Dr. Phillip Snell, DC - The Neurocentric Approach

In this conversation, Dr. Phillip Snell discusses the creation of the neurocentric approach and the importance of diagnostic specificity in treatment. He emphasizes the need for integration and an organized approach to patient care. Dr. Snell also highlights the role of systemic factors, such as stress and inflammation, in musculoskeletal pain. He shares his method of staying up-to-date with the latest research and evidence-based practices. In this conversation, Phillip and Dr. Beau discuss the importance of reading research papers and how it can change clinical practice. They also explore the use of tools like Mendeley for organizing papers and creating programs and courses. The future of the neurocentric approach and the potential of Web 3.0 and AI assistants are also discussed. They touch on the idea of creating platforms for medical advice and the challenges of balancing creativity with professional life. The conversation concludes with a demonstration of using GPT-4 as a research assistant and the importance of embracing creativity.

Trigger Point, Nerve Entrapment, or Radiculopathy: Week in Review 33

Summary

In this conversation, Dr. Beau, Dr. Alex, and Dr. Seth discuss the differentiation between trigger points, radiculopathy, and peripheral nerve entrapment. The docs present three cases of heel pain in runners and ask the audience to determine which condition each case represents. Dr. Beau emphasizes the importance of history taking and examination in making a diagnosis and highlights the need to rule out other potential causes of pain. He also mentions the use of different treatment interventions and adjunctive care for each condition.

Dr. Beau (00:00.406)

Zoom wouldn't let enough people in? No, the quality was terrible. And it kept, after the meeting change thing last time, I just fed up. So this will also allow us to like, it does everything automatically, transcript, all that stuff. So I just didn't think I could have this many people in it. And then you can add them at like audience.

Dr. Beau (00:26.321)

and audience.

Dr. Beau (00:35.018)

understand.

Dr. Beau (00:39.168)

Ugh.

There keeps the email open. Are we getting texts? What says all participants in audience to, so it's gotta be one other person on here. Are you on it or it's slung? We'll see that don't really matter. Six 14. We're not starting yet. Whoa, whoa, whoa. Pump the break. Ola's

Dr. Beau (01:07.623)

Oh, now it's 6 15. Time to go. Yeah. All right. Uh, Alex, you're a little blurry here. No, that's just, it's natural skin. It's got that soft glow skin. Natural. It's got a permanent Instagram filter. Yeah. She, Kaylee said it's her. She's the other one. Oh, so the people are in there. Hey, it's me.

Kaylee, I also heard that you liked boiled hot dogs.

Dr. Beau (01:40.898)

It's like seventh grade lunchroom. Her and Ebna. Seventh grade lunchroom. I'm just, we love you, but nobody loves boiled hot dogs. You're a chef. What are you doing with boiled? Is she a chef? Well, basically. Yeah, what? She said it's not fair, you can talk and I can't. You can type. We can chat. We can chat, you just gotta type quick. Okay, we can review 33. This one's gonna be a little bit different. To be honest with you, I thought it got a little stale when multiple cases are gone. Just.

probably too much just case stuff. I can't defend myself. You can defend yourself. And the way I would defend myself is to not eat boiled hot dogs. So I'm gonna do a little bit of a kind of lecture, but then tie in multiple cases and kind of have this, I don't know, guessing game. But as we, I'm gonna share our...

Dr. Beau (02:38.998)

over here. So I gave this out to people that were in or have been to an art of assessment course. So this is the exam flow chart. While I'm pointing this out is here in a second, I'm going to present three very short three cases. I'm not going to give you the whole case. I'm going to kind of give you the history of the synopsis. Then I'm going to go over what we're going over tonight. And I want you to kind of bank these cases in your mind and start using things like divergent thinking and this intuitive

red hat, if we're using the six hats process to start thinking just from what I told you in the topic of tonight, which one of these cases do you think are, which what we're going to overnight is trigger point, radiculopathy or nerve entrapment patterns, referral patterns. So I have a case that represents each one of those. You don't get a ton of information, but I almost guarantee you just based off intuitive feel and the facts that I'm giving you, you can start to kind of figure these things out.

I'm doing that for two reasons. So you can look at how important it is to follow your intuition, but also prove it with assessment and analysis and things like that. But also, so you can walk yourself through the process of maybe thinking that something sounded like a ridiculous opthia when it was nothing like that, which can be extremely common and not getting tripped up by that. I get that this is not, you don't have all the facts. That's not the point. It's just to kind of be like, yeah, that kind of sounds like it'd be this. Well, is it or not? We'll find out.

So getting back to it, as I said, the topic of tonight is the differentiation between those three things. I would say it's relatively easy. I know some people may be early in practice, would not think it's that easy. I think the reason it's easy is you have to kind of go back to fundamentals of what's creating each one of these things. So I'm gonna go through the cases first because I want you to kind of be front loaded with what's going on with each one of these things. So here we go.

You gotta remember these. If you wanna write them down, maybe I could type them in the chat. I don't think I can type that fast, but that's okay. So we have a 15 year old female track and field athlete that has heel pain that came on in the last week to the point that she had to stop running during the workout that she came to see me, the night that she came to see me. She's dealt with medial tibial stress syndrome over the past two plus years on and off, which we've been treating her for. Prior to track and field, she was a dancer slash gymnast, and that's all you get.

Dr. Beau (05:05.334)

So she has all of these people have heel pain. That's the commonality, okay? Second person, 42 year old male, they're all runners, has started running over the past few months and notes that his right heel is to the point where he can barely make it a mile before he stops. He has been foam rolling his calves and stretching upon questioning as a history of mild low back pain with intermittent flare ups. Also states that he has flat feet and uses orthotics. 53 year old female, trail runner, was put in a boot a few months ago due to,

air quoting, Achilles tendonitis has really upped her mileage over the last year. She had a laminectomy 20 years ago, lumbar laminectomy, L4, uh, notes that she is also dealing with left knee pain. It's on the same side as the Achilles issue, uh, for the past two to three weeks. She's been going to PT for Achilles for the past five to six weeks with no real change. So listening to each one of those, knowing that the choices tonight are radiculopathy, peripheral nerve entrapment, cutaneous nerve, same.

same, tonight, are trigger point referral. That's your three options. You should have some feeling of each one of those, which one is which. Big reveal later, okay? So, let's share this. I think this would be better.

Dr. Beau (06:26.182)

So this is a slide. Let's hit the play button so it looks.

Maybe that looks the same to me. Same, same, but different. Cool. Let's share this then. Same as you.

Dr. Beau (06:42.274)

Okay, so this is something I go over in our assessment of after we've kind of went through the soft tissue assessment portion and we went through trigger point, or sorry, nerve entrapment sites of the upper extremity, which I might go back through those here in a second. But I just try to point out that we have some easy things to start differentiating what's causing this referred pain. So the first one would be, well, you can have a central component.

Well, then you want to say, okay, what are all the things that can create a central component that can refer pain? What do you guys got? Disco, genetic, boom. You have some sort of cord impingement, lesion, cystic change, or you can have some disturbance of the nerve root, foraminal encroachment, assist on the nerve root. Uh, you could tear your nerve root if you're a local PT that's had cervical issues. Shit happens, I guess. Um, crazy.

crazy.

Dr. Beau (07:42.258)

Everybody needs a drink on that one. Or you could have peripheral and I'm trying to make this like very like, this is what you got option wise. So you're like, Oh, all of these presentations. You're like, this is the only thing you kind of got. And I get, we go back to school and say what tumor infection, whatever. Yeah. Pleonasm. Yes. It's not even pleonasm is using too many words to describe something. Seth knows that, but yeah.

It's an, it's an asm. Peripheral neuropathodynamic trigger point. And I'm putting entrapments in all those asterisks because technically that includes neuro pathodynamics. Just if you have a cutaneous nerve irritation, which I did a interview with Dr. Phillips now today, which he kind of talked about, maybe there's a pro dromal peripheral nerve irritation that's causing altered, uh, soft tissue changes. And then, uh, thereby altered Arthur kinematics. So maybe it's.

maybe not backwards from what we originally thought, but maybe there's some other mechanisms of play. So I could even throw that into neuropathodynamics and just say neuropathodynamics trigger point.

And when you distill it down to that, you're like, yeah, maybe I kind of feel like I'm overthinking things too much. So I use this as just a working exercise. We've already went through the six hats process, which we haven't talked about yet, but the six hats is this book we talk about by Edward DiMono that goes over, well, let's see if I can remember them. It's been a while. Maybe Seth, you might have to help me. The blue hat is your process hat, keeps you on task. The white hat is what we call our audits, our objective data hat.

The red hat is intuition. The green hat is divergent thinking. That's kind of this explosion of thought. The yellow hat is convergent thinking. It shrinks it back down. Then you have the black hat that is things that could be going wrong, red flags, initial in the case, or pivots later in the case. Using that process, the first thing that needs to happen if somebody came into your clinic with this, they're saying, hey, I have pain in the ventral aspect of my forearm, and it goes into my first and second digit.

Dr. Beau (09:50.274)

So you're, I mean, that's what they're telling you. Okay? So then you as a clinician are supposed to have this divergent brain explosion moment. They could say, it could be a radiculopathy. C5, C6, we talked about that, cool. It could be a trigger point from any of these muscles. But when you get into the specifics of some of these trigger point referral patterns, you're like, oh, that doesn't really make sense for going all the way into the digit. Maybe it's into the thumb, maybe it's just the wrist. So you could say, oh, these kind of look like it because they'll mimic this kind of, you know.

a referral pattern, but it's not exact. And they would say, yeah, neuropathodynamics radial nerve, and then the cutaneous nerves off the radial nerve. Could be anything like that. And then your exam, right, going through range of motion, soft tissue palpation, joint palpation, neurodynamics, you'll start to suss out which one of these McKinsey, get it, cool. Cutaneous nerve, like we said, lateral anabrachial cutaneous. So.

I just wanted to go over that to show you, we could take all of this, you know, we go over all of this fancy stuff in art of assessment to show you all of the options, all the nerve entrapment sites, all the cutaneous nerves. Reticulopathy, pretty easy to determine what's going on if it's associated with what? Neck pain. I would say motor weakness or reflex changes. And you're like, oh, that's legit Reticulopathy. Because you're not going to get that with trigger points or now peripheral nerve entrapment.

Maybe you could say you get some, we, I think that would be hard press for weakness for sure dysesthesia, peristhesia. You can still have that with trigger point, right? So I have that nerve entrapment. And then the hard thing with nerve entrapment trigger point is like, they're probably together all of the time. So then saying, Oh, it's this or this, and maybe it's both. And then you're just having an intervention point. So instead of using like a neurocentric dermal tractiony kind of cutaneous nerve, you focus on the trigger point.

And that was kind of cool. Would I, so look forward to that podcast with Phil snow. Cause it's kind of what we talked about today, which I didn't know that was what his thinking was and he had some interesting input on that. So breaking it down here, how do you determine just off hearing these short synopsis of a case, right? Cause when somebody is entering your clinic portal, we always talk about, well, we want to start having some sort of intuitive, right? Some sort of stereotyping. And we talk about an art of assessment, how that's not a negative thing, some stereotyping of what's going on.

Dr. Beau (12:09.93)

And then you play the game of proving yourself right or wrong. Hopefully right. Well, by the time somebody's walked in my office and told me stuff like this, which goes beyond the paperwork, or if it's a react or reactivation, which all of these were, um, you can say, well, trigger point is going to be, you can pick a lot of things out of the history. So in your guys's opinion, what are some things that would be, uh, commonalities that people may tell you if a trigger point is the culprit for some sort of

Dr. Beau (12:39.202)

how it presents, time of day, activities, things like that. Is there anything that sticks out? It's probably worse after the activity. Yeah. Well, I guess, go ahead. I was just thinking, I was thinking like, what it might present like in the history. Like if you were doing more, if you had a change in your training volume or something that was abnormal. Yeah. You just ran a lot more or I don't know. Maybe you ran trail and you're.

Probably running road. Yeah. I say if they also feel like they stretch and then it kind of feels a little bit better after they do that, but it comes right back. Yeah. Or maybe they can hit a spot with a little crossbow or something, even create referral, but they're like, it just doesn't go away or something. Which again, we're just not saying that's what it is, but all these things should start like again, diversion where you're like, Oh, I got to like lean into that. Well, actually I guess that's convergent. So if you.

mind explosion, then you hear these historical things, you're kind of already chopping in your mind. The thing that you can't do is what? Skip ahead in your exam and all of a sudden you're like, oh, missed that thing, right? So I'd say history, yeah, things like Alex said, we call it sub-threshold nociceptive input, right? They're doing a lot of work, it doesn't really cause pain, but all of a sudden that muscle's being overutilized, maybe as Phil Snell talked about today, it's actually peripheral sensitization of the cutaneous nerves that then alter motor output.

probably both. I would say if you know your trigger point referral patterns, they have relatively defined patterns. So it's one of those things when you start to learn them, you're immediately in your head when somebody's like, yeah, like they'll literally with trigger point stuff, they'll draw like the referral pattern. Whereas like ridiculous and stuff. I mean, they're usually just like, oh, god, it's like, it's just, oh, that's why I even say, like, ridiculous, these sticks out like source on like, it's just, you're gonna know it. And then if it has, like I said, you know,

uh, my atomal or reflex changes or anything like that. Um, so learn those patterns, realize that they're not exactly the same on everybody and they're not the exact same in every case. Uh, how do you elicit a trigger point response? Push on it. Palpate that bitch. Uh, yeah, you push on it. Is it always going to refer? No. Is it going to cause local pain even if it's not the, the culprit? Probably. So that's where you got to make sure that like it is the thing to work on.

Dr. Beau (15:01.55)

Um, and is it a trigger point? So if you think it's anterior scalene and you go up and there's no trigger point there, it's gone, like just that easy. Don't be like, I don't know if it was a trigger point just early in your career, make decisions. You might be wrong, but make a decision. Otherwise you have. How bad would it be if you ran an experiment and you're like, I don't know if that variable worked or not, but I'm going to go do another experiment and keep that variable in there. And then you keep adding variables personally, like you don't even know what the hell you're testing. Just make a decision.

Maybe the wrong experiment, but at least you ran a clean experiment. Anything else on trigger points that you guys would add in? I feel like you, another one to me, another presentation that you'll see me if it doesn't reproduce the pattern or they don't feel like it's tender. If I, if I think there's three points, they don't realize it's a, yeah. Um, yeah, like I think a lot of times seeing people with like that TL trigger point on an erector, they'll like literally twitch to the side. Yeah. And didn't know that was, oh, that didn't think that was that tender. Yeah. Especially your back. Cause let me.

you know, the, the feedback, like sensitivity of your back and stuff. Yeah. That's a good point. Um, almost like a ticklish type feel. Yeah. Which you will get, you know, I felt like I could go on any, how, and sometimes like the peripheral nerve as well. I feel like that can also get a little tickly. That's what I was going to say. Like I try to explain to patients like ticklishness is like altered neurofeedback. Like you're heightening your sensation because there's altered perception. So the best thing to do to protect it is make ticklish. They don't, everybody's like, really?

like think I'm lying and yeah, I just make up stuff to like make my day fun. Uh, but that's why kids are relatively ticklish. Their nervous system is still developing. So they're trying to like pick up better feedback. Uh, anything else on trigger points?

No. Yeah. And with all of these, I'd say trigger points, the least out of all of these treatment is part of the diagnosis. I think if you're sticking a needle in a muscle to determine if a trigger point's going on, you are terrible at your job. She'd be like, yeah, it's kind of tight. And like, no, you should be like, dude, trigger point right here, like light it up. If you're not to that point, like you shouldn't be using, you know, heavy tools like that. Are we going just purely off of history right now?

Dr. Beau (17:10.702)

for the cases. For what a trigger point is. Like, or what we're talking about, like trigger point. Oh, no, not at this point, no. I feel like reduced range of motion can't. Yeah, yeah, that's a good thing. Yeah, I would agree. But I would also say that any of these can create reduced range of motion. That is one tough thing, because you have a cutaneous nerve, like if you have a nerve entrapment, that's technically a pathoneurodynamic, which an overt sign is reduced range of motion or overt abnormal test, right?

Maybe it's pain that's reducing, it's not a legitimate reduction without that. Yeah, I'd say that's true most of the time. Yeah, trying to think of anything else.

If anybody has anything, let us know. We'll move on to radiculopathy. History, a huge one. I would say 90% of the time, radiculopathy is not gonna show up overnight. It's gonna be this kind of creeping thing that's getting worse and worse. I mean, sometimes you have that kind of like, yeah, I slipped on the ice, fell and slammed my neck into extension rotation, lateral flexion, and then you smack a nerve root or something, or protrude a disc.

Uh, but the history is also what positionally that not that a trigger point could be that positionally this thing just lights up, right? That it also may have what? Like, uh, some sort of, uh, alleviating position versus a trigger point. I mean, there's not many things you can do to get away from that thing. Once it's kind of, you're just like, Oh my God, like that's why people want to jab something in it. Ridiculous symptom. If you have

something besides an extrusion or a protrusion or sequestration that's like out in the canal that cannot be worked on mechanically, you can usually move yourself in a position where you're like, yeah, and that's what people will tell you. That would be the big historical presentation. That's why you come in and Antalgic. You're trying to offload or open the frame and or open the lateral canal. So that'd be the big history point on that for me. Obviously, if somebody tells you.

Dr. Beau (19:16.122)

Uh, it's getting hard for me to walk on my foot, slapping on the ground. You're going to see all the neurologic signs, he'll walk into walking. If anything like that's off, you're going to get it. That I don't think we need to go over that. Um, so I have in here, you know, dermal, total pattern. Right. I think you should know your ridiculous patterns. Just like we get taught in school. Uh, like I said, associated motor weakness, reflex changes, orthopedic findings. So I'm saying orthopedic because those are sometimes testing for ridiculous patterns like what. What's the orthopedic test for it?

mainly to suss out a ridiculous symptom. Slumps, slumps, maximal, framel compression. Uh, I mean, I guess on a lot of circles. Yeah. Kemp's yeah, maybe. Yeah. Let's say, yeah, maybe more sclerotogenous facet driven referral, but yeah. I don't even know what the, like, if there's a real name for it, but whenever we do the straight leg raise where you close the frame in.

Like bananas. Yeah. Is that like an actual? A lot of no, it's modification of drone dynamics. Yeah. Which neurodynamics means straight leg or a slump is neurodynamic maximum frame, no compressions, the rare ones are just closing out the canal and kind of seeing if it pegs them. Um, and then I would also say with a ridiculous opthia, like we're saying, I believe you had an impish in it. If there's a directional preference, which if they tell you or you find one, so I could send to the treatment, you know, can be part of the diagnostic process versus the trigger point. I don't think that's somewhat the case.

Peripheral nerve entrapments, as I said, I'm gonna throw in cutaneous nerve irritation, sensitization, entrapment in there because I think that's mainly what you're gonna see if it's just an entrapment. History presentation with this is, I would say largely activity dependent. So you have a nerve entrapment, it's usually like I go play tennis and I get radiating pain down my arm, I run for a while, my foot starts to burn down the side of my ankle or something like that.

You can have it positionally just like you'd have with radiculopathy, a little bit of trigger point, but I'd say it's more activity driven because of the interface, right? If you're testing neurodynamics, it's usually a big dynamic movement. The other thing is I asked Brett Winchester about this. Michael Shacklock talked about it when I had him on the podcast a long time. You usually have to have two areas of entrapment to have a true nerve entrapment because you're tugging on it at both ends. So that's like a...

Dr. Beau (21:34.89)

You know, it's not moving well in an open and closing dysfunction. And then you have some sort of trigger point or fascial distortion in the periphery. Uh, so what I would say is you can also get this with static positions, like sleeping, which is all of these would come on with static positions. I mean, how many people are you sussing out around shoulder stuff? I fall asleep and like my hand will now it goes down to pattern, right? Well, you could be cutting off oxygen by the muscle can't move. You could be closing down the frame and you could be, you know, closing down, break your plexus. Now you get a, that second.

I mean, all of those. So that history piece, maybe not as much, but I'd say the activity for sure. Also, I don't know if I've ever had a case where I was paying attention enough that if they have a true nerve entrapment, they're not pointing right to where like a cutaneous nerve like perforates the superficial fascia. Like we pay attention if somebody's like, dude, it just feels like I should. But if they're doing this kind of stuff and I'm, if you're not watching the video, I'm just rubbing vigorously over an area.

and it's a cutaneous nerve irritation, what are you probably doing? Pissing that thing off. But that's what most people wanna do, right? Whether it's around the anterior hip or around the elbow, the knee, maybe we don't see people crushing stuff in their knee, but foam roller, it's not out of their quad or stretching it. Again, stretching in these scenarios probably not gonna be the best thing ever. Could be associated with latent trigger points. What I mean by that is,

If you don't have an active trigger point, that would be something that's creating the pain of latent trigger point can alter, like we said, motor control, muscle output, joint, arthrokinematics, and then pretty soon, what are you doing? That nerve is getting tugged on or pulled around from both ends. And that's where I think latent trigger points. So then you have a decision to make. As I talked to Dr. Snell today, what's your intervention point is, you know, the stecho model would say, Hey, you got to get the, the myofascial slings moving so that nerve can move through them. Um,

I'm not saying versus, but maybe another approach is, hey, we desensitize the nerve, and maybe that desensitization of the nerve calms down the rest of the tissues. I don't know, pick a poison on that one. Associated skin findings, talk about all the time. Skin tension, your ability to actually roll the skin and pinch the skin. Trofedema, so that's that orange peel effect in the skin if it's got a lot of, or it hasn't moved a lot and you kind of get...

Dr. Beau (23:57.246)

Oh my gosh, lymph kind of trapped in with that superficial layer. And then just with any of these treatment findings, so if we use a neurodynamic test, you're probably gonna get an over abnormal test, you're probably going to use neurodynamics to jump in and treat that right away. I would say most of the time. So then you treat it, if you have a positive outcome, then you just solidified that as most of these would. Anything to add on peripheral nerve stuff? Trying to think.

And again, like DTM dermal traction is, I would say a pretty good diagnostic thing. If somebody has pain when they extend through their low back and you just grab their, you know, the skin over L four, L five, and you haven't do the same thing and they're like, yeah, I don't have any pain. Might be a good indication. Like clunial nerves are being irritated. Now, is that the only thing? No. But like, if I can change pain, I may change input, which changes output. And now here we go. We're on this like cascade. Uh, anything else?

Dr. Beau (25:01.022)

Now, one thing I will say on all of these, each one will garner a different treatment intervention, but then each one of them also garners different homework and adjunctive care. So sugar point, great thing. Let's say you find a sugar point and somebody is infraspinatus and we do a little bit of DNS, you throw some needles in it. I mean, you may say, hey, for the next day, don't do anything with that, but then like let's stekko around it. So I teach people a lot now.

that if the microphone is the trigger point that we can work on both sides of that microphone instead of working right on it and kind of pissing the trigger point off and get that kind of, the highlighter on it and running through there, get the fascia, heat it up a little bit next to it and you may just kind of keep that thing at bay. Because again, maybe we haven't had enough time to change motor control or whatever's causing the trigger point in the first place. Radiculopathy, you're probably not going to send them home sticking a lacrosse ball in there.

uh, in between their shoulder blade, if they got radiating pain, what are you going to be sending home? Probably in range loading, you know, McKinsey ask stuff, probably not a great time to send somebody home with nerve flossing or something like that. If they, so again, you can see once you have a clear diagnosis or you can like name like, Hey, it's this tissue that I think is causing it. And then yeah, there's functionality that you're going to work around it. There's dos and don'ts with all of these peripheral nerve entrapment. I mean, this is where like taping

And DTM, skin rolling, yapping, all these things come into play. Voodoo floss for you can be like, man, you can really crush symptoms. And again, especially after listening to the Dr. Snell today, I mean, maybe a big deal here is desensitizing the periphery to change output, right? Instead of always thinking like the periphery is sensitized because of something happening from the inside out. Um, and that's the research that Dr. Snell has been really diving into. So there's some interesting stuff that he's looking at that, uh, when

a very strange but, uh, intelligent mind on something like that. He'll come up with some interesting outcomes. Okay. Anything else, there anything else that causes referral patterns for sure clowered signs to the discs themselves. We looked up some Ligar. What was the ligament, uh, referral pattern? What was that guy's name? It's guy's name. You found a ligament referral chart and I was like, yeah, don't even worry about that. Uh,

Dr. Beau (27:24.738)

Huh? Clare. Clare me. Yeah, we'll look it up. Sclerotogenous referral patterns, visceral referral patterns. I mean, the list goes on and on. Most common culprits is what we talked about tonight. I would say the one thing to watch out for is making sure in your history that you don't have some viscerosomatic referral pattern going on. The big ones, heart. Yeah. And it, yeah.

Big ones like common gallbladder, like don't let somebody die of like a heart attack or a clot or something. Cause you're like, oh, your whole hand's numb. And you're like, yeah, let's work on this trigger point. Okay, your arm's a little red and swollen. That's okay. Yeah, so be a physician or that should be taken away from the second part of your moniker. So let's roll these out. So again, a review, we had the 15 year old female track and field athlete with heel pain.

week onset, 42 year old male that started running over the past few months has right heel pain to the point where he can barely run. History of some mild low back pain. And a 53 year old female trainer that was put in a boot a few months ago due to Achilles tendonitis. Now, I'll add something onto hers that kind of does matter. So maybe I slow played you. When I heard that she was in a boot, now she's in my office, she did PT and they said it was Achilles tendonitis. I just asked her, was it red or swollen or hot or anything like that at any point? No.

Firmly tell that patient you never had Achilles tendonitis. Did you have some sort of apathy with your Achilles? Maybe you definitely didn't have inflammation if you didn't have inflammation so you didn't have the ides is the ides Why is that important because? Dumbass doctors need to quit telling people shit. That's wrong. That's why and like don't let them get away with it Now don't be a jerk. I didn't want to make her feel Less than or dumb for having been put in a boot or listen. She's not she did what they told her and that is

why she did it because they hold authority. It's not on her at all. Um, but now that she knows if she has encounters again, it is on her. Um, so that's one thing. There was no inflammation, but I think that most people listening to this podcast, if we had somebody with Achilles pain that got stuck in a boot, you'd already be like, and calm bullshit. So here's the big reveal. So the 15 year old female track and field athlete honking trigger point remedial gastroc needle that puppy literally walked out of the office, no pain and ran attract me.

Dr. Beau (29:46.702)

Two days later, that was Thursday. So, how do we pull that out of that one? She dealt with medial tibial stress syndrome. So maybe there's some mechanical things that she likes to really get out in front of herself, maybe use the lower compartment a little more if she had. Where was I trying to mislead you? She was a dancer gymnast prior to getting in track and field. So now you already know that one of these other two isn't a trigger point thing, but maybe she had some low back stuff. You're like, oh, I gotta make sure I really rule out the low back, which you do. But I've seen her for a long time and I went with the most common thing and I.

palpated that and it referred pain into her medial heel. And I was like, I think that's it. And I know her history because I've treated her so much. So I didn't go back. Maybe I missed something and treat her low back. I threw a needle in that giant trigger point that her referral pattern was gone and it stayed gone. Now, if she was a brand new patient, it's a different way to approach that. The 42 year old male that started running had a heel pain. I was a dumb on this one. So he comes in the first visit.

I do some foot stuff with him because he, I mean, he can't do anything with his feet. He has no, you know, toe yoga is all off. I do that. Because the next time he's like, I'm kind of the same. Then in office, do a bunch of press ups. He gets up, he walks around and goes, you might, you don't hurt at all. I'm like, oh, cool. I'm like, I should have paid attention to him telling me that I've had my low back pain. Now he didn't say severe things. He didn't say he had a laminectomy, right? Which would red flag you this intuition's coming. But he did say he had back stuff.

with intermittent flare ups and he uses, he has flat feet and orthotics because I got led off course by that. Now let me pay attention to that, right? And he was asking me about shoes and what shoes you should get. So he kind of, he played a poker hand and I bet. So did some McKinsey based stuff, worked on some breathing stuff. We worked on some hinging because he was doing a little cross training. I haven't seen that guy in forever. Hopefully still running, but I saw him six, seven times. He was doing awesome. 53 year old runner. We only got one option left. What is it?

peripheral nerve entrapment. So putting a boot a few months ago, the Achilles tendonitis, where was her pain? I don't have the foot model, I should have shown it. Alex, you should just strip your sock off. No. If you go on, so I don't know if you can see this, but low. So we're saying below technically the insertion of your Achilles on the medial and lateral side of your heel. It's technically not even your Achilles. We're not in your Achilles.

Dr. Beau (32:07.554)

No inflammation, not on your Achilles, but you have Achilles tendonitis, get thrown in a boot and it was on the medial and lateral aspect. And she goes, the worst thing that I could do is squeeze it. Well, what's one thing that squeezing your calcaneus medial or lateral is could be indicative of? Stress fracture. It's actually the most common or the best test. But also what lives on the medial and lateral aspect. Well, your lateral and medial calcane or calcaneal nerve.

So they drape off that, what do they come off of? Tibial nerve. What was she also dealing with? Knee pain. Where did I get lead astray with her? I didn't get lead astray. I hit this one on the head, but I treated two prongs. She had a laminectomy 20 years ago, so I asked the question, have you had any back pain and anything going on? Because that hasn't been getting better. She's been doing PT and all this other stuff. So she goes, yeah, two, three weeks ago, my knee started bugging me where I can't flex it without it being really tight through the front. So I go, you know what? Let's not really treat your heel. I was almost certain.

that it was, you know, a peripheral nerve entrapment just based on presentation. I mean, there's, when there's no other anatomy there to cause pain, you kind of gotta be like, that's gotta be the thing causing it. So I said, hey, I'm not gonna treat your heel. I'm gonna tape it, right? So palliative stuff, we think it's nerve entrapment. I'm gonna give you knee gapping flexions because we determined on orthopedic tests that nothing was really going on with their knee other than, you know, restricted motion and flexion. And then I was like, you're gonna go home and do extensions for, you know.

two days and just see what happens. So she came in today. She did extension for two days, nothing happened. She did the flexions in her knee. She said she also did some other stuff and that's probably where her knee was better. But her knee was pretty much better. Her heel, interestingly enough, was better with the tape on and then worse than it was before when the tape came off. I don't think it was worse. I think she just had a refractory like, oh my God. Yes, exactly. So then she comes in. Well, how do I know it's better? Cause I could palpate it and there was no pain today. So today we did all the peripheral nerve stuff, voodoo floss, moving around.

taught her a tibial nerve flossing maneuver. And then that's what I sent her home with. So that again, all of them heel pain, all of them runners, all of them you could think like, oh my God, that's a low back case. Oh my God, that's, you know, whatever. Your intuition will get better and better, but like, it's not like I had a home run with the 42 year old dude, right? Like I was like, let's work on your feet. And it took me a visit to be like, hey, stop. Like I should have ruled out his low back. That was a new patient visit. I didn't do due diligence off of the history in the exam.

Dr. Beau (34:34.838)

So where are you thinking? Where are you thinking the knee came into that after the fact? Probably altered, probably altered running from what she said that her heel never bothered her when she ran. I mean, she was literally like, she couldn't jump without pain. She's in the boot. She was in a, so she hurt had Achilles pain in November of last year. She got out of the boot around the blood rock or right after blood rock.

She wasn't in the boot when she saw you? Yes. She's been out for a while. She did PT after the boot. So she was in the boot for about three weeks, then did five to six weeks of PT after that. They told her to just rest and wear the boot, which is also insanity that you don't do PT while you're in the boot.

10 inches magically. Yeah, I guess it just gets better. It just gets better. That itis that wasn't there just gonna go away. It's got a good job. You go do your thing. Stop freeloading. Yeah. Stop schmuckin'. I don't know, I thought this was kind of an error. We did this way back when in Grand Rounds. I kind of did this like multiple choice. What do you think's going on? Any input on any of those or different thoughts? And again, I gave you very little information on purpose. I didn't want to go through entire cases and suss it out. That's not what this is about.

How do you make a differentiation? Cause this is the stuff you're gonna see the most. And like, Snell said today, like, this is a bulk of his referrals because he's built a practice on people know that he deals with neuro stuff. So that's a lot of his referrals. Well, I think you could just like, you build a practice on gymnastics specialty feet. You could very easily be like, dude, I'm really good at sussing out like these, you know, paresthesia, referred patterns. People are not good at that at all. What?

in our profession, definitely in other professions, they're absolutely terrible. If you can point at pain, like these are all heel pain. We don't think of those as a referred pain or pointing at their heel. When you draw this ridiculous pattern, most physicians are gonna go, eh, it might be your neck. Well, maybe it's not. And that's where you can differentiate yourself. Now, how you sell that or market that, that's up to you, I don't know. I say you get one of those body suits and start doing YouTube videos, like on yourself, like the muscle suits.

Dr. Beau (36:49.519)

Yeah. I think that'll do really good. Yeah. Sticky note yourself. Sticky note. Yeah. Make yourself a cadaver lab nerve model actual pins. And then you can actually pull out your entire nerve. That'd be nice. All right. Well, that's all I got tonight. I wanted a fast and furious with this stuff. I didn't want to go another hour and 15 minutes. Um, I'm assuming.

I don't know, boiling boiled hot dogs is on here still. Kaylee and two other people are one. I think it's one plus two. So the sad announcement is, uh, still here thriving on boiled hot dogs. She's probably eating a hot dog right now. Um, and it's probably delicious. Actually, Seth and I were saying best hot dog ballpark, hot dog, wrapped in foil.

It's been marinating in its own juices. So the buns a little bit soggy to where he could literally just Kobayashi that thing and just, whoa, one bite. You don't like hot dogs? He doesn't like, he doesn't. He doesn't like hot dogs. I use it. Yeah, I see. Dude, I used to eat hot dogs raw when I was a kid, like Oscar Myers. Go in there and see one. Do you want to see one? Thank you. Get away with something. Oh, yeah. I'd be out of there. Gone. You can pipe down about three hot dogs at a ballpark in less than five. I could do a broad.

Like you guys ever microwave hot dogs in your kids? Nope. Just those things explode. Hot dogs did not happen in my house. They happen in my house. You know, it's technically super food. Sure it is. He literally looks peaked from talking about hot dogs. He does, he looks like a puke. I think the next ground round is we have Alex eat three hot dogs. See what happens. Kayleigh said, at least I didn't eat carnitas for literally 16 months straight. Too bad we've gone beyond that.

Not by much, Kaylee. Don't let him fool you. 16 months. 16 months ain't that long. I've been going on beef for about, and we're about ready to split a cow between the office. So you've had to beef it up. It's just going to be different cuts in there. Oh yeah. We're about to buy a grill. Kaylee, we're about to get sophisticated in this house, but the disappointing news is this is going to be the last live one. I, I especially love Kaylee. She's been here for every one of them.

Dr. Beau (39:07.998)

But we have to schedule these around our patient load and we try to do our best to make them a meaningful to everybody. But I mean, I'm just being honest, it's not worth it for this few people. So Kaylee, if you want, Alex probably has your address or something, I'll send you like a hoodie and a hat and stuff for being a beast and always being here. If the other person that's going unchatted wants to represent themselves and you've been represented and I'll do the same for you.

but we'll keep doing these. We're just not, we can do them live. I'm just not gonna try to make them at times that work for people. So it may get announced five minutes before. I'll still go live like this. Jayden's still here. Appreciate you, bro. And so there'll still be the opportunity. It's just not gonna be like a week in advance. I don't know. Somebody's hacking the system. They heard that we were shutting this down. My camera just bugged out.

So we love y'all, we'll still be doing residency stuff and releasing videos, but most of that's just gonna go on YouTube now, I think it's just better way. I'm gonna leave the Facebook forum up, I wanna keep having chats, and I think we had two people that commented on the what's your exam flow. So yeah, keep posting stuff in there if you want to. If you still wanna present a case, I'll still leave that open, you can go fill out the form or get ahold of us or something like that. And we'll see what goes on, now there's five people once I announce that it's going downhill, so.

Yeah, it's how it goes, but we love you. Uh, I don't know when the next one's going to be probably in two weeks, but it might be, I don't know, might be at 10 PM at the farm when we're all just turned. So let's see. 10 PM. I'd be upside down. I'd be upside down at 10 PM. Don't you have a baseball game or a softball game in it though? Um, I'm sure you're dirty. I'm sure we could go ask early that dude over here in the narrows for his inversion.

Yeah. He probably has no idea we exist, but I ran past a guy the other day in the neighborhood that's literally probably two or 300 meters away from the front door of this place. No clue. We exist. No clue. We exist. And he's hanging upside down on an inversion table in his garage. So that's what was about ready to go in there and Batman them. Just punch them right in the back. Adjust them. Walk out. Kick his knees backwards. So you just get more of that farther. Yeah.

Dr. Beau (41:21.486)

But we do appreciate everybody being on here tonight and everything before and like I said, we'll keep doing these just they won't be announced Quite so in advance, but look for those in the Facebook page when we do have a podcast coming Without further ado. See ya

Post Ankle Surgery and Hip or Low Back Diff Dx: Week in Review 32

Dr. Beau and Dr. Alex sit down to discuss a case of an elite gymnast dealing with ankle issues 5 months post-op, as well as an acute onset of hip pain that is proving a bit tricky.

Square 1 System - Shawn Sherman

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Shawn Sherman on Instagram

Square 1 System

Summary

In this conversation, Dr. Beau interviews Shawn Sherman, the creator of Square 1 Systems, a problem-solving framework for movement professionals. They discuss the development of Square 1 and its focus on restoring organization within the nervous system to improve upright posture and locomotion. Shawn explains how he moved away from traditional training methods and began using muscle testing and isometric contractions to address disorganization in the nervous system. He also emphasizes the importance of understanding neuromechanics and the temporary nature of interventions. The conversation concludes with discussing the significance of locomotion and gate recognition. In this part of the conversation, Dr. Beau and Shawn Sherman discuss the integration of changes in gait and how it reflects the effectiveness of treatment. They also explore the assessment of neurologic pathology and rule out true neurologic damage. The conversation delves into the impact of stroke on neurological function and the challenges of treating stroke patients. They discuss the value of understanding the brain's impact on movement and the limitations of current knowledge. The conversation also touches on joint restrictions and trigger points, as well as the integration of psycho-emotional inputs in treatment. They conclude by discussing the customization of the Square One system and managing expectations for pain relief in different cases, including athletes and non-pain cases. In this conversation, Dr. Beau and Shawn Sherman discuss the importance of supporting other therapies and the individual neurological response to different inputs. They explore the potential negative effects of certain inputs and the need to replicate and integrate them into the nervous system. They emphasize the role of supporting other professionals and the initial temporary negative response that may occur. They also discuss the relationship between stimulus and response and the importance of exposure and integration. They touch on the impact of inputs on visual acuity, mobility, grip strength, and exit velocity. They highlight the need for a lab and education center to explore new ideas and geek out on numbers. They conclude with the idea of keeping an open mind and the analogy of Bigfoot to emphasize the importance of being open to possibilities.

Takeaways

• Square One is a problem-solving framework for movement professionals that focuses on restoring organization within the nervous system.

• Muscle testing and isometric contractions are used in Square One to address disorganization and improve movement patterns.

• Understanding neuro mechanics and the temporary nature of interventions is crucial in the Square One approach.

• Constant challenge and testing are important to maintain homeostasis and improve movement patterns.

• The significance of locomotion and gate recognition in understanding human movement is explored. Integration of changes in gait is an important indicator of treatment effectiveness.

• Assessing neurologic pathology requires ruling out true neurologic damage and differentiating it from peripheral or central sensitization.

• The impact of stroke on neurological function varies, and treatment outcomes may differ based on the location and chronicity of the stroke.

• Understanding the brain's impact on movement is valuable, but the specific areas of the brain affected may not be crucial for clinical practice.

• Joint restrictions and trigger points are real phenomena, but the underlying causes are not fully understood.

• Psycho-emotional inputs can affect movement and should be considered in treatment.

• The Square One system can be customized to individual clients and their specific needs.

• Pain relief can be achieved in as few as two sessions, but maintenance and ongoing care may be necessary.

• Athletes and non-pain cases can benefit from the Square One system by addressing movement efficiency and optimization. Supporting other therapies is important in helping individuals achieve optimal neurological response.

• Negative effects from certain inputs can be temporary and can be integrated into the nervous system with time.

• Replicating inputs received from other professionals can help support their work and enhance the individual's neurological response.

• Exposure and integration are key in developing a robust nervous system that can handle various inputs.

• Keeping an open mind and being willing to explore new ideas and possibilities is crucial in the field of neurology.

Chapters

00:00Introduction and Background

06:28The Development of Square One

09:21Traditional Training and Square One

13:08Identifying a Gap in Knowledge

23:00Intervention and Isometric Contractions

26:11Understanding Neuro Mechanics

27:34Addressing the Temporary Nature of Interventions

32:31The Importance of Constant Challenge

33:00The Significance of Locomotion and Gate Recognition

33:56Integration of Changes in Gait

35:02Assessing Neurologic Pathology

37:31Neurological Issues and Stroke

40:30Understanding the Brain's Impact

43:54The Value of Knowing the Brain's Impact

46:14Exploring Joint Restrictions and Trigger Points

48:18Integrating Psycho-Emotional Inputs

53:49Customizing the Square One System

57:42Expectations for Pain Relief

01:00:26Working with Athletes and Non-Pain Cases

01:01:21Supporting Other Therapies

01:02:15Individual Neurological Response

01:02:44Negative Effects of Inputs

01:03:17Replicating Inputs

01:03:44Supporting Other Professionals

01:04:12Temporary Negative Response

01:04:57Stimulus Response

01:05:11Exposure and Integration

01:05:38Visual Acuity and Mobility

01:06:07Grip Strength and Exit Velocity

01:06:36Power and Strength

01:07:05Balance and Coordination

01:07:36Lab and Education Center

01:08:02Playing with Ideas

01:08:30Geeking Out on Numbers

01:09:23Keeping an Open Mind

01:09:29Testing Narratives

01:10:09Crashing Against First Principles

01:10:53Openness to Possibilities

01:11:22The Bigfoot Analogy

01:13:13Closing Statements

Steven Capobianco - The Trigger Point Discussion: Part I

Summary

In this conversation, Dr. Beau and Steven Capobianco discuss the complex topic of trigger points and their role in manual therapy. They explore various theories and mechanisms behind trigger points, including the soft tissue milieu, neurogenic inflammation, and peripheral and central sensitization. They emphasize the importance of considering the broader context of the patient and adopting a synergistic approach to treatment. The conversation also touches on the interrater reliability of palpation and the role of experience in improving accuracy. In this part of the conversation, the subjectivity and objectivity of palpation are discussed, highlighting the challenges of accurately locating trigger points. Advancements in technology, such as MSK ultrasound, elastography, and T1Q mapping, are explored as potential tools for identifying trigger points and dysfunctional tissue. The role of hyaluronan in the extracellular matrix and its impact on tissue mobility and sensitization is examined. The concept of peripheral sensitization and neurogenic inflammation is introduced, emphasizing the importance of addressing cutaneous nerve entrapments in treatment approaches. In this conversation, Steven Capobianco and Dr. Beau discuss the role of touch and movement in addressing pain and dysfunction. They explore the influence of peripheral and central structures, such as trigger points and the limbic system, on the experience of pain. They also delve into the importance of the therapeutic alliance and the need for open-minded discussions in the field of musculoskeletal therapy. Overall, the conversation highlights the complexity of pain and the need for individualized approaches that consider both physical and psychological factors.

Takeaways

Trigger points are a real phenomenon experienced by patients, and their presence should be taken seriously by manual therapists.

The soft tissue milieu, including the extracellular matrix and fascial network, plays a significant role in trigger point development and treatment.

Neurogenic inflammation and neuritis are potential causes of trigger points, highlighting the involvement of nerves and cutaneous tissues.

Peripheral and central sensitization contribute to the pain experience associated with trigger points, and understanding these mechanisms can inform treatment approaches.

A synergistic approach that considers multiple theories and mechanisms may be more effective in addressing trigger points than focusing on a single theory.

The accuracy and interrater reliability of palpation improve with experience, allowing for more consistent identification of trigger points. Palpation is subjective and may not accurately locate trigger points, highlighting the need for advancements in technology.

MSK ultrasound, elastography, and T1Q mapping are emerging technologies that can aid in identifying trigger points and dysfunctional tissue.

Hyaluronan plays a crucial role in tissue mobility and sensitization, and its quantity and quality can impact tissue slide and glide.

Peripheral sensitization and neurogenic inflammation contribute to pain and can be addressed through treatment approaches that target cutaneous nerve entrapments. Addressing pain and dysfunction requires considering both peripheral and central structures.

The influence of touch on the nervous system can impact the experience of pain.

Therapeutic alliance and effective communication are crucial in guiding treatment decisions.

Open-minded discussions and collaboration are necessary to advance the field of musculoskeletal therapy.

Chapters

00:00 Introduction and Setting the Stage

00:24 The Phenomenon of Trigger Points

07:23 The Soft Tissue Milieu and Extracellular Matrix

10:37 Neurogenic Inflammation and Neuritis

26:26 Synergy Across Approaches

27:18 Interrater Reliability of Palpation

28:40 Subjectivity and Objectivity of Palpation

31:59 Advancements in Technology: MSK Ultrasound

32:58 Advancements in Technology: Elastography

34:55 Advancements in Technology: The Pact Device

37:31 Advancements in Technology: T1Q Mapping

39:24 Hyaluronin and the Extracellular Matrix

41:49 Chemical Milieu and Central/Peripheral Sensitization

50:11 Treatment Approaches for Sensitization

57:03 Peripheral Sensitization and Neurogenic Inflammation

58:26 Cutaneous Nerve Entrapments

01:01:15 Addressing the Peripheral Structures

01:04:04 Central Sensitization and Trigger Points

01:05:08 Spinal Cord Central Sensitization and Limbic System Response

01:06:27 The Influence of Touch on the Nervous System

01:07:53 Influencing the Nociceptive Barrage

01:08:23 Considering Other Physiological Factors

01:09:23 The Spreading of Pain and Receptive Fields

01:10:23 Using Touch to Change the Narrative

01:11:19 The Role of Touch in Influencing the Limbic System

01:13:16 The Role of Trigger Points in Pain Referral Patterns

01:15:33 The Effectiveness of DNS and the Importance of Therapeutic Alliance

01:17:01 Making Decisions Based on Individual Factors

01:21:09 The Need for Open-Minded Discussions and Clarity

01:25:02 Creating Productive Solutions for Patients

01:27:38 The Importance of Communication and Art in Therapy

01:30:23 The Future of MSK Powwow and Continuing the Conversation

Citations

Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, Carlisle J, Polisky L, Geuter S, Flood TF, Kragel PA, Dimidjian S, Lumley MA, Wager TD. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022 Jan 1;79(1):13-23. doi: 10.1001/jamapsychiatry.2021.2669. PMID: 34586357; PMCID: PMC8482298.

Stecco A, Cowman M, Pirri N, Raghavan P, Pirri C. Densification: Hyaluronan Aggregation in Different Human Organs. Bioengineering (Basel). 2022 Apr 5;9(4):159. doi: 10.3390/bioengineering9040159. PMID: 35447719; PMCID: PMC9028708.

Ertekin E, Kasar ZS, Turkdogan FT. Is early diagnosis of myofascial pain syndrome possible with the detection of latent trigger points by shear wave elastography? Pol J Radiol. 2021 Jul 12;86:e425-e431. doi: 10.5114/pjr.2021.108537. PMID: 34429789; PMCID: PMC8369817.

Price CJ, Weng HY. Facilitating Adaptive Emotion Processing and Somatic Reappraisal via Sustained Mindful Interoceptive Attention. Front Psychol. 2021 Sep 8;12:578827. doi: 10.3389/fpsyg.2021.578827. PMID: 34566738; PMCID: PMC8457046.

Menon RG, Oswald SF, Raghavan P, Regatte RR, Stecco A. T1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation® in Subjects with Elbow Pain. Int J Environ Res Public Health. 2020 Jan 22;17(3):708. doi: 10.3390/ijerph17030708. PMID: 31979044; PMCID: PMC7037807. 

Cerritelli F, Chiacchiaretta P, Gambi F, Perrucci MG, Barassi G, Visciano C, Bellomo RG, Saggini R, Ferretti A. Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study. Sci Rep. 2020 Feb 21;10(1):3214. doi: 10.1038/s41598-020-60253-6. PMID: 32081945; PMCID: PMC7035282.

Geri T, Viceconti A, Minacci M, Testa M, Rossettini G. Manual therapy: Exploiting the role of human touch. Musculoskelet Sci Pract. 2019 Dec;44:102044. doi: 10.1016/j.msksp.2019.07.008. Epub 2019 Jul 25. PMID: 31358458.

Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015 Mar;54(3):392-9. doi: 10.1093/rheumatology/keu471. Epub 2014 Dec 3. PMID: 25477053.

Dommerholt J, Gerwin RD. A critical evaluation of Quintner et al: missing the point. J Bodyw Mov Ther. 2015 Apr;19(2):193-204. doi: 10.1016/j.jbmt.2015.01.009. Epub 2015 Feb 4. PMID: 25892372. 

Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015 Jul;7(7):746-761. doi: 10.1016/j.pmrj.2015.01.024. Epub 2015 Feb 24. PMID: 25724849; PMCID: PMC4508225.

Fernández-de-las-Peñas C, Dommerholt J. Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep. 2014 Jan;16(1):395. doi: 10.1007/s11926-013-0395-2. PMID: 24264721.

Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Notices. 2014;2014:523924. doi: 10.1155/2014/523924. PMID: 25574501; PMCID: PMC4285362.

Pavan PG, Stecco A, Stern R, Stecco C. Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep. 2014;18(8):441. doi: 10.1007/s11916-014-0441-4. PMID: 25063495.

Jiang D, Liang J, Noble PW. Hyaluronan as an immune regulator in human diseases. Physiol Rev. 2011 Jan;91(1):221-64. doi: 10.1152/physrev.00052.2009. PMID: 21248167; PMCID: PMC3051404.

Femur Fracture and Chronic Low Back Pain Cases: Week in Review 31

Dr. Beau and Dr. Alex sit down on this episode to discuss two cases that wouldn't seem to be all that similar but have motor control/protection root causes.

Ten Years In: OTK (Open the Kimono) Edition: Week in Review 30

Drs. Beau and Sloan Beard sit down to discuss the strikes and gutters of their practice over the last decade in practice.

Motor control and growth spurts, Sinding Larsen Johansson syndrome, simple breathing fix for hip pain

Join The FARM team this week as we discuss a youth golfer facing multiple areas of motor control dysfunction due to growth spurts, a case of bilateral hip pain of unknown etiology relieved by simple breathing techniques, a classic case of the often overlooked Sinding Larsen Johannson syndrome in a youth gymnast, and more!

Dr. Benjamin Stevens, DC - The Continuing Education Ecosystem

https://spotifyanchor-web.app.link/e/smx8rYwTKGb

Dr. Beau and Dr. Seth, sit down with Dr. Ben Stevens, in a roaming conversation about;

- What traits the best clinicians and educators share

- What curriculum Ben feels is vital to become world-class

- Why chiros tend to have a chip on their shoulder after school

- Becoming the best, doesn't necessarily mean you have the best manual skills or own the most knowledge

- And much more

Genetics and Labs Breakdown for Dr. Alex: Week in Review 29

A look into a functional health coaching session at The FARM.

Transcript

Beau Beard (00:00.29)

Your kids are soft. You lack discipline. We landed on the moon. You didn't earn the knowledge for yourselves. So you don't take any responsibility. I slightly forgot who we are. Explorers, pioneers. Gotta make it exciting. Let's get it going. I don't know what time zone everybody's in. So somebody's probably eating lunch. Somebody is maybe getting ready to go to bed. If you're Seth, that's definitely you. Follow up. Yeah. Just woke up and ready for bed already.

Uh, welcome back to another week in review this episode 29 today, we're going over that guy's, uh, genetics and labs. The original plan was to go over or his genetics and labs, his, and possibly Daniel's that is way too much stuff. Uh, some more bang for your buck for sure by going over in detail, one person's, uh, precision medicine data. Then the plan is if it works out, we'll see how it goes over time. Um,

No worries. Well, we have to make room for Andrew Huberman anyways. So we, you know, we get it. That, it says we have other people with, oh, Jayden and up camera. Or I don't know. How come I can only see two people? You know, these two people are the ones not to ask. I got it. But over time, maybe in another month, because I don't want to just do back to back episodes, we'll do Seth's.

data, then we'll do Daniel's and then we can look at correlations or non correlations across different people that are all males somewhat around the same age. So you can see differences and similarities and then how we would approach these even though they may be dealing with some of the same things. So let's dive into it and I'm going to do my HIPAA due diligence. Do you mind if I screen share your personal information with all these people right now? Okay. Now what I'm going to try to not do.

Beau Beard (01:57.091)

is I'm still letting people in here. I'm going to try not to show pertinent data. Dr. Vesco. All right, so let's go over. That's got our address on it. Perfect. So I'll screen share this so you guys can see it.

Beau Beard (02:22.19)

Can everybody see this lab data over here now? Picking that up, cool. So let's take a look at this stuff. Labs to me are nothing more than a snapshot in time of what's going on with somebody, right? It's obviously we can see on both of their labs and we'll talk about Alex's how what they did that morning in terms of fasting, but also training, you know, in the week and the day of led to.

So you can see there's some things that are out of normative ranges. So the first thing that brings up is normative ranges on labs, in particular, a company like lab core that has grabbed up a bunch of other labs. And how do they get those lab norms? It's just based on epidemiological values of normative ranges across the population. What population? The U S I think we'd all agree that the U S is not the healthiest place on earth. Um, so when they grab this normative data,

In my opinion, it's already skewed towards unhealthy. And then we say that some things are normal or not based on those healthy or not healthy norms. And that's not cool. Uh, now when we look at like a, uh, CBC and like a Kim's I'm, these are pretty accurate, right? When you get into things like, okay, the levels of cholesterol, vitamin D, those are the ones that we can kind of talk about, like, well, what should the levels be and some of that was in here.

So we can see on Alex, uh, high potassium, high albumin, both of those play into or could play into things like dehydration, right? Training the, uh, the amount of exertion you did in the week prior the day of, um, we see a little decrease in insulin. Um, and I'm saying a little decreased insulin and a guy, his age is fit as he is, is a big deal. Right. Uh, vitamin B12 is through the roof, which you'd be like, man, that's awesome.

That is not awesome. Uh, and we'll, we're going to decipher all this as we go through it. See that folate is also high. And if you know anything about functional medicine, you're already like, okay, I got a good idea of what's going on. Total cholesterol is one point high. The funny thing is that, you know, 15 points high is still shown to be cardio protective.

Beau Beard (04:37.226)

So we see somebody from the, you know, in this range, 200 or 215 range, it's still cardio protective and people live on average five years longer in that non normal range than people that are in the normal range. Asinine. Um, and then as LDL cholesterol, we can see is what's slightly elevating cause that's 14 points over, but it's totals only two to one. So what's that mean? HDL is maybe a little lower than we want. The ratio is a little bit off, blah, blah. We'll get there. Okay.

Everything else. Because again, just because they put all those down doesn't mean we just look at those and we're like, oh yeah, it's the bad stuff. You look at the entire lab as a narrative of what it's telling you. And that's why when we look down here, let's find his A1C. So A1C for Alex is 5.2. That is higher than I would like to see in somebody his age that's healthy. Ideal world, it's below 5.0.

Believe it or not, I know this says below 5.7. Did you know now you can be 7.0 and still be pre-diabetes? That's insane. That's absolutely insane. So we wanna see a little bit better blood sugar regulation over the summation of 30 days than Alex is having. Well, we also see that he's having an issue with insulin regulation. It would look like insulin production. I'm gonna assume it's regulation.

Um, so let's kind of just start going through this piece by piece. And I wrote all this stuff out. I can share some of this stuff with you if you want later. Uh, the first one, and I prioritize these is low insulin. Um, we all know what the term insulin sensitivity means. This is the opposite, right? He's not producing more insulin than he needs. I don't think he's also in the burnout phase of insulin sensitivity where he's overproduced for so long that he is no longer producing, right? I don't think that's the case. What do I think's going on?

Uh, in my opinion, as we go through this, there's going to be recurring themes. And part of this is going to have to be like a history taking with Alex that we've already done, but we're kind of. Theatrically presenting for everybody on the podcast listening today. Um, Alex runs a little hot. And what I mean by that is not thermoregulation, but, um, he's over here right now, shaking his leg under the table. Like he's, I don't know, playing Mario cart and he's pushing the gas pedal. He likes to whistle and snap.

Beau Beard (07:03.926)

He doesn't sleep well. Um, not necessarily that I would say is like high, strong, like on the edge, a lot of energy, hard to go to bed, hardest stay asleep. Um, so then when we see, okay, he's having low insulin, well, what do we know? One of the first thing that is affected when you have poor sleep habits, insulin sensitivity, right? So even though you may not be in this burnout phase of insulin resistance, when we see some of his genetic data,

paired with the fact that he's fairly lean, his a one C is a little higher than we like, which means what his blood glucose is totally normal on this test. Probably maybe even a little lower than we would like to see, but he was fasted. So if I get Alex 10 AM, you drink coffee sometimes. Yeah. Four ounces in the morning, but post coffee post breakfast, right? At 10 AM, there's a high likelihood that his blood sugar is kind of cruise and higher than I would like it to.

And then maybe we see lulls because sometimes when we do these podcasts, if you like, just look over at Alex, sometimes he's kind of falling asleep, but he doesn't sleep that well. So that happens every once in a while, not just in these podcasts, but sometimes happens to us all the best of us. Rich communists. He talks about how he can't nap, but if he tried to not nap and he like tries to read a book or lay down to read a book, he's out. Yeah. I mean, he can go like minutes he's gone.

So we're, if you listen to, I listened to Andy Galpin's podcast on Tim Ferris, which I think all of you should, it's very, very good. It's literally, it was like kind of mind blowing, not the information, but I was like, Oh my God, he's talking about what I think's going on. Like he's approaching. He can't approach pain is what he would say, but he's approaching performance from physiology, even when we're dealing with musculoskeletal, right? Tim Ferris is telling about his back pain, all these things going on. He's like, dude, what's your respiration rate at night?

How much protein do you have in the morning? All these things that would lead to physiologic effects of non-reparative or non-restorative scenarios around a legit injury. And part of that was led by the fact that Tim Ferriss said, well, Hey, I did a water fast for a week. All my pain went away. Okay. Well, that isn't mechanical. Does that mean it's inflammatory? Maybe, maybe not. Right. There's not just inflammatory, non-inflammatory. There's a whole chemical cascade that goes on in the human body all the time. Back to Alex.

Beau Beard (09:30.726)

Um, the next one on the list, when we see that there's some sort of whatever we're going to call it, blood sugar regulation issue, minor 5.2, a one C higher than I like on a healthy person with a low insulin production. There's a hormone backbone there. We all know that, you know, insulin is a hormone or kind of a pseudo hormone. It's signaling. You have signaling, you know, both, uh, forwards and backwards. Then we get into which.

It should have been evident just off his labs with high folate, high B12. He does not methylate B vitamins at all. That's why they're just cranked up in his system. Right. He's got a lot of them where you were taking a multivitamin. Right. Um, and the folate was methylated though. But the other thing is if you have certain genetic snips, you have to have certain predecessors to just methyl folate, right. To make, uh, these things happen. And if you look at like, uh,

Methyl guard from Thorne, it's going to have some of those things in it. That'll allow it to kind of go through these processes. Um, so B12 and folate are high. We want to test those for writing reasons, but they're a good look into that. The high potassium be highly correlated with what? Either dehydration or lack of sleep. High albumin dehydration or sleep albumin. You can also tie in chronically with inflammation. I have no clue if his albumin is chronically high. Cause this is just a single shot.

If we tracked it over time and it's high, I'm thinking some sort of chronic inflammatory cascade. What was not high on these tests though? CRP, right? Which would be maybe if we wanted to categorize it are more acute inflammatory marker and then ESR a little further out, those were normal, right? So that's where I kind of have to be like, eh, maybe that's not the case. Maybe they were both because they had some of this stuff. Maybe they're.

just a little bit dehydrated that day. Cause you will acutely affect things like albumin and potassium. Obviously those are pretty sensitive, but I don't think that's the case on this one. Um, so those are the big findings on labs. This is where, in my opinion, labs on their own, if I try to take action at this point, yeah, I might surmise what? Be methylated B vitamins. I think we could pick that one up pretty easy. So yeah, that's a good call. And then that's going to have a whole cascade of effects on other things.

Beau Beard (11:52.682)

Right. In particular, like iron binding, um, gut motility, gut absorption. Um, in terms of, uh, you know, insulin receptor site sensitivity, maybe, maybe not, um, there are cofactors that definitely are using that process. Um, that need to be methylated. My guess would be that there's like a couple issues going on and that the methylation is affecting Alex's sleep or inability to methylate along with a few other things.

more than anything and then his lack of good sleep, right. Or restful sleep is affecting things like potassium, albion, his insulin, glucose regulation, and then it's happening in a chronic nature. Is everybody with me on that? So I don't think there's ever, maybe there is, and I'm just not good enough. I know it's called precision medicine that you're like, it's this one thing. I think it's always a few things, just like a musculoskeletal case. Yeah, there's a predominant factor, but there are these other things that I'm still treating.

So now let's stop the share on his labs. Let me know if you have questions on that. Labs are pretty much like, I see what I see. Let me go to the genetic data, see what I see over there. And then I might be able to answer some of the questions of what's going on outside of your, you know, day-to-day or environmental stuff.

Beau Beard (13:11.15)

Is there anything with the testosterone we talked about before? Yeah. Your testosterone, what was it on there? Five, six, six sixties, six, seven, six, 60. I mean, yeah. When we talk ideal range, is that ideal for somebody? How old are you? 26, 26 years old. That's super active, decent muscle mass lean. No, I don't think that's high enough. Um, you know, free testosterone is not terrible.

sex binding, globular hormones, right? And smack dab in the middle for you. That does matter. But if I had to pick something to work on to improve your testosterone, what's it gonna be? Sleep. Yeah. Yeah, a hundred percent. So you're trying to lead yourself back to the same conclusion over and over. And I think that's anybody that, whatever you wanna call it, functional med, precision medicine, just trying to be healthy. That's what you're trying to do. Okay, so let's show his genetic data now.

And on here, I'm not going to go through his three by four analysis. We could all read this stuff. The whole thing is how would you help a patient, right? Or if you are a patient, how would somebody help you decipher this? Um, so what I want to pull up is what I broke down. So I'll pull it up first. Uh, when we go through this, if nobody's ever done this, you have a rubric of low, medium, high, very high. That's the impact, not necessarily negative or positive. Just.

predilection. Then they go a little further and you have this little asterisk mark or a shield mark on specific SNPs. The asterisk is going to be negative impact or likely negative impact. The shield is going to be likely protective or positive impact. That's how they decipher it. As you walk through this report, which I hope you all can see, they walk through your biggest issues. So his issues from a genetic SNP standpoint would be how he regulates inflammatory cascades, oxidative stress, mood and behavior.

If we just stopped there and said, if somebody's got issues with those three things and doesn't sleep well, or they don't sleep well because of those three things, it's just chicken and eggs snowball out of control right away. So that's where as a clinician, you have a decision to make. I think Alex's issues are coming from his lack of sleep. I would argue that he has a hard time sleeping because of his genetic predilections and then that's being reflected in labs and his sleep outcomes. That's my take on it.

Beau Beard (15:36.39)

And because so many things repeat here. Um, so let's kind of go down to the bottom. Cause again, this is more patient, like patients could read this. Like one says, mood and behavior. You're likely susceptible to mood imbalances. Well, cool. I, if I tell somebody that as a clinician, like, yeah, cool. I read your report. Like you can do that. I like to go down to these. So they're going genes by pathway. And then you can say, um, they give you the color codes, like, you know, purple is the most impactful little rubric up here.

Beau Beard (16:10.094)

Cool. Basically colors dictating what's the most impactful release, greens the least, purples the most. And then you can see these little stars, like on COMT over here, see that little star? That's most impactful in a negative manner. BHMT, shield, lower impact, right? Just do to where it's at on the methylation pathway, but still it's a methylation snip, which now you have.

crossover effects, which she has a couple of these and we'll get to probably your biggest complaint outside of sleep is what.

Musculoskeletal like some pains like random, my elbow. Now it's my knee. Now it's my hip. Now it's my back, but he moves pretty damn good. Uh, am I picking up feedback from somebody or is that us? I keep hearing like a, unless there's a chip, they're a chipmunk loose in here. Maybe there's chipmunk. There could be. Um, so again, you can walk down this and now what you have to do is you have to understand, okay, how to, what do each one of these genes actually do?

That's the bigger deal. Oh, you're good Connor. So to elaborate on genetic data, you just kind of have to start digging into, all of these genes, certain snips counteract each other. Some of them it's not necessarily on or off. It's like, Ben Lynch would say like slow or fast, right? It drives another gene to have to pick up the slack.

then that gene picking up the slack causes issues. So that's like understanding the pathways. So literally if we just go down Alex's list of the negatives first, so the genes that may have a negative impact on a system and then start talking about, okay, we know his complaints, consistent aches and pains of a variety of kind. Even though he eats healthy, exercises, moves well, knows about...

Beau Beard (18:10.986)

You know, pain, pain science, how to treat himself. He knows all these things. You think like, man, why is this guy keep getting kind of banged up or have pain? That's why we started digging into this stuff with them. We know sleep is probably his biggest, uh, pillar of health issue. Right. Got spiritual component down. Um, I know we talked about meditation. You seemed like you were scared of that. So maybe that's not happening. I will also say I really, I'm, I'm curious if I brought up, um, like Lisa did labs on me.

Long time ago, like probably 2017, 2018. And my sleep was worse then. Like it's better than it was, but I mean, it used to be two hours to fall asleep every night, couldn't stay asleep for longer than 15 minutes, probably. Um, now I don't know what's she had me on a ton of supplements and things then, but I'd be curious some of the like things you mentioned with chronic, uh, inflammation or if those were the same back then as they were now.

from the genetic report. She didn't do any genetic report back then. The genetic report wouldn't change. Well, yes, I meant the blood labs. Oh, I don't know. Could be, I would say your ability to suck up or tolerate bad stuff, right? Happening, lack of sleep, whatever. The kid's gonna be way better now. So you just may be getting worse at picking up the slack. So this first one, this...

ACE gene, um, this basically provides instruction for making angiotensin converting enzyme. If, uh, why not to Logan? We had a different physiology teacher. I hope we would all understand that pathway and what's going on. But for Alex, what's that mean? We saw what was off on his blood work. Potassium albumin. We said that could be associated with dehydration, right? It's not, we're not saying sodium balance, even though that's what we kind of think here initially, but it's all kind of electrolytes basically because you're doing what with ACE.

Getting your kidney and your lung to kind of cross talk to affect things like what. Blood pressure. I mean, that's, you know, ACE inhibitor. So in this scenario, immediately we're already saying, man, yeah, this guy is healthy. He literally said how many he has this, you know, a shaker bottle. He drinks six to seven of those a day. Now, maybe there's not enough electrolytes in it. We don't know what kind of electrolytes he's losing in ratios, right? We haven't done a legit sweat test. Um, which you can use. We'll get Gatorade sweat patches for these guys, which is good. Nix is better.

Beau Beard (20:35.738)

Um, but already I'm like, well, there's one tick in the box of like, we've got to hone in on how you do that. Since you're an endurance athlete, you're working out almost every day of the week. You work out every day, six days, six days a week. You're not sleeping. So your stress level is already high. So, you know, you burn through minerals and electrolytes faster than other people would as well. So that's one tick in the box of like, okay, let's hone in on your hydration status outside of sleep. We already know sleep's an issue. Like we know we got to fix that just from a subjective.

Uh, you know, account, um, ACTN three is a gene that encodes, um, alpha actinin three, which is a protein that produces powerful contraction, glycolytic type two skeletal muscle, you'd be like, how is that a negative, this is a power gene. Right. So a power athlete, like Usain Bolt is going to have a home homozygous allele of this, that would be the likelihood. Well, uh, for somebody like Alex, if you have this and you have some of the other things like the inability to methylate B vitamins,

Where do methylated, uh, B vitamins come into like the Krebs cycle? Well, they're all over the place. Right. So if you can't create ATP efficiently and you're out there doing endurance athlete things, which still are some power output just over a long period of time, and you're running through your ability for your mitochondria to create ATP and kind of run up against this like immovable force of trying to create energy with cofactors that don't exist for you, guess what happens?

neurochemistry, dysregulation, neurotransmitter dysregulation. And then you can see some of his other genes. He can't clear neurotransmitters, nor can he create some of them as well. So fancy way of saying slow. No, no, no. Like slow, like Ben Lynch slow, or he would be slow. Like not fast in terms of. No, no, no. He would be a fast, this is a power gene, but the reason they're saying this is bad. I'm trying to explain what three by four saying.

If you can create a lot of power, right? Even though I get that there's not purely anaerobic and purely aerobic work. Um, that anaerobic work when you can't use the cofactors appropriately is a lot harder to keep up than if you could. So it would be if you're, we would assume you say.

Beau Beard (22:53.298)

Methylates like a beast and can create energy without oxygen on the fly. Even though that's, I get, that's not real. Everybody bites everybody's head off on aerobic anaerobic limits. I get it. But that's what we're thinking. So for you, that's why it could be bad because you're going to burn through them. You can't create or knock them off as well as other people. So then if you go lift weights, even though that's a good thing, it's not the best for you because you don't handle oxidative stress very well and your inflammatory levels run a little high due to genetic preset.

That's what we were very curious about when we got the preliminary, just looking over the results because ours were kind of flipped on what we expected in terms of that, in terms of the power, because like for all of, you know, we've both been running since we were 12, right? Now you grew up playing more. Okay. What? 14? Okay. All right. But you also played baseball, so you had a little bit of different background. Um, like Seth's wheels.

on a sprint are way better than mine. Like night and day. I mean, you would absolutely. You'd also train that though. Sure, but even in high school, like when we had both had a similar training age, year 400 would have been way faster than mine. And I just never felt like at the end of a race that I could kick it into a gear. It was always like past people in the middle of the race because somebody's gonna come get me at the end.

So there's other fat. We know there's other factors, central governor, ability to push hard, like all these things, muscle fiber type goes beyond genetics. Like this isn't saying you have a muscle fiber type. It's you have the ability to create that like fast and active or synaptic connection. Okay. So then APOE, we've all heard this. What's it associated with? We all think it's kind of the Alzheimer's gene.

The interesting thing is you can see here, we saw that his cholesterol is slightly elevated. Their cholesterol is in his kind of medium, like you gotta watch it. We know that higher cholesterol in particular, a little higher HDL is cardio protective and neuro protective. And the whole thought behind, well, why do genes like APOE exist is when we were cave men and women, if you had a better clotting factor, that's why you see placking in people's brains with an APOE homozygous allele.

Beau Beard (25:09.822)

If you clotted better than somebody else and you almost cut your arm off wrestling a saber to tiger, you're going to live. That would be the thought process behind why these genes that are bad for us when we lived to be 70, 80 years old, we're good when you died when you're 29. Cause does that jive? That's the best explanation I've ever heard. Um, not saying that's right, but I cannot remember the researcher that was on Peter at Tio was basically talking about, like he has that question, like even Peter T I remember being like, Oh, yeah, that's

That's a good explanation. I'll take it. So all we're saying here is, okay, he has, um, the ability to, or maybe the, uh, worst ability to kind of deliver cholesterol than other people. So if he has higher cholesterol, he may not deposit it appropriately. That's also going to be based on other blood work we can do like what APOE, APOB, seeing, you know, what those APO lipoproteins kind of look like.

Um, and then seeing, okay, yeah, your genetics are saying this, you actually have that, but I'm telling you right now, if you can't methylate B vitamins and you've got some gut issues going on, which you dealt with IBS stuff in high school, right middle school. It doesn't matter what those APR proteins are doing because like, you're not going to be able to synthesize those proteins to the, uh, the best ability. Uh, next to COMT, which plays into the clearance of neurotransmitters in particular, catecholamines. The.

Like I have this kind of a homozygous allele. This one plays into like mood regulation, people that can't basically remove those neurotransmitters off the synapse, then have to deal with it longer. And the longer you deal with it, the more agitated you can get. So even though serotonin is a great thing, if you can't remove it, right. Off of that kind of free nerve ending, that's not great for your body to try to deal with.

So that's where people that tend to get a little more OCD, shaking their leg, agitated easily, bipolar behavior, they're having a hard time creating sometimes, which gets into gut access stuff, but then removing neurotransmitters because neurotransmitters can be excitatory or depressive, but most catecholamines are what? Excitatory, so your brain's kind of like, yeah, yeah. And then we try to do things to regulate that.

Beau Beard (27:31.73)

move a lot, right? Stem like the, it's kind of goes with the theme. We're not saying that he's autistic or anything, but, um, no, it might be, um, if you have on, everybody's got a little bit of tisms, uh, but we're still seeing, okay, if he can't get a neurotransmitters, that doesn't help anybody sleep. So even though we have four ounces, caffeine early in the morning, we're exercising, which actually does what creates a plethora of catecholamines that you got to deal with.

Um, and then you might get to like seven, eight PM and you're starting to try to wind down your brain, you know, literally dude, I can't. And you even, you know, maybe you feel tired and you can't go to bed. Um, so again, from Ben Lynch, that's called a slow C O M T. He just kind of, you know, spectrums them versus like an on off, um, GPX one ubiquitous express many tissues where it protects cells from oxidative stress. You'd be like, well, how in the world again, is something that protects cells from oxidative stress, a negative impact.

Cause it can run out of control. So what's the biggest, uh, oxidant that we produce as a human. Like what's the thing that causes the most oxidative stress, like hydrogen peroxide molecules, right? That's what you're creating like H2O2 in your body. Um, so if you have little scavenger cells that are going around looking for that, and you have a gene that's going to uptick those, right? It's kind of saying, go look for it, go look for it. You have more oxidative stress being expressed. What are you doing?

Antioxidants are great until why you got too many of them. And they on their own, which is in a weird switch, they become oxidative stress on their own. So as you're trying to get rid of the rust on the car, they start to create oxidative stress through like cellular overload. It's still a cell that has to work. You with me on that? And any cell that has to work as cellular metabolic waste output, and you have to deal with that and that's kind of where, again, this is just saying it could be.

We have no clue how these genes are being expressed in him at this time. What gives us a clue what's going on with him, his symptoms, his labs, give us maybe a little more detail sometimes. Um, but over time it would have to be what this is where we'd love like wearables, listen to that Indie Galpum podcast talking about respiration rate. Uh, we know HRV has been looked at, you know, wildly for the past five to seven years, just sleep quality, how much sleep are you getting?

Beau Beard (29:54.302)

You know, how accurate, um, they talked a lot about, you know, how the heuristics of like aura and, um, whoop are still based on sleep study models and where Andy Galpin's kind of sleep lab, I can't remember what it's called revive or something like that is not based on basically a sleep study kind of methodology. So they're basically taking the data that you've got from sleep studies for the past 30 years using an algorithm.

based on your heart rate and respiration rate and saying, this is what we found. And he's like, well, yeah, that's still based on a methodology that's not that great, which kind of makes it a little bit flawed. I would be curious about with wearables because like whenever I, I don't really pay attention to the sleep data on my, on my Garmin, but if I ever do look at it, it'll say like, you were awake for one minute. And I'm like, I know that I wake up. Which is all based on movement.

Every time that I, because I sleep on my sides and I toss every time I toss, I wake up and that might happen. Yeah. That's numerous times a night. Cause these are purely the accelerometer is the thing that's dictating the sleep, right? The movement of it. Um, so I, I mean, that seems crazy. Yeah. It'll always be like, usually it's like single digit numbers unless I literally got up and like, yeah, moved around. Chorus is pretty good. Chorus is supposed to be just under accuracy of aura. I just got another ordering. I use it for a long time. I used whoop for a long time.

Um, I don't know, I'm going to pay more attention to respiration rate. They had some interesting data that they were talking about in that podcast. So again, go listen to that. Uh, next up, MAOA gene, uh, this one, I don't know. It makes me think of people that are doing like ketamine and things like that. Cause it's in this category, but monoamine oxidases, uh, again, molecules, uh, that, uh, help break down.

Oxidative stress within our body through enzymatic reaction. So if he doesn't have the ability to do that as well as other people, he can't cleave off those neurotransmitters again. And here we, it's this whole thing. So things that go together are like COMT and MAO or MAOA. And there are supplements you're going to see here pretty soon. I go through like practices and supplements. I'm going to tell you like supplementation, why I'm pointing at it, not just like, Hey, this makes you sleep better. Um, the, uh,

Beau Beard (32:12.866)

Catacolamines in particular that it kind of helps, uh, cleave would be serotonin, dopamine, adrenaline, nor an adrenaline. So real quick, if we go back to the very first gene, we talked about that AC or ACE gene that has a large effect on the kidney, right? So the adrenal cortical complexes surrounding the kidney, right? It has a large effect on the kidney. So if I go down to something where we're seeing adrenaline nor adrenaline, or maybe being dysregulated up, regulated down, regulated, we don't really know. To be honest with you, we think.

maybe there's a harder time getting rid of them. So they're going to stay on neuro trans or a neuro receptors longer. Then I kind of started thinking like, man, I got another like big focus. It's not just hydration. It's his ability to down-regulate a system as best as he can, because otherwise that ain't going to happen. So he has to turn the levers and knobs because it's not his autonomic nervous system is not going to be able to do it as well as like, and I have the same problems I'm going to say as well as mine can other people's because I have a lot of the same stuff here.

Um, what's up? I said, as well as that. Yeah. Um, what's wrong with me? Oh my God. That's why we had to do it. It's all we had to do a different podcast. So you two different episodes. Um, the next one is P EMT and this is phosphatidyl. Uh, phosphatidyl. Oh my God. Let me see if I can say this. Yeah. Ethanolamine. I don't even think that's written right though. Phosphatidyl ethanolamine. I don't think that's right. Methyltransferase. Um,

Catalyzes the nervous synthesis of phosphatidylcholine in the liver. Choline largely acts on the liver and the brain. We know that, right? You have phosphatidylserine as well. It's going to act in a little bit different function mainly on the brain as a neuroprotective agent. You know, cholesterol is conjugated and largely made and then kind of called upon from the liver.

He had fine liver enzymes. We see a little bit of cholesterol issue. I have no qualms with it all, but he also has some genetics that back that up. Um, I just, I put this in here that the body makes a chemical called acetylcholine from phosphatidylcholine. What competes for acetylcholine receptors, which one of the most common things.

Beau Beard (34:29.474)

I bet what will you usually drink tea? Don't you? So I don't think caffeine, Aaron, are you drinking tea again? You were last time. No, that's coffee today. Oh, so I was going to say caffeine, but it's not, yeah, I was going to say coffee. It's caffeine. Caffeine competes for those receptor sites. Right. And that's, you can go through the whole cascade of what happens with the backend of that. Andy Galpin basically told everybody they're fucking idiots for drinking caffeine.

He's like, if you want to be a healthy person, stop use it as an ergogenic aid around training and performance only. Um, I think all of us here, I don't know. I, we all literally, I think all of us said we started drinking coffee in grad school. Like I drank it sometimes and it was grad school where it was like, yep. Come on. Um, I, I used to cycle it more than I do. Now I'm being honest, having two little kids. I haven't.

I sleep like a baby and I, you just would think like, Oh, if you sleep that much better, why would you go back to it? Cause it's addictive. That's my thing. It's like, I've only been drinking. I didn't drink coffee until we became roommates at Logan and I've had sleep issues for nine years. Like well before. All I'm saying is it's not helping. Okay. And the crazy thing is, so if it was worse before and it's not good now, and then caffeine does affect some of these things, you should knock it out completely for a while.

Cause one by one, but I also wouldn't say that's the biggest thing on my list for how much you drink and all these other things together. But we do see that you would have a harder time for that, even though your genetic data says you're a fast metabolizer of caffeine, which was which one? It just says that in the report is a little fancy, you know, thing. Um, but it phosphatidylcholine might be, uh, might help to protect the wall of the large intestine and people with a type of inflammatory bowel disease, ulcerative colitis.

Uh, so if you have a harder time catalyzing this reaction, we could see how that might lead to certain things like that. I don't think you're going to end up with colon cancer or UC, but, um, we're looking at some of the other neurotransmitter based stuff. Now, something that they don't list is like, you know, the star asterisks. This is terrible. Are those because they're heterozygous, not homozygous for the two snips of the two MTF HR genes. But when you pair heterozygous pairs of those with the MAOA

Beau Beard (36:50.794)

Uh, homozygous, COMT homozygous, his body is basically doing what. It can't use coenzymes that would be needed by methylated V vitamins to create ATP. And when they do, it's kind of a dirty process, hence the book dirty genes. Um, and then when he, he tries to, uh, not just, you know, get rid of, or kind of clear the neuro receptor sites, but even just methylated the vitamins themselves or the B vitamin molecule.

is hard, which creates what? Oxidative stress in the process. Oxidative stress happens with every cellular reaction. There's a byproduct, right? This is like, you know, cell biology 101 or physiology, I guess, that like you do something, you get a reaction. Those reactions are usually what in the human body? Water is one. And then usually hydrogen peroxide goes with that. So those are the biggest metabolic waste. We still got to handle those. Most people you have no problem, but

Just like if you put hydrogen peroxide on your hair, you're going to bleach it. That's why your hair goes gray. All these things like that's the biggest things that lead to these. It's not like hair follicle disruption or, you know, abandoning the process. It's literally oxidative stress or damage to that hair follicle. Any questions on the negative? So were you saying that the, the MT HFR wasn't inherently

They don't have it marked as a complete like a, Oh, this is the worst just because it's headers. I guess snips. Yeah. But the combination of the other stuff could make it, is that where Ben Lynch would say like, so it wasn't born dirty, but it can be turned. And the tough thing is, so what's the stat 44% of people are.

almost unable to methylate B vitamins. And then a whole another cascade of people have a hard time. You have a hard time already. Then you pair those two heterozygous snips up with some of the other stuff like COMT, MAOA really gets hard. Because again, just think of, you know, whether it's a core recycle, the Krebs cycle, how many times you run into the same molecules that you're going to have a hard time dealing with. Whether it's like the literal inability to deal with it because you're out of cofactors, right?

Beau Beard (38:59.062)

Or you have neurotransmitters sitting on a receptor site that would like to basically be used at that time. It's like, well, go screw yourself. I'm just going to stay here. Like that's the whole dirty jeans. If you haven't read Ben Lynch's book, it's really good book. I don't know when it was that published. It's quite a while. He 18. Yeah. Um, and he used, he still has a site that I put my genetic data into that was, you know, pre three by four and all that stuff. And I showed Seth the pathways that he drew. You've never seen them. It's absolutely insane.

It's literally like 50 arrows and it's yeah. And you're supposed to pick that apart. Um, at least that helps. Um, but it is it, I liked doing that because it made me have to learn a lot of that stuff and he does give you useful information. It's just harder to decipher.

All right. Uh, maybe the longest acronym for a gene ever PPARGC1A, um, gene promotes methylation as a biomarker of the insulin secretion. Sounds like that could really help this dude right here. So it's helping methylation by a signaling molecule. It's tied to insulin production. Well, the one thing that sucks is what? Your insulin production is a little low, right?

So that's where we're like, okay, something is preceding your ability to signal. I don't think to create insulin, I don't think anything's wrong with your pancreas. I think the ability to signal your need for insulin is being disrupted. That would be my take. Enterleukin-1, I think we're all kind of familiar with what that is, the gene and then how it affects acute and chronic inflammatory states, but well established for a scrolling pathogenesis disorder for auto inflammation, inflammatory disease, the effector cells, myeloid cell, blah, blah. We know that one.

What else, what effects center lukin 1 gene expression?

Beau Beard (40:49.218)

Ibuprofen non-steroidal anti-inflammatories, right? Yeah. Um, next one, this looks like it says Birmingham, but the function of the HMT is to transfer the methyl group from the bay teen to homocysteine thereby forming dimethylcysteine, which dimethylcysteine is what you need. Right. If you have what's called an MMR, a homo heterozygous or homozygous snip.

to then be able to methylate all the rest of B vitamins. And that is what is in methyl guard from Thorne. So this is a big deal. You get somebody that has, let's say it's him, two heterozygous snips on MTFHR, and you're like, eh, I don't think we need to do that. Or you give him, you know, methylated B vitamins, and we didn't pay attention to that. Like he has, you know, doesn't have this gene working for him. He will absolutely need MMR if you don't give it to him.

You're putting, you're making them worse. You're pumping full B vitamins again. You with me? And that's why people that take non-methylated B vitamins that can't methylate them is no different than taking or eating fortified cereal with all of these crap B vitamins. It is neuro-excitatory. So if you want to deal with a kid, that's basically going to punch you in the face, call you names and then go to school and be a terror, feed them Cheerios. All right.

Which is neuro-excitatory. If you don't have a food with a dye in it, it's neuro-excitatory. So it has maybe, I'm not saying it's not the sugar content, right? The carbohydrate to sugar, you know, uh, confirmation. Maybe it's a lot of these neuro-excitatory things like the, the fortification via these non basically bioavailable vitamins, like full acid is not, nobody can use that. Right. It's not, it's not even folate. It's full of gas. It's not transferable.

But then if you can't even use the full eight, like your brain is just like sitting there like, Jesus, I can't clear this. I can't clear this. And here it's not that great for you. Um, COL one, a one gene provides instruction for making part of a large molecule called type one collagen. What's type one collagen make in our body? Bunch of shit. So why did they have that in there as a positive? I like to point these out for Alex because what's one of his main complaints.

Beau Beard (43:06.838)

consistent musculoskeletal stuff. We're not writing it all off as just pain. He came in with a big old swollen elbow, which is what he first said to me when we were like, man, I think a lot of this tied into the backbone of your physiology. So let's take a little segue real quick, Paul Blart style. You gotta fall first. Yes. So he had a swollen elbow. It kind of even looked like a leuconomibusitis, like not that swollen, but his weenus was sensitive.

I know it's just, it'll make you laugh the rest of your life. Um, when you squeeze the skin, it was sensitive. That's weird. Right. That like, why will ask me some cutaneous nerve in some fashion. Well, they're a cutaneous nerve can be driven nuts by like neurogenic inflammation, what is highly correlated, maybe causative of neurogenic inflammation, a trigger point. What gives somebody a proclivity to create more trigger points? You could say a barren mechanics. You could say sub-threshold work. Also what?

central sensitization, right? Systemic inflammation. I mean, welcome to fibromyalgia, whatever you're gonna call it, myofascial pain syndrome, you know, pick your poison on your name. You do that and pretty soon you're doing what I think a lot of people should do is kind of keep asking the question backwards of, man, I see what your labs say, but maybe your labs are being dictated largely by gene expression. Okay, your gene expression is being largely dictated by your environment.

Your environment was dictated by your parents and then their environment. We know the three generations of epidemiology, you know, um, uh, epigenetics. So now pretty soon as crazy as it sounds, he comes in with all these persistent musculoskeletal things in my history. It may warrant not just asking about colon cancer and all these things in his family, but like, dude, you know, have people been, um, a little more ramped up, had sleep issues in your family forever.

Did anybody else, you know, are they a little hyperactive or they whatever, like asking these things, not did they have musculoskeletal pain, but if people deal with the same issues outside of your pain that you did, right. Did somebody have a hair trigger, uh, anger issue, right. I don't know. Grandma beat up grandpa or something. I don't know. Something like that, but getting deeper into it, not just realizing it's one-offs it's mechanics, aberrant motion, overworked tissues.

Beau Beard (45:27.606)

I think it's just a lot closer to the truth of what's actually going on in humans rather than just that mechanical side. I don't think this next one, a metalloproteinase key modulator plays a role in differentiating cardiac stem cells. Funny thing I put down here, they have it on the report is protective for bone.

Beau Beard (45:50.157)

Why?

Beau Beard (45:54.146)

cell creation. Well, no. So cardiac stem cells, so cardiac stem cell has to be still differentiate off the, you know, all differentiate off the same stem cell line says as well, as well as myocardial contraction.

Come on, guys.

Beau Beard (46:15.182)

If you go hyperkalemic or hypo kalemic, what's going to get fucked with first? Yo heart. You're going to die. Um, grandfather and my great grandfather both died in heart attacks. So, and I'm not saying that, but what I'm saying is the reason they put this in the three by four genetic report under bone protective is this is a good signaling molecule for calcium. You with me on that? Yeah. So your ability to dictate how much calcium in your system is like potent.

And then it's basically using the stem cell formation off the back of that signaling molecule to tell where to go. Almost like too much calcium. Is that what you're saying? No, no, no. Um, like a gene, like this gene, right. Is a key modulator. It's like telling things what to do, right? It's not making something. It's not, you know, uh, diffusing a scenario. Um, it's a metallo proteanase that plays a vital role in differentiation of cardiac stem cells.

as well as the contraction, the stem cell stuff doesn't matter for the bone. That's just like, it's telling you, but we know what ions just like acupuncture. If you've read, have anybody read the body electric, this is getting way nerdy. Like what actually differentiates things in embryology, right? They talk about these. What I saw somebody, Jayden, you raised your hand. What do they call them? Morphogens, these kind of, you know, a little, the spaces in between, you know, the embryological zones, those are ionic kind of.

You know, polarized differentiation. So as you have electrical, you know, blasts, a zygote comes together with each cellular replication, there's literally a flash, right? This is the kind of the small big bang that is happening off of the backbone of like an eye, you know, an ion kind of action, just same thing as putting lemon juice on tin foil. You guys never did that in science? No, I did not. Sound of a bitch guys. You can hear the beans in the ziplock. Somebody go grab a lemon and some tin foil or.

tin foil, aluminum foil, whatever, and just squeeze some on there and let it sit for a little bit. Yeah, just go for it. My school project.

Beau Beard (48:21.23)

That sounds about right for Alabama. Yeah. Pretty good. You know what we're gonna say about that? You're gonna make a battery out of a potato? No. It's not a bitch. We know about it though. Okay. I made two points with that. And again, this is my take on this. They don't explain why it's bone. That would be my take. So calcium signaling, I know, and we all know that it's very important. I mean, the potassium, you know, potassium, sodium, calcium balance around your heart, but hyperkalemia, hypokalemia will absolutely do what? I mean, cause your heart to stop and...

heartbeat. No pun intended. Um, next one, L E P R. Uh, we all know what leptin is. We can all see that this guy would probably, how much did you weigh as a freshman in high school? Ooh, a whopping 70 pounds. Get up on that microphone. Uh, 70 pounds as a freshman. I was also about four foot eight. So that kind of, so there was some stuff going on here early in life.

But now you're six foot one. What? I'm not six one. You're six one. Yeah. Five 10. What? One 50. So it's quite a big of a job. Maybe just didn't hit your growth spurt. Um, but you also started working with the nutritionists, which you mentioned her name earlier, uh, Lisa here locally. And I mean, a lot of that was like micronutrients, minerals, which we're going to talk about here in a second of why that may be even more important based on the genetics. Um,

And then you started gaining. What didn't you gain like 10, 15 pounds? Like, well, I lost, I started seeing her because I lost weight. Right. But as soon as you started taking the supplementation with her, yeah, it was pretty quick back up to, I think I was one 30 in college and then I dropped and then it went back up pretty quick. Yeah. So did you stop?

Beau Beard (50:09.514)

Yeah. That was around, that was around when I stopped, like when I quit the team, that was around the same time. Probably. So that's kind of the genes and we could go, I mean, there are literally lists and lists, some that they thought were more important than I would think, because we're trying to also what they don't have is what his subjective experience.

That's what I've got to take into account of like, Hey, I got these jeans. I got to pay attention to what's kind of being shown there. I also have his lab work, which they don't. If I had to pick one of the biggest things from a practice standpoint, it would be your down regulation outside of going to sleep.

But I think anybody on here would be like, yeah, it kind of makes sense what you told me about this dude. How you do that, there are a variety of ways. One of the biggest ones for you is because you work out six days a week is what you do post exercise. So post exercise, like you should lay in a dark room or turn the lights down or go by yourself, put something over your eyes. Ideal, something with a little bit of weight would be ideal and do just breath work for five to seven minutes. So you dump yourself back in, right?

to an anabolic kind of state as fast as you can, parasympathetic state as fast as you can, but also just down regulation to try to dump some of those neurotransmitters you just utilize in the workout. That'd be my big one. And I would also say, as you guys can see here, like if you could meditate, whatever that means to you, breath work, I don't know, clear your mind for 10 minutes outside of that. Like those would be two big things. And I would not do meditation before bed. And I would not be meditating in your bedroom wherever you sleep.

Yeah. Kind of just the only thing that I've made, cause it used to be, whenever all that was like, I feel like when I was really ramped up like in college, it would be some sort of movement that I would, you know, movement routine that I do for go to bed. Don't really do that much anymore. Unless we're like watching a movie or something. Then before I go to bed, I just read for like 15 minutes. I'm like, yeah, that's usually what I do. Well, um, and we could get into all the mechanisms behind that.

Beau Beard (52:16.746)

I'd say the big one is autonomic switching and then that kind of, you know, catabolic anabolic switch as well. Just kind of meditation. What if someone like, this is not just personal. But let's say you fall asleep late. Yeah. Cause you're like trying to clear your mind. Yeah. My big thing. And, um, this is echoed by a lot of people. If you fall asleep that fast when you go to meditate, you probably have sleep issue. And I know you think you don't. A lot of your stuff points to exact same stuff as him.

So these are both two really healthy guys that maybe don't seem like they would have, you know, any dietary issues or hydration issues. And then you look at your lab and they're like, well, something's going on, right? Seth's training for triathlon stuff. And some of that may be skewing his lab work. I don't think that's all of it. Um, but if somebody like the people that get on a plane and they're immediately out, they're like, oh, I just fall asleep on planes. Like.

There's some, I mean, you have restricted oxygen on a plane. You immediately you're out like in CPR position, people that are, as soon as they sit down in a chair, try to do like they're out, like you were sleep deprived. You can tell me otherwise, but until you can just, you know, unless you have some weird, uh, I don't know, narcolepsy or something like that. Like, I think that's what's going on.

So is that your scapegoat? Like I can't meditate cause I pass out. No, we just duct tape you like, I mean, he's literally seconds. Like I've, I've tried the meditating thing, right? And like as I'm sitting there, like I feel myself, I have to like catch myself. The other thing is like, a lot of people have argued against what do you have to sit there with your eyes closed without meditation. I mean, I just listened to a podcast with Mark Hyman and Deepak Chopra, which Deepak Chopra is kind of

Yeah, take it or leave it. But I was telling them about an article that was published in nature. And then the journal psychiatry on meditation as little as 10 minutes a day reduction in almost 95% of diseases overall, not talking alleviation. The only disease they didn't see change in were genetic diseases. So, um, regulation of your, whatever you want to call it, uh, central operating

Beau Beard (54:30.586)

actively directed at what was going on with them. So if you had a lung issue, you were kind of thinking about like, how do your lungs function that, you know, like this, maybe it's positive affirmation, I don't know, but they saw this, it was been published. I mean, that's a massive thing. What I would say is meditation also maybe is like running, but not listening to something, right? You're just out there running, you're breathing, you paying attention to your breath, you're paying attention to something.

Um, because they have done studies where the same brainwave signal show up when people do repetitive movement action. The thing I'm wouldn't want him to do is he has a complaint of musculoskeletal issues that sometimes are associated with running. So I think you have to break association. Same reason. I wouldn't want him to meditate in his bedroom if he has trouble sleeping. I think that's just a psychological kind of diff, you know, diffusing. Yeah. There's literally been times where like, I'll go run. There's times where I've gone and run.

And not listen to music. Cause I just want to kind of take in what I'm surrounding and have that time of not having an input. And then there are times where if I feel like I'm ramped up and I've thought about those things a lot, I'll put music in so that I don't think about. Yeah. At some point that's going to hurt. Yeah. And I have a hard time because I mean, I used to not list before air pods. I didn't listen to anything. Yeah. I mean, I didn't do it. So now I listen to so many books and podcasts running. It's like hard for me to go back. Cause I'm like, Whoa, I don't have that time. Uh,

But I used to literally, I would run no music, no nothing in an hour, hour and a half meditate immediately after I ran 10 minutes using the headspace app. And then I also meditate in the morning. So I was doing like 20, 30 minutes of meditation running with none of that. I don't even have that anymore. And I wonder like sometimes I'm like, ah, like, might be a reason. Um, I don't know. Uh, next we've talked about it, like three different, or sorry, going into supplements. So that was the practice thing. The first supplement thing.

is not necessarily a supplement, not because I think it's most important, but it's not a supplement. So it's just a dietary shift. I know what these guys eat pretty well because they eat the same thing every damn day. And it's not that it's unhealthy, but it lacks variety and lacking variety. If you're going to be have undue oxidative stress, that's where you're going to pay the price. So what tell us real quick, make it up on the mic. What's your breakfast? What's your lunch? What's your dinner? He doesn't have to say any more than one day because it's the same.

Beau Beard (56:46.322)

except on the weekends, except on the weekends. All right. So morning is usually a protein shake, which involves like almond milk, a whey protein powder, creatine, gelatin, frozen fruit. And you're creating the morning. Yeah. Um, change that. Okay. Um, creatine is pretty recent. That's probably the last three months, three months or so. Um, and then

something. Oh, I put some greens in that as well. Then that's what's like Ezekiel bread and peanut butter. And that like four or six ounces of coffee. On the weekends, I will drink more than four to six ounces like if we go to a coffee shop. For lunch, it's usually what it had been was either beef enchiladas that I would make at the house with like a bell pepper and an apple or like snap peas and an apple and a

Um, sometimes it's been a rice bowl. Mine's changed more than sets is constant. Uh, dinner is four eggs. Um, potatoes, like golden potatoes, um, avocado, guacamole, hot sauce, um, snap peas or greens, and then, uh, either like dates with peanut butter or a lot of bars and like that. So there are some vegetables in there, obviously some greens, but this is what we call eating in the brown.

So there's a lot of like protein and just, you know, white rice. And so my big thing is what use more colors to go after antioxidants, polyphenols things to help offset some oxy of stress. Now there have been numerous studies. I get it. That show you would have to eat basically a bushel of blueberries to start to have some sort of antioxidant effect. So you.

create variety overall. You do eat some bell peppers. So there's flavonoids and all these yeah, the pepper seeds. He eats a bell pepper like an apple. So I wanted to get him one of these little rubber bibs with a tray that my daughter uses. Shout out to Jake Shockey. Yeah. So we know Alex has been there by pepper seeds. Yeah, he has a little desk vacuum too. So I don't know if it's been used but

Beau Beard (59:10.894)

because I pick up my seeds. So that'd be my big thing is variety based on colors, both from vegetables, fruits, just you're supposed to try to get as many different colors you can. And I know that's hard, but you know, and we've all heard the stats of, you know, most Americans eat less than five, what is it? Five vegetables, like same five vegetables just all the time. Yeah, I mean, I guess we spinach, peppers, snap peas, used to eat carrots in the morning. Yeah.

I got tired of carrots in the morning. But then same kind of flavonoid group and a bell pepper with carrots. So yeah. Literally the majority of that stems from, we don't want to think about it. Which I totally get, but my thing would be, okay, you eat breakfast in the morning, so get some like one week get blackberries, next week get blueberries, the next week get raspberry. It's a mix, like our frozen fruit is, it's like hairy, raspberry, blueberry and strawberry. Yeah, and then at night maybe start.

getting some different vegetables in that, in that mix. Yeah. We'll talk about you in the future. Just, you know, got to let him reach his sixth birthday in his head before we get to his talk. Um, we got a chat here. Let's see if it's a comment. Oven roast and veggies are the easiest way to be lazy. Yeah. I'm with you in like.

I mean, we kind of got Sloan went vegetarian for a while, which kind of made us do a different bunch of different stuff like that. Um, I also kind of remember, and it's kind of. At certain points you'd be like, Oh, I felt really good. And then you look back and you're like, did I feel better when I was eating like that or now? Like, it's kind of hard for me to remember, but like when she was eating vegetarian, I probably ate 90% vegetarian and I didn't want to, it was just what she was making and what was in the house. I would say I felt really good.

So then I'm kind of makes me wonder like, I don't think I'd ever go vegetarian, but like I probably need more variety, more vegetables, things like that. Unless Paul Saladino shows up at my house shirtless at night and beats me over the head with broccoli and tells me I don't have to eat it or something. I don't know. Next on the list, methylated B vitamins. We already talked about that. This, that and the other. I think at this point, if somebody's taking multivitamin, you would hope that they're methylated B vitamins because so many people have an issue with this. It would just, it's like hedging your bets. It doesn't hurt.

Beau Beard (01:01:35.262)

It removes a step for people to have to methylate it, right? If they can. So there's nothing wrong with that. Um, Omega threes, uh, he had, what do we see in there? He's got, you know, a little bit of maybe cholesterol regulation issue, APOE, some of the other, uh, genes that are associated with possible neural plaque in which even the theory of neural placking is getting questioned. Is that the thing that's actually caused it ever correlated with, uh, you know, dementia or neurocognitive decline?

But that is associated with as far as we know now. So mega threes do a couple of things. We know that they're potent anti-inflammatories. We're talking about things that you could do post exercise. So we've had Seth start some of this based on some of his cholesterol numbers, but breaking up a gram to 1.5 grams of fish oil with one would be in the morning one post exercise, creatine post exercise, because not only is fish oil anti-inflammatory, it signals or it's protein signaling.

again for an anabolic kind of shift. So that's why we'd want to post exercise. So we split the load up like that. Here's a question. You mentioned about building with the creatine in the morning or not doing it in the morning. Yeah. What if I, since I have two training sessions a day, I typically have two, I do one in the morning before I eat. So then afterwards, like that's when I eat and I typically have creatine in my shake after. Well, the big thing is the way that you shuttle.

You know, glycogen in your muscles is basically on the backbone of creatine. And then that's kind of where you suck water volume into your muscles. My thing is with him, he's waking up, drinking water, drinking a little caffeine. He's not working out that system. We already know he already has a hard time maybe because of that ACE gene and stuff like hanging onto water. Last thing I want him to do is retain in the morning throughout the day, go sweat, not have anything to do that post-workout. And I'm not like doing my best. Do you wake up and go pee at night? So that's not a problem. Yeah.

So stuff like that, you're just being as smart as you can, but does that make a huge difference? Maybe not. But there is a, quite a body of evidence for timing on creatine post exercise for glycogen reuptake. I was curious on that cause it even says it on the back. Like what? Typically 90 minutes post. Yeah. But that like you being an endurance athlete, I mean, that's one of your big goals is get rid of glycogen re-uploaded as efficiently as you can. So you can use it. That's where I'd really tell you like.

Beau Beard (01:03:57.23)

If you have a harder workout of the two, that's when you take it as after that, even if it's not a weightlifting cross training session.

Beau Beard (01:04:05.746)

Um, and if anybody has any questions on like, as we're going through this stuff, make sure you hit it. You can wait till the end to, uh, Zinc and I'm going to say Zinc and Trace Minerals cause Zinc is included in a lot of trace mineral, um, supplements. Like if you look at it, uh, mass cell deactivation, which one thing we didn't talk about is you do have two different headers, I guess, pairs for basically, uh, mass cell, uh, degranulation. Like, like it's harder for you to handle histamines. Um,

I don't see any of that in your history profile, right? Like if you drink beer, eat certain things, you're like, I sleep even worse or I'm having runny nose, I don't know. I would say, yeah, like I think- But it's also alcohol. Yeah. Connor and I talked about that like, whenever he was here, that typically, if we've had like probably three drinks or so, I'll wake up, three or more you wake up and it's like hard, at some point it's hard to- Go back to bed. Yeah.

And that can be a lot of things. And you're talking about the running nose as well. I have noticed like you- After workouts. Yeah, after workouts. And like in the morning as well, like you feel like you constantly blow your nose, I feel like. And that could be a lot. He also had like some nose surgeries. Yeah. So. And a lot of that, I mean, there's so much there. I would say poor histamine response shows up a lot of different ways. Itchy skin post-workout, itchy skin after shower.

Um, obviously, you know, wheels and kind of hives are year to carry a stuff like, you don't have any of that. And so then we talked about that was, uh, left like meal prepping. Yeah. That's, it's kind of been a joke in here because they meal prep for the whole week. So everything is leftovers and the amount of histamine that builds up and leftovers, especially like we get out on the four or five day mark and we were just talking about like histamine response and all this stuff. I was like, dude, you guys are like living in the histamine world. Um, we leftovers. It's also.

Yes. It also depends. So protein like meat is going to have much more of a histamine load when it's a leftover versus vegetable, just based on how that protein is being broken down. And histamine is now a byproduct of that breakdown. Um, so zinc will help with mass cell deactivation, but it also helps with the pathway of tryptophan to serotonin to melatonin, which for this guy, absolutely critical.

Beau Beard (01:06:21.514)

So the reason that, you know, trace minerals will have like the orange trace minerals will have zinc. I would want him to take zinc separate or like zinc picking or what is it? Pico late or whatever separate than trace minerals because I'd want you to take that at night, like 30 minutes before you go to bed. And then I'd want you to take some sort of like fulvic acid or Shielajat or something like, I don't care. Good morning. Some time during the day. Fulvic acid. No, no, no. Um, like fulvic acid.

Okay. Yeah. So that's just going to be like basically minerals that are coming from volcanic ash or some fancy sea moss that, you know, some guy went up into the Himalayas, the Himalayas and scraped off a rock. Um, you can take a bunch of other stuff. Yes. The glacier water. What a glacier water. All the way from Alaska. Um, but take them separate cause the zinc is a signal, but now you don't want to take the zinc right for a good about it. It'd be like an hour.

something you could pair that up with if you take magnesium for that or something that's what I do and that's zinc is extremely cheap I mean I don't know like 15 does it matter on the quality though of a zinc like is there a thing to look at yeah all like uh I mean zinc in particular has to be like built into an ion form right because you're having an ionic reaction when you have to like use that just because of a charge so that's where just taking like uh I don't I'm trying to think

Beau Beard (01:07:51.31)

Oh, like a vitamin C. It's a powdery vitamin stuff. Emergency. Yeah. There's zinc in there. You might as well just throw it out the window. Yeah. We could look that up real quick. Do you guys have a computer? Look up what the zinc in by emergency is. What's for a video of zinc going out the window? Well, that's probably going to show up when you look up emergency because your money is. And so there's also a lot of studies being shown on ascorbic acid, not just being neutral, but actually a negative effect.

So that's coming down the pipeline. So watch here, we use like vitamin C and liquid form from like Quicksilver for people. Cause I mean, it's almost impossible to find vitamin C that's not a squabric acid. I mean, it's just like so hard. Yeah. So we use a whole script so you can get any brand of supplement you possibly want. If you're patients, they can sign up for account. And then we suggest different brands

supplements, protein, whatever it is based on what we think is the best, right? Not just like, Oh yeah, we use Thorne for everything. Some of their stuff I don't like. Trace minerals. Like I said, Thorne has one. Fulvic minerals you can find from a couple of different companies are pretty good. Sheal is at, you can get the bull pulled over your eyes. There's a lot of companies selling that, that it's not legit. And if it is legit, it's not cheap. It's usually around $65 for like two ounces. I mean, that's like kind of the going rate. It is not cheap.

But two ounces will last you a long time. So if you've never used the real Shielajat stuff, it's like glue, like you put it on like the end of a butter knife and it's like hard to get off. So you melt it in coffee or something like that. And here's decaf. What'd you find? For zinc? Yeah. Zinc ascorbate? Yeah, so basically the same formation, almost as ascorbic acid, so cool. Is it ascorbic acid? You said it's zinc ascorbate? No, the vitamin C.

But the C is where we get it. Yeah. So that's what it is. Along with the limits, that's, yeah. I can't talk. Yeah. Cool. You said, peakled it? Yeah. Decap. No. It's the voice pack. We got another chat here. Let's see what this is. Don't they still say that ascorbic acid is antioxidative, but just not as good as the whole food form? Do you not like using it at all?

Beau Beard (01:10:20.266)

No. So what they're looking at with the scorbic acid is that you got, sorry, my screen keeps going away. My monitors are backwards here from what I've kind of been hearing and reading. A scorbic acid, um, over time has been shown to be correlated with like more kidney stones, um, signaling in your kidneys. You're basically going to, uh, uptick some it's almost acts like a diuretic.

Um, and then if you use that long-term, cause it's in so many things, we just think vitamin C, like you need more, you need more, take it, you're sick, take more. And if you do this long-term, the chronic nature of it is bad. But when you use like a liposomal vitamin C, like Quicksilver has just a delivery agent, the formation of it's a little bit different bioavailable forms because yeah, there is a scorbic acid in an orange, there's all forms of vitamin C realize when we're talking like, uh,

a luposomal, whatever, or liposomal, sorry, whatever it's vitamin C, glutathione, we're talking an ion of form of zinc. It's how we're delivering it and not a food form. So we're trying to get the mechanism to be the same. You with me? So if I give somebody ascorbic acid without the fiber, without the fructose, we have no clue how these things work in isolation, which is why I'm always a much bigger fan of like food first, because supplements in isolation are

Beau Beard (01:11:48.818)

I mean, what's, uh, I'm blanking on the guy's name. Oh God. The visitor to the islands, people's teeth gave everybody vitamin C. Oh my God. Famous. Come on. Somebody helping with this. Wrote a book. No. Yeah. What was that guy's name? Oh my God. Somebody write it in here. It is Robert.

Beau Beard (01:12:12.362)

Recommend organic lemon juice, sublingual instead of, yeah, that would actually in, uh, you know, lemon juice, like even in your water in the morning, now you have what vitamin C electrolytes, like, yeah, that would be a good thing overall. So Jayden, uh, wrote, if you guys didn't see on the top of vitamin C supplementation, I know several docs recommend organic lemon juice sublingually instead of a C supplement. Do you have any thoughts on this? I'm just being honest and I'm really picky on stuff. I don't know why you'd have to do it sublingually. Um,

I don't know if I want to wake up in the morning and just like put lemon juice under my tongue, but I do. Um, I do in the morning lukewarm, like 12 ounces of water with a little bit of sea salt and then a second glass of water kind of over a longer period of time with just lukewarm water with lemon juice, like squeezed into it. And that's like my morning every morning. So electrolytes, vitamin C. Yeah. Um, I mean, ideal world, I would have lemons that I'm squeezing into my water and limes I'm squeezing my water every morning. I'm just too lazy for that. So, you know,

I just do the organic lemon juice concentrate stuff. Uh, CoQ 10 this one. Yeah. There's some like, uh, insulin sensitivity stuff that we all know. CoQ 10 helps with I'm not giving, you know, Alex, uh, for that reason. It's more for, uh, the decrease in inflammatory response media by TNFA alpha, which he, you know, has that gene, uh, snip as well. So

I would say anything I can do to help with inflammation. And then it does have a bit of an effect on insulin receptor sensitivity. Well, then it's a win. And I know that seems to be, you know, everybody says if you're over 55, you need to take CoQ10. So it seems like, you know, the old person's supplement. Choline, we talked about that, the fossil choline and its action on the liver and the brain.

Interestingly enough, when you're having any type of cholesterol, whether that's a delivery, so you have too many triglycerides or a conjugation issue, right? Low HDL low high LDL, whatever I'm going to say. Colleen, um, taken over 30 days has been shown to reverse non-alcoholic fatty liver disease. Now I don't think you can crush whiskey while you're taking Colleen, expect it to just be like an offset, but people that are, you know, stop drinking.

Beau Beard (01:14:29.782)

have a little healthier diet and up their choline intake, which what's, what's one of the foods that has the most choline in it. Anybody? It has some. Get up on that mic there. Kickback lazy. Yeah. So people can hear those answers. Yeah. I can't tell you how many times I've looked. If you can see me, I look over at Alex and he's just going,

And I'm talking right to him and I'm like, okay, I'll let him go. I am interested. He's not listening to you. Now I created a gap on purpose. These are maybes. So adaptogens, I mean, adaptogens wide open, rhodiola, ashwagandha for what? Inflammation. Inflammation, but more knocking you back into an anabolic state post-workout. It's supposed to help with recovery for that reason. You do get some protein signaling out of these as well for

Building muscle. Yeah. Western price. Thanks Aaron. Yes. She's feeling an idiot. Don't get that one. Not wrong. Oh my God. Um, so the thing is with that, and I just heard another, uh, I think maybe they were talking about this with, uh, Andy Galpin, that almost every rodeo out there except clean, um, that company K L E A N was, uh, manufactured with something else in it besides rodeo.

So like a wooden pass, you saw it a wooden pass water and they're out there selling it. So when you get into herbals, it gets real weird. So that's where I'm just like, I don't know, maybe. Um, and then you also have a limiter effect with some people that like, they have to cycle on and off these because not necessarily liver toxicity, but it does affect how your liver works. So you just use liver enzymes to kind of keep track of that. Right. MSM where do you, wherever you heard that talked about

If you follow the lovely Dr. Ronda Patrick, and if you want to go eat some sulfur or fain and grow broccoli sprouts instead, you could do that. Or you could take some MSN and then alpha-lopi-lipoic acid. Again, a potent anti-inflammatory signaling molecule. Again, for protein, I've mentioned protein synthesis signaling like 15 times because we're realizing how important that is that like what you eat and ingest is like telling your body what to do.

Beau Beard (01:16:48.91)

So you could go lift as many weights as you want, eat as much protein as you want. If it does come from certain sources, it's not as good as others, which people would like to argue all over the place. But that would be my wrap up, which I thought this would take an hour of if Alex was a patient of mine that came in for functional medicine, precision medicine, they're dealing with whatever. I'm attacking you like this. Hey, I know your biggest complaints to me are, you know,

generalized musculoskeletal aches and pains that come and go and seem to maybe not respond to treatment that great. And I don't think Alex is in the slubbiest of places for treatment. So I think we do a pretty good job. When stuff doesn't respond, we're always asking, well, why not? Second, I know you don't, or maybe first, I know you don't sleep very well. And outside of that, maybe there's some other stuff, I don't know, that your roommate would complain about of whistling dixie all the time. I don't know.

And then I'd go through their labs and I'd say, hey, these are the things we're paying attention to, acutely and then chronically. What are we paying attention to chronically? A1C, right, and the insulin. I'm paying attention to that for a long time. Because if we're in any of those ranges, those A, the insulin, will change faster than A1C, just from a time component, but your insulin is gonna tell me if a lot of things are cleaning up. And I'd be explaining to them just like this. I expect the albumin and the potassium to change immediately.

If we kind of start doing what down regulating better, you get your sleep better. Cause I don't think Alex is dehydrated. I'm going to give him some stuff to help. I think he needs, we talked earlier, maybe he needs more electrolytes. I mean, you can go overboard with that. Right. Um, he exercises quite a bit. I would say two noon tablets a week. If you're drinking seven, how many ounces are in a shaker bottle?

That's a lot of water. I mean, we're talking 120 ounces. So you definitely don't want to flush electrolytes out, right. And make it harder for your body to hang on to water. But I think I'd see those change fast. And then we would expect to be vitamins that change like that. Like literally you take supplementation. I tested them on, it should be different. Cause you can utilize B vitamins or water soluble. You're burning through them all the time. They're not necessarily building up. And that's why they're high on a lab test that are high because whatever you ate the day before it's presenting that way or whatever supplements you take, you know,

Beau Beard (01:19:09.758)

multivitamin. But it's very hard. You will find a lot of multivitamins with methylcobalamin in it, or sorry, methylfolate, but not methylcobalamin. They'll have cyanocobalamin, which we talked about was Alex's. You could argue that that's whatever. It's not methylated, first of all, it's also basically grown or synthesized off the back of a cyanide molecule and take it or leave it for what that means.

So any questions on this side or the other with sir Alex Coleman, breaking down genetic labs, all the fun stuff does exactly how we would do it. And then I would wait for all the questions to pour in of what am I supposed to do? And because of patients surely going to go, so wait a minute, all I have to do is take some of these supplements, try to like calm down after a workout, meditate once. And that's what you're telling me to do. And that

That's a hundred percent. We're going to start with just that because if I give me more of that, you're not for sure going to do anymore, but they expect, you know, especially if stuff's going wrong, like I need this like massive overall, no, you don't. You need to do what get a domino, like get one thing to knock down a couple, which also shows them that we know what we're actually doing. You're not just like giving them 50 supplements and then like, Oh yeah, something changed. Well, what effect did that have? You know, and if he said, Hey, I don't want to take all these supplements.

I would say then you got to be all over your diet. If his diet's not great, it's more supplements, right? So you just kind of, you're working with the patient you got in front of you. Um, and then my one suggestion that he may not like is you may not want to work out as much or you need less intense workouts. I know that's we're all in the movement space, the exercise, you know, rehab space. I'm not saying as intensity through the roof.

But maybe for a month he dials it way back and he's like, Hey, I'm gonna make sure that any run I do is only zone two. Any workout I do, I look at like heart rate stuff and I just kind of check in with myself and let your body literally self-regulate because neurotransmitters yes, are largely being created in your gut, but also the feed, you know, I guess the retroactive mechanism for that is being fed off of like, well, how much is there in the first place? And if you keep like ramping the system up all the time, like, well,

Beau Beard (01:21:29.514)

It's a never ending cycle. So at some point you have to, I'm not saying take a break. That's going to go the other way. Right. Like exercise is anti-inflammatory to an extent. Um, but there's a level to all this stuff. So maybe it's like, Hey, you just work out five days a week. Right. Or if you're going to do six, three of those got to be moderate, not, you know, no intensity with it, or use your breath to moderate or regulate your exercise and you're not allowed to go above, like you can't not breathe out of your nose for four of those workouts.

Whatever we want to do, play around with it. It's whatever you like. Is sciences or non-sciences you want to go? Do you have any questions? And if you do, talk to the mic. But we're talking to you, so anything that you're like, doesn't make sense or, I mean, we've talked about this a lot in the office and that's what we, we wanted to present it to you guys. Like we've never done it before. It's an impossibility. So we've been talking about Alex with all this stuff forever. But we just finally wanted to be like, okay, let's break down the data.

really tell you what we want to do. He'll do all this stuff. And then another goal of ours is, I mean, with him in three months, we'll probably redo the performance panel lab wise and see what changes. Alex tends to pass out when he gets blood. So he's really looking forward to that. Really hope that you're going to say six. Yeah. Um, but we want to see changes and then what's stubborn and what's not your genetics, aren't going to change your expression of them will

And then, you know, if that is the thing, like that may take more time than just, you know, having the micro macronutrients in place and the, you know, um, parasympathetic switching that we're talking about. I did. This was the thought that I had, uh, cause as so, I mean, though you've known me for 10 years, 10 years. Um, and as I like process all the things you're saying, how, okay, I'm going to make these changes, that kind of thing.

Um, kind of what got me into all of that in the first place, when I first started seeing Lisa was if you can believe it or not, I was way more up-regulated, I would say in terms of being high shrone. Um, and it was, it was like, uh, it was like an action potential, like all or none, I had to do everything right. And if I messed up like one thing, it was going to throw it all out. That's bipolar, obsessive compulsive, whatever you call it. I mean, that's what it is. Yeah.

Beau Beard (01:23:53.886)

And so in my head, it's like, all right, I've got these supplements I need to do, these things that I could change the diet. We go, you know, we go get dinner on a Friday night. I don't want to go back to the, you know, well, I can't go out to you with Seth. Cause I'm going to think about like, Oh, if I eat that thing, it's going to increase an inflammatory cascade and all these things. And that's like, that's what goes through my head as I process. All right. How do I make these changes? But how do I make it to where it's, it's sustainable, but it's not like,

Yeah, but think back in the way. Okay. So act like we've never talked about this before. What did I deliver to you today? I didn't tell you to eat or not eat anything other than like some blueberries and some colorful foods. I actually said, eat more of stuff. I didn't say not eat anything. Right. So I didn't knock anything out, which I'm very aware of because people will push back on that hardcore. Yeah. When you need to, you need to. You're not telling me you have massive IBS stuff, autoimmune triggers, like all these other things. Cool. Like you need more, you know, antioxidant load. Cool. Eat more.

colorful stuff more often. That's like a goal and that should make it fun. Like that's a challenge. Yeah. And then I said, you know, breath work, meditate, whatever you want to call that, that action and then some supplements. So, and that would be on purpose with you. If I knew you were hyper-visual and I know that you're going to like obsess over detail and then like shut off certain things, I'm like, dude, that's going to run you into what? Stress, which is oxidative. Yeah. So again, there's legit stress.

Right? Physiologic stress, which is oxidative damage or maybe not damage, oxidative, uh, so they're oxidative respiration, whatever you call that. And then there's stress, stress that you perceive that then creates a physiologic response. And that's why, you know, breathing and anxiety or a inseparable loop. It's like, you know, the snake eating its tail, all this stuff is. Stress becomes physiologic, physiology becomes stress. How you perceive it is the difference. And like, that's not my job is to tell you to perceive something different.

My job as a clinician is a presuppose that more of what we're feeling and dealing with from anxiety, stress, musculoskeletal pain, ache sleep is actually physiologic is not just psychological is not just emotional. That there's underlying things that help drive this. And I'm not trying to go EO Wilson, like, you know, social biology, like, oh, that's how, but like.

Beau Beard (01:26:15.938)

There's a lot of stuff that I think is underlying that makes the personality of something the way they are. Not just this like inset, like I have a personality. There's a reason that I probably have a hair trigger. Maybe some of that is I'm born personality. Maybe that's I have the same gene structure, MAOA, COMT, my neurotransmitters get hot. I want to control everything. I'm like very clean OCD, something goes wrong. Because you can't control it. Because why? Your brain is trying.

so hard to just like maintain any of the key ones, something goes outside that I can't control throws me for a loop. And it seems personality, but if you look at it closer, it seems physiologic. And again, it's not like it's one or the other it's part, but again, welcome to whatever you're, I hate the term, you know, BPS, but a human, right? It's just multifactorial. Uh, any other questions? So you're going to do this stuff? Yeah. The biggest one is post exercise.

Yeah, that's what I'm gonna start trying to tell me. Cause I do feel like I've made, well, partially because speed work was what flares up a lot of my symptoms on things. So I've, my runs are all very easy breathing through my nose. Two lifts a week are probably like, have a heavy component to it. I would say you do heavy a decent amount. I'm only lifting two or three days a week. Two of those days I'll start with something heavy. And then like the other day was that

row bike, jump rope and all that was trying to be through my nose. Yeah. And again, it's not that we're saying forever. We're just saying it's no different than kicking caffeine for 30 days down regulation period of workout, like working out or, um, stuff that you're just like having to take a dip down. That's where it'd be really interesting if you did have something like whoop or order to see, like does maybe sleep doesn't change cause that might take a lot.

Um, cause we also know that there's brainwave patterning that is a pattern, no different than a movement compensation. That's like, that's hard to change by itself. Um, but you're like, man, a lot of other stuff changed at night respiration rate, my resting heart rate goes down and then we're like, Hey, keep going. Right. And then let's start adding in another intense workout a week. That's still saying cool. You know, cause I mean, who's to say that we're not talking like you're in a chronic, like red S syndrome.

Beau Beard (01:28:37.53)

or red S I guess that's the syndrome, you know, um, if you don't know, you know, relative energy deficiency syndrome, what they use to call it, you know, the female triad, it's not a female thing. It's not, you know, just male thing. It's multifactorial. Uh, I don't think that's the case, but that's kind of what it was in high school. I mean, you were running into stress fractures left and right. And then from what I remember, like the micronutrient testing that you did out of that lab in Texas, uh,

Yeah. Funny enough, a lot of the stuff you suggested, I feel like I remember taking. Yeah. Like, but you burn, what do you do when you're under this oxidative load and the stress load? You burn through minerals, right? They're used as cofactors and coenzymes. You burn through those a lot faster than other people. And then what do you start doing? You're going to go find them. Where are you going to find them? Bones, things. And I mean, we had a guy that seemingly should have been healthy. I mean,

what fibular stress fracture, metatarsal stress fracture, tibial stress fracture, I don't know. Like just over and over. And I mean, you know, that's where you, you just gotta be a clinician and like, it is mechanical sometimes, it is physiologic sometimes, and it's probably always a little bit of both. That's the harder thing to reconcile. Let's move into any specific Q and A that would be behind just for you guys that are residency members. Thank you for tuning in.

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Runner with Stenosis, Lumbar Extrusion with Resultant Discectomy: Week in Review 28

Welcome back to another edition of our Week in Review! In this episode, we dive into two compelling cases that shed light on the challenges individuals face in the realm of orthopedic and neurosurgical interventions. First up, we follow the inspiring journey of a dedicated runner battling stenosis. Join us as we explore the impact of spinal stenosis on an athlete's life, the diagnostic process, and the tailored treatment plan that allows our patient to reclaim their passion for running. Next, we delve into a lumbar extrusion case with a resultant discectomy. Gain insights into the intricacies of the procedure, the postoperative recovery, and the positive outcomes achieved. This real-life scenario provides valuable information for those navigating similar medical challenges or interested in the advancements of spinal surgery. Our expert panel of healthcare professionals breaks down each case, discussing the medical nuances, treatment strategies, and the importance of patient-centric care. Whether you're a healthcare professional, student, or simply curious about medical advancements, this week's review promises to be both informative and engaging. Catch up on the latest developments in the medical field and stay informed about the triumphs and challenges faced by patients and practitioners alike. If you find this content valuable, don't forget to like, share, and subscribe to our channel for more insightful medical updates.

A Complex Pain Science Case & A Functional Approach to Patellar Tendinosis: Week in Review 27

On this week's episode of the Week in Review, Dr. Beau Beard, Dr. Alex Coleman, Dr. Daniel O’Quinn, and Seth Graham discuss a trauma-related pain science case and a stick-to-your-guns functional approach to patellar tendinosis.

Show Notes

In the first part of the conversation, two patient cases were discussed. The first case involved a high school soccer player with knee pain, and the second case involved a male with neck and back pain. The discussion focused on treating tendon injuries, the importance of loading tendons, and the criteria for return to play. The conversation also touched on the concept of central sensitization and the potential impact of past trauma on a patient's condition. The use of medications and the role of past trauma in the second case were explored. This conversation explores the topic of chronic pain and the role of psycho-emotional factors in its development and management. The hosts discuss the journey of a patient named Dan, who experienced chronic pain and sought various treatments before finding relief by addressing the psycho-emotional component. They emphasize the importance of understanding the whole human and properly diagnosing the underlying causes of pain. The conversation also highlights the need to rewrite the current understanding of pain and the role of emotional responses in its perception. The hosts conclude by emphasizing the importance of confidence in assessment and the complexity of chronic pain.

Takeaways

Chronic pain can be influenced by psycho-emotional factors and addressing these factors can lead to relief.

Understanding the whole human and properly diagnosing the underlying causes of pain are crucial in effective treatment.

The current understanding of pain and its classification should be revised to include the role of emotional responses.

Confidence in assessment is essential for building trust with patients and providing effective care.

Chapters

00:00 Patient Case 1: High School Soccer Player with Knee Pain

11:23 Discussion on Treating Tendon Injuries and Function

19:27 Discussion on Loading Tendons and Return to Play Criteria

24:09 Patient Case 2: Male with Neck and Back Pain

32:48 Discussion on Central Sensitization and Past Trauma

45:17 Continuation of Patient Case 2: Past Trauma and Medications

50:27 Introduction to Chronic Pain

51:14 The Journey of Dan

52:04 The Damaging Bond

52:24 Addressing the Psycho-Emotional Component

53:22 The Impact of Emotional Trauma

54:18 The Connection to His Mother's Passing

55:04 The Role of Psycho-Emotional Pain

56:12 The Need to Rewrite the Matrix

57:28 The Importance of Understanding the Whole Human

58:21 The Importance of Proper Diagnosis

59:37 The Role of Emotional Responses in Pain

01:00:55 The Complexity of Chronic Pain

01:03:44 The Importance of Fundamental Assessment

01:04:13 The Case of the Hip and Foot Pain

01:07:00 The Importance of Confidence in Assessment

01:08:19 Closing Remarks

Repeated Medial Shin Pain, and Medial Ankle Pain, Post Inversion Ankle Sprain: Week in Review 26

On this week's episode of the Week in Review, Dr. Beau Beard, Dr. Alex Coleman, and Seth Graham discuss two cross-country runner cases. One case of repeated medial shin pain, and the other of a girl dealing with medial ankle pain, post inversion ankle sprain. Foot Strike Run Retraining for Patients With Patellofemoral Chondral Defects: A Case Series https://pubmed.ncbi.nlm.nih.gov/37930763/

Low Back Pain of Cervicothoracic Origin & Persistent Medial Knee Pain in Cross Country Runner: Week in Review 25

🔍 In the first part of this video, we dive deep into the world of low back pain stemming from the cervicothoracic region. You'll discover its potential causes, symptoms, and most importantly, effective strategies to manage and alleviate this discomfort. Say goodbye to that nagging pain in your lower back!

🏃‍♂️ Then, we switch gears and focus on cross-country runners who are experiencing stubborn medial knee pain. Whether you're a seasoned athlete or just starting out, medial knee pain can be a real setback. We'll explore the common causes, preventative measures, and rehabilitation techniques that can help you get back on track, pain-free.

💡 Our practitioners will share valuable insights and tips based on the latest research and best practices. Don't let these issues hinder your athletic performance or daily life any longer – empower yourself with the knowledge and solutions presented in this video.

Visual System Finding in Basketball Player with Back Pain; High School Runner with Bilateral Hamstring Pain; Elite Gymnast/Crossfitter with Neck Pain: Week in Review 24

Transcript

Beau Beard (00:00.75)

This is high quality. Riverside, not sponsored. Shouldn't be though. This is fancy. You're looking. We can review 24. Right? We got, how did you get called out in football? What was your number? 87. Damn right! Yeah, I'm just about to have you with it. So we got John in from Arkansas now, not Palmer, right? And then the crew, we're not gonna introduce anybody. Everybody made it? How's your bottom side?

time. We were off for about a week. Yeah, I was unwell. That night I was pretty... We were about 18 hours of... Not great. Uneasiness. Do you think we do it again? I do it again. I've been eating the sauces like all week. Mine was...

I didn't feel good for about 18 hours and then whenever I exercised my stomach started feeling not good. We're just gonna give you the heads up. Just go Google how much the Hot Ones kit is. Alex just over your mouth on it for lunch. Well, I think my patient made me the ghost pepper ones I've eaten. Yeah. Oh, we should have tried that. We should have, yeah. I think like a... Shot next time. A week or two ago was Johnny Cash's birthday and I think it was just to summarize things like Ring of Fire. You can probably call it that. It was a bathroom experience.

the next day and that was propulsion and a couple rings of fire he said jetpack engaged here who's doing cases me Alex I think I am Seth rookies gonna lead off would you were you in the lineup when you play baseball

We're doing it. Dang right. Get on base. Let's get going. Alright. So I found out I was doing a case about 30 minutes ago because Daniel decided he wasn't doing his so we'll see how this goes. It's okay. He had a rough day. I get it. Harry Potter and the Half Truth. I'm kind of a fantastic guy.

Beau Beard (02:00.786)

Well, triple bucked at seven and made it three. And now I'm working out for the rest of the day. Triple bucked at seven. I'm just saving my energy for my children. All right, so, man, I got something in my throat. I just ate. He's still reliving the spice. Probably dairy. Oh, there's just dairy from the last one. That's probably why yours hurt for a week, we'll be honest. Yeah, for sure. All right, so my case, I had a...

16 year old, I guess at the time he was 15, he had a birthday in the middle of all these appointments, so he was 15 when he first came in. That's how long our treatment plans are. Yes, he came in, he complained of having, let's see, right-sided low back pain, that he only felt whenever he was standing at work or playing basketball. He's a, I guess a basketball athlete. What's he do for work?

He works at Publix. He just, like I said, he just turned 16, so his hours are fixed and start getting moved, so I don't really know what he's done up until this point. But I think he's like a bagger grocery and kind of takes things out to the cards at Publix. I think that's kind of what his job is. I'm only asking so people know, because it's about 50%. Is he special needs? No. The jury is not. Publix, right? Oh yeah. So we have to ask? Yeah.

I would say it is. For baggers, it's either young kids or it's gonna lean that way. And he'd be on the other end of the 50% young kids. But he could have been in both. He could have been in both, but he was just a singular. He did have a catch here one time and she chewed out the bagger. It was the worst one, special Nate and I was just like, I don't even know what to say here. Because he wasn't on his game? No, he was moving to life. It's Publix, man, you're good. Hey, you can't drop this kind of nuggets. This isn't Aldi, though.

Like, Aldi is a speed. Yeah. You can tell Aldi was started in Germany. They make you bring your own box and they got it. Like, I'm surprised you don't get a number on your arm to go in there. Like, why don't you get your shit done? Yeah. It's rough, man. That's why I don't go there anymore. Great prices, but customer service.

Beau Beard (04:09.326)

Okay, back to the case. Hey, you're good. He's still 15. No, he's not. He's 16. Almost 17 now. He, let's see, sorry, I gotta read my notes. He had this going on for about a year that he's noticed his low back not really too severe until as of lately. Went to an ortho, Dr. Davis, went to him.

for his low back, who referred him here. Nothing done, he had imaging done, had an x-ray, they saw nothing on it. Like I said, he stayed sustaining for long periods of work and also basketball, or what kind of causes him pain. It's good when he first wakes up, gets slowly worse throughout the day. He's also taken some ibuprofen, but has had no change in terms of pain and has not used any ice or heat.

He also said that he noticed his right side just feels tighter lately and then he states kind of a little bit later I guess in the in the visit that him and his mom have both noticed that he's having trouble kind of seeing things Like on a TV or at school. He's homeschooled. So he has like two days a week that he goes to a I guess a school that's connected with church co-op. Yeah, co-op. That's the word I was looking for

Um, yeah, so let's just take him through. I know I'm the youngest one here, I think, but I would say I'm the most mature of the moment. Interesting. This is what it's like at home ladies and gentlemen. Him getting dogged. Has anybody seen the videos you watch on?

Social media

Beau Beard (06:04.174)

Listen here you snaggle tooth. Okay, so top tier cervical flex. Let's see. He was functional. No trauma. No trauma Literally just woke up about a year ago He said he kind of just started noticing it then but it never got severe enough to where he felt like he needed to get it seen He played basketball kind of over the summer recently made the high school basketball team

Beau Beard (06:30.882)

Yeah, sorry I thought we were like, alright we're done with positions. I don't know what position he plays. You a shooter or a driver? He's probably definitely a shooter. I'm gonna go based on height and weight. McGavin. He probably stands at three points for sure. Scientist. Yeah, professor. Pretty riveting. So let's go functional non-painfuls. He was good on cervical flexion, both rotations.

Upper extremity pattern one and two. Actually, let's just skip that. Dysfunctional non-painfuls, cervical extension, multi-segmental flexion, and single leg stance on the right was dysfunctional and painful. His back pain when he looked with the cervical extension? I said dysfunctional non-painful, sorry. He was DN. The only thing that was painful was multi-segmental extension and then single leg stance on the right.

Both of those were dysfunctional and painful. For back pain. All right, had him drop down, do a half kneeling inline lunge. That was functional non painful on both of those for his, I guess for time. Yeah, balance. Gait analysis, kind of noticed he didn't really extend through his right side of his hip, and he also had an early toe off on the right side. Or I guess heel lift, whatever you like to call it. Let's see, nothing positive on any orthos.

I don't know if that's just me or if that's, I don't know, if I just don't do orthos right, but I don't get people that have hardly anything that's positive on some orthos. In terms of one bar spine? Anything. Or just overall. Overall. Yeah. Like people come in and have pain like all over the place and there's really nothing that reproduces it. They're like, no, I really ain't doing it. I think the key word is actually. Yeah, actually. Actually, I don't have any. John heard it today. The actuallys are my favorite. I guess the only thing that was positive was a stork test on the right.

I'll take that one Let's see the other thing that's noted is you guys got a stork at Palmer. So we talked about this would The only birds we get taught pigeon But I don't know say classified first birds like for what it was for I mean that was a classic. I mean here you guys carry on. Yes, sir

Beau Beard (08:55.714)

He's got it. Straight leg raise is also limited bilaterally, so I'm not going to say it's positive, but it is just limited bilaterally. Neuro is normal. All right, so then I go through check and range of motion. Kid moves impeccable, I'll be honest. Nothing really.

Nothing is limited except for, I guess, if you take a straight leg raise. Palpation wise, he had a restriction in like mutation for sacrum and then he had right ankle dorsiflexion restriction. And then he had a trigger point in his right erector. That was kind of the big key pieces, I guess, that I found. Pain audits, I've got multi-segmental extension, right single leg stance.

And then functional audits is kind of those three things that I just listed. The trigger point in Rhyder Ector, Lumbosacral Nutation Restriction, and then right ankle dorsiflexion restriction. Those are my three functional. Let's see, what did I do? Had him do some press ups because he had the nutation restriction. My man, question. Yes sir. But his multisigmental flexion was dysfunctional painful?

Just this function non painful. Oh, that was extension was extension Central is painful. It was painful

It was painful. But he goes prone, no pain. No pain. Because he also said that I asked him what helps and he's, I forgot to mention that earlier in the history, I asked him what helps and he said, laying on my stomach makes my back feel better. Love to see it. So we love to see it. So I had him lay on, I had him repeatedly lay on his stomach 30 times. Repeatedly. A little clinician over pressure. Sorry, clerk over pressure. Sorry, clerkship over pressure. Sorry, Hogan.

Beau Beard (10:55.301)

He got up stork test and one-to-same mental extension. Both of those were still causing him pain. Single X stance on the right still caused him pain. Go back and check and he still has a restriction so adjusted into extension there. I guess notation, whatever you want to call it.

Adjusted had him stand back up again just to see okay. Is it just maybe need a little bit more I guess Attention thrown in there had him go back recheck all that still painful again After adjusting he still has a trick point his right erector you just say cry pain no I didn't Throw the yellow flag on the play your 55 sure I don't care about that questionnaire and then

Let's see, this is when he mentioned about the not being able to see because I just asked him, I was like, do you wear glasses or contacts? Because he had mentioned that he had trouble like seeing in school.

I can't remember how we got on that subject, I'll be 100% honest, but we got there. You probably looked at your giant Lego rocket and was like, what the fuck was that thing? Yeah, could he even focus on the exam with that Lego rocket? He's not facing that direction, Daniel. In case you guys don't know, Seth is from Madison or Athens, around Huntsville. Huntsville, up until this year, had, or it's getting taken out, right? Yeah, I was driving up last night to Ashland.

Does that mean... I don't know. That's not in our state. That is... I guess it's our state. That's up at the... That's at the check-in. Not the check-in, the rest stop. Good God! He said the rest stop is part of Alabama. Look, like I said, it is part of our state. Anyways, he has a replica of this rocket. It was the Saturn V for the Space and Rocket Center in Huntsville. Made at... About 3 feet below. Made at... About 3 feet below.

Beau Beard (12:58.366)

Great. Googley moogly. His replica, made of Legos, in his room. And when we asked Seth why he got it, he said it was a conversation starter. Has it worked? I've had, let's see... This kid couldn't see it, so... I've had a decent amount of people ask me about the Rocket. I also had a girl that came in, her dad is like really big into Legos. And we bonded over that. I will say, Legos have become more popular. Which I'm not a fan of, I feel like. You said what?

They become more popular. I'm just saying I'm not a fan of it. If you want to have old nimbly bimbly fingers, not know how to chop down a tree, cool. That's fun. Go chop down a tree and come inside and work on a Lego. That's all I'm saying. They have become more popular. That's funny. Once I have a tree in my backyard. What do you mean? He couldn't see a baseball game on TV. It's on the other side, it looks like a fence. Look at that one in the middle. Okay, anyway. Keep going. Bye. All right.

Beau Beard (13:53.698)

You're like, what do you actually need to practice? I was like, well, I remembered it, so I'm renewing my license. Let's see. So, this is gonna be a 25 minute case on visit one. I had him just go on his back, because I just want to check his breathing. That's another part of, I guess, my exam that I do. I had him bend his knees, lay there. I can't really figure out how to mathematically breathe.

Worked with him a little bit. He picked that up relatively quickly. Had him progress where he picked his legs up. Kind of used some like dead bug progressions. Went back and checked all of my audits. None of them changed at all. So no, the trigger point in his right erector didn't change. The only thing I guess that changes because I adjusted it was the... Nutation. Ankle hasn't, still hasn't changed yet either. So then I...

sat him back up and at this point I'm kind of like, all right, what am I missing? So I have my exam flow written on my whiteboard in my room, so the last thing that I haven't done yet is visual, vestibular kind of testing. So I take him through carnal signs of gaze.

As I'm watching him, every time I take his left eye, I guess, to the right, he has to converge, he has a little bit of an nystagmus there, and then when I have him converge at all, his left eye...

doesn't converge as well as the right side does, and then it also kind of starts trailing back towards the middle. So just to clarify, because this is also for hopefully educational purposes, so was it during tracking that he has a blip? So that's a saccade. Yeah. So nystagmus is an end range. Like if I hold it there. Yeah, so if I had him hold, that's the other thing, I guess, like he had a nystagmus when I had him go and hold at the end range, that's all the saccade, and then I held it there. So he had a blip and? Yeah. Okay, cool. So then I had him bring it, I guess,

Beau Beard (15:53.048)

converge he it's still kind of blipped a little bit when he converges on I hold it there as I start to kind of trailing out his left eye so I was like okay that's something to maybe look at so I have him cover his right eye I have him go and try and converge again and his left eye has again no blip no little cicada or anything it's smooth whenever he converges there so I had him go

do some like the pencil push-ups basically, where he has the eye convergence drills, covering the right eye, have him go through like 10 of those, go back and check his ankle, his ankle like completely opens up. And he even mentions to me, he goes, he's like, my ankle feels completely different after that. He goes, that just feels- And you haven't explained anything to him? I haven't explained anything to him at this point. I was just, I was having- Like why you're doing the eye stuff, hey. No, I'm not, I did not mention anything about his eyes being connected to his body like Alex did to his patient. If you didn't know that,

pieces that the eyes are connected to the body. Yeah I just told him I was like I'm just gonna check your eyes and stuff like that they get they could have a connection but outside of that I'm just kind of ruling everything in and out. I again check his ankle and he goes that just feels like completely different he's like does that feel better than the than the left and I was like they're almost identical now.

So at that point I then had him flip over, checked his trigger point and his rider rector. That's like completely gone as well. So since my audits are pretty much clear, I stand him back up, have him go through multi-segmental extension and stork and single leg stance. All those, he has no pay on any of those. And when I edit this I'm going to throw in the, what's the, let the Holy Spirit come through you. And then, Samba!

Beau Beard (17:44.595)

All right, so here we are. Visit one. That is visit one. So quiz time. Before we do that, we're gonna take a advertisement break on a stork test. So sensitivity is 91%, specificity is 78%. I mean, that's about as high as Thessaly's is probably. They went higher than that on a standalone test. I can't believe that's not taught.

Which is insane. We learned Vesalis. We did. I didn't learn it. I learned Vesalis. That's crazy. This also says it's in like a Geley test. We got taught Geley's test is different than that. Yeah, we got taught. That was an aside. Can you explain or what is your summation of why working on convergence would change that stuff?

Let's see. Okay, I guess I forgot to mention as well, in talking to him, he said that he's noticed in basketball, he has, I mentioned he has pain, like in his low back playing basketball, but he has a friend that he's been growing up with, like his entire life. He notices that they're exactly the same speed, they both made the team at the same time, and he said that he noticed now as of recently.

The other kid hasn't been strength training any more than he has. They work out together. They basically do like everything together because I think they're both homeschooled in the same program. But he said every time the kid drives to my right, he goes, I just feel like he's just blowing past me, going to the hole now. He goes, going to my left. He's not. He goes, I don't understand because my right side is my strong side. But he just kind of mentioned that.

That's kind of one of the reasons I started diving back into looking at his eyes as well. Um, let's see. Cause that's what everybody's going to wonder. If somebody was here, like what's that? How in the world is that connected? How's that going down? How would you?

Beau Beard (19:41.21)

A, maybe explain that to him and then what is your like clinical explanation for that? Yeah, so I told him, I said whenever he's having to drive to your right side, your left eye is going to have to go to the right in order for you to be able to keep up with him. I said if you're- Or you have to turn your whole body which just lay down. Either one. Whole body has to move. So I said-

One, that's going to require you to be able to focus on just the object in front of you. Two, you have to use your peripheral vision. I said, peripheral vision as an athlete is pretty vital for what you have to do. And I said, if you're not getting a clear image of all of that together and kind of putting the pieces together with the rest of your body while you move, I said your body could throw up some little, kind of some breaks. And I kind of gave him the...

image of what you have with your kid where the kid was like slow as molasses, had the kid wear glasses and then he just was like an entirely different runner. I gave him that and he said, oh, okay, that makes sense. But I guess for clinically for me, I guess it's that's very, I wouldn't really go too much farther beyond kind of what I said, but he also is probably going to, if he has to go to his right, he's growing.

one he's gone through like a growth spurt of like four or five inches in the last year i believe two since he moved really well video coming out on growth spurt this week too and two since he moved really well he already kind of has just decreased proprioception um... because he's just growing super fast has no idea how to use his entire body um... and if he's having to

One, if it's maybe his vision or something like that that's just blurry, like again, he's just not being able to put all the pieces together. So you're kind of having a hodgepodge of a human trying to be an athlete. And if vision is gonna lead, you know, 10 to 20% of per perception, like I feel like that's a pretty big piece. And especially if he moves really well. But.

Beau Beard (50:17.898)

I think maybe if I knew more on the Z-Health room, because for myself if I would have just tested visual and I saw no lack of convergence, or that's pretty much the main thing that I look for there, if I didn't see that I wouldn't have done anything. But you, whereas, because we were talking about the other day, just because there's

things that would be noted in the visual exam that I just have no idea about. Right, for me I guess it's the, just because you don't see it, it's the, like if you don't see it then you just move on. Like in my opinion, like it's glaring. So it's like. Gather all data. Right, like we always sit there and we argue at home or get mad at each other, but like we don't like. If you only eat rice and beef, something's going to come to that. Yeah. We'll go through that train time. Well it's just because sometimes like, you know, we, since we're still like young figuring it out it's like.

We just, you don't see these things. When people say you see like a lack of convergence, it's like, okay, what does that actually look like? Cause we test on each other and it's like, I mean, if you like look hard enough, you might be like, you might could like maybe see it shift and you're like, no, just skip on past that. It was just like, for my kid, at least it was like, it was pretty glaring. I mean, it was almost like his eye didn't move in. Yeah. I see that over and over it, the course I taught, right? Like passive range motion, joint restriction, like dude, it is obvious, obvious.

you're making shit up. You're just making it up to make yourself feel like, and if you're like, oh, let me go back and check it. No, you're the knower, you know. It's not, oh, I'm not very good at knowing. You will know, I promise you. And then you have to be confident that what you found is true. That's the kicker. Not that like, oh, I don't know, no. Do you think it's true or not? And then the only way to find that out is treat. Go back and prove right or wrong. I even think like, I bet you're the same way.

where it's like, after you do the whole exam, the whole history, everything in SFMA, it's like, do you have a pretty good idea if I'm even gonna even check the eyes? 100%. And then it's like, and so if Brett was here, it's like, that's what I'll be talking to him about, it's like, well yeah, I'm not gonna check it if all these other things aren't already there. Yeah, it'll be very interesting when the Yaakov's info comes out from this dissertation and stuff, like it'll just be, I don't.

Beau Beard (52:25.694)

So Keith Yoho and I were talking about this probably like, I don't think it's gonna change anything because a principle of DNS has always been eyes. I mean, it comes from a neurologic standpoint. I mean, literally, I pull up those three slides from the early DNS A course that's talking about the visual system, how much they lean on the visual system. It's been a little bit, I don't know.

subdued within there because it's become more exercise-based, movement-based. It's like this is all in it as a neurologist, right? Like, polycholage came from like training from neurologists. Like that's what they're looking at. And then if, like I said, you look at a baby, like the first couple of things are polyconnected movement, yeah, visual cues, and then the whole body starts following. It's like that's all I'm looking at. And then I could really, and then you look at like, COBS stuff, which I think it would say like, oh, looking at Z-Health. No, we're looking at neurology, right? He's looking at it and he's like, hey, if we're going to do some sort of visual

input where you usually start. So you're kind of going back to almost like in a way a developmental kinesiology model, or I go to a lower level.

So Daniel with the SFMA and stuff, what are some key pieces where if you see a discrepancy in it that kind of points you to like, hey, let me check their vision. I feel like the easiest is single leg balance and rotation. It's like if those two are there, it's like you're going to check a number of things. If you have passive range, then it's like, okay, why are they not getting there? They have it. So usually it's like, hey, what am I not finding? Yep.

visual system. So as soon as you see an SMCD, check it. Like that should be your literally if you're a student like see an SMCD that's that glaring, go look.

Beau Beard (54:05.734)

Continue. This is a two. So he was able to run twice over the weekend, three and a half miles. Didn't have any pain. He's gonna try to run a workout that week or after I saw him a second time. And then they raced the next weekend. Multi-six liter run. Is your beard red? Holy shit. That was a redhead.

You're a redhead? No hair. Well I was a redhead. I was blonde when I was born. God, I was his clinician. I did a terrible job. You asked that question a long time ago. Makes way more sense. I was red for like, I don't know, a year. I think with the- That's enough time. The beard color though, it's copper. And I think the beard hair is like, as strong as copper wire. I think it's Alabama red dirt clay. That's Georgia. Yeah, it could be.

You just scooped some up and went like... Red clays tray? Red clays trays. There you go. Coming to Birmingham. Proceed. Proceed, sir. Multisieminary rotation right. Functional non-painful now. We continued, we didn't change what we were doing. We were just working on the breathing. Continuing to make it better. Progressed it to intradominal pressure. And then we took out support from chair, bench, whatever he's been doing at home.

And then he was going to do that workout and then race before I saw him. Um, or no, sorry, do the workout. I saw him before the race third visits still has, he's doing great. No pain, his hamstring. I'm saying hamstrings. We know it's not as interesting. Um, and so from there, I was like, all right, we're, we're doing good. Now let's actually like, give you some things to do that are going to help you.

continue improving running and you need to be able to control rotation to the right or just rotation in general as well as extension which is what I was doing the breathing for right because he like he Multisignal multisignal rotation he passed but it was like he is the unit kind of shaking extension. Yeah And then obviously he's not great at creating pressure With which he'd be an interesting one to look at the gate to see if you yeah, yeah Yeah, especially with some of the structural

Beau Beard (56:29.405)

So that day we did a kneeling and standing split squat, Paloff, we just did the hover. David Weck would slap you upside your head. Yeah, oh well. Did anybody watch his Instagram chat? Yeah. David Weck is on a mission for the anti-stiff core. He just thinks that's the devil.

Literally just get on a David Weck kick for your Weck method. I've talked to him on the phone and stuff. He gave us sort of his little pulse pros. He's a nut job. He is. He invented the BOSU ball, if you know what that means. That guy's Weck. Yeah. That guy. So it's the thing that you're supposed to like stiffen up on? No. It's supposed to be mobile, labile to get stable. Mobile, agile, hostile. I'm feeling hostile. He's an interesting guy. He'll probably somehow hear this and all hear of it.

So he ran great at the race, then I saw him for the fourth visit. I just have that he's rocking and rolling. Clinical outcome measures. Was that your diagnosis? We are... Diagnosis rocking? You're out. We were dead bugs today.

because I was like, look, this is literally you running, being able to differentiate limbs, creating a neutral on our spine with intra-bondal pressure. You're doing the rotational stuff at home. And then, you know, I had planned on us kind of talking about, because I don't think they get it with their program, just a general resistance training, because that's what he needs, right? He needs to be challenged outside the sagittal plane. I was gonna say, do you think he needs more? Yeah, I just think he needs to keep doing that, right? And then- But like that level, or like needs to keep up in the challenge?

to add weight, right? We've done some banded things. Impact, plumbing. Which is what we'll do next, but at the same time, so he's a junior in high school. This week he went on a bunch of college tours like with their school. He runs for a really small school around here, and you know, he's around 1930, he's not running a college. Well. He's going to welding school. Yeah. Well actually, he'll probably end up being some kind of engineer, like, he'll make a ton of money. But.

Beau Beard (58:45.45)

It would just I'm assuming that he doesn't talk by a bear turn away Yeah, because most runners like even if they're not gonna run in college like it's a sport that you can continue doing right inside one in the end usually

that's the only thing they've done, right? Like they haven't played basketball or other sports or things that they're gonna continue doing after. So they latch onto that and they will just keep doing it. So. Two key takeaways for me from this. It's kinda like seeing everything. I'm like, wow. Like you can have a huge impact if you just kind of like clarify and work, you know, with a runner that's primarily in a sagittal plane of movement, introducing other planes of movement and some cross training style stuff.

and then number two there's more just a comment I think this is the most polite patient that I've ever seen. Oh yeah. It's always like yes sir and no sir and he's just like you know you tell me what I need to do and I'll do it. That's cool. Who's your dad's neighbor? My dad's neighbor? Yeah the one who me and Bo both seen who says all that time.

Oh, not neighbor but friend. Yeah. Yeah They would ride they would that might be him in about 40 years Any so I just carry on constantly

Beau Beard (01:00:16.27)

Great guy, love you too. Oh yeah, he's seen almost everybody. You see him now, have you seen him? Yeah. How about saying, is that what I wrote in my hand? Yeah. I said, let me read the text right. And that's how I see him.

Yep. Good. Alright. Bring us home. Anybody got a two by four for Daniel? It's a karate chop. Yeah. Right now, just test the integrity of that bone. I'm going to play top ball this week. He had dingers too. Everything else was sore, my hand wasn't. You didn't boon-tip? I wish. Slow pitch bun would be a little bit tough, huh? I'm not blind.

Alright, let's bring it home. This is actually, this case is about a, maybe the biggest fan of Week in Review, at least locally. This is a former elite gymnast, now high level cross-fit athlete and medical resident with a plan to some of this. Reports on July 17th with complaint of left trapezius, neck, tingling numbness. So that's the main complaint, it's tingling numbness, not pain really. That just kind of spreads across the upper trap.

Works with overhead movements, in particular handstand pushups. The amount of handstand pushups will come out here in a minute. She's been working on an average of 80 hours a week. She's resident. She's getting crushed. And then working out at night by herself. If that gives you an idea what type of person you're dealing with. No prior similar complaints. I mean, collegiate gymnast, so multiple injuries. My wife had seen her for a bunch of injuries. She was a gymnast for Alabama. No prior treatment for the complaints she's coming to me with. So that's kind of the general.

Um, general presentation, which is something that I look at more. I think I used to be just more like, well, let's get into S and A and stuff. Just like how's this person like present? Like what do they look like? What do you even call that posture? Whatever. Um, what did she say? What was her analogy of herself? I look like a 10 year old boy that just learned. Oh, I did have a 15 year old boy that just learned about a chest on about peanut butter. Pretty funny.

Beau Beard (01:02:22.806)

She only does bench press or something like, yeah, she's pretty self-deprecating in the best way possible. Um, she probably listens to this. So we love it. Um, bilateral anterior shoulder. So I'm going to try to present if you're watching the bilateral anterior shoulders, thoracic kyphosis, increased lumbar, lower dotted curve, and generally a little bit ramped up. Um, she has built like she's built like a gymnast, right? And that's a big part of this case. Uh, so top tier dysfunctional and painful is bilateral upper.

Pattern one, multisegmental flexion, multisegmental extension, left rotation only, and then bilateral single leg stance and deep squat. Nothing was painful, just some dysfunctional stuff. Gait didn't really pertain to it other than her past history, which isn't, we'll talk about it in a little bit. Specific movement testing, four point rocker, if you're not familiar with that, you're in quadruped, just rocking about, four to five inches forward on locked elbows. Increased T-spine kyphosis, curvature reflection, she lives there.

upper trapezius and pec major activity and then she's an apical breather in general. She's just hanging out and you can literally see her hanging out like this. Range of motion, so prior history with her and the biggest thing that Sloan sawler for and that was just, I had seen her for, she had an osteotomy of her right hip so she has pretty decent external rotation limitation of her right hip with some pain and she's doing high level crossfit stuff and she's not limited by weight.

reps or anything. To talk about the handstand pushup rep scheme that she came in. It wasn't the first visit, but second. First visit she came in, she had done some handstand pushups, some overhead work. I think it was a snatch or something. She comes in the next time, she's like, I'm doing better or was doing better. Then it got worse because I did 120 handstand pushups as part of something else. Like I said, this is by herself in a gym at like 10 PM at night. It's what we were told. Maybe that one.

Yeah, it's good news is she didn't feel it after a hundred. Yeah. Yeah, it's a good call didn't show up at a hundred I was like, yeah, I think I'd have pain in a lot of places Neuro-normal So I'm palpation TL junction rotation extension restriction and lack of posterior IEP Like that's a big deal with her is like it's very hard for her to get like kind of that breath into the posterior aspect We're admin

Beau Beard (01:04:46.27)

right gluteus medius trigger point, right gastroc medial trigger point, and then CT junction, left rotation extension restriction. And that plays all real quick plays into the ortho. So when you load in maximum frame of compression left, she's like a pinpoint pain, but also some of that numbness on that first and second visit into the trap, which is a weird presentation. That's not a ridiculous opathy. We'll talk about, I'll give you the, you know, legit diagnosis in a sec. And then a trigger point in the left upper trapezius.

And then as I said, orthos, MFC on the left, positive with left pain. So my pain audit is maximal foraminal compression. I mean, it's literally reproduces her chief complaint. Functional audit, CT junction restriction and upper trap shoulder point. So she has a restriction extension, left rotation on that side. Giant shoulder point on that left trap. Treatment focus is T-smite extension though. I mean, she and her, like that dead zone, T4 to T6 is just like.

has a hard time conceptualizing in this video for this podcast, I'm gonna put a video of her in quadruped trying to figure out just how to kind of get into neutral. You're gonna see around like, kind of a middle trap, like where serratus anterior should kick in on the medial border of the lower scapula, you're just gonna see a big divot when we cure up. Like she has a really hard time figuring that out. And then, so treatment focus, T-spine extension with improved scapula thoracic stability.

Diagnosis, I'm not gonna give you an ICD-10, but like facet discogenic referral, but I would say it's more a cloward side, like legit disc referral. That's why it's this like specific numbness tingling. Maybe you could call it sclerotogenous, but it's numbness. It's not pain, which is a little bit of pain when we like load, which is a true what? Derangement. You have restriction pain, right? Now that'll play into the treatment here. So first visit.

We adjust all the things that I said restriction-wise. So what was that? TL junction, CT junction, T-spine extension, dry needle upper trap. And we actually leave her with what? Cervical flexions, which I know seemed backwards. She has, we're talking she needs a T-spine extension, but she has that kind of upper T-spine scallop within a little kyphosis at CT junction, which is why she is extended or restriction extension.

Beau Beard (01:07:12.782)

extension restrictions, I said it backwards. So when we flexed her, we could then load her into extension, she's like, I don't really feel anything. So like, I even told her, I go, I don't think it's the home run, but I think this is the best palliative thing we're gonna get fast, right? Which obviously it kind of worked. So homework from that first visit was just cervical flexions, nothing else. Now in visit, we did a little bit of DNS and start position, like Sarah's prayer, but I didn't send her home with that.

Second visit, she comes back and she's like, I'm better, but that was a visit that she's like, I did handstand pushups, I took 100 of them to hit the symptoms. Symptoms she did say were better. And she says the referral is closer to like a local, like around CT junction. So it's not as far out in her trap. So a second visit, adjust. Instead of dry kneading, I just do some stecho around like cervical extensors, around kind of middle lower trap and then upper trap.

and then we go back to start position and then I send her home with strange prayer that time. Strange prayer for her is tough. I mean, she literally, I told you, she's a little ramped up type A. So when we get her into DNS position, she's the person that right away is just like, literally like vibrating, sweating, but she's such a good athlete, she'll get it right away. It's just hard. Like, I think that's why it's hard. I think she gets into a good position fast and then like gets cooked. And I think that's the hardest position to cue. And like,

I think maybe in DNS, it's like the stride of spirit. When you know it's like upper T-spine. Which I'll give you what, so I just got that a couple weeks ago from Prologue and one of their kind of prioritization lists for that position or working on upper T-spine extension or axial extension was create lateral expansion of the shoulder, shoulder blades first. So you're creating like a, basically, we think of the elbows as the pump and fix them, it's actually the shoulder blades, right? That's what's.

pulling the T-spine, either if it was hyper flexed in the neutral or scalloped in the neutral, right? It's just like you're popping a dent out of a hood, like this way. Then you go after axial extension. Somebody cue like, hey, elongation and things. Final move would be nine times out of 10 extension, right? So for her T4, T6 extension, or it could be flexion if somebody scalloped through the entire T-spine. Versus what we typically do is what?

Beau Beard (01:09:32.482)

go right after extension or flexion. Like we want to approximate the shoulder blade or the rib cage one way or the other. So it's like, they had a very clean, like no, one, two, three. So take that. I've started doing that and that's, I feel like it's made the big difference. Which the lateral expansion of the shoulders, that feel is tough for people to get, but when you get it, it's a key because what are you doing? You're putting an eccentric load on the middle trap or an omboy, which literally gives a stable point for the mid T-spine to work off of, which is why we think so many people have a problem.

That's the dead zone. Do you feel like you're still getting like a lap and relax from there? Yeah, probably more so because a lot of people, what's their first move and start position. It's like a backward traction. So if you have lateral expansion, like literally do it yourself. So if you're at home, like put your elbows on a table, pull back towards your hip flexors, you're gonna feel your lat engage and then think east and west or left and right, like give feedback and you're not gonna feel it at all. You're gonna feel the outside of your shoulders with no lat.

That is the hardest thing for people when you're working in these kind of three month prongs, start position, quadruped is laugh and peck, right? Now here's the key, there is some activity, or peck in particular if you're in quadruped. You can't not hang out with your peck, it's just not dominating the movement. So we sent her home with Strayedish Prayer and just kind of said, hey, hang here, maybe you start rocking a little bit. She comes back and she's like, it's way better, but it's still kind of there, which.

I'm gonna be honest with you, she's probably listening to this. At that point I was like, I think it's pretty much fine. Like, I mean, we load her up, she can kind of feel it. She's doing great. So that's where Seth was helping me out in this visit. And we, I mean, we still adjusted, did stekko. Then we started doing like high bared, a downward dog, then elevated high bear, so her feet were up on a step. I mean, she's doing handstand pushups. So we gotta work her into these higher level things. It was really hard for her to conceptualize up writing.

in her mid T-spine when she started to go through these transitions. I mean, really hard. So we didn't leave her without, we just said, the first thing that she always did is like, you were trying to, yeah, you were trying to get her to like, get her shoulder separate from her mid back. Yeah. And she always like, as soon as you wanted to go like overhead, it was just like flex my T-spine and then I'll go overhead. So it was like, but that's what gymnasts are taught. Yeah. And that's what we kind of talked about. Like they are taught to fixate inflection because you can use your rectus abdominis.

Beau Beard (01:11:52.878)

but then they'll have to hyper flex their shoulders and then what do they end up with? Shoulder pathology and one more spine pathology but now we're seeing what? Compression fractures in mid T-spine because the compressive force is being driven either from loading here or basically rotation. And she gets all this stuff. I mean she's a medical professional now, was a extremely high level gymnast, but it was still really hard. So she competitively, you can tell she's kind of like, and I was like, cool.

But we didn't leave her without, she went home with a high oblique sit that day. Cause we were like, we like what we're doing here. Let's take it down a notch and just figure out how to load your left side. Was staying upright and start moving around it. And we'll move you back into quadruped from high oblique sit. So that was, you know, first, second, third. Um, it's literally, we've seen her two more times since then. And it's just been playing around with this stuff since then. I mean, last time we went back to quadruped to downward dog, just seeing like tolerances and that's where.

the video I'm gonna put up is from the last visit I saw her. You're gonna see when we really start to get in the nuance of cues, we have her hang out for maybe 10 seconds. She fatigues out and literally her shoulder really just like pops off of her rib cage. So now it gets down to what? Kind of awareness, motor control, and then endurance. And then you kind of build that in, but I mean, think of a hundred reps of handstand push-up, and she's literally just gonna do whatever she can. So I mean, she just literally, and I'm not gonna tell her not to do it, but just run right over her tolerance all the time, which is gonna start her back into the older.

old motor program makes our job harder but she's pretty much out of pain. I told Seth this or I think I did, I think she could have been done the fourth visit and even the fifth visit I was like I don't think she needs to come in but I think she needs the reassurance of am I doing it right, all that stuff. Literally the last visit she was like I'm feeling really good. Always going to be stuff to work on because she's beating the hell out of herself, she's working 80 hours a week. Yeah, any questions on that one?

Beau Beard (01:13:51.83)

She's got an interesting one just because she's such a high level athlete. Like it's easy to work with, but you also like, it's like everybody you'd want, but then you kind of get to see if everybody did exactly what you wanted to. Like see it change, but then see that it's not even perfect still. Like, oh man, you can do everything you want, but then you're kind of like, yeah, it's not perfect. Keep going, keep going, keep going. It's another thing of, again, just like, almost anybody who's high level, how well they can compensate. So again, it goes back to just like.

how well their tissues are, how good their tissues are, take it where they can feel theirself really well, but then it's just like their body can compensate and tissues can tolerate that, so it's like, where is the actual breakdown? It takes an 80 hour resident doc week working out solo and 120 handstand push ups before it's kind of like, yeah, I get some numbness down my arm. It's kind of like, that's pretty impressive. 50 year old one, overweight office worker. He goes on a walk for a mile down the road and it's like, dude, I've got this.

bathroom ceiling. The bathroom ceiling, like dude I'm dying. It's like how many Alabama gymnasts from like those championships have we seen where it's like as soon as they get some of these positions I'm like, you do it so easy. It's not fair. It's not fair but also you see how, so a big point of contention in our profession is, well could you train an idealized position or movement? It's like well they definitely got trained or not idealized and they hang onto that for like with a death.

and try getting somebody out of like one bar lower doses, like hyper-kyphosis and then like not hyper-flexing their shoulders is like, and that slumming literally just hits home runs just trying to like break that pattern all the time. Which in like, this is one, you kind of see it here a little bit, but it's like this is one off showcase all the time. I can't see it. It's like mud learning. We'll put it, send me the slide, we'll put it up on the video. Yeah. It's like I always think that like, okay, it's like of course if I've been doing it one way.

When we're talking about autonomous, like 100, 300,000 reps, and it's like now I'm trying to learn a new way. It's like your body one time efficiently did it, but maybe in the first year of life and then it hasn't done it since. And then the thing that we talk a lot about with runners is you hit a fatigue point, so you can have great control when you're, you have great neurocognitive function, then you hit a literal metabolic fatigue point, no matter how great neurocognitive function you have, like that goes downhill, then you gotta do two things, what? Kind of.

Beau Beard (01:16:13.474)

push that metabolic gap a little bit while you're working the neurocognitive. And I mean, that's literally time and training and all this stuff. So, I don't know if she's competing or anything, but I mean, it just gets down to, she probably is also under immense amount of stress by not eating awesome, not sleeping awesome. And then how much of that is just driving the bus? I don't know, probably a lot. But again, look how far it took until something finally broke the heads. Right, yeah, so again, Winchester talked a lot about you're the functional metis.

Medicine side of things is just like the buffers around like when you break down and how fast you recover, which is why we should have that conversation, which she knows all the stuff. Implementation is everything though. You can know everything is fine and everything. But this patient may introduce herself because she might bring a case on here pretty soon. So, yeah. She's had some doozies so far when she's bringing them up in clinics. So. I've got an ATV. Yeah, it'll probably, yeah. It was a good chance. Last one was, I'd never have guessed it.

Oh, any final comments? Anything from Peanut Gallery? Nope, just one more. There you go. So we got some show notes stuff to put in there. Z-Health chart, what else we got? The video of her. The video for you. Pajeped Rock. Pajeped Rock, also put in stork test evidence. So you should also put in a picture of a belt where they're like trying.

pull it together and make it snap. So Yana, or John at Yana from Prague was basically saying like, which everybody was like, I don't know what that analogy, like a horse tied to two posts. And if that horse tried to walk forward or backwards, it's gonna like tighten the rope. So it's only got one option. It can move up or down, right? I've heard, you know, Rich talk about this. Everybody explains it a different way, but like.

The best thing you can think of is I think of like popping a dent out of a car. You don't hit the dent, you hit the side. Right. And if you literally hit on both sides of it, you have a higher likelihood of like popping that thing out versus hitting one side because then it could just like deflect. So what you're doing, you're trying to create tension on both sides of the spine and tension being the musculature, right? Not just moving stuff around. But the biggest key there is in particular, I think this gets missed is it doesn't matter if you're starting from a flex position or a hyperextended position. It's moving somebody to neutral to move into axle.

Beau Beard (01:18:34.796)

extension so like it's like it's the same regardless which makes your job easier cool more boots more octoberfest more spin drifts and maybe one more we got to start doing the wild turkey on camera though should have done that we didn't start no you were in a different realm already

Okay, two weeks from now. Also, if you have a case that you want us to present or you would like, you have questions on there or something, start sending those in. Yeah. Dr.obierd.gmail.com and we can either answer questions, we can help present it, and I think we'd like to start doing that because it'd be a little more fun too. So we could do like two of our own and then one of somebody else's. See y'all next time. Bring it on.

Hot Ones Edition! Two Cases of Lumbar Stenosis With Very Different Approaches: Week in Review 23

Week in Review Hot Ones Edition! On this week's episode, we are joined by Dr. Daniel O'Quinn, Seth Graham, Tanner Zimmerman, with cases presented by Dr. Beau Beard and Dr. Alex Coleman. Both cases this week deal with lumbar central stenosis, with two very different treatment focuses. Enjoy!

Chronic Low Back Pain in a CrossFit Athlete and an Adductor Strain Coupled With Neurodynamic Involvement in a Taekwondo Athlete: Week in Review 22

Dr. Beau Beard, Dr. Cody Dimak, Dr. Kyle Thompson, Dr. Alex Coleman, and chiropractic students Seth Graham and Tristen Collins join us on this episode to discuss a case of chronic low back pain in a CrossFit athlete and an adductor strain coupled with neurodynamic involvement in a Taekwondo athlete.

Lumbar Fusion and Radiculopathy and Shoulder Replacement with Cervical Pain: Week in Review 21

In this week's episode, Dr. Beau Beard, Dr. Alex Coleman, Seth Graham, and Tanner Zimmerman discuss a case of lower lumbar fusion with unilateral radiculopathy, as well as a patient who underwent shoulder replacement and still deals with cervical dysfunction.

Heel and hip pain of lumbar origin, Achilles pain and the kinematic chain

Dr. Beau Beard, DC, MS, CCSP, Dr. Alex Coleman, DC, and Seth Graham (chiro student/resident) sit down to discuss how stenosis presents as bilateral hip and heel pain in a patient, as well as Achilles pain that is tied to knee and hip dysfunction.

Abdominal pain in long drive competitor & centrally derived ankle pain in soccer player.

In episode 19 of the Week In Review, we are back after a long hiatus with a brand new clinician, Dr. Alex Coleman, and a new resident, Seth Graham. In this episode, we discuss a long-drive competitor with insidious onset of right abdominal pain, as well as a complex case involving a youth soccer player dealing with ankle pain.