve that’s there. Okay. And it causes a lot of problems, and it’s just a scary-sounding injury, right?

Kathy: But I do have like a bone to pick with this.

Jason: A bone — or

Kathy: Yeah. I have a disc to pick with this. That’s hard to say. A disc to pick with this.

Jason: Be careful.

[3:05] Kathy: Yeah.

Jason: Oh gosh. I can tell you — this is a family podcast. It is — off the air, I’m going to tell you just the worst story about that. So I will tell you one of my biggest pet peeves with this though is when people are like,

Kathy: “I’ve got a slipped disc” — which, doesn’t that make it sound like this little red part might just come out and start pinging around inside your body like a hockey puck?

Jason: Yeah. Like it’s slippery in there.

[3:35] Kathy: Yeah. And I think the words matter, especially when it comes to healthcare. Absolutely. And sometimes the imagery that we get with things can really make it worse than it actually is.

Jason: So I think if people think “I have a slipped disc,” it’s like something has moved out of place —

Kathy: now they’re just like one hiccup or sneeze away from permanent

Jason: paralysis. They’re just hanging on.

Kathy: Yeah.

Jason: Yeah. By a thread. So there’s terms like slipped disc, blown disc, bulging disc, or

[4:05] “the disc is out of place.” You hear extrusions, herniations — all kinds of stuff. And none of it’s really as scary as it sounds.

Kathy: Does it slip like on a banana peel?

Jason: No. No. Right. And they’re anchored really well. So yes, let’s get into that.

Kathy: Yeah. So the disc tissue — first of all, if you were to poke a disc,

Jason: it’s about the density of a pencil eraser. Okay. And there’s two layers of disc

[4:35] material and they kind of go diagonally in two different directions. So it’s a really tough material. It does a good job of resisting rotation

Kathy: and then also, because it’s got a little bit of rubberiness to it, it does a good job of taking compressive forces. So if you didn’t have any discs in your back, you would jump off of a curb and you would just be in danger of your whole spine maybe buckling, right?

[5:05] Jason: Probably. Yeah. So the fact that you have discs — and not just one, but a bunch of them —

Kathy: like 20-some. Yeah.

Jason: I haven’t counted in a while.

Kathy: Yeah.

Jason: I think it’s 25

Kathy: maybe. I don’t know. I should have thought about that before.

Jason: 25, right? Yeah, I think it’s 25. 25-ish. I don’t know. Some people have more, some people have less, which is actually true.

Kathy: Some people have an extra.

Jason: But all that compressive force is distributed across all of those discs. And that is both a plus

[5:38] and a minus. So without the discs, you probably couldn’t bend and twist, right?

Kathy: No. Yeah. You really couldn’t. It gives — well, and I think with biomechanics there are two conflicting ideas. There’s stability and mobility, and they’re mutually exclusive. Like, if something is infinitely mobile it’s going to move and travel wherever it wants. If something’s infinitely stable, it’s not going to move at all. Right?

Jason: And so we’re trying to achieve a good

[6:08] balance to where we can move reliably but not too much. Right.

Kathy: Right. And yeah, so discs are, for the most part, they’re wonderful. We love them. We need them, right?

Jason: And yeah, so I think that’s what I’m going to say about that part.

Kathy: Okay. How do you explain to a patient what a disc herniation is?

Jason: Oh, that’s a good question. Well, first of all,

[6:39] a disc herniation is basically when you have an injury of that disc tissue.

Kathy: Mhm.

Jason: And like any injury, they heal.

Kathy: Yeah. I had a guy who came in and he’s like, “I’ve got a herniated disc.” And so we start talking. I’m like, “Okay, tell me — where’s your back pain?” He said, “Oh, I don’t have any back pain.”

Jason: Okay. Well, what kind of symptoms are you having like down the leg?

Kathy: I don’t have any symptoms down the leg.

Jason: Okay. Are you having any numbness, tingling, muscle weakness?

Kathy: No, no, no.

[7:10] Okay. So how do you know that you have a herniated disc?

Jason: He said, well, I herniated it 30 years ago. And so yeah — I was like,

Kathy: dude, somebody should have told you that these things heal after a while. It’s like if you get a bloody nose, you don’t have a bloody nose for the rest of your life, right? So like, well, I don’t know. I don’t need the tissue because I’ve got a bloody nose. It’s like, where’s all the blood? So

Jason: if it’s herniated, you know.

Kathy: Yeah. Right. Yeah. And the thing is it gets better. Gets better. Right. And so

[7:41] what a herniated disc is — I explained that there’s kind of those two layers to that outer tissue there. But right in the middle of the disc, you can think of the disc like a jelly donut. This is where I’m going to come in because we talked about this before the podcast, but I have a professor in PT school — adamant, so we can say whatever we want.

Jason: No, he is not interested at all in what I have to say, especially at this point. But he just said it is not a jelly donut. Do not ever tell your patients

[8:12] it’s a jelly donut.

Kathy: Well, you know why we say that? It’s because it’s such a good analogy. It’s so easy.

Jason: It’s a good visual. It’s a good visual.

Kathy: Yeah. Well, and so — this is totally an aside, but I was going through my vast library of books.

Jason: Yeah.

Kathy: This morning, and I came across a book that was written by one of my professors in chiropractic school called Chiropractic Technique.

Jason: Oh,

Kathy: yeah. And he signed the book for me. It was like one of those deals

[8:43] where it’s like, yeah, you got to pay 250 bucks for my book. It’s like the only book. Yeah. So I had him sign my book. You know what he wrote? You know what he wrote in that thing? He wrote, “Silence is golden.” And then he signed his name.

Jason: I wonder what that meant.

Kathy: I was like, “Bro, are you freaking kidding me right now? You know how much I paid for this book and this is what you want to write — ‘silence is golden’?” And so it’s like

Jason: in his defense, I do have a podcast now. I’m just sitting around talking a whole bunch.

Kathy: But man, how rude. Scott thinks it’s rude. Yeah.

Jason: That’s totally — all right. What are we

[9:14] talking about?

Kathy: We’re back on jelly donuts. Jelly donuts. Okay.

Jason: Jelly donuts. Jelly donuts. So the reason the jelly donut analogy works is because everybody understands those. You have a donut.

Kathy: Yep.

Jason: And then in the middle you have jelly.

Kathy: Yes.

Jason: Okay. Right.

Kathy: Simple.

Jason: Yes. And so what’s the name of the jelly in the disc?

Kathy: The nucleus pulposus.

Jason: Yes. And I asked you that because you spent so much time practicing beforehand.

Kathy: I never had to say it.

Jason: I just wanted to give you the opportunity to flex it. Right. So

Kathy: for sure. Well, it’s called the nucleus.

Jason: Yes. Or the NP.

Kathy: Yeah. That’s not what I or anybody else calls it, but you can call it the NP. I’ll know what you’re talking about.

Jason: Okay. So, the nucleus pulposus — that is the jelly part of the disc. It’s just not as thick as the rest of it.

[9:47] And so, when you get a disc herniation, what happens is you’ll get a tear in some of those fibers on the outside of the disc. Those are called the annular fibers. There’s a quiz later, okay? And so whenever those fibers kind of tear or get stretched or there’s some sort of injury there, that nucleus pulposus in

[10:17] the middle starts to kind of push out and bulge that piece of the disc out, right?

Kathy: And that can cause — in the most severe cases, some of that can leave the disc. That’s pretty rare. That’s called an extrusion, where you get some of that nucleus pulposus that comes out and it just kind of floats up and down around the nerve, and that really sucks. But that’s not most —

Jason: disc — kind of like when you eat the jelly donut on the wrong side.

Kathy: Yeah.

Jason: And it comes out the other end.

[10:47] Yeah. And you get some on your cheek. Right. So yeah. Extrusions are really rare and they’re painful. But fortunately that’s not most of them.

Kathy: Absolutely. Oh my goodness. So the more common thing is that that nucleus will push and it bulges that disc out. And in more severe disc herniations, it will come out and it will pinch up against that spinal nerve. And when that spinal nerve gets pinched or compressed or just inflamed or irritated, then you will get symptoms

[11:18] that run down your leg, and we call that

Jason: sciatica.

Kathy: That is correct. Scott got it.

Jason: Yeah, points for Scott. Good job. Points for Scott. So yeah,

Kathy: if it’s not on the sciatic nerve —

Jason: Oh, so — okay, this is a great question. Yeah, so sciatica only happens in the lower back. Now, there’s all kinds of stuff that happens like down the leg. People come in all the time, they’re like, “Oh, I’ve got sciatica.” And I’m like, “Show me where you’re feeling it.” And they point at their glute or their thigh

[11:48] or something like that, and that is not sciatica. Or they point at the front of their thigh. That is also not sciatica. So the sciatic nerve is a huge nerve. It’s the biggest nerve in your body.

Kathy: Very big. It’s like the big telephone wires, right?

Jason: And it comes from the levels of your lumbar spine and it goes down into your legs and branches off into specific nerves. But it goes down the back of the leg. So if you’re having symptoms in the front of your leg, it’s not sciatic.

[12:19] Because that’s the femoral nerve. Remember, there’s a quiz later. Jason: Well, yeah. You know, let’s go back to that. In cadaver lab, why didn’t they ever tag the sciatic nerve on an exam? That would have been — why couldn’t they have just picked that one? Kathy: Yeah, it would have been — that would have been question seven right after question number six, which is “please identify the leg.” Jason: Literally. Kathy: Yeah. Left or right? Jason: Yeah. Instead, they tag the lateral sural nerve. Kathy: Yeah. Right.

[12:49] Identify the fascia part. Sorry, I got you off track there. Kathy: No, but so — Jason: talking about sciatica. Kathy: Yeah. So, sciatica is when you have compression of the sciatic nerve and it will cause things like pain, numbness, tingling, or muscle weakness. And one of the key features of that is you will experience those symptoms down past the knee. Jason: Yes. Kathy: Okay. And I say it like that over and over because I made an Instagram video a long time ago and I’m like “down past the knee, down past it.” And so that’s now my

[13:19] trademark way of saying it for everybody — you will have symptoms Jason: down past the knee, right? Kathy: So if you go to your medical doctor, anybody else, and they’re like, “You’ve got sciatica,” and you only have symptoms that radiate to your glutes or your thigh, Jason: you don’t have sciatica. Kathy: No. Now there is something else called — well, there’s other things that can compress a sciatic nerve, but we reserve the term sciatica for when that compression happens right there, like

[13:50] where the nerve is leaving the spinal column. Jason: Well, and actually yeah, the spinal canal. Kathy: And so that is sciatica. So a disc herniation is one of the most common causes of sciatica. Jason: Right. Kathy: All right. Roll the credits. We’re done. We did it. No, just — Jason: Where are we now? Kathy: Wait, there’s more. Okay, Jason: it’s definitely — Kathy: Yeah. So, Jason: Yeah. So, you were kind of mentioning there’s different grades. Kathy: Yes. Jason: Of herniation in a sense, or an injury,

[14:22] right? So, you can have a disc bulge. Kathy: Bulge, Jason: which is when you do have some injury to those fibers and it just — like, it pokes out just a little bit. Kathy: Right. Jason: Right. And sometimes those hurt, often they don’t. And we’ll get into how we know that and why we know that. Kathy: And then you can have a disc herniation, and then you can have a disc extrusion, when you get that material that’s floating up and down there. Jason: Jelly coming out. Kathy: Jelly — jelly of the donut, right?

[14:53] It comes out. Anything that touches — you know that saying “you’re getting on my last nerve”? Jason: Uh-huh. Kathy: For a reason. Because nerve pain is no joke, Jason: right? Well, and that’s another thing that’s actually really misunderstood — Kathy: people will say anytime somebody has some sharp pain or like an intense pain, they’re like, “It’s nerve pain.” Jason: It’s like, “Okay, you think it’s nerve pain.” Yeah. Well, how do you know? Well, because it hurts a lot. And it’s like, well, a lot of things hurt a lot. Like, have you ever touched a stove? That’s not nerve pain.

[15:23] Kathy: And then there’s some people like, “Well, everything is nerve pain,” which technically is not incorrect, because nerves carry pain, Jason: right? But we reserve that term “nerve pain” for pain that’s associated with a nerve being compressed. And usually that will be kind of sharp, electric, zippy-zappy pain, which — that’s the medical term for it. I paid — zippy-zappy. Kathy: I paid over $200,000 to learn the word “zippy-zappy,” Jason: which is actually two words. Yeah. Kathy: Which is why it wasn’t $100,000.

[15:53] Jason: This is why we are not real doctors. Kathy: Nard. Um, so yeah, that’s — that’s the thing. That’s what nerve pain feels like — it’s kind of electrical, crackly. You can also get some burning, that would be nerve pain, but specifically in this context, you know, that’s what we got. Now, with disc herniations, I should say, what I showed there was a lumbar segment, which is the lower back, which is probably the most common place

[16:23] to have a disc herniation because they bear the most weight. But you can have a disc herniation in your upper back. Jason: That’s probably the most rare area to have it because it’s really stable since you have all the ribs. Kathy: And then the lower back is the most common. Next most common place is the neck. Jason: And if you get a disc herniation there, you’re going to have symptoms that shoot down your arms into your fingers, weakness, and things like that. Kathy: So, Jason: Right. Right. Kathy: Yes. Jason: Okay. I think we covered the basics, right? Kathy: Yes. Uh-huh. Wow.

[16:53] Jason: And Kathy: should we talk about how it happens? Jason: Yeah, let’s talk about how it happens. So, Kathy: this is a little counterintuitive, but the least common way that it happens is trauma. Jason: You know, a lot of times when people get a disc herniation, they’re like, “I didn’t even do anything. Like, I don’t know how I got this. It just came on all by itself.” Not true. Kathy: But people think that something like a disc herniation should come from something like a trauma, right? Like, I

[17:23] was in a car accident, or I got attacked by a Sasquatch. Those are the two most common ways that people think they should be caused. Not the car accident, just a Sasquatch. No, Jason: but no, it’s — trauma is the less common way for it to happen. The more typical way for a disc herniation to occur is by repetitive loading and forces that are on that disc and the structures that surround it.

[17:53] Kathy: Mm-hm. Jason: Now, when there is a trauma, the way that that’s typically going to happen — there’s typically two ways. So, I alluded to car accident, Kathy: right? And so you can have a shearing force where — let’s say that you have a seat belt on and it’s holding your pelvis in place and you get hit from behind hard enough that the bottom part of your spine is holding still and the top part gets pushed forward, and it tears the fibers that way. Jason: That’s a very violent collision. That’s not the vast majority of those collisions. And so that’s a pretty rare

[18:24] way to injure it. Probably the most common traumatic way to injure a disc is when you are bent over, then you’re lifting and twisting under load. So loading the spine and then making a lifting and twisting movement. That’s one that will — that will typically, if you’re injuring a disc from trauma, that’s typically the mechanism.

Kathy: The BLTs.

Jason: BLTs.

Kathy: Bend, lift, and twist.

Jason: Oh, bend, lift, and twist. Yeah. I was

[18:54] like, “Are you offering me a sandwich?”

Kathy: Yeah.

Jason: Did they not — they taught you that in fact, the BLT?

Kathy: They probably did, but I was probably sleeping that day, right?

Jason: Yeah. I probably —

Kathy: I was probably talking while Dr. Peterson was talking about it. Yeah.

Jason: Generally, this is anecdotal, but people that are maybe generally deconditioned and then they decide to move their house.

Kathy: Yeah.

Jason: And they are bending, lifting, and twisting over and over and over. And then that one box that they think

[19:25] they can lift that’s 50 lbs and they haven’t lifted 50 lbs in 25 years. And that’s how it can happen.

Kathy: Absolutely. I think I did just briefly mention stress on other structures.

Jason: That’s typically where it is — whenever the other structures around it aren’t doing their job and then you have all that stress on that disc material, and then that’s when it tends to fail. So, if you have a stronger back, if you’re well prepared or conditioned for that

[19:55] move, then you’re going to tend to have more success.

Kathy: Yeah.

Jason: But the flip side of that is the amount of exposure. So, if I am somebody who rarely is BLTing, which I now know is a verb, if I’m rarely bending, lifting, and twisting, I have a lower chance of having that happen because I’m just not exposed to that movement as much.

Kathy: That’s a good point.

Jason: But if my job is bending, lifting, and twisting over and over and over and over and over and I’m doing this a million times in a week, I have a high exposure. So even though

[20:25] it’s maybe not as common — like let’s say it’s one in a million — if I’m doing a million, I’m probably going to have one, right?

Kathy: Good point.

Jason: So yeah, those are the ways that they tend to happen. There’s also a hereditary aspect to this, too,

Kathy: which gets tricky because we get our connective tissue from our parents,

Jason: okay? And the disc material is connective tissue. And so some people have really stretchy connective tissue. Some people have kind of brittle connective tissue. And so there is a hereditary aspect — there are some

[20:57] people who might be more prone to having this type of injury, and you look in their family history and there are other people that have had disc herniations. Now, some people just want to blame heredity on it, and that’s not a good idea.

Kathy: No, because you’re not helpless in all this where it’s just like, “Oh, my dad had a bad back.” Which — I don’t believe in bad back.

Jason: I agree with that.

Kathy: Yeah. So, he had a bad back. My grandpa had a bad back, and so I’m going to have a bad back.

Jason: Yes.

Kathy: Yeah.

Jason: I hear that a lot.

Kathy: Why is that wrong, Jason?

[21:29] Like, why can’t we just blame our parents and grandparents for everything?

Jason: Nature versus nurture.

Kathy: Yeah. Yeah.

Jason: Well, I don’t even know where to start with that. Why is it wrong? Because

Kathy: I mean,

Jason: you’re not destined to have a bad back because your dad had a bad back,

Kathy: right?

Jason: Yeah. I mean, yeah, that’s —

Kathy: we’re not all doing the same things, right?

Jason: No, that’s — that’s totally not. Plus, you only got half his genes.

Kathy: Yeah, that’s right. What about mom? Right. Mom — Mom’s got a great back.

[22:00] Why don’t you choose the good back?

Jason: Absolutely right. Well, and you talked about nature versus nurture, and you look at like, you know, a lot of these people — they can inherit also some kind of sedentary lifestyle from a parent. And so, yeah, if you have a really super sedentary

Kathy: family, and they have some sort of a problem — I don’t even care what the problem is —

Jason: you’re probably going to inherit that problem,

Kathy: right? But if you take good care of your body, like good nutrition,

[22:31] strengthening, things like that, you decrease your chances of also suffering those same bad effects. So,

Jason: yeah, we got to be responsible for our own health.

Kathy: We do. Yeah.

Jason: Stupid bad design.

Kathy: Yeah, I know. It’s a bummer. It takes all the fun out of it. That’s for sure.

Jason: Well, and then there are some other things that increase your risk beyond heredity. So, for example, if you’re a smoker, you have a higher risk of having a disc herniation — you’re at higher risk for everything with smoking.

Kathy: Okay.

Jason: Yeah,

Kathy: we’ve — that’s fact.

[23:01] Jason: Yes,

Kathy: that has been established.

Jason: Totally.

Kathy: We don’t — there’s no question about that. So, just don’t do it.

Jason: Do you ever find smokers are surprised whenever they do start dealing with some of the consequences of these things?

Kathy: Like, I had a patient in today and, you know, God bless him, he’s trying to quit smoking.

Jason: Okay.

Kathy: And it’s one of those deals where smoking is the last thing that’s left because it’s so addictive. It’s a — yeah, it’s — yeah, it’s not really his fault.

Jason: I have people that get sad whenever they hear that they have an increased risk of

[23:32] an injury from like an adjustment or from doing an exercise or anything like that because they smoke, and it’s just like, dang it, right?

Kathy: So yeah, if you want to decrease your risk of herniations — if you have them a lot and you’re a smoker — quit smoking. It’s going to help, right? And I don’t say that like it’s just easy to quit smoking, but yeah, stop it.

Jason: Stop it now. Don’t like that, Scott. No, I’m just kidding. Scott — Scott doesn’t smoke. He’s not a smoker.

Kathy: Not a smoker.

Jason: And we talked about deconditioning. So, if you’re not taking

[24:04] care of your body, supporting the muscles around it.

Kathy: Postural stress is another thing. Like, we’re doing something right now that is actually really bad for discs.

Jason: We are sitting.

Kathy: We’re sitting. Yeah.

Jason: It’s one of the more stressful things that you can do to your spine is to sit.

Kathy: Can you explain that?

Jason: I wish I could. Okay.

Kathy: Well, explain what they taught you in chiropractic school.

Jason: Sure.

Kathy: Oh, I was told that I would not be quizzed on anything I learned in chiropractic school.

Jason: No. It’s pretty simple —

[24:35] to explain. So, first of all, you look at — I already talked before about how all these discs work together. So the more kind of pieces you have stacked, the more elements you’re going to have kind of bearing some of that stress when you’re sitting down. I’ve now taken away the bottom half of my body from kind of dealing with some impact and stress. So that’s one of the things. So I’m not using my hips, knees, ankles, feet, the arch of my foot to

[25:06] kind of help deal with any compressive forces. So that matters in the context of driving a lot. So if you are driving on a tractor, for example, or in a big rig, or you’re doing long road trips, you’re taking away like a third of the shock absorption there. So that puts you at higher risk.

Jason: The other thing too is that whenever we sit, how our pelvis is tilted matters. So as I tilt my pelvis back, what happens is my spine flexes. And

[25:37] when spines flex — remember the BLT, the bending —

Kathy: The bending.

Jason: Yes. That actually squishes those discs and it moves disc material backwards towards those nerves.

Kathy: Mhm.

Jason: And so when you’re sitting for a long time, especially with your pelvis tilted, it’s sustained pressure on those discs and it eventually kind of weakens some of those tissues in the back, especially when you have some of those other factors like heredity, smoking, deconditioning,

[26:07] and things like that.

Kathy: Yeah. Sometimes I try to explain it as — because I can’t tell patients that it’s a jelly donut — but more like a water balloon, right? So between the two bones, and when you flex forward, it pinches the front and then it will squeeze that water balloon behind —

Jason: Yes.

Kathy: — which then presses — because the spinal cord

Jason: is behind

Kathy: Yeah.

Jason: — the disc, and anything that touches the spinal cord and the spinal nerves,

[26:37] you’re going to know it.

Kathy: You’re going to know it.

Jason: You’re going to know it. So it just has to barely touch it.

Kathy: Yeah.

Jason: Yeah. So, and then there’s other things, like if you’re taking a beating — for example, football players. So, linemen — that’s a position where you tend to get a higher degree of disc herniations,

Kathy: Yeah.

Jason: and a lot of that is because linemen are lifting lots of weight in the gym.

[27:07] And also they spend a lot of time bent down — it’s repetitively bending, lifting, and twisting, right? Same with — what was the other athlete that I was — oh, basketball players, right? So if you’re doing a lot of rebounding, coming down in awkward positions, those kinds of things, that repetitive impact can give you trouble, especially if you’re a big tall person and you’re not doing a good job of controlling your weight,

[27:38] then that can cause you some trouble. So you’ll see some of these NBA centers and things like that who get a disc herniation, and it’s just because of the amount of pounding that they’re putting into those discs.

Kathy: And again, it’s exposure. It’s not just like, oh, everybody who’s in that situation — it’s exposure. You’re a professional athlete. You’re doing it over and over and over. Boom.

Jason: Yeah.

Kathy: Mhm.

Jason: Yeah. So that’s what I was going to talk about — the demographic.

Kathy: Yeah.

Jason: Yeah. It doesn’t really discern. The disc doesn’t care.

Kathy: It does not.

[28:08] Jason: Your age?

Kathy: No.

Jason: Your race?

Kathy: No.

Jason: Your religion?

Kathy: Religion.

Jason: Yes.

Kathy: Definitely not religion.

Jason: Your political leanings. Yes. So, if you’re right-leaning or left-leaning, right —

Kathy: if you stay in the center, actually, you’re better —

Jason: I think so. First of all, you have to take a stand, right? You can’t just sit down. You’ve got to be standing upright in the center —

[28:38] upright moderates — you’ve got the healthiest backs there are. So —

Kathy: Oh goodness. Yes, we’re rewriting the science right now.

Jason: The truth.

Kathy: All right. Recognizing the signs. How do I know?

Jason: And I think I already talked about a lot of this, right? So we talked about sciatica. It’s symptoms going down past the knee. Right.

Kathy: Right.

Jason: And you’re going to find numbness, tingling, muscle weakness. And it’s going to be kind of a zippy, zappy

[29:08] electric pain. Now with the numbness and the tingling — first of all, if you’re having sustained symptoms of numbness and tingling,

Kathy: that’s more worrisome.

Jason: Yes. You’re going to have these symptoms on one side, not both sides. If you have them on both sides, we’re thinking something else — like maybe stenosis, or something for another show, right?

Kathy: Um, but with a herniation, what happens is that disc will push out to the right or to the left. Politics.

Jason: Yeah. Okay.

Kathy: See?

[29:38] Jason: Yeah, stay in the middle.

Kathy: Yeah. And so it’ll pinch the nerve on the right or the left. And so that’s usually a sign that you know that’s a problem. Now sometimes — and this is pretty rare — you get a disc that goes straight back,

Jason: and it can pinch off basically — we’ll say it’s the spinal cord. It’s at that part of your spine — it’s not just like a single tube like you would imagine. It kind of spreads out. So that’s why I hesitate, because I’m a nerd.

Kathy: You’re getting detail-picky.

Jason: Yeah. We’ll just say the spinal cord.

[30:08] Kathy: Professors aren’t listening.

Jason: No, they’re not. No. And Dave Peterson never did. So, if you get a disc herniation that goes straight back,

Kathy: that can cause some havoc. That can cause something that’s called cauda equina.

Jason: Yeah.

Kathy: And cauda equina is more of an emergency. So disc herniation — we’ll get into, I’m sure, how it’s managed and what needs to happen. Cauda equina is: let’s do something now, because you risk major damage. So let’s go there for a

[30:39] second. The cauda equina — you’re going to have more serious symptoms like loss of bowel control, bladder control, things like that. There’s something called a saddle pattern of paresthesia. So any part of your legs that would touch a saddle on a horse — when that goes numb or gets tingling, that’s a sign that maybe you could have cauda equina, where you have that disc herniation going straight back, that more dangerous kind.

Kathy: Have you seen cauda equina?

[31:10] Kathy: I have. Jason: Yeah. Kathy: I actually saw it as a student. Jason: Wow. Really? Kathy: Yeah. Yeah. And that was — that was kind of scary because like the lady was describing her symptoms and everything like — Jason: Hold on now. Kathy: Yeah, just a moment. Jason: Just a moment. You have — Kathy: — settling. And one — one thing that a lot of people will say is that they don’t feel it when they wipe after they use the bathroom. So if it’s like, yeah, you know, that — that Jason: — you know, that’s not working. So we, fortunately, we have attending physicians there. And

[31:40] so we present all of our findings and he’s like, “Yeah, let’s — let’s get her to OSU.” And she had decompression surgery that afternoon. Kathy: Yeah. Same — same. We had a woman come in for back pain and — she was seeing one of the other PTs and he was a younger PT and she came in walking but then like literally in her visit started not being able to walk and was kind of like — Jason: like she was drunk or something — Kathy: and he’s like, “Can you —” Jason: which I hear is common at Encore like

[32:10] — that’s what we do, that’s what we do. Kathy: This didn’t happen at Encore. Oh, sorry. Some other — some other place. Yes. Jason: Yes. And he’s like, “Can you come take a look?” So I went over and I was like, Kathy: “Sir, we need to call —” Jason: Yeah. Kathy: “We’re — we’re going to call 911 here because —” Jason: Yeah. Yeah. Cauda equina — same thing. Kathy: Yeah. And it’s very rare. I think — Jason: it is very rare. Kathy: I think I’ve seen three cases in my entire 20-year career. And so,

[32:40] but yeah, so that — that would be the most serious thing that would be going on. And so, in fact, if you’re ever Jason: diagnosed or talked to about a disc herniation, that — that’s something that should be — some of the home instructions is they should — whoever you’re working with should give you some signs to look out for, and that’s the type of thing. So, loss of bowel or bladder control, saddle numbness, and symptoms down both legs because we’re going straight

[33:11] back, not just to one side or the other. So that brings us back to the point that it’s typically on one side or the other. Okay? Kathy: And so, numbness — you’ll tend to have numbness like down the lower leg. So like the calf, the foot, the toes, things like that. You’ll get some tingling, kind of like pins and needles. And so those — so the pain, the numbness, and the tingling — those are signs of like a mild to a moderate disc herniation. And what’s a sign of maybe a more

[33:45] severe one is when you start experiencing muscle weakness. Jason: Yes. Kathy: So that’s kind of on the inner layer of that nerve — those — those motor fibers. And so when you start losing some muscle control, that’s when we need to kind of get to the next level of diagnosis and intervention. Jason: Yeah. Kathy: Because that would show up with things like foot drop. So if you’re walking and you can’t lift your foot and you’re tripping over your foot, if you’re having difficulty like

[34:15] bending your knee, lifting your leg to like climb stairs. Not saying that every time you experience that, that that’s what it is. Jason: It’s not a disc. Kathy: Yeah, in the presence of those other symptoms. You have symptoms on one side, you’re getting the numbness, the tingling, and you’re experiencing some muscle weakness — we have a pretty good suspicion that you could have a herniated disc, Jason: right? Kathy: Yeah. Jason: Right. Kathy: And Jason: what do you do about it? Kathy: Well, there’s one more thing that I wanted to add. Okay. And that is coughing, sneezing, and straining. Jason: Yeah. So that is — that’s a triad of

[34:48] things that we ask about every time because when you cough or sneeze or strain, what happens is you develop a bunch of pressure in your abdominal cavity Kathy: and it will Jason: push on the disc from the front side and if you’re having symptoms, it will push — that — that nucleus pulposus out the back. And so if you’re coughing or sneezing and you feel electricity running down your leg, or it gives you really severe back pain, then that’s another sign that you might have a disc herniation.

[35:18] Kathy: Yeah. Jason: And I should — I should add with that, that sometimes all you get is the leg symptoms. Like there’s sometimes when people have a disc herniation, all they have is leg symptoms. They don’t really have much lower back pain. And so Kathy: yeah, Jason: and people don’t think, “Oh, it’s a back problem.” They think, “Oh, my darn leg,” right? Since the — war, you know, Kathy: so, Jason: it’s a little football injury. Kathy: Yeah. And so it’s a tricky thing because like sometimes you’re like, “Oh yeah,

[35:48] you got a disc.” And they’re like, “I don’t even have back pain.” Right. And then sometimes as you’re recovering, like one of the things that we look for when we’re treating is we want to see those symptoms move north of the knee. That’s a — that’s a good sign of recovery. And as you do that, you might start to have more back pain. We don’t care so much about that back pain. We care about the symptoms moving out of the leg. So, Jason: right. We’d rather have the — that — the back pain worse. Kathy: Yes. Yes. Jason: Yes. And pretty commonly — so that — that’s a process called centralization.

[36:18] And pretty commonly we actually see that where the back pain does become worse Kathy: as kind of all that stuff starts to change and you have inflammation there. And the symptoms down the leg just tend to be really distracting. Jason: Your brain can only process so much Kathy: and it tends to prioritize those leg symptoms. So yeah. Jason: Yeah. Kathy: So yeah, I think that that’s Jason: yeah, counterintuitive, but you do want the back to hurt more. Kathy: You want that pain out of the leg Jason: and like, yay, your back hurts. Kathy: Mm-hmm.

[36:48] Jason: What? Kathy: Yes. Jason: Why are you cheering for that? Kathy: What kind of place is this? Jason: You’re trying to make me hurt. Kathy: I’m just trying to make you hurt somewhere different. It’s fine. It’s fine. Jason: Yeah. All right. I think we’re up to the myth-busting segment. Kathy: Let’s bust some myths. Jason: Let’s do it. Kathy: Who are you going to call? Jason: Mythbusters. That’s — that’s a different show. Kathy: PTCH Podcast. Jason: Yeah. PTCH Podcast. Kathy: All right. Throw some at me. Let’s see what we can do. Jason: MRI shows a herniation, so I definitely

[37:18] need surgery. Jason: Okay. Yeah. So, that is a myth. Most disc herniations don’t require surgery. Kathy: Yeah. Jason: And that’s great news. And that’s the number one thing that people are worried about whenever you talk to them about a herniation — “Great. Now we’re going to have to cut me open.” Kathy: In fact, that used to be the approach. Like, ’80s, ’90s, they were like handing out back surgeries like they were candy. Jason: And there were a lot of them that failed. In fact, there is a diagnosis code that is specifically Kathy: failed back surgery syndrome.

[37:49] Jason: Wow. I haven’t seen that. I need to start using that. Kathy: Yeah. So it’s a real diagnosis code, and it’s because it was so common to have failures in back surgeries. And so now they’re a lot more picky about who they do back surgery on. It actually works out that about 80% of disc herniations can be conservatively managed. Jason: Which means they go to see you, they go to see me. They’re exercising, they’re making some changes in

[38:20] kind of their lifestyle and everything, and the symptoms resolve. That’s not how it works for everybody. There’s a percentage of them where it’s like the surgery is going to end up being the best thing for them. Kathy: Yeah. And the good news is that when that’s the case, those surgeries tend to be really pretty successful. Jason: Yeah. Kathy: And surgery has actually come a long way. Now — disclaimer — I’m not an expert on back surgery, but from what I know, it’s a lot less risky than it used to be. A lot of them are outpatient

[38:51] procedures now, where it used to be like you’re going to spend a week in the hospital and you’re going to work with our in-house physical therapy and stuff. But now you can go get a back surgery like a laminectomy, where they just remove the piece of the bone that the disc is pushing the nerve against. They remove that piece, Jason: and a lot of people get instant resolution of the numbness and tingling. They get the motor stuff back, and they are out that same day. And then it’s just like we’re doing wound care, we’re taking care of the incision and

[39:21] everything like that. They used to have to like cut you open — big Frankenstein zipper — but now it’s like pretty small incisions. And so, you know, a lot of surgeons will require first that you go and do conservative care first, and a lot of those resolve. Kathy: Yep. There’s also that some people can do nothing and it just goes away, because these do heal on their own. Just like nosebleeds are not forever, disc herniations tend not to be. Also, Jason: the jelly reabsorbs. Is that — is that

[39:52] how it works? Kathy: It’s delicious. Yeah. Jason: It absorbs back. And I actually think — and this is more philosophical too — if we lived in a different society Kathy: Mhm. Jason: and we were given time and the means to rehab, Kathy: Yeah. Jason: and not rush back to work and rush back to our busy life, I think we could almost eliminate back surgeries — some of them. Kathy: Yeah. You know,

[40:23] because if you give it time, for the most part, a lot of disc herniations will just resolve on their own. But people don’t have a year. I mean, I’m not saying it will take a year, but people don’t have a year. They got to get back to work. Kathy: Yeah. Jason: They got to pay the bills. Yeah. You know, and so if we lived in a society where you could just go to a rehab place for a year Kathy: and still pay the bills. Jason: Yes. Right. Well, and I’ll say this and it’ll sound weird because I’m a chiropractor, but back pain in America is cultural. It

[40:55] is. Kathy: There is a cultural element to it. Jason: And that’s really weird. Other countries don’t have the same back problems that we do, right? And so there’s something about our culture — and there’s some disagreement on what specifically it is — that makes it so that we have a lot of these types of problems, and some other countries they don’t. And you know, I don’t 100% know what those reasons are. But one thing that I do want to bring up — because in this myth you brought up MRIs — is a lot of times

[41:25] people come in and they’re like, “I think I have a disc herniation. I demand an MRI.” And most of the time we don’t need an MRI. Kathy: Right. Jason: And one of the reasons we don’t want an MRI is because an MRI can actually make it worse instead of better, which seems like a really weird thing to say, but it’s true. Kathy: Mhm. Jason: And the reason is because there’s this really great study they did in 1994. They took — I think it was like 98 people who did not have back pain. Nobody had back pain. They did MRIs on all 98.

[41:55] What they discovered was that there was a pretty high percentage of people that had disc bulges. They even had disc herniations. There was even — I think 1% of them had disc extrusions, where the material is out floating around — and they didn’t have symptoms. Kathy: Yeah. No pain. And so when you think about that, if there are perfectly healthy, no back pain, no leg symptom people walking around out there and they have disc bulges and disc herniations, it tells you that these things aren’t always the cause of back pain. Now, that’s not to say that they don’t cause back pain, because there’s

[42:25] also been studies done where they find people that have back pain symptoms and there is a pretty high correlation of — you have a disc bulge or disc herniation and you have back pain. So those things correlate pretty well. But the flip side of that is that it’s possible to have that problem and not have any symptoms. So the reason the MRI could be harmful is if we do the MRI and we see a disc bulge, what are we going to think? Kathy: Pain. Jason: Yeah, I’ve got pain. Kathy: That’s a pain. Jason: This pain is caused by that disc bulge.

[42:56] Kathy: That’s right. Jason: Which may or may not be the case, right? Because if we would have seen you two weeks earlier and you didn’t have any problems, you could have still had the disc Kathy: bulge. So the other thing too is, once you discover “I have a disc bulge” and you have this pain, that becomes disabling Jason: because now you are somebody who has a bad back. Kathy: Yes. Jason: Which isn’t really a thing, right? So there’s back problems, but there’s no bad backs. Like, there’s no back that’s out there smoking weed. Kathy: Right. Jason: Yeah. And like

[43:26] Jason: There’s no good backs, there’s no bad backs. Kathy: Yes. Exactly. So it’s like it’s not out there like stealing change from mom’s purse or anything like that. So yeah, that’s why we don’t rush to an MRI. Some doctors do. They’re going to rush right out, do an MRI, and it’s because they haven’t seen the evidence, and that’s the reason. But if you manage a lot of these, you’re not in a hurry to get an MRI. You can do enough clinically that you have a good suspicion this is what it is, you know that you can safely start a rehab program, a treatment

[43:56] program, and that you can see this get better. When you want an MRI is when you’re seeing those more serious symptoms — maybe cauda equina — somebody is not improving, they’re losing motor function, then we want to get to the MRI, right? Kathy: But if it’s numbness and tingling and we can find some ways that reduce that, Jason: right? Kathy: No big deal. Jason: It’s going to get better. Kathy: Yeah. You also can’t see a disc on an X-ray. So if you ever do have a doctor that’s like, “Oh, look, I can see you’ve got a disc injury here” — Jason: no. Kathy: Second opinion time. Yeah.

[44:26] Jason: Run if you can — Kathy: find the door. Yeah. Exactly. Will yourself — Jason: if you don’t have foot drop. Kathy: Yeah. And it’s not because those are bad doctors. It’s because those are people that don’t manage a lot of those and they’re just not aware that they can’t see it. So I don’t want to cast aspersions on your primary care doctor or anything like that. It’s just they don’t have a ton of training in it. Just like I don’t have a ton of training in, you know, amoxicillin — right, don’t ask me amoxicillin questions.

[44:56] Kathy: Don’t amoxicillin me. Jason: Yeah, it’s just not my specialty. But I see it all the time — people are like, “Oh yeah, my doctor did an X-ray and we saw my discs are bad.” No. Kathy: You didn’t. Jason: Right. Oh jeez. Kathy: Can you tell me what that is? Wait, we got to keep this to like three minutes. Jason: Yeah. Goodness. Yeah. All right, this is getting to be a really long episode. I’m just dumping all my knowledge about this. So degenerative disc disease — over time you get some changes in these discs. If you live long enough, those discs dry out. They aren’t as pliable. They don’t move as much. Kathy: It’s why people who are 70, 80, 90, they don’t get disc herniations because,

[45:27] well, the jelly is gone. Jason: Dried up. Kathy: It’s dried up. So, yeah. Degenerative disc disease — that’s another disabling term. Jason: Oh my gosh. Kathy: Right. And so — Jason: so harmful. Kathy: I like the term “disc changes” because it’s literal. They change over time. But like “degenerate” — I have people who come in, they even get it wrong. They’re like, “Yeah, my spine’s deteriorating. It’s crumbling.” Jason: And they just feel like they’re never going to get better. So — Kathy: yeah. Jason: Goodness gracious. Oh gosh, this is

[45:58] getting to be a long episode. Kathy: Yeah, we’ll have to do part two. Jason: Yeah, we might have to do part two. Don’t tempt me. Don’t tempt me. So, geez, what should we get to? Should we just talk a little bit about treatment strategies? Because I’m curious — when you see people with disc herniations, what are you doing for them? Kathy: First of all, I’m talking them off the ledge. Jason: Okay. Yes. Kathy: Giving them some education. Jason: We’re on the same page. So important — Kathy: because they need to be validated. Jason: Right. Their pain needs to be validated because it is significant, right? Kathy: But they also need to know it’s not

[46:28] life-threatening. Jason: Right. Kathy: Even though it feels life-threatening. Jason: And then also I try to reassure them it will get better. This is not permanent. Kathy: Yes. So that’s the most important thing I do — just kind of be a resource for knowledge, right? I find that most of the time if I put people on their stomach, they will feel better, and they’re like, “That’s the most relief I’ve had in a week.” Jason: Mm-hmm. Kathy: And so part of that is the mechanical part of pushing the NP

[46:59] Jason: yes — Kathy: back away from the nerve. Jason: Right. So what is it about lying on the stomach? What does that create that makes me feel better? Kathy: Lumbar extension. Is this a quiz? Jason: Yeah. And you pass beautifully. Yeah. That lumbar extension is key. Kathy: Yes. Jason: And so, like, we had the yoga ladies on before, and so that’s like a cobra pose, right? Kathy: Cobra pose, or we call it a press up, which tends to be really successful. Jason: Yeah. Yeah. Yeah. Kathy: And then I think another way to do that is just having people put their

[47:30] hands against the wall and then just dipping their pelvis in towards the wall — the same kind of thing, but you could do it at work. Jason: You don’t have to lay down. Kathy: Yeah. Make sure nobody’s looking at you, cuz they’ll be like, “What are you doing to that wall?” Jason: The wall. Kathy: Okay. Yeah. So, like, we do something called flexion distraction at the clinic, where it’s just passive mobilization of the lower back, and it really kind of helps

[48:00] create some movement in that Kathy: whole complex. Adjustments don’t cure disc herniations, but they can certainly be helpful, because one of the things that happens when you get a situation like that is your brain starts shutting down segments of the spine, and so then you just develop stiffness and more problems. And so an adjustment, if it’s done judiciously in the correct way, it can help to kind of train your

[48:31] brain into what resources are available, and it can kind of enhance your ability to rehab. And there’s like nerve flossing — you want to develop a stronger core and everything like that. Kathy: Right. Jason: Yeah. But I think you’re right. I think you nailed it — the first piece of it, a lot of it is just teaching people this is just another thing. It’s like stubbing your toe. You’re going to get better. Kathy: It’s super painful, so people are kind of panicked when they come in. You know, they’ve been laying in bed. Jason: Oh, don’t do that.

[49:01] Jason: Right. And that’s not what we want you to do. Kathy: Yeah. Bed rest is one of the worst things you can do for a disc herniation. Jason: You have to begin safely moving, becoming appropriately active. Kathy: Avoid sitting. Jason: Yes. Avoid sitting. Kathy: Yeah, car drives no fun. Jason: So, I think I’ve overstayed my welcome whenever it comes to this topic, but Kathy: so much more to talk about.

[49:31] Kathy: I do want to play a game. Do we have time for a game? Jason: Yeah. Kathy: Okay. I think you’re going to like this one. Let’s see. What did I call this before? Who herniated it? Yeah. Jason: Okay. Kathy: So, here’s what we’re going to do. I have a list of celebrities who have developed, you know, this injury, this particular injury, and I’m just gonna — this is an easy game. I’m going to read you a description of the person, right? And maybe how they did it, and you just see if you can name them. Jason: Pretty simple game, right?

[50:02] Not my most creative game, but a game nonetheless. Okay. Ready? Jason: Yeah. Kathy: Okay. This person herniated a disc during stunts for Mission Impossible 2. Jason: Tom Cruise. I don’t even — before you said his — the Mission Impossible. Why did I think it was him? Because he does wacky stuff. Kathy: Crazy stuff. Jason: Yeah. Kathy: Like, I got an idea. Jason: I believe that. Kathy: Duct tape me to the side of this plane. Jason: All right. This one kind of alludes to what I talked about earlier, but this

[50:32] person — whoa. Let me see. I gotta back up. Wait. Where’d it go? Okay, here we go. Sorry, scrolling the wrong direction. Kathy: If you’re watching, Jason is scrolling. Jason: Yeah, this person had multiple disc herniations contributing to NBA retirement, and later became a DJ, a sheriff, and a PhD. Kathy: Oh my gosh. With an honorary PhD. It’s got

[51:04] to be Shaq. Jason: That is Shaq, right? Shaq Diesel, Shaquille O’Neal. Kathy: Right. Jason: All right. Let’s see. How about this person? Wait a minute. It’s like jumping back and forth between lists. Okay. How about this — this singer had to delay a tour and a Vegas show because of multiple disc herniations in her back. Kathy: Canadian. Jason: Oh, it was Céline Dion.

[51:34] Kathy: Céline Dion. Yes. And she had stiff person syndrome. Jason: Yeah. She’s got a little bit of everything. Yeah, that lady works through some pain. Kathy: Yeah. Jason: What about this? This actor herniated a disc after falling from a horse on the set of The Lone Ranger. Kathy: I don’t know the guy’s name. Jason: I’ll give you a clue. His ex-wife did not beat him and give him a herniated disc. Kathy: A Lone Ranger. Jason: Yeah. Uh-huh. Kathy: He played Tonto. I don’t

[52:05] know. Jason: Johnny Depp. Kathy: Oh, what? Jason: Yeah. Yeah, Johnny Depp. Bad back injury. Kathy: Is that the reincarnation of the Lone Ranger? Jason: It was not a very successful movie. Kathy: Okay. I watched — I thought you were talking about — Jason: It was not a great show. And I don’t know if they do it anymore because somebody with cultural appropriation, right? So Kathy: Oh, they did do a movie. Jason: Yeah. Him and Armie Hammer, which is such a great celebrity name, right? Kathy: Yes, it is. Okay. And now I remember. Yeah. Jason: Okay. How about this? This tennis legend — a herniated disc forced him into

[52:37] retirement. Kathy: Andre Agassi. Jason: Andre Agassi. Very good. Kathy: That was a guess. Jason: All right, one more. US president with chronic back pain and disc problems — even wore a back brace. Kathy: Ronald Reagan. Jason: No, no, not even close. Kathy: He was assassinated. Jason: Oh, JFK. Kathy: Abraham Lincoln. No, I’m just kidding. It was JFK. Jason: Okay, good. We could go on and on about back braces, too. But Kathy: that’s another episode. Jason: Yeah, I’m sure it’s past everybody’s bedtime.

[53:09] Kathy: So, we should probably land this plane. Jason: All right. Kathy, takeaways. Kathy: Takeaways. Takeaways. Disc herniations are not life-threatening. Jason: No. Kathy: And most will heal. Jason: Yes, they absolutely do. Yes. Kathy: Most will not need surgery. Jason: Right. And jeez, what do I take away from this? Because I feel like I was just kind of word-vomiting about disc

[53:40] herniations, but I think what I would do is just encourage people that if you have a disc herniation, it’s just another injury. You don’t have a bad back. You’re going to be okay. And you can have a happy life after a disc herniation. Even with a disc herniation, you don’t even have to wait till — Kathy: absolutely. So, Jason: great. Well, I think we did it. Kathy: We did it. Jason: Did it. So, great time to remind people

[54:10] that this is a podcast worth subscribing to. Kathy: It is. Jason: Yes. If we didn’t prove it today, Kathy: we’ll prove it next time. Subscribe, Jason: and that way you’ll know, right, that it’s our next chance. We want you to like this podcast. We want you to share it with people. Kathy: Download it. Jason: Share it — there’s probably somebody that you know that needs to hear what we said, and so share this with them. Print out the transcript Kathy: and send it to them. FedEx. Jason: Yeah.

[54:41] Kathy: Not in a heavy package though. We don’t want to — Jason: Right. Yeah. Put it on the envelope. Right. Bend down, pick this up and twist while you do it — and it would just be full of our business cards. No, Kathy: no, I think that maybe they should just subscribe to us on Spotify, Apple Podcasts, or YouTube. And there’s one more very important thing. Jason: There’s no I in PTCH.