The Healthy Post Natal Body Podcast
The Healthy Post Natal Body Podcast
Again; Post-partum back pain and how to fix it. Interview with Physical Therapist David Jeter
After receiving a tonne, well 6, of emails about postpartum backpain over the past few weeks I am bringing you a chat I had with David Jeter who is an awesome physical therapist. We're talking post-partum back-pain and the benefits of physical therapy and exercise generally.
We discuss many, many things including;
What is post-partum back pain and what causes it?
Is surgery THE solution?
Why is post-partum backpain soo often ignored by both the medical community and those suffering from it?
Why are people not aware just how effective physical therapy is to deal with back-pain?
How the PT community is doing a terrible job of promoting the benefits of exercise and is spending too much time selling cheap-tricks.
And how you can help yourself if you're suffering from any sort of muscle related pain.
In the news this week, this article from the American Association for Cancer Research which demonstrates nicely how certain myths don't die out.
I hear the following phrase a lot in my daily life "A glass of red wine a day is good for you" and it's just not true,
ALL types of alcohol raise the risk of certain cancers, which is something to be aware of.
HOWEVER...That doesn't mean drinking gives you cancer..stuff like this isn't black and white.
As always; HPNB still only has 5 billing cycles.
So this means that you not only get 3 months FREE access, no obligation!
BUT, if you decide you want to do the rest of the program, after only 5 months of paying $10/£8 a month you now get FREE LIFE TIME ACCESS! That's $50 max spend, in case you were wondering.
Though I'm not terribly active on Instagram and Facebook you can follow us there. I am however active on Threads so find me there!
And, of course, you can always find us on our YouTube channel if you like your podcast in video form :)
Visit healthypostnatalbody.com and get 3 months completely FREE access. No sales, no commitment, no BS.
Email peter@healthypostnatalbody.com if you have any questions, comments or want to suggest a guest/topic
Hey, welcome to the Healthy Postnatal Body Podcast with your postnatal expert, peter Lap. That, as always, will be me. This is a podcast for the 1st of September 2024. You know, day before music means I have a guest on right. I'm bringing you a lot of emails about postpartum back pain and all that sort of stuff and I know you're fed up listening to just me talking.
Peter:I did a wonderful interview with physical therapist David Jeter a long, long, long, long time ago physical therapist david jeter a long, long, long, long time ago and we addressed everything and I love david right. We discussed what postpartum back pain actually is, what causes it, whether you need surgery, um, why is it so often ignored by basically everybody, and why people aren't as aware of just how effective physical therapy really is when it comes to dealing with back pain and all that type of fun stuff. David wasn't even selling anything. This is how much I love David. He came on. He's just an educator and I love this dude.
Peter:So, without further ado, here we go. So we're talking postpartum back pain. You know, let's start with what you class. First of all, start this what you class as postpartum back pain, because a lot of the doctors in the uk tend to tend to only call it that if the woman is recently postpartum, and I personally class it as anything that is caused by having been pregnant or having given birth well, I guess I want to answer that question by by starting with probably half of the people that I see in my clinic have low back pain and, and I would probably say, 70% of those patients are women.
David Jeter:And of those of those women, I can't tell you how many times I've had a woman say, when I, when I asked him, okay, well, tell me about this back pain, when did it all start?
David Jeter:And they say well, my youngest son is seven, so about seven and a half years that's how long I've had this back pain, you know, um, so I it just it boggles my mind that women typically get some sort of low back pain during pregnancy and then it just never, ever gets resolved. Postpartum and uh, and granted, obviously there there are plenty of women who get low back pain postpartum as well, which, again, just like you're saying, is anytime after uh, the baby is, uh, no longer inside, uh, then I, I I kind of I kind of term it all, I kind of lump it all into the same category. But certainly pregnancy has a massive impact on the lumbopelvic hip region and clearly we are failing women in general about how we are addressing that.
Peter:Oh, yeah, for sure. Sure, now I'm completely with you. I basically class any period uh, as in. The baby isn't in you anymore. That's postpartum, or caused by because and I obviously come across the the same thing that that you are as in my back hurts, um, oh, that's just the price I have to pay for having a kid. It's quite often or it's because I'm lifting an awful lot more now that I'm shifting baby about an awful lot and toddlers and you know kids grow.
Peter:You keep feeding the things, they, they keep growing and they keep getting heavier but they still want to be picked up and all that sort of stuff. Yes, why do you think I have my own theory on this? Why do you think that solution because there is a solution to postpartum back pain, to most back pain right? Why? Why do you think that solution isn't being presented to women, or women are not getting that um, when they clearly should? No one should walk around with seven years with a back pain, right, right, uh well, first of all, um, that's it.
David Jeter:There's a, there's a, there's a lot of, there's a lot of questions in that question. Uh, first of all, let's take some responsibility as physical therapists, because we are me, you know, I don't know what your background is, but we have not physical therapy. We can solve your back pain, and so that's a failure of our profession to demonstrate that what we do has validity. And so in the medical community, if we don't have that validity, then doctors are not necessarily keen on prescribing something that doesn't have a tremendous amount of validity. Now we have anecdotal evidence and we all believe that our techniques are superior to other techniques and we feel like we can move the needle on a whole host of things. But when it comes down to brass tacks, if you can't show a double blind study that demonstrates that this type of either manual therapy or exercise therapy or biopsychosocial or whatever you're doing has a positive effect, then I think the medical community as a whole has a challenge accepting it as something that should be prescribed to everyone. So that's number one, that's our responsibility, that we have failed so hard on producing research that actually demonstrates what we do works. Clearly. Again, as a physical therapist, I believe it works, because this is what I do all day, every day, and I see change happen in a lot of different people.
David Jeter:So I think the challenges in terms of a research standpoint, though, are how do you get a cohort of people that have a similar problem, such that you can perform a certain treatment to that person, that group of people that will demonstrate an effect that you can demonstrate that a control group doesn't have that effect with.
David Jeter:If you don't do that thing too, I think that is incredibly challenging. I mean, even if you take postpartum women, who are probably of a relatively narrow age range, they have all had this event happen, where there is some amount of trauma to the lumbopelic hip region. You don't do the same things to every person who walks in the door. It has to be individualized. You're doing different stretches based on their movement dysfunction. You're doing different exercises based on their exercise or their weakness or their inability to control movement. So I think I don't know. I don't know how to square that circle, in the sense that I don't know how to produce research that demonstrates that what we do actually works, but I think that's a massive piece of why the medical community as a whole hasn't embraced a routine physical therapy course postpartum, as just this is how it goes as just this is how it goes.
Peter:Yeah, no, that's an interesting point, because I did an episode a while ago where I was asked about some studies into diastasis recti and all that sort of stuff and the only studies that have been done into it, which is kind of more my specialty rather than back pain, although everything links together, right, I mean, everything is connected and therefore, by definition, one problem leads to another problem, um, which we'll get to in a little bit, but it's it's like I said, I was doing some um, I was reading some studies, as I am prone to do, and all the studies into diastasis recta are the studies that show what doesn't work, as in, crunches do not work.
Peter:Uh, okay, yeah, yeah, cool, every every physical therapist experience with diastasis recti knows that this is the case. But but that is essentially the only study you can do, as in does this particular exercise work? No, it doesn't, okay, that's out there then. The problem is then, of course, that those studies get out there and, before you know it, the only studies that are out there into something like back pain or diastasis recti is stuff that doesn't work, which very quickly translates into the media and into, therefore, lay people and Facebook support groups and all that sort of stuff.
David Jeter:Exercise doesn't work people and Facebook support groups and all that sort of stuff. Exercise doesn't work. Yeah, I think the most classic of what you're talking about is that Canadian study that demonstrated that chiropractic physical therapy and a walking program are all exactly the same effectiveness for low back pain treatment.
David Jeter:And so you know, the Canadian government, being the Canadian government, just said forget it, we're not paying for we're not paying for any of that treatment anymore, If it's no, if it's no different than just go walk. Well, what they found was is that their LNI claims doubled in terms of costs, in terms of time off, in terms of medications, in terms of surgery, in terms of all of the all of the other aspects of of LNI, and within a year, they reinstated doing physical therapy with LNI folks for back pain, because they said we don't know what you guys do, but clearly, if you don't do it, it costs us twice as much. So to me, that natural study was probably one of the best studies to date about why physical therapy actually is effective.
Peter:Yeah, and that is exactly the approach that I tend to take Because, like you said, every postpartum person, every individual overall, is completely an individual. So when you look at what they do in France, in France, postpartum people get six standard appointments, six free appointments with a physical therapist or a physio. Boom, because they know that you need this postpartum. You're going to have some issues. They need to be resolved.
Peter:What your issues are are your issues, and only a physical therapist can tell you what they are and how to resolve these, but we know that it ends up costing us more when we don't do it, in the same way that I have a corporate client that is very big that now tells all their employees that complain about back pain yeah, you need to go see Pete first. You need to go see Peter first and get some exercise in before we spend 1000 pounds on a new chair and two grand on a new desk, and then the ergonomics expert comes in with another 1500 pounds and we have five grand in the whole, whereas Pete charges 150 bucks in total. And that's it.
David Jeter:Yeah, yeah yeah, I think in that, in that same realm you know, we see a lot of people pre-surgically for knees and shoulders and all sorts of things, and the number of times that we get the person moving better and they feel better and then all of a sudden they don't do surgery. It's not as if anybody is counting that up and saying, hey, dave, thanks so much for saving the insurance company 10 grand on this surgical intervention. That didn't happen because you did. You know six to eight visits of uh physical therapy. So you know. Again to your point about um having physical therapy immediately, not immediately after, but but when it's appropriate, uh after, uh after, uh after the baby's uh born. You say someone walks into my office and they they look at me and they say I don't know why I'm here, I feel great, I'm walking, I'm back to doing the things I want to do, I don't have any pain. All of those things I'm going to say get out of my office.
Peter:You're fine.
David Jeter:Great, that's fantastic, you know go do the things that you want to do and enjoy your life, and if you ever need me, I'm here for you. I'm not going to do six visits on somebody who doesn't need therapy disadvantageous to the whole system, as making sure that the person who actually does really need some specific intervention gets that intervention.
David Jeter:And I guess the thing that's frustrating to me is the insurance companies know that physical therapy saves the money right, they know that they know every dollar that they spend on physical therapy is $1.50, that they're not spending elsewhere in that community of healthcare professionals, and yet they're still pushing back on visits and whatnot. Now, granted, I don't think somebody should have 60 visits of physical therapy for low back pain.
David Jeter:That's clearly not how it should work for the most part. Or low back pain that's clearly that's not how it should work for the most part. But someone doing 12 visits, someone doing 18 visits of physical therapy, is incredibly cost effective versus the injections, the discectomies, the fusions, all of the other stuff that's going on these days.
Peter:Oh, no, absolutely, and especially because the cost of healthcare even in the UK, where we obviously have the National Health Service the actual cost of it is skyrocketing. It's going up all the time, Whereas the cost of physiotherapy and physical therapy is relatively stable.
Speaker 3:I mean, I don't know about you, but OK, inflation is 10%.
David Jeter:It's terribly stable.
Peter:Yeah, I haven't been able to jack my prices up by 10% this year just because I felt like it, so let's go back. Women come in to you and they say it's been seven years since I gave birth. What tends to be your starting point with your assessment when someone comes in, with regards to the physical side of it?
David Jeter:Yeah, yeah, yeah, uh, what with regards to? With regards to the physical side of it? Yeah, yeah, yeah, um, you know, obviously I'm I'm a manual therapist, you know, by training. That's my um, that's my background. So I'm always into what does movement look like? What you know, are all of the joints doing what they're supposed to do? Uh, are they able to stabilize through their normal range of motion? That is my go-to. So I'm always looking at what can the person do in terms of range of motion? What are the hips doing? What is the pelvis doing? What is the lumbar spine doing? What is the thoracic spine doing? What is the nervous system doing? All of those different aspects of movement are critical. And again, typically what you're finding in someone who has low back pain, postpartum or not, is they have a whole host of different regions that aren't doing their job.
David Jeter:And those regions may not be painful at all, but they may be creating a bunch of stress on the regions that are moving or moving abnormally, and so our focus is normalizing movement of joints throughout the whole system. Again, hips, pelvis, lumbar spine, thoracic spine, even down I move some, some ankles, sometimes I move some upper thoracic spines, sometimes some ankles, sometimes I move some operators thoracic spines, sometimes, um, and then once things are moving and mobility is restored, what you're finding is a lot less pain and when, when pain starts to go away, then we start to really start loading that system in all three planes of motion, loading that system and creating, uh, creating stress in a way where, where they can, that graded exposure of of doing more and more and more, such that the person can tolerate more load than their average daily activities and they can progress on to their own home exercise program or home or daily exercise program on their own yeah, because this is something that I used to talk with my clients a lot about.
Peter:Quite a lot. This for me, well Spartan backbender, any sort of back pain even though I see this in my corporate clients as well, it is very rarely a lower back problem, isn't it? I mean, it's always, almost inevitably, caused by something else not doing what it's supposed to be doing, and the lower back taking the strain of that I mean, I would I would say the the vast majority of people with low back pain have irritation at the, the l45 segment.
David Jeter:I mean, that's, that's just like the most common, the most common thing. And if you think about what the L4-5 segment does, it does bending forward, it does bending backward, it goes to the side some amount, but it doesn't really do rotation. And so if you think about what the hips and pelvis do, they do a bunch of rotation. And if you think about what the mid back, the thoracic spine, does, it does a bunch of rotation. And so if those two regions are not performing rotation, then the brain doesn't care, it just wants to walk or it wants to bend and lift or twist or do all the other things, and it's going to take that rotational motion from wherever it gets and put a rotational stress through L four or five. So it's not unusual at all To have it. I would say not only is it not unusual, it is incredibly common.
David Jeter:It is probably the reason why people have the vast majority of low back pain is because their hips and pelvis aren't doing what they're supposed to do and creating that rotational stress into the lower lumbar spine, which is why, again. We see a ton of low back pain in postpartum women because the pelvis and SI joints and the hips are tremendously affected by pregnancy and I mean, that's just a, that's just an absolute no brainer with with the hormonal changes and and the increase in in movement of the whole pelvis, things tend to not move properly. I know that sounds weird, that the hormones creating more movement make things not move properly, but it does. And if you don't resolve that movement problem, then you have all of these different muscle strength and dynamic control problems. And I think I'm not, as you can tell, I haven't talked at all about pelvic floor.
David Jeter:I haven't talked at all about incontinence, because that's not my thing at all, like I don't do, I don't do what we would call women's health or or or pelvic health. In my, in my practice, if someone is, someone has those kinds of issues, I definitely send them out and I don't pretend to do that at all. But I think that so often women are just trying to do Kegels or they're just trying to do transversus abdominis or they're just trying to do a bunch of exercises to get muscles in that region working, but they haven't resolved the movement problem first, getting the pelvis moving properly, getting the lumbar spine moving properly, getting the thoracic spine moving properly, such that all of these muscles that attach to all these different places can have an attachment that is doing what it's supposed to do. I think there's some inhibition of muscular contraction when you have restriction. I think part of that weakness is actually a restriction problem.
Peter:Yeah, and this is why I always talk about a holistic approach being required. And by holistic I don't mean hugging a tree, I mean looking at the body as a complete unit, rather than indeed just going to get your over. In the uk we call it a, a, um, a mummy, mot, um. You just get basically postcard, you. You get a checkup, someone has a look at your pelvic floor and does an internal exam, if you're that way inclined, and all that sort of stuff. And then you have on the other side of the spectrum, you have the standard indeed engage your TVA. Right. Everybody and I literally just did something about that the other week If you're only looking at engaging your transverse abdominus, then you're missing out a whole section of things that your body is supposed to be able to do.
Peter:And let's be honest, I had, I had someone on jessica marie rose legio and I refer to her a lot. She's a running postpartum running coach and she says, yeah, the tva and activation is one of the least interesting bits about postpartum health. I don't know why everybody focuses on it, other than it's easy, right as in. I can just say focus on this one muscle group. And there you go. I'll focus on this one muscle group and that's simple.
Peter:Right, looking at everything is much more complex and this is why it's so useful to work with somebody who, other than the health, uh, other than the pelvic floor sort of stuff, like you said, I I outsource that as well. I'm a 48-year-old white guy. I'm not going to poke and prod around pelvic floors. Nobody wants to show me their pelvic floor postpartum and I'm more than okay with that. But other than that, this is why it really helps to get in touch with someone who knows what they're talking about, because they can take a holistic approach and they can say to you like, yeah, okay, your tva is important, but so is your soul acid and so is your upper back and you're supposed to be able to do rotational, anti-rotational stuff and make sure your hips move and and all that sort of stuff well and not to not to just totally dive into a different subject.
David Jeter:But you know, as you know, as a manual therapist, I want everything to be about mechanics, right, I want it to be about, hey, this joint isn't moving, and if I can just get this joint moving and, uh, give you some strength coming exercises, then everything's just going to be hunky dory. But it turns out that the brain's attached to the body and the body's attached to the brain and I think I'm I'm finally this the spectrum of mechanical to biopsychosocial in understanding about how people are feeling about their pain. It has a tremendous impact on that pain experience. People are feeling about the the rest of their uh life and health issues. Tremendous back pain yeah, that's interesting freeze up.
Peter:Yeah, you froze up there a little bit yeah, you just froze up a little bit, but I I actually your audio was fine, just your, uh, okay your, your, okay, yeah, yeah that's fine and it's just marked it mentally in my head.
Peter:It's roughly the 26 minute mark that I have some tiny bit of tidying up to do, but that's all that's fine. It's interesting. One of my clients plays golf and, as in, is a golfer. And, uh, it's interesting because they are really big on that mind muscle connection, because they have what they call the golf thought. As in, as you swing, you can think about one thing you can't, think about two or three things you can't. But every individual golfer has a different golf thought. They have a different cue.
Peter:So, exactly like what you said, if I say to someone, uh, activate your glutes, and I say that same thing to someone else, they might engage their glutes in a completely different way because they have no idea what I'm talking about. They're just interpreting what I'm talking about. Um, and for golfers it's, it's the same thing. You have to really individualize that approach and that mind muscle connection is remarkably powerful because so when you say to someone, we want to get that rotational movement in, you almost have to demonstrate to them how it should work for them, if that makes any sense and again, I would even go further and say you know, pain, pain is not damage.
David Jeter:And and I think that there are so many people that come in um having seen their primary care physician or having seen a whole host of other people and they've had different scans and x-rays I've got degenerative disc disease and I've got this, I've got this disc bulge and I've got all of these different things going on on on imaging and they, they are very fearful of movement and they're very fearful that if I do the wrong, my back is just going to be demolished somehow or I'm going to break, and they feel very fragile and I think there's a vulnerability that has to do with postpartum women that is important to respect as well. And just say you've gone through this pretty traumatic event, both carrying the baby and having the baby, regardless of how, how baby came out Now.
David Jeter:Now it feels like your body is a little bit broken, right, and we're in we're, but at the same time it's not broken but at the same time it's not broken, it's going to be okay if we can get you moving and we can get you strong on that tissue that is irritable or the thing that they can find on the scan, or the thing that shows up as this is the source of the pain and and uh and again looking at that movement dysfunction, but also just just recognizing that if you believe that your back is fragile and you're unwilling to move because of that, that is is a massive inhibition to your success. You know, we've got to kind of untrain that, untrain that mindset and get the person to feel good about movement.
Peter:And then it becomes a neuroplasticity exercise.
David Jeter:You know it becomes an exercise about how do we get this person. They come in and they feel incredibly fearful about moving in certain ways and, granted, I can mobilize different things to get it actually moving, but if you don't believe that it can move, you're not going to move in that way.
David Jeter:And so I've got to give you some exercises that teach the brain that says, hey, this is not a dangerous movement anymore, we can do this and we can tolerate this. And then having that great again, that graded exposure of feeling that movement and recognizing that movement is safe and recognizing that we can do a little bit more, and then taking that and encouraging a person to say, hey, you can do this now, and having them recognize it and feel their body move, it's so crazy to me. It's amazing to me how people can't feel their body move. You know, when you ask them, hey, I want you to bend forward, I want you to bend from side to side, when you say, okay, I want you to bend from side to side, and you see one side that is dramatically worse in terms of movement and you say, can you feel that? Can you feel that you don't move to the right?
David Jeter:And they say, nope, I can't feel that I have no idea, I can't tell at all it just hurts and you say, okay, well, I want you to let's get rid of pain for a second, just for one second. I want you to get rid of pain for a second, just for one second. I want you to get rid of that. I want you to just feel your body move. I want you to feel whether you can move equally to both sides, and then hopefully they can kind of understand that. But I have lots and lots of people who are so focused just on that painful tissue that they can't get into this idea that normalizing movement, normalizing strength, is an incredibly important piece of how they're going to get better.
Peter:Oh no, absolutely I think we've, and again, the healthcare profession is a lot to blame for that, and I think it's changing. Now. One of my clients is going in for a hernia operation next week, and not keyhole. So there's a lot of work to be done there, so to speak, and the interesting thing is now that for hernia recovery they advise people to move, whereas they used to say now you're not going to do anything for the next six weeks, you're just going to lie on a bed, or two weeks, or whatever it is, it's going to lie in your bed, you're going to lie on the couch and you're not going to move.
Peter:You can't lift anything you can, you can't do anything, whereas now they're saying, oh no, after two days I expect you to start walking and the week after I expect you to go back to your PT, because the surgeons here are pretty good and they consult and they get in touch with me just to make sure I kind of know what I'm talking about. I'm not allowed to drive, but that has nothing to do with the inability to drive. It's to do with the inability to take an airbag to the chest without stuff opening up should you get in an accident. Um, but for a long time we have been especially post-Spartan women have been told two things Everything's going to be rainbows and unicorns, everything's amazing, because you're going to have a new baby which is nonsense, and after that, everything is going to bounce back by itself.
David Jeter:Right.
Peter:As if, you know, happens uh in in the human body, and because the human body is very this is how it's been the human body is very resilient. There are women in vietnam that just poop out the kids in the in the middle of a rice field and they get straight back to work. Uh, that was always the one that we were told in Holland, where I'm from, originally. And then you have the other side of the coin, which is almost just as bad, which is you'll be very fragile postpartum and you can't do anything you can't do anything.
Peter:Yes and I always say movement. When it comes to muscle, muscle pain, muscle imbalance, movement is almost always the solution yeah, yes avoidance is almost always going to make your problem significantly worse yeah and, and it goes.
David Jeter:I mean again I, I, I. I don't want to take this away from postpartum, but it happens all the time you know, my, my father-in-law, strained his ankle, uh, and he went to an urgent care and they just said, okay, I want you in this boot and I don't want you to move it for three weeks and I was was like, oh my God, is it fractured?
David Jeter:Because if it's not fractured, you should be moving it. Just, gentle, move it, Just put just back and forth. Can you stand on it? Can you do a little bit of a weight shift, Can you do? I mean, what can you do with it without it, without it lighting up? And he was so hesitant to do anything because this, this uh, uh, urgent care person had just said okay, don't do anything for three weeks. And I was like that is not right.
Peter:No, that's why people are still saying that.
David Jeter:That's why frozen shoulders and frozen ankles happen yeah exactly.
Peter:Exactly, yeah, so it's, and then the flip side of that, just like you were saying where you know you have.
David Jeter:You have these women who come in, I'm sure, postpartum, for all of their different checkups and they say, oh, I have all this back pain. That'll probably just go away. You know that's normal to have, it's probably just going to go away, Just you know, do you do? I don't know, Maybe put some heat or ice on it and you'll be fine.
Peter:Yeah, I absolutely love the solution heat or ice, as if that is the same solution and as if those two are not different solutions to different things. Right, yeah? But yeah, you're quite right, they go to a GP because that's usually the first visit and, let's be honest, nobody wants to go past a GP anyways. Nobody wants to go past a general practitioner, because then you're in the system and it becomes a whole thing and in the UK you have waiting lists and it's a pain in the ass and all that sort of thing. So your GP says, yeah, yeah, yeah, you gave birth. That's really tough on the body, so, indeed, you're going to have some back pains. Just stop holding your baby for a little while, stop carrying your kid around.
David Jeter:Right, don't worry about the bonding thing that you're supposed to be doing.
Peter:Yes, exactly, just ignore that bit and just take a couple of weeks off, because that's what everybody can do, and movement, in the UK at least, is very rarely prescribed as a solution.
David Jeter:Well, let me speak to that just a little bit, because, you know, in the United States people like to disparage the UK and Canada for their socialized medical systems. Right, you know, we love to disparage uh, the uk and canada for their uh, socialized um medical systems. Right, you know, we, we love that, we love to disparage that um. But I see that as somewhat of a feature in some ways, because you can't get a total knee in two weeks in the uk, am I? Am I right?
David Jeter:on that you know, I, I, I need, I feel like I need a knee. You can't get that in two weeks, but I know a surgeon who can do that to you in my town whenever you'd like it done. And so the feature of that friction is that there is some time and hopefully, hopefully, the person is doing something like physical therapy in that time frame and maybe improving how they're moving and maybe improving their pain and maybe feeling like, oh, maybe I don't need this knee surgery.
Peter:Yeah, no, that's absolutely true. I mean, I tend not to. There are bits to the American healthcare system that I really like and there are bits to the UK healthcare system that I really appreciate. And yeah, the NHS is a mess. Don't get me wrong. I'm Dutch and therefore I'm slightly biased in favor of the Dutch medical care system, which I think is significantly better. We pay more in tax and we pay more per capita than the UK does for the healthcare system, but it's amazing.
David Jeter:And it's probably still half of what we pay. Oh God, yes, it's a lot cheaper.
Peter:It's a lot cheaper than what you guys pay Because, like you said, you have the guy there in your town that says I have a, a solution, I'll just put a new knee in and I'll be fine. And 10 years later you come back, you get another one, because the life expectancy or the the lifespan of a knee if, if, if you get it replaced and you don't do any, any physical therapy and all that sort of stuff around, there's about 10 years. If, however, you do all the exercise around it, you can make that thing last 25 years. There's no need to actually get that thing replaced. Yeah, um, nine out of ten times the. The issue is, of course, we are very much as a society and I'm as guilty of that as anyone, this is, anyone of looking for the easy solution, right, um?
David Jeter:right, oh, absolutely if someone physical therapy is not the physical therapy is not the easy solution, clearly right we're.
David Jeter:We're asking you to come for several weeks, maybe a couple of times a week. We're asking you to do all of these different home exercises and and whatever. Whatever we're going to have you do, um, it is going to be and and, frankly, at the end of it it's almost more like kind of a life change kind of thing, where we're saying, hey, you need to move like this, you need to do exercise like this in some capacity to be healthy. And I think there's lots of people out there that look at that and say, man, I don't really, I'm not really interested in that. What else do you have? You have an injection for me? You have you. You know, can you? Just, why don't you just do a surgery on this shoulder, can't you know? Can't that make it?
Peter:better. Yeah, exactly, and okay, it sounds like that is the easiest, because it feels like a surgery is the easiest solution.
David Jeter:It never is, by the way, for anybody but also but also I guess here's the other thing too, is we also think of things that are expensive are better. Sure, Right. So you know, if you, if you buy a Mercedes, that is clearly going to be better than a Kia. You know, physical therapy is probably the best solution for the vast majority of people with low back pain, because the movement problem is their actual problem. It's not the painful tissue that needs to just calm down right. Everybody just wants that pain to go away, and if they didn't have the pain there, they wouldn't care. They wouldn't care that their hip doesn't internally rotate at all.
David Jeter:They wouldn't care that they're you know that anything doesn't move right or is super weak, or they can't balance, or all of those other different things that we're looking at. They only care about whether or not it hurts or not, and it's a very binary thing, and if it doesn't hurt, then I don't need to do anything, and if it does hurt, then I have to do something. And so you know, with physical therapy, versus a lot of the other, a lot of the other treatments, it's not only are we asking the person to buy in and do their homework and take a active role in making themselves healthy, it's, it's a. It's a. It's a longer, longer process. And because it's less expensive than surgery, then then clearly the surgery is the expensive thing that that could fix this problem, but it's just too expensive yeah, and, and and.
Peter:Exactly like you said, surgery is science and we don't necessarily have that to to back us up in the same, because, know, someone puts a new knee and it's a shiny new knee, I don't care what you say, that's going to function really well. But you still have to.
David Jeter:We're still doing surgeries that we know don't work in the United States, at least Right. They're still seeing a person who's 60 years old with degenerative meniscus in their knee and doing a scope to clean it up in the United States, at least right. They're still seeing a person who's 60 years old with degenerative meniscus in their knee and doing a scope to clean it up in the United States. I imagine that doesn't happen in the UK.
David Jeter:I imagine that orthopedic surgeons are not performing knee scopes for people with OA or degenerative meniscus because we have demonstrated that that surgery does not work.
Peter:No, as far as I know, because we have a panel in the UK called the National Institute for Clinical Excellence, NICE, and they kind of determine all the things that the NHS will pay for right, because they're going to say this works, so we'll pay X amount for it, or this is too expensive because certain treatments are remarkably expensive. So the benefit of that system is indeed that every now and again, things that get found to not work they have a look at and, okay, we'll stop paying for them because we have a finite amount of money in the system, whereas in the private healthcare and to be fair, I also have private healthcare I have like a top up sort of thing. So I'm 48 years old, I'm going to start falling apart soon, so I need to jump ahead in the queue a little bit every now and again. But even those guys are not willing to just randomly throw money at stuff. So in the UK the profit incentive is significantly less than you have over in the States. Significantly less than you have over in the States.
David Jeter:Yeah, especially again, when you look at different healthcare organizations, that if they do an injection in a office you know, just a medical office they get paid, say, $350, $400 for that injection, but if they do it in a surgical center, they get paid $1,500 because they're doing it in a surgical, even though it's the exact same injection. And so what do they do? They build a surgical center because they can get more money for all of the people that are walking through the door, but even though they're going to do the same exact procedure as they would do in their office.
Peter:So do you find, because obviously a lot of these surgical things are useful, right? So, as in, we need surgeons to be kicking about because they do a fairly decent job of you know surgeries. Do you find that there is a reluctance then in your environment, where you know the surgeons are not that keen to work with physical therapists, or is that changing the overall patient care sort of thing becomes more Okay?
David Jeter:So I'm going to speak to two things. Um, no, because of the surgeons are very busy, they have uh, they have lines. They have plenty of people to do surgery on, so they, they're fine. If you want to go to physical therapy, that's totally fine. They, I don't think that they, um, they prescribe it. Um, they prescribe it quite often and quite often pre-surgically and and whatnot. And the good surgeons again, obviously, in all professions there's bad physical therapists and and whatever too, you know great there's. I, I know that there's some great surgeons around.
David Jeter:When people come into my office and they're very unhappy because their surgeon sent me here instead of just doing that surgery and I'm like well, you know, if the surgeon didn't want to do the surgery, you should probably listen to that person, because you know that's what they do and that's what they want to do. And if they don't think it's going to benefit you, then it's probably not going to benefit you. But I have, but I also. I mean, I'll even say this too it's crazy to me. It's crazy to me to think about how often, how often, the question being asked is not what is my outcome going to be three to six months after the surgery. You know when, when I'm fully healed from this surgery, quote unquote what is? What is this outcome going to be versus what I am today? You know, and I say this to people, I say this to patients, and I just say I just want you to think about this. You know, like, where are you at today and what is your expected outcome right now? If it's, if it's, you know what? I can barely really walk 10 minutes before my knee is killing me. I can't go up and down stairs, I can't play with my grandkids, I can't do the things that I want to do, and I've done a bunch of exercises and PT and whatnot, then your expectation is by getting a total knee, you're going to have a significant benefit. Six months down the road, when you're healed, you should be able to do a lot more function with a lot less pain. That sounds like a great reason to have a knee surgery.
David Jeter:If you have, let's go back to the back, because we're supposed to be we're supposed to be talking about the low back. If you have, you know radiculopathy. You know radiculopathy being a compression of a nerve root in the low back because you have a disc that's herniating and pushing on that nerve root. If it's causing muscle weakness in your legs, so that's causing your foot to be incredibly weak. If you have a bunch of numbness and tingling, if you have a bunch of balance problems because of this and a lot of pain and inability to perform function and you have an MRI that shows that you have a disc in the same distribution of all of these neurologic symptoms then, yeah, that makes sense, then have a discectomy or you know.
David Jeter:I mean whatever the surgeon thinks is the best surgery there. That I'm definitely not anti-surgery, but the the so often I feel like the question is not being asked what is my expected outcome going to be? Because you get people in who are 50, 60 years old they've had back pain for 20 years. It's. It's pretty amorphous, it doesn't really. It's, it's not, it's not going into their legs, it's not causing a bunch of specific muscle weakness and and they're saying, oh, I think I'm gonna have surgery. I'm like well, what do you think the outcome is going to be? There's no indication that a surgical intervention is going to improve this situation by a measurable amount. And and I always I always put it to people, like if you had a brain tumor and someone said, hey, I want, I'm we're thinking about.
Peter:This is the surgical intervention.
David Jeter:The question should again, this is it's the same question what is it going to look like six months down the road? Is it going to be that I'm not going to be able to see out of my left eye and I won't be able to use my my arm? Um, but I'm going to live to, you know to, to see another day? Okay, that's, those are. There's some benefits, there's some some costs there, um, or or if I, if I don't do this surgery, uh, is it, is it potential that I could, I could die within the next month. So I don't know.
David Jeter:There's there's so many that I, people see, people see a lot of these musculoskeletal problems and they, they see this the solutions as a, as a menu. Right, I can do an injection, or I could do surgery, or I could do physical therapy, or I could do chiropractic, or I could do ac, or I could do physical therapy, or I could do chiropractic, or I could do acupuncture or whatever, and I think people should start looking at this more like it is a process. It is a road that you go down. Right, you have this back pain. This back pain started, however, it started maybe during pregnancy. You should always start with a movement-based solution right. What happens when we get this system moving better and we improve the strength of this system? Does the tissue that is irritated does it resolve? Does it calm down? Does it get better If that?
David Jeter:isn't the case right If you get moving and you get strong and that tissue doesn't calm down. Well, maybe we should go down the road further and maybe maybe it's time for an injection to see what happens when we inject it with something. Again, it's not for, not for everybody, but I'm just saying like that's a potential, you know, and if an injection works for a period of time, but it doesn't work for a long period of time, then maybe we should think about some sort of surgical intervention and that we can improve something. But thinking about it not as if like oh, I can either do this or that or this or that. It's like no start with movement always.
Peter:Yes, and especially, like I said, when it comes to any sort of muscular issues. Any sort of muscular issues I have, well, okay, any sort of muscular issues, any sort of muscular issues I have well, okay, if your bicep is completely torn off, you're going to need to get a surgeon to look at maybe, but maybe I mean again.
David Jeter:so let's, I'll be devil's advocate here. If you're 80, 80 years old and you're you're not going to use that arm in a powerful way, and you're diabetic and you have some other issues where surgery is potentially dangerous for you, then you say well, you know my arm works okay and maybe I have some pain, but the risks of doing surgery are greater than that.
Peter:Yeah, no, yeah, yeah. Of course you're absolutely right in that. Generally speaking, I always think surgery, especially for postpartum women surgery, should really be the last resort. It is never an easy option. There are easier options available and exercise is almost always it the trick.
David Jeter:And again, especially when you're talking about postpartum women, you're, for the most part, talking about younger, healthy women Right.
Speaker 3:For the most part.
David Jeter:I mean, obviously there's exceptions to that, exceptions to that. But if you're talking about a 25-year-old woman, the idea that someone's going to jump into surgery straight away without trying to get that system moving better, it just blows my mind that that could even happen.
Peter:Yeah, I have one client who's a personal training client, who had her tummy tuck surgery or diastasis recti surgery before she saw me. So she had it done. She went to see an excellent surgeon. I happened to know the surgeon, he's superb and then six months later she came to me and said I want to strengthen up my core muscles. I said, well, I could have saved you 15 grand. Yeah, you could have saved yourself a ton of money and, let's be honest, a big scar.
Peter:And any surgery comes with risk. It just, it just does. It is not the easy solution that people and physical therapy, especially for things like back pain okay, assuming you work with a good physio, um, and that should also be someone that you feel comfortable with. By the way, just in case anybody's listening, you don't just go to the best, you go to the best person you have a relationship with.
Peter:That doesn't uh, that doesn't annoy you because you're going to need to spend an hour in their company uh, once a week or once, depending how often you see them, uh, or more often and know you need to be able to have real, open and honest conversations with your physical therapist, because if you can't, if I go CEO and I cannot tell you where things really hurt or what movement really feels like, then we have an issue and, like I said, I'm a middle-aged white guy. I'm of the generation that you know. No pain, no gain. So Dave will go.
Peter:Does this hurt a little bit? No tears streaming down my face, but no, dave, push through, we're okay, we're good. But if you feel comfortable and you can just open up and say that this is, this is comfortable, this feels uncomfortable, or even things like I don't know what you're talking about, because quite often I don't know about you, but I describe something to a client of mine or one of the HPMB members and they look at me and I can see their eyes glaze off, I can see them going. I have no idea what you mean.
David Jeter:That's one of the things that I you know, I take a lot of students and that's one thing that I tell them just constantly. All the time I said, you have to tell the person what's going on and what we're, what our plan is, and then you have to tell it to them in a different way, and every time they come in, you tell them a different way of saying the same exact thing, because I promise you they didn't.
David Jeter:They're not going to remember or they didn't get it. They're, they're, they're being polite, so they're saying, they're nodding their head and saying yes, but but almost no one really understands what we're talking about the first time we talk about it. And we have to continue to. We have to continue to use metaphors, we have to continue to communicate in a way and connect with patients where they can feel like what we're saying is making sense and they can understand that a lot of the solution to this problem is getting moving properly, getting their body to move properly, getting everything doing what it's supposed to do and then gradually loading it in and in that recognition that you're, you're not broken and you're not fragile, and if we can get everything doing what it's supposed to do, then you can enjoy your life and enjoy your new baby yes, exactly I.
Peter:I always tell people because I'm bang on with that. I always tell people that, listen, I can't give you your pre-baby body back. Right, you had a baby. That's going to have an impact. It just is stretch marks or whatever. But I can make you stronger and I can make you more confident and I can make you fitter than you've ever been in your entire life.
Peter:Yeah, than you've ever been in your entire life. Yeah, it doesn't matter that you had a baby in between, uh, whether you're 23 or or 42, if you have, if you work on this, if it's, if it's fundamentally, and when you're talking about lower back pain and all that sort of stuff, the things that back pain prevents you from doing even just the fear of, like, well, what you spoke about, the fear I'm gonna do my back in if I lift this. So I'm not gonna go in with my kids, I'm not gonna play tennis, I'm not gonna go to the gym, I'm not gonna go swimming or, even worse, I'll only go swimming because that's the only exercise you know, the only safe exercise. You're restricting your quality of life, even if you're not aware that you're doing it.
David Jeter:And I think also to you know, to that point, I think, I've heard several different women say that they exceeded their previous physical activity in the year or two after a baby because of because of having the baby. So you know, you know, running a half marathon, you know they, they, they find out relatively quickly that their baby will sleep in that Bob stroller, and so those runs tend to get a little bit longer. And you are pushing this stroller and then all of a sudden it's race day and no one's making you push the stroller and you PR this half marathon because nobody's making you push the bomb stroller anymore and you've been pushing it for longer and longer periods of time because baby will sleep, uh, while you're, while it's in there so.
David Jeter:I don't know. I think there's. There's a lot of opportunity for women postpartum to take the time to get their body moving better, take the time to really start feeling good by getting moving and strong and enjoy their new family member.
Peter:Yeah, no, absolutely. I couldn't agree more On that happy note. Was there anything else you wanted to cover? Because I think we went over. Basically we solved all the world's problems.
David Jeter:I think I said I believe healthcare system and everything, yeah, exactly, exactly. So on that happy know, I think we got it Exactly.
Peter:I'm not happy. No, that will press stop record, and press stop record is exactly what I did. Thanks so much to David for coming on. He's one of those guys. He's like I said, he's a physical therapist. He got nothing to sell. He doesn't have a book out, doesn't have a podcast or anything like that. He doesn't need you to listen to anything other than his advice, and that's why I love the guy. He gave up an hour of his time and he didn't need to just helping me out, because otherwise it's just me talking to myself continuously, and I know that I'm charming, of course, and I'm great company, but even I get tired of my voice.
Peter:So in the news this week, this paper that came out from the American Association for Cancer Research came out in December, which is, again, I'm a bit ahead of schedule. So that's when I'm recording this, talking about how few Americans are aware of the links between alcohol and cancer risk and all that sort of stuff. Now, I'm not going to go too deep into the study, it just says that it's an interesting paper in that it says here for instance, 10% of US adults said wine decreases the cancer risk and you mainly find this in red wine right Now. We know for a fact that all alcohol increases the risk of cancer. I'm not going to go too deeply into that. It's much more interesting. How you know, we've all seen the stories in the Daily Mail and other newspapers that say things like a glass of red wine a day lowers, is good for you, lowers the risk of heart disease, and all that sort of stuff. And those headlines are usually based on research that says something along the lines of one of the ingredients in the red wine lowers the risk of heart disease and that then for headline purposes gets translated as red wine lowers the risk of right. And this is quite often the problem with this sort of stuff. That's because we see those things in the press a lot. Same as chocolate might. Dark chocolate is actually good for you, all that sort of stuff. Now, if we just look at these things as standalone things, then say, okay, a glass of red wine actually increases the risk of cancer.
Peter:But we know that the way we consume alcohol has a big effect, right, has a big effect right. For instance, in the thing here that the study's lead author, andrew Seidenberg, cited research that shows alcohol contributed to an average of more than 75,000 cancer cases, almost 19,000 cancer deaths per year between 2013 and 2016. Yes, but what that doesn't necessarily quantify is how people consume alcohol, because we also know, for instance and the studies are are out there that social drinking and by social I don't mean going completely mad with your mates, I mean being in a nice relaxed setting with good food and having a glass of wine with that good food can actually be beneficial to people's overall health. We have to remember that when we look at these things as purely good or bad most foods as purely good or bad, independent of any other factors. So in a completely isolated situation of any other factors, so in a completely isolated situation, we're probably not getting a true picture of the quality of the food and what that food item or drink item does for us. Right, red meat is one of those prime examples. We know, for instance, that if you consume a steak cooked medium rare with spinach, that steak almost digests, and it digests differently than if you have that with chips. Right healthier meal, not because you have the one with with spinach, but because it, uh, as in, not just the meal isn't healthier just because you have some greens on the side, the the steak itself seems to interact differently with uh, with the spinach than it does with the chips and all that sort of stuff alcohol is is is the same up to a point.
Peter:Alcohol, if I sit on the sofa watching I don't know the World Cup is on at the moment. If I watch World Cup football and I drink a bottle of wine with beer, with chips or something like that, or with tortilla chips or whatever, that wine is not going to be, as that wine is not going to be, let's say, processed I'm using the wrong words here, I can't think of the right words digested, thank you, digested. As nicely as, say, I were to go to have a nice meal, nice home-cooked meal, whole foods, and enjoy it with friends and enjoy it in a relaxed setting. We know, for instance, that if we consume foods when we are stressed, that that has an effect of how the food impacts us. So with all this sort of stuff, we have to remember that, yes, alcohol is a leading modifiable risk factor, as the studies lead author Andrew Seidenberg here says that, as in if you don't drink ever and you do all the other behaviors that you would otherwise do, then yeah, okay, um, there's nothing, then alcohol doesn't have a benefit and it could contribute to.
Peter:It could increase your, your risk, the risk of you getting cancer right. Right, obviously, from a very low base rate and we don't know what that modifier is. We don't know how much higher it would be if you had the occasional glass of red wine or had the bottle of red wine. There's no one that has actually proven that to any serious point. We do know, however, that when we say wine decreases the cancer risk, that that is just argument. That is just not true, right?
Peter:We just need to say that alcohol isn't a health food. That's kind of all that needs to come out from this study, and it goes for all alcohol. It is not healthy for us, but that's the same way as the diet Pepsi isn't healthy for you or diet Coke. I'm sure other diet drinks are available as well, just nobody ever drinks them. So if you decide to give up alcohol, that will be beneficial to your health. Sure, but we have to agree that there are different kinds of drinking, and drinking in a different environment, with different foods, different social interactions and all that sort of stuff means that the alcohol has a different impact on you, all food and almost all health. That means that the alcohol has a different impact on you All food and almost all health.
Peter:If you look at things in a vacuum, you're almost inevitably going to come to the wrong conclusion. It could, for instance, well be that drinking a glass of red wine in a relaxed setting would still increase the risk of cancer. However, it could lead to lower levels of stress and that means that you could decrease the risk of heart problems and all that sort of stuff. We cannot look at all this sort of stuff in isolated instances. We have to take a holistic approach to all food and drink. This is why this is where the everything in moderation thing comes from.
Peter:Well, g-speak, you really just spent 10 minutes yapping about a study, only come to the conclusion that everything in moderation yeah, kind of, you're kind of right on that one, kind of to kind of write on that one. Basically, I'm just saying that you know this paper did the rounds and the press gets sent out to various outlets and for some reason someone sent it to me and you know it is. This paper is interesting from an awareness perspective. It is not interesting from a the science says sort of perspective. You know it's, it's not. It is way too complex an area to to be black and white in this. Just be aware that that alcohol isn't healthy, even isn't a health drink, assuming all other factors are the same and your behavior is the same and you can lower stress in the in the same way as in socializing with friends without alcohol, with the good meal and all that sort of stuff. Alcohol isn't going to be healthy for you, and a glass of red wine a day does not keep the doctor away and all that sort of stuff.
Peter:Anyways, that's me done, waffling for X amount of time. Thanks very much again to David for coming on. It is much, much, much appreciated time. Thanks very much again to david for coming on. It is much, much, much appreciated whenever anybody comes on. We're going to continue, uh, our um physical health month, uh, I think next week. Uh, we're doing, uh, we're doing, some stretches, I believe, or have we just finished stretches? Who knows, who knows? Well, you'll know um peter, at healthy postnatal buddycom. If you have any questions or comments or whatever, just get in touch. That's what I'm here for, right, all right, take care of yourself. I'll see you next week.
Speaker 3:Bye now I can't believe we're holding on to what we've already given up. It's like we're pacing around the obvious Separate lives, different stories. Two out of four of us are all fed up. You and I play with fire, but don't say nothing. Oh, we're both busted. We'll get you next time. So long, so long to, so long, so long to.