So you might be active and healthy because of back pain you stopped being as active you gained weight other problem conditions can occur absolutely Andrew you’ve really nailed it it can be a snowball effect so as soon as you start having pain you can’t do your normal activities when you stop doing your normal activities you start gaining weight you become less active you can even become depressed or have mental health issues that come along with it well chronic pain causes depression obviously chronic pain and depression are absolutely something that go hand-in-hand generally speaking we Americans don’t sleep well enough as is but back pain chronic back pain impacts that as well I imagine poor sleep posture doesn’t help you back so sleep is a big part of this and when patients come and talk to me one of the things that they complain about very frequently or want to discuss is how difficult it is for them to sleep I have patients who pretty frequently tell me the only way that they can sleep is in a certain position maybe in the reclining chair and so these people haven’t had a good night’s sleep probably in months and that’s because when you stretch out the pain increases well you know everybody’s pain is different and so it really depends on the individual but what I find frequently is that people can tell me I’ve got one position whether it’s with two pillows between their legs whether it’s on the recliner whatever I’ve got one position where maybe I can catch a little sleep for a short period of time and so that’s what they stick with they’re really just trying to do anything they can to escape the pain for a short period of time