Latest / SOTA Personal Training Podcast / Pain & Pelvic Floor Health (Move Without Fear Seminar)

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Pain & Pelvic Floor Health (Move Without Fear Seminar) · SOTA Personal Training Podcast

0:00
Well, we're going to jump in, you guys.
0:01
So I appreciate you being here first and foremost.
0:04
I think I know each and everyone of you, I think, except for one
0:06
or two. So my name is Phil.
0:08
I'm the founder here. Thank you guys so much for
0:10
coming. This is the second big seminar
0:12
that we've done here, at least to the scale.
0:15
So we're doing a lot more AV stuff and we don't know what
0:18
we're doing. So appreciate your patience with
0:21
us. We've got a really good
0:22
presentation today. We have two experts in the field
0:27
of physical therapy here to help walk you guys how to do just
0:30
this. Just move without fear, move
0:32
more confidently, and whether that's inside or out of the gym,
0:36
we want you guys to feel your best.
0:38
So that's what we're going to accomplish today.
0:41
I'm going to start with a short kind of story on my journey with
0:45
pain. I'll hand it off to Derek, who
0:47
used to be a coach here, and then I'll go to Trina.
0:50
We'll do a panel at the end. I'll do a quick summary before
0:53
that happens, but we're going to jump in.
0:57
I want you guys as we're going through the agenda I just
1:00
covered, I want you guys to take lots of notes.
1:02
So that pack we gave you write down all the thoughts, all the
1:06
things that you are thinking of, things that you think of,
1:10
concerns, comments, questions. Gather that information so that
1:15
we can give you clarity on it by the time you leave.
1:19
Our objectives for tonight's are to do a few things so when we
1:23
want to understand why pain doesn't always mean damage.
1:28
Show of hands. How many people are have dealt
1:30
with an injury in the past, Right.
1:32
Not raising your hand. Yeah.
1:35
How many of you are dealing with one right now that you're trying
1:37
to work through? Blake, our coach, Yeah.
1:41
So a couple of you now injuries are bound to happen.
1:44
You could be sedentary and have injuries.
1:47
You could be extremely active and have injuries and knowing
1:51
how to navigate that can be really, really tricky.
1:54
Every case is different. So that's our job is in the
1:58
seminar to help teach you guys what's what's normal, what's
2:00
expected and just feel more confident to work through that
2:04
so you don't feel like you have to take 10 steps backwards when
2:07
it happens. Not if two.
2:10
We want you to know what you can safely do today if you are
2:13
dealing with one of those things, but equip you with that
2:15
knowledge for when again, we have a bit of a hiccup inside or
2:18
out of the gym. Have that simple framework so
2:21
that you can rebuild strength confidently.
2:23
That's a big anchoring theme you're going to hear is strength
2:28
is the foundation for a lot of these things.
2:29
Even with an injury, we just tweak it and then four is 1 to
2:33
seek outside help, whether it's a physical therapist, a
2:37
chiropractor, anyone that can help you expedite that process.
2:41
That is what we want to do. And also not when not to panic,
2:45
let's put it that way. Best practices, write stuff
2:50
down. Like I said, thoughts,
2:51
questions, concerns, anything that comes up as you're hearing
2:54
things, as you're thinking through things.
2:57
The questions at the end, we'll save and we'll all sit down.
2:59
You can ask us 1 by 1. I want you to participate
3:04
through this with a lens of empowerment.
3:08
So injuries suck. They rob us of our identity in a
3:11
lot of cases, depending on the severity.
3:14
And I want you guys to think about this as a way that you're
3:17
going to be able to breakthrough so you don't lose that sense of
3:20
identity when injuries happen or pain happens and then stick
3:25
around. No tequila bar.
3:26
I know I promised it, but I apologize, David.
3:30
I know. See.
3:31
We'll see at the next one. So, yeah, I hope that sounds
3:36
good. Who's who's excited to learn
3:37
some stuff today and hear from some experts in the field.
3:40
Yes, but we'll do that. We always got to do a second
3:42
round of that. All right.
3:43
You guys excited to be here. That is always better.
3:46
All right, 22's good. I'm going to start with a short,
3:51
shortish story about my journey with pain.
3:54
If you've been here long enough, you might have heard my my
3:56
journey, but I had a lot of car accidents.
3:59
I won't tell you about all of them, but two that really
4:01
defined this place are movements along with my own relationship
4:06
with pain and injury. And it took me from breaking my
4:10
spine to feeling stronger than ever.
4:13
But it, it didn't look like this right?
4:15
It was all over the place. So in 2008 I was rear-ended by a
4:21
woman over twice the legal limit in high school with three of my
4:24
friends in the car and a tiny Jeep Wrangler.
4:28
My my friend Chuck next to me. His seats actually came
4:31
unsheared from the bolts. She hit us so hard we were just
4:34
stopped. Then in 2010, another drunk
4:39
driver went in front of me and I crashed into him and I separated
4:45
my AC joint, my shoulder. Both these things really define
4:49
the rest of my relationship with pain.
4:51
They held me back in a number of ways.
4:54
Most importantly, in that second one, I had an Affliction shirt
4:58
that I really liked. And if you guys know about this
5:00
brand, they were horrendous. So maybe it was a blessing.
5:04
My wife's over there and she's letting me know I got rid of all
5:08
the white stitch jeans. OK.
5:10
But anyway, there was no more no more Affliction shirt.
5:12
They had to cut it when I went to the ER to get to me.
5:15
So it was not not a great day for me or the shirt.
5:19
And then this was a minor of the three.
5:22
But then this lady in Uptown hit me and it really exacerbated
5:27
everything. Kind of re injured things.
5:29
And this is years later. So these things are with us for
5:33
a very long time. What did I do next?
5:37
What did I do next? Did I see treatments?
5:39
Did I do chiropractic physical therapy?
5:42
No. I bought a motorcycle.
5:44
OK. And as my mom would call it, it
5:46
was an oh. Also, there's a proof I had hair
5:50
further proof. You need to point it out what
5:54
they said. That's extremely dangerous.
5:56
She's not wrong. And then later I got another
5:59
motorcycle that was even more dangerous.
6:02
I like doing fast stuff and the injury risk for this sort of
6:08
thing is can be high, especially Carson's won't mess around my
6:14
dangerous hobbies throughout my life, my injuries.
6:18
If you guys can see here, this is a negative correlation,
6:21
right? So as my right right at the
6:23
beginning that lines when I'm at Katie and we have kids.
6:26
So all I want to point out is This is why my wife should let
6:29
me build a go karts because you can see is direct relationship
6:33
there. Tying this back to why we're
6:36
here, something else was happening at that same time.
6:40
Can anyone guess what that blue line would be?
6:43
That's not dangerous habits or hobbies.
6:47
The hints were we're in a place that does this right?
6:51
So like my activity went up right after that happened.
6:56
So what brought me back was getting into the gym.
7:02
I had these these car accidents and they really set the tone.
7:05
I was an athlete in high school and I went from a a very able
7:09
bodied athlete to now being robbed of all my independence,
7:12
my identity, a number of things. And that lasted for years and
7:16
years. And my recovery that followed
7:19
was definitely not linear. It wasn't clean, it wasn't
7:23
quick. And I kind of had two choices,
7:26
right? I can just kind of like sit down
7:29
and take it or I could advocate for myself.
7:32
Physical therapy, I tried it. If anyone's in physical therapy,
7:36
it's hard to adhere, right? It's it's a hard thing to stay
7:38
consistent with. And the way that I got back was
7:43
going to a gym and strength training and learning on my own
7:46
what worked for me. So you guys, if you belong to
7:50
this gym, you're getting a lot of that specificity.
7:53
A lot goes behind programming here, but that's a big theme of
7:57
all this. Those accidents really end up
8:01
being one of the best things to ever happen to me because it led
8:05
to where I am now and how we're helping all these.
8:08
All you guys and and people in the area do exactly what I'm
8:12
trying to do, but a lot faster for you.
8:14
Don't do things that 'cause that non linear path, if you will.
8:18
So we're going to hear from a couple of really awesome
8:22
physical therapist tonight. The first of which is Derek, and
8:26
he was a coacher for a long while.
8:30
Then he said he got into PT school and I tried to convince
8:32
him not to. I said no, don't do it, stay
8:36
with us. He did and he's doing very well
8:38
and he's with Twin Seas Orthopedic.
8:40
So without further ado, I'm going to head off to Derek and
8:44
he's going to start us off with this segment on navigating
8:47
paint. So let's give Derek a hand for
8:50
doing this. Derek, you can take it away, my
8:53
friend. Yeah, I was thinking this would
8:59
be kind of a Step brothers thing.
9:01
You can stand right behind me. This is a Britney Spears mic.
9:04
This is kind of fun. All right, all right.
9:09
Well, thank you for that introduction.
9:11
Phil, like you said, my name is Derek and starting off here, who
9:16
am I and why should you care what I have to say?
9:18
So I'm a doctor of physical therapy.
9:21
I have over 3000 patient hours in outpatient orthopedics.
9:25
That's the field that I work in special interest in return to
9:28
sport and adult athlete population, which is a lot of
9:32
you guys. And then as you can see, Once
9:34
Upon a time, that was how things started here at SODA.
9:37
And then they ended somewhat after this.
9:40
But I had to bring this picture back just for Phil because this
9:42
was my favorite Halloween of all time.
9:44
When I went as Phil for Halloween, I think I did a
9:47
pretty good job. That was my own makeup work.
9:49
That's not facial hair that was full on just blending shading.
9:53
I think I'd need a prosthesis now to be able to pull that off
9:57
with Phil's beard size. But we can, we can work on that
9:59
for next Halloween. We'll, we'll get that started.
10:02
All right. Little overview of what we're
10:03
going to try to accomplish today.
10:05
So breaking it down, we're going to get a little nerdy.
10:07
We're going to get into some research.
10:08
I'm going to try not to bore you guys asleep on a Friday night,
10:10
but we will cover some of that, hopefully have a little bit of
10:13
fun along the way. We do have to get a little
10:16
serious pain, injury rehab that is pretty serious.
10:19
We do also have to get into our fields a little bit because that
10:22
is also a big part of all this and that's what we're going to
10:25
cover for the most part here. So also just getting out of
10:27
here, I have no disclosures, no conflicts of interest outside of
10:30
being a huge fan of soda. This is not official medical
10:34
advice. I'm just going to throw that out
10:36
there. No diagnosis.
10:37
This is not specific, but just my little two cents here.
10:40
If you have been struggling with something or you're dealing with
10:42
something that's frustrating you, it is worth it to go see a
10:45
physician APT at Cairo, someone to help you with your ailments
10:48
and give you a specific plan. So just throwing that out there
10:51
ahead of time. Phil actually nailed this
10:54
already. We saw our show of hands, who's
10:56
had injuries before, who's currently dealing with
10:58
something. And a good way to think about
11:00
that is you're not alone. We've all had pain.
11:03
It's not something that's wrong. It's part of the human
11:05
experience. And so the goal isn't
11:07
necessarily to fully avoid it. It's what do we do when we have
11:11
pain And I think the best way to start with that is what is pain
11:16
for anyone in the healthcare field or the rehab field, you've
11:19
probably seen this image before. And a lot of times we think of
11:23
pain as a problem. We think of something that is
11:27
wrong and, and often times that's part of it, but it is a
11:30
feature rather than a bug. So just to take a little pause,
11:33
this web here, a lot of times we think of injuries as primarily
11:38
this press next, not tissue. All right, there we go as this
11:42
this bottom part tissue damage injuries.
11:44
There's some lists there, but realistically that is just a
11:47
small part of it. A big part that contributes to
11:50
pain is so many other things, psychological factors.
11:53
We've got tissue injury pathology, behavior, lifestyle,
11:56
your environment, your susceptibility to pain.
12:00
And at the intersection of all that is pain.
12:03
So it's a convoluted web. It's a lot of things we like to
12:06
throw around this image in this this graphic, but realistically,
12:09
pain is the the intersection of many individual factors.
12:13
And a good example of that is pain is not the same for any two
12:16
of us. We can have similar injuries.
12:18
You can think of your tissue damage or pathology down here,
12:22
your tennis elbow, your tendonitis, your injury, It's
12:24
going to affect us all differently.
12:26
People deal differently with injuries.
12:27
We get to see that all the time. And so it is one of those things
12:31
to remember that it's not just A1 size fits all with that.
12:35
Not all of our information from pain is useful.
12:39
Kind of thinking of injuries. We've all had those feelings
12:41
where you get a super sharp pain in your elbow or your arm and
12:44
you think like this is it. And then 15 seconds later it's
12:47
gone and it never comes back. What what was that?
12:50
Well, that wasn't, that didn't help us at all.
12:51
That didn't, that wasn't useful information.
12:54
It was just sensation. It was just something that
12:56
happened to us. So sometimes pain tells us a
12:58
lot, sometimes it doesn't. One thing to touch on with pain
13:02
is this is just maybe my own personal gripe, but we are not
13:05
cars. Sometimes patients come in,
13:07
people think I, you know, I need to get this fixed.
13:09
I got to get this taken care of. Sometimes we view surgery as
13:12
something that would happen in an automotive shop, and while it
13:14
looks a little like that in the OR, it's very different.
13:17
You can talk to the guys next door, bam.
13:19
I guarantee you none of them have ever had a car cry in front
13:22
of them or tell them that they're burnt out or that they
13:25
just want to give up. It's very different.
13:27
So with that, we, because we're not cars, there's a lot more
13:30
that goes into it. I don't want to get too crazy
13:33
into this, but this is a really good example.
13:35
And something that is taught in physical therapy schools is it's
13:38
called the mature Organism model.
13:41
And basically what this is, is it's showing us that pain, what
13:45
we often times think of it is as something that happens.
13:48
We think pain goes here, here brain pain couch.
13:52
It's a little more complicated than that.
13:54
We get input from our environment.
13:55
It does send a signal, signal of nociception pain up our spinal
14:00
cord. But then in our brain is where
14:02
everything important happens. Our brain samples a lot rather
14:06
than just reading something as injury.
14:08
It has so much to do with past experiences, your belief, your
14:12
surroundings, what you think of pain, what you've seen in the
14:15
past of people. That shapes your pain experience
14:18
and that leads to how we perceive it and but also how we
14:22
act, what we do when we're in pain.
14:24
So just kind of a zoomed out view of remembering that it's
14:27
more than just a sensation like hot and cold.
14:30
There's a lot more to it. All right, So then just kind of
14:34
covering here a little start with dealing with injuries.
14:37
This is just like 3 sort of really non specific points of
14:41
how, if we're going to categorize what to do with pain
14:44
or injuries, conditions that benefit from all of avoidance of
14:48
all activity, don't do anything. Something hurts, you should
14:51
stop. High risk pregnancy is probably
14:53
the most common version of that. So that's also something that
14:56
you know, if you're familiar with it, you've been, you would
14:57
have been diagnosed with it. That's that's probably the only
15:00
thing that there's good research on it.
15:01
You should do nothing. Things that you should do
15:03
nothing for a little while, concussion, TBI, traumatic brain
15:06
injuries, internal bleeding, things like that.
15:08
Again, things you would be diagnosed with, you would know,
15:11
but that's relative rest. And then things that don't
15:14
benefit from just stopping what you're doing and avoiding
15:17
everything is somewhat everything else.
15:19
It's the things that we're used to dealing with.
15:21
It's those orthopedic injuries. Obviously if something needs
15:24
surgery that requires further consideration, but that's kind
15:27
of a good way of looking at it is there's not a lot of things
15:29
that you shouldn't do anything with when you're in pain.
15:33
So we take a quick break from my rambling here.
15:35
We got a little bit of trivia. So I know you guys have papers
15:37
here. There will be a prize with this.
15:39
A couple of quick questions for you guys to just think about
15:44
South. First one easy one, starting
15:45
off, how many bones are in the human body?
15:47
Don't yell it out. Just either write it down or
15:50
make a mental note to yourself. We've got 69199 two seventy or
15:54
two O 6 ABC or D. Those are your options.
16:00
That's in the adult human body. That was a good question.
16:05
All right, so we got our answers there.
16:06
Oh, also, answers are going to follow right after, so you get
16:08
to check yourself. So how many bones are in the
16:11
human body? That is D206 for any of you ball
16:15
knowers out there. That is that guy's name is
16:17
Bones. That's Bones Highland of the
16:18
Minnesota Timberwolves. Next question, which of these is
16:22
not found in the human body, the Pez and Serene Oz Trigonum Lhasa
16:26
Opso or the Omaha Hyde? Oh, no, I gave it away.
16:30
No, man, that was the best one, too.
16:33
I should have known not to bump that.
16:34
Dang it. All right, you guys, we it was
16:37
lost. So that's a dog.
16:38
That's all right, That you don't want that in your body.
16:41
All right, that one is that one's a Gimme.
16:43
You guys were all going to get that right anyway.
16:45
OK. What ailment or disease is
16:48
responsible for the highest economic burden in the world?
16:51
Is it obesity, low back pain, heart disease or knee pain?
16:57
So what has the highest economic burden in the world?
17:01
Jot your answers down there. And all right, going on to our
17:07
next screen, it is actually low back pain.
17:11
We'll elaborate on that in a little bit, but might surprise
17:13
you out of those options. Low back pain.
17:16
So now what is the estimated economic burden of low back pain
17:20
annually in the world? 3 to $4 trillion.20 to $30
17:24
million two 100 to $300 billion or is it a net positive?
17:28
Do we make money off of low back pain?
17:30
Is it is it good for the economy?
17:34
All right, jot our answers down there and it is 200 to $300
17:41
billion annually. It might sound a little crazy,
17:45
especially compared to those other ones, but it is the most
17:47
common workplace injury. It leads to the most lost wages
17:50
of anything and it is one of the most common reoccurring
17:53
injuries. So that's what leads into that.
17:55
But it's pretty crazy the amount of money that goes into low back
17:59
thing. All right, so with that, did
18:00
anybody get them all right, including the dog one.
18:04
You got them all right. OK, you have a choice.
18:06
You can have a roll of fit hand loops or you can have a lacrosse
18:11
ball. All right, Are you ready?
18:16
That wasn't the confidence. Great catch.
18:19
All right, OK, back into the nerdiness.
18:21
A little bit like Phil. I've got a good case study here,
18:24
so we're not going to zoom in too much on this, but it's nice
18:27
to look at images and X-rays that sometimes can be a little
18:29
scary. So 30 year old male, this is
18:31
your buzzword of the day. Spondylolisthesis and L5 pars
18:35
into articularis stress fracture.
18:37
That's what you can see here. For the record, this is not an
18:42
actual, this is, I'm not violating HIPAA.
18:43
This is a just a picture of that from a textbook.
18:45
So don't worry. But they have had this pain for
18:48
a long time. They get pain intermittently.
18:51
It plagues them. It bothers them from time to
18:53
time. They don't have anything we need
18:54
to be worried about. No red flags, no bowel and
18:56
bladder changes, no symptoms down their legs.
18:58
Things that you would look for in back pain that you would say
19:00
go see a doctor or go to the hospital.
19:03
But they do have pain with axial loading, which is putting
19:06
barbell on their back that hurts.
19:07
They can't do squats, they can't put loads their spine.
19:10
So what do we think this person should be doing?
19:12
Should that's scary. We see that on their spine.
19:15
It's not it's it's going to look like that forever That's they
19:18
have a little fracture in there. It's things like that.
19:20
Diagnosis terms, they can be scary.
19:22
They can. They're sometimes we should
19:24
listen to these things. Sometimes they're just
19:25
information. Like we talked about before, not
19:27
all information is good information.
19:28
But what was this individual doing to rehab from this?
19:34
They were doing this. Glad there's no sound.
19:41
There's a lot of breathing in that.
19:47
Yeah. All right, OK, so again, not
19:52
everyone's rehab is going to look like that.
19:54
I can't. Did I show you guys that video
19:55
so I could feel like a special boy and let everyone watch me
19:57
lift maybe a little bit. But again, how did I kind of
20:01
similar to feel sorry? How did I go from having back
20:04
pain, a small stress fraction spine to doing things like that?
20:08
I used these principles of rehab.
20:10
So these are sort of this is my, my idea of what you need to look
20:15
at what you need to think about when you're doing rehab.
20:17
This is the things that I use in the clinic.
20:19
This is how I either help people or help myself.
20:22
And with this, the, the thing I like to think of as the methods
20:26
are many, but the principles are few.
20:28
There are so many ways to go about doing these things.
20:31
There's not right or wrong answers, there's just different,
20:33
but these principles are things that we should think of and
20:36
we're going to dive into each of these.
20:37
They're just, they're not in order necessarily, but these are
20:40
the things to prioritize when you're recovering from pain or
20:43
trying to rehab. So first movement modification
20:47
to pull back the curtain here a little bit.
20:49
A lot of PTA, lot of rehab is taking the muscles you want to
20:53
use and the things you want to do and scaling it back and back
20:56
and back until it doesn't hurt or you can tolerate it building
21:00
up from there and adding and layering back in.
21:03
There's a very much oversimplified version of it,
21:05
but that's a lot of what these the, the exercises like Phil
21:08
mentioned that are hard to stick with.
21:09
The rehab that's kind of hard to stick with because in the
21:11
beginning it feels really simple and basic.
21:14
It's isometrics on the Roman chair.
21:17
It's squat. I want to be doing cleans and
21:19
deadlifts and back squats, while I can only tolerate squatting to
21:22
a box. Maybe I can't do my box jumps or
21:24
my jump lunges, but I can do a lunge hold.
21:28
Maybe my shoulder is all jacked up and I can't lift it overhead.
21:31
So we should start with something really simple of just
21:33
pushing a wall. A lot of isometric things, a lot
21:35
of these simple things that you shouldn't do forever, you don't
21:37
need to. You can probably move beyond
21:39
them, but they're a really good starting point.
21:41
So modify the things you want to be doing to try to build back up
21:45
your tolerance. Next, finding a tolerable entry
21:48
point and adjusting your total volume.
21:51
What can we do? And what I think of with this is
21:54
runners, those of you who like running, I love you guys, I love
21:57
what you're doing, but it is kind of a huge pain in the butt
22:00
when you like running and you only like running because when
22:03
things hurt, you can't keep running.
22:05
And so this is a good example. What can we do if for that
22:08
example, you want to keep your fitness up?
22:09
OK, can you? I run 3 to 5 miles?
22:12
Can you run 2 miles? Can you run one?
22:14
Can we get on an exercise spike? Can we use the rower?
22:17
Can we use the skiers? What can we do that looks
22:20
similar to what you want to do? And start there, Adjust our
22:25
volume, shrink it down, and then we will build it back up.
22:28
Symptom modulation. This one's a little bit of a
22:30
touchy one, but it's OK to do things that feel good.
22:33
When we're in pain, we want relief from that.
22:35
If we don't want to go the medication route to the
22:38
prescription route, if we want to find things that feel good,
22:41
the cupping, the taping, the soft tissue work, those things,
22:45
the ice, the compression, there's nothing wrong with doing
22:47
things that feel good, but you got to be aware of what you're
22:52
prioritizing with that. Those things and those
22:54
modalities, they're like supplements.
22:56
The example I like to give with this is if someone told you I'm
22:59
about to get in the best shape of my life and you said,
23:01
awesome, what are you doing? And they said I'm going to take
23:03
creatine and that was the end of their sentence.
23:06
You'd be like, OK, that good, but that's not going to help.
23:10
That is a good thing to add on. So you need a strong foundation,
23:13
you need movement, you need things that you're doing to
23:15
build you back up while adding in some of these other things.
23:19
I don't want to make anyone mad, but anyone who's had success
23:22
with ultrasound before, there's a really good study about how it
23:26
doesn't matter if the machine is on or off when you're using it.
23:28
So that's just a fun one for adding.
23:30
Again, these things all have a place.
23:32
I'm not trying to be a hater. So yeah, kind of that again with
23:35
that, that creatine thing. Don't frost a cake made of dirt,
23:38
right? Prioritize the right thing.
23:39
However, dirt cake. This picture is just in here
23:41
because delicious, amazing. It looks really good.
23:44
Don't forget that. And then sometimes with this,
23:47
we'll dive into Natural History a little bit, but we are just
23:49
taking advantage of Natural History, things getting better
23:52
on their own and we're just pushing them along.
23:55
So sometimes the things we do, you see the athletes with
23:58
cupping, taping, things like that, are they getting better
24:00
because of that? Maybe maybe they're just getting
24:02
better and those things are helping them stay on track.
24:05
So that's a big thing there. OK, here's a big part that I
24:08
really want to talk about is avoiding deconditioning.
24:11
Now, inactivity, It comes with a price.
24:13
For those of you who maybe clenched up a little bit because
24:16
you haven't been in the gym in two weeks, that's not
24:18
inactivity. That's a break.
24:20
A little bit of time, that's fine.
24:22
But when we let ourselves go from a level of fitness and we
24:25
have pain and we start doing less and less and less than it's
24:28
been a couple months and now we canceled our gym membership and
24:31
we're not showing up to things, That's where inactivity starts
24:34
to become a spiral that we want to avoid.
24:36
Some things to motivate you to not avoid an activity.
24:39
Good information here on fall risk and thigh circumference.
24:42
There is a good there's some good research that there's a
24:45
positive association between thigh risk, circumference and
24:48
decreased fall risk as we get older, regardless of BMI.
24:52
We tend to disproportionately lose muscle mass in our legs as
24:55
we age with inactivity. So having strong, bigger legs,
24:58
it makes you less likely to fall.
25:01
Osteoarthritis, kind of a buzzword, the bone on bone,
25:03
those things that we we sort of hear a lot about getting older.
25:07
This is an interesting one because adults who are sedentary
25:10
have a 13% higher risk of getting osteoarthritis than
25:14
those who are moderately active. Think about wearing out our
25:17
joints, being too active, doing too much.
25:20
That kind of goes counter to that.
25:21
I do have to add there is a 6% increase if you are classified
25:25
as extremely active. So you can overdo it a little,
25:28
but it's still a lower risk than being sedentary.
25:30
And then this is the one we're going to dive into all 'cause
25:34
mortality and association with VO2 Max.
25:36
So this 2018 study is incredible.
25:38
It's the association of cardio respiratory fitness with long
25:41
term mortality among adults undergoing exercise treadmill
25:44
testing. So does anyone, do you guys know
25:46
what VO2 Max is? Has anyone heard of that before?
25:48
Maybe it's it's it's a measure of your cardio respiratory
25:51
fitness. You've seen people like running
25:53
on a treadmill. The big mask and the tubes
25:55
measures how efficiently your body can use oxygen to the point
25:58
where it can no longer efficiently use it.
26:00
You're given a number that shows your cardio respiratory fitness.
26:03
So in this study, this is about as nerdy as we're going to get,
26:06
so bear with me. What we essentially have here,
26:09
what it boils down to is they tested these groups of adults
26:13
and they stratified them into elite high, above average, below
26:18
average and low cardio respiratory fitness, low VO2
26:22
Max. And then on our Y axis, we have
26:24
adjusted hazard ratio. In oversimplified terms, hazard
26:27
ratio is how likely is it that something bad is going to happen
26:30
to you medically outside, you know, again, going back, not car
26:34
accidents, not tragedies, not things like that, a health, an
26:37
adverse health event. With that, we come down to our
26:41
graph down here. So a little bit of a baseline.
26:43
So these are some comorbidities and it's how much more likely is
26:47
it that something bad happens to you if you participate in
26:50
smoking, if you have coronary artery disease, if you have
26:52
diabetes, hypertension and stage renal disease.
26:55
So we can see here somewhere around 1.4 times more likely to
26:58
1.2 and stage renal disease, a little bit of an outlier there,
27:02
but it's higher. So with that, that just gives us
27:05
a baseline because what they did is they compared people in these
27:08
groups. So if you have elite cardio
27:10
respiratory fitness VO2 Max, which is not a lot of us, but
27:13
maybe some of us that compared to people who have low VO2 Max,
27:18
low fitness, they are five times more likely for something bad to
27:23
happen on an adverse health effect.
27:25
And it gets lower from there. But you've got your comparison
27:27
of low versus high, 3.9 times more likely low versus above
27:31
average, which is probably where a lot of us are in somewhere in
27:34
this above average to below average statistically.
27:36
But you're still or someone who does not have the fitness that
27:39
you have is still 2.75 to 1.95 more likely to have a negative
27:45
health event or an adverse health event.
27:47
So some pretty interesting stuff there as far as just being fit
27:51
and having a high VO2 Max is protective.
27:54
That's we can't go too deep into the causality of it.
27:57
But the research here would suggest that maintaining your
28:00
fitness, maintaining your health, however you can long
28:03
term is going to be better here, not letting injuries and pain
28:05
derail you. So on the optimistic side of
28:09
things, we talked about Natural History before a little bit.
28:12
Is it going to get better? Some more information, some more
28:14
research about the likelihood. So another good study where they
28:17
took acute low back pain, 80% of patients on a low back pain
28:21
score or scale reported improvement by six weeks.
28:25
It's a short term thing and acute thing.
28:27
Rotator cuff tears, you guys have probably heard of that with
28:29
shoulder injuries with issues there.
28:31
Rotator cuff tears are kind of a fascinating one because it's
28:33
more likely that you have one that doesn't hurt than one that
28:36
does hurt. And at once you're 60, you have
28:39
a 50% chance that your rotator cuff is torn even if you don't
28:43
have shoulder issues. And every decade it goes up 10%.
28:46
So you take people who are 80 and they have an extremely high
28:48
likelihood of having tears. So those are things you don't
28:51
have to fear them. It's they're, they're part of
28:53
the normal human experience, anterior knee pain,
28:56
patellofemoral pain syndrome, just another 150% of people
28:59
reported improvement within 8 weeks, less than people, less
29:02
than 50% of people have pain after a year.
29:04
With things like that, whether it is managed with interventions
29:08
or whether it's just healing on its own.
29:10
And then this is always an interesting one.
29:11
The strongest predictor of avoiding chronic pain after a
29:16
whiplash or a neck injury is simply the belief that it's
29:19
going to get better. So those are powerful things.
29:22
Those are important things to keep in mind when you're not
29:24
feeling great. And that is another point of
29:27
this, to get into our fields a little bit.
29:28
It's OK to be frustrated with these things.
29:30
You know, the being in pain, having to deal with injuries,
29:33
having to change what you're doing, change your lifestyle
29:36
temporarily, ideally is frustrating.
29:39
It sucks, it's hard to do. It can feel hopeless at times.
29:43
It can be hard to adhere to the things that you're trying to do
29:45
to change and you just, it's, it's fine.
29:48
It's that's OK to feel that way. Lean on the people around you,
29:52
lean on your friends, your family, your P TS, your fitness
29:56
instructors, your coaches. It's, it's important to
30:00
recognize that and to allow them to help you and allow you to
30:04
help yourself. So with that, how do we keep
30:07
going? How do we, how do we manage all
30:10
of this? So biggest thing is be
30:12
realistic, right? You'll overestimate what you can
30:14
do in six months and you'll underestimate what you can do in
30:17
six weeks. That's kind of a true thing
30:20
about again, the human experience.
30:22
Number 2 is make a plan, not a plan of I'm going to be better
30:25
in six weeks, a plan of how am I going to manage this?
30:27
How am I going to keep going? How am I going to get back in
30:30
the gym? Do the things I want to do,
30:32
whether that's seeking help from a professional or doing it on
30:35
your own. Maintain intensity elsewhere.
30:37
We've touched on this a little bit, but you've got any injury.
30:39
You could have your leg in a brace or in a cast.
30:42
You could show up here and do a million things.
30:44
You can get a full upper body workout.
30:46
It seems a little bit lame and not what you want to do, but
30:49
that's how you maintain your intensity and your fitness
30:52
elsewhere. Consistency.
30:53
That's always going to win. We know that, right?
30:55
It's boring. It's the not sexy thing.
30:57
But the more consistent you are, the more you stay on top of
31:01
these things and keep showing up, the better it's going to
31:03
get. And also remember, why do you do
31:05
what you do? Do you come to the gym?
31:07
Do you stay active because you want to have massive arms and
31:11
now your elbow hurts and you can't?
31:12
Probably not. You probably care about your
31:14
health, your fitness. It makes you feel good, it makes
31:16
you happy. Remember those things and try to
31:18
hold on to them as best as you can.
31:21
And then just a little touch on here for those of you, if maybe
31:24
you've heard of the health span versus lifespan, your life
31:27
expectancy versus how many of those years you're going to be
31:30
healthy for, We're trying to shrink that gap.
31:33
The more we can keep these things going, the smaller we can
31:36
make those years, the less they are.
31:39
That's the goal, right? And then also another benefit
31:41
with these things, if you are, you know, staying active,
31:45
continuing to do these things throughout your lifespan, you're
31:47
going to statistically you're gonna spend less on healthcare.
31:49
That's always positive. And then kind of back in the
31:52
fields as well, moderately active adults are 50% as likely
31:56
to develop depression as sedentary adults.
31:58
So it's there. There's a lot of good support
32:00
about this that it is beneficial for you.
32:03
All right. And then the my closing thing, I
32:05
want you guys to all remember these.
32:07
If you know them, great. If you don't learn them.
32:09
This is what guides everything the American Heart Association
32:12
physical activity guidelines. This is your, you cannot dip
32:16
below this 150 minutes per week of moderate intensity and or a
32:21
combination of 75 minutes of vigorous intensity strength
32:25
training on two days out of the week minimum.
32:28
We're trying to hit all body parts minimum.
32:29
And then we've got other things, other advice in there.
32:32
Minimize sedentary time for older adults.
32:34
You should do things that that keep you moving and keep you
32:36
active. But these are your guiding
32:38
factors for everything, right? Just keep that in the back of
32:41
your head if you're checking these boxes.
32:42
At the bare minimum, we're doing what we need to for a healthy,
32:45
happy life. In theory, right?
32:49
Thank you guys. Next up, we have Trina Fiersted,
33:02
and she's with Revival PT and Wellness right up in Is it
33:06
Golden Valley? Yeah.
33:08
So I'm gonna let her take it away.
33:10
And yeah, buckle up. Take your notes.
33:13
Take it away, Trina. OK.
33:15
Can you guys hear me, beautiful? Like you said, my name's Trina.
33:18
I'm with revival, PT and Wellness.
33:19
I'll talk a little bit more about us in a second, but we're
33:22
going to talk a little bit about empowering and working through
33:25
your pelvic floor. This is something that's being
33:27
more talked about in the women's space, but guys, don't tune out.
33:29
There's stuff in here for you too.
33:32
Just talking more about like how we can lift, what it is, what do
33:35
we do? What do symptoms look like?
33:37
Kind of everything around it because it's a newer area of
33:39
conversation, a newer area of research in the fitness world.
33:43
So like I said, I am with revival PT and Wellness.
33:46
We have a clinic in Golden Valley.
33:47
We also have a clinic in North Loop.
33:50
We have 5 P TS now and we treat not just pelvic health, but we
33:55
treat a little bit of everything.
33:56
So we see a lot of runners, we do running analysis, we do golf
33:59
performance, we do general orthopedic injuries.
34:01
We see people just for general health and Wellness and yeah,
34:05
kind of a little bit of everything.
34:06
And we are an out of network practice there.
34:09
This is our pelvic health team. So we have three of us who are
34:10
pelvic health therapist, me, Maggie, who is our lead public
34:13
health therapist and Sierra as well.
34:17
So we're going to kind of go through first, what is your
34:19
pelvic floor? What's it even do?
34:21
What is involved with pelvic floor actions?
34:24
We're going to go through a little bit about what's it look
34:25
like when things go wrong in this area because it's a little
34:28
bit different than just strictly pain as a symptom.
34:31
And then we're going to go through kind of what is, quote,
34:34
safe to do with some of these injuries or conditions and then
34:38
how to treat them OK as we go. If you have something like a
34:41
quick question, feel free to toss it up now.
34:43
I know we have time for questions later, but people
34:46
usually have a lot of like what even is happening during this.
34:48
So if you ask it and it's a longer answer, we'll save it for
34:51
later. But if it's something quick,
34:52
feel free to ask it. Now, what is your pelvic floor?
34:55
So your pelvic floor, just like anything else, is just a group
34:57
of muscles. It sits in the bottom of your
34:59
pelvis, kind of shaped like a soup bowl.
35:02
OK, it works with some other surrounding muscles, so it
35:05
doesn't always function alone, but it's main functions by
35:10
itself are one to maintain continents.
35:12
We'll talk a little bit more about what that means in a
35:14
minute. Two, to help support all of our
35:17
internal organs here, support your bladder, support your large
35:19
and small intestines. For women to support your uterus
35:22
and ovaries, make sure everything in there has its
35:24
place and is supported. And then three, it also aids and
35:26
sexual function. OK, these muscles act exactly
35:31
like every other group of muscles in our body.
35:34
And it gets kind of clustered as like, what even is my pelvic
35:37
floor? What's it do?
35:37
How does it function? It contracts, it relaxes, it
35:40
stretches, it does absolutely everything that every other
35:43
muscle in your body does. But we have so much less
35:45
awareness around how do we use it?
35:48
How do we make it do those things?
35:50
So how does it work? We use this comparison to like
35:55
an A-frame house, OK? At baseline, at rest, your
35:59
pelvic floor should be relaxed. We should not be squeezing.
36:02
We should not be clenching. No matter how many times you've,
36:06
as women been told, do kegels to strengthen your pelvic floor,
36:09
you should not be doing those all day every day.
36:11
It should just be nice and relaxed and just hanging out in
36:13
the middle. OK, the we're going to go with
36:16
the stretch first because I want you all to try this and see if
36:19
you can feel it with both feet flat on the floor and your butt
36:22
flat in your chair. Try to sit just nice and
36:24
neutral. And 1st, I want you to just push
36:27
down. Think like you're pooping or
36:29
pushing out a baby. We are pushing down into our
36:31
pelvic floor. That is the stretch.
36:33
OK, If I'm going to compare that to our arm, that's like
36:35
straightening your arm. You're stretching out that
36:37
pelvic floor and then when you relax, it should come back to
36:39
the middle. In terms of our A-frame house,
36:42
we're going from here and we're going down into the basement.
36:45
So it's pushing down, it's stretching a little bit, and
36:48
then it comes back up. OK.
36:50
Like I said, times that, we want it to do that.
36:52
We want it to do that. When you're pooping, we want it
36:54
to do that. If you're having a baby, if you
36:55
take a big diaphragmatic breath in, your pelvic floor should be
37:00
going down a little bit and then it should come right back up to
37:04
that middle. If you're someone who feels like
37:06
yours is kind of always down, if you're like I went to push down
37:08
and I didn't feel any movement there, you might need pelvic
37:12
floor PT opposite is contracting.
37:15
So we're going to go up to the attic.
37:17
When we contract, our pelvic floor should squeeze and lift.
37:20
So think the attic gets smaller as we go up, so our pelvic floor
37:24
should squeeze and lift. So if you're sitting here and
37:25
you push down, it came back to the middle.
37:27
Second one is you're going to squeeze and lift that pelvic
37:29
floor up towards your head, OK? This is something we use to,
37:34
this is more for the maintained continents.
37:36
So if you're sneezing or coughing, this is what your
37:39
pelvic floor does so that you don't pee your pants.
37:41
If you're going to back squat or deadlift or lift something
37:44
heavy, this is what your pelvic floor does, so you don't pee
37:47
your pants, OK? So this is more that contraction
37:50
when you do a Kegel, this is what you're doing.
37:52
But that's only one function of your pelvic floor.
37:54
So that's not the only way to strengthen your pelvic floor.
37:57
OK. Does our pelvic floor work
38:01
alone? No, Nothing in our body does.
38:04
But especially not your pelvic floor.
38:05
Like I said, all it does, it goes up and down, but it works
38:08
with your core and it works with their hips.
38:09
Because if you think if I'm going to sneeze or cough or
38:12
laugh, how many people have ever gotten sick and you cough so
38:15
much and your abs are tired? Yeah, like you're sore.
38:18
After a few days of being sick, that same thing happens to your
38:20
pelvic floor. And that's maybe why on day one
38:23
of being sick, you don't have any issues.
38:25
But by day four of being sick, you're peeing your pants.
38:27
When you cough, the muscles are tired.
38:29
They've been working so hard to hold everything in every single
38:32
time you cough that now I've coughed 500 times in four days
38:36
and they're tired. It's a lot of work for them.
38:39
So they have to work together to manage that pressure in your
38:42
core when you're coughing. Or same thing.
38:44
Like if you're going to back squat, you need your core to
38:46
stay here and engage, but you also need your pelvic floor to
38:49
lift so that when you're at the bottom of that back squat and
38:51
you go to push up, it doesn't just push down and then you pee
38:53
your pants, right? It also works with your hip
38:57
muscles. And we'll talk a little bit more
38:59
about this when we get to the treatment section.
39:01
But it sits inside your pelvis, your hips also, they kind of sit
39:04
more on the outside of your pelvis.
39:06
There's actually 2 muscles that act as a pelvic floor muscle and
39:09
also act as a hip rotator. So anytime you're doing a single
39:13
leg strengthening or a split stance strengthening sync, like
39:16
single leg RDLS, step UPS, lunges, anything like that,
39:19
you're strengthening your pelvic floor and you don't even know
39:21
it. OK, They all work together to
39:25
function. One, to do just the basic
39:28
functions of pelvic floor, but two, to do them while you're
39:31
doing other things. Every time you sneeze or cough
39:33
or laugh. We don't just sit here like this
39:35
unless you're someone who knows that you pee your pants and then
39:37
you do sit here like this so that you don't pee your pants.
39:39
But like, ideally we can laugh and walk at the same time and
39:43
still not pee our pants, right? So they all have to function
39:47
together while we're doing daily things to make sure that doesn't
39:50
happen. So we've learned a little bit
39:55
about what is our public floor, what to do.
39:56
Let's talk about what it looks like when things go wrong in
39:59
this area. I know this talk is generally
40:01
about pain, but I want to talk more about like, symptoms as a
40:04
whole. Regardless of what your symptoms
40:07
are, you treat them about the same way.
40:10
OK, just a little. I don't know, fun fact might not
40:14
be the right word, but a fact to kind of get us all on the same
40:16
page with pelvic floor stuff. Now, these numbers fluctuate
40:19
based on what study you look at, but generally in the US, about
40:22
one in four women and one in eight men have at least one
40:27
pelvic floor complaint. That's a lot more people than we
40:31
typically think it is. There's like 2022 of us in here.
40:37
So this would put us at at least like 5 people in this room
40:40
probably having some type of fellow floor symptoms, and
40:42
that's at least one. Some people got a whole list of
40:44
them. OK.
40:46
It is much more common than we think it is, and it's much more
40:48
common than is talked about. Common does not mean normal.
40:52
I don't want you, you to take that as like, oh, it happens to
40:55
everybody. That's fine.
40:57
It just means that it happens a lot, but it doesn't mean that it
41:00
can't be fixed, OK? Common is not normal.
41:03
This is not just a normal part of aging.
41:05
This is not just a normal part of having kids.
41:06
This is not just a normal part of anything.
41:09
It happens a lot, but it totally can be addressed.
41:12
OK, So when we talk about different conditions that happen
41:16
in terms of pelvic floor, I like to split these into two groups.
41:20
Now, these are not necessarily like mutually independent
41:22
groups. A lot of things can kind of dip
41:24
into both groups and symptoms can have a little bit of the
41:28
weakness side and a little bit of the tightness side.
41:30
But for ease of just looking at this in a nice way, we're gonna
41:33
talk weakness on that. Your left, my right.
41:37
Think weakness of pelvic floor, but also weakness of your hip,
41:40
weakness of your core. OK, It's a chain of muscles like
41:42
we talked about, few different things that can happen with
41:45
weakness. We can have different pains.
41:47
We can have incontinence. We can have heaviness or feeling
41:50
like there's pressure pushing down.
41:52
We can have leakage, urgency on the tightness side.
41:56
This can be a lot of times more bowel, bladder function.
41:58
We can have Constipation is a pretty common pelvic floor
42:01
symptom. We can have increased frequency
42:03
of how often we go to the bathroom.
42:04
Hip and low back pain can almost also come with this.
42:07
Pelvic pain can come with this. And again, you'll see on here
42:10
some of these are in both sides and actually more of them can go
42:12
in both sides as well. So it's not always I just need
42:15
to strengthen my pelvic floor and it's not always I just need
42:18
to relax my pelvic floor. It's usually a little bit of
42:20
both. OK, Again, just because these
42:25
things can have something to do with weakness and we know that
42:29
we get timeline, we're supposed to get weaker when we age,
42:33
right? You can fight that by strength
42:35
training. So it doesn't have to be normal,
42:36
but you do have to actively fight it.
42:40
So we're going to talk about two relatively common pelvic floor
42:44
conditions or pelvic floor symptoms.
42:46
This doesn't, these two aren't necessarily the most common
42:49
ones. They're ones that I see a lot in
42:51
a more athletic population, in a more active population.
42:55
OK, so first one we're going to talk about is incontinence.
42:58
What is incontinence as a whole? Again, this is one of our main
43:01
functions of the pelvic floor is maintaining content, maintaining
43:04
continence. Incontinence is just the lack of
43:07
voluntary control of your bladder or your bowels, so
43:10
results in leakage like peeing your pants of either urine or
43:14
feces. OK, either one, who can it
43:18
happen to? Anyone.
43:21
Urinary incontinence is more common in women, but fecal
43:23
incontinence is equally as common in women and men.
43:26
OK, so this isn't just something that happens after you have a
43:29
baby. This isn't just something that
43:31
happens when you're going through menopause peri or post
43:33
menopausal. This can happen to anyone.
43:38
There are different kinds, and we're going to focus more on
43:40
urinary incontinence because it is in general more common, but
43:44
they actually are treated relatively similarly.
43:47
So with urinary incontinence, there's kind of three major
43:50
kinds. First one is stress
43:51
incontinence, and this is kind of the one I've talked the most
43:53
about so far. This is like I sneeze, I pee my
43:56
pants, I jump, I pee my pants, I laugh, I pee my pants.
43:59
OK. Athletic incontinence is just a
44:01
form of stress incontinence, and it's more with athletic
44:05
movements. So jumping, lifting, running,
44:07
anything along those lines that's considered athletic
44:09
incontinence. But they're treated the same.
44:12
The symptoms are the same. What is happening in that, and
44:15
we'll talk a little bit more about that, is it's just your
44:17
body can't manage whatever pressure is happening here.
44:20
So again, like we talked about when you sneeze or cough, your
44:22
core gets tired because the pressure in here is going up so
44:25
many times. It's just that your public floor
44:27
can't manage that, OK. The other two kinds, overflowing
44:32
continents and urging continents, are less about
44:35
necessarily that pressure management and more about your
44:38
reflex of going to the bathroom. So I want you to think of your
44:41
bladder like a gas tank. It's kind of an opposite gas
44:45
tank. So it actually works the other
44:46
way. So as you drink more liquids,
44:47
your bladder fills up, fills up, fills up, fills up.
44:50
Once it hits a certain point, it sends a signal to your brain.
44:53
Your brain says OK, we're going to the bathroom.
44:55
Your brain sends a signal back down to your bladder.
44:57
It contracts. You go to the bathroom, you have
44:59
0 control over that. It is a complete reflex.
45:03
When your brain decides you are going to the bathroom, you
45:06
cannot stop it. All you can do is squeeze your
45:08
pelvic floor and hold on until you get to the bathroom.
45:11
But when your brain says no, we're going, you're going.
45:14
OK. So overflowing continents is
45:17
when your gas tank is getting full, when your bladder is
45:20
getting full and your brain doesn't realize it.
45:23
So we've hit that full mark. Your brain, for whatever reason,
45:26
that signal is not going to your brain.
45:29
So then you're going about the day and all of a sudden you pee
45:31
your pants because you didn't realize your bladder was full.
45:34
OK, why does that reflex happen? Why does that go wrong?
45:40
There's a lot of different reasons.
45:41
If any of you work in like the medical field or our teachers,
45:45
these are like the top two people on my list of I can't go
45:48
to the bathroom whenever I feel like it because I'm surrounded
45:50
by a bunch of kids or I'm treating a patient or whatever
45:53
your job may be. So you hold going to the
45:55
bathroom for really long periods of time.
45:57
So you're actually suppressing that reflex.
46:00
That is one reason this can happen.
46:02
There's a many other ones, but that's kind of the most common
46:04
one I see. OK, the second going to urge
46:07
incontinence is kind of the opposite problem.
46:10
So this one is like my bladder maybe only gets 25% full and
46:14
then it's sending the signal to my brain telling me I have to go
46:17
to the bathroom and I have to go to the bathroom right now if I'm
46:20
doing the dishes, I can't finish doing the dishes and go to the
46:23
bathroom. I'm doing whatever I'm doing.
46:25
I get that signal, I'm running to the bathroom, OK, I don't
46:29
have that second to have that control over my pelvic floor to
46:32
be like, OK, I can walk to the bathroom.
46:34
I can finish doing my task and then end up in the bathroom.
46:37
I need to Sprint there right now.
46:39
So for whatever reason, that signal is firing a lot sooner
46:43
than it needs to because sometimes, and maybe some of you
46:45
have experienced this, you get to the bathroom, You're like,
46:47
oh, no, I'm running there. I sit down to go bathroom.
46:49
And then I didn't really actually have to go that much.
46:52
I only went for a couple seconds.
46:54
That's urgency. OK, Those are less about
46:58
strength. Now, can there be weakness with
47:00
them? Of course.
47:01
Less about strength and more about that reflex that's going
47:04
to our brain. OK, again, who can happen to it?
47:10
Can happen to anyone. Is it more common with aging?
47:13
Yes. Because what else is more common
47:15
with aging? Weakness.
47:18
OK. That does not mean it has to be
47:19
normal. That does not mean it's just
47:21
something you have to live with. So how do you treat these?
47:26
Again, they have different causes.
47:29
We talked about Stress is more about weakness and urgency, and
47:31
overflow is more about that reflex.
47:33
So you have to treat them in that way.
47:35
Stress, incontinence, we do have to focus more on strength.
47:37
Now. It's not just about
47:39
strengthening your pelvic floor, like I said, it's about
47:41
strengthening that whole chain of muscles.
47:44
So if I'm say it's with jump rope that I have leakage, do I
47:48
only use my pelvic floor to jump rope?
47:51
No, I use my calves and my quads and everything else.
47:54
So it's that whole chain of muscles that has to counteract
47:59
the amount of force that I need to jump off the ground.
48:02
So if my pelvic floor is weak and I'm peeing my pants when I'm
48:06
jump roping, but my calves are also weak, then that means my
48:10
pelvic floor is having to carry more of the load because my
48:12
calves aren't doing it. So I can decrease my leakage by
48:16
strengthening my calves and my quads and my hips and my pelvic
48:21
floor. And if I just strengthen my
48:23
pelvic floor, but my calves are still weak, I still might pee my
48:26
pants because my calves aren't carrying their load.
48:31
Yeah. So that's more with stress
48:33
incontinence. Urgent overflow is about
48:35
retraining your brain. It's a really fun game we get to
48:39
play and we get to try trick your brain into like, no, I
48:41
don't have to go to the bathroom yet or giving you a timer of
48:44
like, no, you have to go to the bathroom more frequently than
48:47
you were. It is truly we are retraining
48:49
that reflex. Is there potentially still some
48:52
strengthening that needs to happen?
48:53
Yes. Is there potentially some
48:54
tension that your pelvic floor is carrying?
48:56
Yeah, hard to say. Again, this is not
48:59
individualized, this kind of general information, but it's
49:01
usually a little bit of both. So what is safe to do with
49:04
incontinence? Everything, anything and
49:08
everything is safe now. This is why I hear from people a
49:10
lot. I'm scared I'm going to make it
49:11
worse. I'm scared I'm going to damage
49:13
my pelvic floor. I'm scared I'm going to make it
49:15
worse. I would say you're already
49:17
peeing your pants. How much worse can it really
49:18
get? Right?
49:20
Don't worry about that and go in the other direction.
49:23
OK, we're already peeing our pants.
49:24
Let's get out of there. If I if jump roping is the only
49:28
thing, it's the easiest one to use, I'm going to keep using it.
49:30
If I consistently pee my pants when I jump rope 35 times, I
49:35
want you to jump rope 34 times over and over and over again.
49:38
And then once you're done, toss in a few calf raises.
49:43
We're gonna get up the line I use with my patients.
49:44
I want you to get up and poke the bear, but don't punch the
49:46
bear in the face. Yeah, we're gonna get right up
49:49
to that symptom. We're gonna sit there, and then
49:50
we're gonna back off and let it recover a little bit, and then
49:52
we're gonna do it again. We're gonna get right up to that
49:54
symptom. We're gonna get there.
49:55
We're gonna hold it a little bit, and then we're gonna back
49:57
off. Let your body recover, but also
49:59
don't just be afraid of it 'cause if we keep that way over
50:02
there and I never jump rope because I'm scared of peeing my
50:04
pants, I'm never going to get better at it and I'm never going
50:08
to be able to do it without peeing my pants.
50:11
OK, so we have to do the thing that's scary, but we just have
50:14
to do it within the range that my body can already tolerate.
50:18
OK. Second thing we're going to talk
50:23
about is not necessarily an actual pelvic floor symptom, but
50:26
it does have to do with our pelvic floor strength and our
50:29
pressure management. This is diastasis recti or
50:32
recti, however you would like to say it.
50:33
It's all correct. We most commonly associate this
50:37
with pregnancy. All it is is there is a piece of
50:42
connective tissue that goes from your sternum down to your pubic
50:44
synthesis. It is a stretching of that
50:47
tissue. Not damage, not tearing, just
50:49
stretching so your core muscles are separating slightly.
50:53
It's most common after pregnancy, but it doesn't only
50:55
occur after pregnancy, OK. It also doesn't only occur in
50:59
women. There was a study a few years
51:01
ago that came out that said there are almost as many men in
51:04
the world that have diocese recti as women.
51:07
OK, So other risk factors can be a rapid fluctuation in weight,
51:11
which is why it happens during pregnancy because your weight
51:13
goes up rather quickly and then it goes down rather quickly.
51:16
That can also happen in men. It can be pressure management
51:19
with lifting. If you're not great at bracing
51:21
your core and you keep pushing beyond that, and we don't know
51:23
how to engage this, that can be a risk factor.
51:27
If you're constantly pushing when you go to the bathroom,
51:30
struggling with Constipation, that can be a risk factor for
51:32
this. So looking at our kind of core
51:36
canister, we call it the pop can.
51:38
The top part of it is your diaphragm, the bottom part of it
51:41
is your pelvic floor, front is your core, and back is your back
51:44
muscles. Our goal is to keep that as
51:47
managed as we can. Whatever The thing is that I'm
51:51
doing, I have to manage whatever pressure is going on in there.
51:54
So if I'm coughing, whatever pressure my body comes up with
51:57
when I cough between my pelvic floor, my diaphragm, my core,
52:00
and my back, I have to manage that pressure and keep my can
52:03
upright. OK.
52:05
If you think of a pop can, if you step on it when it's
52:07
upright, it's pretty solid and sturdy.
52:09
If it shifts sideways and you step on it, it's going to
52:11
crunch. So we want to keep it pretty
52:14
solid and upright and be able to manage from all directions to
52:17
keep my core canister as strong as I can.
52:20
So how do you treat diastasis recti?
52:21
You have to learn how to manage your pressure of your core, how
52:25
to make sure your muscles are actually strong enough.
52:28
But then that I'm actually able to engage them when I'm doing
52:31
things like coughing, jumping, lifting, anything like that.
52:34
Because if they're super strong, but I have no idea how to use
52:36
them, it doesn't matter how strong they are.
52:38
So we also have to learn how to engage all three layers of our
52:42
core with our hips and our back and get my breathing involved.
52:47
OK, what is safe to do with diastasis recti?
52:49
You're going to get it, same as all the other ones.
52:51
Everything, everything is safe to do.
52:53
If anybody's been like, you can't do sit ups because you had
52:55
a baby. You can't do planks because you
52:57
have doming or coning or whatever it is.
53:00
It's because they don't know how to load your core gradually.
53:04
OK, maybe we're not doing sit ups today, so we might be able
53:08
to set up six months from now when you learn how to manage
53:11
your core and do a sit up properly.
53:13
But sit ups are really hard to do correctly, OK?
53:17
So it's not that you can't ever do them, it's just that they're
53:19
really hard. So we have to get from here to
53:21
here. We can't just skip all these
53:23
steps. So it's not that you can't do
53:25
them. We just got to get there
53:25
eventually. Same with planks, same with push
53:28
ups, Same with pull ups. There's nothing that's not safe
53:30
to do as long as you're gradually loading it and getting
53:33
there. OK, so we talked about
53:36
condition. How do we fix these conditions?
53:38
I've kind of touched on this as we go.
53:40
A lot of it is just gradual progression.
53:42
A lot of it is load management, getting up to those symptoms.
53:45
Whatever the symptom is, if it's pain, if it's leakage, if it's
53:49
Constipation and gut issues, whatever it is, get up to that
53:52
symptom and then back off. Just like pretty much everything
53:56
else with PT, it's all individualized.
53:58
So it's not that every single person needs to go home and do
54:02
Kegels. It's not that every single
54:03
person needs to go home and strengthen their core.
54:05
It's a very individualized based on what's going on in your body.
54:09
Tightness, weakness. Is it actual pelvic floor
54:12
weakness or is it weakness somewhere else that your pelvic
54:14
floor is having to compensate for?
54:17
And then create a treatment plan for that.
54:20
So like we talked about, these are just some quick, easy things
54:24
that I like to share with people in terms of treatment that you
54:27
can kind of take home and try today.
54:28
If any of these symptoms jump out at you with these symptoms,
54:32
I always tell people if you've been dealing with it for more
54:35
than like a month or so, go see someone about it.
54:37
Don't try to manage on your own. It's not going to magically go
54:40
away, OK? Especially pelvic floor
54:42
symptoms, they typically do not just magically go away, but they
54:46
typically are pretty manageable with guidance and education.
54:50
OK, so breathing is going to be more if you're on that tightness
54:53
side of that Venn diagram I had. If you're on that tightness
54:57
side, thinking pain, thinking Constipation, anything like
55:00
that, these can be helpful. We're breathing and breathing
55:03
means breathing in through your diaphragm, but also breathing in
55:05
through your pelvic floor. OK, So that's kind of that bear
55:08
down position. I don't want you to push down
55:10
ever, but when you breathe in, think, breathe into your pelvic
55:13
floor. That's where you want that air
55:14
to go. These positions are ones that I
55:17
choose just because they put your pelvic floor in a
55:19
relatively they take your pelvis and kind of put them in this
55:22
position. So it's easier to feel that air
55:26
go into your pelvic floor. It's easier to actually relax
55:29
your pelvic floor in these symptoms and it gives it a
55:31
little stretch. OK, Are there is there anything
55:34
magical about these positions? No.
55:35
Could you do deep breathing sitting in your chair, laying on
55:37
your back? Yep, absolutely.
55:39
These are just ones that give it that passive stretch and you
55:42
breathe in. OK.
55:44
None of these are right versus wrong.
55:46
They're just ones that are options for you.
55:48
You can try them, see if they feel good.
55:50
We got happy baby. A deep squat you can support
55:52
with a block so that your hips don't have to do as much work.
55:55
Now, if it feels good to do without a block and you're
55:57
comfortable sitting in a super deep squat, great, go ahead and
56:00
do it without one. If you're not and you're like,
56:02
oh, it feels like my hips are pinching and I'm having to work
56:04
harder and now I'm not able to actually breathe in, then let's
56:07
go ahead and toss a block under your butt, OK?
56:10
And then child's pose, same thing.
56:11
We want to be able to relax and all these.
56:14
Second one is mobility. Now this one also kind of airs
56:17
on the side of tightness. OK.
56:19
Again, if you think of these positions, our same kind of
56:22
thing is happening where we are hinging our hips back.
56:25
We're trying to get some pelvic floor stretch here, so we'll add
56:28
up your rock back with this. You're thinking you're really
56:30
driving your hips back. 9090 press ups are more for hip
56:34
rotation. But again, if you remember what
56:36
I said the beginning, two of our hip rotators are also pelvic
56:38
floor muscles. So if you're ever working on hip
56:40
mobility, you are also working on pelvic floor mobility.
56:46
And the last one is strength. Now I want to preface this.
56:48
These are very low level strengthening exercises that
56:52
would be like at the beginning of a pelvic floor PT
56:54
strengthening and the stage pelvic floor PT strengthening
56:58
looks like dead lifting. It looks like split sands dead
57:01
lifting. It looks like step UPS, it looks
57:03
like lunges. That is what the goal is.
57:06
This is where we have to start. OK, so working on any pelvic
57:11
shifting in this one, I have it on a block.
57:12
You can do it on a exercise ball.
57:15
You can do it if any of you have ever done like hip airplanes,
57:18
anything where your pelvis is rotating, shifting, you're
57:21
stabilizing it, you're strengthening your pelvic floor.
57:25
And then bridges. Everybody loves bridges.
57:28
Again, they're fine as a low level exercise.
57:30
They're fine as a warm up for your workout.
57:32
You should not be 12 weeks into whatever you're doing and still
57:36
doing. Bridges, that's a starting
57:38
point. OK, So Bridges adding the ball
57:41
gets your add AD doctors involved a little bit more.
57:45
Those go in, they connect to your pelvis.
57:46
They really help to stabilize our pelvis.
57:48
They're pretty important there. So again, these are very base
57:52
strengthening exercises for your pelvic floor.
57:54
There's a million other ones out there.
57:56
These are just the two that I chose for you guys today.
58:02
Couple of fun success stories from some of our patients.
58:06
So big thing all, if you take absolutely anything away from
58:10
what I just said in terms of pelvic floor things, it is that
58:13
you can do anything you're currently wanting to do.
58:18
Just go up to the point where it starts to have whatever your
58:21
symptom is and then manage from there.
58:24
Do not just stop doing whatever it is.
58:26
Do not stop doing whatever it is that you enjoy or the thing that
58:29
causes you pain. Just get up to that point and
58:32
then back off. Just have to listen to our body.
58:35
We don't have to sit here and beat up on it all the time, but
58:37
we also don't have to put it in a little box over here because
58:39
we're afraid of it. Yeah.
58:41
All right. Thanks guys.
58:51
I've had three of our three of our members in the last couple
58:54
days. Guys, we're like, do I have a
58:56
pelvic floor? And it's not like a silly
59:00
question. It's it's one of those things
59:02
that should and needs to be talked about a lot more.
59:05
So I have a million takeaways in my own head right now.
59:10
So yeah, thank you, Trina and Derek, this is phenomenal what I
59:14
want to do. Oh, we're going to skip that.
59:15
That's me. Deadlifting and lobster claws.
59:18
Not applicable. Derek showed his video, so I was
59:20
going to show mine. We're not going to do that,
59:22
though. Before we go in, I just have a
59:25
quick framework for how to use this in the gym.
59:28
So when we have an injury or we're fearful of things around
59:33
our pelvic floor or joint pain or something like that, our job
59:36
as coaches is to regress. So all right, normally you're
59:41
doing 185 on the deadlift or something like that.
59:44
Something's not feeling right. Our job is to take that move,
59:46
scale it down so that's tolerable from that end,
59:52
physical therapy and and all the kind of Wellness care around
59:56
that feel they're going to be working on progressions in a lot
59:59
of cases. And so, you know, we want to
1:00:01
stay within our scope of practice as coaches to push you
1:00:06
when you're feeling pretty darn close to your best or maybe a
1:00:08
little bit less. These are the guys you want to
1:00:12
talk to when it's a little bit outside of our scope, when we
1:00:15
have to scale down so much. We're like we're we're starting
1:00:17
to get out of our scope of practice as coaches and this is
1:00:21
what aligns. Your care team, right?
1:00:23
These are the people that you have if and when we find
1:00:27
ourselves in those circumstances.
1:00:28
So yeah, if you don't have a good person in that care field
1:00:34
that fits that role for you, talk to these guys after it's
1:00:37
one-on-one. We've got obviously time for
1:00:38
panel questions, but yeah, it's really great stuff, you guys
1:00:42
really great to kind of tie into the gym side of things as far as
1:00:47
how we want to approach this stuff.
1:00:50
There's a acronym move made sense, so one modify, don't
1:00:55
avoid. This is basically to summarize
1:00:57
everything these guys just said. But really just because there's
1:01:00
pain doesn't mean stop. In a lot of cases, if you have,
1:01:04
you know, an old shoulder injury or a recent one and there's a
1:01:06
little bit of pain, if it's a one or two out of 10, then
1:01:10
sometimes that means it's going to feel better afterwards.
1:01:12
So we again, we have to poke it a little bit, as Trian just
1:01:15
said, because if it feels good afterwards, that could be
1:01:19
beneficial. And that's still within our
1:01:21
scope is your coaches. But what can we adjust?
1:01:23
What can we scale down? Can we scale the tempo, the
1:01:26
range of motion, the speed, the implement all these little
1:01:29
things? Even a 10° change and how you
1:01:32
push something can affect how it feels in your joint.
1:01:35
Maybe it's not even an injury, maybe it's just our mechanics.
1:01:38
So that's what we're here to help out with, obviously
1:01:41
reducing the load. Just go lighter, OK?
1:01:44
Just go lighter. Focus on what's engaging.
1:01:46
A lot of time people will come in and they will just start
1:01:49
lifting weights and we're like, what do you feel working?
1:01:52
What do you mean? Like we're not even thinking
1:01:54
about it. So that's our job to help you
1:01:56
get more in tune with your body and gain some of that
1:01:59
proprioception, right? That knowledge of your, your
1:02:01
joints in space. So you know what's supposed to
1:02:04
be working in what capacity, but avoiding movement altogether.
1:02:08
When we have these things going on, it leads to deconditioning
1:02:10
and that's what's going to cause more issues down the line.
1:02:13
So just stopping is in some cases far, far worse.
1:02:18
O stands for optimized recovery. You guys listen to the sofa
1:02:22
personal training podcast. You know that we're going to
1:02:24
talk about sleep 79 hours. We're not going to spend time in
1:02:27
that. Go to bed and get your phone
1:02:28
out. Just just turn it off, turn off
1:02:30
Netflix, go to bed set, set yourself a routine.
1:02:33
You want at least 7. Some of you guys need 8 stress
1:02:37
management. Who's ever felt stressed at
1:02:40
work, Everybody never all right, He's being facetious.
1:02:46
So we got to manage stress, do stuff with loved ones, like do
1:02:49
stuff that keeps you excited about life, nutrition,
1:02:53
hydration. Again, that's a whole nother
1:02:55
seminar, but make sure you will hydrate before you come in.
1:02:58
Eat enough protein, prep your body so that you are are
1:03:01
optimized to 1 push and get the most out of your session, your
1:03:05
workout, but also recover on the back end.
1:03:08
If you work out here like twice a week for an hour, I think the
1:03:11
math is like 1% of all waking hours or all hours in general
1:03:16
during the week. So we want to make it count.
1:03:18
The rest of that time it's spent doing this stuff.
1:03:21
That's what's on you guys. We can help push you with the
1:03:24
right capacity, but we got to focus on that outside of the
1:03:27
gym. As soon as you walk out, don't
1:03:30
forget about us. Oh, there's a little thing
1:03:33
there, talks about sleep and risk of injury.
1:03:35
I don't know what's going on those five hour people, but I
1:03:39
don't know, maybe you guys sleep less.
1:03:41
I don't know, that's research for you.
1:03:44
But you look, look at the six and seven, OK, let's do that.
1:03:47
Volume and workload. Basically this fancy chart just
1:03:50
says too little, right? Deconditioning too much, too
1:03:54
much, too quickly is what leads to injury in a lot of cases.
1:03:57
So gradual exposure, what I like to call in here, a lot of great
1:04:00
exposure. Same thing these guys talked
1:04:02
about find a tolerable level and avoid the spikes.
1:04:06
It's just like these guys said, say you have, you know, first
1:04:10
golf season, right and you play 18 holes and your your back's
1:04:13
killing it because you just swung a club 30 times, maybe 60
1:04:16
like me, If you're not that great for the first time, you've
1:04:19
swung club as fast as you can and your back hurts, it kind of
1:04:24
like no surprise. So or your treatment plan is go
1:04:27
to the driving range and do 20 swings.
1:04:29
All right, just do that, but do the thing that you want to get
1:04:32
back to at a lower great. And in here we'll just do more
1:04:35
isometrics, things that can keep your core working without doing
1:04:38
exactly the same thing at a high intensity.
1:04:44
Exposure builds resilience. Keep doing the stuff that you
1:04:46
love to do, scale it down, but you're not as fragile as you
1:04:50
think. In a lot of cases, many of you
1:04:52
are much stronger than you believe and we know it because
1:04:56
when we coach you one-on-one, sometimes we're like, no, let's
1:04:59
let's grab the 30s people like no way, absolutely not.
1:05:02
I can't do that. And then you can do exactly what
1:05:05
we thought you'd do with it safely.
1:05:07
So use and lean into your coaches to help figure out what
1:05:10
that proper level is. You're going to feel empowered.
1:05:14
You're going to be less fearful. Strength training is great.
1:05:18
You should do it. It does a bunch of great things,
1:05:20
four bullet points, but it's one of the best things you can do
1:05:22
for your health. So don't stop it.
1:05:24
Just like Derek said, twice a week good.
1:05:26
Minimum 2 to 3 is the right dosage for typically everybody,
1:05:30
especially after 40. Lastly, Oh no, that's it.
1:05:35
That's 4 letters. OK, boom, there it is.
1:05:38
I will share this presentation. You guys want to bring those
1:05:40
things down, but strength is foundation, so cardio is
1:05:44
important. As Derek said, VO2 Max is a
1:05:46
major predictor of your lifespan and your health span, so we
1:05:51
don't want to skip that. That's why you do those those
1:05:53
finishers at the end, 5 minutes, you're going all out.
1:05:55
That's the target VO2 Max rest of conditioning.
1:05:58
Just get your steps in, OK? Make sure that stays in your
1:06:01
plan even through injury, right? It will lead to less flare ups,
1:06:06
more confidence, lower injury risk, all these amazing things
1:06:09
that we want. The closing notes here are that
1:06:13
you are not fragile, right? You were very adaptable.
1:06:18
My journey taught me all about that, how adapt the body is even
1:06:22
when you don't get it perfectly. So give it time, be patient,
1:06:27
good things will come. Movement is medicine when it's
1:06:30
dosed properly. So that's what we're talking
1:06:32
about here is what's the dosage of movement, the frequency, the
1:06:35
volume, things like that. There is a good prescriptive
1:06:39
dose and that's what we want to help find.
1:06:42
The more you do this, the narrower you're going to get and
1:06:44
the closer an idea of what that dosage is.
1:06:47
But lean into your care team and cameras off whatever.
1:06:52
Lastly, move without fear. That's our whole point to this.
1:06:54
Help you guys move more confidently.
1:06:57
Ken, we're going to jump into some panel questions.
1:07:00
I'm going to give you guys a few minutes now to write down any
1:07:02
questions you want to ask. I know you've all been to a
1:07:05
party and there's a physical therapist and you're like, hey,
1:07:07
hey, I got this, I got this thing, my elbow.
1:07:09
Can you tell me what's going on? They're like, so now is the time
1:07:12
to ask. So write down that one to 20
1:07:14
questions you have and then we'll go through in about 5
1:07:18
minutes. So I'm 21 weeks pregnant with my
1:07:21
second baby. Is there anything in particular
1:07:24
you'd recommend someone in my condition avoid and what I
1:07:28
should be doing in the gym? Great question.
1:07:33
No, nothing specifically to avoid.
1:07:36
It's all kind of like we've been talking about like all symptom
1:07:39
managed. So obviously any like nausea and
1:07:43
stuff tends to be like first try kind of limiting.
1:07:46
But beyond that, like any back pain, any hip pain, any kind of
1:07:49
like shooting pelvic pain, those would obviously be kind of like
1:07:53
scaling things, but they've done a ton of research and like it is
1:07:57
safe to still lay on your back to do different exercises as
1:08:00
long as you're not feeling any dizziness or anything like that.
1:08:04
So nothing specifically. Typically the things people do
1:08:06
have to modify first or like laying on your stomach tends to
1:08:09
be ones like burpees tend to be modified, push ups can have to
1:08:13
be modified, pull up, stuff like that, But it's really just
1:08:16
scaling it back a little bit. So instead of doing a full
1:08:18
burpee, put a box in front of you and elevate it and you can
1:08:22
put your hands on there and still do it.
1:08:23
So there's no nothing that's unsafe to do at this point.
1:08:26
It's all based on how you feel, things that are best that you
1:08:30
can do. Honestly, there is so much
1:08:32
research is for the stronger you go into having a baby, the
1:08:35
stronger you come out of it. So genuinely, as much general
1:08:39
strengthening as you can do, and core strengthening is actually
1:08:42
even not necessarily true. Sit ups, plank, stuff like that.
1:08:45
But like farmer's carry, suitcase carry, even like any
1:08:49
uneven weighted lunges, squat, stuff like that is going to set
1:08:52
you up for success. I'm definitely not supposed to
1:08:57
share this story so don't show this to daily but I have an 8
1:09:00
month old at home and my wife daily did the string train all
1:09:05
the way through her pregnancy and yeah she's gonna kill me for
1:09:07
this. But while she was delivering our
1:09:10
baby, our OB, our, our, the, the delivery nurse and then the
1:09:13
doctor in between, they said, are you an athlete?
1:09:17
Do you work out? And I like stood up with my
1:09:19
hands up. I was like, yes.
1:09:20
And then I said for her, I was like, yes.
1:09:22
And she worked out through her whole pregnancy.
1:09:24
And they were like, good job. We can tell.
1:09:26
And I was like, all right. And of course she told me never
1:09:29
to tell that story. So here I put it on camera and
1:09:31
on a mic. It's.
1:09:35
Very endearing. Yeah.
1:09:39
All right. He's got another one.
1:09:42
Come on now. Guys have been in the party.
1:09:43
OK, we got one. OK, good.
1:09:49
So you were talking earlier about pain that is non useful
1:09:54
information that that just sometimes happens.
1:09:57
So, and this is going to be a weird question because I'm going
1:10:00
to be, I'm going to ask the cause of the uncaused what what
1:10:04
causes that kind of misfiring pain information?
1:10:08
Or maybe it's not misfiring. Maybe it's actually something
1:10:10
that has happened. You just don't know.
1:10:12
But that kind of shooting, sudden pain.
1:10:15
That then goes away and doesn't seem to be associated with any
1:10:18
particular movement or or anything at all.
1:10:21
But what are some typical causes of that?
1:10:23
And after what point should you be be?
1:10:25
Concerned about those? Yeah, it's a fair question.
1:10:29
I would say the main thing about that is likely it, it doesn't
1:10:35
matter. And it's not that you have to
1:10:37
fully ignore it, but pain and tissue damage are not as
1:10:41
strongly associated as we used to think.
1:10:44
And so a lot of times, like some of the thing that I was kind of
1:10:47
describing, right, that more often than not, the way you
1:10:50
describe, like shooting pain is just like a very transient short
1:10:54
lived, like nerve irritation and not coming from the spinal cord,
1:10:58
not something that is central, not something that you have to
1:11:01
be worried about. Sometimes stuff like that
1:11:03
happens. Sometimes it has an explanation,
1:11:05
right? A good example is like your
1:11:06
funny bone hitting your nerve on your inside of your elbow.
1:11:09
That is just reaction to something.
1:11:12
Sometimes it can be as simple as just a certain way you moved
1:11:16
nerve tissue. Whatever sent a signal up that
1:11:19
was nosyception, that was something along that line.
1:11:22
And it was so short lived because it was just kind of a
1:11:25
random thing. I would say it's, yeah, kind of
1:11:29
the main thing with that is, is as long as it's not lingering,
1:11:31
as long as it's not lasting, becoming more frequent, becoming
1:11:34
more common or reproducible, that's probably your number one
1:11:38
thing. If you go see someone about it,
1:11:39
they're going to want to reproduce it to try to figure it
1:11:42
out. If you can't, that's maybe a
1:11:44
sign that, OK, this isn't useful information.
1:11:47
It's just information that's coming through and what to do
1:11:51
with it. Not entirely sure until it
1:11:53
becomes pathological. I always kind of describe to
1:11:59
people like our brains number one job is to protect us.
1:12:02
That's its whole goal. And so anytime it perceives
1:12:05
anything that's unknown or it's not sure about it or it just
1:12:08
like doesn't know what caused it, a lot of times it will
1:12:12
consider it pain and it will kind of give you those pain
1:12:15
signals back because it's like, I don't know what that is.
1:12:18
We don't like it, shut it down and to get you to stop doing it.
1:12:22
So exactly like you said, that's what I was going to say is if
1:12:24
it's more consistent, if it starts limiting like your daily
1:12:27
activities, I like that. That's when we're worried about
1:12:29
it. It's like a once off thing.
1:12:30
Then you can usually kind of write it off as not too
1:12:33
important. I have AI have a question for
1:12:37
you guys. When I was when I was 14, I went
1:12:43
to some hack chiropractor and they had me sit in a chair and
1:12:49
try to look up the ceiling. And he said because I couldn't
1:12:51
get my my head flat with my back.
1:12:54
So he said it's something called Schuler's disease.
1:12:56
Is that a thing? Do you guys know about that?
1:13:01
And I, I was like, well, my last name Shrub is that.
1:13:07
Yeah, I'm like that guy at the party.
1:13:09
Is that a thing? I would ask that at a party, but
1:13:12
I think have you guys heard a lot of like, I don't know, myths
1:13:16
or things that people are told about?
1:13:18
I have a condition, right? Because my identity was, well, I
1:13:21
was, Oh no, I have extra curvature in my back.
1:13:24
That's, that's really not good. And then you realize that spines
1:13:28
look all sorts of different ways and people are like, I want to
1:13:30
improve my posture because my spine is shaped like this,
1:13:34
right? And it's like, well, you can't
1:13:35
really change the shape of your spine or you'd be in big trouble
1:13:38
if it was just a, you know, a knuckle crack.
1:13:41
But I'm curious if you guys have heard any other like common ones
1:13:44
that these guys benefit? Yeah, this is my favorite one.
1:13:50
People come in a lot of times and it is some other medical
1:13:54
provider to not be named gave them this diagnosis is a lot of
1:13:58
people come and say I have kyphosis, I have lordosis.
1:14:03
If these are words you have heard of, these are adjectives
1:14:05
to describe your spine, they are not diagnosis.
1:14:08
So we all have kyphosis in our mid back, like your thoracic
1:14:12
spine is kyphotic. Our neck and our low back are
1:14:17
lordotic or they have lordosis and kyphotic just means it goes
1:14:21
this way and lordotic means it goes this way.
1:14:24
And that's it. That's the whole thing.
1:14:26
And so people will come in and have this diagnosis and they're
1:14:28
like, yeah, I have kyphosis in my spine.
1:14:31
Like, yeah, you and everybody else, right?
1:14:34
So it's not a bad thing. It's just a descriptor.
1:14:36
Now, the bad thing is like, if we stay there, if I stay here 16
1:14:41
hours a day, my back's probably going to feel pretty bad.
1:14:45
If I can do this a few times a day, then it's not as bad.
1:14:47
Then I'm not worried about it. So our resting posture, they've
1:14:50
done a ton of research, is not very indicative of pain.
1:14:53
It's more your ability to move through multiple postures.
1:14:56
It's my ability. I can sit with my right leg
1:14:58
crossed, and then I can sit with my left leg crossed.
1:15:00
I can sit slouched and then I can sit nice and tall.
1:15:03
It's your ability to move through those more than it is
1:15:05
just your resting posture. So yeah, there's lots of those.
1:15:10
Yeah, my my favorite one that I touched on is just the wear and
1:15:14
tear, the osteoarthritis, because it's so common in the
1:15:17
aging population and we're getting better evidence that it
1:15:21
if it's painful and it's something you can't manage,
1:15:23
great, that's something to get taken care of.
1:15:25
But if you like, we hear this a lot is they'll be like, yeah, I
1:15:29
have this is my painful knee. And the doctor did an image of
1:15:32
this knee and the osteoarthritis is worse.
1:15:34
It's like, shouldn't that kind of disprove to you that this is
1:15:37
the the that's causing this pain?
1:15:39
So that's one of them. But I would say it's this is
1:15:44
maybe I don't want to make anyone an annoying patient, but
1:15:47
if people give you things like what Phil described where they
1:15:50
label things, they have you, they say you have this, you have
1:15:53
this and they then say, why is that bad?
1:15:57
Because if patient asked me that it's a really good opportunity
1:16:00
to connect with them on OK, here's why it's bad.
1:16:03
And then if they if they say, Oh yeah, that's like you have this
1:16:06
and it's terrible for your spine.
1:16:08
What is that causing to my spine?
1:16:09
What is? And, and if they're describing
1:16:11
things that you're like, yeah, I have, I have issues with that.
1:16:13
That doesn't like I have a hard time with that sounds like it
1:16:16
might be in line with what you're dealing with.
1:16:17
If it's just bad, don't you have these things, you stop this.
1:16:22
That's probably not coming from a good place.
1:16:24
It might be misguided, it might be out of date, it might not be
1:16:27
nefarious, but typically it should be even like in Phil's
1:16:31
case. If you have this, it's OK.
1:16:33
Well, what do I do about it and what do I do about it is not, I
1:16:36
need you to buy 24 visits, 3 * a week for the next month because
1:16:40
we're going to crack your back and tell and then we're not
1:16:43
going to remeasure it. We're not.
1:16:44
And we're not going to look. We're just going to wait till
1:16:46
you stop coming. You know, things like that.
1:16:47
It's like it should be a plan and it should be as frequent or
1:16:51
infrequent or tailored to you, because that's what it's about.
1:16:56
Yeah, you guys all have to advocate for yourselves.
1:16:58
It wouldn't have been in a car accident recently and gotten all
1:17:02
of the mail from all of the chiropractors and the one with
1:17:05
the whistleblower Doctor Who is advocating for one of these
1:17:08
clinics. I don't know.
1:17:10
It was just me. I was so entertained.
1:17:12
It was good marketing. It was like, I kind of want to
1:17:15
go check it out. But that's, yeah, advocate and
1:17:20
obviously people have the education to say these things,
1:17:24
but you just have to go a little bit deeper.
1:17:27
Think about like, what are their intentions with you?
1:17:29
Like stick at the credit card or is it to actually help you move
1:17:32
forward? It might not be so apparent at
1:17:35
face value. Do you guys happen to know this
1:17:39
is just for how many adults are currently walking around with a
1:17:42
disc herniation in their back? Because it's it's more than
1:17:45
people think, right? Yeah, yeah, somewhere around for
1:17:53
you. So Katie's mom went for
1:17:56
something recently and on the right on the scan, they're like,
1:17:59
oh, you have like 3 herniations in other areas.
1:18:01
And she's like, right, rightfully so.
1:18:03
She's like, Oh my gosh, this is bad.
1:18:05
But those weren't any of the things causing the issues.
1:18:07
But again, sometimes that awareness can, can have a, a
1:18:11
negative effect on things unless you have someone to help walk
1:18:13
through that as well. Probably.
1:18:16
Probably violating all my scope of practice rules, but not a
1:18:20
doctor. I'm a medical place.
1:18:23
What are? Each of you.
1:18:25
Seen in your respective fields and sort of in the workout arena
1:18:29
in general for that perimenopause, menopause, post
1:18:34
menopausal? Woman because their needs, our
1:18:37
needs, my needs are completely. Different and so I'm just
1:18:42
wondering what you're seeing if you know in your, you know,
1:18:46
like, yes, it's finally coming to the fore or oh.
1:18:50
It's not that different or I don't know.
1:18:56
Yeah. Obviously working in the public
1:18:59
health space, I see more of this then maybe you do, maybe not.
1:19:05
But I would say I'm seeing a lot more one, just women's strength
1:19:10
training around that time in general.
1:19:13
And because I think there's a lot more knowledge and advocacy
1:19:16
coming out for like, hey, symptoms that come during that
1:19:20
time being like biggest ones that benefit from this is like
1:19:23
loss of bone mineral density. The best thing you can possibly
1:19:27
do for that is strength training.
1:19:29
And so I think in that capacity, I'm seeing a lot more as well as
1:19:33
just like general health fitness, like the more the
1:19:37
better your cardio respiratory system is, the better your
1:19:39
muscular system is going into menopause, the less symptomatic
1:19:42
your menopause typically is. So I think we're seeing more
1:19:46
research in that and knowledge in that coming out.
1:19:49
So I think we're seeing more people advocate for that.
1:19:52
It's definitely not where it needs to be, but I would say
1:19:55
it's kind of moving in that direction.
1:19:58
The other big thing that's kind of controversial in that is like
1:20:00
hormone replacement therapy. There's a lot of big questions
1:20:02
are on that, and I get a million questions on that as previously
1:20:05
there was research saying that we don't do that, we can't do
1:20:08
that. It increases our risk of cancer.
1:20:10
And there has been a ton of new research that says that was
1:20:13
inaccurate. That study wasn't very well done
1:20:16
and didn't have very good methods to actually get there.
1:20:19
So they've done some updated research and have found that
1:20:21
there isn't a clear correlation between that.
1:20:24
So now there is also an increase in hormone replacement therapy
1:20:26
being prescribed. Which is also resulting in less
1:20:29
symptomatic menopause, post menopause, stuff like that.
1:20:35
And I guess, yeah, that that research about hormone
1:20:38
replacement therapy is awesome because there's a lot on males
1:20:42
and not a lot on females and males is maybe if this is
1:20:45
subjective, but a little bit more vanity based, a little bit
1:20:48
more performance base of people wanting seeking things like
1:20:51
that. Where women, it's definitely
1:20:53
more of something that is less they're more altruistic.
1:20:58
I should say. It's necessity.
1:20:59
It's things that maybe will be needed.
1:21:01
I'm the one thing that I would say that I see in the orthopedic
1:21:04
field to watch out for is just that it is not acknowledged.
1:21:08
It's just like I see a lot of post op patients, a lot of
1:21:11
surgical people. It's not something that's
1:21:13
considered because a femur is a femur is a femur unless you have
1:21:19
some, unless you have a Shavetta DEXA scan, you have a diagnosed
1:21:23
osteoporosis condition, something that would be a true
1:21:25
contraindication to surgery. It is not you, you are viewed
1:21:30
the same as a, you know, whether you're a 7 year old woman or a
1:21:34
50 year old man, if they can do surgery on you and I think it's
1:21:36
appropriate, they'll do it and then you recover, that's your
1:21:40
problem. So not that that's the, I think
1:21:42
there are evil intentions behind that, but it's it's perfectly
1:21:45
fine to when you're seeing someone and I suggest something,
1:21:49
ask that question. What if I am perimenopausal?
1:21:52
If I'm menopausal, What does that?
1:21:54
What effect does that have on this?
1:21:56
Because the best answer from someone who doesn't know is I
1:21:59
don't know, but we have resources.
1:22:01
Like there are people I can talk to you where it says it doesn't
1:22:05
matter. It's like, that might be true,
1:22:07
but there should be a little more reassurance provided for
1:22:09
that. So that'll be the one that needs
1:22:10
just a little self advocacy. It's not that they're that
1:22:13
they're people have your worst interests in mind.
1:22:14
But yeah, it's as I'm sure maybe you know, the healthcare and
1:22:18
medical field is very much behind on women's research and
1:22:23
differences between sexes for things.
1:22:25
So just keeping that in mind and that someone who may be an
1:22:28
awesome surgeon has been doing it for a long time.
1:22:32
That's not really something that's on their radar and should
1:22:35
be. Just in the gym front as far as
1:22:41
the Perry postmenopausal focus, it's, it's just about really
1:22:46
working around a lot of the symptoms, right?
1:22:48
And we're not really qualified to change or diagnose too much,
1:22:53
but we're just we're here and we've seen that it's very
1:22:55
common. Most of our clientele is 40 plus
1:22:58
and is approaching or is past menopause.
1:23:01
And so it's about managing, you know, fatigue and focusing on
1:23:04
sleep and the things outside the gym so that we can still do our
1:23:07
job in here as well. But there's been a lot of
1:23:11
advocacy and empowerment for women when they come in and
1:23:14
like, Yep, I'm this. And I know I need a strength
1:23:16
train, so I'm doing this not sleeping great all the time, but
1:23:19
I'm, I'm here to do this. Yeah.
1:23:22
And things like bone density, it's, there have been a couple
1:23:25
of clients who worked with that have take medication for it.
1:23:28
And they wanted just to coincide with that to make sure bone
1:23:31
density stays high early on because, yeah, it's tough,
1:23:35
usually a matter of time for women before they get least
1:23:37
osteopenia. And, and so that can be really
1:23:39
scary. So we're trying to do our part
1:23:41
on that end in the gym. Fueling also becomes so much
1:23:46
more important, like it's already important as is, but
1:23:49
fueling adequately during that time, actually sometimes even
1:23:54
increasing protein and carb intake becomes super important
1:23:57
in your recovery from your workouts, especially if you are
1:24:01
working to increase muscle mass at that time, which is ideal.
1:24:06
Just increasing that fueling, even if it doesn't feel like
1:24:10
normal or naturally, like this is a new diet for me.
1:24:14
This is a new way of eating. It becomes even more important
1:24:17
because your body is working much harder.
1:24:19
Whole balance protein and carbs are the two big just like one
1:24:22
from having energy capacity for your workouts to be able to
1:24:26
actually and your day on top of it.
1:24:28
And then protein for actual like muscle mass building.
1:24:32
But also it's just fueling adequately enough helps your
1:24:36
sleep quality as well. So if sleeping is a challenge is
1:24:39
sleeping is a challenge on that front, fueling enough just helps
1:24:43
in general. And that's more just about like
1:24:45
getting enough intake and having a good balance diet.
1:24:49
Yeah, good question. I could ask questions all day,
1:24:51
but let's lay it on. Let me give you the mic too.
1:24:55
Take these on weighted vests. Every every middle-aged white
1:25:01
woman has one on every Sunday. It's OK if you do.
1:25:04
Yeah, there's no judgement. It's it's it's definitely hyped.
1:25:10
I think it's all in the right direction.
1:25:12
They're rocking because they heard his own 2 cardio's great.
1:25:14
So I got to get more of that and so I'm going to wear this tiny
1:25:16
little vest and get my steps and I I think that's great.
1:25:21
I think sometimes people major in the minors, which is like,
1:25:25
you could just walk briskly. You don't have to get the fancy
1:25:30
weighted fast and if you want to, great.
1:25:32
If you want to truly do like rocking, it might be heavier
1:25:35
than what you have on the point is kind of slowed down so that
1:25:38
you can still walk and get in zone 2, which becomes kind of a
1:25:41
whole other thing. But anything that keeps people
1:25:45
moving I think is great as long as it doesn't cause like harm or
1:25:49
misinformation. But I don't think it'll be
1:25:52
around too much longer on the trends.
1:25:55
I think people who have done it will always continue to do it
1:25:58
and people who didn't probably won't in six months.
1:26:02
But I encourage people to walk as often as you can, whether
1:26:07
it's that or doing other things that you love.
1:26:09
Like that's one of the biggest issues I think in our societies.
1:26:13
People just don't do enough movement across any measure.
1:26:16
I don't care if it's pickleball, walking, golfing, We just need
1:26:20
to do more during our downtime. So if that helps someone do it,
1:26:23
they're motivated by all means. It's definitely not going to
1:26:25
hurt. We were actually talking about
1:26:28
this just a little bit in the back, but it if someone said if
1:26:32
I said what do you do for cardio?
1:26:33
And you said I go for walks and I said OK, great.
1:26:36
What do you do for strength? And you said I wear a rock or I
1:26:39
wear a weight vest and say OK that's cardio.
1:26:41
Again, what do you do for strength training?
1:26:44
It's awesome, but it's not doing what you think it is.
1:26:47
Anything that you could do for 10,000 reps consecutively, it's
1:26:50
probably not building strength. Not bad, just not checking the
1:26:54
box that maybe people are being sold that it is.
1:26:58
Yeah, mine kind of mirrors his is like if it's cardio, it's
1:27:01
cardio, it's just not strength. Yeah, these are good questions
1:27:07
though, big ones. All right, Scott, do you have a
1:27:13
question? I'm going to start just going
1:27:15
names. I know everyone's name, I think.
1:27:22
Coaches, do you have a question? Blake, Rowan.
1:27:24
I can start. I have a question.
1:27:27
So as a coach, I really try to enforce like bracing.
1:27:32
Do you have any other exercises besides like a dead bug that you
1:27:36
would use to help your people learn how to brace their core?
1:27:41
I try to really encourage bracing in different positions
1:27:44
because bracing flat on the floor is like a good starting
1:27:48
point. So either with a dead bug or
1:27:49
I'll have people like banded overhead do a marching or a
1:27:52
bridge or something like that. But then if we transition from
1:27:56
that to squatting, then a lot of times we lose it because they're
1:27:59
upright and we don't have that external support that is the
1:28:01
floor. And so bracing more in an
1:28:03
upright position from there. So I'll have them do a similar
1:28:06
movement. I like to do like kind of in a
1:28:09
split spot position, but a band overhead and get them to pull
1:28:12
and brace here, kind of tuck the ribs down, get a brace core
1:28:16
there and then see if they can hold that.
1:28:19
Anything, anything you can do in the up weighted position.
1:28:22
The big things I try to queue people out of is we're not
1:28:26
pushing out and we're not sucking in because that's the
1:28:29
most common error I see when I'm like, OK, engage your core.
1:28:31
And they're just like, OK, and like we're just kind of pushing
1:28:34
pressure down South, queuing more that it's we're softening
1:28:40
the ribs, getting that full 360 brace and then being able to do
1:28:43
something. I can carry a weight, I can
1:28:46
squat, I can March in place, whatever it is and maintain that
1:28:49
brace. So very non specific answer, but
1:28:52
as the sooner you can get them off the ground, the better.
1:28:55
Yeah, awesome. I do see a lot of low back pain
1:29:00
and sometimes I'll try to get people to just learn how to
1:29:04
brace and kind of up to Trina's point, if it's not about the
1:29:09
pushing out or pulling in somewhere in the middle.
1:29:11
However, a lot of people have no idea how to even push out.
1:29:16
We can suck in and do kind of a not good brace, but people don't
1:29:20
know how to push out. If you've got someone who's
1:29:22
wearing a worn weightlifting belt before they know how to do
1:29:24
that, that's fine. But what I'll do with people,
1:29:26
and we use it like gate belts or like take a band, poop it around
1:29:29
your stomach, figure out how to push into that.
1:29:33
Because if they can then do it really well, it's like, OK, kind
1:29:35
of like what you were saying. That's probably just pushing
1:29:38
out, but at least you're using those muscles now.
1:29:40
Now just think about little bit of pressure into that, embracing
1:29:43
everything tightly. But sometimes a physical cue can
1:29:46
work really well. Hands on your stomach.
1:29:48
Yeah. A band just to get.
1:29:50
All right. Do you know the difference
1:29:51
between out and in? Awesome.
1:29:53
Let's find the middle ground. Because if they only know one,
1:29:55
it's hard to go the other direction or hit him with PVCS.
1:30:04
Yeah. Something to kind of build off
1:30:07
of of that is like low back, right, because everyone thinks
1:30:10
like I have strengthened my core because my back hurts.
1:30:12
So I got to strengthen the rectus abdominis, right?
1:30:14
And would have been told they're transverse abdominis, but it
1:30:17
ends right closer to the mid back, but it doesn't wrap around
1:30:21
like a belt. And sometimes that's what's sold
1:30:24
to people. So strengthen the low back
1:30:26
specifically that Roman chair is probably the most useful tool we
1:30:30
have in here starting with isometrics and just getting
1:30:33
really comfortable with hinging even it's not perfect in that
1:30:36
low back, it's OK to bend a little bit.
1:30:39
Otherwise pretty sure your spine would just be a straight rod,
1:30:42
right? But there are there is movement
1:30:44
that's supposed to be designed there, but you got to use it.
1:30:48
And I think as I said earlier, and the topic of great exposure
1:30:52
is you get wet snow in Minnesota and you haven't shoveled for one
1:30:56
year and you bend and twist for half an hour, it's you're not
1:31:00
going to be feeling great the next day.
1:31:02
So in here, we're trying to mimic some of those, even with
1:31:04
slightly incalculated imperfect motions to replicate what life
1:31:09
is like. Because you guys have seen the
1:31:11
video, What if you keep your back straight all day and the
1:31:13
guys are doing things with perfect posture everywhere?
1:31:16
And that's not, it's not quite how life works, especially if
1:31:20
children hang on you like a crane.
1:31:24
So, so kind of line with that Corb racing is you can't forget
1:31:27
to also strengthen the backside, specifically those years that
1:31:31
probably might not feel great all day.
1:31:33
But Derek, do you have any questions, something you want to
1:31:39
ask them? Phil, why weren't you, why
1:31:42
didn't you show us the lobster claw deadlift?
1:31:44
That's my question is why? Why do we skip over that?
1:31:47
That was That's a sneak preview place.
1:31:51
It that was actually. I think it was perfect, I think.
1:31:56
It would have been me. Hopefully this was helpful.
1:31:57
You guys will send a survey out, but we really appreciate you
1:32:00
guys being here. I'd like to make sure we all
1:32:02
give these two a big round for doing this.
1:32:06
They did not have to show hands that everyone gained at least
1:32:12
one or two pieces of really useful information from this.
1:32:15
OK, OK, excellent. Oh, Scott, you good.
1:32:22
Derek's the only, the only coach that's worked here that we still
1:32:26
will, like, grab food once in a while.
1:32:27
But now we both got kids, so that's over.
1:32:29
I mean, two schedules with children now.
1:32:32
It's not going to happen. And if you've ever planned
1:32:34
anything with Philly? Yes.
1:32:37
All right. Well, again, thank you guys.
1:32:39
We'll be hanging out, but thank you.
1:32:41
We'll still be hanging out and see if any specific questions or
1:32:43
want to ask these guys more about what they're doing, please
1:32:46
do. Otherwise, thank you so much for
1:32:48
joining and we will see you guys in the next one.
1:32:50
Thanks everybody.