I mean I almost feel like back pain is inevitable this is that everybody in their lifetime going to have back pain as you age especially its its vast majority okay the vast majority and not I recently read a statistic that the number one cause of ER visits these days is back and neck pain – really yeah is there a reason why you think that’s happening more frequently now I think we live in a world where we expect things to be better right we live in a world where we expect to live forever play tennis in our 90s we expect to not have pain and I think that that’s totally reasonable right there is means to accomplish that now right so and back pain can be real debilitating I mean decrease your quality of life exactly if you can’t provide for your family you can’t cook you can’t clean you can’t brush your teeth it’s extremely debilitating so it’s reasonable that patients show up an emergency room even though most of those visits don’t really result in anything objectively different right it’s just the pain will mostly go away but most people don’t think that they think back pain exactly we’re done I can’t do anything else exactly there’s an element of catastrophizing in that patients who have back pain just like if they had left had a chest pain don’t think something’s really scary something really bad is happening so and that’s reasonable you