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023 Low Back Pain Part 2

023 Low Back Pain Part 2

By Jurmaine Health

Your sporting choices in childhood or teenage years could show up later when you hit your 30’s – especially when you incurred injuries that were not resolved earlier on. Could your spine be malnourished? It shows up in x-ray as darker shades. We found that in the creative industry, many of our patients suffer from chronic fatigue syndrome. This can occur to young people between mid 20’s to under 40 years old. Find out what else we have seen, what our physiotherapist Cera has been up to, and what else we discussed on this episode.

SHERMAIN [7:05]

Yeah, no, it’s not one diet fits all. You can’t fit everyone into a template. Good food for one person may not be the same good food for someone else. One man’s meat is another man’s poison, that sort of thing really holds true. And that can that can easily contribute to osteo arthritis as a factor.

SHERMAIN [16:28]

(going back to spondylitis)
it’s more equigender and it’s more equalized. Now, the differences that for men is much more easy to recognize, and for women is severely more difficult to recognize or detect

SHERMAIN [23:58]

Capsulitis is a capsule that sits on top of the facet joints capsulitis anything that is it usually means an inflammation.

Dr Shermain Wong is a seasoned chiropractor with particular expertise in Sports Medicine and a passion for the benefits of in ‘Active Release Technique™ (an advanced Soft Tissue Technique developed by Chiropractors). She is professionally trained in ART and has a Masters in Clinical Chiropractic from RMIT University. Dr Wong has provided chiropractic and movement rehabilitation services at international sporting competitions, and provided rehabilitation and training for professional dancers, professional football players and professional athletes.

She can be found at https://www.jurmainehealth.com.au/dr-shermain-wong/

Episode 023 : Low Back Pain Part 2

Podcast brought to you by Jurmaine Health

JACKIE [00:00]

This is Jurmaine Health, the center to help you achieve wellness in both your brain and body. We endeavor to encourage cross communication between health professionals for your health and well being. We will bring you topics on neuropsychology, neurobehavior, neuromusculoskeletal and neurogastro. Movement is well being, metabolism and microbiome, which are also some of the services that we provide. Today's podcast is our second in our low back pain series. And today we'll be talking about the muscular tenderness causes of low back pain. So I have Dr. Shermain Wong with me today. So say hello, Shermain.

SHERMAIN [00:36]

Hello.

JACKIE [00:37]

Sorry about the little wait between the last low back pain episode and today's current low back pain episode. That one can be apologies on my part, as I recently had a surgery for spontaneous pneumothorax that kept recurring. So apologies also as part of this podcast if you do hear me coughing I'm okay, it just I occasionally get caught short of breath. So predominantly because we're talking a bit today, if you hear me coughing, just, everything's fine. It's just so that you guys are aware and I apologize in advance for random, loud coughs. I've got a few topics that we'll go over today. So Shermain and I have were discussing this earlier, and we thought we'd cover on osteoarthritis or also known as degenerative joint disease. We'll talk a little bit about spondylolisthesis, which I know you've heard about us talk in the past in our Sciatica series as well. We'll talk a little bit about spondylitis. Also capsulitis asset syndrome and what as chiropractors referred to as subluxation, as well, might as well start off with osteoarthritis, the easiest one for people know,

SHERMAIN [1:52]

I thought that we should start with your pneumothorax,

Yeah. Isn't it interesting? Then when we talk about pneumothorax, and neck pain and mimicking neck pain and shoulder pain, and those were the things that you had to need, yes

JACKIE [2:09]

Still get a little bit of the shoulder pain, but it makes a little bit of root pain as well. Yeah, that one was removed. Alright, that was the one that I had concerning for the first time. I wasn't as sure if it was a fracture, or if it was a pneumothorax when it first happened.

SHERMAIN [2:24]

So if you guys haven't listened to shoulder pain, podcasts and episodes, it'd be worthwhile for you to listen to them.

Those were in our earlier episodes. I think it's one of our beginning one of our beginning episodes.

JACKIE [2:37]

Yeah, it would have been one of our first ones here. Mm hmm.

SHERMAIN [2:40]

And we spoke about shoulder pain and how it can mimic respiratory issues and respiratory system issues. So it's really worthwhile for you to listen to that.

JACKIE [2:54]

Fortunately, now it's still the shoulder issues now guys come close surgery. scar tissue, of course, shortening the

SHERMAIN [3:04]

shortening arms. And that's right.

So that's post keyhole surgery, post surgery. And so while it depends on the skill of the surgeon, and how the incisions like, how the person heals is very, really much up to their own immunity. And Jackie has one really good immunity.

JACKIE [3:24]

According to my surgeon who said his direct comment was pretty much that the wound is as big as the surgeon more or less and it's up to it's the surgeons dying but the healing the scar healing needs the person's own body. So he was quite pleasantly surprised by my healing he said the exact same thing. I have a hell of a recovery rate the healing purposes so I've got a little lump in one area with a little nick got another little nick that�s got another little lump and one where the main drain was you know, you run your hand down it, you can see the hole, you can see the little mark but on the other two arrows all the three forms going for lump wise, I'd say that that's the one that's got the least the smallest actual scarring scar tissue underneath it.

JACKIE [4:21]

Out of all the incisions. That's the biggest one and that one looks to have currently the smallest scar tissue forming. It's an interesting one.

SHERMAIN [4:29]

It's a good one.

JACKIE [4:30]

And it's a new stitch as well. So might be because of that stitch as well. We'll see how it comes up. At the moment. It's looking like an X marks spot in the area.

SHERMAIN [4:39]

So as far as I'm concerned, we hope to find some treasure in this.

JACKIE [4:43]

Not only do we forget that because that was a treasure.

SHERMAIN [4:47]

Yeah, the whole,

the whole host of yes is a little bit disabled. It can be a bit destabilizing when you see a whole host inside your body your lung, lung feels really

JACKIE [5:00]

especially when like me who thought it was a good only about 10 centimeters or so 15 and then he, I see the video I hadn't, I hadn't recorded. My tube comes out and about 30 to 40 centimeters of a tube.

SHERMAIN [5:16]

So if you guys are listening to our podcast and you happen to just want to see the video in a video you got to DM and let us know that you want to hear you want to see it?

JACKIE [5:28]

Okay, we'll post it. I'll post I'll share the video with you guys but only on requests. It's I mean, it's a bit confronting. It can be special. Yeah.

JACKIE [6:14]

Okay, back to low back pain same with osteoarthritis or degenerative joint disease. Both of them used interchangeably, we're talking about here is what most people known knows your standard arthritis, degenerative thing most of the time comes with time, age predisposes it regardless of how active or how fit you are during the younger years. At some point in time, it will, it is likely to kick in your later years,

SHERMAIN [6:42]

It can and there's also an inflammatory factor to it, worthwhile for people to realize that sometimes it's the diet or nutrition and diet and nutrition for each individual. It's like I think we have started to mention several times over that it's quite different for different people.

JACKIE [7:02]

It's absolutely it's not one diet fits

SHERMAIN [7:05]

Yeah, no, it's not one diet fits all. You can't fit everyone into a template. Good food for one person may not be the same good food for someone else. One man's meat is another man's poison, that sort of thing really holds true. And that can easily contribute to osteo arthritis as a factor.

JACKIE [7:28]

As can just the whole thing's before. Just because you're physically fit and everything earlier on in life that can actually predispose you as well. So your sporting activities what you've chosen when you were playing when you were younger, even going back into your childhood years, you�re your teen years young adult is whatever sport you were exposed to, especially if there was a lot of impact, whether it was a lifting sport or whether it was a running sport with jumping, etc involved, same sort of concept. There might have been some sort of minor tears or minor issues going on that you were exposed and that must have resolved, and that would have resolved and later on, that's how they present

SHERMAIN [8:08]

especially if they're not resolved properly.

JACKIE [8:11]

So we do see that and that's one that we commonly see where it's been more or less continuously exposed trauma like cumulative that wasn't addressed earlier on or wasn't necessarily correctly addressed earlier on. Over the years, it accumulates, and then it shows up. Or the person has this; is the report will show up saying that, yes, there's early signs, already marked signs of osteoarthritis disappoints a person maybe being in their early 30s mid 30s sort of thing.

SHERMAIN [8:43]

Yes, speaking of osteoporosis and being early 30s, versus an older spine. So I think that I've mentioned this to you guys before we had a person coming here. She was she was 19 and her GPs looked at her and said, Oh, you just have a 90 year old of a spine. Her 90 year-old of the spine means that her disk just looks like it doesn't have water, which is normal for all our spines. However, two or three patients after her, came in that day as well, and he was a young man or young guy, I think at a point in time was like 30, or just before 30. And he had several levels of degeneration in there already. So whose spine is older in that sense, you know, and I asked him at that point in time I asked him if he well it looked like, for some reason, it just looks, it looks like a malnourished spine . How do I describe that further? I don't have the nuances for that. What I asked him however, was if he worked in the uh he works night shifts, does he work shift work, but he do shift work, because it looks like he needs more vitamin D, a bit more calcium in his body and he said Shermain, I do work night shifts? I do what matches and I do stay in a dark room most of the time.

JACKIE [10:08]

Either words for you malnourished so that our audience members understand a little bit there we've been going if you saw the X ray it look a little bit more as opposed to where it should look more white for your bones it look more dark you should look it comes up looking more blackish or more hollow is probably the best way to describe what Shermain was saying is malnourished. And just for you guys to get an understanding of an idea I should say this right there malnourished, hollow feeling is

SHERMAIN [10:36]

So that shouldn't have happened for especially for someone who's young and we have we recently have recently and of late. We have been having quite a number of youngsters coming in here. Youngsters by that I mean anywhere like 35 and below 40 and below but you're talking about really young people coming in with chronic fatigue or inflammatory issues and Fibromyalgia type of presentation. So I'm wondering why that's the case and that those symptoms signs and symptoms look like a back pain issue to a lot of the time. Those issues are multifactorial, and multi layered. So it's quite an interesting time of our careers here at Jurmaine Health. We see them see these patterns in mostly people in the arts, especially the chronic fatigue. Yeah, very common out there. Mostly in arts. It's common into musicians.

SHERMAIN [11:47]

And I see that a lot, by a lot and it was, what 20-30 it was a lot.

JACKIE [11:53]

You'd be looking at just quickly thinking about patient base of like the creative side, or like the patients that have the creative side, yes, you pretty much looking at a good 50-75% Plus you need us in percent would be very much fitting exactly into that category.

SHERMAIN [12:11]

That's right. And it can be quite young to, you know, talking about somewhere along the lines of

Majority

JACKIE [12:17]

late and yeah,

SHERMAIN [12:19]

between Yeah, you mid to late 20s. And under 40. Yeah.

SHERMAIN [12:26]

And they are bucking the trend of most what we would describe as most commonly thought of like women in their 40s or 50s. And they are housewives, they are just thinking in their heads and this was what we were learning. Especially, you know, in the textbook in the pathology, that's what that's not what we're seeing. And it's interesting. We'll be speaking about fibromyalgia and chronic fatigue sometime later on this year. However, this is what we are experiencing currently seeing and experiencing right now,

JACKIE [13:02]

As Shermain said, they normally presents as low back pain.

SHERMAIN [13:07]

Yes, that's right.

JACKIE [13:09]

Again, it relates a little bit relates back to what you mentioned as well before about the diet as well. Yeah. inflammatory diets. What is inflammatory diet to one person that doesn't necessarily have to be an inflammatory diet to another person

SHERMAIN [13:23]

or an immune deficiency or an immune suppression is common to

JACKIE [13:31]

comes up with spondylitis as well, where the own body starts attacking itself.

SHERMAIN [13:36]

I don't know about its own body starts attacking itself, should we say it means suppression?

I mean this is a segue, a friend of mine who is a researcher in endocrinology and she was saying that there are frontiers and advances in immunity, such that the is like training that immunity is, circulatory training that immunity, so they would, I don't know what they do but it's almost like a PRP extraction and centrifuging the blood cells and then redirecting it into the system again, but I don't know how they do it. So I'm not going to say very much about that. But it was posted in my personal Facebook. Don't look for me on my personal Facebook.

You probably won't find me, and I'll probably not respond

JACKIE [14:29]

Yeah. That 100% there's no point she doesn't respond

SHERMAIN [14:34]

Until about two months or three or four months later. That has happened to several people. So don't take it too personally. I find Facebook a little bit confusing at best of times. So there we go. The millennial in me

JACKIE [14:52]

continue on because you introduced the inflammatory one. So spondylitis one is oligo spondylitis. Structurally it is disabling the inflammatory conditions. So spondylitis, which is what we refer to as an inflammation of the vertebra, one of the most common. Spondylitis is the one that's most commonly seen in males more often in males, and started under the age of 45. Again, so again, seeing a common trend here, inflammatory conditions under the age, or what you normally expect later on in life. They're all studying earlier.

SHERMAIN [15:33]

The fun thing about spondylitis is that I read the description of that on two different organizations. You have big organizations, one is America and one is in Australia, and the Australian one is saying, oh, and it's mainly in males you seldom see in females. And the American one is saying, well, it's equigender. Let's change it. Yeah, it is equigender. Sorry about that guys.

JACKIE [16:07]

Our little Howie barking. We just had one of our staff members come in and he barked at the door �. going back to spondylitis Shermain listen for my answer. So the differentiation, the differences between the descriptions in Australia and America. It has become neutralized your gender, this distribution,

SHERMAIN [16:28]

it's more equigender and it's more equalized. Now, the differences that for men is much more easy to recognize, and for women is severely more difficult to recognize or detect

JACKIE [16:43]

Is that because we've got more, well not for females can have more, it can have different layers that can be pretty much mimicking and again.

SHERMAIN [16:51]

That's correct.

JACKIE [16:52]

SHERMAIN [16:55]

And also the way that most females will probably describe it can be a little bit more broader than males do. And one is saying urbanization also says that Oh, there's no correlation to abdominal issues. You're talking about Crohn's, irritable bowel, anything has got to do with your abdominal contents and that contributes to duty and realizing spondylitis. However another one says that it does. The thing about this is that can that be researched is that researchable are the parameters researchable or not? Because this has got to do with a lot with the circulatory systems, whether other nerves to that supplies that exists that that vertebral vertebrae level affected? Is it affecting and that supply to the viscera the organs affecting that organ, or is it the other way around? Or is the circulatory system been affected to the viscera or the other way around, or the lymphatic system or the other way around. So you have got three or four factors happening that can easily obstruct any form of mobility in there. So yes, we're talking about mobility and movement right? We love it as you may not really love talking about movement, not less mobility, more movement. So when we talk about movement we're really talking about the supply of do you describe it as just the supply of information of the nerves. Yeah, all right of the nerves to and from a to from the brain, exiting the spine to the organs to the limbs and the feedback through the spinal into the brain is that happening is that working? The is so it's also the same rather it's a drainage happening for the lymphatic system from the from the viscera to into the greater into the lymph nodes is a movement from the arteries to those areas as well. If none of these are happening and happening properly, we are bound to get a restriction. And all the time restrictions means usually involve some kind of friction, because you're talking about lack of movement, right? So in the lack of movement, there'll be compensation in the tissues. And then there'll be friction and overtime friction is, is will create inflammation. So that kind of lack of movement is what we're really referring to. Well, that affects the neuroendocrinology aspect of the body's body and then after your metabolism, especially in ankylosing spondylitis, usually most of the time it happens in the lower region of the spine anyway,

JACKIE [19:50]

normally low back and pelvic, into the ankles and shoulders. I think they occasionally talk about,

SHERMAIN [19:56]

But there's much less I think, yeah. So as a result of that one, you know, one of the recommendations is to exercise and go into elongation of the spine is. And that is mostly to deal with the mental aspects and mental aspects of the pain. But when that happens, that's a lot of axial pressure, you're talking about gravity. So there's a lot more compression that's happening. So a person may feel, I don't know 50% better because the mental aspect is stronger, and the mentality and the emotional resilience of the person becomes stronger. However, the issue is still around.

JACKIE [20:41]

It will also the other part, probably the way that you're getting a little bit more that 50% as well. We're not just the mental part of it or mental as well. But the mental also does always affect the gut itself as well. So if they if they were able to control it, Just say their emotions and everything it means there's at least one less slot player and then gut, yep, that's going to be contributing to that inflammatory portions form as well.

SHERMAIN [21:09]

On the other hand, we have got these organizations are suggesting, oh, you have got to do extension exercises. Extension exercises are going to be really painful.

JACKIE [21:19]

Yeah. Especially if it's starting to fuse itself. Yeah.

SHERMAIN [21:26]

Without the tissues being physically manipulated. And whenever they and then and the beings that suggested to go through things like yoga pilates, etc., which might not be a bad thing, if they do not push themselves beyond the range that they can�t get into. And also, on that note, if their gut health is great. Yeah. So if these conditions need to happen for them to feel like oh, I've got a spondy. But you know, it doesn't affect me so much, as well. Their gut is actually pretty good. They are not sitting or sitting or standing too long for their daily and daily activities. We are bending over too much for that as well. And they have got a fairly mobile. Well, no less compensated tissues within the organs and the viscera and then most likely that they will feel like Yo, I'm pretty good. No issues Sir

JACKIE [22:28]

continuing on with dealing with the next inflammatory one capsulitis. Thank you seeing these a little bit more frequently when I'm having clinic with the fine joints with a little a joint. So that we've talked about and between the vertebrae. Again, probably one of the ones that often go hand in hand with a capsulitis luxation I think as well. Again, facet syndrome as well. I think we were talking about this before, but I think it still does overlap with this sole reason. Depends on how they describe different sites again. The English and the American one the Australian and the American ones have different and don't asked, okay, I'm just apparently calling out random countries names yeah like how they had rather two different versions of as explanations. This is another one sometimes Facet syndrome is described as a degenerative issue between and joint just joint degenerative thing on osteoarthritis on the facets themselves. So they couple of joints smaller joints within the spine, not the two big parts of your own vertebrae but the to the engine beats best way that I can describe you have to look it up guys for me to try and try to build you a picture because it's not going to work. Oh Shermain says me pointing random fingers up to try and point these out and it's not, it's not going well. But we may try to explain this to you to try and build a picture. So as I Facet joints

SHERMAIN [23:56]

Google for facet joints. Yes, and the capsulitis is a capsule that sits on top of the facet joints capsulitis anything that is, usually means an inflammation. So the major difference between these two capsulitis is an inflammation that occurs all the time and all for more prolonged period of time. And a facet joint syndrome is usually I feel really stuck. This is a bit painful with this joint is because it's stuck, it's referring to x, y and z places capsulitis can do that too. And it feels a little a lot more tender than tender and it recurs more often than a facet joint syndrome

JACKIE [24:45]

Probably be more pinpoint specific areas

SHERMAIN [24:48]

That's right a bit more localized, usually is an inflammation of some so it could be mechanical, but it could also very easily mean metabolism all that If you are an athlete, or someone who exercises or something like that you are straining, you're straining some form of movement often quite, repetitive definitely is worse if it has got a pressure coming through that particular joint factor. When that happens, we keep having them we keep hammering the same thing over and over again. Then we start having problems facet joint syndrome. That is the bread and butter of chiropractic and we have gone may see that often. Most of the time we haven't anyway, whether we adjust it or not.

JACKIE [25:45]

Just depends on whether we feel it or not as the biggest culprit more or less.

SHERMAIN [25:50]

Yes it comes it comes hand in hand with subluxation. So let's say the funny thing is about somebody saying the word subluxation everyone gets really hung up or hung up on to the layperson, they don't really care. They don't know really what subluxation is. They don't really care to the medical profession. It depends on you know, the weather of the day. It's a bit Mercurial. A bit mercurial like Melbourne's weather really, it can be really hot. And after that it can be hailing all at once within like five minutes, right?

It is.

And subluxation when you google that Wikipedia will say well, Wikipedia is a very well resourced,

resourced forum.

JACKIE [26:36]

You can't make your own Wikipedia. Thanks.

SHERMAIN [26:39]

Yes, we cannot make our own Wikipedia page. Yeah. So what happens with that? I'm not talking about Wikipedia subluxation two different professions. It means different things. To the medical professions. It means shut off the dislocation, and to the dentistry in dentistry subluxation it means a different thing. Altogether as well do as chiropractors, when we are talking about subluxation it means that the joint a particular joint is under pressure. It has is under pressure because of being either worked too much, or that they are an order we need to realign it. So that's chiropractic subluxation.

JACKIE [27:23]

And our last one today Spondylolisthesis will be the big one currently dealing with our lovely Sarah,

SHERMAIN [27:31]

a physiotherapist

JACKIE [27:34]

who will be having that surgery soon. Oh, she's having a surgery. Yes, she will be having this surgery soon. And let's backtrack where you guys spondylolisthesis is where there's been a slippage of the vertebra on top of the on top of another vertebra most often the last few of the lumbar spine onto the sacrum can happen higher up, of course, but that's usually the case most often follows either degenerative issue of potentially a bone defect with through I should say your area on this all the vertebra or it can be due to repetitive stress in your sporting activities majority of the time and young adult young teens sort of thing in your jumping, running, lifting sports again heavy weight lifting and everything where Shermain has been talking about cumulative compressive forces in one particular direction. Nice they put a they put mine fractures through there. And if the fractures become unstable, that's when it becomes slow. That's when it takes a little while but

SHERMAIN [28:50]

it could have a congenital familial disposition to it too.

JACKIE [28:56]

That's what I was trying to get across with my birth defect one. Remember the word congenital birth the

SHERMAIN [29:02]

Birth defect is something else altogether.

So when you're talking about like spondylolisthesis or a particular weak, that position and predisposition this congenital influence of familial influence usually means that it's genetics. It comes from you know, parents grandparents, is a bloodline thing. Whether how it comes about I'm not sure, no, it's all in our DNA when that happens and, and also on top of that, it can be epidural, can effect low back pain. With post-epidural, you know, make sense, can have a low back pain some, some people have it more than others, however, and on the same token or some surgeons or maybe not even surgeon, some musculoskeletal radiologist or intervention pain management would suggest epidural injections to reduce the pain factors,

Isn't it funny? Yeah, this is when we practice sometimes.

So it can cause pain and then also be a pain, okay maybe they can aggravate us; to relieve severe spondy pain too. So I have one patient sometime back and he's young again, he's young like 20 something and he has got severe spinal spondylolisthesis right to the point that on occasions he would feel pain quite consistently he would feel a severe spasm in his abdomen. So initially I thought that it was some a deep into the abdomen to initial I thought that Oh, he may he because of the choice of his sport. That was what was chosen the sport jujitsu. And in jujitsu, you have a lot of flexion in the abdomen area, right. And there's a lot of pressure and pressure and time and tension in the area of low pressure. It's easy, it's not far fetched to say. Hey, you know, the walls of the artery in the abdominal aorta can be stretched to and can be a lot and a lot of pressure. So I was worried. I was really very concerned. I was like, oh, could it be that you know, that's happening to the walls of the aorta? I was like, well, should I send him for a seat here shows me for MRI, what should I be sending him for? And I was like, well, I would do that after I would I send him for an imaging of his spine. And his both degeneration in the higher. I don't know something like three or four or something like that levels and then he has severe spondylolisthesis in 5, L5 as well you're talking about a 25 year old right? And his I can't remember if I managed to do more for that person or not. So I can't be intervention pain management people and I'm like, mmm, what do you suggest and maybe a call a course of epidural injection thing it's quite funny and I've had people who come in who say, Oh, I have given birth and I had epidural and my spine has never been the same since. So it's like it's quite a conundrum. The information that we are getting right now, there's a lot of mixed messages. So as far as I'm concerned, most one is really concerned with spondylolisthesis in the case with Sarah, our physiotherapist you can feel free. And I would encourage you and invite you to listen to our previous podcasts on her speaking about her experience with spondylolisthesis. And she was very generous and kind and brave and open to be sharing that on in public podcast shall we having a fusion, which was stabilized is fine, which is fantastic. However, what I said at that point in time when we were discussing the timings of what we shouldn't be getting it done, and I strongly encouraged her to have her hormones checked. Because this is all under, you know, this is all the neuroendocrine, right. There was a reason for that. And the reason was is if her hormone levels were good, the recovery rates post surgery will be longer and more protected. We'll be looking at you know, instead of you know, one month or two months, we're looking at six months and all those kind of things. So, it was better to you know, in our minds and she agreed to that it was better for our, for her to have a better if there were hormone issues or interruptions or dysfunctions we will have that moving progressing then comes in the timing of the surgery. So that was how we timed that one Yeah and her time is due soon and her hormone levels have once settled and has stabilized, and we are happy with that. Her wrist has stabilized too. So soon enough we are looking forward to we have already set up rehabing her for a while now. And so have a look. This is why you need to get your exercise done and diligently. So her family. She comes from a family of butchers so

well, meat butchers, I mean selling pork , let's just clarify that. Yeah, that's right. Selling pork. So apparently to hold meats, it's really slippery. Mm hmm. Yeah. And so a lot of times they have arthritis in their hands. Mm hmm. Sometimes, yes, gripping, given that she had severe wrist issues prior to going back and we had some PRP done and, and her hormone levels are stable. She said, I recently asked her, so how's your wrist? Is that okay? Is your back okay? Because you're standing for such a long time? She would say, Yeah, there's no issue. She said there's no problems with her wrist and that was fantastic here. And her back is good. Mostly a lot of time she's been doing her rehab anyway, or her prehab. And pretty much was complaining that her feet would fire because she was standing all day in the wet market you see. So there was quite relieving to hear. Yeah, but quite a relief, I think spondylolisthesis in Australia. And well, America or Canada, or even Singapore or Thailand, the way that they understand how the neurosurgeons in the way they understand how to do diffusion. I mean to fuse the spine. I think they're doing a really good job up there, and up here in Australia.

For the majority of the part I think they are pretty tricky. So you know, even if my parents would do, my parents are from Singapore, they live in Singapore. And even if they were to have a surgery, I'll probably have them come here to do it.

JACKIE [37:00]

I agree anytime dad says he will occasionally have a think of like maybe seeing a specialist up in Poland yeah come back yeah we both know the medical system up there there's no point where we're better with certain things like dentistry no problem isn't that we it's much better up there than it is, but I wouldn't necessarily be trusting for certain surgeries and stuff like that I wouldn't be going up to Europe not to Poland interesting hospitals in certain other countries no problem. Germany's great for them especially a lot of the orthopedics and everything, anything of the sort, but I wouldn't be going all over

SHERMAIN [37:40]

neurosurgery is Germany, I think, and Switzerland.

JACKIE [37:45]

And so it also pays back again, Switzerland. Like you just said, Germany. I think America is fairly good with that as well as a few of them like that. But I do think we're fairly good with neurosurgery here as well. So Sarah is in capable hands we like to think

SHERMAIN [38:06]

Is there any more?

JACKIE [38:07]

I think that's it for us for today. For our third part in our low back pain series, guys, if you like what we're presenting, give us a thumbs up a like or share it with one other person whom you think we may be able to help. For those of you who are coaches, dancers or athletes, and may find difficulty with expressing or executing your movement patterns, please do connect with us on our website www. JURMAINE HEALTH.com.au and JURMAINEHEALTH is spelled J U R M A I N E H E A L T H or please socialize those without Facebook which is JURMAINE HEALTH. Now Instagram, which is JURMAINE HEALTHbody, guys, Joe said you can jump onto jurmainehealthbody Instagram, which can also guide you in the direction of our embodied athlete page. If you're interested in following us on that as well. We're getting involved in that project of ours, have a look and read into that as well.

SHERMAIN [39:04]

And we have an embodied recovery workshops coming up

JACKIE [39:08]

in April.

SHERMAIN [39:04]

So one is in April, the other one is in March.

JACKIE [39:14]

Oh so sorry! We didn't have any more obviously we do. We do have a we've got a webinar coming up as well. We should also have a webinar for Embodied Athlete, right? Yes. Okay. I believe that one's either on the second or the third weekend of March, guys, but we'll keep you posted close to the date as well. And probably the next podcast or podcast after that. So don't stress about again, we also do put out all the information on both the JURMAINE HEALTH Facebook page, and then JURMAINEHEALTH body Instagram page. So watch those two spaces as well guys. And last but not least since this podcast is maybe you our clients, patients and fans, do let us know what else you might like to hear about from us. And that's all for us today, guys.

Thank you for listening, if you enjoyed our podcast, please feel free to connect with us on Instagram at JURMAINE HEALTH Body all one word. We always welcome feedback and ideas too. We are happy to answer any questions, just reach out to us at our website, www.JURMAINEHEALTH.com.au. Tune in weekly for the most relevant information on how to live your best life with your best brain and in your best body!

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Welcome to Jurmaine Health podcast where the Center for brain and body improvement and our team that believes that everyone should live their best life in the best body and with the best brain.

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