We need to talk about... back pain EDIT1

The podcast hosts discuss a finance tip about earning free money by switching bank accounts. They mention various banks offering incentives for switching. They also discuss the process of switching and how it can be done seamlessly using the Current Account Switch Service. They assure that switching accounts does not affect credit scores. The hosts then move on to the main topic of back pain. They discuss the prevalence of back pain and its impact on the economy. They mention that back pain is a common reason for GP visits and results in many days off work. They also discuss the impact on healthcare workers. They acknowledge the debilitating nature of back pain and the limitations of immediate solutions. They mention that back pain can affect people of all ages but is more common in older individuals. They note that inactivity and obesity are contributing factors. Hello there. Hi Scott. How are you? Good thank you, how are you mate? Yeah, very well, very well. We're here again. We're here again, yes, welcome to today's podcast. Today we're going to be talking about back pain. We are. Which is going to be an interesting subject Yeah, it might be a long, long haul to be honest. My back hurts already thinking about it to be honest with you. So firstly, I want to hear a finance tip from you please. I know all the listeners do too, they're begging for it. Yeah, so I was thinking about this and I kind of want to, I want to do stuff for the listeners that are actually going to make people more wealthy essentially. So I don't want to just give some random fact about GDP which I was discussing with you earlier Dave. So this one is about how you can earn some free money. Do you like free money Dave? I don't know, that's a very loaded question Scott. Yes, I like free money. Good, so I'm sure you've heard of it and it has been advertised quite a lot but this is from someone who's actually gone through the whole process and got the money. So here it is. It's changing your bank account. So it's switching your debit card or your current account over to a different bank provider. Bank provider? Bank as they are commonly called. Yeah, bank. And money provider. So quite a lot of them at the moment are actually giving you this kind of incentive to switch over to them. So to name a few, we've got Nat West who's giving a free £200 plus £3 monthly cashback. You've got First Direct who I actually switched to, this is like a few years ago now, who are giving £175. Halifax £150, TSB £200. Obviously there are some small caveats with all of these but this is literally free money and if you haven't been with one of these bank providers before, so say you're with HSBC at the moment or even if you're with Nat West, you can then go to another one and then get that free money basically. So the caveats to know are that you have to put usually a certain amount each month in there, so that's like moving your salary over or whatever income you get. Then you have to have two direct debits usually and then you have to close down your old bank account. So it sounds like a lot of work but it's actually not because there's this scheme, I think it's relatively new, it's called the Current Account Switch Service and basically it's like an algorithm in the back where it's just all done automatically, all your direct debits are switched over, you don't have to do anything, all your salaries switched over and it literally works really, really well because I did this, let's say about two years ago, I actually got £125 when I did it, it was a lower incentive but it worked completely seamlessly. I think the only thing that happened was that I went to the gym and they noticed that I had switched bank accounts, they were like oh that's weird. Other than that, yeah, nothing went wrong. I'd say my advice though is look at when your direct debits are coming out because try and time it where it's not going to go over one when it's being paid just to be super safe, I think. So if you know you've got, I don't know, Spotify coming out on the 12th, then you've got gym membership on the 15th, whatever, maybe try and do it at the end of the month just so it's not going to overlap because it does take seven days, I think, for the whole process to work. But yeah, it's free money essentially. I actually tried to do another switch but they wouldn't let me, so I don't know how many times you can do it. I think there was, again, like a year ago, I'd only been with First Direct for about a year and I tried to switch to Barclays, I think it was, but I said you got rejected. They saw right through me. So if you haven't done it before, it's well worth doing because it's in your account, I think, usually within the first seven days or some of them make- I was going to say, so you get it pretty instantly? Yeah, so soon as your bank's shut, your direct debits are moved over and you can see that your payment, your salary is going into it, they usually give you the money pretty much straight away. Some might have some small kind of caveat where it's like after one month, but usually, yeah, it's pretty good. So, you know, cost of living crisis, let's get some more money. Yeah, no, very nice. I've definitely been put off. I've seen those and I've been really put off by just like, this is too much effort. Like I could, it's going to be a day's work, so I might as well just see patients for a day and earn their money rather than doing it. But if it's easy- 100%. So I thought that as well. I thought it was going to be loads of hassle. I'm going to like, I'm going to miss some payments and all this kind of stuff. Yeah, straight from the horse's mouth, it worked for me. I'm not saying it's going to work for everyone. You know, there are some instances I think when it might not work, but yeah, I think as long as you, as I say, know when your direct debit is coming out, because that's the main thing, I think. You don't want to miss certain payments and stuff. Just kind of do it around the times when they're not coming out and I think you'll probably be safe. But yeah, it's all taken care of for you. Nice. And this might seem like a silly question. You can tell me if it is. Would it affect anything like your credit score, your credit history by changing accounts? No. So this is a really common thing that people think, right? So, and I've joked about this before on the podcast that I've got like 10 bank accounts. As long as you don't take out an overdraft with your current account, you can have as many as you want and it's not going to affect your credit score. So it's not like if I got 10 credit cards, that's completely different because that's me essentially taking out loans kind of and that does affect your credit score. But for a current account, yeah, providing you're not taking an overdraft with all of them, it doesn't affect anything. Again, caveat, some of them to get the reward might want you to do an overdraft, but I'm not entirely sure. I don't think so. But yeah. Thank you, Scott. I look forward to my free money. Should we crack on with the back stuff? I'm scared. I'm scared for you, but yeah, let's start the show. Okay, cool. Right, so we're here, babe, and I'm really excited about this, purely because I know you're scared, because it's a really tough topic to talk about, isn't it? I think it is. And I think it might take a couple of podcasts. I don't know. I don't want to make it a mammoth 14 hour Joe Rogan style podcast. I think we'll try and keep it short and snappy, but without oversimplification. So the topic is back pain. I think it's a super common thing all over the world. So on that note, we need to talk about back pain. Nice. I guess a good place to start is probably the stats around back pain, because I think, as I say, I feel like it's a global problem. It's probably a very common thing throughout the world. But it'd be good to hear some stats about what actually is out there. Yeah, so it's in the top five things that people visit their GP for. Wow. Okay. And obviously, we can only really be relatively rough with exact stats, but it's kind of estimated that 60 to 80% of people at some time in their life experience back pain, which is bad enough to take at least a day off work. So the net cost to the economy, and we're not just thinking from a treatment point of view, we're thinking about days lost in time away from work is, I think, 10 billion pounds to the UK economy. And that was 2018. So it's going to be up from that. Yeah. And I believe, I'm sorry if I do say any stats that are incorrect, but I believe that the NHS workers, I think 40% of days lost for NHS staff is due to back pain. So if you think about, yeah, the economy impact, but also the impact of losing healthcare assistants, nurses, doctors, ironically, from a condition like back pain, is also a huge impact for other reasons and potentially life-threatening to other people. And it's sad for them. I'm fortunate enough not to have really suffered from any bad back pain. I've done my back a few times from carrying something or whatever. But yeah, I can imagine the people that are actually suffering, it's probably very, very horrible. And I think it's a very debilitating condition. You won't have seen anywhere near as many people as I have with severe back pain. You probably have seen a friend or a family member at some point, basically unable to move. And unfortunately, and we will, I'm sure go into this either today or at another point. In some early stages, if it's what's called acute back pain, so acute being quite sudden onset, rather than it being kind of gradual worsening, like an acute back pain, can basically leave somebody unable to move for a number of weeks, really. And they come into the clinic and they're completely distressed, unable to sleep, sometimes on a low pain medication. They're like, please do something for me. And unfortunately, as a physio, yeah, there are things we can do to help. There are little things we can do to modify somebody's symptoms. There are things we can suggest. There is reassurance, which is a really powerful tool. But nobody, and I believe this very strongly, nobody, no clinician can do something instantly like that to get rid of people's back pain. From your experience, would you say it's more older people that are suffering or is it across the board? Like, I'm just assuming it's more the older generation. Yeah. So as with anything, the statistics, we have to go off, we can have anecdotal statistics of what I see day to day. Yeah. And obviously, I can look at the literature and the reported incidence rates. Generally, the older someone gets, the more common any kind of musculoskeletal pain is going to be. So age is definitely a factor. Inactivity, obesity is a huge contributing factor. So the stats say that if somebody has got a higher adiposity, they're more likely to get back pain. What does adiposity mean? Essentially, the percentage of body fat on the human system. So you're saying that the better someone is, the more likely they're going to get back pain? That's what the statistics would tell us. Again, is correlation causation? Is there another psychological impact? There's so many things that could confound that. But yeah, so people who are more inactive are more likely to suffer with it. People who have higher adiposity, I don't like saying BMI, because that doesn't relate to somebody's body fat as much as weight versus height, but that's a completely different subject. Your BMI is massive. Because I've literally ripped the gym all day. So yeah, there's a load of contributing factors. Age is definitely one of them. The older someone gets, the more likely they are to suffer with back pain as well. Day to day, I actually probably tend to see more young people with it, but that's more to do with the demographic of patients that come to see me. I work with a lot of sports people and generally younger people at the moment, and obviously working in football and stuff. So my anecdotal statistics are skewed somewhat. So looking at the overall instance rate is probably more helpful. So I guess the most common back pain I see is lower back pain. It's the hand on your lower back and you're bent over. What would you say is the main cause of that lower traditional back pain that you visualize? So I think to understand back pain, and I know obviously we don't want to turn you into knowing anatomy inside out, but I think you have to understand that there are multiple different structures that make up the back. And any one of those structures can cause pain or irritation for a variety of different reasons. So again, please do stop me if this is boring the living daylights out of you, but I'll try and put it in layman's terms as much as possible. We just need to understand the structure of the spine a little bit to answer that question. So the spine is made up of 24 bones, basically small bones, and they're stacked one on top of each other. In between each of those bones, you've got a gel-like cushion, which absorbs some of the forces that goes through the spine, and that's called your disc, your intervertebra. So the bones are the vertebra and the disc is your intervertebral disc. Oh, that's interesting. So I always thought the disc was the bone. No, not at all. So the bone is the rigid, hard structure, and then in between there, you've got your shock absorber, which is your disc. And we'll talk a little bit, we can talk about that. And then obviously you've got this long column. To keep the bones together, you've got ligaments. So ligaments attach bone to bone. I'm not going to bore you with all the different types of ligaments in there. And then the last two other structures, you've got joints between each bone to help them move on each other, which are called your facet joints. And then you also have the thing that moves the spine, which is your muscles, and your muscles attach via a tendon. So a tendon attaches a muscle to a bone, and the ligament attaches the bone to the bone. Okay. That's really interesting. So from that, I'm going to assume that you can get different pains in different parts of those structures, right? Yeah. Is that where you're going with that? Yeah. So the other thing I haven't even talked about there as well is those 24 vertebrae are split into your neck, your thoracic spine, and your lumbar spine. So your cervical spine is your neck, and there's seven vertebrae there. And they're the most mobile, smallest bones. You've got your thoracic spine. There's 12 of those. Each of the ribs comes off one of them. So the thorax, thoracic spine. And then the lumbar spine often referred to as the L1 to 5 of the vertebrae numbers. But your lumbar spine is the bigger bones. They get bigger as they go down at the bottom of your back. And through all of that column, the column's actually hollow, and you've got your spinal cord running through that. Okay. So that goes from your brain all the way down that spinal cord. And at each level of the back, so there's a gap in between each of the vertebrae where the spinal cord can run out, which then provides function to different areas of the body. And that, so that spinal cord is, it's linked to the brain, right? Yes, exactly. So all the information processing from your brain to the rest of your body travels down through the spinal cord, which is why damage, severe damage to the spinal cord can be completely fatal. Yeah. Yeah. And it's, you know, obviously, if somebody, we know somebody who got very lucky with a spinal cord injury and- Very lucky. You know, ended up, I think, in ICU for 30 odd days after a fracture to the vertebrae, which impacted the spinal cord, but is actually all well and good, other than as a person, he's a bit annoying. He's horrible. But that's what the spinal cord is there to protect. Okay. Sorry, that's what the vertebrae are there to protect, that spinal cord, which is essential for life. Yeah. Okay. So yes, as I said, where is the pain coming from? The pain can be irritation at the joint, so the facet joints that sit between the bones. It can be, as the nerve comes out of different sections, you can have irritation to the nerve root. Oh, okay. Okay, which we'll go into. And you can have disc problems. Often the disc isn't painful itself, but the disc can often press onto the spinal cord as well. Is that known as slipping a disc? You've said it before. Bing, bing, bing, bing, bing. I fucking hate the term slipping a disc. I think it's used really commonly, and it's used by doctors. It's used by GPs. It's used commonly in medical language, but I think it's a horrible word because it seems so catastrophic. Like, I've slipped a disc. I'm like, where's your disc gone? It's not sitting, it's not falling out of your spinal cord and like in your foot. I mean, earlier, and this is interesting, and sometimes for me, I think this is why this podcast is really interesting because I, and I'm sure it's the same for you in finance, I almost assume a level of anatomical knowledge from somebody. I forget that I've spent years doing it, and all these phrases and terms are... I have zero, by the way. I said I have zero, so... All these phrases and terms are really natural and normal to me, but this is why I can't get over complicated. But the slipping a disc, I think sounds really catastrophic. What actually happens to a disc is it can either become slightly bulged, so the cartilage changes slightly, and it, picture like a burger in a burger bun, and it kind of like over spills a little bit, so the disc can kind of bulge. Or if you picture the disc to be like a jam donut, where it's softish on the outside, but you've got that kind of runny inside, that runny inside can actually break through, and that's called a disc herniation, where the jam kind of comes out and then often pushes on a nerve root. That sounds horrible. It does sound horrible, and it is really horrible. It's probably the worst type of back pain somebody can get, because if a disc herniates, most likely there's going to be irritation to the nerve root, and therefore something like, which I'm sure you've heard, it's a really common symptom associated with back pain, is sciatica. So if one of the lumbar vertebrae discs slips, or herniates, or bulges, that material or inflammatory things that come out of the material of the disc, bulging, herniating, press on the nerve root that's responsible for going down the leg. So the nerves that run down the leg, and you have motor nerves and sensory nerves, ones that feel sensation, and ones that control the muscles, essentially send electrical impulses and signals to the muscles, that nerve root is being compressed slightly by material from the disc, and therefore people getting raging symptoms down their leg, but that's coming from a small change at the nerve root at the back. Does that make sense? Yeah, that does. That makes a lot of sense. So you could possibly be having leg pain, not knowing it's your back pain, or would that completely... Absolutely, absolutely. There's so many pains, and that's the lumbar spine, the nerves go to the leg from the lumbar spine. From the neck, for example, it's more controlling upper limb, so arms, hands, pins and needles in the hands can often come from the neck. Even ridiculous things, right? Like I once had a patient that had very pinpoint specific scrotal pain. Oh my God. Just scrotal pain. Did you have to examine that thoroughly, David? I mean, luckily it had been screened by a GP for any other worrying testicular problems, but we could only reproduce that by pressing in the lumbar spine. It's the only time it was reproduced. So, yeah. I have so many questions on that, but I'm going to save them. I didn't get the VP out, if that's what you're going to ask. I know what you're like. No. Yeah, that's a story, I think, a little bit later. Yeah, let's bring it back round to the rest of the pains. I think we were looking... I do apologise. I feel that I've just given you a whole anatomy lesson and it gets a lot more complicated than that, but I hope it provides... Yeah, no, really interesting. So, yeah, I think you were going to talk about some muscle pain next. Yeah, so, yeah, as I said, you can get facet joint pain, you can get disc pain, discogenic pain it's often called. But, yeah, muscle pain can often actually be a symptom rather than the root cause of back pain. So, if you think about what we've just talked about, that the back is the spinal cord running through the vertebra of the back, being essential to human life, the body wants to protect that at all costs. Often, even the smallest of what the body potentially perceives as unaccustomed movement or scary movement or maybe lifting more load than you're used to and a little bit of extra pressure through the spine, which it's not ready for, can lead to the muscles locking up and spasming as like a protective mechanism, like a turtle kind of hiding in its shell. So, often, the muscle might be spasming, but it might be because of a disc pain again. So, I don't know if that's answered your question and often it is as simple as actually muscular tension can be relieved actually quite easily. That is one of the ones that actually where we encourage a little bit of gentle movement again and a little bit of potentially soft tissue release. There's arguments in about its usefulness on that, but almost reteaching somebody that this muscle can just switch back off and relax. Heat can also be useful in that, you know, the neck or back to go instead of being uptight, relax, chill out, your back's actually safe. We've not damaged anything and that's often the root of quite a lot of back pains. When we come on to the topic of structure, we find this term called non-specific lower back pain. So, we've just discussed the structures of the back. Yeah. Most back pain is actually deemed and given a diagnosis of non-specific lower back pain. And what does that mean? As it says on the tin, that we don't necessarily put it down to a particular structure. If I were to scan your back right now, and there are loads of studies that do this, so people without symptoms, asymptomatic people, symptomatic people, they scan their backs and with all of them, they will find structural abnormalities. Right. So, you might have a bit of, again, another term I hate, wear and tear, degeneration at your facet joint, but you might have zero pain. And then you might have somebody that has, you know, facet joint degeneration and back pain, and it would be very easy to go, that's the root of that person's pain, but not necessarily. Does that make sense? Yeah, because there's too many variables. Too many variables. So, often it comes down to ruling out something that's worrying with back pain. And we can go into what the worrying things are, it's not to scare anybody, but there's very few worrying things. Very few that actually change what we're going to do to somebody or, you know, whether they need surgery or anything like that. And there's so many that are just deemed as non-specific. Again, people can have big disc bulges, and if it's not pressing on the nerve root, it can be absolutely pain-free. So, to always, therefore, find a structural problem to the back and go, that person's pain is because of that thing, is a little bit of a jump. Yeah. Sometimes, you know, you can sometimes go, well, that correlates with their pain exactly, so it probably is that. But that's why you've got this overarching term of non-specific lower back pain. There's loads of things that feed into back pain. We talked about this a little bit in the Posture podcast, but fear of movement, do you remember what that was called? Here he is. Here he is. Arachnophobia. I mean, you're right with the phobia bit, but there's no spiders involved. Kinesiophobia. I was close enough. You were close. It was good. It was a good effort. So, there's things like that. Stress, loads of other factors. So, to get too bogged down, even though I've just given you an anatomy lesson, to be bogged down on going, it's because of this joint or this disc, and chiropractors out there, I'm not going to swear, but that believe that, oh, somebody's coming with back pain, and I can push somebody's disc back into place, and it will relieve your back pain. Well, how do we know that's what's causing it? B, you can't push the disc back in. C, I'm going to go on a long rant. D, I'll stop. Thank you, Dave. That was really informative. That was really good. Okay. So, hypothetically, let's just say I've got back pain right now. What should I be worried about? What are the red flags that I should be looking for that will make me think, oh, this is serious, rather than just, it's just a bit of back pain? Yeah. Really good question. You've actually used a word that we use a lot as physios, of red flags. I would reiterate the name of this podcast of Seek Professional Help if you're ever in any doubt. Reassurance is a really, really powerful tool. If you have back pain, the worrying things that I would consider, and the things I would want to rule out as a clinician are, is this, I'm going to use the words that are scary, but is this malignancy? Is this potentially a tumor? Is this potentially cancer? Okay. Okay. And with that, I would go, have there been any other big changes to your health? Have you had any unexplained weight loss? Have you lost your appetite? Have you been very, very unwell and you've got this debilitating back pain, which you can't link to have even moved differently or feel like something weird has happened? Any significant trauma I would always look out to because your bones don't just crumble away, but if someone's kicked you in the back really hard and you have debilitating back pain. Could be an issue. It could be a fracture, which could obviously then compromise the bone being pushed into the spinal cord and we don't want that. No. Pins and needles really doesn't necessarily have to be something to be worried about because it's a common cause of back pain. Sorry, not a common cause of back pain. It's a common symptom of back pain and neck pain as we just, and you kind of hopefully understand a little bit of why, but pins and needles or none, if it goes down both sides of your body, is a worry and any loss of sensation, so you can't feel your foot, for example, and the big one being any motor differences. So you've got back pain and you can't move your foot. That's what's called a radiculopathy. That is ridiculous. Here we are. Ding, ding, ding. That was awful. So yeah, if you've got motor issues, movement issues and back pain, and like down a limb, I would get that checked. Okay. And the last probably one that we always want to rule out is a syndrome called Chord-Requiner syndrome and drum it into you in the NHS. So everyone with back pain, make sure you rule out Chord-Requiner syndrome. Basically the bundle of nerves that control your bladder and bowel function. So if you have any change to your bladder and bowel function, whether that's not being able to go to the toilet, not being able to control going to the toilet, not feeling around your private areas, and I know that you like to feel your private areas. Sorry, that was a joke coming there. That was low. But this is a genuinely serious bit of the podcast. I think any of those symptoms, go and get it seen to. If it's just my back feels a bit stiff, even in a little bit of sensory changes, if they're not getting particularly worse, it's probably going to be okay and it's probably going to get better. I would advise not rushing, soon to get any back pain, rushing to the A&E. But if things aren't improving, that's the point you need to go and see a physio and they can assess exactly what's going on and give you really specific advice. Okay. So I've got pins and needles. I've lost feeling in my privates and I can't walk anymore because my leg's just not working. Who do I see first? 999 straight to A&E. In that scenario, no discussion about it. If you came to me as a patient and you said those things, I would ring. Okay. And actually, this happens to me in the NHS. If somebody was in my room in the NHS and said those things to me, I'm walking them down to A&E. I'm running down to A&E. They can't walk Dave, they've lost their leg. How did they get in the room, Scott? Yeah, absolutely. Changes to bladder and bowel, pins and needles and numbness in the leg, there would be no discussion in my head of, oh, let's see if this gets better. That straight to A&E, we need an urgent MRI. If it's the less severe ones, for people, what do you reckon the best next scenario is? Is it 111 or just go and see a GP or even just a physio? I think in most scenarios, without the worrying symptoms, see a physio. They will screen out anything worrying if they're good. And again, there's caveats to that. There's a lot of awful health professionals out there, really terrible ones. So try and find somebody who... I'm looking at one right now. Try and, hopefully this is a useful podcast because if you don't see somebody that asks you some of these questions, although they can feel a bit personal and a bit invasive to be asked. And it's always setting these questions up right. Do you have changes in your bladder and bowel function? If you come in and that's the first question I ask, you're going to go, oh my God, who is this creep? But if I set it up correctly, somebody should be checking for those things with back pain, not to scare you. And please, please do not go... It's very, very, rare that anything's worrying like that. But in the small cases that it is, at that point, it becomes an emergency. So I haven't actually ever had bad chronic back pain, but I can imagine if I had, the first thing I'd want to do is get a scan just to see what's going on in there. Is that good advice or is that the right thing to do? I try my best to avoid scanning at every single possible cost. Why? Unless I'm worried about the worrying things. Often scans, remember what I said earlier about those studies of like people with symptoms without and showing differences. I think you get this problem where you get these incidental potential findings. So scan your back. Oh shit, I've got X thing. And actually, I'll bring you to a real life example. I've had a number of times, but I had the other day and it just made me really angry. A patient comes to me and goes, wasn't actually a patient I had been treating. He had been seeing someone else, a really good physio, and he'd done really loads of work, had loads of back pain. He'd got back into the gym, was starting to lift, was starting to run. For some reason, the patient, not because of the advice of the physio, I think he got a little bit worried and went for a scan with a back pain consultant. And on the scan, they found some arthritis, some arthritic changes to the joint, the f-acid joint in his back. The consultant, without really assessing the patient or talking to the patient about his rehab or anything, just went, oh, but arthritic changes to your back, can never run again. Wow. So he said he can never run again. And this guy was in his 20s. And I could see him almost welling up in disappointment because running was, he was being running. He had been back to running with the physio and he'd been building this up with only mild, like, ache. And it was like symptoms don't correlate to the scan. There's nothing worrying on your scan. You've got a little bit of degenerative change. We scanned your back right now and we found a little bit of degenerative change without back pain. And I said to you, that means you can never run again. What would you say to me? Well, I wouldn't like it. You'd probably say, fuck off. But because you have had back pain and then we find that and then I get told to run, I might believe that. Even if you didn't, if I didn't have back pain and it was found, I'd definitely think twice about it. It would make you think, wouldn't it? So I think the only thing I find useful about a scan is to rule in something that's really worrying. Tumours, huge disc herniation, called Requiner syndrome, things we've talked about. Or it can be useful if you've got a real problem with a patient, a real difficult to get some of these messages through to them. And I know there's nothing worrying in their back and I just want to exclude anything worrying and go to them, look, I want to send them to a consultant that I know and trusted. Look, there's nothing to worry about on your back scan. It's got X, Y and Z, but these are completely normal. 80% of people have these changes. No, there's no perfect spine like there's no perfect posture. Please now start to listen to the messages I'm trying to get to you with the rehab. The way to get you back fit and strong is exercise, strength training, things I'm sure we'll go into in another episode. But sometimes it can be a confirmation of, sometimes the patient needs to sit for themselves. But yes, at most points, scans are unhelpful. And just to round it off, have you got any good tips and tricks for prevention? So I think there's, you know, avoiding movement is the worst thing we can do. There are going to be some, there are going to be some movements which are more painful for you and some that are less painful for you. And there's no definitive answer on what they are going to be. It might depend on A, where in your back is injured and B, just individual differences. There used to be, physios used to love this thing called the McKenzie method of treatment. And it's quite a, I don't know exactly what year it was really driven, but that if you had back pain, you had to extend your back a lot. You had to lean backwards and near the positions to be in. But that was kind of all proven to be false. There's a whole thing about people who avoid bending your back and flexion and lifting with a flexed spine, which I thought we might get onto today. But I think that kind of worms could last another hour. But do not avoid necessarily flexion. Try and find what's comfortable for you. Get moving as soon as you can, even if it is a little bit painful. As long as you haven't got the worrying symptoms, movement is good. And there's not particularly, I'm not going to go one particular movement is good. Get yourself moving. Sometimes a little bit of pain relief, although I'm not one to say take loads of pain relief, I think it's become slightly demonized. If in the early stages, taking a bit of pain relief allows you to sleep and for your body to recover, then it's probably the lesser of two evils. I wouldn't want to prescribe weeks and weeks of pain relief, but in those early few days, I normally find heat is a better alternative to cold. Again, because what we talked about, about muscles locking up and tension, and actually we just want to get things relaxed and moving. We don't want everything to be tensed up. Don't do the whole lay flat on the cold floor that was around years ago. And then I think if it persists, and even to be honest, even if it doesn't persist, but it's happened a few times, at that point I'd go and see a physio and go, why is this happening? What's going on here? And try and identify that. Another thing is to not worry too much. I know I've talked about the nasty, scary things, but as long as they aren't happening, chill out, because we know that fear is a huge contributor to pain and it's only going to make your back pain worse. So chill the fuck out. It will be okay. The body often takes time to recover. It's like saying, it's not particularly useful saying to somebody who's really stressed, stop being stressed. That's ultimately what I want to achieve with my first appointment with a back pain patient, is let's get you moving. Let's chill the fuck out. I can imagine you just got your patients sitting there, you go around massaging their shoulders, whispering in their ear, it's all going to be okay. Put the whale music on in the background. Because pain is super multifactorial, chill out. Pain does not equal damage. Huge phrase of mine. I've got pain in my back, something must be torn, something must be broken, I'm completely fucked. Not necessarily. Non-specific lower back, it can just be that this is a temporary back pain, you're going to be okay, try to stop, it's catastrophizing. Much, much easier said than done. Even with my knowledge, I think if my back was super sore, the first thing I would do is panic. So it's a tip, but not necessarily an easy one to adhere to. Does that help for the early tips and tricks? Yeah, that's really good. That's really helpful. So I think that rounds off the whole podcast really nicely. So if you've made it this far to the end of the podcast, well done. Thank you very much. That was heavy. I haven't even talked about half of the things I wanted to talk about. Thank you. It was really good, Dave. I've learned a lot and I just want to say, remember to subscribe to the pod, it really helps us grow. But yeah, Dave, sign us out. Oh god, the sign out. Remember, everything you've heard here is from a healthcare professional. However, I'm not speaking to you directly. I don't know what's going on with you. If you do have any concerns or worries, seek professional help. I do have one more question just before we go. Did you touch that man's scrotum?