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June 3, 2019

Fix your back pain with Dr. Sabastian Gonzales

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At some point in our lives, we're almost certain to suffer from back pain. In his book, I Will Beat Back Pain, Dr. Sabastian Gonzales gives us some great strategies to fix back pain.

Allan: (01:22) Sebastian, welcome to 40 plus fitness.

Dr. Gonzales: (01:25) Hey, how's it going? Thanks for having me.

Allan: (01:27) You know, there's a stat you put it in the book that I'm very familiar with. It's that 80% of us are going to face back pain at one point in our life. I find it hard to believe that it's only 80%. I know I have a couple of times, had some issues with my back for various reasons. We'll get into some of those in a moment, but when your back is hurting, it is like the end of the world as you know it because you're just not capable of pretty much doing just about anything movement wise that you would want to do. And even sometimes just laying, you know, the depression and all the things that happen when you're going through that kind of pain, it just really is debilitating.

Dr. Gonzales: (02:13) Yeah, it's a tough thing. If you consider like shoulder issues and ankle ones and like, they're terrible, they're not fun, but when you have a back condition, you literally cannot get up off the ground sometimes. And I know that people don't always like to talk about this, but you can't, sometimes you can't have sex with your wife or your husband, you know, it's like there's all of the other things that are very depressing and it affects a lot of people around you. So yeah, back pain is, it's pretty terrible. And the 80%, I would actually venture to say it's maybe a little bit more because a lot of people don't report their tightness as being a back issue. So just a thought on that.

Allan: (02:49) Yeah, and I would agree with that and you know, you sit there and you just do something and it's just, we'll call it a tweak, you know, it just hurts a little bit, you're a little uncomfortable, it kind of puts you out of sorts for a few days, and so you're obviously at that point, you're just going to pop some Ibuprofen and go about your day, but you're not living an optimal life because you're just not capable.

Dr. Gonzales: (03:12) Yeah, I think it's when it hits a certain point for people when they can't do some normal stuff throughout the day, then they start reaching out for help. But luckily a lot of them do tend to self resolve and I think the body is pretty innate about figuring this thing out. I guess an example would be if someone dislocate your shoulder, you never see them walk around with their shoulder over their head. There's, I think there's these little reset points which would help us kind of get through these, but sometimes you just need a little help along the way, you know? And that's why people are in chronic pain sometimes, you know?

Allan: (03:42) When you got into the book, and this is a little deeper into the book then the beginning, and I kind of wanted to jump ahead to this because I think maybe one of the reasons that we struggle as much as we do is a lot of people actually don't understand how the back works. There's a lot of myths about back pain and one, I'll share with you. I have this great doctor. He's, he's my wellness doctor. I go to him for wellness visits and every time we talk, you know, he is like, so what exercises are you doing? How are you doing? And so when I tell him I'm doing deadlifts and I'm feeling pretty good, he was like, oh no, don't ever do deadlifts they are bad for your back. And I'm like, well, actually no, they're strengthening my back. You know, if I do them right they're not that bad. There's this thing out there of don't do deadlifts. They're bad for you. There's some other myths that you share in the book. So I hope people realize that's a myth. And that's why I'm saying that if you know how to do deadlifts with good form, they're not bad for you. They're actually a good way to strengthen your posture.

Dr. Gonzales: (04:52) It was actually funny, recently I saw a whole thread going around on Instagram where I was, it was the news I think in Michigan or something like that. Some institute put out, never do, squats and never deadlift and stuff like that. So it was kind of interesting, all these things that kind of fly around, but there is a lot of myths surrounding back pain I think. And I guess I should kind of preface this and frame it cause I know there's people out there who are going to maybe take this the wrong way. But this is all based on my own clinical experience as well as the current research that I'm reading. So, I don't want to say I'm Poo pooing on all of these things always, but for the most part, like say rest, like people tend to rest a bunch and I think there's a time and place for resting. But I think there was actually a study where I have to find it. But, when you have too much bed rest, it actually makes things worse sometimes, you know? And kind of with training too and weightlifting, like there's these bell curves, right? It's like you kind of want to be in the middle and the soft spot on a lot of these, I guess myths and fallacies that we have too much training is too much. Not enough training is not enough and you're deconditioned, right? You wanna be in the middle.

But some other things that people tend to think about, you know, their back is that the tightness should always be stretched out. And a lot of times this tightness is protective. Like the body's pretty smart with this stuff. It says if you hurt yourself bending forward, the muscles tighten up in the backside to stop you from doing that from a period of time, you know, and the dead lifting one is obviously something. And a really common one I think is everyone who's getting into their 40s and 50s and so on that it's not always age related and there's not actually, I think the peak actually as I look back, but the peak of people having back pain is usually within their 30s. And a lot of people who are in their 40s and 50s just saying like, oh, I'm just getting older and this is how it is, I'm getting arthritis. And I see people every day and sometimes I'll discuss this with them, sometimes I won't, but they'll say, well, I get the shoulder issue, maybe it's arthritis. And I'm like, well, you know, arthritis doesn't really hurt that often. It's just a sign of something going on. It's like water on the ground it your house and it's just a sign that there was a leak there maybe but there's not anymore. And it doesn't always have to hurt and I think a lot of people, that probably one of the biggest myths ,that I guess would be that people tend to lean a lot of their back pain on that. The fact that they're getting older and that degeneration is occurring and arthritis is there an osteophytes are there that you'll find with an MRI and that's not always the case. I know that you've had experience with some back issues. Did they talk about that with you too or no?

Allan: (07:32) Well, I actually didn't go to a medical professional my back pain. I was fortunate to know what I had done and why it had happened. I was doing crossfit and I let my ego get in the way. The instructor there, the coach, like to program a heavy lifts and then he liked to program dynamic movements and so this was a heavy deadlift for max rep of three. He started us at about 65% of max for 3. And so I calculated my max and then I started just bouncing up. Well, they started running out of weights so my increments up, were a little more than most, most were throwing, you know, two, two and a half on the other side or five pounds on either side. I was going in increments of 10. And so I got up to, what was basically my one rep max and I pulled 2 really easy and the 3rd one I didn't pull as easily. I was fatigued, you know, and a smart man would have quit.

But I had a metcom to follow up with, so I go and I get warmed up for the metcon and then it's a quarter mile run and then it's as it's hang clean and if you don't know what a hang clean is basically where you've got the bar resting against your thigh just slightly above your knee and you lower it down to closer to your knee and then you clean it up to your chest. And to me that movement didn't have perfect form. I didn't do the exercise as well. Plus it was all for time so again, just another confounder of good form is trying to do things faster than you should because you're being timed. And so yeah, that was just a few rounds of that, I think we were supposed to do three rounds and I was on the second round and I finished the round and I walked up to the bar and I looked at it for a minute and I just said, okay, I'm done being stupid. But I sat down on a box and I just sat there for a minute and I'm like, okay, you know, I've got a problem here, I'm hurting and I'm just going to let his sit for a while. That was the end of my workout. I didn't finish that work out cause I at least was smart enough to know when I was injured and you know, not smart enough to keep myself from being injured. But, and then the worst part of it was that I had walked there and it was about a mile from my house so I had a one mile walk.

So that seared into my brain that, you know, the back is one of the most important elements in the kinetic chain. It is a part of the connect chain, whether you're talking about the posterior or the anterior. So front or back, it affects your movement, or side to side, it affects your movement and just about all the different planes that we studied for movement kinetics. And if you're not taking care of it, then you're going to end up with some pain or some tightness from time to time if you're active and doing things. And even if you're not active, there's still the likelihood that you're going to have some back issues at some point.

Dr. Gonzales: (10:45) Yeah. And I really like what you said there with yours and I recognize this with mine too, is that when I had mine, it was also from deadlifting. It wasn't too much. It was just enough to create an issue. And I look back and I thought after one of the reps I'm like, hmm, it feels weird. Okay, I'm going to keep going. You know. And so I liked it with yours, you're taking a good responsibility with it cause you, although they programmed it for you, you really did it to yourself. And mine was ego too. And I think there's a lot of times, the people listening are thinking about all these considerations of the reasons why their back hurts, you know, and maybe they say they sit too much or that their mother or father had back pain or you know, they say it runs in their family and all this kind of stuff.

I always like this to say that the environment is not static. Like we can change it however we want to and we don't have to do anything that we don't want to do. And when it comes to exercise programming, maybe in that one, if someone had an issue with their back and couldn't been forward, who had a past disc injury, maybe a dead life, a clean and then toes to bar all possible rounding, forward torquing movements on the spine. Maybe we'd split that up. Like maybe I wouldn't do deadlifts that day. I would do split squats or instead of toes to bar we might do bird dogs or something. And I had a friend that, he had an interesting story. It was a little bit more relationship to I guess a sciatica type of presentation. But he was working at a clinic at a school and he had all these track athletes that were coming in and they all had hamstring strains, they would call them. But really they presented as like a nerve based tightness because sometimes nerve will create tightness in an area as a response to protect the nerve or the back.

And so he asked them about their programming and they were doing crunches and Russian twist and things like that, a lot of them. And so he basically removed some of the rounding moments in the exercise that they were doing everyday and he replaced them with an extending one and almost all of them got better without even having to treat them at all. And so in that type of condition or that situation and say what yours is, if that's the programming every day, that's the driver of the condition and the back tightness isn't normal. It's just a result of what you're exposing your body to throughout your entire day. Entire Week.

Allan: (13:10) Yeah. And that was my big takeaway from that was that while this guy is fairly decent at his programming you know there are times when he is not on his game and I need to pay attention to that, you know? And so that's less than, and that's really in my mind, that's the value of pain. A lot of people think pain is a bad thing to be avoided. You know, use Ibuprofen, use a pain killer. Pain is actually a very good thing if it's telling you that your movement patterns wrong, it gives you that opportunity to fix it before you do some real damage.

Dr. Gonzales: (13:49) Right? There's one guy I interviewed that had a good saying, he would say if patients are really not getting the point about pain. He says, “so it sounds like, correct me if I'm wrong, but pain is here to punish you throughout your life.” And they're like, well, no, I don't think that's it. It's like, well, pain is your alarm. Pain protects you, right. So when we think of it that way and use pain as your guide it very rarely steers you wrong and you figure out the mechanics of how you can actually improve what your conditioning is. Whether it be a back or hip or an ankle or whatever.

Allan: (14:24) In the book you talked about some questions I assume. It sounded like a question that you'd probably ask your patient and it was, What do you believe to be true about your back or leg pain? Cause I thought, you know if I went to a doctor, if I felt like I needed to go to a doctor and I was there and he asked me that question, I would have a hundred different answers, you know, but, but that's only because I've studied corrective exercise and I've done those things back before I did those things. I remember going to a chiropractor with my then wife, now, ex wife, and she was going to the chiropractor and loved him. And then I went over there and he was basically I can't think of what the actual name is, but he was this Swedish guy, you know that perfect, Swedish looking guy. And I'm like, that's why she's here. And she says, well, let him check you out.

At this point I was 29 years old. I was about as fit as I could possibly be. I was at about 11% body fat and lifting, moving, doing everything I wanted to do. And he starts, you know checking my hips and checking this and that and he says, oh, you could really use an adjustment. I'm thinking I'm not in any pain. I have no outward symptoms whatsoever. You can physically look at me and know that there really weren't any muscle imbalances at that point. I was actually still really good about training balance and not just training upper body and ignoring lower body. I was very well balanced and you know, and if he had asked me that question I would've just said, it's that you get pain and then you do something about it. But what are the most common answers that you get when you ask them?

Dr. Gonzales: (16:26) There's a bunch. So a lot of times they'll tell you that it's muscle tightness. And I just got off the phone with this lady that had gluteal pain. And so right around the cheek on the side hurts when she gets up in the morning, it gets better a little bit throughout the day hurts to sit, actually squatting was okay she said, but deadlifting is not good. And so I can investigate all I want to and then deduct that I want to do a certain thing with her, but unless she's willing to accept the suggestion, she's gonna think I'm full of crap. And so I like to really figure out who, I don't want to say my opponent, but who the other person I'm playing chess with because this person's in here too for my guidance.

And I had an intern in yesterday and he said, I really like how you communicate with your patients. And I'm like, well the way I see it is that this person, this lady in yesterday, she was in for an elbow condition, which she believed it was Golfer's elbow because she was a golfer and she had pain on the inside part of the elbow. And I've found that actually I can change her elbow symptoms based upon a position. So seated she had elbow pain, laying down she didn't. And I'm like, if you had a thing in your elbow right there that was like torn up and just beyond belief, just imagine it just like a fraid piece of meat. It doesn't matter what position you're in, it's going to hurt. Right. And so I told the answer in that I think my responsibility, no matter what the person who answers is to validate that I heard their concern and to disprove them if it needs to be disproved.

Because no matter what I say, what I think is not going to matter because their value system is stronger than what I'm saying today. I had a girl in recently that I'm just going to do the ones that come to mind, a back one doesn't come to mind right now, but this one was fun. She had a knee condition and I said, and she was in for a couple of things, but I said, I was concerned mainly with her knee and so I'd seen her a few times and she said, hey, I'm like, how's this knee doing? Cause it's been flaring up over the last few months or so. And she said, well good. I'm like, explain that to me because you don't seem confident in that answer. Right. And she's like, it its okay.

And like does it hurt? And she's like, yeah, it hurts. I'm like, so do you want to do something about that today? And she says, no. And I'm like, well, how come? She's like, that's just how it's going to be. And she's 35 she's not, she's not old. So she says, this is this why? Because when I was 15 I tore my ACL and I said, did that hurt last month? She says, no, and I said, it hasn't hurt for 20 years and now it hurts today. She says, yes. And I said, so you believe it's from your ACL injury. She says yes. And I said, what do you think's going to get rid of that? And she says, losing weight. And I said, so, which one? Is it losing weight or is it the ACL? And last month you were in pain. So through that, they're not always wanting to have this discussion but to implement what is gonna be useful, whatever that might be.

We need to refute what they've been told and some people have been told, with their back that again, that they did they have a muscle strain. A lot of times they'll get hung up on these imaging findings and a lot of times they'll end up with me, with I have, I was told when I was 15, I had scoliosis, I went to another doctor and he took x-rays and I have arthritis there. I had a disc injury when I was 18 and working out with my friends in the gym and we were squatting and it hurt her since or I have a weak back. So sometimes the remedies are, well, I think I should clean up my nutrition and maybe that's merited. Maybe it's not some people than with the weak back conversation. They'll say, well, I need to strengthen my core.

And so they have all these beliefs of, again, they could be right, they could be wrong based upon what we see. And then they have the corrections they think they need. And I feel like my responsibility with that is again to prove or disprove that. And if there is an intervention that they're doing, which is harmful, and let's just say what the back they're saying, well they are with the core one and they say, well my core is weak because my back is weak and I need to do sit ups. So if bending forward is a triggering movement for them, which it is for a lot of those with disc issues, big or small. Then they're triggering their symptom. So in that case I would tell them, well, here's the reasons why I don't agree with that and I'll prove it and disprove him anyways.

And then I make a suggestion of something else we can try. However, if that same person says, my core is weak, I'm going to do Superman's. So extensions, a lot of times these people extension is fine. So at that point we kind of choose like, is it worth fighting this battle with this person or not? And it probably isn't at that point. So we need to figure out what the triggers are with their symptoms, figure out what their beliefs are, what's going to help and then pick and choose of where we want to dabble with their life. You know?

Allan: (21:29) Yeah. Cause I think that's a lot like with what I do as a personal trainer is I have a limited amount of time with a client, and if they're not buying into the program, then they're not doing the things that we need them to do when they're not with me. You know? So that's where my challenge is say, okay, look, I can work your butt off in the gym or I can work you out online. I can give you a program to do. But if you're not doing the work or you're not eating the way you need to eat, or you're not getting the sleep that you need, or you're dealing with chronic stress, we're still not going to get you exactly where you want to be.

So they do have to kind of do that buy in. And then I want to talk about that buy-in because I think that's a huge, huge, huge thing that it's kind of the 10 amount to what your book is about. If you don't have that, you don't get there. And then I appreciate that question kind of takes us there. And I think the reason that you can do that is because you've become an expert through self requirement. You got injured when you were younger playing baseball and then you got older and you had another injury and you still wanted to play baseball. So I can completely appreciate that. I played football in fairly competitive leagues, flag football and otherwise until I was 41. So I can get the wanting to be out there. And then when your body's just starts telling you, hey, take a break and your brain's saying, no, I still got it.

Can you talk through your second injury? Cause I think that's the one that I really felt like, okay, at that point you were not new to back pain, and you were not new to injuries but you approached it in a very, I think really, I mean you were mature but you approach it, it's hard to be mature when you're in pain. It's hard to be mature when you're dealing with your own issues and it's hard to be mature when there is doctor Google. But you approached in a very good way. So I appreciate if you tell that story.

Dr. Gonzales: (23:29) Yeah. Thanks. So yeah, the second one, I was 35 at the time actually. So the difference of the first one is 16 and I think the big difference between the two was that number one that I now, I hadn't had nine years, eight years of clinical under my belt. So I kinda knew the body a little better, but also because I was older, it was funny how quickly I ran into this what it's supposed to be. Like getting older type of thing, you know? And because everyone tells you after a certain age, it's like your body's going to start to wear away. And so even though I kind of knew better, it still creeped in. And I find even now with some of the things that I'm like, I had a patient just the other day that that had a little bit of mid back pain up and it's not a lot, it's just a little aching and burning and so on.

So this person comes in and they explain it and I'm able to troubleshoot it with them. However, it's hard to troubleshoot on yourself. It's really hard. And although I knew how to work with people with back conditions, it was hard to see through like the fog of having it. And so through the second time I went and saw a friend who was right around the corner and he's a good physician and I offered him money. I wanted to pay, I didn't want anything for free and I know my insurance wasn't going to cover, but I know the value of it and I know what this can turn into. So it's very, very scary and it's depressing and, I want to make sure that I was gonna get better cause I know you can get better.

I just, for some reason I couldn't find my own way doing it myself and I was fearful of movement. I didn't want to bend forward. I didn't want to pick up a weight anymore. You know. I stopped running, I stopped doing everything. And, so I didn't want to de-load and I didn't want to get worse over time, so I talked to him, I said, look, Cody, I had this thing, I want you to help me with it and I want you to be my quarterback basically, and I'm willing to pay you. I will do everything ask, and that's it, you know? So I kind of submitted myself to his judgment of what he thought we should do versus my own. And it was actually, once I kind of did that, it was very relieving knowing that someone else kind of has an eye out for you.

And so he tested everything and like I was even freaking out thinking like he'd get these little flickers in your legs sometimes and it's just, I call him creepy crawlies and it's like, hmm, just Parkinson's, is this MS is this, I mean, so your mind just runs wild. And so he ruled all that stuff out beyond reasonable doubt and gave me a game plan and probably within the first week, and I documented all this to make sure that in case I ever misspeak, that I wrote like a ledger. I wrote like a diary and did an audio throughout the thing because I knew it would be a unique situation that I hope I'm never in again, but I'll probably be in a couple more times. And I think I was about 50% better in a week and I just followed his game plan.

And then, so as I went through that, I eventually got to the point where I was better. I'd say I was like 80/90% better, like didn't have any pain but still have thought. And so as baseball season started to come around again, I, I went back and I said, hey, Cody checked me out. Like I want you to stress test everything. Just figure out where, if there's any risk reward variables. Like, am I going to risk anything by going in his swung a bat, because back when I was 16 I did like four months of Rehab, swung a bat, I was down again really quickly like the first swing. So it freaked me out cause I had this past experience thinking of swinging a battle is going to take me down. So he stressed test everything and he's like, you're good to go.

He's like, the biggest problem with you right now is that you don't have a general physical preparedness. You're not lifting anything, not doing anything. And so I reached out to a strength coach and he took me through deadlifting and squatting and single arm pulls and pushes and so on. And he came into my office and I paid him over a hundred bucks at a time, you know, and he did it twice a week. And so I'm, I'm really the living version of what I wish people would do with back pain. And I know how to cue a deadlift. I wrote a whole darn article on it on bodybuilding.com and but having a keen eye to it and having someone cue you and coach you is extremely valuable and just knowing that it's going to be okay. Like just saying, is this safe now? Like, yeah it's safe now do it. You know?

So that was very helpful. So that was what got me through that. And then now I'm out on my own and I play baseball at season. I have no problems. But it really gave me a good insight to see what patients see on the other side because it's doubt. It's doubt is what they basically get. Are we doing the right thing? Are we progressing in the right direction? Am I going to hurt myself again? You know? And it is scary. So we can help people with that. And I got a unique dosage of it.

Allan: (28:18) And that's what I really liked about that story is it really kind of brought to bear the fact that when we're going through pretty much any kind of physical or a health issue, our brain is the most powerful thing in the room. I mean, if we don't believe we can get better, we're not going to get better. If we don't trust in the process that we're going through, it's not going to work for us because we're probably going to skip parts. And if you're afraid of the pain and all you want as an escape from the pain with the meds, then you're, you're not really getting to the fundamental problem and as a result, you're not getting the help that you need. I do really appreciate that you took the time to say, I want to go ahead and bring in the professionals that are going to get me where I need to be so I can get there quickly, can get and know that I'm going to get there the right way and not re-injure myself, not set myself back even further. Can you talk a little bit about, you know, particularly with your clinical experience, some of your patients are going to come in with the mental disconnects the depression. Some are going to come in with the physical limitations. How, how does someone who's coming into this, how do they beat both of those?

Dr. Gonzales: (29:38) So the first thing is, I think I'll start with this. Just so this is just my overall general overview to people. And I want to make sure that when people come in, they understand that there's phases of the things and things drop off. And cause I know people think that, well, I was given this one thing this one time and it worked and I'm going to stick with it for the rest of my life. So I used to recommend four categories roughly.

There's scab picking, based upon Stuart McGill's work. There's first aid, there's Support and then there's Loading. And some people come in needing a lot of first aid, they just tend to trigger their symptoms a lot and they need to do a little bit more of just wound care and it's simple stuff, then you don't do it forever.

And scab picking is people who with say, fluxion and tolerant back pain like disc injuries, they just like deadlifts and they just don't stop. The good thing with those people is that, and deadlifting is not bad, It's bad at that time. Let me make sure to clarify that or re-clean it up. So that's why I start with a disclaimer. But so the people that are actually willing to keep going, they're actually the easiest ones to help because the people who are scared of movement or scared of weight, they get freaked out really quickly and they, I don't say they overanalyze it, but they're very keen to what their body's feeling.

And I did have a lady before, she came in and I couldn't even examine her at all and she wouldn't get out of a very straight spine position. And I said, let me see. I just want to see what your tendencies are. Let's go ahead and touch your toes. And she's like, nope, don't want to do it. And I always say, why not? She's like, I think it'll hurt. I was like, will it hurt? And she's like, I don't know, but I don't want to attempt it. So imagine getting that person then into encountering load and by load, which is kind of the fourth step, which I had a gentleman last night that he was very straight with picking up weight for, I just have them do a simple care, like a farmer's carry 25 pounds per side, nothing big like grocery bags. And so he's very straight by picking it up. And so I said, I'm okay with that at this point, but what I want to clear with you on is that you look like you're afraid to bend your spine and that's no way to live. You know, and these implements here, like barbells and trap bars and kettlebells and bands, these are all implements to teach how to encounter loads through life. And so he's like, cause he's wondering how far we're going to get with like, what else should we do? I'm like, well, uh, how would you pick up your child? And he would demonstrate it. I'm like, great. That's basically a squatter deadlift. And I'm like, how would you start a lawnmower? You know, and it's a single arm pull and there's a little bit of resistance behind it.

So everybody, I tend to start with, just ask, there's a long process. I start with about an hour of just question, and answer time. And I want to see where they're at with things because some people you can kind of see their hesitancies. Sometimes they're being strong and they're not showing their weaknesses and they just don't talk about it. But when you dig enough you start to figure out where their tipping point is. So I think the original question was how do you differentiate between the two? Is that right?

Allan: (32:54) Well, it's more of, you know, yes, I guess you kind of halfway answered it. When I come into the clinic, you have to be part doctor, part shrink to say, okay, is this a person who's going to drive through and want to do this or is this someone who's going to hesitate and you've got to bridge both of them. You got to keep the, the Gung Ho Ego guy from continuing to hurt himself or hurt herself. And you've got to keep the scared mouse aware that they are going to have to do some things that will scare them in order to get past this.

Dr. Gonzales: (33:27) Right. And so those ones who are a little bit more gung Ho, again, they're easier because they're not afraid of really hurting themselves. They're willing to try things. They're adventurous. So we can be a little bit more cavalier with these people and just as long as I do trigger their symptoms, you give them a safety net. And a lot of times that's their first aid that we've gone over that first day. And it might be something simple. The mouse, like people, I always think it's interesting in being on the other side. When I paid the strength coach to come in and work with me. So he'd come a couple days a week and eventually came one and then he came once every two, you know, and so he's texted me and he's like, did you do some strength work this week?

And I said, well, I skipped a day, or he'd find out that I wouldn't do all of, I wouldn't put as much weight on when he was there or when he wasn't there. And so I think it's useful to be very realistic with these people and say, I think just directly, are you going to realistically do the things that I'm asking on your own? Because I think a lot of people have the best intentions with it, but they don't do it or they don't do it well, or they have hesitation. I did have a guy that came in the other night that I gave them about three things I wanted him to try. And that part of the dealing is me testing to see whether this is gonna work or not and if not, I need to pick a different tool. And so he came back and he said, it hurt to do it and stopped and I didn't do anything. And I'm like, so one of them hurts you, but you didn't do the other two? And so I think it's useful to be very realistic with these people and have the conversation that are you really going to do on your own. And if not, you need to have someone who keeps you accountable. If not me, somebody else, it's fine, but you need to talk to someone about it.

Allan: (35:16) And that's one of the things, you know, when I sit down with a client, I'm like, okay, we're not going to get to the end game if you don't have a very deep emotional desire, I call it a “why” to get where you want to go. So the vision, so if it were back pain, I would, the vision is to no longer have back pain and be able to do the things you want to do physically. But you have to have a why. You have to really have something that's going to drive you and keep you, you know, seated and moving forward. And that's the commitment. So effectively, I think what you're, what you're doing there is telling the patient or the client, you have to be committed to this process or we can't get you where you want to go. And it's not always going to be easy. And sometimes it might be scary and sometimes it might hurt a little bit, but here's the parameters and here's the steps. And when they do that, I imagine it works pretty well for them.

Dr. Gonzales: (36:12) Yeah. And actually I listened to your podcast on goal setting. I think it's very good being very honest with what your goal is and not for losing 10 pounds to fitness skinny jeans. It's to, you know, live longer for your children. And sometimes people are willing to reveal that to us on day one. Sometimes not. I'm sure it happens in fitness coaching as well, but it's because I consider it like, when they come in I'm opening a novel, and their novels big, It's like the size of a Bible, you know? And we're flipping through and we don't know each other and I don't know what's going on with you and you don't know me. It's like, it's almost like a first date too. It's like, how much do you reveal on date one?

So I think as I start to learn more about them, I start to realize where I can ask these questions at. And some people it takes longer than I want it to. And I realize every time they're paying to come in and see me they're paying for, and I beat myself up a little bit about this sometimes because I want to get there quicker for them because I want to be very courteous of their costs, but it's really about the experience and the next part of the experience is them trusting me enough to do what I'm asking them to do. And if we haven't hit that point yet, t's like a stray cat. Like you just, you can't rush that process. It just happens, you know? So I think you're right on the goal setting. For me, sometimes it's scary for people to reveal that.

Allan: (37:39) Yeah. And I can, I can, I can definitely get that. You know, pain is kind of one of those things that cuts through most of the other things that are there. And if we want to avoid it then well, it is. Now. I define wellness as being the healthiest fittest and happiest you can be. What are three strategies or tactics to get and stay? Well?

Dr. Gonzales: (38:03) Well, I would say keep, keep moving and I think everyone has a different definition of fitness and moving. Um, I like your wellness definition by the way.

Allan: (38:13) Good, thank you.

Dr. Gonzales: (38:13) But I think we've come a long way in fitness to where you see everyone's highlights on Instagram's of their PRs and whatnot, and I tend to think you should just start doing a little bit of something every day and start to expose your body to different things. It doesn't have to be heavy. It doesn't have to be extremely challenging, but just do different things. They might be walking. So just go ahead and move. I would say use the shark analogy move, you know. Probably another is, if we're talking about physical fitness or at least related to back stuff is I like people to again, goal set and figure out, you know, why they are trying to get in the shape that they are there in. Um, because I think there's very happy people who are overweight, you know, and like I've seen very mentally unhealthy people that are skinny. And I don't think we realize that until we come out on the other side.

But some of the reasons why they end up in my office is because you're doing things that they believe will get them to that fitness or mental goal that aren't necessarily even needed. So really setting your goal, I think could be useful in figuring out why the heck you're doing it in the first place. Um, the third is just chill. You know, don't take your life so darn seriously. Just relaxing every once in a while your workouts and you're all day doesn't have to be a 110%. Just relax, have a cup of coffee, take some deep breaths, take a walk, you know, just chill. And I don't think we do that enough. And you could do that more in Panama by the way.

Allan: (39:49) Yeah, I did this morning.

Dr. Gonzales: (39:52) So yeah, just chill, you know, like, I tend to not sweat the small things, I'm very calm now and not all things bother me. Uh, In the past they used to, you know, I would get really fixated on certain things, but they're really not that big. And then when, you know, when it comes to the grand scheme of things there's no point in getting yourself worked up about it, you know?

Allan: (40:15) Yeah. I like those. I have a client, I keep telling him, you know, I really like this statement, I stole it from someone else. But is this really going to matter in five years? Will you remember that it happened in five years? So why are you giving even, you know, 10 seconds of thought to something that five years from now is not even gonna bother you. So don't invest that time today to worry about it. But I liked those, so thank you for that. So if someone wanted to get in touch with you, learn more about your book, I Will Beat Back Pain. Where would you like for me to send them?

Dr. Gonzales: (40:49) Probably go to my website, it is going to be easiest. Um, p2sportscare.com. It's for a while I will have just a picture on the front. You can click on it and it just takes you to Amazon. Some people are gonna forget the name of the book, I Will Beat Back Pain. But uh, if you go on Amazon, it's on kindle, it's on paper, it's on audio at audible.

Allan: (41:14) One of the cool things about the audio book is you actually put a little bonus content in the audio book, right? And your audio journals and stuff.

Dr. Gonzales: (41:22) Yeah. So all those ones that, um, I remember the one that I was snippet in. You can hear the cars passing cause I was on PCH over here and I was just getting off a paddleboard and I was like, should I edit them? Like, no, it's kind of cool. It makes it real, you know. But I sounded damned depressed in that thing. So you can't write that stuff, you know?

Allan: (41:42) So this is going to be episode 384 and you could go to 40plusfitnesspodcast.com/384 and I'll be sure to have a link to your site there Sebastian. So thank you so much for being a part of 40 plus fitness.

Dr. Gonzales: (41:58) Yeah, thanks for having me on. This is fun. You're a good interviewer by the way. Everyone should, uh, leave a review for Allan.

Allan: (42:03) It's always nice to have another podcaster on.

Dr. Gonzales: (42:07) Yeah, I appreciate everything you're doing. It's a good job on the podcast and I audio is great. Everything's good.

Allan: (42:13) Awesome. Thank you.

So how did you like that interview? Did you take something away from it that was really good for you? I hope you did. And if you did, would you please consider being a supporter of the show? You can do this by going to 40plusfitnesspodcast.com/support, and that will take you to our Patreon page. I'll patron is a really cool service that allows you to make monthly contributions to a show like this and help us keep the podcast going. So go to 40plusfitnesspodcast.com/support and become a patron of the 40 plus fitness podcast. I really do appreciate it. Thank you.

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