BACK PAIN: The 6 Treatments We Do NOT Recommend (and What Actually Helps)

[0:00] Kathy: I got some back pain. Give me some drugs. Jason: Stop, Kathy. Don’t do drugs. How is somebody supposed to know the right thing to do for back pain? It’s such a common problem. Kathy: Yes, and that’s what this episode is all about. Today, we’re going to talk about the worst things that you can do for lower back pain. And some of these things are really going to surprise you. Mhm. Spoiler alert. One is really common and the other one potentially deadly. You’re going to want to listen to the end. Jason: Oh my gosh, Kathy, this could be

[0:31] our most important episode ever. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But chiropractors and physical therapists don’t like each other. Kathy: Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Kathy: Remember, there’s no I in PTCH. We are back.

[1:01] Jason: Hi. Welcome back to the PTCH Podcast. I’m Dr. Jason Young. Kathy: Oh, and I’m Dr. Kathy Lynch. I forget that every time. Jason: Every time. Yeah, we’re going to have to start wearing name tags, I guess. But can we bring up that today instead of wearing a name tag, you’ve got your Notre Dame on. Kathy: That’s scorched earth today. Yeah, oh boy. Jason: Bringing it. Let’s just check in on your mental health after the college football playoff news and, you know, your team got snubbed. My team got snubbed.

[1:31] Kathy: Yeah. Well, one of my teams — I’m an Oregon State guy. We snubbed ourselves this season. But yeah, BYU, they got snubbed too. Jason: Snubbed. How do you only lose to — what is Texas Tech, the number four team in the country? Kathy: Yeah. Yeah, both times they played them, right? The only time. And you don’t get in. Yeah, I don’t know. I don’t know. Yeah, don’t get me started on Miami or Alabama. Jason: Yeah, well, and how are you in every week until the one week when it counts? Kathy: And I’m like — and yeah. Just kidding, Notre Dame. Yeah, yeah. You’re

[2:01] out. You beat Stanford 50 to 4. Uh-huh. But nobody cares. Jason: And we’re going to knock you down. Yeah, it doesn’t make sense. And you know what’s funny is like sometimes people are like, “Oh my gosh, the PTCH Podcast, is that a sports podcast?” And now we are. Kathy: It is. Jason: That’s all we’re talking about. Kathy: How the college football playoff committee should be disbanded. Jason: This doesn’t match with our open at all, but I love it. I’m totally here for it. So. Yeah, well, let’s talk about

[2:32] something a little more PTCH Podcast related before we jump into the stuff about the lower back. We want to talk a little bit about our stats because we got a surprise — like Christmas came early this year, I guess. You know how at the end of the year you get your Spotify — I think it’s called a wrap-up, right? Kathy: Yeah. Right. It tells you how many times like you listened to Taylor Swift. Jason: Yeah. Yeah, right. Oh. Who’s your most listened — have you gotten yours yet? It goes out. Kathy: Definitely Taylor Swift. It was — is

[3:02] that the most listened to artist? Jason: Yeah, mine is different every year and it’s really weird. Like one year there’s like a country music person in there and I don’t listen to country. So somebody’s been on my account. Oh. Yeah, ruining my stuff. Kathy: Who listens to country music in your house? Jason: Everybody but me, apparently. Kathy: Can’t pin it down, then. Jason: Yeah, yeah. One year it was Desmond Dekker, who most people don’t know who that is, but just outstanding. Reggae. Yeah. So listen to Desmond Dekker if you want. But that’s not what I want to talk about. Kathy: Okay. Jason: All right. So when you podcast,

[3:32] apparently — this is our first year with the podcast — but when you podcast on Spotify, apparently one of the things that they do is they send you a wrap-up for the year. So we get to see like where we rank in podcasts. And I have to tell you, Kathy, I was blown away. Like, are you ready for this? Kathy: Yeah, I’m ready, please. Jason: We are in the top 15% of video podcasts on Spotify. Kathy: Whole world? Jason: What? Yes. How did that happen? Kathy: No idea. Jason: Talking like thousands and thousands and

[4:04] thousands of podcasts. We’re in the top 15% of video podcasts. Kathy: Yes, good job. Wow. Jason: Good job. Okay, you’re special. Another thing too is they told us kind of where we ranked among new podcasts. Podcasts that are new in 2025 — if you just started listening to the PTCH Podcast, that’s because everybody just started listening to the PTCH Podcast, right? Like, “Oh, I was listening to those guys last year.” No, you weren’t. No. So we started in March. So without even a full year, with only like a

[4:34] nine-month resume, we are more commented on, we’re more shared, and we’re more listened to than 92 to 95% of other new podcasts. Kathy: Yeah, this is history in the making. Jason: Yeah, we’re killing it. Kathy: The PTCHes — Jason: Yes. Kathy: — are here. Jason: Yes, and — so thanks, PTCHes, for showing up. Kathy: Really, it’s about them. Jason: And this is — this is when we announce that this is our last episode. And we’re out. Kathy: Not really. Not really. In fact, we have even more exciting updates. But wait,

[5:04] there’s more. We are really close to launching premium subscriptions for the PTCH Podcast. So if you just can’t get enough of this show, we hear you and we’re going to give you more. And so there’s going to be things like extra features — like if you’ve been on YouTube or Spotify today, you saw that we released a special episode Kathy: Yes. with Chris Quaka and it was kind of tangential to our mission here. It was about the

[5:34] health effects of giving Kathy: — giving. Jason: and being generous. It’s the giving season. Yeah, totally. And so extra features like that — maybe you get a little behind-the-scenes look, maybe you get some bloopers. Although like really, on a show like this, could we have bloopers? Kathy: We definitely do. Jason: You’ll see all the bloopers. Right, right. We’re going to do some aggregations. So like we’ve talked a lot about things like squats or pain or different types of things, and we’ll have full episodes where it’s just like picking from or

[6:04] we’ll have full videos where it’s just picking from each episode where we’ve talked about that topic. So you could watch a whole like video on menopause and it’s just going to be taken from all the little pieces we’ve had on the show. And then also AMAs. Do you know what an AMA is? Yeah. Ask me anything, right? And so our subscribers will have an opportunity to go ahead, put questions out there and we’ll make just — we’ll just make a little baby episode just for you answering your question.

Kathy: Yeah. And one of the things I’m most

[6:34] excited for is — for probably our highest level of subscriber — we’re going to give those people an opportunity to play some of our games.

Jason: So the games are the fun part. If you only watch the first five minutes of these videos, you’re totally missing out. The first five minutes sucks compared to the game. The game at the end, that’s what you want to stick around for. So we’re going to give subscribers an opportunity to call in and we’re going to let you play a PTCH Podcast game and there will be prizes and everything. So look for more information coming about

[7:04] how you can become a premium subscriber to the PTCH Podcast. And when we get premium subscribers, then our families allow us to keep doing this.

Kathy: Please. All right, should we get to the episode?

Jason: Yeah, let’s have fun with this episode. Okay.

Kathy: You’re one of the experts on back pain. A world expert, yeah. Yeah.

Jason: Heard. World. You have that sign outside the clinic?

Kathy: Yeah, world expert, right. Usually — that’s what my

[7:35] my license plate is on all my vehicles, world expert one. It’s like W-R-L-D-X-P-R-T. Yeah. Yeah, I don’t know.

Jason: Yeah. I see a lot of people with back pain. Let’s just put it that way.

Kathy: You do. Mm-hmm. And we’ve come up with a list of five or six things.

Jason: Wait, I thought about it. We should do the disclaimer. We should do the disclaimer now.

Kathy: Absolutely right. 100%.

Jason: The disclaimer is we are not giving medical advice. This is strictly entertainment only. Not today. Not today we’re not giving medical advice. So

[8:05] do not take — talk to your doctor.

Kathy: Talk to your doctor.

Jason: Well, we’re going to get you some tips to talk to your doctor. Yes. Especially if your doctor brings some of this stuff up, then you really need to talk to your doctor. I think we’re going to go — what, least dangerous to most dangerous?

Kathy: Yeah, it’s going to be about like that. We have two at the end that are real doozies. One that’s potentially deadly —

Jason: Yes.

Kathy: — and one that is very, very common and super unwise. Like all the evidence says don’t do that thing. Don’t do it.

Jason: Yes. Mm-hmm. Yeah, they say. Whoever they are. Let’s

[8:35] start with something that’s like pretty common —

Kathy: Yeah, let’s hear it.

Jason: — but it’s also pretty basic. Yeah. Acetaminophen, otherwise known as Tylenol.

Kathy: Tylenol. Yeah, Tylenol is something that is great if you want — but I mean, I’m just telling you what the research says. But darn near useless for lower back pain.

Jason: That’s a new peer-reviewed article I haven’t read yet. Yeah, right. Right. And because they haven’t been written, that’s why. So

[9:06] yeah, you know, Tylenol has been extensively studied as a treatment for lower back pain and it’s found to be — mm-hmm — let’s see — virtually useless.

Kathy: Oh. Yeah. Placebo. Yeah, if you get any results from Tylenol, it’s probably placebo. Might as well go eat some ice cream. Yeah, basically.

Jason: And so it’s not a very useful intervention for lower back pain. And I think one of the things

[9:36] really to bring up is when we talk about some of these things, there’s kind of a couple of categories for injuries, especially lower back pain, and that is acute back pain — which is like — not ugly. Yeah, right. It’s like, “Oh, this back pain is so cute,” right? And then there is chronic lower back pain. So one of the nice things about Tylenol is it doesn’t work for either. So. But is Tylenol — I think some people are like, “Oh, Tylenol is super

[10:07] safe.” But is it safe? Like, are there risks with Tylenol?

Kathy: Yeah, I feel like the liver doesn’t love Tylenol.

Jason: The liver doesn’t love it. No. It’s actually — in terms of over-the-counter drugs, it’s the most commonly overdosed —

Kathy: Oh.

Jason: — over-the-counter drug.

Kathy: Know that.

Jason: Yes. Just, you know, right ahead of — I don’t know what — Zyrtec? I don’t know if you can overdose on Zyrtec, but —

Kathy: Sorry, Zyrtec. We don’t —

Jason: Yeah. I mean, if you’re in Oregon, the Willamette Valley, you might feel like

[10:37] gargling Zyrtec, rubbing a little in your eyes and stuff like that, but no. But seriously, Tylenol — more hospitalizations for Tylenol overdose than any other over-the-counter drug. Mm-hmm. So yeah, your liver doesn’t really love it. No.

Kathy: And so, if you want to add a liver problem to a low back problem, by all means. So why doesn’t Tylenol work?

Jason: That’s a good question. And I don’t know that we really know the answer to it.

[11:07] It is — so it’s a pain medication. It’s outside of the category — so there’s different categories of pain relievers. There’s some pain relievers that work on your brain to kind of turn off some of those sensations. There’s non-steroidal anti-inflammatory drugs, which are just like they sound — so they’re not steroids, but they help with inflammation. And those function by kind of inhibiting an enzyme that then would

[11:37] cause pain and inflammation. Tylenol is not one of those. It’s a pain reliever and it just doesn’t work for lower back pain, yeah. It’s a different type of problem. That’s not to say that it isn’t useful for other things. It’s a really good fever reducer, for example. It’s good for other kinds of pains — like people can take Tylenol if they have a headache. But for lower back pain, just the research is not good. Mm-hmm. So skip it. Skip it. Yeah.

Kathy: Skip. Yeah.

Jason: Skip. One of the worst

[12:07] interventions. It’s generally safe, except for — right? And I think if you take three of them, you’re automatically — but probably not true. Remember, this is for entertainment purposes only.

Kathy: Only for entertainment purposes. But yeah, Tylenol generally safe, but if you’re trying to take more to get a bigger effect, it can end up hurting you more than it helps.

[12:37] Jason: Yeah. Yep. Yep. Yeah. This is one of my favorites, this next one.

Kathy: What’s that?

Jason: Early imaging. Everybody wants an image.

Kathy: They do. Yeah.

Jason: Can I get an MRI?

Kathy: Can I get an X-ray?

Jason: Why? Why do you need that MRI?

Kathy: Well, because it hurts very bad. I need to know.

Jason: Yeah. I need to know. I need to name it. What’s causing this pain? So, what’s the problem with early imaging then? Are you asking my opinion?

Kathy: I’m asking your opinion. Okay, professionally.

Jason: Yes.

[13:08] With early imaging, usually what we see in early imaging does not correspond with the symptoms. Yes. And in fact, I have had some recent patients who have gotten early imaging of their back — recently this week — where they had what’s called an anterior listhesis.

Kathy: Great word. Yeah, it’s a good word. It’s a hard one.

Jason: It’s a Scrabble winner. Yes. And it’s really just —

[13:39] — not just, but one vertebrae kind of slips in front of the other one.

Kathy: Right. And just, you know, it was like — it’s literally misaligned.

Jason: Yes. It was like five millimeters.

Kathy: Uh-huh.

Jason: The patient’s like, “That’s got to be it. That’s got to be it.”

Kathy: That’s what I’m feeling.

Jason: Yep. That’s it. I can feel it. Yep. And this pain just started, you know, four weeks ago.

Kathy: Mm-hm. Well, luckily, or unluckily, she had had an X-ray in January. So we went back and looked at that X-ray. Guess what? It was still

[14:11] there.

Jason: Okay. Yeah. Yeah. So, just because you have degenerative disc disease — mm-hm — or an anterior listhesis, or scoliosis, it does not mean that is what’s causing your back pain.

Kathy: Preach. Yeah.

Jason: Yeah. And it’s a big deal. In fact, a lot of patients want imaging because they have pain, and you cannot see pain on an MRI, you can’t see it on an X-ray. And you’re right, a lot of these changes in the spine are good clues as to what

[14:43] might be leading to some of your problems, but it’s a trap. A lot of doctors will do this where they’ll go and order early imaging and they want to find something that justifies — yeah, we were right to order this. And so they’ll look at something like that and they’ll be like, “Yep, see, there’s your back pain.” And it’s totally wrong. And what’s the harm in that? The harm in that is that some of those things you can’t change, right? They’re just — like if you have bone spurs, you can go in and shave down bone spurs and things like that, but

[15:14] it’s super risky and there’s not much value in it too, because you get rid of those bone spurs and guess what? You still have back pain. Well, what do you do now?

Kathy: Go back in?

Jason: Yeah, we got to shave them down harder this second time. So yeah, early imaging is a real trap. And also one of the things that’s really important about it is that it changes the way that people think about their back.

Kathy: Yes.

Jason: Yeah. So, you see an anterior

[15:44] listhesis, you see scoliosis. And these words are expensive to learn, right? So you see these things on there and now it changes how you think about your back. “Oh, I’ve got a bad back.”

Kathy: Mm-hm.

Jason: “My spine is crumbling,” right? And I think we’ve talked about this before, but even using words like degeneration, degenerative disc disease — even any word that’s like over seven letters long — it disables people.

[16:14] Kathy: Yeah, not meaning that like you get the handicap placard, but it changes the way that you think about the resiliency of your body, your ability to recover and things like that. And one of my favorite studies ever — I think I brought this up before — is they’ve taken healthy people that have no back pain, they’ve done MRIs, and they have found that a significant number of these people have some of these changes, but they have no symptoms. So you can’t really correlate everything that’s found on imaging with your symptoms. And so, looking at those

[16:45] early imaging findings, they’ve actually done studies where they showed that people who get imaging early have worse outcomes.

Jason: Yeah. So don’t walk into your doctor’s office and say, “Give me that X-ray now. Give me the MRI right now.”

Kathy: The MRI. Yeah. So when should somebody get an MRI for lower back pain?

Jason: Usually for me, if they’re having symptoms down into their legs — pain past their knee — yeah, and

[17:15] foot drop.

Kathy: Muscle weakness, muscles aren’t working — we need that stat.

Jason: Right. They need the — depends. They know.

Kathy: Good point. Right. They’re having some bowel or bladder incontinence.

Jason: Yes. So yeah, those are the things. When you’re having those symptoms down the leg, down past the knee — mm-hm — and not just the first sign of having them, well, with the exception of maybe some of the muscle weakness and the incontinence. But like if you’re having numbness or tingling, it’s not an emergency to go

[17:45] out and get an MRI.

Kathy: Right. What you need to do is give it some time, treat it, do some active care, and see if those symptoms improve. If they don’t, or they become worse, then yeah, now we’re thinking about MRI.

Jason: Yeah. The other thing is if there’s a trauma, right? So if you have fallen out of the third-story window and you landed on a ladder and then you fell into a pile of broken glass, yeah, we’re going to want to do an MRI.

Kathy: Yeah, you don’t even need the glass. But yeah, if you have a significant trauma, an MRI might be a good idea. Or

[18:15] if we’re suspecting some sort of a disease like cancer, right? So if you think that you have back pain because of cancer and your doctor agrees, then yeah, let’s MRI it up, right?

Jason: Yeah, but otherwise MRIs don’t fix people.

Kathy: No, they don’t.

Jason: They don’t. You know, they’d be giving them out like candy. If you want a surgery, go get yourself an MRI.

Kathy: Yeah. One of the leading causes of surgery, right?

Jason: That’s right. So yes, very good.

[18:46] All right, what do you got next for me?

Kathy: Okay. Ice, ice baby. Should I ice it?

Jason: Probably not. Probably not. Yeah, so ice has become really controversial, right? There’s some people out there that are like, “Well, I learned in first aid that you’re supposed to do RICE.” Right? Rest, ice, compress, elevate.

Kathy: Yes. And actually, the person who came up with that acronym regrets ever having done it.

Jason: Really?

Kathy: Yeah, because the research is not very good for ice. So ice is nice —

[19:16] Oh, jeez. I was trying to say something that didn’t rhyme. But ice is good from the standpoint of you can numb things. It helps to reduce swelling and helps to reduce pain and all those things. And so, you might be listening to me say that and be like, “Well, why is any of that bad, right?” But the other thing that ice does is it slows down some metabolic healing processes and it can delay healing.

Kathy: Mhm.

Jason: Whoops. Yep. Right? So, when you have lower

[19:47] back pain, in particular if it’s from some sort of inflammation or something like that, your body is going to have an actual immune response to that pain stimulus. And if you’re icing your back, then you are kind of blunting the body’s immune response. And so while it might feel good and give you some temporary relief, you’re just prolonging the agony.

Kathy: Just delaying it. Yeah. Delaying getting better. Yeah.

Jason: Just like heat would — feels

[20:17] better anyway.

Kathy: I agree. I hate icing. I think — yeah. It’s like — it’s like torture.

Jason: Yeah. And I think that there are some exceptions, like cold baths are super popular right now. Like people — “Oh, I got to do this cold plunge” — and those aren’t really bad. But that’s kind of a different category of thing because you’re exposing your whole body to some cold shock and so there’s some other reactions that happen. But like localized icing, outside of like, you know, I just had a burn or I just had a

[20:50] sprain or strain — and there’s even some — there’s even some disagreement as to whether to do it then. But in general, ice is — it’s not as popular as it used to be.

Kathy: Not the cool kid anymore. Do you see — right? I did that.

Jason: Yeah, I did. That was good. Yeah, it’s like — and you know, we talked about this before. If your gym teacher was trained in the ’90s, or your dad or your mom was an athlete in the ’80s, they’re going to be like, “Yeah, you need to ice.

[21:20] Both of your knees.”

Kathy: Yeah, I have to admit it’s been hard for me not to tell people to ice.

Jason: Yeah, it’s classic. Yes. Yeah, it’s like — ice on it — it’s better — like Steve Miller Band, right? I don’t know, like classic —

Kathy: Oh, yeah, classic rock. Yeah.

Jason: Sorry. Did they use ice? And now you guys have seen in real time what happens when your joke doesn’t hit. I froze her — as if with ice. All right. So yeah, throw out the ice

[21:50] pack. You don’t need to be icing your back every night if you’re having back problems.

Kathy: No. Okay. Next — hit me with it.

Jason: Number four. Oh, this is a — this is solid. Docs really like to give this one out.

Kathy: Love it. Yeah.

Jason: Muscle relaxers.

Kathy: Muscle relaxers. Yeah. You know, muscle relaxers — first of all, basically they’re sedatives. So there’s that. They’re going to put you to sleep.

Jason: Yeah, and when I have patients who are like, “Yeah, they gave me some

[22:22] muscle relaxers — so should I be taking those on a regular basis?” My first response is don’t ask me about how to take medication, because I don’t prescribe. So it’s outside of my scope of practice to tell people how to take their medication. And so that being said, you should take your medication how your doctor tells you to take the medication. Now, that doesn’t mean that you can’t ask your doctor some informed questions about the wisdom of the medication that you’re taking. And from what I understand about

[22:52] muscle relaxers, having read a ton of research on it, is that one of the best ways to use them is to help you sleep. Right? From the standpoint of if you’re sleeping and you’re getting muscle spasms related to your back, then yeah, a muscle relaxer could be helpful for something like that. If you’re using muscle relaxers to get through your day, you’re going to be disappointed.

Kathy: Yeah, that’s not going to be a good solution. Yeah.

Jason: Yeah, and we don’t want to bag on

[23:22] physicians here. We’re going to do that in the next episode.

Kathy: Yeah, that’s the next episode. Yeah, tune in next week.

Jason: No, and she’s not even joking. Yeah, she told me the topic. She’s like, “Hey, what if we do this?” And I was like, “I’m there for it.” I will actually be on time this time. They’re just trying to help, and like this is something that can help.

Kathy: Mhm. Yeah.

Jason: Sometimes it does help people because they just need to sleep.

Kathy: Totally right. And there is a placebo effect that comes with muscle relaxers.

Jason: Yeah. Because people feel like, “Yes,

[23:54] I’m doing something. There’s something — there’s a button that I can push” or something like that. And so from that standpoint, good. Muscle relaxers do come with risks, especially if you’re going to be operating heavy equipment.

Kathy: Yeah, don’t do it.

Jason: So yeah, by heavy equipment, a lot of times what we’re talking about is something as simple as a car, right? So if you’re taking muscle relaxers, it is not wise to go and drive. You could hurt yourself worse. You could hurt other people. It could cost somebody their life. Sometimes people have allergies or reactions to muscle relaxers, which is another thing that doesn’t really make them ideal. But to your point about doctors giving them out, the reason they do it is because it’s what they have available.

Kathy: That’s their tool. I mean, what do you want to give them, Tylenol? Are you crazy? You lost your mind.

Jason: Want to give them Tylenol? I’m not going to make another — no, so —

[24:25] Kathy: Hit the limit on that.

Jason: Yeah, I did. Yeah, the sensors — the sensors are like, “No.” So yeah, muscle relaxers tend not to

[24:56] be very successful. And I guess I should say, with all of these things, somebody’s probably listening and they’ll be like, “Well, that’s a lie. I took Tylenol and I got better, mister.” Or they might be like, “I iced my back and it was the only intervention that I needed.” And I’m not saying that you’re wrong. I don’t doubt it. It’s just that everybody is a little bit different. Circumstances are a little bit different. If you have back pain that is related to one acute muscle spasm and taking a muscle relaxer

[25:27] ends that muscle spasm and it never comes back, guess what? You are cured.

Kathy: Do it.

Jason: You’re cured by that muscle relaxer. But that is just not the case most of the time.

Kathy: Right. And not reliably enough that anybody should be like, “Yeah, if you have back pain, take a muscle relaxer.” Especially not for chronic low back pain. Like almost worse than useless. So.

Jason: Yeah. You can sleep. Okay. Yeah. Are we getting to the dangerous one now? Okay, this is the dangerous one. Danger.

[25:57] Danger. Again, this is not medical advice today. But yeah, this is the deadly one, yeah.

Jason: One. Opioids.

Kathy: Opioids. Yes. Yes. The fruit of the poppy. Yes.

Jason: Yeah. Narcotics. Yeah, opioids. Okay, so opioids are like your Vicodin, your Oxycodone, your OxyContin, your hydrocodone, all those kinds of things. Those are opioids.

[26:28] And in the early days of opioids, they were thought to be like the miracle drug. Sure. Because they were really effective in terms of helping people who had pain. Most common things that we see them for now are after surgery. When somebody’s going to be dealing with some really intense, serious pain, and so you might get a prescription for one of those things. But long ago, in the

[27:00] ’80s, ’80s and ’90s,

Kathy: Yeah, some of this is the fault of drug companies, but they were putting out opioids, massive advertising campaigns for them, and they weren’t disclosing that number one, it was addictive, and number two, they were deadly, right?

Jason: Yes. Opioids and heroin are essentially the same thing.

Kathy: Yeah. They are hitting the same receptors in the brain, and so it

[27:32] becomes very easily a drug of abuse, especially if you get addicted. Now, there’s some people who get hyper paranoid about opioids. They’re like, “I don’t even want them near me because I don’t want to become addicted.” It takes more than one

Jason: Yeah.

Kathy: in order to get you addicted.

Jason: Yes. But there are people who — like you go for a surgery and you go through your course of opioids, and by the end of that course, you could have some dependence.

Kathy: Absolutely. Some people are more susceptible to it than others.

Jason: Mm-hm. Now,

[28:02] back in the hey, you know, this is a safe drug. There’s no danger with it.

Kathy: The glory days. The glory days. Yes, the Mercedes ’80s, right? Yeah, you could have your Quaaludes and your opioids. And well, like, really.

Jason: Right. Yeah. Yeah, they would give them to everybody, right? They’d give them to athletes. So it’s like, “Hey, go play your game, right?” They gave a ton to veterans. Yeah. Right? And it was

[28:32] not only contributing to veteran deaths, they were contributing to addiction and homelessness and all these other kinds of things. So opioids were just a disaster for a while. In fact, we call it the opioid crisis. Yeah, you Google that and I’ll tell you, it won’t just be one webpage that comes up. There’s a lot. Yeah. And this is one of the areas where

[29:02] you know, people can really get hurt if they have acute low back pain or chronic low back pain and you’re relying on opioids — there’s almost zero evidence that it helps you to heal from a back injury. Right. And it is so dangerous from the standpoint of if you’re on it for a long time, you risk losing your family, your house, your job, your life, your sobriety, all those kinds of things.

Kathy: Yeah. And you made a good point, and this kind of goes back also to Tylenol. This is one of those medicines that works on

[29:32] your brain. It doesn’t actually get to the source of the pain. And so it’s just kind of altering

Jason: Yeah.

Kathy: the neurotransmitters in your brain. Yeah.

Jason: It’s not — you know, like an Advil or an Aleve actually reduces inflammation. An opioid does not do that. Yeah.

Kathy: And that’s one of the big differences and why it’s dangerous. That’s a good point. And some of those brain changes can be permanent, right? So if

[30:02] you are too deep into opioids or use them too often, you can be left with some permanent damage from them. So not saying that opioids don’t have a place or that they’re not useful, but they must be used extremely cautiously. It has to be done under the supervision of your doctor. You should never use somebody else’s opioids. I cringe every time somebody comes in and they’re like, “Yeah, my back was really hurting so my buddy gave me an oxy.” And I’m like, “Jeez.” Does your buddy live under a bridge?

[30:34] He’s about to. But yeah, so you just got to be really careful with this, and really in terms of the risk-reward, there’s almost no reward for taking opioids for back pain. They just

Kathy: They just don’t really work

Jason: Right.

Kathy: well to help you recover from a back injury or a back problem. So yeah, I had my own experience with opioids. I had this just minor surgery on my head —

Jason: Brain-ish.

Kathy: Yeah, then minor. And

[31:04] you know, they gave me oxy because they, you know, cut my head open. And so after about 10 days or so, I noticed myself really looking forward to my next dose.

Jason: Okay.

Kathy: And that’s when I was like, “Hold on here.” Yeah. Let’s see if I can just not take this anymore. I didn’t go cold turkey because that’s the other thing — don’t go cold turkey.

Jason: Yes. Right? But I started to notice within myself like, “Oh, this is giving me a boost. This is giving me a mood boost. This makes me feel good.” And

[31:36] that’s not the intent here.

Jason: Right.

Kathy: So I think I would be one of those people that’s susceptible to it. So yeah.

Jason: Well, and these days, you know, like we said, you got to be working with your doctor on this. You were taking them because your doctor prescribed them. But sometimes people get used to that little boost and then it’s like, “Okay, my doctor’s not going to prescribe them anymore, but I can go get some at the local middle school.” Not in Corvallis. Not in Corvallis. Guys, no. Philomath. Okay, no, just kidding. But

[32:07] man, I know of three kids in our community who in the past couple years have died from opioid use because they were laced with fentanyl. And fentanyl killed them. And so that’s the other thing, too, is that there’s ways to get opioids that aren’t from your doctor and I just would not trust any of them. It’s just not safe, especially now. So yes, okay, we got dark there for a minute. We did. We did, and let’s come

[32:37] back to the light.

Kathy: Okay, let’s come back to the light. Maybe the most —

Jason: Maybe the most comfortable thing that we could possibly talk about, right?

Kathy: Oh, dark to light, Jason. And this is maybe not the most deadly, but one of the most common mistakes people make. Yes.

Jason: is. One of the more dangerous ones, too. It can be, yeah. Bed rest. BED REST. WHAT? WHAT?

Kathy: YEAH. My comforter?

Jason: Yeah, don’t do it. My Serta mattress? It’s ruining things for me? Get to the gym. Yeah, it’s well —

[33:09] and it’s so common. Like people come in all the time, right? And how do they inform you that they’re on bed rest?

Kathy: “This is the first day I’ve been out of bed for 10 days.”

Jason: Gosh, yeah, “I haven’t been able to get out of bed.” Yeah, which — unlikely. I mean, there’s people that legit can’t get out of bed, but they probably just weren’t really trying. Like you’re like, Game of Thrones marathon. Oh man, but yeah, don’t do bed rest if you have back pain. And I understand the

[33:41] impulse to do it because it’s like, “I need to be nice to my body. I need to take it easy. I just need to let this heal up.” But for your back, nah, it doesn’t work.

Kathy: No, research says no.

Jason: Yeah, research says emphatically. Like whenever I was going through and kind of sharpening up all the information for these segments, you know, there’s some things where it’s like moderate-level research says that this isn’t that effective and there’s low-level research that says this isn’t. Bed rest — strong research, strong, strong

[34:12] evidence. Very strong.

Kathy: Yeah. So this is going to disappoint some people because they feel like, “Well, you know, babying it is probably the way to go, and if I don’t use it, then it’s just bound to get better.” But that’s not how backs work.

Jason: No. No. No. So how often do you think somebody is using their back during the day?

Kathy: All the time. All the time. Like literally all the time.

Jason: Literally. If you are sitting in your car, you’re using your back, right? So even when you’re sitting, you’re using

[34:42] your back. Standing, running. The only time you’re really not using your back is when you’re lying down — when you’re freaking lying down.

Kathy: Yes, so that’s why it’s feeling better.

Jason: Yeah. And when we start getting into what are some of the good things that you can do for your back — because we’re not just talking about the worst, we’re going to talk about some of the best — like this is exactly the opposite. So don’t do it, y’all. Get out of bed.

Kathy: Get out of bed. Like, you remember that the Willy Wonka movie, right? Where Charlie’s

[35:12] Charlie’s grandparents were all — Grandpa George, Grandpa Joe.

Jason: Yeah, Grandpa Joe. Dude, I thought that was the grossest thing ever. It’s like these old people all just —

Kathy: All four of them. All four people sitting in the bed. It’s like —

Jason: Right? Oh my gosh. It’s like, “Charlie, why do you want to hang out with that guy? He’s clearly got lower back pain. Let him just sit there and wallow in it.” Oh yeah. Okay, I’m not — I can’t — don’t

[35:43] nobody go watch that show.

Kathy: Okay. I used to love that movie as a kid.

Jason: A great movie, but I would not start watching until after that part, ‘cause it just grossed me out.

Kathy: Yeah, nasty. Yeah. Okay, anyway.

Jason: All right, so what should we do?

Kathy: Okay, let’s talk about this.

Jason: If we have back pain.

Kathy: Yeah, so let’s start kind of where we left off. If you have back pain, stay active.

Jason: Keep moving. Keep moving. But my back

[36:14] hurts when I move. What do I do? Bed rest. Not bed rest.

Kathy: Oh. Gentle, gentle. Be gentle with yourself, but keep moving.

Jason: Yeah, like you don’t have to go and lift a boulder or something like that, but you should keep moving.

Kathy: Yeah, walk, stretch.

Jason: Totally. And there’s something that I like to call active rest, right? So — and I don’t call it active rest because I coined the term.

[36:44] But yeah, active rest is like, “I’m still up and I’m doing things, but I’m listening to my body and I’m not trying to kill it,” right? Sometimes you’ll have back pain and it’s like, “Oh, I got out of this chair. Oh man, that really hurts.” But you don’t know what’s on the other side of that initial movement. Once you get up and move around some, it might actually feel pretty good.

Kathy: It feels better, yeah.

Jason: Yeah. And oftentimes that’s the fix.

Kathy: Yeah. So so many of our muscles in our

[37:15] back — so many of the ones that cause back pain — they’re postural muscles. So there’s just like — this is an oversimplification, but think about two types of muscle fibers in your body. You have fast twitch and you have slow twitch. The fast twitch muscles are the ones that you would use for really intentional movements. Like, “Oh, I’m going to curl these weights,” or whatever. “I’m going to wave at somebody.” Those are fast twitch muscles. Or, “I’m going to go running,” right? Slow twitch fibers are postural muscles. They’re endurance muscles. And so so

[37:45] many of the muscle fibers in your lower back — they are those slow twitch postural muscle fibers. Now, those fast twitch fibers, they get their energy from glucose. So, you know, you’re getting your carbs or whatever. You’re eating your Nestle Crunch.

Kathy: Yes.

Jason: Yeah, not a sponsor, but — maybe. Call me up, guys, right? And so yeah, that is taking that from

[38:15] your blood, from your muscles, and that’s what it’s using to work. Slow twitch fibers — those use oxygen. So how do you get oxygen in your body, especially to your muscles? You got to breathe, right? And how do you get more breaths into your body? You got to work, right? So if you’re doing some aerobic exercise, like going for a walk if you can do a walk, going for a bike ride if you can do a bike ride — if you got lower back pain and you’re having trouble bearing weight, see if you can go for a swim, right? Just anything that you could do to keep

[38:45] moving — that’s going to be helpful for those slow twitch fibers. I like walking in the water, too.

Kathy: Yeah.

Jason: Aqua jogging. Aqua jogging. Yeah, so — and really there’s just kind of different categories of lower back pain, acute and chronic. There are different types of healthcare interventions for something like back pain or musculoskeletal pain. There are

[39:15] active interventions and there are passive interventions. So active interventions are when you’re moving your body under control, doing things for yourself. Passive is when somebody does something to you. For example, a chiropractic adjustment. That’s a passive intervention. I’m doing all the freaking work, people, okay? So that is something where, you know, you’re laying there passively and we’re performing some sort of procedure or help for you, and then you go home and you do your exercises. That’s the active care component. And both of them have value. Yeah.

[39:47] Active care is the solution, though. Right. Passive care — the goal of that is to help you get into your active care.

Kathy: Yes.

Jason: Yeah. Yes. So.

Kathy: Yeah. All right, so that’s step one: stay active.

Jason: Mhm. Number two.

Kathy: Number two. I would say if 5 to 10 days it’s not feeling better, or it’s getting worse, that’s when you call us.

Jason: Yeah. Call us. Yeah, you don’t have to see your physician either. No. Um, and

[40:19] come to your favorite nerd. This is — yeah, this is going to sound bad — but I don’t recommend people go to their general practitioner with back pain.

Kathy: Right. Um, and that’s not a knock on general practitioners, but I think a lot of general practitioners would tell you they’d rather not see back pain, too.

Jason: They do not. They want tummy aches. They want to, uh, they want to know like, “Hey, is it time for you to get your next vaccine?”

Kathy: Mhm. Or, you know, just any of those kinds of things. They generally don’t like back pain.

Jason: No. Because they don’t get a lot of training as to what to do with it.

[40:50] Right. A lot of times, if they’re doing a really good job, what they’re going to do is they’re just going to refer you — yeah — to one of us.

Kathy: Yes. Yeah. Yeah, so just call us directly. And so that piece that you said, though, about — like, what if I have back pain, why wouldn’t I just go straight to my physical therapist or straight to the chiropractor the second that back pain showed up?

Jason: Mhm. Because usually your back pain does resolve — research says — within 2 weeks. Yeah. So a lot of back pain is just going to resolve on its own. And so it’s like,

[41:20] “Wow, are these people bad at business? Like, do they not want clients?” Trust me, there’s enough back pain to go around. We don’t need to get everybody the second you start feeling a little bit terrible. Um, I think maybe the exception — yeah, exception — I’ll just go with: exception to that is like if you have some history of something that reoccurs and you have some familiarity with like, “Oh yeah, this is that thing that

[41:50] happens to my back. I need to get it checked out.” And you know that early intervention helps — then that’s fine.

Kathy: Do it. Call us. Right, but if you’ve never had back pain before and you’re like, “What is going on?” — give it a few days,

Jason: Yeah.

Kathy: right? And if you feel better, awesome. And if you don’t, cool, come see us.

Jason: Mhm. The other thing, too — the other value in getting it checked out — a lot of people are just like, “Oh, I’m just going to wait and see, wait and see, wait and see, wait and see, wait and see.” And like 6 months later — right. Yeah.

[42:21] Kathy: Then they’re limping around and their hip hurts.

Jason: Yeah, and now they have numbness in their something, like —

Kathy: Yeah, yeah, yeah. And so you don’t want to let it go forever, because early intervention — while we’re saying wait a little bit — early intervention on a more complicated problem is going to give us a lot more options, right, to help you out. I guess I would say the time that maybe you have back pain that you don’t want to just wait and see is if it’s also accompanied by a secondary symptom —

Jason: Yeah. Like, “Oh, I’ve got back pain and

[42:53] I’ve got numbness in my leg,

Kathy: Mhm.

Jason: or it’s shooting down my leg, or I’ve got back pain and I’ve got a fever.” Right. If you have the fever, skip us. Go to your general practitioner.

Kathy: Yeah. Exactly.

Jason: Night pain.

Kathy: Yes.

Jason: Pain that doesn’t change with position.

Kathy: Right. All those kinds of things.

Jason: So if it’s accompanied by some other symptom, then yeah, don’t — you don’t have to wait on that. But if it’s just like, “Oh, I think I strained it a little bit,” or “I was mowing the lawn and it doesn’t feel so great” — give it a couple days,

[43:24] and if it’s not fixed, Kathy and I will be happy to help you.

Kathy: Yeah. So. Yeah. All right, what’s next? Oh, we already kind of hinted at this one. Heat.

Jason: Heat. Yes.

Kathy: Love the heat. The heat is on.

Jason: The heat is on. Makes your nervous system less dramatic.

Kathy: Yeah, it does. Takes the drama out.

Jason: Chills those nerves out. It does. And also it basically does the opposite of the ice. All the stuff that we’re bagging on ice for, it actually

[43:55] helps fuel that immune response. It decreases your pain, decreases muscle tension, increases blood flow. You know, heat is really pretty nice.

Kathy: Yeah. And I think one of the other things that’s nice about it, too, is it’s really accessible. So you have access to heat like all the time — a hot shower, a hot bath. Do you ever have patients that are like, “Hey, would you write to the insurance company and see if I can get a prescription for a hot tub?”

Jason: Yeah, all the time.

[44:25] At least once a month.

Kathy: Yeah. And how does that go?

Jason: “Hello, is this the insurance company? Insurance company, hey, I was wondering — could I get a hot tub?” And they’re like, “Hello, sir. Thank you for calling the insurance company. Yeah, let me just ask you a few questions before we do this. First of all, does your home have a bathroom? Yeah, it does. Okay, so thank you. Does your bathroom have like a bathtub? Yeah, mhm.

[44:55] Yeah, it does. Okay, great. Super. So is the hot water in your house hooked up to that bathtub? It sure is. Okay, then you have a hot tub, sir. Anything else I can do for you?” We don’t even want to give you PT visits. We’re not going to give you a referral. Right, right, right. Yeah. So, but all that is to say that heat tends to be really good if you have back pain. Just be careful not to burn yourself.

Kathy: Yes. Not too hot.

Jason: Right. And give yourself a break every now and then — you don’t need to have the heat on 24/7.

[45:27] They’ve got these little wearable heat packs. Those are really good. We have something in the office — yeah — called — oh jeez, it’s from Hyperice. It’s the Venom Go.

Kathy: Venom. I have the Venom. Yeah, so the Venom — they have the one that straps on, but the Venom Go, have you seen that?

Jason: Okay, good. All right.

Kathy: From you. Oh, you did? Oh, well, that’s a great place to get it. No, but so it’s like a little sticky patch. You put it on the spot that you want heated up and it’s got like a little magnetic control box and it’ll

[45:59] vibrate and also it generates heat and it’s like Harry Potter magic, like instant heat. Jason: Good. Kathy: It’s great. Yeah, so if you got like a hamstring strain or shoulder, you know, your back or something like that, come on down to Body Balance. Now, or if you’re nowhere near Corvallis, go on hyperice.com. They’re not sponsors. I just like to point out everybody that isn’t a sponsor. Notre Dame also does not sponsor us. No, no. Yeah, call them up. Yeah. Kathy: So. All right, what about this last part?

[46:29] Jason: Yeah, I love this last part. Kathy: Positivity and reassurance. Jason: Yeah, mindset. Yeah, but that’s worthless, isn’t it? Like, that doesn’t help, does it? Does it really help? It really does help. Kathy: Yeah, it totally does, right? Jason: Yeah. Well, I mean, have you ever had somebody come in who was just really freaked out by their injury? Kathy: Yeah. Yes, all the time. The back is a scary thing for people. Yeah. They’re sure they’re done. This is the calling card that says you’re old. Now you’re old, right? So yeah,

[46:59] how you think about your — it goes back to the imaging thing. Yeah. How you think about your back, how you think about your body, it really matters for your recovery. Jason: Yeah. A lot of times people get better — well, interesting, you guys probably see this too, where people are like, “Hey, I need to get in to see you.” And they get the appointment scheduled and then they’ll come in and they’ll tell you, “You know what? I started feeling better right after I called.” Literally. Yeah. I hear that all the time. Kathy: Yeah, totally, because it’s like help is on the way. And so your body starts

[47:29] letting go of some of that. Jason: Relax. It’s like, ah. And then you come in, you do the exam, right? Or the assessment, and it’s like, “Okay, hey, listen, this isn’t a big deal. We’re going to be able to help you with this.” And they start feeling better then, too. Kathy: Yeah. And so the unknown is painful. Jason: Yeah. So the — Kathy: Scary. Yeah, the more information they get, a positive expectation. So if you have some lower back pain, get moving, get warmed up, and just have a good attitude about it — most of these things, they just fix themselves on their own.

[47:59] Jason: Yeah. If it’s really serious, we’re going to tell you. Kathy: Yeah, we will. We will refer you out. Jason: Yes, yes, totally. Yeah. And the research — the things that there is the most research, most positive research for, are active care and also this positive mindset. Kathy: Yeah. Yeah, so encouragement, reassurance — those are the things with the two best evidence as stand-alone treatments, okay? Which, I don’t know why

[48:31] those two get to be bundled together and we call it a stand-alone treatment, but okay. Standing together alone. Yeah, and then there’s the other things. Like, people are probably amazed, like, “Why isn’t he saying go out and get an adjustment?” Something like that. Well, you know, adjustments are helpful for back pain, but most of the things — if you were to go out and Google this or whatever, and you look at the research, what you’re going to find is there’s a ton of things out there where it says, “Yeah, this isn’t very effective. This isn’t very effective. This isn’t very—” And it’s like, “What?” Even the active care and exercise, it says, “Not that effective.”

[49:02] Kathy: No. Back school, back education, not that effective. Jason: Yeah. So monotherapies are not very effective for back pain. Kathy: Mm-hm. What is effective is combination or integrative approaches. So when you come and see me, yeah, we’re going to give you a massage, an adjustment, whatever, but everybody’s going to leave with exercises. Jason: Right. Because why would I just do one when I could do both and it’s guaranteed to be more effective, right? Kathy: Yeah. And even when people are like,

[49:32] “Oh—” We get people who come in all the time and they’re like, “Oh, you know, I started feeling some back pain, so I started doing the exercises that I was doing last time,” and then they show up and those exercises didn’t work on their own, right? So sometimes that’s reality. A lot of times people could just do the exercises and they are fine. Yeah. But sometimes it’s getting into a space where you can utilize multiple modes of care and it ends up being really pretty effective. So. Yeah.

[50:02] Got to do them all. Yeah. We made it. We made it. Wait, we didn’t quite make it because here’s the exciting part. Are you ready to play a game? So ready for this. Jason: Okay, it is game time. Okay, let me get to my list of game elements here. And Raul, we got the timer for this one? Okay, sweet. We got a timer. It’s a 9-second timer. Which, what a strange timer, right? So, here — if I can find it. There it is.

[50:34] Okay. So we’re going to play a game called — let’s call it the Backs of Life, like the Facts of Life, right? Like the Facts of Life. Yeah. Okay. Kathy: So I’m going to give you three clues and the answer is something that has to do with “back” — like it’s got the word “back” in it. Jason: Okay. Okay. You’ll catch on pretty quick. Kathy: Baby Got Back. That might be one of them. I don’t know. Let’s use that one as an example, okay? So I might say like “rap” and then Raul starts the timer, and then after 3

[51:06] seconds you’re going to get another clue and then it might be like “Sir Mix-a-Lot,” and then “booty,” right? And then you’re trying to get the answer before the time runs out. Yeah. Yeah, you got it? Okay, ready? All right. Here comes the first one. You ready? Mm-hm. Doc. Tor. Raul starts it. There we go. Chiropractor. Biff. Oh — Back to the Future. Kathy: Hey, very good. Good, good, good. Yes, see? That one would have been Marty.

[51:37] Okay, ready? Here we go. Schoolboy. Mm-hm. Angus Young. Oh. AC/DC. Back in Black. Jason: Oh, just barely beat the timer. Very good. Okay, here we go. Ready? Kathy: Okay. Nick Carter. Oh — Backstreet Boys. Aging myself. Jason: All right, here we go. Ready? Brutus.

[52:08] Et tu, Brute? Yes. Julius Caesar. There’s a “back.” The Ides of March. Romeo and Juliet. Backstabbing. Oh. Kathy: That’s what we’re looking for. Okay. Okay. Oh, let’s see. Here we go. Oh, all right. Ready? Lakers. Back to back. Jason: Oh, very good. Very good. Back to back. Yeah, you also would have gotten Michael Jordan and the Warriors. Yeah. Okay, here we go.

[52:39] Supply chain. Amazon Prime. Back office deals. 3 to 5 weeks. Back ordered. Kathy: Back ordered, very good. Very good. Okay. Let’s do three more, okay? Okay. Ready? 15. Permit.

[53:11] Jason: Hmm. Backseat driver. Kathy: Oh my gosh. Those are the worst clues. All right. Jason: All right. Yeah. Okay, how about this one? Country music. Okay, I need one more. Kathy: Gravel. Oh, gravel. Chevy trucks. Oh, bye. Backroads. Jason: Ugh, backroads. Kathy: Oh man, I want to — I want to send you out on a win. Okay, I want to send you out

[53:42] on a win. Here we go. Ready? Okay, here we go. Courage. Posture. Spine. Jason: Strong back. Back. Backbone. Kathy: Oh god. All right, I got one more. All right, ready? Okay. Jason: Golf. Backswing. Oh, that’s a good one though. Tennis.

[54:15] Ping pong. Oh, backhand. Oh, okay, I’ll take that. That’s — I was looking for backspin. Backspin. Okay. Kathy: Very good. Okay, Kathy — Kathy, I think you killed it. You got — I think you got like a million points. Million points in that game. So let’s wrap it up. Take homes, take homes. Take homes. Don’t do drugs. Don’t do drugs, Kathy. Or be on Advil or Tylenol. Yeah, there — it’s rough. Like there’s just not a lot of medication. And NSAIDs — NSAIDs are pretty good for lower

[54:45] back. Kathy: Ask your doctor first. Ask your doctor and beware, because you know, too much is potentially dangerous for other things. Jason: Yeah. Yes, but lay off the drugs, kids, right? For me, I think — I think it’s remembering that multimodal approach, right? We got to have several tools in our belt in order to effectively address back pain, whether it’s lower back, upper back, anything like that. Giving people the tools

[55:15] — not just to help. Like we love to help people when they come in, but people need to have tools when they’re not spending 15 minutes or 45 minutes with us, right? They need to be able to make it through the rest of their day. Kathy: Right. And so teaching those things I think is just really important. So all right, well, we did it. Jason: That was great. That was a good one. Yeah. Hey, if you’ve already — if you hung out this long, just give up. Push the subscribe button, all right? Push the subscribe button. Listen — you like us. Kathy: Yeah. You really like us. Jason: Yeah, you’ve been listening.

[55:45] We’re in a relationship at this point. You lasted almost an hour. Kathy: Yeah, I mean you’ve probably listened to us more than you listen to your kids. If you’re still here at this point, right? You probably listened to us more than you listen to your spouse. Jason: No doubt. Our spouses aren’t listening. Kathy: No. Yeah. So yeah, subscribe, share this episode with somebody and keep an eye out for our premium subscriptions. It’s going to be amazing and so

[56:15] Jason: Coming soon. Yeah, coming soon. So oh, and then there’s that one important thing that we got to get to every single week. That’s that there’s no I in PTCH.