Dr. Ryan Peebles: 0:00

For most people with chronic back pain, and we deal with people that have been having back pain for 30, even 40 years, you can actually get back to an active lifestyle without setting yourself into, you know, an episode or a flare up of

Philip Pape: 0:17

Welcome to the Wits& Weights podcast. I'm your host Philip pape, and this twice a week podcast is dedicated to helping you achieve physical self mastery by getting stronger. Optimizing your nutrition and upgrading your body composition will uncover science backed strategies for movement, metabolism, muscle and mindset with a skeptical eye on the fitness industry. So you can look and feel your absolute best. Let's dive right in. Wits& Weights community Welcome to another episode of the Wits & Weights podcast. Joining me on the show is Dr. Ryan Peebles, a doctor of physical therapy to talk about a topic that so many people have experience with myself included, and that is lower back pain. You'll learn about the deep core and why it's the key to reversing back pain. We'll get into practical strategies on how to recover from lower back injuries, prevent them from happening and improve our back health. I'm going to ask Dr. Ryan about how things like age, lifestyle stress, maybe even footwear and heavy lifting impact our lower backs. We'll get into the pros and cons of chiropractic adjustments, physical therapy and MRIs. I'm personally interested in that one, and we'll learn about his core balance training to reverse back pain. When chronic back problems threatened to take his passion of surfing away from him forever. Ryan committed his life to uncovering its root causes and learning how to reverse them. Now Dr. Ryan helps 1000s of back pain sufferers each year get back to doing what they love. Without pain. He created a unique movement retraining program called core balance training that is highly successful at reversing back pain through increased core connection. Ryan, welcome to the show. Hello, Phillip.

Dr. Ryan Peebles: 1:55

Thanks for having me. I'm happy to be here. Awesome.

Philip Pape: 1:58

So I want to start off with the whole surfer thing. Because you are a passionate surfer. Not something I'm too familiar with. I grew up in, in South Florida. We had beaches, you couldn't really surf there and I never picked it up. But you're a surfer You almost lost your ability to surf because of your back pain. So tell us about that. And how did that affect your identity?

Dr. Ryan Peebles: 2:17

Right? Yeah, so I started surfing when I was super young, my dad threw me under the water. And it was definitely part of my identity. And it's kind of an extreme sport on the spine because of the pop ups. So if you're not familiar with surfing, you know, when you go to pop up off a surfboard, you're kind of doing a cobra, you know, the yoga position of a Cobra for a moment, but it's also kind of abrupt. It's kind of forceful. And so the repetitive nature of that backward bending Can I mean, a lot of surfers struggle with lower back pain. Because of that, you have tight hip flexors, which I'm sure you and your audience are aware of it flexors and stuff, right. So that's going to make it a lot worse. And that was the case for me. And so I started getting lower back pain at a really young age. And worse, you know, it was probably about 610 when it started and got worse over the next eight years, to the point where Yeah, I had to take about two years away or at this at that point, I felt like I was done surfing. But it was a period of about two years, where I couldn't serve until I learned some things about my body and got it back into balance.

Philip Pape: 3:28

Cool. Yeah, I, I've heard a lot of people go through experiences like that some people really never figure it out, never seem to figure out how to recover. I've talked about my story here where I actually did end up having surgery, it was a micro diskectomy for for severely herniated disc, whether I had to or not, I'll be curious to see if that's a question I can answer from today. But for me, it was like getting back to lifting, right. So people like to do what they do they have passions, and we don't want to give these things up because of something that's potentially fixable. So I do want to talk about the mechanics of this. And some specific questions I have. One starts with just this idea of the deep core that he talked about, that it's the root cause. And, you know, my idea of the core is, you know, the trunk and all the muscles and the system that supports that. And I think of that in terms of like isometrics and stabilization, at least when I do lifting. But can you explain what you mean by the deep core and why it's important?

Dr. Ryan Peebles: 4:21

Yeah, definitely. So I wouldn't say the deep core is the root cause I think it's the solution, actually. So, you know, I can get real deep into the cause, but we'll kind of skip to the fun part and talk about how the deep core can be the solution. It is the it's the muscles that you can't see from the outside. It's composed of the muscles underneath the six pack abs, and they tend to wrap around the torso, you know, the flank area around the sides and it's shaped like a corset. And as the Test designed to support the lower back the lumbar spine. And that's the area of our body. You know, if you look at a skeleton, where there's the least bony support, and you can see behind me scaly back there, for those watching, the ribcage provides tons of support for the thoracic spine, and then you have the pelvis down below. And that's inherently very stable, but there's a gap between the pelvis and the ribs, where it's really just the spine. And so we rely heavily on this corset like muscle group, which I call the deep core. But you know, it's composed of several different muscles. And it doesn't really, you don't really need to know the names, because we don't single out any one of them as the Savior, it's not the transverse abdominus, that's going to heal your back. They're all designed to work together. And so that's what the program that I teach is about is about reconnecting with that muscle group and learning how to use it in your everyday life.

Philip Pape: 6:01

I like that you said they have to work together like a system. Again, just making an analogy to lifting weights, you know, people love to talk about muscle groups and individual muscles and individual, you know, isolation movements, when in reality, if you don't have that overall movement pattern down first, and then overall strength with it think muscles work together, it's gonna be hard to go beyond that, or you might be at risk for injury. So it's funny, you said, I was gonna ask you the name of the muscles a little bit, because I'm so interested in like, Oh, what do you call it? It's okay. So, um, a lot of people. And I know, we want to focus on the positive, but we have to start with like, the fact that a lot of people suffer from lower back injuries, things like herniated discs. So just top level, before we get to all the details, what is what's the best way to recover from them and avoid chronic pain?

Dr. Ryan Peebles: 6:49

Yeah, so there, there's a large percentage of lower back injuries that will end up becoming chronic pain and, and there's another percentage of people who will recover and they can move on with their lives. But it's that large percentage that I deal with, it's specifically chronic back pain that we're focused on. And I guess, you know, the best way to avoid it, if I was going to break it down into like, I don't know, it's just like, in a nutshell, it would be listening to your body. And there's so much more that goes into that. But our body is constantly communicating to us the things that it doesn't like through pain, but also the things that it wants more of through good feelings. And so it works both ways. And if if you just do more of what feels good, when what's working for your body and do less of what's hurting, like sitting, for example, is probably a pretty safe way to not fall into that chronic category. But yeah, I don't think that there's really something I could just say, like, Oh, you got a herniated disc? How do you how do you not let it become chronic? Without talking about the core? Okay. It's such a major part. You know, I think even Logically, if people just think about it, like, there's something to do with the core that that is going to be necessary to recover from that. And so that's where all arrows point to for me.

Philip Pape: 8:20

Okay, let's follow the arrows because you mentioned something like sitting right, where I think a lot of people will say that, well, I understand that I've got things that I do all day, because I'm working behind a desk and work from home and I sit, and maybe while I'm sitting it's not, maybe it's not painful, but then there's some pain when I get up or you know, like I'm stiff and all these things. How do you listen to your body? Because like some people I think don't have that signal anymore, right? So how do you relearn to do that properly? Yeah,

Dr. Ryan Peebles: 8:49

I talk a lot about this actually on my podcast as well. So listening to your body is actually more than just feeling pain, or feeling good feelings. You can get into that what you actually what you spoke about, where sometimes you have to reflect back because the body often has delayed signals. And so for example, a lot of people will hurt themselves, stretching or doing any yoga class, but they're not they don't feel like they're hurting themselves in the moment. But then maybe later that night, or even the next day, they're their back is tweaked, and like they just feel off. I think that's a really common experience. And it's not because of what you're doing in that moment. It's because of what you did a few hours ago or even a day or even two days ago. So there's always this ongoing this this like moving period of time where the things that you've done recently affect you now and it does require reflecting back. Another thing you mentioned is like, well, you know, we got to sit a lot for work and I do think sitting is kind of like the enemy. But it's also to stop sitting is not realistic. And it's also not the solution to back pain. Because if if it was that simple, I think that everybody would have a standing desk and a lot less people would have back pain is

Philip Pape: 10:16

are you sitting right now? Are you sitting right? I

Dr. Ryan Peebles: 10:18

am sitting right now. So, you know, it's gonna be just like a lot of things in life, it's a fine balance. And we have to sit just because of the society that we're in. And so that might require us to do a little more cross training, like focused on things that open up the body, because sitting is a very closed position. It's right. It's like the fetal position. And so walking would be a good example of something that kind of is a healthy search synergistic movement that opens the body. So to do that, in between in a little breaks from sitting, to go walking, but again, I don't really think for somebody that's already in a state of chronic back pain that that alone is going to be the solution is just one step in the right direction.

Philip Pape: 11:07

Okay, so what are the other steps? Right? Because you talked about the core, do you want to get into that?

Dr. Ryan Peebles: 11:11

Yeah, so a little background on the cause, because I think you do have to understand the cause, to be able to, you know, understand the solution. So that was my belief. And you can, you know, do your own research. And, you know, you don't just trust me right off the bat, but take what you believe my belief that the cause of the vast majority of chronic lower back pain conditions comes down to muscle imbalances. And so that's just a word or a phrase for when the muscles in your body are the tension and the tone. And those muscles are not the way that they really should be. So the hip flexors might be a little bit too tight. And another muscle group like the abdominals might be a little bit lengthened, and maybe possibly underactive, and the things that you do. And this pattern, there's a predictable pattern and muscle imbalances. You know, the upper traps get tight, the glutes tend to get a little amnesia, we sit on them all day. That's not surprising, right? So this pattern of muscles that are too tight, and other muscles that are too weak, lead to postural imbalances. And if you zoom in really far in the body, if you look at the joints, they just tend to be a little less congruent than they would be if the muscles that are attached to them, those tension guy wires essentially, were more imbalanced with each other. So you can think about a tent, if you if you had a tent that was held up by guy wires, and you pulled some of them too tight and the others do loosened, the tent would be a little wonky, right. So that's a similar thing that happens to our body, that affects the joints, they're not as congruent. So there's more friction in the joints. Or when there's more friction on something like a disc, your L, five s, one disc, it's going to wear down a little quicker. And so that could end up being a bulging disc, or a herniated disc or degenerative disc disease. The the final event that happens is like the diagnosis. But if you just go upstream a little bit, all of these different results can you can kind of find a pattern that they're all coming from this monster of muscle imbalances that we are dealing with. And this is again, specific to chronic back pain. So yes, you can hurt your back in a car accident. But if you hurt your back, picking up a toilet paper roll, it's most likely not the toilet paper roll that hurt your back, it's most likely that was just to use upon the straw that broke the camel's back. And you've been this has been building up for a long time in these muscular imbalances that I'm talking about.

Philip Pape: 14:01

What about the classic situation where and this is what I went through where I had like when I was 30 just a pop, right? And I was like warming up on squats had to hop really painful went away after a day or two years later, came back. And then it got worse and worse till it was like I had a numb leg like sciatica basically, where I can barely walk or stand. And you know, had the MRI and the whole thing. And I had had herniated discs before and it was now completely like squirted out, you know, so to speak. But I didn't have pain between that entire year just the disease acute episodes, is that that's not chronic pain, or can that still kind of be chronic pain? And I just got lucky and didn't feel it because it wasn't impinging the nerve or is this completely different situation?

Dr. Ryan Peebles: 14:47

Yeah, that's a really good question. I wouldn't say what you experienced is actually a lot more common than the back problem from a car accident, or from picking up a toilet paper roll. Although both of those things happen. A lot, the most common one is something in between those two. And so I would consider just the fact that you were warming up that it wasn't like a one rep max, that it was, there was probably something building up to that. Right, right. And then you went a couple years without symptoms. And that is maybe it's not maybe not typical, but it's not uncommon. And part of that could be just because there are no nerves, no pain, nerves, no nociceptors, inside a desk. So the pain receptors are actually on the surface of the disc, and other anatomy other tissues of the body. So it may just be that the way that your disc ruptured, was not triggering the pain signals until it progressed to the point where it reached that again, two years later, I felt it again.

Philip Pape: 15:59

And then when people tell me about their herniated discs, I hear all different, again, a spectrum of things where it seems that with age, there's definitely some correlation, right? Just natural. I'll call it natural degeneration. But you can challenge that if that's not really true, because there are a lot of correlations we make with age that are not because of age or because of other things that happen to happen over time. Because you're getting older, for example, loss of muscle mass, you know, we we talk about our slow metabolisms, it's not because we're old, it's because we've lost muscle as we age. The I've definitely heard the statements like everybody over 30 hat will show something on an MRI. And, you know, almost everything can be healed and doesn't require surgery. And I want to get into all those statements. Because whether true or not, I want to hear your perspective, specifically a herniated disc, but then other things that are very common degenerative issues that cause chronic pain, what what's your take on all that?

Dr. Ryan Peebles: 16:55

Yeah, so definitely, there is an element of aging. And so with aging, there's going to be natural degeneration, osteoarthritis, stuff like that is going to it's definitely going to occur and all of us, and so you can get to, into the research and find that there's something like, you know, over 50% of people, I actually have it, I'm going to pull it up. While I'm talking here, I have a lot of interesting percentages that would make people feel better about themselves, okay, because if you're, you know, 35 years old, and you have a bulging disc, and you may feel like you're, you know, kind of your spines a little compromised, and then you find out that 60% of people your age, have that same thing. And those 60% of people have no symptoms at all, that there's a very poor correlation between these MRI findings and the pain. So I find it one of the most interesting parts of research, so I just pulled it up right now. So disc degenerate, what's what's your age range? What decade are you in?

Philip Pape: 18:02

I'm 42. Exactly. Okay, so

Dr. Ryan Peebles: 18:04

in your 40s. So, in your 40s 68% of people with no back pain at all will have degenerative disc disease 68% disc bulge 50% of people in the 40s. And this is 40. So it might be closer to 40. And then, let's see herniated disc 1/3 of people, one out of every three people walking around with no back pain at all have a herniated disc. So it's extremely common in their ages as you go up in age. Like I can see in the 80s here. 96% of people in their 80s have degenerative disc disease. It's not really a disease. It's just aging. But the problem occurs when it's kind of like premature aging when these problems start happening too early in life, and different parts of the body break down faster than they should like for me, I was 16 years old. I got my X ray. And the chiropractor who took the X ray told me that my my discs looked like they were 40 years old. So like definitely I felt broken. I felt like something was wrong with me and and so that kind of degeneration happened early for me. And there is a reason beyond age. That's related to that. You know, my personal story. I had something to do with surfing but it also had to do with the fact that I started lifting weights, heavy weights, bodybuilding style lifting when I was 13 years old, and I created these muscle imbalances in my body that I've now discovered a really common across the population. It's the same pattern of imbalances that bring you into the fetal position is the same pattern that people are voluntarily going and when they're sitting. So these types of activities, and it's not just sitting, it could be something like stress, when we get stressed out, we hold tension in our bodies, right? Well, the tissues that hold tension, the best are the muscles, they're the most dynamic tissue in our body. And so they can they that's how they say this, the only language they speak is tension. So they, they increase tension, they decrease tension. And when we're tense in our mind, we hold that in our muscles, and there are specific muscles that hold it more than others. Like the upper traps, you know, those neck muscles that everybody can feel gets tight. On the hip flexors are another one. And all of these muscles are the pattern that they that that they that relates all of them is that they all contribute to bringing bringing the body towards the protective position, which is the fetal position, which is sitting, which is how it all relates to this. And so I know I kind of went off on a tangent there, but it's good. Yeah, that's how you can, your body can age prematurely. And if you look at an old person, they are curling back down right into the fetal position, which is what we started life in, we open up and the goal is really just to stay open for as long as possible.

Philip Pape: 21:26

Stay open for as long as possible. So if we were going to take your 16 year old version of you who had been lifting weights, and then had the surfing the the surfing conditions, you know, the Cobra moves the pop ups, right? That and and we also think about humans before modern civilization, for example. What's the difference? Like is, is most of this issue of being too closed in, like you said, sitting a function of modern life? Or is there would this have happened naturally, if humans lived to they were 50 6070? Way back when?

Dr. Ryan Peebles: 21:59

I definitely think it's related to a modern society. I think back in the day, people moved a lot more. And, you know, there was a point in history when the chair had not been invented yet. And so it's really interesting to think that that, that something that we do, probably more than anything else is, is actually not part of our history. Right. So you know, there's, there's a whole lot of people out there that believe, you know, the healthiest thing that we can do is try to mimic what our ancestors did. And, and I think that I'm probably fall into that category. And there was probably a lot less back pain, a lot less postural, a lot less text, neck, back back then. If you've heard of Yeah. So yeah, definitely related.

Philip Pape: 22:54

No, I can I can feel that. So then what are you doing? What did you start doing? After you had that accident? Or that diagnosis of yours, that you also do for other people? Now that helps us get into that better movement pattern?

Dr. Ryan Peebles: 23:10

Yeah, so the first thing I started doing was searching everywhere. For a solution, you know, I went to every possible type of health care provider, every doctor, I went to countless physical therapists, for a 10 year period. I mean, I tried everything under the sun that I could think of and find. And the turning point happened when I decided that I could, I had to just stop searching outside of me, and I had to just take responsibility, I realized I wasn't going to find the person that was going to heal me. It was me, that was the only person that could heal me. And so that was my major turning point. And I, you know, for me, it was okay, I'm gonna commit my life to the body. And I'm going to start, I'm going to enter a profession that's dedicated to healing the back. And so that was physical therapy for me. But, you know, going through physical therapy school, I was, I wouldn't say it was the thing that taught me my solution. What we do in core balanced training is we actually model core connection, core development after how an infant and a baby develops their corn. Because if you you know, if you look at a four year old child, they have developed perfect posture and movement without any developmental abnormalities before your child has perfect posture and movement. And nobody ever told them how to do that, right. They don't know what a muscle is or how to contract it or what their names are. They just naturally did it. And that was through their interaction with really as an infant and a baby with the floor and gravity and thereby and their intention was that they just wanted to get up and be like everyone else. And they were pushing away from the floor. And, and when you're, when you're an infant, your arms and legs are pretty much have no strength, all your strength is in your core. And so they push away from the floor with different parts of their core. And so we've named these areas of the body, we call them support points. And we model after that, we just simply get down on the floor. And when we develop, we reconnect to our core through pushing away from it. And then it's a three month program. So it's, you know, it's a lot more involved in that. But ultimately, what we do is we get familiar with that core connection, and then we apply it to all the functional movements of our daily life, which if for you, if it's, you know, lifting weights, it would, it would integrate that core connection and do a deadlift and do a squat. And

Philip Pape: 25:58

how does that work?

Dr. Ryan Peebles: 26:00

Yeah, so the core connection is simply just learning a way to engage your core, you know, everybody says, you know, engage your core or use your core or whatever. But how do you do that? Nobody for a long time, nobody ever taught me how to do that, like, what was the right way to do it? Like, they teach in Pilates? Or like abdominal hollowing? Or you bring a belly button to your spine? Is that the right way? Or is it bracing where you're like, you know, kind of bearing down? What is the right way to do that? And, and also, like, how intense do I want to walk around all day, like with a 90% contraction, so that the art of it is really learning how to do it naturally, like in a way that's functional, that you can actually do movements, like something a 10% intensity activity, like gardening, or doing the dishes or something, and have just a subtle level engagement is really not something you can teach in words. And that's why I mentioned earlier, like, a child doesn't really know, if you said contract to your muscle, they wouldn't really know. So he learned through the feeling. And that's why it's it's kind of hard to talk about, it's even hard to, it's hard for me to talk about. And I've been doing this for six years. Now. The learning happens through experience and through feeling so you'd have to get down on the floor. And I'd have to say, Okay, push away from from your back support zone, and feel what happens in your core muscles when you do that. Okay? Now do that for a few days in a row and get really familiar with it. And then we're going to get up off the floor, and we're going to pretend you're doing the same thing. So pretend the floor is there, you're going to push away from that support zone, but the floor is not really there. But the same core engagement will happen without the floor. And then we're going to do that with a deadlift. So that's kind of how it works in the program that that would be that would that process would happen over the first like month, essentially, it's a long term, it's a slow solution.

Philip Pape: 28:15

Ya know, like many things, like many things, I mean, we talk about changing our bodies, even with nutrition, whatever else, you know, it takes time you got to learn, you got to put in habits, you have to practice getting feedback, and so on.

Unknown: 28:26

The most value that I got from this was the fact that I had someone that I could talk to about anything, and that there was going to be no judgement, it was just Well, here are your goals, here's the best way that you're going to achieve it. And then let's work together to help you feel inspired and motivated to do that. And a lot of people out there trying to be coaches, and not all of them have done the work and also just be a genuine person that is positive and coming from the heart in terms of wanting to help and Philip really embody all of those qualities, I would recommend him to just about anyone that's looking to achieve goals in that realm of their nutrition and building new habits.

Philip Pape: 29:11

You have you have videos all right, you have a YouTube channel. Yeah.

Dr. Ryan Peebles: 29:15

So I mean, we have a YouTube channel, which is where I kind of just educate on any number of topics with the actual program is kind of like an online course. Videos. It's five minute videos and one lesson per day for there's there's 12 weeks worth of modules.

Philip Pape: 29:36

Okay, yeah, so we'll we'll definitely put that in the show notes. I want to ask a few more questions about some of the causes too, because you mentioned stress. And I remember when I was going through my back issues, somebody recommended a book to me by someone who had his his whole philosophy was about the mental side of you might even know who it is I came

Dr. Ryan Peebles: 29:57

to John Sarno healing

Philip Pape: 30:00

Gonna go? I don't know what your thoughts are on him or on that on that I didn't pursue it too far because it didn't seem necessarily applicable to me. But anyway, go for it.

Dr. Ryan Peebles: 30:09

Yeah, so that is one of the books on the recommended reading list for all students in the program. I've got probably like four books on this list. And so that's one of them is a pretty big deal. So Dr. John Sarno teaches that all chronic back pain is actually mental. And that it's a he calls it TMS. And so he named it and, and so it really relates the mind and body. Now, do I agree with him? Not completely, I think there's a major physical aspect to back pain, but it's very eye opening for people to even just be introduced that idea of the mountains, you know, the mind body connection could actually be that strong that stress in your mind could cause back pain. And I think there's definitely truth to that. I just don't stand in the extreme side of the court that I say all back pain is from that. I often say that 90% of the solution to back pain is mental. And that's because, yeah, we're doing physical things. But so much of what we're doing is requires focus. And I think a lot of great athletes and trainers would say the same thing about their sport or their activity. I know, that's probably, but I just watched the documentary on Arnold Schwarzenegger. And he was talking about that his bodybuilding was actually mental. And the body, you change the shape of your body with your mind. But yeah, there's lifting weights involved. But there's just such a huge component of the mind in doing that.

Philip Pape: 32:03

I agree 100%, I wanted to bring this up. Because when, when I, when I read that book, my wife and I then looked up the documentary he had made, which is hard to find, because it's not like you could just stream it, you know. And they were just case after case after case of person who people who they were in such pain, you know, they were on the ground and their legs up most of the day, that kind of thing. And they dealt with it mentally. But definitely, again, when I think of lifting weights, for example, I've definitely come around to the idea that the physical, the physical is just the tail end of like the chain of effects, right? You've got to have the mental, whether it's resilience, or focus or mindfulness while you're doing it. And I could see how all of that is tied together and people listening, just be open minded about all of this, because what you're saying makes a lot of sense. And if you haven't found a solution, then you know, there's something else that's got to kind of work for you. It's not like it's hopeless.

Dr. Ryan Peebles: 32:59

Yeah, definitely. I mean, I have I read John Cernos book when I was struggling when I didn't have a solution. And it was a, it was a turning point for me just, you know, it was such a massive eye opener, that I have it on my reading list, right for all of my students. But did it heal my back pain? No, it's just something it's another step. Just like what we were talking about with sitting or you know, cross training to reduce the effects of sitting, it's, it's not going to heal you completely, especially if you have a long history of chronic back conditions. But it is a big step in the right direction. And if you and if you do enough of those steps, with different elements, you can definitely no matter what's going on, you can definitely improve your life to the point where tomorrow is better than today. And you can for most people with chronic back pain, and we deal with people that have been having back pain for 30, even 40 years, you can actually get back to an active lifestyle without setting yourself into you know, an episode or a flare up of pain is just improving that relationship with your body. And it's it's a journey that doesn't end you keep going you keep learning every day

Philip Pape: 34:23

really for people to hear you can you can improve every day and part of it is opening your mind to improving your mind and thinking positively and taking that action and all that like you said not one thing is going to solve everything necessarily but they all come together and maybe spiral on each other. I wanted to ask about so getting into solutions people think about one of those is chiropractic. Okay, I've never been to a chiropractor, I've thought about it but tell me your thoughts on about totally open minded are they worth it? Do they provide relief to they make a difference? Doesn't matter based on the chiropractor, you know?

Dr. Ryan Peebles: 34:56

Well, I'm gonna start off by saying that people think I hit cut I practice and I don't, I've had a, I've had a, you know, one of my greatest mentors was a chiropractor. So I, it's all up to the individual. And like in any profession, there are good ones, and there are bad ones. And so if you're gonna go to chiropractic, my best recommendation is to do your research, you know, look at the reviews on the person, hopefully go to someone with like, from a good referral, because the problem with chiropractic is, they, it's possible that, you know, if, if you get a bad one, like I did, when I was probably around 22 years old, they can hurt you, you know, it can hurt your body, if if they do something that's too extreme. And typically, if you have a herniated disc, the underlying nature of that kind of condition is instability. The tissues that connect the vertebrae are compromised. And when they're compromised, that means they're not, they're not holding it together as well as they would, right. So that's it's not as stable as it would as it would be if the tissues were fully intact. And so typically, you just, you don't want to manipulate, you don't want to thrust an injured tissue like that. And the good chiropractors know that they won't do that. And they use different kinds of techniques, and they adjust other areas of the body. But when I was 22 years old, a chiropractor gave me a strong thrust into my injured vertebrae. And it's, you know, that that sent me spiral spiraling for years, actually, I really, it really messed me up. And so that's why I had a really bad experience with a chiropractor in my life. And that's true story. And, and I always tell people, you know, do your research, but they are, there are good ones out there. And there, they are able to help you get, you know, be like, maybe be a catalyst for getting, you know, improving your body. But again, as I said, in the very beginning of the show, there, the solution is not outside of you. It is not somebody else, it only can be you. And it only can be you improving the way that you use and operate this body that you live inside. And that's, that's my strong belief, there is no other solution to back pain, even if you get surgery, you still have to do the work to improve the way that you use your body.

Philip Pape: 37:37

And that's empowering too, right? Because it means we have control over it. Your example of the cat, the chiropractor as a catalyst made me think of like, for example, these new GLP one agonists for for people to lose weight, right? It's like a catalyst, maybe if you've you know, struggled, struggled, struggled, but then you got to do the work. Right? I just spoke to a person who on my podcast came out say he had bariatric surgery years ago. And he's like, it's tough. If you're going to do that, you got to go through the work. So I like that it really comes down to you your choices in your control, but you have to know what to do, which is guy like you here telling us some some of that, what we can try. So what about two other areas would be massage therapy and physical therapy. So obviously, your physical therapist will in there, but massage therapy, what do you think about that?

Dr. Ryan Peebles: 38:21

I think everybody should get massages, because, you know, it improves blood flow to the muscles and makes you feel good. If you can afford it. You know, it's it's a fantastic thing. Some massage therapists can get a little aggressive. And if you have an injury, it would be very wise of you to let them know before getting a massage can attest to that. Yeah. So I mean, I got one, I think it was two days ago. And it was actually pretty aggressive. And I even told him, I was like, I have a history of back problems. It's all good. Now I just want to let you know. And he was doing some like thrusts on my on my spine. I was, you know, in the middle of the massage, I'm like, It's okay, I don't need that. So just to set some boundaries around your body, don't stay quiet. If they're messing with one of your injuries and it hurts. Speak up there. They don't know. They can't feel you know what you feel. But other than that, I think massage is a fantastic thing for you know, all the reasons even if it's just because it feels good. that's healthy for your mind. Which is healthy for your body. So yeah. Is it the solution to bachlin? Probably not. That's the theme of your battle. Yes. Yeah. So So physical therapy. So I'm a physical therapist, right. So naturally, I would have a bias towards my profession. And I will be the first to say that it's actually not that effective for chronic lower back pain. I did ongoing physical therapy for about 10 years when I had my problem, and I got better each time, you know, I would go for, you know, 12 to 16 visits and then get discharged and then start the cycle again. And each time, I would probably get a little bit better. And then as soon as I stopped, the problem would return. And so I think there's a gap with physical therapy, where the exercises and the hands on treatment become the solution. And I don't think that's enough. Because when you get off that treatment table, and you leave the clinic, with those other 23 hours of your day, if you're just living them the same way that you did before. And I mean, I mean, literally like walking around in your body, bending over doing the things in the same way, then that's so much more significant than 30 minutes or an hour on a treatment table. And so I think that the gap with physical therapy is that there's not enough emphasis on integrating the way that they teach you to use your body into activities of daily living of the tasks that you do the mundane things that you do to get through your day, every day. And that's where I think that you can have a long term solution, and not be dependent on exercises, as the things that will keep you out of pain.

Philip Pape: 41:25

I've never heard it put that way. And that was really clear the idea that 23 hours of our day, when we're not in physical therapy, we're basically reversing or worse, what happened in physical therapy, and then that's only for 12 sessions, right, or 16 sessions and the rest is gone. So I've never heard it put that way. But I know personal experience physical therapy, I was always thinking, I was always feeling like it wasn't enough where there wasn't much going on, you know. And then even when I did the exercises, you're right. It's just like these discrete, you know, moments, rather than, Hey, there's this overall movement pattern you need to work on, like you said, the moving like an infant and dealing with your back that

Dr. Ryan Peebles: 42:02

way. Yeah. Well, moving, developing, like an infant understood under, you know, but yeah, I really, I really don't like the whole three sets of 10 thing. And it's so common physical therapy, but I will also say the same thing. It's the there's, there's good ones, and there's not so good ones. And the best physical therapists are doing what I'm talking about. They're doing movement patterns, they're doing movement retraining, and they're telling you the things that will last beyond walking out of the clinic door.

Philip Pape: 42:40

Yeah, I like how you're speaking movement patterns, because, again, just tying it to lifting because that's, that's what I know. Yeah. When I, when I did CrossFit, and all sorts of other things for years that were fun, you know, they were athletic, but they didn't, they didn't make me a lot stronger help with my muscle mass. And then I learned about movement based strength training, right, which a lot of the compound lifts kind of fall in that category where we start thinking systematically. So I like where you're going with that. That you mentioned MRIs before? And I don't know, we didn't really get into it. The level I wanted to, but how effective are they should people get them? Are they misleading? What are your thoughts.

Dr. Ryan Peebles: 43:17

So I think they're necessary because they, they need to be able to rule out something like a cyst or a tumor or stuff that we can't see that could be going on, on the inside. And so they're important. However, I think that the way that we use them is not the most beneficial for most, the vast majority of back pain patients. Because what happens when you have back pain, you get an MRI, you find out you've got, you know, a degenerative disc, or a bulging disc or a herniated disc, like in your case, oftentimes, we get the report, or we talk to the doctor, and then we feel a little broken. And that is not good for the mind. Because when we feel broken, it actually changes the way that we move is there's a name for it. It's called fear avoidance behavior. And so we we a lot of people can develop a parent movements where they're, they would they'll bend over to pick something up in a different way that's more kind of protective are trying not to hurt themselves. And then we'll also avoid activities we'll avoid, you know, when maybe we won't go play that pickup game of basketball. And so that is in as a single event. It's not that big of a deal, but it accumulates and it spirals into, okay, now I'm not going to do that activity anymore either, because my back's not feeling very good. And then you know, you don't use it, you lose it. Your body adapts to this less active lifestyle. And we continue to go in the downward spiral of back pain. So I do think MRIs are important. But I think it's important to educate people like what we were talking about earlier about how common the conditions are, and how they're very poorly correlated with pain. Because remember, those percentages I was giving you earlier, were all for people that have no symptoms, no back pain. And so there's a poor correlation. And sometimes there's people with severe back pain that have none of those conditions. There's the MRI is unremarkable. But they have severe back pain that is that exists, and it's not uncommon. So to educate people, if you're going to give them the report, and then also, I think there is something to be said about maybe just not actually giving people the report, if there's no red flag, if there's no reason to believe that there might be a cancer in there or something and say, you know, your your spine is relatively normal. And we recommend you, you know, being a little more active and getting some maybe getting some physical therapy to treat the pain that you're feeling that there's nothing really about this MRI that makes you broken or different than the rest of society, sure. And then have the effect on people of feeling broken, and then acting different and behave and moving their body as a broken body, they can feel that confidence, which really, I mean, I've made an entire YouTube stream about this, it really improves the health of the way that you move when you move confidently versus in fear.

Philip Pape: 46:45

All in the mind. And really, a lot of it is in the mind. It's funny, because again, like just my own personal experience with the surgeon I had the first time I had an MRI that showed, you know, showed a herniated disc. And he said, You know what, this is fine. Like, it's fine. 10 years later, as I had really bad pain symptoms, he said, Well, now it looks like you probably need some intervention, which again, for my unique case, may have been the case, before the 60 something percent of people in their 40s, who have some degeneration without pain, then you have people with pain without degeneration in their MRI, logically, then there's an overlap of people who have pain and have something in their mind MRI, but that may not be causing the pain. Right? It's

Dr. Ryan Peebles: 47:27

more of a correlation. And it's not causation. Because again, there are so many outliers. And I think that the way that you had that experience with your doctor was respectable, and I'm sure that there's a lot of radiologists and doctors out there doing it that way. And I'm I hope that it's that's a trend, because it's not the way that I experienced healthcare when I was when I was going through my problems.

Philip Pape: 47:57

So consult how many people who have a herniated or bulging disc? Can healing without surgery? Like, is there a number in your mind that is it? You know, 95% of people? Is it half? Is it everyone? Like what are your thoughts on that?

Dr. Ryan Peebles: 48:10

Definitely, I don't know. But if I had to guess I would say probably north of 80%. And maybe we'll just go with the 8020 rule, because it's so prevalent. Yeah. And I think that the even with people that get surgery, you know, there's so many people that actually get a second 1/3 One. And I mean, I know multiple people that have had six microdiscectomy days. And it's because you know the surgery isn't doesn't heal the disk, either. It's just removing a, you know, a torn piece of the disk that might be pushing on a nerve in most cases. So. So regardless of the surgery or not, I think the solution has to happen. And the only time I would recommend getting surgery is if the pain is so bad that it impedes the ability of you to do that the actual solution, you know, the core connection, if you can't get down on the floor and do it because the pain is so bad that that's when I would get surgery, and then also if there's motor nerves involved, so if you're experiencing paralysis in your foot or ankle or your hip, that would be definitely a case for getting the getting the part of that nerve that's compressed, just to remove that whatever compressing that nerve.

Philip Pape: 49:39

And then as far as the healing goes, is the the movement pattern training that you do the primary part of this or is there an extra element of strength training or something else on top of it?

Dr. Ryan Peebles: 49:52

We don't use weights. So the program is heavily focused on just the Developing the core connection. And then we apply it to functional movements. So we once in those first four weeks, our people feel confident with the core connection that we teach. We start to apply it to standing and hip hinging and deadlifts, and squats. And then we get into these other functional movements that train, hip rotation, and thoracic spine mobility. But the way that we leave people off in the program is we kind of usher them into applying this into the things that they love to do. Because really, that's the motivation for a lot of people is like, I can't do this anymore. For me, it was surfing. And that was my motivation to get my body healthy is so that I could surf again. So to apply it to what you love to do, whether that be weightlifting, or running, or yoga, we actually, you know, I'm a big believer in yoga. So I, I kind of end the program, say like, this is how you would apply all this stuff to a yoga move. But yeah, I will say that I think yoga is the best for healthy people, people who have their bodies in balance. And if your body is really out of balance, you can definitely hurt your back, trying to do a yoga move that your body's not ready for. So

Philip Pape: 51:19

yeah, sounds like just about any movement can can be until you train it. So what about last thing is what about other pain in other areas? Since you deal with a low back? If you have shoulder issues or hip issues? Does this tend to resolve some of those? Or is that kind of outside your scope. And there's other approaches for those? Yeah, so

Dr. Ryan Peebles: 51:36

the focus of the program has definitely lower back pain. But what we've found over the years is that definitely we have the side effect of people telling us that their knees are getting better and their hips are getting better and their neck feels better. And it's not surprising, because we're addressing the body as a whole. And we're improving the posture of the whole body. And those muscle imbalances, that same pattern. It's a predictable pattern of muscle imbalances. And I often refer to it as the monster is underlying a lot of neck pain conditions to you know, like patellar tracking disorders where the patella is actually just in the groove a little laterally, and it's causing a lot of friction. Well guess what's pulling it laterally? A tight muscle on the outside of your leg. And so that's a muscle imbalance just zoomed in to the knee and so that it's that same pattern of multiple monitors that were just generally improving. And yeah, it does tend to make people feel better and other areas that they didn't really expect.

Philip Pape: 52:38

Another another good reason we call it the core right? core of everything. All right. So I there's a hard stop in about five minutes here. So I want to ask you the question I ask all guests, and that is, is there any question you wish I had past you? And what is your answer?

Dr. Ryan Peebles: 52:53

Oh, man, that actually puts me on the spot because nothing that nothing's coming to me right now. No, I can't really think you covered a lot. And I thought you had some really good questions. So I don't got anything for you there.

Philip Pape: 53:12

That works. That works. All right, man. So where can people learn about your program and your work?

Dr. Ryan Peebles: 53:18

So you can go to court balance training.com, you can go to YouTube and just search for balanced training. We're all the same names on Instagram, Facebook, whatever. But I think the best resource that I can recommend anybody is the master class, I just took all the most kind of valuable information that I could and I tried to pack it into the smallest video possible. So it's 15 minutes. That explains explains with illustrations. What I was talking about, you know, the underlying muscle imbalances that often lead to chronic lower back pain, and then the solution that that I believe, is the best way to long term address this muscle imbalance and get get back to doing an active lifestyle.

Philip Pape: 54:13

Awesome. I will add all those in the show notes. And your approach is refreshing and makes a lot of sense to me. Always looking for solutions to this because it is so prevalent, and I really appreciate you coming on the show, man.

Dr. Ryan Peebles: 54:24

Yeah. Thanks for having me. Philip really appreciated. And I look forward to checking out more episodes of your podcast.

Philip Pape: 54:31

Yeah, man. Check it out. All right. Thanks for coming on.

Dr. Ryan Peebles: 54:33

All right, you're welcome.

Philip Pape: 54:37

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