Hello, and welcome to another episode, and this week's topic is imaging. Is it good or bad for back pain? And so, some people may think, well, imaging, how could it be good or bad for back pain? It's not a treatment, it's just a picture, right? And so, what we found is that it actually has a significant impact on the outcomes of back pain, whether or not you get imaging. And so, we're going to dive deep into that.
It may seem like a bit of a mundane topic, but in my research, I got pretty excited, and I'm excited to share. So, I had an opinion going into this about my beliefs, my personal beliefs, and what I've been taught, and that opinion was strengthened by my research, which I'll share with you. I'm a physical therapist by profession, but my training is much more of a melting pot of different schools of thought, and philosophies, and I have a personal history of chronic lower back pain of about a decade, and this has had a massive influence on the course that I've taken in my life, and it led me to where I am now, which is helping other people to climb out of the cycle, and I kind of put everything I've ever learned over the last 20 years into a single program called Core Balance Training.
And so, we can talk a little bit more about that as we include the topic for today into why Core Balance Training is the way that it is. So, why don't we get right into it. So, imaging.
Is it good? Is it bad? You know, my belief is that most people want imaging. It can be helpful to determine a diagnosis. It's helpful for doctors to diagnose their patients, and it's helpful for patients to have an explanation for why they're experiencing the pain and possible dysfunction or disability.
And so, there's a very useful place for imaging, and as we'll see in some of the research, there is a tendency for most patients and doctors to want to get or give imaging. And so, that's the general school of thought, but there's this other school of thought that imaging might actually be bad for outcomes, for the long-term outcomes of back pain. And that's where I stand.
That's my personal belief, and so I'm going to take the next 5-10 minutes to try and tell you guys why that might just be the case. I have done a whole bunch of research on this. I came into this presentation with my opinion, my bias, that I learned in physical therapy school they taught us, and my own personal story and experience.
And as always, I did a whole bunch of research. I spent an entire day diving deep into a rabbit hole and found lots of new information and studies that have come out since I was in physical therapy school. Is immediate imaging important in managing low back pain? Psychological factors are something to consider.
The influence of clinical diagnosis on beliefs in patients with nonspecific chronic lower back pain. I try to find studies, so these are controlled trials, ideally randomized, so there's a blind nature to the study where the participants don't know what side of the study they're on, whether they're a variable or not. So these are some of the things I got into, and I just found so many studies, and ultimately what I'm going to do is I'm going to focus on this one study here that we started out with because it has everything that I found in all the other studies compiled into one place.
And so this is from the Journal of Orthopedic and Sports Physical Therapy. This is one of the most famous journals in the field of physical medicine. It's not a single study in itself.
They call it a clinical commentary because it's based on many, many studies that they accumulated and basically formed an opinion based on randomized controlled trials. The randomized controlled trial is the best attempt at an unbiased study that we have in research. So this is a commentary based on lots of different studies and their opinion.
I'm going to be doing a lot of reading today. So the rate of lumbar spine MRI in the United States is growing at an alarming rate despite evidence that it is not accompanied by improved patient outcomes. Overutilization of lumbar imaging in individuals with low back pain correlates with and likely contributes to a two to three fold increase in surgical rates over the last 10 years.
And so what that means to me is if someone gets imaging on their spine, so I have pain, I go to the doctor, I say, doc, I got pain in my back. And that doctor says, let's take a picture of your spine. That act alone of taking a picture of my spine increases the chance that I'm going to get surgery by two or three times.
So furthermore, a patient's knowledge of imaging abnormalities can actually decrease self perception of health and may lead to fear avoidance and catastrophizing behaviors that may predispose people to chronic back pain. So what that means to me is if I get this image and I see the damage in my spine and I receive a diagnosis, I'm labeled with something that it can change my behavior, it can change my perception of myself, and it has an impact of me to further realize any damage that's in my spine. And that's very understandable.
It's actually not surprising, right? But what it can do is it can create something called fear avoidance behavior. And so I will change what I am doing in my day to day life because of what I've learned about myself and maybe what I've been labeled with. Okay, skipping down to the next part, any inappropriate use of lumbar spine imaging can increase the risk of patient harm and contributes to the recent large increases in health care costs.
Well I'm not too concerned with health care costs on this stream, although it is a factor of course for our country. What I'm most concerned with is what's the best thing for you to do for your spine? You have pain, maybe you're considering getting imaging, maybe you've already had imaging, and what can we do about that to best improve your future and the outcomes of whatever situation we're in? So we're going to get into some evidence about these kind of commentaries here. And so it says approximately one quarter of adults in the United States have reported having low back pain lasting at least one whole day in the past three months.
And so this is just saying that a lot of people have back pain and you're not alone if you have back pain, you're pretty much normal, right? So a quarter, so 25% of adults in the last three months have had an entire full day of back pain. Low back pain is the most frequent disorder managed by physical therapists, which is me, and it accounts for 50% of patients seeking outpatient physical therapy care. So it's extremely common.
And so this is a big issue. How should we treat this massive epidemic? So there is a place for imaging, and I'll talk about my opinions about that, but first we will get into some recommendations from the American College of Physicians and American Pain Society. So these are the recommendations.
It basically says we shouldn't routinely obtain imaging. It should be done only in certain situations. And clinicians should evaluate patients before to determine if imaging is supported.
And really, I think they're going to talk about it, but I have some very clear guidelines for when people should get imaging, and I'm going to share those with you shortly. So the evidence supporting these recommendations includes a number of randomized clinical trials. Remember I said those are the highest quality of research based on studies, clinical trials that we have in, I guess, the world.
Recently, a meta-analysis of six randomized trials. So they took six of the highest quality studies, and then they combined all that data and did what's called a meta-analysis. And so this is basically even better because it's removing any potential biases in a single study and combining them together.
The total number of patients in this meta-analysis was 1,800, and they primarily had acute or subacute lower back pain, which means it was recent onset or in the last three months would be subacute. And so the meta-analysis indicated that there was no difference in outcomes for pain, function, quality of life, or overall patient-rated improvement between those who were provided usual care without routine lumbar imaging, which is, I never really talked about this yet, but imaging is an umbrella term for x-rays, MRIs, and CT scans. And there was no real difference between those who did have the imaging, okay? So here's where it gets a little bit interesting.
So the vast majority of patients with lower back pain do not need diagnostic imaging, and even a smaller percentage require advanced imaging such as MRI. So if you have lower back pain and you've gotten an MRI, like me, I've had probably multiple MRIs on my back, the chances are from the research is that it was unnecessary at the least, not beneficial, okay? So that's what so far this paper is saying, is there's no difference whether you had in benefits, whether you had the imaging or not. And the vast majority don't even need an x-ray.
So let's keep going. And before we were talking about appropriate, now let's talk about more edgy stuff. So MRI may in fact facilitate the medicalization of lower back pain due to its visually exquisite depiction of pathoanatomy.
What that means to me is you can see the damage really clearly. And for me to get that done for my spine and look at the damage, it's going to make me feel like I have a medical problem, okay? And so it's going to highlight, like I'm doing to these words, the damage in my spine. That's a fact, right? It is questionable whether the term pathoanatomy or abnormality is even appropriate because these things that the MRI is seeing could be non-pathological.
They could actually just be normal, age-related or degenerative changes. So as we get older, as our bodies age, we have degeneration that happens in every joint in our body. And so to be able to take a really high quality picture of an aging spine and see damage, it might just be normal and it might not be appropriate to call it abnormality.
So that's kind of the point it's trying to make right now. Here's some data, for example, among asymptomatic persons, people without pain, they have no back pain, 60 years or older, 36% had a herniated disc, 21% had spinal stenosis, and over 90% had a degenerated or bulging disc. And so these people have no pain and they have what someone with back pain might be diagnosed with as a disease.
But most of these people, if they have no back pain, they usually don't get imaging and they would never know that they have a disease. It doesn't really correlate strongly with the actual pain. These people didn't have any pain, okay? So Kargi, it was a study, performed MRIs at baseline, so no symptoms, no pain, no lower back pain, and then a repeat MRI if a patient developed an episode of lower back pain.
This study was really interesting to me. So first he took MRIs of people with no back pain and he followed these people for five years and if they had an episode of back pain within those five years after the first MRI, then he would take another MRI of these people. So the sample included 200 patients.
The patients that went on to develop clinically serious lower back pain during the subsequent five years, 84% had unchanged or improved lumbar imaging abnormalities after the symptoms developed. So that means that even though they didn't have pain, had a picture of their spine, had their whatever abnormalities in their spine, and then years later they had pain and had another picture of their spine, that picture could have potentially gotten better, looked better on the MRI and their symptoms were worse. So what this is showing is that there's almost, there's no correlation and sometimes an inverse correlation between damage seen in an MRI and pain.
Furthermore at baseline, so these people without lower back pain, there was a high incidence of what in most studies would appear to be potentially serious pathology. Nearly 50% had either disc protrusion or extrusion. So these people had no pain and 50% of them had disc protrusion, which means herniated disc or extrusion is just a worse herniated disc, different stages of herniated disc.
Nearly 30% had annular fissures that would be a tear in the disc and there was root irritation, which was like sciatica, radiculopathy, and 22%, none of these people had any pain. Over 90% of individuals had imaging findings without any significant low back symptoms, indicating that the association between such findings and symptoms is tenuous or not really strong. And another thing I found interesting is that they're trying to use imaging to predict future lower back pain and they said a history of depression was more predictive of future lower back pain than in imaging studies.
So what we've kind of found so far in me reading to you guys is that a lot of people have back pain and imaging, getting imaging doesn't seem to help the outcomes of back pain. It doesn't improve the future of people's lives by getting imaging. And there's also not a strong correlation between what they see in the imaging and the people's pain level.
So those are what we've found so far and now we're going to get into something a little more controversial. I hope that I don't upset anybody here, but now we're going to look at the harm that imaging can potentially cause. So the potential harm associated with over imaging of lumbar spine in patients with lower back pain includes radiation exposure.
I think most people know that a CT scan is like, I think, like 1100 times worse than an x-ray. So if you can ever avoid a CT scan and the doctor wants to give you one, you can ask for an MRI instead. They have a very similar level of accuracy and detail, very, very similar.
But the MRI doesn't expose you to radiation. That would just be in any case, you know, of your head or whatever. I would always suggest going with the CT.
This is just a side note. Back to the point. So over imaging, radiation exposure, right? So x-rays, CT scans, MRI doesn't expose you to radiation, but it increases your risk of getting surgery.
Okay, interesting. And labeling, when patients are told they have an abnormality, so this is part of the harm of getting imaging. People get labeled, you can get labeled, oh, you're not normal, you have an abnormality and that labeling, stamp it on your forehead.
You carry it around with you in your life. You know this about yourself and it will affect your life. It will change your behavior.
It will change your participation in life activities. And so that would be what they're talking about there. So in 2007, 2.2 million lumbar CT scans, oof, totally unnecessary because you could be getting a MRI and not get the exposure to 1,100 times the amount of radiation as an x-ray.
So 2.2 million lumbar CT scans were performed in the United States. Based on the radiation exposure patients received, these CT scans were projected to cause 1,200 additional future cancers. Whew, okay, I don't even like reading that and that's not part of the point I'm trying to make.
Radiation is a whole separate issue, but it's a thing. It's a factor, okay? It is generally believed that at least a third of these scans were not medically necessary. I'll just say this now so I don't forget later.
I read in another study that doctors prefer to get imaging and higher detailed imaging is better for them because it helps to protect them from malpractice lawsuits if they were to miss a diagnosis. So some doctors are more prone to getting imaging for their patients to protect themselves. Understandable.
In our country there's a lot of suing going on and so that's something to be aware of. You could go into your next doctor's appointment with this knowledge and knowing all the facts and making your own opinion, maybe you can refuse imaging knowing what the outcome could end up being. Okay, so let's get into a little more.
Lumbar spine radiographs. So a radiograph is an x-ray. They provide an estimated radiation dose equivalent to six months of background radiation.
Again, not a major point, but six months of just normal living in one snapshot of time, like a picture, right? So there's a strong association between rates of advanced spine imaging and rates of surgery. This is more relevant to the topic. The points I'm trying to make is strong association.
If you choose to get imaging, if your doctor who is, you know, a power figure, doctors we look up to, if your doctor says you should get imaging, then there's going to be a higher likelihood if you get that imaging that you're going to end up getting surgery in the future. With no other variables accounted for, just simply that there is a strong correlation. So what they're going to find is the use of MRI versus an x-ray early in the course of an episode of lower back pain resulted in a three times increase in getting surgery.
With no other factors accounted for. If you get an MRI, you're three times more likely to get spinal fusion, okay? Spinal fusion, if you don't know about it, it does not have a good outcome. The 35% success rate, okay? So with no improvements in outcomes in the subsequent year, okay? So MRIs go up, surgeries go up.
There's other factors to be accounted for, but there's also a strong correlation. So in addition to the potentially harmful effects of radiation and the risks associated with spinal surgery, there's evidence that telling patients they have an imaging abnormality has negative effects related to labeling, okay? So this is like my main focus with you. When you get a diagnosis, when you get an image and you see your damage, it has an impact on you, whether you know it or not.
And this is where I wish this study was more focused on this part, but this is, there's a term for this. It's called fear avoidance behavior. And it's a huge problem in the back pain population with people who tend to avoid doing life things because of what they know about themselves and the pain that they feel and the damage they've seen.
This is based on research, right? This is not really just like someone's opinion. I could find the study or studies that this conclusion was based on, but it has negative effects for a doctor to take a picture of somebody's spine and look at the damage and say, you have this damage in your spine. It worsens the outcome.
So it can be very difficult to counteract these negative consequences following imaging because people see it with their eyes, right? I don't believe until I see it. Well, I see it, I believe it. And the beliefs are really powerful.
And so it's really difficult. It's my job to reverse these negative consequences. And it is, it's very difficult.
I feel like I have to spend this presentation proving to you all that imaging is more harmful than good, except in a few cases, which I still haven't shared and I will share that. For example, herniated disc, degenerative disc. If you find that, if you get told that, if you see that, it's very hard to reverse the effect that has on your mind, okay? A patient will typically focus on this as the source of the problem.
And I'm guilty of that. Everybody probably is. It's probably impossible not to, okay? This is a case study and it's like a story.
I'm going to read the story to you guys. So here we go. MRI images from a 62-year-old male who had bilateral hip replacements in 2002.
The MRI images from a 32-year-old male with chronic lower back pain, okay? So the images from the 62-year-old male demonstrate significant lumbar degenerative changes associated with intermittent symptoms. So not a whole lot of constant back pain, but sometimes he has back pain. He managed this with exercise, yoga, occasional physical therapy.
He had an episode of lower back pain in the summer of 2010, which he recalled as sharp after canoeing and hiking for two weeks. All right, seems like a pretty active guy. He was able to work through his pain with ibuprofen and stretching during his two-week trek.
The patient subsequently had a full recovery from his exacerbation after nine sessions of physical therapy and he was contacted six months after his initial visit and noted that he had recently completed another two-week backpacking hike of the United States-Continental Divide and no back pain, okay? So that's the 62-year-old man. Now we're going to talk about the 32-year-old man. The 62-year-old man's spine has significant degenerative changes and intermittent symptoms.
Now we've got the 32-year-old's spine and it actually, to me, it doesn't look quite as bad. We'll see what this says. So the 32-year-old, more like in my age group, he is an auto store manager, had a history of chronic lower back pain.
He was off work for disability with severe lower back pain. It shows his MRIs from 2009 that were interpreted as relatively unremarkable, okay? Degenerative disc disease at L4-L5 and L5-S1, mild disc protrusion at L4-L5, central canal sufficient, not deemed a surgical candidate, referred to PT. The patient attended 24 sessions over a nine-month period on core strengthening and conditioning.
He had some improvement from the physical therapy and let's see, we're going to get away from these numbers here. He returned to work at a new job and continued with moderate lower back pain levels and disability. Clearly, here's the conclusion that we can draw.
Clearly, this patient's MRI results are not reflective of serious pathology, yet he continued to have lower back pain. Whereas the 62-year-old male in our first example had the proverbial spine of an 85-year-old and enjoyed a robust physical lifestyle. Wow, that was a mouthful.
And so I'm going to finish there with all the reading and stuff and I'd like to inspire you guys to reflect on your own history. We all have a history. I have a history of when we received imaging and what were the results of that imaging and did it change the way that you lived your life afterwards? Did you receive a diagnosis? Have you received imaging? Reflect on that.
Did it have an impact on you? Because this story we just read, and there's countless stories, there's trials, including thousands of people that are very similar to this, where the imaging has almost no correlation to the pain, the results of imaging. The damage that we see has almost no correlation to the pain and the disability. Okay, so we're going to switch gears here and we're going to go into more like my opinions.
This was all research-based, but we're going to go into maybe a little more research. So this is just another kind of... So these numbers just show that if you have degenerative disc disease, you are a normal person. Good job, because most degenerative changes are a normal age-related process and not a disease or pathological process.
So more than 50% of people in their 30s have it and it only goes up from there. It's very similar for a bulging disc. Pretty similar numbers here.
Herniated disc. We cannot let these diagnoses that we receive make us think that we are broken, that we are not normal. What they mean is we are normal and the pain that we may be feeling may have no correlation to the disease.
I don't know if you remember, but from the beginning of the study that I was reading, the commentary was that people who have no back pain at all, that receive imaging as part of a study, they receive imaging of their spine, but they have no back pain at all.
Over 90% of these people will have a diagnosable condition of their spine with no pain. And yet there are people who have severe pain, like the 32-year-old who had an more or less unremarkable image of his spine with severe pain. So the correlation is unreliable at best.
And we cannot allow the diagnosis of the imaging to make us feel broken or that we have a bad back or that we are doomed for the rest of our life. I hope this lands for you. D, thank you for being here and thank you for posting.
I'm going to address your first question. So you said, I've had two back fusions from L2 to S1, and now I have a short left leg and pain at my knee and pain for my back. Am I a good candidate for this? D, thank you for sharing.
Thank you for asking. Thank you for being here and having the courage to try and help yourself. It's very common for people who have one back fusion, which is a surgery and a process that I hope nobody has to go through.
It is a very long process of recovery. It's very common for people who have one to have another one in the future. We will talk more about that.
I'll have a whole week of presentation about spinal fusion in the future. So we'll talk about that. So it's okay that happened to you, D, and there are things you can do to improve your life, yes.
My question to you is, have you had a day that is better than the day before it? Even if the day after that was even worse, have you had a day that's better than the day before? So if the answer is yes, if maybe in the past year, one of those days was a little bit better than the day before, then that gives me all the hope in the world that you can build on that improvement. There was something about that day or, or something you did in your life that made that day a little bit better and your back pain was a little bit less. It means you can be helped.
And yes, this program is for people who have had spinal fusions or not. The only way that I would say to wait is if you had a spinal fusion in the last three months. So then I would say, wait, you want to be at least three months out of the fusion, just to make sure the hardware fuses to your bone all the way.
Let's keep going, Tim. It is alarming to hear that they say you need a spinal fusion, but if I can give you any hope, if I were to do an entire presentation on spinal fusion, which I am going to, there's going to be a lot of research out there to show that the outcomes are not better than not getting a spinal fusion. So you're doing the right thing by doing the program now and doing everything you can to avoid that.
And then if for some reason they determine that you still need it, I would gather your information and make your own opinion and decide that you are in control of this decision that you make. You did say you're feeling better today. So that is a great sign.
I was just asking Dee that question, right? Can you have a day that's better than the day before it? Well, if you can, then you can be helped and you can build on that because you can have another day that's even better than the better day and that is called progress and that's what it's all about. It's one step at a time. Kim, you're glowing in the dark.
Me too. I talked about CT scans earlier and the amount of radiation that they expose you to, I was told by a radiologist that I still work in hospitals and different settings, I still do, and I recently asked a radiologist about the exposure and he was the one that told me, I think he said 1,100 times an X-ray. Feel free to try and confirm that anybody, but 1,100 times the amount of radiation of one X-ray.
I've had two CT scans, at least one of my brain when I was 11 years old and one of my abdomen. So yeah, I probably glow in the dark too, Kim. And so you and me are in this together.
There's just more of a reason for me to try and be as healthy as possible because the psychological impact of radiation exposure is just the same as anything else, right? I have to stay strong. Ed, how are you doing? Good to see you again. Two images, two different surgeons, no significant issues.
All right. That's great news. So you say you saw the second surgeon because you were wondering about spinal cysts.
I'm going to let this segue into my answer for when imaging would be warranted. When is it a good idea? And this is not really just my opinion. This is supported by a lot of studies.
So I'll just tell you. The times when you would potentially want to get imaging on your lower back or when you have severe, unrelenting pain that is not associated with the activities that you do in your life. So it cannot be helped by changing position or doing something that doesn't hurt your back or doing something that feels better.
It's unrelenting and it is not affected by what you do. So say, for example, I have severe back pain, which is increased by sitting, which was my past. That would not be a candidate for imaging because it is increased by sitting.
That means it's decreased by not sitting. Right. So if the pain does not change, no matter what you do, it's unrelenting, constant pain over time, then you might want to get looked at because that's considered as a red flag.
And so they would want to check you not for degenerative disc disease or herniated disc. They would want to check you more for something like a cyst or a like what Ed said, he was curious about a cyst or a tumor or some physiological, some pathological situation such as cancer. The red flags are generally usually going to be related to ruling out cancer.
OK. And so it's like severe, unrelenting pain that does not change or does not go up or down depending on what you do with your body, because it's not a result of what you do with your body. It might be a result of a growth on your spine or other red flags would be like rapid weight loss or rapid weight gain, but most often weight loss, night sweats, pain that is comes on in the middle of the night only and it's severe.
It's not like positional pain. It's more pathological like cancer. All of these are cancer red flags.
And so those are the times when it might be warranted to get imaging just to rule out cancer, but not to get a diagnosis. OK, I hope that's clear. And then there is one I can't forget to mention.
There is one situation with a physical back problem that you would want to get imaging. And that would be if there was a physical trauma like a car accident and we needed to potentially learn if there was a risk of spinal cord damage. This is called a spinal cord injury.
It can lead to paralysis and stuff like that. But that wouldn't happen. Typically doesn't happen through degeneratively.
It typically happens through a severe physical trauma like a car accident. But if you are experiencing loss of the use of your legs or feet, inability to lift up your foot or to pull your leg out to the side, that could be indication of a nerve getting pressed on that controls those muscles. Those are the times when it might be beneficial to get imaging.
I wouldn't even say beneficial. It would just. The doctors want that to happen and the solution is still going to be the same.
It's going to be strengthen your supportive musculature around the spine to better support the spine, not just during exercise, but during all the movement that you do throughout your day and your life, that's going to be the solution. That's mainly my conclusion on imaging. And I wrote down some facts here.
Imaging is a poor indicator of pain and vice versa. So pain is a poor indicator of damage. There's no strong correlation.
Imaging does not need to improve for pain to improve. This is a really, I think this is a really important point. So there was another study I read where they were talking about this.
And so you can have your pain improve where the imaging stays the same or gets worse. Okay. So imaging is not your benchmark to get better.
Like, is my back getting better? I'm going to go get another image to compare with my previous image to tell me if my back pain is getting better. That is not logical based on all the research that we've found. Okay.
So your imaging, if I were to get an imaging done on my spine, which I haven't done in over 10 years, I don't do imaging anymore on myself. If I were to, I'm sure it would be gross and disgusting and it would scare me and I would feel a little worse about myself. And I know that it doesn't look good in there.
I just don't want to see it. Okay. Out of sight, out of mind.
And so that is just saying that it's not going to affect my determination of whether I'm getting better, not my imaging. Okay. And then the last point I wanted to make is it's just a picture and it's just a one moment in time.
Okay. A picture of you, a bad picture of you does not determine the rest of your life. It does not doom you to a life of disability and immobility.
It's just a picture in time. One moment. Okay.
Maybe you were diagnosed with stenosis simply because in that moment of that picture of that x-ray, you were laying on your back and your hip flexors were really tight that day. And it was pulling on your spine, closing down the vertebrae because they were just sitting in this backward bent position during the picture. But then you got up out of the MRI and your spine was no longer in that stenosis position, but yet you got the diagnosis because it was a bad, one bad picture.
Don't let a picture determine your life. Let's go on to my thoughts. Um, imaging has a negative impact.
Okay. It shows people the damage. It has this effect on people of making us think that we're broken.
You're not broken. You're normal. People without back pain have the same or worse looking spine than you.
So don't let it impact your mind. And if you can avoid getting imaging because you're not showing red flags for cancer, then don't get imaging. Beliefs influence our behavior, right? If I believe I'm broken, I'm going to change the way I move.
I'm going to try and protect myself when I move. But those protective tendencies change our muscle patterns and our movement patterns. And that creates, that leads to abnormal movement patterns.
And that leads to the muscle imbalances that I teach in the masterclass. If you haven't seen the masterclass and you want to keep going as we shut down here, it's in the description below. There's a link to the masterclass where you can learn about muscle imbalances and how they result from abnormal movement patterns.
And those abnormal movement patterns result from that acronym after, after, called FAB. It stands for fear avoidance behavior. It's a huge problem in the back pain world where people have a fear of hurting themselves.
So they change the way they move. They avoid activities. They don't do life and they don't do the things they enjoy.
Depression and anxiety go up and we call that a spiral. It's the downward spiral of back pain. The pain goes up with it.
Okay. So beliefs influence our behavior and they also influence our outcomes. We have the placebo.
Any treatment on the planet, any treatment in the universe, any treatment to a human being is influenced by what we believe about that treatment. 33 to 35 percent of the outcome of any treatment is either placebo or nocebo. Okay.
So that means that if I believe that the treatment is going to help me, then I'm going to have a 33 to 35 percent better outcome. And if I believe, if I don't believe the treatment like acupuncture, there are studies to show that people who believe in acupuncture are helped by it and people who don't believe in it are not helped by it. Okay.
And so the nocebo is the opposite of a placebo and that's the result of imaging. If you get an imaging done and it shows you the damage, you believe in worse things about yourself, you will experience worse things about yourself. Believe in yourself.
Okay. If imaging doesn't help and maybe hurts and belief definitely has an influence on our lives, then why don't we harness belief instead of imaging? Let's harness the power of belief. You are not broken.
You are strong. Your images do not determine your life. And wherever you are, I hope that something that you learned today will help you move a little bit more confidently because that movement with confidence is going to have a positive impact on your future.
I'm going to reach to grab this cup. Am I going to do it in a protective way so I don't hurt myself because I'm weak and damaged? Or am I going to do it with confidence because I know that I'm strong and I'm not going to hurt myself? And so this all needs to be done in subtle ways. This is not an argument for you to go jump out of an airplane.
It just means if you're going to do something today, whatever you're going to do, instead of doing that activity with fear, just make a switch in your mind and do it with a little bit more confidence and feel the impact. You'll notice it has an immediate impact. It doesn't matter what you're doing.
It could be just getting into bed if that's what you feel like doing next. How are you going to get into bed? And so that's what I would encourage you to do as we part for today. And as always, I thank you for being here.
And I'm so grateful for the ability to have a positive influence on even just one person. And I'm grateful that you are taking the step to empower yourself to improve your life. So thank you very much.
And until next time, take care. Bye.
