Latest / The Driven Athlete / Interview on Approach & Philosophy of Practice - "The Bender Continues" podcast | Ep 64

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Interview on Approach & Philosophy of Practice - "The Bender Continues" podcast | Ep 64 · The Driven Athlete

• 0:03
  Speaker 2: you guys ready everyone good, yeah, let's do it, let's do it cool.
• 0:07
  Speaker 1: So thanks again for being here today.
• 0:08
  Speaker 1: We're really uh excited to talk about physical therapy, excited to talk about your credibility and your history in the entire physical therapy division of health yeah obviously we're talking a lot about different health topics in our segments, but specifically focusing on physical therapy here today.
• 0:27
  Speaker 1: So cool.
• 0:28
  Speaker 3: Thanks for being on.
• 0:28
  Speaker 3: No, definitely Thanks for the invite.
• 0:30
  Speaker 3: It's funny Like excited to talk about physical therapy.
• 0:32
  Speaker 3: It's like dentistry, like.
• 0:34
  Speaker 1: I want to go to the dentist to really talk about that.
• 0:37
  Speaker 4: It says yeah, I mean I think, because we're athletes like we all, just you know, we've gone through it, so we have a passion for it.
• 0:48
  Speaker 1: We understand how our bodies work and all the things that we've had to deal with over time.
• 0:50
  Speaker 1: So totally yeah, and we'll get into that today.
• 0:51
  Speaker 1: Each one of us have probably worked with the person in your field in one manner or another, because of the fact that we've basically acquired injuries pushing yourselves athletes active?
• 1:01
  Speaker 3: yeah, totally so.
• 1:02
  Speaker 3: I mean, for people like you guys like it's it, I would hope, a little exciting as in like this is super interesting because I push myself, like if I battle my own injuries.
• 1:10
  Speaker 3: It's like, can you fix this stuff?
• 1:12
  Speaker 3: Like, is this, there's a solution?
• 1:13
  Speaker 3: You know, like how do I go about it?
• 1:15
  Speaker 3: You know what I mean.
• 1:15
  Speaker 3: It's like, that's what we do, let's get after it.
• 1:19
  Speaker 1: Hell yeah, and that's what you do.
• 1:21
  Speaker 1: Can you talk a little bit about athlete restoration company and what makes your company different than the typical physical therapy facilities around the rest of the country or maybe even the globe?
• 1:30
  Speaker 3: Yeah, totally no, I appreciate that question.
• 1:32
  Speaker 3: So the name is definitely unique in that that's who we try to serve.
• 1:36
  Speaker 3: And a lot of people will ask, like, do you only work with pro athletes or college athletes?
• 1:41
  Speaker 3: Right, like I'm kind of intimidated to come in, like I'm not really I'm not a pro football player, and it's like, actually the meat of our schedule and the meat of the people that we see the most that's all high demand are like the active, uh, athletic weekend warrior moms and dads, um, professional young professionals, um, and then people who are in their you know, uh, uh, aging athlete type of phase of life, where they're like I really want to maintain my mobility and vitality, independence, um, like what does this look like when I become 75 and advance into 80?
• 2:11
  Speaker 3: yeah like because if I'm 65 right now or 62 and I'm running 5ks or I'm doing this like and my hips giving me trouble, it's like, what does that look like 10 years from now?
• 2:20
  Speaker 3: Does that mean I need a hip replacement?
• 2:21
  Speaker 3: It's like actually, you can avoid that stuff.
• 2:23
  Speaker 3: You might not need it, um.
• 2:25
  Speaker 3: So anyway, we, we cater to the active, motivated and enthusiastic people that want to get better, they want to stay active, and they're super curious and intrigued and interested of like oh, this is cool.
• 2:37
  Speaker 3: What can you help me with my neck too?
• 2:38
  Speaker 3: Or like helping my shoulder, you know, can you help me with all this stuff?
• 2:41
  Speaker 3: So that's what we like to work with.
• 2:42
  Speaker 3: Um, and the Can you help me with all this stuff?
• 2:44
  Speaker 3: So that's what we like to work with.
• 2:45
  Speaker 3: And the clinicians that we've brought on board in our team are motivated and enthusiastic in the same way, because we get fulfilled and thrilled with working with people who are motivated and pumped too, versus the people that, unfortunately, that are in the insurance space which we'll get into in a minute Usually those type of patients.
• 3:01
  Speaker 3: They're really nice people, of course they're great.
• 3:04
  Speaker 3: The clinical practitioners are great too, but they're really nice people, of course they're great.
• 3:05
  Speaker 3: The clinical practitioners are great too, but they're usually not super the same kind of motivation and stage of walk of life.
• 3:11
  Speaker 3: You know what I mean, where they're like.
• 3:13
  Speaker 3: I'm just here because my doc told me to.
• 3:16
  Speaker 3: So I imagine like or like well, I'm just in here to satisfy my insurance justification so that I can get surgery and injection, like in a month, but I have to do this first to show it doesn't work.
• 3:30
  Speaker 3: Great.
• 3:30
  Speaker 3: So you just belittled our entire career.
• 3:31
  Speaker 3: What am I doing here?
• 3:32
  Speaker 3: You know like what that that sucks, you know, but anyway.
• 3:33
  Speaker 3: So the people that we see that are like we're out of pocket, right, so they're motivated and pumped, they're going to pay attention.
• 3:38
  Speaker 3: You know what I mean.
• 3:39
  Speaker 3: Like, imagine if you were to go see a practitioner that you're you, if you were to go see a practitioner that you're, you know, um, really invested in what you do for your, their life, and you're like this is what we do, we're specialists in this, and you're like and guess what?
• 3:49
  Speaker 3: This is inflated, of course.
• 3:51
  Speaker 3: Let's say it's a thousand dollars an hour.
• 3:52
  Speaker 3: Would you show up late or would you be like, dude, I'm going to do early, I'm gonna have my notepad and I'm going to implement this my life.
• 4:02
  Speaker 3: So those are the people that we try to that we cater with too, and you know you attract who you.
• 4:07
  Speaker 3: You know you attract who you're with and your, your personality and your um, your vibe, you know what I mean.
• 4:12
  Speaker 3: So that's what we've tried to cater to.
• 4:14
  Speaker 3: So we don't only just treat athletes.
• 4:15
  Speaker 3: Anybody who's active and athletic like you're an athlete and we want to maintain your high level activity and your vitality, independence, and you know.
• 4:24
  Speaker 1: So you touched on right there a couple of points regarding the cash pay type of program opposed to insurance based, and how it could really change the direction of the clientele that you deal with, mostly from a really a mental standpoint of why they're coming in and the why and have the result.
• 4:42
  Speaker 1: Is that a common thing for physical therapists, That'd be cash pay or is it more of an insurance-based program that you typically see?
• 4:50
  Speaker 1: Why did you structure towards the cash pay thought process?
• 4:54
  Speaker 3: No, definitely very, very dominated by the insurance and network type of clinic setup.
• 5:00
  Speaker 3: For sure, because insurance runs the world.
• 5:02
  Speaker 3: As you guys know, I can talk all day about this stuff there.
• 5:05
  Speaker 3: Super interesting joe rogan podcasts on this.
• 5:08
  Speaker 3: I listened to it.
• 5:08
  Speaker 3: I'm like my mind was blown and I'm like I had no idea how bad.
• 5:12
  Speaker 3: You know, but anyway, um, but you know.
• 5:14
  Speaker 3: So it totally changes the, the vibe that the um, the people that would be interested, the mindset coming in, right, it's like here's a professional, I'm going to be one-on an hour, right, that's.
• 5:24
  Speaker 3: Another unique factor is that we're only one-on-one for an hour with everybody.
• 5:27
  Speaker 3: So we spend a lot of hard mental effort on like let's figure this out, you know, versus half assing it.
• 5:34
  Speaker 3: You know what I mean.
• 5:39
  Speaker 3: Or like oh, I got lunch in 20 minutes.
• 5:40
  Speaker 3: Like yeah, so go over there and result you're looking for.
• 5:42
  Speaker 3: So I think a unique factor in addition to that is our mindset as in like imagine going to a healthcare practitioner place and they actually try hard, Like they actually put some mental effort to like let's dive into the matter and figure this out.
• 5:58
  Speaker 3: You know, versus like not really caring, and then on top of that the uh back-end administrative type of support.
• 6:06
  Speaker 3: Imagine you call and you get a phone.
• 6:08
  Speaker 3: You get answered with a human right away and they actually have a good attitude.
• 6:12
  Speaker 3: Yeah, that's a breath of fresh air, you know.
• 6:15
  Speaker 3: Versus waiting for 15 minutes, they don't answer.
• 6:17
  Speaker 3: They're going to give you a call back and you get a robot and it's like push one for the extension or whatever, and then when you do talk to somebody, they have an attitude right.
• 6:24
  Speaker 3: That's unfortunately a very common stereotype of healthcare practices.
• 6:28
  Speaker 3: It's like I'm just, I need help and you're going to give me an attitude right, but the reverse, it's like a breath of fresh air.
• 6:34
  Speaker 3: So, anyway, we try to embody all that.
• 6:37
  Speaker 1: As a patient of yours in the past.
• 6:38
  Speaker 1: One thing that I would also say is probably a benefit that I've seen as a I would say, a problem for many clinicians in other facets not just physical therapy but in other fashions is the duration of your appointment right.
• 6:50
  Speaker 1: Sometimes a clinician will come in and spend five minutes with you and like here I'll write you a script.
• 6:55
  Speaker 1: You guys are invested and really take care of a long, short-term and a long-term approach to getting you to where you want to be, which is not common.
• 7:05
  Speaker 1: Well, I appreciate that?
• 7:05
  Speaker 3: No, we do try to, that's for sure.
• 7:07
  Speaker 3: We try to invest.
• 7:08
  Speaker 3: Other small business owners I've talked with in the past.
• 7:12
  Speaker 3: They're having our patience.
• 7:13
  Speaker 3: I've been clients of theirs or other things like construction or plumbing or whatever.
• 7:17
  Speaker 3: And then talking to them it'd be like does anybody care what they do?
• 7:21
  Speaker 3: anymore, Does anybody care about their craft?
• 7:23
  Speaker 3: Or like trying hard, does anybody try?
• 7:25
  Speaker 3: Versus just half out BSing, just like I just want to make the money and just like move on, you know.
• 7:29
  Speaker 3: But anyway, so we, yeah, an hour, we spent an hour and the first steps, of course, is to like get things feeling better.
• 7:36
  Speaker 3: We explain, we try to explain a lot of stuff and dive into the education component, because then need education is really huge because the people we work with they're invested and they are going to do stuff like they're like what can I not do?
• 7:46
  Speaker 3: What should I do?
• 7:47
  Speaker 3: What exercises, what interventions can I do on my own at home?
• 7:49
  Speaker 3: Right?
• 7:50
  Speaker 3: Versus like do I have to do this stuff?
• 7:52
  Speaker 3: You know, it's like, hey, did you my shoulders to hurt?
• 7:54
  Speaker 3: So like, did you do some of your stuff we talked about?
• 7:56
  Speaker 3: I don't even remember what we talked about.
• 7:58
  Speaker 3: I was like what are we doing?
• 8:00
  Speaker 3: You know what are we doing here, guys, but anyway, so the cool thing is like with this, like you said, like we, we try to invest very hard and we live and die based on our results, because once we are out of network and we're cash, we're fee for service, rubber cash.
• 8:12
  Speaker 3: So, um, on the front end.
• 8:14
  Speaker 3: People are like, why would I do that and pay quadruple the amount right of a copay or for free, when I could go to this other insurance place for free and see you guys like, why, right, but so we live and die by some results.
• 8:27
  Speaker 3: So, that being said, like a lot of people that are functional and active and motivated, enthusiastic, I was saying, um, the typical standard progression for health care is, for sure, like, oh, I use my blue cross, blue shield, right, my humana, that's, that's what you do, right?
• 8:39
  Speaker 3: So they go that route.
• 8:40
  Speaker 3: They don't get better, they don't get the results you're looking for.
• 8:42
  Speaker 3: It's like I'm still not able to play, three days a week, sand volleyball.
• 8:45
  Speaker 3: Right, go back to the dock.
• 8:47
  Speaker 3: And it's like you don't need to do that to live.
• 8:49
  Speaker 3: Why don't you just stop?
• 8:50
  Speaker 3: I have an idea just rest for six weeks, ice, take some advil, just do that.
• 8:56
  Speaker 3: But they're like I don't want to.
• 8:58
  Speaker 3: Yeah, it's deflating.
• 8:59
  Speaker 3: Number one, and then number two it's like you're going to tell me how to live my life and then it comes to us and was like awesome, let's get after it, we're gonna modify some things.
• 9:05
  Speaker 3: Well, we got to work on your scapula.
• 9:07
  Speaker 3: Better, work on this.
• 9:07
  Speaker 3: We've got a rook on that and that's you're gonna hit harder, you're gonna be jump better, like whatever, and they usually eat that up and it's like you're gonna not tell me not to do it.
• 9:14
  Speaker 3: That's awesome, you know.
• 9:15
  Speaker 3: Versus like let's get after it, you know.
• 9:18
  Speaker 5: So I think it's almost like a perfect match of y'all's attitude.
• 9:24
  Speaker 5: Because, you're right, you look at different industries.
• 9:26
  Speaker 5: People are more, they're monotone, they're just watching the clock and customers know that when they call in, it's like this person you almost want to hang up and try someone else because it's just not what you look for.
• 9:35
  Speaker 5: But if you get someone energetic, it's like let's go.
• 9:37
  Speaker 5: Then you're motivated.
• 9:38
  Speaker 5: So you know that that's the attitude at your company and you know that you've got those two client customer classes where it's hey, you're just trying to get back to quote unquote, live your life.
• 9:47
  Speaker 5: And then your target market almost sounds like is those who, yeah, I want to be able to live normally, but then I want to go do all those things I want to do, and at a higher level, right, right.
• 9:55
  Speaker 5: So they come in.
• 9:56
  Speaker 5: You've got it sounds like you've got the approach for that.
• 9:58
  Speaker 5: So do you more where they're almost beating the recovery timelines.
• 10:07
  Speaker 5: Is it more an aggressive approach?
• 10:08
  Speaker 5: Is it just that culmination of of perfect match, like I guess what's that story look like?
• 10:11
  Speaker 3: when individuals come in, it's hey, it's going to be six to eight weeks, right um, yeah, people, a great question, so a short answer speedy recovery, for sure, like it's expedited totally because we, like I said, a lot of us the education yeah and people don't, uh, recognize or acknowledge.
• 10:27
  Speaker 3: it's just ignorant.
• 10:28
  Speaker 3: They don't know yet, right, and I'm not sending bad people.
• 10:30
  Speaker 3: Um, they f it up over and over again without knowing what they're doing.
• 10:33
  Speaker 3: Sure, it's like I woke up and it hurts that.
• 10:36
  Speaker 3: That it's.
• 10:36
  Speaker 3: I'm meant to be in pain forever.
• 10:38
  Speaker 3: It's like, no, you're not, you don't have to be unless you choose to right.
• 10:41
  Speaker 3: That's another different realm, different realm of of, like the psychology component, which I'm not a psychologist, but there's definitely a lot of the mental component.
• 10:47
  Speaker 3: I think it's very underweighted, but anyway, um, so it's expedited.
• 10:51
  Speaker 3: For sure we can educate people.
• 10:53
  Speaker 3: We show them like your sleeping position is contributing to these things lingering, um, or your training is definitely contributing to this lingering.
• 11:01
  Speaker 3: If you don't set your shoulder, your back or your hip up for success before you work out with these little mobility interventions or activation recruitment exercises, you're setting it up for failure of compensation patterns to just linger, and forever faster.
• 11:14
  Speaker 3: You know what I'm saying.
• 11:15
  Speaker 3: So there's definitely the increased expedited results, for sure, um, and a lot of that's the education, yeah, yeah, but the uh, but anyway.
• 11:22
  Speaker 3: The other question was to say was people usually ask okay, cool, when can I be a hundred percent?
• 11:26
  Speaker 3: Ultimately, it's up to you that also it depends on some factors and I just did a YouTube video on this of like, uh, or a podcast um the severity, um the irritability level, um the the nature of the injury, right, um all in the age of the person, right.
• 11:44
  Speaker 3: That sets the stage of like it's very, very severe and it's been going on for eight years, right, and I'm not, and I'm 68 years old.
• 11:52
  Speaker 3: That's going to take a little bit longer.
• 11:54
  Speaker 3: We understand that turnover is going to be a little bit slower compared to an 18 year old athlete who sprained their ankle mildly last week.
• 12:02
  Speaker 3: You know what I'm saying?
• 12:08
  Speaker 3: That's going to's gonna be fast, right, or a muscle strain that was like two weeks ago.
• 12:10
  Speaker 3: It's like, dude, you'll be good in a week, right, just don't overdo it right now, don't overstretch it, right, um, and do these little things, um, yeah, so the uh, the severity, the intensity of the pain, how long it's been going on, the age of that person that all determines, like, how long it's going to take to notice significant improvements and changes.
• 12:24
  Speaker 5: You know so you almost have to dial them back, in a sense, where they come in.
• 12:28
  Speaker 5: They've got that attitude, they've got that energy.
• 12:30
  Speaker 5: They want to go five days a week.
• 12:31
  Speaker 5: It's like we don't need that.
• 12:32
  Speaker 5: Like love it, or do you kind of run with?
• 12:34
  Speaker 3: that, uh, a little bit of both, it depends.
• 12:36
  Speaker 3: Yeah, um the.
• 12:38
  Speaker 3: We definitely get a lot of some of the people that are like all right, so if I do these exercises, 10 like just a number, like it's just so you don't forget, right, 10 doesn't matter, it's just eight to 12, like whatever right, as long as it doesn't hurt, not making things worse.
• 12:49
  Speaker 3: They're like all right, cool, if I did a hundred reps, would that get me better, 10 times faster.
• 12:53
  Speaker 3: Like, if I did it every day 10 times, would that increase by tenfold.
• 12:57
  Speaker 3: And it's like oh no, there's still.
• 12:58
  Speaker 3: You.
• 13:00
  Speaker 3: Cells and tissue take usually six to eight weeks to have a good foundation of turnover, to have a healing potential.
• 13:07
  Speaker 3: Right, so, not necessarily, but on the other end, right, it's like if you don't eff it up continually, you implement some of these things.
• 13:15
  Speaker 3: We're not going to tell you to rest, because no one likes to hear that in the boat that we work with usually.
• 13:19
  Speaker 3: It's like just rest.
• 13:20
  Speaker 3: It's like I'm tired of resting, I'm like I'm gonna lose my mind here.
• 13:22
  Speaker 3: It's like I've been resting for six weeks and then they dive in back to a hundred percent again and it comes back and they're like it doesn't, it doesn't work.
• 13:30
  Speaker 3: Yeah, it's like just got to modify.
• 13:36
  Speaker 3: That's what we said.
• 13:37
  Speaker 3: We just got to modify some stuff.
• 13:39
  Speaker 3: Right now, I'm not going to tell you to stop.
• 13:41
  Speaker 3: I'm not like you did a workout.
• 13:42
  Speaker 3: I want you to work out.
• 13:44
  Speaker 3: I would probably avoid these things right now because if it's vulnerable and it's gonna irritate it, I'm pretty confident in what you're telling me, so I would avoid those things.
• 13:52
  Speaker 3: Instead, substitute these type of workouts and exercises instead For your shoulder or your back, like whatever body parts that lit up the thing.
• 13:59
  Speaker 3: Modify and implement this instead and then we can test the water over time and elevate some stuff.
• 14:06
  Speaker 3: Try some things.
• 14:07
  Speaker 3: It causes some issues?
• 14:09
  Speaker 3: Okay, we'll back it down Right and we can course correct in the meantime.
• 14:12
  Speaker 3: We just want to avoid the rollercoaster of being like super dramatic, of like I did a high, intense, super hardcore workout and it was too much and it lit everything up.
• 14:21
  Speaker 3: You're going to take like you're going to take us back we much and it lit everything up.
• 14:24
  Speaker 3: You're going to take like you're going to take us back.
• 14:25
  Speaker 3: We have to stop the bleeding at some point and that's what we're going to modify.
• 14:27
  Speaker 3: So use your symptoms as the indicator.
• 14:28
  Speaker 3: Is it causing issues right now versus the mindset of like, well, I'm going to do it anyway and push through.
• 14:33
  Speaker 3: We would expect that to cause things to irritate, for sure, okay, is that going to be helpful?
• 14:37
  Speaker 3: Probably not, right?
• 14:39
  Speaker 3: Okay, your pain threshold the next day that night.
• 14:42
  Speaker 3: How did you feel the next day?
• 14:44
  Speaker 3: How did you feel right?
• 14:45
  Speaker 3: And then use that as like an indicator of like, I think I'm at a good spot.
• 14:48
  Speaker 3: I don't feel too bad.
• 14:49
  Speaker 3: I didn't light things up, I did push myself in some aspects, but I don't feel worse.
• 14:53
  Speaker 3: Okay, cool, let's run with that nice that's what we would run with.
• 14:57
  Speaker 4: Okay, yeah, does that make sense.
• 14:58
  Speaker 3: Yeah, yeah, yeah I love that.
• 15:01
  Speaker 2: So, kyle, obviously one thing that's that noticeable is you know, we talk about the medical industry, we talk about just physical therapy as a whole and you've mentioned a few things where essentially you're looking for, or your business is more focused on, a how can we really help preventative but also really help the motivated athlete and or patient, whether they're 60 years old, coming in to get better right at the end of the day.
• 15:27
  Speaker 2: So if you could just describe to us some success stories just around advanced manual therapy and I'm sure there's multiple, obviously being an expert in what you're doing but could you just share some of the maybe the epiphany, some of the great stories you've had?
• 15:42
  Speaker 3: Yeah, totally no good question.
• 15:43
  Speaker 3: So, in my opinion, I feel like, um, the main separator for clinicians is their um ability to recognize things and differential diagnosis Right.
• 15:54
  Speaker 3: And that comes with humility too, by the way, like, if you see a practitioner, it's like I've seen this a thousand times.
• 15:59
  Speaker 3: I know exactly what to do.
• 16:00
  Speaker 3: This is what we do every time for this yeah, yeah I would be like I would just question it right and myself I would be like what makes you feel that way?
• 16:07
  Speaker 3: Did you consider potentially this out here might be a contributing or this might also be a factor, but anyway, so that comes through humility in my opinion.
• 16:16
  Speaker 3: Um, and always diving back into, like this was interesting, let me research this.
• 16:20
  Speaker 3: So anyway, the differentiation and able to recognize some stuff in the competency component.
• 16:25
  Speaker 3: And then the second factor is what you can do with your hands.
• 16:27
  Speaker 3: It's, in my opinion, because the manual therapy, I think, is the game-changing separating factor Joints.
• 16:36
  Speaker 3: You can't alter and affect some joint play and some joint alterations and compensations just with exercise alone.
• 16:44
  Speaker 3: Some changes happen over time, for sure, and we can't address and intervene those things that have changed just with exercise alone.
• 16:52
  Speaker 3: That's just what some of the research suggests.
• 16:53
  Speaker 3: So the factor that she's going to change, that is a manual therapy, so we can mobilize some joints and intervene at the joint level.
• 17:00
  Speaker 3: Soft tissue restriction plays a role with that too.
• 17:01
  Speaker 3: So, soft tissue, for sure.
• 17:02
  Speaker 3: But what I use is the purposeful discretion level.
• 17:03
  Speaker 3: Soft tissue restriction plays a role with that too.
• 17:04
  Speaker 3: So, soft tissue, for sure.
• 17:04
  Speaker 3: But the, the the purposeful, the what I use is the purposeful discretion I'm not going to like.
• 17:09
  Speaker 3: We can do manipulations, for sure, but we're not going to rack and crack everything like a bunch of wild cowboys, like we're going to pick and purposely choose, purposely Like why am I not going to manipulate here and why am I going to choose to manipulate or mobilize here?
• 17:19
  Speaker 3: That's part of the differentiation and then be able to execute that with a manual therapy.
• 17:23
  Speaker 3: I think those are the two separating factors.
• 17:25
  Speaker 3: So, with that being said, the really cool moments that I live for that we live, I think, is really cool and fulfilling is when somebody has been coming in.
• 17:31
  Speaker 3: Things haven't been working.
• 17:33
  Speaker 3: They're still in pain, right, if their shoulder, their neck, their knees or back, their ankle, whatever, right.
• 17:37
  Speaker 3: And we test, we're like all right, show me the athletic movement that you do that causes a pain.
• 17:41
  Speaker 3: Right.
• 17:41
  Speaker 3: If I do shoulder press, that hurts, all right.
• 17:43
  Speaker 3: So show me a shoulder raise, right, let me do some provocative rotator cuff testing.
• 17:47
  Speaker 3: Right, probably the rotator cuff.
• 17:49
  Speaker 3: It's not that hard to figure that out.
• 17:51
  Speaker 3: The differentiating factor for us is like why did that happen in the first place?
• 17:55
  Speaker 3: So it's not easy, it's not hard to figure out.
• 17:57
  Speaker 3: Someone has tendonitis, right, but like.
• 17:59
  Speaker 3: But why?
• 18:00
  Speaker 3: Why is this individual battling this tendonitis?
• 18:02
  Speaker 3: We'll get that in a minute.
• 18:04
  Speaker 3: So we do manual therapy stuff.
• 18:05
  Speaker 3: Right, we'll intervene just with some manual therapy, some soft tissue stuff in the back end, and then we'll retest the same movement literally 10 minutes later.
• 18:12
  Speaker 3: And they'll raise their arm.
• 18:14
  Speaker 3: We'll do a shoulder press provocative test and it doesn't hurt, like I didn't do anything.
• 18:18
  Speaker 3: We didn't even do an exercise, we just did manual therapy.
• 18:20
  Speaker 3: We did the same movement and they're like I literally don't feel any pain right now.
• 18:32
  Speaker 3: It's like what did you do?
• 18:32
  Speaker 3: That's what we love.
• 18:32
  Speaker 3: We're like what did you do?
• 18:33
  Speaker 3: That's cool, because it's like you can't fake that and there's somebody's maybe already skeptical anyway coming in, right, it's like we do, we intervene with some manual stuff, we retest the same movement you did like literally 10 minutes ago, and now it doesn't hurt.
• 18:42
  Speaker 3: That's a cool buy buy-in moment.
• 18:43
  Speaker 3: It's like yo, this is like this musculoskeletal stuff can be fixed.
• 18:47
  Speaker 3: There is a solution.
• 18:47
  Speaker 3: We didn't even do any exercises yet, right?
• 18:50
  Speaker 3: So imagine if we did do some exercises.
• 18:52
  Speaker 3: Now that things are set up for success, we can stabilize the heck out of stuff and fix the underlying compensation patterns is why it became a problem in the first place.
• 19:00
  Speaker 3: That's going to solidify the changes over a period of three weeks, which is like three sessions.
• 19:06
  Speaker 3: Don't F it up in the meantime.
• 19:08
  Speaker 3: It would be unreasonable to think that you wouldn't notice significant improvements.
• 19:12
  Speaker 3: So anyway, the buy-in moments like that, that's a cool moment that we have and there's plenty of examples I can think of in my head right now.
• 19:21
  Speaker 3: Just like a simple one this guy came in with a shoulder rotator cuff.
• 19:24
  Speaker 3: It was just his arm was hurting, my shoulder hurts, right, we have to rule out some stuff if it's coming from his neck.
• 19:29
  Speaker 3: Is his rotator cuff actually the painful tissue?
• 19:32
  Speaker 3: Maybe his biceps tendon?
• 19:33
  Speaker 3: That's not that hard to figure that out.
• 19:34
  Speaker 3: But where are we going to intervene?
• 19:35
  Speaker 3: Do some manual therapy stuff?
• 19:36
  Speaker 3: We've got his scapula moving better.
• 19:38
  Speaker 3: We did some soft tissue, loved his biceps tendon.
• 19:39
  Speaker 3: We probably dry needled his rotator cuff and mobilized his scapula.
• 19:43
  Speaker 3: For sure we can reseat his shoulder joint in a better position.
• 19:46
  Speaker 3: Then it's like hey, stand up real quick, let's retest.
• 19:48
  Speaker 3: Stand up.
• 19:49
  Speaker 3: He does the same movement and it's like what did you do?
• 19:53
  Speaker 3: Like, yeah, I don't even feel it.
• 19:54
  Speaker 3: I it's like awesome, let's go from there.
• 20:03
  Speaker 3: You know that's so.
• 20:04
  Speaker 3: That's what.
• 20:04
  Speaker 5: I promise you, that happens very often.
• 20:05
  Speaker 5: Listen, I appreciate you being discreet, but Kenny's been complaining about his shoulders for years.
• 20:09
  Speaker 5: You could have just said it was Kenny.
• 20:13
  Speaker 3: I think we needled you, for I need you for sure, but he's just.
• 20:17
  Speaker 3: I mean, this is you're a muscular dude, right?
• 20:20
  Speaker 5: he's jacked, don't make his head any, it's got to sit on those shoulders.
• 20:26
  Speaker 5: You know what I'm saying what?
• 20:28
  Speaker 5: What guy doesn't like hearing that?
• 20:29
  Speaker 3: but anyway, like you're a very muscular dude, so like there's definitely some changes that happen right and it sets up the shoulder joint for not the best success for reaching overhead and then pushing it, and then usually for ex-athletes who are now in their 30s or 40s, they're like usually it just goes away, just push through it, but now it's just not going away.
• 20:49
  Speaker 3: That's why we have to intervene, but anyway.
• 20:52
  Speaker 3: So yeah, kenny was one of those dudes, but he did good.
• 20:55
  Speaker 3: He did good.
• 20:55
  Speaker 3: Yeah, we did needling.
• 20:57
  Speaker 1: We did cupping.
• 21:03
  Speaker 3: Cupping fan.
• 21:03
  Speaker 3: Yeah, um, I usually like.
• 21:04
  Speaker 3: I'm sure if y'all have seen, like um michael phelps, you know those rings on his back yeah I usually don't cup like that.
• 21:09
  Speaker 3: I'll put some lotion on and we'll cup one cup, like across the fascial lines and the functional lines.
• 21:13
  Speaker 3: Um, it sucks, but usually it hurts, like it doesn't feel good, but I'm like it's pain with a purpose, it's discomfort with a purpose to make a change.
• 21:22
  Speaker 3: And usually active athletic people are like I just want the result, like I just they just do it, just get after it, right.
• 21:28
  Speaker 3: Well, it's not going to be feel great, but you're going to hate me for the next 45 seconds, but then it's going to make an improvement right right and we do this continually, we'll notice changes.
• 21:38
  Speaker 3: Usually they don't want the fufu treatment.
• 21:39
  Speaker 3: They're like I want results.
• 21:40
  Speaker 3: It's like, all right, let's get, we'll do it.
• 21:42
  Speaker 3: You know I'm not gonna kill you, but like it's not gonna be comfortable, you know but anyway, real quick before we move on.
• 21:48
  Speaker 1: A lot all these guys were were in my wedding, but the day before I got married we did a cupping session and if you looked under like my collar- oh, we did.
• 21:58
  Speaker 3: Yeah, I had like.
• 21:59
  Speaker 3: Oh, I remember that I had like, because you went golfing.
• 22:00
  Speaker 3: Do you like a bachelor party golf trip too?
• 22:02
  Speaker 3: Wasn't it probably one of these guys?
• 22:04
  Speaker 1: yeah, yeah but we, I just had like the red from marks from the cupping, from like my neck to like my lat to your lat, yeah we'll.
• 22:11
  Speaker 3: We cup the lats a lot on people.
• 22:13
  Speaker 3: Um, post your rotator cuff for sure.
• 22:15
  Speaker 3: Um, it just restricts motion, it checks motion.
• 22:18
  Speaker 3: That we can, we can loosen up, we can mobilize that stuff.
• 22:21
  Speaker 3: But yeah, I'm a cupping fan.
• 22:22
  Speaker 3: Yeah, the reason is because it lifts and separates the tissue right so it can break up adhesions.
• 22:27
  Speaker 3: It can break up some fascial interstitial tissue adhesions.
• 22:31
  Speaker 3: Um, it brings, it brings blood flow so it breaks up capillaries.
• 22:35
  Speaker 3: That's why it's like a hematoma.
• 22:36
  Speaker 3: That's where the bruises come from.
• 22:38
  Speaker 3: It gets really red and purple.
• 22:39
  Speaker 3: Um, versus like scraping right, like Graston, it crushes and scrapes tissue.
• 22:47
  Speaker 4: So I know people get results from it.
• 22:49
  Speaker 3: Yeah, um, it hurts.
• 22:50
  Speaker 4: It doesn't feel great.
• 22:51
  Speaker 3: Yeah, I'm just like.
• 22:54
  Speaker 3: I'm like in my head here's a tissue that's already an area that's lit up and vulnerableushing and scraping seems a little aggressive versus like lifting and separating the tissue for the benefit of breaking up soft tissue restrictions.
• 23:09
  Speaker 2: That's where my head goes first Interesting.
• 23:10
  Speaker 2: I'm curious just on that Is that a general consensus or is that something that you believe in and just your research and obviously, years of experience?
• 23:20
  Speaker 3: I would say more anecdotal, and the research definitely is good on both, and the grasson has good research.
• 23:27
  Speaker 3: The interesting thing is from what they're finding, it usually the tissue and the joint range of motion that you're looking at retracts within 24.
• 23:34
  Speaker 3: Hmm, so that's where the exercises come in right, where it's like we, if you scrape or cup or soft tissue restrictions right, that one session alone really isn't going to bring lasting results.
• 23:45
  Speaker 3: Yeah Right, massage therapy is a great avenue to work on stuff, for sure, but unfortunately we have a lot of people that come from with us that have pain from massage therapy.
• 23:54
  Speaker 3: Like I'm getting massages.
• 23:55
  Speaker 3: That's great, it'd be a great avenue.
• 23:56
  Speaker 3: We got to work on soft tissue, tissue restrictions and they're very valuable, fixing and getting resolution for a pain issue that might not bring lasting results.
• 24:05
  Speaker 3: And part of that is the corrective exercises which those choices come from differential diagnosis and recognition of like why is this person having shoulder pain the way they are versus somewhere else in their body, or like another, or their colleague or their friend?
• 24:19
  Speaker 3: And a great way that I for the clinicians that we teach.
• 24:23
  Speaker 3: So I'm also part of this fellowship program for manual therapy.
• 24:25
  Speaker 3: It's a the american academy orthopedic manual physical therapy, physical therapist, and it's a really cool um clinical education and advancement kind of direction that clinicians can go.
• 24:39
  Speaker 3: So I finished mine um um seven years ago, six years ago at six and a half Um, and since then they've asked me to stay on as faculty.
• 24:47
  Speaker 3: So I travel around different places in the country to teach these manual therapy concepts and choices and things you can add to your quiver um toolbox and then the differential diagnosis as like the purposeful discretion Um.
• 25:00
  Speaker 3: But the question we asked those clinicians and the clinicians we mentor is like two, two, really.
• 25:05
  Speaker 3: Okay, there's a baseball player that has anterior shoulder pain, right, it's not that hard to figure out if he's a young, flexible dude, right Kid, and their teenager right Early twenties, maybe it's probably the biceps tendon, okay, anterior shoulder pain.
• 25:18
  Speaker 3: The bicep, the long head of your bicep, is a very small rope-like tendon that has a very close relationship to your rotator cuff, and it's an easy site for getting lit up if it's put under stress and strain constantly.
• 25:29
  Speaker 3: Okay, and the anterior capsule, and you have nerves all up in that area, right, so it's not hard to figure out that a biceps, the biceps tendon, is the angry tissue.
• 25:36
  Speaker 3: Cool, they want to know, like, what hurts this biceps tendon?
• 25:39
  Speaker 3: Okay, cool, how are we going to fix it though?
• 25:41
  Speaker 3: Right, and uh, if a practitioner or clinician said, oh, it's just overuse, they just need to rest, it's like that.
• 25:49
  Speaker 3: And my, that's a, that is a cop-out.
• 25:51
  Speaker 3: And the reason why I asked that is here's an 18, 19 year old baseball player on a team, the team of baseball players.
• 25:58
  Speaker 3: Is this kid just throwing 50 more than everybody else, volume wise?
• 26:03
  Speaker 3: Everybody else is throwing.
• 26:05
  Speaker 3: So why is this kid?
• 26:05
  Speaker 3: Why is timmy getting this bicep tendon pain and all of his friends aren't, is he?
• 26:09
  Speaker 3: Well, he's got to be doing something different.
• 26:11
  Speaker 3: If it was an overuse problem, that wouldn't everybody have tendonitis come three months into the season just from throwing too much.
• 26:18
  Speaker 3: Problem solved, rest, and I take idel and ice.
• 26:20
  Speaker 3: It's not the case, because plenty of them have no pain, they're totally fine.
• 26:23
  Speaker 3: So then, what is timmy doing different?
• 26:25
  Speaker 3: Something is mechanics, right, I'm not a baseball pro or pitching pro, but there's something biomechanic.
• 26:31
  Speaker 3: I am biomechanics and pain, that's what I do, so there's got to be something biomechanically.
• 26:34
  Speaker 3: He's doing something different.
• 26:36
  Speaker 3: The core plays a role with that lead hip.
• 26:38
  Speaker 3: Internal rotation plays with that.
• 26:39
  Speaker 3: His external range of motion in his shoulder, his scapula, his T spine, all those things play factors and we can differentiate and figure out what he's doing differently.
• 26:49
  Speaker 3: That's causing the biceps to overcompensate and that's where the painful tissue is.
• 26:53
  Speaker 3: It's not the.
• 26:54
  Speaker 3: That's not the problem.
• 26:55
  Speaker 3: The angry tissue isn't the problem.
• 26:56
  Speaker 3: It's a victim.
• 26:57
  Speaker 3: It's getting overwhelmed and overworked right.
• 27:01
  Speaker 3: So, with that being said, then if we're going to dedicate and direct all of our treatment to that lit up tendon, it's not solving the problem.
• 27:09
  Speaker 1: Because it's not the problem.
• 27:10
  Speaker 3: It's just the fire alarm.
• 27:11
  Speaker 3: The analogy we give is like imagine there's a fire going on and the fire alarm is blaring.
• 27:15
  Speaker 3: That's the biceps tendon.
• 27:16
  Speaker 3: Okay, cool, I have an idea.
• 27:17
  Speaker 3: Let's duct tape a pillow over the fire alarm so it makes less noise.
• 27:21
  Speaker 3: Is that going to solve the fire?
• 27:23
  Speaker 3: Probably not.
• 27:24
  Speaker 3: What's going to prevent the fire from stopping and going further intensifying?
• 27:28
  Speaker 3: Why not just put the fire out?
• 27:29
  Speaker 3: That's a good point.
• 27:30
  Speaker 1: Right.
• 27:31
  Speaker 5: I appreciate that because you know you were stowing a lot of big words there I was trying to follow, and then he goes.
• 27:35
  Speaker 5: Hey man, there's a fire.
• 27:46
  Speaker 3: There's, there's a fire alarm.
• 27:47
  Speaker 3: The fire alarm is not the problem.
• 27:48
  Speaker 3: Don't try to fix it.
• 27:48
  Speaker 3: I'm like okay, good Got it, my bad, no, you're great.
• 27:50
  Speaker 4: Yeah, totally.
• 27:50
  Speaker 4: Ask questions Like I, my bad.
• 27:50
  Speaker 4: Yeah, reel me in.
• 27:53
  Speaker 4: All right, you're good, you're good.
• 27:54
  Speaker 4: It's actually funny.
• 27:55
  Speaker 4: You said the victim piece and then you gave the analogy, because I literally was just listening to one of your podcasts and you made this comment, um, and, and you were kind of making the point that a lot of times athletes, they compensate to get the job done.
• 28:03
  Speaker 4: So they're doing something different, even though they're doing the same action as everyone else, but that compensation factor is basically going to end up being the root cause.
• 28:11
  Speaker 1: And you have to try to identify what that is Exactly, exactly.
• 28:14
  Speaker 4: But I do have a different question.
• 28:16
  Speaker 4: You piqued my interest as we were talking about the cupping and the grass and all those kind of things.
• 28:29
  Speaker 4: Yeah, um, you're probably seeing a lot of stuff is coming to market on um.
• 28:30
  Speaker 4: You know all these different tools like the percussion massage machines they're actually seeing.
• 28:31
  Speaker 4: I'm seeing cupping machines that are coming out that are just like battery operated.
• 28:33
  Speaker 4: It's kind of crazy what they do.
• 28:34
  Speaker 4: Um, as you guys are going through and exploring the the tools that are outside, are you, are you suggesting some of your clients for long term and and other things that may be just based off of the type of athletics that they're interested in?
• 28:47
  Speaker 4: are you prescribing them some of these tools and then kind of, yeah, good question, um, or is it really something that should be done by a professional, or where's the line, kind of I know the tough thing is, I don't hate those things, right, right, it's not going to hurt anybody, right?
• 29:02
  Speaker 3: Unless they overdo it.
• 29:03
  Speaker 3: You know what I mean.
• 29:04
  Speaker 3: And that's where we gauge like, is this a zealot?
• 29:06
  Speaker 3: That's very zealous individual.
• 29:08
  Speaker 3: You know it's going to like, dude, you're going to over-treat it, it's going to you're going to light stuff up.
• 29:11
  Speaker 3: You know there's, there's a line there.
• 29:13
  Speaker 3: Usually no, usually don't do it right.
• 29:25
  Speaker 3: So we don't want to, like, cause a problem.
• 29:28
  Speaker 3: Um, we don't want motivation and enthusiasm to cause an overuse injury or an overuse problem.
• 29:34
  Speaker 3: You know, I mean, I say that with a lot of my athletes the personality differences, right.
• 29:38
  Speaker 3: Um, we have a lot of of athletes in the past that I've worked with that have chronic knee pain after a surgery.
• 29:46
  Speaker 3: We usually don't see post-op because they're going to go with their insurance and they get the foo-foo treatment the first six weeks anyway.
• 29:51
  Speaker 3: Right, you can get that, we can get both.
• 29:53
  Speaker 3: You know what I mean.
• 29:54
  Speaker 3: They come see us simultaneously but anyway, eight months in after their surgery ACL as an example they're still battling knee tendonitis, right, sure are still 10 years later yeah, that's not an uncommon thing by any means.
• 30:07
  Speaker 3: It's usually because they didn't address some of the compensation issues of, like, muscle strength and it's really a recruitment problem.
• 30:14
  Speaker 3: It's like a neuro, a neuromuscular recruitment issue, not like a strength output problem and a joint mobility problem.
• 30:20
  Speaker 3: And then the mechanical problem.
• 30:22
  Speaker 3: The mechanics, like their coordination of movement.
• 30:25
  Speaker 3: You know what I mean.
• 30:25
  Speaker 3: But anyway, in those moments, some of those athletes, there's two types.
• 30:30
  Speaker 3: There's the people that aren't doing enough and they need to step it up, like you need to do more, right, and we'll call them out and be like you need to do more of this.
• 30:36
  Speaker 3: Dude, I can tell you're not doing your homework.
• 30:37
  Speaker 3: Do you want to play basketball or not, right?
• 30:47
  Speaker 3: Um.
• 30:47
  Speaker 3: The second one is like we need to reel you back, you know, and that's where we say like we don't want good intentions and enthusiasm to lead to an overuse injury and they're just doing constantly too much.
• 30:51
  Speaker 3: And they're they're usually in the mindset that I was kind of in, which is like I'm falling back If I don't continue.
• 30:55
  Speaker 3: I'm, I'm getting outworked, I'm getting outpaced, I've got to get after it.
• 30:58
  Speaker 3: I can't take a week off.
• 31:00
  Speaker 3: It's like you know who takes weeks off?
• 31:02
  Speaker 3: Sometimes LeBron, steph Curry, sometimes I've got to take a back seat, sometimes I've got to shut down, but anyway.
• 31:09
  Speaker 3: So, to answer your question concisely usually not.
• 31:11
  Speaker 3: I wouldn't be confident they would do it right and hit the right things.
• 31:14
  Speaker 3: I would rather hit pretty purposefully.
• 31:18
  Speaker 3: If they're already into it, then I'll show them and I suggest some stuff.
• 31:22
  Speaker 3: You know, but they're just soft, they're usually, they're just avenues to to work out some soft tissue restrictions and knots and soreness.
• 31:30
  Speaker 4: You know what I mean and and and when I kind of talk about like recovery tools too.
• 31:34
  Speaker 4: I mean there's, there's a huge market for that.
• 31:36
  Speaker 4: I'm a huge foam roller person.
• 31:37
  Speaker 3: I love it, I think they're great Um that's the number reason why I would suggest it.
• 31:41
  Speaker 3: I would be like do you like it?
• 31:43
  Speaker 3: Okay, yeah, so um.
• 31:45
  Speaker 4: I, I guess, I guess.
• 31:46
  Speaker 4: Um, my question really is is around like the, is it, I guess?
• 31:52
  Speaker 4: Should people be looking for the quick fix?
• 31:54
  Speaker 4: It's almost like, uh, I go to a chiropractor and I've always heard the term that they're crack doctors, you know, you just you kind of get that instant relief Like, yeah, I just foam rolled my back, I feel good, I can get my workout in, whatever, yeah, or is it just better to not think about the tool but think about the movement pattern and try to do the mobility routine and make sure you're prepping yourself to do the act, not try to use the tool as the quick fix?
• 32:14
  Speaker 3: As a savior.
• 32:15
  Speaker 3: Yeah, yeah, uh, yeah, totally so the usually it seems like the root cause of non-traumatic pain and issues for active people is from repetitive micro trauma, micro injuries, or that happened little things over many, many, many episodes.
• 32:33
  Speaker 3: So, those and it compounds repeated movements that cause the same things to happen over and over and over again, not knowing yet.
• 32:40
  Speaker 3: And imagine like someone in their twenties they're super young, resilient and healthy.
• 32:43
  Speaker 3: They don't.
• 32:43
  Speaker 3: They don't really feel stuff, and then it goes away, yeah, uh.
• 32:46
  Speaker 3: But then they become 35 and it's like this isn't going away.
• 32:49
  Speaker 3: This is lasting way longer than I remember.
• 32:51
  Speaker 3: You know, like WTF, bro, it's not getting better.
• 32:53
  Speaker 3: Well, you're also older and the same things have been ingrained in these muscles, in the soft tissue instead of the joints, for years and years and years.
• 33:00
  Speaker 3: So it's repeated movements and then prolonged postures is the other position.
• 33:06
  Speaker 3: So, like prolonged postures.
• 33:08
  Speaker 5: Everyone pull back.
• 33:11
  Speaker 1: When I say that everyone sits up right.
• 33:15
  Speaker 3: Prolonged postures is the second component, that like, why did this hurt out of nowhere?
• 33:19
  Speaker 3: I didn't do it.
• 33:19
  Speaker 3: I think a car accident.
• 33:20
  Speaker 3: I didn't fall down the stairs.
• 33:20
  Speaker 3: I didn't do it, I think a car accident.
• 33:21
  Speaker 3: I didn't fall down the stairs, I didn't sprain my ankle, but all of a sudden my knee hurts.
• 33:26
  Speaker 3: So my back has been bothering me.
• 33:27
  Speaker 3: I don't know.
• 33:27
  Speaker 3: I tweaked something.
• 33:28
  Speaker 3: How long has it been going on?
• 33:29
  Speaker 3: Oh man, probably like six months, and now it's just progressively more noticeable.
• 33:34
  Speaker 3: That's usually our bread and butter.
• 33:36
  Speaker 3: That's comes from repetitive movements and micro injuries and micro trauma over many, many, many episodes.
• 33:41
  Speaker 3: That just now the straw that brought the camels back right.
• 33:44
  Speaker 3: No pun intended.
• 33:45
  Speaker 3: Or prolonged postures that facilitate some of the same changes.
• 33:48
  Speaker 3: And the the most influential prolonged posture is sleeping because we sleep.
• 33:55
  Speaker 3: How many days a week do you sleep?
• 33:56
  Speaker 3: Seven for hopefully eight hours.
• 33:58
  Speaker 3: Right, so the positions that we put for hopefully eight hours.
• 34:00
  Speaker 3: Right so the positions that we put.
• 34:02
  Speaker 3: He's our non-sleeper.
• 34:03
  Speaker 4: Oh, really, you're one of those.
• 34:06
  Speaker 3: I don't know how they do.
• 34:07
  Speaker 3: How do you guys do that man?
• 34:08
  Speaker 4: It's not by choice.
• 34:09
  Speaker 2: Johnny, what time did you wake?
• 34:10
  Speaker 2: Up this morning let's not talk about that, but yeah.
• 34:16
  Speaker 3: so, like you know, we sleep seven days a week and hopefully six to eight hours.
• 34:18
  Speaker 3: Nine hours, that's a lot of added potential irritation or set up for failure that might contribute to issues or maybe should cause more irritation and problems.
• 34:30
  Speaker 3: So anyway, yeah, so it seems like for long-term fixes for non-traumatic pain, like it just came out of nowhere.
• 34:39
  Speaker 1: I don't know why this hurts.
• 34:40
  Speaker 3: We have to find out what the compensation patterns are and the movement system impairment is the MSI.
• 34:46
  Speaker 3: That's what we usually go with and that's usually a combination of mobility disparities in the neighboring joints and muscle recruitment and activation disparities in the neighboring joint.
• 34:57
  Speaker 3: So if some things are very, very dominant and active and you do something challenging over and over and over again, what's the first things that are going to contribute to turn on to help the very strong, dominant guys, when the muscles not the dormant, less active, less recruitable guys, right.
• 35:12
  Speaker 3: So imagine, for like knee tendonitis, right, what's going to get broken down and irritated faster?
• 35:19
  Speaker 3: The overtime workers that don't get any rest, or the ones that are in welfare and don't really work, the ones that overwork and go over time constantly, that's your biceps tendon, your patellar tendon, your D tendonitis, all that stuff.
• 35:32
  Speaker 3: Does that make sense?
• 35:32
  Speaker 3: Or like the low back spasms?
• 35:34
  Speaker 3: So it's like, why is that happening in the first place?
• 35:36
  Speaker 3: We have to fix that.
• 35:42
  Speaker 3: Um, the soft tissue tools and stuff can definitely settle things down and get you.
• 35:44
  Speaker 3: If you're like tight and sore in an area, right then, and you're not like battling an issue, great avenue.
• 35:47
  Speaker 3: I'm not gonna tell you not to foam roll right, or use a theragun or something like that, or hypervolt, and then same thing with a chiropractor, so like it has this place in medicine, just like anything does.
• 35:56
  Speaker 3: And the number one thing that I would ask is, like, do you like it?
• 35:59
  Speaker 3: Okay, not going to hurt you, right?
• 36:01
  Speaker 3: If you're battling something that's been going on for a long time and going the same approach but you're not noticing results, if nothing changes, nothing changes, which is the way anything is, unfortunately, so that means that something's being missed.
• 36:15
  Speaker 3: We have to find a different avenue or a brainstorm and differentially diagnose, like, what's going on and why aren't you getting results, then maybe we need to intervene a different way.
• 36:26
  Speaker 3: You know, I mean, that's, that's the route I'll go to be politically correct I'm having a lot of aha moments over here, but anyway, so it's interesting like um, I'm not knocking on any professions or anything like that, because there's definitely physical therapists that people like I've been seeing my pt for eight years and you know he keeps my shoulder or she keeps my shoulder good.
• 36:42
  Speaker 3: Or I've been seeing my Cairo for 15 years and that's the reason why I, you know I'm able to do the thing I'm able to do, but it still hurts.
• 36:49
  Speaker 3: I'm like, dude, it takes six weeks to feel improvements.
• 36:53
  Speaker 3: Right, like three weeks, you should feel like a noticeable improvement after four visits.
• 36:57
  Speaker 3: For like, that's what we expect as in like I do feel improvement.
• 37:03
  Speaker 3: Yeah, it's not hurting as bad.
• 37:04
  Speaker 3: I'm not able to go 100 yet, but I do notice from prior that, like I'm able to do some stuff and it doesn't hurt as bad.
• 37:09
  Speaker 3: We're on the right track.
• 37:10
  Speaker 3: Cool, nice, let's continue this trajectory.
• 37:12
  Speaker 3: Versus course correcting you know what I mean.
• 37:14
  Speaker 3: Versus like it's been 15 years and my back feels the same, but it allows me to do things I want to do.
• 37:19
  Speaker 3: I I would question that, you know.
• 37:22
  Speaker 3: Like let's, let's investigate some other things, you know.
• 37:26
  Speaker 2: Interesting.
• 37:26
  Speaker 2: Just want to confirm.
• 37:27
  Speaker 2: So you said you identify the root cause and you believe where it's coming from.
• 37:31
  Speaker 2: Roughly three to four weeks there should be some type of improvement, yeah.
• 37:36
  Speaker 3: Yeah, so, and here's the reason why I say that so, like some people who are, they're otherwise healthy, as in, like they don't have other comorbidities, right, they don't have red flag signs and symptoms, red flags being like underlying diagnoses that we're missing, right, one of the biggest campaigns, because physical therapy is a pretty new autonomous profession.
• 37:55
  Speaker 3: It used to be, in like the 80s, 90s and early 80s and 90s, a bachelor's degree and then you worked under the scope of a physician, of a doc.
• 38:05
  Speaker 3: It's like, hey, I just want you to show them these exercises real quick, right, and then they go over like weekend there's, there's like some science behind this.
• 38:12
  Speaker 3: Then it advanced into a master's degree and I got a little more autonomy, which, of course, in the, in the realm of money and power and ego, which everybody you know, and it's an energy, uh, field was resistance, like you don't need to do that.
• 38:25
  Speaker 3: Yeah, this is, this is easy, it's an ancillary service, which it was.
• 38:29
  Speaker 3: It was, and they were getting more science behind it.
• 38:32
  Speaker 3: And they're like let's advance it to a doctorate degree where we can almost take the role of, like a primary care provider for musculoskeletal things.
• 38:41
  Speaker 3: That's under our scope, right, I'm not a cardiologist, I'm a neurologist by any means I'm not.
• 38:45
  Speaker 3: I'm not a medical doctor, I'm a physical therapist.
• 38:47
  Speaker 3: I'm the first one to say that.
• 38:48
  Speaker 3: I'm not going to misrepresent myself and call me something.
• 38:50
  Speaker 3: I'm not right.
• 38:51
  Speaker 3: But for the world of musculoskeletal issues and biomechanics and pain from musculoskeletal issues, dude, that's our bread and butter, that's what can get, and we might be able to save you a visit to the primary doc, to the orthopedic, to the x-ray, to the MRI, to the injection and then the fifth surgery, maybe right, but anyway.
• 39:08
  Speaker 3: So, with that being said, it was a bachelor's and a master's, they advanced to the doctorate degree and there was a lot of resistance, and like this is degree inflation.
• 39:15
  Speaker 3: You don't need that.
• 39:16
  Speaker 3: You're still under the scope of these docs, which was at the beginning still true, and now it's more autonomous, right Interesting.
• 39:28
  Speaker 1: So with what you're saying, so like bold statement you can get somebody better in four visits.
• 39:30
  Speaker 3: I was like of course I'm not going to get somebody a hundred percent better in four, but we should notice improvements.
• 39:33
  Speaker 4: Yeah.
• 39:34
  Speaker 3: Meaning that, like we're on the right track and we're intervening the right way.
• 39:36
  Speaker 3: So how can you be confident, then, that this person coming in with left shoulder pain it's not coming from a heart issue?
• 39:42
  Speaker 3: How do you know?
• 39:43
  Speaker 3: It's not cardiovascular?
• 39:44
  Speaker 3: One of these big campaign, there was a magazine article back in like the early 2000s, this orthopedic doc group who was feeling threatened by the advancement of sports physical therapy profession.
• 39:55
  Speaker 3: A magazine article.
• 39:56
  Speaker 3: It was nuts and it was like this person bending over with pain.
• 40:06
  Speaker 3: And at the top.
• 40:06
  Speaker 3: It was like how can you see the underlying cancer in this person's back pain?
• 40:08
  Speaker 3: So can't a physical therapist.
• 40:11
  Speaker 3: And I was like whoa, there was some steam after that, right?
• 40:13
  Speaker 3: Nobody can see that unless you have imaging.
• 40:16
  Speaker 3: That's the gold standard, right?
• 40:18
  Speaker 3: The argument is that, like, well, the docs will be able to recognize and differentially diagnose like this smells different.
• 40:25
  Speaker 3: My brain is automatically going towards this might be something underlying we're missing.
• 40:30
  Speaker 3: Let's get some imaging and testing and refer you out, whereas a physical therapist like, let's do some hamstring stretches to fix and me all the while they have multiple myeloma on their low back, like a cancer thing in their back, or a cardiovascular issue in their heart, and they're referring pain to the left shoulder that looks musculoskeletal but it's actually a heart issue.
• 40:47
  Speaker 3: So how can a physical therapist know that?
• 40:49
  Speaker 3: Right, it's red flag questions and red flag screening that we would then be like this doesn't smell, right, let's refer you out to a cardiologist, to a doc.
• 40:56
  Speaker 3: You know what I'm saying.
• 40:57
  Speaker 3: Let's get some imaging to roll things out.
• 40:58
  Speaker 3: We would never be like I think this is a cardiovascular.
• 41:01
  Speaker 3: You have left ventricular fibrillation, you know, like our issue.
• 41:04
  Speaker 3: Or you know a heart murmur?
• 41:18
  Speaker 3: That's not.
• 41:19
  Speaker 3: What Does that make sense?
• 41:21
  Speaker 3: So, to answer your question, if somebody like we should see proven improvements in three to four visits, right For sure.
• 41:27
  Speaker 3: As long as it's a musculoskeletal driven problem, that's not an underlying sinister pathology we're missing.
• 41:34
  Speaker 3: Like a heart problem or rheumatoid arthritis issue, right or, um, I can't, a tumor oncology problem.
• 41:41
  Speaker 3: That that's not we can't fix that right.
• 41:43
  Speaker 3: We got to get back to imaging and get some other refer, refer out and stuff.
• 41:46
  Speaker 3: I'm saying so if it is musculoskeletal rooted, the person's otherwise healthy, like they don't have a bunch of core mobilities.
• 41:52
  Speaker 3: That's going to limit their healing potential.
• 41:53
  Speaker 3: They're not a crazy smoker, they drink a bunch.
• 41:55
  Speaker 3: And they're 68 years old and they're morbidly obese.
• 41:57
  Speaker 3: They have type 2 diabetes, congestive heart failure, they smoke, drink and they also 68 years old and they're morbidly obese.
• 42:00
  Speaker 3: They have type 2 diabetes, congestive heart failure, they smoke, drink and they also have a heart issue.
• 42:03
  Speaker 3: They're going to be a little challenging of noticing results.
• 42:08
  Speaker 3: You know what I'm saying Quickly, quickly, and I would be like we could still fix your shoulder pain.
• 42:12
  Speaker 3: It's just going to take longer.
• 42:13
  Speaker 2: You know what I mean.
• 42:15
  Speaker 3: But anyway, I hope that answers your question.
• 42:16
  Speaker 2: No, that's a great perspective Perspective.
• 42:17
  Speaker 2: That's really good stuff there.
• 42:19
  Speaker 4: I kind of want to take this into a future state thought process.
• 42:23
  Speaker 4: Obviously, as someone so enthusiastic as yourself and wanting to help driven athletes, I would assume that you're probably eager to learn more and you're looking at different innovations that are happening within your field.
• 42:36
  Speaker 4: I actually remember on one of your podcasts you mentioned about the fluid that's in the joints and how you can reactivate that over a very long period of time.
• 42:46
  Speaker 4: It seems like a very innovative practice.
• 42:48
  Speaker 4: I know you kind of mentioned how you might get a little flack about that in that episode, because that's the alternative to a knee replacement, which actually Ryan's wife just got a knee replacement pretty early on your wife got a knee replacement.
• 42:59
  Speaker 3: Pretty early on your wife had a knee replacement?
• 43:00
  Speaker 5: Yeah, so I was going to ask you.
• 43:01
  Speaker 5: You know, with the age range of clients that you see, you know what's the earliest you've ever seen someone, that you've worked with someone for a knee replacement oh man.
• 43:10
  Speaker 3: There was a guy that this was back in Houston.
• 43:13
  Speaker 3: He had a gunshot wound in his knee.
• 43:17
  Speaker 3: Okay, all right.
• 43:18
  Speaker 3: That Okay, all right.
• 43:20
  Speaker 3: Fair, all right.
• 43:21
  Speaker 3: And how old was he?
• 43:22
  Speaker 3: Yeah, he was like early 20s, mid-20s.
• 43:24
  Speaker 5: Fine, we'll throw that one out.
• 43:26
  Speaker 3: But that's not the same.
• 43:27
  Speaker 3: Yeah, it's different.
• 43:30
  Speaker 5: She was 30 when she got hers replaced.
• 43:31
  Speaker 5: She just had chronic knee issues at the joint.
• 43:33
  Speaker 5: It just didn't sit properly.
• 43:36
  Speaker 5: She played indoor volleyball so all the jumping didn't help.
• 43:38
  Speaker 5: But at 15, her doctor told her yeah your knee's about 50.
• 43:47
  Speaker 5: You're going to get it replaced before you're 30.
• 43:48
  Speaker 5: And sure enough, you know she just had it done in um november.
• 43:50
  Speaker 5: Okay, but you know we're in the room post-surgery.
• 43:52
  Speaker 5: Everyone's got about 50 years on us then we go to the first pt and all she keeps hearing is you know?
• 43:57
  Speaker 3: wow, you're the youngest that is the um, for sure, but it was nerve-wracking, because then you're thinking you're 30 years old.
• 44:03
  Speaker 5: Like we went back and forth on should should we do this, should we not?
• 44:07
  Speaker 5: But it was all about removing the pain and now yeah like she's doing her rehab.
• 44:11
  Speaker 5: She's doing leg extensions, her uh, knee replacement.
• 44:15
  Speaker 5: She's firing off great her quote-unquote good knee that has similar problems.
• 44:19
  Speaker 5: She can't eat it because it's just it's grinding.
• 44:22
  Speaker 5: It's just bone on bone.
• 44:23
  Speaker 3: So yeah, I hear that all the time, so like bone on bone bone on bone thing.
• 44:27
  Speaker 3: So yeah, that's definitely to answer your question.
• 44:28
  Speaker 3: That's definitely the youngest I've ever heard.
• 44:30
  Speaker 3: I'm sure that, like we like, the great thing is that she is.
• 44:36
  Speaker 3: She feels significantly better.
• 44:37
  Speaker 5: Cool.
• 44:38
  Speaker 3: We would just go.
• 44:38
  Speaker 3: We would just go from there and crush stability and strength and minimizing any compensation patterns to for the best longevity possible.
• 44:44
  Speaker 3: Totally, um, I wouldn't, so that I'm sure the docs talked about it like they're usually a shelf life of the the prosthetics they put in there.
• 44:52
  Speaker 3: Yeah, um, and it depends, you know I mean, but um, I mean max 25 years, something like that, you know?
• 45:00
  Speaker 3: Um, so a revision probably is in the future if she's this young, that's what they're like.
• 45:04
  Speaker 3: Oh, wait till you're 60, because then, like you'll be dead before you need a revision could you imagine talking to somebody?
• 45:09
  Speaker 4: that like, and a long enough, well like what's that's?
• 45:15
  Speaker 1: not a.
• 45:15
  Speaker 3: It is what it is right like we're a mortal human beings, like on a long enough time horizon, we'll be dead to be dead, but anyway, that's definitely the youngest.
• 45:23
  Speaker 3: There's a life shelf on those things Usually show, revision might be in the future.
• 45:26
  Speaker 3: But to answer your question, to go off of what y'all were saying, so I hear bone on bone very often and that doesn't.
• 45:33
  Speaker 3: It's not the end-all be-all as in like well then, we're F'd, I'm effed until I get a replacement.
• 45:38
  Speaker 3: Yeah, so I'll just meander around and just live with it until I get a replacement.
• 45:43
  Speaker 3: It's actually not the case as in like um, and this is some awful.
• 45:48
  Speaker 3: Also, the psychology component, which I'm not a professional psychologist by any means, uh, but I know that we can't separate the mind from the body and there's a ton of interplay between the psychological component and physical pain, right, um, between the psychological component and physical pain, right, somatosensory pain and psychosomatic pain.
• 46:05
  Speaker 3: There's been proven that there is emotional-based pain.
• 46:08
  Speaker 3: So we also have to have a delicate dance between that too.
• 46:13
  Speaker 3: I'm not saying your wife's like that, I'm just saying in general this is a part of the conversation, but that's something we have to consider, sure.
• 46:20
  Speaker 3: So that's going to dictate my approach and some of my talking points with certain patients.
• 46:24
  Speaker 3: You know what I mean.
• 46:25
  Speaker 3: It's not always black and white as in like you have a rotator cuff problem and then we need to fix the rotator cuff.
• 46:30
  Speaker 3: Orthopedic surgeons are very black and white.
• 46:32
  Speaker 3: We call it like patho anatomical.
• 46:35
  Speaker 3: There's a pathology, there's an issue of the anatomy.
• 46:37
  Speaker 3: So solution let's fix the anatomy and that will fix the problem.
• 46:41
  Speaker 3: Not always the case.
• 46:42
  Speaker 3: There's plenty of people that have had disectomies and they have pain on the other side of their back afterwards, like they get a lumbar surgery and their pain switches sides and they look at the image afterwards like your back looks great.
• 46:56
  Speaker 3: This doesn't make any sense.
• 46:57
  Speaker 3: You should be fine, right, but they still have pain.
• 47:01
  Speaker 3: Explain that Okay, it's because the structure doesn't always dictate symptoms.
• 47:05
  Speaker 3: The structure of somebody's knee and the bone-on-bone structure, whatever, doesn't dictate what the progression is going to be like or their symptoms currently, because there's been plenty of people that have very arthritic-looking knees that are like I've seen knees that don't look great, people that are in like their that don't look great, people that are in like their mid 70s and she's like it doesn't hurt, I just I'm just not strong enough to go downstairs or upstairs and stuff.
• 47:30
  Speaker 3: I remember this one lady in particular.
• 47:31
  Speaker 3: She had like a huge valgus deforming, like it was bent inwards and sideways like knock, need right one knee and it was crunchy and it didn't sound good.
• 47:38
  Speaker 3: She was limited range of motion like.
• 47:40
  Speaker 3: I mean he't hurt though.
• 47:40
  Speaker 3: So I was doing a bunch of things and exercising it doesn't hurt, it's just challenging because I'm not strong.
• 47:46
  Speaker 3: But I just need to get improved strength for my life and independence.
• 47:49
  Speaker 3: I was like this is a classic exhibit A.
• 47:53
  Speaker 3: It's very interesting.
• 47:55
  Speaker 3: The other thing I was going to say with orthopedic surgeons that are dude, they're so smart, they deserve a ton of respect.
• 48:05
  Speaker 3: They like, in my opinion, med school residency fellowship is probably like the hardest academic trajectory anybody could take.
• 48:09
  Speaker 3: It takes a ton of respect.
• 48:10
  Speaker 3: The hardware they get pounded Um, but they have their diagnoses.
• 48:14
  Speaker 3: They have their box of window of perspective and diagnoses Right Um.
• 48:19
  Speaker 3: And, with that being said, not everything is pathoanatomical.
• 48:24
  Speaker 3: So if somebody is battling knee crunchiness and irritation of their knee when they do jumping and stuff like that and they were a previous athlete I've heard a lot of times they come back from a doc visit and they had an image and the doc says you have the back of a 70 year old, you should be in more pain than you are.
• 48:42
  Speaker 3: Like what the fuck Like so much?
• 48:45
  Speaker 1: much.
• 48:45
  Speaker 1: Why would you say that man like that will?
• 48:47
  Speaker 3: help nothing.
• 48:48
  Speaker 3: So I'm like oh, oh, oh, but you haven't.
• 48:51
  Speaker 3: You get paid when you have surgery.
• 48:53
  Speaker 3: This, oh my gosh, you get paid with injections.
• 48:56
  Speaker 3: The more mris you refer you.
• 48:58
  Speaker 3: There's an incentive with that.
• 48:59
  Speaker 3: All, unfortunately, the ethics I can't not neglect.
• 49:02
  Speaker 3: That plays a role.
• 49:03
  Speaker 3: I'm not saying your doc's doing this, I'm saying in generalities or like man, it's like okay, well, hey, I have this guy telling me that's in a white coat, he's super smart, he's a surgeon and he's wearing a white coat, that my back looks bad and I have pain and clearly on this image you can see the herniated disc.
• 49:20
  Speaker 3: So let's schedule surgery next week.
• 49:22
  Speaker 3: So I scheduled a surgery and had the surgery right.
• 49:24
  Speaker 3: Or my bone on bone on my knees, have a knee replacement.
• 49:26
  Speaker 3: As long as your knee's effed up, you're going to be effed up.
• 49:28
  Speaker 3: So until you get a knee replacement, you're effed.
• 49:31
  Speaker 1: At the end of the day, they don't get a paycheck for turning people away.
• 49:35
  Speaker 1: That's my gripe with it.
• 49:37
  Speaker 3: Unfortunately, every profession is like that and, as an example, imagine, like psychologists, right Mental health counselors they have a mortgage and they have bills.
• 49:47
  Speaker 1: Right, so like would it?
• 49:49
  Speaker 3: would it be a benefit for these professionals to solve all their problems, to have their clients never come back again?
• 49:54
  Speaker 3: Then they get paid session by session, I don't know, right?
• 49:57
  Speaker 3: Well, we're in the same boat too.
• 49:58
  Speaker 3: Like someone could argue the same thing with us, right, it is a business.
• 50:02
  Speaker 3: But anyway, with that being said, I would always question and get second opinions.
• 50:04
  Speaker 3: Right, you can always do that.
• 50:06
  Speaker 3: So the bone on bone thing and this is the podcast talking about, all right.
• 50:10
  Speaker 3: So synovial fluid, that's the fluid you're talking about Synovial fluid is the lubrication and nutrients of a joint.
• 50:18
  Speaker 3: So your articular cartilage, which is the cartilage where, if that gets worn down, that's where the bone on bone suggestion comes in play the cartilage does not have a vascular innervation and it doesn't have a neural innervation, so there's no blood vessels that go to innervate your cartilage and there's no nerves that innervate your cartilage.
• 50:36
  Speaker 3: So that then suggests they can't heal.
• 50:39
  Speaker 3: The more blood flow available, the more potential for something to heal.
• 50:43
  Speaker 3: So a muscle strain, dude, those things heal up quick.
• 50:47
  Speaker 3: There's a ton of blood innervation for that All right.
• 50:49
  Speaker 3: Cartilage has very, very, very low or none blood innervation.
• 50:54
  Speaker 3: So the the thought was always it can't heal then.
• 50:57
  Speaker 3: So arthritis is a progressively getting worse issue that won't improve.
• 51:04
  Speaker 3: It's like as soon as you hit a level it goes down, it can't go up, there's a ceiling forever and then it goes down again and it's a progressively worsening issue.
• 51:11
  Speaker 3: I'm just saying there are some research articles out there that have found improvements in articular cartilage, vitality, brilliance and thickness On the imaging.
• 51:22
  Speaker 3: They call it like brilliance ority brilliance and thickness on the imaging.
• 51:23
  Speaker 3: They call it like brilliance um, or like the signaling um, or thin thickness.
• 51:27
  Speaker 3: And one of the studies I was referencing is like they were doing this test.
• 51:30
  Speaker 3: Um, it was an 11 year study of these dogs, these beagles, that they had in a control group, that they just were normal dogs.
• 51:38
  Speaker 3: They live their lives.
• 51:39
  Speaker 3: And then they had this experimental group.
• 51:41
  Speaker 3: They put a double their weight weighted vest and they had them run seven miles five days a week for 11 years.
• 51:48
  Speaker 3: It's like running's bad for you.
• 51:50
  Speaker 3: You're going to break down your joints.
• 51:51
  Speaker 3: There's a certain life shelf of someone's joints and if the more you run, the earlier you're going to have arthritis.
• 51:59
  Speaker 3: So yeah, I mean you want to run and look good and be you know, look good in the bathing suit, but then at the same time, you don't want to break down your joints.
• 52:04
  Speaker 3: Apparently, that's not true.
• 52:06
  Speaker 3: Based on the empirical evidence that I'm just referencing, it's on me, these other people that are researchers this was up for a Nobel prize, by the way.
• 52:20
  Speaker 3: They didn't win.
• 52:20
  Speaker 3: It was just.
• 52:21
  Speaker 3: It was these beagles.
• 52:22
  Speaker 3: That's where the ethics come in.
• 52:23
  Speaker 3: It was like oh, my God.
• 52:25
  Speaker 3: I know.
• 52:26
  Speaker 3: But they got really good information Of that control group that didn't do anything, a dog that's played normally, and then the experimental group double-weighted vest, seven miles a day, 11 years.
• 52:37
  Speaker 3: You would expect their knee cartilage to be broken down, yeah, so they sacrificed the dogs, they opened up their knees, expect their knee cartilage to be broken down.
• 52:43
  Speaker 3: So they sacrificed the dogs, they opened up their knees and they did investigative studies.
• 52:45
  Speaker 3: The control group of dogs had thinner, more brittle cartilage and the running experimental group had thicker, more vibrant and brilliant cartilage.
• 52:53
  Speaker 3: It's like explain that I don't know right, well, it may be that when mechanics, the synovial fluid and the compression of their joints stimulates your body to adapt to it, and if it's not an irritating and overwhelming stressor, an adaptation of breakdown will occur.
• 53:17
  Speaker 3: Adapt to that causes, we would surmise, underlying subchondral bone that grows forward up through the cartilage and it generates it from the bottom up over many, many, many months and years of time.
• 53:32
  Speaker 3: Right, so somebody that's betting.
• 53:34
  Speaker 3: So that's what they're suggesting, that's what the article and research suggests.
• 53:37
  Speaker 3: So I'm like, oh, this is crazy.
• 53:40
  Speaker 3: So the term motions lotion that we use all the time yeah your synovial fluid is triggered to be produced when you feel friction, when the joint feels friction on itself and pressure because it's like we need to lubricate.
• 53:51
  Speaker 3: Here we need and that's that's where they get it's, it's um nutrition as well as nutrients.
• 53:55
  Speaker 3: So what they're suggesting is intermittent compression of your joints, which is like resistance training, right, not so much where it's like overwhelming and too much, because that could cause an issue.
• 54:05
  Speaker 3: Just like water you can drown in water, you can drink yourself too much water, too much weightlifting there's a detriment to that, of course.
• 54:13
  Speaker 3: But some on purpose, intermittently, with an appropriate amount of compression and an appropriate amount of stress over many, many years.
• 54:21
  Speaker 3: I'm talking like a minimum of 12 months, two years, three years, where every time you work out you leave and you're like my knee doesn't hurt worse, actually it feels looser.
• 54:31
  Speaker 3: Keep that trajectory over years where your main goal is to not hurt after you work out.
• 54:37
  Speaker 3: What they're suggesting is the cartilage would be improved.
• 54:41
  Speaker 3: Nuts, right?
• 54:42
  Speaker 3: I?
• 54:43
  Speaker 5: just had an aha because I tore my ACL 10 years ago, okay, and we talked about overcompensation.
• 54:48
  Speaker 5: So I tore my right knee, yeah, and my left knee for whatever, no, I'm sorry, my right knee, excuse me, the one I tore To this day.
• 54:56
  Speaker 5: If I am inactive, it will just get more sore and more stiff, versus me going and hitting and continuously working out.
• 55:05
  Speaker 5: So it's all kind of believe in the whole bugle thing here, like just keep it going and it's going to strengthen in that inactivity.
• 55:11
  Speaker 5: I'm talking, like you know, maybe a couple of weeks a month and I'm like I don't understand why it's hurting.
• 55:15
  Speaker 5: I haven't freaking, done anything.
• 55:17
  Speaker 1: And then I go do stuff and it's like damn this like it's feeling back to normal.
• 55:20
  Speaker 4: So sounds like use it or lose it kind of deal.
• 55:23
  Speaker 4: Oh really, David.
• 55:24
  Speaker 2: Goggins mentality right there.
• 55:25
  Speaker 3: Yeah so he's an extreme.
• 55:28
  Speaker 3: I'm not saying run seven hours.
• 55:32
  Speaker 1: He's extraordinary, he's super intense.
• 55:35
  Speaker 3: I love his mindset and stuff for sure.
• 55:37
  Speaker 3: But yeah.
• 55:40
  Speaker 3: So if you don't use it, you lose it.
• 55:41
  Speaker 3: It's totally true.
• 55:42
  Speaker 3: But, with that being said, said that sometimes can deter people like, well, I'm too far gone right, yeah it's not true, like you're gonna make improvements.
• 55:50
  Speaker 3: This you just start like I'm at like as an example, like smoking, right, it's like as soon as you stop smoking, like within three weeks, like noticeable tissue perfusion and oxygen delivery has been noticed and the research, which is insane, right, just, it's never too late to stop or to start doing some stuff purposefully.
• 56:08
  Speaker 3: The main question out like the, the main thing that I would present with is like just don't make it hurt every time you exercise.
• 56:15
  Speaker 3: That's a great indicator.
• 56:16
  Speaker 3: So for patients that see us, they're like my knee hurts, been battling an issue for a while and every time I try to work out it hurts, right.
• 56:23
  Speaker 3: We definitely like modify some things, modify the intensity, modify your expectations.
• 56:28
  Speaker 3: It's going to take some time to settle things down and then we can progress and intervene appropriately.
• 56:33
  Speaker 3: And in the meantime, let's intervene.
• 56:36
  Speaker 3: Some of the compensation issues, like that's your workout is working, the compensation issues.
• 56:41
  Speaker 3: And then if you want a six pack or bigger biceps, then do the auxiliary work stuff afterwards, totally Right.
• 56:46
  Speaker 3: As long as I'm causing more pain, right.
• 56:48
  Speaker 3: But let's work on these compensation issues in the meantime and exercise and workout and I very confident that people will be like my knee just feels better, it feels like it just feels looser.
• 56:59
  Speaker 3: You know, right, totally so what I would also ask people like yourself it's like I didn't do anything and it hurts.
• 57:07
  Speaker 3: You're also walking, you're sleeping, you're picking up your dog, your kids, you're getting in and out of your car, you're pivoting out of your car, you're walking upstairs.
• 57:15
  Speaker 3: And if there are underlying compensations, right, they're minor, super minute stuff, but it plays a role, because how many steps do we take a day?
• 57:24
  Speaker 3: That's 10 000 reps, that's a lot of reps that can maybe ingrain and reinforce issues, but then also just like irritate stuff a little bit and that compounds and adds up and it's like, well, now it hurts and I don't want to, I don't want to exercise because it hurts, right.
• 57:38
  Speaker 3: So then it's like you try once and it hurts again.
• 57:41
  Speaker 3: It's like I'm not meant to work out and that's it too far gone so we just gotta like intervene with some stuff.
• 57:46
  Speaker 3: That's where the manual therapy comes in.
• 57:47
  Speaker 3: If we can set the joints up for success, to move better and it doesn't hurt with doing these little things, right, um, then it helps to encourage and reinforce, like, oh, I can be okay, yeah, right.
• 57:57
  Speaker 3: So at the meantime, resetting some mental expectations of like redefine right now what you call a workout.
• 58:04
  Speaker 3: This is your workout, right?
• 58:07
  Speaker 3: As ex-athletes, I was the same boat where I was like, if I don't power clean, squat and bench, do weighted dips, I'm not actually working out.
• 58:16
  Speaker 3: It doesn't count you know I'm just like messing around with these BS exercises.
• 58:20
  Speaker 3: What a joke.
• 58:22
  Speaker 3: I am Like my self-value is directly linked to my bench press max.
• 58:26
  Speaker 3: You know that used to be like that, but anyway, like it'd take a while right Cause my shoulder would get bummed, my back would hurt.
• 58:32
  Speaker 3: Like well, I'm going to do it anyway.
• 58:34
  Speaker 3: I'm not actually working out unless I do these out.
• 58:38
  Speaker 3: Was there was a dude like we ought to be careful what we see on Instagram for sure influencers and Instagram experts or whatever.
• 58:44
  Speaker 3: There are some solid sources out there.
• 58:46
  Speaker 3: In my opinion.
• 58:47
  Speaker 3: We just gotta, you know, pick and choose and be discretionary.
• 58:50
  Speaker 3: But there's this guy I saw on there, is it?
• 58:53
  Speaker 3: He said he's a dad, he's like in his gym working out and he's front squatting like 95 pounds and he's muscular and he's like I'm never gonna front squat more than 95.
• 59:03
  Speaker 3: I don't need to like.
• 59:05
  Speaker 3: I don't want to like.
• 59:06
  Speaker 3: My goal is to just be able to keep up with my kids and run and play and not be hobbling around and in pain.
• 59:12
  Speaker 3: It just depends what your goals are.
• 59:14
  Speaker 3: Some people are like I want to run a 10 K.
• 59:15
  Speaker 3: I want to run five 10 Ks this year.
• 59:17
  Speaker 3: Like totally different.
• 59:18
  Speaker 3: The boat that I'm in like.
• 59:20
  Speaker 3: Of course I want to be able to work a workout.
• 59:22
  Speaker 3: I want to feel confident.
• 59:23
  Speaker 3: My physique plays a role with my confidence, for sure.
• 59:25
  Speaker 3: I want to feel strong.
• 59:26
  Speaker 3: I want to be a good role model for my kids, a symbol of discipline and hard work and effort, and motivate my kids, have my kids be proud of me, have my wife be proud of me, be all those examples for my wife too.
• 59:37
  Speaker 3: And working out is a part of that.
• 59:39
  Speaker 3: So me only doing simple elliptical or assault by workouts won't get me there.
• 59:45
  Speaker 3: So I do want to do some other things, but that's my goal.
• 59:49
  Speaker 3: But at the bottom line and this is what we hear from almost every patient that we see I just don't want to hurt anymore.
• 59:54
  Speaker 3: We can get there and then we can progress.
• 59:57
  Speaker 3: But there's a reason why you're hurting.
• 59:58
  Speaker 3: The other podcast I was talking about, like there is a solution for musculoskeletal stuff, dude, there is a solution.
• 1:00:05
  Speaker 3: Things don't hurt for no reason and if we rule out red flags and underlying sinister pathologies that were that maybe we're missing and we can, you're just.
• 1:00:13
  Speaker 3: You're inherently unhealthier person.
• 1:00:15
  Speaker 3: You don't have a ton of comorbidities, you're not smoking and drinking a ton.
• 1:00:18
  Speaker 3: This should get better.
• 1:00:20
  Speaker 3: Things don't hurt for no reason.
• 1:00:22
  Speaker 3: There's a reason why it's hurting if it's musculoskeletal, musculoskeletal joint pain, right, um, that's, we just have to figure it out, right.
• 1:00:30
  Speaker 3: But anyway, so that that's so for me.
• 1:00:32
  Speaker 3: Like, yeah, from my it's just my humble perspective and the way I look at stuff I really respected that dude who's like I don't need to squat more than 95 pounds.
• 1:00:39
  Speaker 3: My value in my life doesn't depend on my squat, my front rack, uh, max.
• 1:00:45
  Speaker 3: You know what I'm saying.
• 1:00:51
  Speaker 3: I don't care what you think.
• 1:00:52
  Speaker 3: Like, if it's like I go to a gym or something like that, or like you're not as much of a man because you don't work out as hard as I do, congrats, I don't care you know like I have two plates on the bar.
• 1:00:59
  Speaker 2: Yeah, exactly but.
• 1:01:01
  Speaker 3: But there is still a competitive version of me where it's like I gotta, I gotta, I want to look good, you know, and be confident and physique and stuff for sure it.
• 1:01:08
  Speaker 3: It's just something I got to battle and just weigh out your pros and cons and your goals.
• 1:01:11
  Speaker 3: You know what I'm saying but anyway, that's a yeah, I love it.
• 1:01:15
  Speaker 1: Look, I think there's no doubt that we can keep you here for four hours.
• 1:01:20
  Speaker 3: It's already been an hour yeah.
• 1:01:30
  Speaker 1: I mean, we, we have lot of the things that we are, that you talk about.
• 1:01:31
  Speaker 1: We've seen it from the inside, so we have a really simple, direct correlation with an understanding of everything that you, you preach and you practice.
• 1:01:38
  Speaker 1: So, with that in mind, I think that the a few takeaways that we've gained today for the guests who are listening are it's never too late to start right right you.
• 1:01:48
  Speaker 1: You have the ability at any point to to kind of take that step forward and start to go through rehabilitation in any way that that seems fit for you right and then also that there's.
• 1:02:00
  Speaker 1: You know, there's certain things that, like james brought up earlier, where there's maybe easier, like DIY or at-home resources that you could gain because your shoulder hurts.
• 1:02:13
  Speaker 1: But I think that everyone has to look at things from a deeper level because your shoulder hurting, it may be that fire alarm.
• 1:02:20
  Speaker 1: It may not be the core problem that you're dealing with.
• 1:02:23
  Speaker 3: It's usually not.
• 1:02:24
  Speaker 1: And in many cases it's not.
• 1:02:26
  Speaker 1: So, seeking guidance from a professional or someone who understands the physiology of the human body in a deeper fashion could lead to a faster recovery process, because it might not be the fire alarm that you, for the last six years, have been trying to make quiet with that pillow.
• 1:02:43
  Speaker 3: Yeah, exactly.
• 1:02:45
  Speaker 1: So seeking the correct guidance is really important from someone who's a professional.
• 1:02:49
  Speaker 3: At least get some concrete answers Exactly and you know what People want closure.
• 1:02:53
  Speaker 1: You know they want some closure and a really good place to start is by going to Kyle's podcast that he has online, the Driven Athlete podcast, where he talks about an overwhelming amount of areas that are common areas for problems and issues and he brings guests on to talk about those different things from angles of high grade professionals.
• 1:03:15
  Speaker 3: I know you recently had, or that you're going to have, someone at an olympic level yeah, she just came in last week and then, um, I had a pro tennis player on.
• 1:03:23
  Speaker 3: Yeah so a couple months ago and then I've d1 football players coming in next week.
• 1:03:27
  Speaker 1: So I mean so from high-grade athleticism to general activities like posture and you know, office posture, sleeping posture, things like that.
• 1:03:37
  Speaker 1: So tune in to Kyle's podcast, because there's a wealth of information that you could gain on that podcast itself Tons of different episodes, dozens and dozens of them.
• 1:03:45
  Speaker 3: I appreciate that.
• 1:03:46
  Speaker 3: Yeah, thank you.
• 1:03:47
  Speaker 3: One thing that I'm somewhat nerd out on, I think, is the mental component, like the psychology of just performance and sports, but then also for rehab and pain Pain science.
• 1:04:00
  Speaker 3: That's a whole different subject that we get into with fellowship training and stuff.
• 1:04:04
  Speaker 3: To pique your interest.
• 1:04:07
  Speaker 3: Real quick, real quick, uh, little wayne, little wayne, quote this was the first thing that brought up in our training.
• 1:04:12
  Speaker 3: Pain is an opinion, okay, pain is an output.
• 1:04:16
  Speaker 3: It's not an input, which is totally interesting as an example, like real quick, like imagine something like a shark attack, someone gets their leg bit off, or like your quad, like chunk, and at the time they're like I feel like something hit me, right, this is weird, right, they're like that was, that was aggressive, and doesn't like hurt, right.
• 1:04:35
  Speaker 3: And then look down their quads missing and they're like f, then things kick in, right, this is interesting I'm gonna go straight up.
• 1:04:43
  Speaker 5: I dislocated my my arm oh, yeah, put my arm down doing a pump return.
• 1:04:47
  Speaker 5: I got up, everything's fine, but everyone's looking at me and I'm like why?
• 1:04:50
  Speaker 5: And I look down and I see that my arm is over here and that's when it all hit me yeah, it's a shark attack thing same yeah.
• 1:04:57
  Speaker 3: I did that with my finger, yeah oh yeah, but anyway, those are super aggressive examples, but like it's just to demonstrate we can't separate the mind from the body and ultimately, pain, it's been proved like it is a thing pain is an output.
• 1:05:10
  Speaker 1: It's not an input, just just saying or if you want to get more aggressive pain is pain, is a weakness, is weakness leaving the body denzel from uh rhythm titans is that what you said no water makes you weak great
• 1:05:25
  Speaker 3: movie every football season like late aug.
• 1:05:28
  Speaker 3: I watch that movie just to get ready for football season.
• 1:05:31
  Speaker 3: Just to get hyped up.
• 1:05:33
  Speaker 1: Well, now I'm going to think about the 75-year-old lady who had basically bone on bone and had no pain.
• 1:05:39
  Speaker 1: I'm going to be like, well, she had no pain.
• 1:05:41
  Speaker 1: Kyle said.
• 1:05:42
  Speaker 3: Yeah, Kyle said.
• 1:05:43
  Speaker 4: Kyle said she was good, Dr Kyle yeah exactly.
• 1:05:46
  Speaker 3: Oh God.
• 1:05:50
  Speaker 1: Thank you for being on today.
• 1:05:50
  Speaker 3: We really appreciate.
• 1:05:51
  Speaker 3: Yeah, totally, man, thanks for the invite and the shout outs and stuff.
• 1:05:53
  Speaker 3: Um, and definitely if y'all have any questions like if you have any questions at home y'all can reach out to us.
• 1:05:57
  Speaker 3: Our phone number is 561-899-8725 if you live.
• 1:06:02
  Speaker 3: We actually just had a phone call with a dude in poland, by the way yeah so we do consults.
• 1:06:07
  Speaker 3: You know we can chat at least to get some answers, or our email, which is team at athlete rccom.
• 1:06:12
  Speaker 3: Those are great ways to reach out to us.
• 1:06:13
  Speaker 3: But we're always open to um, to questions and guidance and stuff like that if we feel like we're a good fit.
• 1:06:19
  Speaker 1: And then conflicting opinions and suggestions and comments, podcast ideas, like we're always open to discussion awesome and even, at the least, drop a comment in the thread here and reach out.
• 1:06:29
  Speaker 1: We'll make sure that you get past Kyle's information in the event that you're seeking some questions or some answers.
• 1:06:34
  Speaker 3: I appreciate that.
• 1:06:35
  Speaker 1: Awesome.
• 1:06:36
  Speaker 3: Well, thank you.
• 1:06:36
  Speaker 3: Thank you, Kyle, thank you Thank you.
• 1:06:37
  Speaker 3: Nice.
• 1:06:41
  Speaker 2: Very good.
• 1:06:42
  Speaker 1: It's weird being on the other side.
• 1:06:44
  Speaker 1: Yeah, I know, yeah.