The Intervertebral Disc

Dr. Ben Boudreau: [00:00:06] Yes, so the intervertebral disc, so tonight we’ll be talking about disc herniations, but I wanted to go over the anatomy and structure of healthy discs and so in the low back, in between each of our vertebral bodies sit these little cushions. And what they do is they act as shock absorbers. And the inside of the disc is filled with a gelatinous fluid made of collagen and mostly water. 90 percent of it is water, actually, and sugars. And then the outside layer of your disc is formed out of multiple layers of tough fibrous tissues. And so they’re meant to absorb shock and distribute forces evenly in your low back. Whenever you take a step or you’re running or going from sit to stand there, there to act as a cushion.

Dr. Clayton Roach: [00:01:03] Yeah, so one thing I want to add to that Ben that you didn’t have there is the disc also acts as a pivot point. Because two vertebrae and one on top of each other in the inside portion is water, it’s almost like your discs are on a little marble. It allows you to pivot front back sideways and so that you can have movement in that area. So the disc is a very, very important part of the spinal structure.

Dr. Ben Boudreau: [00:01:31] And so a lot of the discs, like the disc, will receive its nourishment from the actual vertebral bodies above and below. It has these endplates on either side. And so whenever you take a step, all of that blood that’s filled with nutrients will travel from the actual vertebral body into the disc. And you wouldn’t think of the bone as a structure that nourishes other structures around it. But bone is such a vascular structure that it will supply blood to the structures that are around it, which is really cool to think about because we think about bone as being sort of this boring structure.

But no, it’s filled with a lot of good nourishing blood. And so whenever you take a step and whenever you are resting in the evening, the body will use that time for the blood to properly be distributed along with those plates and into the bodies.

Dr. Clayton Roach: [00:02:27] So that process is actually called imbibition. So basically, when you’re walking and overtime during the day, as the discs start to get a little thinner during the night, it’s almost like a sponge that you would compress, put it in water and then you might go to sponge is going to fill up with water. That’s the imbibition

Dr. Clayton Roach: [00:02:49] Where the disc is imbibing the nutrients from above and below those two vertebrae. So I just drew the endplates here, one of the tops, which is the bottom endplate at the top vertebrae, and this is the top endplate. So those two vertebrae or the sacrum in this case, but these two vertebrae here and here would basically give nutrients to this disc over here.

Dr. Ben Boudreau: [00:03:11] And I just want to point as well, just so that we can sort of preface the idea of what we’re going to be talking about more tonight. You notice how closely those nerves sit to that vertebral body. They’re. And so it’s a really tight-knit, packed area, there isn’t a lot of space left over, and that’s why whenever we get any sort of degeneration in that area where the nerve comes out can really impinge upon. So as you can imagine, when losing is when there’s an issue with the disc, it becomes just as apparent, if not more.

Dr. Clayton Roach: [00:03:45] Yes, so so we mentioned a difference in that this morning and night here, Ben

Dr. Ben Boudreau: [00:03:49] Yeah, yeah, that would be a great point.

Dr. Clayton Roach: [00:03:52] Yeah. So there are four discs. It’s been a while Ben sort of twenty-four discs. And what happens is during the day when we’re weight-bearing, the water starts to go outside the disc. By the end of the day what happens, the disc is actually thinner than what you first started with in the morning. Now, because during the night you’re going to go non-weight-bearing and lay on your bed. The water starts to go back into the disc. You are actually your highest, your tallest during the morning. Bear in mind that throughout your lifetime, if you don’t take in enough water. Here’s another big benefit of drinking a lot of water, what will happen is you’re going to lose permanent height in the disc. So what happens?

You’ve got 24 discs that lose one millimetre. That’s twenty-four millimetres, two-point four centimetres of height that you’ve lost. This is a very important reason why you should hydrate that you may not have known about. So give us a thumbs up if you’ve learned something just from that because that is totally important for chiropractors because we talk about the spine all the time as to the benefits of drinking a lot of water. So if you want to measure yourself, always measure yourself in the morning, you’ll feel better about yourself.

Dr. Ben Boudreau: [00:05:28] Maybe just before we move on to the next slide, just going over the regular anatomy of an X-ray. And that is the normal curve of the lumbar lordosis there. And as well as paying attention to our disc spacing and disc heights and how there’s beautiful spacing there between vertebral bodies.

Dr. Clayton Roach: [00:05:51] And I think this spine has a little bit of a small spondy.

Dr. Ben Boudreau: [00:05:54] Oh. That is a little bit of a spondy, so that is a spondylolisthesis and spondylolisthesis is when the spine, the vertebral body moves ahead of the structure that’s beneath it.

Dr. Clayton Roach: [00:06:08] So you see how we couldn’t finish off this line here. This line should have been in line with the back of the sacrum right here, but that vertebrae have gone forward by this amount of distance there. So not completely normal, but I like the height of the disc here. That’s a really good height. And I like the holes here are fairly clean.

Dr. Ben Boudreau: [00:06:32] But until you get down to

Dr. Clayton Roach: [00:06:34] A little bit here,

Dr. Ben Boudreau: [00:06:34] L5, S1,

Dr. Clayton Roach: [00:06:35] So not quite normal, but doing pretty good. So, yes, very, very important for us to maintain the curve, just like we’ve talked about curves all the time in the neck. The lower back one is also very, very important.

Lumbar Disc Herniation

Dr. Ben Boudreau: [00:06:47] So I just want to bring attention to the fact that there are different types of discontinuations and there are different levels and severities of disc herniations that you can have. Of course, there are little bulges. And so the disc herniation is when the nucleus polyposis that gelatinous material in the center of the disc begins to protrude in place. A lot of pressure on the annular fibres that are around it. And so when it does protrude and it breaks through the annual of fibre, it’ll start to place pressure on the nerve, just posterior. And so you can see how there’s an example of a prolapsed disc there. That’s one when the base of the actual herniation is larger than the actual spout where it comes out.

There is an extrusion of the disc herniation, which is very severe because the gelatinous material then breaks through that annular fibre on the outside and we’ll place a lot of pressure on the disc. Then there’s the sequestration. This would be the most severe because when you have sequestration, that means that a part of that nuclear polyposis, that gelatinous material breaks off from where it originally was and it could have the potential of placing pressure on nerve structures below the area of involvement. And it becomes a very tricky situation in that regard.

Dr. Clayton Roach: [00:08:13] Yeah. So let me use an example. Let’s say you had a Boston cream donut or a jelly donut. It really is the best analogy. So the outside part of the donut is going to be your annulus fibrosis. So that’s the fibrocartilage that’s supposed to maintain the cream inside that donut. And the cream in this example is about 70 and 90 percent water. Right. So if the outside part of the donut becomes weak, what happens? Same thing as a tire for a car. The cream inside starts to push out. And what happens is the fibre on the outside is not strong enough to keep the cream inside.

So starts to buckle and starts to blow on the outside. That is what you see here with the prolapse example. Now, at one point it gets so weak that you start to have a puncture. And what happens now? The cream is actually outside the donut and now the cream is starting to fall apart. And now you’ve got pretty much all you could have had it over here as well. But direct contact on the nerve that’s adjacent in this area.

Dr. Ben Boudreau: [00:09:24] Yeah, exactly. And so the most common areas of involvement are the lower parts of the spine. That’s the area that takes the most pressure, L5, S1. So the last lumbar vertebrae before you reach the base of your sacrum there, that’s the most commonly involved area and disc herniations are most commonly seen in people between the ages of 20 and 55. It’s very common to have disc herniations in young people because that’s when the disc is most filled with fluid and so most likely to herniate. And also, as you begin to age after the age of fifty-five, the actual there’s less fluid and less water in that disc. And so there’s thinner and older individuals and less likelihood of a disc herniation in that regard.

Dr. Clayton Roach: [00:10:12] Now that said, you have a less likelihood for a disc herniation, but a higher likelihood for what’s called degenerative disease, where the vertebrae start to get closer together because disk space is actually more narrow. Right. And typically, if you’ve had a disc herniation earlier, you might not have known about it later on. It will show up to be degenerative diseases because the water just kind of gushed out and now there’s no cushion anymore in between the two vertebrae.

Dr. Ben Boudreau: [00:10:36] And one of the important reasons why maintaining disk space and doing the things you have to do, like maintaining that structure, getting adjusted regularly, doing exercise is to help promote the proper movement of your spine. And core bracing is so important even at a young age and moving forward into deep into your 60s, 50s and 60s, 70s. So important. And I mean, I think one thing that’s important to mention is that the disc is actually the live structure. It’s got vasculature going there. So it’s got blood flow. So it’s a vital part of the spine that actually this is known for lack of a better term is alive that we need to keep.

Disc Herniation Part 2

Dr. Ben Boudreau: Well, so good vertebral movement is so important because remember what we said, the vertebrae are above and below are going to feed that disc, the nutrients that it needs. So if your spine is not moving, the disc is not going to change. That means so spinal movement, inner segmental movements, not just global movement, is super, super important. And so this slide here is basically the left slide is explaining that disc herniations can protrude or they can bust out in different portions of that disc there and they can place pressure on different parts of the nerve.

Dr. Ben Boudreau: [00:12:03] And so there is one that can come out centrally there. This will actually place pressure on the nerve and it can lead to symptoms that will present on both sides, so left and the right side, which is something that we really have to watch out for as chiropractors been doing our exam and assessing when somebody comes in with symptoms in both legs, that this is one of the things that we need to consider. There can also be herniations that occur further around, less to the center, and they can go from one side to the other. And so paracentral for Mental in the foreman and that little round part and then extra foreman, which is outside of that area.

Dr. Clayton Roach: [00:12:48] Yeah. So one thing I want to say that probably the toughest herniations to solve are going to be the centrally located ones. So in this area, this is what’s called the spinal cord. Right. So one of the things that a lot of people don’t know is that when you have a disc herniation in the cervical spine, in the neck area,

Dr. Clayton Roach: [00:13:13] Let’s see, this is the neck area and you have a central disc herniation. When you look at the spinal cord in the neck area. OK, and there’s a disc herniation putting pressure here when a lot of people don’t know, is that the outside fibres in that spinal cord actually represent the legs. So you can have a disc centrally. Herniated in the neck area and symptoms will be in the legs, displaying as perhaps leg pain, leg numbness and tingling weakness. Bear in mind that when a disc herniation is in the neck, the fibres for the legs are on the outside part of the spinal cord. So any amount of pressure on that spinal cord will impact the legs even more than the arms because that’s what typically happens. So centrally located disc herniations are the toughest to treat. I find clinically

Dr. Ben Boudreau: [00:14:14] And that’s a great point. Moving on to the x-ray, to the right there, it’s very difficult to see a disc herniation on the x-ray. However, this picture here depicts a type of disc herniation that can occur and you can see it on an x-ray. This is known as a schmalz node, is what we call it in radiology. Now, the schmalz node is an inferior disc herniation. When the disc and when that nucleus pulposus permeates down, it will actually place pressure onto the vertebral body below. And it creates a little node. And so that is the nucleus pulposus and it’s entering into the vertebral body from the top.

Dr. Clayton Roach: [00:15:03] Now, typically these schmalz nodes happen when there’s axo compression, so somebody falls straight on their feet and they’re typically young. Why? Again, because there’s plenty of water in the disc. So usually there is a straight downward pressure. Some people get hit on top of the head or they fall flat on their feet. And there’s a compression that happens. And you’ll see that indentation from the nucleus boom hitting the bone there and creating an indent. So, yeah, so that’s one of the only disc herniations you’ll actually see on X-ray because the disc is soft tissue and you don’t see the soft tissue on the X-ray.

Dr. Ben Boudreau: [00:15:45] But what we can see on X-ray are the changes that occur because of the disc herniations like reduced disk space narrowing. Right. There won’t be as much space in between those vertebral bodies. And so we have to be aware and then you have to manage that with the case presentation, which is what we’ll get to next.

Dr. Clayton Roach: [00:16:05] Yeah. So typically what’ll happen is if you see enough change on the X-ray that kind of smells like a disc herniation, then you would take an MRI and the MRI would then confirm that hunch that there is a disc herniation. that is one of the fattest lumbar spine I’ve ever seen. Yep.

Examining Lumbar Disc Herniations

Dr. Ben Boudreau: [00:16:25] And so I wanted to take something that represented that where the spaces where were narrowed there, the spaces are actually the widest in the lumbar spine as well as in the neck region and are thinner in the mid-back. So a lot of times you’ll have a lot of really thin spaces there, and that’s where you’ll begin to see a lot of degeneration. First is in the middle back because a lot of our changes will occur there first. Now, I wanted to start by talking about the chiropractic examination. And so when people come into our office and they present with excruciating leg pain, a little bit of back pain usually has a key indication that there is some type of disc involvement or some type of pressure being placed on the nerves there.

And so depending on the level where it’s coming from, it’ll actually cause a distribution of pain that’s a little different. So, for example, if the S1 nerve was involved, which is when the disc herniation occurs between L5 and S1, you’ll get pain running down the back of your leg. OK, whereas if L3, L4 and the L4 nerve root were involved, you get paid more on the outside of your leg, a lower leg there.

Dr. Clayton Roach: [00:17:41] Yeah. And I mean, from a layman’s point of view, most of the time patients coming in are going to see they’re having sciatica. Right. So remember the sciatic nerve, which we covered in other episodes, is made up of the L4. L5, S1, and S2, I believe, to right. Yeah, and the S2 nerve root, so any of these can be called sciatica. So that’s why sometimes we kind of grin a little bit when people say, you know, I was diagnosed with sciatica. Well, there’s much more to discover based on that diagnosis, because we need to know which nerve root is involved.

And that’s where we need to perform an examination, because which nerve root will tell us probably which nerve is compromised and where do we look on the x-ray? What changes can be made? So to just say it’s sciatica. Anybody can say it’s sciatica you don’t have to go to your medical doctor for that. Any pain in the back of the thigh there’s going all the way down is going to be called sciatica.

Dr. Ben Boudreau: [00:18:43] And so for us, as chiropractors, it’s very important and paramount that we determine which level is involved because we can correlate this with your x-ray findings and then the direction of, OK, this is very likely to be a lumbar disc herniation. We can go to an MRI to confirm. You can order it and begin treatment right away because we know that chiropractic treatment for lumbar disc herniations is very good.

Lumbar Disc and Surgery

Dr. Clayton Roach: [00:19:09] Yeah, totally and know over here, obviously, compared to the other extreme that we had, you can see here that the back of the vertebrae is following a very, very straight line. So when you lose structure, you lose function. Specifically tonight, we’re talking about the function of the lumbar disc. So over time, the outside part of the disc starts to weaken. And then, lo and behold, over time, that nucleus on the inside starts to bulge and make its way out to the perimeter of that disc. And lo and behold, it’s now probably in the hole where the nerve is and now you start to have pain that’s presenting in this fashion. You know I actually had this question not too long ago, what happens when you have a disc herniation?

Do you need surgery? Well, one, it’s got to be a last resort. So definitely you want to see a chiropractor before you say yes to surgery. I always say at one point, if you let it go long enough. You will become a good candidate for surgery. It doesn’t mean it’s the right thing though right. So what happens when you have a disc herniation Here’s L4 and here’s L5 what they do is they actually do a discectomy many times. They’ll do a discectomy, meaning they take the disc out and they fuse the two vertebrae together. So now what you have is L4 and L5 no disc in between that are fused together, usually by taking a bone graft from your hip and the fuse the two vertebrae together.

Dr. Clayton Roach: [00:20:37] So now they’re moving as a unit, unfortunately. What happens, though, because four and five are now moving as a unit, it’s not as good a movement as what there was before. So l three or four starts to use up. And I’ve had a patient that has gone through three surgeries. So he was first fused between L4 and L5. He got a disc herniation above. They fused L3 to L4 and later on they fused L2 to L3. It kept happening. Now imagine you’ve got a lower back that’s not moving at all. So that is not great in the beginning. If it’s just starting, what they can do, what they can do, what’s called a micro discectomy.

So they just take the part that’s ballooning out and they cut it. And they actually I believe they use some kind of thing that actually creates scar tissue. So basically it holds up for a period of time. But if the stress on that area does not go away, you usually will get a reoccurrence. So those are the surgical options. They are sucky sorry for my French sucky options. The key is to catch it before and prevent that from happening. And having somebody say you’re a great candidate for surgery, which means it’ll work for a while, but all surgeries eventually come to the same endpoint, which means that they fail.

Dr. Ben Boudreau: [00:21:56] So. So they need to be taken care of. Right. And we talk about how the disc has great vascularity. So it does have that capacity and potential to heal. You just have to put it in the right spot. And so that’s part of our job is putting the segments in the right area so that there’s less stress on that disc when you go home and do the proper thing so it doesn’t come back out again. But there is good vasculature around that and your fibrosis. And so when you do have a bulge, there is a capacity for that, for that sort of those fibres starting to heal. And so I just wanted to deliver. It’s been a while since I’ve done this.

Chiropractic & Lumbar Disc

Dr. Ben Boudreau: And so I want to deliver a study that was comparing patients that were being treated by chiropractors, those with no disc herniations confirmed with an MRI. And then those who didn’t have the lumbar disc and see who got great results. Right. And sorry, those who weren’t treated by a chiropractor and did have a lumbar disc herniation. So those are the methods there and the results that people are getting significant improvements in back and leg pain after one month of chiropractic care. And so they used spinal manipulative therapy.

That’s SMT so that’s what we do as chiropractors when we adjust the spine. It’s more of it’s the technical term, I would say, for adjustment. And so chiropractic care, lumbar disc herniations, very good results. And so definitely something to consider, especially when you think that you have a lumbar disc herniation or you have one. Now, you should be seeing your chiropractor. To get your bag checked, yeah.

Chiropractic & Lumbar Disc

Dr. Clayton Roach: [00:23:40] So let’s just take a second to check-in, guys, hope you’re enjoying this information and just for one second here, just give us a few thumbs up if you’re learning something tonight, because a lot of these words get thrown around like a disc herniation. I got a slipped disc. Now learn what you’ve learned tonight, the words slip means movement. The disc slips, but it’s really in layman’s terms. So we as chiropractors would never use the word slipped. But is it bulging? Is there a prolapse?

You now know the proper terms. So Slip really doesn’t tell us really much. What does the disc look like? Because it’s just kind of an all-encompassing term. So, yeah. So definitely we see this a whole lot in the clinic. As the study reveals, many patients go to physio and then go to massage therapy. And unless you get the mobility back in there, the disc can’t get any healthier because there’s no movement above and below. So once we get out of this screen there, Ben, we can talk about what happens in surgery. Usually what they do. I’ll explain a little bit about that. I’ve had a few patients go through that as well.

Dr. Ben Boudreau: [00:24:52] Yeah, I just also want to bring attention to it’s very common to see an SI joint issue with the sacroiliac joint issue on the same side as the lumbar disc herniation. And so in the study here, a lot of the patients that presented with the lumbar disc had NECI joint problems, and the chiropractors were treating that as well as the site with the lumbar disc. And so just making you aware that just treating one structure isn’t going to clear everything, you have to be able to clear the rest out as well, which is why we pay so much attention and clinic to the involvement of other structures and their relation to the primary cause.

Dr. Clayton Roach: [00:25:33] Yeah, when you think about it, the lumbar spine sits on top of the pelvis. The right side of the pelvis is not working. Well, the lumbar spine surely isn’t going to work well either. Yeah.

CoQ10

Dr. Clayton Roach: [00:25:44] All right, so we’re just going to end and then we’ll go. I’m going to explain a few things about surgery, their supplement of the month. We’re going to talk about CoQ10 is probably one of the best antioxidants that you can take. It’s very high in what’s called the ORAC scale. The ORAC scales, a measurement of how intense the antioxidant is. Ginger is also very high, but CoQ10 is very, very high, definitely has many benefits, as you can see here. But one thing I will say is if you are on statin drugs, Crestor, Zocor, Lipitor, all those or drugs, those statin drugs, you should be on CoQ10.

Your doctor probably knows this by now because it’s known information, but there’s a very specific thing that happens inside the cell, inside the mitochondria for your what’s called your electron transport chain, that your statin drugs are depleting, that your CoQ10 can replenish. So if you are on a statin drug CoQ10 is a necessity. It is not. If it’s necessary, it is necessary for sure. And research is showing this and not just you know, it’s not chiropractic research. It’s pharmacology research that’s well-known. Right. So definitely. Definitely. Definitely CoQ10

Dr. Ben Boudreau: [00:27:16] Yeah. And it’s not. We delivered new supplements of the month each month. We’ve done one that was a little bit different. This one doesn’t necessarily go along with the same lines as lumbar disc herniation. It’s not like this is a prescription for that. I wanted to bring forward a new supplement that we could talk about and that is extremely relatable and that a lot of people likely know about. And if you don’t know about it right now, this is definitely something that if you’re on statin drugs, like what Dr. Roach is talking about, this is definitely something that we would recommend to help with some of the side effects of of taking those medications.

Dr. Clayton Roach: [00:27:55] Yeah, yeah. So definitely just a little plug on Orthomolecular. We had a guy who was we were interviewing on Hump Day conversation, John Constas, who was the rep with Orthomolecular products phenomenal company in terms of pharmaceutical-grade supplements. So very, very good. So little promotion Here, so till June 18th, what we’re doing at the clinic is going to be Mother’s Day, Father’s Day, we have to switch things up because of the new restrictions and stuff. And what we’re doing is we’re going to be giving away a $500 gift card to the Sensei Spa. And basically, as you can see here, it’s an outdoor sport or cold plunge, hot tub, sauna. It’s phenomenal.

My wife and I were there when everything was kosher and good to go. We really, really enjoyed the Day they give that you can get a massage, their facials and stuff like that. So we’re going to give out a $500 gift card. Yes, I see a heart going up. Definitely give us some hearts and love here. And basically how it’s going to work is you refer one person to the clinic, we’re going to give you a raffle ticket and it’s just going to be a draw. And then and then what happens if you refer to people, you get three raffle tickets, three people, you get five for people. I think you get seven.

So the amount of raffle tickets you get goes up incrementally based on how many patients that you refer. Now, all the patient has to do is call us before June 18th. They don’t have to book an appointment before June 18. But you need to call us for an appointment before June 18th. So we try to pick something that would go for both mothers and fathers and combine the two together. So this is going to be a good busy month for us. And again, just like we asked you to

Dr. Clayton Roach: [00:29:59] Share these episodes. Our goal with this and our goal at the clinic is to create a change in our community and unfortunately, a lot of us, at the clinic, Ben and I see patients coming in that only found us what I feel to be way too late and could have been done way before I had a patient last week. She said, the only reason I’m here is that somebody shared the Humpday conversation and her word was, what The hell is this? She clicks play and we’re talking about neck pain going down the arm happens to be what she has calls us. And you know what she said? She said anybody who’s giving away free information like that has got to have a good heart.

So I said, you know what, I really appreciate that, because we’re just doing it to give out information. But nonetheless, this lady is over 60. She’s had this problem for such a long time that obviously the result would have been better if she was 40, 30. Right. So prevention is key. So do us a favour. Make sure you share these episodes. Take a second right now and just click share. Right. Just do it. And you know the same thing by referring somebody to the clinic. They may thank you forever for referring them to the clinic and changing their lives because.

Right now, we’re going through a lot, and the only thing worse about going through what we’re going through right now is to go through it and be in pain, right. So people are at their wits end in terms of how much they can handle. And we’ve handled a lot. But everybody has a breaking point. So you never know what sharing this episode could do and what referring people to clinics and taking stuff out of their buckets. Their bucket is not as full so they can somewhat handle a little more and adapt a little more to everything that’s being thrown at us.

Dr. Ben Boudreau: [00:32:01] Oh, for sure. Definitely having people come into the clinic and benefiting from the things that we can do with our hands. Is is the ultimate is the ultimate goal is to be able to touch the lives of as many people as we can. Right. And right now, it’s easier to do that, to do that mission over Facebook lives. And we’re so happy with the way that this is coming out because. You know, we’re not only having an impact on the people directly in our community, the ones that we can physically touch, but we’re also having an impact on the communities that are near and dear to our hearts and that we can’t be together with right now.

And so we’re more than happy and we love doing this. So so, guys, that you appreciate this episode, and if you learn something, do us a favour and share. We need that chance. Writes, I think there are many people that want to be and that might have a dispensation, might not know where to go for help, and they might find this topic very useful. Give us a few thumbs up and hearts. We love doing this, guys. As always,

Dr. Clayton Roach: [00:33:06] We love it. So next week, again, we’ll have somebody. That’s my goal. That’s my homework for this week. And it’ll be somebody that’s going to bring some information. And my thing is, when you’re on Humpday, you got to come up with the goods, just like John Constas did. So a few go, that’s for sure, for you guys. Coming up, anything else? Ben.

Dr. Ben Boudreau: [00:33:31] Another great topic. Thank you so much, Dr. Roach. Thank you, everyone, for tuning in this week. This was Humpday conversations number twenty-two with Dr. Clayton Roach in Dr. Boudreau Roach Chiropractic Centre in Bedford, Nova Scotia, Canada. Lumbar disc herniations in the books. Thank you guys so much for tuning in.

Dr. Clayton Roach: [00:33:52] Thank you so much, guys, and thank you Ben for these wonderful PowerPoint slides and your input. You are a gem to work with. Really appreciate and thank you to everyone who tunes in tonight. And we look forward to seeing you next week, at nine o’clock. Take care, guys.

Dr. Clayton Roach: [00:34:09] What’s up? Listen, if you like this episode, you’ll probably like the other ones, chances are pretty good. So here’s what you need to do. You need to like us and follow us on Facebook. Following means, you get notified when these two guys are alive. Next, family, friends, you need to share these episodes because you never know. You might help them because they need this information as well. And guys, if you ever miss an episode, make sure you subscribe to us on YouTube.

Dr. Ben Boudreau: [00:34:29] That way, you can watch the episode over and over and over again.

Dr. Clayton Roach: [00:34:32] Guys, we love you and appreciate you. Take care.