Month: May 2022

How to Improve Oral Health Naturally EP|66

Live LOUD Life Podcast
Lafayette Colorado

Episode 66

How to Improve Oral Health Naturally

With Sarah Wands

Tune in with Dr. Antonio and holistic dentistry specialist Sarah Wands as they discuss oral health. The effects of fluoride, nutrition, and bacteria on your mouth. 


Episode Highlights

4:00 – What’s the deal with fluoride?

9:00 Daily practices to help with oral health

11:00 Eating hard cheese at the end of your meal

15:00 Good and bad bacteria in your mouth

17:00 Mouth taping to prevent mouth breathing

23:00 X-rays

27:00 Top 3 tips for oral health

About Sarah Wands


  • Certified holistic nutritionist
  • Holistic dental coach
  • Owner of Root Raise Rise

Connect With Sarah:

Sarah on Instagram:

Anthony Gurule  00:08

Alright guys, welcome back to the Live LOUD Life podcast. My name is Antonio, your host of the Live LOUD Life podcast. And today we have Sarah Wands, on into we’re going to be talking about dentistry and holistic dentistry, functional dentistry, we’re trying to come up with like, what the name really is, but you know, it’s one of those things that’s kind of sometimes buzz wordy, but welcome. Thank you. And I’ll let you introduce yourself talk a little bit about, you know, your past your your, not your CV resume, per se, but what you’ve been doing and what do you do now?


Sarah Wands  00:40

Yeah. So thank you for having me. First of all, I love your guy’s practice. And I feel like we’ve known each other for a while. But, so, I’m Sarah Wands. I’ve been in dentistry for 10 years as a dental and surgical assistant, I just recently left after the birth of my daughter, she’s now coming up on a year and a half. And so I really wanted to fuse my background as a certified holistic nutritionist as well as my experience in dentistry to offer Holistic Dental coaching. So that’s what I do now. It’s essentially private coaching related to oral and dental health.


Anthony Gurule  01:22

That’s awesome. And so we were kind of chatting a little bit before, you know, get a little bit of background kind of helping me get an idea of where we want to go with this. And what you just mentioned was really great, because and rightfully so we give credit to certain professions based on more or less the, the letters behind the name, right, which is, which is fine, because they’ve gone through a lot of schooling and everything like that. But even like within our profession, you get to a sometimes complacent level where when you’re talking about it, or I’m gonna back up. We were talking about this came up with about a pediatrician and talking about the whole crawling CDC guideline that’s like another whole thing. But it was essentially like we saw kids, we’ve seen kids that are fine and have no health issues because they didnt crawl, like I understand that right?


Anthony Gurule  02:15

And you can see healthy or people being without disease without intervention. But some people want a different lifestyle. Some people want to be more proactive. And I think that dental coaching is great, because I mean realistically from what I remember about my dentist telling me was brush your teeth and floss and come in every six months, and then you occasionally which is gonna lead us to our first question, do a fluoride treatment because you need this in order to not get cavities and have healthy teeth, so on and so forth. Use it oh, this is a different one, I think come up Listerine and different things like that, to kill off gingivitis and gum disease and things like that. And it sounds like there’s a little bit more to the story.


Sarah Wands  03:03

Yeah, absolutely. And I would say that those general approaches and recommendations haven’t changed much. I you know, I think slowly, in different areas, dentists are starting to shift their focus on to supporting the body more versus


Sarah Wands  03:20

disinfecting, like you just said. But I think dentistry really mirrors the medical approach in general with what it’s doing. And I think we’re just a little bit behind on current information.


Anthony Gurule  03:35

So on that, let’s kick it off with with fluoride.


Anthony Gurule  03:39

That’s a big one. For you know, those are family, your family very similar to some people that are coming into us who are wanting less toxic. Take the things right now our body can handle toxins. This is like the big argument like well, we’re exposed to toxins and all these things all the time.


Anthony Gurule  03:57

But as you had already indicated, even with other things, there’s an accumulation level, right? And when you’re doing repetitive things, such as fluoride treatments or having it in toothpaste on and so forth. So what’s the what’s the 411 on fluoride?


Sarah Wands  04:11

Yeah, so you know, a fluoride I think we’ve all experienced it in I would say three main ways, which would be you know, in our toothpaste at home, at the dentist with you know, the little painting or the swishing, right. Oh, trays, the foam trays


Anthony Gurule  04:27

And they’re foaming out of the mouth…


Sarah Wands  04:28

yeah, just you just die and as a kid. And then the third way being fluoridated water, which most communities have at different levels. And it’s it’s kind of been touted and it’s a strong belief within the dental field that it’s absolutely essential for preventing decay, especially in, you know, poverty level communities. However, the actual evidence and research doesn’t support those claims. So and that’s not to say that fluoride doesn’t harden the teeth at does. But in order to harden the teeth, it actually has to pull minerals further out from the teeth. So it creates this kind of issue. So without without getting too crazy, without getting too far deep fluoride can actually weaken the teeth more so interesting. Yeah, florid can actually weaken the teeth more so and they did a really interesting pretty large study. They audited multiple practices, their insurance billing, and they wanted to know okay for practices that did more frequent fluoride treatments on kids, did they have a lower incidence of cavities and needing fillings, and they could not find a correlation. So of the offices that regardless of if they had, you know, high and frequent fluoride treatments billed for their kids, they didn’t have a lower incidence of cavities.


Anthony Gurule  05:55

Wow. Yeah. So the thing that we are assuming it is doing hardened teeth to prevent cavities, it’s not actually it is not happening.


Sarah Wands  06:02

And you look at how much we’ve raised the level of fluoride, which is completely unregulated and not tested for safety, by the way, it has not correlated in a, you know, lower incidence rates of decay. And in any community.


Anthony Gurule  06:18

what are obviously a little bit more of a deep dive of it could be possibly a bunch of different things. But what are some of the big concerns of high levels of fluoride?


Sarah Wands  06:27

So, specifically with fluoride in water lines is a big issue for your body. Because it not only are you getting it when you’re drinking it out of your tap, but you’re also getting it with any bottled juices.


Sarah Wands  06:42

And babies, whenever you’re mixing formula together. Anything that’s packaged, that has water in it, that’s going to have a fluoride factor to it unless it’s been purified water. And what they’re seeing with that, as they’re seeing in increased rates of ADHD in those communities, especially women who are pregnant and had frequent fluoride exposure, their babies have higher levels of ADHD, autism, cognitive disabilities, speech delays. So it really does, it really affects your brain development In those earlier years, especially,


Anthony Gurule  07:18

that’s interesting. So going back to Now, assuming that it was supposed to be doing the hardening teeth, when this, you know, one of the things we were chatting about beforehand, as well as like, what then would parents like us do when we have kids who obviously want to eat certain things on and so forth.


Anthony Gurule  07:36

But if we don’t want the fluoride treatments, and we’re trying to be, you know, mindful of filtration and things like that, what are the ways in which we can harden the teeth to prevent decay, cavities, so on and so forth?


Sarah Wands  07:47

Absolutely. And that’s where I come in, really, because just like you said, so many parents and families are becoming aware of the effects of Florida and they want to avoid them.


Anthony Gurule  07:57

But their big question is, okay, well, if, if we’re not doing fluoride, what do we do? And, and so my big approach is, you know, it’s looking at, why are your kids getting cavities? Why are they? Why are their teeth experiencing mineral loss? and just different other lifestyle factors. And so just for general prevention, I mean, it really comes down to diet and making sure that their mouth isn’t hanging open all day long.


Anthony Gurule  08:39

Yeah. And then as far as, I guess, a consumer product, because obviously those things take time to work on and first and foremost needs to be diagnosed and actually looked at, but most of us assume and no good daily hygiene for our oral health is good, right?


Anthony Gurule  08:59

Obviously brushing, brushing and flossing. So in terms of like, outside of dealing with deeper dive things of diet in life, or sorry, breathing and different things like that, what are daily practices that you recommend people do to to help in conjunction with the lifestyle? Things are changing.


Sarah Wands  09:17

Yeah, I think that’s going to be pretty standard across the board. You know, without looking at individual factors, I think,


Sarah Wands  09:27

You could brush before eating nobody really likes doing that. But you know, if you’re going to wait until after breakfast, wait at least 30 minutes so that your pH and your mouth can balance out a little bit.


Sarah Wands  09:42

Oh, yeah. You don’t want to start brushing your teeth when they’re in a de mineralized state.  Yeah. So your teeth are at their weakest at right directly after eating. So I would say you know, either brush right away, or you know, have your breakfast and then brush. brush and floss.


Sarah Wands  10:01

You asked what you know, if people are avoiding fluoride in their toothpaste, then they can really go with a hydroxyapatite toothpaste. And hydroxyapatite is essentially the mineral that makes up the majority of our teeth. So when you have that in a toothpaste on your teeth, it can actually mechanically fill in to weak spots in your enamel.


Sarah Wands  10:21

So, brush with hydroxyapatite if you if you don’t rinse it out after that’s ideal floss. If anyone you know was working on imbalancing, their oral biome, sometimes they can do like either an essential oil mouthrinse or a brand I like is Brio tech mouthrinse that can be helpful. I know a lot of people like their mouthwash. So that’s a really great swap.


Sarah Wands  10:46

But without talking about diet stuff throughout the day, one of the main things to focus on is after you eat, helping to balance the pH in your mouth and getting those minerals back on your teeth as soon as possible.


Sarah Wands  11:00

And without even making significant changes in your diet. Two ways to do that is to eat hard cheese at the end of your meal.  And I can explain that more if you want to by eating hard cheese at the end of your meal. It helps to balance the pH in your mouth, make it more alkaline so that those acids aren’t, you know, work in their devilry all day, but also supplies a lot of the minerals that your teeth use to remineralize right after you eat.


Sarah Wands  11:32

there’s actually some really cool research about other countries, they did a study with kids, they didn’t change their diet, they didn’t have great diets to begin with. But they didn’t change their diet, and the only thing they changed was adding one ounce of hard cheese after they ate and their cavity rates dropped. Like significantly.


Anthony Gurule  11:50

what would be an example of a hard cheese?


Sarah Wands  11:52

like cheddar cheese or parmesan or and it could be like goat or milk or you know, cow or whatever. But that can be significant impact, believe it or not. The other thing that’s a great thing to integrate is Xylitol gum, okay? Xylitol helps neutralize acids in the mouth and helps the teeth get back into that remineralisation state.


Sarah Wands  12:10

So, you know, for kids where obviously picky eating is an issue, right? And it’s hard enough as a parent trying to help your kid eat a healthy diet and an ideal diet. But if if you couldn’t change those things, or maybe you co parent, or you have other guardians that and you don’t have full control of their diet.


Anthony Gurule  12:31

Yeah, grandparents.


Sarah Wands  12:34

Grandparents we already know. You know, if you can get them eat, like cheese after meals or just send your kid was in Xylitol gum. Yeah. Interesting. It’s a great mitigating factor for those tough diet changes.


Anthony Gurule  12:48

Before I forget going back the hydroxy apatite. is that right? what are what are some brands that people can look up to that have that?


Sarah Wands  12:56

Yeah, because not all brands are great, actually. So hydroxyapatite toothpaste brands I love, we’ll be Rise Well. And there’s a small company of like a family owned company out of North Carolina calls happy tooth toothpaste. They both have Hydroxyapatite options. They’re really great.


Anthony Gurule  13:16

Now being that they that in particular, is the mineral Correct? Is the mineral that the tooth is mostly made of, and that’s going to fill in the memorization as you go. Is anyone creating a because you talked about mouthwash too. Is there a way in which or if anyone’s doing like a, like a mouth wash, where you swish it around, and you try to hold it? Or? You You know, what I mean? Is there anything outside of just gum in which hydroxy apatite and Xylitol I guess, can be applied and used to help with that for maybe someone who has a more serious case of demilitarization or something like that.


Sarah Wands  13:56

sure Yeah, both of those companies actually have mouthrinses that how okay have Xylitol and there I look at mouthrinse and and I like to distinguish between mouthwash and mouthrinse because mouthwash is more of clearing out bacteria in your mouth and the good bacteria as well. mouthrinses I like to look at more of as supporting your mouth’s natural biome.


Sarah Wands  14:21

So whenever people do have you know more chronic decay issues or you know, gum disease or periodontal issues a mouthrinse can be helpful if it’s you know, xylitol or more neutralizing essential oil based


Anthony Gurule  14:35

Oh, nice that…I just had a question I apologize it literally just ran out of my head.


Anthony Gurule  14:44

So we were Oh so the bacteria that’s what it was? Yeah. So very commonly as common practice in encouraged by at least one viewers younger dentistry and things like that is the mouth wash. So your Listerine and your things like that. So that’s Zapping everything right?


Sarah Wands  15:01

Yeah, you know, what’s interesting about most mouthwashes on the market, even prescription ones is they’re actually acidic. So completely counterproductive to what you want to have in your mouth.


Anthony Gurule  15:13

So why are they prescribed than just that you’re killing bacteria, right? You’re killing good and bad. But the thought is that if you have too much bad, then that’s what’s going to be causing an issue.


Sarah Wands  15:22

I don’t think that conventional dentistry really acknowledges the existence of the oral microbiome in general, they don’t really honor that, you know, environment in your mouth. So what they know is there are six specific strains of bacteria that cause cavities, Periodontal Disease, Gingivitis, bad breath, all of those things.


Sarah Wands  15:45

And so their thought is, okay, well, let’s just kill those. But they don’t respect the fact that there are certain strains of bacteria in your mouth that you want to keep colonized. And so when you bring in something like Listerine, or mouthwash, you’re really just disinfecting everything. And it, it just creates more of an imbalance. That’s kind of like taking antibiotics in your body. regularly.


Anthony Gurule  16:08

Yeah, well, and going back to which we did a previous podcast, if anyone is interested, we talked about holistic dentistry for tongue ties with Dr. Liz Turner in Lakewood.


Anthony Gurule  16:21

So this comes back down to how does the bad bacteria grow? diet, lifestyle, mouth breathing? Can you touch on some of that, and how that obviously, just like, our poor diet, and everything else can mess with our gut microbiome, diet and mouth breathing effect with our oral microbiome?


Sarah Wands  16:39

Yeah, so just like any other microbiome in your body, like your gut microbiome, everybody has to like, lots of different bacteria in their body at any given time. Yeah. And same, same thing for your mouth. So you really just want, you don’t want that overgrowth of the bad bacteria, you want that kind of balance happening, and you know, leaning on the good bacteria being more predominant.


Sarah Wands  17:03

So there are there are different theories with that, you know, a lot of conventional dentistry will point to, you know, acidic foods and sugars, and they just tell you, like, brush and floss more, which disrupts those strongholds of the bad bacteria.


Sarah Wands  17:17

Yes. But then they tell you, you know, snack less, cut your sugar, don’t eat acidic foods, which isn’t realistic for most people granted, but it all of that misses the part of supporting the good guys. So you know, what can we do to support the good bacteria in your mouth without blasting, you know, antibacterial washers in there.


Sarah Wands  17:41

And, you know, that can come down to it, there are different factors like mouth breathing, you know, if your mouth is dry, your mouth is open. That is just a playground for bad bacteria to flourish. So you know, if you sleep with your mouth open at night clenching and grinding. During the day, even people notice that that’s a huge factor. And certainly acidic foods and sugar are a factor as well. But you know, eating neutralizing foods, like fresh fruits and veggies. Fermented foods are a great source. Anything with dairy is fantastic. Anything mineral mineral rich with bone broth is going to be great, too. So I try to tell people take care of your mouth, like you would take care of your gut, because what’s happening in the gut is going to show up in the mouth eventually and vice versa.


Anthony Gurule  18:34

Yeah. with the fermented foods, right? So just because I know that that’s amazing for microbiome, so you essentially all the things that we’re saying for the microbial gut biome is going to essentially affect the oral cavity as well, just because, yeah, consuming it directly from there, right? that’s awesome.


Sarah Wands  18:56

You know, the, the only nuance there, of course, because there’s nuance in everything is for someone who’s experiencing inflammatory gut issues, leaky gut, IBS, things like that. You see those issues with your gums and your oral tissues as well. And for those people, sometimes, uncooked fruits and veggies and fermented foods aren’t appropriate for them yet. So, you know, that’s something that to take into consideration as well. You know, whenever someone has any kind of chronic disease in their mouth, gut health should be one of the first things people look at.


Anthony Gurule  19:31

Yeah, yeah.


Sarah Wands  19:32

So that’s the only time I would say that, you know, it’s not the same for everyone


Anthony Gurule  19:41

From the previous episode, right. So one thing that I have not done yet because I know I have a tongue tie,


Sarah Wands  19:45

I can see I can see.


Anthony Gurule  19:48

And I have a tongue thrust and I am habitual mouth breather, like during the day I catch myself but you know, the underlying cause is not being addressed. I just sit there and I’m open and When I when I, when I sleep, I know I sleep with my mouth open and I’ve tried mouth taping, but it’s so hard for me to breathe through my nose that then I just rip it off at night because I’m just not getting enough air.


Anthony Gurule  20:12

And so I have not done the thing that I know I need to do mostly because it’s it’s a process, right? But for adults, right? You’re kind of like, why do you know these things? Like the conversation of tongue ties in these things seem more prevalent when you’re talking about kids per se. But as an adult, you do have to realize and understand like, there’s still things that can be done. I’m not too far gone, right?


Sarah Wands  20:34

Yeah, no,


Anthony Gurule  20:34

but there are underlying things that sometimes you need, you know, additional support for our intervention for or if you want to call it microbe surgery, I don’t know what that originally would be called microsurgery.


Sarah Wands  20:48

Yeah. So, you know, having oral ties can show up and it looks different in adulthood. You know, it can because at that point, you know, some people have already experienced a lot of dental work because of those factors. And so, you know, they probably been told at that point that they just have bad teeth, or soft teeth, or whatever. Or they clench and grind, or they have a lot of different body tension or migraines. And so it looks a lot different in adults, because they’ve had that issue for so long. But it’s definitely not too far gone at any point you like you say, obviously, the first step for helping you breathe at night would be like, Okay, well, let’s tape your mouth until you can, you know, look at your underlying causes. root causes are important.


Sarah Wands  21:34

But let’s help mitigate where you’re at right now. Mouth taping is great. Unless you can’t breathe through your nose.


Anthony Gurule  21:40

Yeah, then you’re just suffocating.


Sarah Wands  21:41

Right, which it adds an extra step for you, it means you, you have to go to an ENT, an ear, nose, throat doctor and they have to scope and make sure there’s no obstructions, which is critical for kids too because you don’t want to take your kids mouth, and then they can’t breathe at night for sure. You know what I mean?


Sarah Wands  21:57

As adults, you have more control and awareness over it. But it just adds that whole extra step, which I know is great for you.


Anthony Gurule  22:04

Well, and that’s what’s great about Dr. Liz Turner at Fox point dental she has the imaging capabilities to look at airway obstruction and everything, which is good, which is I need to get it I need to get it first and foremost.


Sarah Wands  22:15

Yeah, because they can take a comb beam scan, a 3d scan, and they can see your nasal passages and your throat. With an ENT it’s a little bit different because they can evaluate you while you’re laying down they can see exactly what your airway is doing. Yeah. And what your nasal passages are doing when you lay down when you when you relax.


Sarah Wands  22:32

So it’s different. And let the scans are definitely helpful for diagnosing.


Anthony Gurule  22:37

well, and I’m sure because I on on any given basis like when we go to get our dental checkups and cleaning, which is this is prompting the next question is I seem to always have way more cavities than Nichelle does. now she’s definitely better at flossing than I am. I will admit that excuse me. But I do think it has to do more so with the fact that I am constantly mouth breathing. Yeah, bringing in the bacteria, everything else you had talked about.


Sarah Wands  23:02

Yeah, because when you nose breathe through your, your nasal passages are that filter, when you breathe through your mouth, you don’t have anything to stop that bacteria from coming in.


Anthony Gurule  23:11

which fortunately enough, I don’t get sick a lot. But when I do I get sick, sick.  I don’t get sick a lot, even though I do a lot of mouth breathing. But that being said, I have in again, bad apples in any profession. Right? So, you know, we got to we got to call it what it is. But the evaluating the diagnostics for cavities and dental health, I have felt that there’s been a stronger shift towards relying on more technology to do that, ie X rays.


Anthony Gurule  23:43

And we’re talking about all of this beforehand to is when do, when would someone you know maybe speak up and say, hey, it seems like we’re doing a lot of X rays. Are those needed, right?


Anthony Gurule  23:54

Or, you know, kind of just being that advocate, obviously, for more so for your kids, or even as an adult understand. It’s just like, it seems like that’s a lot of X rays to rely on for finding cavities as opposed to the dentist actually doing an examination and looking so is there a benefit to doing the X rays?


Anthony Gurule  24:12

In general, as a screening, is there a benefits to doing X rays to seeing the underlying Silent cavities that are apparently under the enamel that could be dealt with before they become big cavities?


Sarah Wands  24:25

Sure. Yeah. So we could go in so many different directions here. Let’s just start with you know, we were talking before we started about different philosophies on X rays, and it’s hard as a patient to know what’s needed and what’s too much.


Sarah Wands  24:42

So my best advice is when you’re, you know, finding the dentists you want to partner with, you know, ask them what their philosophy is on X rays, if they’re if their philosophy is led with what your insurance will pay for, office policy. That’s not going to be a best fit for you or your kids.


Sarah Wands  25:06

A better approach for X rays X rays, first of all are, they are an important diagnostic, you know, tool to have, and we’ll talk about that in a second. But a better approach and philosophy to look out for Well, if you’re, if you’re looking for a dentist is risk based assessment, and their level of prevention, some dentists are more aggressive, some are more, you know, watching weight.


Sarah Wands  25:29

But, you know, if, if you know, and they know that you really don’t get cavities, much, you don’t have a lot of dental work, you have a pretty good diet and you take care of yourself, you probably don’t need X rays that often, you know, and I’m not gonna give a frequency, you have to work that out with your dentist. But if if you know and they know and you have a history of cavities at every visit, or


Sarah Wands  25:53

you’ve had a lot of dental work done, if you have implants or root canals, crowns, bridges, you’re going to need more monitoring, monitoring. And there are other different diagnostic tools. But there’s really not a great way to see cavities starting between the teeth, unless they’re too big, other than using X rays. But x rays, their purpose isn’t only checking for decay. It’s not always a great sign if your dentist doesn’t take thorough X rays, you know, as a new patient, it’s really good idea to have a full set every five years, maybe one, you know one that shows everything, because what’s important is that they’re also looking for any jaw cancers, any cysts, evaluating the bottoms of the routes that are not seen on routine X rays. There are different, you know, especially if you’re having your airway evaluated, you know, those 3d scans can be important. But having that full scan is important for for cancer checks and looking at any you know, the bottoms of your roots especially. So, you know, it’s hard if you get cavities a lot, or if you’ve had a lot of treatment, you’re you’re going to need more monitoring. Yeah. And it’s just it’s really comes down to philosophy, I would say. But, you know, if you if you’re someone who does need X rays more frequently, you’re doing things to help support, you know, glutathione levels, and just cellular health in general, upping your vitamin C around that time can be really helpful.


Anthony Gurule  27:30

That’s fantastic. What are some of the some of the what are, you know, one or two of the main things we might already touched on? So it could be like, yeah, what we said about this, this and this, but if you were to boil it down top one, two, maybe even three, like what are the top main tips, if you were, you know, I can see the blog post three best things, right.


Anthony Gurule  27:53

But like, you’re kind of like, you know, kind of like you’re kind of like your anthem, the thing that you like to really talk about and make sure people know when it comes to general good, holistic, functional, whatever you want to call it. Oral Health, like you’re like, these are the things that I really encourage people to look for and do.


Sarah Wands  28:14

Oh, gosh, that’s a good one.


Anthony Gurule  28:17

Like diet, right lifestyle, obviously, like starting from start starting from the bottom, like making sure the foundation of what good obviously health is because you could do you know, he said we talked about similar to like, like you use weight loss as an example, right? Like, you can be working out as hard as you want. But if you’re not eating well, and if you’re not sleeping, well, you’re not gonna get results, right.


Sarah Wands  28:39

Yeah. So you cannot out brush your diet. That’s yeah, it’s a bumper sticker. Oral Hygiene is not the top can like, factor for what determines if you get cavities or not. Your dentist might tell you otherwise. You know, their only advice like you said before is brush and floss more.


Sarah Wands  29:00

And you might get shamed into, you know, you might go in, you’re like, Hey, I’m brushing and flossing a lot of time. And they’re like, I know you’re not because you look at your mouth and you’re like I swear and it just turns into this guilt trip thing every time you go to the dentist because you’re like I swear I’m doing this but it’s not working. It’s because you cannot out brush What’s going into your body. So if I could, if it could only be three things it would be mouth taping if you can, and then getting minerals and fat soluble vitamins. So if you’re not getting magnesium, calcium phosphorus into your body every day, and you’re not getting enough vitamin A, D and K especially vitamin K especially then your teeth are never going to have the mechanical tools to rebuild early decay in the enamel. weak spots.


Anthony Gurule  29:59

And then as a side note, we talked about fluoride, right? What’s the best way that you have found or or products that help filter the normal levels of fluoride that are put into most water sources that we see?


Sarah Wands  30:14

Yeah. So you know, what’s interesting about fluoride in the water supply? Just what, there’s such a, it’s such a huge topic, but the EPA is actually currently in a lawsuit. Oh, four unsafe fluoride levels in the water lines. So that’s a whole separate thing, if you want to look into the lawsuit that the EPA is dealing with right now, because it is a it is interesting to say the least.


Sarah Wands  30:42

But I, if it’s accessible to filter your fluoride, I mean, reverse osmosis is going to be the gold standard. There are a lot of other countertop countertop options like Berkey, Aqua true is a reverse osmosis on your countertop, that’s going to get the most fluoride out.


Sarah Wands  31:00

And then if that’s not accessible, doing you just find Bill water, bottled water that’s been filtered, is going to be the next best thing.


Anthony Gurule  31:08

Do the, I don’t have those now, but it was like in college, I thought it was like the thing that was best, you know, good enough, but like, do the Brittas And those things, do much of anything?


Sarah Wands  31:19

No, they don’t touch fluoride.


Anthony Gurule  31:21

they don’t touch flouride? what do they filter out?


Sarah Wands  31:23

I mean, they they take out chlorine to an extent and some of the hard minerals, and you know, some percentage of the heavy metals. But they they’re not going to get like different types of bacteria out. And I mean, they might get a mild amount of sediment out of your water. But unless your filters specifically taking out the fluoride, I mean, you have to look for it. It’s not going to work to have an attachment on your faucet or a pitcher.  Unfortunately, it tastes better because it has less chlorine.


Anthony Gurule  32:00

Well, that’s all the questions I had, is there anything else you want to leave us with? Before we wrap up?


Sarah Wands  32:08

You know, I would just say that the reason why this in a profession came up for me is there’s such a wide gap between, you know, conventional dentistry, people have their dentists that they like, they’re great dentists, but they’re missing the boat on true prevention and nutrition guidance.


Sarah Wands  32:28

And a lot of people don’t have access to biological dentists. And, you know, the care that they’re looking for, for whatever reason, distance, finances, etc. And so I love being able to bridge the gap, and help people with all the things they can take care of at home to take care of their teeth in a holistic functional way.


Sarah Wands  32:50

You know, and it just kind of takes some of that pressure and work off a dentist’s a dentist can only do so much in the office, so much of it is at home. And it’s it’s such a new topic for people. So self guided workshops. so that people can really dive in for themselves.


Anthony Gurule  33:36

Well, and I’ll make sure you get all that. Make sure you got all the correct links, everything but we’ll put obviously all that in the show notes and stuff so people can easily just click and find it.


Sarah Wands  33:44

Yeah. Well, thank you so much. This was great. I mean, I learned a few good things and about certain topics and obviously as a reminder to myself, you’ll get myself checked out. I do too. I mean, people are who work in dentistry they


Anthony Gurule  33:59

we’re always our worst.


Anthony Gurule  34:02

Well, thanks again. I really appreciate it.


Sarah Wands  34:04

Thank you.


Anthony Gurule  34:04

All right. Take care guys.

How to Treat Shoulder Pain: Conservative Treatment Options & Rehab Programs

Condition Series: How To Treat Shoulder Pain

If you’re like me and you’ve ever had aching shoulder pain before, it can be super frustrating. Now, as humans, right, we depend so much on our hands. So what’s important is our hands are attached to our arm, which is attached to our shoulder. So anytime we are going to grab something, pull, reach, push, do what humans do, it becomes very frustrating when you have an achy or painful shoulder.

Now, this can be dealt with in a very easy, systematic way, if you know what to do.

Hi, my name is Dr. Antonio, I am the owner here at Live Loud Chiropractic and Coaching with my wife, Dr. Nichelle. We are based out of Lafayette, Colorado in Boulder County. Our aim and our focus is to help guide you to the adventurous life you are made for. And we do that through a number of different ways ranging from chiropractic and coaching. Now, in that middle is really where the magic happens, because that’s where we come together as a team to make a plan on how to actually dive in and deal with some of these common conditions such as lower back pain, neck pain, and in this case, shoulder pain.


Why You Have Shoulder Pain

Now, what’s important to understand about shoulder pain, and this is the same thing we say, with all the other issues that come into our office is outside of significant trauma, there’s a reason why you have pain.

What does that mean? Well, in the case of shoulder, we’re looking at repetitive use injuries. So in this case, or an example we might say is, “Well, I started having shoulder pain after joining a new a bootcamp class or CrossFit class, or some sort of workout class.” okay, well, we see a change in the amount of load in which the shoulder was actually experiencing. So it would make sense that that might be part of the problem. So we have to address treating something, i.e. like a shoulder injury, we have to understand the mechanism of how it actually started. Because if I simply just rub on the tissues, work on adjustments, and help you deal with the pain, what’s going to what’s going to prevent it from coming back, if you don’t address how it actually started in the first place?

if we take a step back, ask you about your lifestyle, ask you about your recovery, ask you about how what you’re doing for training and working out, how intense is it. all of these other factors that actually have more to do with your shoulder pain than simply what your spinal alignment looks like, that’s going to give us way better of an idea of what to do in the program and the plan to set you up with to actually deal with your shoulder pain. Okay?


Now, one thing that I do want to add to that is we are very much about maintaining momentum, right, you’re coming into us because you’re frustrated, you’re not able to work out, you’re not able to pick up your kid, you’re not able to get up and down off the floor, whatever that might be. And you feel like you’re not able to keep moving forward with life and/or you might be even moving backwards. we want to help you maintain that momentum. So we are going to encourage you to keep moving, to keep exercising as best as you can. But what we’re going to be able to do for you and help you through the coaching and the chiropractic assessment model, is help you look at the things that we know to be the main triggers for you, so that we don’t keep spinning around in this pain cycle.

Right. If we can break the pain cycle and get you out of there, then we’re going to be able to layer on top of that, better movements, better rehab, better strength, better mobility, whatever applies to you. And then on top of that, layer in our soft tissue skills, whether that’s dry needling, MRT or cupping, as well as adjustments so that we can maintain the proper range of motion and joint mechanics that you need for your body and especially your shoulder.

So if you have had shoulder pain before, or you have a chronic achy shoulder that you just can’t seem to get over, and or if you have a loved one that’s been dealing with a shoulder issue, constantly reaching over grabbing their shoulder, This video is going to be very helpful.

Shoulder Evaluation & Assessment

Alright, so we’re gonna be walking you through what a shoulder evaluation and you know, expedited treatment would look like. So essentially, what we’re going to be deciding through our evaluation, obviously, your history is going to be determining the direction of where we’re going, as indicated in the intro to this video, when we see a peak or a spike or a change in load, or a change in exercise program, whatever that is, we’re gonna see common areas that are aggravated more.

And those are typically impingement type of syndromes, bicep tendonitis, rotator cuff irritation, those are going to be your three kind of primary focuses. Now the reason why those are happening, that’s what we have to decide and dive into. We’re trying to determine the underlying causes of those, it’s very easy to diagnose what is irritated, but it’s harder to figure out what are the actually precipitating factors that led us to that.

Looking at range of motion, proper range of motion for the shoulder blade, shoulder, thoracic spine and the neck are going to be our most critical things to look at.

Basic Shoulder Range of Motion

  1. Take both arms straight up overhead. We’re looking for 100 degrees of flexion. And ABduction as she comes up, and we want to see if she can get that nice and vertical. We’re also looking for any catching points, or painful parts within that arc.
  2. Next we’re looking at internal-external rotation and extension of the shoulder. So she’s going to take this hand, reach behind her head and touch this opposite shoulder blade. So we want to again, look at nice vertical arm here.
  3. Right arm underneath over to here. Great. So now we’re looking at internal rotation of her shoulder and extension. And we want to look at shoulder blade movement here.
  4. Left side underneath over to here and we’re looking to see you know, comparatively side. Do we need symmetry? No. You do not need to chase making sure both sides are symmetrical. We are asymmetrical human beings.
  1. Tip the chin down, touch her sternum.
  2. Extend back, as far as you can.
  3. Look over your right shoulder. Awesome, look over left shoulder.
  4. Ear to shoulder, tipping side to side. Wonderful.
  5. Stand feet together. And she’s going to look over her right shoulder. And then she’s going to twist her whole body to the right. I’m looking at ankles, hips, low back, mid back and neck with this gives me a good global range of motion. Good, back to neutral look left, turn left.
  1. Keeping legs straight, toe touch, we want to look for thoracic spine flexion here.
  2. Come back up, arms up overhead, and then lean back as far as you can. So we want to look to see what our extension looks like.


Modified Sphinx

1. Come up on your hands and knees. Cat cow. we’re getting a good global assessment of how the spine moves.

2. Move your feet forward just a little bit. Sit your butt back towards your heels. Now move your hands back a little bit, this is going to be you can go back a little bit further. By moving her hips back, that locks the lower back from being able to move more.

3. Now in this position, because again, we’ve locked out the lower back, we can go through the other ranges of motion. So obviously, we get a little bit of hip shift, but from here, I can really start to see how the spine bends side to side. So we’re kinda like windshield-wipering the spine here and going side to side.

4. Now next is we want to look at rotation again. So there’s a way for us to isolate more about the rotation that we want to see from the mid back. So from here, you’re going to put one hand behind your neck, and then your other elbow is going to drop down.

Now, as indicated, right, some of the main things that we run into bicep irritation and impingement type of syndromes. And impingement is something that will happen with range of motion as you come up overhead, it’s the level that how it’s a level of impingement that could be created in an issue as dictated again by the scapular limitations that we might see.


Looking at How the Shoulder Blades Move

So what we’re going to look at here is how the shoulder blades should actually be moving. So as we already were showing, as this arm comes up overhead, we want to see how far this goes. Now, if that shoulder blade is pulled down, and back or too tight, she’s not going to be able to, to raise it as high. So we’ll test this right just as a as a proof of concept. So if I hold her shoulder blade, and I say now take your arm up overhead, you can see how it just kind of stops, right. So we oftentimes do this unintentionally, because we’ve been queued, keep your shoulder blades down and back, thinking that’s the more stable position. But in doing so that actually limits your range of motion. So if I’m locking this down, because I was acute, or I think that’s the better way to do it, and this is coming up and over, you’re basically banging your your arm or your humerus, the ball up into the socket roof. And that creates impingement sensitivity, whether it’s a rotator cuff, the bicep tendon, so on and so forth. So we want to make sure that that shoulder blade is moving well, this is this is one of the primary things that is oftentimes overlooked, we focus on massaging bicep tendon, working on the rotator cuff, the upper trap, and not knowing that we actually have to queue and promote that scapular range of motion.

So some of the things that we talk about is making the arm long. So if she’s here, and let’s just say for instance, she was actually having a pinch here, one of the cues that helps prevent that and or improve her symptoms is by simply asking her to make her arm long. So I’ll say, hey, try to reach out. So in doing so, you’re actually going to promote scapular protraction. And that’s this lateralization of moving away from midline, as opposed to pointed down and back.

Now, this is still stable. Yes, pulling down and back is stable for rows and other things like this. But we have to now train this. So if she was to make a fist, and now to say, make your arm long, and now resist me, she’s craving stability through a protracted shoulder blade position. Okay? Now, this is critical, because more times than not is we just don’t have the stability out there. So we think pull down and back to make us tighter. So that’s something that we have to we have to test out and make sure that that is an appropriate position. Now, this is also important for the rotator cuff because the rotator cuff muscles, they all start from the shoulder blade. So the relationship from the rotator cuff from the shoulder blade to the actual ball, right your arm, the head of the humerus, needs to be defined and improved.

So if I’m again, retracting, but yet this is wanting to come out, well, you see this battle between the rotator cuff muscles, the shoulder blade is being held back, the arms trying to go up and the rotator cuff muscles don’t know what to do, they’re not able to stabilize and adequately hold on to the shoulder if we’re having these opposing forces. So this is another reason when we’re looking at rotator cuff injuries, that we have to improve the scapular mechanics to improve the whole relationship on how everything is moving.

Now, outside of that, if we’re looking at rotator cuff issues, we’re going to do our standard testing of hey, resist here, resist here, fine. This helps us again, determine the exact tissue or the exact area that is angry. Again, that is the easy part that it’s very easy to find, hey, this is the this is the issue that everything’s kind of stemming from, but we have to understand and know why. And more importantly, what are the things that we’re consistently doing on a routine basis, whether it’s at home, whether it’s in your workout, whatever that is, that’s consistently insulting the tissue and making that wound or injury quote unquote, fester and linger. So that’s more important than actually understanding the site of pain. of understanding what you should and should not be doing from an acute injury to a sub acute injury or a chronic injury to allow you to progress further forward to be able to do more things.


Make a fist. Scaption is going to be about 45 degrees off the midline. Now, what that simply means is the head of the humerus is going right in line with the socket, and the shoulder blade from this position.

So this essentially gives the rotator cuff and a lot of the muscles the best force tension relationship, meaning it’s at its strongest point, right.

So for compression, all we’re starting with here is just hey, resist me, I’m gonna push down against her as she fights this. And this is a compressive load into the shoulder. So this allows us to first initiate what a conversation of compression resistance actually looks like. And then we would put her under load, such as a bottoms up carry, or in a plank position, anything in which I’m pushing into her body through a compressive force, and she has to resist that and maintain the shape and the positioning that we want.

Now, you might feel shaky in these positions, and that’s okay, that’s your body’s, that’s your body working with your muscles to figure out how much load or how much strength that it needs to present with what it’s being asked to do.


Trust fall. you’re just gonna lean back. Okay, so from here, you can see that there’s traction from her shoulders, right. So if we had a suspension trainer or something set up, go ahead and pull your hips towards me a little bit. Now just bend your elbows and do a row. So pull up right now lean back, right. So this is just a mock kind of what a row would be on a suspension trainer, a TRX. So this is perfect, though, because I’m creating distraction from her shoulder. And she has to resist her body being or her arm being pulled away from her. This strengthens the rotator cuff more than almost anything else that we can do outside of these like just single exercise of internal external rotation.

So these are phenomenal to be able to build more resilience than strength, because we have to be able to pull ourselves up from the ground, or we have to be able to push ourselves up on the ground and starting with these basic exercises are wonderful for rehabbing and retraining the shoulder complex.

Now outside of that, what we’re also going to do is carries, right. we talked about distractive loads, if I was to just grab a couple of weights, couple dumbbells, couple kettlebells, that’s constant distractive load down into my arm. And if I just simply resist that, and walk for distance, as if I was like carrying a wheelbarrow, that’s a great exercise for building a lot of strength and load into the shoulders, and not compromising ways that might be pinching or adding to that.

Downward Facing Dog & Plank Exercise

A full plank has a lot of compressive load. Now what a lot of people have trouble with shoulder pain is getting up into that position. So we can train this by going through compressive loads into a downward facing dog position. So from here, all she’s going to do is lift her hips up towards the ceiling. Right? Now we see a somewhat vertical position here.

So I can retrain an overhead position that might be troublesome with the dumbbell or pressing weight through a compressive load that she’s able to control. Then she’s gonna come back to a plank, right? And now she’s in control.



So if this is something you’re dealing with shoulders are pesky, right?  it’s a ball and socket, so it gives us a great amount of mobility. But because of that, it makes it more complex when dealing with these injuries. Especially if you’re someone who’s hyper mobile, we oftentimes just hear “Stretch, stretch stretch,” you’re oftentimes going to see the need for doing more stability training so that the shoulder feels comfortable while going through ranges of motion. And then we can layer in mobility on top of that.

So if you found this to be helpful, and you’re dealing with the shoulder injury, please do not hesitate to reach out to us. If you have a family member again who’s dealing with something like this and they’ve just kind of been put through the wringer. We’d love to have a conversation with you or that family member or a friend to help them regain shoulder mobility and function so that you guys can live a loud, adventurous life. Thanks for tuning in guys.

How To Heal A Disc Herniation Without Drugs or Surgery

Condition Series: How To Heal A Disc Herniation Without Drugs or Surgery

If you have been told that you have a disc injury, disc bulge, disc herniation, or anything to do with a disc within your lower back, this video is for you.

Oftentimes, when we hear disk injuries, disc bulges, and disc herniations, and most of us think that means immediate surgical consultation or immediate surgical needs. Now, in some cases, it is very pertinent and important to be co-managing this with an orthopedic surgeon. But for the majority of cases, that is not the case. So my goal here today is to help reassure you and give you some confidence in your body and in your back, if you have been told that you have a disc injury, a disc bulge or a disc herniation.

I’m Dr. Antonio Gurule with Live Loud Chiropractic and Coaching. My wife and I have owned Live Loud  Chiropractic and Coaching in the Lafayette, Colorado in Boulder County area for seven years. I’ve suffered with this. I have treated many patients with disc bulges and disc herniations. In addition to myself, and what we have done through all of our education and learning and teaching and trial and error of working with people is helped to come up with a system that helps you determine:

  1. If it is a disc herniation or disc bulge
  2. The severity of that
  3. What to do next


The Problem with Disc Herniations

You have to have a proper assessment and evaluation to determine what are the triggers and the things that make things worse. Disc injuries usually don’t respond well to rotation and flexion. That being said, if you were to be picking something up where I’m flexing over and bending forward, that is going to be compression of your spine under flexion.

And that is what’s going to be putting the most load on the disc. If a disc is trying to heal from an injury, it’s going to be very hard when you keep pushing on that disc and eliciting more pain and damage. If that’s not being addressed from your PCP, your physical therapist or your orthopedist, then what’s the use? Just putting medications, drugs and, you know, maybe some core stabilization exercises on there is not going to help, you’re going to keep spinning yourself in the loop by recreating more pain. the more pain you create, you’re going to be more sensitive to the pain, which only heightens the amount of pain that you feel. And all of a sudden you’re stuck in this loop.

Disc Herniation Assessment

Today we’re going to walk through a basic example of what a disc examination and assessment might look like. And some of the common cues that we give for movement and some of the common active rehab movements that we give early on and throughout to help you get over the disc injury.

Now again, this is the basic example that helps. This is in no way intended to say that this is for you. Because every disc injury is different in how it happens, the chronicity of the cycle will change and dictate what we need to do. You need a custom plan to help you once and for all get over the disc injury to create more confidence so that you can lead a healthy, active loud life. And if you’re interested in that, please follow along and I think you’ll enjoy this video.

Flexion Intolerant Low Back Pain

So as we already indicated, the more common presentations of lower back pain that we see are what we refer to as flexion intolerant low back pain. Now flexion intolerant, low back pain simply means your back does not tolerate flexion. How is flexion presented out throughout the day? well bending over to pick things up. We have to also consider though when you’re sitting, right and we kind of slump. compression is where things most gets sensitive or irritated when we’re talking about flexion intolerant low back pain.

Now with that, as we already indicated in the intro, these are commonly seen with disc injuries. Now disc injuries does not mean herniations, it does not mean bulges, you can have an annular tear, or some sort of disc sensitivity from an injury, and or from trauma-based and or repetitive based loading patterns that create a essentially desensitized disc. So these are the important things to understand. And what we’re going to try to show today is how we tease out or understand that this is more disrelated, or some sort of compression and flexion irritation.

Now, if you already have been told you have a disc injury, and has been confirmed or an MRI, the good part about that is we can expedite that and just understand the sensitive patterns, as we already indicated, we want to know how sensitive is inflection, whether that’s standing or sitting, load, so on and so forth. But if you’re unsure, and you just have this this back pain that’s been either chronic subacute or whatever that is, we want to determine what is actually the sensitized issue and what are the positions and movements again, that are craving this recurrent pattern of pain that you’re not able to get out of.

Because once you understand that, then we can very temporarily splint this so that we can allow the body to not become so sensitized to that pain cycle, and then reintroduce that later on.

The example that we commonly use is if you had a cut on your knuckle and you kept bending your fingers, that scab or that cut would essentially keep opening up in prolonging the healing process. Whereas sometimes you might need to actually splint or hold that finger straight for a while to allow the healing process to occur. And then after everything’s healed, we regain mobility and function back to that. That’s essentially how we treat disc injuries and these flexion intolerant lower back injuries.

So what we want to look for is, again, what are the positions that are most problematic for you? And then we have a few early intervention tools that I’m going to share with you today that will help you in that early sensitive or painful process.

Now, again, these are great for this early intervention, they’re also very well used and beneficial for just kind of like a daily spinal mobility or scrub, even if you’re not having pain. And if you’re someone who commonly is bending over a lot, labor workers, even those that are more sedentary in a desk position.


Movements for Looking at Range of Motion

  1. Bend down and attempt to touch toes. Any pain there?
  2. Feet together, arms up overhead, and then lean back. But we do have to keep in mind, if this hurts so much, what your body will commonly do is throw you into an extension where oftentimes you’re kind of walking around like this, because you don’t want to go forward.
  3. Heel drop test. Stand up on the toes, and with legs straight, drop hard on the ground.
  4. Compression of the spine. Sit at the end of the table, sit up nice and tall, then grab the end of the table and pull yourself down. Any issues?
  5. Still seated, kick one leg out in front of her and hold that up. Any tension? Does that go down the leg? Does it create burning symptoms, numbness on and so forth?


When we’re looking at disc mechanics, the disc sits in between the vertebral bodies. So if we flex the spine, round it, and add that compression, we want to see if there’s more sensitivity. More likely than not, if it’s a disc injury, we’re going to see with that compression and flection and these types of movements, increases a pain, potentially symptoms down leg if it is more of a disc herniation or bulge. And that’s what we need to determine for the extent of the injury.


Basic Movement Patterns for Herniated Discs

Now, in knowing all that, what do we do, right? Well, we already know that the disc is injured, and we have a flexion base injury. So this is where we come into the knuckle model, right? We need to temporarily help her “splint” this so that we don’t keep putting more and more pressure to the back of the disk where the injury is.


These are great for two main reasons. They help reduce the pain sensitivity, and help with the healing process.

  1. Hip Hinge

The reason why this is important is we’re always bending forward, right, you’re bending forward to pick something up, you’re unloading the dishwasher, you’re washing your face, your hands, we’re typically in a bent over flexed position. If this causes pain, we need to get to a position here where I can load more of my hamstring and my hips to reduce the load on the lower back. The lower back is still being loaded here. But the but the load is reduced.

  1. Supported Squat

So in our office, we have a suspension trainer or a TRX. You can also use rings or anything like that. At home, though you might not have that equipment. So what we use is a banister, or a kitchen sink, and you’d essentially just hook your sink, she’s going to be using my hands though to just demonstrate this moment.

Stand with a wide, open stance. Holding on to your support, lean back into your heels a little bit, not just your hips, like your whole body leaning back like you’re waterskiing, right?

So there’s two ways in which I try to coach this. So what I want you to try to do is, don’t let your hips go backwards as much, I want you to try to go straight up and down.

Now the second way we coach this is I want you to waterski more, so I want you to really set your hips back away from me. Really move the hips away from her hands. So in doing this, we’re actually decompressing the lower back.

But hands are anchored this way, what’s in the middle? lower back. So on each rep, that lower back is getting a little bit of traction and a little bit of decompression to help relieve a lot of the tension and aches and pains that we get from that compressive feeling of having these lower back injuries.

  1. McKenzie Extension Variation

On the ground, get onto your stomach in an upward-facing dog motion. Shift your weight into your hands and let your hips drop gently. Do multiple reps.


So again, these are the basics. First and foremost, understand pain. Second of all, work on some of the stabilizing muscles that help stabilize the lower back so you feel more comfortable.

These are kind of like your core exercises, but done in a specific way so that we’re not again picking at the scab, then we look at mobility for the mid back and the hips to make sure we have everything we need, then that’s our foundation of getting back to strength, power, agility, or whatever sport or activity that you enjoy doing.

It’s got to go through this progressive plan. We layer in again, soft tissue, dry needling adjustments, all the things that help act as a catalyst. But if I can give her these tools, she’s able to control her pain, so much better at home. And then it doesn’t feel like this end, this end diagnosis, “oh, I have a disc herniation. And all I can do is take medications and sit around.” No, we say this is your medication. These things work oftentimes better than muscle relaxers and ibuprofen and drugs because it maintains your mobility and it gets your body more confident about how to move rather than just sitting and waiting for the pain to return only to come back super stiff and weak.

So if you want to deal with your low back in a very progressive yet conservative way, this is this is how to do it. If you want to just take drugs and wait till it works, that’s totally fine. But most people want to get back to their life. And if you want someone advocating for you to help you through a disc herniation, disc bulge, or disc injury, we’d love to be that advocate and that support team for you. If you found this helpful, please feel free to reach out to us. If you have a family member who is dealing with low back pain, which is extremely common, and they’ve been through the wringer over the years, We would love to have a conversation with them to see how we can support them, whether in the office or even virtually having a consult or conversation over the computer. Thanks for tuning in guys, live loud.

How To Treat Neck Pain: Conservative Treatment & Exercises

Condition Series: How To Treat Neck Pain

Typically, it’s estimated that roughly three out of 10 people currently are experiencing some form of neck pain, discomfort, or upper back pain. Now, based on how we live in Western society, I actually think it’s slightly more. But there’s a lot of reasons from that as to why we think this is happening.

Now, argumentatively we’ve been reading books and reading newspapers and looking down for many years outside of the cell phone, but with the way modern technology is and how much more time we actually spend on computers, we’re actually seeing our world lives in this box. Right? Currently, you are watching this video on an iPad or an iPhone or your computer and our world lives right here. We very rarely, often look outside of this box where we live in. And that is, I think, a lot of the reason why we are experiencing a lot of neck pain.

Now, what do we do about that?

My name is Dr. Antonio, I am the owner here with my wife of Live Loud Chiropractic and Coaching. We are based out of Lafayette, Colorado, in Boulder County. Our big focus is to help guide you to the adventurous life you are made for, to help build stronger families and a stronger community.

Now, that is oftentimes very challenging when you’re dealing with pain. So not only are we trying to push and be very proactive about an active lifestyle, sometimes we have to deal with the pain and discomfort that is preventing us from enhancing our life and being able to do the things that we want to do.


The Problem with Neck Pain

Now neck pain is one of those things that really wreak havoc on people’s lifestyles and their daily activities because so much of our proprioception and awareness, and our senses come through our head. If you can’t turn your head and your neck very well, it’s very hard to see, it’s very hard to hear when you want to be able to turn your head, right? So these are the important things that we want to address when we’re looking at neck pain.

Now, as we always state, we are very much about setting an example about a patient, active care model, meaning we need you to move–we need you to play an active role in this process. It is not simply just adjust, soft tissue work, and all of a sudden things go away. Because what you have to know and consider is outside of major trauma; major trauma–automobile accidents, falls, so on and so forth. There is a reason why you are starting to feel neck pain.

What does that mean? Well, it might be the way you’re sitting eight hours a day, it might be the way that you’re moving, it might be the way that you’re exercising. We have to determine what changes need to be made. Because if I simply just do adjustments and soft tissue work, and you go back to the same lifestyle that got you here, what’s to say it’s not going to happen again?

Our role is to make sure that you’re set up for success. Not just turn into this model, which is adjust, fix something which makes it feel good. Come back when it hurts. That’s the old model. That’s the old chiropractic model. That’s the old PT model. It’s very much a band-aid. “I Hope the pain gets better, come back and see me when it’s getting worse.”


I want to set our patients up for success. And I know you want success too. What is success? Well what are the goals you want to be able to do? Hike, walk, play with your kids, wrestle, jujitsu, weightlifting, I don’t know, it doesn’t matter what it is, but we want to meet you where you are to get there.

Now, as we already stated, changes need to be made. If we don’t change the behavior or the lifestyle that elicited the pain in the first place, again, outside of trauma, then we’re not going to get anywhere. So what we’re going to do today is walk you through what a what a neck complaint, examination and assessment looks like, and the common ways that we help treat neck pain.

Treating Neck Pain

Now, I’ll say it again, what we do is layered on top of everything else. What does that mean? Well, I can do adjustments, I can do soft tissue care. Whether that’s MRT, whether that’s dry needling, or cupping, etc. And then that’s going to be only supplemental to the active care model that we would need you to be a participant in.

What does that mean? Well rehab care might include strengthening exercises, very commonly for the neck, this is strengthening the upper back with more pulling. We’re going to talk about posture awareness. We are not very strict on posture, but we like to highlight the role in which posture plays with neck pain so that you have a better awareness about how it influences it. When you have more awareness and you understand it then it’s going to apply better rather than simply saying, “you need to have better posture.”

We oftentimes get so many people saying I know my posture sucks, but they don’t even know what to do about it, or why it sucks and what that means. So that’s going to be part of the process and part of the conversation.

But today’s video is simply to help show you how we go about this and some of the ways that we can help someone with neck pain, address the issue, set up a plan, and more importantly, look at that end range goal, and to help build that plan to the end range goal outside of just slapping on band aids and saying come back when it hurts.

So if you have neck pain, I know this video will be very important to you and will have a lot of great tips of showing you what a proper assessment, evaluation, and treatment plan should look like. And if you have a loved one, family friend, or co worker that has been experiencing neck pain, you peek over and they’re always rubbing their neck or doing something like this, I highly encourage you to share this with them. This is something that can really change someone’s life by getting the right direction, and the right care, and the right provider to help dig them out of this hole, which can sometimes feel very daunting. So thanks for tuning in, guys, and I hope you enjoy.

Examination Process for Neck Pain

There’s a number of different ways in which neck pain can start. But again, outside of trauma, there’s usually a reason or an indication as to why it’s happening. And that’s first and foremost what we have to understand and discuss with the patient through our consultations and our history and the examination. But now what we’re going to be doing is actually breaking down the examination process.

1. Sit up nice and tall and bring chin to sternum.

Perfect, we look at how does everything flex over? How does everything look on the backside? Any pain?

2. Look up towards the ceiling and extend back as far as you can.

This one’s always interesting, right? As we already indicated, everything we look at is in front of us. very rarely are we looking completely up, completely down, or over to the side, right? Even when we’re looking at our phones, it’s never just straight down. So we want to start looking at those end range positions to see how much mobility do we have there, And does it elicit pain?

3. Look all the way over right shoulder. Then look all the way over left shoulder.

4. Ear to shoulder, ear to shoulder.

What we commonly see, right, people think ear to shoulder, that’s the same thing, that’s shoulder to ear. We want to look at pure cervical range of motion.

5. Take the right hand, reach behind her head and touch the shoulder blade.

Switch sides. Oftentimes, you see a lot of upper trap tension with neck pains, we want to see how does her shoulder mechanics work since the upper traps are such a major player with shoulder mechanics.

6. Now I’m going to push down on the spine there, check for symptoms.

7. Then I move the head sideways, add compression, and then tip it back a little bit, add compression and then just straight back, add compression.

Okay, so next, if that is the case, if someone having this pain down their arm, then we can look at does distraction improve it. So I’m simply just trying to lengthen her spine there. For some of you that are having ridiculer pain down your arm or a pinched nerve better known as, this could elicit a response of improvement and that would be a good sign, and something important for us to know.

So that’s how we differentiate the type of pain that we have. We’re dealing with localized joint pain or something more of a pinched nerve that’s going down the arm.

Non-Weight Bearing Evaluation for Neck Pain

This allows me to palpate and feel how the joints move and operate. So if someone during their active range of motion have them moving themselves, they don’t have a lot of good range of motion, I can now test it non-weight bearing to see if it feels any different.

Start to feel around. This allows me through my hands to feel if there’s specific areas that seem to be stuck, or kinked, if you will, and that’s where we’re going to try to focus our treatment. that treatment could be the active treatment that we give her, or the manual treatment that we’re going to do for her. 

Ask for any tender spots, how does that feel? Because that’s going to give us an idea of certain muscle groups or muscle bellies that need to be addressed.

  • Soft tissue work
  • Dry needling
  • Cupping
  • Manual therapy


We’ll be doing our standard adjustments, which would have been essentially be if I feel stuck spot, I’m going to basically just try to have a wiggle. And we’re just going to do small adjustments like that. Very light, very delicate adjustments, that elicit movement in the stuck joints where we need them to start moving.

Now outside of that, right, we have to look at the movement side. So here’s a few things that we do.


Movements to Help with Neck Pain

  1. Chin Tucks

simply put, your chin is going to move back and forth like it’s on a drawer slide again, a drawer side does not go up and down, it simply goes forward and backwards.

What we want to make sure is just the head is kind of tilting and moving back and forth to allow the chin to move back and forth. We don’t want to see a lot of movement from the back or the lower back or the mid back from here, it should be simply just coming back and forth from the chin.

Now similar to what we did for our lower back exercises, sets of 12, 15 and 20 seem to be a sweet spot.

  1. Movement Mapping

Movement mapping is exploring all the corners of range of motion that your neck should have. We don’t force any range of motion, but this gives us a good proprioceptive awareness and map of what range of motion is limited.

What this looks like: we start off with just the basic cue. So chin down, chin up. Chin down, chin up, we get an idea of what we’re doing. Now we’re gonna say go chin down and hold. Okay, now I want you to turn your head like you’re saying no when you’re down. So we can take all those joints through flexion. And now add some rotation, well, what we can then do is go down again, and we can say ear to shoulder. Right, so now it’s a little bit more lateral flexion.

Now, we can combine all of those together and say, chin down, ear to shoulder. Now, hold that and then turn no. But we’re really challenging a lot of the joints within the neck to see what their movement is. And this is actually very therapeutic, because we’re starting to loosen up a lot of the tight joints that have not moved in a certain way, in a long time, more range of motion that you have and more mobility, oftentimes, you’ll see a significant reduction in pain as itself.

  1. The Dissociation Exercise

in addition to what we just described as the upper back strength, having significant influence with neck range of motion, we can now dissociate those two movements, so that we can make sure that the neck can move independently of the upper back. All you need is a band.

Hold one end of each band, straight arm pull the arms away from each other. Hold back here. So now in doing this, you feel all these muscles are tight, right? So it’s gonna feel a little weird. But now move your head by almost doing that same kind of movement mapping side to side up and down.

So here we’re setting the stabilizers, we’re setting the back the way that it should be set, and then we’re asking the neck to move independently, which helps loosen up a lot of the tight joints and muscles that are dependent on that upper back support.



It always starts with proper evaluation and a movement criterion first to determine what triggers are constantly picking and irritating at it so we get out of that negative feedback loop. Then we put on the movements, the movement mapping the chin, tuck some of the basic things that help you scrub out and maintain better range of motion within the neck joints and muscles, as well as then layering on the soft tissue care whether that’s MRT, dry needling, cupping, and adjustments to help sweeten the deal and supplement more motion and more pain reduction, if you will.

So if you are dealing with neck pain, I’ve been there. We’ve been there. it sucks but it really limits a lot that you can do. And no one wants to walk around all day all stiff-neck not being able to drive and do other things. So if you’ve been dealing with this for a while, please, please give us a call. We’d love to help take you through this good evaluation and help you set you up with a better plan of success. Once and for all, stop neck pain.

What Exercises Are Safe To Do During Pregnancy EP|65

Live LOUD Life Podcast
Lafayette Colorado

Episode 65

EP|65 What Exercises Are Safe To Do During Pregnancy

With Dr. Antonio Gurule

Is it safe to exercise during pregnancy? The short answer is yes. Tune in as Dr. Antonio lays out the benefits and guidelines for working out during pregnancy. 

Episode Highlights 

3:50 – Defining exercise during pregnancy–it’s different for everyone

5:54 – Is working out during pregnancy safe? Long story short, yes!

9:54 – What you can do besides walking

12:05 – Diastisis recti

15:32 – Alternative core exercises: goblet squats, deadlifts, planks, etc.

About Dr. Antonio Gurule

Nutrition Building Blocks Broken Down


  • Father
  • Doctor of Chiropractic
  • Owner of Live LOUD
  • Personal Trainer & Health Coach

Anthony Gurule  00:00

Hey what’s up guys, welcome back to another episode of the Live LOUD Life podcast. My name is Dr. Antonio, I’m your host of the Live LOUD Life podcast. My wife and I, we co-own Live LOUD Chiropractic and Coaching here in Lafayette, Colorado. We are just outside of Boulder, Colorado in Boulder County. And our mission is to help families. We want to help make families stronger, so that we can build a stronger community. We want to help guide you to the adventurous life that you and your family were meant for. And we do this through chiropractic and coaching. chiropractic, obviously being more of a hands on approach, more of a clinical conversation, clinical diagnostics, but the coaching aspect is really what we believe is, you know, the foundation of what our system methodology, whatever you want to call it is, because a lot of this comes around through just coaching suggestions and recommendations. also, you know, obviously within that comes into clinical prescriptions of certain things to eat or supplements, so on and so forth. But it’s coaching a lifestyle, it’s coaching, it’s coaching a philosophy and a foundation about how to live an active healthy life as an individual, and setting an example of a healthy active life for your family, for your immediate family, for your friends, and more importantly for your community. So stronger families to make a stronger community as a whole would be a win win, right? And that’s what we want to be able to do. we want to be able to help fill in the gaps in the holes that you’re maybe not getting from, from other roles and conditions.


Anthony Gurule  01:43

And today that’s in particular where we’re going to talk about. it’s going to be a little bit more of a shorter episode because this is more of a quote unquote, you know, just discussion around how to lay out a framework and a better understanding of how to work out or what exercises are safe or maybe not safe during pregnancy. This is a very, very common question that we get.


Anthony Gurule  02:12

My wife Nichelle has created a mini course that has some workout ideas, recommendations, and prescriptions than laid out into a workout. She guides and  educates other clinicians on how to broach this topic as a chiropractor, how to better serve prenatal patients through chiropractic care, but also exercise recommendations and prescriptions, having recommendations with other personal trainers within the community whether that’s CrossFit whether that’s Orange Theory, chatting with coaches and owners and saying hey, if you have prenatal patients and they’re having these types of symptoms, or this has happened, here’s some better recommendations, not modifications. We call them lateralizations–you’re just you know, you’re doing something something different or something else we you know, we borrow that term from Charlie Weingroff, who’s a physical therapist and strength conditioning coach. But it also and also doulas, right, doulas and midwives and OBs who are directly involved with the prenatal process from nearly conception all the way through, having this conversation. we know that exercise is important during pregnancy,


Anthony Gurule  03:19

There are so many different studies that talk about the benefits of exercising during pregnancy, not only for the mom, but also for baby, which is quite interesting. They’re seeing increased cognitive-what’s the word I’m looking for? Excuse me, their cognitive output as a as an as a child through as they age is actually better from moms that actually worked out during pregnancy.


Anthony Gurule  03:50

Now this is tough, right? How do you define working out or exercise? it’s different for everybody. But we want to, and we encourage that, and yet we’re sympathetic to the different stages of life, aches and pains, so on and so forth, which obviously would limit what you can do from an exercise perspective. So you know, it’s a bit of a gray area on determining what is working out? what is exercise? What are the physical guidelines or recommendations for pregnancy? And without getting into the like, nitty gritty detail of every single thing. And obviously, every potential situation, if you had this versus this, what could happen? we’re not gonna be able to do that. What we just want to lay out is what is what are we trying to accomplish here, and we want to encourage you to stay as physically active as possible.


Anthony Gurule  04:41

And one of the things that constantly comes up is, well, should you add something in that you have not already been doing? Let’s say for instance, someone just through the stages of life with work and kids or whatever that is, they were not able to work out as much before they got pregnant, but now that they’re pregnant, whether they have more time or they understand the importance of exercises during pregnancy, well, would we say, “Well, you haven’t been exercising, so you shouldn’t do too much.” No, that doesn’t, that doesn’t really make sense. Now, we would encourage not to do too much, there’s obviously, you know, a too far swinging the pendulum of the other way. But we wouldn’t say “no, don’t exercise because you weren’t doing something before,” we just have to find those first few stepping stones to help them start to gain some momentum. and help hold their hand, if you will, So that their technique and they feel confident about lifting, or how far they’re walking or whatever that is. And that’s an important topic, because a lot of times people want to add things in, but they weren’t quite ready or weren’t doing them before. And they then assume that they’re not able to do them at all. So you do have to take that in consideration, there is a ton that you can do, and that you can still add, even though you weren’t doing them prior to pregnancy.


Anthony Gurule  05:54

Now on the big questions is, is it safe? you know, outside to contact sports, or different things like that the majority of what you’re going to do is safe for pregnancy, right? Rock climbing, we have pregnant patients that have been rock climbing before, obviously, there’s a certain inherent risk with certain sports or activities. You know, you could fall off riding your bike, you could fall over running, right, so we’re not encouraging any of these by any means. We’re just kind of, you know, setting some suggestions, if you will. And you have to take into consideration.


Anthony Gurule  06:31

Now, there are certain things to consider when you’re talking about like weightlifting, and how heavy and the intensity that you’re doing. And if you’re doing Valsalva movements, which is essentially holding your breath to maintain a more rigid or stiff torso, as you’re seeing changes in blood volume and blood pressure, you know, you do have to take that in consideration. And that is again, of course a conversation with your provider that is managing your, your pregnancy, but we recommend Mama’s weight lift, or do resistance training. During pregnancy, again, we talked about about load management and the intensity and things like that, but you can still lift and do fairly intense things. And it’s a fairly as a you know, as a scale and a wide range during pregnancy and see a ton of benefit from that. Now, are we trying to hit one rep maxes and PRs during pregnancy, I mean, some would argue yes, but I would argue, why, that’s not really an accurate representation of what your strength is anyways. So you know, you do have to to kind of keep manipulating the numbers and the weights and the intensity and the sets and reps in order to do it. But weightlifting and resistance training is safe, and it is effective. Now, outside of that, there’s not a lot of unsafe things to do, again, outside of contact sports, or things that would elicit, you know, potential trauma to you or baby based on impact we’ve had, again, not our recommendations, but some have tried very just easy scheme, because they’re in the winter months, and they wanted to and they felt very confident about not falling. So you know, you have those types of things.


Anthony Gurule  08:16

Overall, again, we’re talking about movement. You need to move, and it’s good to get your heart rate up. And it’s good to breathe hard. So that doesn’t mean just because you’re pregnant, you can’t do HIIT training or circuit training or CrossFit or Orange Theory. But you do have to listen to your body and understand certain signs that would indicate that things might be too much, right? Now those are going to be different for everyone, but a lot of this comes down to you know, lightheadedness, you know, breathing too hard. Certain aches and pains within lower extremity, chest, abdomen, so on and so forth would be obviously like your more extreme ones. If you’re becoming pale or anything like that, I mean, again, these are the same criteria, though, that would be if someone else was working out or training too hard. So it’s realistically the same thing. It’s just that your threshold level for all those most likely have gone down. And depending on what type of an athlete you were before, you’re going to be maybe a little frustrated that you’re not able to do the things you were able to do previously, which makes sense. But if you’re someone who wasn’t exercising before, you’re probably going to be a little bit more hyper aware of that, of just feeling that shortness of breath or that uneasiness. So again, we’re not saying you have to push through that because we’re not trying to set yourself up for a strength and conditioning program to increase your metabolic capacity to increase your strength and conditioning during pregnancy. We’re trying to help you maintain a healthy active pregnancy.


Anthony Gurule  09:54

Now, walking. walking is great. but in general, we encourage you to do something above and beyond walking. Obviously, again, certain things would dictate that you would not be able to do so. And this is again, any exercise. Any exercise that you do during pregnancy needs to be consulted with and work through and have a conversation with the primary physician who is managing your pregnancy, whether that’s your nurse practitioner, your midwife or your OB or obstetrician, right. But we would encourage more than just walking. walking is fantastic, but that’s kind of like your baseline minimum, right? Just like our activities, or recommendation activity guidelines. We want a few days a week of where we’re kind of just doing this steady state getting our steps in, you know, kind of pushing ourselves, we’re huffing and puffing, but still just kind of at that conversational level, but you’re not really getting a lot of benefits outside of that.


Anthony Gurule  10:55

So if you’re just walking, high five. kudos. can you do something more? Can you do some bodyweight squats? Can you do some bodyweight, you know, good mornings? can you do some walking lunges? do you have a suspension training, we’re able to do some bodyweight rows? Do you have some bands that you can do some rows with? You know, there’s a lot that you can do that allows you to get a little bit more out of that. Now, again, this all comes back down to preferences of exercises that you like to do, because that’s gonna allow you to maintain the most consistency, but then also the intensity that you like to do. And we do encourage having an open mind and at least being willing to try some high intensity things that allow you to still get your heart rate up a little bit. And it’s okay to lift more than five or 10 pounds. And not saying that that is a bad thing. There’s programs out there where it’s all directed around that where it’s lighter weight, high rep, but I just don’t want individuals and mamas to feel like they’re not able to do more and or being ashamed because other people are just saying they should back off because they’re pregnant. “why would you need a lift that much?” It fits within your strength, and your comfort, and your wheelhouse, that is totally fine.


Anthony Gurule  12:05

Again, you if you’ve been doing that enough, you understand the risk reward ratio and having a conversation with your practitioner has driven us to kind of help navigate and guide as you start to get further through pregnancies, what things maybe we need to change or manipulate. But that’s totally fine. Now outside of that, the question around safe also comes up around core exercises. diastasis recti, pelvic floor strength, so on and so forth, we want to enhance the capability of understanding how to control tension within your abdominal wall and your pelvic floor through pregnancy, because the pressure is increasing due to baby taking up more space. But we’re not we’re not necessarily we’re not gaining more strength, right.


Anthony Gurule  12:45

And so what a lot of people assume it’s when we’ve seen this, is “I don’t want diastasis. So I’m doing more core work to prevent diastasis from happening.” diastasis recti will happen in 100% of moms, it’s estimated at the week 35 Everyone will have some form of it. Now it is technically not a quote unquote diagnosis, though, until 12 weeks postpartum, because it is a normal thing that everyone will get. So you can’t diagnose someone with something that everyone will get–doesn’t make sense, right? So after that, though, if you still have weakness or spacing issues, then we can have a you know, a stronger conversation about putting a diagnosis on that.


Anthony Gurule  13:26

But what we’re trying to enhance and help is what exercises are quote unquote, not safe versus unsafe, but adding too much pressure or tension into the abdominal wall or the pelvic floor and creating more laxity. again, as that pressure for as baby’s growing starts to put more pressure on the pelvic floor and the abdominal wall. If you’re doing more things that increases the pressure within the within the abdominal cavity that’s going to push on that separation even more and/or push on that pelvic floor even more, creating potential incontinence or prolapse issues and/or more bulging and doming within the abdominal wall stretching out that separation or that gap even further, potentially making the recovery process more challenging or slightly longer. I’m not saying that it will but potentially, so we do have to take that in consideration. So we go through activation exercise of the pelvic floor, of the abdominal wall so that you better understand how to control those pressure increases while you’re lifting or exercising so that you simply can stay at a management level.


Anthony Gurule  14:28

And that in turn, helps you get through pregnancy of understanding how to lift up your older kiddo, having to lift up dog food or anything like that. It’s just managing and controlling pressure. So there’s really not anything that I would say that safe or unsafe. Now, things that we would advise against for core exercises is sit ups or crunches. You know a lot of those things that create like hanging knee raises and different things like that during pregnancy. A lot of those things that create a lot of intra abdominal pressure and tension. and especially during a flex position, that tends to put a lot more pressure on the abdominal wall, the separation where diastasis will occur as well as the pelvic floor.


Anthony Gurule  15:09

So, you know, while we never say never, there’s definitely a category of things that we definitely urge against because the risk/reward benefit and again, risk not being “injured,” But risk of potentially putting more pressure and making the recovery process  on the other side harder, is not is not something that we find to be as advantageous. But you can still get the benefits of quote unquote, core exercises through full body movements such as goblet squats, such as deadlifts, you know, depending on the phase that you’re in, push ups, which are, you know, a dynamic plank. or being able to do a TRX row, which is a reverse plank as you’re just lifting yourself up. three point rows where you’re on, you know, two hands or doing like a row on a bench, where you’re in a tabletop position that’s adding anti rotation exercises. So there’s a ton that you can do that still highlights and isolates, the core isolates, sorry. that highlights and will emphasize core activation, but through a full body compound movement. And what’s great about that is during pregnancy, depending on your energy levels, it’s hard to do all the little isolated accessory and all these separate exercises as it is. So it’s kind of nice being able to combine everything, so you get more bang for your buck, especially if you’re a parent and you’re on and you’re on baby number two or three, right?


Anthony Gurule  16:31

So what exercises are safe for pregnant women to do? All are. reduce or eliminate for sure contact activities, different things like that. the increased risk activities of you know, trauma and things like that. Outside of that you’re managing pressure, I would definitely encourage reducing anything that’s heavy lifting, that’s, that’s requiring you to do Valsalva moves, you’re having to hold your breath for an extended period of time. that changes blood pressure, so on and so forth. But outside of that, Pregnancy is a completely safe time to do all exercises. we definitely as we highlighted, urge and encourage, you know, certain things over other ones just for you know, added bang for your buck or full body movements, so on and so forth. And that, but outside of that you are free to do what you want.


Anthony Gurule  17:19

If you want guidance, though, you know, there are there are trainers out there that work specifically with prenatal patients. we would love to be able to have that conversation with you if that’s something you want to bounce back or navigate. Because we do want to encourage as much as we can. A very, very active pregnancy through exercise working out or however you want to describe that. So if you found this beneficial, please like share, subscribe. if you’re pregnant, I hope you can utilize this and take some of the information for you and yourself. If you have anyone else you know… a relative a family member, a friend who is pregnant and they’re unsure they’ve been you know asking this question what things I don’t know what things I can do. I don’t know if it’s safe for baby share this video with them. We’d love to be able to provide a better frame of reference and or context to be able to ask better questions so that they can find the workout program  or the movements that work best for them during their pregnancy. Until next time guys live loud .if you’re currently pregnant, Congratulations, and we look forward to helping and serving in the future.

How to Treat Lower Back Pain

Condition Series: How to Treat Lower Back Pain

It’s estimated that 70% of Americans will be suffering from some form of lower back pain at some point in their life. Now, if you have experienced low back pain before, you know what it’s like, and you’ve been there before, if you haven’t, I hope that it doesn’t happen for you, but this is going to be a short informational video about addressing some of the common lower back conditions that we see across the United States as well as in our office.

Hi, my name is Dr. Antonio Gurule. I’m a chiropractor here at Live Loud Chiropractic and Coaching. We are based out of Lafayette, Colorado, just outside of Boulder, Colorado, in Boulder County.

Today we’re going to dive in and show you what we do here at Live Loud Chiropractic and the philosophy and the approach that we take to lower back pain.


Our Approach

We focus on a movement methodology, a movement mentality. Meaning, movement first. If I can show you and prove to you, and help you gain confidence in the way that you move, especially if it’s painful movements that are exacerbating or triggering your pain, then you’re gonna have a lot more confidence going around your daily activities.

As an example, parents, if you are a new parent, or if you’ve ever been a parent, when you have a new baby, you are constantly bending forward, whether you’re sitting on the couch, or a loveseat, whether you’re bending over to pick up your baby leaning over a crib. And in order to change diapers, you oftentimes will experience some lower back pain or tightness.

So that’s our whole process. That’s our whole methodology, is helping you find those different nuances of movements that help reduce the triggers in the amount of pain that you’re experiencing. And then we’ll layer on top of that better ways to improve your mobility or your strength through a active rehab process.

And then on top of that, we’re gonna layer in obviously, the things that we’re good at, which is manual therapy, whether that’s soft tissue treatments, such as using our hands or our thumbs, whether that’s dry needling, cupping, Graston, scraping, and then on top of that, obviously being chiropractors is being able to perform adjustments to help maintain the mobility and the movements within the joints that we want.

Now, this is a group process, we have to be working at this together. Oftentimes we get individuals coming in expecting a chiropractor to fix them, when that’s the whole reason why they’re stuck in this feedback, this negative feedback loop and not being able to get out of it, because they’re expecting a quick fix–an adjustment or a muscle to be worked on in order for this to get better.

We have to remember that there is more to this outside of trauma or an accident, but even then there is a rehab process that needs to happen that got you into this in the first place. And movement, skill acquisition, strength, endurance, and mobility is going to be the way for you to get out of it, and stomp on that back pain once and for all.

Evaluation for Lower Back Pain

The most common back pain that we see, at least in our clinic, and that most people experience is what we refer to as flexion intolerant back pain, meaning your back does not tolerate flexing forward very well.

What does our movement assessment and evaluation look like? As well as the orthopedic assessment, And some of the common ways that we treat lower back pain, again, as a layer on top of the mobility, rehab, and movement that we already talked about.

  1. Bend down and attempt to touch toes. Does this create any symptoms? Does it cause any pain?
  2. Go down, touch your toes. and let the head drop as well. Does that increase any tension or pain anywhere?
  3. Go feet together again, arms straight up overhead both sides, and extend backwards as far as you can. Any pain or symptoms there? We also want to look for any dumping.
  4. Feet together. Look over your right shoulder, and then turn your whole body to the right. So twist shoulders and hips. We’re looking for good global range of motion within the hips, the spine, and the feet. Any symptoms there? Then look left, turn left.
  5. Sit down and grab either side of the chair. Keeping yourself nice and tall, pull yourself down into the chair. Any symptoms with that? This creates compression of the spine.
  6. Still seated, slump into your lower back. Grab this chair, and I want you to pull yourself down. For most that are having symptoms here, this would elicit more pain, again, helping us through the diagnostic criteria of determining what part of the spine in the tissue is most irritated or sensitive.


Non-Weight Bearing Evaluation

So oftentimes, commonly, what we see with lower back pain is we can get referral pains on the back of the leg or the hips.

  1. Straight leg raise.

This helps assess the neural tension of the sciatic nerve in the back of her leg. So I’m going to have you just relax this leg on my shoulder here. First and foremost, we want to see if this elicits any pain or creates any symptoms. From here, I’m going to simply ask her to tell me when she feels the first sign of tension in her hamstring.

  1. Now I’m going to pull the toes up.

Does that change the tension? More intense? And does it go anywhere else down the calf down the feet, or anything like that?

  1. Heel drop test. Stand tall and just plop down. With my leg straights, I’m basically trying to send an impulse or an impact up through my spine.
  2. Testing for Facettes Syndrome. Give yourself a big hug. And essentially, I’m going to kind of move her around to determine if there’s any sticky spots or spots that create pain for her in that lower back area, or the facettes.


Movements to Reduce Lower Back Pain

Decompression. All you need is a banister, a rail, a doorknob, or a sink in which you can hold on to.

  1. The Supported Squat

We’re gonna face each other with a nice open stance, like we’re gonna be doing squats, and hold hands. So by her hanging on, if you notice from that profile view, her butt is essentially moving her hips in the opposite direction of her hands. If I was to draw a straight line down from her hands to her hips, we see a relatively straight profile here. what’s in the middle? Lower back. So hips go one way, hands go the other. That offers a little bit of decompression or traction in the lower back.

  1. Hinging Pattern

Hips go back, spine stays nice and long.

Widen Your Stance. Spread the feet apart a little bit more, and then toe out. Do the same hip hinge, but your stance is now wider. This actually gives her a little bit more range of motion, allowing her to go down to the ground more.

  1. Extension-based Movements

Use your hips to shift your hips back and forth.

If you’re able to just bend that those joints back and forth nice and easily, it creates this pump, which allows the joints and everything to kind of get re lubricated and loosened up without eliciting pain.

  1. Modified Upward Dog

This is going to be very similar to the classic Upward Facing Dog movement. The only difference is we’re not actively trying to lift ourselves and create extension, we’re going to try to do this in a more passive manner.

Get on your hands and knees, and walk your hands forward just a little bit. Shift your weight more into her hands and let your hips drop to the floor. This creates a nice bit of extension in our lower back, and then we’re going to come back up. Perfect, and we’re gonna go back and forth. The sweet spot for these reps seems to be about 20. When you do about 20 of these, everything seems to loosen up really nicely.


Manual Therapy Care for Lower Back Pain

So we’re going to briefly walk you through palpation and care, manual therapy care for lower back pain. Alright, so after we’ve done the movement assessment, we’re trying to determine what movements feel good based on the pain you’re experiencing.

Major focus is the movement in the mid-back and the hip.

How do we work on this? Well, we work on soft tissue as we normally would, working digging into trigger points. we would go through the adjustments that you would obviously expect from seeing a chiropractor.

And especially when we’re talking about the hip, we want to make sure that we’re seeing good hip range of motion. There’s a number of stretches that we can work on and give. And there’s obviously certain areas within the soft tissue around the hip complex in the lower back, that can help unlock the hip joint as well.

Chiropractic Adjustments for Low Back Pain

So we’re just going to do one lower back adjustment here. Now, a lot of times people are concerned, is this going to be aggressive? Is this going to hurt? it really just depends on obviously, the provider you’ve seen, obviously, growing up with my wife, Nichelle, and learning how to adjust gentle from an early age. That’s our whole focus. if adjustments aren’t for you, obviously, we’ve described a number of different tools that will still help you. That’s why we do not focus solely on adjustments, because it’s not for everybody.


Here’s the plan. Figure out the movements that are painful, figure out the things that are painful, figure out the joint dysfunctions and the areas that are not performing as we would like to see and set up a plan on how to gain mobility, gain more strength, and gain more confidence so that you can systematically scale those and progressively load that to get stronger and stronger and more mobile.

That’s how you beat lower back pain and really create a better long term plan for that. Please do not hesitate to reach out to us with any questions. Again, our goal is to guide and support you to that adventurous life that you are made for, and we want to be an advocate through being that coach and leader, as a provider for you.

The Silent Symptoms of Concussions and Brain Injuries With Mary Finck DPT EP|64

Live LOUD Life Podcast
Lafayette Colorado

Episode 64

The Silent Symptoms of Concussions & Brain Injuries

With Dr. Mary Finck PT, DPT, CBIS

Tune in with Dr. Antonio and physical therapist Dr. Mary Finck as they discuss concussions. How to identify the silent symptoms, manage micro traumas, and treat concussions. 

Episode Highlights

4:03 – Silent symptoms of concussions

7:00 – How micro-traumas come into play

8:00 – Big tells of concussions

10:00 – Outside resources for healing- nutrition, diet, rehab, exercise, etc. 

17:00 Example of treatment for pediatric patient

30:00 How to correctly fit a helmet

About Dr. Mary Finck PT, DPT, CBIS


  • Doctor of Physical Therapy
  • Certified brain injury specialist
  • Owner of Roots Physical Therapy & Wellness
  • Mother

Connect With Dr. Mary Finck 

Roots PT Website: 

Anthony Gurule  00:09

All right, welcome back guys to the Live Loud Life podcast. My name’s Dr. Antonio, your host of the Live Loud Life podcast, and today we have our good friend, Mary Finck.

Mary Finck  00:19

Hello, yep, yep.


Anthony Gurule  00:21

Talking about brain injuries and concussion rehab. So she’s a physical therapist, I’m gonna let her obviously spew her credentials, her specialty, so on and so forth. But I think this is going to be an awesome episode. This is not anything that we we deal with here as far as a rehabilitative process. So I think it’s going to be a lot of great information. And interestingly enough, which I don’t know if you have any specific statistics on this, but how many just head injuries we get. I know for me playing sports, talking about before the podcast, how many adolescents and kids actually suffer from brain injuries, brain injuries, concussions, so on and so forth. But we’re gonna dive into it. So welcome.


Mary Finck  00:59

Great, thanks. Yeah. Thanks for having me. Business credit. Yeah, yeah, so. So I’m Mary Finck. I’m a Doctor of Physical Therapy. And I’m actually a certified brain injury specialist through the American Brain Injury Association, which pretty much meant you just had to do a lot of training and experience and hours to be able to like take a test and say that you provide specialty care to this population. So I originally got into treating brain injuries because my dad had a TBI, which is a traumatic brain injury from a rollover car accident when I was in high school, and it changed his personality, and he had headaches, and we unfortunately lost our business and our home. So it was quite an impact. Yeah. So that’s how I kind of got into this. And then I realized we started understanding what was going on with him and what happened and the loss that we suffered, because we call this like an invisible injury. Because you can’t see that anything’s wrong with you. It’s just our brain controls everything about our body. So if it’s injured, it can affect a lot of things. So then I kind of, you know, went to college, played basketball, blew my knee out, got to do PT myself, and then around the same time, started understanding what injuries my dad had sustained, and that like PTs helped people with brain injury. So that was kind of when I went that direction, like 2006 to 2009. So just kind of worked in all different settings and like rehab at Craig Hospital, literally like helping people walk again and get out of like a vegetative state, more severe injuries. And then the past seven or eight years, I’ve been more in like outpatient and helping with people with like kids with concussions and car accidents and stuff like that.


Anthony Gurule  02:51

And what’s your…? In case I forget. I will forget to ask at the end. Business Name plug.


Mary Finck  02:57

Oh, yeah, yeah. So my new business is Roots Physical Therapy and Wellness. And we’re in Louisville, Colorado, and the website’s So Colorado. So I’m really excited to get this up and running and help like more of the community and a diverse population.


Anthony Gurule  03:18

So first question, I wanted to spin off of  and plug, or spin off and come back to some of you had said is the silent injuries, right. So these are the big things. And obviously, a rollover accident. Pretty clear to see especially if someone has an abrasion or something on their head. Right. Okay, you hit your head, you probably suffered from some sort of injury right? Outside of those. And obviously, there’s a range of, you know, severe versus to acute, but yet small. What are some of the silent symptoms and things that you see, see or hear, you know, or evaluate or assess that you look for? Yeah. And that someone who is not as versed at understanding those silent signs, what should people be looking for?


Mary Finck  04:03

Sure yeah, that’s a great question. I mean, just to kind of give more of a broad answer, because this could be something you could look for in your children that might have like a concussion or a spouse that was in a car accident or someone fell off the ladder or whatever. But I would say a lot of fatigue headaches, blurry vision, dizziness, balance, like difficulty speaking or like memory issues. We kind of sub categorize head injury into physical, emotional and cognitive. And then there’s like a huge energy reserve and when your brain isn’t functioning and all those areas, your energy reserve gets tapped, and then there’s like extreme fatigue. Like acutely after a concussion, why someone would vomit is more of like a labyrinthine concussion, which is what I treat as a vestibular therapist, is your inner ear organ has all these really fancy hair follicles and things that stimulate like your brain to know where your your head is in space. So that just gets like super shook up. And then people feel like they got off a roller coaster. So if you’re vomiting, like, consistently after a concussion, you have a pretty substantial labyrinthine concussion. But definitely, it can be kind of minor. My daughter unfortunately has had like four. And it, you know, affected her ability to read because it can affect like the eye movements, which is part of what I retrain. your ability to focus attention. So kids with like ADHD, many of them have had history of concussions, and there’s no correlation there. And like overstimulation, like kids with like sensory processing issues like just getting like hyperacusis or overstimulated. So I mean, everything, if it’s a very severe injury, it’s going to like cause weakness or paralysis on one side of the body, or you wouldn’t be able to, like, walk without a walker, or, you know, like more severe and more visually obvious symptoms. But that’s usually not the case. And most people in that situation got help quickly, which is part of the problem is that people do not get help, because they don’t know that there’s something wrong.


Anthony Gurule  06:15

Yeah, so they’re, I mean, that’s hence the the silent thing. Because you’re just going about your everyday life. What um, I’m just trying to think back too, because I started going through the rolodex of how many concussions I think I’ve probably had. a number from micro–and this is the question I wanted to bring up–is how do you see micro traumas come into play? So for instance, my my sport I played was soccer. Headers. One after the other and you get some of those–call it ring your bell, right? We kind of just hit. and I didn’t I didn’t lose, vomiting or anything substantial. But how do you see micro trauma or the micro dosing of the sub level injuries add up? Or is it not as significant?


Mary Finck  06:58

Well that’s what CTE is, or Chronic Traumatic Encephalopathy is like these accumulative sub concussive blows and like football, soccer, fighting, whatever, hockey. but it’s not necessarily like reported incidents of concussions. But these repetitive sub concussive like quick lead, quick stars, and then it got better. that we’re seeing, usually an athlete’s like within 10 years of stopping playing their sport, that then there’s like headaches and anger, and dysregulation of emotions and memory issues. So that is something that is like, more growing awareness of that there is like a pretty substantial problem here. And it’s causing people, you know, a lot of these guys end up, you know, physically abusive, in jail, or committing suicide, unfortunately.


Anthony Gurule  07:52

So on that note, because if you’re dealing with cognitive issues, which obviously could fall into the category, or should fall into the category of PT, but oftentimes people go to neuro, or PCP, and then you’re dealing with emotional things, so people go to a therapist, or something like that. What are some of the big tells outside of Yes, I played a sport or Yes, I think I’ve had trauma, that would indicate that a post, sorry, a previous concussion might be the actual leading factor. as opposed to an actual issue that can be handled with therappy. Make sense? Like, what are the things that you’re trying to diagnose? Or look at right? Say, this is the reason why I think it’s more so from the concussion?


Mary Finck  08:39

I mean, a lot of that kind of twofold answer would be diagnostic. So like making sure you get a brain image, there’s no tumor or MS, or something else that can affect brain function. And like cause and effect, like mechanism of injury like this is when things started changing in my life. But sometimes it can be such an accumulation of concussion and like after one concussion, you’re two times as likely to get another and after a second, you’re like eight times as likely to get a third. So like, it just becomes like this terrible snowball effect. But statistically, it just grows and grows and grows. So some people don’t know, a second sub concussive blow if the first one didn’t heal is going to result in additional or worsening or even new symptoms and like even more of a longer recovery.


Anthony Gurule  09:31

and that was so that was gonna be the question, which I think you answered. So because the brain tissue has not adequately healed, that makes you more susceptible to the next, just like another just like an injury we would see on the body. What is healing really look like outside of just, outside of just time? What are some things that you’re doing to help healing? What are some of the outside resources that you promote for healing ie nutrition or something like that?


Mary Finck  09:58

Right. Absolutely. Nutrition and like any anti-inflammatory diet, and there’s certain supplements that are good. trying to just get like a healthy. like you, I always tell patients you got to put good gasoline in the car to drive the car, right? So and then just identifying the areas of deficit because we call this like a snowflake injury not one is the same and each person is a different person. So then add an injured brain. So trying to if there are like severe emotional issues, was there, is this a result of like abuse or a car accident? Do we need to do like trauma therapy? so making sure people get like the right emotional therapy. cognitive therapy is usually done by like either a speech therapist or occupational therapist. And that’s more helping with like getting back to school and getting back to work and memory issues at tension like why usually say more of the marbles, what I do is more the physical dimension of retraining, vision, dizziness, balance, coordination, and then trying to get all of the systems working together. Because even though that brain lesion might be like a disconnected nerve, we know neuroplasticity has the ability to heal. So we just kind of find out. I always tell my patients like find a way around the traffic jam. So we’re just trying to find a new way. And sometimes after enough time, you’re just like, Okay, this is how it is, how can you modify or change your life around that?


Anthony Gurule  11:28

that’s a good point, I use a very similar concept where it’s just like multiple roads to Rome, or sometimes you run into a roadblock. You have to just switch how you’re doing something temporarily. Hopefully we can get back on the main highway. Not always. So one thing I have heard, and I don’t know any sorts of amounts or numbers, but using obviously goes within the anti inflammatory conversation, like omegas and high fat diets, not diets per se, sorry, adding higher fat content, good, healthy fat, right? How does that come into play?


Mary Finck  11:59

Yeah, so there’s a lot of research with like ketogenic diet and stuff like that with like brain recovery. The hardest thing for someone that is like truly injured is like, there’s so many elements about their life, like sometimes I can’t go to school, I can’t go to work. And so adding like some, like more complex diet is hard. So I usually just try to tell people like, you know, limit soda, limit sugar, or try to eat foods that come from the earth, and like trying to make it more basic, because it’s just too hard to then also add a huge dietary change on top of like, manage the rest of their life. Just like a general way in this population, specifically, because you could get into like, a lot of nitty gritty with that, and the research and everything, but just trying to keep people like generally eating healthier. And drinking enough water too.


Anthony Gurule  12:47

for sure, which is so funny to say don’t drink soda, don’t eat excessive amounts of sugar.


Mary Finck  12:51

Right? Just so easy to just do that. But some people don’t even know that’s a problem. And then you talk about inflammation. And you talk about like, limiting to less than 20 grams of sugar. And a lot of people don’t even know that the soda they’re drinking at 76 grams of sugar. So it’s just education.


Anthony Gurule  13:08

So as a side note, which, Nichelle always (my wife) always kind of points out for people that are consuming or having trouble with sugar just to put it in content, context, how much a gram of sugar is, so four grams of sugar is essentially like one sugar cube. So when you’re looking at the sugar content of anything you’re eating, divide that by four and that’s how many sugar cubes you’re consuming, right? So when you look at literally whether a bottle of soda, and it’s like 76 grams, right? Just literally how many sugarcubesyou’re just drinking down. And that’s the and that’s the that’s the big killer for so many things. It’s just liquid calories, but like liquid sugar. just so much easier to consume and just guzzle down. Imaging. so I came across, I don’t know if it’s wavy or walk– Is it WAVi?  Yeah. So boulder-based group. I did a scan. Obviously, it didn’t have a post scan before. They said I passed with flying colors. I don’t know what that meant, per se. What are some of the scans people should be looking at getting? Obviously, you mentioned the MRI, you know, looking at lesions, tumors, different major space occupying thing, but what are some of the other scans that provide you the good information of how cognitive brain function is actually performing.


Mary Finck  14:23

There aren’t really a lot to be honest, like there’s your answer. I mean, a lot of the times people get in an accident or they have more severe head injury, they went to the emergency room, they’ll do a CT to make sure there’s no bleed. Then usually neurology or primary care if there’s more substantial red flags, which would be like severe loss of control, double vision, severe memory loss, like more significant symptoms would order an MRI to get more detail of the brain tissue. But these are like cellular level changes. So it’s not showing up on a lot of imaging. So the WAVi I believe is showing like EEG signaling. But a lot of what I do is visual and vestibular. So there’s something called a V and G–video and a stagger gram. So we order that a lot to check like ocular tracking, because your eyes are controlled and controlled by your cranial nerves, and only that comes from your brain. So if there’s dysfunction in the eye, or there’s a dysfunctional like eighth, the eighth cranial nerve to the vestibular system is not working, then we can use those objectives to test for that. But a lot of the times, we don’t need the testing to like treat the patient, we just like treat the patient, not the image, but we’re trying to rule out anything more severe going on, you know, because I have had patients like, well, they had this brain tumor they didn’t know of, because they got in a car accident, they got a brain MRI, never would have known that was there before because they were functioning pretty well, right? Or, you know, MS come up like a time or two. So it’s just trying to rule out something else. But even like with my dad, his imaging was all normal. And then three years later, that like diffuse axonal injury showed up on a scan. So that the biggest thing is just as is not showing up.


Anthony Gurule  16:13

So are there any? Are there any blood marker indicators?


Mary Finck  16:18

I know they’re doing research for don’t using that as an indicator in the emergency room. But I don’t think that’s mainstream yet to my knowledge, but


Anthony Gurule  16:27

I didn’t know if there’s a sort of like specific thing that would be leaching out that would indicate…


Mary Finck  16:31

they’re trying to test for emergency room like protein levels, I think or something but I’m not sure. Because I don’t work in that acute setting. Like what is standard. Usually, most of the time these patients don’t even have imaging done in the emergency room unless there’s like significant symptoms.


Anthony Gurule  16:48

So that makes sense. So I’m curious, and I know you had mentioned kind of piggybacking and going a little bit deeper into the therapies you provide, right? So obviously, you’d mentioned, it’s a multifactorial approach, right? You got to look at this, you got to look at this, because there’s so many elements, and there’s only so much you can do from one end, but you focus on the physical. What does that retraining really look like? Yeah, especially when you’re dealing with eye movements, and so forth. I know, you had mentioned previously like balance, so on and so forth.


Mary Finck  17:20

Depends on the patient.


Anthony Gurule  17:22

Let’s use a.. Um


Mary Finck  17:24

I give you like a pediatric, like a kid example. And like an adult example or something.


Anthony Gurule  17:29

If you’re okay with sharing, like, how you’ve been treating your daughter.  Kind of like what have you been doing for her? Because obviously reading if you’re having trouble tracking with your eyes, that can make it more challenging.


Mary Finck  17:39

So my daughter is a perfect example of like childhood concussions going on notice, especially because I was like, Okay, I’m not going to blow this out of proportion because of what I do. And I kind of just pushed her to go back. The research shows like this group of kids goes back to school, this group of kids sits in a quiet room in the dark. And the group of kids that goes back to school gets better faster. Like you use the brain to heal the brain. Still, these days, people are getting advice, like sit in a dark room. And like, yes, for the first day or two of mental rest. Yes, appropriate. But that is not like how you treat a brain injury these days.


Anthony Gurule  18:17

Because that still is a common suggestions, When, and it’s no different than like someone saying like rest like the right protocol for an ankle injury. It ould be beneficial for the very acute, right? When would somebody know that they are okay to get out of the dark room and start being reintegrated?


Mary Finck  18:36

Just trying to do that and see how the body responds, like trying to add…


Anthony Gurule  18:41

Like the body’s response would be like dizziness…


Mary Finck  18:43

…headaches, stuff like that. Yeah. So just trying to slowly add back life in. Knowing that it’s not going to just be like it was, you know, most concussions clear in like seven to 10 days and then more pos concussion is like two to four weeks. So if we’re going longer then to a month, then you have more like substantial, lingering symptoms. But that’s only 10% of the population like most concussions heal. But that’s like the 10% of the population I treat, for sure. Yeah. Which I really think that that data might be different. It’s just because it’s not recognized. It’s not a recognizable injury.


Anthony Gurule  19:17

The one thing we always say to is like when you’re looking at statistics, right? And we’re slightly biased because we work in specialty fields. But for the patient, when you’re looking at a statistic, you are that statistic, right? So it feels like it’s 100% because that is you.


Mary Finck  19:31

That’s right, that’s right.


Anthony Gurule  19:32

And that in it sometimes feels a little bit more skewed because they’re just like, oh my gosh, I’m one out of 10 people, this must be really bad.


Mary Finck  19:40

Right? Right. Right.


Anthony Gurule  19:40

Yeah. On this spectrum, higher. But it doesn’t also mean it’s horrible.


Mary Finck  19:47

Right, right. And yes, and like trying to get people to identify with like, who they are as a human being and not identify with like their injury or their brain injury or their back injury but like, trying to make sure people don’t know I’ll identify with this new diagnosis. And that they put themselves in their human first is like super important, I think in general. But going back to like the testing and stuff, yeah.


Mary Finck  20:13

But so she initially was climbing and she hit her head on a bar and like got really dizzy and that that lasted about a week of like a lot of dizzy and like I couldn’t take her in the grocery store because all the visual stimulation, she was getting like super dizzy and seemed to clear pretty well. And then only a few weeks later, my son who was, I don’t know, 15, 16 months like threw a glass vase that shattered on her head. It was about like a centimeter thick base. Luckily, she wasn’t like cut. But that was like sunglasses on for days. Like she slowly seemed to get better. And then she just tanked in school. And it was like her reading levels went down and she couldn’t focus because she said the kids it sounded like the kids were hammering her head because she couldn’t focus on all the noises coming in. And her attention was worse. So she actually wrote a book. It’s called my invisible injury, a story of kid concussions. it is not published, So if anybody is a publisher, I got a good book. There’s not another kid concussion book out there. So mommy published it on Shutterfly and sells like cash copies. Yeah, but we’ve sold probably, like 80 copies of this book, but I just I just, it’s not like mainstream yet. Yeah. But her story was to tell other kids like that this is what happened. And this is what a concussion is about. And this her last concussion, she then maybe a year later flipped out of the hammock and fell right on her head. And she couldn’t walk for two hours. So like that was substantial, like there was motor loss, right? But then she kind of cleared, so trying to retrain like the eye tracking and the convergence and the balance and trying to like, recreate the pathways that are injured is just more part of like how what I test and then that kind of helped guide my treatment. But when people get more advanced, you’re integrating balance with vision exercises and having them do cognitive things at the same time, like make a list of fruits and vegetables. That’s like high level vestibular concussive therapy, like you’re getting back to normal at that point. Because the multitasking can pretty much tank like in the research, the multitasking gets really hard. And when you start doing more than two things with a head injury, so


Anthony Gurule  22:30

Do you start to see changes? Also just thinking because your background with CrossFit and everything else. Or people start to see changes based on their metabolic, I guess, output changing? If they get back to exercising, breathing harder, How does that come into play?


Mary Finck  22:50

So that’s like a huge piece, because there’s something called like the buffalo concussion protocol, which is trying to like get hyperperfusion of oxygen to the brain through exercise for healing. And that’s kind of the concept of like hyperbaric oxygen treatments. And like why people go to sea level and feel like a normal person. Again, there’s just like, more oxygen, because we’re at Mile High here. But yeah, like, as soon as we can get exercise back in like that is ideal, because it will help the brain like in an athlete is going to naturally just heal better, because they already have such a high function of vestibular system and cardiac output and all of that. But yes, and so in this protocol, we measure like heart rate and symptom response and oxygen levels, and like, take them through, like progressing, getting every minute, a little bit harder. And then there’s just like a threshold, we call that like, your, your sub Max threshold is when you got symptoms. So then we have people exercise it like 80 to 90% of that heart rate. So trying to get people back to exercise.


Anthony Gurule  23:54

And on top of that, outside of maybe that, do you see, do you do you give any specific breathing exercises to help facilitate that?


Mary Finck  24:04

Absolutely. Antonio.


Anthony Gurule  24:09

That was not a question we asked before. But do you then help coach that through the metabolic efficiency as well? Like, does that help if they start that sub, or that that threshold? Right, right, oftentimes, that threshold, at least when someone’s clean, clear, it’s it’s almost your aerobic capacity threshold when you switch to more hyperventilation right? So if someone’s starting to get symptoms, assuming that that heart rate is at a sub threshold from their arobic capacity, cueing breathing, so that they’re more efficient, allowing them to maximize that heart rate?


Mary Finck  24:41

Absolutely. I mean, part of how that pulls in so much is like because when you have a trauma to the head, you’re gonna go into sympathetic, you have your sympathetic and your parasympathetic. So you’re going to be sympathetically over driven and a lot of head trauma is a result of direct trauma like an accident or something hit my head or, so the body’s like going to get stuck in that state. Yes. So trying to teach people, I actually give breathing stickers out. So I have people put stickers like on their wall, on their phone, in their car. So they’re like visually reminded to like, do the “in your nose for four, hold for a second, out of your mouth for six,” or whatever, however you teach your breathing, like, just just breathe. but mindful breathing will calm and activate the parasympathetics to be able to because a lot of, this is kind of a whole nother topic, But like Postural Orthostatic Tachycardia Syndrome–POTS, or dysautonomiam, is very common with concussion, because like the brain-heart regulation is off. So people get like, heart palpitations, they get like, they can’t regulate temperature. So there’s this huge, like weird body response, and people don’t know what’s happening or that that has anything to do with a concussion. So trying to like retrain the parasympathetics. And exercise will help reset the parasympathetic.  It’s pretty, pretty complicated topic of concussion. But yes, essentially, like if you’re breathing more mindfully throughout the day, you’re going to have a better response, like when you’re trying to exercise for sure.


Anthony Gurule  26:17

but I think it’s so important too, because most people want to get back to some sort of physical activity. And I could see that being a very strong rate limiting factor, because you know, and the fact that you integrate that in so very, very soon or suddenly, is very good, because we often see, right, it’s just like, and it’s the same we talked about, like don’t do anything for your low back until you feel like you’re healed. But then that gap from when you feel better to what you want to be able to do is too great. Yeah. And then you start just yo-yoing.


Mary Finck  26:47

Yeah, so I have a I have a good example of that one. So I had a girl that she was a veterinary surgeon was like traveling and a wild dog ran in front of her on her bike, and she crashed and got a head injury. Well she came for her hamstring injury. but she had her sunglasses on and she couldn’t be in the waiting room, she couldn’t fill out her paperwork. And so I was like, I think I can help you with your concussion too. And so this was like a very high level elite biker. But she was scared because of her PTSD, or getting on a bike to get back on a bicycle. So she decided to take up running, but she wanted to run Hundreds. So so what we did was like just slow integration, like and so she slowly added her miles, like she slowly, she couldn’t run in the dark, because she got so dizzy and disoriented. So I had her like, put a headlight on and just start walking around her neighborhood a few laps at night. So it’s just like, slowly, like that’s an extreme example of getting to like a sport. I think she’s done like seven or so Hundreds at this point. And she can like practice again, I don’t think she does surgery, but she practices as a vet again. But it was just like, sometimes it’s such a slow process, trying to give people hope that like not to give up because it can it can be really rough.


Anthony Gurule  28:07

But no, I think that’s actually, it’s funny. You mentioned like slow process. And obviously, when you’re talking about brain injuries, the processes, I’m assuming, much slower than like other outside tissue healing, just because they’re toleration for certain things a lot different. But the way you describe it, realistically, I think is important for everybody is that that’s that’s the rehab process for anyone. It’s the stepping stone mentality, we’re building a pyramid, the pyramid, the foundation of the pyramid, is all the boring shit that nobody likes to do. But it sets the foundation for everything else. Everyone assumes. And whether it’s 100 mile race or elite type of thing is the tip of the pyramid. For some people, for some of our patients, honestly, it’s gardening like yeah, like the thing that they want to be able to spend their time and do. But yet and what comes to mind is this patient who I have, who is 77, suffered from back injury. And everyone told her well don’t do anything that hurts your back. So for six months, she hasn’t done anything. Now she can’t even get out of chair, she can’t even kneel down and garden. Like we have to go back to our foundation. So the example you gave is beautiful because it’s the same for anything else. And it’s all about managing what’s tolerable. understanding the threshold of symptoms. And you laying out the symptoms that people should be mindful to think about is important for realizing what your threshold is.


Mary Finck  29:32

Yeah, I would say another really important note is like the emotional effects because just imagine like your brain not feeling right and your body not working and like the suicide rate and young kids with like multiple concussions like there’s absolutely correlation, so like just encouraging parents to like be very mindful what’s happening with their kids and sports and like getting people the right help because it just comes to a point where people just feel like they don’t I don’t know how to be in control anymore, right? They just can’t like, be, you know, have another day of headaches or be able to like, “I can’t focus” or whatever it is.


Anthony Gurule  30:09

And layering on top of that, right. The stress have already being, depending on the age, a student athlete, right, you know, playing college. This has been phenomenal. I learned a lot of great stuff to look out for. Any last little tips that you try to spread, as far as like brain health and awareness that we can leave people with?


Mary Finck  30:31

Yeah. How to check if your helmet fits right. You know this?


Anthony Gurule  30:36

I don’t.


Mary Finck  30:37

So if you’re putting on your kid’s helmet, and you put it on, and you tighten the back, then you have to strap it enough to pass the Shake, shake test. So if you shake your head and the helmets moving around, it’s not going to be very proficient, but helmet’s just gonna prevent a skull fracture, you can still get concussed within a helmet. But if the helmet’s just floating around all over the place, it’s probably going to be a little less effective. And then like finding a concussion, concussion provider, just looking for people that have the experience, because there’s a lot of people getting into concussion care, which is great. But if you don’t know exactly how to treat this population, you actually can make people feel a lot worse. So making sure people have like, extensive training in this area.


Anthony Gurule  31:23

So obviously, if people are local, you have that provider here in the Boulder County, Broomfield County, Weld County area. But if someone’s not local, Do you do telehealth?


Mary Finck  31:36

Yeah, telehealth within my licensed states. So I think I’m licensed in like five different states. But you can always just reach out and I can help someone fins. There’s Concussion Compass–is a good foundation. And then you can look for providers in that area.


Anthony Gurule  31:54

Now, I did have a question about the helmets real quick. Yeah. MIPS. You know, helmets have so MIPS technology, the part that attaches to your head, and the actual shell can actually slide and move a little bit. And it’s supposed to help disperse energy. Is that even…?


Mary Finck  32:11

I mean, it’s it’s propably how you fall, angle, force, the brain, whose brain? I would say it’s probably better than, like, not having that. But yeah, it’s just like jello floating around in there. And as soon as it shakes it, just yeah, it just can get injured. So just do the best you can do and gotta live life.


Anthony Gurule  32:34

Don’t be scared.


Mary Finck  32:35

Yeah. Don’t be scared. Just yeah. Because anything can happen at any time.


Anthony Gurule  32:39

Well, thank you again.


Mary Finck  32:40

Thank you. Yeah.


Anthony Gurule  32:43

And we’ll put again, we’ll put all the contact information. So if you guys are local, where you can find Mary here, Boulder County, Weld County, Broomfield County, so and so forth. But I mean, I just encourage you guys, I have healed from my injuries, took time off, did the things. And I’ve been, you know, trying to be mindful is if certain things come up, could it be a result of that? Fortunately from my injuries, I have not suffered from a lot of major things. But there are so many people that are dealing with the silent injuries. So hopefully this provides you guys with a little bit more context, a little bit more research, provides you also with some encouragement that something actually could be and is going on, because oftentimes, as you said, the silent things get swept under the rug. You didn’t see anything on this. We didn’t see any of this like, it must be in your head. Well it is! What are we gonna do about it?


Mary Finck  33:37

Thank you. Thank you. Yep, that was great.

back pain

EP|63 Your Piriformis is Not Causing Your Sciatica Pain

Live LOUD Life Podcast
Lafayette Colorado

Episode 63

Your Piriformis is Not Causing Your Sciatica Pain

With Dr. Antonio Gurule

Episode Highlights

Learn what piriformis syndrome  is and the real causes of sciatic nerve pain.

3:42 – A breakdown of what sciatica is 

6:32 – Understanding what the main injuries for nerves

9:36 – Describing the piriformis

12:09 – How piriformis syndrome gets diagnosed

15:49 – What really is causing your sciatic nerve pain

20:00 Solutions  

About Dr. Antonio Gurule

Nutrition Building Blocks Broken Down


  • Father
  • Doctor of Chiropractic
  • Owner of Live LOUD
  • Personal Trainer & Health Coach

Anthony Gurule  00:00

Hey what’s up guys, welcome back to the Live Loud Life podcast. For those of you who are new here, my name is Dr. Antonio, your host of the Live LOUD Life podcast. My wife and I, we own Live LOUD Chiropractic, we’re based here out of Lafayette, Colorado. And our big mission and focus is to help make stronger families to then in turn make stronger communities. We hope to help fill the gaps between the information that you’re getting from your providers, whether it’s clinician, a pediatrician, an obstetrician for prenatal/postnatal, whether it’s your nutritionist, or your your strength and conditioning coach or your personal trainer, it’s just being that sounding board. And that advocate for helping connect all the dots for those things that you’re maybe just not quite getting answers to. And we do have some specialties that we focus on primarily, but what we really want to help is just have that, at least initiate that conversation, and going through this diagnostic process of helping you find the right person, even if it’s not us. Because while we do work on a number of different conditions, whether that’s musculoskeletal neck pain, lower back pain, mid back pain, knee pain, hip pain, shoulder pain, you know, your kind of traditional thing, We also work extensively with prenatal postnatal, on pediatric issues from milestone tracking from your peds, lactation issues with your infants, how to work out safely and effectively and efficiently during pregnancy, as well as how to return to fitness during postpartum. So you know, there’s a number of different issues and things that we would love to be able to help you with. And if that’s something if any of those sparked your your curiosity or generated a question for you, please do not hesitate to reach out.


Anthony Gurule  01:52

But today where we’re going to talk about is one of my specialties. One of the things that I primarily love working on and focus a little bit more on in particular, which is lower back pain. And in this particular case, we’re going to be talking about the myths, myths plural, the myth of sciatic pain in particular, we’re talking about piriformis syndrome, or the piriformis muscle being the primary cause of sciatic issues. Now, for those of you who are watching this video, this podcast on YouTube, we have a number of different videos that talk about this issue that dive into a little bit more than anatomical considerations, which, if I remember to, and I will promise I will try to, is I will overlay some of the anatomy on this video as we’re speaking so that you can get a better understanding of what we’re talking about if you do not have anatomical knowledge. Because most of us, to be honest, we’ve seen a picture of the piriformis muscle and you know, a physical therapist or another chiropractor or someone pointed out and said this is what’s causing your issue because you’ll see the nerve going through it. And that’s really where things get mixed up and, and then all of a sudden we get stamped with this piriformis syndrome sciatic issue, and lo and behold, right, that’s what that’s what the cause is when really, it’s a lot more complex than that. It could be more complex, sometimes it’s a little bit more simple, but more times and a little bit more complex than just a muscle that’s tight that’s pushing on a nerve. So that’s where we’re going to be diving into today. So if you are someone who has suffered from piriformis syndrome, sciatica, or lower back pain with radiating pain down your legs, or anything around that, this video is definitely for you.


Anthony Gurule  03:42

So let’s back up here. How does, or where does the sciatic nerve, your “sciatica,” quote unquote, when you say you have sciatica? That is what it means it’s coming from the sciatic nerve. And where does the sciatic nerve come from?


Anthony Gurule  04:00

Well, breaking it down as simplistic as we can, you have your brain, your brain then goes down and goes into your spinal cord and then from your spinal cord, you have a bunch of nerves that come out. And those nerves come out of this space that is in between your vertebral bodies or your spine. So your spine is not one just stiff rod, there are multiple bones and joints within your spine and those stack on top of each other and there’s a little space called the parameter in between those two bones and that’s where the nerve comes out. You also have arteries and veins that go in and out of that space that go in and out that and kind of follow the same path. and then from there, those nerves Then branch out. Some of them combined together and you have these really intricate they’re it’s called the plexus is really intricate weave of nerves that then distribute to the rest of your body.


Anthony Gurule  04:59

And the reason why this is so elegant and great is that if you were to have damage at a single nerve root level or other areas, you have multiple innervation orientations, or spots that originate from, to help you maintain a lot of function sales. So for instance, when you’re looking at a lot of the the nerves that make up either your arm or your lower leg, you’re gonna have anywhere between two, three, and sometimes even four nerve roots that then come together to Then branch out and make a larger one. So if I had an injury, like a disc herniation, on the L3 nerve root, I still have innervations input from L4 and L5. So that allows me to maintain a lot of functions. So where I wouldn’t just be, it’s not just like one nerve root then goes out to one particular area. And if an injury happened, then it shut off, and you can’t do anything therefore moving forward. Right, so it doesn’t work that way. And that’s what’s beautiful about it. Now, that being said, the sciatic nerve is again, a conglomerate of a bunch of these nerves that come together, and it’s actually quite big. If you were to take your pinky finger, someone even say your index finger, right? That is about the size of your sciatic nerve as it exits your pelvis and then starts to make its descent down your leg. Now from there, it will then branch off again, to make additional nerves that go into different areas of your body. So that you just have again, this this wide, vast distribution to for not only sensory, but also motor function.


Anthony Gurule  06:32

Now, where we want to go with this is understanding what are the main common injuries for nerves, right? The nerves just like any other soft tissue can be damaged, bruised or irritated. So for instance, most of us have felt this before you hit your funny bone, which is really your ulnar nerve, which goes behind your inner elbow. And when you hit it, you get a wide range of symptoms, most of these symptoms usually around like a numbness or tingling, some of which could be pain. And that and that is from direct pressure or input or impulse on the actual physical nerve itself. Now you can have an abrupt injury, if you will, if we call it an injury, an abrupt impulse on the nerve just as we described, which creates this immediate sensation and this immediate zing. Or you could have something that progresses a little bit slower over time. So it’s kind of like this slow occlusion of pressure that starts to be that starts to go on the nerve. Most of these, though, usually happen as a result of like trauma, if you will. And that trauma then has either direct response of pressure on it from a physical body itself, or it could be pressure from swelling, which is very common for like a disc herniation, or something like that doesn’t always have to be the disc that’s pushing on the nerve. But the acute injury then creates an inflammatory response. And then inflammatory response brings more pressure from fluid, and then that fluid, in turn then creates pressure on the nerve root itself. Now, again, you have to consider we had multiple levels that made up that sciatic nerve as it went down the back of our leg, the symptom that you feel, though, is down that same path. And it could be coming from any one of those levels. Now there are orthopedic tests, and different evaluations to help us determine to help us determine what level of nerve root or issue it may be coming from. There’s different ways for us to tease this out from whether it’s muscle test, sensory test, you could do more complicated, like EMG studies and things like that. And depending on the extent of the injury, would it would be beneficial to know but But oftentimes, it might not necessarily matter for us to specifically know what exact level we’re dealing with here to make progress. So you have to keep that in consideration.


Anthony Gurule  09:09

And this is why the conservative approach of understanding mechanism of injury and what things are making things worse, and what things are making things what things are making your symptoms better, are more valuable, in our opinion, to do first rather than jumping straight to diagnostic imaging, so on and so forth. Because you’re gonna get an array of different conflicting information that may or may not be pertinent to the actual case at hand. So you do have to take that in consideration.


Anthony Gurule  09:36

But what we’re talking about, now further is again, that direct pressure so when you’re now looking at the orientation of how the nerves go down through the pelvis, they they go through this sciatic notch which is this little notch, kind of near our sits bones, which sits bones being your butt bones like what you sit on and it through a going across that same sciatic notch from your sacrum to your femur is a muscle called your piriformis. Now, your piriformis is one of a few muscles that make up these smaller, external rotators that are that are essentially deep stabilizing muscles. And that sciatic nerve can weave through the muscle, but it basically is, you know, this kind of roof, if you will, that sits on it. And when you start poking around, with nerve related issues, you’re gonna get, you’re gonna see a lot of trigger points and a lot of different areas.


Anthony Gurule  10:42

So one thing that’s kind of a side note, which does add to the value of this conversation is, when a nerve is pissed off, the nerve has no ability to protect itself, it is sitting there on its own, it cannot protect itself, but it does influence as we know, through motor control and output, it does influence what the muscles do so if something is vulnerable, but yet it can manipulate and control the muscles around it, you’re going to see guarding, some relate this a spasm trigger point, so on and so forth, to help protect the nerve and muscles don’t know anything else. They don’t they don’t know how to do anything else. But squeeze, right, they can only shorten it, they can only squeeze. So when they get an impulse to protect something, they don’t know how to do anything else but squeeze and then they’ll develop a lot of trigger points and tightness. And when you push on those, depending on the innovation system, you’re going to elicit very similar ridicular or radiation patterns that your sciatic nerve will present as. And so what happens is people start poking around in the glute complex where the piriformis is, and the rest of external rotators are the glute medius, or the glute min. And they’ll be very tender. And sometimes they’ll radiate and create a radiating pattern that mimics what the sciatic nerve path would be.


Anthony Gurule  12:08

And this has been studied extensively and janitor val is kind of the the the innovator of trigger point research and knowledge where they elicited saline injections into certain  hyper responsive loci in the muscle, which would be trigger points. And then they had people map out where they felt the symptoms. And then you see these these distributions along the leg. So if you ever type in like trigger points, you usually see like a leg or a region or a body part. And you’ll see all these red dots. Those are all the areas which an individual within the study indicated that they felt symptoms, usually pain or something like that, right. And so then when you’re poking on where the piriformis muscle would be, which would again be very hard to determine where the piriformis specifically lies, and I can get the landmarks of the sacrum in the greater trochanter and go into the middle. But keep in mind, you have also other muscles there, such as operator internists, external, glute med, so on and so forth. So for me to be able to take my thumb through all that meaty layer of your butt muscle would be very hard for me to say the piriformis is this one. And this is the one that’s causing the pain because it’s tight and I’m recreating your symptoms, right. And that’s how piriformis syndrome gets diagnosed. It is this piriformis muscle is tight, and your sciatic nerve runs through it. And thus, when we push on it to elicit more pressure on the sciatic nerve, we recreate your symptoms, and that’s the cause.


Anthony Gurule  13:44

Now, one thing I will agree with, if you will, within this is the palpation diagnostic process if a nerve is irritated, for instance, if I hit my funny bone, that ulnar nerve, and it’s already irritated, and I go back with my finger and rub on it, it’s already sensitive  into the point where I would be able to recreate that pain a lot easier. So if you’re palpating in the area, and the sciatic nerve is already irritated, for whatever reason, then you’re going to be able to elicit a similar response. That doesn’t mean that it’s the  piriformis muscle that’s going to be squeezing on and causing the exact issue. Other ways the sciatic nerve could be aggravated, would be from a potential disc injury or an inflammatory response up near the lumbar spine putting pressure on a nerve root and then that nerve root through that track of the sciatic nerve is also hyper sensitized. Right. You can also see in a stretch injury we’ve seen individuals who assume that they are stretching their hamstring, go through a stretching protocol when in turn they’re actually putting more stress on their sciatic nerve through the branches throughout and they hypersensitize the nerve that way. This is through straight leg, supine straight leg raises, other things like that in which we can differentiate hamstring tension, calf tension versus sciatic nerve tension. And then other than that, we see what we what some refer to as like snags, and snags, meaning the nerve itself should have an ability to slide throughout our body. So if you’ve ever heard of nerve flossing, this is where this comes into play. And essentially, if for whatever reason, and typically we see this kind of in a very small, a hyper sedentary population, and when we say this, a lot of times people assume this is not them. And this will be a sep- that we talked about physical guidelines, activity guidelines, in a couple of previous episodes, which I encourage you to go check out.


Anthony Gurule  15:49

Most of us are more sedentary than we think–we sit at a desk for six to eight hours a day with minimal micro-breaks. But yet we do an hour of exercise a day. And we assume that that’s enough. Realistically, when you look at even if you were to track with your overall step counter, we are not that active throughout the day. And when when you’re sitting in, when you’re primarily in a city pattern, you create a lot of tension around the hips, and a lot of the musculature around the hips and the connective tissue in which, which includes ligaments and connective tissue and muscles right, in which the nerve is encompassed through. And it doesn’t have that sliding capability. So if you have a nerve that’s supposed to be able to glide and slide as you move, because you’re not moving enough, that creates this tension within that nerve. And thus then you can elicit symptoms again, right. So a lot of what stretching is also believed to be doing outside of hopefully elongating our tissues and making them more extensible is allowing us to be more aware and accustomed to the nerves stretching. you can’t go from you know, do you know the stiff rubberband and assume that you can just stretch and we’ll be fine, you have to work it over time. And all of a sudden the nerve, which is just a connective tissue, we’ll have a better idea of being able to stretch a little bit. And it won’t be as sensitive to that. But in addition to that, you’ll see the convergence factor of nerves moving being able to be more efficient. So a lot of this comes down to again, just having supple and mobile soft tissue that allows things to glide and slide well. So those are just again, a few of the reasons why the sciatic nerve might also be irritated.


Anthony Gurule  17:28

But what we wanted to highlight is again, the fact that the piriformis is such a small role and factor into the whole hip complex as itself into the whole lumbar plexus and sciatic nerve. You know, area that the majority and I would be confident to say the absolute, absolute majority, 99.9. And I’m making that statistic up, but 99.9 of the time, it’s most likely not your piriformis is most likely not piriformis syndrome, it’s your piriformis isn’t so tight, just because you can’t get into a pigeon pose, which again, piriformis in that position is one of a few muscles that are being stretched in pigeon pose just because you can’t get in the pigeon pose doesn’t mean your piriformis is so tight. And that’s what’s causing your sciatic issues. Now, will it help for you to address a deep pigeon stretch and doing trigger point work in your hips and stretching? 100%. 100%. But you don’t get confused that just because you did something correlation not equal causation, just because you did something and you got a positive response, that does not mean that you fix the actual issue as to why it was coming through.


Anthony Gurule  18:38

That is dealt with primarily through the diagnostic process of understanding how it came on in the first place. What are the movements that you’re doing? Where are the range of motion limitations that might be adding more load to a certain area? But again, it’s most likely not your piriformis muscle causing your sciatic, your sciatica, or your sciatic nerve pain or numbness or tingling down your leg? So then the question would be well, what else was it? Well, we again, we highlighted a couple of the potential things that could be what is your particular cause? I don’t know you have to go through an evaluation and assessment. If you don’t have someone to do that for you, we’d be happy to team up with you and we can set up you know, online consultation or an in person session to help you deal with that. But we see time and time again, movement helps tremendously. That’s why we’re not discounting the pigeon stretch and the trigger point work and just going through general movement. we know that helps.


Anthony Gurule  19:32

and those that have this sciatica, and one thing I did not mention, which is critical to understand, is acute versus chronic.  So many more of these cases are chronic. sciatica issues like I’ve had sciatica since high school which is a patient recently that just comes to mind and realistically through his occupation, very sedentary so the so the referral stuff that he’s having down his legs, it’s not really true sciatica. it only goes just past the hip. And it’s very dependent on hip movement as opposed to like some of the other diagnostic or differentiation movements that we’ve done.


Anthony Gurule  20:09

And what we simply started with was just a movement mindset of starting to do supported squats, and hip hinging, and just loosening up that whole posterior chain. Lo and behold, everything has gotten better. And yet his belief was that because he was told by a physical therapist back from high school is that his piriformis was too tight. And that was the cause. he always just that was piriformis syndrome and that he wasn’t able to ever stretch it out or release it out. And that was the Doom factor for him and constantly having sciatic pain. So this sciatica in any nerve related issue, needs proper diagnostics, consultations, workshopping of understanding triggers, causes of pain or increasing the symptoms, because it’s gonna be very hard to get out of those if you don’t know what those triggers are. But more specifically, finding the specific thing that helps alleviate the nerve pain, whether that’s opening up the foramen through an opener that allows perforation and signaling to go through. whether that’s anti inflammatories, depending on the extent of how acute the injury is. whether that’s flossing–nerve flossing exercises to make that nerve excursion smoother, if you will.


Anthony Gurule  21:28

So I see it more as (and I’m not saying a cop out because it’s the other, the other provider Whoever didn’t necessarily know anything else.) But we see this more or less as kind of a cop out diagnosis. We did a recent podcast on you know, how Fibromyalgia is diagnosed, which essentially is an exclusion criteria just like hey, we couldn’t figure out anything else. Right. sciatica. You know, they’ll do a couple orthopedic tests to try to determine but there may be inconclusive, it’s just like, ah, you know, your hip’s tight. I’m not quite sure what the cause is, it’s most likely your piriformis muscle because we poked on the end, and it’s tight, right? That’s usually how this is laid out. And that is really just not a service to you as a patient or a client.


Anthony Gurule  22:15

So I hope this was I hope this was helpful. Again, if you if you’ve been told you had piriformis syndrome before, or you have a tight piriformis and that’s causing you sciatica, I think this is a very important video for you to go through and send to, you know, a loved one, a family member or friend who’s who’s been complaining about this as well. Because in what we’ve seen, and in in our mind, it gives a lot more confidence about what you can do in the future. Because if you think it’s a tight muscle, and you’re still having symptoms, and you’ve just been stretching the hell out of it, you’re not getting anywhere, that’s super frustrating. You’re like, Well, shit, that’s what it is, you know, I’m not going to be able to change it. And when you have a different lens and perspective about what’s actually going on, it gives you a lot more. It really helps empower you to be able to do more about this.


Anthony Gurule  23:00

We appreciate you tuning in guys. Again, we’re Live LOUD chiropractic here in Lafayette, Colorado. If you’re local, we’d love to connect with you and help you with your aches and pains to help you live a fuller life to help you feel stronger, more confident about your movement. If you’re not local, we do offer online consultations because we want to again, be be in a role and a position to empower you, even if it’s just a consult to help you navigate what that next step would be. A lot of people don’t have that. And if we can do that for you, we’d love to be able to help out. So be sure to like and subscribe to our YouTube channel or podcasts. You can also find us on Instagram where we’re doing much more shorter pieces of content but still very valuable and useful to parents, to families. To you know if you’re a prenatal if you’re postnatal, if you have little ones at home, we’d love to be able to share that content and that information to help you live a loud life. Until next time, guys.