Tune in to all episodes of The Dr. Beau Show below, or follow the links to Spotify or Apple to listen at your leisure.
Function Trumps Pain, Records Being Broken, and the Teams’ Upcoming Adventures: Week in Review 41
In this conversation, the team discusses various personal updates, including training for upcoming races and the challenges of live streaming. They delve into the latest trends in track and field performance, highlighting recent record-breaking achievements. The discussion also covers clinical cases, providing insights into patient care and treatment strategies. Additionally, the host reviews recent research articles related to fascia and its role in health and performance, emphasizing the importance of understanding the underlying mechanisms of treatment.
Links to articles discussed:
Fascia as a regulatory system in health and disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC11346343/
Uphill Treadmill Running and Joint Mobilization Improve Dynamic Stability and Ankle Dorsiflexion Range of Motion in Young Adults With Chronic Ankle Instability: A Four-Arm Randomized Controlled Trial
-
Beau Beard (00:00.142)
with my parents. Like a live call? Yeah. Oh, a meeting.
Beau Beard (00:16.076)
Whoa, it's like showing you typing on the note as you're doing it. All right, mic's up because we're live recording, doing all that. So while you're typing stuff, you somehow got to make it entertaining for everybody else. Let me see if I can figure this YouTube stream. look at that. Looks absolutely abysmal. So it's a little delay. Cool. I'm not going to click on it. Well, let's see actually.
If I can mute this and then that way I can pay attention if there's a chat. All right, so this is our first attempt at, back up here in a sec. First attempt at streaming live, it looks abysmal from what I can see, so we'll see how this turns out and we'll pay attention to the chat. It looks like there is a 10 second delay, maybe.
But either way, if you have a question, you can put it in on the Riverside chat if you had the link to that, which I just posted on Instagram. But I'm going to try to make these little more interactive if we have viewer questions and then we've changed the format of the week interview. It's fun to talk all nerdy and talk clinical cases and stuff like that. But I think like five people listen and one of those people is Tyler Lindburner.
So if you're listening and you have a question on the live chat, chime in. We appreciate you listening. But we're going to change format up a little bit. So first things first, it's kind of anything exciting going on with you guys? Maybe don't get too personal. I mean, we don't even know about like, you know, an impressive bowel movement or being evicted. Well, that's, that's off in the future a bit. Have you guys found any place to live? No, waiting on my tax return. I'm waiting on Alex to get his tax return.
Pre-approval, all that jazz. So you're still trying to buy a house? Yeah. And I'm trying to rent from the guy who's trying to buy a house. Oh, so you're going to be, oh look, you already have an investment property. Yeah. OK. Our third option is moving to England, Yep. OK. Finding somebody else. Oh, with Evan? No, Evan's moving to England. third option is moving. I thought you said your third option is moving to England. was like, that's a, OK. 2025 has been off to a hot start. rent one, or move to England. There's a lot going on in 2025. Yeah, remove from a house, buy a house.
Beau Beard (02:44.334)
Not sure when he's going to buy a house. Let's see. Other roommate. sure if we're getting approved for a house. Other person's moving to England. Yeah. So it's been sweet. That's fun. I had a stomach bug earlier this week. Yeah. Absolutely torched me. That's pretty exciting. cold going on. Everybody's dropping like flies. I was sick last week, but we have kids, so we have a better
Y'all bring the stuff here. There's no stomach coming from us. crap he had. Yeah. That was church group right there for you. was. Anything else? So I got hot and heavy on the, posted all of it and I followed it for the first eight weeks to a tee, but trained for the Mount Chi Ha 50K, which is Saturday. Also it was snowing in like 19 degrees this morning. So I hope that changed a little bit before Saturday.
Yeah. but my motivation kind of tipped off around week nine. mainly just, kind of, well, not, not kind of, don't like running 26 miles on a Saturday. So, I didn't follow the plan to a T after eight weeks. What was funny was we went to dinner with the Toshas. So if you're from Birmingham, you know,
David and Mary Jo Tosh are basically the people that are responsible for growing the trail running scene in Birmingham. They hold the Southeastern trail series, blood rock 100, the Lake Martin 100. Now the Southern States, 100 and 200. And we were at dinner with them and Travis Grappo who owns Oak house, shout out Oak house came up and we were talking about that. goes, oh yeah, yeah, yeah. You're like me, you're 280 HD. You can only do a six to eight week block training, like lead up. There's no way you can do a like.
12 to 14 week, goes, I've had the same thing happen over and over. I was like, yeah, maybe that's a good point. So, um, and then I kind of decided around that nine week mark that I didn't want to do the race. And I mean, I was signed up from before I did the 14 week training block, but then Sloan was kind of jabbing at me a little bit and I decided I might as well do it. So yeah, Saturday I'll be doing that. The goal was sub five hours. I think the goal is now just, uh, I don't know.
Beau Beard (04:58.016)
Race myself not other people because then I'll blow up if I because it's some fast looks like some fast people signed up so we'll see but on the next week interview in two weeks, I'll give an update on that race and see how it went. Nothing else really going on. got I guess from my end. got my my triathlon season. I guess finally is going to start when that certain hopefully hopefully. Yeah, so I got a bike fit yesterday for my tri bike. It was sweet. yeah. Shout out bike link and Hoover. Yeah, that was Joe.
is a man. looked at me and I got on there and he goes, he started asking me like everything that was like painful on this bike, which I basically bought it from a friend and I just like, you know, this thing will do and just like hopped on it, sort of riding and it feels abysmal when I rode it. It's fast, but it feels abysmal. So I did like a sprint try last summer, still didn't like get it fit. So it's been like, I guess a year since I've had the bike or close to it. And even though it,
felt abysmal to Seth, he was still crushing me the one and only time I rode with you, which I was on a road bike and you're on a tri bike. So yeah, there's that. But yeah, he got on there and I thought the bike, it kind of like helped me a little bit, guess, learn a little bit about...
the actual positioning of the tri bike, cause the bike itself is a little big for me. Like I, I'm like five eight. So like a good bike fit for me for a tri bike should be between like 52 and 52 centimeters for like bike frame. this is like a 56. So I'm like riding on the cusp of it being like a little too big. So I had hearing that I had the seat kind of lowered as far down as I could, like the seat post itself. And he's like, yeah, you're actually pretty cramped on this thing. And I was like, I'm actually cramped on this. I was like, I feel like.
feel like it's a little big for me so I don't feel like I can like toe off as well like I guess in the bottom of my pedal stroke. And he's like, no, he's like, you my hips were like pretty uncomfortable on that thing. So he actually raised my seat and moved me forward. And once he did that, I felt like a whole lot more like open It makes sense for Tri-Bike because I'm just pushing back. Yeah, because he's like, you know, the whole goal of this thing is not to be comfortable.
Beau Beard (07:04.884)
It's to make the, it's to make it's to become less fertile as your basically pudendum gets crushed. He just like, it's, he goes, it's to make the run suck less. So, but anyways, we, we moved everything around a little bit, like move my seat up, move my, move my seat forward. and went out back and like, he's like, I want you to actually like put this thing in like big gear. So he goes, right now you're not, you're not cranking down on it. And he goes that, that bite can chew up some ground.
because he's like, have big cranks on there. And it felt like incredible. was like, I could push, I could push in big power for a long time. So when's your first race? So I've got to do Athlon with the Vulcan Tri Club March 1st. So that's next weekend. Yeah. So was nice. Nice time for a stomach bug. So wait, what in the do Athlon, your? It's a mile run. It'll be a 17.3 mile bike and then a mile run. And then that's all at Oak Mountain. So the bike will be hilly. Yeah.
So there's no rhythm at Oak Mountain. If you ever come to Oak Mountain, you're like, hey, I want to like get into a groove. Don't. It's fantastic for strength, but it's not like a beautiful. Yeah. And then they've got a practice triathlon in April, April 19th with the club that I'll probably do. There's supposed to be like a sprint try option. And I think this was supposed be a longer option if you want to do your longer races. But that is three weeks out from my 70.3.
So I'm just gonna do the sprint try, just like a gear up. Where's that at? Which one? That sprint. The sprint, it's gonna be at Oak Mountain as well. So it'll be in the lake and then it'll probably be, if I had to take a guess, out to like Lunger Lake area and back from the beach. And then- And you landed on which half Ironman? I'm gonna do 70.3 golf cause- sub-cancelled and all that. Yeah, so the reason I say like earlier that I was like my season's gonna finally begin, last year I actually built You've been training for 15 years at this point with no race.
But I built up last year, I did a sprint in Tennessee, and I think it was June. And then I had two other races set up that we were gonna do in July. Me and you were gonna do one in Guntersville. You were gonna do at Half Ironman before that. You were gonna do it in the late spring of 2014. I was gonna do Chattanooga. Yeah, so there was lot of having to shift.
Beau Beard (09:31.054)
Last year was like my first real year being in practice, trying to figure out timing of different things. We went to a couple seminars early in the year where we traveled out of town. I was like, I just can't go three weekends in a row and then go out of town again for a half Ironman. CCSP thing too. CCSP. We were supposed to do Mountain Lakes in Guntersville. Me and Bo were. Not in Gold Lakes, Mountain Lakes.
And then you were out of town like six weeks in a row and you're like, can't, I can't do another weekend out of town. I got COVID the week of Buster Britain in August. And then September came around and I was like, well, at least I'm still signed up for my half Ironman in Augusta. And as I did that, Hurricane Helene decided to make an appearance.
And basically just like smoked all of Augusta, which I actually packed my parents drove down They picked me up and we were at my house and I just went back inside to like go to the bathroom before we like hopped on the road because we had like, know, four hours to Augusta and As I was in there came up mom goes. Hey, did you get the email? They just canceled the race So like I was like seconds away from being on the road heading there. We still go. Yeah, at least I didn't go
So yeah, then didn't get a refund, but we got to change whatever race we wanted to move it around to. So I chose Gulf Coast. So yeah, it should be interesting. It's an ocean swim, which that's kind of dicey. It's like me sharks and jellyfish. And then, which I guess I've never swam in the ocean, so I really don't know how far down you can see in like pretty clear salt water. Yeah, I don't know how far they'll have you down. The further you go out, I mean.
Yeah, but I you have sandbars for a while. Yeah, I don't think I'd want to see. And then yeah, it should be a flat bike, flat run. It's just gonna be pretty warm. There's no shade. And what's the date on that again? May 10th. All right, so we got a lot of stuff. I might do exterior again. I'll train for it. just, there's a lot of stuff going on that weekend and I still don't know how much, I mean, we're gonna be involved, but I might be doing a lot. So then I just, I don't know.
Beau Beard (11:50.286)
I'd like to do it again for sure. The big thing is I I still, told myself after this race, after the 50 K that I was going to get a membership at the Y and swim while it still cold. It's, it would be very hard for me to get to the Y early enough and still get here and do stuff. Like, I don't know. They open at five. Yeah. I'm here at 6 AM on early days getting work done. And then the thought of getting back in that lake like three times a week and swimming.
With the E. coli. That doesn't bother me. It ain't hot. It's it's thought of driving 30 minutes out to Oak Mountain, swimming in the lake. Then I feel like I want to do some sort of small break like run or bike with it. And then there's two hours and then I mean, it's time. So it takes time. Um, I'm going to train, but maybe not as much as I did last year. Uh, if you swam any, you would swim more than you did last year. No, I swam quite a bit leading up to it, but I only signed up three weeks before. Right. So I swam a lot in three weeks. Right.
So if I got three months ahead of it, I started well, March, April, May, two and a He basically trained to fatigue. And then said, I'm gold. Whoa. Let's get out there and survive. So that's kind of the happenings in here. Like events, you've hit how many Tuesday night runs now? man, since the first week. first week January, like six. So we've been doing Tuesday night runs, track shack and us.
have partnered together to do runs at Veterans Park, a three and a six mile option, three and five mile option every time. we're brainstorming on how to create a summer series with some giveaways and things like that, that will be based on attendance. So if you're listening, start showing up so you can put your name in the app for maybe some stuff, Adirond or at the end of the year, we're still working on that. So I don't want to announce too much. what else? We'll be at a couple of races.
Working some stuff. So we got the wine 10 K the first week in March or that Saturday, March 1st, think, right? Uh, rump shaker, which is March 22nd, Saturday. Where's that at? It is downtown regions part. It starts at regions field and finishes there. So we'll be doing our normal song and dance stretching, soft tissue recovery, healing, you know, the crippled, um, don't show up in a wheelchair and expect miracles. That's not going to happen. Uh,
Beau Beard (14:14.702)
I think that's it for events. The barn burner, way off in June. Yeah. 10 K and a half marathon. So it's always been a five and 11 mile, which was odd. And I think it'll be easier to market with those distances, but also, I it just should be better races. Cause you mean it's easier to train for something that, you know, you're already kind of maybe in the mix for. I think that's it. Anything else event wise? I don't think so. Seminar coming up in Nashville, first week in April.
Running retreat running treats same weekend. So Jonathan Croy, what's the company with this company called finish line? He's doing a three-day running retreat Friday Saturday Sunday Sunday. Yeah, Alex is doing a talk Friday night and then leading the hike Sunday morning and then they also have Corey Waltering which if you don't know that is I don't know if he runs for North Face anymore it might Ultra endurance athlete that ran for North Face. He was on the
eco-challenge that was last televised on Amazon. Um, he's been on a couple other, he was on a, another endurance show that we watched. can't remember what it was. Uh, yeah, he's a, he's a cool guy. Uh, pretty funny. I don't, he's the keynote speaker one day. then he got Trey from zombie trail races, Carrie Morgan from cadence running, cadence run coaching. Who else?
Yeah. One more speaker. Yeah. Yeah. It'll be good. Um, it's a whole weekend, full running and education, fun stuff. And if you know Jonathan, you know, it's going to be a good event. So yeah, I think that's it. So let's move over to, well, before we off events and happening, this isn't personal to us or the farm, but what in the is going on in track and field craziness. If anybody's been following our social media posts on Thursdays, um, these guys, you got one coming out today. I'm assuming, right?
Yes, but it won't be actually track related. forgot I made the video, but I haven't posted it. Yeah. So in the last two weeks or so, give or take, it's a, there have been, I think six world records broken in the men's on the men's side, at least there was like a race walk up in there that I, I don't know what it was, but I saw that it was of the six. don't keep up with that. No, it's, it's impressive that you can.
Beau Beard (16:39.338)
stick your issue, your iliac crest in your armpit, but, and walk with two feet on the ground, but supposedly, yeah, supposedly. I did see some guy ran like five or ran, sorry, walked five 24 for a mile recently. And that broke a record by like 10 seconds or so. no way two feet on the ground. Right. That no way. I don't know. your legs be 10 feet long. There's a side. Yeah. So
Starting, guess, shortest to longest, you had the men's mile. This is indoor season, so there'll be different records for the indoor and outdoor track seasons. Men's record in the indoor mile was originally broken at the Millrose games by American Yara Negus. I ran 3.46.6 amongst a huge crowd of other countries' records. The guy who got second was an American, also would have broken the world record. It was just a fast race overall.
really cool because the same day American Grant Fisher broke the American record in the men's 3k running 722 and also another race where you had fast competition so him and Cole Hawker went to the line Cole Hawker also broke the previous record but it was you know obviously Fisher leaned him at the line however five days later after Nagoose broke the
Indoor mile record, Jakob Ingebrigtsen soloed a 3.45 one. Indoor mile. Now he had a pacer, but he won the race by like eight seconds. again, I think he's got some good competition this year, but there's a clear division between him and the rest of the field, at least over in the European side. And then in...
Six days after Grant Fisher broke the indoor world record for the 3K, he breaks the indoor world record for the 5K running 1244. Took a substantial amount of time off the American record. Just really cool to see him run two world records in a matter of a week. He was a guy that graduated high school at the same time and he ran sub four minutes for the mile in high school. Everybody's like, hey, this guy's gonna be it. And he had a great collegiate career, but just won his first Olympic medals.
Beau Beard (19:00.974)
this past year, two bronze medals in the five K and 10 K. So for him to break world records is, you know, he's kind of taking the next step. And then after that, the next day you had on the road, Jacob Kipley Mo from Uganda broke the world record in the men's half marathon, his own world record. Crushed the world record by 50 seconds, 56 minutes, 42 seconds, which is for 19 a mile. That's he, I saw the splits.
per 5K, average 5K would be $13.25, but his, so two $26.50s for 10Ks, his 5K from 10K to 15K was $12.57.
Beau Beard (19:46.305)
That's 407 a mile, 1257. And he won by over two minutes and the dude's 25. Like he got started on the road racing very young, didn't really do much on the track. He has run some, but you would think, oh, you know, why doesn't he run? Surely he would break a world record on the track in the 10K, which I think he could, but he likes running on the road. So what do we think is going on?
Yeah, there was a really funny satirical post put out, I think, by Grant Fisher, because he's sponsored by Nike, and in the picture after the 3K or the 5K, it was him. Are you good, Dawford? We're having some technical, not so technical difficulties. There's a post that he put out of Post Race, and he's holding his spike.
Right. And all I said in the caption was it's got to be the shoes and which everybody's been discussing as that's the big differentiator in the last few years of these super shoes or carbon plated, different foam shoes on the road. see that playing a bigger role. they were originally designed for the marathon. And you think about if you increase efficiency in a shoe and then you get to do that for the course of one to two hours, that's going to have a bigger effect than in a three K seven and a half minute race.
And when we were racing in high school, there were spikes that had carbon fiber plates and release carbon fiber in the sole of shoe. So I think he was making fun of the fact that you guys think that has to do with the shoe, right? not that all of these people are now pushing each other really, you know, to the next level. And you think about, a similar effect whenever Roger Bannister breaks four minutes in the mile, nobody thought it was possible. Then after he does it X number of people very soon after that record.
broke four minutes in the mile. And three weeks ago when we saw Ethan Strand run 348 for the mile, two seconds faster than the NCAA record in that race at Milrose games, you had a collegian run 348, Gary Martin from Virginia. You had an 18 year old from Australia, Cam Myers run 347.2 taking six seconds off of his previous U 20 world record. Um, and like all of those guys,
Beau Beard (22:15.02)
would have been like the top six or seven of the race were now the top six or seven world all time. So you get in the right race with the right people and all it takes is for everybody to be pushing each other and think that, well, he did it so I could, there's a chance I could do it. There's also that guy from Adam State that he ran like 736 and
This is his vision to his division to his time would have been NCAA all time leading for D1 and D2 coming into the season. But currently he sits like six or seventh on the like all time instead of late list just because you've had six or seven other guys faster than him this season. And that previous record was from 2023. So that record was set last indoor season. Which if you also think about, we've talked about this just being involved, you know, somewhat in the high school cross country scene and track and field like.
four or five years ago, you just like in our state, you just saw this like boom where it was like, what's going on? Like you guys were even telling me like the times that kids are running now, like you, you guys wouldn't have even been like in the mix with most of those guys or, you know, records that were broke were not even like, you know, worthy of like top 20, you know, when you guys were there. So like, maybe that's just the matriculation now where four or five years later, you see people coming up out of those ranks of whatever that move was.
So that's what I'm always just trying to like think like, yeah, it could be a Roger Bannister moment. Sure. Cause all of this got broke right then, but it's like, obviously people have to be better to be able to do that with the psychological push. it's like, has something changed? The only thing that I could say that has really changed has been, well, I'd say maybe two major things. Footwear that you're training in, which David Roche talked about this quite a bit on his podcast of which we, think I was talking to you about training and
carbon plate to choose versus not for speed work. And we looked at both sides of it, right? So if you train in them, David Rocha's take is training them all the time when you're doing speed work, you know, interval, fart look stuff, because you're going to be able to have a higher output in an easier effort, right? So you can actually, the workload goes up, even though you don't get banged up and energy, you know, like energy efficiencies up your kind of retort was, well, I want to have to work harder both from a mechanical standpoint, right?
Beau Beard (24:33.496)
but also an energy standpoint when I'm training. then if I put on the shoes, then it's easier. I kind of think of it like, so when I was in high school is when like parachute training became really big for like sprinting, both being pulled, you know, drag and being pulled. So it's kind of like, well, you know, which one's better downhill running, you know, for sprint training, things like that. Like we know all this, you know, may have an effect. So my thought was maybe people are adapting to this footwear that they're training in, right? So the output's getting higher.
then there are wearing it. So it's almost like you just kind of have like a, like a bionic human. They've gotten used to that footwear because we know it changes mechanics because we've talked about, you know, the stress fracture run up with a different mechanical load. So that's one thought. The other one is I think there's a hell of a lot more, just more cross training occurring in the running population, but also much better. So it's like, there was always a, if you looked at, you know, high school runners, collegiate runners, cross training was doing planks and pushups and stuff like that.
then they ran a bunch and now you're like, I think in particular in college, we realized like, you can't do that. But also it can't be hand me down strength conditioning programs from other sports just to make them do something. So as you get more specific, maybe people get better there, but that doesn't probably explain people coming from other countries. And I don't, you know, I don't know how all that stuff follows, but there's gotta be something going on there. That's a big shift. And besides just a mental, I think it's, there's a mental part there for sure. My other thing is
you weigh in both options of like, wanna work harder mechanically versus using the shoes and it helps your efficiency so you work, I guess. Not work less, but it's a little bit easier. To me it's like, does it matter? Because if you're able to run a faster pace and an easier effort, do you not just adjust the times down a little bit so now effort's higher? if you ran 5.15s, now you're actually running a 5. You're running like 5.05s.
Right. Repetitively. Like, does that even matter? Like at that point, you're still getting the same effort. I guess if you were using RPE is your natural. Yeah. The only thing that I see that being a difference in is just how they view other people running that time. If they see that, this felt that easy. And I ran five fives versus running five 15s and feeling the same effort. If they go, well, if that felt that easy at five five, I can race at four 50 and be better. then your whole race strategy changes based on like relative. Yeah.
Beau Beard (26:59.352)
perceived effort. Yeah. I don't know. There's a lot of stuff and what, so I brought that up to Travis Grappo too. Cause I mean, he's a huge running nerd. I mean, huge. And he was like, bio carb. I mean, that's just first thing he says, bio carb. It's all it is. He goes, took it once and like best run I've ever had. was like, So also I think nutrient like in the strength and conditioning energy. And they're probably drinking. Did we ever drink electrolytes in high school? I barely drink them now.
Which there's a whole debate on that of, okay, how did people perform at a high level before we had any of that stuff? Right? Cause it's not like people weren't doing amazing things. And then we think we have to have all these things, but then you do think about something like, you know, a company like Morton's coming around and I mean, it literally does change, you know, pH balances and your ability to shuttle things. Like it said, there's that now I don't, we'd have to look at how many of those athletes are actually using that stuff. I doubt it's actually that many. I don't
be interesting. lot of them are using that, other drink, the ketone IQ. Yeah. Which that again, we get into the mental, the big one there besides recovery, cause they've found most of the research looks at the recovery from an endurance standpoint is coming at taking it after right. And your ability to basically not have to utilize glycogen and glucose for like brain, right? Cause that's 20 % of that and taking it after you're able to shuttle, you know, things into the periphery. And then I'd say for longer bouts, which
maybe the half marathon gets into that, it's a lot of that central governor's theory of like, it just, it's easier because you have that, which maybe if you pop up a four or five K and you're all lit up or neurologically stimulated, maybe it is easier. don't know. Um, I wanted to get some of those for the straights I'm this weekend, but I just, haven't, maybe I will probably crap my pants or something if I've never taken them. expensive too. Yeah, it's come down a lot though. So I was looking at it's like 20 bucks a shot, isn't it? Uh, no, that's for the like,
I think it's like four or five bucks a shot. Oh, okay. It used to be $125 a shot. So you just come in three vials when they first came out three vials that were the little like immune booster size shot things and it was $125 for those three. They're not for a shot for those three. Yeah. Yeah. So yeah, it's come down, but we'll keep, mean, obviously Alex has been putting out posts every Thursday. It's a lot of track and field stuff. So follow along on that. But I mean, we're always, you know, we're talking with runners constantly in here because
Beau Beard (29:21.506)
people in the amateur ranks of running want to want to lean on nutrition and shoes and stuff harder than they should because that allows them to put in the same effort and expect something better. But at the end of the day, it's still effort based in terms of training. So I shouldn't expect much difference in this 50 K after falling after falling off after eight weeks. But the last time we've also put in a dedicated eight weeks of training is probably when you and I were trained for a five K. So yeah.
it still should be better than it would have been if I was just doing nothing. Let's kind of jump over to just interesting cases. So if you guys have any just fallen at any point, like I said, we used to do a very deep clinical dive on like one or two cases and that was fun for us and our, know, crony friends, but I think we all get a little bit more out of it. If we just kind of highlight some interesting stuff in here, things that were different. And again, if you have any questions about this, you can always.
you know, post in the comments of this video or send me an email. But one of them was a woman came in, she's in her early sixties and was having bilateral shoulder pain and she does private training at a local gym here and basically just said, I can't do anything. My right shoulder's worse than my left, but I can't do anything cause my shoulders are killing me. And then my right shoulder in particular is killing me at night. So in our clinic and anybody's clinic that, you know, knows their head from their ass, both shoulders are hurting you. We're like, it's
probably not your shoulders. maybe there's something going on with the right shoulder, but then it's still gotta be something central if it's both. And that doesn't mean necessarily like you have a neck issue. It could be how you're operating around your, you know, around your rib cage and your scapula thoracic joints. So with her, at first I was just, she was like, well, I'm not really doing anything with my shoulders because it was just bothering me so much. Okay, let's just not do that for a week.
So we take her through some tests and like we can recreate neck pain on her right side. So that's kind of positive for an orthopedic test, but like she has almost zero rotation through her thoracic spine. I mean, she's a little bit kyphos and then she literally is telling me that her low back hurts if she just walks for a long time. So she's just stuck in extension cause she's flexing her mid back, but like every visit with her, I've had to talk her back into the fact that it's her mid back, even though her shoulders aren't bothering, cause she's not doing anything, which I should all like, I try to tell her like, if you can do stuff in your day to day,
Beau Beard (31:40.302)
and it's not bothering you besides when you went in there and like did presses and lateral raises that should tell you you don't have a shoulder injury because you can do day to day stuff. So I'm just want to throw that case out there because I'm a lot sure a lot of people, maybe not a lot of people have, you know, both shoulders bugging them, but if your shoulder or whatever is only bothering you during a, a hard challenge, you go on and bench press and you're like, my shoulder bugs me then, but it doesn't bother me any other time. You probably don't have an injury. It's probably either how you're bench pressing.
It's how you have to move around your shoulder when you're bench pressing because of how something else doesn't work or doesn't integrate or sync up. So I want to highlight these cases for almost patient, not just education, but so like you kind of arm yourself if you're working with somebody or you're Googling stuff, they go like, that doesn't really make sense. If you, again, trying to logically break down like why would both my shoulders hurt? Why would they only hurt when I do this instead of just Googling?
shoulder pain, you're going to get rotator cuff tear, labrum tear, and then you just, you're just down this pathology rabbit hole. So I wanted to highlight that one from just a pure functional case. I have no clue if she's actually better because we can't reproduce any pain in her shoulders on orthopedic tests. They move fine. She's very mobile. We can recreate neck pain. I sent her home with retractions and her neck got worse. And I was like, perfect. Like you have a neck problem. Obviously that doesn't mean that's like going to solve all of her shoulder woes. Cause there's probably a big like,
how you do things around your mid back once we even get your mid back moving, but it's just solely get your mid back moving and kind of see how things go. another shoulder case. So this guy has had bilateral shoulder problems, but he had a left shoulder problem a long time ago. Now he came in with a right shoulder problem. this guy, so he used to come in with a little piece of paper and it would tell me all of his warmup drills, all of his exercises, and he'd just go over every visit, even though it was hadn't changed since the last visit.
And then he get done, goes, what do think about that? And I just, I kind of got the point. was like, yeah, it's good. Cause I just, whatever I said, it's not going to change. Now it changes cause he's we've had success, but this guy wanted to see how much, how many times he could do 185 barbell bench press and his right shoulder started bothering him. We had told him with his other shoulder, which he had a legitimate labrum tear diagnosed on him or I, and we said it was nonsurgical and we got him over that without surgery. So that's why this success came in and he came in, he's like, got the same thing.
Beau Beard (34:07.148)
same thing on the shoulder started her bench press. I was like, well, let's check it out. It was not the same thing. I think he has my like a probably grade two, you know, whatever you want to call it, tendonopathy strain of his super spinae, this very specific testing that shows that hurts with, you know, putting a shirt on in the arcs that we would expect like the first 15 degrees and then up top and then coming down, he gets that big like catch. So I want to bring this one up because when I tested his shoulder the very first day,
he would have pain with some of our classic orthopedic tests, right? So like your arm at 90 degrees, external rotation zero, empty can, which is supraspinatus test, know, kind of moving from that labral shear test from the pronator position to the supinator position, that caused pain, you know, pushing hurt, but he was like, that was worse, but he had no loss of strength. like functionally it's like clean, but like he has pain with almost everything with his shoulder. So we've taught, obviously you guys know this, we talk a lot about.
what the orthopedic test is doing. It's testing integrity of a tendon, a ligament, you know, the labrum, whatever you want to say. So I explained that to him and I'm glad I did because he came in the second time and he's like, I just don't think I'm doing any better. We test everything. He has less, less of those tests are painful, right? So it came down to just empty can, none of the pain was going from pronation supination, but he's saying it's the same. I'm like, no, it's not like it's functionally improving your, I know your pain's the same.
You know, so let's just, I think we should keep going because he's kind of worried. Do I need them or I also know comes in the third time he's like, I had, you know, some good days, but I had some days where it was worse. like, we don't want you to go. I tried dumbbell bench press and like started with twenties and then 25s and 35s and got 45s. And he's like, I couldn't do it. I was like, how many sets? He's like five sets. was like, So you did something you haven't done. You did the thing that hurt it before. we go in and test them and nothing hurts. Right. So.
Like, and he's like, yeah, but he goes, if I put them a shirt, like I'll get a catch. And so then I, then you try to explain, okay, functionally your shoulders doing better, but now your strategies around how you did stuff. And literally if he just thought about not elevating his shoulder while I did this stuff is way better. So if you think you're super spinae, this always explained to people, it's a little muscle and tendon that's going to live right under your AC joint. And it's like a butter knife on a rope. If you get into this elevated position, that's, you know, basically a secondary shoulder impingement. And I was like,
Beau Beard (36:33.368)
I'm not saying you got to do that all the time, but watch how it changes when you're just cognizant about your shoulders working. A good, another good point for people to think about of how do I determine the difference between what an image says, what I Google and am I actually having progression if I'm at a PT, a chiro, or just trying to get over something myself? Cause now I'm, I'm always, we're always telling people to test stuff. Hey, now you go try a dip, right? I told him, Hey, I don't want you to try to
just dumbbell bench press again, I'd like you to try to do a pushup beyond, you know, like on a parallel or a box or something and see if you can get into shoulder extension without your shoulder just going to this elevated position because he tried one and he's like, that hurts. But his shoulder was up in his ear. And I go, can you try to just think about that? And he did, he's like, it doesn't hurt. was like, again, that's maybe that's not what we do, but we can use as a test, right? So if you just drop yourself in to that movement a couple of times before you go do your workout, cause he's going to keep doing this stuff and your shoulder hurts.
maybe you shouldn't do those other things. So it's a preemptive test, then knowing him, he'll probably start doing pushups from parallettes and that's fine. Cause I explained to him, that's a closed chain movement. It's a little easier to work around and stuff like that. So that was interesting. That's actually, had a Peggy, the gym she's either the post coming out today or it's coming out this week about one of the gym goers who she would do a single arm row. And she said she had
upper trap, you know, shoulder pain doing the single arm row and Peggy videoed her doing the row and you see the first rep where Peggy says, okay, I want you to row this weight and pull the weight to your back pocket. She does that. No shoulder elevation. Then she doesn't tell her anything on the second rep. She immediately goes to shoulder elevation, see your upper trap pull and she goes, yeah, that hurt my shoulder. That's the exact same thing. So it's, and you know, I, I don't think I did. I did a post about it. I should do a,
video on like motor learning and coaching like the best way, you know, so if we get somebody that has like a bad rep, a painful rep, we don't highlight the bad rep and be like, see elevator shoulder because the whole reason somebody does that is because that was a good way to operate. It got him out of pain. It allowed him to move their shoulder into a position they couldn't. So now to highlight the bad and say, well, don't do that. You have to
Beau Beard (38:51.362)
they may not even be aware of how to do the other strategy. Hence when she didn't have any coaching, she just went to a position that created pain, which seems not logical. Like why would you create pain? Right? You'd be like, she, you think she'd do it the non painful way repeatedly if we just showed her how to do that. But like your brain is gets set in a pattern. There's no reason to like dig itself out of that rut. So that is literally like a motor learning strategy that, you know, keeps you in a pain pattern without maybe an injury. So that's again, I tell people all the time, it's the reason we have a job.
We're trying to not just say, that's a bad rep. Let's do it this way. And then try to be like, why is that so hard for them to do or why can't they conceptualize that or what can't they feel or whatever? Maybe they can't move around something. Maybe they're mid-back stiff. So it's hard to retract and depress their shoulder blade. don't know. But that's our job is to figure out is there a why? Maybe it's not, maybe it's just coaching, right? It's technique. Okay, then we can coach them, but it's not just, that was a bad rep. Let's keep our shoulders back. And then pretty soon they're like, well, I'm having pain even doing that. And they're like, well, I should have assessed stuff a little more.
Yeah, that was a part of the discussion for her, at least when she was asking, you what, could I do to tell her that or how would I, or how would I word something on the caption about that? So instead of saying that the shoulder elevating was a bad rep, say that the other one might be more efficient because your shoulder, your upper trap is going to elevate your, your upper traps doing what it should elevate your elevates your shoulder blade. But if you're trying to pull away to buy your side, your shoulders blade shouldn't have to go up. That's counterproductive for where you're bringing the weight.
And if the lats can extend the shoulder blade or extend your shoulder, then that would be what you want to use more. in that position. So, and again, trying to like weaponize people with logic, like you can, why would you do this? If it's not the best way to pull away. That's a question that yeah, you could ask with that guitar. That's why having somebody look at you and be like, God, yeah, you really, maybe your shoulder can extend. Yeah. And that's, that is literally our first job is like,
can you do the movement or do you just, you choosing not to do the movement, you know, subconsciously. then, then you can make a dividing point of like, that's a complete coach Peggy job. Like she needs to coach you up on this, get you to, you know, pick that pattern up, eventually make that a subconscious motor pattern or dude, we got to work on your shoulder or you do and get it moving different. And then this gets a whole lot easier and there might not even need to be a reason to coach it. So I wish more people understood that because it was just a gaping hole of,
Beau Beard (41:16.248)
Well, if I think about it like this, it doesn't hurt. And then they wonder why they have to consistently think about that all the time. And you're just not hitting that, like, you know, putting the cart before the horse type deal. this one's just a little bit different. It's just one of those that you're like, whatever somebody I've seen forever. And I was seeing her for, she was basically having mid or like pain just inside her shoulder blade. Her right shoulder is just chronically elevated. I'm talking like, literally you cannot pull it down. She's hanging off all this stuff, mainly through like brachial plexus tension.
Um, I saw her like four or five times and it really wasn't changing. She was having her eating pain down her arm and we'd get that to go away, come back like two or three or two or three days after a visit. Well, I didn't know. She just went to a PT that's like really close to her house and she came in. hadn't seen her for a month. She came in and she goes, well, that was, uh, that was my first rib. And I was like, Oh, okay. Um, and both 10 years ago, it have been like, no, no. Um, and I was like, Oh, okay. And she goes, yeah. So the PT just, you know,
I saw him twice a week for like four weeks and I go, well, how is it? She goes, I don't even think that my arm is still like pretty bad. Like I've been here and I was like, so what'd they have you doing? And she goes, well, some flossing. Well, she didn't say flossing. She goes this, right? So I'm showing you like a median nerve flossing thing. Um, and then he, she was like, yeah, they just pushed on my, you know, around my pack and kind of a lot of soft tissue. So I was like, okay, but it's better. So whatever in her terms, I just point that out to not say like, oh, I was right. They're wrong. What we're going to do is different. It's just,
the confidence with which you say something. Again, that person was like, yeah, it's first rib. And she's like, oh, whereas I was like, yeah, I think you're, know, brachial plexus has a lot like that doesn't, she doesn't know clue what I'm saying, but like she even said that she went home and Googled her first rib and like she had, it's all picture of it. So now she has an image of it in her head. So I should have done a better job with her because I've seen her for so long. I just kind of figured like, no, she's not going to just go off to PT land and do some weird stuff. So.
The interesting thing with her is from the clinical side, her first rib moves awesome, right? So from a joint standpoint, but in our world, if somebody has like brachial plexus tension, if we take them through a flossing maneuver, we'd be like, that's kind of a no-go for right now. We got to like detention it. And that's what I was trying to do with her with like some DNS and exercise the whole time. So just kind of interesting that she's like, you have to do this, which is probably the soft tissue that they were doing, just getting stuff moving. Cause it's a giant like brachial plexus nerve entrapment.
Beau Beard (43:43.234)
around there. But it still goes back to strategy. Like, why is this? mean, she literally lives like this. So she walked in and just like, why should you do that? Tough one. But at the end of our visit, she has like a 20 gallon purse and she just throws it on that shoulder and she's hanging out like that. Can you just not do that? I go, hate to be that person, but just don't do that. She goes, it's so hard. I go, you're literally doing this to hold that purse up. She goes, I know. So again, I'm not saying that causes it, but it doesn't help anything. So, but I bring that one up of confidence of delivering a
for a patient and a clinician, if you deliver something confidently, it doesn't mean you're right, right? That you just get buy-in, but a patient realized just because somebody delivers something confidently does not mean that they're right. So you gotta play both sides of that. Interesting one from my standpoint on the clinician side, a person that a good friend of ours, we all ran a half marathon a couple of weekends ago. During the half marathon, her left knee started killing her in particular on the downhills to the point where she's probably the fastest woman in our group. And she came in close to the last woman.
Cause it was bothering her so bad, but post-race she could flex it fully, do a squat, all this stuff wouldn't bother her. She goes, it just seemed like it was impact. And she's had a history of low back stuff. So she came in the other day. She's like, my knee is still bothering me. And she goes, I was, they went to the Daytona 500 and she goes onto the way to Daytona. They drove. She goes, my whole leg was just like going numb and tingling all the way down to the, basically medial arch of my foot. okay. she goes, that's better. And it's just kind of like above my knee, like in my hamstring now. I go, okay, let's check it out.
positive slump test on that side, both for, guess you'd say positive or positive a better neurodynamic test. So like lack range motion or ankle compared to the left, but then also like straight leg raise is positive. slump just by itself and no like neurodynamic is not really positive, but then her quad had a bunch of trigger points and Vassus lateralis and you know, through rectus and just like twitches all get out and I go, okay, so
your back's not bothering at all. You got this kind of ridiculous stuff. Your knee is the big complaint. Let's just treat your low back and the nerve and just kind of see what happens to the quad. Cause I think that's causing the knee stuff. All those trigger points went away and we didn't touch your quad. So I point that out again for us, cause we're always talking about an audit. So that is a perfect functional audit of a trigger point that isn't even technically, yeah, it's kind of, obviously it's limbo sacral plexus. So obviously all those nerves converge at some point.
Beau Beard (46:09.678)
But if we thought if somebody came in sometimes we just think oh, it's sciatic nerve and then you're a quad or for some reason we like Splice those out. Well, it can't be that. Yeah, which is your low back I mean l2 3l4 like back is getting compressed snot for whatever reason And we didn't do that much work on her low back. It was like getting her sciatic nerve moving soft tissue some Openers on that side and I mean gone in terms of trigger point now will they come back she goes and runs will come I don't know
pointing that out again of we know a lot of lower extremity pain is derived from your low back and that doesn't always mean like neurologic, ridiculous stuff, right? Those muscles might be getting more neurologic output because your back is kind of angry and you have signals coming in and out and it's kind of just like everything gets a little chaotic and you just bombard muscles based on you are doing work, you're on a downhill and now that muscle just like has to turn on all the way because it doesn't have like a good throttle.
So it's like zero or a hundred and that's kind of what a trigger point is. again, I'll have a follow up next time on her for sure. And just kind of say like, yeah, like working on her back is kind of the thing that helped her knee the most or maybe it didn't, but no positive or speed tests on her knee, no swelling, no point tenors on her knee. So you gotta be like, okay, there's something else going on here. So I that was interesting for sure. I'll skip this one because we're running out of time, but
one more, guy that I've seen forever came in the other day and he, switched careers completely and he's in his fifties, moved to building homes. And he said he was flipping over a countertop, like a Formica countertop and felt a pop in his elbow and had extreme pain. But he's like, I kept working and he goes about three hours later, he goes, I literally couldn't like pick up a hammer with my left arm. no swelling or anything that day. But he goes like the next day I woke up, he's like, I couldn't like move my arm.
No bruising, no anything like that. So he comes in and he has a brace on that elbow, like a Velcro brace. Said he's been taken ibuprofen, still been working, but there's things he can't do. And takes off that brace, giant pocket of swelling on the inside of his like distal bicep and just kind of look at it, test city as pain with all ranges of motion that are resisted, right? So like 45, 90, 135, uh, elbow flexion, but he isn't giving up ground on any of that.
Beau Beard (48:31.488)
I bring this up because I just put out that video on, you know, is it a nerve injury or is it a strain and like how easy it can be to diagnose a strain. If somebody has swelling, you had some sort of soft tissue injury like that amount of swelling. I mean, it's pretty diffused in a focal pocket. he's not able to do things. It got really bad a couple hours later, right? So obviously strain, not rupture, also didn't have recoil, but he's in an age category where being very sure that like,
what grade that strain is because this guy could get out of pain in two weeks. He goes and flips another countertop and just absolutely ruptures bicep off the tendon and you know, has like the neck tie roll up off a cartoon into his shoulder. So he's very like, what should, what can I do? What should I do? Cause he's like a small crew cause he's just doing this, you home building on his own. but I bring that up about the diagnosis thing, right? Because was it a tendon? Is it a muscle strain? Where's it at? What grade is it?
So with him, based on how it tested, like you can almost unequivocally say like musculatindinous junction, like a one plus, you know, strain of the long head of your biceps. Why that matters. I mean, now your rehab is super specific to, okay, it's about a week old. he did say that it was getting better and then he touched a hot wire and yanked his arm back and he goes, that sent me through the roof. So fast twitch stuff with a muscle strain is going to drive it crazy. Just like if you come back after hamstring strain and
everything's good and then you take off to sprint. You're like, Oh, get to you again. So I had to like paint a picture of him and like, okay, I'm to give it three visits. And if we don't see, you know, really good progress or if it goes backwards, you do some at work, you know, catch something we might get an MRI just to protect this guy. So he doesn't, I if he's built in homes, that's his livelihood now. And he ruptures advice. He's out for like, you know, minimum eight weeks, if not longer. Um, so the guy wouldn't be able to work. He also doesn't have disability insurance because it's small business that he just started.
So taking all of that in is a good management piece of like, I'm not just going to fly off the rail and be like, I think it's a mild strain. Let's just kind of start loading it like very specific on the angles. So we're playing in that 135 cause long head pronation versus supination matters because of where he actually feels the most kind of tenderness when he's loading it, right? Cause you're going to change how much you like break your radialis and short head versus long head using dry need only to create a pro inflammatory things. It's weak old.
Beau Beard (50:53.388)
So all that comes into play, which it could be wildly different if he comes in the day of I'm not sticking needles in the thing. I'm probably not loading it day of it's a, know, grade one plus strain. I'm going to keep it moving, get the edema out of there. So again, being diagnostically accurate for a clinician top notch, but for a patient, you deserve that amount of accuracy. So your treatment is very specific. So you, don't get knocked out of work, but also I could have this guy.
doing things pain free in two weeks. But then I told him right then and there, I was like, you're going to have to be cognizant of not just flipping a countertop over when you're out of pain because it is a strain. And that's hard if you're out of, know, say we make a mistake and he has no swelling or like, I think it's just a nerve or something. And he flips a countertop in two weeks. He's out of pain and ruptures. I mean, that's on you, you know? So again, the swelling helped. were certain things that kind of pointed that out, but yeah.
you ever think, because he didn't have any weakness, right, when you were doing any of the... He wasn't buckling. mean, he said the, and again, you take their history into account, he was like, I couldn't lift stuff. But then he had also told me over the week, he had gotten better. So that's where I'm like, grade one, one plus. Yeah. Right. Also, he didn't know any swelling. So if I have a tendon that you keep using because he's doing construction.
It's going to get pissed off. So that's why I was like, okay, that also sounds like a mild strain that you're just not able to let it heal because you got to do stuff. Um, so yeah, I mean, we, so in the treatment, we dry-needled it for a pro-inflammatory cascade. Um, I taped it up to try to draw the edema out of there back up towards his, you know, axilla, uh, went through isometric loading and I said, Hey, we're just going to do two to three days of isometric and then probably move into like eccentric stuff. Cause I think we need to cause it's grade one.
But I need you to go home and make sure it responds well and also see which angle is kind of the worst, but in a good way. Like where do you feel it the most where by the end of those four to five sets, you're like, Oh, that's achy. And it was that 135 because we did one round of it in here next time. Cause it'll be a little further outside of the acute window. We'll do some BFR and you know, maybe go through eccentric loading with that stuff and just push them a little bit harder. So like I said, I think in four visits, I can get that guy like going and then he's going to have to continually load it, you know,
Beau Beard (53:10.03)
the next couple of weeks specifically. But I said, you could use stuff at work and go up to countertop and just do an isometric for 45 seconds. It doesn't have to be a band or a rope or, you know, it be a saw or something. So we can make stuff up. yeah, when you were deciding whether it was a strain or not in the first, what was telling you that the swelling was coming from, um, the Muscogee tendinous junction versus it being neurogenic. just where
So again, where your pain is. So when we test them up here, he has no pain at all. Right. So the lever, so you just work your way down, just like when you do. So we have a hamstring strain, right? Somebody's on their stomach. You're to start them at, you know, maybe less than 90. So maybe 45, depending on their range of motion, but 90, 135, 160. And you're thinking you're working your way down the hamstring, but also like the further you get out with some people, the higher they'll present with pain up towards their shoulder too.
because the lever's at its longest and you're just, in my opinion, you're working further out from the muscle belly. So if everybody listening or watching, if you just take your bicep and squeeze it as hard as you possibly can in a ball, you're gonna literally probably almost cramp like in your bicep, right? But if I had you hold something for the longest time in a straight arm, you're probably going to feel strain like for most people down in your elbow, right? Just cause we're not doing a lever with our shoulder. The other thing was when I tested them, so we found out that
And I'm saying a big arc of flexion, right? So maybe this 150 degrees, I don't know. Um, the higher I got him, the better it got some more use his shoulder. Right. So the more he's up here, right? Offloading this, like he's like, yeah, that's, I don't really have anything. So was like, okay, that seems like it's deep in there. I don't think it's on his bone, right? Just cause of how it's acting and things like that. He's also 50. So becomes less likely with that injury. He felt a pop. What's that mean? Maybe something.
But that's also the most susceptible area of a muscle if we don't think it's a tendon injury and the way it's acting doesn't sound very Tendon either it got better in a week, right? If he's like dude, I can't do anything and I mean you might pull a trigger on an MRI even if somebody's coming in there and they're full range motion mild pain They're not buckling but you're like say it's blown up like a balloon and you know stuff like that But yeah, so that again that would be my strong assumption. All right, so that also tells me where I'm needling but that's also
Beau Beard (55:30.542)
when I'm palpating, right, I palpate on like head of the radius and stuff like that, like there's nothing you move up and you're like, oh, it's kind of in that, you know, junction and how big that junction is a little bit different on everybody. Yeah, kind of a little bit of that. Let's move on while we still got 10 minutes or so to some research articles. Do you guys get a chance to look at these at all? No. These are just interesting. We're not going to like get in the weeds. We'll put links to these in the show notes here.
One that I thought was interesting, this came out in what, just two weeks ago, week ago? It just says February. published in September, released in this journal in February. It says uphill treadmill running and joint mobilization, improved dynamic stability and ankle dorsiflexion, range of motion in young adults with chronic ankle instability, a randomized controlled trial. So, Wayne Norton would be happy.
I just thought it was interesting because they're literally using, it was either a standalone running groups. You're running on a treadmill uphill for this is three to four or three times a week for four weeks, 20 minute running sessions. Or you, well, let me read through it. So participants were randomly assigned to four groups combined uphill running and joint mobilization. The joint mobilization was like grade four. So it's just joint mobs, uphill running alone.
joint mobilization alone and a control group. people that had restrictions that they did nothing with, the uphill running with the joint mobilization and uphill running groups is 20 minute running sessions, three times a week for four weeks. And then they used a wide balance test cause they're trying to look at chronic ankle instability, the Cumberland ankle instability tool, which is a, I don't think that awesome. And then weight bearing lunch tests. So that's, you know,
not too far off like a Gary great type thing, not non weight bearing angle, dorsiflexion degree using Goniometer. So reading through this, the biggest group that showed response, which again, if we, the most input was the people that are getting joint mobilizations and running uphill. But when you read through kind of the methods and the outcomes here, because it says the uphill running and joint mobilization superior to either intervention alone with a success rate of 1.5 times.
Beau Beard (57:53.966)
1.55 times greater than just uphill running But when you look at the uphill running versus with the joint mobilization like they're kind of the same So this is I was just talking to Seth about it It's not confusing. I think I understand why but like I run a lot of trails and there's always a lot of hills But there's also not maybe 20 minutes of a hill right at the same incline in a controlled scenario But I know a lot of people that do a lot of like
long, slow hiking, running where they are doing either heel repeats or they'd be doing enough. They're going slow enough. Like they're putting in more time than that. And I, I don't want to say I guarantee you their ankle mobility is not improving and the chronic ankle instability tests are not improving in those people. So just thought it was interesting that, you know, what is the mechanism there? Again, we know that joint mobilization from like a grade four grade three,
you know, if somebody's doing it for you, you're doing on your own, like, yeah, you're going to improve a little bit of input, but like how much is that actually going to change if you have a joint restriction or tissue? I don't think a whole lot, right? It gives you more feedback. So the ankle instability stuff makes sense. The Y balance test and stuff like that. The dorsiflexion, that was interesting thing to me. That's you saw it was almost the same, whether you got joint mobs or running. So then it's the uphill running that's the factor, right? Cause the joint mobs are helping the stability tests.
So one of the harder things in my opinion to change is ankle dorsiflexion, right? We, you did a undergrad research study on breathing and ankle dorsiflexion cause we were just curious. We're constantly leading ourselves back to an ankle that's like, probably causing a lot of this, but also that's a long road to walk or will it change at all or should we focus on it because it's hard to change. So it would really be a, I guess a smack in the face if it was like, I should just have everybody.
either walking or running on a treadmill, you know, 20 minutes, three times a week, and that would actually improve their ankle mobility better than anything. So I just wanted to point this out in terms of like, I don't know, I don't know, you'd have to understand the mechanisms better. Also, if you looked at the amount of load that that is a 60 minutes, you know, total, that's not a ton, right? But if we looked at like Keith Barr's work for like a tendon, what I was kind of looking at is right. after about, you know,
Beau Beard (01:00:13.134)
two to five minutes that tendon stops kind of having to recoil. So now you're going past that point. If I keep working it, maybe if you had a stiff area of a tendon, just like he says, you have to load the tendon enough to allow the portion that won't load to evacuate fluid, but also get tensilely loaded. Maybe that's what's happening is you like, basically you lose that recoil ability, the tendon. then as you keep walking uphill, you're like,
maybe pulling on that portion that's not stretching or fascia or whatever I'm going to say. Um, cause again, this isn't people that have Achilles tendonitis, but if we had, if I had to guess why a lot of people have stiff ankles, you've had massive adaptation around your, the end of your gastrocnemius soleus group and that's what's, you know, stopping you. So I think about one of our patients, a young guy that used to play tennis and now trail runs that has less than zero degrees of dorsiflexion. Like he is in the negatives by maybe four degrees.
what would happen if I gave this to him? Because I've told him forever that like you have to change this because that's a cause of some of your back pain and he had a hip surgery and then he has knee problems. So I just be curious and he would be probably somebody that would do it, right? But it would be out on a hill on a trail. So yeah, it was just kind of interesting to think about with those people that you're like, I need them to change it. Maybe you're like, come do this. I don't know. What do you guys think? I think it would suck. It would suck. minutes, three times a week. the grade was 5%.
Yeah, that's Yeah, dude, that's not a let me make sure on that grade dude. Those are some fears runners Yeah, 20 minutes straight hill at 5 % You're probably talking That's 200 280 for a heart rate. It's David Roche ledville training right there on his I'd be a max heart rate for at least 17 of those minutes. It's probably two mile plus hill. Oh, yeah You'd be be grinding I Could see why something changed you either you you literally had to
I'll put in the show notes to grade or I'll put the whole article in there. Um, it's downloading right now, so I don't want to take the time. The other article that I thought was kind of interesting just because I've been going on a little more deep dive, um, into fascia land, which every once in a while just kind of pops up with, you know, interesting stuff and people want to blame all our woes on it or that you can fix everything by the focus. Um, not gout. I was going to talk about gout.
Beau Beard (01:02:36.974)
That was another thing with that patient with the elbow problem. but was an article that came out August of last year called fascist regulatory system and health and disease. So again, the article is almost looking at it as like the, the end all be all. But what was interesting or I thought was interesting is this concept and they literally call it the watchman of the Kim, like the ability of fashion communicate. And we knew that fashion.
could communicate or was communicating faster than neuronal communication, right? So like as fast as your neuron can fire, which is different for, you know, you know, a C fiber versus like an a fiber and things like that, but like how fast those can communicate somehow things were happening faster than that. So then it came down to basically testing both the electrical gradient and piezoelectric gradient of fashion. They kind of found out like, Ooh, fascia is communicating this. Still people don't understand how that's why even some people are thinking there's some sort of
quantum entanglement with fascia, which gets wild. But this is also saying now they think like immune regulation is coming from fascia communication. So if we thought about like where lymphatics live, you kind of like start to, I guess, like use logic to be like, yeah, it can make sense. I bring that up because I just maybe think of somebody like Kelly Sturrett or Perry Nicholson. So one of Perry Nicholson's biggest things is like, you know, lymphatic mojo, which I took that class is pretty interesting.
And then, you know, if you're getting like a lymphatic massage, like he even said in that class, like it's the pressure usually of like a nickel on your skin. Like it's nothing. then you think about Tim Brown, if anybody knows who Tim Brown is, he's been, the sports medicine director of the world surf league for like 20 years. he is recently kind of coined his own method called SPRT soft tissue. So SPRT was specific positional relocation taping. So he's like the godfather of like Kinesio tape.
but he does these like super light strokes over an area, which he says is based on Wilson's law, right? So whatever nerves innervate a joint, innervate the surrounding musculature, right? I think that's Wilson's law. That's a long way back. So he's saying that if you gently work on the periphery that you'll like joint restrictions and things get better, right?
Beau Beard (01:04:56.684)
I just bring this up because it's a good thought piece. So if you're clinician listening, you need to read stuff like this. And this gets back into the art of assessment course of having these good base of your pyramid of core sciences, a good filter to be able to read stuff like this. Look at somebody like Perry Nicholson or Kelly Stratt. Kelly Stratt's huge in, you know, lymphatics, getting fluid out, flushing it both for the proprioceptive, mechanoreceptive response. Once you have that fluid out of there, but also just like healing rates go through the roof. Tim Brown.
I mean, before it changed to the move in advocate, like, you know, Steve couple Bianco was the fashion doc, like all of these things kind of tie in. again, I don't think it's an all be all, but like trying to conceptualize the way that you treat things and not just going in, you know, with a hammer and like, you know, from the treatment standpoint of bypassing these things. And I think that's where you can appreciate like, well, different tissues and different nerves and different structures respond to different amounts of pressure.
different amounts of load, like the running study. So always thinking about not just like, I'm working on joint stuff, right? Why would the joint be restricted? Why is, why does this guy still have swelling a week later? But the more you think about this stuff, the better condition you're gonna be in. they're just being like, I'm gonna get swelling out and Kelly Surrett says, wrap it in a voodoo floss band and move it and I'm pushing fluid out. That doesn't really help you to just do what somebody else says, even though it might work. You gotta be like, why does that work?
Why doesn't it work on some people and it does work on other people? So again, read this article if you get a chance, just interesting. Obviously there's a ton of research on fashion coming out all the time, but I have a whole folder on that. But I'll be doing a video on the Myofascial Meridian crossover with acupuncture here pretty soon because I didn't realize it was something, I didn't know that quite a while ago, I blanked on the researcher's name, they took...
Trevell and Simon's work and overlay that with acupuncture meridians and they redid the study because it was originally like a 75 % overlap. They redid it. It's like an 81.5 % overlap and myofascial trigger points and their referral points and then, um, acupuncture meridians. So again, why does that matter? Because we're, I'm big on learning referrals and things like that. So then if you're like, well, a lot of these acupuncture points are trigger points.
Beau Beard (01:07:15.488)
And then just like our motor index points guy, you're like, if I treat in a chain, I have a bigger effect on a trigger point. Like again, you're trying to hone your skills. You're like, I don't just stick a needle in a tight muscle. You're trying to be better than that and just, you know, play around too. So you can get creative. Be like, I'm going to do every, you know, acupuncture points, three points away from this trigger point and then the coinciding trigger points. a lot of your acupuncture points are trigger points.
Right? And then you think acrobatics points are holes, right, or vacancies. So then you'd be like, well, what is that? Well, that's where fascia is going to intersect. So those are the envelopes. So I don't know. It's something to think about. And like I said, I'm digging through some research. I'll do a video. Just kind of my thoughts. I know a lot of people talked about this, but yeah, that's what I'm interested in right now. Any comments on the watchman of the fascia?
None, So go look up if you haven't. Tim Brown, SPRT Therapy is doing live Instagram stuff like once a month. You can get an invite to that. We'll put links to these articles. If you have any questions, whether you're a patient or a doc about anything we talked about or anything in the future, let us know and we had such a massive live chat. It'll be impossible to get to all these questions over here, so we'll do our best and I guess we'll see y'all next time.
Right? Yep. See ya.
The Burden of Truth: A Cautionary Tale for the Fitness Industry
In this conversation, Beau Beard and Brian McKenzie explore the intricate relationship between health and performance, emphasizing the importance of understanding the process over the outcome. They discuss the evolution of human performance training, the role of responsibility in health, and the significance of introspection and learning. McKenzie shares insights on pain, change, and the illusion of sport, advocating for a more holistic approach to health and performance. The dialogue highlights the need for deeper conversations and collective responsibility in leadership and personal growth
Transcript
Speaker 2 (00:01.902)
so on the show today, we'll have a intro prior to this, but joining me is Brian McKenzie. We've actually never met, so I'm really glad to have him on the show because I feel kind of like a fan boy. I've been following Brian's work for a little while. And, first things first, we don't need like birth to now, but for anybody listening who doesn't know who you are, can you just give us like a brief intro and what you're up to these days?
yeah, I got involved in human performance as a trainer, in, Southern California. it was, I found it through school of all things. I did not like school. I was, I'm not a fan of school, hence, you'll never see acronyms after my, and I would do that on purpose regardless, but I don't, you know, I, at any rate, I,
I got enamored with going fast, I guess. And I love skateboarding, BMX, but I played sports too. Sports probably saved my life. I loved water polo, played it all through high school, and then I was also a swimmer my entire life. And so I used a lot of that stuff as kind of the idea behind what I actually found. Nonetheless, I didn't find human performance or what it was that I found until
my late 20s. And then I got heavily involved in it, trained a lot of people, worked with a lot of people, ended up getting pigeonholed into the endurance world and spent some time there doing things particular ways, following particular methodologies, enjoying that, getting addicted to that, I guess you could say.
Fortunately, I was mentored by a good group of people. One of those people was a guy by the name of Dr. Nicholas Romanoff, who was the creator of the Pose Method of running. That was early 2000s. That was like 2001, 2002. And then, you know, he flipped everything I was trying to understand on its head. He just made me question things in a way that I'd never seen. And I started considering things at that point. And this is important because I started considering things that were not conventionally thought of.
Speaker 1 (02:19.392)
And this is a very, as you could tell from his name, he's very Russian. And Russian thinking, Eastern block thinking, has always been very different and very kind of ahead of the game, regardless if we're looking at performance enhancing drugs or systems around that, which we now see.
Not always maybe by the rules, but yes ahead.
Exactly. Yes. And they looked at the athlete very differently than the rest of the world actually did. And thus that was kind of where I started really playing with things. And so I inevitably ended up creating quite a paradigm shift in the endurance world by looking at reorganizing the way we were looking at things. so I took a different approach and that approach became a skill-based training to endurance training. And that also involved intensity.
It that also then involved a considerable reduction in volume of training for most athletes. And that was where I kind of made my mark in the world, where I gained some kind of leverage, to a large degree, I guess you could say, you know, I, I gained some popularity, I polarized some things and you know, I, I've continued on that path, but you know, I've, I've, been, I've always been in search of,
more learning. I'm, I just because I didn't like school does not mean I do not enjoy learning. I have my, my library is full of every probably book you've a lot of the books you've actually used with your degrees that I've had sent to me by physiologists and people who are running programs and things. And I've gone through these things and I've, I've immersed myself in education.
Speaker 1 (04:12.11)
through that vehicle of my own desire to learn more and put myself around people who actually have educated themselves to a large degree but are doing it differently. And so where we're at now is we've opened up a door into looking at the, I'd say human performance from a more deep practice standpoint and we're using breathing to a large degree.
as a way of getting there. a lot of people pigeonhole this into thinking that our new thing's breathing. And breathing isn't our thing. We're just actually, it's something that we do and we don't stop doing it. Yeah. And it's a tool and it just so happens that it's...
it's integrated into everything we do physiologically or psychologically, right? And even from a movement standpoint, right? So it's just something we're using as a tool to connect dots that we've been talking about for quite some time. So ultimately I look at human development at this point and my job largely is kind of a research and development guy or
a creative, you will, because I literally my job is almost like a professional athlete, although I'm not trying to win anything. I'm trying to understand things. so on a daily basis, whether when I get up in the morning and I'm doing some sort of breath work or I'm doing some sort of like altitude training thing, or I go get on my bike or I go get in the gym, I'm using that.
as an understanding of what it is I'm doing and how I connect movement, I connect my breathing, what my heart rate's doing, all of these things so that I can understand it on a deeper layer to actually put that information out to kind of get people to start exploring more about the innate abilities as human beings versus
Speaker 2 (06:18.094)
In essence, you're the ultimate player coach. Yeah, I mean, that's, you know, if we can organize sports, that's what a player coach is. Somebody that's still putting themselves in the gauntlet repeatedly. Maybe not with the same mind frame, right? From this, like, how do you tap into performance? A lot of times just like, hey, I have to be doing this thing to coach this thing. So I want to break down because that was a lot of info. So there's a lot in there just in the beginning. When we talk about performance,
Just yeah.
Speaker 2 (06:46.912)
The thing that in my opinion should precede performance is human health. And this show is called AnthroHealth. But I know paradigm has shifted a bit even in the last five years. But a lot of the times health is completely lost when we go after performance. We sacrifice health to get to that level. So I want two questions here. How would you define health and how would you define performance? And then how do you bridge those two?
in what you're doing as kind of a daily N equals one of yourself and using that experience with yourself and other athletes and other people.
Yeah, well, I appreciate that question. I don't look at health and human performance as two different things. Yeah, I don't think you do, based on your question. to be, know, like I looked into your work, you know, and I typically, I do that with
i agree i don't think they should
Speaker 1 (07:52.364)
you know, anything I'm going to really jump on. but you know, there's a reason why practices like chiropractic have ever have risen up. And it's, it's largely in part because we've put a bird, beast of burden on the medical community that shouldn't exactly exist. Medicine is important. It's a part of our lives. And it's also why most of us are alive and are in
capable of living the lives we have. That should not be, that should not carry the burden of this is health. And unfortunately, that's what we've done because we, by and large, the populace wants to look at health as a quick fix or something that can happen.
And that's why you can't just come in and work with a chiropractor or even most chiropractors don't just have a chiropractic doctorate. Right. That's not what they carry. They carry many more things to that. And it's not that doctors don't do that, but literally there's all these underlying things that start to, you know, come with that because you start to see, wow. I can't just adjust somebody's spine here and think that
this is the way to help. They've got to actually start taking care of them. So you'll start to see dips dabbles in nutrition, right? And I'm not going to get on a you I don't want to hop on the game of how much you know, how much nutrition information doctors get, you know, but we're all aware of that to some degree. And unless you are a doctor who goes and invests your time and seriously into nutrition, you have no real understanding of nutrition. And so the information
And that field is starting to understand the gaps in that knowledge and how that applies to this lack of being able to help people nowadays stuff is different.
Speaker 1 (09:51.606)
Of course, of course, but I don't think it's their burden to take on. I think that if you're going to specialize in being an ENT or you're going to a podiatrist or a gynecologist or what you stick to, you stay in your lane and stick strictly to that and let's be very clear what that means. so health is literally lifestyle.
That is all it is and how I live my life. And if my lifestyle doesn't match what it is that I want or I'm not getting, then I've got a lifestyle problem or I've got a health issue. And whether that falls in line with my knee hurting, whether it falls in line with some sort of disease that I have or ailment I've got or sickness I contract or a performance issue.
I feel it's the exact, I feel it's all the same thing. And I can, my job has largely been to take what it is I believe I understand in that if I can affect an elite performer with breathing, controlled respiratory, controlled ventilation in a performance situation, and that can get them to either A, understand something or perform better.
That is going to have an impact on somebody who's sitting on their couch and can't find the time to get off of it and go for a walk. Right? Or is dealing with cancer. Right? I don't think I'm going to cure it. I don't think that's the, what, what, what, that is not what I'm saying in any shape, way, or form. But I do know that if I can get somebody to start being more aware of what is going on, that they actually can, can
change something for the greater. And that greater has a psychological, physiological, and a mechanical place. And these are the principles that we live by.
Speaker 2 (11:58.316)
When we talk about this all the time to our clients, I mean, we have an extremely athletic population, but then they're, you know, we call them regulars or Jen pop, whatever you want to call them, the people that aren't going after performance per se. But one of the biggest things I talk about are these catalyzing aspects of whatever you're doing. if I have decreased energy overall due to nutrition, sleep, whatever it is, I'm a heck of a lot less likely to do whatever rehab drill I give somebody.
So maybe instead of going after rehab, I have to go over here and mess with this to give them, you know, find the time, AKA maybe energy to do the thing, to get themselves out of pain. yeah, like you said, we, the always learning, right? Always be learning if that was our, you know, 80 quote. We find the gaps where we're not able to help people and we don't completely go down that lane because there are specialists in all of those.
but you have to know enough to maybe start the fire under somebody's ass to get them to do what you need them to do in your lane. And that is becoming more so. mean, you know, you think of like the book Sapiens and talking about creating these commandos of health, right? Like these, these people that have to know a little bit of everything and are they going to be the people that take over? And this is the next question I want to get to, or are we going to create more of this reductionist medical system with all these specialists?
So you said that the burden in your opinion doesn't lie with, you you know, the gyno, the OB, the cardiologist to tackle all these things. Do you think the burden just lies with the individual? Like health is ultimately our responsibility. It's our body. It's our life. It's our lifestyle. Um, how far do you think that burden lies with a person before they need to go out and learn from others or, you know, seek out help or, know, that's hard nowadays. I there's a bunch of shit out there. Um, and that's like half the battle is like,
peer in through the weeds to see what's real. So where do you think that burden lies and how do people kind of address like finding out how to take care of themselves?
Speaker 1 (13:57.376)
Well, so I have a question for everybody who listens to this. What is freedom?
Hmm. Ooh, man.
and what is truth. And I'm sure that whether you want to look at this from a spiritual or religious context, that a lot of people can understand that, what truth is. But what I'm connecting is that truth with physiological and mechanical truths, right? So.
If you can't get those things aligned, this is called responsibility. And this is, this is why I feel as a society and, and, and at large, and this isn't everybody that people struggle. They're not actually really that honest with themselves. I have spiritual truth, but I am a hundred pounds overweight. Well,
I don't know that you totally understand what freedom and truth mean. And if you're not paying attention enough, then you're just not understanding truth enough. And so I think there's a whole connection to this entire thing. I mean, I'm not somebody who chases spiritual context, I like, because I think the moment that people actually do, you know, try and chase spiritual context or try and chase the spiritual side of things,
Speaker 1 (15:30.818)
that they're going to miss it. I think it's a body mind connection that you inevitably find through awareness. And that truth in itself exposes itself to who you are and realistically. So the fact is, is the reality of everything is we all carry responsibility and we all know what we all understand to a large degree, difference between right and wrong. there, yeah, there are people out there that yet they have, they struggle.
They have meant there's true mental disorders and things like that that are going on that people struggle and I am totally compassionate to that. What I am not compassionate to is just people who want to take the quick fix to something where it's, I'm, you like pain, you brought up pain or, you know, just briefly went by it and it's like, look, factual information.
What science says whether i'm reading a book about the brain or whether i'm reading something about people who are you know Addicts, you know, or i'm reading something about people who you know, or i'm reading something about, know orthopedic stuff and people being in pain with joints, right? People who run from pain Are in far more pain than those who actually go towards pain to understand pain and
you see that even in the in the brain that people who actually deal with chronic pain actually dedicate more areas in the brain to pain when in fact they aren't actually dealing with as much pain as somebody who really I mean I I've surrounded myself with some pretty interesting people and I've seen people running around on limbs that should have been replaced long ago that
basically are like, I can get through this. This no big deal. And then we go get MRIs. And it's like, yo, you have no headgear femur. Like, it's been worn off. And it's like, what? Like, you've been running around in all this pain. And it's like, but you're not, they're not actually dealing with pain. And I there's instance after instance after instance with this thing, you know, with these types of experiences. And I'm not, I'm not trying to
Speaker 1 (17:51.0)
put people down who are dealing with pain and who are in these things, but I am saying that if you, this is where real change actually happens. And this is what real change actually is. And it's the death of a way or a pattern or a habit that has got me in a place that I'm doing something that has me in this control mechanism. And it's a behavioral control thing where we're using our survival skills
as a means for non-survival type situations. And we've been doing this since we were children. We all do it. I'm not like I do it, right? And fortunately for me, I've got a wife who will call me out on, you know, and I'm like, damn it. All right, she's right. I've got to stop doing that. And that's where truth starts to play itself out. But physiology has the same mechanism here. And this is why we've gone towards this breathing thing is because
There's only one way to understand what we're doing with energy and the way we can measure it right now. And that's through respiration. And that's what we've been doing for eons. And we use a metabolic cart to do that. And we measure every single breath, what goes in, what goes out. And based on the carbon dioxide and oxygen going in and out, we can understand how we're burning things metabolically. And so when I'm moving more of that needle towards I'm burning more carbohydrate or I'm offloading more carbon dioxide,
and I'm pulling oxygen in, I know we've got a problem. And so if I've got somebody going on a walk who's got to open their mouth to do that, then I've got somebody who's physiologically or metabolically inefficient. that could be, now, if I've got somebody doing that on a walk, but I've gotten an elite athlete who's got to go out on a run and they've got to run or they've got to work out for an hour with their mouth open.
That's a problem. And our body says that. mean, do think there's a reason why we store in quote unquote plus or minus 2000 calories of glycogen? Like what uses sugar in our body all the time? Brain, nervous system. So if I'm depleting those things constantly, what am I depleting my system of? Well, my nervous system and brain are gonna have be a little bit more foggy. You're gonna have to overwork today.
Speaker 1 (20:14.926)
Or my body's gonna have to overwork in order to produce that I don't insert that so then we got people who are eating a lot of crap food Because they feel this need or desire to move towards something that's gonna fulfill that desire or that the need for sugar or carbohydrate right and it's this whole compounded effect of What does my what is the reality or what is the truth of what's going on? And I'm not you know, I hate
to be as deep as this and I don't want to go over people's heads with this, but this is the reality of what we're doing with our lives and we're trying to hack being healthy.
I think what you just said is probably the biggest problem with let's not even call it health, just the field of human, like being a little more human is that we think it is wrong to go over people's heads when what we should be trying to do is go into their heads and get them to go inside themselves. And that's what you basically just said, like these three truths, right? There's factual truth. That's the things that we study, but they're not really truth until they've been tested, right? That's the whole.
the whole scientific process. we have truth is like, it is known, right? That would be, we know right and wrong from a moral standpoint, basically from the time we were little kids, even if our parents don't really tell us. But then you have perceived truth, the things that you've done through life that build a lens to look at both of those truths and then say, I know that says this and I thought that, but now I kind of have my own little amalgam. But I think that's what, you know, if you use breathing as an example of this,
The hardest things for people to do are be honest with themselves, like you said, which requires introspection, spending time with yourself. That could be from the mental aspect, physical aspect. But when you get down to brass tacks, like there are a lot of people that are willing to push themselves, you know, on a run, you know, per se, but then they won't take the time to slow down on that same run and see what's the quality of it. How do I breathe? You know, what could I change with these small factors and stuff saying, I'm just going to crush it.
Speaker 2 (22:22.062)
And then that turns into your entire entire lifestyle, which like you said, health is a lifestyle and people are out there just, you know, this, like you said, snowball is rolling downhill of my cognition has declined due to how I breathe through the day and then how I exercise. Then the food choice is based on that state that I'm in. And then all of a sudden I'm three months down the road. No wonder I have an autoimmune disease. Like you've literally kicked your body's own ass and now it's
going to fall under the health purview of we got to take care of it with, you know, some, maybe it's functional medicine or the standard medical side. But I think we need to, in my opinion, as we said, the burden lies with us. We need to, I think in our field, stop thinking, I've got to, I've got to go down to a level where they understand it. No. Well, I think what we should do is say, you know, I have a client, you know, two months ago, she got a brand new Porsche and she was super excited. And she came in and she said,
You know, I've had to go to the dealership three times just to figure out how to work this damn thing. This is the same client that won't take enough time to figure out how their body works. So here's this thing, your best asset you're ever going to get. You're with it your whole life and you're not willing to read. You know, there is no manual of human health. There's a lot of books on it, but there's not a, you know, something you can follow, but we're very wary of taking time with ourselves to learn ourselves when that's
biggest asset I think you have. It's just figuring your shit out and then applying that day after day and that's going to change every day. So you're constantly revisiting it. So what are some practices? I know obviously breathing is a big part of what you do personally and then also professionally. What are some practices that you have used that have either not been so great at figuring yourself out and then other things that have been just game changers?
Yeah.
Speaker 1 (24:18.254)
Thank
mean, everything I've done has had some sort of impact on me, good or bad, right? you know what mean?
Speaker 1 (24:36.224)
Running was a great fun thing for me, but I was doing it to learn something, to understand something. And it wasn't, it's not necessarily my jam, right? And so a lot of people think that I'm this running, used to think that I was this running guy.
Did you go knowing that that it was? Yeah. Okay.
Yeah, yeah, I went into ultra running and that was where I went into really went into running but I started running when I was doing triathlon. You know, and I thought I was gonna stick with triathlon but then I just got just got too cultish for me. I'm just not real good with cults even though people be like, well, you're part of CrossFit. I was like, well, actually, I'm not part of CrossFit anymore but
There's nothing wrong with CrossFit and there's nothing wrong with triathlon. just wouldn't becomes culty. And there's a lot of things, a lot of people. Yeah. I'm just like, I'm good. you know, I running was, I think I still run from time to time and I use it to expose things. And, and so my practice is largely about exposure. And, know, I think somebody like Jocko Willinick is very important in the fact that what he's talking about.
It is absolutely a reality in the fact that if you can create discipline and a habit to something you can you can basically create freedom in something I also think paradoxically though that Once you've started a hat once you've created a habit that You should be breaking that habit and and building on that changing that to some degree
Speaker 1 (26:19.242)
So for instance, let's just say you're getting up at 430 in the morning like Jocko, right? And this is, know, like I get up early and then I go work out and I start the day, seize the day and starts my day and I feel great about it. Well, once you're in a routine and that just becomes something that you automatically are doing and you know you're going to do, well, change that up. Like do something different with it.
You know, for me, like breathing became something I went and started to understand a lot of different things. Like I went through several different pranayamas, like yoga, traditional breathing practices. I did those in the morning, stuck with them. Then when I, those became very big habit. I fell into the Wim Hof thing. did Wim Hof for a very, for I think probably like four to six months. Right. And then I started noticing some things with that, that I wasn't real. I just didn't.
Enjoy as much and so I started going in back into some other thing or I started looking in the free diving culture in the world Started doing co2 and o2 tables. and then after I've got real good at that or you know got my breath holding down and started to understand that deeper I Changed that into well Now I can start manipulating my o2 levels to start to play with things when I'm
you know, working out or my CO2 levels when I'm training. So instead of just going in in the morning and doing breath work, I started doing some more mobility type stuff or yoga. got more involved in yoga, right? Like I started doing yoga in the morning. Then I would go and start my training and I would use my cardiovascular training. Like I do a lot of bike stuff. So I'd go and I, I,
Apply a lot of the knowledge that I learned through those varying techniques or methods and I would start applying it to the training that I was doing to understand what I could do with the training so Wasn't like I was getting rid of my breath practice, right? But the breath practice got manipulated got changed that habit changed I became I started diving into it differently and I've spent six or so more years playing with these various different things
Speaker 1 (28:23.798)
and trying to understand them and connect the dots with inside the spectrum of other habits or other things that I created in order to learn more about them so that I've never pigeonholed into just one thing or getting up at 430 in the morning. But the fact of the matter is, is I naturally get up somewhere between four and five thirty in the morning. alarm. That's what happens. I never used Jocko's thing. I was in the military. I got up early. I was always an early riser.
but I go to bed early. And so I pay attention to things. And so I create habits around things that I'm doing. Right. And so naturally, if I get up early, I'm probably going to be pretty tired around seven 30 or eight o'clock at night. So I follow that. I don't, I don't mess with that. That that's what those are called principles. Like, Hey, like I'm not going to go to dinners at eight o'clock at night, no matter who or what they are. Like,
I just it's just a print. don't care if it's a big money deal or a big business deal or whatever. I'm sorry, I'm not going to be effective at that time at night. And then it's going to screw with the next day and I may have meetings set up or important things set up that next day that are now going to suffer as a consequence of that. Right. And so I start to integrate these things and lo and behold, wow, most of my day is
has controlled breathing centered around it and me paying attention to what's going on in my head and when my thoughts run away, when my body's feeling a particular way or I feel pain doing something and I've manifested that through time by just implementing little things that I created habits out of that then I changed those habits, right? And so it literally became this compound effect and you know, throw nutrition into that. wow, well I played around with paleo, I played around with vegan, I played around with
Low carb I played around with keto. I played around with high protein or low protein or high car like I did a high carb I was part I was part of a high carb club like I understand all these different ideologies that or methods that people End up gluing and crossfit like I didn't crossfit when I was a crossfitter and I glued myself to it to understand it so that I didn't need to be it and so just taking this even back
Speaker 1 (30:45.298)
to when you brought up Harari and like Sapiens and what we're going to be looking at here in the future, I think, is a, I already think it's happening and there's a guy by the name of Sam, Sam Veknon, I believe is his name and he's a highly intelligent guy and he's out of Israel and he talks about a lot of this stuff as well, but
there's going to be a separation of humanity that's coming. And it's the same separation that's going on right now. And it's the people who want to take a pill for what's going on. And there's nothing wrong with taking a pill when you come out of surgery or you've got some inflammation going on when it's acutely done.
But when it becomes something that is chronic and that you need for long term, and I'm talking SSRI, I'm talking opioids, I'm talking whatever it is, if you're not willing to go down that road to understand what is going on, and sure, there are people and things that are going on that are gonna need medications the rest of their lives. Those exist. That is not, by and large, most of the population. It's a fraction of the population.
but it's the same population that sits there on social media and thinks that social media is actually socializing and thinks that by looking at what some gal or some guy who's got a million followers who has no real worth in the world other than the butt they're showing or the abs they're showing or whatever it is they're doing, right? And there's nothing wrong with this. Only the fact that I'm comparing myself to that and thinking that's a real
That's real. And that is something that I'm engaged in versus the conversation you and I are having right now. And even though this is virtual, it's still happening. And I'm responsible for the words that are coming out of my mouth because you can question those words. And we have a conversation going on where when I post something on the internet and somebody feels like they don't agree with that and their opinion is warranted on that post that
Speaker 2 (32:43.768)
Even though it's virtual.
Speaker 1 (33:04.91)
Your opinion isn't warranted. It isn't. And it doesn't matter what your opinion is. You have your own platform in order to provide information on and people can choose or not to choose to be there. But the fact that you think or I think that my opinion is warranted or that it's valid to be on that is the problem. It's not everybody's an expert. And even for myself, I may not be the expert, but I'm going to put out information as I've not only experienced it,
but as we're testing and I'm having scrutinized on the, I'm going to put it out and you are more than welcome to absorb that or take that and go, you know what? I questioning this. I'm to ask this guy a question. So ask me.
I made a rule that probably six months ago, if I, cause I, I mean, I follow my Instagram is basically in Twitter for like research, like people that I want to learn to get ideas. I made a rule that I can only ask questions because early in my career within my field, there is a lot of just dogma and you know, this, that, or the other. Um, and I would get caught up in some of this shit and you know, that was my own fault. Um, but I made a rule. I can only ask questions. I can only learn from what they post because
I agree with what you said. My opinion doesn't matter. And I also that post, even if it's a long form post is that's all it is is a post, right? So if I ask one question, but I don't ask it in a question, I just throw it out there like your typical, you know, end of a end of a talk question. That's not a question. They just want to hear themselves validate their own point. That's what I was doing early in my career is like, no, this is my stance. I may form it as a question, but it wasn't, it was just a dig.
And I think if we went about it in this deliberative process where we say, and Brian put out a post, it's freaking awesome. I may not agree with this, but I got to figure out what he was talking about first. And that may take 10 questions, right? But then we can actually, that isn't a conversation, but at least it's digging in instead of just digging at. And yeah, I agree.
Speaker 1 (35:05.538)
that there's a yeah if you ask an intelligent question on my platform you will get a response if you direct something or create an opinion you're gonna either I'm most likely not even gonna touch it or respond if you're put something on there that's in poor form I'm just gonna remove it you're gonna get blocked because it just go somewhere else man
Why do you think that you are like that? So everything that you were just saying, even how you went out running in the beginning, you went at it because you knew running wasn't your jam, but you to figure something out and then trying all these diets, trying yoga, breath work, different types of breath work, A, that's kind of your job right now. You've made a living on knowing all this stuff and then diving into it and then dispelling kind of your
take on it to athletes and other people. But what like have you always been like this? Is this how you were as a kid? Like I'm gonna do a million things and you know or I or is it that because there's a little bit of that like anti establishment to your entire approach, right? yeah. Which is cool. We need more of that. But why do think that is?
Well, I mean, I guess, well, A, yes, I've always been like this. This is the part of me that has been true from the beginning.
And it's cool that you're capitalizing on that. That's literally what you're getting out of this.
Speaker 1 (36:28.27)
Yeah, and this is what it's like, you know, I figured out who I was. I figured out who I was right around 30, you know, now.
I took some time. What'd you do in that?
your side. There was a lot of learning from 30 to 100%. Let me tell you, you know, like I did not handle myself very well. And I've come off the wheels have come off on the internet with me before, you know, and this is the interesting thing about social media itself is like, the moment you realize that this isn't actually real, you can actually do with it what you choose.
versus it controlling you you becoming responsive or reactive to it. Right? And I felt I jumped off all social media for about a month. And then I realized that, you know, in this like, matrix-like moment was like, there is no spoon. Like, I can't run from this thing because this is where people are going for information.
So there's an inherent responsibility in what I'm doing as a person and as you know, what I've chosen to do with my path and people wanting to hear information from me. Granted, it's not an epic ton of people, but there's enough people that push my button and be like, yo, what are you doing next? What's going on? I want to know like, what is this? And we're providing information for our platforms, right? What we're doing. So there's a responsibility for me to actually do that.
Speaker 1 (38:04.78)
And that's what I think that's, that's where it lies, but that doesn't mean I need to sit on there and go through the comments and look at the likes and the moment I'm looking at how many likes and what, like all the comments and all this stuff versus going, okay, did somebody ask a question here that it's actually relevant? That's a very different scenario or looking through the feed to see what I can compare myself. When I catch myself doing that, it's got me right. So I think for me,
I've always like, there's been this, there's been this pull and push that's happened throughout my life, the anti-authoritative movement, right? And there is an absolute need for an authority to a large degree, but that authority is not one person or one thing. That is a group collective. And I think,
By and large, when we start to agree as a group, that's what it is. But I don't think at any point in my life, when everybody was doing the one thing or got hooked to the thing, you know, when that was the moment I, I don't know why, but it was almost like I naturally understood it was time to change. It was time to do something different. And it's not that I needed to
bounce out of it or completely take myself away from it because I went and I did running and running essentially became an identity to some degree. The moment I realized that was when I walked away from it. And the moment I start to realize I start to get and I, my identity gets kind of attached to something. It's time for me to dissociate from that. Or I think dissociate's a bad word. It's time for me to walk.
in a different direction. That doesn't mean I can't come back and use it from time to time.
Speaker 2 (40:05.6)
Have you read, I'm sure you have Robert Green's book Mastery. So it's interesting because if you think about it from, yeah, the cultural standpoint, maybe the past hundred years, but then the evolutionary standpoint of why you may do that, you know, that's what spurred, you know, we've, there have been multiple Renaissance movements throughout time, not just the Renaissance. And one is happening now in my opinion, but that's what we're talking about when we talk about this kind of well-rounded man. So there,
Yes.
Speaker 2 (40:34.488)
there would have been tribal leaders throughout time that were just absolute beasts at one thing, right? The hunter, the thinker, the medicine man. But what you probably saw more of over time was more of this like polymath, like leadership where humans, know, not just men, but also women became very adept at multiple things to the point where they could lead people. Because like you said, it's not one person that creates leadership. It's a group.
And the reason being is everybody brings different ideas, knowledge, basis, expertise, and then it's ever evolving. But if you're the person that is the hunter, that shelf life is low. And you're also the tribal leader that's probably going to get taken out by somebody else because they think they're the better hunter. when you, you know, and this isn't a competitive scenario I want to build. want to say as humans, are cognition is our power, right? Our ability to adapt to, you know, around our environment.
But that's only because we became awesome at everything, not one thing. If we would have just been really good persistence hunters, we wouldn't have made it out of the other.
What you're really describing here is, have you read Nassim Taleb's book, Anti-Fragile? Yeah. Yeah. The more specialized I am, the more fragile you are. our problem is, and this is to take nothing away from Elon Musk, is that we're putting all the power in somebody like Elon Musk.
Elon Musk is a highly intelligent person who's doing some great work. He should not be, in my opinion, he probably should not be running a company. He should be the creative mind behind what that company is doing. He should have some power, but trying to run that company is making him go nuts.
Speaker 2 (42:24.492)
killing his ability to create more ideas. Yeah.
100%. 100%. So you take this tech world and we start to go and look at people who are, created these platforms and we look to them for leadership. Really? You want a guy like Mark Zuckerberg leading everybody? You want a guy like Jack Dorsey leading everybody? These are guys who literally sat in their rooms on computers and didn't socialize with people until they were like 30. Right? And this isn't to take anything away from them. This is just factual information.
So they created platforms or got involved in platforms that allowed them to not have to actually be involved like we are right now. And be responsible for a lot of the things that they're doing or saying. And thus now everybody's on there and we're behaving like them. there's these, and the problem here is that it's altering the way the landscape of our brains work. Because we're not needing to use them in a manner that they're actually
And then we won.
Speaker 1 (43:26.562)
We've evolved to use them. Thus, we're shutting them down and creating dopamine trigger responses to things and reactiveness to things that in regular social atmospheres would never go anywhere.
When what you're touching on parallels what we've done with celebrity, right? We got it. Our perception of leadership has been based on popularity, which was at one time maybe a bit of a life and death scenario of, you know, the popular leader or do I stay alive because people like what I'm saying or they don't. There's going to a reason. This we turn that mastery of technology, right? These people that.
are to establish ideas and create something out of nothing. And then we took that in our, our kind of monkey brain to be like, my God, if they can master that they can lead us. Maybe not.
Exactly right. know, maybe at one time, maybe at one time, you know, I think there was a time actually in entertainment where you had some real Renaissance type people. And that doesn't mean they don't exist right now. yeah, yeah, yeah. And they still do. And that doesn't mean Jack Dorsey or Mark Zuckerberg is a bad person. They're just means we just put we just as a society put pigeonhole these guys.
into some responsibility that they are incapable of actually dealing with and I don't know if you've ever watched an interview or eat I mean she spent or whoever it were I mean if you've ever watched these individuals or listened to him all you got to do is go and listen and see and and and go Yeah, we probably shouldn't have these guys Leading a charge towards something or giving them too much power like allow them to do what they're doing and you know
Speaker 1 (45:20.406)
understand that but going towards these folk or anybody for that matter who just has a high popularity rating or high money rating or you know like hey Wern Buffett is knows what he's doing with money he does and by and large I've listened to him he's pretty humble and he's he's probably a very very rare human being at the top of that list in fact
I know he is because I've met a few billionaires and they're not all people who I would want in charge of things. Like they're pretty, a lot of these guys can be very, and gals can be very power hungry. That is not somebody you want in charge, right? You need people who understand that power is actually a responsibility, you know, and looking to people like that and understanding their limitations of what they're doing and being able to say,
this isn't a decision for me. This is a decision for a collective. You know, this is a decision for a group to make or this guy over here should be involved in. It's why, you know, this is the problem of science as well. We look at science to guide us into everything versus like, hey, just because that study said that doesn't mean you shouldn't go and, you know, be playing around with that in a different manner. mean, hey, go actually do what that study said.
Did you get the results that gave you, that gave them for you? And, you know, literally that's where you start to figure out, N equals one. I guess there is some differences in how we're actually doing blood work as a doctor and the limitations of what's in what the general population shows as a marker versus an elite athlete in somebody who's dealing with chronic disease. there may be some differentiation there.
And I mean, even more of some, some, some different variables in order to look at, Oh, cholesterol. Maybe we should be looking at different markers with the cholesterol versus looking at the overall marker or blood pressure or whatever. You know what I'm saying? I mean, it just goes down and down and down to where we've pigeonholed ourselves in the places that aren't exactly that. Hey, science works for a reason. And it creates a broad scope for us to be able to look at and go, that's interesting.
Speaker 1 (47:45.344)
maybe I should consider applying this in some fashion to my life. And it's not necessarily how, it's why, right?
So we're talking high level here, like how, you know, a collective, how leadership is formed, you know, all this stuff, but I ask myself this question a lot. So there are big issues in the world that need tackling, right? Finances, the environment, know, everything. When you and I'm
assuming here, so correct me if I'm wrong, you work with a lot of athletes and high performers and things like that. I have a big focus on athletics because that's what I grew up doing. Um, I chose that because the compliance is a lot easier with people that are already athletic. But when I look at it, sometimes I'm like, is this just fluff, right? Like I'm allowing somebody yes to use their body. But a lot of the time it's in pursuit of things that are just, what the hell does it matter if you're on a marathon? What the hell does it matter if you can do collegiate basketball?
So what you like? How do you form that when you're like, okay, if my mission is a human, you know, and this is my thought, my mission as a human is to help out everybody else somehow. Right. And that is going to be figuring out first of all, who, who am I and how do I plug into that scenario to be part of that collective? And then sometimes I'm like, really? I'm helping, I'm helping these, these bros and gals run trail races. Awesome. But how is that? You know, yeah, they're happy. And that, and then we can talk about the exponential snowball effect. But sometimes they're just like, damn, this seems
pretty cheap to think about athletics as a very important part of our society. And I know you could argue, what's your thought on that? Like how do you reconcile that with who you work with and what you're doing now?
Speaker 1 (49:35.01)
Well, I'm happy to hear where your thinking is with this. I'll tell you that. You know, is sport healthy? This was something Kelly Starrett and I talked about and we put it out publicly. And it was a long conversation, and it's on that disruptors episode that we put off on power, speed, endurance.
Sport is not healthy. Sport is not health. And in fact, what we're starting to find out is it's fairly unhealthy. And it's being used in the same exact manner that the same things that we're dealing with in an unhealthy society is dealing with. It's just being, it's just a different mask. It's just a different identity. I'm
a professional rower or I'm a professional basketball player, I'm a professional runner or I'm ultra runner, right? And I've worn these things, And it literally, the moment that occurs, we've just stepped into, we've just stepped out of health. That doesn't mean you can't go run trail marathons or ultra marathons or compete at an elite level. But to take on something
in the fact that or with the idea that it's about winning is I'm just or it's about accomplishing this goal is you've just removed, you've just created the biggest illusion that we have.
I like that look at it.
Speaker 1 (51:16.172)
Nothing wrong with winning. There's nothing wrong with winning and there's nothing wrong with accomplishing or running an ultra marathon or running a marathon. Nothing wrong with that. If that's what the goal is, you have just skipped what it means to be or to be a human being. It's about process and it's about going through a process and it's there's going.
If I go to the Olympics and win and I've watched this with several Olympic gold medalists and it is a horrific experience to win a gold medal. Horrific. Yet what do we as a society do with it? We lift it, we lift it up and idolize it. Yet nobody cares what happens to these people. And it's been very public about what guys like
Idolize it.
Speaker 1 (52:12.726)
or people like Michael Phelps have gone through. He can't stop. Yet he's dealing with depression and all these things and know, is he depressed or is that just a byproduct of what he's been doing? Like we all get depressive symptoms. We all deal with anxiousness at times. Why is this continuing to happen? What is the means? So what is the process of what it is we're doing?
Is it about the goal or is it about the process of the goal? And then what's the process off that? So if I've got to go run an ultimate, and this is something I picked up real quickly on in the ultra running world was people would go and we would go, I was a part of it, go and do an ultra marathon. The moment you finished it, you're thinking about the next one you want to go do. Right.
But we weren't thinking about what it meant to actually do that and come off that mountain. You know, there's a story my wife picked up and I can't remember where she got it, but she tells it all the time. And it's about these two mountain climbers that go up into, I think might've been Nepal or whatever. And they go up there and there's an avalanche or there's a group of people that go up climbing in Nepal and there's a big avalanche. And most of the people are killed and two of the guys survived.
And they're both hurt pretty well, but they both can walk. And one of the guys is a little more banged up and a helicopter comes in and they're able to come and they get the one guy and they take him down and they take him from the helicopter down to the hospital. And the other guy is approached by one of the Sherpas. And the Sherpa says to him, if you don't walk off this mountain the same way you came on, you're not going to understand.
what it meant to go through what you just went through. And this is our problem. And so the guy walked down the mountain and understood, and you know, it takes a long time to get up to the mountains in the Himalayas from Nepal. It's not an easy trip. It's like week takes a couple of weeks, right? So it took this guy a couple of weeks to come down and understand the process of what happened and the people that died and the things that happened versus jumping into a helicopter, being rushed to safety.
Speaker 1 (54:33.868)
and not having to totally process what just happened. Right? I was just, I almost broke my neck, you know, and I went through this thing that I had to come to terms with pretty quickly. and, and, and look, I'm very fortunate. I'm walking, I'm moving, I'm fitter than I've been in a decade. I've, know, but I, I tee that up to actually going through a process of understanding, Hey, I might be paralyzed right now for the rest of my life.
I may be burdening my wife and my family and everybody around me to a degree that I need to take responsibility for what just happened. And what just happened was I was playing on a playground with my nephews. That was it. But I chose to be there and I chose to go through it. that's life, man. Life is that.
And if you're not in the process of what it means to actually injure yourself and understand that injury and walk off that mountain, then you're going to skip the entire thing and you're going to be dealing with depression or anxiety and all of these things that you refuse to want to understand. Therefore we medicated and don't understand it. I going to say. Yeah.
What a great analogy. That story is just for life nowadays in general, not everybody, but that we will, the helicopter could be your, your phone. could be Netflix. It could be, could be anything to transport you from the interested to where you were, alcohol. could be a numerous things that we don't, you know, ask them what the next race is. We transport ourselves to the very next thing. Cause that's how we're being trained to operate.
First all, I think you have your next book title. It should be illusion of sport and dive into this. we talked about, but you, you asked, well, what are my thoughts on this? And this, this is where I, I struggle. I see sport, which it always was. It was a branch off of what we did as humans, right? A lot of, you know, like lacrosse came out of your coin games, but the first game to the ear coils was a version of hunting, right? You're training boys, how to do something to survive.
Speaker 2 (56:46.72)
It wasn't because you wanted to be really good at that sport. It was a necessary skill or task or thought process for life. We've completely lost that. So what I always try to get myself to understand or athletes, because let's say I'm trying to get somebody out of pain that does want to run an ultra race. If you attach your outcomes to a getting rid of pain, be completing the race and that's it like good luck. Like you're, you're not going to make it in my opinion.
And I think we have to figure out like, why am I driven to do this in the first place? Why would a human nowadays when you don't have to want to run a hundred miles, why would a human want to, you know, take a bike ride across America? Like, why would we want to do these things? And it's not like you have to understand anthropology and evolutionary biology to ask this question. You just have to, you have to, you know, it's the Toyota ask the five wise, like why am I doing this? You know, my friends are doing it. I'm in that community, you know, whatever it is.
but we skip, right? Just like you said, we get on the helicopter and we say, I don't, you know, I'm, gotta get in shape. I got to run a marathon. That's what everybody does. And then we, never get the why. And then when we get hurt or we get lost, like, and that's what you're alluding to. The process is starting with the why and then everything else builds off that in a very nice fashion without, you know, when shit gets hard or you get injured that
you've got to fall back to the process because it's not going to be a B line, you know, or a to B for anything in life, let alone an athletic endeavor. But I always fall back to like, why would I want to do this? Like what's in my DNA? What's, know, what would drive me to do this? Because, you know, and we could go super deep on this and say, you know, you talked about freedom. Well, is there free will or am I just like, man, am I manifesting these neurochemical signals to drive myself into some place that
you know, my, my body's inherently telling me to do, even though I think I chose to sign up for that race. I don't know. You know, that's, don't know if anybody can answer that to be honest with you, but what the, want to kind of, I want to be respectful of your time. I don't want to wrap up with something that I ask everybody. And this may be hard if there's not a singular concise answer. That's fine. But it's more of the concept as we evolve as people. And in particular, if we think of ourselves as a bit of a researcher or a coach, we have to change our mind.
Speaker 2 (59:03.724)
almost every day, right? On things we used to believe. So I'm always curious, like what is something that you unnecessarily did? And this could not even be an athletics. What's something you believed? Like I'm talking like this is the way it is, right? That you have 110 % change based on knowledge or learning from yourself or other people you've surrounded yourself with.
Everything.
Probably the best answer. I know it's a tough.
Look, there isn't a thing I can't walk you through other than the fact of the one thing that I've said I've been my entire life was
wanting to to understand or do things in the way I wanted to do them, right? And and that's basically I just want to learn I want to learn and I am of sound mind at this point that no matter what my opinion is on a particular subject or idea that that is not the only way or thing that process that that could be.
Speaker 1 (01:00:20.856)
They're, you know, it's, like.
I loved long slow distance. I love all of that. And I thought that was the answer. And that's not an answer. No, it's, like, just come back to the last question or the last thing we were talking about is it's like, you know, there's a lot of people like that are chasing dragons, man. And you, you,
sport and athletics and, and, know, becoming an ultra runner or trail runner or whatever. That's no like, there's a lot of people that do psychedelics now and, and they, and they're in it and they, they're in it for the, you know, like the journey and the guy getting guided through this yet. I continually hear these people continuing to go back and do them and participate in this.
And that is no different than the need to go and race again and or accomplish something again. Right. It's not the accomplishment. It's the process of these things. And so I think they're like I read a book on a particular subject. I get some information. I download I try and process that and learn from that. I'll read another book on that information that comes from a different point and I'll start to go down that rabbit hole.
and see that there's things to understand from that. my, I think the most intimate thing I could be honest about is even my personal life and how I've behaved and done things and the ability to look at how my wife sees those things or feels when I behave in specific ways, good, bad, or indifferent. And my ability to actually stop
Speaker 1 (01:02:27.502)
hear what she's saying, process what she's saying and look at it as though maybe there's some truth in that. And that regardless of how I'm behaving and how I feel, that no matter what I'm stuck to about that might just not be right. And that is the biggest fear we have. There's a prolific writer, name's James Baldwin, was African American guy, he died.
a little while ago, part of the entire movement of civil rights, but he used his mind more so than being somebody like Martin Luther King who stood up and we all know and recognize and Martin Luther King is amazing. But James Baldwin is particularly attractive to me for his thinking and the way he thought and wrote. And one of the things that he distinctively talks about.
is the fact that we that changes this inevitable thing. But the fact of the matter is, is that real change only comes about through the death of habit and behavior and these things that we may hold on to that we think are true. And the only reason we're hanging on to them is because of the fear we may be wrong or that there may be another way. And that is the reality of life.
And that is the reality of everything. And I think that I'm just open to the fact that I could be wrong about everything and that there might be another way of doing it. But I'm going to make damn sure that I enjoy the process of that and that I make it a game. And I never stopped being a kid in that sense. And it's like climbing a tree or building a tree for it or skateboarding all over again and trying that thing.
and not looking at it as this burden of like, man, I've got to change who I am. you know, well, yeah, your body is going to change anyway. Like your brain, your cells are going to turn over. Your skin changes, your hair changes, your brain cells change. Like all of this stuff changes. Yet we fight that one truth. And that is our only true reality is death. And like we will die.
Speaker 1 (01:04:53.036)
and we behave as though we're not going to. And that's our problem.
what not that I can add to the eloquence of Baldwin on this, but in my mind, real change, like you said, he's alluding to like, you know, a, have to realize there's a habit to break it or to change behavior. But that in my opinion is literally what makes us human is the ability to have decision, right? Like there were not whether that's a farce or not, right? We are choosing what we do. And I think this whole conversation could be summarized in or
you're living your life or your life in a way that you're better equipped to choose more appropriately more often, right? And in a faster fashion because you're constantly evolving your thought process when you're faced with something that challenges your views, challenges your physicality, whatever it is, you're you've built this, this basis or this foundation of how you think. And we've said thinking, I don't know how many times, maybe we'll do a little statistic here after we get off here.
But I think that's what we miss nowadays because we're, told a lot, right? We, like you said, we look at social media, we look at the news, we're told a lot. The thing in my opinion that makes us human is to decide and we're robbing ourselves of our own decision. And that gets, it gets worrisome. wouldn't say scary. It gets worrisome because like that is what you get to do. That's the only thing that you're assured is that you get to decide, right? And it's sometimes harder to make a decision based on circumstance or
that you always have the ability to decide. And one thing I wanted to kind of point out that you said like, people are out there chasing dragons, 100 % agree. You know, I was just reading an article on the new midlife crisis is extreme athleticism, right? That we chase these things. I think it's fine to chase dragons, just like you said earlier, as long as you admit that it's an illusion, right? Dragons are not real, as long as you know that.
Speaker 1 (01:06:52.65)
Once you understand there's no dragon, you can do with it what you want.
Yeah, like.
And think that's a, just that alone, if people can really grasp that, like that will change so much what you do throughout your day. It's like, hey, that's not just a race. That's many things in our daily life. This is not real. This is something I'm making up to either force myself into that or to make myself do something. We do it all the time, right? I have to do A because of B. Do you really? Have you really?
like thought about this, do you have to eat this certain way to lose this weight or are there 15 other options and they may be better for you than that? And we we confine ourselves in these, you know, just tunnels and gauntlets of just sometimes.
It's this fragile world that we create, man. It's just a glass box. I mean, it's unfortunate that, you know, the civil rights movement has been what it's been. And we've had to use black and white as that representation of what ultimately is truth or reality. And it's the reality of what's going on. And I think that's what Baldwin was really trying to convey.
Speaker 1 (01:08:08.3)
was I just want you to think about what you're saying and doing and what the reality of things actually are. And when you realize that I'm a man just like you're a man and that I deal with the same shit you're dealing with or I have to deal with a burden far greater than you because of the color of my skin, you know, and it's no different than what the Me Too movement's doing either. And it's like, when we actually start to come together and start to think about this stuff,
even in the context of sport or human performance, it's the same thing. It's no different. And when we actually get to the reality of what's going on, there is, there's only one possibility. And that's all I'm in search of, you know, and that's all I'm trying to do is have fun and expose that through the medium of human performance or human development versus
civil rights or you whatever. Like this was the medium I chose in order to convey the message of, hey, you're in pain because you're not listening. You're moving poorly. Let's check your, let's, let me show you through running mechanics, reality of what's going on. Are you in less pain now? Okay. Change what you're doing. Listen to what's happening, right? If you're overweight, maybe change what you're eating or, or consider something or
Hey, what's going on with your breathing? Like how is this affecting you? Why is this? Why are we going after this so hard? Why do we understand this in the way that we do and we're talking about it the way that we are and by the way, we know aerobic Efficiency, we know aerobic capacity affects everything and the more and the better you're at with it The better off your entire system functions brain and body And what you may be doing
is not necessarily aerobically efficient, even though you think it might be. So here's that reality and here's that truth and may you find in that exploration the reality that I found. And you can do with that whatever you want at that point.
Speaker 2 (01:10:25.77)
I don't think we could put a better bow on it than that. I mean, if you had to sum up why you're doing what you're doing and what you're doing, you know, and keep conveying the message. Like you said, your message is just one, you know, I think the thing I like most about what we've talked about today is that even though you have built a following and you've done a lot of great things and you may not have an acronym behind your name, you've got a lot of accolades of what you've touched and who you've worked with and all these things. But the thing is that you're still saying it's just my thoughts.
I'm could be wrong right? Let's just consider this as an option. This is my Perspective, but we just we need a hell of a lot more of that and not just the field of human performance We just need that overall in my opinion nowadays There's a lot of names that you could put on that but I think you put a good bow on it and Yeah, anything you want to leave us with mean, I feel like this is just like I should just have one liners bill of just quotes through this whole thing I'll do as many of those as I can
but I can't thank you enough, man. This was an awesome conversation. I like we could go on for four hours. I'm sure we could and it could get deep. That's and we need, and that is, that's a good point. Like you said, social media is not a conversation. Have more conversations with people, right? Just on daily bit, like learn something from somebody different. That's probably one of my favorite parts of my job is that I get to see people that do a bunch of different stuff. Yeah, I get to help them, but
they're telling me about their job, what they do. Like I learned as much from them about just human life overall, as I do from, you know, even high performer, like, yeah, you're a wealth of knowledge, but just because I have a stay at home mom with four kids doesn't mean she can't teach me something that I never even thought about. And I think we need to have that mindset more of the people around us, which you don't could get into the whole thing with civil rights and social equality and thinking everybody's got something to say. Brian.
Can't thank you enough, man. Appreciate you being on here. Yeah, and how can people reach out to your social media? Give them a few hits here.
Speaker 1 (01:12:28.462)
Well, Beau, I appreciate you having me on, Instagram is Brian, you can find me, Brian McKenzie, at underscore Brian McKenzie. Twitter's Brian McKenzie. And then everything we do, everything I'm doing is done off of Power Speed Indurance. And you go there and you'll find everything.
And I'll put links to all that in the show notes. So Brian McKenzie guys, appreciate you having on. We'll talk to you guys later.
Simple Ways to Tell if You Have a Nerve or Muscle Problem!
Summary
In this conversation, Beau Beard discusses the critical differences between muscle strains and nerve injuries, emphasizing the importance of accurate diagnosis and treatment. He outlines the grading systems for muscle strains and nerve injuries, provides insights into self-testing methods for patients, and highlights the significance of movement in recovery. The discussion is aimed at both clinicians and patients, offering practical advice for managing these common sports-related injuries.
Transcript
Beau Beard (00:00.128)
Okay, today we are differentiating between nerve injuries and muscle strain. So over the past decade of treating athletes in the field and both in the clinic, you wouldn't believe how many times, you know, the athlete or other clinicians kind of get confused by this. So I wanted to, you know, talk on a clinical level, but I also want to throw in some tidbits for patients of how you can self-test to determine, you know, do I have a muscle strain or am I dealing with a nerve injury and, know, how those two things are going to need different care.
So the first thing we want to do is break down, okay, muscle strains. This is the easy one to diagnose when we have a significant enough muscle strain. So the grading system for muscle strains is one through three. We can kind of have a plus where we have a one plus, a two plus. So let's work backwards. So you're going to know if you have a grade three. Most often we've seen people with some evulsions.
Like their hamstring off their ischial tubes the bone in your hip where it actually pulls off they operate for Quite a while without knowing they know they had an injury but maybe not a full, you grade three of Olsen if you have a muscle rupture, you know of the The muscle itself the musculoskeletal junction you're going to have diffuse swelling, know, this is where you know Somebody's leg can look black or severely bruised significant loss of function strength for whatever muscles affected
Sometimes you'll get recoils to say it's the biceps, say it's the quad. If you have a full rupture, may get, you know, I think of when in the old cartoons, when they kind of be wearing a necktie and the necktie rolls up in their face, you can get this recoil effect. So that's a grade three. So it's a severe full rupture, significant pain. Yeah, grade two. So involves partial tearing. You're still probably going to have significant swelling, bruising, discoloration. Noticeably we...
weakness, loss of function, we just don't have a complete rupture. So in these scenarios where we suspect grade two, grade three, we may get imaging depending on, is this an athlete or a weekend warrior, just kind of somebody that's operating around the house? What do they have coming up in the near future? And the way that we're going to, the examination that we need for this from imaging is an MRI. And sometimes when there's diffuse edema and swelling,
Beau Beard (02:16.686)
You know, a grade two or a gr you know, a full rupture, maybe, you know, it gets mistaken for a grade two, vice versa, but a grade two, we're going to still know diffuse swelling, bruising, all these things. When we get into the grade one, this is where we start to need to differentiate between, you know, is this a grade one muscle strain, which is going to have minimal muscle fiber damage, uh, you know, mild pain and tenderness, which is going to be dependent on the person and you know, their pain tolerance and sensitivities and things like that. Um,
No significant loss of strength or movement. It's going to be sore. It's going to be tight. No visible bruising or swelling. And you can recover anywhere from a few days to a week or two. What can take part is that we can have a grade one, maybe even a grade two, or a subgrade two, so a one plus muscle strain.
a recent example. So baseball player was rounding first base. sees it, the throws coming into second faster than he thought it was going to. And instead of turning around, he thinks he's going to make it. takes off of that, you know, next gear and feels a pop in his hamstring. And, know, then the parents call in and say, Hey, my son had a hamstring pole. Can you treat them? So we bring them in, no visible swelling, no visible bruising.
Significantly sore reduced range of motion. So he goes to touch his toes. It hurts We'll talk about some other tests here pretty soon But immediately now I have to differentiate will act is it actually a grade one muscle strain? which is going to be somewhat of a Diagnosis by exclusion that it's not grade three grade two and I'm going to rule out the nerve injury and then we're like down to a grade one muscle strain Or we have a nerve injury or we have a little bit of a tandem So I think this athlete in particular had a little bit of a tandem
So I'll go ahead and explain this case and we'll keep going through the nerve injury part. So I he did have a grade one strain of the bicep femoris, kind of right below the musculatina junction, so not up where it attaches your pelvis, but you know, a little bit below that. more affecting him more acutely, I believe was the nerve sensitivity and the way that we went through testing and treatment retest.
Beau Beard (04:33.646)
kind of proved that and has proven that. I'll actually see this athlete again tomorrow for the fourth time since the injury, twice a week now for two weeks just to kind of get them back up there. I think it's gonna take about five visits to get them back out. But I think it's more neurologic irritation sensitization rather than the muscle strain. And again, grade one is gonna heal on its own and then we have to make sure that we decrease that sensitivity or the nerve traction injury. So three grades of muscle strains. Now we can go through.
You know, there's two different classification systems for a true nerve injury, sedans and then sunderlands. Sunderlands is a five tier sedans is a five or three. Let's just go over the sedans just for ease of use on this. So the first injury, the mildest neuropraxia, this is you almost get neuropraxia anytime you, you know, maybe you occlude a neurologic activity due to the position that you sit in, a traction injury, like a quick traction, you reach for something, you fall.
So there's no what's called wallerian degeneration. Wallerian degeneration is basically a slight or progressive, depending on how severe the injury, demyelination. So the myelin is basically the fatty covering or protection around that neuronal sheath that helps the nerve basically stay insulated but also conduct its signal appropriately. This can recover in days to weeks. Like this is quick and this is a mild injury. We go above that, we go into axonotmesis. So this is a moderate injury. This is where we have
could be a more acute aggressive injury or could be a more prolonged sub acute injury. So let me give examples. A very common thing would be the hamstring pull, take off into third gear or we trip and fall on the trail and we extend that leg and we get a fast traction injury on the nerve. Nerves can stretch, right? The sciatic nerve can stretch the most of any nerve in the body, but it's still around a half an inch or something like that.
It's not a lot. And when we try to stretch it fast and hard, and maybe there's excess muscle tension because we're falling and we need those muscles to be on, the nerve gets traction and that traction can create a lot of irritation or sensitization. But it could also be sub-threshold. It's not this acute thing. So think of the case of maybe degenerative change in an area of your spine. So the holes where a nerve exits are called the neuroframina. Neuroframina maybe gets a little more bone around it as we age and have some degeneration.
Beau Beard (06:54.058)
little by little that nerve is just kind of having some more mechanical input and it can go, you know, through axonotmesis. So it has this kind of, can move and offload it. So there's positions that help, but if we maintain one position for too long and then that can kind of build, which leads us to the third classification, which is neurotmesis. This is severe. So this is where we have maybe a crush injury. have a full blown traction injury with actual damage, physical damage to the nerve.
We obviously have wall layering degeneration in both axonotmesis and neurotemesis, but the degree, the onset, because it only takes around minimum 12 hours of compression to create the first signs of wall layering degeneration. you know, think of somebody going to sleep. I'm not saying you're sleeping for 12 hours, but you get into that window of eight to nine hours, somebody wakes up and they're like, man, I just have radiating pain down my arm or, you know, peristhesia, numbness, tingling. This is where the difference between these two is,
where axonotmesis has the ability to recover. So when we look at the research says recovery is possible through axonal regeneration, one millimeter per day or one inch per month is the clinical expected outcomes and regenerative change. So it can take a long time. Neurotmesis, we've had basically permanent damage. So we're not going to have remyelination of this nerve. this is going to, you know, even if we had a complete like...
know, rupture of that nerve from a traction injury. If we repaired, it's not going to, you know, have the same nerve conduction. And, you know, a small tangent nerve conduction velocity study or an NCV. There's a lot of research on the clinical efficacy, wouldn't say efficacy because the test works on how important that data is. So if we have a nerve conduction study that shows up with more than 30 % decrease in nerve conduction, that's supposed to be clinically relevant.
I'm just telling you, I've seen enough of these tests that like that doesn't tell us a whole lot because we don't know if that was present before or caused by what we're treating at the present moment. So three grades of muscle strain, we could have three to five. I'm going with the three due to just ease of use, nerve injuries. So how do we start to differentiate between these two? So going back to the baseball player. So if I just go through a couple of pieces of clinical information here, if we haven't been over and touch his toes, he has
Beau Beard (09:09.814)
on the first visit had some pain, reduced range of motion noted from him because I don't know what it looked like before. What's normal. It's reduced today, but I don't know what his normal toe touch looks like. Then we take them through some actual clinical tests and these are some things that we can do at home. So if you bend over to touch your toes, if you've had a hamstring injury, right. And let's just use that as the example here. It's probably going to hurt whether you have a muscle strain or nerve injury. So, okay.
The next test would be what's called a slump test. And you'll see a video here of somebody kind of rounding their back, rounding their neck. And then we're kind of seeing, A, if we're not moving the leg, can we reproduce symptoms in the legs? So that's the first portion of the slump test. If we do, and we're not moving the leg, the likelihood of that being just a muscle injury or a muscle injury at all is going down. But then we can add in tension on each leg. And again, if I stretch the hamstring,
in this scenario, it's probably gonna cause pain. But now I'm trying to also see if I stretch the other side. Do I create any symptoms on the injured side? And I can go through that test. So that's something you do at home and kind of see like, if I just round my back and don't move my knee, as you can see from this, you know, little video here, there's pain. Well, you know, maybe there's more neurologic sensitivity. The other thing that we have to make sure of or that we can kind of rule out, like I said, if we're moving our back into flexion or tractioning our spinal cord, which in essence then pulls on the nerve,
then I could play around with, okay, if flexion hurts, I could kind of go through some cobras or extensions, my low back repeatedly, and then retest some of these things. So I could go through and, know, in our office, if somebody had a restriction and extension, which would be a qualifier, but at home, you could just do it. No harm, no foul. As long as it doesn't cause pain or discomfort or, you know, more symptoms, go through some lumbar extensions or some cobras, maybe 20, 30 reps and retest your toe touch, your slump test.
Just kind of see better or worse same and then that starts giving you more of an idea. The first thing that you need to do is determine what is a bruising, swelling, things like that. If you have bruising and swelling, you for sure have a injury to the tissue. And again, you can have both. You could have a nerve injury and a tissue injury. But when we determine nerve versus tissue, we're doing three things. we're being clinically or diagnostically specific.
Beau Beard (11:28.738)
The specificity leads us to the second thing, leads to appropriate timelines. So if have a grade one muscle strain or a grade one nerve injury, neuropraxia, we're in that same time threshold of days to weeks to recover. We get into grade two muscle injuries, we're a couple weeks to, if we look at this, three to six weeks is the norm. If we look at a grade two, that kind of axonotmesis injury, we're talking, we said the one millimeter per day, one inch per month.
This is weeks to months, depending on the severity of it. So we might have to determine what we're telling the person, the expectations. The third thing would be what we're actually doing to treat. So if we're treating a muscle strain standalone, we know with muscle strains, it's not necessarily that we need to immobilize. Immobilization of tissue injuries is about the worst thing you can do, depending on whether it's a tendon, a ligament, any of these things. We need movement and we can't do too much or we risk further injury.
But if we don't have load and load management these appropriately, which means movement early, trying to make sure that we're, you know, stressing the lines of tissue. So I would encourage you to listen to the podcast out of a Keith bar on tendonopathies and how to load the lines of a strain line of injury specifically, we're going to have healing that's delayed, but also not as a, it doesn't heal as well. So it takes longer and it's not as good. So we need to move these things early and often.
And then let's say it's okay. So now we go through a load management protocol. There's a little bit of protect there with the muscle injury, a nerve injury. If it's minor, right? So it's just this kind of neuropraxia, a little bit of attraction. We're ruling out muscle. It may be, we've got to go through some nerve, you know, gliding and sliding, maybe calm down some tissue tension around the nerve, because maybe the nerve can't slide and glide. So we got to make sure it can move through those tissues.
And you know that could look like a sciatic flossing maneuver gliding maneuvers you can see pictured here and that you know when you hit your head your first inclination is to rub it that mechanical input competes for pain and if we've had a little bit of a traction injury, yeah, there may be sensitivity, but if you remember with neuropraxia and I would even argue into the you know, Maybe we have a one plus neuropraxia injury where we have mild wallering degeneration How do we get you know anterior what's called an interior grade and retrograde?
Beau Beard (13:52.91)
nutrition to the nerve, well, it's movement. It's the same thing. So you need movement. So if the nerve is being strangled by an entrapment, whether that's muscular or other, you myofascial, get it moving. But even if it's movement where we're not creating too much tension and exacerbating the injury or the sensitization is going to bring nutrition to that nerve to help it heal as fast as it can. So again, if we kind of review, we have the three grades of muscle strains, three grades of nerve injuries.
There's simple tests and I'm using a sciatic nerve injury. Again, there's also all sorts of neurodynamic tests because what we're really trying to make sure of once it's a nerve injury, right? If we haven't had a crush or a full blown, you know, car accident with a full, you know, traction injury is where on the what's called patho neurodynamics. So the aberrant movement of the nerves, what's causing that? Is it, you know, around the spinal mechanics, the nerve can't move through those neuro-foraminar around the vertebral complex.
in the tissues that it's moving through. have common entrapment sites and nerves, how we move, so ranges of motion. All of these things matter because then that again gives us more information to be more specific with the treatment. But at home with the example of the sciatic nerve injury, muscle strain, so is it a hamstring strain or is it a nerve injury? They're simple tests that you can do. then, you know, as we move out into other areas, we would have to have more specific tests, but that would be a tall order to go over all of those in one video.
So I hope that helps as a clinician. I hope that helps as a patient differentiating between muscle strains and nerve injuries.
Is Shoulder Pain Ruining Your Life? SLAP Tears Demystified: Week in Review 40
In this episode, Dr. Beau and Seth discuss various case studies focusing on shoulder pain, diagnosis, and treatment approaches. They explore the complexities of managing patient expectations, functional goals, and the importance of understanding the underlying issues contributing to shoulder injuries. The conversation emphasizes the need for a comprehensive approach to rehabilitation, considering both physical and psychological aspects of patient care.
Transcript
Dr. Beau (00:01.038)
All right, we're back with, I think we said Week in Review, episode 40 last time. We had a great conversation. You'll never know what it was about because the microphones were not selected as the correct input. They were on. We had a great time. It was probably the best podcast we've ever done. I don't know. Actually, it wasn't. It wasn't. Yeah, there's no way to solve it. So I'm just going to, maybe I'll just put it out and put the video out and let all the YouTube comments come in. like, I can't hear anything.
see how crazy it gets. Or just have people put their own audio on. You get actually those little lip readings. That's what we end up The NFL sideline. that's what we do need. That's how we get more views probably. So as you can see, it's just Seth and I today, so everybody else is extremely lazy. know Daniel's oldest son's daycare flooded because pipes froze, then he's kind of dealing with that.
And then I think Alex had to get his perm redone or something. That's typically what happens. That's like a daily. Yeah, it's good. Every other week, then it gets the blue dyed out of it. All right, so today, Seth has a shoulder case. I'm going to kind of just have some filler stuff. And then I actually have an update on some shoulder stuff. we actually talk about that in the last one? Seth's not an update. We'll talk about it a little bit. The person you're going to use is actually like one of the main cases from last time. Yeah.
Yeah, so I'll talk about his case after yours and just kind of draw similarities and stuff. So I'll try and move them my kind of way. All right, you're good. Let's go for it. Sweet. So I've got a 53 year old male that has right anterior superior kind of shoulder pain. Um, he's had this pain like off and on for the last 10 years. There you go. Sorry. He's had it off and on for the last 10 years. Um, but more so felt it, um, Monday, I guess two weeks prior to me seeing him, he was in, he plays in a soccer league.
He's a goalie. So he felt his shoulder when he dove landed kind of felt it right in the front of his shoulder Then the next morning going to work he reached behind him to grab something out the back of the car and when he lifted he felt his shoulder like pop How old is he again? He's 53. It's just side note. I've known this guy for a long time He's like into a lot of varied activities They do like endurance horse rides and then his wife go I went on if they would say climb mountains, but they hike
Dr. Beau (02:24.834)
bigger mountains, like more than just like hiking around here. So a super active guy for a 53 year old. Yeah. That's like at the end of this, like I've gone two weeks without seeing him so far. it's because like this last week he's been down at like his farm doing like horse riding. Yeah. So yeah, he's doing his own thing. Cool. Then let's see. Yeah. So it's happened two weeks ago before seeing me it's progressively gotten worse since he's been in the gym. He goes about three days a week.
Overhead pressing, pull-ups and push-ups are the most painful thing that he does, but he can get through them. He said once his shoulder kind of gets a little warm, it feels a little bit better. And then kind of some pertinent surgeries. He had a labrum surgery to the same shoulder 10 years prior from the same type of fall that he had in soccer. So the exact same thing. Dove to his right, kind of trying to save a ball like above him when he jumped, landed, to his shoulder.
We're saying like landed on he was on a car and it felt top of his shoulder which can be a position you can dislocate a shoulder so that also sets up mechanism injury for maybe overseeing here and then he said he can't really find anything that's like helped it except I think he took
Cerebrex maybe? Celebrex or something. Celebrex, that's it was, yeah. He's like, that's about the only thing that I can get relief from. So top tier, so we're gonna start with just exam, top tier. Dysfunctional unpaingfuls to me that were important was cervical spine extension and right rotation for his neck were dysfunctional unpaingful. Right upper extremity pattern two, so him kind of going above his head.
that was painful and then bilateral multisigmental rotation but more so to the right. That was painful or not? None. Okay. The only thing he had painful was upper extremity pattern one we had to reach behind him, touch his left shoulder blade, broke out the bilateral rotation. He can clear it passively in lumbar lock and then to the right he can clear it
Dr. Beau (04:36.142)
Sorry, dysfunctional, painful, active and passive. So he cannot get there, like joint restriction is just like, mean, it's like a hard block, like he's not going any farther. And then active, goes the exact same range. So exam, shoulder flexion, resisted. I guess that'd be like what, Yerkesons or something like that? Is that what going With your elbow bent, yeah. It's like slightly bent, shoulder flexed, pulling down. That's painful and weak.
Full cam is painful and weak, but nothing with empty cam. So if his thumb turned down, he's fine. But if his thumb's turned up, more pain there. And it's also weak. What's that mean to you? To me... Or do you remember what that means from the orthopedic tests? What the differentiation is? Because you basically...
Superspinatus is going to be on the 45, right, with empty can, but then you do basically a labral shear test, right, with the arm straight out in front or at 90 degrees of flexion, 90 degrees of abduction. So the whole difference is you're going to go palm down, you're going to go palm up, doesn't matter which one you do first. So when you have palm down, you have more of the basically posterior cuff, right, that's coming into play, more same posterior cuff, hyperspinatus, teres minor.
When you flip over, you take some of those out and now you're back on kind of bicep tendon, your gissens. So then you're trying to match. And again, orthopedic tests, I don't know, you know, if it's completely, you know, their shoulders clunking, thudding, it's a two out of five strength. Yeah. But it does tell you, which we'll talk about in this, like it can tell you stuff and then you're like, okay. Yeah. I was on it because multiple pieces of data also the same thing, not just one orthopedic test. Yeah. so yeah, I guess like you're going after more.
The two things that come into play with both of those is like more bicep, like you mentioned, is more involved. then like anterior part of the shoulder, which he said, like, again, it feels the exact same as last time that he had this surgery, or I guess he had the same injury. Neurodynamic testing, recreated nose symptoms, just kind of checking bilateral since he had a restriction for cervical spine. Just checking just my neuro a little bit there. Shoulder flexion painful around 90 degrees to 100 degrees. So if he just like actively goes overhead for shoulder flexion in front of him.
Dr. Beau (06:51.674)
around 90 degrees, he's like, that's where it kind of hurts and catches. And then if he gets through that, he's fine after that. There's like a small little range that he's in. And then immediately as well, when he goes into these, whenever he gets around the part that it's gonna get painful or he expects it to be painful, he's like just super upper trap dominant. And here's a little tip, especially if you're a student or new doc, big conversation here, which sometimes you're like, oh, like I'm way ahead of that. And I don't think a lot of us are.
So lot of times, we'll go through all these tests and you're still like, I don't really know what hell's going on. And then we'll throw out something like, scapular stability or scapular diskinness or something. So let's say somebody has like, I was taught via Winchester advanced biomechanics, like the flexion abduction arc, right? You do abduction, hands apart or palms away flexion. You're looking for reduced range of motion pain, but you're also watching the scapula thoracic or scapula humeral rhythm.
One thing that I've kind of found interesting is, just like if somebody is on a bench doing bench press, your scapula is basically stabilized by the bench. So if somebody has reduced range of motion or pain with just flexing or abducting their arms, you can also have them lay down on your table and repeat the test. If it's wildly different, the likelihood of it being a legit injury goes, in my opinion, not to zero, obviously you can have injuries that you can bypass, but way lower. And then you're looking at maybe the biggest dysfunction and you're like, it's a good little test. Cause what do you do in the flexion abduction test sometimes?
you put your hand on their scapula and you guide it and see like, it improve it? You can lay them down, which is kind of like a, can we make a name up? Like we're to call it the scapula thoracic lock. Boom. That's what we're doing. Great girls. We're coming for you. Yeah. The ST lock. So lay them down on the table, repeat the flexion abduction arc or you know, whatever you want to do flexion and just kind of see. So just a tip if you're like lost. the only reason I went, I say shoulder flexion is because I had him.
when he was sitting up, do the abduction, trying to get back of the hands to touch, and that looked fine. Cause he's like, yeah, I'm good out into the sides of me. He's like, it's only when I'm in the front that I start to feel anything. is another clue, like tick in the box of the same information. So we've had Uregesens, we've had basically a palm up, right? Or a full can in 90 degrees, 90, 90 abduction flexion. And now we're seeing abductions totally fine and going through just pure flexion is worse. So.
Dr. Beau (09:11.416)
Then I put him in a four by four rocking just to have him like sit back on his heels. and he was pretty okay. He's like, whenever he like loaded his, I guess, like loaded his shoulder more. So when he rocked forward and started feeling a little bit more, when he rocked back, he was fine. There's like more load coming off of it, which led me to, since I'm adding compression with that, I put him on his back to go to like some, clicking and catching of shoulders, like a contest, I guess you would call it that. Adding some compression.
And he did have a little bit of a click in his right shoulder. He had a little bit of the same thing in the left, but I'd say it's a little more on the right. Now again, am I still seeing, I guess, previous injury? don't know what his shoulder felt like 10 years ago after the surgery. So that's some of the pieces that I'm not 100 % sure on. But have to go off of what I found in the office that day. And then I also had him on his back. Like you talked about the scapula thoracic lock.
I actually retested Superspinatus, I guess empty can, full can, and he had no pain with his supine. So if you just like, yeah, again, lock his shoulder blade down pretty much, he has no pain with any of it. In case anybody's gonna order this, we call Brooke Bush Institute Check Me. It's a Brian's test with hand up, hand down at 90-90. Oh yeah. So there you go. And then if you're just taking like a peer examination or a presentation of what he looks like,
pretty big like bilateral rib flare, pretty hypertonic erectors, like lumbar erectors outside of that. And I guess more so upper trap, some hypertrophy on both of those as well. But he's also, I'd say like a pretty well built like individual if you want to say. Neuro normal and then palpation. had trigger points basically around his entire shoulder. So like pec minor, pec major, nymphs finitis, teres minor.
Then he has some tone upper trap elevator and then jump restrictions was going to be CT thoracic TL and then right shoulder extension. So I had him face down just pulling his right shoulder back. And he actually said he's like, that actually feels really good when you pull my shoulder back. So pain odds for me would be shoulder flexion active and resisted four by four rocking, which just kind of helps me mimic a little bit of some overhead positioning and push up positioning, which he mentioned were painful. So I'm going to get into our specific testing.
Dr. Beau (11:34.126)
That would be kind of my area that I threw that in and then functional audits I actually am going to go after the shoulder extension first just because that was the That was a pretty big difference side to side along with the previous injury and he also mentioned that it felt really good when you did when I did that and then Because he only had pain when he actively did it so I know I mentioned it was dysfunctional and painful when I had him
go into a paternity pattern one but it was dysfunctional non-painful through passive and then thoracic extension and then the trigger points in the shoulder are kind of my like major three and then the fourth one that I will get to eventually later would be some rotation. So my diagnosis I have is like a laryngeal tear, laryngeal irritation, maybe a little bit of some biceps tendinopathy somewhere in there.
well just because of again all the other big tests that we mentioned just adding up to that's you're checking like fear for that are all around that exact same those structures so treatment wise first day did some soft tissue around his shoulders trying to calm down the trigger points did some start position to also get him to see if he can learn how to just turn off some musculature because he's super like peck heavy when he's just like in that start position
Has like almost zero clue how to do that So I'm like trying to get him to like relax that and he's like I have no idea how to get that work to relax and whenever he does He feels he almost just has to go to like shoulder or I guess a t-spine flexion. That's about the only way he does I like offload his pec So I'm using it for both t-spine extension and some trigger point stuff Five-month sideline for the posterior cuff to try and create some space for the anterior portion of his shoulder to get into creating some rolling motion
to centrate his joint around his shoulder. Then I had the shoulder extensions for my other piece that I had. And then...
Dr. Beau (13:42.114)
I adjusted CT thoracic TL. So homework, sent him home with the shoulder extensions and then some T-spine extension for some foam rolling. Just because that is like super stiff and if I'm gonna get some shoulder extension, I need his T-spine as well to move pretty well. So second visit, he goes to the gym about, I mentioned three days a week. State said his shoulder still has pain when going overhead, but he was able to do some kind of pull-ups and push-ups.
which is improvements from the last time. I think I saw him four days later on this one. So I guess he's been to the gym only one time since I saw him. So shoulder extension had zero change to it passively. Trigger points around the shoulder are the exact same. So it basically feels like we're back to absolutely no, like there's nothing different this visit, but somehow he's able to have no pain during the two movements that were painful from the first visit.
So pain audits changed but functional audits did not. So again, adjusted the CT thoracic TL, especially into the right rotation. And then I did more soft tissue work around the right shoulder. After doing that, I went and checked shoulder extension and that is equal bilaterally. So that kind of gets me into the, you know, did I actually go after like his joint, I guess last time? Or is it more so the musculature around it that was restricting that?
mobility which here I do some soft tissue work without any extensions and it's like boom extensions like clear when you say soft tissue work just for so some stekos some a RT also just to help kind like save my hands a little bit I use the little like massage gun on both sides trigger points or especially around like Terry's minor and around the front of the pack so then it start position again
side lying then moved him to the low oblique kind of start position so he's propped up on his elbow laying on his right side knees bent almost like he's fixing to start a side plank position. Mainly trying to use this position to see if he can drive against expansion between both shoulder blades to try and drive into the ground or t-spine extension or t-spine uprighting to make everyone can throw in there. He's like super shaky just holding that position so I haven't had to move I
Dr. Beau (16:05.016)
he's up onto his knees yet literally just holding that position he's super shaky. So I sent him home with the T-spine foam rolling in this low oblique start position because I was like it's tough enough for you to
I guess like work towards, but you can do it well enough. So yeah, those are my two things that I sent this time. Third visit, he has zero pain during weightlifting, but reports it's only when he lifts it in certain positions. So he has nothing on any of his like overhead pressing, nothing with his pull ups. He's actually able to do some kipping pull ups, push ups are fine. I think he's mentioned as well.
I said this was like a month or so ago. So I think he mentioned they did some like front rack positioning stuff, which he's like, it used to be painful. wasn't anymore. So soft tissue again, feels about the exact same as last as the last couple of visits. Orthos from the first visit are still about the same and still weak. But if I push on serratus anterior, kind of like right underneath his like shoulder blade, and I push on that. And if I redo any of the orthos, he has no pain in full.
full strength. he's like, he kind of looked at me, he's like, that kind of doesn't really make sense. But we had just talked about the, you're basically helping either his shoulder blade or creating him to like some pseudo stability there in his shoulders. Like, yeah, I feel comfortable because I actually have some input here and I feel stable. So did basically the exact same treatment as I did last time, mainly because I, but I added in some rolling here.
In that like low oblique, so I had him pressed up But instead of again rolling up onto his knees I had him still hip on the ground and just rolling as far as he could almost like a crowbar But he's rolling forward Just because I've got to kind of address the motor control aspect because we've shown a couple times here the motor aspect is one of the biggest pieces right if it was like more so a true injury if you want to call it that some of the pieces of like snakebites and shoulder blade and push on certain structures shouldn't I guess make necessarily make it
Dr. Beau (18:12.684)
any less painful or stronger. So my audit shouldn't be changing like that. And then I send him home with the exact same, the exact same stuff as last time. So T-spine foam rolling, that little big start position, but I just did more crowbar action this time. This visit, I also mentioned about him getting like a massage before he saw me, just because I do have to spend a decent amount of time doing some soft tissue around his shoulder. I was like, if you paired it with...
you know, one of our massage therapists here would actually like help me a ton so that I can spend more time on the motor aspect. I don't have to actually dive into the.
once as much. So fourth visit which I'd say this is probably two weeks after I saw him for the first time. He was able to throw the ball as a goalie this week with no pain and now only has pain with pulling movements but nothing with kipping pull-ups. So his pulling movements is going to be your rows. That's about the way time he feels it. Hasn't gotten a massage yet. Rechecked previous syndrome exercises and then I advanced to like bare holds and then did some like hand removal stuff.
to try and see if he can't load this right shoulder, stabilizing some coronal plane and some rotation challenge. He can't perform it on the right side at all. So he just like has no clue how to do it. But yet he checked his left side. He's just like super stable. So like right side, has to like almost like lean completely over into it and will not like basically almost falls over trying to hold that position. So I sent him home with that exercise. And then...
We had about like a two week hiccup here, I guess, where I didn't really see him because we had Christmas and New Year's that was thrown into the middle of all this. So he's like, I didn't do anything for my shoulder over the holidays because he had like 15 people that stayed at his house. So he's like, I was trying to deal with family stuff. So he's about the same as the last visit. This time he finally comes in, got a massage on his shoulder before seeing me and said it felt incredible. But he goes, I felt like I got hit by a bus after that.
Dr. Beau (20:17.486)
So his only discomfort this morning was when he was working out in a single arm kettlebell squat snatch. So he's like, we had some pushups thrown in there. We had some pressing, but the single arm kettlebell squat snatch. that's just literally him just doing a snatch based to catch it super low. Um, so I was like, I just want to see, see what that looks like. would like to know what percentage of people can actually do that exercise. That's why I wanted to see. That's why I had him perform. 1 % of the American population. Cause it was, yeah.
So I had to do, think it was like 10 of those for like four or five rounds. it was, it was a decent amount. was a decent amount of volume for, for that exercise. So I was like, I just wanted to see him perform it for me. Cause I was like, we're now getting into where it's like specific, specific exercises or it's bugging him and not necessarily just everything like it was at the beginning. So it's more of the why, like why are we, why do we keep kind of running into this issue?
Especially in that one like plane of motion like 45 degrees out or so, you know 90 degrees to 100 degrees of shoulder flexion We're still kind of getting caught because he's like when I'm going to go overhead to catch the to catch the snatch He's like there's that pain point but catching it is fine So it's again just that little middle section He cannot get his arm all the way overhead because he was like because I asked him how much he was using I was like that I was using 30 pounds to do this I was like, well, here's like a 10 pound weight. Let's just see if you can do with 10 pounds
can't get his arm all the way overhead, upper trap heavy so when he goes to pull and the whole time he's doing it, it's just, I he's just laying into his right upper trap, has to lean super heavily onto his left side as well in order to do it because he just can't rotate enough to the right to catch this. So recheck the bare hand removal and was able to crush it this time. Lumbar lock with right rotation with dysfunctional non-painful on the active component but was functional non-painful with passive.
So we've kind of cleared that joint restriction. It's just the active component he cannot do. So I had him do the overhead position. So like a little half kneeling kettlebell windmill. So he's in like one knee. So left knee would be down, right knee up, right arm has a kettlebell overhead to work on this catch position, but also some right rotation. And I had him do this and he's like, there's no way I'm getting to the ground on this. He's like, I can't even get there.
Dr. Beau (22:44.044)
And he couldn't get to the ground with his hand for the first like three or four reps and eventually started getting to where he could. but the only way to get to the ground, had to like roll super heavily onto the outside of his foot. So I was like, let's just chunk that for right now. They're going to able to supine position. I guess like legs up almost like you're in a three month position and he's having to hold the kettlebell in the right hand and do like windshield wipers to learn how to like let his body kind of rotate one direction and back, keeping the shoulder.
on the ground. So did I think like seven of those reps with his legs going to the left and then had him go back and recheck that little supine or the half kneeling windmill. This time he like crushes it. So he just like boom straight to the ground and comes back up. It's still difficult, but he at least has like, oh yeah, that feels like way better. And then I had him recheck that little kettlebell squat snatch. And he's like,
It feels much better to do, but it's still difficult to get his arm all the way overhead. So I sent him home with that little supine rotation because he's like, have some kettlebells at home if I can do this. So I just used what he had. I even said, hey, you don't have to have any kettlebells or any weights to do this with. And then for warmups in the gym, I actually have him doing the little half kneeling, half kneeling windmill.
And then I asked about like some upcoming training and games and told him for the current moment to eliminate overhead pressing since he's going to be playing a decent amount of soccer coming up. And since we're trying to address the overhead component of rotation, just to like not keep like bugging the bear since a lot of the overhead stuff is still still kind of clocking him. But he scheduled to come back in early next week. So that's kind of where we're at with his case. there's kind of two big things that stood out throughout there.
yeah, you're probably all over the diagnosis. So then, you know, I've done, I did a podcast, which I'll put a link in here, to a podcast that it was Steve Coppobianco. And I actually did a talk on this at the rehab symposium in Orlando this past summer. I'm like, why, why are trigger points forming? And there's, you know, a couple of hypothesis, like a sub-threshold workload, neurologic protection of an injury.
Dr. Beau (25:07.721)
sensitization. So then you talked about, that's why I asked the question of like, what soft tissue are you doing? So we, when we throw the kitchen sink at stuff, so we're like, oh, I a little stecho, did a little ART, did a little, you know, basically like percussion. Those are three different mechanisms, right? Stecho, you know, maybe they're all creating the same effect and we just don't understand stuff well enough. But let's say it's sensitization that automatically changes the bullet that you put in the chamber, right? So you're like, man, if I go in there and blast it with stecho, it might get more sensitive.
And the reason I bring that up is what did he say after he had a massage? He's like, feel like I got hit by a truck. So the light and what was the one thing that kept not changing? The soft tissue component. So again, you always are trying to ask these questions and I'm not saying I know, don't, neither one of us know, but you start to try to guess better of A, why is the shoulder, you know, have a much higher tendency and trigger points in it to begin with. Second, why isn't it changing even though, you know, pain is changing and function, other function is changing. Then you kind of say, well, God, why did he get so, you know,
have so much soreness from a massage. And then you're starting to say, man, there may be sensitization. And that leads you to, well, why is it sensitive? And then you gotta deal with that. Does it help you or is it just kind of like, it's a thought process. But you're always thinking about that stuff. And again, I highly encourage you to look up the research on this stuff. I've done a whole research review on trigger point stuff. So yeah, go look that stuff up and start asking those questions yourself. The other thing is if you kind of work,
You know, throughout his whole treatment plan, all of his homework, I he was always like, foam rolling his T-spine. He got a T-spine rotation, came down towards the end there that basically he had, you know, passive rotation. If you, you know, get rid of the lumbar spine, but he's still actively really couldn't figure it out. So then it also kind of begs the question, even though there was stiffness in his T-spine, if, you know, let's say in a magical world, we could have Gray Cook come look at this guy from day one, you know, in parallel of what you're doing. And he's like, God, there's just a...
thoracic spine motor control issue, right? And that's what he's working with from day one because then, maybe that's, and then you're like, why is it right shoulder? He had an injury, right? So then we got always, which we talk about this a lot, like rule out pathology and legit injury. you treat the area, but then it leads you back to, again, this is the biggest issue. And I think that's what you landed on because it's, you don't get better in exercise over reps, right? And it's not loosening. It's like you're figuring out.
Dr. Beau (27:30.574)
So it's not that something's actually changing. It's just you're kind of taking the parking brake off a pattern. We're establishing a new pattern. So I think that's kind of a good thing for people to see or hear, I guess, that you did work on a shoulder because you had trauma. So you had to calm it down. And you're like, that's why when I have a shoulder extension, I have to get it moving. That shoulder extension popped back after the first visit, didn't it? Yeah. Then after that, you're like, I got to keep changing the things. And you keep working around the shoulder, soft tissue and stuff, but it comes back to thoracic spine, thoracic spine, because it keeps showing you that.
When you're dealing with the injury, it's like we always talk about you need to go off the biggest thing for functional audit But again, he's still like in pain really can't really do much of the gym But he also was playing soccer and even this first thing. Hey, I've got some soccer matches coming up I don't want us to be able to play as a goalie Like do you think I'm gonna be able to do that? They asked me they've already texted him and asked him like before he saw me if he was gonna play this weekend So it was kind of like I'm gonna do everything I can to kind of like
calm this down as much as possible and not just add more fuel to the fire. Because if I'm trying to change, let's say his function, it's kind of like a baseball player. If I go in and I dry needle a trigger point in his lat or something like that and he goes out on the mound, that should open him up to a potential for more injury if he's going to continue playing. Is that there for a reason for a protective component? So was like, let's just add something easy to go after his shoulder extension needed to get worked on.
There's other pieces that, like I said, we led to, but there was so much, guess, I could have worked on on the first visit. It's like, let's just start kind of locally around like where it hurts. And then we can expand once he's able to like get back against a little bit more like normal routine to an extent. that, I think you're allowed to be a lot less worried about like changing function by going after something. So, you know, if you, we always hear the horror stories of changing stuff in a pro athlete. We're not dealing with pro athlete here, first of all. Second thing, this is goal alignment.
you matched what he said he needs to be able to do with what you did from treatment because you could have just went after a thoracic spine and not a shoulder if he's like, I'm not gonna be doing anything for the next month. And that's what you have to weigh it against is like, I'm gonna be doing this. I'll be like, then your shoulders are gonna be able to do different things very quickly versus if you thought, know, we have multiple, I mean, the next case I'm gonna talk about like same thing, right? This guy's job is a physical job. And it's like, okay.
Dr. Beau (29:53.838)
you we have to make this decision because of what you want to do, not necessarily what I think needs to be worked on. That's in our world, very different than you got an MRI, you see an orthopedic surgeon, you have a torn tendon, they think they need to repair the tendon. And that's regardless, most of the time of what you have coming up, just because it seems like drastic, even when it's non-traumatic tears that just been around for years. So that's our job is to determine goal alignment of what do need to do? How much time do we have? What are you willing to do with?
hey, we think there's a little bit of injury or not, and then how much time is it gonna take to change this function and things like that. So it's kind of a big equation that you're trying to know, weigh both sides and make them even, but it's never gonna be even. The other thing too is, like you said, aligning with his goals, like.
There was no part, I guess, to the exam where I felt like he needed to not do any of those things. If he had a true injury, felt like most people would be like, all right, how long do I need to sit out? His was more like, am I gonna be able to play? And he also mentioned, he's like, yeah, he also didn't say that he was gonna cut back any of the gym. He's like, yeah, I'm still going three days a week. So it's kind of like, you're still staying pretty active, it's just bugging you and you're kind of getting annoyed by it. That's the other piece too.
So the case that I talked about at length last time, which I'll kind of still give like a five minute overview, but somebody I've seen for a long time, they've had a multitude of injuries all over because they own or partial on a Taekwondo gym. They coach, they're sparring all the time. They compete themselves, likes lift weights. Super interested obviously in the movement world because of he does. So it takes the advice, but then also
you know, not to be mean, it's kind of stuck in a bro weightlifting mindset. And I think some of that's kind of his detriment with Taekwondo. It's just, there's a bad intersection there. So anyways, I've seen this guy for a long time. One of his constant complaints just kind of his shoulders will bother him, you know, right shoulder, left shoulder on and off on and off over the past couple of months, his left shoulder has become more more bothersome to the point where he started telling me I can't do lateral raises. I can't do front raises, which
Dr. Beau (31:57.774)
I hate to say there's bad exercises. There's a lot of laboral sheer with those exercises been proven if you're not in the angle of scaption. And it's not like we have to do everything in these safety ranges, but it's kind of like doing bench press with your elbows at 90 degrees. We just know that's not the best thing for your AC joint. All right. So if we get into the same angle of scaption and like a pushup or a bench press, it's a little bit better. Now, if you break your arms apart and they're in dumbbells, it's even better, right? So there's just these like things with exercise where you're like, it's not bad or good. They're just better options for most people.
So I tell him, hey, let's just not do those things. Let's do 45 degrees. Let's do more single arm pressing with kettlebells to see if we can calm it down because I know at the crux of this guy's issue is a bunch of rib cage stiffness and it's thoracic spine stiffness, but it's how this guy's rib cage basically is stuck like you said with your guy in kind of this inhalation schema where it's just flared up and he has excessive tension around his lats like a lot of people. So now he's stuck in extension.
He can't get his shoulder in full flexion. So when he gets to the top of the shoulder range motion, I mean, if you think about the angles here, think about your rib cage being tipped back and then your shoulder still can't get over head. I mean, you're just basically leaning on the back of your shoulder at some point. And what's the catching in the front? Usually your bicep tendon. So he's telling me all this stuff and I'm, I wouldn't say I'm being laissez faire, but I told him right away, I was like, yeah, I think your supra-cenaeus is kind of bugged. It's not torn, but like it's for sure bugged just based on, know.
what's, don't even know, push button task, because it's bursitis, but like pushing where the tendon is right to the medial aspect of your AC joint, empty can. Doberns, I think it's pushing something. Push button, Doberns, think we were pushing on like for bursitis, which is terrible, it's so stupid, it's not funny, but anyway, we're going through this and I'm like, yeah, it's kind of bugged and I'm not really worried about it because.
huge functional things to work on to allow this guy to do stuff. And he's doing stuff that isn't awesome for your shoulder anyways, especially he's sparring and doing all this other stuff. So I keep, you know, coaching like, let's go after rib cage, rib cage, rib cage. And it was tracking along well then last visit, which would have been a little over two weeks ago as of today. He comes in and he goes, you know, his Achilles had been bugging him. He's like, that's been better. He had an oblique strain on his right side, which ties into the rib cage stuff. goes, that's better.
Dr. Beau (34:16.161)
because this lift shoulder is just, it's really starting to bug me. And he goes, and he says, you know, do you think we should get an MRI or something, which is like a light bulb for any clinician of like, when they say that, they're basically saying like, I need some confirmation now. And if you, I'm not saying you can't talk your way around that back to function, but if you went, you know, at this point I'm three visits in specifically on the shoulder. So I'm getting into a trial of care. If you're not having success in terms of like,
relieving their pain, getting them to do what they want to do, goal oriented stuff, and they throw the flag of, I think I need an amateur console. You better listen to that, otherwise you're going to lose them. And I don't run the risk of losing this guy. He's like notoriously my biggest fan, and maybe the loudest patient in the office, but lose them from that care. Like he just goes to somebody else, I'm like, dude, my shoulder had so-and-so and you didn't know. So I kind of say, hey, we can get him right. That's totally fine. I don't bring anything up about North Beat console. I go,
On that MRI, it's going to show a small slap tear and it's going to show some like tendonitis or a partial tear of probably supraspinatus. And that's just kind of your right shoulder might have the same thing. just doesn't hurt as bad. And goes, I get it. get it. And then he like, you could tell he's like, yeah, I just need, you know, really need to know. got a lot of stuff coming up and like love that I did that. So the MRI, what was it? A little bit of AC degeneration, mild tendonitis, supraspinatus, small slap tear. And they literally said small slap tear and it's the head of radiology for.
the hospital around here. So we tell them that and because I knew that if there were positive findings of what I said it was, even though I think it's a rehab scenario, what I'm really leaning on now is I think those findings don't warrant surgery. So I went ahead and sent them to the orthopedist that is our conservative kind of orthopedic arm with no like, I wasn't teeing up the orthopedist like, hey, let's not get him out of surgery. Hey, go have a consult because I need to be able to trust that guy.
Now if he says it's surgical, I will call that orthopedic surgeon or orthopedic doc in this scenario and be like, why is this surgical? There's no tear in the tendon, tendonitis, and we have a small slap tear. So now hopefully we get an orthopedic surgeon to tell this guy, hey, it's not surgical, you need to do rehab, maybe give them some medication, don't know, injection. But what we get is this massive confidence influx of like, okay, I'm headed the right direction.
Dr. Beau (36:39.724)
His shoulder could feel better next time he comes in just because of that. Because you're managing the case appropriately, he feels more confident. Maybe he does lay off stuff even more because two people have told him and technically somebody I guess higher in the echelon of triage. But it's a big management case because I know I could have just like kept him going and he'd keep getting frustrated because he does so much stuff from a goal misalignment where I'm like, dude, can you just lay off? And he just doesn't. For part he can't because of his job.
part he doesn't want to because he just wants to grow out. So it's a good case because I was diagnostically accurate, which gave him confidence when the images matched what I told him it was. That's not always gonna happen. Second, like Seth said, I knew it wasn't bad enough to need to just stop anything. I was just trying to modify stuff to A, not make the injury worse, but B, get him out of pain faster. Last thing is,
I knew I needed to work on this core functional deficit of rib cage, just general movement and basically 3D, but mainly rotation with him. you think about somebody with Taekwondo, doing a ton of rotation. This guy's had multiple oblique strains. So now what do I get to do when he comes back in? Yeah, I'll ask him about a shoulder. Maybe he got Mlock's camera cellbrack or something or an injection. But I get to go, hey, we're just gonna let your shoulder chill out. So we're just not gonna do that stuff of picking the scab and we're gonna hammer your rib cage.
And now I get this big aggressive four or five visit slam of like, you should be sold on this, right? So that's what we're trying to do with all these cases is manage them so well that they come to the conclusion, which we're giving him info for him, but he comes to conclusion, my shoulder's beat up, but it's okay. Bo said I gotta work on this stuff. And the ortho that we sent him to also talks about dietary changes, anti-inflammatory supplements, all the stuff that I've told him, so.
You get these echo chambers in a good way. But again, I don't know, he hasn't had, or I don't have the notes back, we checked right before the podcast. I don't have the orthopedic notes, I don't know what he's told him. I can only cross my fingers that he did not say, hey, let's do surgery. Now, if he had to do a surgery, and I even went over this with the patient, he goes, what's the surgery like that look like? And I said, with a small labral tear, they'll go in and they'll, you know, one or two sutures, you know, maybe not even, I don't know. That, maybe they clean it up.
Dr. Beau (38:59.956)
One or two sutures and if it's small tear, mean four weeks and you're not back to full go, but you should be out of like post-op PT and back to kind of training at a low level. So we'll just see, but I will for sure do a legit follow up since we didn't have the previous podcast and we're back here because of lost audio. Yeah, just review diagnostically accurate, managing the case well, and then working on, know, the thing is the thing is the thing, like working on what you need to work on in the face of an injury or not. And that can be really tough as a clinician at any phase of your.
career. So, hope that helps. Any more to add on his case or your case? Any thoughts come up while I was talking? I think the toughest part is again, like making sure that you still are addressing your biggest functional audit even in like you mentioned the face of an injury. Yeah. Right. Weighing the odds of not the odds, but weighing the, is this more of like, okay, I need to refer this out for like a...
some other type of intervention, right? Surgical versus like imaging, right? Not being nervous to pull that too early. Cause there's two cases where we have like very similar, I'd say presentations for both of us, but it's, you referred for imaging and I didn't, but yours was because he wanted it. And mine was like, mine did ask about it because he asked, goes, at what point do you consider getting imaging? So at that point it still kind of lands in my ballpark of like,
He trusts me with his care and understands and I just walked him through like, if the weakness continues and then it starts to affect your daily life and or pain slash audits are not changing, that is where I will start being like, hey, we need to go out and do these things. But if I can push on a different part of your body and make those changes where you have full strength and no pain to me, that doesn't warrant you having surgery. If you thought about it like this, if every one of your patients was gonna have
surgery or some high level medical intervention for every injury that they had. Let's not say it's like chronic pain or it's like legit like, you know, tendinopathy, a tear, whatever it is, an injection even for like neurologic sensitivity. Like there was some high level intervention where you're like, the injury is being treated. That's how you should treat everybody. We have tools to do that stuff too, right? Dry kneading for pro-inflammatory markers, offloading tissues to let them heal. Like we're doing that in our own way. So I'm not saying you're not treating the injury.
Dr. Beau (41:20.814)
But just imagine, play the game for a month. I know it's a lumbar disc herniation, I'm gonna send them out for a discectomy. That's just what you're playing in your head. What would you be treating when they came back into your office? If you play that game, you'll start being like, I probably wouldn't be just shoving them in a lumbar extension. Because if that was your answer, post-discectomy for somebody that's like, God, I still kinda have a little bit of radiation in my hip.
You're not gonna get anywhere with anybody, I promise you that. You're gonna be treating pain, you're gonna get lost in the mix and be like, and then they're gonna have another intervention, they're gonna come in and you're be like.
And that's, I mean, it'll happen to you, it happens to all of us, but that's how I would have you think for a while. And that's why you have to be so good at ruling out or ruling in injury to know, do I need to do some things for the injury or hey, my big job is to offload that tissue, offload that joint through the functional capacity or functional changes because it's just kind of getting irritated. Which you said, like tear or irritation goes one way, you know, maybe a tear comes in it. And let's say you get an MRI, let's say my guy, you flip the script.
His MRI is clean as a whistle.
I hope you weren't working on his labrum. Good luck explaining that one. So, and again, it's not to say that sometimes the thing is you could be working on somebody's shoulder and they have a shoulder shoot. Yeah, but you better have some information that led you there instead of just like, your shoulder looks like we're under a shoulder. Because what if Seth was just stopped at shoulder extension? This guy go gets an MRI and his shoulder is just fine. And now Seth has to reconcile with him. The guy's for sure gonna be like, what's wrong? You're like.
Dr. Beau (43:01.486)
And let's say a shoulder extension got better and that's us like, I don't know, we got shoulder moving and there's nothing wrong, I don't know. Maybe you have chronic pain, which I think happens a lot. You just run out of data, basically. So I run that experiment. If you run that experiment, you're somebody that listens to the show, like tags on social media or something with, I don't know, to hashtag function over surgery or I don't know, fake surgery, sham surgery function, something, we'll think of a good hashtag.
The thing like that, I think it'll help you quite a bit. I think it's a good way to think though. You just think the injury will be taken care of. And again, sometimes that is your job. Sometimes just chill, but think of it like that. And I think it'll flip your mind real quick and like, oh, I'm a tree over here. And there's other reasons that you wouldn't treat a hotspot. This guy, when he got a massage, shoulder, I wouldn't say it was worse, it hurt. Cause I wouldn't say that. mean, like I'd be lying if I said I didn't walk in there every time and being like, I'm getting an MRI today.
I walked into the room being like, based on how he is and just kind of knowing how he acts, like his mannerisms in the treatment room, I'm always like, yeah, we're getting an MRI today. And then I go and check things and he's, as we're rolling through things, the MRI starts coming down lower on what I'm gonna order, just because what he's telling me and function and what I'm feeling. It's like I'm walking in on this being like we're getting an MRI today just because he's had a previous surgery to that same shoulder with the same injury. like.
He knows things about his shoulder because he's been there. You can go too far the other way. You could have too much bravado behind. I'm not like with my guy. I don't need no MRI. And he comes at me with like, and you're like, you don't need one. Even if there was a small tear, it'd still be rehab based. That might be what you legitimately think. And you would say behind closed doors, that is not the best way to manage that case for 99 % of people.
Most people, you get a pro athlete that's gotta go through a season and you know, this gets talked about a lot. So let's put somebody with the exact same pathometatomical diagnosis of my guy, a small labral or a small slab tear, a little bit tendonitis, a little bit AC, and let's say they're a pro quarterback and it's a week before the season and they fell. Outstretched arm going for quarterback sneak and they come to you, this is probably not gonna happen, but a pro athlete, they come to you and you have to make what decision?
Dr. Beau (45:22.734)
Could they play through it? How much do I tell them? How much does it warrant telling them to not let them worry about it? How fast can I get them good? What would they not be able to do? Because in that scenario, you're talking about millions of dollars, playoff, like all these things come into play. We talked about that with pro athlete, like why shouldn't you treat everybody like that? Like goal alignment, like what do we need to do? It makes sense sometimes to be like, I know they have this going on, but I'm not gonna give them the full rundown. like, hey, there's a giant tear in your shoulder, but I think we can rehab it. Just be like.
Short is a little angry, but you know, doesn't get better, we can get an MRI. Like you choose your words, which is again, management. And I'm telling you, you're gonna have to make those decisions too, you know, based on personalities, previous experiences, chronic pain scenarios of not saying the same thing in almost the exact same scenario. And that just takes clinical, you know, awareness, which here's a pitch for the art of assessment. We just went over module one, which was introduction. Module two is on observational skills.
both in the treatment room and outside. And we talk a lot about the different levels of awareness. know, one of those gets into just general awareness, like emotional, you know, intelligence and being aware of the scenario that you're dealing with rather than just like, you got your ideas, you spit them out, regardless of who's sitting in front of you. Best clinicians in the world are really good at managing people. They're good with their hands, they're good at diagnostics, but they're amazing at managing people in the face of maybe not having some of the skills that other people do.
That's on bobeer.com, our assessment hybrid will be doing a live module next week and then we'll also next week interview 41, which will be recorded in two weeks. We're going to allow, if you're part of that, you can be on that show and ask questions. We might even have somebody from that cohort present a case or something like that. So look forward to that. Any last words? Thank you. See ya.
Kelly Starrett Exposes the Performance Paradigm You’ve Been Missing
In this conversation, Beau and Kelly discuss the evolving landscape of health and wellness, emphasizing the importance of community engagement, environmental factors, and the need for behavior change. It highlights the significance of nutrition, the role of youth sports, and the necessity for structural changes to promote better health outcomes. The discussion also touches on the adaptability of humans and the importance of making small, impactful changes in daily life. Ultimately, the conversation serves as a call to action for individuals and communities to take charge of their health and well-being.
Chapters
00:00 Introduction and Current Endeavors
00:39 Shifts in Consciousness and Health Practices
03:51 Population Health and Community Engagement
06:35 The Role of Change Agents in Health
09:27 Understanding Human Complexity and Health
11:47 Nutrition and Environmental Mismatches
16:26 Streamlining Health Choices
20:05 Cultural Shifts and Behavior Change
27:27 Grassroots Change in Health Awareness
30:14 The Importance of Nutrition and Sleep for Kids
33:03 Reconceptualizing Youth Sports
37:39 Small Changes for Big Impact
42:45 Evolving Perspectives on Health Practices
49:39 The Complexity of Health Research
Transcript
Beau Beard (00:01.425)
So yeah, it's good to virtually meet you. I know we've never met but I followed your work for a long time so that's why want to have you on the show and I'm going to go ahead and start recording because we always start talking and then you wish you would have recorded some of the jibber-jabber up front. Are we on video too or is it just audio? I won't use the video. We tried it before and everybody bitched and moaned because they're like do split screen it's weird we don't like it. like cool let's just listen to it then. So yeah no video.
Pick your nose and do whatever you So yeah, we're gonna dive in man. You ready? Do it. So I don't think the guest today needs much of introduction, at least if you're in my field, he doesn't. So I'm not gonna have him walk us down his storied past of where he is today, but I do wanna hear what you are doing as of the past few months, because I know you're always involved in different things. So if you can just give us a brief hello, tell us what you've been up to, what's going on, what's...
putting a fire to your feet every morning when you get out of bed? Well, thank you so much for having me. We're doing two things. One, think we've seen a wholesale shift in people's consciousness. We've hit a tipping point. Internet, general fitness community. think I'm watching people do behavior changes in my community around their nutrition. We're seeing Matt Walker and his book on sleep has been changed.
game changer for people. So the next piece I think is really for us continues to be about how do we better serve? How do we stream our own information and contents? We're in the middle of a gigantic redesign with our ecosystem because when we started this thing, for example, we didn't think we'd make 5,000 videos without we make a couple of videos. And now we have like the library of Alexandria, which is a little bit confusing for people. Don't let it burn down, man. I know. The scrolls are stuffed in the rabbit holes.
And, um, but really we're really looking at a population health issue. How, how do we take what we are understanding to be much better practices in let's call it the health and wellness space industry. And then how do we actually get those things into the people's hands that need it? So for a long time, for example, we've always taken this approach that, you know, sports and high performance environments was our laboratory to take those concepts so that we could spin them back.
Beau Beard (02:27.672)
Cause we really pressure tested, you know, as, as a diversion in physical therapy, there's a definitely a bigger push to treat the whole person again. Right. And, and there's been a real resurgence in thinking and talking about things like chronic pain by making mentioning that we've got to look at the whole person. Biopsycho and social, how's that person's stress? How's their role in their environment and community? How did they.
How they think, are their preconceived notions? Have we medicalized? You really common human processes. But what's interesting is that, you know, that approach is vital and important because it pulls us out of the old, you know, it's all mechanics. You know, your posture sucks, that's why your neck hurts, you know? And understanding that humans are really, really resilient and adaptable people. But if you're a coach or have ever worked in...
a group setting or dynamic and performance, you've had to talk about your nutrition and sleep and stress and do my athletes feel supported and loved? Otherwise we couldn't get those things out of them. And so on the one hand, I'm like, Hey, once again, look what we've already learned in high performance society, high performance environments, whether we're talking the military, where we're talking, you know, NFL, if we're looking at basketball or, or Olympic athletes.
And what we should continue to do is take those lessons because there really are stress tested around what we think are the most durable shapes, what are best eating practices, how do we get go from high stress to recovery back to high stress again? How do we manage that? And we're starting to see those practices bleed into the great society. And so one of the things that we're continuing to work on is, okay, we think we have a much better hold, a much more cogent
model about what is sustainability for an average person in a busy life. And now let's go ahead and take those practices and make sure that we're actually giving them to people who don't self identify as fitness junkies or athletes, right? That means my mother-in-law, that means my children. And so, you know, we're, we, we have a nonprofit called Stand Up Kids. We've been doing it for about seven years now. We're in our seventh year and it's a, we try to get kids out of sedentary desks.
Beau Beard (04:45.208)
traditional work desks at school into much more dynamic environments where they can sit on the ground and work, where they can have a desk in space that's heightened for them for standing. It's individually adjusted in place to put their foot. They can perch, they can fidget, right? Re-imagining the environment. And right now we're engaged in some long-term research with UCSF over a two-year study trying to say, hey, look, we're figuring out that there's definitely a mismatch between sort of the modern environment and who we are as
people. And the problem is that we're so durable and we're such extraordinary people and such an extraordinary organism that we can buffer a lot. But we have to do a, we have to do kind of a couple things. The one hand is we have to say, okay, most of us are probably going to be a hundred years old. mean, if you ascribe to you vault Harari modern medicine, you're probably 120 years old if you're in this generation and
who we are for this back half of the 40, 50, 60, 70 years we have left really is gonna come to matter even more. And what it means is that we need to start kind of playing in this long game and we're seeing the complex interaction of sedentaryness and stress and poor sleep habits and sleep density. We're seeing even the dyes and perfumes. There's some new research that really the dyes and perfumes that we're using are hugely endocrine disruptive and that they're part of the
part of the problem. It's not just the problem, part of the problem of this whole complex in Mail. You know, I just ran in my community. have a couple of friends whose kids have tried to commit suicide. They're 13 and 14 years old. And we know that kids suicide rates are up 50 % under 18 in the last, you know, three or four years. So there's something going on with this sort of modern age. And I'm not saying we should pine for the Paleolithic age, but
We've got to come back to what our first principles and what we're spending a lot of our time now is working at a population health level to try to streamline it and make it easier and more digestible for people so they can be a hundred years old because that's our birthright. know, first of all, I think Kelly employed some spies because he's literally checking off questions on my list as we go. But what I, what I kind of postulated this podcast to be about was kind of the future of health, not healthcare. and,
Beau Beard (07:05.9)
The first thing that we have to touch on before I want to unpack this thought of moving back to a time versus moving forward in time and adaptation and evolution. But what we have to unpack is you're a change agent within our field and then within the greater healthcare field overall and then within hopefully the just human population is these ideas, you know, matriculate and percolate into other areas. But why sometimes I ask myself this question. I want to know if you feel this way ever.
Sometimes when we're in the athletic realm, it seems kind of for not right we we're getting these athletes to do things that are very specific for them which they get an enjoyment out of and it is sometimes in the vein of health but then we talk about hey I'm trying to get somebody to stop using this perfume in our first world country to have a non-endocrine issue when somebody you know in Bangladesh can't even you know a Can't even get their hands on perfume let alone clean water. So do you ever kind of feel like man?
why did I choose this, first of all, athletic performance realm, then take that into gen pop. And how do you go about saying, you know, this is what I'm using to change the world and this is why I think it's so important. Well, I really appreciate the sort of the dissonance that you feel there because, know, at some point I'm like, wow, let me just, you know, at San Francisco, did I just help some upper middle class person PR on their triathlon? Is that enough? And what I'll say is, first and foremost, is that I love
physical culture, I love play, this is who we are as human beings. So, you know, why do we have a nervous system? So we can move through the environments, can sense change and play and environmental play is really the best way that the body, which is a complex system, self-tunes itself, which becomes more robust. So at a cellular level, we have this notion of mechano-transduction, which means that if I want my Achilles to express its Achilles self,
at a cellular level, I have to load it. Okay, well, what does that mean? Granularly means I have to have mechanical input into the Achilles and foot in order for those cells to express collagen in a healthy normal way so that I have a system that's anti fragile. And when we say anti fragile, what we're saying is a system that not only can handle stress, but actually gets better because of stress, right? That's an anti fragile system. We're not just interested in, can you withstand the stress? We're interested in the body is
Beau Beard (09:34.764)
as an agent where it can handle these things, but for these things, actually become better, better organized. So, you know, I, for whatever reason, adore exercising, adore training, adore sports, but you cannot be in that space or in this field and not talk about sleep and stress and nutrition and what you suddenly, you know, it was not my dream to lecture adults about their crappy posture.
Right? That's, that's a dead end conversation that doesn't inspire anyone that, you know, there's no research to support posture cause like, what are we talking about? What we're talking about is human beings are in doubt. I mean, if we take a step back and look at, and this is a book from Adam Rutherford, who wrote a book called, a brief history of everyone who ever lived. And it's really a modern snapshot of all the genetics and genomics and epigenetics out there. Like what's real.
What is fantasy around genetics? Your genetics do not tell you what kind of white wine you should drink. That's a bad use of genetics, Ancestry DNA tells you where some of your people lived temporarily. That's all it tells you. It reminds us that a thousand years ago, if you're a white person in America, we have a common ancestor a thousand years ago. If you're on the planet, we have a common ancestor 3,000 years ago. So the genetic piece is interesting, but
What he says in that book is the human brain is the most sophisticated structure in known universe. Just let that sink in for a second. And it's attached to the most complex, psychosocial, emotional animal the world has ever seen. So you have the human being, which is the most complicated, sophisticated structure and complex theory ever. And you think that taking a turmeric shot and biohacking, it's not, it doesn't work that way.
It's just the body is too complex. And what we then have to come down to are what are first principles? What are the pieces that allow people to have access to their native and birthright function in their capacities? So to your conversation, hey, I don't have to be lecturing people in, you know, who are food insecure about what shampoo they're using, but that is a
Beau Beard (12:00.492)
part of this conversation of saying, look, what's best for the human? Well, subjecting yourself to really crazy dyes and perfumes in your, in your shampoo and in your dishwasher on your laundry detergent. Maybe we could do without that because you're putting that up against the biggest organ in the body, the skin all day long for hours and hours and hours. No, why aren't you walking at all during the day? Why, know, what are the things that make us human? You know, we,
my wife is much more into nutrition than I am. but I am you know, you have to speak this conversation. And because we can't talk about your health, you know, the research indicates that we used to probably eat 60 to 80 kinds of vegetables in a year, right? We just had a lot of diversity and everyone knows that eat the rainbow. That's not that's, you know, that's old school as it gets. The average
human being probably eats, you if you're a ninja, you probably eat 20 vegetables in a year. And if you're a typical person, eat three kinds of vegetables, you know? And what we're seeing is that a lot of the things that we took for granted have just been suddenly changed underneath us, right? Sun exposure. I mean, let me give you an example. My kid was born, she was a preemie and you know, she was born at UCSF, pretty good hospital, born like six weeks early. And they're like, okay, we're discharging you.
but you need to give her these vitamins. And I was like, my kid drinks mother's milk. Like she doesn't need vitamins. And they're like, no, no, no, she has to these vitamins. And I was like, look at me in the eye and tell me that mother's milk is incomplete neonatal nutrition. And they were like, it's not, it is. And I was like, what's the problem? And they were like, well, white people in San Francisco don't go in the sun. That's the problem. And I was like, there's no vitamin D in the mother's milk.
So if I expose my kid to some vitamin D, that's enough and they're like, yes, but people don't do that. So could you please take these vitamins? And I was like, no. So what we're seeing is we want to keep coming up with complex technical solutions for systems and environments that really could be streamlined so we can give people their life back. We could streamline and make it easier. You should walk a little bit. you got to sleep.
Beau Beard (14:19.47)
You know, do you drink any water? Yes or no. you know, how do you, when you're a super stress case, what do you do? And what we find right now is, you know, people are self-medicating at a real, an alarming rate, you know, and at our highest levels of sports and performance, we see it. It's Adderall and Ambien. I can't sleep. I take an Ambien. I wake up. Can't wake up. Take an Adderall. And if you're thinking to yourself, Ambien and Adderall, that's crazy. Well, welcome to the major league baseball, to football, all of this. And at the same time,
What I'll say is if that doesn't feel crazy or that still feels crazy to you, do you drink wine and do you drink coffee? Because that's the same thing. And what we're seeing right now is that people are really struggling to turn off, to feel good and awake, to feel tired. And so we're really seeing a mismatch. then because the human is so tolerant, it's difficult for us to appreciate the outcomes because we live in the now and maybe out in the future in front of us is a month.
But really we're talking about what this looks like in 10 years and 20 years, 30 years and 40 years. And it's really difficult for us to, to manage those things the best we can. Right. So we need to do a better job of, of integrating these practices because we understand them to give us access to our physiology today and protect our physiology for tomorrow. And that's still difficult because it's difficult to do research on the most complex structure in the human, in the, in the known universe, which is the human body.
with a multitude of variables. Yeah. So when we talk about, like what you said about like, it's almost the Joel Salatin of the human body, right? Let the Achilles be the Achilles, the Achilles-ness and then you got to talk about humanness. Like what does that mean? And that is changing and that gets tough because what you said of this kind of looking back with a soft glow on, know, know, Pleistocene and whatever we want to say of, you know, the we lived before.
But what we have to realize is like we are one of the reason we've been successful is our adaptability and we're kind of trying to adapt. And that's what are your opinions? Like obviously environmental mismatches are a huge player in this. But instead of thinking our environment needs to shift back to this, I live in a log cabin, I'm going to go throw and I'm going to just stare at a pond or you know, whatever it is. Like how do we get people to realize like it's not that it's.
Beau Beard (16:44.366)
Like you said, we're trying to streamline. We're trying to make sure that you don't have to add 10 things. You may take away 10 things, you know? So what do you find yourself telling people more often than not of, hey, these are the biggest five things we need to do. This is how you're going to manipulate your environment better. One that we may have actually made an infographic on our site called the 24 hour adaptation cycle. And really what the idea was, you know, we think in this 24 hour cycle, that's how we're wired. We always evolve that way. I mean, so
It's our physiology, it's our chemistry. And what we saw in there was, hey, you know, I'm not, was just having a conversation with someone where I was like, you know what, human beings are awesome. And it's really nice that I'm not gonna die of a tooth abscess. Like I really appreciate that, right? I don't wanna go back 100 years. That's not, know, people forget that the Spanish flu in World War I, right around World War I, killed more people than World War I. Just like 100 million people, right? That was less than, like, that's 100 years ago.
the flu wiped out a huge chunk of the population of the world. So that was yesterday. And I like today. I like my phone. like, but we have to understand that I, just think we're in a time where we're trying to create equilibrium again with this, you know, and the example is I have two daughters and I'll tell you that, you know, I have to protect them against things like Snapchat, you know, and that, you know, these are powerful, incredible technologies, but I would have abused them too, you know,
I mean, and my grandma was like, you whippersnappers and your HDTV. I was like, grandma, like you would use that HDTV. You would love to have six channels, but you didn't have a channel. you know, so the idea here is, we need to help people understand that this is not a finite game they can win. And there's a wonderful book and a blank on the name, but it's called finite and infinite games. And it's about
using some kind of the aspects of game theory to think about complex problems. And a finite game is a game like soccer. You know, everyone's declared a winner and a loser. You know what the rules are, has a start and stop, right? And the goal is to win. And you're very clear about what the rules are. Well, an infinite game can't be won. In fact, the only way you can win an infinite game is to try to play better and to try to keep everyone else in play. And what we're starting to see now is that
Beau Beard (19:08.746)
some of these drains on our ability as humans and health care in America is a good example. So let's make it granular so we're not talking in sort of big terms here. When you and I went to high school, the chances of us being diabetic were one in 4,000. That's the current research straight up. Chances of being diabetic now if you're a child are one in four, right? One in four.
If you're a Latina or Latinx woman, male, excuse me, then your chances Latino or Latinx, your chances of being diabetic are three out of four. And if you're an African-American woman, it's three out of four. So we're not talking about anything, obesity. We're not talking about, we're talking about straight up just insulin sensitivity, environmentally driven changes in your neuroendocrine system that makes you insulin sensitive. Right. And that is a gigantic.
issue that we're going to have to face at some point because it's going to cost us more. We're going to lose a bunch of people's quality of life. They're not going to manage this well. you know, that's for me, some of the things we're talking about really are about social justice. know, Greg Glassman of CrossFit, for whatever reason, however he got there, realized that soda is a gigantic problem. And we're going to have to really
wrestle with our relationship with Big Food and Big Pharma, if we are going to take a view that the role of society is to make society better for those people who want to come play. Otherwise, we're still on the hook. So, you know, for us, it really means, you know, like, if you're an adult, and you're and you never knew that drinking a gallon of sugar juice every day is bad for you, like, well, now you know, and now you can make a choice. But for our kids,
A lot of the conversations that we've gravitated towards are, some of the kids don't have agency and they're products of a system of food insecurity, of food quality insecurity, of stress, of sleep. No one's protecting these things, right? What we have is a mismatch. Excuse me one second.
Beau Beard (21:26.944)
And sorry about that. You're good. Just my wife and our office manager having a party. And the idea is, you know, we're at some point, the right and moral thing to do is to think structurally at a population health level about what does that mean? And what that means is you don't have vending machines in the school, right? What that means is you just don't offer donuts at the swim meet. It means that you just make a simple situation simpler.
by constraining the environment so that's not one more choice because I'm wired for sugar, I'm wired for alcohol, I'm wired for pleasure, I'm wired for it, And I wanna make it so I don't ever have to choose those things. if, know, there's a great, did you see the documentary? I think it's called The Magic Bullet, is that what it was? Right, and it was about using a ketogenic diet intervention with sick people. And there was a girl who was highly autistic, couldn't speak.
right? She she she's eating chicken McNuggets and yeah, and goldfish, right? And after she doesn't eat for three days. And her parents are like, my gosh. And we always tell our all our parents friends were like, Hey, we've never seen a child dark die of starvation of hunger. Right? They might have starvation in certain countries, but here they're gonna eat eventually and after three days, this girl just started shoveling down the broccoli and fish and meat and chicken and right and
That's really the model for what I'm advocating for. It's like, and I figured this out a long time ago, if I don't want to eat cookies, I don't buy cookies and keep them in the house. Otherwise I'll eat the cookies. So for me, it's really just about, you know, we see adults and you can relate to this, you go to Starbucks and your choice is, well, I can have a 2000 calorie Frappuccino with caramel for breakfast. you know, that's fine once a month. You what mean? Like you don't eat
birthday cake every day, shouldn't drink a bottle of wine every day. And I think what we're realizing is we have to start earlier and we have to because by the time patterns and behaviors are set, and I'm conditioned to my environment, it's really hard to back that out. It's hard to make those changes. And we make those changes by being additive. We streamline people's environments, make it easier for them to make the right choice. And we do things like, hey, instead of not eating that,
Beau Beard (23:52.046)
why don't you, one of my friends, Eva Klairsinkowski, her concept is the 800 gram challenge and optimize nutrition. And she's like, hey look, just do me a favor. Eat 800 grams of fruits and vegetables today. That's it. And then whatever you want on top of that. But I don't know the last time you ate 1.746 pounds of food, but that's a lot of fruits and veggies. And you do not feel underfed on that diet. And she's like, oh you wanna eat?
almost two kilos of apples today, knock yourself out. No, people do not become diabetic because they eat too many apples. That is not the problem. And she's like, and besides tomorrow, you get sick of eating apples and you start eating carrots, and then you're get sick of eating carrots and you're like, Oh, what else is out there? So when we try to make it easier for people to conceive this, and we do things like a walking school bus for our kids, what do we do in the morning? How do we get to school? We walked 1.2 miles one direction or 1.2 miles the other direction.
And suddenly it's not a thing that I have to program or do. It's just how we got to school. So what we really want people to be able to do is say, Hey, where do I put invest practices into a life that really is stressed and really is compressed so that people don't, they don't feel crazy and that they feel like to have the opportunity to make choices. The choice isn't accidentally made for them. So something that hits home with me there is I was watching a
we have the TV on in the office in here and a commercial came out for yet another drug for diabetes. And it just, you know, again, same thing, like if they stopped making more drugs for diabetes, people would be forced to rely on diet and exercise, which has been proven time and time again to reverse type two diabetes. But what instead you tend to see in particular, we're in good old Alabama is somebody is going to double up on their medication or their insulin and go ahead and have that piece of cake or that whole rack of cookies. And it's,
It's almost as if we've shut off some evolutionary triggers, right? That is a complete threat to your health and wellbeing and possible life. But we're willing to completely try to gain the system to just continue to live the life we want. But if a lion was chasing us down, we wouldn't just put on shades that block it out and say, I think it's just gonna run on by. But that's what we do every day.
Beau Beard (26:13.3)
Yeah, and that's cultural shift, right? That's really what you're suggesting is that how do we change our culture? the really the only salute look, if you're in, well, my father's position, my grandfather's position, I'm a psychologist, I'm a physio. Behavior change is the most difficult thing we do. is man that is show me how to change behaviors and I'll show you that we can, you know, change the world, right? you know, changing patterns and changing behaviors is
is the crux and it's so difficult that I have seen sat in on heart surgeries where people are who know better who are smart, talented people are getting five stents put in, right? And having, you know, cabbages and they have all the resources, five family members are there, they're loved, but it's that difficult to change your behavior even though you know you're going to die. Even though you know that this is going to because the behavior is set that sugar
and the way that our brains work and porn and alcohol and addiction. mean, we're wired to this. And so we, at some level, we're like, dude, this is a biochemical issue. Let's think about it in those terms. Like unwiring someone's dependence on sugar is really, really difficult because man, get a kick. That was a survival instinct. So again, I would point out that, hey, let's start earlier. And when we're thinking about sort of the complexity of this,
You know, it's easy to make a mistake. And let me give you an example. have a cat, right? We have a used cat from our pounds and we just fed him high quality cat food. And then one day we noticed he was drinking a lot of water from the fountain. And what we said was, one of our cats diabetic. took him in and he was diabetic. And I said to myself, what do cats eat? They eat meat. They're obligate carnivores. What was I feeding my cat? Not meat, cat food. And subsequently we ended up with this cat who was diabetic and we had to give our cat shots.
And what I did was we went out and bought meat cat food that's designed for cats, not full of, and we were doing grain free. We were buying all the, the Shishi stuff. And in three months, my cat is no longer diabetic. I know better. And I still made my cat diabetic through his diet. Does that make sense? Like I am like, wow. I, don't know anything about anything. If I did that. And I think that's, that's how we're, know,
Beau Beard (28:36.172)
We're showing love to our families. That's how our moms love to show us. We reward people with cookies, you know, all of that. So, you what I'm saying is, look, we're gonna miss some people in this boat, because I agree with you. Like, we're not gonna catch everyone. But we can certainly catch some of the young kids. And that means that we need to get involved with our school activities. We need to get involved with schools. We have to talk about lunch programs. We have to talk about, you know,
and eventually we'll catch everyone. Because I really do think people are smart enough. The phone already is so we're starting to see a change in the consciousness around phone usage, right? Already there's like, we're gonna lose again, we're gonna have a generation of crazy people, but we're also gonna have the second generation be like, well, I don't want to be like that. You know, gotta put my phone down. So these are comp, you know, what's the the Makin
quote, it's like for every complex problem, there's a solution that's simple, straightforward, easy to understand and wrong. And the goal for us is to say, what, what can I control? And then let's start there. And, that means it's not at a governmental level. It's not at a state level. It's maybe not even a community level. Let's start first and first with my family. Then I'll go ahead and work with my and talk with my friends. And that's
this grassroots change that we're gonna change. And there is, I mean, I live in Marin, California. I can go in a steamed raw goat milk latte at my farmers market. That's pretty crazy. Delicious. But there are also 17 kinds of kombucha at the gas station now. Like something has changed, right? So I think if human beings can get to the moon, we can solve this problem too. And we're gonna have to because it's going to be such a drain on life.
that people are going to be so sad and miserable that we're going to have to, we're going to have to think structurally about how we manage. Otherwise it's going to ruin people's lives. And this is our shot. And like most things that has to get to a tipping point, which is sad, but you know, and maybe we've passed. I don't know. I don't really think we have in all areas and it is obviously it's not one health is not one thing. It's multifaceted for sure, but let's kind of dive into, we're talking about starting much younger, like
Beau Beard (31:00.546)
you know, my dad, diabetic, has been for numerous years and asked me, you know, like, man, I'm just, I, know, it sucks to have to sit down because you're out of energy. Like I used to just be able to go and he goes, well, how would I combat that? And I was like, you know, XYZ, but it would have been nice to work on that machine 10 years ago. So you didn't get to where you are right now. And that's where it gets tough because you don't want to just say, that's too late. But when we work with kids, let's, let's go from saving the world to the flip side.
So when we're working with kids, it's very important to talk about, you know, nutrition and sleep habits and technology habits. But then the flip side of the childhood culture now is this almost professional athlete mentality that we equate with health. So if a kid is not on his phone or maybe crushing things that are healthy, Gatorade and, you know, protein bars and whatever, then that kid is.
not having an off season, we're seeing overuse injuries, we're seeing things we would never see in a kid, even autoimmune issues that are just wacky and 20 years ahead of their time. How do you tackle that when you're like, we can't have kids sitting on a couch. We also can't have kids that never have a complete off season or getting just beat to hell. So how do we get parents to realize like, that isn't health, this isn't health, it lies somewhere in the middle there.
Well, you know, the first thing is that, um, if you want to make a system obsolete, you have to propose a better model, right? And you don't have to be this message. You know, I have a lot of smart friends like you who are working on your side of the country and at your population. I'll be on my side of a copulation of, uh, the country, not copulation population in country. get a country full. That's right.
I'll meet you in the middle. And you know, what I, what I think is, you know, the role of community, the role of the business, the role of school. Now these are the places where we can make the biggest change. And that might've been the church in the past. might've been YMCA and youth organizations, but we have to sort of reconceptualize where people are spending most of their time and then begin to have the conversation. You know, because if, if you don't know better, then you don't know better, but
Beau Beard (33:24.27)
once you start to see it and it sticks around, how many times you have to offer a kid a vegetable before they accept it? 20 times, 30 times with my daughter, Caroline, 150 times, you know, so, um, you know, the idea here is that it's not a game we're going to win. We don't have to win it because people are really, really tolerant and it, because the body is self-tuning and self-correcting when it begins to get inputs that are more in line with its needs.
we do see self correction and people do lose weight. They do become more insulin sensitive. The thing is that we have sort of all of a sudden radically changed a lot of the moving pieces. you you don't, it's not, it's not an either or because all of a sudden, you know, our kids are playing sports or not playing sports or they're, not active, but they're only play competitive soccer.
We're seeing real conversations. One of my favorites, if you listen to this, is called Change the Game Project or Changing the Game Project. And it's really this reasonable group of people who are talking about the reformation of youth sports. And we shouldn't be surprised at youth sports. Like your dad, for example, is a perfect product of the system. He's a normal expression of the complex system. It's just, it's a person and it's personal. So you can't think of it that way, but you know,
And frankly, I blame all the baby boomers. This is my favorite kind of current cop. I'm like, oh, it's the baby boomers, it's their fault. And, um, but what we, what we want to say is if we fetishize professional sports, we shouldn't be surprised then that we fetishize collegiate sports and see the professionalization of collegiate sports. And by, by consequence, the professionalization of high school sports and middle school sports. And, you know, it's a normal expression of the system. So, you know,
Where do you begin to tug the string? Tug anywhere. mean, if you've ever flown, mean, Virgin America, God rest its beautiful little dead airline soul cells. But on the touch screen, it said touch anywhere to begin. And I think that's really what's important. You can begin this conversation anywhere. And instead of saying, I'm overwhelmed by this, choose one thing. know, hey, I'm just going to make sure that my kid has access to a vegetable once a day. That's amazing.
Beau Beard (35:47.15)
You know, one of my friends is a guy named John Berardi and his company is Precision Nutrition. And John was doing some really complicated work with a very, very sick person, morbidly obese. And what John said is, Hey, I need you to get a dog. And that's your first order of business. And the guy got a dog and was like, what do I do with this dog? And he's like, just take care of your dog. And let's touch base a couple of weeks. And the guy's like, man, I've been walking. I have to go out twice a day and walk my dog. And I was like, really? That's so weird.
And then he's like, okay, what next? He's like, all right, I want you drinking a glass of water today. When you get up and then he's like, he's like, do that for a week. And all the guy had to do is start walking his dog and he started drinking a glass of water. He lost 50 pounds in like a month. And so when we look at these complex, socially driven issues around food structure, learning around food, all of that, what we can begin to do is just control one piece. Here's the simple thing. If you have kids in the room,
We have a simple rule at our house. There's no technology allowed in bedrooms. All the phones are out in the kitchen. And every once in while, my 14 year old daughter will violate the rule. She's just a kid and that phone is heroin. We don't blame her, right? And what ends up happening then is that we have a lock box with a timer on it. And when she loses her phone, my phone goes in there, my mom's phone goes in there, her phone goes in there. And it doesn't unlock until 7.30 the next day. And the only way in there,
is to break open the thing. so what we do, yeah, you can't, you have to break it. You can't take the battery out. I'm just picturing a kid with a crowbar at like midnight, like trying to get into that thing. You can only break it. I think what we're realizing is that, hey, you know, we see that these systems are complex, but the first thing we're gonna do is try to protect our kids' sleep. And how do we do that? Will we remove the choices that would disrupt their sleep?
Right? You know, we tell adults who are always talking about sleep deprivation. I'm like, Hey, look, if you got into bed 30 minutes earlier a day, then even say go to sleep, just get into 30 minutes earlier, just go to bed at 10 being about nine 30, go to bed 11, get in bed at 1030. In two weeks, you will have slept an additional day. Can you imagine what the performance advantage is, or your life or the quality of your skin or your sleep habits? If you slept one extra day every two weeks, that's pretty remarkable. And that's what you're getting.
Beau Beard (38:11.02)
with these small changes. who is it? Is it Eric Cressy who says, you know, small hinges swing big doors. And that's really the idea is that where are the easy touch points before we say, Hey, look, you've got to change how you're, you know, what, what perfume you're wearing and you're, know, we've got to give people options and we've got to show them that there are small changes they can make that will make radical impacts. And when people do feel better, they make better decisions. And
That is what we've been actually predicated our business on for the last decade is that people are so smart and that it's our failure as people to think of people as smart that they can't make the right decision that they need their children. that is just the patriarchy at its worst. So I know that we can do better and let's give adults choices to make and give them better information. Then they can make better decisions.
Absolutely. And I think speaking about the future of health, I think you're going to see, you know, whether that's PT, Cairo, MD, whatever it is, your clever clinicians are going to realize that these catalyzing agents, right? What's the, maybe it's a dog, but whatever the biggest thing is to work on for you may be the simplest thing. And then that's a cascading effect where I knocked out 20 things versus our reductionist approach that has been held in place for the last century that got us
pretty much where we are right now. So I think you're already seeing that rewritten. I mean, that's this whole conversation, right? Is rethinking how we go about it and not saying you need to do 100 things for your health. You need to do the biggest things for your health that just take care of all the rest. But when you get into the marketplace too, you're gonna see the opposite. You're gonna see every supplement, everything you need for your health. And that's just, it's another facet of the same old thing.
Well, I think to your point, no, can't, you know, you can't market sleeping better or, or go into bed or sleeping in a dark room. There's not a lot of profit there. So, you know, we're not, if we can't sell it, you know, we don't, we don't prioritize it, which is why we just have to begin to have these conversations much earlier. And I think that thing's locked. So, then when it opens, pop the door shut. What we're seeing then is, you know, let's, let's make these small changes.
Beau Beard (40:35.662)
and then the rest of it will work out. we have time. I don't think people realize how long a decade is, how long 20 years is, 30 years. And so what does this look like when you make one degree of change on the horizon? Just let that thing run for a while. And remember, you have tomorrow. You'll get the rest of it tomorrow. So what's great is that this infinite game that we're playing resets every day where you can make another decision, you know? And I...
That is the heart and soul of the matter is that you have time and small changes will go a long way. let's do first things first because arguing about what squad is the best squad or which, who's kung fu hard style is the best. Right now on the Twitter, physical therapists are not very good to each other on Twitter right now. They're really nasty.
And there is this notion that, you know, people are too dumb to decide what works and what is placebo. And that really is shocking to me. And I saw just a physio who's really trying to change the conversation around chronic pain, understanding chronic pain and telling people and changing the message that we are really resilient and fragile people. I appreciate that. But, you know, I saw that person equivocating.
They're like, well, you know, yeah, there's some research on myofascial release, but it doesn't really make long-term changes. And I was like, so you're against people making themselves feel better as opposed to what the long-term changes of OxyContin or Percocet or ibuprofen or splints or inactivity. Like what, what are we talking about? You know what mean? Like what I want to do is give people all the choices and show them how they can make themselves feel better.
and then we can have the next conversation. again, at some point, let's start somewhere and wherever that's important to you, do it. When I think a lot of that comes from we are on a new horizon of how we think about health and in that new horizon frontier, everybody's fighting for real estate, just like when they broke open the Western Plateau and said, go grab your land. Everybody's trying to do that in the digital world. And it comes down to that of I'm right, you're wrong. We're planning our flags and what we got to realize, it's all land. It's all health. It's all the same quit.
Beau Beard (42:56.408)
Like you said, it's fodder for intellectual real estate, but other than that, it really doesn't have any value, you know, and you're going to find that out, you know, we mobility is a word that's very popular right now. And we coined it. mean, we obviously didn't make up the word mobility, but there was no mobility. Everything was stretching beforehand. And we purposely use the, I purposely use the word mobility because it was a word that was only used by people who were trying to mobilize the joints, mobilize tissue. And now you can see that.
there is mobility everything, right? And people, someone asked me recently, how do you feel about that? I was like, that was the point. It changed the conversation to get people to care about their tissue health and to care about their range of motion and be able to have a set of tools to make themselves feel better and to be able to remove any professional person who had any financial vested interest in them doing that for themselves, right? And that's what we're doing. So to your point, you know,
this is not my dance space, this is your dance space. It's the dance space. we, until we have changed all the conversation, we need to invite people to the, to the table. And that means you're going to have to occupy a, in in an aggressive market, you know, and you're to have to show people that you're, you're better. And that's, that's, that's what this is about. Now let's, let's get to the two wrap up questions that I always ask. And this can go wherever you want. The first one is,
What is something that you long held true that you've completely pivoted on that you completely had to change your mind whether that was based on evidence, experience, or a little bit of both?
So, you know, I think the first and foremost is that I have become much more moderate in my approach to what people need to do to feel better. Like, you before I'd be like, you better have a movement practice and you better eat a vegetable, some collagen, and you better, right? And now I'm like, did you walk today? Did you get a hug from someone you love? Did you get some sleep? Great, you're killing it, you know, like.
Beau Beard (45:00.47)
I've had to reset sort of my expectation around first principles first. I would say that certainly about, where are we going to begin this conversation? secondarily is that I don't, you know, we have long benefited from the modern age of having access to the best gymnasts, physios, doctors, Kairos, power, and the synthesis of information has been profound. And
we missed how important breathing was in this conversation of being able to affect how my mind works, my ability to pressurize before an Olympic lifting national titles for my aerobic athletes and really seeing the profound changes that taking, we just, we were stumbling around and kept tripping over these bars of gold and we're like, these bars of gold are so annoying. They're always laying on the
We started picking them up and we were like, my gosh, you know, people have been thinking critically about these things for a long time. And it was a big untapped resource. I went back to my notes and of course I taught 10 years ago and I talked about breathing as parasympathetic and down-regulation, how we integrate with PNF practices. And I stopped there and I didn't realize how much I was missing until the last probably three or four years. So talking about maybe, like you said,
instead of bombarding people with all the things of health and getting down to kind of brass tacks. Do you think that's a natural evolution of your practice or do you think it's because you're getting a little patina and we're getting a little more mature in our life and realizing that it's, I'm not going after it as a professional athlete anymore. And that those are the things that I see the most, you know, bang for my buck in my daily life. And now it's like, Hey, I was doing this. Cause I think a lot of us take what we're doing.
and practicing because you know, think the best in the field, at least the health field live what they're doing. Right. If I go to an orthopedic surgeon, that's 200 pounds of a weight and doesn't run and tells me to stop running. I'm not listening to him. If I go to you and you're like, Hey, just walk, or you tell me you need to be heavy deadlift in twice a week and crud. I think either way I'm more apt to listen to you. So do you think that's natural? Like I've just been in the game so long. I realized this or Hey,
Beau Beard (47:23.47)
as I've been in the game so long, I'm hitting a little bit of my senior hood here as a human and I'm starting to realize, man, I didn't need to crush it that hard all the time. I think that's valid. I think that that's a reasonable way to approach or kind of think about the evolution. We're all maturing. It takes a long time to integrate and synthesize and to understand. We're seeking to understand. I also say that
you know, at the heart of this, I think, you, you come back to keep coming back to first principles and you know, when, when you see the truth of something, you know, you've got to figure it out, you know, how does this reconcile? And, you know, I'll put the Wim Hof at the center of this revolution and breathing right now. mean, Lauren Chai, Leon Chaitau.
at all, been taught, wrote an incredible book, you know, but Wim said, Hey, I think we're missing something here. And he was really doing this on holotropic breath. Let's get high. Let's feel better. Let's change our brains a little bit. And I think, you know, at the heart of our model with my friends is that I'm part of a community of tests, retest, share. And what we're really trying to do is come up with an integrated model.
of functionally of how human beings work. And when someone raises their hand and says, Hey, I think this is a way we can improve performance. And then when we start to play with that test, retest and share, think it was, we were all blown away at how much better we could do, how much more untapped potentially have. So one of the things that we've, we've always tried to do is say, look, let's not do a set of behaviors because it may prevent a problem.
That's a poor way to sell anything, right? What we've always said is, hey, let's engage in these behaviors because it gives us better, more rich life. It gives us better capacity. You can lift more, you can go faster, you can feel more engaged with your children, you can sleep better. What's important to you? Right, that first conversation. So when someone comes in with a new piece of data, you know, we always are saying, hey, is this explanatory? Is it predictive?
Beau Beard (49:48.558)
producible? How does this fit in our schema? Because if someone brings us something and it creates interference in our understanding pattern, then that's a hole in someone's thinking. And we've got to reconcile, either change our model or change their model, because those things should integrate. Even if we're using different languages or different tools, ultimately it has to reconcile. I think at some point, we have become more mature because
you know, we've singing practice and practicing, you know, I've been, we've been doing this for a long time. And I think what we should see is a normal maturation of the model, but it keeps keeps coming back. So, you know, I'm fortunately, I'm not a lonely man on an island, I am surrounded by the most talented cabal of people who show me all their work, who are like, look at my notes, what do you think, you know, and I do the same thing. And I think that is how we're really going to change the world. And that's and that's, you know,
If you see someone on the internet shouting down at someone else, you should have alarm bells going off. All of the masters talk about what they're doing and why they're doing it. And they're like, come see anyone else who says to you, that system is broken. You got to do my system. That person has some holes in their thinking is really insecure because what they're selling is bullsh. So let's take the flip side question. So what is something you
Almost would guarantee to be true. You know to be true either again from experience personally with Athletes patience what it might be that just hasn't been proven. There's not empirical data. It's not in the research and you may be doing it you're looking at implementing it into your own life or you know athletes lives Well, you know we have poor support for
our physical interventions ourselves. What we can say is this set of behaviors makes people really strong, right? But, or this set of behaviors makes people better on the bike. But can you show me the research supports George St. Pierre and his training and it's becoming the greatest fighter of all time? Or can you show me the empirical data that makes, you know, that helps us understand Usain Bolt? Well, it doesn't really exist.
Beau Beard (52:15.83)
I think what we have to do is we have to move out of this. need evidence-based practice is really important and practice-based evidence is important. And what we always are going to have to do is go back and some subjective research where we look at what our best practices and try to derive, know, sort of first principles out of there. you know, that's if Sir Francis Bacon was alive today, he was the father of the scientific method.
That's what he would say. Let's look at big data sets and let's try to derive the patterns underneath that. Let's engage a little bit more clinical reasoning. So it's difficult for a movement practice. It's difficult to show that yoga makes better people. Like there's no proof that yoga works, right? And that's like trying to prove that human beings should run. know, like, well, okay. mean, where's the science to support that? Where's, know,
And so I think sometimes we try to apply our scientific method and we fail to forget that for two and a half million years, human beings have been super clever. And what we can do then is go in and try to understand at a higher level of, hey, what's the commonalities between the way all human societies eat? What is that? Turns out that a lot of societies eat offal. They eat connective tissue and collagen and organ meats. There's a variety of vegetables in there.
You know, you know, we should look at why martial arts and gymnastics make good people, right? Why, you know, what, what's the science to support the gymnastics makes a better, more organized person when they're 80. And the problem is that we can't run this data because the human being has too many inputs and outputs, too complex. can't control for these things. So it's a poor, you know, as a physician, they say, you know, as a surgeon, if you want good outcomes, choose good patients, right?
And if you want good research, choose good subjects. Well, turns out human beings are really crappy subjects. And you know, like there's not in a piece of research to support that one eating strategy is better than the others, not a single one. But what you know, and equivocally is you can't eat like a jerk forever. Right? You can't. And so, you know, where do we go then if we can't point to a piece of research and say, that's it? You know, if someone has an intervention that makes them feel better, or they have an interaction with a person,
Beau Beard (54:43.372)
and they get some non-conditional positive regard with their clinician and they feel empowered. Is that placebo? Is that the fact that human beings are tribal animals and that's, that's a first principle. So, you know, lots of ways into this, but I think first and foremost, you know, that the idea is induction is looking at big patterns and trying to understand through clinical reasoning, what are better practices? And it doesn't mean it's the only practice. It just means maybe this is one way that works better. So,
I think in our field we'd like to have definitive research, if we look at the sports medicine research, for example, most of it's not done on women. Why not? Well, women, can't control for women's periods and menstrual cycles, so we throw women out. So lot of the research that people are supporting is done on men who are 18 to 24 and college age, and there's no women there. So what are we really studying? Small group samples? So we need to keep applying rational clinical reasoning and pattern recognition to
complex systems and and Fortunately, I think we're gonna have big data to back us up I think this is gonna be the future of really trying to understand what's going on is through big data And what a better way to wrap up the future of health and I'm forward to that Again, I cannot thank you enough. You are like I said a change agent within the field You know our field PT Cairo, but also just health overall keep doing what you're doing Whatever keeps you inspired
keep hitting that every day and I know we'll put info on how people can a hold of you if they don't know how but at MobilityWOD, MobilityWOD.com, we'll put up links to all that fun stuff. All your work's been great, I'll put up links to your books. Anything you wanna leave us with? Is there any stage advice you got for us besides the last hour of everything that just is like a ton of bricks here? Come join the revolution. We are humanists.
We believe in the power like people are extraordinary and and we think that there's really untapped potential we you know, we we think we want people to eat this way and sleep this way and move this way because You can actually get more more work done. You can feel better at end of the day You can look better naked like what's important to you? Like it's all there and it's it's more simple than you think Absolutely. Thanks. Kelly enjoyed it man. My pleasure. Thank you, man
This D1 Runner’s Comeback Will Blow Your Mind: Navicular Stress Fracture Rehab: Week in Review 39
In this solo podcast, Dr. Beau discusses a case study of a collegiate runner he has been treating since middle school. The conversation delves into the runner's injury history, particularly a navicular stress fracture, and the impact of carbon-plated shoes on their biomechanics. Dr. Beau explores the runner's phenotype, rehabilitation strategies, and the importance of maintaining mobility during growth spurts. The episode concludes with insights on performance goals and the significance of individualized care in sports medicine.
Transcript
Dr. Beau (00:01.006)
Okay, it's time for solo cast the day after Christmas. So the office is a little bit quiet. So I feel like come in here and break down a case about a D1 collegiate runner, somebody that I've seen since honestly middle school. So I have a long track record with, you know, just kind of taking care of the little likes and pains, a few major injuries, a major injury here about a year ago, which I wasn't the lead on just because now they're in college. So then they're under the supervision of their athletic trainer and the team doc there, played a role in that. And then this person also got to see some,
decently well-known people within my field, the conservative musculoskeletal realm, looking around at the same issues. So you also got some interesting insights and input there. So to go back in time, let's just phenotype this runner. This is a male runner, he's in his sophomore year of college right now, or junior year, sorry, junior year college.
lost about a year of competition to a navicular stress fracture, which we'll get to that. But if we back up and we just go after the phenotype of this runner, this is your, know, if I use Keith Barr's kind of description of a stiff person versus a stretchy person. So we're just looking at tissue composition, maybe from a collagen standpoint. But that stiff person or stiffer person is gonna score lower on baiting criteria. From a running standpoint, they're going to be, have more proclivity to, you know, kind of bounce off of tissues.
maybe not getting to end ranges so they lack some of the, you know, maybe motor output from, you know, accessing a full range of motion, but they have a stiffer tissue profile, which sometimes can be advantageous for a faster runner. Now this is kind of a mid distance guy, you know, cross country 1500, two mile. You're going to hit a cap where, you know, this always blew my mind when I was doing research for my course, Rethinking, Running Rehab. I wanted to know from a literature standpoint, what,
what's that composition, what's that phenotype of elite, like marathon distance runners. I would have assumed it was like this person I'm talking about, the more stiff, the more, you know, kind of running into stiffness to allow them to bounce, you know, down the cross-country course of the track. It was actually the exact opposite. So these people aren't hyper mobile, but they're, you know, own a full range of motion, basically would in our world pass a top tier selective functional movement assessment. And then you kind of have to surmise, right? This wasn't in the data.
Dr. Beau (02:25.378)
but you kind of take the stab that, they probably have fantastic motor control, just like any good athlete would, because again, an elite marathoner is basically sprinting the entire marathon. So their motor control is through the roof. We always talk about this with elite athletes. have great inputs and really good outputs. Their sensory motor input-output game is just top-notch. Same thing with an elite marathoner, distance runner. And yeah, there are going to be, you know,
different veins off that, but if we look at a bell curve, they fall further to the right on the mobile side. And then in my opinion, we see a lot of these amateur runners that are decent, they fall more into that stiff profile. So maybe that's why we see some of these injuries show up, but we can also have that more mobile runner. And if we look at foot types, if we're zooming in on this runner in particular, they have that more pescavis, rigid midfoot.
And that can lead to more injuries. Now the data would say that that type of foot is going to dictate that they would have more injuries up the chain. So because they can maybe dampen forces at the foot using that soft tissue matrix, using the arch of the foot, that they're going to end up with more things about the knee, or I'd say knee and up. So knee, hip, things like that. That is not the case for this runner. And if we look at the flip side of that from the data, there's people that, again, this is not a, we're just talking the static position or posture of the foot, so more of a
pes planus or a collapsed medial longitudinal arch, they'll deal with more lower extremity injuries, metatarsal stress fractures, medial cibial stress syndrome, fibular stress fractures, things like that. This exact opposite, this runner in particular has dealt with everything more or less up until this last kind of thing that I've been seeing them for below the knee in terms of, so in particular lateral foot issues, pronial tendon issues, because they live in this kind of supinated, extremely springy,
rigid midfoot, which they've just kind of capitalized on, which I'll talk about why I think that's happened also. Some stress reactions, never a full blown stress fracture until this navicular stress fracture, which we'll get to that as well. But why I think this foot type didn't follow the literature, nobody follows it to a T of the expected outcomes. But I think why this happened was this runner is extremely motivated.
Dr. Beau (04:47.598)
a driven type A, gonna do it on their own, and from a very early age started stacking on a bunch of volume.
there is no better window to gain mitochondrial density and build aerobic capacity from a physiologic adaptability standpoint than kind of in that 13 year old to 25 year old range. You're just never gonna be able to lay down mitochondria, new mitochondria, but also uptick mitochondrial density and also the secular size.
Like all these things are just kind of up ramped at this time. And that's why we see so many people. I was bringing up Lance Armstrong was a, and again, there's a genetic prowess there of his ability to shuttle lactate and things like that. But you see people at a young age get this aerobic base. Courtney DeWalter was a cross country skier. Lance Armstrong got on a triathlon. All these people had these huge, usually lower impact, massive aerobic base building periods of their life at a fairly early age that then capitalized on these elites.
on a genetic component for a bigger engine or VO2 max than a lot of us mere mortals will be running around with. So that being said, I think during that formative time of aerobic base building, this person went gung ho and already had the phenotype of the stiffer tissue profile. And we know when children or teens hit these adolescent growth spurts, which that peak height velocity kind of shift
It's kind of a curve where we have this initial bump, it comes back down, peak height velocity goes way up, goes down, then we have one more peak usually later. But that's gonna be about 12 to 15 years old, depending on sex. And we got all these things going on nowadays that shifts that earlier and earlier. But during that time, we see what happens to most children. They lose ranges of motion because bone growth outpaces muscle and for sure tendin-muscular tendinous junctions. And as they do that, they lose range of motion. So we're always telling.
Dr. Beau (06:50.924)
know, parents and student athletes. I wrote about this in my book. A lot of good information comes out of the Canadian Center for Sport on this of, you know, tracking gross spur to making sure that kids, athletes in particular, maintain mobility through this peak height velocity phase because if you lose it, it's hard to get back. So we want to maintain it. So going back to this runner, I think they stacked on a ton of miles, didn't do a lot of like mobility maintenance. This is just as we were kind of getting acquainted.
I I barked at them about it, you know, as we went, but you know, as you start to lose this stuff, it gets hard to get back. And then they built stiffness on stiffness. So their body had to capitalize on what they're already good at to maintain the amount of volume they're doing. But also like this is a, you know, a high motor output, good athlete as well as their, you know, ability to push into the ground or create kind of this, you know, a good power output in the ground is capitalized due to the stiffness. So they're using a stiff chassis more or less to like drive
you know, torque into the ground. So we have that component to it. So I follow this athlete through high school. They have a great high school career, help the team, you know, become state champions, gets recruited, goes to the University of Kentucky, is there. And this is right around the height. You know, the end of his high school career was the boom or the initiation of carbon plating in shoes in particular, you know, was supposed to be or it was aimed at race footwear.
And we didn't know, we didn't know. And all of a sudden, literally two or three weeks, which I've talked about this on social media before, two or three weeks before I saw this athlete in my office, which I didn't know this was happening, or maybe we heard from his mom initially, that there was a study that came out showing, and it was a small study, same amount, I wanna say it was 15 athletes, but it was all elite, collegiate runners that were basically being
stricken with, I don't know if that's term, navicular stress fractures. And they were correlating that there are mechanical changes that happen with carbon plated footwear that changes a wear load is first initiated the footwear displaced through the foot and ankle. And then there's debate on, the impact forces may be going up overall with the carbon footwear, which that's a whole nother conversation.
Dr. Beau (09:14.828)
Either way, there's been a very good, and again, we're not saying causation, there's been a very strong correlation of wearing carbon-plated shoes, and we're not saying just erase. This is where the trend started to come of people training in these things. So this was like, you know, being worn every day or multiple days a week, changing mechanics, and any time you introduce a new mechanical load, the tissue has to adapt. And in this case, we basically have, you know, the navicular, and I'll probably throw up an image at this point.
If we look at the navicular bone.
It's more or less, you know, I'm kind of pulling up.
Dr. Beau (09:57.314)
You know, can have accessory naviculars, I guess would be the most common plight around here, which is kind of like, it's basically a little shelf on the bone called your sustentacular tali. In my opinion that accessory naviculars becoming a wolf's law on demand that we're seeing more of a bony overgrowth on that sustentacular tali because you're probably using a passive stability
process or strategy around the mid-foot. So then we see that the posterior tibialis tendon crosses or goes under that, you little hook and then you basically create more bone to lean on it. But in this scenario, we see this rash of navicular stress fractures and you know, the navicular is this kind of floating bone. It's basically supported by other bones around it. it, know, navicular means boat in the foot or sorry, in
Latin and this floating bone is a rarity to have a stress fracture and because it's not having impact forces basically dictated upon it because it's basically conforming to the rest of foot. Now you can get stress reactions anywhere. We've seen people that get multiple, you know, like cuneiform, know, cuneo navicular stress reactions, degenerative change within that joint structure. But this basically floating bone
rarely get the stress reaction, in particular in elite runners. So then we see this kind of change. Well, we hear from this runner that, or I think his mom is the one that told us that the surgical intervention for the stress reaction, which it becomes surgical because you can have basically an island of bone or what's called an osteochondritis dissecans kind of lesion occur where that island of bone within this floating bone just kind of becomes dead. It's hard to heal. It's also, you know, it can be a tough diagnosis because of where it's at, MRIs.
are the best we have for stress fractures. But by time we catch them, I don't know, it's just a hard diagnosis, I'm being honest. So bone plugs, basically a bone plug of your own bone that's usually being harvested from elsewhere in the body, the pelvis or something like that, is being used to drive in to fill the gap of this bone island or the stress reaction, stress fractured area. So this runner had this surgical intervention over a year ago.
Dr. Beau (12:24.35)
Gets told the timeline. I think the initial timeline I am not for sure was 12 weeks to you know Maybe it was eight weeks to start loading which would be typical bone healing timelines again I have another chart in our exterior rethink or any rehab of the actual full scale healing times for a healthy individual We're always you know thinking six to eight weeks somebody's out of a cast or a boot the bone injury That's not full healing. It's around 24 to 30 weeks is full bone healing to get the full
know, cortical structure, trabecular structure in place. And if we think of a bone like this, you know, and now we have to think if we're changing and, without getting too lost in the details, because a lot of this is theorized and there's different plates and different shoes and different super foams. And so I'm not going to speak for all the shoes, but the overall theory, if we had to be very simplistic about this was that with a carbon fiber plate, basically that plate winds up right. And it just allows us to,
collect more potential energy, which we can then drive into the ground in terms of kinetic energy without, it's a passive energy source for us, which is largely what your foot and the windlass mechanism of adequate range of motion, right? We were talking about this range of motion equation where if we lack range of motion, we may lack motor output because you're going to be sparing of the tissues. If I can't control the range of motion, I lack motor output because I just kind of get trapped in these end ranges. You know, like maybe somebody that's a little
more of the hypermobile side. But you know, this Goldilocks zone of good range of motion with good motor output is the key. Well, if I can, know, the windless mechanism is basically, you know, winding up the big toe across the plantar fascia through the Achilles tending, displacing, you know, or allowing all that to wind up. And yeah, with some drive from the soleus as the biggest driver of endurance output, we get a bunch of elastic recoil or integer return to the ground. Well, you throw a carbon plate in there, wind that plate up.
you get more, but what they found out was it was displacing force earlier into the front of the foot. And then basically, instead of force being driven up into the tibia, which is what we typically see. the lower portion, lower medial portion of the tibia or lower distal third of the tibia is the highest impact point on a human when they're running or just bounding or anything like that. That's why you'll see a force sensor put there when we're doing like gait analysis and force studies.
Dr. Beau (14:50.722)
So now we see it's displaced into the foot. you know, as the foot hits the ground and we see a lot of, you know, faster runners or more of a forefoot to midfoot or full foot runner, we see that the force is being driven through the foot instead of up the chain. And it was going into this, you know, kind of floating navicular boat like bone, you know, no bueno, even though you get more energy return and, know, probably an adaptation period where if they, you people weren't training in these all the time, which they weren't being coached to do, all these things are at play anyways.
This runner deals with this, has a surgery, gets cleared to run, gets back into running, short order, we're talking a month or two into run training, I think 20, 30 mile weeks, they start getting a literal bump on that distal portion of the medial tibia that we're talking about, like a little bony reaction. It's sore, it's not stopping him running, but now there's a little hypervigilance, we talked about this last time he was in the office, a little hypervigilance that's occurred because now,
They've had all these little injuries in the past, but now they had a big injury that kind of, you know, been a little insidious, hard to pin down. Then when it pinned it down, it was a surgical intervention, knocked them out of running. They get back in running, they're like, dude, my medial shin's hurting. So they are going back to school. I kind of, you know, just concur on that. You know, it looks like a little bit of stress reaction, the medial tibia, you're probably offloading or changing, which we know happens with any injury and surgery is just a planned injury that's, you know, made to heal eventually.
and they get back into running and it takes a little bit of rehab and kind of, you know, bouts of time on time off to kind of get over this medial shin stuff. And then they kind of, you know, they start having, you know, maybe some mid foot pain, which really worries them because that's where initial injury was. And then some lateral foot pain and kind of basically my take on it is where you're going through it was, you know, you're to have to accommodate with, you know, a foot that A doesn't move quite the same. You've probably lost a little bit of mobility just from the injury and the surgery that you had.
But also you're trying to stack much miles on again on a compensation and you know, this is part of the game of like You know, how far can we go before the scales get to too far in one way? So this person, you know competed they Had a cross-country season all these things occurred this year. Well, then I see him in the office For the first time, you know two three weeks ago and now the complaint is, know I'm having some like almost like distal anterior tib around the front side of their ankle like
Dr. Beau (17:16.942)
tightness, soreness, but the main complaint is they're having like inside of the hip and back of the hip kind of discomfort that usually is only there with easy runs and almost non-existent or non-existent at all with a harder workout, faster tempo run also dissipates fairly quick. This person had the opportunity to see early with this injury, a really good practitioner in Chicago that was well known in the gate world. They also on this go round were coming back from a training camp.
in Big Bear, California, and this person got to see Courtney Conley, who's just like, you know, the OG of foot stuff at this point in the world. And again, I haven't talked to Courtney about this specifically, but I'm assuming we're saying the same thing. But if you feel what's going on in this person's hip, I mean, they have a ton of tension and more or less adductor magnus and a giant Hawking trigger point and the deep posterior rotators of the hips. When we're looking at, you know, quadriceps,
and the gameli group. And anytime I see trigger points in that deep rotator cuff of the hip, it just is like a lockdown of security or you're having to do more work to stabilize your hip. Well, if we think about bipedal stabilization on one leg at a time, there's kind of just this, know, a gross heuristic, but it makes sense. So if I'm stepping onto my right foot,
more or less the lateral posterior portion of my hip, the lateral rotators, the muscles we're talking about, glute med, men, you know, max a little bit, along with the adductor group and then the opposite side QL are kind of what are stabilizing single leg stance. Obviously there's a lot more stuff built in there, but we think of these like these deep kind of lines or groups of muscles. So when we see things can change around the foot, we can, you know, almost map predictable.
compensatory patterns around the hip or up the chain. Well, so now we take somebody that has always more or less lacked calcaneal eversion, right? And the ability to eaver your calcaneus means that you're gonna be able to max out force displacement, in particular torque, through the first race. So if we kind of hit on the outside of the heel, which they're great at, right? They live in inversion or a supinated position. In particular now,
Dr. Beau (19:34.958)
and then cross over control pronation into that kind of Myers line orientation, displaced force view, lat calc annual eversion, you kind of come off it lacking a little bit of that end range so you can have more drive out of the calf, more drive out of the hip, whatever, everybody's got their thing. So this person came in and the one thing that they did tell me that Dr. Conley told them was that when they did a gait analysis, they kind of had this weird little, basically they were whipping back out into like heavy.
supination on this right side more so than the left. One of the weirder things to me with lower extremity injuries is inversion ankle sprains and the secondary compensation to it. What you'll see with an inversion ankle sprain, so everybody's rolled their ankle, you roll it to the outside, yeah, you can roll it to the inside. Way more common, roll it to the outside. You would think people would want to live where they're kind of walking on the inside of their foot and towards their big toe to get away from the rolling of their ankle again. It's the exact opposite.
So the architecture and the design of the human foot dictates what? That the stiff rigid position of the foot is the supinated or inverted position. Cause you're kind of stacking in particular stacking the cuneiforms and that navicular bone into a conformation that allows for a rigid foot both from bony architecture but also winding up the passive tissues around the lateral portion of the foot. When an ankle sprain occurs, you'll see people live in that position cause people come in with restriction in.
pronation or eversion through, you know, calcaneo-novicular joint, cuneiform-novicular, all these kind of different restrictions, but then soft tissue, you know, people are sore up through the pronius or the muscles going up the outside or fibularis group, whatever, I'm old school. This person, that's what they're complaining of is pain and kind of the anterior tib pronius group. They've always had this rigid foot, which is a little more rigid and eversion, you know, kind of midfoot pronation than the left.
And now they're having like lateral and inside of the hip stuff that's worse on easy runs. You'd be like, okay, well, let's break this down. And these are all just trying to create a narrative that makes sense. So we can make sure we're working towards an appropriate goal instead of just kind of being like, we're going after your stiff foot and it should work out. Like I like to write a narrative that doesn't just go too crazy into the weeds of like, you know, a plus B plus C plus D plus, you know, it's like a plus B equals C. Does that make sense? Cool. Go with it. If it doesn't change or re address.
Dr. Beau (22:00.15)
In this scenario, if I had a navicular stress fracture, a mid-foot injury, and maybe I lacked motor control, which literally we lay this person down the table over a out from injury, just testing static positions, right? What you would do with a low lying orthopedic exam, when we wind them up into a inverted position, they can't resist inversion, not with, because they have pain, just not there, they can't resist eversion. So when we see that, you'd be like, well, you know, muscle testing sucks, applied kinesiology sucks, whatever.
Just a protective mechanism of the body is to decrease motor output to basically spare tissues or pain itself will decrease motor output. So you just take it like that, you have decreased motor output. Yeah, you could change it by having them think a positive thought, think about unicorns rubbing their earlobe. I always tell people if they come back in, second visit, third visit and it's not like that anymore, that's what matters. Because we don't want just lingering decreased motor output just like if, I'm not saying we do this, if you did it.
a single leg glute bridge test and said, your glutes weak. If they couldn't do it, whatever that means to you, cool. But if they can't do it, that's still not normal, okay? That's all we're saying. As we said, there's also joint and tissue restrictions around here, but then we see the hip really bothers them. Their go-to, they're showing me, not me asking them, is a single leg pogo jump on that right side. And when they do it, they basically turn Dellenberg. So they lean to the right, jumping on the right leg. And again, if you imagine biomechanically what's going on.
The outside of the hip is in a massive concentric load and it's like the outside or the lateral rotators and posterior hip musculature are creating a sandwich of driving, you know, the femoral head into the acetabulum and then leaning on the adductors and their biggest complaint is this like inner hip burn tightness work pain in particular with squats and easy running. So back to why easy running might be bugging it.
When they get into these higher speeds, they're saying it's non-existent. What's this person? Tight, springy phenotype. What are they gonna do less of? Have to control the motion from pronation or supination or pronation. They get to bounce off mid ranges. Their ground contact time is nil. This is a fast runner. They also have much bigger arcs of motion through hip extension. So now he can use the front of his hip to drive, Or allow his leg to drive behind him and pull it back into him.
Dr. Beau (24:25.902)
So this is where, again, if we took a small tangent on decreasing impact as the end all be all, I know it's harnessing impact into the ground for upward and forward propulsion. So we kind of demonized upward propulsion in runners for a long time and then realizing the average of elite runners in upward travel is around 15 centimeters. That's a huge amount of motion. Well, then we're basically jumping from limb to limb or leg to leg when we're running. We don't want to decrease that. We don't want to flatten runners out, which was a coaching cue for a long time.
We have a very bouncy runner by nature here. And when they get to bounce, AKA run fast, he does pretty good. When he takes bounce out of it, because you slow things down, you reduce the ability to wind up this tissue or this passive tissue is quite so stiff, he has to use a little more motor output, which creates in my head, more workload around his hip because he's having to basically live or he lives, he doesn't have to. The compensatory mechanism that he's lived with is it's like, I'm just gonna live in this rigid,
supinated foot that seems like a safety mechanism that he has to learn to unlock. Now, I will put this video in the podcast video for you to watch as I'm doing it, but I'm just gonna kinda talk through it. So we had him in the PT bay here the other day, and this is our second visit since I've seen him, and we kinda knew like, hey, from an audit standpoint, what do wanna see change? Your foot's gotta move a little bit different. It's always been stiff, but I'd like to see a little more, know, navicular eversion.
mid-foot open up. So we started working on that and we're using basically the trigger points in his hip and adductor as audits. Those are compensatory mechanisms. They're secondary, they're not primary. Don't treat secondary things, use them as know, dashboard lights to dictate if we're on the right track or not. So we do a lot of work using his foot.
to kind of work his hip into submission, using some DNS stuff, lateral lunges, cueing, really cueing the foot position and the stabilizing features of his foot. And we can improve it. He goes out and runs and he's like, yeah, it's kind of the same. Comes back in and we throw him into this drill and I'm gonna put the video up. And you're gonna see two different sides. So his right side is the injured side. And I just wanna say on here, we had permission to show these to everybody.
Dr. Beau (26:44.48)
It is a night and day difference. And you can even see I zoom in on his right hip at one point. He literally does what we said. He leans on his hip, which is this extremely common compensation pattern across a lot of athletes. So if we look at MLB pitchers, you'll see a lot of a cam deformities, which could be, you know, early pitching. And again, creating a bony deformation or bony response. Maybe we call it, shouldn't call it deformation, just adaptation to the demand.
but they'll start leaning on the inside portion of their hip. Any type of rotary athlete, we see it in runners all the time, that they make this like sandwich where they'll just use passive stability. Like just imagine that we're using the head of the femur as deep into the acetabulum as we could, not necessarily maximizing surface area, which would be called like functional joint centration, not maximizing surface area of the acetabulum, but we're just kind of driving into one portion and making make.
Basically a concentric muscular contraction sandwich and what's his complaint? Pain in the back of his hip pain is adductor In their palpable trigger points there and we can change it actively and then he goes out and runs and it comes back So we put him in this drill So you'd be like why is he lean on his hip and then in my opinion, it's he lacks Basically tibio-tailor rotation which plays in the navicular eversion but not from a passive stable standpoint
This is the shutdown mechanism that he's used to kind of keep himself safe post injury. Because in my opinion, if you can unlock tibiotalor rotation, which AKA is how you kind of drive torque into the ground. If we look back at Sergey Grekovichky's, know, kind of spinal engine theory, that if I can't create that torque through that, you know, that domed joint of the tailor, you know, the tailor joint there.
If that's a good way to kind of keep yourself safe, but not maximize power output in the ground, decrease speed, displace force elsewhere that has to work. And now that's what we're seeing in my opinion. So you can see the drastic difference of left versus right. But then you'd say, okay, well, why aren't we working to the ankle? We are, we just, have to load his hip. So his ankle has to dictate what his hip does. So what we had to do was we didn't send him home with this drill. This drill kind of puts him into a stranglehold. It's like putting somebody in a half Nelson and saying, use your arms, not going to happen.
Dr. Beau (29:07.47)
What we did is we kind of did some, use some wedging to play around with basically like a supination, uh, curtsy or a curtsy lunge. Um, we really queued up his footwork, right? His foot stability kind of creating a tripod active, um, you know, toes, but really through the ball of the foot, right? So through that first ray through things like a lateral lunge split squat, front foot elevated split squats. We kind of get deep into the hip to work on, you know, those posterior hip musculature and the lateral rotators.
really like the lateral lunge, especially slide plated because his adductors just want to walk down. So now we get to essentially load his adductor while we get to work on foot mechanics. And these, as I explained to him numerous times, these are active mobility drills for basically his, his tailor joint, like his ankle in particular for rotation, which he totally got. And we even threw a little drill, which I can put a video in here of like we call them, God, if I could.
You remember ankle pendulum. Sorry. I named stuff weird and blanked ankle pendulums. We just have a sandbag on the knee. saying, keep your foot planted. Gently let your knee, if it was a flashlight, like kind of pan to the right and left, which is forcing rotation yet. You know, femurotibial joint for sure, but it really at the tibia Taylor joint. And he just can't do it. But he goes, you know, when I keep my foot planted, he doesn't get any of that pinch in his adductor, you know, groin area on that right side.
What's also mean? I don't know because I do not have a feedback visit yet off of this last one, but we also saw a change, drastic changes in the trigger point, like abolishment of the trigger point is post your hips. So that kind of deep rotator cuff of the hip adductor was better tone was decreased. But if we, two of the passive things, we put them into hip internal rotation from a 90 degree, position supine, you get a little bit of like pull there, but we could decrease all of the active pain components in things like a squat.
lateral lunge, split squat with cuing his foot, right? So when he uses his foot different, I'm not saying better, but different than what he's learned and to compensate with, he has no pain whatsoever. And he would kind of be like, which from a motor learning standpoint or concept, that's what I wanted him to adhere to. So it's kind of a negative feedback loop. So sometimes I might wanna say,
Dr. Beau (31:28.492)
Hey, what do you feel here? He's like, I feel my big toe or the ball in my foot or whatever he feels. That's his feel for whatever we deem a correct rep. But I'm gonna be honest you. I think sometimes for him right now, it's better to say, when do you not feel your adductor? Well, that was the highlight for him when he's like, ooh. And then he's like, when I do this with my foot, that's why I feel my adductor. You know, ding, ding, ding, here we go. Now.
You know, he's got big goals. He's basically high, you know, going into he's an indoor right now wants to have an indoor season, which is also the indoor track is stressing, you know, that right side into, if you think we, you know, I think there should be way more alternating directions, especially in training with track athletes in particular indoor, cause it's such a tight, small track. but now you got to think of the bank of the track, the material and indoor track is made out of. it's a little bit spring year.
And then we put the right foot, which in this scenario, it's right side up the track. What's it have to do way more of? Well, it's going to land. we remember we said we use some wedging. So when we wedge him to the outside, he's like, God, I have no pain. But what's he have to do? He still has to drive back through his first ray. And if that's what he lacks, which in my opinion, it is, it's just, think, giving him a good challenge. And he even said that without me queuing that up first visit, he goes, I think indoor has kind of, you know, made this a little bit worse or staying out a little.
It's just a different challenge, right? So again, your adaptation threshold is kind of what, not kind of what, it usually is what determines injury or not. So we'll see, but he has big goals and definitely big goals for outdoor. And then this is, you know, like I told him, the cool thing is this is kind of no different than what we've ever worked on. You just went back to your, your strong suit or your play from a compensation or safety standpoint. And it showed up for the first time ever with hip stuff. Like I said, him like,
you don't have a hip injury. You don't have a tendonopathy. You're not having, you know, sports hernia or this, know, pubic gramus, you know, or ischial or ischium kind of irritation yet. So, you know, just kind of stay the path, keep working on your foot. And then this could not only, you know, decrease pain, but have some performance outputs. We kind of drive into the ground a little bit harder and more efficiently, which we know so much now about how much more running economy is affecting outputs of even these, you know, mid distance athletes than, you know, maybe a greater
Dr. Beau (33:46.786)
maybe not greater equal component of real capacity and VO2 max. So it's kind of cool, but I know that was a lot of nerd talk about lower extremity injuries and running. but it's just a very interesting case, especially being, being a solo podcast to kind of just go over with somebody I've seen for almost the entirety of my career right now, which is going on 10 years and following them through their career. yeah, it'll be interesting and I will for sure do a follow up. I will put some videos in
or you guys will have seen some videos throughout this. But if you have questions, you can always reach out to me because I know some people are more interested in this others. My big thing is if you're a patient or runner listening to this and you have a question on this stuff, it probably behooves you to just do a consult and that's not me just trying to sell you on a consult, but trying to answer a high level question for a personal medical question or personal performance.
question being answered via email, it's just like that's very hard to do and you're not going to get the value out of it. So my suggestion would be to do a console or go see somebody, you know, like me or that's just kind of trained and can look at, you know, running and mechanics and gate and tied all into good functional approach. I hope if you're a, you know, a student, a doc in the profession that you learn something, if you're a patient or an athlete, same goes for you. And I hope everybody had a good Christmas and we'll see you in 2025.
The Secret to Pain-Free Movement: Dynamic Neuromuscular Stabilization Revealed: Week in Review 38
Summary
In this conversation, Dr. Beau and the FARM team discuss the principles of DNS (Dynamic Neuromuscular Stabilization) and its application in patient care, particularly focusing on movement, breathing mechanics, and motor control. Through various case studies, he highlights the importance of understanding fixed points in the body, the role of intra-abdominal pressure, and the significance of assessing rib cage functionality. The discussion also touches on practical applications in pediatric care and the continuous learning process involved in mastering DNS techniques.
Transcript
Dr. Beau (00:01.932)
Who knows? I can't see.
Hello in there That's what I thought at first and then like I the description
Dude, says DNS Nana. Yeah, that class looks cool, except it's just rich and Brett. Who's the third? starts with an mode. She should, but, but it's in Napa. So they're just going to drink wine. Cool. I'd like to drink one. When I saw where it was, sent to Katie into possible trip question mark. Yeah. well talking about DNS, that's going to be the
gonna say flavor of the day. I think I've been watching too much Guy Fury. I guess.
Dr. Beau (01:18.158)
All in a Copa Soba. That's not obviously all in a, that's to say that's an A and that's okay. So she'll be cool with him. Get in there. That's basically who I don't want to say. Well, whatever is basically running the rehab like Prague school at this point is just off being famous. but we are talking about DNS, any hot topics. We were just talking about how great of a
care, my kids got it, the nurse practitioner, which was leave that for behind the scenes. we had a patient that went to their primary care and had magical palpation skills. they had, they had abdominal pain and bilateral anterior hip pain and their primary care touched their like spinous process of their low back and goes, yep, you're having muscle spasms. Even though she could do like no back pain, full like toe touch extension and like
Yeah, never, I don't know, never once felt her back. But I mean, that's maybe they, where are they DO? Nah, I don't They have a piece of hair under 200 telephone book pages. The mammillary skills have gone, but. Mammalitis. Yeah, mammalitis. Any updates on any other previous patient stuff? I mean, I guess one that I haven't shared about. Scooch up a little bit there.
The one that I haven't shared about, and I actually just got off the phone with him where he, like every now and then something will come up with like with his neck and his upper back. Me and Bo both had treated him in the past. And I just looked at him last visit and I was just like, hey, I just want you to get an MRI. I'm not scared about anything. And, but just to further explain everything that's going on. And then he did. And then you could see the right neurominal frame, like narrowing.
And I was like, so this was like, when you get in a difficult jujitsu position, and you're just doing that for fun. And then you have all this stuff going on your right side. And then it's like, he's listened to Runtala, listen to like a Tia, listen to all the DNS stuff. And then it's just got me, you get to re-preach it all. Yeah, which is usually our job because we don't know anything. just, we just happened to be in Birmingham. So just, yeah. Echo chambers of other people. Any other updates? What was the last?
Dr. Beau (03:37.73)
Last one, I mean you. Scooch up on these mics, bros. I'm at the edge. You could straddle the edge. Or you could come around a little bit or you could bring this to you. Or you could just hold it like you're singing. So we had what I think for what cases we did. Last one we did was the LCL. That's right. I have not seen mine since then. mine comes in. She's running like the one month. OK.
Actually, she did. She raced a trail half marathon. She did great on, I also treat her husband and her husband did really well in the race. And he said, it's a pretty tame trail, but I rolled my ankle a couple of times. And when I did, I went, no, my wife's in trouble. I think she fell twice. But I think he's rolled his ankle like once on, yeah, for the past two years. He's been has well, and it was one of those and he goes, I just rolled it and I kept going. was fine. It wasn't like the time we saw him last year.
Hotter than hell. We're talking about the acute ankle sprain protocol thing. We just need to send more people like, hey, there's this whole video of bulletproof ankles. It's actually a way that you can probably not do that anymore. again, what do we know? That's why we're doing a podcast. We talk about what we don't know. That's actually the theme of today. So Sloan and I were talking last night. She saw two new gymnasts yesterday. So this one, again, not being my case, I'm kind of giving you the
30,000 foot view, but this gymnast had been working with a PT for the previous three months because she was having low back pain, which surprised, surprised with the gymnast. The PT referred her to Sloan. She's just like, she's not responding. She'd also taken, I don't know if she is still currently taking time off, but it had taken quite a bit of time off. Nothing was changing. So Sloan's working with her and you know, as most things usually kind of go back to like just fundamental, she's like, okay, let's, you know, end up in.
three months supine, see what she can do. She was kind of telling me she's you know, scalloped in her upper back or like super erect in her thoracic spine. And she's like, when I tried to get her to kind of depress her low back into the table, she couldn't, she literally couldn't get like T12 down to the table. And you know, then someone's like, well, I need her to get her rib cage down and she just couldn't do it. And you know, the byproduct of that is she was going into like cervical extension, which is common.
Dr. Beau (06:03.788)
when somebody's kyphos in their mid back, but then it's kind of, why are they doing that overall? And then she, so on, it's kind of going further. She's like, well, I need her to get, you know, that area of her back down. Cause that's like the fixed point. I was like, well, no, it's not. So this was like, we had a probably 30 minute conversation from that point. She goes, what do mean? That's not like the fixed point. So for those listening that aren't familiar with DNS, one of the common themes of DNS is you have a fixed point or a punctum fix them is
how as we go through movement development as a baby, you have to have something as a base of support to then move from. So if a baby is, you know, set down because a human can't do much on its own, it's set on its back, the fixed points are what? So you guys know what the actual fixed points for just, we're saying a supine, let's say six week old. So the external occipital protuberance. Should be shoulder blades. Yep.
And then, is it sacrum at that point? So I always liked the analogy. Brett Winchester said it during, think the last DNSC that I took that if, the patient was lying on a glass table and we can look underneath Adam, that's what you'd see kind of pressed in or like flush against the table. So then someone's like, well, why do we, which is, you know, these are all good questions and you know, I was an attack in her and she was asking good questions, even though, you know, we're both pretty far in our career. She's like, well, why do we want people to flatten their low back into the table? And I go,
Well, then you're asking what's the goal of the exercise that you're doing, not the position that you're in. So again, if we take a three month old baby, have they developed a lower dosis in their lumbar spine yet? Not really, right? You still have anatomical differences in the shapes of those vertebrae for the most part, but you haven't uprighted yet with gravity to kind of force you into that lower dotted curve. So when a three month old is on their back, their spine is relatively flush across the board. If we take any of us and we're at,
rest in three months supine, right? At rest, that's resting, which it should be. Your low back may be in contact, but that doesn't mean it's pressurized into that glass table, so that's flush. So would we have pressure on the top of our hand if you're picturing if somebody's laying on their back and I'm trying to slide my hand under like mid low back? Yeah, I shouldn't be able to get it under there. There shouldn't be an excessive, you know, lower doses or extension. But when we tell people to flatten their back into the table,
Dr. Beau (08:29.932)
That's not the fixed point. Sloan goes, wait a minute, T12 is not the fixed point? goes, what's your diaphragm? go, your diaphragm is the internal fixed point, but then it needs fixed points like an X, which is off of really your sacrum, right? In your scapula. And then to have movement of your head, which starts with your eyes as a, you know, six week old, which is when we first get that first optical, you know, fixation, you have to have a fixed point of that EOP to then be able to roll your head around.
Right. Which then you have another triangle from your OOP to your scapula, kind of a triangle down to your diaphragm from your scapula diaphragm to kind of the edge of your sacrum, right? Your PSIS. But that was kind of mind blowing for her. So she kept going through, she goes, well, then why do we want them to do that? go, if somebody's in start position, which for those listening, just like child's ish, a lot of the times you can use that to do what? Induce.
Flection, somebody's low back, you can use it to shut off the erectors or get them to relax. So in that position, when we say where you're supposed to flex, because again, if you laid a six week old baby or put them, know, knees under them, basically the pose that you'll use for like newborn portraits, right? Tuck their legs up under them, have them kind of laying on their own hands. That's kind of start position. That's why it's called that. They're in flexion.
So then you kind of have to start asking, what's the goal of the position? Do I want their erector to shut off? Do I want them to be able to flex their low back? Do I want their back to just be innate and I'm air quoting a neutral position? And she goes, well, I wanted her to be able to get T12 down because I knew I needed a rib cage to be able to depress. And she goes, so I just had her do a big inhale and an absolutely full exhale to get her low back flat. And I go, but in that case,
If you're not palpating the difference, which I think would be hard to do the difference between what your rib cage is doing your back. You're now watching like parasitic movement, right? Or respiratory coupling. So what that what I'm saying there is if I just say, Hey, take a big exhale. You can just be flexing your low back. So you're still running into well, I need my rib cage to move independently. Right? Of my spine. I don't want to flex my spine to use breathing. And that might be why she's in that scenario in first place. Now you're asking all these chicken or eggs.
Dr. Beau (10:50.346)
And I'm going, I'll go back to hierarchy here. But it was a very good conversation to have because she's like, well, I just feel like I don't understand DNS well enough to move out of the sagittal plane then. And I go, we don't necessarily need to. And I kind of brought up stuff that you and I have talked about, Alex. go, Sloan told me that she's like mildly kyphotic or lumbar spine, not TL junction, like lower lumbar spine, right?
And I have this kind of hypothesis that a lot of this has to do with kids being sat up too early. They don't have that lower dotted curve formed and you kind of like literally like fold in your lumbar spine and now you have to get hyperacted in your T spine. It can happen for all sorts of reasons. It's just a theory. It could be rotational sports, which this girl didn't do. So I was like, we'll just be a little more fundamental with it. Be almost like FMS or Grey Cook. So if her upper back is scalloped, you know, then we have to ask the question, well, on palpation,
Can it flex, right? If her lower lumbar spine is flex, can it extend? So the first question is what? Can it move from a just mobility standpoint? Second is, can they move it then, right? Which is a stability or motor control thing. And then it's load management beyond that. Like that's, and again, too, like, it can't be that easy. That's what you're doing all the time. And we make it complex with all this. It's three months, it's six months and, know, a fair input.
And again, you can use all that stuff to speed up any one of those processes of health and mobility or stability or whatever. And then I go, okay, so then let's, have that hierarchy. So then if we said, okay, cause she's like, well, I have a hard time. Cause I was like, if somebody couldn't get that T12 down and they have this scalloped T spine, like three months soupines probably not a good position for them. Right. Cause I would assume, and I don't know, they probably lack, you know, motor control or stability around the periscapular region.
Right? That's why they're like that. And that's why they can't get T12 down. So it's like you're like having the body when you're assessing in three months supine. All right. So if they couldn't do something in the lumbar spine, don't think it's a lumbar spine issue. Think like you don't have a fixed point above your lumbar spine to probably work from because your legs and feet aren't on the table. Cause she was trying to. Yeah. Vice versa. So now she's trying to drive her head into the table. they're either, you're like, maybe that's a problem. And then vice versa. What if Sloan
Dr. Beau (13:13.742)
took her legs, right, while we support, put T12 down, and all of a sudden you see that like her neck, like you should be working on upper quarter stuff. Which we would all be like, that's literally regional interdependence cooked into DNS right there. So then I go, okay, let's create a hierarchy where you're like, because I said in that scenario, maybe you put her in, know, start position or a modified start position to work on scapular stability or, you know, upper quarter stuff. She goes, that's where I get kind of lost. I go, okay. So Sloan was,
Not under the impression she was correct and like, I thought the diaphragm was the key. I go, is, but it has internal fixed points primarily to your rib cage and your spine. So the first thing we got to do is make sure they can breathe, which we all just work on. Like, you know, do they have a decent breathing pattern where we're getting circumferential expansion and not necessarily this apical motion? Cool. Once you've established that, then you have to very quickly do what? Determine, can your rib cage actually move? And then if it can move, can it move independent of your spine?
So that'd be the second hierarchy for me. So that's why I said, I think it's a flaw to coach somebody with huge inhale, full exhale, okay, now keep your ribs down. Cause we don't know what happened to their spine versus, you know, go from their head and literally like drive, you know, gently their rib cage down, which if you go to Prague and watch them work, that's where you're going to see is they're going to guide the rib cage down and then kind of watch what happens. Do they go into cervical extension? Do they?
you know, bring their shoulders into protraction. You know, is there a bunch of rigidity? So it's a palpation and it's a, you know, mechanical fix. And then third after that would be, well, now you can start working on, you want to flex or extend or, you know, whatever. But I think that helped her of, again, we all know that, you know, does it move? Can they move at load management? Then it's like, well, can you breathe? However we want to say that, like diaphragm, rib cage movement is a huge deal.
because of the diaphragm function and then independent movement or that uncoupling of respiratory motor uncoupling that needs to happen. And I just think that like, it took me a long time to figure that stuff out. But I think a lot of that came from me looking at breathing so much and being like, like the independent movement's a huge deal. And then also seeing how much of DNS in Prague is rib cage focused and all the Mojishua stuff and manual therapy is largely rib cage. And you guys have seen the rib cage chart.
Dr. Beau (15:40.876)
So I wanted to kind of bring that up because again, here's somebody that's taken some DNS courses, not as many as any of us honestly, using the concepts. But then in that scenario and how this all started with that gymnast was, comes in, has extension-based pain, but also now has flexion-based low back pain. My theory on that was, and I'm not knocking anybody, I bet what she was doing with the PT for the past three months, because that's when the flexion stuff started, how they were load managing a poor motor control scenario.
both parts are flex and extend. So Sloan was like, well, I put her in a Cobra and when she lifted up, was like highly lumbar erector driven, right? And she had some pain and Sloan goes, okay, let's start over. You know, got her to relax her erectors, just use her arms and go into extension. She's like, the girl said it hurt 10 times worse. She goes, so that seems really facet driven. She goes, the thing doesn't make sense is why does it hurt almost as much to flex? And I was like, that sounds like a motor control thing, right? Like you're not necessarily.
Cause she's had imaging, right? So we have all these things going, we're like, well, we've ruled out, you know, major pathology. So it's like, well, what would cause that? You can't shut off your rectors even when you are getting them to relax. Like, cause that's also a misnomer to say like, we see them on versus like, let's shut them off and go back to your extension. Well, they're, you know, probably not. Or can you palpate the multifidus? Obviously the primary care for our patient yesterday can. It's impressive. Yeah.
so again, I wanted to bring that up because we had a 30 minute conversation. think that's got value for all of us and hear people listening as well. And there's a lot of stuff that, you know, I came back from Prague and explained how one of the DNS instructors was like, I don't know how somebody, I can't remember who asked the question, but I don't know how they exactly framed it. But basically what's some of your pet peeves of DNS that you see perpetuated, you know, being taught. And it was.
agreed upon by all the instructors there from the Prague school. They're like, we don't coach IAP or intra-abdominal pressure. We want to see that occur as an ideal pattern, as a byproduct of proper position, work, reflex, whatever it is. And here was kind of a point of conjecture for a long time. What do mean? You're not going to coach it. But that scenario we just talked about is a perfect scenario. Because what would you have to work on? Breathing.
Dr. Beau (18:07.47)
But that's not necessarily being like, hey, let's create pressure. And I think there's also a difference of coaching IAP versus letting it occur and then drawing awareness to it, which is no difference than if we took somebody into a hip hinge and we didn't say, hey, we're going to look for hamstring tension. You get into a hip hinge and they're like, you say, what do you feel? And they're like, I feel hamstring tension. You're like, do you feel your low back? No. What do you usually feel? feel my low back. You just drew awareness to a difference.
I think that's maybe more appropriate or what the, know, prog instructors are saying. And again, it's nuanced. We, think feeling for IAP is way more important than creating it falsely because it's probably too much. And you know, is that going to persist? Probably not. so yeah, that was not mind blowing for me, but it was a good reminder of like, those little knowing that little thing can change everything, right? Of like, that's not our fixed point.
where is T12 or I'd say upper lumbar spine, the actual fixed point, like what positions in supine or developmental? You said the upper lumbar spine? Yeah, like L1 through L3. months? Yeah. So, and that's what I was telling Sonia ago. When the goal is to create mild flexion of lumbar spine, that's where six months, but that's a higher level position. And by that time you've also, you're probably loading up on, you know, elbows for sure, hands.
So you're having to control sagittal plane motion more off the ground. So now you have more lumbar pelvic control. When you do that, you can flex your spine. You've already started to develop a little bit of a lower dose, that's why I'm pushing into extension. But the other thing is, when you're working on that with people, a lot of times you have to assist that, right? It's a hard position to get into. you'll, I remember Dave Juring showing us like, you you're putting the tops of your feet underneath, you know, basically their butt and letting them sit in flexion and then.
playing around with breathing and pressure and can you remove a foot one at a time? But that gets back into like, I just remember learning the old SMA, like four by four matrix where it's like, can it move? Can they move it? And there was a lot of like lumbar flexion drills, because they're always working in this primary movement pattern function of like flexion or, you know, fetal position is like the first position. So you'd actually if somebody had low back this function of extension and flexion, you'd actually go after flexion first.
Dr. Beau (20:32.738)
just they were trying to create again a heuristic. So they have that little, you know, rope walk drill that we do with people sometimes reach her flexor spine up and they do cat cows and they do standing, you know, med ball stuff. But that's where Sloan kind of started with this girl. She knew she needed to flex her lumbar spine. So she gave her a med ball and had her do basically like breathing walk downs, right. And the flexion I was like, but you just want to load management. Technically you gave her load and you're working her through flexion and we don't know if she can flex your T spine.
right at all, we don't know if it moves. that's, you know, and I'm not calling my wife out here for anybody to listen like, God, they're throwing her in the bus, not there. I told someone I was going to talk about this because it's like, song couldn't answer the question goes, I can tell you for sure how well our T spine flexes. So don't go to the higher order motor control stuff. And again, you can use motor control to help mobility. I'm not saying that, but if you don't know, how do know if it changed? How do know what your actually primary like
portal of entry or your functional audit, whatever you're call it is. But we've talked about that a lot and here like just make stuff simple. And I didn't have the option to make, well, I probably made it complex in my head. I didn't have all these tools when I started. So it literally was like adjust soft tissue and bird dogs and Stu McGill's big three. So you had to really be on that because it's like, God, if I can't get somebody to move, you know, like what else am gonna do? I didn't have anything else to do with them.
And I was probably messing up DNS left and right because I was trying to do what I've been taught by Brett in clinic on the fly. but I didn't know all those nuances. So you're just putting somebody in a position and like expecting stuff to change rather than knowing the expected outcomes first. Like we were just talking about, if they can't get their, you know, TL junction down, we'll watch what's happening elsewhere. And that's kind of where you're probably working or noticing dysfunction or whatever you want to call that.
So any input or the questions on that kind of topic, specifically on like, know, fixed points, you know, that hierarchy, anything on that. Cause what I queued these guys up with before the podcast was like, Hey, we had a good conversation last night, Sloan and I, do you guys have any questions about DNS in particular that have just kind of stuck with you since you've learned it? Like you're like.
Dr. Beau (22:55.79)
It's never made sense or this has never been clear. Cause there's lots of things in DNS, the further you go through it, like you'll go to a seminar or something. You're like, God, why didn't somebody say it? that's first time. Like numerous things that I've went to and I'm like, I wish somebody would have just said that because it just was a lot easier. And some of that's language barrier when you learn from certain people. And some of it's just, there's a lot. And some of it's just, you don't, you're not smart enough when you go to take the class or you don't know enough. Yeah. guess that's more so the one. Yeah.
Well, when you're early, like I said, I got taught from an instructor working on live patients, you're like, that'd be the best. That's like learning to, if somebody was just like, hey, I'm gonna tell you if this lab values this, just tell them it's wrong, right? Hey, if this lab values this, tell them this is wrong and then tell them what to do. And you don't understand like human physiology. And you do that for a couple of years and pretty soon you're like, when this is wrong, this is what we do. You don't have an understanding, you just got.
taught like the basic rules. That's kind of what I was taught. It's like, we get in this position, you want to work on pressure, you want to work on breathing. I don't have all the know-how or the experience. So anything come to mind of other questions in other realms in DNS, and maybe we can take it outside DNS, like conceptual stuff. It's never made sense. I don't know if I'll have the answer either. Mine would be not necessarily always on just the breathing portion, but
how often would you say you try to cue someone on like the movement you're trying to get out of it instead of letting the, I guess like movement happen if that makes sense. Like you put somebody in a position and you're just like waiting to see what happens versus like, hey, I need you to do this, this and this for me while we're in this position. And you're saying with their breathing or overall? Like overall, guess, like if you're, I don't know, like a low oblique and you're really going for some tip.
And then like how often are you queuing that versus just like you just tell them, Hey, I want you to roll over that bottom hip, see what happens. Yeah. So, I was lucky enough to do a manual therapy course at Rich Olm's house last year. And so it was a smaller group, way more, you know, questions being asked. And, towards the end of the course, we all went around the room and said like, Hey, what'd you take away from it? What are you probably going to change or any big, you know, mind blowing experiences? And Rich was like, I'm going to start queuing people way more.
Dr. Beau (25:21.41)
He goes, was under this, because there used to be this guise of DNS of like no talk, reflex, stem, it's all manual, like reactions are gonna happen, which is true. But then, mean, we're there with Martina and then Robert Arden was there and then like just queuing all over the place. So my thing is, your queues, no different, well it is, it's motor learning. So how you're queuing is a big deal, right?
drive your knee into the table is not nearly important as a cue to me of, can you get your hip to work? Watch what happens. Do they try to drive their foot into the table? Do they drive their knee into the table? Or do they turn more? So it's no different than what we just said with Sloan. If Sloan's like handy, they're T12 down and then you're watching what happens. So then you gotta ask, okay, what's the goal of the position? Well, then if I cue something around that, so let's say Seth said low bleak. Let's say it's five months shoulder roll.
sort of they're on their side, their arms kind of out in front of them like a, know, pitcher stretch almost position. And we would know, okay, what's the goal of that position? A little eccentric load, you know, on the posterior capsule, you know, creating a synergistic kind of action around the shoulder, hopefully offloading the neck. The neck doesn't get too involved. So we could, you know, that's where I give the cue all the time. I'm not telling them, hey, I want you to do this. I'll just smash them to the table. I'm like, hey, can you lift me up?
Because the first thing we want is that lateral expansion, right? We don't want them to just like drive their arm into the table. And then you watch what happened. They turn their neck on. Okay, well, that's now I might have to cue like, what's the cue? Shut this off. Like I'm fine with that. If they can't do that, then you got, you know, props, which again, if you're motor learning, what's low level stuff, it's device feedback. So if I give them something to like rest their head on, that's not near as important as like, can I get a good pattern while they're, you know, doing it on their own or offloaded?
So think that's a big deal is like, don't go hard after what you just need to happen. Like I know I can get if I just drive your knee through the table or hey, resist me. You can do the resist me stuff because that's kind of the manual input. But maybe the better thing there is if it's resistance first is don't tell them to resist you. Right? Like a lot of DNS is like, think if they're in three months supine, you're not like pushing on their ribs and telling them like, hey, let your ribs go down yours.
Dr. Beau (27:46.872)
See what happens if you push on somebody's hip and let's say they give you no resistance or you can't move it, you're also palpating like tone and stuff like that. So you could kind of push them for a second and then if they push back to feel like keep going or like there's a lots of ways but remember I put out that Instagram posts that walk through the phases of motor learning. That's what DNS is and a lot of it we try not to give verbal stuff but like Rich said like why not like best in world are doing it more than he was.
Right, which he, this was a manual therapy course too. It's not like an exercise course. So that's where he was really blown away. goes, man, like we're doing rib cage work and stuff and you know, lot of cues with that. So yeah, it's a quite a bit, but don't go hard and heavy after I need this to happen. So I just go after this. And then also never have the expected, you're going to feel this. So I think we're all doing that well. And here if you do something like, Hey, what do you feel? Rather than like, Hey, do you feel your hip?
Like it's a bad, that's leading the witness. Like don't do that. Cause it got a lot of people. How many times have you done like a sideline, like hip roll, you know, movement and somebody has pain, right? And then the pain's not where their issue was or cramps in the top leg calf. you're like, yeah, or whatever it is. you know, what do feel? I'm feeling, yeah. Cramp them up her back and you're working on their hip that could tell you something. Maybe that means nothing. I don't know. You gotta, you know, that's information you gotta deal with at that point. Yeah.
That was a very important, I forget when we talked about that, several meetings, staff meetings ago of asking them, what do you feel here versus, you should feel your hip in this. And I still do that occasionally, unfortunately, but for the most part, I'm trying to think, all right, how, what do you feel here and let them tell me, and then decide if that's important to change or have different. thing to reconcile is.
So the question out there is, what if they feel the wrong thing? That ain't up to you. So how do you determine right from wrong or good from bad with a rep? Does it have the desired outcome? So let's say, I don't know, like a single leg deadlift. Let's just say that. So what would we expect somebody to feel in a single leg deadlift? Lower than the posture hip. Yeah, like hamstring. Yeah, that's what we'd expect. We wouldn't want them to feel probably pain in their low back.
Dr. Beau (30:08.954)
Yeah, that. So what if somebody's like, feel my right cue well, and they're on their left leg. Looks perfect, you know, all that. Maybe, you know, that's where it gets a little more nuanced because that's, know, Greg Rose is really good at this of everybody's got different input. Some people have different kinesthetic awareness, but also like, why is that thing hard for him while you're working on in first place?
you know, it might not be because they need to feel their hamstring. It might be, hey, what if they lack central stability and they're a single like deadlift, now they do feel their opposite side like flank. That might be a good thing, you know, especially if it's loaded. See, that's a hard reconciled thing and that's not a rule that's just, you know, per case, per scenario, per exercise type thing. But again- I can't put one in mind of like, she wasn't good at like, she has like some hamstring issues that she's dealt with like in the past. Like at least one of my patients said that she had like a-
hamstring tear at one point. So then we started working on like some coronal plank because she has like terrible balance. So I had to do suitcase carries. Well, before thanks, this was like right before Thanksgiving came back and she was like, I was almost down for the count during like all of Thanksgiving because I was so sore around like my obliques and on like my right QL that like I almost couldn't like touch it. And this is a lady who runs like, you five miles, like three or four times a week. How much weight were you using? I think I used 20 pounds. Yeah.
So it shouldn't have been super heavy. And yeah, she was like on my right side, which is where she has all our hamstring issues on, was just like destroyed. But there you go. that's, know, is that a good thing or a bad thing? And I only had her go down our hallway twice. Yeah. She did it on both sides. She did it on both sides. And her right one is the one that like got smoked. Yeah. So again, that scenario, like I kind of like that stuff because again, soreness now gives you more feedback. You're more aware of that area. I mean, there's a
all sorts of stuff you can play around with that. But yeah, think the more, again, if you layer understanding, know, great grows would be like, if you understand motor learning and you can do whatever you want, because that's like, you understand the concepts of all rehab more or less. That's what we're doing. Then you have to kind of understand physiology to understand like tissue demands and you understand aerobic capacity. So if you want to be in the rehab realm, you understand those like big pieces. I think you do pretty good. Obviously you got to play a little bit of intrinsic motivation stuff.
Dr. Beau (32:34.04)
Cool. You got the rehab part down. on table, maybe it's a little bit different, right? There's more palpation nuance there. Maybe, maybe less. don't know. any other questions like that within DNS realm or yeah, what do, what do we think is happening when let's say you're looking at somebody in three months supine and, there's an asymmetrical expansion of interdominal pressure from side to side.
and you're able to cue them up to create it uniformly across one. Why, why do we, what's the mechanism behind why that's only showing up on one side and how are they then able to change it? we contracting half of the diaphragm? Like what's, what's creating the inability to eccentric those muscles in the abdomen on that side. And then how did they actually change it? Yeah. And I don't, anybody listening, I'm not an instructor.
I'm only able to think like I'm the all-knowing DNS whatever, but in this office, I kind of have to, because I'm the senior kind of clinician. like these are the questions we're addressing. We're addressing all the time. No, great question because that's part of the assessment, right? Like it's, you know, you're looking at somebody in three months supine from the head. If you're in DNS, what B, you're kind of like, there's, you know, big valleys there.
or a valley you're saying on one side. go back to what we said with what would you see on the glass table looking underneath? So you basically see EOP a triangle down to the shoulder blades. And then if you cross triangles over to the sides of the sacrum and then the diaphragms in the middle was six different attachments, roughly different anatomical attachments for everybody in the middle of your abdomen. So also realize that it's not a contraction game so much in terms of like PRI where you're having a harder time doing in my opinion.
functioning of the diaphragm differently. You said a very good thing of like, why aren't they able to, let's say somebody had a right-sided inability to create IAP or they have kind of an indentation around their hip flexor, just more tone. Well, they don't have a great oblique sling stabilization strategy going across there. So that's why they can't let it eccentric load because they're in a concentric load to create some semblance of stability. You're saying you would expect to see some change in the opposite scapula.
Dr. Beau (34:55.682)
Point of support. can't write rules, right? So we have what? Ipsilateral and contralateral patterns. So if I'm, we're using a three month supine position. So that is a what position? Ipsilateral, or sorry, that's bilateral. Well, it's yeah, ipsilateral homologous, right? So it's basically flipped over, you're on hands and feet. When you're there, do you need a lot of oblique control? No, right? Cause you should have everything kind of paired up. But if you have dominance on one side, right? You've had an injury, you shut down function.
It's just kind of how you play. So you can't say, they have right-sided, it's going to be left-sided shoulder blade stuff, right? Not necessarily, right? Because it can be still ipsilateral, be rib cage expansion on the right, right? They don't have enough pliability. So there's a lot of options, but you're just taking that piece of information and saying, exactly, well, why wouldn't they have it? Well, if I go feel their abdomen, it's soft, that's not a heavy concentric load thing. So that's different than somebody that's like brazed up and no IP.
Here's two wildly different things. So now I can do what I can change the position and see if the inter abdominal pressure changes, which what they're saying in Prague of like look for it rather than coach it. Let's say you see it change in a right sideline position. But that side down. Yeah. I mean, you can make that a contralateral ipsilateral position, depending on how you, you know, move the top, know, extremities.
Well, you can play around with that a little bit and you're like, man, it's better regardless when they're on their side. Well, that seems more like a right-sided like issues. And I'm looking at like maybe rib cage piability again, like can they expand in the lateral, you know, compartment, maybe even their hip, how that plays into it. But that's, and again, you don't have to use all that stuff, but I'm just saying if there's a single sided things, what I usually guess there's like a blank sling stuff. Yeah. But it could just be a rib cage movement. That's, know, you know, lateral scoliosis, like changing.
Yeah, and train things like that. I think it's also good to note the difference between high threshold pattern and low threshold, like they have nothing going on at all, right? Or like, they're just not able to create pressure because they're so like cranked on. Those are two wildly different things. And then we get into all the stuff that they'll teach you in DNS, which is just likelihoods. So do you remember what you're taught in DNS when somebody has like, let's say an inadequacy and intra abdominal pressure on one side?
Dr. Beau (37:16.558)
Like more often than not, that's the side that you're gonna have injury or pathology in lumbar spine. And that's not really research driven that I am familiar with. That's just more anecdotal in the terms of like when you're looking at, you know, assessment from a DNS standpoint.
Kind of makes sense. Your dysfunction, maybe shut down. It's like an ankle sprain. You shut down your, I don't know, right? Mechanisms, you can make anything plausible. You could also say, well, it's going to be opposite side, right? But that's what you're kind of, or least I was taught, is like when you see single sided dysfunction, that's usually the side. But those are the games like, you know, Pablo's playing, he's like, you have lumbar sprain. Like he's just looking at the presentation and kind of making the best guess. Yeah. Anything else on that in particular?
trying to make up anything else or any more input on that. How often are you assessing the rib cage in different positions besides just three months? are you using that as like your main assessment and then going from there? Main assessment, honestly, I do it seated. I mean, with almost everybody I'm having to go hands on head and I'm just kind of giving them like, I don't even know what those, there's compression tests. You're checking for rib fractures. Yeah, rib fractures. Like I'll do that right away.
on a lot of people, then yeah, three months and then on their sides, but on their sides is where I start usually working on it, from manual therapy, but it's intercostal, it's just rib cage pliability. Yeah, three months supine because again, you can do it prone, I guess it doesn't really matter. It's just literally, I think rib cage pliability is one of the easiest things to feel. Then you got to determine, well, what are you actually going to do? You're to use breathing and your manual therapy, just exercise to get that to move better. it?
we've talked a lot about in here of is that rib cage stiff because they lack stability on the opposite side. So that's again, that like posturing around it, like good luck manual therapy and that into a more mobile rib cage on that side. But going back into the asymmetrical finding stuff, mean, that intra abdominal pressure is no different than if we had somebody in a four point rocker test. So hands and knees rock and then you see one shoulder blades like massively flared or winged or something. The other side's normal. You can't
Dr. Beau (39:27.342)
draw the immediate assumption that like, they have an abdominal like oblique sling or oblique sling issue because you're still right in a homologous position. Yeah. So it again gets back into assessment, taking parts away, change positions, you know, stuff like that. Any other questions in DNS realm? Daniel. mean, I feel like my biggest thing is, you know, my own kids. It's like,
You know, have my one and three could be poster kids for DNS. My middle one where it's the one and like every guy wants their son to be a stud athlete. And he just so happens to be the one who was born with like a little bit larger diastasis who kind of started to drag his leg, but is also the one who if I'm throwing a ball with my boys, like one of them is going to catch it with his body.
And the two year old is going to like reach up and catch it with his hands. And I'm like, of course you are. And then it's like the whole rib cage like playability, like we're talking about, like I brought up to you where, you know, I could see him dragging his leg and like my weakest point is for sure. Knowing when and making sure I'm doing a stem the right way. And his crawl ended up took longer than I wanted it to. Cause you know, you want to feel like, you know, DNS. So you want it to start, like you want to do it and you'd be like, boom, change in a week. I'm amazing.
And then it really took at least a month where you start seeing it normal and then I'll be and it's kind of like some of the things that were said just about patients general I just feel like you see the position you want to say why mm-hmm and then so like with him like I'm in the we're in the den like two nights ago and He brings up because I put the DNS kids poster up and he was just like I want to do the bear and I was like perfect and then so like we're doing it and then like I'm trying to treat it like a game like we're playing and then
he'll be in a position for like a second and a half. And I'm like, nobody, let's keep on doing this. And then he wants to do a different one. So I'm like, okay, cause I want to treat it as fun, play, cause then he's going to want to keep doing it. And so that's like the biggest one that I'm working on now with him is just rib cage pliability. And then just like making sure you like compensation patterns because, you know, I don't know, you know, you hear anything from like three to five.
Dr. Beau (41:50.446)
And who knows if it's even older, but it's like, I'm in my mind, I'm like, okay, those are like my age limits where like, want him to be resolved to this before we get to that point. Cause then it's just all fun from there. But then just always making it fun for kids because I mean, if you've ever worked with a baby or a kid, they don't love it. And then you're trying to make them do what they don't want to do. so, yeah. Yeah. You know that, you know, I've talked a lot about Maddox our oldest was
in the birth canal like head cock back into extension and oblique. And then, I mean, not right away. But when she started like trying to lift her head up and stuff, like she literally couldn't like she goes into like extension and like had to roll to the side. And I was like, man, now you were at the course with Brett. And when we had Maddox in there, and she was nine months old, he goes, you got a perfectly healthy six month old baby. Yeah, nine months old. got a variance in there.
But that for a long time, was like, God, so, you know, I was working with her. wasn't changing. You know, looking at other stuff and she gets collarbone fracture that adds a little more peace into it. But while I was talking to someone last night, the kids were in the living room and I go, well, look at Maddox. Like, you know, she had this deep neck flexor kind of, you know, whatever you say, weakness and stability. We've worked on it, but then look at her rib cage from A to P is like shrunk down or pretty compressed. You look, she's like,
upright like this. So she could turn into that person that's got like a scallop T spine because why when she goes to get up off the ground, like she probably has to extend heavily from here and like push her head into the ground. Right. So she doesn't have this like clean, like, I have a fixed point. Where's the fixed points for you to get up off the ground, shoulder blade, and then you can lift your head up and then you could do a crunch. So again, we each remember we do the kind of Lindell lift test. so she couldn't do it. I her head just, wow.
So that's like a sit up and then little by little she would go into gymnastics and they do sit ups and they're coaching her. So now I'm like, did she just learn how to compensate well enough that a sit up looks 95 % better and it's terrible or is it better? that's, you know, I feel like I don't know everything by, feel like I know a lot and I'm like, I still don't know with her. is it perfect? And then there's no perfect, right? That's the thing. It's not, is it better? Yeah.
Dr. Beau (44:10.072)
Can she get a public ground doing a setup? Yeah. Does she choose to still? No. So I just watched her the other night cause she's doing like four rolls or somersaults all the time now and stuff. And like, if she goes on her back, well, she'll just roll to the side. And it's like, I don't know. Cause that's a preference thing. You look at our youngest, who's not even two, she just literally gets a ball ground like a ninja. That's different. Yeah. So then again, a lot of people listening, like, why don't you work with them more?
It's not easy, right? That's not a cop out. And we still do work with her. I worked with her two weeks ago. We were down in our garage working on it. And at the same time, I don't want to be like overbearing with it where they think they have an issue. And yeah, so we just try to make it fun. We look at it. And then if it got, anything got severe enough or she started to complain of pain or something like that, it's like, yeah, we're going to go after it. So it sounds like a wait till they're in discomfort, but like nobody is developed.
perfectly. And maybe there's some, I don't know. Maybe you'd be like, isn't that what the best athletes in world? No. Good kinesthetic where you're second, right? You've got some stuff different, but kinesthetic awareness and athletic ability, whatever you want to call that, which we were just talking about that course, which they're going to talk probably a lot about that. at that, what was it? The neurologic approach to athletic development.
That's probably what they're gonna be talking about is like, well, can we help it? Yeah, are some people inborn with it? Can you improve those? You know sensory motor processes for sure and that's what we're working on with DNS Not just the mechanics and calming down, know trigger points knee-centric stuff Yeah, you're aware of it for sure Any other question? Sorry, nevermind. Yeah. Yeah. It looks like it. It looks like it you tell me that is not like Nana Of course it is. Nana, California?
No, DNS. at the top. It DNS Nana. yeah. I was wondering what you were saying. was like... Because the P is like... Yeah, okay. Well, Rich will love that you called out his design skills. please come at me. He'll himself to sleep tonight. That's okay. We all need to do that every once in a while. Any other big conceptual questions outside of DNS? Where you're like, doesn't make sense. And if you're listening, if you have any of those, like, you know, share it.
Dr. Beau (46:32.75)
And a comment or something when we share this the Instagram or Facebook Or you know, whatever write me a letter send out on a carrier pigeon or something Anything else? I just think every DNS course you go to you just like what's the why try to understand why you're doing it like I remember when I first got with Bo Like I did exactly what you're not supposed to do like I jumped around a different DNS course is not necessarily in order and then some of the basics once they clicked and I mean like
you know, being a Rambo every day, like it clicks pretty quickly. But it's like, understand the why then I think you're looking at different cues. mean, now I think every seminar I go to, my notebook is just filled up with like cues and old wording. we're talking about DNS goes for everything. Yeah, right. Like diving into Z health stuff, soft tissue. Like I was telling these guys that I think they need to go take an ART class because helps massively with palpation skills you have.
Not that you have to be able to legit soft tissue thing to fall back on. Sometimes when you're like, you see this calm down, it's not. And let's say you're not gonna dry needle. It's a kid and they're terrified of a needle and know, stecho, you need a bunch of different tools, but also you're expanding your knowledge. then if you're like, dude, I take the ART stuff, it just doesn't make sense that like, creating a slight pressure, moving the muscle is gonna calm down or trigger point. I'm with you. That doesn't make any sense to me. But if I'm talking about,
increased tone in the muscle and a nerve that's running through them, the nerves irritated, makes perfect sense to me, right? Especially if I had a trigger point, calm down the trigger point, now I wanna move stuff through there. Maybe that's not a time for neurotraining. Like you have all these reasons, but then all the concepts need to be questioned when stuff persists, which I've had a bunch of where you're like, that just doesn't make sense. Like maybe they're not right as an option, right? Or maybe you just aren't far enough down the road to have it make sense, but that's what's gonna make you better is to constantly like,
ask those questions and get around the right people. And I'm trying to think what I asked. We were watching Pablo work somebody up in the auditorium in Prague and Robert Lardon was standing in front of me. I asked him, why is Pablo doing that? And he's like, I don't know. And this is somebody who I've put on basically the same level. He literally was like, I don't know. So that's at same time, like not everybody has all the answers all the time anyways, if you think they're best in the world.
Dr. Beau (48:56.366)
All right. Speaking of DNS, DNS April 4th through the 6th in Nashville, Tennessee, we actually still have an extended Black Friday sale, I think going until Audra wants to shut it off this weekend because she's mean. It's going to run longer than that. We'll see. So Black Friday, 20 % off with Brett Winchester, DNS in, I keep wanting to say Vegas, but Nashville, Nash Vegas.
A lot of fun stuff going on there. And then we talked about the course, is July 25th, 26th. They didn't tell me to talk about it. It just looks like cool course with Rich, Brett and Alana. That'll be a cool one. yeah, anything else? Merry Christmas. Yeah. I guess this will be the last one for Christmas, won't it? Yeah, for sure. So we'll see. We'll be the last one for this year. No, you have one right after. right. For Christmas.
I will be gone. So Merry Christmas everybody. It's on Kwanzaa. Can't miss that. And the first day of Hanukkah. So yeah, I'll have some different costumes waiting. All right. So Merry Christmas and see you this year.
Michael O'Neal - Forest for the Trees
Summary
In this conversation, Dr. Beau and Michael O'Neal explore Michael's journey into the health and fitness world, discussing his personal experiences with injuries and the search for effective healing methods. They delve into the limitations of mainstream institutional approaches to health, emphasizing the importance of user experience and alternative methods. The discussion also touches on the cultural movement deficiency in society and the need for training, as well as Michael's motivations for writing his book to enhance his credibility and provide a resource for clients. In this conversation, Michael O'Neal discusses the importance of establishing authority in the health and wellness industry, the shift towards alternative health solutions, and the need for a systems-based approach rather than a goal-oriented one. He emphasizes the significance of understanding the market's demand for alternatives, the interplay between mental and physical health, and the evolving landscape of health practices. The discussion also touches on the limitations of traditional evidence-based practices and the potential of a resonance model for better outcomes. Additionally, the conversation explores intriguing topics such as simulation theory and the role of probabilities in decision-making.
Transccript
Dr. Beau (06:51.876)
Thank
Dr. Beau (07:31.14)
What's going on, man?
Dr. Beau (07:35.406)
Can you hear me?
Dr. Beau (07:44.42)
Hello?
Can you hear me?
Dr. Beau (07:55.534)
Can't hear you, Michael, if you can hear me.
Dr. Beau (08:08.138)
If you're, I see that you're trying to connect to Yeti, if you can hear me, is it USB connected?
Dr. Beau (08:50.734)
Nothing yet. And I'm not seeing any like noise feedback, so it's not picking the mic up at all, however it's connected.
Michael O'Neal (09:03.666)
There we go. Okay. Excellent.
Dr. Beau (09:03.694)
There you go. Whatever you just heard.
What's up, man?
Michael O'Neal (09:09.535)
Midday gap. Just gym in the morning, home in the afternoon, gym in the evening.
Dr. Beau (09:16.505)
Yeah.
Yeah. What, what time is your next client or a class? Okay.
Michael O'Neal (09:20.467)
That's, well, I, five. Go back at five, yes. I have a pretty decent chunk.
Dr. Beau (09:29.378)
Yeah, well, we're already recording and we'll jump into it. I don't like to just, we usually get talking and then wish out we were recording. So we'll just kind of make it organic. so first things first, man, you and I have known, you know, of each other and known each other for a little while now, but I've never really heard your just, you know, laid out origin story of how you got to where are today, like why you're in the health and fitness world and you know what.
Michael O'Neal (09:31.538)
All right.
Michael O'Neal (09:37.63)
Yep, let's do it.
Dr. Beau (09:57.316)
what all those steps were, so do want to just kind of lay that out for me?
Michael O'Neal (09:59.728)
Yeah, I have heard your origin story and you had a shattered leg, correct? Yeah.
Dr. Beau (10:08.228)
When I was nine, yeah, almost 31 years ago or something, so a while ago.
Michael O'Neal (10:11.385)
and I had a torn up hip when I was 16. I was a kicker and a punter and this is actually how and the the the the book that I released this summer like the the very first part of it is the sight like of the scene of the injury so I was a kicker and punter from middle school through high school and then into college but my
Dr. Beau (10:23.065)
Mm-hmm.
Dr. Beau (10:34.785)
Mm-hmm.
Michael O'Neal (10:40.538)
summer going into junior year of high school, I had about a year of chronic hip and back pain that I was popping anti-inflammatories through and suddenly one of planted for a kickoff and then just rip. Like I can still hear the sound that my right hip flexor made, which kind of as a left footed kicker, I actually injured
my non-kicking leg, which just added to the confusion of everyone who tried to treat me, but everyone was unsuccessful in treating me. So I think I have a story that is similar to a lot of people where I had inexplicable pain, followed by a preventable injury, went through all of the mainstream institutional channels to solve, and no one could solve it.
adequately for me. From there I...
search the corners of alternative medicine. And I worked with chiropractors, I worked with a massage therapist who ended up helping me more than anyone did. And what that demonstrated to me was that it wasn't about the institution or the credentialing of the provider.
It was about the provider's ability to problem solve.
Michael O'Neal (12:19.834)
If I had a hip injury
And at 16 you said, Michael, you get to go work with...
Michael O'Neal (12:33.567)
without using any names. If you got to work with the premier sports medicine clinic in the state of Alabama, or here's some massage therapist in a random strip mall off Rocky Ridge Road, one of them is going to solve your hip problem. Now make a bet which one it is. Well, sure, sports medicine clinic, obviously.
Then over the years I learned that that was not a one-off. I continued playing college football. The massage therapist who helped me helped me enough to where I was continuing to kick. looking back, what kicking for me was trying to cash checks that my, trying to write checks that my body could not cash. So really the best solution for me would have been just like stop kicking footballs for a while.
But when you are in high school and you're pursuing a college scholarship, that is not an option. But if you just went, hey, everything is on the table, stop kicking football, stop engaging in this highly specialized activity that your body is underprepared for. Not just saying that that activity is inherently bad for the human body, but my body was underprepared for it in several ways. That is evidenced by the fact that I had an injury, no debate there.
So I managed to manage my pain through college and I even got to the point where I wouldn't even go to the athletic training staff because every time I went, it was the same script. Hey, this hurts. All clamshells. Boom. You're gonna tell me my left glute doesn't fire? I'm a left-footed kicker. I promise you my left glute fires just fine. Clamshells are not helping.
So I got to the point where I quit going to athletic training staff. I would just go see my massage therapist and you and I know that the label of massage therapist can be very broad. The woman I worked with was fully trained in Tom Meyer systems. And then if you get into even further corners of alternative medicine, the Burrell Institute,
Michael O'Neal (14:49.377)
with visceral manipulation, craniosacral therapy. So like a lot of stuff that, like if you're looking for Lane Norton to endorse human evidence, randomized evidence-based trials on it, he's not endorsing it. But those were the corners of the industry that helped me where the...
Michael O'Neal (15:15.881)
evidence-based ones did not. So to, and I just saw that over and over again. I saw more people slipping through those cracks and that's what eventually led me to
Dr. Beau (15:22.488)
Thank
Michael O'Neal (15:32.733)
I became a massage therapist and you you follow me, got into like FRC and some PRI and we can, I'm sure you and I could dive into the benefits and the limitations of each and every one of those systems. you're big with DNS, you're also been through FRC, so you and I, could spin off into that conversation, I'm sure. But the big takeaway was the
The mainstream institutionalized approach is not cutting it for a significant percentage of problems that people have.
where are those cracks and how can people fill those cracks outside, while operating outside the constraints of that more mainstream institutional system. So I became a massage therapist, I larked as a physical therapist, like legally, I never sold myself as a physical therapist, but I worked adjunctly with physical therapists, I worked adjunctly with chiropractors, I worked adjunctly with
Dr. Beau (16:27.246)
Mm-hmm.
Michael O'Neal (16:43.758)
Crossfit coaches, I was a Crossfit coach and eventually I built up enough of a base doing the restorative exercise or like how do you want to brand it? Like it's on the spectrum of therapy to training. Like you're not on the therapy table but you're not fully back on the training floor. And so I was operating somewhere in the middle of that spectrum.
Dr. Beau (17:03.149)
Mm-hmm.
Michael O'Neal (17:11.564)
when I started a reform motion therapy, which was massage therapy. And then you could call it corrective exercise, restorative exercise is what I did. But then what I noticed is I was getting better outcomes doing more restorative exercise than actual massage therapy. So eventually I moved more towards doing the restorative exercise. And then I realized that there's no need for a lot of restorative exercise if you don't screw yourself up exercising to begin with.
So what if I just created a well-programmed training plan for people? And that was when I moved more toward the personal trainer function. So then I had this stack of like manual therapy, physical therapy, lowercase p, lowercase t, and then personal training. And what I found is that outside of
extreme circumstances. Like obviously I'm not going to perform surgery on anyone or if someone probably doesn't come to see me the day after their ACL repair. But what happens when your insurance says that you're done but your body says that there's more work to do?
Dr. Beau (18:21.772)
Mm-hmm.
Michael O'Neal (18:35.361)
Insurance isn't paying anymore, but the gym you're trying to jump back into might not be able to regress enough for your needs. So then you're with a cash-based physical therapist. So cash-based physical therapy, a lot of times, really just looks like highly regressed personal training. It's like, where's the line? Who are you seeing? And so I started taking on a lot of clients who had graduated from physical therapy.
Dr. Beau (18:46.148)
Mm-hmm.
Dr. Beau (18:54.734)
Mm-hmm.
Michael O'Neal (19:02.533)
but weren't ready to get back into their arms theory class yet. They graduated physical therapy, but every time they try to go back to their, you know, Pilates class, something just isn't working. So then I just put those people on any of that restorative exercise and then really just into a well organized training plan. And some of them I bridged the gap and then they went back to where they were, but
Eventually enough of them became personal training clients of mine that decided to open a gym for them.
Dr. Beau (19:39.972)
So when you say, you said in there somewhere that you started getting better results when you kind of maybe moved even away from a hybrid approach of like table and training to more of just, you know, the training approach and, you know, preventative of don't, you know, basically fuck yourself up in the first place. What, what's better mean though? Are we just talking less pain? You know, these people you're saying they couldn't quite get back to whatever they wanted to do. So it's just improved function, ability to operate in whatever form, like is it legitimate?
outcome measures or some assessment or you're like, hey, just people got out of pain, they moved better and felt better. Like what was better?
Michael O'Neal (20:15.046)
Let's start with how I was functioning as a massage therapist. And here's the cycle you run into. I do my workouts, my hip gets tight. I go to Michael and he rubs on my hip. My hip feels better when I go to my next workout. Two to four weeks later, my hip is just as tight as it ever was. And now I go back to Michael to rub on my hip.
So if I wanted to create a subscription service for massage therapy for people like, like I could, I could be the tightness management guy.
But what would happen is when I started increasing the corrective exercise or restorative stuff, I ended up getting rid of people as massage therapy clients. Hey, I'm coming. So how, I guess ultimately you say, what is better? Better would be their perceived need for my services.
or for that particular service. And then if like, you know, there's only like, there's table tests and you want to, Hey, you have 15 degrees of hip internal rotation. Last time I saw you, you had seven and like, you and like, you and I both know that we can neurologically hack a table test in a matter of a few minutes. So I like, I never appealed to a protractor as the proof that my methods work.
Because what happens if you appeal to the protractor, but then your people don't feel better and stop coming to you? I had an evidence-based outcome. Well, but they didn't have a better experience. So it's kind of that, now if you can have both, that's great, but eventually what I realized is that trying to interface at the strict metric level,
Michael O'Neal (22:15.735)
required would in order to justify it, would require having to make up more stories like about the metric. So you know, yeah, the narrative like, we're evidence based or we're not narrative based. Like every metric has a narrative and like what happens when you show a regression in your metrics. you're
Dr. Beau (22:25.504)
The narrative has to tell it.
Michael O'Neal (22:40.251)
you're not stretching enough. No one's ever stretching enough, right? As a kicker, my back hurt because I wasn't stretching enough, even though I did two to three, 20 to 30 minute stretch routines per day. you got to stretch your hamstrings more. Like I can kick my foot over my head. I don't think hamstring flexibility is the issue here.
Yes, I think what is better? If people perceive less pain and are able to do more at a of a user interface level, that would be a useful definition in the way that I operate. And because I do not have to code things for insurance.
Dr. Beau (23:22.936)
Mm-hmm.
Michael O'Neal (23:35.24)
Like I am not married to a protractor test. And it like, cause I have some people where I actually need to, they need less range of motion. I need your hit to rotate less. So wait, are you regressing range of motion? Well, like in a, in a sense, yes. Like you're, regressing a quality that you have a surplus of in order to.
Dr. Beau (23:48.877)
Yeah.
Michael O'Neal (23:59.425)
access more, access a different quality that you're deficient in, so like more stability. And I think because I have more, because I have more of a...
Michael O'Neal (24:15.089)
more of an independent and not as institutional approach, I'm able to function with more of an n equals one approach. And that can work for or against me because if I'm like, I know like it's all on me, right? If there are better outcomes and people are having a better experience, then I reap the benefits of those. If there are worse outcomes and people have a worse experience, I don't get to say, but Blue Cross Blue Shield said,
Dr. Beau (24:32.44)
Mm-hmm.
Michael O'Neal (24:44.777)
This is what I have to do. And this should work. Should. I did this, your body should do this. What happens when it doesn't? Well, the textbook said it should. So as a practitioner, I don't have to change my mental model because my methods didn't work. Because I am accountable to the science, I am accountable to the evidence-based research paper that I derived this modality from. Therefore,
Dr. Beau (24:49.74)
Mm-hmm. Well, you're...
Michael O'Neal (25:14.92)
I am right and your body is wrong.
I think that's the message a lot of people get.
Dr. Beau (25:21.572)
Well, here, I'll open up a big topic and then we'll kind of like, you know, pick at it and explore because we're touching on topics that we'll talk about, you know, in your book, force of the trees here, we'll get into that specifically, but you're kind of touching on the trappings of, you know, methodological based approaches, but also then institutionalized approaches, which can get down to the finances versus like what you were taught and kind of how those play off one another. But another big thing in here is also
why ask the question of what's better, it is going to be an off the wall question, but it will, I think, drum up a good conversation. Have you ever seen the show, the stage show by Darren Brown called Miracle? So Darren Brown is a mentalist, know, a hypnotist, and he does a stage show, and the lead up to the stage show is showing Darren Brown for a year or two going around all these holy roller evangelical pop-up tent faith healing.
Michael O'Neal (26:01.117)
No.
Dr. Beau (26:18.242)
shows, we'll call them shows, right? And he's basically calling out to, you know, the camera crew, hey, this is why, you know, the preacher, the pastor, whoever speaking is doing this, saying this, this is what's going to happen. And it's just, you know, it's like he's calling plays like Tom Brady is, know, on Sunday. And then he has a stage show. So it culminates in his stage show where he literally explains to the crowd.
I'm going to use the same techniques and methodologies that a evangelical preacher would in that pop-up tent in that southern field. And I can literally help you with aches, pains, maladies, but this is not faith-based. That's his claim. And then proceeds with the show and has some pretty miraculous outcomes, the name. So my question is when we start to talk about all these things of poking holes in, well, hey, people are in less pain than they operate better. And it's about the user experience, right? Which I agree.
But then we kind of have to start to think about if we want to continually sharpen our sword and prune and get better as a practitioner, provider, business owner, is the N equals one actually all experiential or do you actually have to be sound to science? Because I would agree, and follow me on this thread for a second, that evidence-based, and we know that a lot of evidence is
persuasive and paid off and stuff like that. Maybe it doesn't explore the topic that it's actually saying it's exploring. But we also know that if you don't actually adhere to science-based principles, like I know you're fan of Andrea Spina. So if we had to look at what we're doing with an exercise in terms of what the expected adaptation is, what the expected physiologic response is, we have some hunch we're running off. We're not just saying, hey, I want you to feel better and operate better, and we're just going to do X, Z.
even though it might make them feel better, we're like, this is the response. So in your mind, how do you go into your gym each day or programming for a client or whether it's continuing to educate yourself, do you ever have this kind of dual approach, a devil and angel on each shoulder of saying, we don't understand enough and there's this user experience approach where my job is to get them feel better and operate better. But does that, if I,
Dr. Beau (28:38.552)
Fully focused on that, will I ever actually get better at a practitioner? Or do those even need to collide? And I think that's where a lot of this comes from nowadays because I think generally in our field, we know what the general public doesn't, but we kind of know like our field is a bunch of, you know, hopped up on methods that we got taught and we hang on to in regards to work. Like you said, you have to get paid a certain amount of visits and we just have a lot of conflict.
And I think the conflict arises from that. Nobody quite knows if it's a user experience thing because we don't know how things work and there's a lot of placebo effect, you know, and, or are some people better at using first principles of science to get results. And when it doesn't work, you know, it's not a blame game thing. It's like, well, you know, God, there's a whole holistic approach to health, which is literally your book, right? It's all of these things, you know, nutrition and sleep and all these things. So.
I know that's a huge question, but that's how I wanted to set a foundation for the rest of conversation of where do you find yourself in between user experience better versus, I've learned a lot about exercise physiology and I want to get better as a practitioner. Where are you on that path currently that's going to set you on this next five to 10 years?
Michael O'Neal (29:51.935)
What would you say is the difference between a first principle and an assumption?
Dr. Beau (29:57.774)
So first principle is going to be something that's based on a hard science. So I know what the physiologic response is to altitude in terms of what's gonna happen with my hematocrit pack. I know what's gonna happen if I exercise in heat and how I can mimic that. I know how that's gonna be affected if I have a lack of iron. So that's a first principle. know how that science, we know, I say no, right? There's very few laws in physical science versus assumption. An assumption would be,
If we go back to the 90s or maybe for you 2000s, hamstring tightness is correlated with pain. That's a strong assumption, right? And then there's evidence that would show you're gonna have increased prevalence of low back pain, increased hamstring injuries with lack of mobility through the posterior chain or hamstring. You're gonna see that evidence out there. So that's, guess, my quick example of what I see as a first principle versus assumption.
Michael O'Neal (30:53.791)
I agree that some people are better at
Michael O'Neal (31:03.434)
reasoning. So you say like there are people like Spina who's all like this is the science and you were were reasoning from first principles.
Michael O'Neal (31:19.543)
People, the reason I ask that question is because people throw out the first principles term a lot, but no one really ever says what their first principles are. It's, we reason from first principles. Well, what if you pick the wrong principles and what if your reasoning isn't good? Reasoning from first principles doesn't necessarily protect you from getting a worse outcome.
Dr. Beau (31:47.652)
I would disagree. think the first principles are set. First principles are science if you're in the health world. If we're going to say that first principles here in finance, there's theories and schools of thought. That's like philosophy almost, right? There is a science to finance, but at some point it's kind of a philosophical approach. When you get into science, again, we don't know everything by a long shot. I we look at neurology, we know less than 5 % about, you know, how the human brain works.
So again, you're running on first principles based on the current level of science where it does hit against kind of like the ocean crashing against waves is I agree for two things. Individual reasoning is a problem because you run in your own biases and assumptions and everything with the knowledge or information at hand. And that's what we're all dealing with on an interpersonal level, right? Of like what I have to deal with, but also how I deal with the client and how I kind of interact with them with that information.
But that being said, it shouldn't change first principles. To decide a first principle for a go-to practitioner is that you have to have a high medial arch is not a first principle.
Michael O'Neal (32:53.287)
That way, they would say it's the first principle, but then you would say that's an assumption.
Dr. Beau (32:57.838)
But then you would have to show me from decades, which again, then we get into all these, we don't wanna name names, all these things where they kinda like wanna knock everything that's been learned about a realm, biomechanics, anatomy, whatever, it's like, I get that that stuff is not a law, right? There's Wilson's law, there's Wolf's law, we have laws, we're like, yeah, that's the response. You get that response physiologically.
But where I have a problem is when somebody says, hey, this is a first principle, that's how we operate, and they may get results, and this gets back into our question actually. You get results, what do the results come from? User experience, interface between two people, placebo effect, is it legit, and we just don't have the science to back that up? So again, back to kind of my question, and if you have more for me, I'm open for it, but how do you keep down the path of getting better? I guess what I'm asking is how does Michael O'Neill
sharpen his sword if you're kind in this like, well, my job is to create the best user experience. Is it still like, I gotta go learn more methods or is it like, man, I need to get, I need to go read, you know, up on Hilton's, you know, customer service principles and like, you know, experiential learning and everything that's gonna make that person have the best experience possible.
Michael O'Neal (34:17.781)
if you're hurting people in your workouts.
then there is at least one first principle that you're not adhering to. We could say load management. Have you seen that there's some meme and it's like a puppet finger person and each finger is, I think it's like physical therapy and massage therapy and it may be one of those like inner, this method, this method, this method, this method, and then the hand underneath them all, it just says load management.
Like, how many methods could we look at and you and I would just say, like they finally regressed something. It was actually load management and the tendon had appropriate time to recover. it was, you were, there was a discrepancy between like the tendon remodeling cycle and the muscle breakdown and rebuild cycle. There's a curve I'll draw for lot of my people. Like if they start,
If they have like tendinitis pain that starts to, don't want to say flare up, that starts to show up. that's, well here, guess I can, maybe I'm answering your question. Here is an example of how under, so let's say understanding the science, but then creating an accessible user interface for that science for your clients to.
increase their compliance and make sure that they are still getting the outcome that they hired you to get them. So let's say that I have someone who starts getting some elbow pain with some pulling. Let's say that this person has been with me for four months, been progressing, beginner gains, cool, maybe previously not all that trained. You and I both know that it wasn't whether I decided eight reps or 12 reps that got his lap stronger.
Michael O'Neal (36:19.255)
It was the fact that he went from doing nothing to doing something. So now he's been happy with his progress, but then let's say month five, maybe month six, he starts to get a little elbow pain. And one thing I established with everyone in their first week with me is there is the muscle, the muscle working pain, and then there is the like the ice pick and the joint, there is the hot tendon. And so I try, I, but like, I don't have to,
I don't have to even use the word tendonitis. I don't have to use the term closing angle joint pain. I used to. I was so pretentious when I did that. I don't do that anymore. So I'll say like joint pain, know, is it like ice pick and shoulder pinching pain, right? If you feel anything like that with anything that I ask you to do, let me know. And then there's a movement modification. Maybe I throw in, you know, cars or positional isometrics or
You have some sort of like rib cage, you know, breathing, whatever it needs to be, like modify their program accordingly. But one, one thing I will do if the, the, say what, what I know is tendony stuff that's happening. I'll say, all right, you have your muscles and I'll draw, I'll draw a waves. Like here is how your muscles break down and recover. And it's a higher frequency curve. draw this on the white.
And then I'll say, here's how your tendons get stronger. And I'll draw a much lower frequency wave. And then I'll pick a point where the muscle curve is high and the tendon curve is low. And I'll say, when you have this tendony pain, it is because the muscle and the tendon are
getting strong they're being worked or and they're getting they're recovering at different rates so right now your muscle isn't tired your muscle can still do this pull but the tendons that that muscle attaches to is not ready for this pull you're not broken there is just a mismatch mismatch between what your muscle is prepared for and what your tendon is prepared for
Michael O'Neal (38:39.856)
So let me modify this. I'll take this pull, I'll change this angle to something that is not painful, and then we will retest it. Another benefit I have, I work with all of my people two to three days a week. So a test and retest for me is every session they work with me. I don't have a month, two months between sessions. They're not showing up to me only when I'm in pain. So I know...
I know what their baselines are because I'm working with them so frequently. I know what they're capable of and I can tell when something is off.
Dr. Beau (39:18.244)
So big thing that I think I help perpetuate not a positive light, but I've worked with the group You know rehab the performance for the past, you know better part of decade Which basically help him PT students Cairo students strength addition coaches kind of bridge that gap which you've mentioned that You know lingo a couple times of we don't want to leave people in rehab purgatory, right? Low low level load management you want to get to this thing and then you know benefits run out or you're at the end of your Expertise and you just kind of leave them in no man's land
But what I think I helped perpetuate again in a negative light was that everything is just load management. That you can skip the diagnostic process and just be like, we can regress the load, slowly progress the load, change the angle, change the angle of tissue load. And the problem that I saw occurring in new docs or students was
You know, your first job, like you said, if you're hurting somebody in the gym, you're breaking a first principle from a, know, a clinical standpoint. mean, you're breaking that, you know, do no harm. How do you, what's the hedge? And I think this is good because you're, know, you've been in the table world, massage therapy, you've been injured yourself. Like you're explaining pain in a very coherent way to your clientele. Like when, what's the break point for you where you're like, God, you got to go get this looked at, right? We tried to manage it or like, this is just too severe. Like what, are there any like,
Certain teasery you gotta get out of here man, or do you feel like you handle stuff pretty well within the gym? And you have a high, you know ratio of success with most things
Michael O'Neal (40:48.401)
zero improvement or worsening for 14 days or more, say go get it checked out. That is my...
And just based on everyone I've worked with, if I have seen you, so what that gives me in a 14 day period, I will have seen that person between four and six sessions. I will have regressed their load. I will have changed their angle. We will have done the load management thing. If the load management doesn't yield any improvement for 14 days or if it's worsened, that's when I'll say, yeah,
go get it checked out. Now, if they want to get something checked out before that, I'll never tell them not to. If they ask me, let's say it's two days in, hey, should I go get an MRI? I'll give them, hey, give it two weeks, because in two weeks, you at least won't feel like you've wasted time or money getting that more advanced imaging, but I'll also know that
it's probably beyond a basic modification that I can make in one of your regular scheduled sessions. Now, maybe I need to pull up my therapy table again. I don't really use my therapy table much anymore, but there have been times where I say, let's do an extra session, a restorative exercise session, and maybe I am walking them through, maybe it is elbow cars at that point.
Maybe it is like really specific elbow, pails, rails, or positional isometrics, which you could still say that's load management, but it's more specific load management. Now I'm trying to think, I'm trying to think if I've had an issue with anyone in my gym where that hasn't worked. Because obviously I want, like I want to have a limiting
Michael O'Neal (42:50.686)
principle and so one of those limiting principles is 14 days with zero improvement or worsening go get some sort of opinion. MRI, go see your doc. I'll you what's happened more times than not. When I have referred out after 14 days, they don't get any helpful.
information from whoever they go to. Yeah, like they come back and it's, my doctor who looks like a walking heart attack told me that I just need to take it easy. Like, cool. And I think that's why I at least go to 14 days because the probability that if they go see a doctor at day eight, nine, or 10, that doctor's probably, of course, if there's an acute injury, hey, yeah, yeah, we're talking like, hey, this,
Dr. Beau (43:15.748)
That was my next question. Do you do anything?
Dr. Beau (43:21.956)
Thank
Dr. Beau (43:39.544)
Yeah, we're throwing that out.
Michael O'Neal (43:42.184)
this little tendonitis sensation creeped up on me. also there people go off and do their own stuff too. I don't deal with that as much because my people see me so frequently, which was part of why I, when I was doing the restorative stuff several years ago and it was, you know, make someone feel better, know, regress the load, give them some sort of restorative exercise, but then they'd run back to whatever they were doing and then they just,
Dr. Beau (43:44.42)
Show it up.
Michael O'Neal (44:12.551)
get re-injured. And so I thought, what if, what if rather than feeling like I'm too good to be a personal trainer or like I'm too good to just be a gym owner, what if I just took ownership of people's training more comprehensively rather than
all these trainers, all these gym owners suck. Now come to me and let me fix you. you went back to them, you got hurt again? Well, I mean, I'm just better than them. I don't know why you're still going to them. Well, where should I go? Well, who should I train with? Well, you know, I'm like, wait a minute. What if I actually believe that I was getting superior outcomes and I could create a superior fitness experience for people? At some point, I had to act on that and assert more ownership of people's training.
And that's why when I think, and I knew you've opened a gym as well. So would, there's probably some resonance with what I'm saying and work at some point you were probably like, you know what? I just want more ownership of people's, of people's fitness, because I think that I can create something that will serve them better rather than sending them off here and here and here. And you know, maybe I trusted the coach who used to be at that gym, but now they hired a new one or like, you can't control those variables, but.
you can still be held responsible for the things that happen even though you didn't put them through a workout. Will Bo fix my elbow? And then I went back and I did these butterfly kipping pull-ups and tore my elbow up. But I guess Bo just didn't do a good enough job for me. And whereas Bo probably would have said, let's have a conversation about the why behind your butterfly kipping pull-ups as a 47-year-old attorney.
Dr. Beau (45:55.556)
Which is, again, so here's a, and again, just use this as a thought experiment, not, I'm definitely not attacking, I just, I love, you're a very bright guy, so I like talking about the stuff. So do you ever feel like, this is a thought I have, so that's why I'm asking. Is it a trapping to think that, and if you don't have these clients, I guess it's a moot question. So if somebody comes to you and you have a training perspective around ameliorating pain and helping people perform better and accomplish their goals, let's say somebody doesn't exercise.
And I like the example of like a laborer, right? Construction worker, somebody that unequivocally, if you looked at their life should be healthy. They're moving around all day, they're lifting loads, they're doing things, but they probably, you know, and then we'd be like, they don't eat well, smoke, whatever, all these other things. But do you ever feel like a trapping is also, everybody's got to train, right? Well, that's an appropriate way or just train again, because we could talk about ideologies, methodologies.
And then we're like, hey, to get people out of pain or keep people out of pain, they have to train or they have to train a certain way. Is that a trapping? Is that no, that's how it is. Cause we have a lack of movement within our culture. Any thoughts on that?
Michael O'Neal (47:06.671)
If one of my clients finds a better solution for their problem, then they will leave me and they'll use that solution rather than me. And then I just wasn't good enough or the right fit for that client.
Dr. Beau (47:24.388)
Yeah, and I guess, I mean, that's a succinct way to answer it, but it also doesn't get you a jail or get out of jail free card. So let's say you have a 67 year old woman that comes to you, never had pain in her life, right? Just moseying through, she's going to, you know, church group on Wednesday, goes to church on Sunday, it's in her garden, she's active, but she's not, you know, lifting a barbell. It's got a good social circle, eats fairly healthy, she drinks water, she's not smoking cigarettes, she's not gambling, you know. She comes to you she's like,
Michael O'Neal (47:35.637)
Mm-hmm.
Dr. Beau (47:53.796)
kind like a month ago, I didn't do anything. My back just started hurting. And let's say, and again, thought experiment, you take her through three months of like stellar, know, getting her moving, working on maybe specific movements, and then also just, you know, kind of loading her chassis so she can, you know, tolerate stuff. She's feeling awesome. She falls back into her normal life. Do you think that's a failure of her?
what she's doing in her normal life or do you feel like, you're actually inadequate in movement and load and that's what you would need to substantiate long-term benefits.
Michael O'Neal (48:33.046)
I want to make sure I understand the example. She was not in pain for a very long time. And then all of sudden, she has back pain at 67.
Dr. Beau (48:42.316)
All right, yeah.
Dr. Beau (48:46.18)
Nothing's changed in her mind. just, know, backstarted bugging her, it's getting to the point now she's wanting to do something. She heard good things about you, she shows up.
Michael O'Neal (48:52.702)
And then she comes to me and she spends a few weeks with me and her back feels better. And then wait, what's, and then what happens after that? She stops working with me after that?
Dr. Beau (49:00.036)
But she's not a gym rat. Yeah, she's not a gym rat. Yeah, she's just like, don't want to, I'm not big in the gym. Let's say it's summer now. It was winter. She's like, man, I love gardening. I want to get back out. I don't have the time to come in here two, three times a week, Michael. And let's say you don't see her for the summer. She comes back in next fall. She's like, my back's bugging me again. Do you think that's a failure of her? Like she needed you and needed to keep going or do you feel like...
That's something might be going on with your back or like, I know there's a lot of options there, but I'm trying to ask a broad question, like a societal question with a specific example.
Michael O'Neal (49:49.271)
So is it her failure because she stopped working out with me? Or is it her failure because she stopped working out?
Dr. Beau (49:56.612)
or just working out, it doesn't have to be you. Like even you can be like.
Michael O'Neal (50:04.053)
I
Dr. Beau (50:07.128)
Like, do you see movement and load management and training almost as a deficiency in Westernized culture? That if she's not doing that, well, you your back pain, let's call it just generalized back pain or idiopathic back pain. Is there a conversation in your mind going on or with her that you're going to have that you're like, you know, this, you know, we wouldn't want to diagnose asondinamri, but if we don't do X, Y, Z, like it's going to be hard for you to operate. Cause I'm assuming.
the further you get into your career, that's, you know, all of us are going to be hit with those people that return. And they're going to return to the same stuff that came before because they fell off for whatever reason, right? Time or whatever money. And then how do you reconcile that? Like, that, well, hey, we fall right back into like, you stopped taking your fish oil. Like we're just going to start taking it again. Or is there something else going on? Like, is it a cultural societal thing that we lack that movement load management and day-to-day life?
Is a, she has a specific pathology and that's why she's having this recurring thing. Or is it just a, you know, it's a forest for the trees. They're a holistic approach and there's other areas of your life that I think you could help. And then you wouldn't need me as much. And then that's kind of the approach. And maybe there's not a clean answer to this, but I'm trying to draw out again. Points that you hit on your book of, you know, cause I'm at, sometimes I catch myself being like, God, we need more of this. Like you need to move more. You need to do, you know, you need to pick up something heavy. And it's like.
Michael O'Neal (51:17.975)
Hmm.
Dr. Beau (51:29.668)
Yeah, but there's also people that have never done that and don't have the same outcomes, you know, and that's that's hard to reconcile. And if we're doing an N equals one approach, of course, that's what we'd say to again get out of jail free. But any thoughts again on that?
Michael O'Neal (51:42.145)
Yeah, maybe take her through some past life regression narrative therapy and try to understand the relationship between her back pain and her seventh great grandmother. And then we could talk through it and then her back pain would go away. And then I could be on that TV show about how their persuasion actually hypnotizes people into not feeling pain. No, I think...
I think if we're gonna use her as a proxy for the broader culture, and I think it's safe to say that there is a, we could say there's a movement deficiency. Like overall, the design of Western culture is more sedentary. You can.
become very rich and very successful to the detriment of your health and a lot of jobs and professions incentivize sacrificing your health for better pay, for better status. I think, when you, so if you answer the question from a broader cultural perspective, I think it's safe to say that there is a movement.
deficit among more people than probably there ever has been just because of the design of society and the design is the destiny. can I take that? What happened? Then the question is, well, what happens when an individual example of does not fit the pattern of the broader culture?
Michael O'Neal (53:25.536)
And that's why I don't work with a ton of people.
Michael O'Neal (53:30.73)
if she works with me and feels better and then she stops working with me and doesn't feel better anymore, then she comes back and works with me and feels better.
I don't care about the causation. Like everything's, well, it depends. has multiple causes. Yeah, that's fine. Should I do her adduction drop test? And if she's, maybe she's not managing her left AIC pattern well. And then get her to do an adductor pullback. And what if like just that makes her back feel better versus going through my training program?
What if you had just done the lunges and never done the hip lift and the adductor pullback? What if you do the adductor pullback and someone feels better and they never lunge in their life? You could find, I'm sure you could find examples of all of all of those. I've still had some restorative, I still do some restorative exercise with people. Like I'll do a four session series and it's, Hey, it's usually when they've hit a roadblock and then I give them of course load management.
but then of, okay, I've been answering this question more from the perspective of movement volume, but we could also add the lens of movement variability. So usually when I work with the people who are active, because then you could say, Michael, you just get a bunch of people who aren't doing anything, and then you put them in their system.
And even in your book, you talk about how most people aren't trying to go from great to optimal. They're trying to go from inadequate to adequate. So anything will work if you're just finding a bunch of inadequate people, giving them anything that's not, not totally idiotic, and then they're going to get better. To which I would respond, yeah. But guess who got them to do the things they need to do to be adequate? you never, you never.
Michael O'Neal (55:40.002)
You didn't need that exercise program. wasn't that exercise program that helped you. was the first principle of increasing load and blah, blah. Okay, but who got them to do it? Who created a setup that they bought into?
Michael O'Neal (55:57.743)
So then with the other people, the people who are already training like crazy, but then they run into a roadblock, those people tend to need more variability, maybe less volume and more variability. So we have two categories of people. There's the people who are going from inadequate to adequate, where all you have to do is basic stuff that doesn't hurt them.
perform well on a regular basis, they're probably gonna get better. And then you have the people who are trying to go from great to optimal. Those people usually need a little more variability. But then I don't work with, only people who I've worked with who are trying to go from great to optimal, and there are a few like garage gym warriors who, like, hey, I some technique focus and cool, like I teach them some single leg work.
and then they're backstop hurting because they don't hit a traditional deadlift two days a week anymore and they start to work in some single leg work. To you and me, that is very simple and that would be part of something that we put into a regular program anyway. But to them, that may be the first time they've ever heard it. And then the other, the far end of that spectrum would be with some of the kickers and punters who I've worked with at the college and pro level.
That's the whole conversation in and of itself. When you're, I need to plug in, my battery's about to die.
Dr. Beau (57:33.07)
You're good.
Michael O'Neal (58:17.564)
done.
It's not showing that I'm plugged in.
Dr. Beau (58:54.489)
there.
Michael O'Neal (59:08.867)
Okay.
Dr. Beau (59:10.37)
Thank you. I can hear you, but your mic's off. So you're on your FaceTime.
Michael O'Neal (59:11.377)
I had to change my mic. Are we okay to continue like this? Okay, Yeah, so I don't know, did that capture what you were looking for from the little old lady example?
Dr. Beau (59:18.34)
We're good. Yeah. Yeah, it sounds fun.
Dr. Beau (59:28.568)
Yeah. So another thing I pulled out of there is you kind of said, which I agree with that it's, and we've heard numerous people in the fitness realm, you know, maybe the biggest job that coach has is actually getting people that wouldn't work out on their own to start working out. Right. There's people that are just going to, they're going to train regardless of what you or I have them do. They're still going to train. They're still doing something. Do you have any keys or,
maybe not tips, but like anything that you focus on to really like stir up intrinsic or internal motivation for your clients or somebody that's maybe really, maybe they've been referred to you and they're just not really hopped up to train. There's like, I'm here because I want to feel better. Like, do you have anything you focus on with them to try to get them motivated and get them going?
Michael O'Neal (01:00:15.363)
A lot of the people I train want the most efficient solution to their desired outcome. Fitness is one of the most difficult things to Alex Formosy is on everyone's algorithm now. And I think one of the best things that he has ever laid out is the value equation. Have you seen him talk about that?
Yeah, so the, can't, I don't remember exactly everything, but the, like the belief you're going to get your perceived outcome and, or your desired outcome is on the top of the division. And then one of the things on the bottom of the division is like divided amount divided by the amount of time and effort it's going to take. There, there is no
Michael O'Neal (01:01:12.709)
Yeah. Let's look at Ozempic. Like why does Ozempic sell? Because it gives people their stated dream outcome with minimum effort and minimum time. You and I would, our knee-jerk reaction to the Ozempic craze is probably, well, you could get all of these outcomes with.
with lifestyle change and exercise and dialing in your diet. And once you get off the shot, you haven't created any behavior change. So all the weight's gonna come back. like, so that is the, that is, don't just want to say rational. That is the rationalistic approach. And a rationalistic approach to any problem does not account for human behavior, human psychology.
Michael O'Neal (01:02:14.701)
One of the things, so how do I try to, understanding that I'm selling one of the things that is the hardest to fit into that value equation, what are the ways that you can kind of soften the blow? Well, hey, I got a buddy who works out like crazy and he trains like eight sessions a week. Like, do I have to do that? Like, no, you do not have to do eight strength training sessions a week.
If you're looking to be Chris Bumstead, then you probably, he's probably doing some doubles on hypertrophy sessions. he is doing more sessions per week than there are days in a week, no doubt.
If you are looking to lose your gut, increase bone density and have adequate muscle mass, you can strength train two days a week. And as long as you're really efficient with those sessions, here's what I say, 104 a year, 104 a year. And it doesn't even have to be two days a week because I know you're going to go on vacation.
but can you come in three days the week before you go on vacation?
So I think framing it as 104 workouts a year is what you need to make progress, but also avoid burnout. And some of my people come three days a week, like as much as they can. And that's fine. 156 a year. When I was playing college football, we hit the weight room three days a week in the off season. I don't know that any layman needs more strength sessions per week than
Michael O'Neal (01:03:58.363)
like the Alabama football team does. Now, of course they're like, they're doing their agility drills. They're practicing as well, but you know, maybe like for gen pop, the most I'd probably ever recommend would be like a four day a week split, like five, if you were to split like upper and lower, but really what we run, we run two to three full body strength sessions a week. I used to do more of an isolated split, which is actually my preference for me.
for someone who is going to do four to five strength training sessions a week, like I will take one session that is chest and triceps because I still have some of the vanity of 12 year old Michael when he started bench pressing in his garage with his dad. So I want a day where I train chest and triceps. But for most people, you can do a 45 to 60 minute full body strength session with some interval conditioning and there are
VO2 max is going to increase with the interval conditioning. Muscle mass is going to increase as much as I would love for everyone to honor our ancestral endurance bias, biological blueprints. A lot of people just aren't going to run for an hour. A lot of people just aren't going to bike for 40 minutes. A lot of people just aren't going to do zone two stuff because it's boring.
So if you, for the people who actually want that and are bought in, then I do have those options as well, but what is the bare bones minimum? 104 full body strength slash interval conditioning workouts a year. Give me 50 to 60 minutes two days a week. And you're gonna get the outcomes increased. You're gonna get all the outcomes that Peter Ati is telling you that you need to improve.
You're going to get the outcomes that you hear Andrew Huberman saying, increased bone density, increased muscle mass, VO2 max. These are the formulas for longevity. So that is what our gym is optimized for, to move people toward that. Increased bone density, increased muscle mass, increased VO2 max. And if you want to run your first marathon, cool. I have options for that too, that actually integrate with the strength training that we're already doing.
Michael O'Neal (01:06:22.833)
So we wanted to take a true hybrid approach, training the disparate disciplines that do not overtly compliment one another and oftentimes interfere with one another. But the hybrid athlete conversation may be another episode.
Dr. Beau (01:06:39.524)
Yeah. yeah. So I would agree. Like everybody's time pressed financially pressed. So, I appreciate the input on the kind of intrinsic buy-in there. I mean, we've touched on almost every topic that's in your book in some way or fashion, even though you expand upon it quite a bit. But what was the, what was the catalyst for writing this book was just, I want to get my thoughts out there. Was it, I keep telling my clients the same thing. Like what, what got you to sit down and actually do this?
Michael O'Neal (01:07:12.101)
saying the same thing over and over, but then that's like, well, you can make a blog, like why write a book? Well, you know that having, being an author, it just increases your ethos, makes you more credible. As someone whose credentials are LMT, NMT, CPT, I don't have the institutional ethos.
to go toe to toe with MD, DPT, DC. really, part of it was a tactical move to increase my credibility as an authority. Hey, website, download the first chapter of my book. Hey, here's the book. Hey, what's different about here versus other place you train? Well, here's the guy training you and here's the approach he takes. Here's what he believes. So one, was about
increasing my credibility and an authority knowing that the strict institutional credentialing would be an uphill battle for me in the industry considering that my like actual degrees are bachelors of philosophy and religion and a master's of education to be an English teacher. How's this guy gonna help my shoulder pain? Write a five paragraph essay about it.
So that was one. And then two, to have a ready-made resource for clients and potential clients. Because it is, like it's kind of the script. Because at some point you're saying something over and over again. you know, when you're like, when you're writing your Instagram captions or you're sending an email, like, huh, what can I create from scratch today? Huh, what if I go to my paragraph in this book? What if I take those first two sentences? And then there's something.
happening in the zeitgeist right now that I could particularly tie that to. And now you have a jumping off point for other content. beyond the traditional answers of like, man, I wanted to write a book so I could help people. Cool. So the entrepreneurial or the professional, the tactical move in that department is like increasing your credibility and establishing authority.
Michael O'Neal (01:09:34.231)
especially if you're someone who cannot rely on diplomas to just flash at people. And then also to compile your worldview or your method into a ready-made document that anyone can access as a, it will also say very, it is a low-cost lead generator. If you read my book,
and then you come in to sit down with me about training with me, you've already read my book. If you read my book and then decided to seek me out, you're a very hot lead. From a business perspective, it is a very good lead magnet as well. But I will say it's
Dr. Beau (01:10:21.124)
Is there anything else outside of the gained authority besides just growing your gym or is there anything specific that you want to do with this or plan to do with this if it not necessarily if it blows up just kind of pulls on a few strings within the profession or a little bit outside of the profession? Anything in mind?
Michael O'Neal (01:10:42.511)
didn't write the book with anything like that in mind. One of the things, well, part of writing the book was following my own advice or following some of the best advice that's ever been given to me. And the advice is prioritizing systems over goals. The goal was not, want to write a book. The goal was never, I want to open a gym. The goal was never,
Like I want to be a massage therapist. The goal was not, want to be an author. There is a system I'm trying to build of, I want to be part of a system of alternative health. I'm gonna call them lifeboats or rowboats. Because I think people are starting with,
Even from the last time I talked about this on a podcast, it's just accelerated.
People are more open to alternatives than they've ever been. say distrust in mainstream institutions, all that. People are more primed to seek out superior alternatives than they've ever been, especially in health and wellness. Those are the cruise ships, those big institutions. I view what we're doing with our gym as a lifeboat or as a rowboat.
The benefit of those is that they are very easy to steer. Turning a cruise ship around takes miles, but you can turn a rowboat on a dime. I view myself, I view my gem as, and this book is part of that. We are one of those rowboats, or one of those lifeboats. I think that the farm is one of those lifeboats. I think it's a bigger lifeboat that's been around longer, but that's...
Michael O'Neal (01:12:42.241)
I wanted to join that movement of alternative health solutions. Seeing what you've done at the farm for the past 10, 10 plus years now, for you to not just open up a chiropractic mill. Like you could, you can make a lot of money cracking a back every five minutes. Yeah. Yeah.
Dr. Beau (01:13:05.86)
think about it every once in a while.
Michael O'Neal (01:13:11.557)
But we know the end game of that. We know what that gets people. And so I think with your lifeboat, I wanted to build a lifeboat, and we could name several others, there will be a critical mass of lifeboats at some point where there really is a competing cruise ship.
And I, everything, every big change happens gradually then suddenly. And I think we're creeping up on the suddenly. I'm glad that I got to get started before, like the people who just want to cash in on the next big opportunity did. Cause you, like you, Hey, I've been doing this. Like you, I'm sure you see stuff in the headlines. You're like, I've been shouting this for 10 years. My, my people come into me and say,
You hey, I saw this on on this podcast and it says that I need to be taking creatine. Have you ever heard of creatine? I'm like, yes, I bought my first bottle of creatine at the GMC down the street from my house in 2007. And my mom wouldn't let me take it when I got home because my doctor, my pediatrician told me that it would dehydrate me and destroy my kidneys. So yeah, yeah.
Dr. Beau (01:14:34.072)
My mom thought I would get kidney disease.
Michael O'Neal (01:14:36.303)
And so, so my dad, my dad promptly took that creatine bottle out of my hand and he marched it downstairs and hid it under the kitchen sink in the basement so that he and I could take it as we left. Yeah. It's the one I don't, I don't remember, but I do remember seeing like Jekyll and Hyde and like magic eight ball, like they're black magic. Like there was some, there was some hardcore pre-workouts that ended up getting.
Dr. Beau (01:14:46.116)
C1. C1 is what my brand was from GNC.
Dr. Beau (01:15:02.786)
Which to our parents kind of aid, who knows what was in that shit back then though. So.
Michael O'Neal (01:15:09.817)
Yeah, yeah, like I get the high STEM stuff, but then, you know, with the creatine is a great example of, you hear the term bro science, right? So this is something else to develop industry literacy among my clients. say that, and I have a drawing I did for this too, I say the bro science is 20 years ahead of
now I'm forgetting my own example. say, okay, here we go. The bro science is 20 years ahead of the institutional research. The institutional research is 20 years ahead of whatever is being implemented as evidence-based practice. Evidence-based practice is 20 years ahead of whatever is being taught in schools at the time. And whatever is being taught in schools at the time is 20 years ahead of whatever insurance is willing to pay
So you have about a 60 to 80 year gap between the actual best practices and then whatever your insurance company is willing to pay for.
Dr. Beau (01:16:19.192)
Yeah, it's not that far off.
Michael O'Neal (01:16:19.695)
Do you think, let me run this by you, because I'm in my own echo chamber, no one really, do you think that's a broad strokes captures the state of the industry?
Dr. Beau (01:16:31.746)
Yeah, in my, so to bounce back to your previous topic of, know, lifeboats versus the cruise ship and kind of the mounting, you know, the tipping point to use Gladwell's, you know, term. I tell people all the time is in our office because, you know, this is something I want to bring up out of your book that I just, and I'm poking fun here, so don't take this in a negative light. You kind of talk about, Hey, the best way to suss out a PT is if they take insurance, don't go to them.
you know, if you go to a Cairo's office and it's flashy, you know, showroom, like car showroom, like, you know, run. And it's like, we take insurance and I feel like our staff has smiles on their faces. Like, dude, just Michael, like shooting shots across the line here. But what I always tell people is we take insurance because, and this is the honest to God truth. have no qualms talking about this is like the state of Alabama has extremely high reimbursement rates for somebody who does rehab based chiropractic. If that changes, we got to change real fast. And do I think we make as much money as we should make?
Michael O'Neal (01:17:10.095)
Yeah.
Dr. Beau (01:17:29.42)
No, I don't, but I'm willing to take that hit to kind of service both from a business standpoint, but also service a community. That tipping point is not too far away, but that capitalist structure of our country is what's going to create the ultimate tipping point is the consumer will say, I'm not going to pay $800 a month for insurance and then still have a deductible and only be able to go to these people. And then these people are terrible because they're in network. And then I still go to somebody who's out of network and pay cash. And when
And I always kind of say, I think people like you, obviously you're in a little bit different realm, not an insurance model, but we're already set up. I'm like, dude, let it come. Then the competitive market plays out and whoever was taking insurance, it's going to be whoever's decent at their job because you could charge $150, you could charge $25 and people are still going to be like, it's not insurance, which is just wildly misunderstood consumer market right now. But anyways, that's a long side conversation.
Back to your question to me, yeah, but agree. And that's the market shifts based on those things that are paid. But then if we played the other side of that, you know, I went to Cairo school, people say, I mean, I get the question all the time, where'd you learn to do this? And I always, you know, jokingly say non-chiropractic school, right? It was all the stuff we learned outside, which a lot of that stuff teeters on bro science, but it gets back to our initial point of.
My thing is the people that push the envelope within our field, the general field of like, you know, health and wellness, the movement, whatever you want to call it, are the people that are really good. And I hate to bring it up again, like adhering to first principles, understanding science and playing with it enough, right? From their experience, a bunch of N equals ones over time and saying, I could give a shit less of insurance pays for this. think it works. I'm to do it in my practice and kind of see if it still works. And that gets back to what is actually better. and if you can tell, I'm trying to put a big bow on this conversation, but
I think what we have to be aware of is institutions are necessary still because they do create credentialing which allows for people to not get hurt. That's the whole goal, right? If you have a state board, you go to school, you get credentialed. What tends to happen though is people don't get better even though they don't get hurt. So that's another form of neglect or harm. And what you're kind of, think alluding to is the...
Dr. Beau (01:19:46.244)
the mounting frustration and seeking different results, alternative medicine, cash-based PT's, looking at a personal trainer, which we would say from a credentialing standpoint, it's like, I'm gonna go to them for my aches and pains and overall better health and wellness. The markets push people there. The market is demanding that. And I think, like you said, you're in the best position possible. You're established, you're a bright guy, you're creating systems, not a money grab.
Right, you're playing the long game in essence and creating credibility with a book like this. One thing I want to ask you though with the book, I mean I'm looking at the cover of it right now, have the trunks on the tree, we're talking about some of the different pillars of health. How much of that plays into what you guys are discussing or I guess educating your clientele on?
So is it just they're going in there and you're lifting weights and you're working on endurance or are you working on a holistic approach or is that in the future is you wanna be a bigger rowboat? Yeah, how do you guys approach that?
Michael O'Neal (01:20:56.079)
Do one thing well first. well, yeah, if you look at the book, am that far tree on the very first tree, I am not performing orthopedic surgery at Reform Health and Performance. But, then, you know, physical therapy, you know, lowercase P, lowercase T, I'm able to capture a pretty broad spectrum of what someone would experience in physical therapy. And it kind of what you said about,
Hey, how do you pick a physical therapist? When I went through my session with you a couple of years ago, one thing I noticed about our session is that you did not have three other people scheduled at the same time as me to work with you. also you did not hand me a sheet of paper and then go type notes on your laptop.
Dr. Beau (01:21:42.094)
We just did that because I knew it was you. No.
Michael O'Neal (01:21:53.969)
while I followed the sheet of paper that you handed me and three other people doing the same thing. that, and that, like when you, and you, you know this, when I talked about the insurance based physical therapy mills, that is the model that I am talking about. Because I, and I think I say that in the book that the, actual economic model relies on, you know, four patients per provider per hour. So, and like, I was a tech at,
I was the one who was running around hitting timers, changing laundry. do your shoulder like this. so I've, I've been immersed in that. yeah. So at the gym right now, we are in our current location where like we actually have a gym. I'm not, you renting space from another gym. have a closet and then a train. We were two years in our current building and we do, can say, Hey, we do strength training and VO.
Because like it's straight training and hit. We put it in the session together. So I want to do that very well. I've had a couple of people later on more endurance stuff. So I write programs and coach people through that as well. We do, I tell people, I don't have a nutrition conversation with anyone until they have demonstrated that they'll show up and work out for at least two months.
So I'll do for people who need a nutrition consult, I'll sit down and do this periodically. And then it's, hey, how much effort do you wanna put into this? Do you wanna do more of an elimination protocol or do you wanna count all your macros? And then you just have to figure out what will they actually do. Mental health, I don't think there's...
any mental issue that like getting jacked and in shape can't solve. I wouldn't say that there's no issue, but I think it's a lot higher than most people might want to estimate.
Dr. Beau (01:23:51.854)
Bro, so I'm for you right there.
Michael O'Neal (01:24:07.747)
Yeah. So, the, like the mental, I the mental health is a by-product of honoring your biology when your, when your body is functioning properly, then like there, there's no distinction between your brain and your body. Like there is, but there's not, there, there is no question that changing your body changes your brain. So that would be my interface on the, mental health side. And then just being relationship based, like training people, like, it's not really a, it's not really a fitness job. It is a relationship job.
So what let's see mental health strength training and during its chiropractic I am NOT doing any acute high-velocity adjustments at my facility in case you were wondering Though sometimes as a massage therapist you might go across a rib and get a nice clunk, but that is within my scope of practice and then yoga I We don't do yoga at my facility and most of the people who are into yoga
I'll say this, the hardest, the most difficult problems that I have had to solve with people has been from hyper flexibility, not from stiffness. So in the yoga department, that's fine if people wanna do it, but most people are gonna be better off learning to control their hamstrings through a Nordic.
Dr. Beau (01:25:09.796)
They already got what they need.
Michael O'Neal (01:25:38.373)
versus stretching their hamstrings through a forward fold. I've talked about this in the book. I've worked with several yogis who snap their hamstrings, like just doing a forward fold. And the rehab process, that was load management. It was like, your hamstring cannot manage any load. So let's teach it to manage load. I talked about a couple of those in the book as well. And then what you said, dude, is this...
planting the seed for growing into something more. It is part of the system that can create all the necessary and sufficient conditions to grow into more. What that more is, I don't exactly know. But we're just taking the next necessary and sufficient step to do what we need to do right now, knowing that that will open up more options in the future.
Dr. Beau (01:26:33.676)
And again, I'll obviously put a link forest for the trees, a new paradigm for health performance and longevity. I have three. yeah. So, I think you and I's book are like identical length. So I knew Kindle and I was like zoom and three. was like, I'd have to go look. So, cause when I honestly, when I got done with my book and then I saw how small it was, when it showed up in the box and print, was like, God, like this looks like, what was the old,
Michael O'Neal (01:26:39.441)
Thank you for reading it, by the way.
Michael O'Neal (01:26:47.542)
really?
Dr. Beau (01:27:01.496)
Reader's Digest or something. was like, man, but that was just my ego taking a hit based on size, which, know, surprise, surprise.
Michael O'Neal (01:27:08.741)
But this is the optimal length for people to actually read it. that like, Yeah. So that, you wanted to apply that, like, what is, how do you write the best evidence-based book? Well, it's gonna have to be Peter Atiyah, know, just a thousand pages long. I got, so I tried to audio book that and I got like the recorded a chapter and I haven't touched it since.
Dr. Beau (01:27:14.52)
Right, especially nowadays. It's actually too long.
Dr. Beau (01:27:29.569)
Yeah.
Dr. Beau (01:27:34.872)
Mine's still on 1 % in Kindle, if that's how you.
Michael O'Neal (01:27:36.433)
Really? Yeah, well, and he said that that was the pared down version. said, he said, yeah, he said, he said, yeah, the first draft just read too much like a textbook. Like, this is what, if you look, I, I, Peter, it's, he has better information in his book than mine guarantee it, but you and I aren't making it through 1 % of it. If people make it through all 120, 30 pages of ours that actually do something with it, then like,
Dr. Beau (01:27:41.54)
Yeah. 300, 300 page cut or something.
Dr. Beau (01:27:48.036)
Which again...
Michael O'Neal (01:28:06.063)
Who's evidence-based? that's the whole forest or the trees. What are the mechanisms that account for biology and human behavior and actually drive people into action so that they can get the outcomes that they at least say they want?
Dr. Beau (01:28:23.076)
Yeah. I mean, that's on the forward of my book is this knowledge and action. Like if you don't act on whatever you took or can't because you didn't take any information because it was such an overload. Yeah. What's it matter? these last two questions and I got one follow-up. ask everybody on the podcast. just, you know, take it wherever you want. what is one thing that you long held true? It doesn't have to be within the health and wellness realm, but if it is, that's okay. And you've, you know, righted, your 180 degrees different on that now.
you know, whether it was a year ago, five years ago, you're just like, God, I used to think this is the way it was and I was so wrong or I learned different.
Michael O'Neal (01:29:29.659)
access to more and better information creates superior outcomes. I used to believe that. I do not believe that anymore.
And I had to sort through about a hundred things that I wanted to choose from to answer that question.
Dr. Beau (01:29:45.08)
So what's the alternative to that then?
Michael O'Neal (01:30:00.377)
I what I just said a consensus approach.
What is the consensus of this community based on the information that is available?
Michael O'Neal (01:30:21.041)
like four out of five doctors agree that blah, blah, blah, blah.
Michael O'Neal (01:30:28.121)
I think that used to work. I don't think that works anymore.
So let's call that a consensus model. The alternative is a resonance model. And a resonance model is a community's ability to rapidly A-B test things.
And so, yeah, of course, well, that's a form of having more and better information. Yes, yes, but when you like that's the broad strokes and then when you break it down. So how do you how do you get more and better information that actually drives superior outcomes? And I don't I don't necessarily think that the consensus model wasn't the best one for the time, but I think that the consensus model is. Too bloated to be useful anymore and a resonance model.
of local networks rapidly A-B testing for problem solving is the way of the future, especially with the rate at which information can be tested and teased out with AI, with pending simulations. That's kind of what I like with my gem.
All the Lane-Norton conversations happen in the context of the consensus model, where my gym is a resonance model. I am doing the A-B testing on a regular basis and figuring out what is effective for my population. Now, can I extrapolate and say that every decision I make for my clients is going to map to be the best decisions for other clients in another context? Like, no, I can't say that, but I'm not trying to say that.
Michael O'Neal (01:32:15.345)
Because I view myself, now if I were a cruise ship and I were making those claims, then that would be a problem. But I specifically position myself to not be that cruise ship. I specifically position my scalp to function within a particular scope of resonance so that I am not claiming to do something I'm not able to do. But I'm...
but trying to position myself in a way where I can grow to claim more over time. Yeah, so I would say a consensus model of information and application versus a resonance model of information and application. That is what I had done a 180 on.
Dr. Beau (01:33:05.218)
Yeah. So the flip side of that question, is there anything that you hold true? You're like, I think this is the way it is, but there isn't any evidence out there. you know, whether that's peer reviewed a book on it, you know, a consensus. They're just like, yeah, that's the way it is. And just, there's nobody that's agreeing with that at this point in time.
Michael O'Neal (01:33:33.967)
I want to have a more context appropriate answer, but the first thing that comes to mind is that aliens are already on earth and they live underwater.
Dr. Beau (01:33:43.672)
I didn't say you had to keep it in the health monastery.
Michael O'Neal (01:33:44.625)
Yeah, yeah, but that was just the first thing that came to mind. I think aliens from other planets and or galaxies are already here and I think that they are underwater and I think that we've likely we've already interacted with them, know, like the octopus or something. They could also be microscopic so we can't see them. What if aliens are microscopic and they're already here?
they're living on the corner of your bedroom rug and they have an entire civilization, but they came from another galaxy. think probability is that, I think they're already here and I think they're either underwater, microscopic or both.
Dr. Beau (01:34:29.966)
Yeah, would also say the last Senate hearing also plays into that as well.
Michael O'Neal (01:34:30.065)
That's it.
Michael O'Neal (01:34:35.631)
Are they talking about that again? When there's something in Mexico where they like unveiled alien bodies a few months ago or like last year? Yeah.
Dr. Beau (01:34:37.72)
Yeah, they are.
Dr. Beau (01:34:44.772)
I haven't seen that. They just did a Senate hearing last week where another, I want to say Navy officer, Navy for sure. don't know what level officer, but he was like, yeah, there's for sure. Like he was talking about an F 22 that got surrounded by six UAPs, which is now what you have to call them. Six UAPs and like, they almost like crashed the plane and he's like, yeah, we have that recorded.
Michael O'Neal (01:35:06.369)
Well, I would consider Congress a consensus model. So based on that information alone, my resonance model would lead me to not believe anything about the alien testimony that's said in Congress.
Dr. Beau (01:35:21.316)
Well, but the one question that really stood out there was they asked specifically, do you think it's a drone? Cause he said a lot of this is probably drone activity. And then he goes, there's about 20 % that's unexplained, which they created also a hotline. It was like a R O P or something, or you can call in like for UAPs, which also shows you how prevalent is because it's probably drone. Then he goes, the other 20 % unexplained. go, what do think that 20 % is? Do you think it's other nations, us reverse engineered technology or other world? And he goes, don't know.
And they go, well, if you had to guess it goes all three. And so it was just kind of an interesting answer. Yeah.
Michael O'Neal (01:35:54.641)
One more quick one. I think it is likely, so everyone's talked about dissimulation, right? And it's kind of boring, like no one really has an interesting approach on it. Do you seem to have a regularly occurring set of problems in your life that follow a particular theme?
Dr. Beau (01:36:17.516)
Yeah, but I think that's my own doing. literally am writing a blog about that right now. Yeah.
Michael O'Neal (01:36:21.379)
Okay, well, let me give you an alternative explanation for that. You are a simulation character and the function of your existence is to A-B test how to problem solve for that problem in the whatever world programmed you.
Dr. Beau (01:36:41.22)
Did you watch or listen to the Joe Rogan episode with Brian Cox, astrophysicist, that talks about this?
Michael O'Neal (01:36:46.225)
No, but I see clips from him and I just saw one where he was like, you could travel the speed of light, then you could travel to another galaxy, but you couldn't come back and tell anyone about it because it'd be like four million years. It's like you could travel to another galaxy in 27 seconds, but by the time you got back, it would be four million years. But what did he say?
Dr. Beau (01:37:10.158)
The craziest and anybody that's still listening at this point like thanks for sticking with us But the craziest thing I was just talking to Sloan my wife for anybody that was no last night about this That have you seen the like a laser level experiment where people took DMT? Have you seen you know, I'm talking about it all So they take a laser level so it's beaming a laser across a drywall like a drywall wall and There on DMT was the original experiment and they look at this laser and everybody
Michael O'Neal (01:37:32.753)
Okay.
Dr. Beau (01:37:38.926)
There was like 1500 people in this experiment and it's interesting because he commented on it. He's a Cambridge trained astrophysicist. They all see code. Every one them like says the exact same thing across the board without being cued up on what to see. They look at this laser, like matrix code, like code raining. Yeah, whatever the code. So he brings this up because Brian Cox brings up simulation theory, Jorgens, like you've seen these videos of people. goes, yeah. And just like completely like.
Michael O'Neal (01:37:53.083)
Like one.
One zero, one zero, one zero, okay.
Dr. Beau (01:38:08.388)
whether it's confirming or he's like, yeah, that's, that's a thing. And I was like, what? mean, it was just one of those like, and then he brought up the thought of, they're on DMT and he goes, well, they're actually have and are doing studies with people that are not, know, to, you know, basically RCT that it was just crazy stuff like that. Or I tell my wife, she's like, I don't want to think about it. That's, don't want it. I don't think.
Michael O'Neal (01:38:27.601)
Yeah, so how about this? The idea that things, and this applies to history as well. Everything that's observable and even observable history, like artifacts, they're only observable because we are attempting to observe them. Like they are, the idea that they are rendered on demand as we approach observing them, like the edge of the map of the video game. Like you can't go beyond the edge of the map, but if you're...
you know, falling through the sky, like you see the animation pop up, like as you get closer to it. So part of the reason that there is so much discrepancy among historians and there is so much discrepancy even among human accounts of events and human memories, presently, so not even past, is because whatever engine, whatever processor we're running on would require too much bandwidth.
for everyone to be able to account for the same events the same way. So if we just have discrepancy among our memories, but that is the norm, then we just get to argue about who remembers something right or who's more evidence-based when as a matter of fact, the discrepancy of memories is just a way to save on bandwidth because the entire processor could not accommodate. Like render it kit, there's no reason for it to expend resources.
rendering the moon if no one is able to look at it. But once the moon is observable to us, like it's observable because it's, well now we're rendering it because they can't observe it and they expect to observe it.
Dr. Beau (01:39:58.531)
one.
Dr. Beau (01:40:07.746)
Now you're actually playing back into the conversation of when I brought up like Darren Brown. So if you think about, you know, we've are a lot of people have heard about the default mode network and like how much your prefrontal cortex is actually shutting down incoming input, right. And creating whatever you're experiencing that point in time versus, know, now the Brian Cox talked about this as well. You know, the overarching theory is that like it's, it's a dampening effect. That's what your prefrontal cortex is. not a grabbing effect. And that.
that dampening effect, you know, we don't know what we don't know. We can't see the microscopic beings. We can't see all this other stuff that's actually occurring. But then that plays right back into to try to bring this back home. You know, the experience of pain or perception of movement or previous experiences, previous injuries. And that's where it gets really, if I have to sometimes stop this stop process, because it like leads me to a point of no action, right? I said like one of my monitors.
Michael O'Neal (01:41:06.426)
Yeah.
Dr. Beau (01:41:07.234)
like knowledge and action, because you think if, wait a minute, if everything can come down to, you're just not allowing that thing to be processed or you're allowing that thing to be processed over and over or in a certain fashion or tied to certain emotions. It gets really down to why am I doing X, Y, in that treatment room or in the gym when I should be tinkering with that mechanism. And I think there's going to be a lot more explored in that realm in the next five to 10 years for sure, because we'll be able to use, as you said,
you know, propped up AI simulations in that kind of avenue, because you can't do those types of experiments on people because you'll probably leave them, you know, partially lobotomized. But it'll be very interesting, but I toy with that all the time of like, God is all the hands-on and movement-based stuff. Because I don't know if you've ever heard of, you know, the name Giancarlo Russo. He's a Rome-based physiotherapist, hypnotist. So one of the most interesting people I've ever met in my life, because he literally
Michael O'Neal (01:41:46.619)
you
Dr. Beau (01:42:06.232)
will hypnotize somebody with like, you know, 10 out of 10 sciatic pain. They got a, you know, positive straight leg raise on the table. It lit up, puts them, know, puts them in a, you know, hypnotic state. No presentation of that takes them through a straight leg raise like 20 times. I wake up gone. So when I see something like that, you immediately have to start at least questioning like, what in the hell is going on? Because we've got all these fancy first principles. And again, that's where I say we, it's only the
Information at hand, but then I think the best in the world are always questioning Why does that work if this is what we believe and then you that's how you keep pruning or sharpening the sword? Yeah, that stuff's wild to me and I just don't know what to do with it right now I don't know if we'll ever do anything with it. That's my thought
Michael O'Neal (01:42:42.085)
Mm-hmm.
Michael O'Neal (01:42:51.609)
Here's how I alleviated some of my anxiety about the need to be correct.
Michael O'Neal (01:42:59.863)
Everything is probabilities.
I try to interface at the level of probabilities.
Michael O'Neal (01:43:09.391)
versus this is right or this is wrong. And the benefit is as you stack more and more probabilities, then you will approach a pattern of rightness that is more reliable. I think that fits the resonance model, your rapid A-B testing. But framing a lot of my decisions as probability-based rather than evidence-based or certainty-based.
Because like what evidence-based, you could argue like that should, should, my least favorite word, like enough evidence-based practice put together like should yield a reliable probability-based practice. But the problem is the evidence is applied as, it worked for this cohort, it'll work for your cohort. No, like the evidence is part of a pool of probabilities. And if you judge yourself as a provider,
based on your ability to get any particular situation right or wrong, eventually you're going to be wrong enough that you'll quit or you have to develop some sort of psychological mechanism to, or cognitive dissonance, or you have to rely on, well, I'm right more than I'm wrong, which is ultimately what? A probability. So if you can frame everything as a probability, then it's
Dr. Beau (01:44:22.722)
drinking habit.
Dr. Beau (01:44:28.866)
Right. Confirmation by.
Michael O'Neal (01:44:35.483)
takes away the counterproductive moral judgment on yourself as a provider. And it also takes away a lot of the arrogance that you can develop as a provider. Like, I got it right. Well, you played the probabilities correctly, and that is your job. So you're really like, you're not right or wrong. You're an arbiter of probabilities. And if you are effective, if you're an effective arbiter of probabilities, then
you will create a net positive effect on the people who you are interacting with.
Dr. Beau (01:45:09.828)
So what we found out is you are a gambling man and that's what I'm taking away from this entire podcast.
Michael O'Neal (01:45:16.355)
I will if I well I Have no I'll say too much. There's not about me. It is about someone
I have a client who has a very good job, but he says his real job starts during sports season. And interestingly enough, the way he approaches everything is a systematic probability based proprietary that he created. So he will bet on every pro game that is played every weekend and he will bet on select college games. He has been doing this for several years.
And he, like I said, he has a good job, but he tells me that his real job starts in the fall. But it's all probabilities system based. It's not, man, my gut, man, I feel like this team. blah, blah, blah is, it is. And he doesn't win every game, but in the betting world, you do not have to win every game. You have to win enough and you have to allocate your units appropriately.
That is how the system works. It is a dispassionate mathematical probability based system. And I think flipping, you don't want to remove the human aspect from what you do, but there is a lot of value in being able to adopt a frame of like dispassionate probability based action.
Dr. Beau (01:46:50.884)
Yeah, it takes a lot of the getting your teeth kicked in every day with, you know, poor outcomes, which is just the reality of being in this business. If we're talking about, you know, pain relief, you know, movement change, I mean, that's just how it goes. Cause you're dealing with humans. it's messy pattern recognition, you know, like one of my favorite books on this topic is kind of black swan is like, we do a pretty good job at like seeing the patterns that we're used to play out. But then when a pattern breaks, a lot of people tend to just throw that pattern out. Like you said, like I do good most times.
Michael O'Neal (01:47:20.123)
Yeah.
Dr. Beau (01:47:20.13)
And then it's knowing when to pay attention to that kind of outlier. Like, does that matter? Does that mean anything? Should I explore that? was like, that's like you said, that's playing the probable, you know, outcomes. And again, back to a big framework that we try to create in here, both from a clinic and when, you know, work I do outside of here is like, we're trying to create good clinicians. mean, that's ultimately what we're doing. Right. And that's somebody that a help somebody, but also doesn't take advantage of somebody. And at end of the day, like,
Being a good clinician, which gets back to the first question I asked you, like what's better, is like that's what we're asking. Like what actually makes a good clinician, right? Is it good human management skills? Is it good clinical skills? Is it diagnostic skills? It's obviously an amalgam of those, but it's usually not what most people think it is or were taught in school.
Michael O'Neal (01:48:06.105)
Yeah, well, and interfacing at the level of probabilities. I forgot the second half of my sentence. That's okay.
Dr. Beau (01:48:19.108)
50-50.
Michael O'Neal (01:48:20.045)
Yeah, that's pretty well what going to say.
Yeah, I know. It's It's escaped me now. It must not have been that important.
Dr. Beau (01:48:29.464)
You're good. Well, hey, we kind of went off the reservation there at the end, but that's actually more fun for me.
Michael O'Neal (01:48:35.729)
Maybe that could be the behind the paywall upgrade section for your podcast. If you want to hear more. Yeah. Yes, I think you could go to a tiered subscription. You've been podcasting for like 10 years now, haven't you?
Dr. Beau (01:48:43.032)
Just tease the microscopic UFO theory or alien theory.
Dr. Beau (01:48:56.236)
Yeah, on and off and that's, you I do it for me, honestly. Like it's one of those things. Like I thought in the beginning I was doing it for an authority grab. And then I realized like, I just like talking to people and I gain a lot of it or a lot out of it, both from like actually learning something specific, but also just talking with people within the field. yeah, it'd cool if it blew up. I'm not going to be like, no, I wanted to stay small. Like that's in my game, but like, yeah, I've just been doing it on and off to have fun with it. Yeah.
Michael O'Neal (01:49:25.455)
Cool. Thank you for having me on. This has been the best. I've been on a single digit number, but this has been the most enjoyable for me. Yeah.
Dr. Beau (01:49:40.174)
Cool, man. Well, it's, mean, I've talked to you in person and we've known each other. So my last question is, before I let you go here, know you've gone long. Are you training for anything? So the last time I saw you in person was Exterra, right? And we actually, just had a meeting with the Exterra staff yesterday. So are you gonna do that again this year? Or you got anything coming up that you're training for in the endurance world in particular?
Michael O'Neal (01:49:45.229)
yeah, we have that third question.
Michael O'Neal (01:50:02.565)
high rocks in April.
Dr. Beau (01:50:04.545)
Okay, all right, so you're going all legit hybrid, huh?
Michael O'Neal (01:50:07.985)
High Rocks Miami, April 19th as someone who is a weak runner. It's triathlon is like you can hedge. man, better, but yeah, it a short, was a 5K. Like you can dive through a 5K. Like you can be like zone 5B.
Dr. Beau (01:50:27.202)
Yeah. And that was a short run. Yeah.
Michael O'Neal (01:50:37.239)
and you can just keep going for a 5k and that sucks. If you're decent on the swim, adequate on the bike, dive through the 5k, if you cannot run, don't show up to high rocks. So I'm putting myself in a position where if I am not running regularly and I've been running more than I've ever been,
without any injury. like when I, the first time I started running several years ago, like I had like a nine to 11 minute mark where my old right hip would flare up. Like I would just have stop, right, I'd have to walk. So I wasn't even thinking in terms of like heart rate based training, threshold, it was just like, can I run for 15 minutes without my hip hurting? So like the fact that I'm even able in a position to train,
a running intensive event and get to play with the heart rate and the threshold. And I'm not quite pricking my finger in between intervals yet like the Norwegians. But the fact that I've gotten to enter that world as someone who was getting nerve block injections as a 17 year old and missing an extra point in the biggest rivalry game of the year because of the pain and wondering like,
Am I going to end up like my grandfather who has had double hip replacement? I have only been better every decade of my life from teens, better in my 20s than I was in my teens. I'm 33 now. I'm better in my 30s than I was in my 20s. I plan to be better in my 40s than I was in my 30s. Yeah, so it's really cool that I can look at a running intensive event.
and say, I'm like, I'm going to train for this. I'm a weak runner, but I know like, I, you're a weak runner, it's because you just haven't run enough. You know, like strength, can, you can, you can exhaust like 90 % of your strength potential in a couple of years, but with endurance it's, is years. It is. So I've started running more regularly last year and about a year end or running.
Michael O'Neal (01:52:56.165)
multiple times a week and it's, it can be tough because you don't see that light switch progress that you see in the gym. But compared to where I was last year, I feel so much better. And I know maybe, maybe I can be the heaviest, the heaviest finisher with whatever time that I finish. I don't know, we'll see.
Dr. Beau (01:53:21.39)
Do you have a goal time for the HiRox?
Michael O'Neal (01:53:23.535)
Yeah, I haven't looked into it too deeply. I know the world records like 54. And I read that like most people who are in shape can probably do about 90 minutes. That's realistic. So what I'm doing, I'm pretty much running a half marathon training plan. And then, because it's like it's it's running there.
The reason I gas out in high rocks won't be because of the thousand meter rope. It won't be because of the sandbag lunges that are like 65 pounds. If I gas out at high rocks, it will be because I suck at running. So if I run, basically train for a half marathon, make sure that my volume and intensity is appropriate, know about what pace I'll be able to hold. I'm hoping for the 90 minute range for my first line, but we'll see.
Dr. Beau (01:54:19.33)
Yeah. Yeah. Amen. Well, keep me updated on that. And again, thank you for coming on here to said I'll be linking to Michael's book and social media, which is O'Neill health. Any last words of wisdom or anything else you'd like to tell before we jump off here?
Michael O'Neal (01:54:41.521)
Yeah, I just appreciate being on. I've talked a lot. I think I've said that all I need to say, I appreciate you inviting. I appreciate you inviting me on because I know that you have, you have built a platform over the last several years. and there is a lot of, you have put a lot of yourself into that platform. Like less. Yes, you have the farm, but like the farm is your, that is, I, as someone who
has started his own thing recently. Like I, I appreciate,
I appreciate being invited into that fold. It's because I know how I am about inviting people into the fold and I am not as established as you and your operation are. So thank you for inviting me into that fold. I appreciate it.
Dr. Beau (01:55:33.732)
Yeah, man, you're a great resource for people to learn from. So go check out the book. check out any other podcasts that Michael's been on and yeah, we'll maybe we'll catch some social media posts and we'll I'm starting a new like thought dump blog area. so maybe we'll get back on and talk about like hybrid training or high rock specific stuff at some point and kind of just do a real nerd out session on that, but we'll see.
Dr. Emily Splichal DPM - The Feel and Function of Movement
Summary
In this conversation, Dr. Emily shares her journey into functional podiatry, emphasizing the importance of viewing foot health through an integrated lens that includes movement, sensory input, and overall body awareness. She discusses the shift from traditional podiatry to a more functional approach, influenced by her background in fitness and human movement. The conversation explores the significance of ground reaction forces, the role of the autonomic nervous system in chronic pain, and the potential of regenerative medicine. Dr. Emily also addresses common misconceptions in podiatry, the importance of patient education, and the need for innovation in the field.
Transcript
Dr. Beau (06:06.744)
and we've had like social media interactions and things like that, but I've known of you since I graduated school, which I graduated in 2013, but kind of give me your origin story on just a little bit about, know, who you are, but then also how you got into podiatry. And then we'll, we'll kind of extrapolate later into where you're at now. how'd you get into this whole world to begin with?
Dr Emily (06:26.837)
Yeah, so podiatrist, but really functional podiatrist, which is, it's not a formal title within podiatry as far as a training yet anyway, but I'm really trying to bring this awareness of.
functional podiatry to the profession, to the industry as a way to appreciate the foot from an integrated perspective, thinking of diet, sleep patterns, obviously functional movement, fashion lines, so very integrated as far as how I like to approach patients. I also have a master's in human movement, so I truly believe that I actually treat movement, not feet. Of course, because your feet are connected to the rest of the body. All of that appreciation began, I believe, from
being a competitive gymnast for 13 years. So I was barefoot, body weight, fascial, body tension, just these concepts and philosophies that were taught from a very early age that I carried into.
my adulthood, had been in fitness for over 23 years, and I did fitness while I was going through podiatric medical school and through residence. So everything I stayed within the fitness industry, which really just further reinforced my appreciation for movement. And that's really, again, what I believe that I'm treating is movement.
And then I did a lot of self-exploration out of school for breathing, pelvic floor, fascial lines, a lot into emotion. And then of course, anything sensory based. I'm very much into sensory stimulation of the feet, the body, really perception of self. And I believe that our movement begins with us being able to connect to where our body is in space.
Dr Emily (08:04.375)
And I actually think that that's where most people are missing as far as movement accuracy, movement efficiency, and then movement longevity is it is a sensory based process that begins with connecting to ourself in space.
Dr. Beau (08:18.222)
So to dig into that a little deeper, why podiatry? Why, I mean, you could have went a lot of different realms within movement and medicine. Was there anything, did you have any like personal stories that led you into that? Or is that just kind of like, well, I'll throw a dart and land on that. And then you've just built this empire around it.
Dr Emily (08:34.071)
you
Yeah, no, was really not a fancy story where I was doing fitness in New York City and those were two things at that moment in my life that it was speaking to my soul. Sounds kind of crazy. And I said, I want to go to medical school or graduate school, but those are the two requirements. I have to be able to stay in New York City and I have to be able to do fitness. And there in Harlem is the New York College of Podiatric Medicine. And here I am today.
Dr. Beau (09:04.172)
go. But that's, mean, environment, just like movement environment plays a huge or critical role. So I mean that, you know, that's, you know, not too dissimilar from a lot of people that just have personal experiences with specific areas of medicine, right? You just happen to be in that environment where, here's this facility. you mentioned that
Dr Emily (09:04.599)
I not think it would be.
Dr. Beau (09:25.656)
You know, early influences, but I also kind of read on your bio that, I mean, you were going through surgical training or were about ready to graduate or had graduated. You can, kind of elucidate that. But when was the shift from this, you know, let's say the, classic, you know, allopathic look at, you know, podiatry or medicine from an orthopedic standpoint, particularly with the feet. Two more of this function based model, like obviously came from fitness, but where was that actual medical shift?
Dr Emily (09:53.749)
Yeah, so I think the fact that I stayed in fitness while going through podiatry school is very important because we were learning things like plantar fasciitis and advising patients, stretch your ankles. And we were being told as students, a way and.
were like, that's the way, like the only way. And I was like, no, it's not. know, foam rolling was starting to get into the space, more fitness than in a medical training. So you wouldn't see that yet in like a medical setting of really understanding self-myofascial release and stuff. So trends will hit the fitness industry a little bit faster. So I was seeing this and I'm like, that's not the full story. So it started to...
bring in this questioning or challenging that I'm actually learning this very narrowed scope of advisement and recommendations for patients that it was starting to challenge like my beliefs or my entire my internal environment. Then as as I was kind of continuing through my training the barefoot running boom happened and this was really really important.
That's why I actually stepped away from my surgical training, took time off, went back to school, got my master's in human movement because I was like, wait, there is a lot more to this. So what I felt authentically.
was true and how I wanted to practice ultimately podiatry was more in that direction. I was like, the only way that I'm going to be able to do that is I have to step back, get this, connect these dots and then go forward so I can control the way that my future looks. So it was really around that point. And then when I did get my master's in human movement, I focused entirely on barefoot science, the nervous system, footwear surfaces. So I really was starting to carve out that niche.
Dr Emily (11:44.459)
Then when I went back to surgical training, because I had to complete my residency to get licensed, I was kind of playing the game a little bit where I was like, I knew that ultimately this is not what I believed. And I started to incorporate from day one, graduating residency and doing private practice of let me do a gait assessment. Let me get you out of the chair.
And I remember practicing in a large group in New York City, and I was the only one that came in with that belief. And all the other docs were like, what is Emily doing? Like all my patients were walking down the hallway. I'm explaining. I'm telling short foot to everyone. And everyone is just like, what is she doing? And then eventually it became quite apparent that I could not practice the way that I wanted under conventional insurance because I need more time with patients. And eventually that's how I shifted.
Dr. Beau (12:34.648)
So let's double click on something. you're going through podiatric training, but gait analysis was looked at as like a little bit of outside the box, like, well, what are you doing?
Dr Emily (12:46.291)
I know the irony of that. Yes, that we... I know, I know. So we learned gait, of course, not to the level of how I look at gait now, but we did learn it in podiatric medical school because it's part of podiatry technically. But there's this pressure under insurances that is the reality of healthcare. And I know that you understand this to some degree, is...
Dr. Beau (12:48.398)
You
Dr Emily (13:13.587)
You just have to funnel these patients in and out. Like if I have, they would book my patients so I would have 10 patients waiting in the waiting room, upset, and I'm like...
Like a young doctor, I'm like, I have to get them out. So I would just be like, right? Like you have heel pain, plantar fasciitis, this is what you do, boom, boom, boom, you're out in 10 minutes. And I was just like, my gosh, that does not sit with me. But I have no choice, because these people are in the waiting room and I have to get them moving. And it's just that I understand the struggle of why.
why traditional medicine starts to get that way and why doctors feel pressured even though they don't want to, right? So I was just like, no, I'm just gonna, I'm gonna say no more. And I stepped away from it.
Dr. Beau (14:02.946)
my, to back up to the barefoot running boom. I started grad school in 2009, which was the year that born to run came out. And I still remember I had started reading it, went home for Christmas break. It snowed like a foot overnight. And I finished the book that night and went out and ran a half marathon and like a foot of snow, just because I was so hyped up in new balance, Minimus, and the whole slew of all the idiocy that followed from me personally of, you know,
Medial shin splints and all the stuff I dealt with coming from a sprint background and trying to transition was just, I think actually really good for me. Cause it was firsthand learning of experiencing those injuries, why they occurred, that it was on me and all the broken rules that I disregarded. Did you, I know you came from a gymnastics background. Did you get into barefoot running or were you just kind of extrapolating, you know, that movement into your specific like sports of choice?
Dr Emily (14:58.293)
Yeah, so I would just extrapolate it. And then my focus, even though was the barefoot running boom, the minimal shoe boom, I was really getting into the science of impact forces, muscle tuning theory, how the intrinsic muscles work, how our fascial system works. And then I would pull that into really barefoot training. And right away during the beginning of the barefoot running boom, I was coming in as the barefoot training voice, meaning the reason why a lot of people were getting injured as they trained.
transitioned very quickly. Many, many people did exactly what you did. And then the shoe companies would get blamed and it was, it's not the shoe, right? It's not Vibram's fault. It was that there was not this understanding of how our body actually relates to impact forces and the prehab to the transition you could say, or the pre-training.
that that's what I really wanted to focus on. And then I applied it to every sport. And that's why now I speak on a lot of conference circuits that are, you know, football, NBA, whatever sport it is, because it applies to...
everyone. But I remember when there was a lot of the press around like the five fingers and remember New York Times articles about, you know, how they're being sued or whatever. And everyone's like, aren't you concerned that this is going to just like take away your entire career? I'm like, absolutely not. This is actually validating what I'm doing and building strength that we need to really understand the training component. And it is a little bit unfortunate that the barefoot running boom or the minimal shoe boom
that's just kind of what I'll call it more that the minimal shoe boom was associated with running and people truly believed that to wear minimal shoes meant that they had to run and I was like that you don't have to become a runner because you want to wear those shoes I admittedly am NOT a runner I was a sprinter my body does not like long distance I like to do very quick movements
Dr Emily (17:04.423)
Very ballistic, do not do endurance. Emily and endurance are very much the opposite outside of cycling. Then I can do a little bit more endurance. yeah, I was like, I'm going to demonstrate that there's other benefits and power to this technique and this science and that it's not a trend that there is research and evidence behind what we are actually advocating here.
Dr. Beau (17:27.978)
when for let's say a student's listening to this, you know, today in 2024, almost 2025, the thought that this wasn't really a thing is probably pretty weird, right? That if we go back, you know, even five years, that's when I'd say the barefoot specialist stuff really became like very popular, right? There was this barefoot running and then the minimalist shoe. And then it, you know, it took that, you know, that Vibram lawsuit to kind of everybody to question. And then you actually saw the maximalist shoe, like
push and you know, that was the cascade coming back against that. so, you know, this, this shift from, know, typical podiatry into this, you know, functional movement and, you know, foot focused, practice base, but who were some of your specific early influences that helped shape, you know, what you're doing today, but also back then.
Dr Emily (18:17.343)
So I would say Dr. Perry Nicholson was, of Stop Chasing Pain, he was one of the most influential, partly because he was challenging kind of traditional chiropractic beliefs and philosophy. He's just a rebel. Yeah, to this day, he's very much of a rebel in saying like, no, there's more to what we were taught. There's more to what you can demand out of your body. he just really...
Dr. Beau (18:31.566)
to this day.
Dr Emily (18:44.777)
inspired me to kind of push into podiatry that same way and challenge a lot of the beliefs and then just be fine and say you need thick skin here'd be a black sheep push into it that's really how
industries move forward as you need someone who's essentially going to shake it up a little bit. So he was very influential on that side of things. A lot of the pelvic floor work, Diane Lee's work was great. Facially, absolutely love Robert Schleip. He is out of Germany. He is incredible. I love his work, his approach to everything. And then in the UK, James Earls, who wrote the
Dr. Beau (19:24.75)
Born to walk. Yeah.
Dr Emily (19:25.739)
Yes, he's amazing. He's spoken at several conferences that I've hosted. He's incredible. His approach. Everything is complimentary. No one is... Like we're not vying and saying like, no, it's not a competitive space. We're all just mutually trying to elevate and pull a little bit out of everyone's unique lens.
And I often tell people like my, my lens is from a podiatrist podiatrist movement perspective. Hear what I have to say. And then you might be talking about the exact same topic and hear how you say it. Cause you have a slightly different lens. were trained different, right? And then through both of what we're saying through our unique lens, does something I say or a word that I say resonates a little bit more with you or maybe similar with you and how I describe something they get completely confused. Like it's.
I love to learn from different specialties who have these different lenses because then that really broadens your understanding.
Dr. Beau (20:27.128)
Why this is something I say all the time, you know, whether it's with a, you know, an intern or whether I'm teaching is even in, you know, we're both in this realm of, know, the functional movement, you know, group and PT Cairo, all that is thrown into this giant pile. There seems to be a lot of conjecture and arguing, which is all in, you know, semantics and details that probably don't matter. But honestly, most people are saying the same thing, even when they're arguing over, you know, the same point because.
we're talking about, you know, human physiology, biology, anatomy, and, know, there might be minor discoveries that are being made that help like reshape some of that stuff, but really this stuff is principles, right? These are first principles. So that's what I want to ask you. If we kind of, you know, pull back the curtain a little bit, maybe more for the patient base of somebody listening, what are some of the principles that you live by, whether that's the lens that you specifically look at?
know, foot function through, you know, whether it's building, you know, a more, a stronger, more functional foot. What are some of those things that you, maybe find yourself telling, you know, patients or clients that you work with, but also topics that you're discussing at a conference with other physicians.
Dr Emily (21:35.863)
Yeah, so I have a few key ones that people know when they're referring me a patient that that's essentially how I'm going to be looking at them is very much the sensory story and that everything begins with our perception, our perception of where our body is in space. But if we kept it foot specific, just this high awareness of where your foot is in space and how your foot is contacting the ground. And then when your foot contacts the ground.
Do you actually perceive ground reaction forces and how quickly are you perceiving them? How accurately are you perceiving them? I find that most injuries that I see in my office are going to be a breakdown in either the timing or the accuracy of the perception of impact forces, which are vibrations. A lot of that has to do with shoes because there's cushion in the shoes, the cushion is absorbing the vibration, but the vibration is
our understanding of how hard we're striking the ground, the characteristics of the surface that we're walking on. So if that is inaccurate, the rest of that movement pattern essentially is going to be slightly altered.
So that's one of the biggest ones is this sensorial disconnection from the foot and the ground. The other one is the timing of the stabilization pattern between our foot, which is the only contact point between the body and the ground and our center of mass or deep core. And that's a lot of this foot to core sequencing that people know when they look at my work. It's a fascial connection. It is very fast. It is something that is pre-programmed into our nervous system, our myofascial neuromuscular system.
and it is something that has to be activating before our foot even contacts the ground. And I often find that a lot of compensation patterns are because that's just not happening fast enough, this foot to core. So I do a lot of pelvic floor work with patients and because your pelvic floor connects to your diaphragm, I do a lot of diaphragmatic work with patients.
Dr Emily (23:36.617)
and understanding that. So that would be another one. The third one just to mention, because I think that it is something that often comes up in the space of feet podiatry, foot strengthening, functional movement, is going to be different foot types. And that a lot of people may think that...
just because I'm a believer in minimal shoes or they may be a believer in minimal shoes, that there is no time and place for custom orthotics or supportive shoes. And there actually is, and there's certain foot types that are not just weak. not all flat feet are just weak. There's obviously ligament laxity. If someone comes to me and they have a torn spring ligament, which sits directly under your tailor head, that they're just going to be getting this mid-foot unlocking that is structural that you cannot strengthen.
than anything sufficiently to try to take that a wink to control that unlocking that is happening and contributing to this individual's movement patterns or injury risk. So those are like a few things that I often talk about or emphasize or we'll see in my office.
Dr. Beau (24:45.742)
from a patient standpoint, what are, if somebody's listening to this at home and you mentioned the first one, you're like, lot of people are suffering from like a sensory disconnect, which could be footwear driven. could be, know, habituated. What are some tells like what, you know, if somebody's not dealing with an injury, right? Because that's kind of our job is like, okay, let's go through diagnostics and see, okay, you know, that sensory perception is correlated to the dysfunction or the, you know, the injury. What could they pick up if they're like, I'm not dealing with a foot injury, but maybe that's going on.
Dr Emily (25:16.033)
So anything related to gravity. So our relationship to gravity very much begins with our relationship to our feet and the foot and ground relationship. So it could be just postural fatigue. You cannot stand long hours. You just hit a fatigue point when you're standing. And I know many people that are just like, I cannot stand long hours. It kills my back, my feet, my lint. Just everything tightens up. They're essentially passive in gravity, which is a fascial response. And just maybe
reconnecting to it. It could be, I mean you said no foot pain, it could be foot pain because foot pain, plantar fasciitis, stress fractures, IT band, shin splints, these are all quote unquote overused injuries, but I don't like to just blatantly or easily blame impact as the cause and say well therefore impact is bad.
Dr. Beau (25:51.726)
Right.
Dr Emily (26:10.015)
It's actually the relationship and the disconnection to the vibration or to the impact forces that that's what's broken. You're out of synchrony with the ground and with ground reaction forces. It could be diffused foot fatigue. So those do become a little bit more gravitational or impact force related. It could be efficiency. It could be that you feel like you are running and you're like, whoo!
That is exhausting. I am running like I'm running through molasses or something like that. You're actually not working with the ground. And when you work with the ground and you find your fascial system and you understand how to connect to gravity and vibration, there should be an ease in your movement.
But that takes understanding and really feeling and sensing the energy that comes from the ground and working with it. That's a skill. And unfortunately, we don't teach that a lot in kind of day to day or you're going for a little 5K run on the weekend. Unless you're taught that, we don't know how to connect to that.
Dr. Beau (27:16.974)
I like that you, know, we sometimes in our world too, we would say, that's a, you know, what we could use these fancy terms, sensory motor integration, and that's going to be something where we just have to improve the sensation. You're to have this direct feedback loop that's built, but then you're saying, well, there is a skill to also being aware of that. Just like I wasn't aware of, you know, until Dr. Steve Capobianco, you know, the upwards of 60 % of the population can't feel their own heartbeat, which to me being somebody that can, I was like,
Dr Emily (27:42.487)
All
Dr. Beau (27:45.56)
That's wild to realize like people's feedback loops are wildly different. So yeah, it is about improving feedback, but then what do you do with that feedback? Which is what you're saying is like, that's a skill based outcome or output. Then, if we dove, if let's go into running just a little bit on that kind of thought process for a long time in the running research, especially when I was in school. So if we go back a decade, everything to do with decreasing running injuries had to do with decreasing impact.
So I just kind of want to get your stance on this because there's been a pushback against that of and you said this almost verbatim of using the ground or using ground reaction forces to your advantage So is there any you know, maybe you have a more eloquent way of saying it's not just about decreasing ground reaction forces or is it?
Dr Emily (28:32.523)
Yeah, so it's not about decreasing ground reaction forces. It's actually...
feeling them faster. And then when you feel them, what do do with them? Right? Like how does your body actually utilize and store ground reaction forces or impact forces? I mean, we are inherently designed to absorb ground reaction forces and use them. And when I do my teachings, I often say, okay, when we walk, we have one and a half times our impact force and you release two and a half, right? When you run, you experience three, you release five to six. When you jump eight to 10, okay, gymnast,
find this one fascinating. Gymnasts doing like a tumbling pass. So Simone Biles, right, the goat that she is, is getting 18 times her body weight in impact forces, right? But...
You could initially be like, what the, right? my God, how are her bones not fracturing as she's experiencing these impact forces? I like to look at it and say, well, of course, because how else is she going to do a triple back or the bios five or whatever it is, right? Of these incredible feats of.
human performance requires the energy that we achieve from the ground. Where else did that energy come from? It is coming from gravity and the ground and the acceleration and the impact forces. So we actually need impact forces to do dynamic movement. Now the way that your body absorb impact forces is through stiffening.
Dr Emily (30:02.239)
And this is the muscle tuning theory. This is not my theory. This is Dr. Benoni's theory that impact forces are vibration. And as that vibration is coming into your body,
It can't be uncontrolled because uncontrolled vibration to your bones is what causes stress fractures and shin splints. So we have to damp or stiffen the muscles as that vibration is coming in so that we can take the vibrational energy and store it within our connective tissue. That's where it is potentiated or stored as potential energy, which you release as elastic, elastic energy. That's what gives you the ballistic movements or it's called the catapult.
Polt effect and you are able to go forward. So that dance with the ground of stiffening is based off of isometric contractions. So a lot of foot strength and the intrinsic muscles of the foot contract isometrically to stiffen and protect the bones of the foot and to allow that energy to go into our connective tissue. So that dance, which is the muscle tuning theory,
starts to fall apart if you actually don't feel your feet, if you don't feel the ground, if the cushion is absorbing the vibration, not your muscles, not your fascia. So then how are you getting the energy to move? Well, you use your muscles. When you use your muscles, that's a lot of energy, that's a lot of work, you start to stress muscle tendon junctions and you get itises. So that's essentially the dance of how I look at movement. That's the lens at how I look at movement.
and that was not taught in pediatric school.
Dr. Beau (31:43.586)
Yeah, it's a lot. It's, know, with everybody here, you know, within this room, all medicine or, know, whether it's strength conditioning, lot of unlearning, and then it's, you know, reformulating same information, but reformulating your thought process around it. And then it's kind of creating a synergistic, you know, approach to, well, this is kind of what I think based on, you know, years of experience with all that information. That's why I like, you know, we had Keith Barr on the podcast not too long ago and, I love, I still.
use a slide all the time when we talk about almost the phenotypes right to that more flexible person versus the more stiff person and how we could use different training parameters to literally tune the system, differently, which I talk about all the time with like high school runner or sorry, middle school runners because they are, you know, and the nicest way possible, the notorious black sheep of sports, they get thrown into.
30 miles a week and they're usually, you know, like a baby giraffe and you know, maybe it's laxity from a lack of movement early in life, or maybe there's a legitimate, you know, mobility thing there. But then the motor control aspect is decreased. Then we add into it a sensory, you know, whatever we want to call it dysfunction deficit, you know, misappropriation. It's a nightmare. I mean, and then we come in and we want a typical treatment for, you know, a medial, you know, tibial stress syndrome or something like that. It's this, it's very hard for me nowadays to be like,
You know, this is more of a training and an environmental thing than a, know, decreasing pain, inflammation and strengthening a specific area. Cause you kind of have to look at it as like an organism, which is what you're kind of saying, which I want to kind of get to here in a second is too often we get siloed. All right. You're a barefoot X or a foot expert, but you're looking at the whole body, the whole person. And now you're even, you know, we let off the conversation with you're looking at, you know, this integrative.
or the environmental medicine piece to it. So what are some of the other areas that you, as you've gone further in your career, obviously you're looking at tissue health and anatomy and biomechanics, but what are other things where you're like, man, these are having a monumental effect on people that I'm seeing with the typical injuries that I saw 10 years ago, I just am having a different lens. Is there anything that really pops to mind where you're like, yeah, that's a big player?
Dr Emily (33:56.351)
So one area that I started exploring is the power of just the autonomic nervous system and the state that the individual is in. I'm not a trauma expert. I'm not a mental health expert. I appreciate it. And a lot of where I started to incorporate that is that I was starting to see
and specialize in, think just because of my approach, is chronic patients. So chronic pain, chronic movement dysfunction. I started getting a lot of CRPS patients. I started getting dystonias in my office. And things that, well, things that face value that you wouldn't know were dystonia unless you're looking at it from a different perspective. And a,
isolated dystonia that's coming in, like runners dystonia, oftentimes that there's something traumatic that's inducing that why are they housing this, you know, energy, let's just say, in their gastroc, right? And it just becomes a little bit more complex that if someone is trained to look at the human body and medicine too literal.
Like I have to be able to see it. I have to be able to show something on the blood test or the MRI or the EMG, whatever it is, right? And you're too literal. You will then miss the...
huge complexity that is the human body and the human in general. And I started seeing this and getting a lot of idiopathic diagnoses, things that would just be falling under biopsychosocial or psychosomatic. And I was like, I have to create space for this person because no one is. And they're very hard patients to navigate when someone's coming in with something psychosomatic and just being told it's in their head. Like it's just a layer of complexity.
Dr Emily (35:55.801)
that then I would start referring them out. I got a lot into the benefit of, and that's more of a little bit literal approach, but the benefit of Botox for different dystonias and spasticity. Kind of side over here is I really got into regenerative medicine and I do a lot of that. Acupuncture, dry needling, photobiomodulation, hyperbaric. So I just really started to expand.
both emotional, energetic, alternative, holistic, and that's how I practice now because I've just realized that a lot of these things cannot be taken literally if I don't see it, touch it, feel it, see it on an imaging, then that's not what it is.
Dr. Beau (36:40.812)
And I mean, a lot of us, you know, within the medical realm and obviously even, you know, just general public are realizing that the siloed approach is probably not the best approach and it's created a lot of problems, even though, you know, it's necessary sometimes, but it's, created a disjointed and myopic approach to medicine, which doesn't really benefit the patient most of the time. That being said, and you know, you were mentioning some
newer therapies, most people, but a lot of these been around for a long time, you know, hyperbaric chamber, you know, biophoto modulation. This is kind of one of my, I'm undecided. So I feel like I'm on the ridge line of a mountain. I don't know which way I'm to fall down. Let me kind of explain that. I feel like I, I can very easily dive into that realm where I'm like, Hey, I want to really understand the complexity behind this case. This person has a unique history. There's things here.
Dr Emily (37:19.285)
Thank
Dr. Beau (37:32.034)
you know, whatever it is, know, chronic low back pain, recurrent injury at a certain, you know, training period, whatever it is. And, you know, I could dive in with all of my fancy tools and be very specific in my diagnostics. But then I have this other thought sometimes, and I want your opinion on this is it's almost like the environment we live in, we pander to that and not panders sounds like a dirty word, like, you know, I have a one year old and a four year old. If they fall down and you pay attention to it, it's worse. They will have a more.
extreme reaction to whatever happened regardless of the actual injury that occurred. And in our current state of health as a nation, in particular in the West, we're just not a very healthy population. Then we focus on the things that are bad. And it's almost like we kinda in my way of looking at it sometimes like, man, am I doing my patient to disservice by diving further in, right? To not necessarily the pathology, like pathologizing them, but like,
Well, let's make it as complex as we can or hey, there's all these other areas that you could work on that just make a human healthy. And if you do that, we're not saying it's, you know, it's not a specific like ICD 10, like, get more healthy. will, you know, cure your MTSS. But what are your thoughts on that? Because I just, I literally like day to day, I'm like, God, I don't know if I'm doing a disservice or I'm actually being the best clinician that I can possibly be. So any, any feelings on that?
Dr Emily (38:50.252)
Yeah.
Dr Emily (38:56.279)
my gosh, so many. And I wish I had a pen near me to write down all my thoughts that it was bringing up. So when I see a patient and they have a diagnosis, let's say it's idiopathic neuropathy on one in like a 30 year old. So they're like, I don't understand this, right? Like I'm 30, I don't have any comorbidities. Why do I now have this idiopathic and they don't even understand what that is. So.
Dr. Beau (39:21.102)
Mm-hmm.
Dr Emily (39:22.187)
that just as an example could be any of these diagnoses is that I will say, okay, this is your reality. This is your reality, right? You do not have to be, hi, my name is Emily and I'm neuropathy and therefore I cannot do anything. I'm like, no, it is here. It's just part of this phase. It's like a snapshot of your life,
day your presentation is here. You cannot be truly blended with this identity. And I feel that that's just what I've learned from chronic patients is they become so encompassed by that I am this diagnosis. Therefore, I cannot live to do what I want to do. And I'm like, if you understand that you have this and you're going hiking because you want to go hiking and you start to feel the neuritis symptoms, just say it.
I hear you, I feel you, I acknowledge you. I understand you're here, but I'm still doing this. So there has to be this, this separation in a sense, right? Oftentimes I will also tell patients with whatever it is, it's a, it could be something as like a ligament-laxed flat foot, which sounds not that big of a deal, but patients come to me because they're so set on trying to change their foot structure. I'm like, this is your reality.
How are we going to work with it? Or if you have another diagnosis that the only way to fix that is surgery, you are refusing surgery.
So I will teach you how to live with that reality. And I often tell them, I'm short. That's my reality. How do I work with this reality? Right. So we have to work within it. If I give programming, I tell them oftentimes that I'm not looking for a structural change. I'm not looking for your foot to go from this degree of pronation to this degree of new. That is not the goal. It is feel and function. It is not actually looking for a physical structural change in what your foot looks like, what the alignment is.
Dr Emily (41:21.909)
the degree angle. That's not my goal and that should not be your goal or the outcome that you're trying to follow.
I will often tell them also that let's say you're 55, 60, whatever it is, and you're having this presentation, I'll just say your body has this stress threshold. It's right here. It's multifactorial. It's emotional. It's energetic. It's sleep. It's inflammation. It's musculoskeletal, whatever it is. But we have this. Right now you are riding above it. I'm going to help to get you below that threshold, even if it's just below that threshold so you can have a higher quality of life.
and not feel whatever symptom it is every day throughout the day. You can start to push that threshold a little bit more, because you want to go for a hike. You want to walk your dog, whatever it is. But I'm going to try to get you to a place that you can push the system and just continue to ride under the radar. what I say. I just want you to ride under the radar. I'm not going to make you perfect, because that's not realistic. You're 60. I cannot get your connective tissue to look like you are 20.
or to get out of muscle imbalance and muscle compensation patterns that didn't exist when you were 20, because there's so much history, there's so much human that existed between 20 and 60. But if I can get you under the radar.
So things like photobiomodulation, acupuncture, hyperbaric, whatever it is, I say together, collectively, consistently incorporating modalities such as this move you towards this goal of riding under the radar.
Dr Emily (43:02.171)
Red light alone is not this magical treatment that is going to reverse things and take away all your problems. That's not the way that it is. We look collectively. They're all part of the story that have to be done in total to move you towards this forward. That's how I respond to something like that.
Dr. Beau (43:20.024)
Yeah, which I love your input on that. And in a sneaky way, you said in there, you know, the person going for a hike and you know, the neuritis symptoms kind of start to show up and you kind of acknowledge and you're aware, you like I'm going to press on. I mean, that's, know, if we, if we took the filter off, you know, we go on social media, that's people saying quiet the inner bitch. Like we're all what we're trying to figure out is, okay, is this a, is it a handling issue?
It's the language around these things. So people come in with, like you said, a diagnosis that they own. And I think sometimes we're told on the medical side that people want to own that diagnosis. Like they want to live in this pathologized, look what I can't do. And I think often the medical models that's built has put the label on them for all sorts of reasons, because it's over specialized, they've got siloed, they've lived with it for so long. They're like, I just thought this was the normal.
Dr Emily (44:01.495)
Thank
Dr. Beau (44:15.578)
so again, it's kind of an unlearning process and we become, know, maybe not the educator, but like the unlearning, you know, assistant at that point. So let's say somebody comes into you, and it's not just about, you know, chronic pain relief in the face of just getting out of pain. let's say somebody has a performance goal and there is a legitimate, like you said, you're looking for feel and function. And let's say they have a legitimate issue that they will not be able to change.
So let's say they had a knee replacement. Let's say, you know, I've had numerous patients with a, you know, an ankle that's been fused because of a previous injury in those scenarios, is it just, okay, this is our reality. We got to learn to live with it or, know, how far do you go with people that are like, you know, I've had people that are like, I'm to do this and I'm the eternal movement optimist. And in the back of your mind, you're like, it's going to be tough.
Like, have you had any those cases where you're like, yeah, that's my, that's what my job is to get them there. Or you just kind of hit them with, Hey, this is the reality. That's not going to happen. I know that's, you know, a very specific question, but again, that's, we're seeing more and more people being led to the path of extremism. got to push for this crazy goal to get yourself out of the scenario or you just don't do anything. So think it's good to have the conversation of, what is appropriate in the face of, you know, all of this information out there.
Dr Emily (45:35.485)
Yeah, so,
I will share a story of a patient who is a, like a master shot putter and he still will compete on it. He does a lot of power lifting and he has one of his feet is he had a fracture. I think he fell from a ladder. So he had a very classic telescoping into the calcaneus and it was fused in a certain way and he lost some of his limb length. But he was, he came to me then with compensation patterns from trying to
to do these things, not understanding that that was his foot and he had a leg length difference. So part of it was saying, okay, this is your reality. You now have a limb length difference and you have a foot that is fused in like a supinated position with limited ankle mobility from the hardware and the fusion.
So part of it is, okay, we understand this, that's it's your reality. Step two of it is I explain so that the patient or the individual actually understands how the foot is designed to move and how those movements translate into the tibia, into the knee movements, into the femur, into the hip, into the lower back, and how just energetically this coupling goes up the rest of the body.
then I have him understand that your right foot cannot do that. And also because your limb length, your pelvis is now sitting oblique, right? So I'm getting him to understand just integrated mechanics of the foot and energy transfer just so he gets it. Then I say, you can't do that. But you're still doing these activities that demand that. So what you need to do, I will give you the skills so you can keep doing that.
Dr Emily (47:15.105)
But there's going to be a level of transfer stress because of your foot structure, your reality, we'll call it. So I'm going to teach you what you need to do before you do those movements to try to get a little bit pliability and a little play in your system so that you can tolerate the stress of the activities that you are going to continue to do. And then I'm going to teach you how to reset to try to just decompress the system, take pressure off the pressure cooker, whatever you want, do a little reset so that we can avoid this stress.
threshold as much as possible given your reality and that you're going to do those activities. So I try to work and empower them as much as I can especially if they're refusing to do a certain activity as such which I actually get a lot of patients who do that and I've had professional athletes come to me and essentially I say this is really what you need you can't do that right now because you are at the prime of your athletic career.
So how can I teach you or empower you to essentially just...
put a bandaid on it for sake of better word and avoid any major issue. So you can keep playing at this peak knowing that when you retire, you're going to have to this surgery. It is kind of working with the reality of the situation so that one, always want them to understand what's going on. I want them to always understand their body, understand the stress of their activity.
Ultimately, this is how we fix it. We can't do that right now because either you refuse it or it's not the appropriate time. And then let's empower you as much as we can. Boom, go here.
Dr. Beau (48:57.238)
Yeah. In meeting them where they're at, you know, but regardless, regardless of their expectations. And I think that's where we both know this being in the clinical model. A lot of this is like, you know, it is a lot of patient management or people management, right? It's, it's like corralling thought processes, like cows in a field. Like nobody wants to think about it like that. Cause it seems like you're manipulating somebody, but that's not the, what we're saying here. We're saying there's realistic.
Dr Emily (48:59.573)
That would be a good way to say it as well. Yes, I'm them.
Dr. Beau (49:28.386)
Barriers there's also Sometimes people push past things. I mean, I've seen things I can't explain or things you're just like wow I never would have thought you could do that or changes from a biomechanical sample. They're like, wow, I should have had a little more, you know or a little less Cynicism around that scenario But all of the that to be said is we still have to put on our clinical hat first and like, you know rule out Well, are you going to cause a bigger issue or hey? Yeah, you can you know keep going and we can have that surgery later
When we're talking about, you know, right, wrong, the gray zone in between, when we're talking about the barefoot movement in general, which is, I don't know if it's, it's height now, if that was a few years ago, you probably have a better pulse on it than me. Are there any things that really stand out that you're just like the general public or maybe it's, social media or popular media at this time are absolutely getting wrong.
They're just like, if I see another message about this or somebody asking about this, you're just, I'm going to pull my hair out. Anything stand out.
Dr Emily (50:29.719)
I mean, my big one's not necessarily about the barefoot running. It just, you hit it when you said that, is the correcting of every single foot. There is a professional, unmentioned, that said, I've never seen a flat foot that a strengthening the glutes cannot fix. And that is actually...
highly inappropriate to say because yes, your glutes are external rotators that can create a little bit of an inversion or a lift to the kilcaneus in the subtalia joint which lifts your navicular. So yes, that stabilizes the foot, but then that overrides everything that we just said about ligament laxity, a torn post-tib tendon, torn spring ligament. So things like that create a lot of...
consumer confusion or patient confusion going into things. And then unfortunately, most of those patients I see because they try to do it and I've had many patients say, I have been awesomely diligent, strengthening my foot and doing these protocols for a year and my foot is exactly the same. And I was like, dude, you could have come to me a year ago and I would have told you if your foot was not going to change yet.
feeling function probably did, but they were looking at the wrong outcome. The other big one is bunions. And I wish I had a dollar for every one that I see online that says that they can reverse. I guarantee my program will reverse your bunions without surgery. I would just, I be a millionaire if there was a dollar for every person that said this. And that is just grossly inappropriate for...
patients and consumers as well, because that's not possible. Because people are looking at bunions as a toe problem. It's not a toe problem, it's a first ray problem. The bunion is actually the opening of the first and the second metatarsal, which is more of a mid-foot issue or a first ray metacuniform instability. And that's not how it's being proposed.
Dr Emily (52:29.655)
through social media and other programs. And they just think it's literally the angulation of the tone. If I make the toe look straight, then I fixed the bunion. Again, that is grossly inappropriate for someone. So those are two big ones that come to mind. I think also...
On the regenerative side, where I really focus on things and where I hope to bring clarity in the space through podcasts such as this is, let's say an example of chronic plantar fascial symptoms, osis, apathy, call it what you want.
it will be addressed from a where your glutes are weak or your core is weak or it's the movement pattern. They're looking at it what would be called globally that there's what contributed to this happen in the first place, which is accurate. You need to be asking why did it happen to the right foot, not the left foot? Why is it?
persisting to a degree from a movement pattern. But what is being overlooked is if you really zone and you like microscopically look at the plantar fascia and you see that the collagen and the organization of the connected tissue and the fibers is highly chaotic and it's very sticky and there's neovascularization, there might be even some partial tearing, that just looking globally at the movement pattern and the timing of the glutes in relation to
of the foot will never take away that patient's pain because you have to first fix the actual collagen fibers and the connective.
Dr. Beau (54:07.426)
Ooh, watch it, you're gonna get your functional movement card pulled here.
Dr Emily (54:12.496)
I know. I know. All right. So you have to first fix that. So what I do with that is that's where I will do regenerative injections in their shockwave and this whole category of regenerative medicine.
where oftentimes how I will propose it to a patient that I see is if they've been doing all of this, we'll call it functional movement approach if we want, which I'm a big believer in, it's just the timing of it. That's what I'm saying. So I will take my card back. Is that if they've been spinning their wheels.
Right? And I just guide the patient in it. I don't say this is what you need to do. I give them their options and I tell them things. And I say, if you've been continuing to do the same thing, let's say for several years, and you're still in the same place.
just take a step back and say something is not working. If your plantar fascial symptoms wax and wane, right, and as soon as your symptoms start to increase, you back off, you stop running, maybe you throw on some supportive shoes, you do that for a couple weeks, you're good. Everything calms down, right? Then you say, I'm good, I'm going to go running again.
several weeks of running, boom, boom, boom, you amp it up, boom, you're right back to where you started. You do the same thing and you're doing this over and over and over, right? Then I'm like, something is not working. What is there's the saying of like doing something is like you keep doing the same thing over and over is then you are like, don't know. Yes, something like that. Where I'm like, I just want to help you.
Dr. Beau (55:48.011)
insanity. Yeah.
Dr Emily (55:54.699)
to finally get your connective tissue to a place that it can hold and tolerate stress even 50 % better than where you are right now.
But the only way that you can do that is you have to look locally at the connective tissue and the organization or the disorganization of the connective tissue fibers itself. Let's bring some integrity. Then let's look at the global pattern that contributed to that in the first place. And then it's going to stick a little bit better. So that's, that's just one thing that I really try to create and just say, it's just the timing, right? You just, you just did step three before step two.
And that's why I'm here. We're just going to do it in a different order and then hopefully guide you towards success.
Dr. Beau (56:42.894)
Yeah, I call that fancy, or fancy functional manner woman. So I was on the board with a company for a long time rehab to performance that basically helps, you know, create a better model for PT and Cairo students of this, you know, rehab to performance of how do we take somebody from. Whatever I'm going to say a traditional physical therapy model into strength conditioning and delight, you know, whatever they want to do in life. What I actually probably helped perpetuate in a negative fashion was
more of the, the ladder, right? That all of a sudden we started seeing students, new docs skipping right ahead to this functional movement approach, which if you listen to somebody like Greg Cook, the first thing is protect, right? And then move into that. And sometimes you are protecting by offloading things, by changing movement, right? It's a dance. It's not just, you know, protocol of, you know, we got to get this tissue to change. have to have fascial lines kind of appropriated. Then we move into function. No, it's, it's whatever's appropriate for the patient based on, you know, diagnostic.
Dr Emily (57:29.879)
Thank
Dr. Beau (57:41.386)
approach. But I just saw this over and over that people were throwing out classic diagnosis because they got so bastardized. nobody has plantar fasciitis. That's your job is to if they do is it osis is it apathy, whatever it is. and then we saw people skipping to it then running into the exact brick wall that you said of clinical insanity of, why isn't this getting better? they have a legit, you know,
Dr Emily (57:55.893)
Yeah.
Dr. Beau (58:06.158)
A tissue change, if you do, if you do bicep curls, you'll get a bigger bicep because the tissue is accommodating to that stress that, know, and you can have a misappropriated response or an appropriate response to stress, or, you know, load management, whatever you're to call it. So I love that last sentiment and had a little, you know, let a little steam out of my valve because that's something that I'm just like, your, if you're a clinician, your first job is to actually create a diagnosis to make sure that they can keep moving forward in the face of that. But then secondarily, what
that determines your treatment. So if you have all of these tools and you just lean on, well, I'm gonna get them to move a little bit different and strengthen this and optimize this synergistic client, that's not a being physician, that's a high level strength, condition coach. And no knock to them, but that's like, why did you go to school to create that diagnosis if you're not even gonna use it or weaponize it? So that's a personal, if you wanna call it a pet peeve that I think I can actually help.
on the student base, which I like openly talk about now, like, whoa, back up. You gotta give me something here. And if there's nothing, yeah, move forward with that approach. But you did that in a protocol or checkpoint system. Let's stay with this theme. Go ahead. Yeah.
Dr Emily (59:18.079)
And I can just add that, I'm sorry, that everything that we're talking about for the listeners is there is the way that I approach a patient and say this or literally anything that I've said over the last hour, how long we've been talking, you can't take everything of direct context and face value because there's many, many questions that are actually under the analysis and the decision-making of what I'm doing and what you're doing, right? So...
You know, that's why I don't want people to like come to some conclusion or A equals B in literally anything I'm saying. This is a lens, but then there's a lot of peripheral consideration that is being done for the appropriateness of what I just said for each patient and what I'm adding into that and how I'm guiding them through this regenerative protocol. And that's...
probably what you had meant when you were really pushing into that functional approach is that in your mind just from clinical experience, there was a lot of peripheral consideration you had that they just didn't have the clinical experience yet. So they then just took it as a literal path to go down and.
It is hard to teach and explain clinical experience that is being done in the background that we probably don't even realize is being done as we're looking at a patient and making these decisions.
Dr. Beau (01:00:47.416)
Yeah, and even, you know, pruning the treatment and appropriate clinical process as the antithesis of everything that's supported on social media. I mean, it's the exact opposite. Like you said, I can, you know, change anybody's foot, you know, function and form based on, you know, glut me, you know, activation or strengthening. It's like, that's the expectation because that's what we're sold as sound bites and protocols and a plus B equals C. Humans are.
the most complex organism on the planet, yet we somehow think that this reductionist view that's, know, shown or highlighted on social media and even, you know, I've probably, some of the stuff that I've probably put out seems like that, because you kind of have to, you're talking without context of each patient, you're talking without context of within a diagnosis, there are so many different variations of the exact, like thousands of,
You know how that's going to present and that's what I you know, I was just reading a comment on a video I did from years ago on IT band syndrome and I was like, yeah, I guess they you know, they totally missed a point or did I completely miss construe? You know what I was trying to say and I think that's you know, you have had a you know, decent social media present for a long time as well as I have and I think that's one of our goals.
Is to help educate the general public along with other physicians, but sometimes even when we're trying our best It's like if you lack that context, like you said it You're never gonna miss hit the point if you were in a treatment room with us all day You would realize like my god The same conversation never exists even though the same concepts and first principles are always at play And that's that's the only thing that persists Everything else is just you know water Sticking with maybe the pet
Dr Emily (01:02:26.649)
Thank
Dr. Beau (01:02:31.522)
P even I don't want to say in a negative we'll get a positive or not really positive negative just different lights I ask everybody else or everybody of the same question. So is there anything that you Long held true or you know, you're like that's the way it works that maybe in the past year or two You're just like wow. I have totally
Dr Emily (01:02:36.599)
Thank
Dr. Beau (01:02:52.686)
know, 180 or change my opinion based on new evidence or, you know, things that I've seen in practice, is there anything that stands out that you're like, yeah, I've completely flipped or changed my mind on that thing.
Dr Emily (01:03:03.674)
I wouldn't say necessarily for...
for my patients and how I approach them, what I will say is, one that I will give credit towards is like muscle testing and some of the benefit of just table work. And it is one that I would knock a little bit. So I'll throw myself under the bus. Is that I'm very much a believer of how our body works in gravity. And if we do muscle testing on a table
to activate muscles on a table and then nothing is done when a patient stands up in gravity and starts to move in gravity, I don't see how that transfers as much because then we fall into these gravitational induced stabilization patterns. So that maybe it wouldn't even be a pet peeve in how it would transfer, but I had NKT done to me for a back spasm that I had.
This is this weekend. a little. So I didn't have a class, so I Sky Robertson Lang Robertson, she works with Dr. Perry. So she did it on me.
Dr. Beau (01:04:12.974)
Who taught your class?
okay.
Dr Emily (01:04:25.375)
long story of how I had pulled my back out anyway. And she was doing a, it's called Nervy and another cranial sacral test on it, right? Where you look at an X and you look at parallel lines, something that's beyond my scope, but she was doing it on me and I was like, Hey, I'm game cause my back is spasming and I want to get back into the gym. So she was doing it. And normally I take this philosophy of table work, not transferring to gravity. So I'm just like, man, it's like a mobile.
Dr. Beau (01:04:25.506)
Mm-hmm.
Dr. Beau (01:04:35.086)
huh.
Dr Emily (01:04:55.289)
and in time, like I just don't really believe in it. Mind you, I haven't studied it. So anyway, so she did it on me and she's doing it and I'm like, my gosh, okay. So I'm sitting there and I'm like, my QL and my glutes are no longer spasming me. And I'm like, okay, well, I feel great right now. So I'm going to be a believer. Then I got up and I started walking around and it started, started going right back to where it was. So I was like, uh-huh, see. And then I just kept doing the reset of what she taught me. And it just started to consistently.
quiet the QL and the glutes. So maybe part of that was, okay, it's the consistency of what's found on the table and then doing it as you are in gravity to make sure that this pattern sticks. Again, it's a fragment of a much more complex story of me. It's not factoring in my posture, my pelvis, my foot. Do I have a limb-like discrepancy? It's just this fragment in this moment in time.
to try to quiet the storm of the spasming QL in the glutes. And she had used NKT. So that was one where I was like, okay, maybe my perspective on table work muscle testing is changing or I'm open to that change to see how maybe that could be woven in with my patients. And...
Could it be a tool for a certain patient that something else isn't working to get them in a state of comfort and something that can help them? So, I'm open to it.
Dr. Beau (01:06:28.116)
And we could have a whole conversation on that, which I've had entire podcasts on, you know, theory surrounding trigger points and peripheral sensitization and how that plays into central. there's a very, you know, interesting, it's not new information. just how you again, synthesize the existing information and Dr. Phillips knows integrate with, great amount of work with the neurocentric approach of like, you know, if you have a trigger point or something that's in this like heightened state or, know, this,
high threshold, you know, strategy, like you have less feedback. And if we talk about sensory input and then, you know, that table work may translate to just better sensory input and then you can change movement and who knows there's lots of theories. But like you said, the context again is apparent because it was you. So you have, know, your N equals one. yeah, NKT or neurokinetic therapy, anybody that's never heard of that David Weinstock. my professor of neuroanatomy at Logan was Kathy Dooley, who's one of their preeminent instructors. She's
Amazing. and anybody, know, muscle testing gets beat up because of, you know, apply kinesiology and, know, maybe some of how that gets used. But if you want to learn how to isolate muscles, which even if you're just talking about pathology, Hey, did you strain this muscle? You have a tendinopathy in that area. Like it's the best way to learn that. So that's my little plug on that methodology. let's flip the question around. go ahead.
Dr Emily (01:07:50.671)
What I will say with that, just because I'm not shitting on NKT because I have a lot of patients and a lot of NKT therapists refer me patients, is it is part of the collective collaborative approach that I think people should take with patients. It's the one thing that podiatric medicine podiatrists, even though I've trained myself a lot outside of...
a typical podiatrist of how I want to approach human movement. It is not a big part of podiatry of body work and testing and a lot of what you would see under chiropractic that that's just part that is not emphasized in any way. I wish that it was because it all
obviously ties into the human being who is moving and breathing under, you know, on our table. So, yeah, I'm not knocking it in any way. I have very, very, very little experience and exposure to it. I teach a lot of NKT therapists about foot types and, you know, gait patterning and the sensory stuff. So I think sometimes it's about how do we appreciate enough of another method for referral and that when, let's say you...
are referring me a patient that you know that I'm coming at it appreciating the methodology that you use with a patient so that there's never a conflicting or confusion to the patient then of the messaging that's being delivered by different professionals. So.
Dr. Beau (01:09:18.254)
Yeah, our profession's great at that. I I say our profession, overall, the physical medicine space of just conflicting ideals, getting thrown at patients, and then you have to reconcile that at your next doctor's visit, which is amazing. So let's flip the question and we'll wrap up with this. So is there anything that you are like, I think this is the way it is, I think this is my truth behind this thing, that doesn't have any,
Dr Emily (01:09:32.428)
Yes.
Dr. Beau (01:09:47.18)
white papers, peer-reviewed articles, substantiated evidence out there. Yeah, they're just like, I think this is how it works. It's been working for my patients. Anything that stands out in that realm, they're like, yeah, people would absolutely call me crazy or it's woo-woo, but you're just like, yep, I see it work and that's what I'm sticking with.
Dr Emily (01:10:03.308)
I mean, I would say so I'm very much into body schema, connection to self. There is facets of research you could say that because I work a lot in chronic neurological conditions is bringing in texture of the feet, compression apparel, weighted apparel, wrist weights, and then I just want them
to actually just visualize the movement and see their body moving in space in their mind's eye and just really strengthening that component of human performance, injury prevention, injury rehab is this kind of the power of the mind and the visualizations role.
in the way that we are connecting, improving our movement. Almost as if you were, I'm going to visualize my planter fascia healing, right? Obviously you to give it some injection or some growth factor or something. But the role of how that plays in movement optimization and injury prevention. That's the space of where I am right now in my career. And I just think it's because I've slowly moved through the literal, which was school, then became a little bit more fascia.
now it's kind of more abstract and it's become this area of energetic abstractness and the power of the nervous system in the mind and the brain from a healing perspective that a lot of that can't be picked up on Western medicine imaging or testing. But that's where I actually just feel. So maybe I'm moving in this whole space of like energy medicine. I don't even know.
Dr. Beau (01:11:46.062)
Well, can, the further I get into it, you can tell why some, you know, there are people that I knew when I was in school that were, you know, 30 years in practice that were, you know, world famous and acclaimed. And then they moved into this very woo woo, etheric realm. And you could see how it can happen. Not that that's where I'm saying you're going that, you know, you're going to be, you know, having a mandala on the wall and, you know, chanting around your patients anytime soon. But you could see because you, I think because
The more you know, the more you realize how little you know and you realize when you start to see that chasm of like, dear God, I've done physiology and biology and anatomy and neuroanatomy. It doesn't explain 90 % of what occurs because everybody has such a unique experience with pain and injury and recovery that it starts to lead you into this like.
we don't really have good terms to explain it. So then it comes out as this like energetic and then we start going over to like Eastern medicine side and trying to reconcile that with Western medicine ideals. And it's like, it's messy, right? But that's why I could see people like kind of, they seem like they got off the radar. It's like, actually that's probably more truthful of saying, I don't know. And then when we try to unlabel stuff, people attack you of like, what do you mean energy or, know, and that's where the disconnect.
happens for a lot of people is they can't reconcile traditional Western medicine with the unexplained and then whatever language you use around that is, know, I guess that depends on what part of the country lived in, how well it's responded to.
Dr Emily (01:13:12.811)
Yeah. You know what, what I was going to add on that also, and maybe you could feel this way, that when I'm evaluating a patient just because of the repetition of it or the years of experience is it's like I can see the tissue healing. That sounds so crazy because I'm not seeing the tissue healing. But as I guide a patient through a regenerative protocol, it's
I just am feeling each phase of how I'm progressing that patient.
And I don't know how to explain it in any other way except I'm literally guiding them. And after the first two weeks, they're like, I'm kind of here and I'm kind of like gauging and understanding the timing of remodeling and tissue healing and how they're presenting to know how to guide that patient specifically based off of how they're presenting at this many weeks after the injections to know where to take them without stressing them too much to then kind of take a few steps backwards. So that's the other part that I'm like,
I just, I can't put words to how I handle my regenerative patients and guide each of them uniquely in that process. But I feel like I can, I have this deep understanding of how tissue heals and remodels.
Dr. Beau (01:14:28.728)
I think what you're explaining is intuition and you know as Yuval Harari would say is intuition is just pattern recognition overlaid with experience and then pretty soon just like the chess master is not aware that they recognize the pattern it seems again it seems etheric or inexplicable it's not it's just that now you're operating on a subconscious level which is not pre-frontally regulated and you're like well I can't explain it just because it's not
Dr Emily (01:14:30.357)
There we go. You just...
Dr. Beau (01:14:53.774)
You don't have a language model for the abstraction that's occurring in your 80 % or 85 % process subconscious mind. That's what we're hoping all clinicians go to. And if you go to a good clinician, you're hoping what's not happening is that their peripheral cortex is shutting down because they're lazy, they're tired, they're burnout. Rather they've explored.
you know, continuing education and had a bunch of patient encounters and keep an open mind. And pretty soon it's like, holy cow, how did they come up to that conclusion? Why am I getting better under their care versus somebody else? And it's who cares if it's unexplained at that point, or you can't, you know, button down the exact diagnosis and why this one, you know, progress better than the other. yeah, that that's hard for people to digest, especially like I can imagine a student listening to that and be like, what the hell are they talking about? But anybody that's in practice, you know,
Dr Emily (01:15:41.249)
Mm-hmm.
Dr. Beau (01:15:44.686)
you know, five, 10, 15, 20 years, you're like, that's kind of more of what I'm doing. And if somebody like sat in my corner and literally had to review every case, I'd like, why'd you do that? And you'd be like, I don't know if I could give you the peer reviewed answer right now. But that's the truth, right?
Dr Emily (01:15:55.787)
you
Dr Emily (01:16:00.095)
Yeah, that was so well articulated. You said that so much better than me. So thank you for bringing that to that.
Dr. Beau (01:16:03.956)
well, I think it's because I think about that all the time, right? Is that I, again, I have to reconcile sometimes like my wife was, I had like a giant trigger point and like my SCM that was radiating up into my head, you know, just last night. And I was like, can you work on this? And she started like poking around and like my second rib and like behind my scapula. And I was like, what, what are you, why'd you do that? was, you know, painful, but it's referring directly into like my mastoid for any nerds listening. And I'm like, how'd you know to go there? She goes,
I don't know, like just kind of seemed like where I should go and she goes, I couldn't tell you that there's some protocol. And I think the people that have come up, this is my like kind of last note on this, the people that have come up with like different methodologies, NKT, ART, whatever it is, they actually are just those pattern recognizers that can then bring it back to the frontal cortex and put a structure around it. All right, we could all have our own methods. Like you have your own methods, own courses you teach. That's what you've done, right? You've taken that.
Dr Emily (01:16:54.956)
Yeah.
Dr. Beau (01:17:02.126)
you know, all of that stuff and then said, well, this is what I'm to put out to the public. And the people that do that the best are the ones that are, think, the most honest that like, Hey, I don't know everything. This is kind of what I believe to be true. And it's going to continue to change as more information comes to light. And that's the people that I like to talk to, like yourself. so again, I want to thank you so much for coming on. And, like I said, I've been following you forever. I've been aware of your work. I remember, you know, just watching videos, reading blogs from back in the day, but.
We didn't even talk about Noboso, so I apologize. When did you start Noboso?
Dr Emily (01:17:37.431)
Yes, so Niboso, for the listeners, if they're like, what are you talking about? Is a sensory based product line that I started in 2017. That was kind of beta testing how it is. All of the products from Niboso feature these tiny little...
pyramids, little triangles that are creating a textural pattern. Really it is two point discrimination, kind of like braille. And it is on all of the mats, insoles, socks, release tools. We have fitness equipment or rehab equipment. So there's over 40 SKUs now. And my goal of starting Noboso was to get even more out of the foot. This is initially, I was.
advocating that people take their shoes off, do barefoot training. And then I started really getting into surface science and just essentially saying, if we're taking our shoes off, then what do we stand on? No one is talking about that. Like, does it matter what we stand on? What's up with turf versus wood? And so then I started getting into it and I was approached by someone in the industry as far as creating a product. was working with a lot of the companies out there that everyone.
now appreciates and integrates as kind of that foot specialist and they were like, I know you've danced with product ideation. Do you want to create something? And I knew that I wanted it to be sensory based.
Our first product was a barefoot training mat. And now we actually sell 90 % of our products are everything but mats. Because we've seen the utility of texture be much further than just this mat. So it's been a fun journey. We just closed an investor. And it's a strategic partner. So my goal is to hopefully have it acquired soon. And then I can focus on other fun stuff.
Dr. Beau (01:19:27.82)
that's, you, your team was kind enough to send over some of the small wedges, which for what we do from a functional rehab standpoint are really cool because obviously you have the sensory input or the tactile input that's being played, but then we can change the input based on the position the foot's in, which is much like playing with an active orthotic almost with like, you know, a specific rehab drill. I really, we've played around with all sorts of stuff like Thomas showed and different, you know,
you know, people in the realm. And so I just like when people play with different ideas. So again, that gets back into the taking a principal playing with something that like, Hey, there was this kind of evidence out there. Nobody ever done this. Let's put it together, see what happens. And he's kind of got to fall or pull on those strings and, you know, follow it and tell hopefully it gets acquired and you get some time back and keep learning more and do something different.
Dr Emily (01:20:13.175)
Yes, yes, encourage, I encourage honestly the younger generation to do that because I feel that there is not as much innovation in this space as of late.
And I don't know why that is. We're around the same age as far as pushing trigger point, kinesiology, TRX. There were these different modalities that were pushing into the fitness, athletic, rehab space. And I just feel that there's less of that now. So don't know if you have theories on why that is, but it's.
Dr. Beau (01:20:26.894)
I think
Dr. Beau (01:20:46.296)
I think people are scared social media, you know, we think that, if you're going to create a product, you would use something like social media or, know, something like that to push it. And I think people are scared to put their ideas out there because so many people come and, you know, rain hellfire on it for whatever reason. And I think the biggest thing here is to, to end on this note, I think is actually a great kind of wrap up.
is nobody really knows what the hell's going on. It's the people that are honest about that within our profession are actually the ones that live at the top because they're aware of it. And then they can eloquently describe or explain that to a patient while also letting that patient know that like, I got your back and I do know a lot, but that doesn't mean that we know near everything. But that's where I think students and new docs and you know, people newer in the field are kind of just like, I don't want to put my opinion out there because I don't know how it's going to be, you know, seen or reflected back to me. It's like,
At end of the day, you are following, you know, adhering to first principles, you are following, following sound science. And I don't mean peer reviewed articles. mean like what physiology, anatomy, biomechanics, why wouldn't you put out there? That's your job is to help like grow the field, innovate both for patients and the field, right? Your colleagues. So I'm with you, you know, whether that's ideas, you know, products, we need more and more of that, but we also need
conversations like this so we can talk about these things where it's not, you know, a one minute video or a little post that people just, you know, write comments on and find out like, why do you think that? Why do you do that? And I think we had a lot more of that. We would all again, probably realize we're saying mostly the same stuff and we're just like disagreeing on, you know, the words you used or semantics or something like that.
Dr Emily (01:22:27.903)
We're all just trying to improve humanity. I mean, that's ultimately what we're doing, right? Advance a profession. My goal with Noboso and my work is that this concept of the sensory foot and texture specifically, but just neurosensory stimulation goes far beyond me so that when I'm no longer doing this stuff that people still are looking at the foot, not just as a biomechanical gateway into movement, but as a very powerful neurosensory activation.
area of the body that if utilized can improve movement, reduce injury, athletic performance, all of that and just really further push into that.
Dr. Beau (01:23:07.118)
Well, you're a perfect description of preparation meets luck, right? Because timing is everything and like I said, there's never been a bigger time for kind of the foot movement and everything that we've kind of seen spilling over. So again, I want to thank you for coming on and being a big part of kind of what I've learned, but also just overall, our medical community and keep pushing the limits. yeah, thanks again for coming on. I really appreciate it.
Dr Emily (01:23:32.801)
Thank you so much, it was an honor.
LCL Sprain Diagnosis and the Functional Approach: Week in Review 37
In this conversation, Dr. Beau discusses various cases of knee pain, focusing on lateral collateral ligament (LCL) sprains. He presents two case studies: a 58-year-old male skateboarder and a 43-year-old female runner, detailing their injuries, treatment approaches, and rehabilitation strategies. The discussion emphasizes the importance of understanding the underlying causes of pain, the role of strength training in recovery, and the need for a holistic approach to patient care in sports medicine.
—
Dr. Beau (00:01)
back so this is I was behind an episode so that was 36 35 and actually we went till May I thought we said April the last season
That's a conspiracy. That's the new conspiracy we just started throwing around. Is it subtract? Updates from last week. My runner I haven't seen. I'm assuming that means he's better. I thought you did. No. I saw him the day after. That's right. He was fine. And then he raced. like, I'm here because it was supposed to be... Yeah. And he raced. One wasn't competitive. If he did get boxed down, it was like tenth or like first half mile or something.
I guess they've had sexual assault since then too, which we also won that race. So, good. I'm seeing them. Hopefully just not grand or invariant by the way. Your runner? Yeah, she's doing great. Her runner. Crossfit. Runner, Crossfit, High Rocks competitor. She's good. She... Hybrid athlete. Hybrid. Anything with high in there? We're just going start putting it. I've only ever seen that High Rocks word like twice. I don't even really know what it is. High Rocks is an endurance-based Crossfit.
It's like you do some, I think it's like a thousand meter row and then you have something to do that's like weight based in the middle. So like, it's like a thousand me. Like one of them that looked up is like, you have a thousand meter row and then you have like burpee broad jumps for like a hundred meters. Then you're back on a rower for like a hundred, like for a thousand meters and you to standardize. Like this is the workout that you're going to compete in or is it change? a, okay. It's that format. so no other updates. She's good.
Yeah, she did some lateral runs, like some shuttle runs, but she was worried about that. Yeah, she has no issues. Are we talking like elementary school PE shuttle run? I don't know. didn't ask what grade level shuttle run she was doing. I'll do that next time.
hearing me or not. I'm a lot of squeaking. For any patients listening, we just changed up the functional health coaching model on here. It's now some monthly based membership. can go to chiropractor.com, Backsplash, whatever. I don't know what it is. Functional health coaching, something like that. Find out more information on that. can sign up in office or online. Also, there's a forum at bottom. I don't know who's got their vibrator on. Somebody. Maybe it's me. No.
It is Alex. Alex is getting his reminder to say it's prostate medicine. Yeah, there's an info form down there if you have any questions because a lot of people just kind of want to know more about it. It's bullet pointed and if you ask more questions, I'm just going to be honest, I'm going to probably tell you bullet points because it's pretty low. So yeah, we'll have to get more people involved in that, but let me know if you have any questions for real. Presenting today sets the lead. So what's the case about? So this one's going to be outer knee pain.
And again, we're being a little more broad. So what would be the, so go real fancy. What would you diagnose as side if you're being a fancy doctor person? LCL sprain. Ooh, that's not that fancy. But trying to be Fibular or lateral collateral ligament. The reason that we're saying lateral knee pain is in our doctor's meeting last Thursday.
case and then what Alex is going to present on. But we started with differential diagnosis and when we come up with like 12 things. yeah, LCL, which this, you know, is a, I would say not a classic mechanism, but a classic presentation of LCL disruption or sprain. But in there we have what? LCL, lateral meniscus, tibial plateau fracture. We put trigger points in the differential diagnosis because they can be
solo pain generators outside of any pathology, lumbar radiculopathy or pseudo radiculopathy. Peroneal nerve. Peroneal nerve. What else we got on there? Cutenius. Yeah, cutaneous nerve. Peripheral sensitization. Meniscus. Meniscus. Our big one was just a list of trigger points I referred there. Yeah, and a lot of people are like, well, it's not really a diagnosis. There's a lot of people running around with, and this is what we know more now is,
You get an image on somebody, everyone knows this, let's say they have tear in their lateral misc, when did that happen? Is that even the pain generator? Then the trigger point could be fin-storing mechanisms creating pain. You get into this whole discussion and I think that should be a primary diagnostic feature. So all that's been said, get after it Seth. Let's do it. All right, so this case, I've got a 58 year old male with left outer. This case. We're losing all West Coast viewership right now.
Sorry. this… On the prescribed plan I'm looking at, 58 year old male with left outer knee pain, he noticed this about two weeks prior to this first visit. He was skateboarding, stepped off hard into an incline. Mind you, he took like 18 years off of skateboarding and got back into it just because of something he wanted to do, I think, with his son. So he now skateboards.
Yes. Yes. It's it's out there and starts like, Sean. If you want to go kind of body type, I wouldn't say it's like your normal skater, skater look. He's got a, he's done very well. He's lost like a hundred pounds or something like that. I think in the last year, year and a half or something, went through some like traumas past. So now he's kind of getting back into it just with walking.
and then getting into some trail runs, which is actually where I met him was actually at a trail race that we worked. But yeah, so into an incline. So he's trying to do some trick. He said that he's just trying to learn, I guess, like how to get the skateboard up onto the side. I don't know, a little ollie type thing. I don't know. I don't really know super like skateboard fancy terms, but he's trying to go up and he kind of got nervous. he kind of got step stepping off. And so he was like hard planning because he tried to some speed into the ramp.
hard plant to an incline. He noticed he has some radiation with his symptoms up into his lateral thigh and a little behind his knee. He had some swelling that he noticed after this incident about two weeks ago, sorta went down, but hasn't really gone down too much since it happened. He notices that the worst pain is when his dog actually comes up and bumps into the outside of his knee and he gets like a shock. Yeah.
which he gets a reading sometimes up again until the lateral aspect of his thigh.
like Wigman's
see how his referral pattern is like up into.
which initially my first thought was kind of like, we're dealing with a nerve. Cause when I hear like a little shocking symptom, when you get smoked really quick in an area that the nerve is pretty close to the skin, I'm like, okay, we're probably dealing with a nerve. But then when he points to it, I'm like, there's not really a nerve out there until like where it radiates up into. The other thing that he complains about is he does, so he does some like stretching routines when he's in the shower. yeah.
I did not go into detail. I just said, so when does it hurt the most? And he's like, every morning I do some type of stretch routine in the shower. And that's kind of how that came up. So it was a pretty broad question that led to a very specific time of day. So he notices that when he squats down, he does get some pain in the outside of his knee. Outside of that, he has a little bit when he walks, but nothing really except for mostly when he notices that his dog, because I think he has four dogs at home.
So whenever he walks, I'm like, all of them are about like knee height and one like just smokes his knee. Prior to this event, about like a month before he clipped a tree mountain biking, broke his left big toe and fractured a couple of ribs on his right side. Past surgeries, rebuilt collarbone in 2023, gallbladder removed in 2020 and a melanoma removed in 2000 in his mid back.
And his main goal seeing me today was he wants to be able to run the endless mile in three weeks.
And he did the 72 hour one and his goal was 100 miles. Did he do it? He got 100 miles in.
So pretty sweet. So watching him walk, a little bit of, I would say bowing of his legs when he walks on both sides. If you want to say almost like the cowboy walk, where like kind of like a wide based stance, like knees, I don't know, just a various kind of stress to him. No extension of left hip. And then he has a foot flare on his left as well. Top tier dysfunctional non-painful on most things, all cervical and obliquity patterns, multi-segmental flexion, extension.
right rotation and single leg stance on the left.
doing class four speed tuss, Pokemon where it hurts.
In particular, in this case, yeah, there was a trauma, but if you listen to the beginning and you're familiar with like an LCL injury, if you looked at like a football player that's going to have an LCL terror soccer player, you'd usually think like some like inside to outside, like blow on the knee, right? And you're going to think bend the knee to the outside. well in this guy's case, he just like Seth said, he had like a heart plant, which doesn't seem at all like that would be an NR differential diagnosis.
which brings in things like tibial plateau fractures and things like that. I don't know how much you think it weighs on it, but having that various kind of knee formation already, and then you're stressing all the time, if you take hard step, mean, maybe there's more lateral force there. Just general broad-based movements, some of those hurt, some of those don't, and some are dysfunctional. That's kind of what we talked about in our doctor's meeting was actually like how many people are actually walking around with a degenerative?
LCL sprain and based on his age is kind of something that popped into my head of like he could have degeneration here and then now it's just getting ticked off because he's doing something that's out of the ordinary. Which again drives me nuts and if you're a patient listening like you know look at the image report or ask the physician that you're dealing with. Drives me nuts when they say like a sprain but it doesn't say acute or degenerative which would be called off edema which is what they're usually calling things off of. You can also have
know, less a coke response, you're going be thickening, you know, all these things and they just might call it a spring. You're like, well, is it old? Is it new? And that's kind of what we were just talking about. So that drives me out telling the impression of the reporter, it's just like spring. New, old, what are we talking about? Yeah, I feel like they usually do that on a fracture, they don't on the soft tissue side. The stress fracture, yeah. They'll call like signs of recurrent healing or non-healing or something like that. Yeah, just, I feel like get impressions in general.
Which is funny, did you guys see the impression from my patient that went to the open MRI? The MRI that you can just go on your own, no referral. Had grades on there, for... Yeah, the report was huge. I don't think the read was awesome, but the report was just massive, which is kind of funny for this cheap open access MRI. The report was like 10 sentences long. Going off of that as well, I know it's kind of side note. I didn't realize that...
Was it the stress reactions? that what we looking at? Had different grades to them or something like that? was like grade one through like five or something like that. That's based on percentage, right? Of healing you're saying? No, progression of basic.
how much the stress reaction might go on from the periosteum.
I would assume we can look it up real quick. A grade three would be where you can probably pick up on an x-ray if you have that 60%. So let's keep going. Yeah, I'll keep going. So just a recap. Top tier dysfunctional, non-painful, all cervical, upper extremity patterns, multi-segmental flexion, extension, right rotation and single leg stance on the left. He was functional non-painful with left multi-segmental rotation and single leg stance on the right. And then...
Dropping down inline lunge, dysfunctional non-painful with right knee down, left leg up. And then I tested a little bit more just because there was a discrepancy in rotation. I used lumbar lock to see if maybe anything with like his mid back. He was dysfunctional non-painful bilaterally there, just in his back in general. I mean, it's very, very stiff, which I'll get to in terms of palpation. But I also use it as well for just a passive knee flexion, because he said he gets pain with squats.
So I just use it as a passive knee flexion to see if it was like load that really like bugged it and he had no pain when he did that. Other exams, so orthos. Varus stress was painful. Thesales was a little painful when he rotated out. I did Nobles test, which is just a little bit for like some IT band stuff. If you like, know, flexion extension.
poke on the IT band, sure, whatever. But more so just kind of compressing the bursa that's underneath there and then taking them through extension, no pain there. What's Obers? Obers. Obers is a side lying pull the leg behind it and the hip extension and let it fall. So what's the- That's IT band. Abduction, is it? IT band is Obers. What's the one with abduction? Internal rotation. rotation. Is that Faiers? Fai-deer? Fai-deer? Where you're like letting it hang in and see-
There's fey bears, o bears, fey deers, and fey air, and feyers, and then leg air in the air. In the air. the air. I did not do belopment. I'll just tell you that.
The grading for stress reaction fractures.
which starts out with periosteal edema.
Yeah. Sweet. Then I went over and did a little bit of palpation. So easiest way to check LCL is put it in like a fey bear test almost. So you kind of put heel, I guess put it like a little, how would you put that? Quad lock? I don't know how to put, say that bend the knee, flex it, lay it on the other knee. And palpated is LCL from there, painful. And then.
Lumbar orthos, negative, couldn't reproduce anything, just looking for any low back referral, checking those out, couldn't do anything there. Presentation, if I had him prone, a little bit of hollowing of his left glute. And our last intern, Patrick, was in the room and he even picked it up. He's like, that glute looks different. So when you lay him down, his left glute just sunk in. It's not as full as the right one. So it's kind something I just took into note.
No.
Range of motion, external rotation of his left hip is limited and then he had limited ankle dorsiflexion on the left, neuro normal and then palpation wise. Limited and extension of left hip, tibial ER on that side, TL thoracic and CT junctions. He had a trigger point and lateral gastroc, vascular lateralis and then tone of his left glute musculature. I just put tone of like whole musculature on that left side.
because I wouldn't say it was like trigger point, but I'd say it's just like holding on for dear life with the hollowing there. Functional audit, I actually used the glute as one of mine. I had single X-stance on the left and then his central stabilization strategy is pretty bad. Pain audit, bearish stress and tenderness of touch. So I came with my diagnosis, LCL sprain.
Treatment day one, I did a little bit of grasslander, instrument assisted over the LCL just to kind of promote some healing. Because again, it's been going on for two weeks. It's kind of promote a little bit of something going on there. Looked at three months supine for his IAP because laying down on his back, he has a pretty significant like rib flare. So I just want to see like how he breathes in general. He's also a pretty tense person. So like whenever you're moving him around, I mean, it's like kind of fighting a bear the whole time. He can't relax. I'm like, hey, just let your leg go and.
that actually makes it worse where he just like holds his leg up in the air for you. And I'm like, all right, do what you were doing before. So then I wanted to attack honestly his left hip just because I noticed the way the hollowing of his left hip. So I knew that he had a little bit of trouble, I guess, absorbing some load on the left side with the mechanisms of injury that he has. So I was like, let's try and calm down some musculature on the hip. So I put him in a five month rolling position. He could not roll.
So I lay him on his left side and have him like just push back into me and he literally can't produce like any force into me. So when you say hollowing, you're saying like atrophy of musculature or active like contraction? Active like contraction. that was the thing I was like, can you get this to relax? And he can like slightly for a second. But I mean, for the most part, he couldn't like eventually he couldn't just like let it all the way relax. So again, put him a five month sideline on left side.
have him push back into me and he can't. So like we can't even do like step one. So then I was like, let's try and roll you a little bit farther and see if I can't get a stretch on it. And then you push back into me. He still can't do that and actually catches a cramp on like his like right hip trying to do this. Which while we're doing this, you can feel him using his right leg the whole time in order to push back into me. So I was like, okay, well how can I do something with this left hip in general? So I put him in actually a little star plank on that left side and had him just hold, which he started.
kind of seeing like, okay, hey, my left glute like burns holding this position. And then we worked a little bit trying to get him to like lower down in that position just to get some stretch on it. And then taped his LCL, which I did a little bit different than you described in our meeting, which I just put a piece of tape down kind of lower third of the thigh all the way down to like the top third of the calf on just the outside. And I took a piece just because I noticed he had a little bit of like tibial external rotation.
limitation, I took tape and wrapped it so it kind of almost like pulled it into external rotation to kind of help offload his LCL a little bit. And it's also just some pain relieving just because it's over the LCL. So adjustment, CT thoracic, TL left ankle, homework, send home, Starplank and IAP work. Second visit, which this technically was actually visit four because the second visit he came in, we worked on his neck because he got laid back in a
dental chair and had like, I don't know, his neck got smoked from it. And then third visit came in with some like right low back complaint. He got up that morning and I don't know, he like couldn't hardly stand up. So we worked on those two things. So second visit, feels much better today, which I would say this is probably a week later. Did not feel it while skateboarding this week. Still a little tender to touch, but I think the first visit.
And then various stress is still slightly painful, but he said it's like a one or two. His glue, he said, is super sore from the exercises that we sent home. So the next visit I did some grass and again, some IAP, like review and star plank review. And then we moved into a rotational plank, cause he still couldn't do the, like sideline position. So I moved into a rotational plank to see if he can maybe use his elbows as a little bit of like a prop, to work on the left hip.
So I sent him home with rotational plank. Third visit, no tenderness to touch this time. No orthos are provocative either. And then treatment, reviewed IEP rotational plank, did a hang position to start kind of getting his foot involved because again, we're still dealing with a fractured toe on his left foot. So he's still trying to offload his toe a little bit and then worked on some 90-90. Fourth visit, which how far do you want me to keep going down? Because I have...
I've seen him probably like 10 times and I did to like visit five is kind of where I stopped for this. But fourth visit did some low oblique this time with rotation because I wanted him to start kind of seeing what it felt like to use his foot and lower leg in order to rotate around his left hip as we're instead just kind of like pivoting around his knee more so using his hip. Couldn't figure out how the life of him to do that.
which I kind of just like helped him like pin his foot down. He figured out what that felt like and was able to kind of do it from there. So sent that home with him. And then fifth visit, I worked on some rotation just because he had that discrepancy if I'm not mistaken, it's to the right. Yeah, right rotation. So I did a diagonal RDL because I know it's going to his left when he's doing a like some rotation to the left, but then also did a half kneeling kettlebell rotation to the right.
because it helps work on some like left hip extension and right rotation, which is two things that he's lacking. So homework, I did some diagonal RDL. But after this visit, this was, think, this was Thursday. No, this would be Wednesday morning. I saw him, yeah, Wednesday morning. And then he started the 100-miler for the, I guess, the endless mile on Thursday. And on this visit, he had no pain, was ready to go. I saw him again Friday.
which it was kind of just like a little bit of like a tune up, let's make sure you're still feeling okay to get through this thing. He was like 50 miles in when I saw him on Friday, and then he hit his goal of 100 miles by the end of Saturday. So. Okay, so let's break that down for patients listening. Guy came in with lateral knee pain from stomp.
Why did he choose us?
He just talked to me at a race and liked what we did. He had heard good things about us. We've seen him in past. So he's an old patient. Seen him for Achilles stuff and things like that. So have a history with him and then we're in his face.
Permanent history stuff, you know, like he'd have had yet ever had knee stuff before. So there's like no big orthopedic injuries. kind like, what's going on here? he's got all these things he's wanting to do. you know, again, just trying to break down for patients listening, like the big findings aren't that, you know, in my opinion, that Seth thinks it's an LCL sprain. It's like, like you had a weird little injury. Let's work on your hip.
and kind of these other findings around it so we can alleviate undue stress on that thing that might be occurring all the time, not just in skateboarding. It's probably hard to pick up the translation of a lot of, if you're a patient of when we say things like, we sit or low bleak sit or five month sideline. But basically, if we had to really break this down, it's this guy, like Seth said, has a hard time.
dampening load around his left hip and in particular like sucks at creating a rotation or like stopping rotation on that side. So then if we had to take the two mechanisms on the side of your knee that might check rotation, one of those being LCL, like it might be getting beat up because of that. I think that's why Seth was working on that. And then in terms of like future plans, like you said, you've seen them a bunch more times. Like, is there anything that you think you should be doing in terms of like, you know, lifestyle shifts?
You know, in terms of like train a big goal in here, I think we try to take whatever we're working on immediate realm and then say, Hey, let's like, we're going to play the, apply these concepts into like what you're doing in cross training or something. there anything that you're like, you know, if I see this guy consistently over the next year, like this is what I'd be working on. Anything different or is it just kind of same theme and just more of the same, you know, build it up.
I know you sometimes we kind of lean heavily on like potentially just being like, he just needs to go like into a gym or something like that. but I do think that that is something that he would benefit from because he doesn't do that. His only form of exercise is literally just like, so he started walking a mile, because I'm not mistaken that someone like in his life passed away, went through like a hard, hard block there where he got like super depressed. so.
His goal was just to get back into it was just to start walking a mile every day. And I think every month he added 10 % to that. Andy had been to a point where he couldn't run anymore. was a guy that was at recurrent acutely saying that I think he had a stress fracture, a legitimate fracture at one point in his foot. And like he had all this stuff and that's, you know, there for a while. was like every time we saw him in a race, he was racing. He'd walk up and like, I can't do this. And then he like, I don't know if he took time off or just started walking instead of running. don't know.
Yeah, he took like two years off of like not doing anything just because of life. But yeah, so he's up to where he's like, so his exercise consists of he does longer like ultra trail runs with I would say minimal running during the week and like a mile and a half walk is like his like big form of exercise along with skateboarding.
So I think that that's something that will play really well with the gym is just like, honestly, you sometimes have to set yourself up or get the joints, tendons in those areas to actually be ready to handle the stress that you're putting through it, right? At least increase the muscular endurance through there. Just again, he had, it sounds really cool, right? He got my knee pain, he's back skateboarding, we're in the Sun and All the Rays. We'd be setting up.
soon we're like we're just another person that's you maybe better than other offices and getting people out of pain moving but we actually didn't like push them to be like a healthier person or a more resilient person so I think that's something that's highlighted is in our framework we're never just like to get out of pain get you moving get you do that race that is a goal but like hopefully that's motivation and then we can kind of build off that to like hey we get you moving a little bit different and you feel better like we think you got to work on these things whether it's
something that we're supplying or just frameworks and concepts that we educate them on. But that is extremely common theme in the ultra running community. It's just, you're only doing that thing where you're vastly underprepared for the competitions you're doing. And I fall into that category sometimes too, if you're just going to stuff and I'm know, credit bearer. Yeah. Cool. Anything else with that?
He also told me that he prints off every time, the, whenever I send him like, our rehab, my patient, he prints off all those. Cause he's like, I want to add these to my routine. So he goes, I kind of get up. And even though we haven't done these in a while, I still kind of do stuff from the very beginning. Cause he, he told me he's like, I know, cause he said I can see the difference from what we've done in here to when I go out and I do run and I do walk. He's like, I can tell that there's a, there's something different about how I feel when I go do them.
And he's like, so I just thought, well, if I feel this good now and I continue working with you, what could I feel like in a year? So he does have like a long-term play like in his mind. And he's like, I want to get to where like we start taking this stuff, like to some weights. mean, he mentioned about doing some weights. That's why I brought it up. mean, that's intrinsically motivated. You didn't tell him to do that. He's also setting up an amount of time with stuff that we would all be like, well, that's not really changing.
shifts. But then we can just do what? It's like say, hey, we don't want to add more time. We just want to slowly progress those drills, challenge more, use the same amount of time, whether it's daily or a couple times a week. like you can literally start to really have a big change. And that's the tough thing is when somebody is looking for a quick fix, get out of pain, get me out of here. And you know, there's bigger lifestyle thing, like you don't, you know, they have to come up with the idea. So these are the literate telling you that. it's teed out, which is nice. And then the other thing is
You mentioned like stuff that we're like going to continue working on. his mid back, I know that's something I brought up because I mentioned central like his central stabilization strategy, but I can throw that on anybody almost I feel like. But for him specifically, he had that melanoma removed back in 2000 around, I would say like if you want to get specific T6, T8 range. And he's actually like tender over like where it got removed on the left side. And I would say that's probably one of the stiffest spots for him.
especially when he tries to create rotation, which the half kneeling like kettlebell rotation, he can do it if he's just body weight. I add a five pound weight to that. can't, he can't hold the, he can't hold that up at all. So it's honestly just like getting him there in that position. And then I honestly just apply a little bit of pressure, but that kind of goes back to like, you know, what do you start with for like the most like functional piece? It's like,
to a point, like I gotta treat the injury here, like almost like touch him where it hurts, treat the bigger underlying thing, but then it's like, you mentioned, do I set him up for, you know, a potential, not catastrophe, but like, fall because he has more confidence in the left side, even though we didn't actually address like, hey, how you stabilize around your core is like not great, a med-back super stiff.
That's the key to what we're doing. It's like, yeah, like everybody's got this thing like, my left hip doesn't move like my right. I should work on that more than I do, but it doesn't mean that I'm just doing mobility stuff for 15 minutes every day. Like you could program, you could do that sometimes, and then you can program stuff specifically. And it's, in my opinion, it's not that one's, I think we kind of get in this discussion of like load management, weight room fixes everything, quit doing your stupid mobility stuff.
like that's not completely true. mean, there's stuff that you have to do tissue work on, you know, things like that. yeah, it's a little bit both, but that's the end goal for all of our people is a healthy person, not in pain. And, know, that's rarely just like get their T-spine moving or their T-spine moving different to the office. The other thing, the reason why I started working on it is because he said that he went on a longer run this, this weekend and started feeling like his upper neck or like upper back between his shoulder blades.
whenever he ran, whenever he started like getting up to a jog, he started having like pain up through there in which, know, first thing I started getting like nervous. I'm like, yeah, you have like any heart issues or something like that. But then like, I put him to like a little FCS test, which is just 90 seconds of can you split the weight 75 % and I actually did it like half his body weight and he barely passed. mean like at 90 seconds, he was like going to the ground.
body weight split in which
seconds and see you in eight.
really and you should be able to do 75 % of your body weight split between two implements for 90 seconds but not a big struggle at all. Then there's proxies if you have grave issues and stuff like that. Yeah, it's a good test overall. Alright, so not a full case presentation but you have a similar, it's in a tag, lateral knee pain? Yes, lateral knee pain and it's not the case we discussed on Thursday.
So just give us for this instead of the whole thing like give us similarities like this is LCL case is something different You know why they come in obviously it's lateral knee pain or knee pain And then you know what differed from sess even though because again what I'm trying to highlight for people listening is All of us in the room could have lateral knee pain. We get all of gun something. I tripped on the trail. He was skateboarding
He was playing flag football, you just been training for a race and all this have a lot of knee pain when you come to the office. we could all be very orthopedically minded, poke on, everybody's got an LCL sprain. And then what's that mean? So what's giving you rundown on that? Yeah. So this is a 43 year old female, a former collegiate runner. Her and her husband both were, and then now her kids are pretty high level runners as well. They were on vacation in Colorado.
And she had this, hers is also an LCL sprain. Hers was a traumatic singular incident where she was, they were walking the Manitow stairs. last stair she fell coming back down. mean, I think it's 2300 stairs. and she's prone to be a little clumsy, which looking back on her original intake now, I
I remember. 2768. 27. Yeah. It's a lot of stairs. Actually, technically it'd be 5400 because she went up and down. she fell on the last one down? yes. She fell the whole way? No, stair. The last stair before the parking lot. Yes. Yes. but she had also had a fall right before that. and she, mean, clumsy, but she's not a motor moron.
to put it lightly. But now looking back on her intake, I did make note that she has major visual discrepancies and visual acuity from left to right, legally blind in one eye. And she does wear glasses, but sometimes doesn't wear them when she runs. So there's also a possibility. However, so this was two weeks, no, was a week after it had happened when I saw her generalized swelling around the knee. She had not been able to run.
And had a bunch of abrasions around it too. that was, she's also, all right, this is sore cause I landed and cut my leg up. but so initially we, she did have some pain on orthopedic tests, Thessaly, Alpe's compression, no laxity in the ligaments, just pain on that outside by the LCL and really not a, a true functional audit at this point. Cause she was.
She had fallen and it was a tingly event. And so we were really focused on trying to get the swelling out. Did a lot of her pain and limitation was in knee flexion. or no, sorry. She had pain with flexion and extension and, she could tolerate knee flexion with gapping, putting a bolster behind her knee. So we use that to help get swelling out, interest instrument assisted soft tissue. and then I had just sent her home that first day with knee gapping flexions.
Over the first few visits, we did some more maneuvers of pumping that fluid out with knee-gap inflections, plantar inflection sits, had done some voodoo flossing around the area to continue getting the swelling out, and we taped the outside of her knee. And so for her, I saw her, I guess the actual trial care was 12, 13 visits over the course of, that was early July, and the last time I saw her was late October, and we were at the point where
She had gotten back to running sometime in August, late August. So six to eight weeks before she was back to running again and gradually increased that. But over the course of starting to introduce load, kind of similar to you with him was that I went to a side plank so that she could get some isometric load on that LCL and then progress that from there to...
various forms of lateral stabilization in a lateral squat with diagonal single leg deadlift. And she's one that kind of similar different in running because she's mainly road running, but she doesn't do any sort of cross training and your resistance training. And she had gotten to her, she was a little more open to that because her daughters that had been in here had also, they could benefit heavily from doing some of that. And they've started to do some of that in addition to their training.
So she got into where she was working out with one of her, I think her assistant coach twice a week and doing a lot of the things. Really it started by just doing a lot of the things we had shown her in here. And then now she's at the point where she's doing box step ups and lunges and skater jumps, things that we basically just progressed those forces up to including some plyometric. she's always had general, she mentions later, I've always just kind of had general knee pain going downstairs.
running down hills, getting up on and off the floor. You say you've always just had general weakness? Yeah, no. Well, she has not loaded her knees, you know, in any kind of way outside running. So she's not getting a lot of loaded knee flexion at all. And she says, you know, I'm just not I don't feel like I'm old enough for that to be a thing. And it's kind of embarrassing when I'm getting on and off the floor, like talking to my she teaches, she's like talking to middle school students, which I get down there level and I come up and getting up.
So long story short, she had started including some of those things and they were uncomfortable at first. She was a little resistant to any sort of tempo squats, that kind of thing. we backed it down to starting with a bear crawl where she could get some loaded knee flexion and then to a sled push. And then eventually to where she's doing some tempo goblet squats. And the last time I saw her, had run, she did a nine mile run.
which was the longest she'd done all year. She's running about 20, 25 miles a week. She's doing a half marathon in a couple of weeks, her and her husband are. And yeah, and now she's still continuing to strength train twice a week and feels a lot stronger doing those things. So yeah, it was more of an acute trauma that needed to be addressed. She didn't necessarily have a dysfunctional issue that led her to that problem, maybe other than not being able to see.
and then, but we were able to say, Hey, you know, I know you want to continue running for the foreseeable future. And something that I think that will benefit your longevity in that is some form of resistance training outside of the sagittal plane more than your body weight. cause I feel like I've heard from her, from other people in that age bracket who have run for half their life is that, well, you know, I do some resistance training. I, I do some body weight squats and I do some.
I've got some five pound weights at home and which we all know is not enough to stimulate any sort of buttressing against the forces that she's going to experience when she's running. Buttressing, man. I hadn't heard that word in a minute. Yeah. Go for it. You can steal it. You can use it. I'll copyright it. You can give me a couple of dollars at home, put it in the jar. So yeah, so that's where she's at now. And I don't think we, don't have a, an appointment on the books necessarily. It's more of a now she can use me as she needs me, but.
Well, I was looking for the chart. couldn't, it's on my hard drive, but you kind of said this happened back, happened during July. Yeah. Right. And then we're first week of November now, or second year, first week November. Four months. So it's also, you know, if we look at, so say somebody has an ACL surgery, right, the earliest NFL players get back nine months, which is pushing it, right. And a year is like the classic like ACL return to play. So even with, you know, if we graded those, I grade one for sure with
you know, Seth's case, I don't know. Maybe two. know, grade one plus two over here. So there's a timeline too, to when we expect that tissue to be more resilient just from a healing standpoint. You can throw all the loads at it. want the world, doesn't matter. The thing still has to be able to respond. Physiologically, you can just help. There's two things you're helping promote. You're helping promote a pro-inflammatory response when you load it or do soft tissue. Second thing is, which we talked about with like Keith Barr and
a bunch of other people, you look at Tom Smires, like the actual lines of stress that you're laying down across that area are a pretty big deal for expressing a full range of motion that can buttress the forces that are applied against it in the future. And that's something I don't think it's talked about enough of. General PT, right? If we leave people severely under-loaded, then maybe we didn't like...
You you get full range motion on the table and then you don't apply like the stressors when you're up off the ground. Like you said, outside of the front to back or sagittal plane. And if we thought about like the lines of tissue just on an LCL, like how are you going to respond to sagittal plane motion when you have to control current plane like shift in there? just adds something that gets missed quite a bit. You know, I would probably agree on like a lot of return to play criteria for like post-op TT stuff for an LCL is going to be like skater jumps and barrel bounds and stuff like that.
but I don't know how much that's getting stressed. know what mean? So I think that's a good point of timelines matter because we regularly see people, you know, getting around 10 visits for us is like maintenance stuff. So like you have to take that into account with the diagnosis of like, are we have legit trauma versus like, I think you're just having pain from, like you said, a trigger point or something. That's wildly different. It doesn't mean we kick you out of the office if we think there's stuff to work on. But again, that's taking into account with that exam.
Any other commentary on knee stuff in general or any of these cases? There was something to note when she started to get back into running. She was very hesitant about it. She obviously loves it, but she doesn't want to go back to square one. She doesn't want that to re-injure. The big thing for her was progressing those forces to where she's running.
on a more uneven surface and then she would notice when she'd have to take turns, those kinds of things that she's being challenged in the lot in this outside of sagittal plane. And I think that helped it click for her that, I need to do something that I have to do in this lateral stabilizing strategy to be able to load that because if I don't, me making these turns on trail runs and things like that isn't going to get any better because she could see the progress in, hey, if I just run on the track or if I run straight in the neighborhood, I'm fine.
So, yeah. I feel like that's also a community as well that doesn't prioritize strength training. Right. Yeah. Because I would, I would even say people who bike and swim still do more, I feel like than runners do. Cause it's like you go do some squats or something like that. People are always afraid of like, it's going to take out for my workout the next day and stuff like that. And it's like, well, upfront, yes, because you're like super sore. haven't done it. But if you stay with it, eventually like helps you run him because you come more efficient.
You're able to produce more force at the ground, keep your cadence and what happens, your pace starts picking up. So it actually like over the long term starts to help. But yeah, upfront, it's growing pains and it's nothing. It's just like anything else. And how many times when we were running, was it we would continue doing our normal strength plan for the week at the beginning of the season, even though, yeah, we're going to be a little bit sore from it, but come towards the end of the season, taper that off and you've got the benefit from the training over the last three months.
But now you actually feel poppy when you're not doing those things for the last two or three weeks of the season. And experience and goals matter. So like we're bringing Michael O'Neill, who's a local personal trainer here that just wrote a book to come on and talk about like hybrid training, you we're kind of talking fun out of concurrent training is what it's classically called. But again, if I took, you know, your patient, right, that a certain point of life just wants to be able to continue running, maybe drop into a race every once in a while.
They're actually gonna do better with concurrent training overall, right? That would be if you'll get data or just like, you know anecdotal stuff Because you're you're going for a longevity play All right, you know lean muscle mass is great for a of reasons and also power output diminishes VH versus if I want to be an elite runner there is for sure a lot of diminishing returns for strength training we get further into a cycle like you have you do have time trade-offs just from physiologic ability to adapt to training but also like
body mass, mean all these things come to effect but like that's, I don't know how many people you guys have on your schedule for the next two weeks. Any of those people are at zero, besides maybe our high schooler. Yeah. And we said last time, he could actually use a little more muscle mass. yeah. Like he's too far on that side. Yeah, so it's a dance but like very rarely it's like, God, I'm gonna miss my training. like, the two days that you think you're gonna lose from that like a road.
stuff you gain like power output in general, know, know movement efficiency and muscular endurance. Yeah, I'd rather her drop from five days a week to three of running due to days of strength training and she gets to where she feels like she can do two days of strength training and one of those days she does a double where she runs and lifts. Cool. But again, think of the mindset that gets pounded into you from the time you're in high school, then you coach people that are running, you're literally training them up. They're even different than what you're doing.
They fall into the same like schema like they're running with their athletes. They're like, I'll do what they do. yeah, it's not quite the case. So like I said, we have a podcast coming up talking about that. also, I don't know if it's going to happen. I'm trying to get Jason coupe on the podcast. So if you're familiar with who that is probably in my opinion, one of the preeminent endurance coaches out there, he's written same book now, second edition, which is kind of thought of as the ultra marathon, you know, training Bible. So
get him on and he'll go into the weeds, but we'll try to make up more lame as terms when Michael and Neil comes on. So that's coming up here pretty soon. Anything else?
If you're a doc, student, patient listening, and if you have specific areas you want us to address, because we're picking from our patient base, but if you're like, I've had a consistent problem with this as a patient, or I see a lot of this in the doc, let us know and we can try to hit that. So you can email us, hit us up on social media, but as always, appreciate listening, and we'll see you two weeks.
Sural Nerve Entrapment: Week in Review 36
In this episode, Dr. Beau, Dr. Alex, Dr. Seth, and Dr. Daneiel discuss the journey of an elite distance runner dealing with foot pain. The conversation begins with personal updates and transitions into a detailed case study focusing on the runner's symptoms, assessment, diagnosis, and treatment strategies. Dr. Beau emphasizes the importance of understanding the psychological aspects of competitive sports and how they influence treatment decisions. The episode concludes with a review of the runner's progress and future recommendations for managing his condition effectively. In this conversation, Dr. Beau discusses the complexities of diagnosing and managing athletic injuries, particularly in runners and CrossFit athletes. He emphasizes the importance of individualized treatment plans based on the athlete's specific needs and circumstances. The discussion includes case studies that highlight the interplay between strength training, injury prevention, and performance enhancement. Dr. Beau also addresses the psychological aspects of injury management and the significance of patient buy-in for effective treatment outcomes.
Chapters
00:00 Introduction and Season Overview
02:51 Life Updates and Personal Anecdotes
07:06 Assessment and Diagnosis of Foot Pain
14:44 Treatment Strategies and Patient Management
20:58 Progress Evaluation and Adjustments
25:21 Final Treatment and Future Recommendations
28:56 Navigating Athletic Injuries
36:52 Case Study: CrossFit and Running Injuries
Transcript
Dr. Beau (00:01.294)
Yeah, it's episode 32 now. How long? The last one that was on YouTube was January. Is that right? January? It definitely wasn't this summer. Yeah. 30 episode 31 from what I saw. it's been a break. So over the summer, Alex went through puberty. Yeah. So welcome to the party. Now gross weight is much needed. 145 pounds. Yeah. It's going to enter a couple of bodybuilding competitions, lightweight division.
What else? just got done with Farm Fest. Yeah, I'm glad that's over for a year. And we're back with the theme or the concept for this season. And this season is probably going go through, what do we say, next April? Yeah, and before May. Every other week, do a week interview and we'll have a theme of what the injury or body part is. So this week, we wanted to focus on the foot.
And then we had two similar cases. We're going to be talking about those. then, know, any questions or anything that come up from comments online or anything like that, we may address those as we go. So I'm going to dive right in. Any other life updates? No, speaking of weight and he's going to be entering weight competitions or chop the interesting. wasn't talking. Yeah. So Samurai is gone, but also got a new taco.
So he drives around with his hair in the back of his truck now. Just not quite ready. it since January. I had a third kid. That's right. yeah. Yeah. he has more weight. Less weight, more weight. Same thing. Yep. my half Ironman got canceled. That's strange. I that I got hit by a hurricane. Well, you had COVID missed that triathlon and then. Yeah. was a good summer. Seth is our semi-elite triathlete that doesn't really do triathlons. He just trains a lot. Yeah.
Yeah, he's the biggie of triathlons. But if we're going off of weight, you mentioned he's entering like powerlifting competitions. If you want to do like the strongman competitions, the women's division, the lowest division you can do, which I learned from the patient, is 160. That's tough. So Alex still be a lifetime PB bodyweight. And you'd still get crushed by everybody. easily. Yeah, easily. Well, all of us probably would. What else? And I just have the crushing weight of life. it's just, yeah. That's heavy.
Dr. Beau (02:23.234)
Houseful of girls. Houseful of girls. They're actually pretty good this morning. Although Maddox went to bed with regular hair and woke up with like Jamaican braids. Interesting. Somehow that just happened overnight. Yeah. And that's never been a toss and turn and woke up with a braid. That's because you were awake the whole night. You gotta go to sleep to have those magical things happen. Someone on Monsters Ain't probably somebody from Jamaica came through. It was probably Alex. Jamaican Monster portal. Scare feet, scare feet, scare feet.
Yeah, shows you how bad I am at doing girls hair when Maddox told Sloan right before she went to bed, hey, can I have a braid so my hair is not my face? And Sloan's just like, I'll do like 18 Jamaican braids in like 10 minutes. And it takes me like 10 minutes to do a ponytail. you done the classic social media with the vacuum, suck the hair up with the ponytail? I pretty good at the brush it up type deal without her crying too much. But it's usually just the crying that gets me. And if she has like syrup in her hair or something, then go brush it up.
And he always has everybody here, know? tough guy to go to bed with. That's daily, that's daily. All right, let's get into this first case. So, theme is foot, and then we got more specific. You'll see what we run into here with the diagnosis. But 17-year-old male, I say elite distance runner. Elite is, he just threw down what, 1456, a couple weeks ago. And this is a previous patient of mine, which also plays into how I handle this case.
But he came in two weeks ago with pain across the top of his left foot. And he was like, it's not so bad that it's stopping me, but he's just, he's a runner. He's an elite runner. He's type a like that's the, what you get usually. So he's worried that was state three weeks out from that initial meeting. So now we're only a week out. They actually have a meet today, right? So they're at Scottsboro today. I'm not going to say that.
but he was just worried. And I was like, okay, let's take a look at it. He notes that he thinks it's due to wearing spikes and racing more. That's just kind of what he thinks. And previous history real quick, saw this guy two, two and a half years ago now had legitimate like left hip instability issues. And he'd always had left foot pain to the point that he had like a classic like turn Dellenberg couldn't balance on that leg, but can balance perfectly on his right. Like stuff where you're like, whoa, how'd you
Dr. Beau (04:48.622)
I could wait with this for so long. But he came in at that point for left hip pain. So now this is the top of his left foot. So I'm already kind of thinking some of old stuff maybe. Pain is worse after running, but he never really has pain during your run, even workouts. he's, you know, it's been going on for about two weeks at this point, which into cross-country. Heard it's going upstairs or doing a heel raise. And as I said, he's three weeks out from a state meet. Pertinent things to note, he's already committed.
to the college of his choice. Why I think that's important is if I was in his shoes, I would feel massively de-stressed if I was already committed, going to a D1 school, got a scholarship, but he's also wanting to do Nike Nationals. So then he's like, he has also asked me like, do you think I should do that? And I think his parents were not wanting him to for, I don't know, variety of reasons. So we kind of had to tackle a bunch of things. It's like, he's got a little bit pain in his foot.
He wants to know how hard he should be training to be able to do Nikes. And then also he wants to, he wants to win state. Do you get, what do you get last year? Second? Was he fit? He didn't win last year. No, he didn't win. I thought he was fifth, I think last year. No, I mean, not only does he have a chance of winning state, like he could set a state record, potentially. Cause this race will be, top three will be a very quick race. And it should be a fast course. and then whether it helps or hurts a couple, what last week, a couple of kids really ran.
super fast times on a fast course, which could deflate his confidence could inflate his competitive side. I've seen him kind of grow over the last couple years and he's way more competitive, but he's still like I literally asked him because the race he's doing today. He won't be racing anybody. So he's racing clock. And I was like, what are you going to try to do? He goes, well, I'm going to put down a faster time than I have like another PR so I know that I can.
And I was like, well, that's going to take a different race strategy. And he goes, yeah, I just don't want to blow up. go, how many races have you blown up on this year? He's like, none. go, you kind of need to find where that limit is. If you're going to be able to push and not following somebody. So if you have to lead a race or something like how you can figure that out. So again, all those psychological components plan to how I'm going to treat his foot three weeks out from state and things like that. so again, I've seen this guy numerous times for check-ins and that initial hip thing over the past two and a half, three years. So top tier, I didn't do one. I'm just being honest, comes in three weeks out from state.
Dr. Beau (07:06.84)
paint on the left side or top of his left foot. I'm not, you might be like, shame on you for not being, you know, fall on that rubric, but whatever. I do watch him walk. Obviously he's having pain in his foot. This is nothing new for this instance, but he has left early to mid stance. He just hangs out in like mid foot eversion or pronation, right? Like that left foot versus right just hangs out on the, you know, medial longitude and large. And then he has a lack of great toe extension on the left, which plays into that. If you're already in pronation, it's hard to kind of.
you know, vault off that. So I'm aware of that, but that's how it was two and a half years ago. Maybe we should work on it more. Maybe it's part of it. Maybe it's not. I also restructured, not necessarily how I wrote up my exam, because this is actually how I do my exam, right? I had it ordered different, but this is actually how I do it now that I have gotten into it a little further. So then they're going to sit down on the table. You start palpating right away. He has a latent trigger point and I'm getting on the
boat of Fibularis, I guess I get rid of Peroneus. Is that what we're making the move to? And say Riz, is that what I gotta do? I went backwards to Peroneus because I learned it as Fibularis. you actually did. So now I like back on the- Peroneus is better. Let's do a poll when we put this up. Hearing Peroneus doesn't sound right, but you gotta go with it. Yeah. You just don't want those peroneals getting triggered. Peroneus almost sounds like what Ron Burgundy would say. Like I'm working on my-
You definitely don't want to make this mistake and say you're right, perinatal, right? I had some perineal. I virtual console put in. Hey, I think I'm having an issue with my perineal muscle. And I was like, wrong virtual console. Acupuncture. Sure didn't point. Would Logan Basie come into the equation? What's that called? Something zero, isn't it? What? Anus. Acupuncture point. What point is that?
the look of we should know this. Not yet. No, we should. Yeah, we should. look it up. Let's go price prony longest latent trigger point. So it's a mean trigger point there. Non referral into that site. But it's you know, and you'd be like, are you looking at the dorsal foot the pronies group you got three muscles in there. Tertius just covers the dorsal foot. So that's especially somebody that hangs out in that everted pronated position. Like the lateral musculature is just hanging on.
Dr. Beau (09:33.262)
that's kind of how you're stabilizing. And you'd be like, aren't they hanging off passively the inside? Yeah, it's both of those. So in my opinion, little overactivity of the lateral compartment and a little underactivity of the medial. And again, we're looking for synergy like grains on a horse, usually on those. Do you find that same trigger point on the other side? It's tight. So he's a runner. And this is where it's hard to know, like, well, is that a latent trigger point? Just tension. It's way more snappy than the other side. And what I was initially looking for when I was palpating that was what?
on superficial pronial nerve to see if it's pronial nerve, should be pronials. We learned it as superficial fibular nerve. Well, common ask Dr. Dooley, who I would say is the authority on anatomy from my perspective, we'll ask her what she says. But I was looking for that nerve. And again, you can palpate that on almost anybody. But again, strumming that doesn't create symptoms on him. So I'm like, Trigger point there, then tenderness to touch over the dorsal aspect of his foot in particular, like
kind of the joint line of the tail and a vicular joint on the dorsal aspect there. So just like, yeah, that kind of hurts. But I mean, there's a bunch of stuff that are tendons, muscle nerves, bunch of stuff, right? That's it. No swelling, no redness, no irritation like that. You're looking for lace bite, like dumb stuff. Like I say dumb stuff, like stuff. They're like, you're tying your shoes too tight. And how are going to find that out? Usually like some, you know, marks there, you know, bruising or something like that.
So range of just general range motion. He does have decreased ankle dorsiflexion on the left. Again, think of how he's using his left foot. The stuff's probably going to be different on that side. So it is different. It's a soft tissue restriction. In my opinion, around gastroxal, it's just like you're hitting soft tissue, you know, a restriction from an orthopedic standpoint, there's nothing classically positive, but we go into pogo jumps. You can tell he doesn't want to do it, but it also does hurt. So he's kind of like, don't like, I don't want to do it. And then he had told me a heel raise heel raise.
bent knee and straight knee both create symptoms. And then I have him do his right and it's sluggish compared to that. So you can just see like, I can't do it as fast as Poppy. Can't do it as on the left. can't do it as fast on the left, which I'll skip ahead to the special test. So then we did a soleus endurance test, which we're looking for like, can you do a, you know, just quick count of 20, 25 reps. He can do all the reps. It's just super slow. Like he has to sit there and think about it. He's, he said a one out of 10. Yeah.
Dr. Beau (11:56.198)
from a neurologic standpoint, he's a covert positive for cerebral nerve sliding dysfunction. So what's that mean? If you imagine if we put him into an inverted ankle position, right? And you could either slightly internally rotate that leg or cross the body. Like I know Seth's going to talk about, he would have this, Patrick Aranturn was in there with me. He would have this like jump. Like we would hit like about 70 degrees and he'd like, and then I did it a couple of times, he'd do it. And then we were all like, does that hurt? And he's like, what you talking about?
And even his dad's like, yeah, you're like jumping before we said it. And he goes, no. And then if you did it a couple of times, it went away. You're like flossing it basically. So I was like, eh, is that covert? Because he's showing something there. And it was a little bit reduction in range of motion compared to the right. But it's covert because it can create symptoms. Jumping in its hip. He's had hip stuff. So I'm saying sliding dysfunction now, if we wanted to differentiate, that distal, is that proximal, is hip. I'm not going to go that far because it's covert. Like, I'm just like, OK, it's some info.
I did because of that little jump, like he was like, you know, snapping around it. did openers and closers. So I laid them on his right side and just opened up his left side, flip them over, you know, it's closing one side and opening the other did both sides. No change in that test. Right. Closing didn't make it worse. Yeah. Nothing made it worse. Nothing brought on symptoms. Nothing also changed that little jump, right? If you did it a bunch of times, it would start to go away. So, then we did perform two sets of 20 press ups just to
check to see if it changed anything, then change anything. And we're also doing, I should have mentioned, pogo jumps in between those. So I checked the sero nerve, neurodynamic test, same, get up, pogo jump. And again, it's hard when somebody's like it's a one out of 10 or two out of 10, he's like, yeah, it's the same. Okay, cool. Already talked about special testing was the soleus endurance test, can do it, it's sluggish. So it's not like I'd want it to be, but that also could just be pain, right, that he doesn't want to do it. So with all of that,
I have to kind of say, well, it's the dorsum of his foot this first visit. So my pain audit is pretty easy. Pogo jumps or heel raise, right? Functional audit is still that trigger point. mean, that's kind of the, we could say reduce strange motion. I think that's been like that for a long time and probably it's kind of like his left side versus right with dorsiflexion. Treatment focus, foot intrinsic stability, motor control, right? So I think how he uses his foot and he even, he's the one that said,
Dr. Beau (14:18.798)
I think it's from wearing spikes and my foot has a harder time doing things than the right side. And I think when I have less stability or help from a shoe, this stuff happens. was like, probably it's a call. So my diff die would be, know, if entrapments the right word or not, you know, that's up for debate, but cerebral nerve entrapment, sliding dysfunction, pathoneurodynamics, something the nerve is irritated. now.
You'd have to ask me at this point, because I'm arriving at the diff die, because I have three visits in, you'd be like, well, how'd you end up on serral nerve? It's the top of his foot, right? So winding up serral nerve was the positive neurodynamic. He's got restriction in dorsiflexion, which what is serral nerve? It's a concomitant of what? Medial and lateral cutaneous, serral nerves coming together and kind of coming down over the musculatinnous junction of solus and gastroc. That's kind of where it's going to
you know, be most exposed. Obviously the diphthi fifth metatarsal stress fracture. I he's kind of having dorsum lateral foot stuff, no swelling or anything like that. then I kind of have to skip ahead. It was dorsum of the foot and then it goes to lateral. So it changes which plays into the nerve thing. and then trigger point referral. There was no referral when I was palpating, but that doesn't, maybe I sucked at palpating that day, right? But he had that trigger point that could refer there for sure. Okay. So treatment on the first day.
Stecho parallel to I'm sticking with pronious pronious longest just kind of knocked down tension, which it does quite a bit. Then we immediately go into five months sideline with the focus on the foot being the fixed point, right? The lateral aspect of his foot being the fixed point, not the side of his knee. And again, it's not that you're right or wrong. It's actually different positions. Remember there's RT two and there's, you know, four different RT, you know, two, one and two.
we're using the foot. So what I tell everybody, imagine that if you're laying on your side, like that foot would be pushing down to the ground. So like, we're just using the side of the foot, right? Is the ground. And when he does that, like he feels in his hip though, like more than if we use his knee, which is kind of the goal. And we work through that for two reasons. I'm, you know, kind of hopefully doing an isometric of those pronious groups. So I can knock down more tension. I'm working around his hip that probably needs some input and feedback. yeah.
Dr. Beau (16:38.158)
And then we go back and so you have his foot slightly inverted is what you're saying. So it's neutral. Okay. So it looks like it's even because he's working to keep it neutral. That's what I was curious. You're planning him to. Yeah. So I just tell people like put your foot flat and imagine you smash in the ground if it was underneath your foot right now, because they want to almost like traction down into the table a little bit. Yeah. And I'll push their foot down on the table for the first few reps too. But again, common mistake if you're looking at like a low oblique set.
These people just pivot around their knee instead of actually keeping their foot down and creating hip rotation. And at that point, the knee is the fixed point, not the foot, but the foot's a good guide. coach. Then the Arkansas Walmart headquarters calling to put my bow beard products out on the fishing. Do you want me to answer it then? Yeah, I got a new fishing lure coming out. Perfect. Heck yeah. I'm excited for you. Yeah, that's cool. Then we did hang stance.
We found some cool stuff on the second visit with hang stands, but we're just working on getting this foot into a better position. The reins on the horse synergistic play between the lateral medial compartment. That's the big thing. What's the timeline between visits? We're still on one right now. So we're just, I'm kind of going through the treatment there. And then we worked on supination curtsy because again, I want to draw up the medial arch, you know, and put it in a better position, a centriated position, and then have him work around that, you know, for right now it's in the coronal plane.
But a supination curtsy is basically, looks like kind of a curtsy lunge-ish type thing. You're just moving around your foot with your legs staying neutral and kind of working on for him, really keeping the ball of your foot down and not letting the inside of your foot kind of escape. You're working on like that foot doming shape. Is that what you're really working on for the supination part? And like we were working on this with another patient yesterday. Big mistake is people get into that position. They think we want this massive arch and they're actually loading the outside of their foot more, which is probably what he's doing when he like runs them.
ground and then like has uncontrolled, you know, pronation version. So we have to be really aware of like, no, we want you to load the inside of your foot and then be able to like keep your leg neutral and move across your body and eventually rotate and jump and land and all those things, which is tough for him. And that's all I sent him home with. So you have a next to curtsy, right? I'm doing it. And I even told him, go, I told him after the first visit, I go, I'm going to leave it up to you if you want to come back. And a lot of people like, why would you do that? Because he's a type A kind of like,
Dr. Beau (19:03.95)
He'll do it. Well, he'll do it, but also I don't want him to like buy into an injury scheme. And I think he has nerve irritation. So if he was better, even though we might say, there's stuff to work on from a functional standpoint, I think it's better three weeks out from state with somebody that's like hyper-vigilant to be like, you're doing good. Like go. Yeah. You've been fine for the past couple of months. Like just go. So that's what I told him. If you need me, I'm here. If it's still bothering you, come back in. He showed back up, you know, the following week. Are you, are you having him do that?
mostly before he runs, after he runs. A of times throughout the day. Again, you're gonna have not an isometric load, but guess an isokinetic load of the pronius group on the side. the big goal too would be, let's say that nerve, because again, the lateral cutaneous branch of serral nerve like basically goes on the medial border of pronius longus and gastroc, right? So it's like right in there.
And then it kind of connects back in with the communicating branch back into that medial branch to make Searle. So if he has much tension, like that's our patho neurodynamic scenario, whether it's entrapment or whatever you call that. so if I can dump tension, that's my goal. now I'm hitting two birds with one stone. Let's say I didn't pick up a trigger point referral or it is the nerve. I'm doing two things at once now, right? I'm offloading muscle to get the nerve moving. I'm slightly like kind of moving that nerve around. That's my thought.
That's all I send him home with, a couple times a day, do it before you run, warm up, if you're in pain, see if it takes symptoms away. That's the coaching. Do you worry because he's a type A person that he's gonna do that a lot and then he's not gonna have a sore hip that affects his running or? No, because it's body weight and if he did have a sore hip, hopefully he's like, I suck at that. If he did, like, cool, it'll go away in a day and then it's like, you know, it's easy. So the big reveal on this is visit two.
So he comes in and notes his pain is reduced, but now it's moved mainly, like he doesn't really have pain on the dorsum, so it's like on the lateral aspect. So it's like over the top of his fifth met and like around the side and even like kind of underneath. So it's all around. So the diff died, now you gotta be like, ooh, this guy have stress fracture reaction, you know, makes me a little bit nervous, but the same thing doesn't hurt when he runs in particular, if he does a hard work, I was like, I don't feel at all. And then it goes afterwards, it'll hurt. And we get more of that story in the third visit.
Dr. Beau (21:28.526)
So we go back in, you know, a second visit, it's always assessment and treatment. So palpation of cerebral nerve slightly reproduces symptoms at that like musculoskeletal tendinous junction of the gastroxylulose group. It's like right in the middle of your calf, like right before it turns in your Achilles, you push there and he's like, you gotta start feeling that out into the lateral part of my foot, which is good for me, but really good for him. So it's like, hey, see, this is what we thought it was. Yeah. Now the neurodynamic test that was positive four is negative.
So that's not present at all. So now I'm thinking, it's probably was a patho neurodynamic scenario and the nerve stays irritated for a while. The nerve's still irritated. Let's take care of business. No jumping now? He's not jumping when you do that? Yeah, we're jumping. And mean, again, still has slight pain, but like he's like, it's a one. And then sometimes he'd be like, I don't even know if that's it or I just don't want to do it. That's literally what he's telling me. So I'm like, that test kind of sucks now. No, sorry. When you're doing the neurodynamic test. no, no. Yeah. So it's just clear. Like full range motion.
Totally. But yeah, pogo jumps. I threw out because it became just, I don't know if you actually know if it's better if there's pain or if you're avoiding. So it came down to kind of like heel raises. Like how are we doing them? Do you have any pain? Move right into hanging stance. Now here was the kind of interesting thing. So we're getting to hanging stance and he's been doing supination, curtsy and panchanger's foot. When he gets in there, if you can imagine a foot that lives in midfoot pronation.
And when he tries to like load the ball of his foot and use the rest of his toes, A goes into that, you know, compromised buckling of the distal joint of all of his metatarsals. But then his pinky toe is like, I would call it a dewclaw, but it starts to like literally turn like purple. It's like he's having occlusion, like from a vascular standpoint and like, then you do like not capillary refill from the bed, but just his toe. And I mean, it's totally different than the other four toes. Patrick was still in here in turn where you're like,
So we go over to his right foot, totally different, right? You can stand there. so we're doing that and I go, well, now we can use that as more feedback, right? Like obviously the neurovascular bundles that's running between your fourth and fifth met, like it's getting compromised because you're just crushing everything as you go over here and then try to probably overuse interossei or something to like stabilize instead of like, abducting and all that stuff. That's gonna be really tough change in two weeks, which is why I approached it the first time like.
Dr. Beau (23:53.294)
Yeah, there's stuff to work on. Let's just get you out of pain. You know, and that sounds lazy, but it's the best option, I believe. So that was kind of cool for me to see. He definitely could tell the difference. Then I was like, maybe we can change that. And then we really have a different kind of test to look at. Because of that, I started working on diagonal single leg deadlift with foot loading because imagine I have his left foot down. And for those that aren't familiar, imagine a single leg RDL and you're leaned against the wall towards the leg that's down, right?
I could put a video up because what's that do? He has to keep the ball of his foot down, but it's biasing weight over to the lateral aspect of his foot. So it naturally gets his foot down and he's basically just doing the same thing as, know, a curtsy. He's just loading his foot and moving around now. When he does that, he gets a way better setup for the transverse arch. Like you see kind of like vaults that fourth, fifth met space. Really cool. So, and he didn't have the like a color change in his pinky toe. It's like, yeah, perfect drill.
Still want to do the supination curtsy because you got to like feed those in. So I go just mix those together, like make them a little random. like a couple reps of this, a couple reps of that. And that's what we send them home with. Diagonal single leg deadlift, supination curtsy. Third visit, we got even more data. So I said pain is only occurring after a run, especially workout. So again, doesn't ever hurt during a run, just each push it or after being sedentary for periods of time and then moving in. But he knows it's, I think he works at a fast food restaurant, Republics. I don't know, it's not.
But if he's up moving and working, he has like no pain. So it's if he sits down and gets back up and then he'd be like, is it tendon? You know, there's not a tendon that wraps all around the side of your foot. So now I'm like, okay, that's probably you're just moving the nerve and desensitizing it throughout the day and it doesn't get a chance to do that. So again, let's say let's back up to first visit, we had a covert aberrant finding on a neurodynamic test. Rule of thumb for over positive would be what?
not doing any flossing usually or send them home with that. Now we're into the third visit. I'm like, dude, you have just just nerve irritation, opinion, like the peroneous trigger points gone. I'd say dorsiflexion is probably about the same. Heal lifts still reproduce the symptoms. But what we did is if that musculatinnitus junction just voodoo floss the snot out of it, and then I had him do heel raises, which does two things that helps you do a heel raise because you have compression, but he's like, I have zero pain. Now, again, mechanisms there just
Dr. Beau (26:18.286)
pushing on some make it easier to do, but also you're compressing that nerve and giving a much input. And he was like, yeah, that's nothing. So I was like, okay, to me, that's going to again, concrete what we think is going on. and with, because of that, we, went in and because he has just kind of resting increased tone where that sero nerve drapes over that musculatennis junction, I just went in and kind of dry needle parallel to it, almost like a steko ask dry needling, right? Just going in along that channel.
you know, promoting some like kind of input. When we put in a couple of those needles and again, we're not on the nerve, we're in the muscle next to he's like, yeah, I can feel like pain in my foot, like on the side of it, which kind of crazy to me, because you're not in a trigger point that should refer you're not also on the nerve. And he would only you know, he'd poke it in, then he'd be like, Yeah, I feel it and go away. And like, did that for like two, three needles.
Hanging stance again now we're moving into heel lifts because that's something he's had a hard time with because of the starting position his foot and being able to move over to his big toe already he's already on it so it's hard to generate force when you're already in that position. So just working through a more active version of what we've been doing. Hanging stance with heel lifts, capillary refill was improved so like pinky toes not turning purple that's better you know maybe that's a variety of reasons. Really stochotic movement.
So when he goes up, he's got these like ratchet and going down, like, whoa. And that to him, even though it's us, like, that's, you get that with a lot of stuff. Like to him, he's like, my God, which is kind of good. I was like, yeah, that should be smooth, man. So then because of that.
and seeing how much he responded to seeing like what that looked like. I was like, let's just work on that with like, you know, a squeeze and lift drill is you got a lacrosse ball between your feet, trying to cue up like, again, synergy between the medial and lateral compartment, drive through your big toe, did a bunch of reps of that, and then just sit on single leg. And I was like, be able to repeat that feel in a single leg stance. Which again, without being in hanging was again, like really like, you know, stochastic.
Dr. Beau (28:26.51)
So we did heel raises and then we finished with cerebral nerve flossing and I kind of preempted that with like, I'm going to have you do this a lot for the next two days. Just see what happens with symptoms. So I'm out of that like acute irritation thinking that there's actually a nerve entrapment or interface issue thinking it's just inflamed. still swollen or whatever we call that. Now he's telling me if I move around all day, it's better. Okay. Let's move around more specifically and see if we can abolish it completely. So teach supine, cerebral nerve flossing, right? Just, you know, like at 90 degrees, kick your leg out, you've heard it.
slightly planar flex. So now he has supination curtsy diagnosing like deadlift, just mixing those around or warmups and then sero-nerve flossing like pretty hot and heavy for two days, which I will see him tomorrow because he has a race today. So I don't know how he's doing beyond that. But I just thought it was kind of an interesting one from there's always a hundred things to work on, but then it's also a scenario driven of like
I'm going to be honest, like if he comes in tomorrow after his race and he's doing better, I don't want to see him next week for state. I think that's a bad move with his personality type. Even if there's a million things to work on. I know a lot of people would think that's stupid, but then what I will say is I don't want to see you next week, but I want to see in between then Nike or I guess he has sectionals next week. yeah, then Nike. Yeah. So three in a row, but I don't want to see him after all that stuff unless something flares up. Cause then we got out or indoor, just clean up stuff.
indoor because he's also got to get prepped for like college where he's going to get either spanked with higher intensity or more volume for both. And that's what I was trying to get him to realize like your training is going to go way up. And if this stuff falls apart, just in season with, I mean, they, what do you max out at 45 miles a week or something? Maybe he's got, don't know if his volume is high, but his intensity is pretty high. Right. And then we could, you know, we'll see what happens in college. I also know where he's going and kind of how they roll for the most part. But yeah.
It was just any of those things get magnified. So like we do want to keep working on it. Just not right now. I think that's the biggest deal with this case besides it having some like, I wouldn't say confusing, but it, the second visit, like, God, do I need to send this guy for an image real quick to just rule out stress reaction? Tough thing there is like, we know like has to be pretty far progressed for an X-ray. We're definitely not getting MRI. mean, you also saw symptoms change location in one visit. And that's what I kept telling him to reassure him like,
Dr. Beau (30:47.95)
In my opinion, it can't be an injury. I've gotten fooled though. Cause again, a stress reaction or fracture can cause a lot of pain, right? And then what we know now from nerve sensitization, the periphery, if something's going on, like a bunch of nerves could just be irritated and you'd like, the nerves are irritated and you do have an injury too. So that's something to be aware of. Yeah, that's a point. you're here, he wasn't having anything after easy runs though, right? It was just after workouts. Initially the easy runs where he felt like it was worse after. I just think that was the amount of time he was doing stuff, right? Just more time.
on his feet. Yeah, maybe not more time, but like dirt or, you know, the duration of effort versus like an interval and rest and stuff like that. I think there's longer time on the ground on easier on that. Yeah. When you run harder. And he also mentioned which I, I have a hard time reconciling this when people say it now, just from what I know. But he's like, yeah, if I'm on like trailer softer ground, feels better than concrete. And you know, like we've said, like we attenuate the impact force on that. So it's the same, but I mean, that's what he told me. So, you know,
I mean, I feel like they just get a different stimulus when you're not running on the flat concrete asphalt the question I should have asked, which I didn't, are you wearing a different shoe on concrete or versus trail? then maybe that's what's going on there too. don't know. Any questions on that one from, and again, I wish I had tomorrow's visit, but again, we can, you know, two weeks from now do a quick update on him and just be like, Hey, how are you doing the races? How's foot doing? that stuff. And off of the X-ray, if you're thinking about pulling that, are you doing bilateral?
No, no, just because like stress reaction fracture, I don't need to compare like normal anatomy from a joint standpoint. If I was looking like we had somebody a while ago with a Liz Franck like ligament thing, you have to there because like he has abnormal anatomy from a degenerative standpoint. Now, if you're looking at recurrent stress fractures, like we had a gymnast with a tibial recurrence, like at some point, like her second set of images, like if you don't do bilateral, you're a dummy because like
If we have the same showing up, it was like just how our tibia is and it's that's not the driver symptoms, but it's a new thing. So I'd say no in that scenario. but again, if he came in for the third time for fifth met pain, I'll be like, yeah, let's look at it. So we don't call something wacky. Yeah. Anything else?
Dr. Beau (33:07.298)
And if I'm being honest, this kid just needs to lift more weights too. he, he's stringy. So his, well, and what we also know with like strength conditioning, if we were, know, Hey, use your foot the way we want to use it, work on single leg stuff. That's also input. So if we have talked about all these motor control rehab drills, like working out is input. If you're aware and conscious about what you're doing or not just like,
you know, sticking headphones in and banging out reps and stuff. like that in itself is a twofold getting stronger being able to create more force, which also reduces impact and things like that up the chain. But then also it's just like motor input with that, you know, feedback loops. think people don't think about it like that sometimes. Which knowing that team, I I know they strength train in the summer. I don't know what they do during the season. I don't think I don't think anything. Yeah, I don't. Nothing's mandatory. Most things in high school.
I mean, like we can speak on experience. feel like we didn't really do any weight training because you had limited space. Football and baseball always kind of took, they kind of took precedence. We did during track, but that was because we had the weight room at the track that we shared with the football team and they were in off season. So we always had volleyball, basketball, football and baseball, all of those were going. So was like our weight room time was like, you might get in there once a week, maybe. Which I also know that they're
program that they get in off season is handed down from the strength and conditioning coach that runs football. So it's not even specific. It's literally that program. again, it's still something in their high school. Yeah. not. And again, should it be running specific? I don't know. But it should be people that are low body weight, low power out specific. I was going to say, most of the time when they do anything that they're having to load their body outside of the sagittal plane with extra weight than just their body, they respond.
Yeah, well, if you give him some like, some topical even like easy plyometric thing that they did like once or twice a week, that would go a long way. Which is crazy to consider that, you know, he's running 445s for a 5k each mile and be like, those are way going there. You might actually run faster. Yeah. Well, that's, I think that's something that across the board, if you saw, Hey, the big game plan for all, or I mean, female and male,
Dr. Beau (35:28.526)
senior high school runners that are going to run in college that the move into outdoor like towards the end outdoor you just start lifting weights and like don't put on a ton of weight but you want to put on some lean muscle mass and like get some power under the chassis to bulletproof you're going into college training over the summer and also get stronger before you increase volume and intensity. Yeah I feel like for college like intensity is not that much increased it's just volume I feel like is what goes up.
So then it's tougher to recover because you're dependent on how hard you had to push in high school. think that's the chat. So your, your story versus his story would be very different. What if we look at some of our other runners, like our guy that's at UK, like that guy never had to push here. And then when he got there, like he is not fast guy and all. Yeah. The intensity as programmed is the same, but the intensity went way up for him. He's like, Ooh, like I have to push harder to do what they want me to do. And then same thing for him. If you're the top dog and you have a program workout and it's like,
Again, he doesn't even know where his limit is. His biggest detriment right now is that for sure, from performance standpoint, for a lot of reasons, mentally and physically. Anything else on this? Because I know you got kind of a secondary case that's similar, right? Yeah. Do you want me to do the entire case, or do you just want little pieces? Give us the rundown on what was similar, but what was different. What led you to, is it same diagnosis? Yeah. Mine is same diagnosis. Give us the...
history of why they came into the office and then the pieces that were wildly different. Yeah. So mine would be a 23 year old female. She's really big into CrossFit. She decided that her best friend wants to go to all these different national parks. So there was a half marathon in South Carolina at some national parks. So she was like, yeah, I'll just sign up and do it. She's been training for high rocks, which she's competing for in a month, I think, over in Texas.
And then, so that's kind of like her main focus. So if you look at her, not so like your typical runner, she did this probably about 10 days ago from when I saw her. She said that the day after her half marathon, she started having like outside of like calf pain into the lateral aspect of her foot when she was just like walking around. The other piece was big like impact movements. She started feeling like zinging kind of like upper leg.
Dr. Beau (37:49.846)
And then just walking around, she felt it kind of like shoot down. So you kind of have like two different directions that it kind of runs depending on the impact. She has nothing if she does like squatting, like really no movements inside the gym bother her except like if she decides to go run or walk around. Outside of that, that's pretty much the only, that's pretty much my like main history piece. She said that she made the appointment on like a Sunday and then she saw me like two days later. She said the day after that she made the appointment. I started feeling a lot better, which is pretty typical.
that I wonder if that's actually named that effect. And you guys have people tell you all the time, right? I made the appointment as soon as I made the appointment, I started feeling better. Maybe that's how good I am. Over the phone, starts making a difference. placebo, but it's like an action step. Like you made an action on doing it and literally people say it all the time. Yeah. So almost every patient feels better. Yeah. Unless they smoke their back, pick up a tissue. High low back is not going to feel better. didn't, her top tier, I ran through it.
but it is no different because I've seen her in the past. It's the exact same. Main things for me that I was looking for, I guess, I'm not trying to bias it, but just how she moves overall, mainly flexion extension, because she's had low back stuff in the past where her multi-segmental extension was dysfunctional non-painful. So I looked at that. Both rotations are dysfunctional, but again, that's a lot of hip, I would say tissue is her limitation there for the external.
external rotation and then single leg stance on both sides. I call them functional, but if I wanted to get real nitpicky, I mean she passes the test, eyes open and eyes closed, but she kind of leans into her low back a little bit on the right side, which she's had right low back pain in the past and she has right foot pain. Well, that's something that I probably should have done on our patient because like you did have single leg stance stuff in the past, which would clear completely, which is the other thing I didn't say is like that stuff all completely normalized 15 seconds, eyes closed bilateral.
So I should have checked that to see, has it gone backwards? And again, I probably am ending up the same place, but it like be good again, like clearance stuff. And I'm not like dogging top tier SMA for the clinician. But again, I don't think I need that, right? I think the patient sees that like, big change, right? Cause it's harder to say like, hey, see how your foot's working different when you walk and run, like they don't pick that up. Yeah. And then even though she passed, I still dropped her, just again, based on her previous history.
Dr. Beau (40:15.926)
I still dropped her down into like a half kneeling in line lunge just to see if I took away the foot, how she would stabilize if she still kind of leaned into that low back a little bit. She didn't when she went down to her knee, but she still passed on both sides. And that was even after I had even had her like come up eyes closed and stuff like that. So really nothing on top tier that was really big. Since she had this pain after running my two tests again were the kind of the exact same of just a soleus endurance test.
straight leg and bent leg still kind of both reproduced her pain on the right side and it was also slower. She still got to like 10 or 15 until she was just like how many more do I have to keep going? I mean she was kind of crushing on me that her right side was just slower. So then she's like how many do I need to do? But there's no pain. Then I was like okay if she has no pain there next step would be something that's got some impacts the pogo jumps. Right side is not really that much slower than the left I wouldn't say. She just has pain and she's like I can kind of feel it there.
Which I would say is a better pain on it at that point, because you don't have like a performance or functional deficit comparatively. yeah. Did she get that zing? Yeah, she feels it on the out. Sorry. She feels it like on the outside of her calf, of, guess, if you want to like a third of two thirds of the way down or like peroneals all the way down, like into the fifth met, like that exact pattern. And she kind of like points it and like, it's almost like a draw the line with her finger. And then.
I'm trying to think of what else. Then I went to like my orthopedics, nothing reproduced it on low back. Well, first I checked her foot, nothing was there. didn't sprain her ankle, she didn't roll it during the race. So I kind of just made sure I checked all my boxes there. Was she tender to touch anywhere? She was tender to touch over again, where she like pointed to and drew the line. But I wouldn't say it was on the tendon. It was kind of like right behind the tendon, over the nerve. And if you compared it side to side, that side I would say was larger than the other one.
So a little bit like neurogenic swelling. And then lumbar orthopedics, just because again, she's had low back stuff in the past. I rechecked some of the things that reproduced her pain in the past. like Milgram's nothing. Straight leg raise didn't reproduce it until I had her cross her leg across her body. That reproduced it. With inversion? Inversion. Okay. Yeah, with inversion. Inversion, plantar flexion, and then taking it because I could do that like laying on her back.
Dr. Beau (42:42.764)
I could dorsiflex her foot, which she has restriction range of motion in her foot. Nothing reproduced it there. I could plant her flexor foot and invert it. Nothing there. As soon as I took it across her body, it got about halfway and she like jumped and she's like, yeah, you got to stop. Which again, isn't classic differentiation, but kind of is that like you have below the knee or, know, cause we know where that kind of comes out of the calf. So it's hard to say, well, ankle or knee, like lower shanks. Like that's good to know. And she also on that side really wanted to like do the straight leg.
raise for me. I don't know how to like say that any more than it is but like you take her left side her leg was pretty much just like limp her right side she wanted to kind of force it in the way that she wanted to and keep her knee bent. So I kind of just took that a little bit into consideration. Nothing with like her slump test either. So again I kind of rolled out a little bit of like low back disc stuff.
And then that was the only, I guess, orthopedic test that was positive with straight leg raise across. I even like banana'd her to see like if it was like reproduced anymore with like opening her. Banana means if they're supine and like their shoulders and their feet stay put, you'd move their hips to one side. like if they're standing, you'd be leaning one way and then standing the other. So you're like opening one side and closing the other side and then repeating it straight leg raise. So I just was going to see if that changed anything. It didn't, it didn't change, didn't help, do anything. Which is a good point. Like I didn't do that. I could have known with John.
I went into openers as a test and then retail. You're kind of doing all the same stuff and sometimes it's faster to do that but then you get full because if you hung out for 20 breaths in an opener you might get a different result. Again, that's where sometimes it's hard to be like, we're like, don't fall, fall to protocol, you can bounce around and then sometimes if you did fall, maybe you would suss out a pure McKinsey, a pure neurodynamic. There's merit to both. And then palpation wise, so I kind of went locally and then moved my way up. So if you start moving up to the hip,
She has like massive like tone in the right glute around like glute med piriformis area and then lumbosacral mutation which are all things that we had previously worked on probably like four months ago I think was the last time I saw her maybe. So I've just had her since she was already flipped over I had her knock out like three sets of 15 for some press ups just to see if we could do anything down below.
Dr. Beau (44:59.342)
She's getting her PhD in some like nutrition stuff and like anatomy things. So she was kind of curious on what all we were doing, why we were attacking her low back with her foot. Yeah, I did. I I asked her if I needed to get on the table if she was a doctor now. No, I'm just kidding. But I just had her knockout press ups had no change in any of the tests. So then I did.
Sorry, I gotta get down to my notes. Should we have the Lane Norton double blind? What is it? Double blind, placebo controlled, randomized, step whatever he yells every time, which also you see his newest article they put up today on a low back pain is not caused by loading. Terrible article, by the way, just cause you can read a research article doesn't mean like whatever, sorry. Side note. And then, if she had, since the only thing that reproduced it,
was that basically tensioner for the serial nerve for the straight leg raise. I had her stand up and put one foot up on the table. So I guess you're like a tensioner into like a slider, if that makes sense. So she has heel on the table, her foot's plantar flex and inverted knee bent, kind of like lean forward a little bit. And she's trying to extend her knee. And as she extends, whenever she gets to the point where she starts to like either recreate the pain or it feels to get like super tight, she slowly lets her foot go into E version.
So I used that as just – as kind of my like test but also like a little bit of my treatment because I was just like maybe she has like a really big like tensioner on that side since she has a lot of tone in peroneals and in her glute. I had her – I coached her to do that. And so I had her do 10 of those, went back to the pogo and she could pogo up and down with like nothing. So then I was like okay give me 10 more, went back to pogo, still no pain with that.
had her go on her back, straight leg raise across her body, that's completely gone. So then I put her again, just because I had noticed that she kind of like lays into her like low back, doesn't really like to load her hip, but she's in that single leg stance. And she has that massive tone, I put her in a sideline position to work on the tone of her right hip. As soon as I put her in the sideline position, I was like, just kind of pushed back into me just to meet my resistance. I mean, she's like already like shaking a ton, which to me was kind of my...
Dr. Beau (47:26.016)
where I'd like to head with her is like that right hip stability. But in her mind, she thinks she has something that's like seriously wrong with her foot, which she kind of kept saying the entire time. Like if she gets up, she's like, yeah, she has no pain, but she goes, I just don't think that that's like what's wrong, which is kind of cool. So it was the second patient I've ever been told that like they had changes in that I was wrong. Second? I feel like we've talked about this before. No, my fifth patient ever told me I was wrong. And then
That was during preceptorship. And then she was just like, I just don't think that it's like the actual nerve there. She's just like, it just doesn't really make sense to me. Then you should have told her she was no, she's talking about us. So you're right. So then I had her, so I just started showing her. was like, so you see how we like tensioned it a little bit and then showed her all the tests that we had just done. I was like, we have no pain with any of these. And I was like, if it wasn't this, this probably would still have pain.
And she was like, yeah, that kind of makes sense. So then she got back up to the POGOs and she goes, it's like still kind of there. And she, and so she was like, so what do mean to take her home? Cause she had to kind of like leave kind of quick. Cause she forgot that she had to teach in Tuscaloosa in like an hour and I had like 30 minutes with her. So I sent her home with those sero nerve tensioners. Actually, that's actually like what I sent her home with cause nothing else reproduced. She had, since she has that high rocks coming up and her main thing was she just didn't want to have pain cause she left and she was like, am I still good to be able to like.
load pretty heavy for my competition. was like, yeah, you're good to still do these things. Your nerves is pretty irritated. I like that's why I'm sending you home. Cause I was like, one thing I'm also seeing is does it make it worse? Right? Cause if it, if it makes it worse, I know there's either some tone that we need to calm down, like in like peroneals, we need to work on this hip a little bit more, especially if you're adding like your training back in since it's not really like half marathon focused anymore. but it also gives us a good, you know, way forward of what your next month's going to look like heading into the competition.
so she was like, okay. And then kind of left like, you know, not really like in my opinion, fully bought in on that one. so it was, yeah, I don't know. It's kind of, kind of, I only saw her one time. I looked, saw her yesterday. I see her, I think Tuesday, because I'm out, I think Monday, but Tuesday afternoon, I see her for like her second follow up for that. And the hyrox is when? That is late November. I think like, I think it's like a month out from like, to like this weekend, maybe. Yeah. So do you.
Dr. Beau (49:50.976)
What's your confidence interval that you're right? 98%. So then if you're 98%, then it's all management, right? She doesn't think it's that. You think it is. She may be like, want an image or she goes someplace else. Do you have anything else that you're thinking on how to manage it? Not better, but just how do you keep managing it? Yeah, the next time she comes in, just in my opinion, work pretty locally of just calming out some trigger points if I can reproduce it.
Like she seems like kind of person that likes things like locally worked on. Maybe not fully just like, let's work on your right hip because she's again, I would say above average if you're talking to CrossFit. she kind of has this like she's, feels like she's good at moving her body, which she does move pretty well besides like these one things. And then,
I guess working on the right hip and then linking that with her low back a little bit more since she's already had that in the past. And again, I kind of pulled up and like showed her like why she could have the like low back with the foot because I brought up the Expo study that we kind of always like throw out and she wanted to go look up that research herself because she like likes to do that research. So she wanted to kind of see it firsthand. See how you weaponize what she's like not being trained about how she's going about getting trained.
It's like a little bit like there's this article and that may literally, that can change your pain. I you know, I know that sounds wild. Cause I showed her, was like, mean, even if we, if we take this study, you know, there's 30 % of all foot cases have some type of low back components. I'm like a third out of all things that come with the have foot pain could be coming from your spine. And I was like, you've had low back stuff in the past. So I was like, dude. of you listen to the Ron Hruska podcast with Winchester and them? So you had a really good point on there.
Because they're asking like how do you know if you're on the right key link with all of the stuff that you do? And he goes almost regardless of key link if I don't start where they think I should start doesn't matter what you do I think there's a really good point here that like it's not trying to pull the wool over their eyes But like let's say you you're not like I'm 98 % sure what it is Which means you're also you got symptom relief, but then who's to say we can't just like fool them by like
Dr. Beau (52:08.11)
You know, what if they mentioned they're like, you know, did she ever mentioned what she thought it was? Like stress, you know, she, she she said she's like been rolling her calf a little bit. So she has, that's kind of helped it a little bit. like, who's to say she has a trigger point, know, lateral gastroc perennial group, whatever. Stecho the snot out of it after doing neuro dynamics, get a pop around. And I know that sounds like you're being sneaky, but again, you're still decreasing tone, which is probably playing into it.
And we may be like, that's not the most important thing, but it might be the most important thing to them. And then we have to, we don't have to talk our way around managing the case. You're literally doing what they want you to do, which doesn't hurt them. It helps. Or if it's a net neutral, I, you know, a crew scatter, like a point of like, you just like, they'll literally tell you what they think's going on, what they want you to do. And if you start there, you're going to have, what did he, how do you say it? I can't remember the exact terms. We basically said you're going to have better outcomes.
overall and he goes, that's a clinical like thing that you should be working with, not just like a placebo higher. He goes, that's a clinical like buy-in changes the game. It's like, that's a good thing to note if you're like, you know, I was notorious for explaining what was causing their pain and why I had work there. And you know, you can get good buy-in like that, but I think it's a lot easier to not have to like fight that battle in the first place. And then if they ask questions, why are we working on our hip? Like, I think there's some hip involvement and it just might be easier.
Yeah, that's what I mean. Five minutes into like what Seth was saying, I was like, he's going right down the right target, doing everything right. And then on those patients, you can almost hear their hesitation at some point. And then you kind of think, OK, if I don't give you a foot drill, even if it means nothing, if I don't show you how to load your foot, because nobody does everything perfect. And then so as soon as I show you that, but then I'm like, now I'm going to do all of this. Then it's like they think those little foot and sometimes it hits right like.
The other patient came in like, think when I wear shoes with less stability, like my foot has a problem with that. And then I was like, it's nice when it does agree 100 % with what you say. But when she's like, man, I worked on my calf and you're like, yeah. mean, cause I mean, she's worked on her calf. She also said that she's been rolling out her foot and she's like, it's kind of been helping. So I mean, she's kind of nailed all the soft tissue in that area, a decent amount. Show me over the nerve reproduces her pain. And she also was like, I guess the other thing was she was like, yeah, when I'm like sitting down, it hurts like walk. But also if I just like do my foot like this and kind of turn then it like.
Dr. Beau (54:28.694)
really kind of gets it. So I mean, you have like two options, or you have like a muscle and you have a nerve and the trigger point didn't reproduce it, you come off of it and it's like, I think that would be a good tip for all of us with anybody listening to this clinician, just like whatever they literally tell you they think it is, unless it's wildly different, or they've been misinformed, and that's leading them astray, but whatever they tell you they think it is. And then like, you know, we always ask questions, what have you done to tell up through what previous treatment we had, things like that. I think then you can like be like, this is like, you know,
they're the buy in is there because they're like, you're treating what I want. Because imagine if you went to a restaurant and you know, they're like, yeah, I'd like this. Like, nah, I think what you really want is this. And they're like, this is the best. This is the best restaurant. Right. And you're like, yeah, and they're like, I want this like, we're the best because you're gonna get that I think like there's a conflict, you can be awesome. And you might be right. Like, that's the best wine pairing. Like, no, I that one. You know, whatever. It's like, it's good.
Well, you go back to years to where like now you don't have to check all those because you've showed him the wins in the past. Yeah. And again, for me, I should have checked it just now. Like, his single league balance is worse. Like good to know when he does get further in training, it does get worse. I think that is happening, but like, don't know if it didn't check it. So that's more for me. He might see that. I think he already knows that. And I, maybe that's not good to show him right then. I can't bounce. I'm going around state.
Hey, I literally told him that first, let's just calm stuff down, get you right back out there. That's, know, and that's why I was like, see you later. I don't hope I don't see you next week. totally different scenario if he comes in and you know, a has different injury or be at summer or something like that. Cool. Any other questions or any more on that case? And again, we'll do like a quick five minute update total on these two on the next one. So we can see one or two more visits on there and then at least one more visit with our guy here. Yeah.
We won't know what the next cases are because we're going to be deciding those week before the weekend reviews. But the cool thing is in the upcoming shows, whatever the case or body area injury that we're bringing up, we'll have discussed and gone over either the concepts of the legitimate injury and the previous week's doctors meeting. So we're going to have way more info and might even be able to shoot some videos of stuff specifically those cases. So it'll be a little more in depth. But again, leave us a review, leave some comments, let us know what you want to hear. If you have any specific questions, we'll try to address those.
Dr. Beau (56:49.902)
any closing remarks? All right. Well, I'm having a fun time. My crotch is vibrating. And I mean by that is somebody's been trying to blow me up. My phone's down here. we got to go. So see you next time.
The Modern Musculoskeletal Approach - Dr. Brett Winchester, DC
In this engaging conversation, Dr. Beau is joined by Dr. Audra Lance and Dr. Brett Winchester to discuss the evolution of clinical practice over two decades, emphasizing the importance of patient management, communication, and the integration of functional medicine. They explore the significance of confidence in patient care, the evolution of DNS, and the role of mentorship in healthcare education. The discussion highlights the need for enjoyment in work and the excitement surrounding upcoming educational events.\
Chapters
00:00 Introduction and Podcast Evolution
01:57 Changes in Clinical Practice Over Two Decades
06:05 The Importance of Patient Management
10:12 Balancing Function and Patient Communication
13:57 The Role of Confidence in Patient Care
18:09 Understanding Functional Approaches
21:50 The Evolution of DNS
26:02 Teaching and Mentorship in Healthcare
30:11 Integrating Functional Medicine into Practice
33:46 The Importance of Enjoying Work
38:11 Looking Forward to Future Education
41:55 Conclusion and Upcoming Events
Dr. Beau (00:00)
Audrey's over here shining up. So she glows. You're already, you're already out going to do Brett and I, so don't worry about it. yeah. So Brett, this is, I think you've been, well, no, you've been on this podcast twice since we called it the farm cast, but I have like podcast ADHD with the name changes. Cause you were like one of the first guests way back when on my original podcast, which I don't even know that what I was called true health or something now, but we've got.
Brett (00:06)
to.
Dr. Beau (00:29)
Brett Winchester on here who has the Gestalt Education podcast. have Audra Lance who has Mind Your Body, yeah, podcast. We got a bunch of podcast hosts. I mean, we're basically all famous. If you haven't heard of us, that's your problem. But Dr. Brett Winchester is joining us today. We're gonna talk about a menagerie of things. We have no clue where it's gonna go. I've got a list of questions, but we'll just kind of have to figure that out as we roll.
Audra (00:38)
your body.
Dr. Beau (00:58)
let me, Audrey, you're kind of buzzing a little bit, maybe not from wine, but your speakers. So let me see if I can get something going here.
Audra (01:07)
Not today, but look at my coffee mug. It's very fitting.
Dr. Beau (01:10)
Ooh, I like it. That's yeah, definitely fitting. I'm going, we just got it. Have you guys heard of the Toshibo? T -C -H -I -B -O coffee machine. It's like a grind and everything all in one. It's elite status in our office, just got one and everybody is super excited. So I'm probably gonna be broke in about six months, but yeah, totally. So was last year 20 years in practice?
Brett (01:11)
Go bird.
It's alright, worth it.
Dr. Beau (01:41)
Or was it two years ago now?
Brett (01:41)
I'm pretty sure I'm in my 22nd year, think. So yeah, close enough, yep.
Dr. Beau (01:48)
Okay, so over two decades in practice, let's lead with a huge question. What's changed? What are the biggest changes you've seen in your practice style? I know we could go way far in the medical realm, but in your practice style and our kind of group of practitioners, what's been the biggest change?
Audra (01:57)
you
Brett (02:11)
I think that the blend of what the evidence was telling us and how that is obviously critically important, then kind of learning a valuable lesson that I wasn't going to fix everybody in two and three visits, that's probably the biggest change looking back at my career that I had to learn the hard way. I always say that being in a relatively small town, having to always see my patients and run into them and then...
tell me they've done something else or tell me that they weren't doing as good as I thought they were doing. And then that was really, really humbling. And then from that, I really, really learned how to manage cases way better, I feel like. And I feel like when you're young, you do manual care, you teach rehabilitation, of course, and you cut the patient loose and you just automatically assume that they're fine.
And the reality of it is a lot of our cases require management, even in the evidence -based and functional side of things. And I mean, even people like, you know, Grey Cook, Shirley Sarman, you know, other people have talked about this also. So it's not just like our faction of people that have come to this conclusion. It's, yeah, of course we want a minimal dosage, but then, you know, you know, most of us, you know, we go get our hair cut once a month, you know, and
You could cut your own hair, but usually you have someone that you trust to advise you on that. I kind of think of ourselves in that role to kind of guide them through the musculoskeletal or the functional medicine, whatever it might be. I feel like a lot of people are afraid to say that. I just feel like anyone who disagrees with that, I kind of feel like they're not actually in the grind every day that's having to manage these cases.
And I just think finding that perfect sweet spot with every patient is kind of the skill of practice. But if you made me say it be that, the other thing would be like, I am enamored every day with the ability of the human body to adapt and compensate to things when they're not ideal. And I think you got to be careful when you're doing a job like we're doing to make sure that you're not working on an adaption and compensation.
and really pride yourself and really getting after the actual cause of the problem. So those are some things that kind of stick out. It's probably a little bit harder than I thought it was going to be maybe when 20 years ago.
Dr. Beau (04:37)
Hence the two to three visit fix everybody mindset. Yeah.
Audra (04:42)
Yeah.
Brett (04:43)
Yeah, because you got the human factor. You're dealing with human beings and now more than ever humans are going through really difficult things with social media and just all kinds of crazy stresses. So there's a lot of complicating factors that make our job harder, I think.
Dr. Beau (05:00)
Yeah. You'd mentioned in there, management, the two to three visits is maybe not, well, it's not realistic, it's not maybe. A lot of students and new docs and even docs have been in practice for a while, get coached on like, hey, you need to hit a certain number of visits for a treatment plan and this is the average one to look at.
is, you know, because we have a lot of docs and students that listen to this, is that something that you guys actually look at from a practice model or is it kind of just like, man, whatever that patient needs, it's a case by case basis and that's what we give them? Or are you kind of like, hey, man, we're running a business too, like we got to make sure we're not just booting them out the door. So how do you guys approach that?
Brett (05:38)
Yeah, well, I mean, I think everybody wins in the model that we're talking about because I mean, never do we talk about like just the financial side of it. It's always really what the patient needs. Now I will say we do have parameters early on. you know, just as an example, if you saw a new patient, you know, most of us are here at our office, they're gonna see that patient two, usually two times a week, unless it's like an acute disc arrangement or something like that. And then we reevaluate them at.
the three week mark and I never over promise. never, I just say in three weeks we'll reevaluate, we'll see where everything's at, but really, you know, 10 years ago, I really went all in on function and I was kind of a hypocrite because I was telling people like on the seminar circuit that I was treating function, but really at the end of the day, I was really, I was kind of a pain chaser quite honestly, if I'm honest with myself.
So I kind of just had that moment in frustration where I was like, you know what, from this day forward, I'm not doing that at all. Like I am going all in on changing the functional audit of all my cases. And if I do a good job with that, I know that the pain is going to closely dovetail with that. And I just went all in on that. And when I say that people think that, you know, I'm not being empathetic. Of course I'm being empathetic and
We're also classifying our patients like whether it's the centrally mediated case with like Annie O 'Connor, for example. So that's all kind of built into the cake, but I just felt like I was really over reliant subjectively on what the patient was telling me on how their case was. And the second I made that switch, it was the most liberating, amazing feeling in my life. Because if you think about it, it kind of takes all the pressure off really. It's like...
All I can do is try to be world class in my ability to change the function of the case. And if I'm good at that, I also sort out who's my centrally mediated case because all the audits are changing, but they're continuing to tell me that they're no better. And then the other thing is like the structural case that you and I aren't gonna help. if I have somebody who's got like a femur last tabular impingement and a labral tear, the only way that I know if that patient's gonna get better is by doing a trial of care.
The severity of the MRI, findings, tell us something, but they don't tell us everything. Like James Andrews says, if you want an excuse to do a surgery, basically do an MRI. So the severity of the MRI means something, but it's not the end all be all. The trial of care is how we know whether or not we need to escalate further medical treatment. So we are in a position to be the most amazing gatekeepers because the surgeons love us too, because if...
Dr. Beau (08:03)
Yeah.
Brett (08:22)
If you get done with us, then it's like, don't send them back to me. We tried everything. We changed function. They're ready for surgery. So I think we're really in a great position being a chiropractor, physical therapist, or ATC to be that initial gatekeeper. The hard part is, it's hard to find people in the world that are really good at that initial trial of care. we all have people that contact us and are like, who do you have in a certain city? It's like, ugh.
Dr. Beau (08:45)
Mm -hmm.
Brett (08:51)
Like, because you need them to be able to give a really good trial of care. So, yeah.
Audra (08:56)
Yeah.
Dr. Beau (08:56)
So just to, go ahead, Audra.
Audra (08:59)
Just along with that, I think that's really key and like for the students and doctors listening, because we have some of these conversations in the background of all of us. So just to like clarify and side note, y 'all, I mean, we're talking to one of the industry leaders here. He's helped, know, Dr. Bo and I like from students through now, I still call him on a regular basis and we talk through, you know, cases and everything and even business stuff. So, I mean, this is such a treat. Like, thank you for coming on here and like sharing your wisdom.
and thank you for being such a good mentor and friend and all the things like we're so excited to have you but so you were saying you know about like changing to function
Brett (09:35)
I'm excited.
Audra (09:41)
And I think where sometimes students and which is so true, like treating on that and using your audits heavily. But from like a patient care standpoint and being the doctor and building that relationship, you also talk about the effect or a lot, which we can get into. And I think managing of yes, in my head, I'm doing audits and functions, but the patient still needs to be heard. Like you need to convey to them, you're hearing what they're saying, maybe touching the pain, touching them where it hurts.
but in your head and your treatment plan you're like, okay, I'm really functioning, I'm functioning, but we're not separating of, hey, don't even listen to the patient of, it's my knee and why are you treating my shoulder? Like, you need to have that patient education and like that, like you're saying that empathy and everything. And I just wanted to hit a little bit more on connecting those dots. Cause sometimes I think in seminars it gets lost of, I only do function. I don't listen to what they say. I kind of tell them to shut up and it doesn't matter.
Brett (10:40)
No, and I mean, I definitely, I mean, you know, and we work hard like around here is you can call it customer service, you can call it it factory, you can call it whatever you want. But I think like, and you could also call it tough love where you're basically, you're listening really, really well to the patient. But it's also, I think it comes back to also like present time consciousness, which is very few doctors in the world.
are giving you 100 % of their presence when they're with the patient. So I feel like when you do that, then you really are forced to be in the moment and do a good job. And I feel like that's one thing that people don't do a very good job of. But I think that actually helps in that because although I'm beating this functional drum, I don't think any of my patients would tell you that I'm not a good listener and I'm not hearing what they're saying. I just think like we've all been there too. We're like,
you walk into the treatment room and the patient's wanting to tell you they're no better and you slowly, subtly point out something that's quite a bit better and then they completely change their tune and they're like, actually, now that you said that, things have been quite a bit better. So I think that sometimes the changes in our world happen subtly, so they need to be pointed out. But in saying what you said, I would 100 % agree with you.
Audra (11:42)
Yes.
Brett (12:06)
There's a lot of like little soft skills that go into getting people better. Like the rapport is established in the first 13 seconds you walk into the treatment room and they've actually found that 93 % of it is actually nonverbal. So it's not actually what you're saying to the patient. It's do you have a smile on your face? Do you look like you're too busy? And then the other most important thing that somebody in this world can offer to your patient is reassurance. So
And this is why certain people who we would consider to be not very good at what they're doing, they are capable of getting miracle after miracle. And then you have like some evidence -based Kyra who's a complete superstar from a knowledge standpoint, and they have a little tiny practice that no one knows about. It's the people that are in more in the evidence -based side of it, like we're in, we have more tendency to question even ourselves. And that inadvertently gets
transferred to the patient without us realizing it. So sometimes, you know, we need to, in our world, have a little bit more certainty and confidence. And I think the soft side of being a good physician, there is so much there, Audra. And like I've spoke now over the last three years, quite a bit on this topic, which I don't talk at all about any of the clinical things, but just all the little things that make you a good healer. And being empathetic is one of them.
Audra (13:04)
me.
Brett (13:30)
I look at some of the other people in the world and I you kind of see like what their schtick is. For example, like Annie O 'Connor, the best listener I've ever been around. Stu McGill, the best coach I've ever been around. Like Mike Shacklock or Tom Michelle, they know research really well that they convey that to the patient. Therefore, they're very impressive in confidence because they are explaining the research to the patient.
And I feel like everybody's kind of got, you got to kind of find your own way, but like that's your it factor. And you know, you're doing a good job when you're exploding your practice, you know, like if you're not exploding your practice, I mean, you got to be able to take one patient and turn it into 10. And if the patient's leaving, want to refer you 10 people, then you know, you're probably on point on what you're on your education. But like, I think it is helpful for most of us because we do.
Dr. Beau (14:14)
Mm -hmm.
Brett (14:25)
air too much on asking our patients how they're doing to maybe like almost mind -deaf yourself into the functional side of it. That way you can just start like kind of thinking that or just kind of imagine like let the body tell you how they're actually doing and I think that can be helpful for the young clinician who may be shading too far into the subjective side of it, which was me by the way. I mean I have the scars to prove it so I'm...
Audra (14:29)
Yes.
Brett (14:53)
I am speaking from experience.
Audra (14:54)
And I think that's like having a little bit of control over the appointment. like, can you talk more into that of like, you know, how do you go into room and make sure you have control? Cause we've all been in that situation. I still get into it today of like, woo, I just, I'm losing control of this. Like they're taking over. Can you talk a little bit more about that?
Brett (15:16)
Yeah, I mean, if you go through your schedule today on everyone that you don't want to see today, those are all people that you're not controlling very well. Shockingly. think that that is where, and if you get around the people who are really good at this, you'll see they do a good job of establishing the control because, you know, your patient is, you know, like they're trying to manage something like your analytic patient.
Audra (15:24)
Right.
Brett (15:46)
They just are too close to the situation. And it's like I tell them, like, if I'm seeing them, like, let's just say for functional medicine, it's like, you're not going to know more than me on this. Like, I know you think that you do and you've Googled and stuff like that. So like, quit trying. Like, let, trust me to do that for you. And I think, you know, establishing that and I think to that point too, Audra, would be, because you got to be confident, you got to be certain, but you can't be cocky. So you're like,
playing in that like little delicate world there. But I think doctor certainty is so important that I don't even have words to describe how important that is. And I feel like the orthopedic surgeons are so good at that. So they basically look at an MRI and it's so clear in their mind like what needs to happen. So then you do a surgery and then, you know, the patient's all bought in. What do we do? We will,
Audra (16:14)
Yes.
Brett (16:42)
Hymn haul about you know, well I think we might be able to help you and like you're not even confident about the functional findings that you're looking at if you could just convince the people that are in our world that like if you could get it as Excited about your functional findings is the orthopedist is on their structural findings You're gonna see a completely difference in the compliance to whatever you're recommending to the patient But for some reason because we question so much and I guess we don't believe it ourselves it
that part's kind of challenging, I, to your point, and I work hard with our people here and our interns. Like if you're not confident in the beginning, fake it until you have the confidence, but like that's where like some of us need to do some soul searching on the technique systems that we're bought into because you're not confident and certain because you're not getting the results that would make you confident and certain, you know? But if you've seen some...
Audra (17:34)
you
in.
Dr. Beau (17:37)
One to dig in, dig in with the.
Brett (17:39)
I was entirely... sorry about that.
Dr. Beau (17:42)
I was just gonna say, because we really, keep talking about this functional approach, which we all assume everybody knows what that means, right? And again, there may be patients listening, whatever. A lot of times I think, and Brett, you have way more interns flowing through your office than I do, but sometimes it almost seems like the expectation of some people that are a little green is that the functional approach would be,
like you're treating, you're always treating something that doesn't look like it would apply directly to what's going on. They're like, you have to be treating away from the side of pain. has to be some like almost like, how did you pull that rabbit out of the hat? So I just wanted you to, maybe that is the case. Maybe. So how I always kind of like frame this is if somebody walked into my office, I 99 % of the time they'd understand, they'd just be like, I kind of get what you're doing. They wouldn't be like, why were you working on their big toe to like fix their left wrist pain? So
Do you feel like that is the case or do feel like, man, it's just a grab bag, it's a patient presentation or like, because I think that gets coached into people that like if you are treating too close to the side of pain or local function versus like distal function, that's almost like a shameful thing to do.
Brett (18:56)
No, and I think that's a misconception. I do think we tell those stories though because they're very inspiring for people to make them look globally. And I think like it depends which technique system that we're talking about. For example, like MDT, is a big part of one of the things we do here. I mean, that is 100 % a local treatment. That is like taking the painful joint and seeing if there's a directional preference.
Dr. Beau (19:03)
Yeah.
Brett (19:23)
If you're working with athletes, you're probably going to have shockwave and laser, all that treatment's going right to the area of complaint. The soft tissue techniques are often, they don't have to be, but they're going to the area of complaint. But then if you have in your triage system, like DNS for example, DNS is really unplugged from where the symptoms are and really trying to find where the key link is.
we work hard on, so like we might be doing something locally because you got to play the game tonight, but then overreaching, we're still working on the big global finding. But I think like the big thing when you're young to kind of appreciate is that you could do local treatment and turn the intrinsic muscles on in the foot and completely change the range of motion of the hip, or you might not have that miracle happen.
But understanding if you're on the key link, whatever the key link is, you're gonna have the greatest effect on all the audits across the body. So that's how you actually know that you actually are on the key link. you know, the human body's an absolute puzzle, but I tell our young, until you gain your confidence, treat locally. You'll have, if you took the next patient that walks in, who's got a sore shoulder, do a subscapularis ART move.
Do a DNS, three DNS corrective exercises. Mobilize your CT junction or manipulate there. And if you take 100 patients, 90 of them are gonna get better with that approach. But as you get better and better at this, you get more of like a sniper where you know exactly what you need to be doing. And as it turns out, the more patients that you see, the more money you make. Funny how that works. like.
Audra (20:52)
you.
Brett (21:05)
being efficient with your assessment actually rewards the people who are bought into this because you're still getting a world -class result as you're seeing more people and you're making more money, but I guess you could argue that you're helping more people too. So it's not just a selfish money.
Audra (21:05)
Hmm.
Dr. Beau (21:21)
Well, I think you're also buying exploratory real estate by building rapport and reassurance in those first few visits. If you do treat locally, just because you might get lost. If you try to jump to this, like, you know, extrapolative functional approach. And I think that's what a lot of new docs need to do is like, make sure that the person understands what they're doing, that they can have a result. And then you can be kind of playing around on the fringes, which they'll never even know or be aware of what you're doing. And then little by little, you're like,
kind of like a researcher like, I kind of made this correlation. That takes years. some people, yeah, it might be better than others at pattern recognition or just the manual skills or have an intuitive approach to it. But I just feel like I wanted to ask that question because I think that's kind of the story gets built that you have to be treating things that you wouldn't almost put together to be considered a functional approach. And I think that leads people very astray.
Brett (22:15)
No, I would not know that's like what people say and I don't think that's the case honestly. I do think though like most people, know, like especially if you're young, that's where like I love our buddy, you know, Grey Cook because Grey Cook has made people look globally, you know, like no one's made people look more globally in the world of what we, you and I do in the last 20 years than him because the SFMA
is a way, I'm not going to say it's the end all be all by any means, but it is a way to make you a young clinician look globally and then gain confidence on finding a problem that's away from the side of complaint. But I think also, if you can buy into the idea that in our first year of life, if everything's developing the way that we want, that the body is such a pure, perfect point. You don't have any trigger points, you don't have any joy blockage.
Your soft tissues are perfect. If you did a neurodynamic test and the patient was able to relay the information, all of that would be perfect. In my mind, what I'm imagining is I'm restoring every single patient that I see back to that state. I could have an 80 -year -old stenotic patient, for example, that I'm gonna see today. That's never gonna happen, of course, but in my mind, I'm imagining that's what I'm doing, and I feel like your patients will be better off if that's kind of your mindset.
But I think also like in a treatment plan, you have your chiropractic miracle, which is you've done one adjustment. We've all been there and like you've changed someone's life for whatever the reason is. And then you have whether or not on the other end of the continuum, they would require an orthopedic intervention, which is less than 1 % of the people that we see. So in between there, you have what I call the functional black hole. And that is where the evidence -based crowd is doing a horrible job of managing. So you didn't get a miracle day one or day two.
you know they're not going to surgery, your miracle now needs to occur over a three month period. And you can still get a miracle, but it's just not like that overnight miracle. So what do you do? You slowly start chipping away at function, you know? And that's where like the clinical auditing process helps you so much because you're basically getting the roadmap on what you need to be changing as you're moving down this functional journey. And then as it turns out, you get your miracle, but you get it three or six months later.
Dr. Beau (24:19)
Mm -hmm.
Brett (24:38)
And you get it the the old -fashioned way through hard work and home exercise and You know all the things people know it just we become so into like instant gratification That like if something doesn't work for a day. We think we're doing the wrong thing Which is a huge mistake and changing function takes time and the analogy I use my patients is like you don't put braces on your teeth wake up the next day and be like my teeth are straight rip off the braces no, it's like a two -year process of your teeth being sore and
Yeah, and then you wear a retainer after that and like some things just need and require a little bit of management.
Dr. Beau (25:15)
Yeah, which I mean you mentioned DNS and again most people listening probably know what that is but you know you're an OG of DNS. I kind of got into it early when you know the original crew was going back and forth to Eastern Europe and back.
Again, we led with the question of kind of what's changed in your clinical perspective. I know DNS has changed massively from not even being called that to now being called DNS and then all the changes that have occurred in between. But with our upcoming course that we're hosting you for in April next year in Nashville, what have been the biggest changes or the biggest change, I guess, in DNS since you first got involved with it? And I know there's a ton, but is there one or two things that stand out to you?
Brett (26:02)
Yeah, I we've just gotten way better at teaching it. And I feel like I think we've unplugged a little bit from like the perfectionism of human movement to where we feel like, okay, this joint has to be like in this specific position. Otherwise, it's a problem. And I do feel like early on that created a little bit of a problem because people would leave a seminar, like people would be afraid to move literally because they didn't think they were moving like in the ideal strategy. So I feel like
unplugging from that was, was critically important. And then DNS is a very active treatment approach versus originally it was very passive because of the heavy influence of reflex locomotion. And, I think that like, those are the big things. And I think since it's still in its infancy, so really we're still like, we're not even at 20 years old yet. So, I mean, by the year and we were just with, Pavel here recently here in St. Louis at the DNS war Congress.
He's always changing also. So I mean, it's kind of an exciting time in DNS because people are all over the world doing different things and we're all working with different patients and athletes and we're coming back together and we're being like, wow, this is miraculous for this particular patient type, for example. So that's what continues to get better. I feel like from a teaching standpoint, it's like now you could say, hey, Brett, what do you?
What do you like from DNS and spinal stenosis? And I could rip off five different things, whereas before we weren't good at doing that. Now we just have more context to give people advice with the patients that are currently seen. And I do feel like too, we've made it, it's easier to, it's way easier to apply, way easier to apply than it was 15 years ago. We honestly, early on, we did a horrible job, myself included, at teaching it.
But then you just kind of get better if you, I think, I don't know if anyone's probably taught more DNS seminars in the last 15 years than me. And I feel like being out on the road and have people ask me difficult questions, having some of my so -called enemies in the room to question everything that I'm doing, it just kind of makes you stronger and be able to go back and think about things differently. And that's, I think, what
part of the process of making it kind of change the way that it has for the better. For those of us on the western part of the world, probably getting more English instructors has also helped maybe just because there can be a problem with translation and stuff like that. So feel like that also has probably been helpful for the Americans and Canadians probably.
Audra (28:46)
Yeah, and one of my favorite things about like going to any of your courses, especially DNS though, is just like that applicability. Like you talk about clinical cases and give, like we'd show practice patients and you're saying, well, if this case comes in, this is what you do on Monday. And I think that's really helpful to like tie it all together, especially if it's your first DNS course, you know, you're drinking through a fire hose. So what at this DNA course, like content -based, like what?
is the meat of it, what are you kind of teaching, what should people expect?
Brett (29:17)
Well, I think like the one thing that I feel like if people can buy into and really understand, like, and one of the main tenants of DNS is intra -bondal pressure. So people know that they give lip service to it, but I feel like very rarely do people actually understand that. So like, if people can take that away from the first, that's just the first day in A, it's well worth your money there.
And then, so once we've established exactly what that should look like with the patients, then we start building on developmental exercises from that. That's kind of the foundation. The other thing is a lot of the assessment in all of DNS is in the A course. So you learn how to like really look globally at the patient and look at, you know, if we're talking about SFMA, that's like a movement assessment globally. DNS is more of like a stabilization assessment globally.
So then it gives you some tools to kind of look at the body that way. To the patient thing, now I always challenge myself to have really difficult patients there because I've learned that it's good pressure and it also, like you should have nothing to hide. And I actually learned this from Scott Urbawe, he's one of the gurus in MDT. And he told me one time, he goes, my job when I work up a patient in a seminar,
is actually not to create a miracle. My job is to expose the system. And if I do a good job of doing that, then I did my job. Of course, we're all rooting for our patients to get better when we see them. when you see a patient live in front of a bunch of people, really what you're wanting to actually accomplish is you're wanting to expose what the system is. And then hopefully you get lucky and you have a good result. I think that's like the goal of and we'll definitely in Nashville, we'll find some patients to.
to work with, I'm sure. So that will be a highlight of that. And then, yeah, I think it's one of my favorite courses to teach. I think it's like, it's really good. I mean, there's always fluff in every seminars, but I feel like in A, there's really not that much fluff. And what I like about A2 is on the Sunday morning, there's a two -hour section on ontogenesis. And I've worked really hard to make that information applicable, where you're just not sitting there looking at
a bunch of useless pediatric stuff that you're never going to use, like always trying to tie that back to the adult patients and make that information a little bit more useful.
Dr. Beau (31:49)
I like that you said, you know, expose the system because I, don't know if you remember this, whenever I interned in your office, which was man, that was like 12, 13 years ago now that I was going to go take a DNS a seminar and you're like, I'm being honest with you. I would just kind of take what I've taught you in here and I would try to apply it for awhile because you even told me you're like, it's hard to apply. And I probably, a lot of that was coming from, like it was hard to teach at that time. So it was like, and then when I took the NSA, you know, after I actually graduated,
and then I was like, get what you're saying. Cause you like, I left that seminar. I was like, I don't know. So I liked that you're like, Hey, we have more applicability. We have a system, know, systematic approach. you're leaving that seminar now like, I know how I can implement this, what to look for in an assessment. So I think that's for anybody listening, it's looking to go or hasn't gone or even refreshing those skills because it's evolving all the time. would assume like that's the highlight now for me is coming from, you know, I kind of learned Brett was just.
I don't know, got baptism by fire like, hey, let's do this, let's do that. And then I was like, eh, you you go to their first course like, I get it. Like you saved me. Going back to you as an educator, and this is getting a little bit away from DNS, but like you've been a mentor to a ton of people. I mean, you have ton of interns. I was an intern in there. You've been a mentor to Audra. And there's always kind of that like, you know, ripple effect of like,
you're actually having more of an effect on people because of the people you've taught. So it gives you a much broader reach than you being like the best in the world. But I actually took your TMJ course. So this just speaks to you as an educator. And we were talking briefly before that you were probably most proud of your TMJ course. So I took that course. I thought I was decent at teaching TMJ. And then you literally in that course, you're like, man, this is a system. Like this is one of those things that I think you can have a playbook for.
So here's my kind of, I guess, sales pitch for that TMJ course, but just a fun story to tell that during that course, you bring up a lot of research on, the one that I'm talking about now is migraines and like the correlation or maybe causation of TMJ dysfunction and migraines, in particular migraines are so, so idiopathic. So I had a patient that came in, she has had migraines since she was like five years old, she's now in her mid 50s, she's been treated with everything you can,
medical cocktail and every treatment. And we literally run her through an exam. actually ordered a full spine and Mariah to rule out, know, syrinx and some different things. And she comes back in and I'm like, you know, one of the main functional findings that we found, which gets into the function play was like, you know, the three knuckle test, she looks like she's been chewing on leather. She's got giant masseters. Like I was like, you know, I think we should just run with this, even though she had no primary TMJ complaint, just migraines.
and send her home with a McKinsey -esque approach to start. And she literally comes in the next time. She's like, I'm out of migraine sense. And just like, know, full mouth opening, running through it. And now we're over a month in and she's like off medication and stuff. And it's just one of those that you're like, it was almost, if you had no functional approach to lean on, I would have been completely lost. Cause she had no symptoms, right? Of TMD. Everything else was like.
peachy besides having these like almost constant headaches that would, you know, flare up and down. So I talk about all that to go back to this mentorship piece that a, if I hadn't spent time in your office, B, if I didn't know who you were as an educator and C, had I not taken that particular course, there's one case where I'm just like, well, I got to refer them out because I'm just lost. so when you approach like that TMJ course is kind of your course.
Do you feel like there's still gaps in your education that you're trying to fill that then help you be an educator? Do you feel like you're kind of at that level now where you're like, man, I know there's always something you could learn or you like, really think I need to start pouring more out into our profession and into our colleagues. Maybe it's a little more of your opinion. You're not necessarily just teaching DNS. We're not teaching MPI. It's more of like, hey, I've had a lot of swings.
And I've got some thoughts. Is that kind of where you're headed or is it still, hey, we got these really good playbooks, why stray from it?
Brett (36:16)
I feel like, I mean, the it's like looking out in the ocean. really feel like, I mean, now I probably like my biggest, I mean, now I see so many functional medicine cases now where like, I think one thing I'm kind of is amazing me currently at the moment is how many like middle aged female menopause patients, difficult musculoskeletal cases are related to like fluctuations in estrogen, progesterone, testosterone and like.
how important that is even in the musculoskeletal world is like a valuable lesson that I'm learning right now. So like, I feel like the thing that I'm currently kind of amazed with is these patients that aren't responding well to the model, which usually, you you plug in the model, the patients get better until they don't. And one of the reasons is, is because the body's so complex. I mean, it could be because of autoimmunity, it could be because of hormonal problems, metabolic, and like, I think...
you know, for the aging clinician, you start to learn to appreciate those things a little bit more. And then I feel like as an educator, my job is not to go somewhere on a weekend and sound or look smart. My job is to, if I'm a bunch around a bunch of tri ones who are learning to adjust, I have to almost like just put myself back in that moment and be like, you know, and not even talk about all the other things we could talk about. I mean, they need to learn how to palpate joint blockage and how to do an adjustment.
me sounding smart on the stage does nothing for them. So I think always just trying to be a chameleon and morph yourself to who the people that you're talking to are, that's what actually makes for good educators. And I feel like there's not enough of those people in the world that are just willing to humble themselves and talk to a bunch of try ones or try twos on how to get good at manipulation. And so to answer your question, though, I feel like where I'm really learning a ton about is more like
in the functional medicine side of it as it relates to musculoskeletal medicine and you know, like kind of filling that need for my patients and then educating the world on some of those thoughts is probably the, you one of my future things. Besides the obvious stuff, the, even like the TMJ, like, I mean, the more I'm around dentists and orthodontists and stuff like that, the more I'm learning about in their world, like whether that's palate expanders, whether that's tongue tie, whether that's...
you know, just surrounding myself with the right people to kind of like understand that. So I would say, no, I mean like it's like you think you get to a certain level and you just don't like you just, you just want to learn more. You just keep, you know, it's just like more. It's like this thirst that you, you just can't get enough of, but it's like fishing or golfing and you you catch a big fish or you have a great drive and it's like, it just what keeps you going. And we always joke around here. You get absolutely.
Dr. Beau (38:53)
Mm -hmm.
Brett (39:08)
your face kicked in and you're like, you leave the office, like you're like, I just don't even want to do this anymore. And for some reason you wake up the next day and you want to do it again. It's like the coolest thing ever. And I think like if you can learn to treat all of your patients, almost like a puzzle and almost just love the process and revel in like the, you know, the complexity of it all, you never really burn out. You just like, you're like a little kid every day. It is kind of like, my God, I cannot believe this connection.
And that kind of gets you through dealing with all the difficult people, which we all have to deal with, which all of us see the same people in our day. They just have a different earth costume and a different name. But really, whether you're in Troy, Missouri, or Birmingham, or Nashville, or Sydney, Australia, we're all seeing the same people. So it's just whatever we can do to continue to push the profession forward.
Audra (40:02)
And I know like at Gestalt, you guys combine the fun with the learning and that's like a game changer and that draws more people and it's just like, I know I'm gonna get to go have fun and network with other doctors and everything. And I know we're playing on the same thing. Thank you for, you know, showing us that. Since you've been through this.
like in a lot of other cities with your company, how important that is and what a game changer for people's like learning experience of combining, hey, we're gonna hang out and have either intelligent or non -intelligent conversations, but have fun and like relax a little bit. And I know I walk away feeling like I learned way more, but then also got another level of like connection and networking and this was even more worth it.
Brett (40:51)
Yeah, I mean, I've definitely learned from Taylor and some of our younger docs here, Pete and our other associates, Taylor and Austin now, where they know how to have fun. really, I knew how to have fun when I was in undergrad and things, but then I took the first 10 years of my career and I put my head down and I just was a grinder.
And now I'm different. I've kind of learned like it's actually the world's a better place when we learn how to have fun and it helps with the culture of the office. It helps with the culture of teaching. just yeah, I think that that's that's a special part of it. And I think that like it's it's understated. But, know, 30, 33 percent of your life is spent working. Thirty three percent of it's hopefully spent sleeping. And then you have your family, your hobbies and stuff like that. So.
If you're going to spend 33 % of your life doing something, then you better be having fun doing it or else it's going to be a long life.
Audra (41:50)
And what are you most excited for about coming to Nashville for this course?
Dr. Beau (41:52)
Thank
Brett (41:55)
Well, first of all, to hang out with you guys. like that is an educator back to what Bo was saying earlier. Like the biggest compliment for me is to see like people that, you know, we've had an influence on like go on and like lead our profession like you guys have. And it's just like, to me, that's like so gratifying and like whenever I see like on social media, like you guys doing great things, it's like, it almost makes me blush because I'm just, it makes me so proud. But
And then like as far as like that, I mean, Nashville so fun. I mean, like if you don't have fun in Nashville, that that's your own problem. So nothing's better than a night out on Broadway or day drinking in Nashville. So yeah, I think Nashville is just kind of the new Las Vegas for us in the Midwest and it's a great city. And then you surround yourself with great people like yourself. It's a recipe for a lot of education, but also a lot of fun. So that's.
Dr. Beau (42:29)
You
Brett (42:51)
probably what I'm looking, yeah, now I'm old enough to where I kind of look for, am I going to a great spot? Do they have good wine there? Are the people good? Yeah, and that, so that kind of checks all boxes for me there in Nashville.
Dr. Beau (42:59)
You
Well, and funny enough, you're part of the story of, know, Audra and I as whole run into an education company and why it's called Blackjack Education. Because, you know, we spent a little time in the casino in Prague and maybe they weren't as big of a fan of how we had fun as Americans as we were. That's kind of what we're aiming for. So like you said, Nashville or Nash Vegas is kind of becoming this small, you know, Midwestern or Southern Vegas.
And that's a big aim of this is we know from, I'm going to be honest, like I told Brett before this, like I've stole a page out of your playbook in terms of how our office runs. Like we have essentially communicated like group office for the docs and like, you know, there's a bar in there. It doesn't mean we're drinking in between patients, like we're, we want an office where if you wanted to hang out here and talk about whatever it is or clinical stuff, you, you would feel comfortable doing that. And I,
Audra (44:00)
you
Dr. Beau (44:04)
We know that's a game changer in other companies, so why not in the medical field where it can be a bit stodgy and maybe uppity is not the right word, but it's like, I'm a doctor and this is a place of higher learning that needs to smell like leather and mahogany or something. So yeah, I stole a page from you and that's what we want to also really focus on at these courses because it is three days of information and you can attest to this. know, Brett, on that third day.
everybody looks like a deer in the headlights or a zombie because it's not that it's bad information whatsoever. It's so much great information that you're just, you don't know what to do. So I think if you can keep the fun and the motivation and the networking high that kind of offloads that pressure and refreshes you a bit. So that's a big goal of Audra and I for this upcoming seminar in April.
Brett (44:54)
No, think that, I mean, that is absolutely, and I learned that too in our office actually. When, cause our center area was all divided up originally. And one day I'm like, you know what? I don't like this. I think we're just going to knock down the walls. So then we knocked down two walls to open it all up. And I mean, that's led to a sports book that we run out of there, a full bar. I mean, it is just a disaster in there, but all, all I think in a, in a good way.
The new thing we're wanting is we're wanting a roulette wheel with the electronic readout and we want our, we're going to have an omelet station I think and make the interns cook us omelets in a tuxedo.
Dr. Beau (45:37)
Wow, we've got a ways to go to get to that echelon. So we got goals to strive for at least.
Brett (45:44)
Anyways, yeah, no, the point back to, yeah, let's have a little bit of fun.
Dr. Beau (45:49)
Yeah. Well, Audra, anything else? Any, you know, pressing questions or are we leaving off on the fun component and, you know, expect that everybody just show up in Nashville now and, you know, go sign up immediately after you listen to this.
Audra (46:04)
I mean, I feel like we won that round.
Dr. Beau (46:07)
Yeah.
Brett (46:07)
Yeah, yeah, think so. Yep.
Dr. Beau (46:09)
Well, to reiterate one more time, the person that I quote from a professional standpoint as a mentor, the most in our office, or when I teach myself is you. And the person I've probably learned the most from is you. And that's not just in the respect of things that you teach for. It's overall because I think you're a great integrator, which is one of the things that I want people to realize that applicability means that you're able to integrate something like DNS into other tools you might have.
if it's in addition to and I think you're one of the best in the world and I think you're a king at that like, hey, this is how you can apply this. This is how you can do this right now. You got to these other things like you can pay attention to this, but this gets you further down the road. So that's what I'm looking forward to. I don't remember the last time I took the NSA. It's been a few years now. So it'll be cool to just see what's changed, see you teach that. So I'm looking forward to it as well.
Audra (47:03)
I second that. All the things.
Brett (47:03)
yeah, it's going to be a big time. Yeah.
Dr. Beau (47:06)
Well, not to be a dog on this too much, but April 4th through the 6th, go check out blackjackeducation .com to sign up. Brett's going to be there signing autographs besides teaching. We've got some gambling coming. I don't know if it's going to be a roulette wheel readout right in the seminar, but there'll definitely be some cards and some money thrown around for sure.
Brett (47:30)
Ew, I like where your head's at. That makes a lot of sense.
Audra (47:34)
Yeah.
Dr. Beau (47:34)
Alright guys, if you have any questions hit us up on social media. Anything else, Audra?
Audra (47:39)
No? Can't wait to see ya!
Dr. Beau (47:41)
All right. Thanks again, Brad, for being on here. We appreciate you, See ya.
Brett (47:44)
Bye team. Bye.
Audra (47:45)
Yes, thank you. Bye.
Introducing Blackjack Education
Dr. Beau and Audra discuss their new venture, Blackjack Education, which aims to provide a unique and fun approach to continuing education for chiropractors. They share the story of how the idea came about during a trip to Prague and their vision for the future of clinical education. The first course, featuring Brett Winchester, is set to take place in Nashville in April 2025. They emphasize the importance of networking and building a community within the chiropractic profession, as well as the need for business seminars led by non-chiropractic experts. They also highlight the value of having fun and laughter in the learning process. In this conversation, Dr. Beau and Audra discuss their advice for chiropractors in their first year of practice. They emphasize the importance of learning motion palpation and becoming comfortable with adjusting. They also highlight the significance of DNS A (Dynamic Neuromuscular Stabilization) as a foundation for chiropractic practice. They discuss the value of ongoing education and the need for a community that supports growth and learning. They announce a giveaway for a free spot in a DNS A course and discuss their plans for future courses and events.
—
Chapters
00:00 Introducing Blackjack Education
10:43 The First Course: Brett Winchester in Nashville
15:06 Building a Community and Networking
17:38 Beyond Clinical Education: Business Seminars
20:11 The Power of Fun and Laughter in Learning
22:14 The Importance of DNS A as a Foundation
24:45 The Significance of Specific Skill Sets
27:46 The Need for a Community of Professionals
30:15 Building a Supportive Community
35:13 The Importance of Collaboration and Growth
39:45 The Best Bet in Education
—
Transcript
Dr. Beau (00:00.174)
Cool. Yeah. Well, I'm driving to sunny Illinois this weekend. That's our big trip. Yeah. That's where I'm from. So it's my mom's 70th and we're doing, she'll never listen to this, but we're having a surprise birthday party. If this ruins a surprise, I'll be impressed with my mom's podcast skills. So yeah. Yeah. I like to record because we miss all the good stuff, the side banter and all that fun stuff. Look at you with your team USA. Are you even watching the Olympics?
Audra (00:04.248)
Eww.
Audra (00:09.313)
Audra (00:16.229)
my gosh. Okay, so we're live. We're going. We're doing this damn thing.
Okay. Yeah. Well, I know I'm wrapping it. Yes, a little bit when I'm home, like can catch it. Or I like see the snid bet, like, you know, replays of stuff, but yeah.
Dr. Beau (00:32.43)
Yeah. Did you see the, pommel horse guy? what it pod. So the guy that he basically has Coke bottle glasses can do a Rubik's cube in less than 10 seconds. And he only does pommel horse and he sat through five rotations. like two and a half hours and showed up, scored out. They got the bronze medal, go back on the podium for the first time since 2008.
Audra (00:37.019)
No, I did not.
Audra (00:56.253)
Yeah, I saw that they won medals since 2000 or like 16 years. Like that's awesome. Yay.
Dr. Beau (01:01.026)
Yeah. Yeah. Pretty legit. Yeah. So we've been watching him paying attention to all that fun stuff, but the reason for the podcast, and I wish maybe I'll have some fancy sound effect drum roll or something, but Audra or Aja, if you're in Czech Republic, and I kind of started talking. do you want to tell a story? You me to tell a story of how this all came about? I think that'd be a good way to kind of get into it. Okay.
Audra (01:09.585)
Woo woo!
Audra (01:27.869)
You tell it and then I can ad
Dr. Beau (01:31.672)
So we went to Czech Republic to the rehab hospital, the Motel hospital this past August. And basically you're there for a week. Anybody that's in the DNS world knows that's kind of the last, not the last thing, but you, you know, to be certified and then you can go back as much as you want. You go to the hospital every day, no air conditioning. You get your basically heads filled with a bunch of knowledge and get shown up by all the clinicians there.
And you get let loose like a wild animal at 5 p and, you know, go eat, go do your thing. And pretty much every, what was name of the hotel? It'll come to me. But anyways, hotel in downtown Prague that we're staying at every night, pretty much almost every night, a bunch of us would go to the casino, but Audra and I tended to be the only ones that gambled, whether I don't know why, because it was nine to one check dollars to US. So we were loaded.
Audra (02:09.487)
gosh, I don't know.
Audra (02:30.013)
yeah, we were having the time.
Dr. Beau (02:30.286)
yeah, so we'd play blackjack. mean, there wasn't many games there and let's just say the overarching theme was the Americans were not their favorite people and we were kind of the only people in there. luckily all of the dealers were kind of like, it's almost like people working at Disney world. They're, none of them were from Prague. Like the one guy was from Rome, his girlfriend was from Rome. so it's kind of cool to talk to all those people. We played blackjack.
Audra (02:42.46)
Not at
Dr. Beau (02:58.83)
So we're sitting there one night and I don't even know, I have no clue how we got on topic of like continuing ed classes or something. Yeah, just brilliance coming from fermented grapes. And, we were kind of talking about, yeah, we should like bring courses to the Southeast. Like there's not a whole lot. And then we were like, yeah, like Nashville would be amazing, which is where Audra practices. And we're like, yeah, if we did it, we'd have to name it something to do
Audra (03:05.851)
Many bottles of wine later.
Audra (03:10.587)
OZN,
Dr. Beau (03:25.762)
gambling or something and we're like, yeah, blackjack. mean, again, we're a couple bottles of wine deep. And here we are almost a year later. I mean, it's going to be August this weekend. a year later and the big announcement is yeah, blackjack education is a thing now. And.
Audra (03:34.844)
I know.
Audra (03:44.23)
I'm so excited.
Dr. Beau (03:45.333)
We're our first course. I'll let you announce the first course now, or if you have any, there's tons of stories that we could tell from Prague and the little bits and pieces and almost getting kicked out of the casino. Thanks Brett Winchester. And, but yeah, our first course I'll let Audra get into that is, kind of the big announcement also of this podcast. And then we're going to jump off into why we're doing this in the first
Audra (03:55.517)
Yeah.
Audra (04:05.981)
So we are bringing the Brett Winchester to Nash Vegas the first weekend in April 2025. So pull up your calendar right now, save the dates. The course will start Friday the 4th. It'll be the 5th and the 6th of April 2025 in Nashville. I know, I'm so excited that we're actually officially putting this out
Dr. Beau (04:32.14)
It's pretty, mean, you and I, I how long you been in practice
Audra (04:36.413)
We're about, you're a little ahead of me. I'm like 10 and a half years.
Dr. Beau (04:37.87)
Yeah, like, yeah. So we're right both there. So 10 years in, we both done a ton of continuing that on our own. you know, I think you've hosted some stuff, maybe a clinic I have too, but a, the reason we kind of decided on Nashville is just more accessible, right? international airport, obviously, like you said, Nash Vegas is just blowing up. So there's a ton of stuff to do in this first course is in the Gulch, which is kind of the hip, hip area.
Audra (05:04.711)
Mm -hmm.
Dr. Beau (05:07.638)
So we're excited about that. And we'll talk a little bit about the gym. We're having it out and what we're going to do with the gym. but really us both practicing in the Southeast, you're kind of right on the tip of the Southeast getting into the Midwest almost, but like, it's kind of a desert for continuing education. So from the geographic standpoint, that's the big play is like, you know, I'm right next door to Atlanta. You're right. North of me in Nashville. obviously go down into Florida, you know, Orlando, Miami gets a lot of stuff, but we're kind of in this little like Island of not much.
Audra (05:22.407)
Absolutely.
Audra (05:28.785)
Mm -hmm.
Dr. Beau (05:37.464)
I will say the Tennessee, what's that called now? Southeastern Chiropractic Conference or something, something like that. They do a pretty good job. But we just want to offer more of what, whatever we're to call our style of practice, the people that we kind of like to surround ourselves with. We want more of that, that's more accessible and for sure a lot more fun, which will be a big part of this. So what's theme of Blackjack education, Audra? Like, what are we, why are we going to be different? How are we going to be different?
Audra (05:42.417)
yeah yeah yeah
Audra (06:07.345)
Well, and this is what we were talking about when we founded this business in Prague, a couple red bottles deep, is just like, gosh, we all are in practice and students too, y 'all. I mean, it is just so, I don't know, sometimes you get so down. There's so many great things, don't get me wrong, but sometimes it gets heavy and you're just exhausted and you're like, why am I doing this? And sometimes you just have that bad stretch of like, am I stupid? What am I doing? Am I getting anyone better? And we just like.
And then sometimes you go to continuing ed, especially like, I don't know, some of your state run stuff or like stuff that's near us. And you're kind of like, okay, you're getting all this information, but you don't know how to process it. You sit by yourself because there's no one you know. And, or someone that doesn't like, is not interested in the same things you're interested in, which is totally fine. But you're just kind of like, God, I wasted my whole weekend and spent all this money. We were like, we would love to combine like from the doctor and student perspective of fun.
And what does that look like for you and I when we came up for this? Well, one, we like to work out and take care of ourselves. So we partnered with Shed Fitness. They are an incredible gym. like we said, we'll talk more about them, but that's where we're going to host it. And they are offering members who sign up for our seminar a free workout class before the seminar starts. I mean, how gracious and incredible. And it's just one of the coolest hip gyms, strength training
it's gonna be in the gulch. So if you stay anywhere in Nashville near the gulch or downtown, you can walk everywhere. So once again, healthy for you and fun. And it kind of gives you a break from the monotony of studying and practice and just is gonna put you and surround you with the top of the top. And we're gonna be able to have those conversations where you get that passion ignited. And then we get to go out and have some fun on the Nashville town, which I'm not gonna tell you exactly what that is yet, because that's gonna be a surprise.
Dr. Beau (07:59.65)
Yeah, and that's the other reason is if you, I mean, we can talk a little about Audra's practice. Audra's rubbing elbows with people that all of us would know who they are. So we'll have some fun kind of behind the scenes stuff that I think will just be unique. And that's part of this. That's probably part of why we're doing it. But outside of that, the reason it's also Blackjack Education is we're gonna tie in this kind of theme of
You know, let's say gambling can be a healthy habit if you know how to control it. I just listened to a podcast with, Michael Eastern. He was talking about scarcity brain and why, you know, all this stuff, why, slot machines work, but we want to use this theme of like fun because as most of us know, yeah, there's going to be great information from somebody like Brett Winchester. It's going to be great information from a course like DNS a, but if we're all being honest, I mean, I don't know how many times it'll be for you. This will probably be my fourth.
a course, right, just by itself, it becomes less about the material. Like you, pick up little points, right? Like, yeah, like I need to focus on that. I forgot about that. I've never heard that. I can apply this better, different for sure. That's going to happen. And it, depends on what stage you are in practice, student, new doc, seasoned doc, you know, whatever it is. But the bigger part of this is, which we can all agree on is you go like -minded individuals. If you're, you
Audra (09:04.251)
Something that like changes your
Dr. Beau (09:26.964)
As Winchester will say at the seminar, I guarantee you getting kicked in the teeth. you go to these things and it kind of revitalizes you. And I think there's twofold here. We don't want to be a Tony Robbins. You just get pumped up and go home with no knowledge. We also don't want to pump you full of knowledge and you go home kind of being like, God, there's just more stuff to think about. We want to bring both together. and there's, you know, Gestalt that Brett's part of does a great job at that. I mean, they built a model that, you know, we're not,
Audra (09:52.551)
Amazing, amazing.
Dr. Beau (09:57.304)
stealing their trademark or anything, but like they're doing a lot of good, you know, good things. So we want to mimic some of that and then bring it, you know, a little more local. And then it'll just be our own flavor. Like we've talked about some different ideas, what we can do, like we said, for the after party and the nightlife and really try to get people talking about it and making them want to come back and makes it selfishly, just like the reason people write books or whatever, it's scratching your own itch. It's right in our backyard. And we, wanted to provide that cause it's what we'd want, you
Audra (09:59.953)
Amazing.
Audra (10:26.781)
Mm -hmm.
Dr. Beau (10:27.19)
That's I think a big deal here. So let's talk a little bit. Let's hit all the details of this course and then let's kind of go through the backstory of clinical education where what we like to see maybe where we think it needs to go. But we said first week in April,
Audra (10:43.281)
Yep. And in the gulch of Nashville, it's just like a section right off downtown, like any big city, know, Nashville is like the main name, but then there's all these little sub units. It's an international airport that keeps expanding. There's so many direct flights. That's another reason you and I thought it was like a good idea. And if you're in school in Georgia, Florida, Kansas, Logan, Chicago, it's all driving distance. So instead of like having to go from Florida to Kansas, you just get to come to Nashville, which is fun.
We're gonna be near downtown. So if you stay in the gulch or probably downtown Nashville, you can probably walk and it's the shed fitness will link in all the stuff of the address. But it'll be Friday, Saturday, Sunday. And you can take one of the gym classes either Friday or Saturday before the course. And the course will start at 8 .30 and then we go to a 4 .30 and then Sunday, know, it just depends how much you get done, what time all that.
goes for. What else am I missing?
Dr. Beau (11:46.734)
I was just going to say, yeah, on this course and probably all future courses for, you know, let's say we hit that like downtown epicenter, Gulch area. We probably won't peg a hotel because you know, that people can use points and whatever you want card wise, but you can still be in the central area. And like I said, you can walk to almost all these places. We, you know, did a kind of mash mine group there, not this this year, but last year. And we just stayed right down there and went to, you know, CrossFit gym and then scootered around and did all this different stuff.
Audra (11:57.351)
Mm -mm.
Dr. Beau (12:16.876)
I think it'll be easy for people and that's what we want to do.
Audra (12:19.589)
Mm -hmm. And I think it'll create, like, depending what you're looking for, like, of course, we're going to bring the group together with, a fun, you know, like, happy hour nightlife activity. But maybe the other night or two, you kind of find your own mastermind group, I would call it. And you guys, if you guys are foodies, you can go out. There's incredible food. If you're more of, the cocktail vibe bar and the rooftops, you guys can go mastermind and hang out up there, or you can go honky tonking.
Dr. Beau (12:44.078)
And we also want to hear from you. You know, I've, when we've hosted courses here, like last time Winchester was in town, we did a live podcast. Those are kind of fun and we can do like a Q and a, which I think is good for people that, you know, maybe had time to have a few drinks and talk about some stuff from the course. And like, I wish it would ask this and you can ask it in a kind of forum. we're open to ideas too. You know, this is, have a little less than a year, but plenty of time to make this thing a what people want
Audra (13:06.352)
Absolutely.
Dr. Beau (13:13.26)
We would like to, you know, kind of speaking for Roger here, we want to build a community rather than us to just pushing what we wholly want. And I think the more we get feedback, the more we kind of shape this thing. And, know, two years from now, you know, hopefully we're one of the, you know, once a year people like, man, I'm going to one of these seminars just because it's fun, even if it's something you've done in the past. And, you know, we do have, I'll drop a few hints here.
I'm talking to Michael Shacklock. So that will be next up as long as we can get his schedule to coincide and
Audra (13:44.196)
and Dr.
Dr. Beau (13:46.318)
coming up next. we got, you know, all our friends and our favorites and what some of feel like family at this point. But then that's something we also want to hear from you on is what, who do you want to see? What do you, who do you think is not being represented enough? Like, man, I wish we could hear from these people, especially in the South. Maybe it's people we don't even know of that could be great, you know, kind of break ice or ice breaking moments for them in this area. Like, okay, let's go hear from some new people and some new minds. So
We're open to feedback and like I said, we want to create a community. The website's up and live, Blackjack Education. We're on the socials,
Audra (14:21.795)
and yeah, Instagram and message us there for all that stuff like of what you want, what you want to see. Cause that's what we're going to check together and like keep having meetings about how we plan this. So that's the best way to get your opinions and thoughts heard.
Dr. Beau (14:37.838)
So let me ask you this. At this point in your career, mean, you have a clinic, you're on the road with, you know, people in the music industry for the most part, you're traveling outside of that for fun, it looks like. It sounds like, I don't know if you're ever home and you're a nice new house. But if you're going to take the time, right, outside of a course that we may be hosting, what are you looking for in a continuing education course at this point? Is
Like material driven, like man, I don't know enough about this. it like, you know, cause there's a lot of mastermind groups now too. Like is it, there's all these people going to this and almost a FOMO like, man, I want to go be part of that group. Like what is it that's driving you in particular at this phase in your career?
Audra (15:22.253)
being a business owner, I know you can relate to this, I want to do it all and everything and you learn in life and like after years of practice, you can't and you have to choose which is hard. So I think it ebbs and flows depending where I'm at in the business and everything but I always love material and even I like going back to seminars a second time because you know it's kind of information overload drinking from a fire hose like we were saying in Prague and
what key things did I miss the first time that I can really perfect before bringing in something completely new is kind of where I'm at right now. But then also I really have found so much value in the connection with other docs. And that can be from learning how maybe they word something or how they run the behind the scenes practice or how they market something to some stuff that I'm like, my God, that works so good for them, but that would never fit with my model.
but just being able to collaborate and have an open mind and just, know, network with people. It's also helped me, I mean, people are moving from Nashville all the time and to Nashville, but to meet other docs and other professionals, even, you know, students graduating of, hey, I know they have some similarity to what I do and we already have an open conversation because we've been at the seminar together. Here, let me connect you with them and, you know, be able to talk. And I think that's really helpful because we're all here to help people and that just can expand that network.
Dr. Beau (16:45.186)
Yeah, I would say, yeah, I, I echo all that for sure. And one thing, I mean, I have a few friends that are kind of on the periphery of whatever we're going to call this group. not like there's an in crowd or a click. just the people that are seminar nerds in our world. Like we're all going to the same stuff. That's how we know each other. We need to expand upon that, but the people that I know that are in our field that are friends of mine, you know, from before Cairo school and
Audra (17:01.597)
Mm -hmm. Mm
Dr. Beau (17:10.124)
I mean, they are coming to me like, hey, how do you stay connected with students? you know, can you get me connected with this person? And that is a, I wouldn't say that's a peripheral, advantage to this. would say that's a direct advantage to this. and, know, to say it any other way, I think it's just kind of like pulling the wool over people's eyes. Like, yeah, it's education, but it is a hundred percent networking, which leads me into, I would also like to see, more business seminars that aren't led by.
chiropractic business specialist. So this was a big piece of advice to me when I started my practice to get a consultant that's not a chiropractor or is not in that field because you want somebody that can look at your business without that kind of, you know, that colored lens or that perspective. I would like to see some of that because there's some great minds and the cool thing is building a community. If we can make this thing large enough that we can pull in, you know, some of those people that we all, you know, read their books or listen to the podcast.
Audra (17:43.282)
Me too.
Dr. Beau (18:08.518)
and listen to them. mean, the sky's the limit on what we can do. But that's kind of what I'd like to see is like, hey, what do we, we're not just missing clinical education. can promise you that. And we
Audra (18:19.037)
Yeah, it's so much more that is actually what makes your business and your I mean, I'm gonna go a little like whatever what's his name, but whatever it's like we got to be happy in practice or you're get burnout and I'm big proponent on that and like controlling the stress level and having people to vent to and I know that sounds like woo woo and whatever but it's so true and it's something that even in like our circle it's there but you don't talk about it and we all use each other for it of calling. my
I got my teeth kicked in as Brett would say, like, what would you do with this patient? I mean, I think that is something so helpful that's not mentioned. And another thing to change lanes without signaling, I'm really good at that. Circling back to one thing that Bo and I have in common, that is one of the reasons we also were like, let's do this together. Not one of us doing it on our own is you're not gonna get any bullshit from us. Like we're gonna tell you how it is. It's gonna be, and you know, we're gonna be honest with you.
whether that's things that have worked for us, things that have done it. But we are two of the people, I like a lot, but just so you know from us that there's no bullshit, like you said, we're not pulling the wool over your eyes or whatever. Like it is straightforward and it's gonna be good. Like if we're spending our time that we don't have, putting this together, and it's a lot of time, we've already invested a lot of time to even launch this, you're gonna get something that is up to world -class standard, because that's all our clinics are and that's all we'll do.
Dr. Beau (19:45.836)
And I, again, I appreciate the compliments, even though you're giving yourself one too, but I'll take them. But the thing they also, yeah, we're, you know, maybe time strapped, but then that shows you what we value by where we will put more energy. But what I would also say is we, like you said, we value, you know, being healthy, feeling good, having fun, and I can promise you one thing, and this is proven.
So if I taught a seminar, it is proven if you have fun and if you laugh, you learn more. like there's again, these what seem like peripheral benefits are actually direct benefits. And like we should target that rather than like, I got to go to the state convention to get my 12 hours. And you know, we haven't even talked about within our business, you know, will we see these courses? I mean, we could, I mean, that's, know, again, community, let us know what you want. But again, I think we can make this really, really cool where,
more voices are heard and people feel like they're involved, not just like going to these seminars. Yeah, and think there was just a lot of opportunities will open up because of that. Another question that I kind of wanted to just pose in general between the two of us. If you, cause this is a question I get all the time, I'm sure you do too. If there's students that are listening to this and let's say they're starting on
seminar bonanza, they're in the middle of it, they're just graduating and they're like, I don't know if I'm gonna be able to afford it. What would be your advice to them? Because the questions I get are this, what seminar should I take? And then you gotta decide, well, should you be taking a whole lot or like you said, honing other skills? Like how would you frame that for somebody? Like what are the must haves in terms outside of school? And then how would you tell them to do that in terms of when they're in school, when they get
And then as we go through it, obviously start filling in knowledge gaps. I think it's easier as you get out into practice. What about those first like year left in school to two years in practice? What would be your advice?
Audra (21:46.075)
Ooh, and that's a hard one. Well, I'm gonna echo what I know a lot of y 'all echo is like, if you are a chiropractor, you need to be in motion palpation and learning how to adjust. Like that's a non -negotiable and comfortable with it. Cause a lot of people are coming to you to get adjusted and everything else is a benefit cause they don't even know yet until they walk in your office. So that's number one. I would say one of the reasons we're bringing DNS A is partially for the students.
because it is such a good science base slash introduction to DNS, but it's the foundation. Like you literally learn everything in DNSA that you, like I do it with every patient partial of what I learned, because it's the stability, it's getting the diaphragm and core to activate correctly with the brain. And every injury, every case, you're using some of that stuff. So I would say that's one of the reasons we even said, let's do this one first. And...
Then from there, also depends how you want to practice of what I would like guide next. What about you?
Dr. Beau (22:49.176)
Yeah, I mean, it's so if you're going to like preceptor in here, I mean, we require that you are part of MPI because we just know that the adjusting skill level is going to be, I could literally give you a patient, you know, day one that you step into the clinic and it would probably be a comfort level thing, even though we don't do that. DNS a at a minimum, just cause again, you have to have a conversational level understanding of DNS, even if you don't know how to apply it. That's okay. That's not the easiest thing in the world sometimes. Yeah, for sure. I mean,
Audra (23:15.559)
We're all still learning.
Dr. Beau (23:18.264)
So here, well here, let's take a segue. I don't know about you, but I'm, you know, let's get your side of it too. When I went to Prague, I didn't know what to expect. I think you kind of, there's a little mystique to it. You go over there and you're like, what the, like nobody really tells you anything on purpose. So you show up to the first day and we had such a big group that we got split into two groups. We were at the Motel hospital and the other group was at move, what was it called? Move first or something. Yeah, I don't know.
Pavel's clinic downtown. so we go into the hospital. What I was blown away by was we all know, I'm sure within this realm, like the instructors that are coming over here all the time, right? Martina and Marcella and all, and all these people that are coming over. You go over there. So there was what I think 140 ish, some clinicians in the motel hospital, all walking around in like these white, almost nursing outfits and all these scrubs. Every one of those people.
is like one of us, like probably better if I'm being honest in the DNS realm. So there would be all these clinicians, right? That are all PTs, physiotherapists just walking through and they'd come into the class and they'd like be just randomly helping. And then they'd walk back out to go see a patient. The slow realization that you're like, like people seek me out in Birmingham, Alabama, Nashville, Tennessee for the specific skill set. And these people are just walking through the hall, like literally coming in and helping you.
Audra (24:18.225)
Mm -hmm.
Dr. Beau (24:45.324)
the poor little Cairo from Alabama do this thing better and you're like, huh, okay. So the humbling effect of that was huge. What was your experience with
Audra (24:54.027)
for sure. That, to piggyback off that, that for sure, but I loved when we were like split into the small groups and there was like five of us and we had our own patient. We got to work up with a clinician and they were hilarious. Like they are amazing over there. They called you out. What do you see? What would you do next? And why would you do it? And that just really forced you to like use your brain, although it was like smoking, cause there was so much new like stuff to put together. But I think that pushed me to grow.
a lot and was really cool.
Dr. Beau (25:26.124)
And that's, I, again, can't let too much out of the bag, but we're one of the things we're talking about with, Rich Olm is kind of doing almost a never before done class of almost like a DNS expansive intro. And you'd be like, isn't that DNS a you have DNS exercise one, you have DNS, a DNS strength training one, you have all these kind of like first level courses, which some of them, you know, you have to do exercise one and a before you can take like strength training one. But his idea was
I mean, there were certain things over there. Like this is one I've been talking about in the clinic is, do you remember when I'm in a blank on her name, the blonde, she, somebody asked the question of, well, when do you actually coach up like intra abdominal pressure and like you're, and she goes, woo, I'm glad you asked that question. Cause this is like my pet peeve. She goes, we don't coach it. We look for it to occur, which is a sign that you have, you know, good joint, centration, functional, centration, good co -activation and that you're actually, you know, it's a reflexive outcome.
of proper positioning and exercise. we were all, at least I was, was like, shit. So I brought that back and like my clinicians as they should, when I told them that they kind of pushed back to like, talk about like, how are they going to know how to do it if you don't coach? I'm like, you do like if we thought about, and I know we're getting a little kind of the weeds here, but like you do the DNS test, but then you're trying to see like, well, could I provoke a response?
Audra (26:30.225)
Yep, I said whoops.
Dr. Beau (26:50.304)
with positions, with different exercises, with, you know, reflex STEM, whatever it is. So I think there's a lot of stuff that could be addressed, right? So maybe almost like a non -clinical course that's a lot of like, Hey, let's kind of sift through all this, which would really help people create a better roadmap for just DNS. Cause there's so many options, especially courses, exercise, now strength training. I mean, it's, you know, it's expanding all the time. So, and we're just talking DNS. haven't talked neurodynamics or, know,
Audra (26:59.1)
Yes.
Dr. Beau (27:18.656)
Stecho, all these things. So I don't know about you, Audra, but I see an opportunity for like forum -based conglomerate of things where we get people together and we're talking about stuff too, whether that's, you know, that's some of the fun stuff after the course or we do singular courses like that. But I think there's need for that overall because I think people gather all these tools and then we don't use a lot of them. So they become dull.
Audra (27:23.792)
Absolutely.
Audra (27:30.939)
Mm -hmm. Mm -hmm.
Dr. Beau (27:46.764)
Maybe we do use them, we're not applying them as well as we could. And I think that's hard and that's R2P tries to do a little bit of that, but at the same time, we need more of that type of stuff. So I think we'd like to provide
Audra (27:57.297)
Yeah. And just even how we implement it into our clinic with our patients, like we both probably were similar, but spend different time with patients and different things. And like, what does that quote unquote roadmap, even though it's customized to the patient, but like, okay, are you starting in hanging stance? Are you doing something like in kneeling? Like how do you discern that or decide that? And I think that's always a fun conversation.
you know, that can change. And as we learn more, I'm sure you have that, me too. Like I've changed so much, my order and things. Like I had someone come in who had moved soon, who came back for work and they were like, my God, it's been five years, but you're doing something completely different. And I was like, good, that's a compliment. Cause I changed it as we learned.
Dr. Beau (28:38.894)
That's our current intern here. Shout out to Patrick Creer from Palmer. He said today, goes, man, good for you for just meeting the patient where you're at. And what he meant is, have pretty much every patient day. Me eight years ago would have been shoving down their throat, you've got to do this, I want to see this happen, we've got to improve this. And now I'm kind of like, it's almost like you have to let the patient reveal.
how much they're going to do, how motivated they are. We all know those hot button terms and trisic motivation and all this. But that's the stuff that I would like our company to be, maybe set up ourselves of fun, but also like, well, hey, let's come into a DNSa course with a super power in our field like a Brett Winchester and be like, yeah, we're gonna get all the DNSa stuff, but when
Like who's to say that Audra and I don't become moderators and we were like making sure like, hey, we want all these questions coming in for the two months before. And maybe there's 10 that overlap or like, let's make sure this gets talked about. And then hopefully you leave the course and you're like, man, a lot of stones got flipped over that might not have, you know, and I think that'd be
Audra (29:38.929)
Yep, I love.
Audra (29:48.059)
Yeah. And I think that's our whole emphasis too on like fun, yes, but like community, which equals fun. And we also want to know how best for that community serves you guys. Like, do you want a Facebook group or what do you like is community where you have access, you know, to ask questions or say what you want besides just DMS DMing us on Instagram. and the seminar is a emails where you just respond back to our, you know, what, what feels good to you and just like, let us know
Dr. Beau (30:15.426)
Yeah. so one thing we want to do, and this is kind of on the fly, just so you guys know, you know, the no bullshit, window here, we want to give away a course. we've been, we've been toying around with like how to do this best. And we were talking about this a little bit, back and forth before we got on this podcast. So what's our word going to be? What's the, what's the hashtag or what are we going to have people shout us out online? What do want it to be? So we've
We gotta have some gambling term. Obviously we're blackjack. I mean, it could be hit me, it could be double down, could be, what do we got? Hit me, right, hit me. Hit me, okay, so here it is. When you listen to this podcast, so if you're listening right now, you need to go share this podcast in some form on Instagram. We'll use Instagram, because that's the most, you know, probably used thing that we're gonna be channeled across.
Audra (30:54.535)
I like Hit Me. I think that's funny.
Dr. Beau (31:13.186)
So share this podcast in some form. Tag, what's our Instagram handle here? Boom, so BlackjackEDU and we'll be posting this podcast from there so it'll be easy to find. But tag us in that and hashtag hit me and you will get entered into a drawing for a free spot to this DNSa course, regardless if you're a doc or a student. So I know there's different price points but just one drawing.
Audra (31:18.855)
Blackjack, EDU.
Dr. Beau (31:40.462)
And let's say, so today we're recording this on July 30th. Let's give people tell we'll draw on September 1st. So we don't want to give you a ton of time. We'll give you a lot of time. We'll give you a month and we'll be reposting some clips out of this. So it reminds you guys. But you got basically at a month to listen to this thing, get your 2025 planned out. Hopefully the other thing that we will have coming up here in the next month or two, we'll see how.
Audra (31:49.071)
Okay, that's fair. That's a lot, that's generous.
Audra (31:56.244)
huh.
Dr. Beau (32:09.656)
how much more time we can find is getting some more people on the calendar, whether that's Shaqlok or Dr. Olm and having those announced, we can kind of help you guys plan out as well. But again, by the end of August, have shared this, we'll enter you into the drawing. You can't share it more than once to get entered more than once. So share it once, we'll get your name in the box. We'll do a drawing for a full free entry and maybe we'll do some little side prizes for other people that shared it that we'll only announce at the actual
Audra (32:40.06)
Yeah, I like
Dr. Beau (32:40.194)
So if you show up and you share it and we got your name on that list, maybe we'll have some cool gifts for people that did us some due diligence online. What else we got,
Audra (32:48.901)
And we're, well, I messed up. It's at blackjack underscore edu. But we're excited to have you guys help build what you want with us and just be a part of this and have some fun and help a lot of people.
Dr. Beau (32:53.006)
There you
Dr. Beau (33:04.098)
Now my question is, maybe not the guys, but the girls, might be going, does everybody get a pair of white cowboy boots if they show up?
Audra (33:10.653)
And jean shorts.
Dr. Beau (33:15.266)
I mean, if anybody's been to Nash Vegas in the past two years, you're seeing a party bus full of girls with white cowboy boots and jean shorts. I mean, that
Audra (33:23.889)
I mean, and everyone needs a cowboy hat, because that's what all the tourists do too.
Dr. Beau (33:27.756)
Mate, hey, we're already thinking about those swag gifts. So maybe we'll need shoe sizes. Technically you need a cowboy hat size too. So we'll talk about
Audra (33:33.483)
yeah, all right. Yeah. See, we're fun. This is gonna be fun. We haven't even been drinking. That's the best part.
Dr. Beau (33:41.026)
What else? Yeah, yeah, just wait. Yeah, we heard the Gestalt education company's wine budget. I don't know if we're gonna topple that this year, but we'll try to rival them for the years upcoming year. Are we missing anything? Is there anything else we should be hitting on this big announcement?
Audra (33:56.06)
Yeah.
Audra (34:02.385)
Now just go follow us for all the updates of everything that's to come and more details about this. Don't hesitate to reach out with any questions and share with your friends. Cause that's how we're all gonna build this and keep it going. And we're excited.
Dr. Beau (34:16.066)
And then if you do visit the website, which I highly suggest you do, blackjackeducation .com, scroll down to the bottom, there's the subscribe area there with your email. I would highly encourage you to join that list because that's where we'll be sending out updates about these courses. We may be sending out some little surprises in there. So you just want to be up to date and maybe, know, even before this course or after we start a little newsletter action, depending on what you guys want. Cause I think it'd be cool to do follow -ups on these things, you know.
you know, we were thinking about this or we pulled a case out. One thing we should bring up is there's probably going to be opportunities for special examples of cases at these things that I think you guys are really going to enjoy. So that's just another little teaser of actual patient cases from, I don't know. I don't know how I want to best describe that. Just some fun stuff. That's right.
Audra (35:09.797)
It's a surprise that you can only know if you come.
Dr. Beau (35:13.164)
So it's gonna be awesome. I'm super excited. Like I would be excited if I was a part of this, like just hearing this and be like, yep, I'm going. If you guys have questions, best way to reach us as Audra said is DM us and we're both kind of gonna be checking that. So hopefully we'll get back to you fairly quick. Outside of that, anything
Audra (35:19.281)
Yep.
Dr. Beau (35:35.754)
Awesome. That's right. So sign up. Now this is one thing you and I haven't talked about. Let's talk about live. Let's show them little behind the scenes planning, why not? Do we know what's the limit on this? Are we limited on space? So let's make some people get a little anxious that they need to sign up today. What's our limitation size wise?
Audra (35:35.773)
That's rock and roll.
Audra (35:46.417)
Ha
Audra (35:57.149)
Well, we could go by what the gym owners told me the limits on the class size are. You want to do that? 30.
Dr. Beau (36:02.51)
which was, Ooh. So you guys heard it here. There may only be, we'll see. We'll have to double check that, but let's say for right now there are 30 spots. We'll double check that, but I would probably agree that, yeah, maybe we could fit five more if we're not, you know, doing power cleans and stuff during a DNS class, but you never know, Brett, he might.
Audra (36:25.327)
And I will say, like talking out loud behind the scenes, from a business perspective for us of like what we're gonna be allowed to do and how much fun we're gonna be able to have and what we're gonna be able to give away, the sooner you sign up is when we're gonna have, okay, like we can go hard here and like go all out instead of waiting till the week before.
Dr. Beau (36:39.886)
Yep. Yeah. So if we have 30 people, yeah. Yeah. If we have 30 people by the end of the year, mean, a there's two things. And again, I think this is good stuff to talk about. We have a pot of money to do fun stuff with, right? A predetermined amount of people, but it also allows us to, if we want to plan those events, it gets much, much easier to be like, we've got 30 people coming to this spot. the other kind of cool thing, which this is specific to DNS before we hop off here
Audra (36:57.038)
Mm -hmm.
Dr. Beau (37:07.062)
You do, you know, not toot in our own horn, but Audra's a DNS practitioner. I'm a DNS practitioner. So going to a DNS course that, know, if it gets over a certain amount of people, it's mandatory that it's assisted by somebody. not saying that's necessarily going to be us, but like we would also be there in addition to. So going to these courses, I can't imagine there's a course that we're going to bring into Nashville that one of us hasn't taken at least. So it's not like we're teaching level for neuro dynamics, but at least we've kind of been there. So it's again,
we're getting a second, third, fourth looks at different questions. And I think that that just helps kind of create an environment that's, know, fosters overall. You could be 20 years in practice, five years in practice, you know, two years into school and those varying levels of competency and knowledge just kind of all meld together and, know, make it, like I said, one big fun party.
Audra (37:58.501)
And I want to remind everyone, because I know when I was a student, I felt like this too, of like seeing the doctors that were at the top and there's not enough room. There's room for everyone at the top and we want to help everyone come to the top because that means we're going to help more people and have better quality care. So that's part of the reason why our hearts and souls are like putting this together and doing it. Because we truly believe that like, come on, let's all get to the top together.
Dr. Beau (38:21.58)
Yeah, if we, we could very well leave it a educational desert, just be like, let's roll and, you know, send each other patients that are, you know, too far outside the reach. That's not what we're trying to do. you know, and we, we mentioned it already, like that scarcity mindset, which is a good book. If you haven't read Michael Easter's last book, which maybe that'll be something we talk about, that yeah, we need to grow this entire community because,
You know, what is it? All the tide, all rising ships. I don't know what the saying is. Doesn't matter. That's what my wife does. She's the idiom like DJ. She's like mixing those things all the, all the time, but we need to grow it because then that just helps everybody. You get a like -minded community because I'm telling you right now, it's fine to be on an educate in an educational desert. It's not great to be in a clinical Island. And when you're just kind of out on your own, you can do some wacky stuff. You start making up your own stuff. That's not
Audra (38:56.925)
I'm bad at those, I mix them together.
Audra (39:03.559)
Yeah.
Dr. Beau (39:21.486)
you know, very valid, you kind of get lazy, maybe you get frustrated. You know, you just want to kind of have people to A, to lean on, but also keep you in check and then grow together. I think that's, that's just a key in any profession, let alone just ours. Yeah. Well, Hey, I think we, I think we hit all the high notes in almost 40 minutes here, which is pretty impressive for
Audra (39:41.509)
Yeah, and what's our saying? Blackjack education, what do we say, what we decide on?
Dr. Beau (39:45.624)
for our slogan, the best bet in education.
Audra (39:47.365)
Yeah. Okay. We're the best vet in education and we hope you bet on us.
Dr. Beau (39:52.334)
That's right. So again, one more time, blackjackeducation .com, blackjack underscore edu on Instagram, share this podcast, hit us up with hit me, hashtag hit me to be entered into that drawing. And we will, we might do another podcast. I don't know, we'll decide how we want to announce the winner and we'll announce September 1st. So regardless of how that comes out, we'll announce September 1st. So we'll be looking forward to
Audra (40:10.395)
I know, that's what I'm thinking.
Audra (40:19.037)
All right, well, toodaloo, y
Dr. Beau (40:20.963)
See you guys.
Maximize Tissue Health with Dr. Keith Baar, Phd
Summary
Dr. Beau interviews Keith Baar, a muscle and tendon expert, about his research and findings. They discuss the practicality of research and the challenges of sifting through vast amounts of information. Keith Baar shares his background in kinesiology and how he transitioned to studying tendons. They delve into the importance of tendon as a master mechanical tissue and the implications for tendon injuries and rehabilitation. They also touch on the use of vitamin C and gelatin in enhancing tendon health and the importance of timing and targeting in collagen synthesis. The conversation explores the use of blends of proteins, such as whey protein and hydrolyzed collagen, along with vitamin C, to benefit the musculoskeletal system. The combination of these components can increase connective tissue protein synthesis and muscle adaptation. The importance of vitamin C in collagen utilization is highlighted, as it is essential for collagen secretion from cells. Fasted training can enhance adaptation by increasing metabolic stress and activating specific molecular signals. The timing of nutrient intake, particularly protein, is crucial for optimal muscle and immune system function. The concurrent training effect, where strength and endurance training are combined, may be influenced by protein intake and metabolic demands. The benefits of fasted workouts and the time dependency of glycogen depletion are discussed, with a focus on mitochondrial adaptation and connective tissue response. Splitting training sessions into multiple bouts can provide more stimuli to connective tissues while still achieving the same adaptive signal for the heart and skeletal muscle. Low glycogen training can be achieved by having a low carbohydrate dinner the night before a session, resulting in a fasted state without negative effects on the body. Multiple smaller sessions of rehab exercises throughout the day may be more effective than one longer session for tendon healing. The donut hole theory of tendon healing suggests that offloading a tendon can lead to scar-like changes, while loading the tendon can promote healing. The relationship between muscle mass and strength is not linear, and strength gains can be achieved without significant muscle growth. There may be a nutrition molecular pathway that can increase tendon lengthening, which could have implications for athletic performance and injury prevention.
Chapters
00:00 Introduction and Background
04:07 The Practicality of Research and the Importance of Foundational Work
08:29 The Role of Tendons in Muscle Growth and Adaptation
16:18 Effects of Different Loading Strategies on Tendon Health
25:12 Enhancing Tendon Recovery with Vitamin C and Gelatin
30:30 Targeting Nutrients to Specific Tissues through Blood Flow
32:43 Optimizing Protein Blends for Musculoskeletal Health
43:03 The Importance of Timing Protein Intake for Muscle Repair
48:45 The Concurrent Training Effect in Elite Athletes
54:44 The Role of Whole Foods in Protein Intake
01:02:58 The Impact of Nutrient Timing on Training Effectiveness
01:10:40 Stimulating Connective Tissues in Training
01:13:31 Balancing Glycogen Levels for Training
01:22:23 The Importance of Going Harder or Faster in Training
01:26:24 Understanding Tendon Healing and Growth
Dr. Beau (00:56.686)
you
Keith Baar (03:56.757)
Hey, Dr. Boo.
Dr. Beau (03:58.222)
Hey, how you doing Dr. Barr?
Keith Baar (04:00.117)
Not bad, that was everything.
Dr. Beau (04:02.03)
pretty good, man. I appreciate you coming on here.
Keith Baar (04:05.781)
Absolutely. Why don't you tell me a little bit about your program and everything and what the plan is for today.
Dr. Beau (04:16.174)
Yeah. and I'm recording by the way, cause I always hate missing stuff if we get into good stuff. So we'll cut whatever we need to, but yeah. I am a chiropractor. I'm here in Birmingham, Alabama. I was actually introduced to you, via another doctor beard on the science of ultra. so that's when I first kind of found out about you. And then since then I kind of went on a flurry of just, you know, reading research that predated obviously that podcast and, mainly is it a
Keith Baar (04:33.749)
Okay.
Dr. Beau (04:45.422)
pertain to tendinopathies and what you'd put into that field because it plays into, you know, a rehab based practice like ours. and I mean, we'll talk about this. Obviously it looks like it's kind of segued into, you know, more metabolics and, you know, molecular kind of, mechanisms within tissue and training. And that's, I have a lot of questions, which by the way, when I started looking through the abundance of research, I was like, holy cow, 226 articles, or at least that's what it says on research gate.
Keith Baar (05:07.477)
Yep.
Dr. Beau (05:15.342)
50 ,000 some citations and I was like, I've got a lot of research I got to do on this guy. So impressive.
Keith Baar (05:24.533)
Yeah, well some of it, well a lot of it's just luck being in the right place at the right time and especially at the time that I was doing some of these things, we were the first ones to do a lot of the molecular components and so when people go back and look and say, all right, we're doing this based on X, yeah, so we gotta cite this one. And because we had the opportunity to get some of that stuff in first, we get cited a lot. So it's really good.
Dr. Beau (05:37.582)
Yeah.
Dr. Beau (05:51.31)
Yeah.
Keith Baar (05:53.237)
We try really hard to make it so that the work that we do is repeatable and that we encourage people to repeat it and we try and be explicit in how we do things. So, yeah, hopefully that lends it to being kind of more accessible to not only scientists but practitioners and other people as well.
Dr. Beau (06:14.542)
Well, that's what I've appreciated is the practicality behind it. You know, some research, I guess all research has practicality if you can extrapolate and decipher, you know, what it means to you and your practice. But I feel like most of the things that I've seen from you, you know, that I was aware of or became more aware of as I kept looking at things, preparing for this, I was like, I could see how I could use that. And it's not just information that's kind of good to know, which I think is great in this day and age.
in my opinion from the practitioner side where we do get a lot of information that's just kind of like, well, what do I do with that? You know, and that's, I get that there's always more questions from research and sometimes that's the goal. It's not to answer something, but it can get a bit frustrating when there's just more information to peruse through and you know, you got to stay on top of it and you know, say what's next.
Keith Baar (06:46.805)
Yep. Absolutely.
Keith Baar (07:00.789)
Yeah, I know exactly what you mean. We sit there and there's hundreds and hundreds of articles that come out every week and you have to sift through to find the one or two things that are actually useful, both from a practice standpoint, but also from a science standpoint, because a lot of it is not useful and a lot of it isn't done as well as you'd hope. And so it makes it more difficult to actually figure out what is real and what's reliable.
Dr. Beau (07:13.55)
Yeah.
Dr. Beau (07:24.59)
Mm -hmm.
Keith Baar (07:31.221)
And so that's why a lot of people, a lot of scientists actually repeat the stuff that other people do because they want to make sure that if that's the new starting point, let's make sure that starting point is on solid ground. Let's make sure that it is part of a foundation that we can then build the future work on. And we get into a lot of problems when people don't go back and redo that foundational work. Or they redo it, they can't get it to work and then they don't publish it, they can't get it to work. And so nobody else knows.
Dr. Beau (07:49.07)
Mm -hmm.
Dr. Beau (07:54.094)
Yeah.
Keith Baar (08:01.365)
you know what? That really didn't work. And so we're all led down a path that goes in the opposite direction.
Dr. Beau (08:08.846)
Yeah, which I can, I mean, I'm sure you can think of plenty more than I can, but yeah, there's been various examples of things that we thought were true or a mechanism that were at play and we're like, eh, maybe not, you know, and that, like you said, it kind of rewrites existing things and then it explores a whole new avenue of research, which I mean, that's, I'm sure why you're, you know, in it, which I do want to back up for a second and.
Keith Baar (08:28.501)
So why don't we go ahead and start more formally now.
Dr. Beau (08:32.814)
Yeah, so as I said, I really appreciate you coming on the show. And the first thing I wanted to kind of talk about was actually, was this the plan all along? Because I saw in your, a little bit of your bio, you were, correct me if I'm wrong, your undergraduate degree at University of Michigan was in mechanical engineering, correct?
Keith Baar (08:55.093)
I was a kinesiologist, so I was old school, so I kind of went to college to become a gym teacher because I thought that is the perfect situation. But the reality is that I went into the U .S. and they don't train the gym teachers the way they do in Canada, so you don't get that holistic training. And so it wasn't as enjoyable.
Dr. Beau (08:56.942)
okay.
Dr. Beau (09:04.238)
Nothing wrong with that. Yeah.
Dr. Beau (09:19.694)
Yeah. Well, so then what was the shift? Like what happened? What spurred the, the want to go to graduate school and then how did you, I know I heard part of this on the Just Fly podcast, which I thought was an interesting story of how you got into working with tissue and tendons in particular, but what was that gap from, you know, going from a kinesiologist into higher level graduate studies?
Keith Baar (09:28.661)
Good.
Keith Baar (09:41.813)
Yeah, so I started, like I said, as a Kines major and one of the classes that I got to take, because at the University of Michigan, a lot of the sport coaches had to teach as well. And so one of the courses I got a chance to take was strength and conditioning from a guy named Mike Gittleson, who was for 20, 30 years the head strength coach at the University of Michigan. And then I just basically pestered him and pestered him until he let me become a strength and conditioning coach with the football team. So I...
I started from that strength and conditioning coach background and I was considering kind of next steps. I thought about medical school, but then I tried, I was a surgical assistant and did a bunch of stuff and I realized that it was a lot of repetition, a lot of the same thing all the time. And I was looking for something where I could be a little bit more creative. And so I thought, you know, coming from a home where both of my parents were professors and they basically could do
whatever they wanted to work on, whatever they thought was interesting. I thought that that was really cool. So started going graduate work from there. Went to University of California, Berkeley and did a master's degree. And there, the two things that were really important happened. One was I got exposed to Dr. Firestone, who basically was talking all about molecular biology and how you could have these.
Dr. Beau (10:47.662)
Mm -hmm.
Keith Baar (11:04.501)
genetic things that control what's going to happen at the tissue level or at the whole body level. And I thought that was really cool. And that was fairly new at the time because I'm old. And then the other thing that was probably significantly more important is I met my wife. So those two things were the things I took from Cal. And then I went and did a PhD at the University of Illinois, Chicago. And there what I was doing was I was trying to do what I wanted to do as a strength coach, which figure out
why some people got big and muscular when they lifted weights and other people did the exact same program and didn't get any more muscular. They got stronger, but didn't. So you get into this, well, why, what's causing the muscle to grow? There, what I did is I developed this model that was based on how we trained our athletes. And so I just electrically stimulated the nerve and what happened is all the muscles of the hind limb contract.
Dr. Beau (11:47.662)
Mm -hmm.
Keith Baar (12:00.085)
Because there's more muscle in the back of the leg than the front of the leg, that caused shortening contractions in the back, lengthening contractions in the front. And as everybody knows, when you're doing really heavy lengthening contractions, that's a greater stimulus for growth and adaptation. So within that model, I had muscles that were growing, say, 15, 16 % over six weeks, muscles that were growing seven or eight percent, and then muscles that weren't changing in size, all within the same animal and the same leg. And what that allowed me to do...
Dr. Beau (12:11.598)
Bye.
Keith Baar (12:28.245)
was identify a molecular signature that was basically the first time that people had talked about this protein kinase called mTOR, and it's important in the adaptation of skeletal muscle to loading, to exercise. And so what we did is we identified that the greater hypertrophy we saw at six weeks was exactly proportional to the activation of mTOR that we saw six hours after the single bout of exercise.
So our correlation was 0 .99 something. And so it was really, really high. And so that was really interesting to us because it suggested that this central regulator of protein synthesis was activated by resistance exercise. And when we activated it, we got bigger muscles. And so people then went on to start looking at mTOR for, yeah, exercise in people, because we did the initial studies in rats. They saw the same thing in people. They then showed that
Well, mTOR is activated by amino acids as well. So the reason why you're straight training plus your leucine rich amino acids are good is because leucine activates mTOR. So when you did the two things together, you got a bigger stimulus and you got more muscle growth. So that was the core of what I did for my PhD. And then I went to Wash U and I worked with John Hollins, he was the kind of father of endurance exercise. And he had discovered that mitochondria increase in muscle when you do endurance exercise.
Dr. Beau (13:46.03)
you
Keith Baar (13:55.286)
That was long enough ago that that was the first positive effect that people had seen of endurance exercise. Cause at that point people didn't know that it was good for them. So he was showing for the first time that the skeletal muscle showed a doubling of mitochondrial mass. And then what I did is took the molecular biology I'd learned from my PhD and brought it there. And we discovered this protein called PGC one alpha, which is important. It's what they call the master regulator of mitochondria. So
What we showed is that when you do endurance exercise, you activate or increase PG -suan -alpha. You make a smaller, more active form of the protein as well. And the result is that you get more mitochondria when you continuously do that. And so, so that allowed me to, to get kind of use the molecular biology to really try and figure out how endurance or strength training affected muscle. So historically I was a muscle biologist and that's where I was focused.
Dr. Beau (14:36.718)
Mm -hmm.
Dr. Beau (14:52.238)
Mm -hmm.
Keith Baar (14:54.997)
And that was basically where I was doing all of my work. And so the transition to tendon came when I started thinking that I could engineer muscles and just put whatever genes I wanted and make this super muscle that we could then maybe put into somebody or do whatever. But the guy that I was working with, Bob Dennis, who's probably one of the smartest people on Facey Earth, he was trying, he was doing things like he was taking little engineered muscles and he could swim fish around in a little.
Dr. Beau (15:04.718)
Mm -hmm.
Keith Baar (15:24.213)
little liquid that he had. So he would engineer these little robot fish and put two muscles there and then he would contract them and they would go back and forth so that you could actually have a fish that swam. But what he was finding was the muscles were pulling off of where he was tying them into the fish and so there we had to try and understand the tendon and that's where I started to kind of begin to appreciate tendon as a tissue.
Dr. Beau (15:50.574)
When that's, I saw a quote from one of your articles, and again, if it's misquoted, you let me know, but it said, tendon is the master mechanical tissue. And then in that same article, I believe, it talked about the, if the musculoskeletal tendonous junction experiences five time greater strain than the mid portion or the enthesis. And just yesterday, I had a patient in that had a distal biceps tendon repair where they basically, you know, cut the edge of the tendon off and then.
re -implant the muscle right into the radius. And he's about, I want to say seven, eight months out. And he just kind of asked me, he goes, am I just supposed to like, you know, full range of motion? He's doing everything. He's back in jujitsu. He's hanging off a pull -up bar. But he goes, it's just constantly sore. And I had been reading through all your work and I was like, well, you don't really have the dynamics at play. This would be my hypothesis. And I want to hear your input because you've removed that tendon and now you just have muscle, which has less dynamics in it.
Keith Baar (16:40.789)
Well.
Dr. Beau (16:47.086)
And then an enthesis, which is the stiff portion, but it's engineered, right? It's plugged into the bone. So my question there, which I didn't want to start here, but you kind of led me here. There's, we know there's ligament ization that occurs with like taking a hamstring or patella graft and putting it in an ACL. So we go in a year later and that's legitimately ligament. Does that happen with that type of, you know, plugging a muscle into a bone? Do we get tendon ization? Is that going to occur? Is that not, you know, the mechanism at play?
Keith Baar (16:50.837)
Thank you very much.
Keith Baar (17:15.957)
Yeah, so it's a great question and really so functionally what we have and this is part of just the change in mindset for me that's happened over the last 10 to 15 years is that if I look at a muscle now, so I used to be all focused on the muscle and the muscle and the muscle, but really what I've got is I've got the bone on one end, got the bone on the other end and that the muscle is actually just an expansion of the tendon where we stick
these contractile proteins in so that we can produce a force. So as we do that, now what we've got is we've got, as you said, tendon is this incredibly interesting tissue from a mechanics point of view, because on one end it's stretchy and then the other end it's stiff. So it's a variable mechanical tissue and that's why it's important. And so when you do take a muscle and you basically take out the tendon and you stretch it,
First of all, you're gonna start adding sarcomeres in series for most of us. That means the muscle's gonna get longer. We don't know what happens at the interface very well. We know that you're gonna form some sort of structure that's going to look like the anthesis or the bone ligament tendon interface, but we don't know exactly what that structure really looks like. And we certainly don't know whether you're regenerating the variable mechanics that you should have at the muscle end of the tendon. And so...
Dr. Beau (18:11.694)
Mm -hmm.
Keith Baar (18:37.845)
The best thing you can do at certain points like that is to try and load it in ways that are going to maximize kind of the properties that you're looking for. And there, what we want to do is if we take somebody who's never exercised before and we have them exercise, the tenons are going to get stiffer. Okay. Just because the structures are now getting load and they're now going to, when they get loaded and
Dr. Beau (18:54.51)
Mm -hmm.
Keith Baar (19:06.517)
in a single direction, more of the collagen becomes aligned. And as that collagen becomes aligned, it has more stiffness. But once we've started to train, and we're taking athletes who have trained for a long time, now how we load is going to make it so that we either have more stiffness at the muscle end of the tendon or less stiffness at the muscle end of the tendon.
Dr. Beau (19:17.038)
Mm -hmm.
Keith Baar (19:34.869)
Okay, so if we train with rapid movements that don't allow time for the collagen to kind of shear past each other, that is going to be these dynamic plyometric really quick movements. That's going to cause the collagen to work as a sheet and the collagen is going to then get stiffer at the muscle end of the tendon. That doesn't mean from bone to muscle it's going to get stiffer necessarily. It means that at the muscle end of the tendon you're getting a little bit stiffer.
Dr. Beau (19:42.734)
Mm -hmm.
Dr. Beau (19:56.686)
Mm -hmm.
Keith Baar (20:04.117)
And if that's the only way that you train with very light, very fast movements, over time, the muscle into the tendon becomes stiffer and stiffer. And what happens is eventually, because we're not giving a big load to the muscle, the muscle is not getting a signal to be strong. We're giving a tendon, we're giving a signal to the muscle into the tendon to be stiff. And now the tendon is stiffer than the muscle is strong. And now when we take a step, that's when we can, we can injure the muscle.
And we counteract that by doing heavy resistance exercise that does two things. It makes the muscle stronger, but it also means that we're lifting the weight slower. And as we lift the weight slower, the muscle end of the tendon, the collagen will slide. That'll break little cross -links that are in that area. And that'll result in less stiffness within between those fascicles or those, or the different collagen levels. Okay. So, so what that means is the muscle end of the tendon gets a little less stiff.
Plus, as the muscle fibers themselves get bigger, it pushes out the collagen fibrils. So now when I load them, they have to actually come together as they get pulled. And that also means that there's less stiffness in the system. So all of these things will give us less stiffness. So in an individual where I've got, I've basically removed the tendon, what I'm gonna try and do is I'm gonna try and do slower moves.
Dr. Beau (21:30.862)
Mm -hmm.
Keith Baar (21:31.317)
It don't have to be really, really heavy, but they have to be slow. So people know from their tenninopathy studies that, okay, the standard of care is slow eccentric loading. Perfect. That's great. But Michael, care is shown beautifully that if you do heavy strain training, it has the same effect on tenninopathy that slow eccentric had.
the two things have one important aspect in common is that they're both done slowly. So the heavy strength training, I'm moving the weight and the weight is going slowly. If I do that exact same lengthening program that's going to treat my tendinopathy, but instead of moving slowly, I just drop really fast. Now what I'm going to do is I'm going to have a negative aspect of that training. So the velocity at which we're loading is super important for treating tendinopathy. It's for
Dr. Beau (22:03.886)
Hmm.
Keith Baar (22:27.125)
getting that kind of variable mechanics and the muscle end of the tendon, all of those things. And so that's where we would then begin to use the slowest form of contraction, and that's maybe an isometric. And so for somebody who's coming back from removal of a tendon, we're going to do very early in the process, we're gonna do what we call low jerk isometrics. We're just gonna have them contract the muscle. And the low jerk component is, again, most of the patients, most of the people that you're going to see in your practice.
Their damage didn't come from from holding a stretch too long or from slowly moving into that stretch. Their damage came from playing tennis and smacking a ball. The ball is accelerating one way. You're accelerating the other. You get jerk on the tendons of the outer part of the elbow. You get tennis elbow or maybe they're going to be golfers. And now they're hitting a mat or they're hitting the grass. They're accelerating a club one direction. The grass is giving them resistance. They get that instantaneous jerk.
that's going to give them golfers elbow on the other side of the elbow. You're going to have lots of jumpers getting jumpers knee where they're getting dynamic jumps all the time. All of these things have this common property of jerk. Jerk is not that person that we hate. It's actually a physical property. So where I am is my location. The rate of change of my location, that's my velocity. The rate of change in my velocity, that's my acceleration. And the rate of change of my acceleration, that's my jerk.
Dr. Beau (23:50.286)
Mm -hmm.
Keith Baar (23:56.565)
So when I'm accelerating one way and there's something else accelerating the opposite direction, that means two accelerations are coming together. That's when we get jerk. The most common is like I'm going to go lift the weight. I'm accelerating the weight up. If I'm doing a deadlift, I'm accelerating up. Gravity is accelerating down. When I hit the bar, when I get that catch phase, that's the jerk. So when I'm reloading after an injury, I minimize that. And the way that I do that is I
Disperse that contraction over a longer period of time. So I begin so I slowly apply force over about a three to five seconds I'm gonna hold it there and then I slowly let the force off and that's ideal for keeping the jerk down so that the likelihood of injury is low and by holding that isometric now I get all this little shearing at the at the end of the muscle in your case and that's going to help that collagen that's within
the matrix of the muscle to begin to have some of the same principles of a tendon, where at the muscle end it's going to be more less stiff and at the bone end it's going to be stiffer. We wouldn't necessarily say that it's going to tendonize, but you're going to get something that's as close as you can in that situation.
Dr. Beau (25:12.59)
Mm -hmm.
Dr. Beau (25:18.83)
Well, and this is why I wanted to bring you on though is because I talk about your research all the time, in particular one paper that has beautiful illustrations in it that basically give the visualization of what you just explained about slower, heavier loading is gonna have a different outcome than faster, lower loading. I believe it's 30 % below, one rep max and below that, and then faster loading.
Keith Baar (25:19.701)
But very long.
Dr. Beau (25:45.07)
has different outcomes. And I just kind of try to point out when I'm teaching about running rehab or tendon rehab of we can extrapolate on that old heuristic of, hey, you start with isometrics, you move into eccentrics, then you move into concentrics and then ballistics. We can be a little more specific based on the injury at hand, the tissue profile also of the person that we're dealing with, right? Are they using whatever baiting criteria or, you know, the sport that they've played for years and how they've evolved or adapted.
But in that same article, which the other animation or the other picture that's in there, which is just amazing and it's been talked about and I looked up the outside magazine article that you're quoted in is the use of vitamin C and gelatin, which is one of the things that I know you've talked about a lot. But this always, again, I mentioned your name within the chiropractic PT realm and everybody's like, who? And I'm like, how does not everybody know who Keith Barr is?
Because these things, when you see it, and again, correct me if I'm wrong, a 2X increase in outcomes of tenninopathy just by adding, what is it, 15 grams of gelatin and 200 milligrams of vitamin C 30 to 60 minutes prior to exercise. I mean, just knowing that, if we were working with a professional athlete, let alone a stay at home mom that plays tennis a couple days a week, if we're 2Xing the results, I feel like that should just be.
why aren't you doing it, especially with such low cost interventions as vitamin C and gelatin?
Keith Baar (27:15.989)
Yeah, so it is one of the things that... One of the studies that a lot of people look to is the study that I did with Greg Shaw of the Austrian Institute of Sport where we fed people either 5 or 15 grams of gelatin. We've since done it with hydrolyzed collagen which has the same effect. And, you know, really before I even go too far, people say, what about this special one that comes from this company that's more exp...
We've never seen a difference between even the cooking gelatin that we get at the grocery store versus the hydrolyzed collagen. They all...
Dr. Beau (27:49.518)
which is what I tell people to buy. Because of your research, I say you can go get the 30 cent packet of gelatin and I'm pretty sure, and that's one of the questions I want to ask you, is there a difference between, which we can have a sidebar on, different types of collagen, hydrolyzed, bone broth, all, you know, there's lots of options.
Keith Baar (28:03.029)
Yeah. So the only thing I do is I tell people not to go from a bone -based source. So the bone broth works as far as the collagen goes. A lot of the gelatin works as far as the collagen goes. But where a lot of it comes from is from the bone, obviously for the bone broth. And so what we make sure people understand is that most animals, they store their heavy metals in their bones. So if you're going to take...
Dr. Beau (28:30.83)
Mmm.
Keith Baar (28:32.341)
you know cows and now boil down those bones and now we're going to isolate stuff out of there. Actually there's good data that says in bone broth there's high levels of lead and other things. So we try and stay away from the bone based ones and we try and encourage people to do a skin based one. And so that's the only real thing that you're looking for is something that comes from a pelt or a skin or you know, cause there's usually fish skin or pig skin or, or any of these types in people who are, you know, halal will go for the fish or
you know, if they have different, that's totally fine. But there's not really a fundamental difference in how you hydrolyze, for example. So if it's hydrolyzed collagen, totally fine. If it's gelatin, it's totally fine as well. It's a little easier to incorporate hydrolyzed collagen because it dissolves in relatively cold liquids. And so you can put it into, and a lot of people will put it into their coffee or they'll put it into other things that they have kind of at the same time every day.
Dr. Beau (29:12.43)
Mm -hmm.
Keith Baar (29:30.677)
and they just get into that routine. And the reason that that's important is because what we see with collagen synthesis is that we see this, you know, this cyclic nature to it. So there's a circadian rhythm that comes to it. There's beautiful work coming out of, out of England and now in Copenhagen that shows that there's a circadian rhythm to collagen synthesis, but also it takes about 24 hours for the collagen synthesis from your exercise yesterday to peak today.
So, so that's why we want to have that kind of collagen dose about the same time every day. If it's an hour before training, that's great because then you're going to target it to the area you trained. But it also means that when I do it again tomorrow, it's already, it's also going to get targeted in the same way. So if 24 hours later, collagen synthesis is higher than it is today because I exercised yesterday. Now I've supplied more amino acids, more building blocks for the, for the collagen. So the cells can.
make more college in potential.
Dr. Beau (30:31.662)
Can you touch on the targeting of it? Did they do radionucleotide studies with collagen on rats, looking at where it's going based on stressors and tendons? Am I wrong on that? Or what's the mechanism on targeting?
Keith Baar (30:41.589)
I haven't seen that. So, Osir has shown that when he gave kind of radio labeled proline, which should go into collagen because it's every third amino acid, or he gave it as hydrolyzed collagen that was radio labeled, he saw that more got into the musculoskeletal tissues.
when the mice or the rats consumed it as the whole protein rather than just the amino acid. In the skin, the amino acid got incorporated into collagen at the same rate, but it seemed like the musculoskeletal system, so the cartilage, the muscle, connective tissue, and the tendon, those things seemed to do better when you were giving a more native molecule like a hydrolyzed collagen or whatnot. So that's the only one that I've seen there.
The reason that we give it an hour before when we're trying to target a specific tendon is what we're trying to do is we're trying to use blood flow. Normally we use blood flow to deliver the nutrients that we want to the tissues we want. So one of the best things that everybody can do is after dinner is take a 10, 15 minute walk. All that's going to do is it's going to target more of those food items that you've eaten. So the carbohydrates, the proteins and the fats.
are going to go to the muscles that you're exercising. So you're walking muscles in that case. So that's an easy way to target what you've eaten using blood flow to specific tissues. The problem with our connective tissues, our cartilage, our tendons, our ligaments, there's not a lot of blood flow in these tissues. So what they normally do is they normally get their nutrients from the solution that they're in. So they're in, say they're in a synovial joint.
they'll get the synovium has a has a liquid in it that's going to allow as I load the tissue either compression for the cartilage or tension for the for the tendons and ligaments now what they're going to do is that's going to squeeze out the liquid that's in the tissue and then as it relaxes now it's going to suck liquid in from the environment if I've put the call it the hydrolyzed collagen or whatever into the system beforehand now there's more of that to deliver to those musculoskeletal tissue
Dr. Beau (32:43.79)
Mm -hmm.
Keith Baar (32:58.517)
And some of the work that I've just been doing on my sabbatical in Maastricht in the Netherlands was to use what's called a blend. So we know that there are specific amino acids in collagen, specifically glycine and proline, that are very low levels in, or relatively low levels in other protein sources like dairy protein. So most people will go out, they'll have a whey protein after they've done their exercise. And that's great for their muscles. We talked about...
leucine -rich protein, activate mTOR, you're going to get more muscle protein synthesis. The problem is that what you see in what Luke Van Loon's lab has shown is that after you consume just dairy protein or whey, glycine levels, for example, drop. And that means that it has the potential to become limiting. And so what we've been doing is blends of proteins that would have, say, 20 grams to 25 grams of whey protein with five grams of hydrolyzed collagen with the 50 to 200 micrometers.
Dr. Beau (33:28.942)
Thank you.
Keith Baar (33:57.749)
Milligrams of vitamin C and that seems to give a lot of really good signal to All tissues at the same time. So if you want to do things that are going to benefit the whole musculoskeletal system Having a blend like that where you combine some Milk based or whey based protein with a little bit of hydrolyzed collagen and some vitamin C That's a really nice combination and we've we've got data that's that's in review right now that shows that
Dr. Beau (34:03.662)
Mm -hmm.
Keith Baar (34:27.445)
we can increase kind of connective tissue protein synthesis in the muscle when you take muscle biopsies using that blend over placebo control. So what that's telling us is it's telling us that yes, the hydrolyzed collagen might play some sort of a special role, but having the whey protein, the leucine rich protein might also be beneficial. And we know that from some of the
some of the studies that we've done in the lab here, because if we use an inhibitor of mTOR complex 1, our little ligaments aren't as strong. And so, in fact, that's one of the ways that people have probably heard IGF -1 as a way to improve tendon or ligament function. The way that IGF -1 works is it activates mTOR complex 1, that increases collagen synthesis and decreases collagen breakdown.
Dr. Beau (35:00.494)
Mm -hmm.
Keith Baar (35:21.525)
And so we're adding the leucine -rich protein. That's going to activate the same thing that IGF -1 does, slightly different mechanistically. But when you do, say, the exercise together with that leucine -rich protein, now you've got the signals that are going to allow that tissue to get bigger and stronger.
Dr. Beau (35:21.71)
Mm -hmm.
Dr. Beau (35:42.542)
One of the questions I had for you, just because I know you've studied and you're, you know, the kind of synopsis of what your lab's looking at, you mentioned the leucine, you know, protein signaling in particular. I have a couple questions on this and I hope, I know I'm all over the place, but I have so many questions I want to ask you. You said there's kind of an additive effect when you see these things, like an entourage effect in a food -based source because of all of the other things like...
Keith Baar (35:58.485)
Okay.
Dr. Beau (36:09.358)
Are you studying these at all or have any other labs studied side by side like vitamin C? Like vitamin C is notoriously hard to absorb in a non -food base. So are you looking at that, like the synergistic effect of like, you know, is it the, you know, fructose with fiber plus vitamin C helps, and then it's hard if you have a synthetic, you know, ascorbic acid or something like that base. Is there anything out there?
Keith Baar (36:30.869)
Yeah, so the way that we've done this is basically by messing up a little bit. So what we've done is we've done it so that we had a vitamin C powder that we stored in our laboratory in front of the window in Northern California in the summertime. So it's getting totally getting blasted by the sun all day long. That experiment, we ran all of the experiments. We looked.
There was no increase in protein in collagen synthesis. And we did another experiment where we took, we were using Ribena or this basically a concentrated fruit juice that had about 50 milligrams of vitamin C and we made gummies. So in order to make gummies, I dissolved the gelatin in a boiling by boiling the Ribena. When you boil vitamin C, it kills the vitamin C and that one
even though it had the same amount of amino acids in it, you actually saw no increase in collagen synthesis. So again, the vitamin C is fundamentally important. What we use, we use a vitamin C powder. So we don't find that there's a problem with that. It could be that if you take the vitamin C together with collagen, there's not a problem, but maybe it's in a whole meal or something else, it becomes a little bit more difficult to digest.
But a lot of times what we'll do if I'm going to make this at home is I'm going to make a smoothie. There's going to be blueberries, strawberries. I'm not putting any vitamin C in there because the fruit is going to have that. And so I'm using the fruit not only as a flavoring to give it some consistency as well because it's frozen, but I'm also using it to deliver the vitamin C that I want.
Dr. Beau (38:08.718)
Mm -hmm.
Keith Baar (38:19.445)
Because I don't need it to be pharmaceutical grade vitamin C that's going to be in my system for a long period of time. I just need it to come in at the same time as my hydrolyzed collagen or my whey protein and these things coming in together so that the cells not only get the stimulus or the building blocks. And the reason that vitamin C is essential is because in order for the cell to spit out the collagen so that it can get into the tendon, the ligament, the cartilage, it actually needs vitamin C.
to add a little bit of a change in the molecule. And when you do that, it then can release from the cell. So when we do experiments in the lab and we wanna measure how much collagen the cell has made, all we have to do is take vitamin C out and then the vitamin C stays in the cell, or sorry, the collagen stays in the cell. So then I can just bust open the cell and measure how much collagen was there. And so if I take vitamin C and I add it in a dose dependent manner to my cells,
Dr. Beau (39:07.214)
Mm.
Keith Baar (39:18.581)
All that happens is when I collect the cells, I bust them all open. The ones that had the vitamin C don't have any collagen in them anymore because they've opened up and they've released their collagen into the meat or the matrix, whatever. And that's why vitamin C is essential. So if you see a lot of studies where there's no effect of collagen supplementation, many, many, many of those are done in an overnight fasted state.
Dr. Beau (39:35.886)
Mm -hmm.
Keith Baar (39:48.469)
where they supplement with collagen, but they don't provide vitamin C. And if you don't provide vitamin C, you're not going to make and export the collagen from the cells that you make it from. And so if you're just going to measure it in the matrix of say a muscle or of a tendon, you're not going to find it there if you don't have vitamin C because it's not going to be secreted from the cell and incorporated into the matrix. And so vitamin C we've known is important.
The first nutrition study ever done in the 1700s, there was a Scottish doctor. He basically took a bunch of sailors with scurvy and he fed them different things. One of them was like turpentines. I'm surprised anybody survived. But two of them got a lemon and two limes and those ones got better within a few days. And so they didn't know vitamin C was in the lemon and the two limes, but then they started giving all the sailors lemons and limes because they knew that that would stop scurvy.
Dr. Beau (40:27.886)
Yeah
Keith Baar (40:47.509)
And basically all scurvy is was that you'd stop producing collagen. So the result is your any old scars would open up, your teeth would fall out, your hair would fall out. All of these tissues where collagen is essential to bind you together would start to deteriorate. And you could fix that just by adding vitamin C. So for 300 years, we've known that the vitamin C component is really important. And so.
Dr. Beau (41:13.102)
It seems like more manufacturers of collagen products and supplements need to read some of the research because I mean, just with what you just told me, it's like vitamin C is the key that unlocks the ability to utilize collagen. But then if you see a standalone collagen for your coffee or something and that's not in there, I'm not saying that's useless if you eat it with food that has it, but it could be.
Keith Baar (41:37.685)
Yeah. So that part of the educational process is just making sure that when people, if people are having it in their coffee in the morning, that they have a piece of fruit, that they have a glass of juice, they have something that's going to give them vitamin C. Because just by just having the collagen itself isn't enough in and of itself. Within a mixed diet, you're going to get enough vitamin C through the day. But if you're not delivering those things about the same time,
Dr. Beau (41:58.606)
Right. Which I think is a great point.
Keith Baar (42:07.797)
And most of us have a small breakfast that maybe is a, especially in Europe, they're gonna have a coffee, they're gonna have like a bread -y thing, and that's gonna be their breakfast until lunch. They're not gonna really have fruits or vegetables until maybe lunch or dinner. If you're delivering your collagen four hours or eight hours or 10 hours before you're gonna have any vitamin C, yeah, your daily vitamin C is gonna be sufficient, but now you've taken your two signals and you've...
and you've separated them far enough where maybe they don't have the synergistic effect that they would have if we took them together.
Dr. Beau (42:43.086)
Well, I have a couple of questions about fasted trainings. I know you have some research on there, but talking about time dependent delivery of that. So for people that are doing intermittent fasting that maybe have just black coffee in the morning and are waiting till maybe 10 a or 11 a to eat their first meal, but maybe work out in the morning, what is the time dependency window on that? Like how much time do we have?
Keith Baar (43:02.677)
Yeah, so again, when we talk about taking something 30 minutes to an hour before, that's to get the optimal effect. So it doesn't mean that there's no effect if you take them later. And again, one of the reasons that you're not necessarily going to have as much blood flow, you're not going to have as many of the things to target it, but you're still going to get an effect by putting these things together and to taking them in together as one unit. And so what we would tell people to do is,
Don't worry about it if you're training first thing in the morning, you're, you know, cause this is what I do. I get up in the morning. If I don't train first thing in the morning, time is not really going to make it so that I've got another point in the day where I can train. So I train early in the morning before I eat anything. And then I'll come in and I'll have something kind of later on where I'm going to then bring in some of these things that are going to help my body respond to that training and adapt.
as optimally as I can. And so for me, that means having something that has a milk -based protein, has some collagen in it, has a little bit of vitamin C with it, and then maybe something, if I'm really pushing it, I'll get some Epicatechin -rich cocoa, and that's really gonna form the kind of core of what I'll do as far as my recovery after that training. So if I was taking people who are time -dependent feeding and they were gonna say,
not eat until 10, 11 o 'clock, totally fine. I would have something like that. They would have something where you've got a little bit of milk -based protein if you can handle it. Plant -based protein's fine. You're just gonna probably need to increase the total amount because it tends to be lower in leucine and it's a little bit harder to digest. So if I'm taking 20 grams of a whey protein, maybe I'll take 30 plus grams of say a soy or a pea protein.
Then I would take maybe five grams of gelatin with that or hydrolyzed collagen. I would put it all together if I'm gonna do it in a juice or I'm gonna do it in a smoothie, maybe a bunch of strawberries to give me my vitamin C because they're in season right now or whatever other fruits in season that's gonna give you that, great. If you're gonna do something like Epicatechin, you can do it with, I just use natural cocoa because it's...
Keith Baar (45:27.829)
It's fairly, it's a really good source. And so you, you just adding that, then you have to figure out your vitamin C unless you like fruit flavor chocolate stuff and that's fine. But you can do something that has a mixture like that and it's perfect for the rest of the day. Or you can eat something that's going to be say yogurt with some fruit. You can sprinkle a little hydrolyzed collagen on it. You can do it that way. There's lots of different ways you can do it. You don't have to worry about precise timing.
Maybe you're gonna get 80 % of the effect, but it's still a huge amount. Whereas, you know, if I'm elite, then that 20 % makes a big difference. If I'm not elite, if I'm just training for life, getting 80 % of the things right, that's a win. That's a huge win. And so that means getting my fruits and vegetables and getting some of one of these supplements maybe once a day, you know, relatively close to my training, that's a big win for me.
Dr. Beau (45:56.334)
Mm -hmm.
Dr. Beau (46:25.39)
Yeah. And I agree that sometimes we get in the weeds with this stuff with the light, you know, the general public and you know, we're going to granular when we should take care of the 80%. But if we're, if we stay granular for a second, when we keep mentioning leucine, and I know you've done some studies on, you know, leucine, supplementation and branched chain amino acids. So you kind of mentioned for different protein sources, leucine, you know, not being as high in a plant based protein.
Do you, is BCAA supplementation a net positive or negative? Should people be focusing on loose, seen rich foods like eggs or other things in addition or?
Keith Baar (46:59.765)
Yeah.
Keith Baar (47:04.565)
So I would, I always focus on the food component. The only time that I ever do any kind of supplementation is if the food is insufficient. So what I'll do is I'll look at my meal. If I'm going to have something that's maybe it's a carbohydrate based meal and it doesn't have much, maybe it's a hot day. I'm going to have a salad and it's going to be something that's going to have lots of veg, but it's not going to have much by way of protein.
Now what I'll do is maybe I'll add some cheese to it. I'll add some eggs to it. I'll put something that is a protein source on it. And there maybe it's not enough. So then maybe instead of having a water to drink, I'll have a milk to drink. That's basically how I would do it is I would focus on actually getting the food components and looking at what you're going to eat. And if it's not going to have enough protein, adding in either from
either a lean meat, an egg, cheese, any, or just, you know, instead of drinking water, drink milk, all of those different ways are ways to increase the protein content of what you're doing. And they're far better than sitting down and taking some sort of supplement.
Dr. Beau (48:15.534)
we'll get back to amino acid supplementation, but jumping into fasted training. So we've mentioned, you know, time to minute feeding and intermittent fasting, which it's, you know, it was huge there for a while. Now we're seeing some articles come out on maybe some cardiac risk and is it actually doing what we think it was doing or is it still beneficial? So I know this is a broad sweeping question, but from your standpoint, because I know you've done some studies on this and I saw, correct me if I'm wrong again, that if we do,
workouts in a fasted state, wasn't there increased protein synthesis that occurred with those workouts?
Keith Baar (48:50.741)
Yeah, so this is work that we've done some, John Hawley's done some, other people in the field have looked to say, if you want, especially if you're relatively high level, you can get more adaptation by doing some of your training in a low glycogen state. Not all of your training and you don't want to do it all the time. So the best study is probably one from John Hawley, where what he did is he took triathletes who are training multiple times.
They had the exact same amount of carbohydrate in their diet. One group, they had all of their carbohydrate in the first part of the day. They did their last training session. Their dinner after that would have protein and very low carbohydrate. And then they would get up the next morning and train in that low muscle glycogen as well as low liver glycogen state. And they saw about 3 % greater improvement in run performance than the ones who,
had the same amount of total carbohydrate, but had some of that carbohydrate after that second training bout. So what it tells us is that some of the reason that our muscles adapt to our exercise is because of the metabolic stress of the exercise. And so if we compound the metabolic stress of the exercise by adding a metabolic stress of doing it in a fasted state or doing it in a glycogen depleted state, we get certain molecular signals that are higher.
and that will provide an increase in adaptation that results in greater performance. So where we use this is mostly in either elites, but if we're not talking about elites, we're going to use this more in people who don't have a lot of time to train. So what we're going to do is I'm going to say, okay, you can only train say three days a week, but you have this goal of running a marathon. So what I'm going to do is I'm going to take one of your training bouts, it's going to be over here.
The other two of them, I'm going to do them together. I'm going to do one of them in the evening. And then you're going to have a low carbohydrate meal. So you're going to be in muscle glycogen depleted from the exercise that you did. You didn't replenish that. And then you're going to sleep. Your liver glycogen is going to be depleted to run your body while you sleep. You're going to run, you're going to exercise again the next morning and you're going to do that session in a glycogen depleted state.
Keith Baar (51:15.125)
muscle as well as liver. I'm gonna give you a little bit of black coffee in the morning just to get you so that you don't feel like it's as hard as it would feel like if you didn't have that. And you're just gonna train in that fasted, that muscle and liver glycogen depleted state. And now from those same three training bouts, I'm going to get more adaptation than if I had done those Monday, Wednesday, Friday, say. So that's how we would use it.
kind of in a structured system. If I'm doing it with elites, when they're in their base phase, now I'm doing two days a week where they're doing evening training, next morning local hygiene training, and I'm gonna do that twice a week and just have that as part of the component of their training. They're gonna train the other six days a week as relatively normal.
Dr. Beau (51:56.11)
Mm -hmm.
Dr. Beau (52:09.646)
Are there any specifics on the first meal after one of those back -to -back fasted training sessions? Is there anything that would be focused on or just typical, you know, good nutrition resupply?
Keith Baar (52:10.741)
settings on.
Keith Baar (52:18.069)
Thank you.
Keith Baar (52:21.749)
Yeah, just typical good nutrition resupply. I would, I would again focus on having protein because protein building blocks. The one thing that happens when you have those fasted training sessions is that you can become much more, you're much more likely to get say upper respiratory tract infections. And so what we'll do first, you know, if that's a problem for some people, we could maybe bring in some, some fish oils to as a kind of
something that we add into what they're doing to improve some of their immune function. But then when they do have that next meal, I'm gonna make sure again that it's gonna have loose and rich protein, because that's not only good for building our muscle, it's also absolutely essential for the functioning of our immune system. And so, when people were getting their vaccinations,
This is one of the things we were trying to make sure that everybody was doing was taking in leucine rich protein with the vaccine so that as you're having that immune response, you're giving your immune system all of this, you know, leucine rich protein that's going to stimulate and help that immune system respond to that insult. So whether it's getting a virus or getting a vaccine, we're going to want you to have of the of the food that you eat. We want it to be.
high quality protein is going to be the core of it. And we would do the same in this situation where we would put at the core, we're going to have a foundation of that high quality protein so that that's going to help our immune system fight off anything that maybe came in when we're doing this more stressful, low glycogen training. But it's also going to help us build, repair any damage that we've done. And then we're going to bring in the carbohydrate as a way to replenish the metabolic stores that we've.
Dr. Beau (53:45.742)
Mm -hmm.
Keith Baar (54:10.933)
depleted by doing that double training.
Dr. Beau (54:14.573)
So I work a lot and obviously, like I said, I found out about you from Dr. Beard's podcast. Work with a lot of ultra marathoners, do a lot of running myself and correct me if I'm wrong. So I know you're also becoming more efficient at glycogen, kind of pulling glycogen out of the muscle in the liver. So delivery mechanisms, is it actually having a metabolic response outside of just the, I guess, like a protein signaling response?
My assumption of what was being talked about is that you're becoming more efficient at fatty oxidation versus like having this fast burning glycolytic system.
Keith Baar (54:53.685)
Yeah, so basically what you're doing is you're getting more of that thing that we discovered, PG -21 alpha, because it's activated by that metabolic stress. You've put more metabolic stress on your muscle, you're going to get a higher PG -21 alpha. What that does is that increases the production of fatty acid oxidation enzymes. It increases the production of glucose transporters. It increases the production of mitochondria.
Dr. Beau (55:01.358)
Mm -hmm.
Keith Baar (55:18.613)
And so now when we go to exercise, we should have more mitochondria within that muscle. It should produce energy, more energy per unit of oxygen or more energy per oxygen inhaled. So we've got more mitochondrial mass within the muscle that we're going to use. And so now when we deliver oxygen, we can extract more of that oxygen, produce more ATP. And so yes, we've become a little bit more efficient at that submaximal level.
So what you would see is if you train this way repeatedly for say six to eight weeks, what you should see is when you go out and at a submaximal rate, and if I look at my heart rate monitor, my heart rate monitor should be a step or two lower because I'm not having to push as hard to go at that constant rate. Okay? So.
Dr. Beau (56:09.166)
Is that a sustained response or what is the, so let's say I continue the same training efforts, but I remove the fasted workouts. Is that sustained or does that have a shelf life?
Keith Baar (56:20.789)
So it will have a shelf life, but it's got a fairly long shelf life. It's basically what we see as people go from the base phase to specific preparation. That specific preparation, we're shortening up, we're speeding up, we're getting these things. But as we do that, we're losing our overall aerobic engine. So we're not giving as long and as prolonged a signal to the muscle to get all of those mitochondrial adaptations. So over time, we're getting a little bit less of that structure.
And that's causing our metabolic or our aerobic engine to kind of slow down a little bit. But now we're using that different training. So we all have experienced that by going from the base phase where we're trying to build that aerobic engine to specific preparation where we're trying to increase our performance by speeding things up by going short and fast. As we do that, it's just like when we talked about earlier when all I'm doing is short, fast movements.
Now I'm getting stiffer. That's making me more efficient. That's making me run faster. But when I'm doing that, I'm also not getting a signal to my muscle to be strong, but I'm also not getting as much of a signal to my muscle to keep the mitochondria that I have. So over time, I'm losing a little bit of mass and I'm losing a little bit of mitochondria slowly deteriorates. And then what's going to happen is next base phase, I'll get that back. And so that's what we're doing as we go from base phase to specific prep.
So we're trading off kind of aerobic engine for speed and performance. And so that's basically what we do is we go between those two areas.
Dr. Beau (58:03.342)
So talking about that mechanism of, you know, what's, you're not challenging the muscle the same way when we kind of go into that harder, shorter duration, you know, maybe more specific. So I pulled a quote from one of the articles that was looking at concurrent training. There's a big push in this hybrid athlete model now, which I guess a lot of people would say they are part of, like I lift weights and I do a lot of endurance stuff. I wouldn't say I'm necessarily specialized in either. So I don't know if that makes me a hybrid athlete or if I'm concurrent training or I just.
have variety, but it basically said like, this suggests that the inhibition of mTORS as a result of the activation of AMPK by endurance exercises is likely not a molecular mechanism underlying the impaired hypertrophy and strength with concurrent training. So is it more in the realm of what you were talking about or was there another mechanism that was found out or they're still looking?
Keith Baar (58:50.965)
So there is still, we are still looking. So one of the things that's really interesting as far as the concurrent training effect is that the concurrent training effect has been diminished over the last say 20 years. So when it was first identified by Bob Hickson in 1980, if you go back and you look at the diet, the diet was around 0 .8 grams per kilogram body weight of protein.
Now when we look at the diet, it's up around 1 .2. So one of the things that could be explaining the fact that people are able to be more of a concurrent training athlete is that we're increasing the protein content. And so there's mechanistically some of what happens as we do lots of endurance exercise. Well, if we do lots of endurance exercise, we need to have lots of mitochondria. Those mitochondria are able to produce more energy.
But it also can lead to a little bit of, it shouldn't lead to any loss of efficiency, but it does mean that you need more caloric input to maintain that bigger muscle, more mitochondrial mass and all of that. Evolutionarily, when protein was a limiting thing, because we did not grow, you know, we did not evolve at a time where we go to the store and get a big bag of whey protein and just eat as much protein.
we evolved when we're eating tons of roots and maybe we get some meat from time to time. If you're in that situation, you don't want to have huge muscles that need lots of energy because that's going to be problematic. So there are a number of these, what we call molecular breaks that prevent us from growing our muscles really, really big, especially when we have more metabolic challenges like endurance exercise at the same time. So really we don't see it now until we get
to really high training loads. So we're about to see the Olympics soon. You're going to see the rowers. Check out the rowers, especially the eights. The women's eights are, they can be 80 to 100 kilos. These are big, strong women. The men are going to be, they're going to be 6 '6", 240, 260 pounds, like 100 plus kilos. They're training 30 hours a week to row.
Keith Baar (01:01:12.629)
to get the endurance capacity in order to do that. The performance as a rower is directly proportional to your body weight. So the more you can maintain your muscle mass, the faster you are as a rower. So when you're training 30 hours a week and you have to be big and strong, have to have lots of muscle, that's where we're gonna see that still, no matter what we do, we're gonna see that concurrent training effect. We're gonna see it in our heptathlon athletes and our decathlon athletes.
but we're not gonna see it in the Monday, Wednesday, Friday, exercisers who go to the gym and they do weights and that's not an issue. We're seeing it more about with people who do seven, nine workouts a week or do long distances. So there's not gonna be a lot of your ultra endurance athletes who lift a lot of weights and suddenly gain lots of mass because they're running a distance. It's gonna make it really, really hard for them to build muscle.
Dr. Beau (01:01:50.318)
Mm -hmm.
Dr. Beau (01:02:09.358)
Well, that is the big push. I don't know if you're familiar with Nick Bear. You know, that's his thing is basically bodybuilding or functional bodybuilding with ultra endurance. And again, I don't know the actual supplement routine or if there's any, you know, other aids there. That's not what we're talking about. But some of this gets talked about of like facet workouts and, you know, supplementation around there. One of the other questions I wanted to ask you on the, you know, facet workout state is,
There's a big push in the, I would say just the popularized training realm of like you need some sort of amino acid supplementation, essential amino acids, if you're going to do a fast workout, in particular if you're doing multiples a week. Is there any validity to that or what would the thought process be on why that's important?
Keith Baar (01:02:57.397)
Well, there isn't any need. And the reason for that is, it comes from a recent study out of Luke Van Loon's lab by Yorn. What they did is they did what they called the barbecue study, where they fed somebody 100 grams of protein, and they looked over 12 hours. And you could still see protein coming in, or amino acids coming off of that protein for 12 hours.
So what that means is that if I take a big bolus of protein, so I've done my overnight fast, I've done my fasted training, and then I'm going to deliver a huge amount of protein, that huge amount of protein, I'm going to be digesting and absorbing for a long time, especially if I'm taking it from a food source. If I take it from pure amino acids, what's going to happen is it's going to go in and out, because those get digested, absorbed really quickly, and they're removed from the body really, really quick.
If I take it from a food -based source, now it's going to take a lot longer for those to get in, and it's going to stay around for a lot, lot longer. So if you are going to do, say, you know, the people who do one meal a day, for example, what we're going to do is I'm going to do that one meal a day, and I'm going to do it right after my biggest training bout. So if I'm going to do my weightlifting in the afternoon, say, I'm going to have my one meal a day right after that.
So then I'm going to take in a big, huge bowl of protein. I'm going to be digesting and absorbing that for 12 plus hours. What's going to happen is that's going to come in and that's going to get delivered more to the muscles that I've just exercised because our blood flow is higher to those muscles for about two hours so that they can regenerate and pull in the metabolic things that they've gotten rid of so that they can replenish glycogen. They can replenish some of the other...
energy sources, but also so that they can pull up amino acids and build that muscle again. Then I can do my endurance exercise the next morning, for example. And now I'm in a pseudo fasted state, and that's going to provide me a good stimulus to get a big endurance adaptation. So if I'm doing, say, one meal a day, I'm doing my endurance in the morning, I'm going to do my strength right before my one meal a day.
Keith Baar (01:05:16.437)
That's going to deliver those amino acids to the muscles that I've worked. And then I've got 12 hours before I go back and I run, I'm going to be in a somewhat depleted state when I do that. That's going to give me my stimulus to get full adaptation there. If you're going to supplement with amino acids, it's not technically fasting, obviously, but you can do that.
Yeah. And if I'm going to do that, I would just do a whey protein supplementation. And that would be enough to maintain the protein component. And it's just like we had talked about before where the, the collagen, the hydrolyzed collagen is given a lot of times just as an unflavored, no vitamin C. That's because it's supposed to be an ingredient in something else. So what I do when I use whey protein is I get a unflavored whey protein that is nothing else.
So in one scoop of 20 grams, it's got 80 calories because there's no sweeteners, there's nothing else. It's just whey protein. And now what I can do is I can put that into something and I can use that if I just wanna, if I'm trying to have an aesthetic where I'm trying to change and I've got a really tight calorie budget. Now what I can do is I can use that whey protein as a way to kind of deliver.
however many amino acids I need in a leucine rich protein that's got all of the amino acids, that's gonna be a high quality protein that I can use, but I wouldn't normally do that because I would normally use food to do that. And I would, but, and if you're gonna do that, the reality is you're not doing fasted training because you've eaten a whey protein. And so yes, you're gonna do a low calorie training.
completely, but you can do that as a, you can do that with tofu, you can do that with other protein sources that don't have a lot of other calories in them, and that could be just as good for, because, but that's again, something that people are doing because of some aesthetic that they want to achieve. It's not necessarily something that would be health -based or that would be positive outcomes in the long.
Dr. Beau (01:07:34.638)
I would have to assume based on everything you've said that, and again, I'm just using the example of kind of the workout and then a, you know, fasted state overnight workout in the morning, that there's going to be a time dependency on that workout in terms of benefit, right? Because if you start pulling further into glycogen stores, does it become, does it negatively affect you at all? Or is, if let's say we're talking, somebody wants to go run 20 miles in a fasted state, is there a point where it's like, you do need glucose in the system?
to still run for that period of time or is there benefit to a long prolonged effort over an hour or whatever based on fitness of what's going to put you into that realm of basically going back into that like short burn cycle.
Keith Baar (01:08:14.901)
Yeah, so there's lots of training techniques that have used either some sort of low glycogen or just longer training. So Arthur Liddiard used to have people run 100 miles a week only in singles so that you would be running 20 plus miles. And the reason that he was doing that is because he knew that you would deplete the glycogen. And as you deplete glycogen, yeah, your performance goes into the toilet. There's no question about that.
But then you have to have other sources of fuels and those other sources of fuels are going to be fatty acids predominantly, maybe some ketones or other things like that. But as you're bringing those in, those require the mitochondria, whereas carbohydrate only partially requires the mitochondria. So it's a greater stimulus to the mitochondria if you're doing these long sessions that have that...
extra depletion to them. The problem is when we look at the body as a whole, what you're getting is you're getting a great stimulus for the heart and skeletal muscle in that situation of this adaptive stimulus. But if I'm only working out in singles once a day, what I'm doing is I'm getting only 10 minutes to 20, you know, 10 to 15 minutes of a positive signal to all of my connective tissue.
because my connective tissues adapt differently to training than my skeletal muscle and my heart. My skeletal muscle and heart, if I go out and train for three hours, they're adapting for three hours. If I go out and train for three hours, my tendons, ligaments, cartilage, and bone stopped adapting at the first 10 minutes. Now all you're doing is you're picking up fatigue or you're picking up tissue level fatigue that's going to cause breakdown, but you're not getting any positive signal.
And so this is something that I've talked a lot with Camille Heron about because Camille started her master's degree is in bone mechanobiology. And she knew from a long time ago that bone responded to as few as four to 40 stimuli. And that's all the bone would need in order to get the maximal stimulus to adapt. And what she had always figured is if she did two sessions a day, she would get two signals for her bones.
Keith Baar (01:10:39.253)
her tendons, her ligaments. That's the part that she and I talked about is it's very similar for tendon, ligament, and cartilage. So by splitting that into two, I still get a muscle stimulus. The muscle stimulus is still say, if I was gonna do 20 miles, if I did 20 miles once, I get one stimulus for everything. If I get 10 miles in two different pouts, I get two stimuli for my bones, tendons, ligaments, and cartilage. And I get the same stimulus for my heart and my...
and my skeletal muscle. So that would be, if I look at this from a holistic viewpoint, that's a much healthier for the system as a whole, because we're giving as many signals as we can to our connective tissues. And we're still getting the same adaptive signal to our heart and our skeletal muscle. So I would be much more inclined to do something like that.
Dr. Beau (01:11:33.07)
Mm -hmm.
Keith Baar (01:11:38.229)
If you wanted to do some of the sessions in a low glycogen to get a higher signal to the muscle in the heart, then all I would do is take the second session of a day, make sure that after the dinner that night just was protein and low carbohydrates, so protein and fat. We usually do like a fish with some vegetables, like some broccoli or some.
some other vegetables that are relatively low in carbohydrates as well. And now what we're going to do is we're going to have fish in that. And then the next morning when I get up to get my, to do my next session, now I'm in a low glycogen, low carbohydrate state. Now I've got that signal that you're looking for from your fasted training, but I haven't had the negative effects on the system as a whole. And so I would be much more inclined to do something like that than to do big long fasted workouts.
Yeah, you're really tough if you can do that. That's great. If it's all about toughness, fine. But if you want to get the most of your adaptation, if you split those into two and you do one of the situ one of them, your carbohydrate replete so that you've got lots of carbohydrate, you do some more performance based moves because now you've got more carbohydrate. You should be able to go faster. You should be able to maintain that for a little longer. But then after
Dr. Beau (01:12:34.67)
Mm -hmm.
Keith Baar (01:13:00.853)
maybe three sessions a week if you really wanted to do it that often, but two to three sessions a week after that evening bout dinner has protein and vegetables and they're relatively low carbohydrate vegetables and now the next morning when I get up and train now I'm getting that same kind of fasted signal but I don't have to do it every day and I'm getting a much more holistically healthy way of training.
to have the same contact level.
Dr. Beau (01:13:31.118)
So if we were to take that same concept of using time to have the biggest stimulus on, let's say the passive tissue systems, let's keep on tendons. So let's say in the clinical realm, if I had to extrapolate that, would it be correct in saying, is let's say I'm a PT, a chiro, and I wanna send somebody home with home exercises for their Achilles tendonopathy, reactive, degenerative, whatever stage it's in, would it be better then to have
multiple smaller sessions of those rehab exercises throughout the day, rather than like, hey, can we come into the office for 30 minutes, do work, and like you said, due to temperature change and hysteresis, we stop losing the effect. Is that a better programming idea or is that not quite right?
Keith Baar (01:14:14.325)
Right.
Keith Baar (01:14:17.973)
Absolutely. Absolutely. And I know the structure is a little bit more difficult because, yeah, we want to have patients in for 30 minutes. We want to do a whole session. But the reality is that if I'm doing that, if I'm loading, say, and if it's just Achilles tendon, I can load the Achilles tendon after about, you know, 10 minutes of load, that Achilles tendon isn't going to get any more positive signal. All I'm doing is building up the negative signal, which is, you know,
There's two signals that happen from any exercise. One is the positive signal that the cells sense the exercise. They sense the exercise because of mechanical stimulus, because of a metabolic signal, because of some sort of signal. And that signal to those cells in our connective tissues, our tendons, ligaments, cartilage, and bone, seems to last about 10 minutes. And after 10 minutes, we're not getting a further benefit of that exercise.
But every time we load that tissue, it's getting a little bit more fatigued. It's getting a little bit more likely that we're going to get some small little damage that we then have to repair. So if we know that the 10 minutes is all we need to get the signal for the cells to adapt, then our training can be 10 minutes. If you want to do it in a clinical setting, what you can do is you can do, okay, what we're going to do is we're going to do 10 minutes on the right leg.
We're just going to focus on right leg. We're going to do, we'll do a few more different things. We'll do not only the Achilles, we'll do the quad and patellar tendon. Maybe we'll do some hamstring work. We'll do that on the right leg. Then we'll do it on the left leg. Now we've done it two separate 10 minute sessions. Now we've, we've, now we've got a 20 minute session where we've actually done much more and we've gotten more stimuli into the, into the, into the art problem tissues.
And now we're gonna then do that again, say at the end of the day. So if I start with my physical therapy in the morning, I'm gonna learn those, I'm gonna do those at the end of the day. And if I can do them twice a day, maybe once a day at the start when my tissue is really reactive and I'm gonna get more inflammation and other things, I'm gonna do that once a day, 10 minutes. And then as I start to build, now I can build in a second bout where I can do those two things eight to 10 hours apart.
Keith Baar (01:16:41.941)
And yeah, that's what I'm sending my patients home with is they're going to have a training plan that's going to have these two bouts instead of one bout because those two bouts are going to give me twice what that one bout gave me. Even if the one bout is the same time, same time under tension, I'm still going to get two signals from those two bouts, say eight to 12 hours apart.
Dr. Beau (01:17:07.15)
Well, we're gonna turn you into a sneaky longevity expert because I also saw an article that talked about what was it? Titled train hard, not long. And it was talking about bouts of three minute exercise of higher intensity. This is for longevity, correct? Not necessarily performance outcomes. But we started thinking more general public training for life. And we start taking concepts, right? Concepts, few methods or many and say, hey, there's benefits to facet workouts.
Benefits to how you program your workouts and not just hey, I got to get my 10 miles But maybe you know time dependency it's easier to do five miles in the morning five in the evening instead of having to do You know an hour and a half in the morning in terms of intensity You know we could talk about running or weightlifting whatever it is if we talk about intensity What what was the verdict you know out of that paper? Maybe there's been multiple papers looking at intensity over duration
Keith Baar (01:17:46.709)
Yeah.
Keith Baar (01:18:02.933)
Yeah. So again, part of what we're looking at here is that especially as we age, there's a number of different things that we have to take into account that happen within our tissues. The first thing is we all begin to lose this protein dystrophin that we know about because of this disease muscular dystrophy. And what that protein dystrophin does is it pins all of our muscle fibers together so that they work as a unit.
And when there's less dystrophin, you get more sliding. And as you get more sliding, you get more little holes in the membranes of the muscle and you get more damage that leads to soreness. So what you'll hear from older athletes all the time is I do the same workout, but I get more sore and it takes me longer to recover. Yes, because what happens is you're now getting, there's now less dystrophin, you're getting more sliding, you're getting more injury. And when we rebuild,
instead of when we were young and those fibers were held together tightly and they would move as a unit and there would be no damage, when I'm going to have my protein synthesis response after exercise, if I haven't damaged anything, I can build that muscle fiber bigger because that same amount of protein synthesis can make the muscle bigger. If I've had a slide, if I've had shear that's caused injury, now what I have to do is I have to regenerate. So instead of getting the same rate of muscle growth when we're older,
we get a slower rate of growth because we have to regenerate or repair the proteins that were injured, okay, and repair the muscle fibers that were injured. So that's one component of it. The other component of it is we tend to, maybe probably not your listeners who are, who probably do a lot of loading, a lot of exercise, but most of us in the population are becoming more insulin resistant.
One of the reasons that insulin is important is it what it does is it opens blood vessels that supply amino acids to muscle beds to allow us to synthesize protein. As we become more insulin resistant, we need to use other stimuli other than insulin to deliver the blood to the muscles that we want it to go to. That's where exercise comes into. We're using exercise as a way to deliver those amino acids much more as we're older.
Keith Baar (01:20:26.549)
What we see in young individuals is we do an exercise about today, protein synthesis is up, stays high, and then it actually stays high up to 48 hours later. When we look in older individuals, it goes up about the same, but it comes down much faster. So that would suggest that we maybe need to exercise a little bit more frequently, and it's probably because insulin resistance is higher. So we...
The reason that protein synthesis stays high is because insulin is helping to deliver amino acids and we're getting that highest protein synthesis in the younger muscle. So those things all go together. And then the last really important bit is when we just take people who are older who don't do anything, what they do is they lose the fast fibers first. We lose type 2A fibers because we have to, in order for us to recruit those type 2A fibers,
Dr. Beau (01:21:17.102)
Mm -hmm.
Keith Baar (01:21:24.789)
we have to go faster. Okay, so there's this thing called the Henneman's Size Principle, which is my brain's gonna send a signal, and the faster the signal goes, the more important it is, so that what I'm gonna do is the faster the signal, the bigger and the more motor units I get. And the bigger motor units are the ones that are the fast motor units, the two A's, the two X's. So if I wanna get those, because I'm getting...
older and I don't want to lose my type 2A fibers, the way that I can do that is I can either lift a heavy weight or I can go faster than I feel comfortable going. So if I just go out and I walk at an easy pace, which is what doctors usually tell people when they say exercise, that's not going to be useful for things like brain health. For brain health, we actually have to go faster than we feel comfortable going. And that's what I was referring to for these some of these longevity.
things is that it's going to be important that we, for us to deliver amino acids to the muscles that we have. But not only to the muscles themselves, but to the muscle fibers. So if I use my type 2X fibers, I am going to deliver more of the amino acid that I've eaten to the muscle, to the type 2A fibers. And so those are going to stay bigger. I'm going to be able to maintain my strength and a little bit of my speed for longer. So all of those things tell us that as we get older and
Dr. Beau (01:22:48.526)
Mm -hmm.
Keith Baar (01:22:51.797)
Again, the brain health component is really important, especially for people who have neurocognitive history in their family. Part of what happens is if we just put people on a generic exercise plan, they're going to go out. They're going to exercise at a comfortable rate. They're going to walk along. They're going to talk to their friends. That's great for your heart because at 40 % of your max, your heart is stretched fully. I'm getting a really good signal to my heart to have good adaptations.
The problem is that we've never seen positive changes in neurocognitive behavior or Alzheimer's disease or Parkinson's disease with self -selected pacing. But when we go over speed training, so we go faster or harder than we feel comfortable going, now we see that Parkinson's can be improved by that. We can see that Alzheimer's disease, you get improvements in brain function specifically within the regions that are affected by some of these diseases.
So the reason that we talk about going harder or going faster when you're old is because most of the time we tend to say, you're old, you shouldn't do anything. You're old, you shouldn't lift a heavy weight. We're gonna give you these little tiny weights to do. Don't wrap your old people in bubble wrap. All that's gonna happen is they're gonna die sooner. The best example is we all say, you're old, we're gonna move you out of your two -story house into a one -story house.
Scientific evidence shows that when you do that, the person who moves from two stories to one story, they die sooner than if they had stayed in the two story house. Because the struggle to go up the stairs multiple times a day, that's a higher intensity exercise. Going up the stairs is what keeps them alive. We know that one of the biggest things, one of the best predictors of longevity in humans is our muscle mass and strength.
Dr. Beau (01:24:25.166)
Thanks.
Dr. Beau (01:24:36.43)
Mm -hmm.
Keith Baar (01:24:43.989)
So why would we take somebody who is building their muscle mass and strength by going up and down the stairs? Yes, we're worried about them falling, but the biggest thing that we can do to prevent falls is to help them get strong. So if you're stronger, you actually have better balance. All of these things are gonna be all wrapped together. And so when we look at it, we gotta take bubble wrap off old people so that they can go a little bit harder than they feel like it. It's gonna be good for their brain, their heart. It's gonna be good for their skeletal muscles. Everything.
And then maybe what we're doing is we're exercising a little more frequently because it comes back a little bit. We don't have to go hard every single time. We just have to do enough to get blood flow to the muscles that we want to keep so that we can get delivery of what we eat to those muscles. And doing small bits of exercise is a great way to do that.
Dr. Beau (01:25:19.854)
Mm -hmm.
Dr. Beau (01:25:38.766)
Well, not to mention, I mean, there's benefits from a hormonal standpoint with, you know, lifting heavy weights and I mean, which, you know, now we talk about osteopenia and parosis and yeah, I mean, we could go on and on and on on the benefits and you know, there's benefits and that's the big thing. And the sad thing is, yeah, we need to remove the bubble wrap from our, you know, older population, but kids, I mean, the, the lack of movement vocabulary and the reductionist nature of, you know, whether it's, you know,
not specialization, but just kids don't have a huge movement profile at an early age now. And then we see that they have kind of an avoidance to these activities for the rest of their life from it. So it's like, it starts early of getting them used to it, but then not stripping it back away from them in a protective nature later in life. Well, I'll absolutely be burned at the stake if I don't ask this question by some of my colleagues. So the donut hole theory of, you know, how a tendon heals.
Keith Baar (01:26:22.997)
Yep.
Keith Baar (01:26:34.773)
Mm -hmm.
Dr. Beau (01:26:36.11)
Is that still the best model we have? Is that what's actually happening? Cause I know there's been some case studies that you've either been an author on or co -author of, that's not always the case based on whether it's supplementation or I believe some different loading protocols, but is that still basically the model that we should all be thinking is occurring when we see a tenopathy at hand?
Keith Baar (01:26:58.997)
So a tendinopathy is basically when load isn't going through a certain part of the tissue. So I can produce a tendinopathy in a matter of days by putting you into a boot, immobilizing you for a certain period of time. If I look at the tendon structure, it looks much more like a scar after that than it does like a healthy tendon. There's a really nice, so we've done a bunch of...
studies on basically what that suggests is that if there's no load going through a tendon, the tendon starts to look like a scar. What do we mean by a scar? Well, there's more cells in the tissue. The collagen fibrils themselves are smaller and the orientation of the collagen fibrils isn't as aligned. And there's a guy named Hayashi, he's a Japanese professor and he basically produced, took a healthy patellar tendon in rabbits.
stuck a metal wire through the patella, through the tibial plateau, and just tightened it enough so that there was no tension on the patellar tendon. Within seven days, the orientation of the collagen had changed. There were five times more cells. All of the things that we would consider a scar, he had produced in a perfectly healthy tissue that had seen no injury mechanism. We've done the same here in Davis using a rat model. We've seen it across all kinds of different situations.
When you remove tension, you produce a scar. So what happens normally in a tissue, in a tendon, when I get some damage and there's some injury, we break some collagen fibrils. And we do break collagen fibrils. Do we see the ends of collagen fibrils when we look using electron microscopes? No. But I can also produce a collagen gel in my lab by taking a solution of collagen, changing the salts.
and it'll produce a collagen gel. And if I go look for ends of collagen molecules, I won't find them. Why? Because collagen is an extraordinarily sticky tissue. And so what happens is that the little collagen molecules, any ends that are there are just going to stick to whatever's closest. And so you'll never find an open end because it's so sticky that's going to stick. So yes, you break collagen fibrils or you break collagen molecules.
Keith Baar (01:29:21.525)
And now what we've got is an area that is got some untethered and around it you've got perfectly normal collagen. As I change the directional orientation of the collagen because they break and now they stick to whatever they're close to. As that happens, now what I've done is I've changed the orientation of the collagen. And so what that means is if I pull on that, it takes longer for the orientation to get back to linear. And that's when it's stiff.
because that's when I'm loading the backbone of the collagen. So if I've got this region that has to do this before it can get tension on it, or in parallel with that, I've already got a region that's perfectly straight and can take the load, what happens is the load goes through the healthy part of the tissue in a process we call stress shielding. So when I've got a stiff tissue and a compliant tissue in parallel with each other, so that they go side by side,
And if I load them equally, all of the load is going to go through the stiff tissue. Because it's stiffer, as I go to load it, that's going to deform less. Well, it's going to deform and the one that is less stiff isn't going to feel any tension at all. Okay? That's just the way any tendon is going to work. So if I've got a tendon, especially a big tendon like an Achilles or a patellar tendon.
And if that damage happens in the center of the tissue, what happens now is the center isn't going to feel any of the tension because the tension is going through the sides. But as I pull it longer, it's actually going to get skinnier because the tissue is isovolumetric. So now the strength, all the strain is happening to the healthy part and it's being pulled together. So what you get is you get compression of the middle and you get tension on the side.
And the result is that you're compressing the cells within the center of a tendon. The cells in a tendon are the same from the same mother cells as the cells from our cartilage. So if I compress a tendon for any period of time, Catherine Vogel had shown this beautifully that if I compress a tendon, what happens is the cells start to produce large proteoglycans just like their collagen.
Keith Baar (01:31:47.413)
What do those large proteoglycans do? They suck water into the tissue. So now I've got a central core tendinopathy. I've got strong parts. And then I've got this compressed region. That compressed region is going to show me water. And so when I image using MRI, using ultrasound, I'm going to see a hole and I'm going to see a donut. And traditionally everybody says, well, treat the donut, not the hole. Well, that doesn't, that doesn't get you that.
never fixes the tissue. So what you have to do is you have to treat the hole. The way that you treat the hole is by understanding that the tissue is viscoelastic. And what that means is if I pull on it and I hold it, the healthy part of the tissue is really stiff at the beginning and then it's going to exponentially decay in its stiffness. And as it goes down in stiffness, what happens is it becomes less stiff than the scar.
Dr. Beau (01:32:18.542)
Mm -hmm.
Keith Baar (01:32:45.525)
And now what's going to happen is the scar is going to feel a tensional load, which is what it needs in order to fix itself. So if I hold a relatively lower intensity isometric for 30 seconds for even longer, what's going to happen is the healthy part that's shielding stress, shielding the injured part, that's going to relax. Now I'm going to get tensional load through the injured part. Remember I said that it only takes 10 minutes of loading.
to give the signal to those cells. So if I do four 30 second isometrics where I hold my tissue, so if I have a patellar tendinopathy, if I do say a Spanish squat or if I do an isometric leg extension and I'm just gonna pull on it and I'm gonna put load across it, I'm gonna do that for 30 seconds. Say it's an overcoming isometric, I'm gonna push out. You can do it as hard as you can, you can do it at 80%.
Dr. Beau (01:33:16.302)
Mm -hmm.
Keith Baar (01:33:42.037)
We haven't seen that it makes a really big difference. It's really the time component. And so I'm going to hold it for 30 seconds to 40 seconds, somewhere in there. Now what I'm going to do is I'm going to take a two minute rest. I'm going to do that again. I'll get four repetitions. That'll give me eight minutes of work. That's close to my 10 minutes. If I do that, what happens over time is I'm getting the signal to the central core that there's a directional load that comes across here.
And now it can actually start to synthesize a directionally oriented collagen in the place where that hole used to be. And it's not... Go ahead.
Dr. Beau (01:34:17.006)
And even though there's fluid within there, the tensile load overrides the compressive force against the fluid in that scenario.
Keith Baar (01:34:24.404)
So what happens, what happens, remember, viscoelastic means that what part of what I've got is the stiffness is the, is the liquid component. So if I hold it for longer, what happens is as that continues to lengthen, the fluid from in there is actually lost from the tissue to some degree. This is how we use loading to decrease inflammation in a connective tissue. So exactly. So I don't ever, I don't ever do big anti -inflammatories.
Dr. Beau (01:34:36.878)
dissipate.
Dr. Beau (01:34:42.67)
Yeah. OK.
Dr. Beau (01:34:47.726)
It's like ringing a sponge. Yeah.
Keith Baar (01:34:53.749)
What I'm going to do is I'm going to load and I'm going to hold because as I hold and load, what's going to happen is it's actually going to squeeze out all the liquid that's in there and then I'm going to release it and I'm going to do that again. And as I do that, what it's doing is it's squeezing out the sponge. And so over time, you're not going to suck in as much fluid because now what I've got is I've changed the material properties. I've given the right signal to that central core. And instead of making proteoglycans that are going to hold water, it's now going to make
collagen one in a directionally oriented manner, and it's going to regenerate that area of the tendon that has been damaged. And we've seen that happen in some of our case studies within seven weeks. That it's, that you've completely filled a hole in within the patellar tendon. And these are significant injuries within elite athletes. So it doesn't take a huge amount of time to do it. You just need to get in there and get load through that tissue.
that's going to allow stress relaxation for the donut. And then it's going to put load on the hole, directionally oriented load that is in the direction of that tendon. Because that's the signal that the cells are now going to use to directionally orient the matrix they make. And because they're being loaded in tension and not in compression, they're going to make type one collagen, and they're going to decrease the production of proteoglycan.
Dr. Beau (01:36:19.534)
So you said in the absence of load, you see a proliferation of cells within the tendon. But wasn't it Cubos article that looked at the cross sectional area of muscle versus tendon and offloading and you see the cross sectional area of muscle stays the same for six weeks, whereas tendon decrease in that same period. And wasn't that the whole drive for the non -off season for the NBA athletes and the rampant patellar tendinopathy?
Keith Baar (01:36:45.301)
Yeah, so, yeah, there's problems with that because anytime you offload a muscle, so again, Luke Van Loon's lab has shown that you lose about two kilos of muscle mass over five days from the quads. So, and that's with immobilization, but when you offload, you're gonna lose a fair bit of muscle. But what we've shown in our...
rat model is we lose about 10 % of the muscle mass over a handful of days, but we lose 20 % of the collagen mass. So yes, the tendon is actually, and Luke has shown that if he takes all of the tissues of the knee out, that the turnover rate of the achilles, or sorry, of the patellar tendon and of the anterior cruciate ligament is actually higher than skeletal muscle. It's almost twofold higher. So it's not surprising that then we're going to see collagen go down faster than we're going to see muscle go down.
And yes, this would mean that I don't want to have a period of time where I'm not loading my tissues. So if I'm a throwing athlete in baseball, they always shut you down for a period of like four months, no throwing. Well, that's horrible because those tissues, ulnar collateral, ligament, all of the tissues within the shoulder, you're going to atrophy for four months. And so then I'm going to start throwing again.
Dr. Beau (01:38:02.542)
Mm -hmm. And then you keep the force productions, the force production stays relatively high even in the face of a loss of some muscle mass. So now we can still, yeah.
Keith Baar (01:38:10.389)
Because there we're using we're using our fascial spring. We're using we're getting all of this velocity from from this fascial component But the tissues are no longer strong They're actually quite brittle because they've lost collagen mass and they've become a little bit more cross -linked And so that makes them more likely to get injured So a lot of the things that we've traditionally done as again healthy. we're gonna keep these people healthy. So we're gonna
You know, we're going to keep our old people from lifting weights or from doing stairs. We're going to keep our athletes from throwing or jumping in the off -seat. All it does is make them much more likely to get an injury in the future.
Dr. Beau (01:38:49.198)
Yeah, which is a interesting irony, but it pays the resiliency of humans and that we're constantly adapting one way or the other, right? Adaptation is neither negative or positive. It's just the direction you apply force or input. I don't want to take up too much more of your time, but I always ask these two questions to kind of end with. You can take them in whatever direction you want. The first one would be,
Keith Baar (01:38:58.197)
Okay.
Dr. Beau (01:39:14.766)
What is something that you long held true or believe that you have completely changed your mind on in the last maybe year or two? Is there anything that stands out?
Keith Baar (01:39:24.405)
So I'm going to open it up beyond a year or two. I used to, as a beginner, because I started in muscle, I thought that in order to get stronger, I needed bigger muscles. And that has completely and utterly changed. I can get people to be bigger and to be bigger without getting stronger. I can get people smaller that are significantly stronger and I can do every in between. So this relationship between muscle mass and strength.
is not nearly as linear as people or as I used to think it was.
Dr. Beau (01:39:58.83)
So what is the, so let's say we have somebody that gains no or like very little muscle mass or size but becomes exponentially stronger. What is the mechanism at play then?
Keith Baar (01:40:09.237)
So a lot of it is, again, there's two components that people focus on. Actually, there's one component that people focus on, muscle mass and then the neural component. Everybody's like, well, your brain is doing it. I don't think that those are the two components. I think that those are two. The last one is the force transfer component. And we've got data that we've just generated in about 600 rock climbers where we do a low force isometric where they put partial body weight.
on their fingers and they hold the partial body weight. It's like between 40 and 80 % of their body weight, just so that there's tension across the forearm muscles. And they do that for 30 days. They increase strength the same amount as if they hang as much weight from their body as they possibly could and do max hangs. And when you do the two of them together, they're additive, which means that when we're doing the heavy, heavy lifting, our brains...
are activating the muscle more and our muscles growing. When we're doing the light one, we're working on that force transfer component. When we do them together, we're getting a bigger increase in strength because those three components are actually what we have for strength. So when we're getting somebody who is getting stronger but not getting bigger, we're affecting how their connective tissue or that force transfer component of how they're doing the movement.
Dr. Beau (01:41:33.07)
Yeah, I cannot remember which paper it came from, but there's beautiful visualization of the windlass mechanism of the foot talking about those three subsystems playing together to create really good like, you know, drive or high threshold drive with a runner. So yeah, I love that. Okay, the flip side is what is something, and again, you're a researcher, this is literally what you do, but what is something that you think is true or this is the way it is, but there's no evidence to support that quite yet.
Keith Baar (01:42:02.965)
Keith Baar (01:42:08.245)
I don't know. That's a good question. So one of the things that we have recently shown is that there are specific pathways that are important in tendon growth. So in tendon hypertrophy, so it gets bigger. So we've just had a paper that shows that there are a class of drugs that can increase basically the cross -sectional area of a tendon.
We have preliminary data and we think that it's true that there's a different pathway that actually helps the tendon get longer during development, but also might be at play, say, after an Achilles tendon surgery where we get a longer tendon. And so we think that there's a nutrition molecular pathway that works that way that's important in tendon lengthening. It would be really interesting to look at in young athletes and in young people.
because if you can get the tendons to grow a little bit longer, maybe even just increasing collagen production as well, you might make taller athletes, you might make people with longer tendons who are more efficient and faster. So there's a little bit about that that we haven't done enough to know, but there's at least some hints that it might be possible.
Dr. Beau (01:43:25.006)
even that spurs my interest in you know 12 year old you know basketball player dealing with Oshkin slaughters you know that the growth the bone growth is outpacing tendon and we get it you know apophysial kind of traction so that yeah i think there's multiple applications to something like that
Keith Baar (01:43:37.397)
Yeah. That's one situation where the hydrolyzed collagen and gelatin has worked almost always for me. So my daughter was a big soccer player when she was like 10 to 12. All of her teammates were having either Achilles enthesotomies or Osgood's Flatter. Within two weeks of putting them onto hydrolyzed collagen and vitamin C, it would almost always go away. Like we didn't have a stick like the George.
Dr. Beau (01:43:46.798)
Really?
Dr. Beau (01:43:51.854)
Mm -hmm.
Dr. Beau (01:43:57.038)
and
Dr. Beau (01:44:05.198)
I hope you have stock in a company because if you don't and I post that, it's going to start flying off the shelf. Yeah, which is a good thing to know. It makes sense. And we talk about, you know, there's just a huge epidemic of just calorie deficiency within youth athletes. And then you talk about nutrient deficiency on top of that are in parallel. So knowing specifics like that are important.
Keith Baar (01:44:29.333)
And most young people don't like to chew their food and when you have to chew, because it's grisly, that's when you get the normal way to get collagen. So if you're avoiding all of those types of things, then it wouldn't be surprising that there are limitations based on intake that you can reverse really quite quickly, especially in growing individuals.
Dr. Beau (01:44:55.342)
Very interesting, all right. Well again, I know you're a very busy guy and I can't tell you how much I appreciate. I've been a fan of yours forever. I've been quoting your research articles in my classes, trying to get the word out to more people in my profession. So I just wanted to kind of give you a kudos. Obviously I know you're gonna keep doing this, so I'll keep tabs on you. Any last parting words or anything else that you're wanting to kind of leave the audience with before we jump off here?
Keith Baar (01:45:23.157)
No, that's great. Thank you for those kind words and thank you for having me. And then, you know, as things come up, I continue to post things. The only time that I actually go on X now is to actually post when there's some new stuff coming out of the lab. But we try and get that out there and we try and do everything that we publish as open access so that everybody can get to it so that it's not behind the paywall.
Dr. Beau (01:45:41.518)
and then.
Keith Baar (01:45:50.229)
And then if there is anything that's old that's behind a paywall, you can feel free to email me and I'll send it to you.
Dr. Beau (01:45:57.07)
I appreciate that. I'll put links to obviously what social media have out there. Some of the links, which a lot of these, like you said, are full text, non -paywalled. I'll put links to anything that we discussed specifically. Again, thank you, Dr. Barr, and hopefully I'll be able to talk to you sometime in the future and catch up with you on what you've been working on. All right, well have a great day. Thank you.
Keith Baar (01:46:16.085)
Sounds good. You too. Take care.
Ketogenic Diets and Mitochondrial Function: Benefits for Aging But Not for Athletes
Collagen and Vitamin C Supplementation Increases Lower Limb Rate of Force Development
Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis
Training with low muscle glycogen enhances fat metabolism in well-trained cyclists
Nutrition and the Adaptation to Endurance Training
To perform your best: work hard not long
Tendon mechanics: the argument heats up
Greg Rose, DC - Assessment is Gold
Summary
In this conversation, Dr. Beau and Greg Rose discuss various topics related to movement and injury. They touch on the alternating joint hypothesis, the three pathways of injury (trauma, insidious onset pain, and altered motor control), and the importance of hands-on palpation and manual therapy in treatment. They also discuss the potential for a TPI-like model for screening and coaching runners. Overall, they emphasize the importance of understanding movement and addressing both mobility and stability issues in order to prevent and treat injuries. Running as a sport requires highly trained skills, just like pitching in baseball. Any movement can be turned into a sports skill with the right boundaries, technique, and rules. Running can be a skill, especially in sprinting and distance running, where training plays a significant role. However, the challenge lies in maintaining proper form and technique over long distances. Shoe fitting is crucial in running, as it should match an individual's physical abilities and needs. Force plates have revolutionized training by allowing coaches to understand and evaluate athletes' movements and exercises. Guidance devices, like RNT, can be helpful in teaching proper movement patterns, but it's essential to transition to performing without the device to ensure transferability. Motor learning drills should be practiced with variety, high conscious level participation, and sufficient time to strengthen tissues and make individuals more resilient. The decision to transition from motor learning to strengthening is a coaching decision based on trust and proficiency in performing the desired movement pattern. In this part of the conversation, Greg Rose and Dr. Beau discuss the concept of advantageous asymmetries in sports. They talk about how certain asymmetries can be beneficial for athletes in specific sports, such as golf and baseball. They also touch on the topic of normal movement patterns and how they can differ among athletes. Additionally, they discuss the importance of force production and how it affects performance. They mention the idea of the 'big brake theory,' which suggests that an athlete's ability to decelerate is crucial for acceleration. Finally, they mention ongoing research and development in the field of movement analysis, including the exploration of top-tier movements for assessing wrist and foot mechanics.
—
Chapters
00:00 Introduction and Background
02:01 Understanding the Alternating Joint Hypothesis
03:17 New Chapter 3
09:03 The Three Pathways of Injury
24:47 Applying the SFMA Model to Running
26:08 Coaching Runners from a Skill Standpoint
26:15 Is Running a Skill or a Natural Human Movement?
28:16 The Importance of Training and Technique in Sports Skills
30:21 The Role of Genetics in Athletic Performance
33:30 The Significance of Proper Shoe Fitting
37:02 The Insights Provided by Force Plates in Analyzing Movement Patterns
46:49 The Value of Feedback and Guidance Devices in Motor Learning
49:28 The Combination of Guidance and Practice in Motor Learning
51:55 Making Informed Decisions in Progressing from Motor Learning to Strengthening
52:20 Motor Learning and Repetitions
52:51 Advantageous Asymmetries in Sports Performance
56:29 Ankle Mobility and Running Performance
57:35 The Role of Force in Sports Performance
59:04 Training the Non-Dominant Side of the Body
01:01:31 Future Developments in Movement Assessment
01:13:37 FARM Cast Outro.mp4
—
Dr. Beau (00:00)
or even.
Greg Rose (00:01)
I'm here probably 60 % of the time and then California probably I'd say 30 % of the time and then the other 10 % traveling all around. You know what I mean? Yeah.
Dr. Beau (00:15)
Yeah. Wow. Why Arkansas? Do you have family there? Does your wife have family?
Greg Rose (00:21)
This is my wife's whole family is from here. She was born and raised there. We got a killer property and we have 80 acres here. We have our own river. You can paddle board and fly fish. I mean, we grow most of our own food. It's like adult camp here. It's awesome. Yeah.
Dr. Beau (00:24)
Okay, gotcha.
wow.
Yeah, sounds terrible. Well, I'm already recording because I hate like missing stuff. So we're just going to kind of dive in. But I just, I appreciate being on here. I know obviously you're busy traveling around and working with everybody. But for those that don't know, I can't imagine if you're in our field, you don't know who Greg Rose is, but I ran into Greg at the, what the ACRB rehab symposium a couple of weeks ago, gave a great talk that I got to sit in on.
And during that talk, as most of us do, that are kind of, you know, nerds in the seminar realm, like a bunch of questions came up and I asked, I think I asked the most questions during your entire talk. but I didn't want to take over. So there were a lot of things like perfect format would be podcast to bring you back on and just ask more things that I was kind of curious about. so I'm going to jump right in if your game. I don't know. Yeah.
Greg Rose (01:22)
Yeah.
Let's do it. Thanks for having me. Cool.
Dr. Beau (01:30)
and again, I'll give a little bio on Greg, but again, I just, he's not a newbie in our field. So if you don't know who he is, Google Greg Rose and you'll find out really quick. the big, the first thing I wanted to jump off on, because I think it's going to set up the rest of the conversation was you brought up again, which I've heard you talk about. I've known about for a long time is the alternating joint hypothesis, which Mike Boyle, Greg Cook, you know, mobile stable joints. My question is, and.
Greg Rose (01:38)
Ha ha ha ha.
Good.
Yep.
Dr. Beau (02:00)
I don't want this to be like, hey, we say different stuff when we're in different crowds talk. That's not what I'm trying to get after here. But is that, is that a rule or is that a heuristic? And what I mean by that is, is it something you live and die by or is it something it's like, hey, when you're kind of new and you're learning things, it's a good, it's a good rule of thumb. Or if we had different level of professionals, it plays better for, you know, maybe the coach.
Greg Rose (02:06)
.
Dr. Beau (02:26)
versus the medical professional just because we operate at different levels of information. Like we're all just operating at different levels. What's your take on that?
Greg Rose (02:34)
Okay. Yeah. So I well this is a loaded topic, but I would say that
this is our 99 % rule, right? So I would say nothing's 100%, right? But like you said, I think this is a very gross oversimplification to understand how the body would prefer to move. Let's put it that way, or was designed to move. And we always say that, you know, certain joints were designed to be very mobile. Those are the joints like the ankle, the hip, the shoulder, the thoracic spine, the wrist, because if you look at the joint,
angles and you look at the orientations and you look at the space of the design of the joint it's meant to move in all three planes pretty freely right so you know like your ankle can move in every direction your wrist can move in every direction but then there are certain joints that are designed to move in one plane of motion right like your lumbar spine you know I always say lumbar spine it better be mobile like you better be able to move your lumbar spine now in our joint by joint approach we call it a stable joint right what that means is that
Dr. Beau (03:29)
Mm -hmm.
Greg Rose (03:36)
it's very mobile in one direction. I think a lot of people think stable joint, though, and they just go, that doesn't move. I mean, the last thing in the world I'd want is your lumbar spine not to move, right? But what we want the lumbar spine to do is move in the axis that it was designed to move in, right? It was designed to flex and extend. When you try to twist and side bend from your lumbar spine, a lot of bad stuff happens, right? So I think, basically, I think the number one thing people, they argue about, like, should that be stable? Should that be mobile?
Every joint in your body is mobile. That's why they call it a joint. It's supposed to move. Our philosophy is more of three -plane versus one -plane joints. And so what we say, and when you think of it that way, it's pretty much the 99 % rule. It's kind of like, all right, your knee was primarily designed to flex and extend. Can it rotate? Yeah, it can get up to almost 20 degrees, depending on if the knees flexed or extended. And can it side bend? Yeah, but do I really want it to side bend? Probably not. You know what I mean?
I think in my way of thinking about this is I always try and make the path of least resistance through your mobile joints. If your mobile joints are restricted, the body tries to take the path of least resistance. Well, a restricted mobile joint is not the path of least resistance. So it tries to go through a stable joint. When a stable joint tries to become a mobile joint, which it can 100%, we tend to get bad stuff happen.
Dr. Beau (04:47)
Mm -hmm.
Mm -hmm.
Yeah, and I bring that up because again, you're creating a, it's almost like creating a recipe with treatment. You create some sort of schema so people can better understand how something works that's extremely complex because it gets argued, you see it in social media and all over the place, this whole, I don't know how long this concept's been around that people are like, well, every joint's supposed to be mobile and then it gets kind of misconstrued or taken out of context.
Greg Rose (05:28)
I think this is that word stable. Like when we say mobile stable, mobile stable, I think when they use that word stable, I think people might think of that as immobile.
Dr. Beau (05:38)
Yeah, well, it gets into the neutral spine, you know, misrepresentation and things like that. Again, I'm not saying like you and I are on the same team, like, we're against all those other people and we know what we're talking about. But the misconstruing, I think, literally just comes down to people wanting to argue. I think if you literally sat down in the same room, we'd be saying the same stuff.
Greg Rose (05:57)
Sorry, I got my doctor. But I actually think, I actually think there's all there's, it's terminology is first and foremost. I think when people, when you really sit down and listen to them, you kind of go, wait a minute, you're saying the same thing I'm saying. They just don't realize it. And, and then sometimes I think they start arguing over is what's more important, strength training or stretching. And if I'm going like strength training versus stretching is not the mobile stable car. Those are two totally different conversations, right? Like if I want to improve your mobility, I can use strength training, right? That, that
Dr. Beau (06:05)
Yeah.
Greg Rose (06:27)
We're not talking about like what's more important, stretching or strength training. I see a lot of people confuse that and I'm like, well, you're not even speaking about the same topic, right?
Dr. Beau (06:37)
What a way do you feel like, cause a lot of what you and Greg Cook and the whole FMS, SMA kind of team have done is tried to simplify things, right? Create screens, create assessments. And sometimes I think the simplification actually gets a lot of pushback because it seems over simplified. And then people are like, well, that's not how it is. And you're like, yeah, we know.
Greg Rose (06:57)
Yeah, I mean, I think, I think, you know, it's kind of like, I believe everybody prefers. This is just my personal bias to be talked to like third grade. Right. So I, I don't want to be talked like, like I'm an idiot, but I just want, please make it simple. Like, don't, you know, like the MRI is for the doctor. You don't hand the MRI to the patient and go, here you go. You look at it. You've got, had a lot of education to read it. And then you try and explain to them in third grade, what's going on. It's the same thing here. And I feel like.
you know people sometimes like me and your screen is it's so basic like there's so many more than we're like it's not basic enough like we're trying to make it simple
Dr. Beau (07:32)
Yeah, which it is important. And again, I think I was telling people in the crowd while I was listening to your talk of, you know, why I thought you were such a good teacher is how, you know, analogy stories and simplification and simplification for the purpose of understanding, not just to dumb it down. but that's tough. I mean, you're literally taking the most complex thing in the known world, the human and trying to like make it more understandable within the realm of, you know, a professional setting. something else that you brought up during that talk.
Greg Rose (07:48)
Yeah.
Dr. Beau (08:02)
was you talked about this, and I don't wanna, I'll let you tee this up, but you talked about the three pathways in injury, right? And I think you brought up a coach from, what was it, soccer? Or yeah, or yeah.
Greg Rose (08:12)
Ireland. Yeah, Liam Hennessy, one of the best physical therapists on the planet. Yeah. Yeah, so you know, when we were doing our advisory board at TPI, right, we have advisory boards on, so at Titleist, we have advisory boards for coaches, we have advisory boards for fitness professionals, and we have a medical advisory board.
And when we got that medical advisory board, me being young and naive, I said, I want to make a difference like everybody does, right? And I want to do something special here. And I remember saying to Gray, at the time, Gray Cook was on that board, along with a bunch of other smart men and women. And I said, hey, you've got your functional movement screen, right? That's for healthy people. But you always say, if someone's in pain, it can alter the FMS. And it's really not designed for people in pain. I'm like, we should create a pain one, right? And he said that.
I always say I felt like I was talking to Henry Ford. He was like, you know, actually I've been I've been actually working on one and I always say he showed me the backbone of the SFMA. I always feel like we got in the car, we drove and I'm like, this is amazing. Now halfway down the road the tires fell off and the engine blew up, but I was like, that's a cool idea, but it needs some work. So we went and basically made it our journey to let's perfect this screen. And I took a bunch of these smart men and women
on the advisory board and I said I want you guys to help us do this right and I said you know I want to be able to come up with a movement screen that can predict injury
Little or predict us the the cause of injury right better than any other movement screen on the planet because I always say You know their source and cause right so if your knee hurts That's the source of pain, but the cause could be your neck right it could be anything so we're like could be coming with a movement screen that could identify the true cause of the source of your pain and This very smart man Liam Hennessy said to all of us He said you know Greg if you're gonna come up with a movement screen and and you want it to be the
on the planet, you really need to understand the mechanism of injuries that can happen. And I'm like, well, I think we're pretty good at that. And he said, I don't think you are. And I go, what do you mean? And he goes, so I think this is the problem in medicine. And this is probably 2005, maybe? He goes, Greg, I think we can put all injuries into three buckets. He goes, the first bucket would be trauma. So obviously, if somebody punches me in the face, I know where the injury came from. It was a fist hitting me in the face.
And he said, are you good at diagnosing a trauma? I said, yeah. So if somebody gets a trauma, I can see where the swelling, the pain is, right? Let's say you twist your ankle. Ankle swells, so the trauma creates the pain.
And then I could see how they alter the way they walk because the injury created the altered movement. And he said, I agree with you. I think you guys are good at trauma. He goes, there's a second way to get injured. The second way to get injured is insidious onset pain. He goes, what if you didn't sprain your ankle, but you just started walking and your ankle had pain? I think we've all experienced this. Insidious onset pain. I don't know why it hurts. I don't remember doing anything, but it just hurts.
Dr. Beau (11:05)
Mm -hmm.
Greg Rose (11:22)
He said, are you good at diagnosing insidious onset pain? I was like, well, it's not as easy as trauma, right? But I was like, you know.
I can track dermatomes. I can evaluate the joint. I think I can still figure out why the joint's hurting. I go, when you get insidious onset pain, it alters the way you move. I understand why you're moving weird. And then because you're moving weird, it can lead to bigger traumas because you're not used to walking this way. And I go, it's so related, but yes, I think we can diagnose that. He said, good. He goes, now there's a third category of all musculoskeletal injuries. And he said, that's basically altered motor control.
He goes, in other words, have you ever woken up where you just weren't walking the same? Maybe you slept on a different bed. You ate some different food. Maybe you worked out in a gym that you haven't been out before. And we've all experienced that too. Let's say you're traveling. And you get up and you're just like, man, I just feel stiff today. So now when you feel altered,
you don't usually do nothing, you usually just walk it off, right? You just alter the way you move. So this altered motor control, it's altering the way I move, so I'm moving weird. Because I'm moving weird, I'm vulnerable because I'm not used to doing this, and that can create trauma, which can create pain.
Dr. Beau (12:23)
Mm -hmm.
Greg Rose (12:37)
We all agree that those are the three mechanisms. Trauma, insidious onset pain, or altered motor control. And then he said, are you good at diagnosing altered motor control before it's a problem? And I said, no, that's the problem. And he's like, so he goes, you need to understand, though. He goes, I'm not even sure if we know what normal is.
But we need to know what normal is before we can identify abnormal. But we all know this is probably the leading cause of musculoskeletal pain is some type of altered motor pattern is happening before the trauma or the injuries happening. And he said, you know, this is going to be a tough journey. This is what Liam said to us. And we all in our young cocky stage said, you know, hey, I think enough smart minds around us, I think we could we could knock this out in six months. Well, that was 2005. You know, I would tell you that we're virtually
Dr. Beau (13:25)
Mm -hmm.
Greg Rose (13:28)
almost 20 years into this and we're still not done by the way but the SFMA has come a long way and it's it's pretty pretty impressive but our whole goal was to try and do what Liam said become the best at identifying altered motor control because we know it's probably the number one cause of musculoskeletal injury in humans.
Dr. Beau (13:47)
Well, and that was, I mean, you and I didn't, you know, we went to the dinner, you know, that Saturday that we were in Florida and I was kind of giving you the 50 cent version of what I was going to talk about on Sunday. But this was kind of, you know, this is a question. This isn't, I an answer or anything. But as more research has come out and in particular people like Phil Snell and Justin Dean have started kind of elucidating some of this and, you know, this goes out back to Diane Jacobs. And I mean, people talk about this forever.
There's the three mechanisms. I mean, trauma, let's remove that. We get that one for sure. Obviously, I don't want to put words in your mouth, but I think you just said it. Like the SMA and that tool is very much focused on altered motor control. We go after the dysfunctional non -painfuls and try to let things change, right? Permeate through as we focus on those. My, kind of what I was bringing to topic was, there's a lot of evidence showing that sensitization in the periphery can occur without altered motor control.
Greg Rose (14:31)
Yep.
Dr. Beau (14:45)
It can just happen with normal movements, right? Without aberrations and then we can get into the whole, are there bad biomechanics and good biomechanics, which I think I kind of know where you'd lean on that one. But then that leads to the question of, well, there's two questions. Are there times when you're actually treating pain to not let the compensation come through? And how do you pick that up in the screening process or the assessment process?
hey, I think this is insidious onset pain and we know that that will change motor control or alter motor output. And then the other one is, well, how often is that happening? And like you said, you know, the SMA mindset is, hey, we think alter motor control is driving the majority of the pain that we're seeing outside of trauma. And again, I don't know. I'm just looking at both sides. I mean, I've, yeah.
Greg Rose (15:31)
Let me just say real quick. I believe in all three categories. I do believe there is pain generation without altered motor control first. Like I said, I don't think it's the most common, but it doesn't even matter. If we have the debate on what's the most common, who cares where all three are possible? You have to be good at all three of them. I'm not sure if your question was, do I believe that there's a...
Dr. Beau (15:59)
No, I guess because again, I agree that all three and again, I think it would be hard to determine the, what is the biggest swath. But my thing is if we have a real trauma, we can, that's easy to pick up. We had an on -field assessment, right? Your sideline care, ultra motor control. You guys literally built in my opinion, the best tool for sussing that out. Well, then is it, Hey, it's a exclusionary criteria. You went through all this and then this is what you're left with. Then is that how it's treated or is there some other way? And that's kind of what I was presenting in
Greg Rose (16:00)
Yeah.
Yeah.
That's it.
Cool.
Dr. Beau (16:28)
I was just presenting the evidence, not necessarily the best tool, because I don't know if there is a best tool.
Greg Rose (16:34)
Here's what I'll say about it, and this is in no way the correct answer to your question. But if you had somebody in pain and you did a top -tier S -symphoma and it was clear, everything's red, then I would say all terminal control is not your source or not your cause here. So I'd go. Now with that said, it's very rare to see somebody who passes all those, but that doesn't mean they can't have both, too.
And then it gets to that chicken or the egg like if somebody came in did it start with insidious and now they have the alternate motor control because I don't know when I got them after right so you know the question is is how long can somebody have this descent or this pain pattern and not show alternate patterns I think you'd have to get them fresh like I think it would
Dr. Beau (17:10)
Right, yeah.
Yeah, and I think it's almost immediate. I mean, look at an ankle sprain and we know it's like literally a scissorhap.
Greg Rose (17:29)
Yeah, that's probably it. But I'm just saying like, like if you said, Hey, what if there's a bunch of people who don't have altered motor control, but they have these problems with Pamir? I'm like, how long could they have those problems and not alter their motor control? I don't know. I don't know if that exists. It sounds like a unicorn to me, but I, maybe, maybe we get them fresh. You know what I mean?
Dr. Beau (17:47)
Yeah. Well, that tees up this next part. So again, maybe it is just exclusionary. You're like, man, we've went through this. It doesn't fit the categories and now we're jumping over here. This stage in your career. So you said 2005 was the first like kind of epiphany moment with the Espanay of Gray showing you that. So almost two decades later.
Greg Rose (18:07)
Yeah.
Dr. Beau (18:12)
Are you, if we walk in and I shadow you for a day, you know, treating golf and stuff, is it just like the playbook of SMA? Is it strict? You're running top tier to full breakouts or if we watch Gray grows like how the hell did he get there? Cause you're jumping around now because you're allowed to break the model.
Greg Rose (18:29)
Remember, if you're in SFMA, I apologize now. I'm the jerk who made the flow charts, right? So I'm the engineer of the group. So I like flow charts. And when I create those systems, I do not deviate, right? So I just feel like I've...
You want to say experience allows you to jump, but experience can make you make a mistake by jumping too. So I think if somebody walks in, first of all, if somebody comes into TPI, comes in to see me, if they have pain in any form or fashion, we're doing top tier, so we immediately break out. Now if they don't have pain, that's a different story, we're going a different route. But if they have pain, we're running the rule book. That's the way I do it. So some people are surprised. We have people shout at me all the time, and they're like, I thought you'd do something totally different than you teach in your class.
Dr. Beau (18:53)
Great. Yeah.
Greg Rose (19:18)
I'm like, no, we actually do exactly that.
Dr. Beau (19:20)
Which is refreshing, it's gotta be, because I'm sure that exists out there within the teaching and seminar world. So I did ask you this question, we didn't get to talk on it too much, that if you get to the end of the SMA, outside of a motor control issue, like an SMCD or whatever the most current terminology is, you basically get down to like a tissue disorder dysfunction or a joint disorder, which comes down to hands -on palpation, which I heard you.
Greg Rose (19:44)
It's either you get mobility or stability. And if you've got a mobility problem, it could be joint or tissue. Yeah.
Dr. Beau (19:51)
Yeah. So for those, you know, maybe students, new docs, even people that have been in practice for a while, there's a, I don't know how big a wave is it is. It can seem bigger than maybe it is due to social media, but there's a big wave of, Hey, we can be totally hands off of treatment. We can do an assessment. We can go through load management protocols. So let's say somebody uses an SFMA and they get down to the area via breakout that they think there's a problem.
how important is hands -on palpation, and then we could take that into actual manual therapy if that's necessitated based on exam.
Greg Rose (20:30)
I mean, this is gonna show my biases now, but you know, I feel like...
that one of our weapons is our manual therapy skills, right? So I feel like I always, I always, I know we have rules on whether it's tissue or joint, but when I get my hands on it, I can kind of start to really tell, you know, and this is where experience comes in, like, no, that feels like the joints are shifted or no, that feels actually like more tissue. And, and I feel like I always say mobility problems are like brick walls, right? You want to knock down that brick wall. Now exercise can
be a hammer and chisel and you can knock that wall down but sometimes you're like just give me some TNT right that that's manual there that's that's what we do right so I'm like if I can just blow the wall down in one visit and then keep and have the exercises keep the wall down I'm going speed I just feel like
Clients, as we all know, humans want the easy button, right? I mean, if, you know, this is why people take medications and pills and so on, they just want the easy button. And I'm going, you know, I'm pretty much the easy button. You're the easy button. If you lay down on my table, I don't know how much easier that gets, right? We can kind of knock this loose. Now, I always say, you can't be lazy. You're going to have to try and keep that wall down and I'll show you the drills and stuff to do that. And if I can't get the whole wall down, you're going to have to help me with these exercises, perpetuate this. So a lot of times it's a teamwork approach, but
Now, there's nothing wrong, like if you're not licensed to do manual therapy, hammer and chisel works too. Like, let's, there's nothing, let's keep going, let's knock the thing down, and there are some amazing exercises. Now, I'd say with a little caveat, this is why SFMA differentiates mobility from stability. If it's an SMCD or stability problem, well, I'm going to, I don't know what to mobilize. There's no, definition, there is no mobility problem.
Dr. Beau (22:20)
So in like you guys going back to the whiteboard ever, have you ever thought about going further into helping people determine, you know, joint versus tissue just beyond, because I mean, when I got taught the class, maybe it's different now. I mean, you guys were like, well, you got to figure that out with hands. Have you went further?
Greg Rose (22:32)
We did it.
So now? Yeah, in our level 2 SFMA, we have an entire diagnostic algorithm now where we go through and we try and give you the signs differentiating. Like, I'll give you a couple. So the big signs we would say between tissue and joint. So joints tend to be, I call it equal opportunity employers. They restrict multiple points, right? So if a joint's restricted, let's say your hip flexion is restricted, but everything else is clear. Not saying that can't be joint, but that you more thought that there was a higher chance it's tibia.
whereas hip flexion is restricted, hip intro rotation is restricted, and hip extension is restricted, I'm starting to lean more towards the joint, it's probably restricted. So joints tend to go multiple planes, tissue tends to go single plane, but once again, I can show you tissue that restricts multiple planes, so you gotta get in there and palpate. And then the second most obvious would be when you're taking a joint, like if I'm flexing my elbow, right?
where you feel the tightness. If it's on the contractile side, there's not many tissues that get restricted on the contractile side. That's usually a joint block.
Or if it's on the elongating side, you feel something tightening up, that's usually not joint, that's usually more tissue, right? So if I feel something on the elongating side and only one plane of restriction, I'm pretty confident I'm dealing with a fascia or a tissue or some type of connective tissue. If I got multiple planes, it's on the contractile side, I'm going, yeah, it smells like joint to me, right? So we kind of go through, we show an accessory joint palpations. If it's restricted, we always like the palpate joint first, because if the joint's
not clear, it's kind of even hard to get to the tissue tension, right? So we do accessory playing. In our level 2 SMA, we teach in our online classes and live classes how to do those palpations. And then we do a tissue evaluation that we really took from Mike Leahy at ART. I helped him teach the diagnostic track for ART. And it's a tissue palpation.
find where the links tension are. So yeah, we do kind of, I think we do now help you get to that local biomechanical testing.
Dr. Beau (24:40)
Yeah. Yeah. Cause you basically just left us out to fend off the wolves. Yeah. You're just like, better be good. no, I figured that was coming, but you know, we were fairly early in the game. so now getting more, I'm interested in all this stuff. And now like, I have questions that I've literally had since I took SMA almost a decade ago now. obviously the TPI, you know, SMA medical model has been wildly successful with golf and tennis and baseball, rotary sports.
Greg Rose (24:43)
I left it in you forever.
Dr. Beau (25:10)
The Sfma and FMS are based on neurodevelopmental models. He talked about that a little bit in Florida. When we look at running, right, because I'm in running both from personal, what I like to do, but also who I treat, it's kind of at the top of the neurodevelopmental model, right? Like nobody teaches you how to run, but for some reason there's a lot of gate training and gate retraining and all that. So I'd love to pick your brain on, first of all, do you think,
Greg Rose (25:26)
you
Thank you.
Okay.
Dr. Beau (25:40)
that a model like a TPI model of screening specific for running as a sport could work. I know it's a broad question.
Greg Rose (25:46)
I have no doubt. I'm 1000%.
Dr. Beau (25:53)
Okay. So here's my next question then. So I, I've thought about this for years, actually put a pitch into Brooks about the Brooks running Institute, trying to steal everything that you ever put out there and say, Hey, there's this TPI thing. And the pushback I kept getting from people in the field that work with running is well, you know, running is the thing that's not learned. And then there's a, there's two diverging paths, right? It's basically, if you look at dynamic systems theory, right? You have a tractor states and
Greg Rose (26:03)
I think it would be great. It would be great.
Dr. Beau (26:21)
how a joint can move or what's allowed or not allowed is gonna drive something. And then you have this whole gate retraining that you can see people, you can change via cadence and stride length and all these different mechanisms. I don't know how much you've worked with runners. I'm sure just from being a biomechanics nerd, you could dive into this, but I know where I stand. I just wanna kinda hear what you think. If you think that model can work, you just said yes. Well then.
Do you think that we should be or could be coaching runners from a skill standpoint, just like a golfer? Because I asked the question during your talk of.
Greg Rose (26:53)
I can't even believe that's a question.
Dr. Beau (26:55)
Well, in the, but if you look at the, if you look at the research again and you look at the highest level people in the field, there is not a concise, you know, one side or the other. It's, it's literally split in the middle.
Greg Rose (27:06)
That's crazy to me. So it's like I can use this analogy anywhere. Like if I said, you know, throwing's not trained. It's just something that humans can do with time. Right. OK.
But pitching is a skill of throwing that is highly trained. So I agree. Running, humans can run. That does not mean you're going to go beat Usain Bolt. That's a very highly trained sprint is a very highly trained. So is that what we're talking about? Running as a sport? Are we talking about this?
Dr. Beau (27:24)
Mm -hmm.
Yeah, both sprint and distance can get some different, you know, ideologies. I get that. But yeah, just running as a sport. Yeah.
Greg Rose (27:47)
Yes, you know, it's kind of like, you know, I always feel like when you're young, you learn basic human movements, the fundamentals, fundamental movement skills, right? So throwing, you know, running, sliding, hopping, all those things. And those have no, there's no objective. It's just, you know, throw that way, right?
When you put it into the framework of this is a baseball game, you have to stand on a mound 60 feet, six inches away. You have to hit into a certain zone over here and you have to fool a hitter over there. It now becomes a barely highly trained skill. And there is no way anybody's going to tell me that you can't train pitching, right? From, from throwing, right? Those are two different, even if it was, I'm a hunter, I'm going to throw spears. There is an artwork that's passed down from generation to generation on how to do these things. Right? So to me, any movement of course,
Dr. Beau (28:22)
Mm -hmm.
Greg Rose (28:40)
your humans learn how to do these movements. But any movement can be turned into a sports skill, right? If you put the boundaries, the technique, there's rules, guideline, anything that has that, now all of a sudden motor learning becomes an appropriate thing, right?
Dr. Beau (28:43)
Mm -hmm.
Greg Rose (28:55)
And I've spent many hours watching coaches improve people's running. Just because biomechanics is sometimes opposite of what you believe. What do you think? You think, I should do this until somebody really highly trained and skilled tries something new and different, learns something, until that information is because it's not intuitive. It's not natural to pitch like that.
You know, if I sit in, I guess, different tracks, different terrain change all these things. But to your question is running a skill, it depends on if this is a sport. If it's sprinting the 200 meter, if it's hurdle, those are sports. Those are 1 ,000 % training, right?
Do I agree all humans can just learn how to run on their own? Yes. Will some be faster than others? Yes. They might get luckier. But if I train somebody how to sprint based on our biomechanical information, they'll beat all of them.
Dr. Beau (29:57)
What about, does it change at all for distance running? Let's say we get a marathoner.
Greg Rose (30:01)
1000 % it's still a skill
Dr. Beau (30:03)
The reason I ask that is, so if you look again at dynamic systems theory applied to running, what they've seen, especially as they study more ultra marathoners, is people, they slip into this attractor state regardless of coaching. And they see this shifting that they've seen, basically they did a study at Western States where they just put basically Dartfish -esque technology on people and watch what happened to their gate and they saw people gate shift.
So they would go to more pendular gait, kind of a double stride. So they're almost like speed walking to running. And they would do it normally to basically probably offload tissues and metabolically efficient. And then coaches took that data and started coaching people to basically gate shift throughout an ultramarathon to change their gait consciously. So you talked a lot about motor learning concepts in your talk, which that's where I wanted to go with this. Cause now it gets very interesting to me that, okay, for sure I agree. We can coach the skill of running.
Greg Rose (30:53)
Thank you.
Thank you.
Dr. Beau (31:00)
But then you see the longer somebody runs based on metabolic demands and then also biomechanical efficiency, like what you can do for muscular endurance and how the joint moves, that people tend to fall back into the same old pattern, that old book, as you would say, right? At a certain distance and then it gets really hard. Do you think that's, you know, just another training like echelon they have to kind of work on or like, do you think that's just like, God, that's a really hard thing to change, which I get it's hard to change. That's motor learning.
Greg Rose (31:29)
I guess what I'm trying to say is I would find it really hard to believe that if I took the top three ultra marathon runners in history and I put them in front of a young ultra marathon that they couldn't teach them anything. Do you agree with that?
Dr. Beau (31:46)
Yeah, I agree. Yeah, and again, I agree, but again, there's no absolutes. I think we'd agree on that as well. If you looked at the top, yeah.
Greg Rose (31:54)
Yeah. Let me say something about genetics. Okay. So you always say like, you know, we always say, you know,
Working hard beats genetics when genetics doesn't work hard, right? But if genetics work hard, it's hard to beat, right? So there are maybe some freaks who are just born with all the knowledge, all the wisdom of wherever they got it, and coaches just need to get out of their way, right? I am sure we can come up with examples of that. But I am also 1 ,000 % sure that is not the majority. That is the extreme minority.
Dr. Beau (32:09)
Yeah.
Greg Rose (32:30)
And I'm going, I don't know if I'd like, if I want my kid to win the Super Bowl as the quarterback, I don't know if I want to just go, I just hope they got the genetics where I, we've seen you can train a quarterback. You know what I mean? Yeah. Now again, might be one of those, like you said, like, you know, I,
Dr. Beau (32:42)
Yeah, yeah.
Greg Rose (32:48)
I don't want to be so naive to say, like, I just, I can't imagine that you being the best at a sport and to be the best in the sport, you just need nothing. Just, just no previous information, no coaching, just keep people away from you and you'd win. I, I'd have to see a lot of evidence of that. You know what I mean?
Dr. Beau (33:07)
Well, the other interesting thing is, is when you look at the differences in people's gait based on anthropometric measures and male versus female and where, what sports they play growing up, what distance they ran growing up and how they got into the sport of whether it's marathon, ultra marathon, you know, the Olympic trials are going on right now. I, what I see in running is that it's not a TPI approach of there's a million swings for a million golfers. It's there's running gait.
and then that has to permeate across. I think that's the problem in my opinion of how running is trained as a skill is it's very put in a box. And I get that there's.
Greg Rose (33:43)
Well, let me tell you, I'm gonna give you the secret sauce here. This is, you know, people always ask like, so you said not a TPI model. Well, let me explain to you what a TPI model is. Like how we, because we like that we've done this for softball, we've done this for baseball, we've done this for tennis. Actually, I'm building one for quarterbacks right now with Jordan Palmer. And we've got, I built one for US lacrosse, we never launched it, but we got like, I feel like you can do this for any sport.
Dr. Beau (33:54)
Mm -hmm.
Mm -hmm.
Greg Rose (34:09)
Here's maybe the difference and maybe they'll understand my philosophy. I believe that if you take any sport, let's take running, right? And you take the top 20 minds in biomechanics or coaching, put them in a room. And I said, okay, guys, let's all agree on what's the best way to run. How's that gonna go? Is that gonna be smooth or is that gonna be like World War V?
Dr. Beau (34:32)
In running, I'd say it'd be fairly smooth if you took the top 20, but it.
Greg Rose (34:36)
So I'll talk to the top 20 coaches in the world. I'm talking about the top 20 coaches in the world. Coaches, not players, like the coaches, and say, can we all agree on this is the best way that you should run?
Dr. Beau (34:47)
I think there'd be a little bit of strife, but I think largely everybody agrees.
Greg Rose (34:50)
Okay, okay. Well, that would be very unique because usually there's lots of like different techniques and stuff in there. Normally, like, how did that go like?
Dr. Beau (34:54)
Yeah. How people train, I think would be the point of conjecture and running. Yeah. Yeah.
Greg Rose (35:00)
I'm not even there yet, it's just more of agreeing on what running should look like. Normally what we find, like if I said, let's take 20 baseball pitching coaches, put them in a room and say, okay, what's the best way to pitch? We're gonna have a debate, right? They're gonna have a hundred thousand percent. Because you and I both know there's a million ways to pitch, right? So they're all right and they're all wrong, right? So what we never do is we never say, here's how you run.
Here's how you golf. You'll never, if you come to TPI, we will not tell you how to swing a golf club. What we do instead is we do the complete opposite. We all go, could we agree on the most fundamental biomechanics that people shouldn't do? So we go, you know,
Okay, when you swing, should you move towards the golf ball during your swing? Coaches will say, no, you shouldn't do that. You lose space, like in baseball you get jammed up, you can't hit an inside pit. Okay, we agree you shouldn't do that. Should you start with your upper body first, and so your lower body, that's called over the top. Every coach says, no, you shouldn't do that either. Now if I said, how should you start? That's not our philosophy. All we're saying is we agree on these certain
Dr. Beau (35:47)
I don't know.
Mm -hmm.
Greg Rose (36:11)
Fundamentals that shouldn't we shouldn't see so what we do is we we go through and we we interview for years like two three years Tons of coaches and we get down to a point where we go Okay, we came up these 15 things that every coach agrees with right so like we call it like in golf We have the big 15 right in baseball pitching. We have the big 12, right? The big 15 are the 15 most common Characteristics that every coach on the planet that we've talked to would say yeah, of course you shouldn't do that, right?
So once we show you, like, here's all the things you shouldn't do, people go, now I know what to do. I'm like, well, first of all, I didn't tell you what to do. I just told you you shouldn't do these things, right? And then what we do is we say, you know, it's interesting. A lot of people do these things, right? A lot of people do these things. And we go, why? Why do people do these things that we all agree you shouldn't do? Well, one of the reasons people do things is because that's the only physical thing they can do. They don't have ability. So we said, is there a way for us to do a physical assessment, to screen somebody?
And see if they can't do this, they're probably going to do one of those 15 things. So to answer your, to go back to your running, like if I was going to go after marathon or ultra marathon or something that mattered, I would sit down instead of trying to figure out, okay, what's the best way to run? Like, can we all agree on, here's the things you shouldn't do, right? Maybe a coach gave him the wrong information. And if you, if you can agree on all the things that you see people do wrong, you've got a potential to come up with a screen.
Dr. Beau (37:21)
Mm -hmm.
you
I mean, I teach, we basically have seven parameters that come from all of the gait analysis research from the most detrimental to the least detrimental.
Greg Rose (37:40)
That make sense?
And can you do a physical screen and predict if they're going to do this? And you're already happy.
Dr. Beau (37:55)
For sure, I basically came up with mishmash. And my thing is, I guess I'll kind of eat my words from before. I think what happens is, which I think this happens in all sports and why you guys are successful. So let me back up. I think coaches and trainers try to get people to run a certain way without seeing the physical limitation, which creates the problem, which in essence, now we have a non -implement sport, right? And the body is the thing.
And yet we just kind of say, we don't want to have overstriding or a tibial inclination angle of this much. And we don't look at, can their ankle even do that? And then we create a problem by trying to idealize the running. And I think that's the crux.
Greg Rose (38:33)
I'm gonna date myself, but Patrick Swayze said, don't put baby in a box, right? We don't do that, right? If you're saying everybody's gotta swing like this, I totally disagree. Yep. Yep.
Dr. Beau (38:38)
Yeah.
Yeah.
Yeah. So, well, that answers that for the running, which again, I figured that would be the answer. My thing would be...
Greg Rose (38:56)
And by the way, I'm willing to learn if I'm wrong, I'm all ears. Yeah.
Dr. Beau (38:58)
No, no, no. I mean, when I put, when I pitched this to Brooks, I literally said, well, per Gregor's story, Titus wanted to sell more golf balls. I'm sure you want to sell more shoes. Like let's go. I think the thing is, and yeah, maybe in golf, what would be your take on shoes get looked at as a fix or a, an implement to change running, right? More of a drop, a catalyzing, you know, forward propulsion, more cushion, a carbon plate.
Greg Rose (39:08)
Yeah.
Dr. Beau (39:27)
So now the thing that you're selling is supposed to change the mechanics. If I change the mechanics, does it negate what shoe I wear? And I know that's maybe a harder question to answer, but like if I, let's say Titleist now sells golf clubs for a specific type of swing. Does that change what you guys do?
Greg Rose (39:41)
Well, I think maybe I'm thinking of this a little differently, is I would say, based on your physical abilities, right? Let's say you've got somebody who's got great ankle mobility, and then you've got somebody who's got horrible ankle mobility. Would you put them in a different shoe? Then the shoe matters, and the type of fitting matters, right? Based on their physical weight. So I agree, 1 ,000%, right? Like if somebody's got no mobility,
I probably want a shoe that's as mobile as possible. Somebody's got no stability, I probably want a shoe that's stable. So I feel like people think of shoe fitting as in like, okay, size and last and volume over there. I'm going, you know, you and I are both going, how can we assist the human, right? So first thing I need to know is what the human can do and then try and match a shoe to that. So I feel like it...
If like, you know, I'm going to take golf, right? Because we obviously we.
Dr. Beau (40:41)
Well, Footjoy did this for a while, didn't they? Yeah.
Greg Rose (40:43)
I'm gonna take off because we own foot joy, right? So we do we we evaluate we're big on shoe fitting with our players and what we do, you know, we we actually I helped design a shoe called the project way back for foot joy was the most mobile shoe in golf at one point But we have the most stable shoe right all the way down to the most mobile shoe We tried to create a suite of different ones because that's how we were fitting We were basically first of all, we would go in and we would Evaluate their mobility stability. We would look at the lower extremity for sure and if they we would put them in three buckets
It's very mobile, very stable, a tweener somewhere in the middle, right? One of those. And we had shoes that we had preferences. Like if somebody had no mobility, we had the very, we call them the happy feet, mobile shoes, trying to give them mobility. And if somebody had no stability, we had the platform stability shoes and then just normal somewhere in the middle, right? Like a drag for us. And basically we would then go and we would try and figure out what's the best last, you know, one of the things that people don't understand about shoes is that as we get older, most people's feet actually get smaller.
and wider. Like, you know, if I say I'm an 11 and I try an 11 because I was 11 when I was 12 years old and I just haven't tested it ever since. And I just go in and I say 11 and it feels tight. I usually ask for 11 and a half. We're actually a 10 and a half wide is probably what you need. So people come in with the wrong size shoes and the left foot and the right foot sometimes aren't the same size. I mean, there's so much to that that I think is ignored in the world of professional sports that when you get the right fit on there, they go like, God, like I can use the ground better. Like the ground reaction force.
on force plates are different when you actually fit them properly.
Dr. Beau (42:16)
Yeah. What would be your take? I didn't plan on asking this, but just because again, I agree with matching, you know, foot architecture and ability to the shoe during performance. What about in practice? Does it change with footwork because you have this whole, you know, a minimalist shoe movement to strengthen the foot. And we could also say, well, if you have a, you know, a really rigid foot versus a very mobile foot, you could still use stability to train either one of those. Would you change what you're doing with that? I'm assuming yes.
Greg Rose (42:40)
Hello? Hello?
Yeah, I mean it depends on what the goal is, right? You know, I'm always like, you know, in training we try all kinds of stuff and then in performance we're gonna go with what we think is gonna perform the best right now. Right?
Dr. Beau (42:55)
Yeah. How much, so you brought up the story during your talk also of asking Mark Blackburn if he had to pick one tool to use the rest of his life, it would basically be force plates. Force plate treadmills have been huge, bilateral force plate treadmill has been huge for gait analysis for the past two decades, floor treadmills. How much has that changed what
Greg Rose (43:07)
Yep.
Dr. Beau (43:21)
you do in terms of working with a golfer in terms of working on their body, but also golf as a skill.
Greg Rose (43:28)
Force flights have changed the way I look at players and train players more than any device in the last 10 years, right? Like I said, I feel like force flights have done two things. Number one, they allow me to literally step inside my player's body and try and feel what it feels like to do what they do. Like just think about, imagine if you had a sprinter and you're like, I can't figure it out, but I can I just step in your body real quick and just run the race in your body. You'd be like, as a coach, you'd be like,
I didn't realize you were doing this, right? I'm always like, I always want to step inside my athlete's body and feel like, hey, what are you doing? And I, before we used to look at 3D or 2D video and it would show us like, okay, their hands are here at the top. So we'd put our hands there at the top and we go.
Okay, I think you're doing this. But not knowing that there's 400 different ways to put your hands in there at the top, right? And how you put your hands over there can be, can dramatically change the feel. And that's what we get from the force plates. It's how you move, right? I can see, are you pushing forward or to the side? Are you going vertical? Are you twisting? Are you torquing? Like we can see all those things. And then the second piece, so first of all, it allows me to get a better understanding of what my athlete's doing. And then secondly, and probably the more important thing is I started evaluating our exercises.
right in our drills and I'm going, do they match what the athlete's doing from a force production on the ground? And I can tell you right now, about half the stuff I used to give people, it wasn't even close. Right. And I'm like, you know, we used to go like, I can't believe that doesn't transfer. Like that seems like such a cool drill or transfer. And then we got the first plane and I'm like, no, I know I doesn't transfer. Actually, it's potentially negative. Like it's completely different the way they're creating force. So, so now, you know, we started, we went down this pathway about three years ago going, I got to take every exercise, get them on the force blades and I can start mapping out the exercises.
I'm like, this is gonna be amazing, right? So I start taking medicine ball drills and I'm going through and I remember I had one athlete and we went through like 30 drills and I was like, this is awesome. So I took the 30 drills and I'm like, all right, this one's more of a frontal plane torque. This one's more of a lateral. And I was like, all right, we gotta do some more. And I was like, you know what? Let me grab another athlete. Let me just make sure that that's what those, like at the next seven, 30 exercises. And he did them completely differently. And I was like, damn, okay, that was dumb. Like everybody doesn't do exercises the same either.
right? But now I can at least see when I give somebody an exercise, are they doing it the way that they do it when they swing, so that we transfer. That's just been game changer.
Dr. Beau (45:53)
Do you go that in depth with each player now of like if you're giving them correctives or something that you put them on the force plate to see if it's actually getting what you want?
Greg Rose (46:01)
We've always done this under 3D just to make sure that their sequence is like their way they're transferring energy But now I can see how they start their power to see if it's the same way and then does it transfer through their body I always feel like man anything you do on a regular basis throughout the day if you're just like I'm just gonna practice my backswing in my office, you know
man, it better be perfect, right? So I'm like, you can measure that now to see if it's actually perfect and we can go keep doing that. Or I can't tell how many players come in. I'm like, let me see the drills you've been working on. And I'm like, don't ever do that drill again. Like that's actually part of your problem.
Dr. Beau (46:33)
Well, I thought the two best slides in your entire talk in Florida were just the bullet points of motor learning and then feedback of like summarizing. Cause that's, and you could kind of tell within the crowd there, like that was, I wouldn't say mind blowing, but like there were people that maybe have never heard that, but also definitely weren't adhering to it just based on the questions and the pushback. And I think it's very interesting.
My one question there is, and this is just kind of a fun question, I guess. So you talked about basically using an aid, right? Some sort of device or something for feedback. So where does something like R &T fit into that? Cause you were kind of bristling against like a feedback. So if I use, you know, and you like, you said there's a time and place for it for sure. R &T were using a band obviously to direct traffic into the, you know, the mistake. So how's that fit into that whole?
Greg Rose (47:08)
Thanks.
RNT, the fancy name for that we call challenge feedback. There's facilitated feedback, challenge feedback. So any type of feedback, right, to me does one major thing, right? It helps the athlete do the motion properly, right?
Dr. Beau (47:47)
Mm -hmm.
Greg Rose (47:47)
That does not mean they know how they learn doing that, right? It helps them do the motion properly. Now once you get them to do the motion properly, you can now start the motor learning process and teaching them how to learn how to do that and how to remember to do that. So guidance devices I think are great, like reactive neuromuscular training, RNT, to go, that's what it feels like to do that properly? You go, yeah, that's what it feels like. Now what does that feel like? Now you ask the athlete and the athlete goes, man, so when you were pulling me to the right, I was trying to prevent myself. So as I turn,
I felt I felt more like in my groin where I usually feel on the outside of my head perfect Okay, as soon as you have that feel we can take a feel we can't take form form doesn't work We can take a feel and we can create a motor pattern now, right? So it's like a you know create this book on the shelf in your brain and once you have that feel we can go into all the research that shows you how to do this but now you need to go to do it without the guides device because No, we're not gonna be pulling on them in their doll swing So they have to be able to reproduce that feel but they needed to know what the field felt
like in the first place. That's where guidance devices come in. The problem is that so many people just practice with guidance device and they never let them know. So they never really actually took the next step to see could I do it without the guidance device. And that's really important. So I think the motor learning world for a while was like get rid of guidance devices because it wasn't transferring. But I'm going okay just because it didn't transfer doesn't mean it's not a good device. Maybe we're just not using it properly right. So anytime you do RNT you do any of these things you can do this with a patient or as a client. I think the
Dr. Beau (48:58)
Mm -hmm.
Greg Rose (49:17)
The RNT entire goal is to reproduce a normal pattern and give you the feel. Once you have that, get rid of it and try and reproduce it.
Dr. Beau (49:27)
In your world, this probably isn't a huge issue because you're dealing with extremely high level athletes and you even said you're playing above the pain line most of the time. So for somebody that's in clinical practice, whatever you want to call them, the loving term that I've actually heard come from the TPI world was a motor moron, whoever said it first. But let's say we have somebody that's not kinesthetically graced. You're right. So now how much like,
Greg Rose (49:48)
That's the norm, by the way. Yeah.
Dr. Beau (49:54)
does that change? Obviously you have a high level athlete, like they may need like literally like four reps with some sort of RNT and I got it and then you remove it versus somebody literally you think they got it and then they come back in and it's abysmal again. Like how do you.
Greg Rose (50:05)
We've all experienced that person where you do the RNT, it looks great, it's so different than what they normally do and you go, can you feel that? And they go, I don't feel a difference, right? That's a motor morgue. They're like, you're like, dude, it's like.
the amount of movements like reduced by 12 inches and they're like, I just can't feel it. So if they, if you have that person, I, in my personal opinion, you can't move on. You have to try and keep doing more guidance devices, more things, because until they can feel it, they're not going to change because they tell the difference between the old pattern and new pattern. So I feel like this is probably, like I said, the norm is that usually you have to try two, three, four or five different things until they go, no, that felt different. I can feel something there. And you go, now where did you feel it? Right. And it's going to surprise you because out of their mouth,
doesn't matter as long as they can feel the difference. And then like I said, take the RNT away and say, OK, show me what you were doing before and now show me the new feel and see if they can do it without it. If they can, then you can do without it. If they can't, we're going right back to the guidance device.
Dr. Beau (51:04)
I think I saw the most people sit upright in their chair when you asked how we program motor learning drills at home. And there were a couple of answers and then you're like, it's like if we did 10 minutes of work with a bunch of variety, high conscious level participation, I don't think that happens. I think the hard, okay. So I think that was a great piece of information, absolutely fantastic.
then you said, you know, there is the strengthening side. Like, yeah, now we gotta, you know, print that pattern, we got it, and you gotta strengthen tissues, make people more resilient. Is there, just like you have helped people in SMA level two determine, you know, joint versus tissue, how do you help clinicians determine when can you make that jump? Okay, how do you know it's a proficient pattern and how we can go into training it, you know, in the gym setting?
Greg Rose (51:54)
Yeah, I think this is this is a coaching decision, right? So this is just what this is what
Bill Belichick would have done with Tom Brady making a coaching decision you're doing with your patient, right? Going, number one, do I trust them to do this at home on their own, right? And then number two is, is it at the point where I don't even have to say anymore, they're just kind of doing it, right? Or they'll say, I don't even feel it anymore. And you're like, let me check. And you're like, what's, cause actually now it looks kind of good. That's when I shift into, okay, hopefully, cause our goal is for it to become automatic. I don't want you to have to think about it, right? So that we could just do strengthening on there. So to me, that's a game changer.
day coaching decision. Pretty obvious though. It's usually pretty obvious.
Dr. Beau (52:36)
Okay, you also mentioned, yeah, and again, I would say, but I think sometimes you see one or two things. People perpetuate motor learning concepts, whether they're doing it right or wrong, through the entire rehab trial of care, or it's right to strengthening in the face of the motor plan not being idealized or as good as it could be, or offloading the sensitized tissue.
Greg Rose (52:44)
Sometimes it's not.
Yeah, I think that's a good point too is that, you know, a lot of times you're like, we got to build a new motor pattern and you don't realize that they actually have the pattern or they just built a bad one on top of it. And most people like within a minute or two don't need motor learning. They just need they just need repetitions now or strengthening. Right. And
Dr. Beau (53:09)
Yeah.
Greg Rose (53:18)
Again, that doesn't surprise me either sometimes. I'm like, you know, it seems like maybe if they say, you know, I used to do that when I was 14. And then somebody told me, OK, then we're not building a new motor. I just got to remind you.
Dr. Beau (53:27)
Mm -hmm.
Yeah. You talked about, and I've heard you talk about it before of normal, normal aberrations movement or normal dysfunctional non -painfuls with certain athletes, right? Whether it's a unilateral athlete. Do you think that those are, and let's just use golf as one, and then I want to kind of ask about running, but let's use.
Greg Rose (53:49)
It's like you're talking advantageous asymmetries type of thing. Yeah.
Dr. Beau (53:52)
That was my question. Like, are they advantageous or are they just normal asymmetries?
Greg Rose (53:58)
Okay, well I definitely believe in advantageous asymmetries for certain sports, right? I've fallen by countless hours of like like okay like If I take a Well, let's do Captain obvious a baseball pitcher, right? You know, their total arc should be normal, right? But it better be shifted to external like they better have
Dr. Beau (54:16)
in
Yeah.
Greg Rose (54:23)
two three or I don't like three ones but they should have a two three on the FMS shoulder or else you know we have a station at the NFL Combine right and if you know anything about football combines the pre -combine training people try and make the athletes
perfect the combine scores, right? It's like, I want to get the best. So they're like, we're going to nail a 21 on the FMS, you know? So we get all the data for the teams. And I can't tell you how many times teams have said to me like, hey, I got this quarterback and they got a 21. I'm going to quarterback out of 21. I wouldn't draft them. Like that's, that is not normal for a quarterback. If you tell me their shoulders balanced, I'm like that, that either they're not throwing it off or somebody did the test wrong. That's, that's messed up. Right? So I feel like there are like,
you know, how you get these asymmetries is important, but I think there are, there are, you know, to me there's, I call it, I hope this makes sense, like in FMS we call it the, or.
Okay, like let's say you want to win the Masters. We call it the jacket bracket. You know, if you want to win the gold medal, we call it the medal bracket, right? If you're going to be a, you want to win the gold medal in table tennis, right? Pretty confident you need to be between a 15 and a 17 on the FMS. And I can show you how you need to be able to do that. Now to keep you in that 15 to 17, there are certain advantageous asymmetries that we feel help you in the sport. Now, stay there. You don't try and make these asymmetries in training, right?
Dr. Beau (55:34)
Mm -hmm.
Mm -hmm.
Greg Rose (55:52)
It's just you practice so much it develops these So we always say like your goal. Here's the cool thing for you and me the guys in the pit crew, right? We're trying to balance them like we should be treating you trying to bounce it But your volume of practice shouldn't let us win, right? So that if we got the good ratio of treatment to practice you'll stay in that bracket, right? Now if we treat you too much and you're not practicing enough All of a sudden you start going above your bracket, right? If you're practicing so much, but you're not getting enough treatment You'll start to drop below your bracket and keeping them in that bracket is is
Dr. Beau (55:55)
happens. Yeah.
Right.
Greg Rose (56:22)
you know is is quite the challenge but that's that's kinda how I look at those advantageous asymmetries.
Dr. Beau (56:27)
Yeah, which I would 100 % agree with that. And again, if we, and I know you, what'd you say you have something like over 5 million data points within, is it multiple sports or just golf?
Greg Rose (56:34)
Yeah. We had multiple sports, whole Olympics. Yeah.
Dr. Beau (56:38)
Okay. So when we look at running, the two big, this got into a big social media thing a couple of weeks ago that, you know, it's normal for runners not to be able to touch their toes and then obviously deep squat because ankle mobility issues. So here's my question. Obviously that's normal amongst that population, but then you can very quickly look at data on not being able to touch your toes and the correlation to low back pain, even though people want to say there isn't one there a hundred percent is. So again, now we're.
how do you reconcile, you know, now you're working with a major pattern, like just a flexion pattern, somebody were saying, Hey, it's normal, you can't do it. And then you're like, well, man, there's all of this information saying that if you can't touch your toes, there's a much higher risk of low back pain. So again, I know we're trying to balance them, but where, cause I know we're tuning athletes and you need some stiffness, especially depending on what sport you're playing. Like, is that just again, game time decision? What's the phenotype of the person in front of you or are, are there certain things that you're like,
God, I know that's advantageous, but like, could we get more, a better flexion pattern, you just control the end ranges better. Like, are there certain things you're like, we don't like that, even though it's normal in that population.
Greg Rose (57:44)
Yeah.
Yeah, normally, I'm trying to think in my mind, normally they're advantageous asymmetries. Like right toe touch is better than left toe touch. Versus bilateral can't touch the toes, right? Those are usually not advantageous. There's not a lot of those, right? So.
Dr. Beau (58:00)
Yeah, like a curve runner in 200. Use the Usain Bolt, yeah.
Greg Rose (58:13)
You know, again, like you just said, the curve runner, I could see one side potentially being stiffer than the other side. But in general, most professional athletes are way more mobile than non -professional athletes.
Dr. Beau (58:26)
100 and that that was my argument if you look at the bell curve professional marathoners are Super mobile you and I wouldn't think they were until you look at the data and you're like, they can sit in a full deep squat and touch their toes and
Greg Rose (58:34)
Yeah.
I mean, look at Olympic lifters. I mean, people think, the weights, I mean, they're probably the third most flexible athletes in the Olympics. They've got to get under the bar. They don't get the bar with their head. So I think that,
people go, they're tight compared to who? Like compared to the most flexible person in that sport or compared to normal humans? Because normal humans are the ones that are tight. These athletes are not. I'm like, and people say, you know, John Rahm, you know, on the PGA tour, he's on the Liv tour now. John Rahm, he's a big guy. He doesn't have a big backswing. He must be tight. I'm like, actually, he's one of the most flexible guys. He learned to play from a short swing, right? That's just how I learned, right? I'm like always to blab these people.
Dr. Beau (58:53)
Yeah.
Greg Rose (59:19)
who challenges something you need to test more professional athletes.
Dr. Beau (59:24)
No, that's a really good point about the population comparisons like that. I was actually talking about
Greg Rose (59:30)
Yeah, because I hate it when they say, really fast athletes have to have tension and have to be tight. And I'm like, now you're telling this kid who has no flexibility that he should be tight. That is not what they're talking about. Like that is that's lack of mobility. They're talking about tissue tension. That is totally different. Yeah.
Dr. Beau (59:40)
100%.
Yeah.
Yeah, the ankle dorsiflexion debate within running is a huge, just, I think, misconstrued. Like, I think you're hitting the nail on the head and I think people just normalize things that can lead to injury.
Greg Rose (59:57)
I think things that are hard to produce, like if you find somebody who's got tight ankle dorsiflexion and you don't know your stuff, it can be very challenging for the medical practitioner to improve that. When they don't have the skills, most people don't go, I need to learn the skills. They go, it must not be that important. I see that a lot. So don't, yep.
Dr. Beau (1:00:16)
Yeah, yeah, normalize it. I was talking with a golfer in here the other day, which it's a different scenario when it's a club golfer. He was like, basically he wanted to know why I thought he needed to increase the amount of rotation and swing, right? Because he had basically a stability motor control dysfunction. And I was like, you don't want to play it in ranges and all this stuff. Trying to explain it to him.
And he goes, was that what pro golfers do? So I just kind of had a question come to mind when you brought up John Rahm, right? So if, because I heard you say what, force applied over longer times or more force applied is how you're going to get more distance out of the ball, basically. So if you have a John Rahm that has more in the, you know, bank in terms of range of motion, why not maximize it? And you're like, well, he's doing great. So don't change it. But is there ever like an injury prevention mechanism where you're like, well, he doesn't have to create as much force now if he can go further.
into it as long as he's not running up against that physiologic barrier.
Greg Rose (1:01:12)
Sure. Yeah. Yeah, so John's a great example of this. I mean, John was born with club foot on his right foot. So his ankle is pretty much fused. I mean, you can't really use his ankle. And the more he rotates, the more he goes unstable on that backside. Right. So he grew up playing high line and these little short change direction sports. And in a way, I'm like, this is perfect, man. Like you were not taking you beyond your physical range of motion. Now you have them. You have the range of motions.
Dr. Beau (1:01:19)
Mm -hmm.
Greg Rose (1:01:40)
Like we said, there's three ways to develop power, right? You apply more force, you move your hands faster, or you apply that force and velocity for more time. A longer backswing gives you more time to apply that force and velocity, but I'm like, John Rahm is like the size of you and me combined, but he's huge, right? I'm like, he's got so much force and velocity, I don't even know if he needs more time. Like he doesn't. So if he took a bigger backswing, could he hit farther? The scary answer is, yeah, he probably could. He doesn't need to, he's still one of the longest hitters out there. But I think what he's done is he stayed in
Dr. Beau (1:01:47)
Mm -hmm.
Yeah.
Greg Rose (1:02:10)
inside his physical abilities.
Dr. Beau (1:02:13)
Yeah, so you've created that barrier. Well, kind of the last two questions I ask everybody on this podcast, you can take it wherever you want, keep it in the professional realm if you want. But what is one thing that for a very long time or for a long time you held to be true that you completely changed your mind on? They're just like, I shift.
Greg Rose (1:02:32)
I think we talked about it. Force, man. Like the force, I'm telling you, like, there are, you know, throughout my career, there's countless examples. Like in SFMA, we talk about proprioception. We used to think everybody had proprioceptive problems. Now we think it's more mobility problems. But I think force has completely changed the way we look at players to the point where,
I agree with Mark Blackburn, like if I was only going to have one tool going forward it would be a force plate and assuming that the drill looks good does not mean they're creating force the same way they do in their sport. To me I'm like, wow it looks perfect, they have to be doing it right. I just don't believe that anymore. So that's probably where I would go with that question.
Dr. Beau (1:03:13)
Mm -hmm.
Is the only proxy for that, like, cause you said you're putting, you know, athletes on force plates for exercises. So let's say we have a clinician or a golf coach that doesn't have force plates. Is there any proxy besides feel for making sure that like, if it looks good, because like you said, form, isn't the thing we want to fall back on.
Greg Rose (1:03:36)
Yeah, I mean I think you know it's kind of like you know I don't have an MRI machine, but I've learned a lot from MRIs right so force plates the same way like I think don't be like I don't have it so I can't do this no we've learned so much from it that I think you said it though you know if you're trying to get something to transfer Please don't look at like that looks like a golf swing so that exercise must work right. I don't care if it looks golfy
What's more important is does it feel like your golf swing, right? If it feels like your golf swing, we're probably getting some benefits. If the exercise feels totally different than when you're doing the sport, I'm not sure if we're using our time appropriately, let's say maximizing our practice.
Dr. Beau (1:04:17)
I remember Charlie Weingroth's talk at World Golf Fitness Summit. I don't know what year it was, golfish, that everything, if it looked golfish, you go, that's great. And like trying to get away from that. Well, real quick, you had mentioned that, you know, another one was maybe the proprioception versus, you know, now, can you just touch on that for a second?
Greg Rose (1:04:23)
Yeah. Yeah. Yeah. Yeah.
Yeah.
Yeah, so you know, I think, how old are you, Bo? OK, so I've got almost 15 years on you. So when I was going through school, and maybe it's the same when you were going through school, everybody had a proprioceptive problem, right?
Dr. Beau (1:04:40)
40.
It was pretty much the same.
Greg Rose (1:04:53)
Yeah, that's kind of what we were taught. Like everybody had a personal. And then I started looking at a lot of the, you know, I'm thinking golf, we got to have speed balance. And we started looking at all these unstable surfaces. You know, you have the air, X pads and you have the balance on stuff. And the research is coming out really clear that it was very poor transfer. We're like, this is crazy. Like you think that if we work on unstable surfaces, it would transfer really well. But I wasn't seeing the transfer either. And the research was saying it doesn't transfer.
Now when we started SFMA, we got to Single Leg Stance. And I told you we had a bunch of smart people there. I grabbed Dr. Mike Voight from Belmont Therapy. His doctorate was in proprioception. I said, Mike, you are going to help me do Single Leg Stance. And Mike, with his Southern accent, was like, no problem, Greg. He goes, we'll knock this out first. This will be easy. It took us three years to do that. I keep blaming on him. I say, Mike, you must be slow. But basically, our paradigm is wrong. We felt like everybody started with proprioception.
trying to do Perception.
Now it's like so captain obvious, right? Like you said, a fundamental switch. It's, you know, how do mechanoreceptors, proprioceptors, how do they work? Right? When a joint moves, it stimulates the mechanoreceptor and pressure changes in, can stimulate this. Right? So to say when you sprain your ankle, you damage your proprioceptors and now you have no stability. It makes way more sense that when you sprain your ankle, you lost mobility and you're not stimulating it anymore. Because what we've found now is that if I just give you your mobility back, it's amazing. The proprioceptors are working now.
Right like I don't think they were ever damaged. It's just they weren't getting the proper input, right? So we flipped our entire thought we were like like you said rule out by exception We said let's check first to see make sure there's not a vestibular problem, right? And then if there's no vestibular problem, let's just make sure that you've got the appropriate core control mobility Let's just make sure you've got ankle mobility him like because if you don't have those Let's just break that loose first and see if all of a sudden your balance approves because 95 % of people improve now when you do that, right? But
If your vestibular is good, you don't have any core, hip, spine stability or ankle mobility problems, then we're going to go, okay, then you probably do have proprioceptive problems. Based on our millions of data right now, that's less than 6 % of the population. I've been going through school, I thought it was 96 % of the population.
Dr. Beau (1:07:08)
Yeah.
You needed like eight BOSU balls and yeah, blindfolds and everything else. Well, the flip side of that question is what is something that you hold to be true or you're just like, I think this is the way it is, but there's no data to support it yet. And I'm gonna hold you to a different candle that you can't use something that you have data on from TPI that has been released.
Greg Rose (1:07:15)
Red.
think about that. Okay, big break theory. Now this is something Tom House and I, Tom House, one of the best coaches in the baseball football world.
We have a philosophy we call the big brake theory, which is that you will only accelerate as fast as your brakes can decelerate you. So we're going, if I'm in a car, I don't want to go so fast where my brakes don't work anymore because I'm in trouble.
So we feel like the body puts an internal governor on you. So this is why we're really adamant. And there's tons of people that call us wrong. And again, the evidence we have, I say no evidence. I think the evidence is, what's the word, non -conclusive yet.
People say, should you waste time training the opposite side of the body? We always say, I feel like it's a huge value to train the opposite side, not only because the biggest, fastest athletes in the world have some type of history of non -dominant side training. It's scary, the volume on there. But I feel like the best way to train your breaks is to...
to go explosive in the non -dominant side, right? So we do lots of non -dominant side, like for your sprinters, I would have them run backwards. Do you do that with your guys now?
Dr. Beau (1:09:01)
Yeah, and I mean, a lot of this, you know, you're a big mentor to me, even though, you know, this first time we've kind of talked privately, but I still remember, you know, I think you brought the example up of who are the fastest people in the NFL. It's usually cornerbacks. Now, is that because they run backwards or just that's the position they fell into? Nobody older now, but it's a good, it's a good correlation to make, you know.
Greg Rose (1:09:13)
Yeah.
Yeah.
Yeah, yeah, it's like, you know, if I go through like.
you know, the fastest swingers on the PGA Tour, you know, like they were left handed in this sport, now they compete in this sport in long drive. If I go to baseball, like there's always this like, man, I didn't think about it. But yeah, I did this when I was young. I did this left handed or blah, blah, blah. And now I do this. Like I know coaches now like in baseball and softball that if you're a right handed thrower and left handed hitter, they'll draft you. If not, they won't even draft you because the data is so overwhelming that but no one in the research can prove that that's a
Dr. Beau (1:09:32)
you
Greg Rose (1:09:54)
And there's some very, very smart people that say it's BS. But I can tell you right now, every one of my athletes is training non -dominant side.
Dr. Beau (1:10:02)
Well, and I think if you take it out of rotary sports, so if you look at, you know, Trent Nestler, I guess he's probably the biggest influence on ACL, you know, research that we probably have. I mean, looking at how people decelerate, right? Rolling through the ankle instead of breaking on the toes, but also like just how they decelerate. and I mean, that's probably, it's one of the best, like, you know, return to play criteria, but also risk assessments you can do for ACL. So I think there is a lot of evidence in that realm.
Greg Rose (1:10:19)
Yeah.
Yes.
Yeah, but again, I think a lot of people will tell you it's inconclusive right now on the big break theory, but I'm doing it no matter what, to answer your question.
Dr. Beau (1:10:38)
And again, you don't have to obviously release any, you know, clandestine secrets, but is there anything you've always kind of said what if you come to a TPI or SFMA seminar and something's not new, that's kind of on you guys. So what's on the horizon? What's coming out in the next few years? Anything big?
Greg Rose (1:10:54)
I'll tell you something about that. I was pretty excited about it. We had a very, very smart gentleman from the Johns Hopkins organization come to one of our SFMAs. And one of the challenges why we have not put wrist and hand in the SFMA yet is we can come up with a top tier. I think he showed me a top tier for wrist that might work. So we still don't have foot, wrist, and TMJ. And we've been working on those. And it's the top tier that's the limiting piece here. It sounds weird, but that's for another podcast.
I think you might see a risk breakout in top tier coming for estimate at some point. I told you I'm hoping that we'll be launching a couple other sports, quarterback certification, and then we're working on all of our level twos in baseball and softball now too. And then I would say our tools, our apps, the things that complement us is something that we've been spending a lot of time on. But I love, like what you said, running. If you want to take a running one to the world, dude, call me.
I'm in. I love doing new sports and doing that stuff. Everybody calls me the juice extractor. You give me the 20 smartest people in running, we will extract the juice from their brain and come up with a screen.
Dr. Beau (1:12:07)
Well, and that's, I asked the question during your talk of, cause you said, you know, one of the big, two of the big pieces is hand TMJ and then foot and wrist for gymnastics, which is, you know, what my wife specializes in is a nightmare. I mean, that's like one of the biggest plagues in gymnastics and I know in golf, it's also up there for kind of a killer of careers. Is there, I know you said you might have one for wrist. Are you guys actively working on foot and ankle a little bit more, or is that something that's just kind of back burner?
Greg Rose (1:12:33)
What's kind of weird is like we know how to break out the foot. It's more if I said what's the top tier movement that identifies altered foot mechanics? That's where it gets complicated because you're like is there one movement that I can do to see if there's all things in the wrist and foot or in the TMJ and I'm like...
Dr. Beau (1:12:37)
Yeah.
Gotcha.
Yeah.
Greg Rose (1:12:54)
I think TMJ might be a little easier, but the foot and hand had been challenging. But like I said, a very smart person showed me something a couple months ago and I was like, man, that actually, that might be it right there. Yeah, it's weird. Like I said, we have breakouts. So I know like your foot's a problem. I think I know how to break out your foot, but I'd like to have a top tier to make it fit into the model. You know what I mean? Yeah.
Dr. Beau (1:13:13)
Mm -hmm.
Yeah, well hey, I'm always excited and I keep tabs on you guys obviously and it's been a few years for us since I've been to a TPI or SMA so I'll make sure I head to one if it comes around earlier, we'll host one here in Nashville, Birmingham soon but before we jump off any last.
Greg Rose (1:13:27)
in.
Are you in Nashville or Birmingham? Where are you at?
Dr. Beau (1:13:36)
I'm in Birmingham, but we just started an education company where we're hosting in Nashville just because it's easier to, it's more fun. People want to go to Nashville. It's easier to fly into the Birmingham. So we're doing a lot more in there. Yeah. Yeah. we're actually heading or heading away from you, but we'll be heading up towards, we go through Arkansas on the way up to Missouri. which I didn't realize it's like fly fishing Mecca in North Arkansas.
Greg Rose (1:13:45)
Well, actually, you're a little far from me here in Little Rock. Yeah.
big time. It's like, have you been there before?
Dr. Beau (1:14:02)
Yeah, I saw a trout. Yeah, I saw a trout on the water tower, wherever I was. I was like, and then I started looking into it and yeah, it's amazing.
Greg Rose (1:14:08)
Beautiful area. Cool. Awesome. Well, thanks for having me, Beau. Appreciate it.
Dr. Beau (1:14:12)
Absolutely, Greg. Thank you so much. And yeah, hopefully I'll see you again soon and get to talk with you a little bit more. All right, man. Take care.
Greg Rose (1:14:17)
Sounds good. See you then. Yeah, bye.
Mike Stella, ATC - The Movement Underground
In this conversation, Dr. Beau and Mike Stella discuss the role of manual therapy in rehabilitation and performance enhancement. Mike shares his origin story as an athletic trainer and how his injuries led him to explore different approaches to recovery. They discuss the importance of manual therapy in pain modulation and creating movement opportunities. They also address the criticism of manual therapy and the need for transparency and education. The conversation highlights the value of manual therapy in the context of individualized care and the unique needs of elite athletes. In this part of the conversation, Dr. Beau and Mike Stella discuss the challenges of providing individualized care in a healthcare system that often prioritizes volume and efficiency. They explore the complexity of movement and how it can vary from person to person, making it difficult to define optimal movement strategies. They also touch on the relationship between movement dysfunction, pain, and injury, highlighting the need for a personalized approach. Mike shares his experience in building a sustainable private practice that offers high-quality care and discusses the importance of patient education and communication. They also discuss the role of social media in marketing and building a brand. In this final part of the conversation, Mike Stella discusses how he gained a following on social media and the importance of providing valuable content. He emphasizes the need for competence in one's field and the ability to display that competence in a consumable way. Mike also shares his journey of building his business and the lessons he learned. He highlights the importance of authenticity and the power of the relationship between clinician and patient. Mike concludes by discussing the qualities he looks for in his staff and the importance of overcoming adversity.
https://www.themovementunderground.com/
@mikestell_atc
Erson Religioso: The Eclectic Approach
Dr. E was heavily involved in the early days of blogging and podcasting in the physical therapy field. He developed an ISTM course and brought his own tools to market. He initially resisted the evidence-based movement but eventually embraced it and changed his approach. Dr. E's parents are both physicians, which influenced his decision to pursue a career in healthcare. He leaned heavily on manual therapy techniques early in his career but has since shifted towards a more eclectic approach. He emphasizes the importance of being open-minded and not being 100% certain about anything in healthcare. Dr. E has gone through different phases of practice and has learned to critically evaluate different treatment approaches. Dr. E emphasizes the importance of McKenzie principles in his practice, as they modulate pain and improve function. He appreciates that McKenzie's techniques work, even if the theories behind them have been disproven. Dr. E believes in empowering patients with loading strategies and modulating pain before introducing strengthening exercises. He emphasizes the importance of dosage and patient compliance in achieving successful outcomes. Dr. E also discusses the need to refer patients when necessary and the challenges of integrating different treatment approaches. Dr. E discusses the importance of balancing work and family life, and not being solely defined by one's career. He shares his own experience of achieving his goals and finding a balance between work and personal life. Dr. Beau agrees and emphasizes the importance of finding a balance and being passionate about what you do. They also discuss the impact of being a role model for their children and the importance of enjoying what you do.
Starting with Conservative Care First: Week in Review 35
In this episode, Dr. Beau and his team discuss the importance of triage in musculoskeletal care and the decision-making process when determining whether a patient needs to see a specialist or undergo surgery. They share several case examples, including a high-level runner with a foot injury and a patient with a chronic shoulder dislocation. The team emphasizes the need for individualized care and the importance of considering the long-term implications for young athletes. They also highlight the role of primary care providers in ordering imaging and making treatment decisions. In this conversation, Dr. Beau discusses two patient cases. The first case is a 36-year-old male with chronic low back pain and disc bulges. Dr. Beau focuses on addressing the patient's pain and improving his movement patterns. The second case is a 47-year-old male who experienced increased headache and neck pain after receiving a Y-strap adjustment. Dr. Beau emphasizes the importance of a thorough examination and appropriate treatment.
The Low Down on Sever's Disease
Severs' disease, also known as calcaneal apophysitis, is a condition that affects children between the ages of 8 and 14 who are going through a growth spurt. It is characterized by pain and inflammation in the heel, particularly in the back of the calcaneus. The condition is caused by the growth of bones outpacing the growth of soft tissues, such as tendons and ligaments. Factors that contribute to the development of Sievers' disease include playing sports during the growth spurt, wearing restrictive footwear, and lack of attention to growth spurts in sports physicals. Treatment options include rest, immobilization, isometric exercises, motor control training, and dry needling. It is important to accurately diagnose the condition and tailor the treatment to the individual.
Hip Pain vs. Ovarian Cyst Differential: Week in Review 34
The conversation discusses a case of a 34-year-old female with hip pain and a history of low back pain. The patient is active in CrossFit and has been experiencing right anterior hip pain associated with squatting, running, and jumping. The pain started several months ago and has worsened recently. The chiropractors suspect an internal hip issue and work on stabilizing her back while calming down the hip. However, further examination reveals that the patient has a history of ovarian cysts and potential endometriosis. The chiropractors recommend that she see an OB/GYN and consider functional medicine to address the hormonal dysregulation.