Latest / The Layback Podcast / Dan Braun, DPT, Braun Performance + Rehab (Ep. 58)

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Dan Braun, DPT, Braun Performance + Rehab (Ep. 58) · The Layback Podcast

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Hey everyone, welcome back to the Lay Back podcast.
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Joining us today is Dan Braun. Dan is the founder, owner,
0:08
operator, all the above for Braun performance and rehab as
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well as the head of rehab for ISO Fit.
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For those watching, you can see that on his hat.
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Dan and I got connected through a good buddy of both of ours.
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Shout out Matt Tomitz seems to be the ultimate connector
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lately. He he's the man with all that
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stuff. Also just took a new job with
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1080 Sprint. So he he's got some cool stuff
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going on. But yes, big thanks to Matt for
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getting this rolling between us. Dan and I first met officially
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at winter meetings this past year.
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Had an awesome conversation just in like the food hall in the
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middle of the hotel in Dallas running through our tech.
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They, they pulled out ISO fit, just set it up and we were
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running through exercises and getting a lot of heads to turn.
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So it was funny that I guess we were both the center of
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attention upon our first meeting with people wondering what the
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hell is going on as we're doing donkey kicks and searcher squats
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and some Max effort grip strength stuff just in the
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middle of a Dallas hotel. But Dan, this is probably a much
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more relaxed environment to actually talk in and I'm excited
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to dive into things today. Thanks for coming on and I'm
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looking forward to this. Yeah, Adam, I really appreciate
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your time and looking forward to hopefully sharing some good
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insights with your audience, man.
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Definitely, yes. So things might be a little bit
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different today from one of our normal conversations look like
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given most of the athletes, clients, patients that you treat
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seem to be lower body injury based.
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Now, that doesn't mean the work you do does not apply to what
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we're doing in the arm injury world because you're also
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working heavily on research and kind of pushing the industry
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forward on how exercises are implemented or what may be a
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professional clinician might choose to use as an implement in
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the return to performance. So I definitely want to go down
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that road as we progress. But let's kick it off a little
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bit with your background, how you got into PT, and then maybe
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even what you're doing beyond the PT world.
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Yeah, I mean, it's quite a story, but I'll keep it short
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for people. I did a undergrad and exercise
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science at Lebanon Valley College and rolled right into my
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doctorate of physical therapy program there.
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So I was able to get both in about six years.
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So I was a full time practicing clinician at 24 years old,
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thought that I would know everything and rule the world
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like everyone does at 24. And I very quickly learned that
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there's a lot more to this whole physical therapy thing than I
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realized. I kind of pivoted a little bit
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for my first job out of school and got into the partnership
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situation that I'm currently in where I'm kind of overseeing our
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Maryland operations in the clinic and we've got multiple
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clinic sites and I've got multiple PTS working underneath
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me. Along that time, I've kind of
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had a podcast that I've kept going for about 5-6 years now.
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I don't even know. Kept the podcast going and along
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that way Matt, Brad with ISO Fit, Matt, Tanya and Gohan and
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Mark with Oro. Met a lot of other great people
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and was thankful enough get involved with them that way.
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And as of the current moment, I'm just kind of running it on
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all fronts and seeing where things take me.
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So you mentioned a few things in the mix there.
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You're doing a lot more than just treating athletes and
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trying to get them back on the field.
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So maybe if you could talk a little bit more on the high
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level overview for ISO fit in Oro, just kind of explaining
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what those couple of things are. Yeah, definitely.
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So I got connected with Brad a number of years ago after I'd
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brought an individual named Derek Millander on the podcast.
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We released our episode and I was quickly connected with Brad
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afterwards. And essentially, ISO fit, it's
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just a device to restrain movement.
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So it allows you to do isometrics, overcoming
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variations, yielding variations. And I have about four of them
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myself. I use them clinically for a
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variety of different things. At the end of the day,
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ultimately functions as a fancy wall that I can push in or pull
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on and it won't move. The Oro is a Surface EMG type of
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device that connects to my phone via Bluetooth.
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So if you have a iPhone or iOS device, you can just connect to
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it and then you can get real time actionable insights into
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muscle activity. So I use that with a lot of my
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rehabs, almost all of my rehabs, I would say just to get a little
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bit more insight as to what might be going on under the
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hood. Things that I might not be able
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to see with my own two eyes in relation to how that person's
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moving or how that person is accomplishing tasks that we
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throw their way. Great.
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OK, I think those are some awesome things to hit on early
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on. Normally we would do this on the
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back end, but since it's already come up twice, let's just go
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over some of the quick details of the podcast on your side if
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you want to shout out the name of the podcast and maybe kind of
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what you guys cover. Yeah, I mean, it's just Braun
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Performance and Rehab podcast. I try to drop about two episodes
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a week and that ranges from subject matter experts like Adam
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all the way up to athletes and other active individuals trying
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to give everyone a seat at the table, break down the walls that
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exist between our disciplines and bring everyone together to
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hopefully enhance our knowledge and the performance and rehab
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spaces. Perfect.
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Thank you. Like I said, normally do that at
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the end, but no sense burying the lead since we've already
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talked about it a couple of Times.
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Now let's step it back in your own process as a clinician, how
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you've progressed. Obviously you've brought in
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technology such as ISO fit and Oro or different advancements to
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your practice, but maybe how have you seen things change in
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your relatively short time in the industry?
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Granted, you're still young, you're still growing, but it
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sounds like you have made a ton of advancements on what you are
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doing and then even what you're trying to spread education wise.
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So I'd love if you could just walk the audience through that.
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Yeah. I mean, I think anyone in any
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space needs to find a way to evolve with the times.
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And I think that the rehab space is certainly no exception to
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that. I think that when I graduated
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from school, I had a great base knowledge of a lot of different
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things, right? You kind of get that great
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30,000 foot overview, but you start to take that general
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30,000 foot overview and apply it specific use cases and you
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start to realize there's gaps or there's things that we're
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missing or maybe the way we've always done things isn't
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necessarily the way we should continue to do them.
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Take for example, your ACL or your post op shoulder return to
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sport testing. A lot of the ways we've returned
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these athletes to sport hasn't really changed in 30 plus years.
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A lot of the protocols are still the same, yet we have
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advancements and new technologies available to assess
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things that we previously could not.
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So I feel like it's kind of on the clinician a little bit to
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take matters into their own hands and learn about some of
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the advancements that are being made and learn about how we can
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better provide for the athletes that we get to serve day in and
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day out. I use those words intentionally.
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I look at what I do from a rehabilitation standpoint as a
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service based thing. It's not about me at the end of
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the day, it's about the athlete that I get to work with.
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It's the athlete that I get to get back to doing what they love
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and hopefully they stay there indefinitely.
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And I think the more we just focus on what is best for the
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athlete, the better our conversations become as
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clinicians. I think you may have provided a
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nice route to go down there. Your words and hopefully I don't
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even butcher this from a few seconds ago you said deciding
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what is best for the athlete. So maybe in the exercise
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selection process, how do you decide what is best for the
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athlete? Yeah, I mean, there's definitely
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a method to the madness, like anyone would say.
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The Oro plays a role in that for myself, where I'll EMG an entire
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session and see what exercises elicit the best response for
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whatever muscle I'm trying to target, whether that's the quad
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or the deltoid or whatever we're after.
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So there's a scientific approach to that.
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But otherwise, a lot of times I'll kind of leave it up to a
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little bit of individual preference based on how they're
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responding to things and what they like to do.
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Take the squat, for example. I really don't care what
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someone's favorite squat variation is, whether it's back
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squat or front squat or serger squat, whatever they like.
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But if we need to load them heavy and we need to get
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stronger through the squat pattern and rehab pick whatever
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their favorite is and we'll just attack that.
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It doesn't really matter to me, but I'm certainly not going to
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force them to back squat if they don't like the back squat.
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We have plenty of other options with plenty of other tools in
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the toolbox that we can use. So I think it's a combination of
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how can we combine scientific advancements and technology that
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we have with the ability to just kind of give the athlete that
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we're working with a seat at the table.
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I think that's a great way to go about it.
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You're still empowering the athlete to provide what they
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enjoy. And ultimately, if an athlete
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doesn't enjoy their process or their experience, you're likely
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going to be leaving food on the table.
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They're not going to be excited or motivated every time they
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step in to get better. And I suppose you always have to
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take into account that human element for what you're doing.
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Exactly, Yeah. And building off of that a
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little bit, there's certain things that I don't like doing.
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And if I have to go someplace two to three days a week at a
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time when I'm already down bad because I'm recovering from some
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kind of injury, maybe I'm not playing the sport.
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I want to do whatever it is and I've got to go do a bunch of
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things that I don't like to do. Or maybe I'm around someone that
10:20
like just doesn't understand the situation that I'm in and I just
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don't feel like I'm being heard. I'm not going to want to go
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there. I'm not going to want to put my
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I'm in and check the boxes and you know, yeah, all good, keep
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it moving kind of thing there, right?
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Like I'm going to mentally just kind of check out of that
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situation. So I think the more, again, the
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more emphasized you can be on what is the athlete need and
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what is best for the athlete and giving them a seat at the table,
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even if it involves maybe not doing the first or second best
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exercise for them. Maybe it's the 3rd or 4th best
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exercise, but it's the one that they can actually do and it's
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the one that they enjoy doing. I'll make that transaction any
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day of the week. I'll pick the exercise that
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they're going to do over the exercise that maybe is a little
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bit better because of research, but if they can't do it, then
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there's no point in trying to chase that rabbit, if you will.
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Right. It's kind of the chop wood carry
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water approach to a certain extent.
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Just do what you can do every time you're in there and you're
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going to yield tremendous results over time, especially
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with the type of injuries you're dealing with or the injuries
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that we most commonly see in our world.
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It's very seldom small, ticky, tacky things that just rest in,
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I don't know, something that makes you feel good will make it
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go away. Right.
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I hesitated to say ice or something like that since all
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the research is out on ice. But yeah, whether whether it's a
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topical cream to make it feel better, like if that's making it
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feel better, like that's not what you're treating in the
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grand scheme of things. You're you're treating things
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that have a legitimate treatment plan over the course of month to
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month to even a year. So it, it is very important just
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to kind of stack wins in that regard.
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Now kind of moving this along, when would you begin to
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introduce the exercise or the modality that might be the first
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or second choice that the athlete might not have been on
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board with or prepared for early on?
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Is that when you'll introduce kind of testing again or data to
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ultimately say like, look, this might not be your favorite, but
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we're at the point where we need to expose you to something new?
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Yeah, I mean, it becomes question of, you know, what my
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role is with the athlete and where I kind of fit in at their
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metaphorical table, if you will. Let's take the squat, for
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example, since I brought that up earlier.
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There's times when maybe athletes start with me squatting
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on a slant board and then overtime we get that slant board
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away because the range of motion has improved, their eccentric
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control has improved, their overall movement strategy is
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better. So we don't need that anymore.
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That's great. So maybe we can take that away.
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They feel good with it and we're off to the races.
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So with that, I kind of look at it as almost like a criterion
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thing. It's like, hey, you don't want
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to do this. It's not the best exercise for
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you right now. Why is that?
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Look at it a little bit deeper, kind of form our checklist,
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check those boxes and then say, oh hey, now we can actually do
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this exercise because we've met all the criteria.
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Once we met those, then we're off to the races.
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However, like I mentioned, it always comes back to what is my
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role with the athlete because I am more than happy to steer the
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ship or I'm more than happy to kind of take a backseat role.
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There's a lot of other great individuals in the space, right?
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Strength and conditioning coaches, chiropractors, athletic
13:49
trainers. And I think ultimately it's not
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about what one person can do, but about what we can all
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collectively do to help the person in front of us.
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So, you know, it might not necessarily be the kind of thing
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where I'm the one that's going to take them from where they're
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at to where they need to be. I'm going to get them maybe 80%
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of the way there and someone else is going to finish the job
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for them. So I think that ultimately, like
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I said, I like to have that systemized approach of, OK,
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here's where we're at, here's where we need to go, what are
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our steps to get there and how do we check those boxes off
14:23
systematically in order to get there.
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But by the same token, I'm perfectly OK knowing that
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someone else might be the one to finish the job.
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As long as we've communicated and as long as we're on the same
14:33
page, I'm OK with that transaction.
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Have you seen that communication loop change since your time
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entering the industry? Because it seems like that theme
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is discussed way more now, kind of the all hands on deck
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approach as opposed to the this athlete is mine and I'm going to
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see this through style of approach.
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Yeah, 100%. And I mean, admittedly, I think
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out of school I certainly had a little bit of that kind of
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mindset. And I don't want to throw stones
15:06
at glass houses here by any means with education because I
15:09
certainly learned a lot. However, I felt like a lot of
15:13
emphasis from my schooling was on autonomous practice and how
15:17
to kind of go your own way and do your own thing that way,
15:20
which is great and it's great to have that confidence.
15:22
But again, ultimately, I think it's more about how we all
15:25
collectively fit together and work together.
15:28
And I think based on the conversations I've had with a
15:31
lot of people, a lot of people have tried to make it work on
15:34
their own and they realize that they can't do everything on
15:38
their own. They can't be Superman and solve
15:41
every single problem or eventually they run into a
15:44
little bit of a roadblock. Or hypothetically, maybe you're
15:48
working with a baseball pitcher and he has a lot of laxity in
15:51
his elbow and he starts explaining a mechanism that
15:54
sounds a lot like almost like a UCL type injury.
15:57
It's like, well, I might be able to rehab them post operatively,
16:01
but I'm sure as heck not going to do their surgery.
16:03
So I better have a good relation with their surgeon's office,
16:06
their surgeon's physician assistant and so on, Right.
16:09
Like I think, but ultimately the more you have relations with as
16:13
many people in the space and the more you can kind of build that
16:16
rehab team around you, the better off everyone is going to
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be. Then again, it took me a little
16:21
while to kind of fully grasp that concept and I'm certainly
16:24
by no means perfect at it. It's something that I think
16:27
we're all trying to be better about.
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But I think as long as your actions align with what does the
16:33
athlete need and what is best for them, then you really can't
16:36
go wrong. Obviously there's times when
16:39
you're going to clash heads and butt heads a little bit along
16:41
the way and that's normal. But again, as long as you're
16:44
always acting with the athletes best interest in mind, you're
16:47
going to be OK. I think that's the beauty of it
16:51
to a certain extent. If everybody is acting with the
16:55
athletes best interest in mind, as you said, there are certainly
16:59
going to be times where there are disagreements.
17:02
But ultimately everybody wants the best for the athlete.
17:06
They want to see the athlete succeed.
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So often times that clashing or that network having small
17:14
disagreements is going to require each member of the group
17:17
to come fully prepared to a discussion with research backed
17:21
information or previous case studies citing why something
17:27
might be the course of action. So to me this is kind of a
17:31
rising tide raises all ships type of situation where if there
17:36
are more cooks in the kitchen, yes there is a potential
17:43
situation for disagreement, but in the end to me it seems like
17:47
the athlete is going to benefit most as long as cooler heads can
17:52
prevail. Yeah, 100%.
17:54
I think that's a great point. And I think ultimately it comes
17:58
back to knowing yourself when you're in those situations,
18:01
right? Like knowing like, hey, maybe
18:04
I'm getting a little bit emotionally invested or
18:06
emotionally heated right now and I need to take a little step
18:09
back, right? Like I think it's normal that
18:12
everyone might look at things and think, well, my way is the
18:14
best way or it's my way or the highway, right?
18:16
It's like, well, I work with a company that makes isometric
18:19
exercise equipment, so of course I'm going to say isometrics or
18:22
die, right? But it's like, no, sometimes
18:24
there's a million different ways to skin a cat.
18:27
And ultimately it doesn't have to be like one right or wrong
18:32
approach. It's about whatever one makes
18:34
the most sense for the athlete at the time.
18:37
And I think that I'm just at a point, at least in my own
18:40
career, where I'm willing to kind of like take more of a
18:44
backseat role if that's what's needed in order to get the
18:47
athlete back. Like I said, I have no problems
18:49
kind of steering the ship, but I think it's more about how do we
18:53
fit into that team and just kind of be available, be an asset, be
18:57
a resource and ask the question more of how can I help and what
19:01
do you need me to do? Because you're going to find out
19:04
a lot about people by doing that.
19:06
And I think it just makes things a lot easier from that
19:09
interdisciplinary team management approach as opposed
19:12
to just trying to run in guns a blazing with everything.
19:15
I think a lot of times when people talk, they think that
19:18
there's like beef between certain professions and
19:20
healthcare. And personally, I don't I don't
19:22
think that is a thing or I don't think it should be a thing.
19:25
I think it's just all about, again, knowing where you fit
19:28
into the team and knowing what you can do to help enhance the
19:31
work that others are doing. So how often are you
19:35
communicating with athletic trainers at schools or sport
19:39
coaches? Yeah.
19:40
So I try and keep a regular communication on a weekly basis
19:45
that way. So give you an example.
19:47
I fax all of the notes that I have from university athletes to
19:51
the university athletic trainers at the end of the month.
19:53
They all have my cell phone, they all have my e-mail.
19:57
They can reach out anytime to me.
19:59
As far as orthopedic providers, I'm communicating with them on a
20:02
weekly basis, whether that's the surgeons directly or their
20:05
physician assistant. And same thing with the strength
20:08
and conditioning coaches as well, is they all have my cell
20:11
phone numbers. They know that if they need
20:13
anything, they can reach out to me, whether that's force plate
20:15
reports, VBT, whatever they want, I can get it for them.
20:20
And I think just making yourself available and accessible is
20:23
really, really essential. I would like to have more of a
20:26
formal interdisciplinary meeting.
20:29
Where it's everyone brought together.
20:31
However, I'm not part of a university, I'm not part of a
20:35
organization or anything like that.
20:37
I'm on private practice. So a lot of times, and this is
20:41
just based on my own experience, I think that the universities
20:44
have their own, I think teams have their own and that's great.
20:46
But you know, they're probably not going to bring me on the
20:49
private practice into those things, which I totally
20:52
understand and respect that way, but that's something I could see
20:55
in the future being a beneficial thing for us all. 100% I
21:00
completely agree with what you're saying.
21:01
I think in a perfect world, schools or organizations could
21:05
bring in outside help and to be fair, that is kind of what we
21:09
see at the professional level. When athletes have more of their
21:14
own agency, especially at the highest levels, NBAMLBNFL, they
21:20
might work through their own agent to find a medical provider
21:25
and then that private professional might be involved
21:30
when the athlete is transitioning back in.
21:33
Unfortunately, that is less often the case with scholastic
21:37
athletes or athletes at the university levels.
21:40
But fingers crossed, maybe we'll see a change in the future now
21:43
with this NIL world we live in and more rights to the student
21:48
athlete. But I, I want to shift a little
21:50
bit now since in a sense we buried the lead on ISO fit and
21:56
isometrics. This is something that you have
21:58
spent a lot of time on. Obviously we have spent a lot of
22:01
time on in the flex pro grip side of things.
22:04
I think we both have a pretty large bias that isometrics
22:08
provide some incredible benefits in the rehab and performance
22:14
space. Now I would like if you could
22:17
back things up and kind of tell the story about your exposure to
22:22
ISO fit. I know you said it came from the
22:25
from the podcast, but maybe your own evolution of using
22:30
isometrics in training and in rehab to ultimately benefit your
22:36
athletes? Yeah, definitely.
22:37
I mean when I first graduated and I was working my first job,
22:41
I saw a variety of different patients.
22:44
I saw younger athletes, but I also saw some middle-aged and
22:48
older adult individuals as well. And I didn't always get through
22:53
one-on-one time with all of them.
22:55
You know, there's times where I had two people at a time or
22:57
three people at a time and I had to kind of adapt what I was
23:01
doing. And one of the things I found
23:03
with those populations is sometimes they come in and
23:07
they're hurting and they're in pain or down bad that day.
23:10
And I might not necessarily have the time to fully adjust the
23:14
plan for the whole day on the spot.
23:16
Can critique that all you want. We can have a whole separate
23:19
discussion on the healthcare system at some point and talk
23:22
about, you know, patient PTS juggling two to three patients
23:25
at a time. But that's just the nature of
23:27
the beast. And while you might not be able
23:30
to correct systems overnight, we can certainly adapt.
23:33
So I adapted and started adding in a significantly more
23:38
isometrics to my rehab programs because I found a lot of times
23:42
people are not in pain when they're not even moving.
23:45
And it's kind of hard to injure yourself.
23:47
Like if I look away, if you're not even moving, I don't really
23:50
have to worry about you getting injured doing an exercise, for
23:53
example. And so I started to add more in
23:55
and I was starting to see a lot of benefit and results from
23:58
that. People are getting stronger.
24:00
People are certainly like reporting less pain and they
24:03
were just feeling better after every session, which honestly,
24:07
when you're a new Greg clinician, that's kind of what
24:09
you're after. It's like, hey, I want you to
24:11
feel better than when you walked in or I want you to feel like
24:13
you did something and you checked the box and you know,
24:16
this was worth the time that you invested into it and the money
24:19
you invested into this session today.
24:21
So I was pretty happy, happy with those initial results.
24:25
And then like I mentioned, I was connected with Brad shortly
24:28
after I did a podcast with Derek Melander.
24:30
So we got connected that way and we just stayed connected over
24:34
the years. They didn't immediately buy a
24:36
product or anything, but like I said, it was kind of like a
24:39
glorified wall. And I used a wall for a lot of
24:41
things. But from a facility standpoint,
24:44
you have a tendency to make the walls dirty or maybe put a
24:47
little hole in the wall on occasion.
24:49
You know, stuff happens and you start to think maybe there's a
24:52
different way we can to do this. So I also wanted to add in more
24:55
of like a isometric like force testing, if you will.
24:59
Like I really like the mid thigh pole and the belt squat and some
25:02
of these different things that you're seeing guys post about
25:05
all the time. And the majority of them are
25:07
significantly smarter than I'll ever be.
25:10
But I like the concept of having some kind of other way to assess
25:15
force output instead of just relying on something like A1 Rep
25:18
Max, because a lot of the things I was looking to assess, you
25:22
couldn't just get from a simple one Rep Max.
25:25
And I think the isometrics kind of opened up the door to new
25:28
frontiers and testing. So like I mentioned, I've got
25:31
for the ISO fits right now, But before that I was doing
25:34
isometrics very similarly with what I have and still making it
25:39
work that way. I think it was just kind of a a
25:42
need initially and then I saw the results and then I just kind
25:45
of kept going all in on it because people are getting
25:48
better, people are getting stronger and they were hurting
25:50
less. So I naturally wanted to stack
25:53
all my chips in on whatever was moving the needle forward for
25:56
people. I do think it's very interesting
25:59
that this started for you out of necessity and it grow to you
26:04
seen the opportunities that can ultimately come from it and the
26:08
ability to get creative. So now this might be speaking to
26:13
our own biases a little bit, but are you looking for ways to
26:17
implement isometrics? Lee, are are you kind of like
26:21
going out of your way to implement isometrics or are you
26:24
using it for a specific athlete case?
26:28
Now I, I can speak to this because I don't want you to feel
26:31
like you're on island here. Yes, there are.
26:34
There are other ways that we can contract musculature and see
26:39
improvements from, but there's no question if you're doing an
26:44
overcoming isometric, you can get tremendous data from it to
26:50
make more informed decisions. It is pretty difficult to get a
26:55
good amount of data from an ecentric or a concentric action
26:59
unless you only care about subjective feedback.
27:03
Now in the world we live in or we meaning this guy over here
27:08
talking about Flexpro grip and they're trying to get finger
27:11
forces. I care a ton about the objective
27:16
measurements of the fingers. Now, I do care how an athlete
27:20
feels, but that's to a certain extent early on might be a
27:24
little bit less important. I don't know.
27:27
Of course the way they feel matters, but if they say they
27:30
feel good and they're weak, I don't really care how they say
27:35
they feel. Now, like I said, I just kind of
27:37
wanted to share that on our side before you feel like your answer
27:41
puts you on an island. Yeah, No, definitely.
27:43
I mean, I don't necessarily feel like it would put me on an
27:47
island here. I mean, First off, for context,
27:49
my clinical situation is notably different now because I'm seeing
27:53
about one patient every 40 minutes or so on average.
27:56
So I get a lot more individual one-on-one type time with the
28:00
athletes that I do get to work with.
28:02
And I think ultimately it's not necessarily looking at one thing
28:06
as the end all be all, but understanding where it fits in
28:10
the framework. Because at the end of the day,
28:12
in my opinion, I think we need all of the things.
28:15
I think we need the isometric training.
28:17
But the end of the day, athletes are still going to need to run
28:21
and Sprint and jump and cut and change direction and that sort
28:24
of thing. And if my goal is to take them
28:26
from day one post op on the table all the way back to them
28:30
doing all those things unrestricted on turf, then at
28:33
some point we need to do those things.
28:34
So it's all a matter of where does the piece fit together in
28:39
the puzzle and how does it fit within my overall framework
28:42
Early on, from a post op standpoint, I pretty much always
28:46
start with the isometrics because again, it's very
28:49
difficult to injure things when you're not moving.
28:52
So it doesn't matter if this is a lower extremity like an ACL or
28:55
a hip or even a shoulder labrum or rotator cuff or whatever it
28:59
is. A lot of times you'll look at
29:01
protocols and they almost always start after, after range of
29:03
motion with some kind of isometric, you know, get the
29:06
muscle to fire and activate, but don't have to worry about the
29:09
movement piece. So I really go all in on that
29:12
early on because it's like, hey, look, this is what we're allowed
29:15
to do with respect to tissue healing.
29:17
We can still get some really good stimulus to the muscle if
29:21
we do it correctly. So I go all in on that early on
29:25
as I progress towards the mid stage of their rehabs.
29:28
Again, this is regardless of if it's lower extremity shoulder,
29:32
whatever tend to keep an element of the isometrics in, but it's
29:37
not necessarily the only thing that we do.
29:39
You know, we still play around with a lot of compound patterns.
29:42
We'll play around with extended eccentric type tempos and
29:46
different things really varies based on the athlete and their
29:49
sport and their past training history as well.
29:52
Like obviously if this is the first an athlete is ever being
29:56
exposed to some kind of formal training process that I'm
29:59
probably not going to beat them up with a ton of crazy things
30:02
that you would see share it all over Instagram.
30:05
I'll probably keep it pretty simple and straightforward and
30:07
just kind of check the box for them and they're going to get
30:10
results from that and I'm OK with that.
30:12
So mid stage isometrics are still there and I like to keep
30:15
it. You mentioned from a data
30:16
standpoint, I do like to keep it as a way to get objective data
30:21
points over time. So in the fall I was doing a
30:24
combination of ISO, mid thigh pull.
30:26
I was doing that once a week with the athletes and then I was
30:30
doing this in the full and I'm still doing it where I'll take
30:33
the Oro, the surface EMG and I'll just get MVC for their VMO
30:38
and their rec FEM on a regular basis.
30:40
That way just to give me a more like robust data set as to where
30:44
they're at and how they're progressing objectively over
30:47
time. And why I mentioned that is I
30:50
think in the return to sport conversation.
30:52
And again, this is regardless of shoulder, knee, lower extremity,
30:56
upper extremity, whatever. We've cleared athletes based on
30:59
return to sport being an event almost.
31:02
It's like a day and a time that you look forward to and if you
31:05
pass certain things, you're magically good to go.
31:08
But in reality, that is just a snapshot of that athletes
31:12
progress over the past several months or potentially even
31:15
longer depending on the injury. I'd rather make the decisions
31:19
based on data points that show me their progress over time.
31:23
Or I can map it out and visualize it ahead of me as
31:26
opposed to trying to look at 1 moment in time and saying, well,
31:29
they checked all these boxes, so they're good to go because the
31:32
next day they might not check half those boxes or the day
31:35
before, they might not check half those boxes.
31:37
So I'd rather see the trend over time as opposed to looking at,
31:42
you know, 1 little set of data points, if you will.
31:45
And I think the more we can kind of collect that systematically,
31:48
the better we do from a rehab standpoint as well because it
31:51
gives us the option to course correct if something's not going
31:55
according to plan, right? I don't think any, everyone
31:58
would say that rehab is always linear and it's just a constant
32:00
marathons of UPS. Sometimes we go up and then it
32:03
dips down a little bit and then we go back up.
32:06
But when we notice things are not going the direction we want,
32:09
that's our opportunity to step in, intervene and course correct
32:13
it. And so the more often you're
32:14
looking for those little dips, the sooner you're able to course
32:17
correct. And sometimes those little dips
32:19
occur, you've just got to push a little bit harder.
32:22
Other times it's actually a time to take a step back and look
32:25
outside of what you're doing. There's been times when I've
32:28
been perfectly happy with the rehab program we've designed for
32:31
an individual and I'm OK with what we're doing.
32:35
So then we have the conversation about what other factors could
32:38
be influencing it. I think a lot of times we as
32:40
clinicians tend to put everything on our self and think
32:43
that it's all our fault. When in reality, sometimes it's
32:46
the fact that your athlete is in midterms, they're sleeping two
32:50
to three hours a night, they're eating one meal a day, and their
32:53
significant other just broke up with them.
32:54
It's like sometimes life happens and gets in the way and we just
32:58
kind of forget about that side of things, the other context as
33:01
well. So I think ultimately
33:03
understanding that you have to have a framework for everything
33:07
that you do, isometrics are certainly a key element of that.
33:10
For me. It definitely starts heavier on
33:13
the isometrics and then phases out over time.
33:16
But I keep the isometrics in there from a training standpoint
33:19
and I also keep it in there from a objective data collection
33:23
standpoint as well long term. And I think that that becomes
33:27
extremely valuable to our overall process and working with
33:30
athletes. I think a couple of the major
33:33
highlights in there might be the low injury risk, especially
33:38
early on, and then the ability to create a frequent and
33:43
repeatable observation window. It enables you to check back in
33:47
constantly on what progress an athlete is making without having
33:53
to worry too much about form during an exercise, or them
33:58
getting overly fatigued for that matter.
34:01
As opposed to if you are trying to check in with an athlete and
34:05
have them do a Max deadlift to see if they're improving versus
34:10
just a single bout. Mid thigh pole.
34:13
Those two things are entirely different stimuli to the body.
34:18
Yeah, they're definitely different stimuli.
34:21
And it's the other piece that I think you're kind of alluding to
34:23
as well is because you can train these frequently if you're
34:27
pressed for time or if you're like me, where you only see
34:30
athletes two to three days a week, if you're lucky.
34:33
Or you might have to fill in the gaps when they're not in front
34:36
of you or you might have to make the most of the time that you do
34:40
have with them. And it's like, how can I get a
34:42
lot of different stimuli in a short amount of time?
34:44
And I think that we talk about isometrics, but we don't often
34:48
talk about micro dosing isometrics where it's like, hey,
34:51
I want you to do these three or four things, but I want you to
34:54
do them every single day. It's only going to take you, you
34:57
know, 5 or 6 minutes or, you know, hey, when you come in,
35:01
we're going to cover 20 different isometrics, but we're
35:04
only going to do them for 20 to 30 seconds each.
35:06
And now in less than 10 minutes time or in 10 minutes time, I'm
35:10
able to actually cover 20 different isometric type things.
35:13
So I think that there's a lot of power that comes from that
35:17
casting a wide net to cover a lot of different things as
35:20
opposed to I think that there's a lot of value in digging deep
35:23
and going into that inch wide mile deep that I'm sure everyone
35:26
has heard about. But I also think at the end of
35:29
the day, athletes solve movement problems and have a wide array
35:34
of movement strategies that they use.
35:36
So if we're not exposing them to a variety of different training
35:39
stimuli, then ultimately we're kind of not providing for them
35:44
fully. We could be doing better, if you
35:46
will. So I think the more we kind of
35:48
cast that wide net understanding that athletes are constantly
35:52
compensating and constantly doing things in new, crazy,
35:55
different ways, the better off we're going to be.
35:58
Taking some time now on what you said about the micro dosing of
36:04
isometrics. Somebody worth mentioning here
36:07
is Doctor Keith Barr, kind of a leader in muscle tendon
36:11
research. I love that you're not even
36:13
furiously for those who are listening, not watching, Keith
36:17
Barr just had another awesome interview recently with Eric
36:23
Cressy on the Elite Baseball Development podcast.
36:26
And the way Keith Barr talks about isometrics and the
36:31
training of muscle tendon units is full spectrum.
36:36
You can do it Max effort kind of as we mentioned to get a look
36:41
into capacity to a certain extent, maybe for lack of a
36:45
better word. And then on the lower intensity
36:49
side, exposure to low intensity long holds for overall tendon
36:55
health or muscle tendon unit quality.
36:59
And it sounds like that's what you can tap into often on the
37:03
micro dosing side with athletes. Is that correct?
37:07
Yeah, definitely. I mean you could very easily tap
37:09
into one single set of a long duration hold from that micro
37:13
dosing side pretty easily. Or by the same token, you could
37:16
in theory do one or two single sets of a shorter duration,
37:21
higher intensity type of hold or type of pushing or pulling
37:25
isometric if you will. I think that the longer duration
37:28
though from a micro dose standpoint because as you
37:31
mentioned as someone fatigues, the intensity is going to drop,
37:34
right. The nice thing about overcoming
37:36
isometric in particular is it's essentially Newton's third law
37:40
applied to exercise, where my force output and resistance are
37:43
going to be matched in real time.
37:45
So if all the sudden my force output drops, I feel less
37:50
resistance force as well. So it's never more than my body
37:54
can handle because it's always exactly what my body is
37:57
producing. So I certainly have no issues
38:00
personally loading people up with a wide array of those at
38:04
pretty high frequencies daily or twice a day, even with a longer
38:08
duration hold that way. I certainly haven't seen
38:10
anything in my own experience that kind of leads me away from
38:14
that at the moment. Right.
38:16
And bars research would even say on that complementing what you
38:20
do or applauding what you do there is if intensities are low
38:24
enough and the actual window of work is short enough, these can
38:28
be done every six hours. Bars research would show that
38:34
every six hours the muscle tendon unit is fully recovered
38:38
and ready to go again. So if we maintain work in kind
38:43
of the 10 to 25, maybe up to 30% of maximum voluntary
38:50
contraction, the muscle tendon unit can just be taxed again.
38:56
And why wouldn't that be used continuously in early stage
39:01
rehab or for a tendinosis type of athlete case?
39:07
To me this is just low hanging fruit that doesn't often get
39:11
applied. No, it definitely is.
39:13
And you know, again, considering the nature of some of these
39:16
procedures, right, like if we throw ACL out there again, it's
39:20
like, well, ACL often involves a graft harvest of one of the
39:24
tendons in the lower body. So it's like the sooner we start
39:27
putting some kind of load through that tendon, the sooner
39:30
we're going to get that pain inhibition response to settle
39:34
down. Because I think that's the other
39:36
component of this where isometrics work really, really
39:39
well is there's analgesic effects.
39:42
So it's like, hey, now I can actually use exercise from a
39:45
medicinal standpoint to calm things down from a pain
39:48
component as well from like a pain neuroscience standpoint.
39:51
And so I like to do that. I'll make that transaction any
39:54
day. But you know, the other piece
39:55
says, well is just overall the tendon is loading adaptations
39:59
that you can get and just the overall nervous system
40:02
adaptation that you can get as well.
40:04
As you mentioned, even just the low intensity, long duration
40:08
hold. It's like if you're turning the
40:10
lights on to a muscle that hasn't seen.
40:12
Daylight in a long period of time, that's going to have a
40:16
profound effect and that's going to change things.
40:19
When you go through the PT school, a lot of times they talk
40:22
about muscular inhibition and agonist antagonist muscles and
40:26
how the hamstrings inhibit the hip flexors and so on that way.
40:30
And, you know, I think a lot of the times, at least for myself,
40:33
the whole concept of muscle inhibition thing kind of went
40:36
over my head for the most part because I was going to work with
40:39
athletes, so I didn't need to know nervous system stuff.
40:42
Like what does that matter? Like I can just make them
40:44
bigger, faster, stronger, bulk them up.
40:46
And then I started to realize that there's actually something
40:49
to this whole world of neural efficiency.
40:52
And it's not necessarily just building a bigger engine, but
40:55
the electricity or power that supplies the engine, how can we
40:59
make that more efficient, if you will?
41:01
So I found that we can kind of enhance that like neural input
41:06
to the muscle or the neural side to movement.
41:09
A lot of the times we'll actually see improvements that
41:12
at least I personally would typically relate to that more
41:15
horsepower oriented, bigger, faster, stronger approach.
41:20
I'm curious what research or maybe past presentations you've
41:26
given because I I know you often get called upon to present or
41:31
speak at different seminars. Are you talking about isometrics
41:37
or the power of isometrics? I know we're even scratching the
41:40
surface just on this quick call here.
41:42
I'd love to turn this into Power Hour of Dan, just going as deep
41:48
as he possibly can on all the research you've done for years,
41:52
but maybe what are some of the topics that you've talked on in
41:55
the past or what might be, I guess, important information
42:00
that other clinicians could easily implement in their
42:04
practices? Yeah, definitely.
42:06
So a lot of the presentations I've given in the next several
42:09
that I'm given all kind of revolve around isometric testing
42:13
and isometric training for sports performance and sports
42:17
rehabilitation. And then some of them emphasize
42:19
like the entire rehab process a little bit more.
42:22
And then others are going to emphasize more end stage,
42:26
something that might be more considered from like a sports
42:29
performance or strength and conditioning involvement there
42:32
as well. I think ultimately for the
42:35
individual to really like, understand and take away is know
42:38
the general types of isometrics. So what is the difference
42:42
between overcoming where again, I'm pushing or pulling into
42:45
something that's not going to move, as opposed to a yielding
42:48
isometric where something is trying to pull me like gravity
42:52
and I have to actively fight against it.
42:55
So also knowing the principles behind them.
42:58
So like I mentioned, with an overcoming isometric being where
43:02
the force produced by the body is going to equal the resistance
43:06
force with that real time change.
43:07
And I almost kind of look at the overcoming isometric like a
43:10
failed concentric where you're kind of pushing, trying to move
43:14
something, trying to move something and it just won't
43:17
budget. Whereas the HEMA or yielding
43:19
isometric, I should say there there's a lot of different terms
43:22
that'll get thrown around interchangeably.
43:24
But yielding isometrics, Hemas or holding isometric muscle
43:28
actions, essentially the force produced by the body has to be
43:31
greater than the resistance force.
43:33
So that has to or that tends to carry over a little bit more
43:36
towards the eccentric because we're resisting the pull of
43:40
gravity on the way down South. Understanding the general types
43:43
of isometrics. And I think ultimately when it
43:46
comes to implementing them into your program or programming
43:50
them, I think a lot of times people look for protocols and
43:53
they look for something that says we'll do this, do that and
43:55
so on. But ultimately it comes back to
43:58
asking questions. I mentioned before that I'd like
44:00
to ask questions. So ask what is your goal?
44:03
What is your like adaptation that you're trying to drive with
44:07
your programming? What is the athlete in front of
44:09
you presenting with? What did they need?
44:11
Is there anything in particular that you need to know as well?
44:15
How much volume can they tolerate?
44:17
When is it going to be done in the session?
44:19
Is it going to be early on or is it going to be later on in the
44:22
session? Are you going to be doing some
44:24
kind of testing with it, right? Are you going to do like a
44:27
dynamometer assessment for force output?
44:29
Are you going to EMG it or are you just doing it for a training
44:32
purpose? I think ultimately all of these
44:35
things come back to knowing the underlying principles and
44:39
knowing what adaptation you're trying to drive and then how you
44:42
can drive it based on the person sitting in front of you at that
44:45
time. Awesome.
44:47
Well, I appreciate you running through that.
44:49
And Dan, as we kind of reach the tail end of this episode, is
44:54
there anything that you want to get into that we haven't
44:58
discussed yet? I know we've been hyper specific
45:01
on isometrics and kind of your story to a certain extent.
45:06
Maybe is there something coming down the line that you're really
45:08
excited about? Or maybe something way out of
45:11
left field that I have no clue. No, I mean, I think we've
45:15
covered a lot of different things.
45:16
As you mentioned, we could talk about this for hours and hours
45:19
and still just be scratching the surface that way.
45:22
There's a lot of different things that we can get into from
45:24
a research rabbit hole standpoint.
45:26
I really appreciate the time to chat with you again and be on
45:28
your podcast here, Adam. And I mean, I'm just excited to
45:32
see what the future holds for both of us.
45:33
I know you're doing great work with Flexpro.
45:35
Then obviously it sounds like you're a fellow enthusiast of
45:39
isometrics and how that can, in your case, impact not just UCL
45:44
and other baseball type injuries, but even performance
45:47
like methods to improve like spin rate and different things
45:51
that way. So there's a whole nother level
45:53
to this that we can certainly get into in the future.
45:56
But I'm really appreciative of your time and the opportunity to
45:59
chat a little bit about what I've been up.
46:02
Of course, man, and I know we talked about it early on, but I
46:06
want to make sure once again, you get to share ways that
46:09
people can follow you or stay tapped into what you're doing.
46:13
Yeah. So I mean, if you just follow at
46:16
Braun, Braun under score PR on Instagram, that's probably where
46:21
I'm most active. Otherwise, if you just punch in
46:24
Braun Performance and Rehab to your favorite podcast platform,
46:27
I should pop up there as well. Perfect, man.
46:30
Well, thanks a ton. I really appreciate it Dan and
46:33
looking forward to continued conversations and very soon.
46:37
It sounds like if people want to hear more of Dan and I going
46:41
back and forth, not just on Lay Back podcast, but he was also
46:47
nice enough to have me on the Dan Braun Performance podcast.
46:52
So really looking forward to hearing that episode.
46:55
Everybody go check it out. Dan, once again, thanks a ton
46:59
into all the listeners out there.
47:01
Thanks for laying back with us.