Latest / The Body Pod / Fixing Rehab: Smarter Healing, Pain Relief & Strength Training with Dr. Tom Walters

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Fixing Rehab: Smarter Healing, Pain Relief & Strength Training with Dr. Tom Walters · The Body Pod

0:00
Speaker 1: Hi everyone. My name is Haley and this is Laura
0:02
Speaker 1: and welcome to the Body Pod. Welcome back to another
0:14
Speaker 1: episode on the Body Pod. Today, I have the privilege
0:18
Speaker 1: and pleasure of interviewing doctor Tom Walters. Tom is the
0:22
Speaker 1: founder of rehub Science and dedicates his time to teaching
0:26
Speaker 1: people about human movement, pain, and how to most effectively
0:31
Speaker 1: recover from injury. He specializes in the treatment of musculoskeletal
0:35
Speaker 1: pain and movement disorders, combining kinesiology, education, manual therapy, and
0:42
Speaker 1: an individually tailored therapeutic exercise to treat orthopedic conditions. He
0:48
Speaker 1: is a board certified orthopedic physical therapist and strength and
0:51
Speaker 1: conditioning specialist based in Santa Barbara, California. In addition to
0:57
Speaker 1: his clinical practice, he also runs one of the largest
1:01
Speaker 1: world's largest social media accounts dedicated to physical rehab, which
1:05
Speaker 1: is at rehab Science on Instagram. And he's the author
1:09
Speaker 1: of my all time favorite book, Rehab Science, that we
1:14
Speaker 1: will be discussing today. So without further delay, let's jump
1:17
Speaker 1: into this discussion with doctor Tom Walters. Welcome everyone. I
1:29
Speaker 1: have doctor Tom Walters with me today and we are
1:33
Speaker 1: covering If you are watching this, his book rehab science,
1:37
Speaker 1: which Tom, I'm going to say, this is literally like
1:40
Speaker 1: my bible. I have used it so many times. I
1:44
Speaker 1: think I told you I have a client that lives
1:46
Speaker 1: right by you and we were working through some elbow
1:50
Speaker 1: tendonopathy and I was so glad to see that I
1:52
Speaker 1: was doing most of the things in this book. But
1:54
Speaker 1: I was like, Tom, what do you think about this?
1:56
Speaker 1: Because these tendonopathies can take for ever. So before we
2:02
Speaker 1: get into that, let's go ahead. And I wanted to
2:06
Speaker 1: touch on something that you said at the very first
2:09
Speaker 1: of your book, which is, in many ways the rehab
2:12
Speaker 1: model is broken. So can you tell us a little
2:15
Speaker 1: bit about where you started in your journey as a
2:18
Speaker 1: physical therapist and then what kind of led you to
2:21
Speaker 1: kind of doing your own thing.
2:23
Speaker 2: Yeah. Well, first off, Haley, thanks for having me on.
2:25
Speaker 2: This is amazing to get to Thanks for buying the
2:28
Speaker 2: book and mentioning it. It really was the goal to
2:31
Speaker 2: create a resource that people could self manage their own
2:34
Speaker 2: pain issues and injuries because most of physical therapy right
2:38
Speaker 2: there is a manual therapy. My residency was in manual
2:40
Speaker 2: therapy where I'm using my hands to work on people,
2:42
Speaker 2: and that can be good in the beginning for getting
2:44
Speaker 2: people out of pain. But most of the evidence revolves
2:46
Speaker 2: around exercise and movement, and those are things people can
2:48
Speaker 2: do on their own and you can teach them in
2:51
Speaker 2: a book or some resource like that. So it's been
2:54
Speaker 2: so fun. It's been out for two years, and it's
2:56
Speaker 2: been really cool to see people using it in that
2:58
Speaker 2: way and kind of like solving on their own. So
3:02
Speaker 2: but yeah, thinking about Yeah, the intro of the book,
3:04
Speaker 2: we start kind of talking about the rehab model being broken,
3:08
Speaker 2: and not that the interventions are broken and don't work,
3:10
Speaker 2: but just the model that it's delivered through. And I
3:13
Speaker 2: think anybody listening to this who has insurance and goes
3:17
Speaker 2: in the medical system with insurance recognizes immediately the limitations
3:21
Speaker 2: and physical therapy is no different. We basically, you know,
3:26
Speaker 2: physical therapists. I only lasted two years. I've been a
3:28
Speaker 2: PT for eighteen years. I was only in an insurance
3:30
Speaker 2: model for two years because of just the limitations placed
3:35
Speaker 2: on you and how that impacts the quality of care
3:37
Speaker 2: that you can deliver. I mean, the clinic I was
3:40
Speaker 2: at was actually better than a lot of other clinics.
3:42
Speaker 2: We would see people for an hour when they first
3:44
Speaker 2: came in and then every follow up session was thirty minutes,
3:46
Speaker 2: so it actually wasn't better. But I had a lot
3:48
Speaker 2: of friends to people every fifteen minutes. So you're sting
3:53
Speaker 2: thirty people a day, There's just no way you're really
3:56
Speaker 2: having enough time to talk with them about their symptoms,
4:00
Speaker 2: like all the back history that might be related to
4:03
Speaker 2: their pain. Like we just there's so many factors that
4:05
Speaker 2: go into pain, in your stress, your sleep, your nutrition,
4:07
Speaker 2: Like there's no way you can cover that even in
4:09
Speaker 2: a thirty session. You just can't catch up with people.
4:12
Speaker 2: So a lot of physical therapists are kind of shifting
4:15
Speaker 2: out of the insurance model and going towards cash pay
4:17
Speaker 2: clinics and trying to figure out ways to better serve patients.
4:21
Speaker 2: But yeah, in terms of my background, I was an
4:23
Speaker 2: athlete all growing up. I was a martial artist and
4:25
Speaker 2: a gymnast, so I had a lot of which tied
4:27
Speaker 2: in really nicely with physical therapy because I was always
4:29
Speaker 2: barefoot and I just a lot of movement control, you know,
4:32
Speaker 2: so a lot of body weight training. I'm really thankful
4:35
Speaker 2: for all those years in martial arts and gymnastics just
4:38
Speaker 2: because it really did kind of help me learn sort
4:43
Speaker 2: of like applied kinesiology in a way like canesiologies study
4:47
Speaker 2: of human movement. And before I knew that term or
4:49
Speaker 2: what went into kinesiology, I kind of just learned about
4:53
Speaker 2: my body and how to control my body and how
4:55
Speaker 2: to strengthen it and all those things. And basically it
4:58
Speaker 2: had knee surgery in high school. I had a not
5:00
Speaker 2: a real serious surgery. I just I actually had my kneecap.
5:03
Speaker 2: I was born with it in two pieces. It's called
5:05
Speaker 2: a bi partape ptella, and it would hurt me when
5:08
Speaker 2: I land from jumping like in gymnastics. When I land,
5:12
Speaker 2: it would hurt on the front of my knee, and
5:14
Speaker 2: it was a very small little piece, and so I
5:16
Speaker 2: just had it taken out and then everything was better.
5:19
Speaker 2: But that was I went to physical therapy after that,
5:21
Speaker 2: and so that was sort of my first exposure to
5:24
Speaker 2: using exercise to rehabilitate the body. I was always just
5:27
Speaker 2: used to performance and how do I get a longer
5:29
Speaker 2: jump higher, things like that. So then I went I
5:32
Speaker 2: did an exercise science degree in college, so my bachelor's
5:36
Speaker 2: degree is an exercise science. I was really most passionate
5:38
Speaker 2: about exercise physiology exercise science, and then went to in
5:42
Speaker 2: the US, you do a three year doctorate in physical therapy.
5:45
Speaker 2: You have to have a bachelor's degree and then you
5:47
Speaker 2: go do that. And so I did that and mostly
5:48
Speaker 2: focused in orthopedic physical therapy. So it's all the common
5:52
Speaker 2: conditions people are used to thinking about, like back pain,
5:54
Speaker 2: neck pain, you know, tennis, elbow plantar fasciitis, all these
5:58
Speaker 2: meniscus tears. It's like all the things most of us
6:00
Speaker 2: are going to experience. So, yeah, that's been kind of
6:04
Speaker 2: that was kind of where I started and got it.
6:07
Speaker 2: How I got into PT.
6:09
Speaker 1: Okay, well, I love it, and we're so glad that
6:13
Speaker 1: you now have this. I mean, what is your Instagram?
6:17
Speaker 1: You have like a million and a half followers or something. Bananas.
6:21
Speaker 1: But when I started reposting, I mean, I'm so lucky.
6:24
Speaker 1: I don't even know how I fell upon you, but
6:27
Speaker 1: however I did, and I started following you and that
6:29
Speaker 1: I posted something, and the people that I look up
6:32
Speaker 1: to most in this space that like they are they
6:38
Speaker 1: all commented on my story and they were like, Tom
6:41
Speaker 1: is the best. I've been following him for years. Where
6:44
Speaker 1: have I been? So let's dive in. Let's dive into
6:47
Speaker 1: the book. So for the reason you wrote this book,
6:51
Speaker 1: as you kind of just talked about, when we look
6:54
Speaker 1: at it and and there are a lot of things
6:58
Speaker 1: outside of maybe a cute and acute injury. Most of
7:03
Speaker 1: the women that I work with are coming in with
7:07
Speaker 1: with chronic tendinopathies, So, you know, outside of a skiing
7:12
Speaker 1: accident or something like that, some of this stuff. And
7:17
Speaker 1: I have a program called Foundation Happens where we cover
7:20
Speaker 1: a lot of the uh, you know, the commonly weak
7:24
Speaker 1: links that nobody wants to target because everyone wants to
7:27
Speaker 1: use the big prime movers and push pull and do
7:30
Speaker 1: the deadlifting and do the back squad and they want
7:32
Speaker 1: to start lifting heavy, which the message is getting out
7:34
Speaker 1: to women that they need to lift heavy. This is
7:37
Speaker 1: all great, but do it too soon, too fast, and
7:41
Speaker 1: every single time there's a tendinopathy. So do you see
7:46
Speaker 1: this in your practice? And is there a difference between
7:50
Speaker 1: someone that's maybe twenty or twenty five versus someone that's
7:54
Speaker 1: like forty five, fifty and beyond.
7:58
Speaker 2: Yeah, definitely a difference. And it's of what I see
8:00
Speaker 2: in my practice too. It's mostly connective tissue disorders teninopathies
8:04
Speaker 2: like you're talking about, especially for the people who are
8:06
Speaker 2: active or haven't been a lot very active and then
8:09
Speaker 2: suddenly get active. It's usually tendinopathies. It's there, your tendons
8:14
Speaker 2: are Your tendons and ligaments are connective tissues, so we
8:17
Speaker 2: kind of think of them generally is just connective tissue disorders.
8:20
Speaker 2: I mean, of course, some people do have muscle strains
8:22
Speaker 2: and other more severe injuries of something traumatic happens, but
8:25
Speaker 2: most people who are just kind of exercising and start
8:28
Speaker 2: to develop pain, it usually is a tendinopathy, and it
8:32
Speaker 2: does come down a lot. In the physical therapy world,
8:35
Speaker 2: we talk a lot about load management, So it's managing
8:39
Speaker 2: how much load you're putting on your system, how intense
8:42
Speaker 2: that load is. So like like if you imagine you're
8:45
Speaker 2: going to pick up a strengthening program. If you just
8:48
Speaker 2: go and you haven't been doing any strengthening forever or
8:51
Speaker 2: for the last few years, and all of a sudden
8:53
Speaker 2: you just go gangbusters and you're doing an hour of
8:56
Speaker 2: string training every day, you're likely to develop tenopathy. Or
8:59
Speaker 2: if you just pick up running program and just start running,
9:01
Speaker 2: all you need to build into these things. Your your
9:04
Speaker 2: muscle skeletal system has this great ability to adapt but
9:07
Speaker 2: it's kind of slow. Your cardivascar system adapts a lot faster,
9:11
Speaker 2: you know. So a lot of people get into trouble
9:13
Speaker 2: where it's like their heart and lungs can handle what
9:15
Speaker 2: they're doing, but their muscle skelet system takes a little
9:17
Speaker 2: bit of time to catch up. And so, and it's
9:19
Speaker 2: for sure different with age. Like you mentioned, I'm forty
9:22
Speaker 2: three now, my body just takes it takes a little
9:26
Speaker 2: longer to recover. It's easier for me to tweak something.
9:30
Speaker 2: If I don't have a good warm up, I should
9:31
Speaker 2: never warm up. I just jumped into everything. So I
9:34
Speaker 2: think in your nineteen when you're in your teens and twenties,
9:38
Speaker 2: you see people will develop teninopathy, but they have to
9:43
Speaker 2: really be pushing themselves way higher volume. It's just it's
9:48
Speaker 2: excuse me, harder to trigger those kind of issues in
9:52
Speaker 2: younger people. As we get older and changes in connective tissue,
9:56
Speaker 2: changes in hormones, like all these age related changes, you
9:59
Speaker 2: just see way more tenpathies and they're just way easier
10:02
Speaker 2: to kind of flare up and get triggered. And I
10:05
Speaker 2: always tell people the nice thing about tenanopathies is there
10:08
Speaker 2: I would say they're seriously annoying, but they're not serious,
10:11
Speaker 2: like they're not It's not like an injury that you
10:14
Speaker 2: need to worry a whole lot about in most cases,
10:17
Speaker 2: like you're going to tear something or something's really broken
10:21
Speaker 2: or damaged. It's just more that they're painful and that
10:25
Speaker 2: can obviously really limit you in life. So you have
10:27
Speaker 2: to figure out how to manage them. And a lot
10:29
Speaker 2: of that is kind of figuring out how do I
10:31
Speaker 2: manage the load on my system and kind I kind
10:33
Speaker 2: of take baby steps, kind of kind of break my
10:36
Speaker 2: exercise down into steps or gradually get into something so
10:39
Speaker 2: that I don't make those tendons kind of get angry.
10:43
Speaker 1: Yes, and so the muscle usually adapts much faster than
10:48
Speaker 1: the tendons and the ligaments. And I think that at
10:51
Speaker 1: least from what from my view, this is what happens is,
10:56
Speaker 1: you know, people are feeling great and they're they're getting
10:58
Speaker 1: excited and they're motivated. So a lot of women at
11:01
Speaker 1: this age are coming back from having children, you know,
11:05
Speaker 1: having jobs. Now they're dealing with aging parents. There's nine
11:09
Speaker 1: million things, and so they're finally coming around to making
11:13
Speaker 1: themselves a priority again. And so there is this excitement
11:17
Speaker 1: and motivation to get back in and start training, and
11:20
Speaker 1: they're hearing these messages. But I'm always you know, on
11:24
Speaker 1: my app like slow down, Like if we're in this
11:27
Speaker 1: for life. Sure, a tendinopathy might not, you know, be
11:32
Speaker 1: something that is going to completely sidetrack you forever. But
11:35
Speaker 1: it's a setback. And and as women at this age,
11:38
Speaker 1: we just if we can avoid setbacks to the best
11:41
Speaker 1: of our ability, let's avoid those setbacks. So do you
11:45
Speaker 1: ever look at like if you you see people once
11:49
Speaker 1: they have the tendinopathy. But is there like a prevention
11:54
Speaker 1: strategy where like some prehab that you would say, oh,
11:58
Speaker 1: if people just did this for this elbow tendinopathy or whatnot,
12:02
Speaker 1: you could probably save a lot of these tendinopathies that
12:06
Speaker 1: pop up.
12:07
Speaker 2: Yeah, for sure, there's a ton you can do. I
12:09
Speaker 2: think at a base level it is sort of like
12:12
Speaker 2: the accessory complementary type strengthening exercise. As you mentioned teninopathy.
12:17
Speaker 2: The best research for preventing and treating teninopathy revolves around
12:20
Speaker 2: strength training. You know, It's what we call resistance training.
12:22
Speaker 2: If you're just it's any kind of external force that
12:25
Speaker 2: your system has to resist. So people tend to think
12:27
Speaker 2: about as strengthening. It could be body weight. A lot
12:29
Speaker 2: of it's body weight. Actually sometimes it's banned. Sometimes it's dumbbells,
12:33
Speaker 2: but that type of exercise has the best evidence. Basically
12:38
Speaker 2: it if you think about when you strengthen your everyone
12:40
Speaker 2: thinks about it's obvious. Then your muscles get stronger, But
12:43
Speaker 2: your muscle's attached to tendons, and a tendons attach your
12:46
Speaker 2: muscle to a bone. So when you put tension through
12:48
Speaker 2: a muscle, you also improve the strength and capacity of
12:51
Speaker 2: the tendon. And that's tendons or what where teninopathy comes from.
12:55
Speaker 2: So if your tendons are more resilient, they're less likely
12:58
Speaker 2: to develop teninopathy. So at a base level, from a
13:01
Speaker 2: prehab standpoint, Yeah, just being kind of intelligent about thinking about, Okay,
13:09
Speaker 2: what are the tendons that most likely develop teninopathy? What
13:12
Speaker 2: movements and muscle groups am I going to use in
13:14
Speaker 2: whatever exercise program I'm starting? And then you know, for
13:19
Speaker 2: a period of time as you're maybe before you even
13:22
Speaker 2: start that program or in the early stages when you're
13:25
Speaker 2: going slow kind of like you're saying, gradually getting into it,
13:27
Speaker 2: it would be adding in some of those strengthening exercises
13:31
Speaker 2: that target the tendons that are most likely to develop teninopathy.
13:34
Speaker 2: So there are things like the achilles tendon, the elbow tendons,
13:38
Speaker 2: you know, like the tennis elbow and golfer's elbow, the
13:40
Speaker 2: rotator cuff tendons, the patellar tendon on the front of
13:44
Speaker 2: your knee, especially if you're doing a lot of jumping
13:46
Speaker 2: and squatting and things like that. Oh, the glute tendons.
13:51
Speaker 2: Gluttendons are a big one, especially I see lots of
13:53
Speaker 2: females with glue tail teninopathy. So on the outside of
13:56
Speaker 2: the hip. People can imagine there's this kind of bone
13:57
Speaker 2: on the outside hitm. We used always think of it
13:59
Speaker 2: as birsitis, but a lot of females, especially around kind
14:01
Speaker 2: of the menopause stage, end up developing glue till teninopathy. So,
14:05
Speaker 2: but there are a bunch of there are exercises you
14:07
Speaker 2: can do, stringthing exercises that target all these tendons and
14:10
Speaker 2: will make them more resilient. So just adding something like
14:13
Speaker 2: that at the early stages of your training program, or
14:17
Speaker 2: even like a few weeks before you start the training
14:19
Speaker 2: program can do a lot in terms of reducing their
14:22
Speaker 2: chances that you get a teninopathy and have those setbacks.
14:26
Speaker 1: Yes, okay, so let's break this down because everything you
14:29
Speaker 1: just said was on my list of these common the
14:34
Speaker 1: common injuries that without fail. And so anytime someone comes
14:39
Speaker 1: to me and they're looking at my programs, I will
14:42
Speaker 1: always preface the conversation. I'll say, have you ever done
14:45
Speaker 1: like a foundation program or a general preparation phase or
14:49
Speaker 1: or anything, because it's great that again you want to
14:52
Speaker 1: start lifting, but have you ever you know, what have
14:55
Speaker 1: you done? And when they tell me their their program
14:58
Speaker 1: or maybe they haven't done anything, it always is petel attendon,
15:02
Speaker 1: low back. Uh, I would killes tendon, but like planto fasciitis,
15:10
Speaker 1: elbow tendinopathies, rotator cuff. So that's pretty much. Do you
15:14
Speaker 1: find that synonymous in males and females or do you
15:17
Speaker 1: see more in females or what? Do you think?
15:21
Speaker 2: They're really pretty close between the genders. I would say
15:25
Speaker 2: the one that stand the ones that probably stand out
15:27
Speaker 2: to me a little bit more in females probably are
15:30
Speaker 2: like plantofasciitis, the glue tail tendinopathy. The other ones I
15:36
Speaker 2: wouldn't say in my mind they're pretty even between the
15:39
Speaker 2: male and female.
15:40
Speaker 1: Great and probably Okay, So if we were to go
15:43
Speaker 1: to elbow tendinopathies, how would you treat that once somebody
15:48
Speaker 1: has one? And can we do some of those exercises before?
15:52
Speaker 1: So just give an example of maybe a couple of
15:54
Speaker 1: exercises of what that looks like.
15:56
Speaker 2: Yeah, So, when you're thinking about teninopathy in the elbow,
15:59
Speaker 2: most people are going to be familiar with the terms
16:01
Speaker 2: tennis elbow and golfer's elbow. It doesn't mean that you
16:03
Speaker 2: had had to get it playing those sports. It just
16:05
Speaker 2: tennis elbow is lateral tendinopathy. It's on the outside of
16:09
Speaker 2: the elbow, so, and it has to do with our
16:11
Speaker 2: wrist and finger extensors. So they're the muscles that kind
16:13
Speaker 2: of lift your wrist up there on the top of
16:15
Speaker 2: your form. Those attached on the outside of the elbow,
16:18
Speaker 2: and then on the exact opposite side of your form
16:20
Speaker 2: are your finger and wrist flexors and those attached on
16:23
Speaker 2: the inside of the elbow. People will get pain at
16:26
Speaker 2: those two spots on their elbow. The you say it
16:28
Speaker 2: hurts on the inside of the elbow or the outside
16:30
Speaker 2: of their elbow, and so when you think about the
16:31
Speaker 2: research being most supportive of resistance training if you had
16:36
Speaker 2: pain in the outside your elbow. Example exercises would be
16:38
Speaker 2: things like risk curls. We call them wrist curls. So
16:41
Speaker 2: you're holding a dumbell, your arms kind of supported on
16:44
Speaker 2: a table so that your hand is hanging off the
16:47
Speaker 2: edge of the table, and then you're just holding a
16:48
Speaker 2: dumbbell and you're lifting it up and kind of squeezing
16:50
Speaker 2: your wrist extensors. Another on, another muscle that attaches out
16:54
Speaker 2: there is our muscle called our supinator, and it turns
16:58
Speaker 2: your palm over so that you're Alma's facing up. We
17:00
Speaker 2: always just say like you're holding a cup of soup,
17:02
Speaker 2: so your palms facing up. So superinator rotates your form,
17:06
Speaker 2: but it attaches on the outside of the elbow too,
17:07
Speaker 2: so we do these banded exercises or even holding the
17:10
Speaker 2: end of a dumbbell where we have to rotate and
17:12
Speaker 2: strengthen supinator. So those would be two examples for the
17:15
Speaker 2: outside of the elbow. The inside the elbow is kind
17:17
Speaker 2: of just almost the exact opposite. You'd flip your form over,
17:20
Speaker 2: so you're starting with your palm facing up, arms support
17:23
Speaker 2: on a table with your wrist hanging off, you hold
17:25
Speaker 2: the dumbell and you do these kind of wrist curls
17:26
Speaker 2: where you're lifting up and down. And then on that
17:30
Speaker 2: inside the elbow, you have a muscle called pronator terries.
17:32
Speaker 2: That one turns your form over so that your palm
17:35
Speaker 2: is down. So the same kind of do you use
17:36
Speaker 2: a band or a dumbbell to rotate and strengthen pronator terries?
17:41
Speaker 1: Yeah? Perfect? Okay, And does grip strength play into that?
17:46
Speaker 1: Can that help that?
17:47
Speaker 2: Yeah? Big time. Grip string thing is an amazing one.
17:50
Speaker 2: There's all kinds of grip tools, like the little squeeze balls,
17:52
Speaker 2: there's the traditional grip strengthening devices. Yeah, especially for it
17:55
Speaker 2: can help with both types of elbow to anopthly. But
17:57
Speaker 2: it's going to be really relevant to gal the inside
18:01
Speaker 2: on the inside of the elbow because it's you're using
18:02
Speaker 2: our finger flexers when you squeeze something and those muscles
18:06
Speaker 2: run up your forum and their tendon attaches on the
18:08
Speaker 2: inside of the elbow. On the media epicondo, that kind
18:10
Speaker 2: of bony spot on the inside of your elbow.
18:12
Speaker 1: Yeah, oh well, that's the one. That's the one that
18:15
Speaker 1: I had of my client and I was like, this
18:17
Speaker 1: has got to go away. It's not going away.
18:20
Speaker 2: You're so annoying too, right, Like you said this at
18:22
Speaker 2: the beginning, ten and off. But these can last a
18:24
Speaker 2: long time. They can be super resistant. There's even some
18:26
Speaker 2: research showing that, like Planofasciatus said he came out recently
18:28
Speaker 2: and said it can last up to a year and
18:31
Speaker 2: a lot of people. So you know, and you hope
18:33
Speaker 2: that with rehab you speed that process up. But some people,
18:36
Speaker 2: I mean, I've had people over the years that it's hard,
18:39
Speaker 2: right because you have this thing that's annoying, but you
18:41
Speaker 2: don't want to give up the exercise that you love
18:44
Speaker 2: so and you wouldn't tell people that be completely sedentary
18:47
Speaker 2: and give it up. You're always trying to find that
18:48
Speaker 2: load management concept of like how much volume of exercise
18:51
Speaker 2: can they tolerate without totally flaring the tendon up. But
18:54
Speaker 2: you would never tell them to completely rest. That's what
18:56
Speaker 2: doctors used to tell people. And tendons don't get better
18:58
Speaker 2: with rest. They will, they will in the acute phases,
19:01
Speaker 2: they'll kind of calm down, but as soon as you
19:03
Speaker 2: stress them again, the teninopotly will come back. The only
19:05
Speaker 2: way to make it permanently go way is to gradual strengthening.
19:09
Speaker 1: M Okay, so if we move down to let's say
19:13
Speaker 1: the petel attendant. So if someone were just coming in,
19:19
Speaker 1: there's I mean, you're the expert, so you tell me.
19:24
Speaker 1: I usually use like some isometrics like a wall squat
19:28
Speaker 1: hold something like that, but then also like ecentric more
19:34
Speaker 1: eccentric work with a heavier weight and then you know,
19:38
Speaker 1: lifting the assisting the leg backup or the arm back
19:41
Speaker 1: up and then going down again like that. Do you
19:44
Speaker 1: see are those common approaches or do you have any
19:46
Speaker 1: other ones that you would use?
19:48
Speaker 2: Yeah, that kind of framework works really well for a
19:51
Speaker 2: lot of people with teninopoly where its you start with isometrics.
19:54
Speaker 2: Isometrics are if people don't know that, it's a where
19:56
Speaker 2: your muscle's contracting but your joints not moving. So it'd
19:59
Speaker 2: be like if you imagine you did a bicep curl
20:00
Speaker 2: need has held it halfway and didn't move. The muscles
20:03
Speaker 2: still working, the tendon's working, but there's no movement, so
20:06
Speaker 2: the muscle fibers aren't changing in their length. And isometrics
20:10
Speaker 2: have kind of cool research showing that they kind of
20:12
Speaker 2: if you hold an isometric for thirty to forty five
20:15
Speaker 2: seconds and you do four or five reps like that
20:16
Speaker 2: each day. It has a similar kind of effect to
20:19
Speaker 2: like taking ibuprofen. It's a hypoalgesic effect, so it kind
20:22
Speaker 2: of helps knock pain down, and it's really useful in
20:24
Speaker 2: the beginning stages when it hurts too much to move
20:27
Speaker 2: through full range of motion, but you can just have
20:28
Speaker 2: the person hold, so like that pateeller tendon example, doing
20:31
Speaker 2: a wall sit. Everybody's probably had some experience with like
20:34
Speaker 2: wall sit and how brutal they are for your quads,
20:36
Speaker 2: but they're a great one for isometrically loading your pateller
20:39
Speaker 2: tendon in those early stages and then usually when people
20:44
Speaker 2: start to feel better there, then we'll go to like
20:46
Speaker 2: the ecentrics, and so that's where you're only doing half
20:50
Speaker 2: of the exercise. It's the part where the muscle fibers
20:52
Speaker 2: are lengthening. Our muscle fibers are all strongest with eccentric contractions.
20:56
Speaker 2: So if you imagine that bicep curl example, again, it
21:00
Speaker 2: would be the down phase of the curl, So like
21:02
Speaker 2: you might put your arm in the top position, pass
21:05
Speaker 2: the dumbbell to your hand with the other arm and
21:07
Speaker 2: then slowly lower it and then when you get all
21:09
Speaker 2: the way to elbow straight, you take the dumbbell back
21:11
Speaker 2: with the other arm reset and so you're just or
21:13
Speaker 2: like the squat, like if you're doing a Pateeller tendon
21:16
Speaker 2: you would only do the down phase of the squat.
21:18
Speaker 2: That's the eccentric portion for the quads. So sometimes we
21:21
Speaker 2: do an exercise like this called a decline squat, or
21:25
Speaker 2: even a bench like I will sometimes give people an
21:27
Speaker 2: eccentric bench squat. So what they do is say your
21:30
Speaker 2: right leg had the Pateeller tenonopathy. You'd stand in front
21:33
Speaker 2: of a bench. You'd do a single leg squat. You'd
21:36
Speaker 2: start standing only on your right leg. You'd lift your
21:38
Speaker 2: left leg off the ground. You'd do a single legg
21:40
Speaker 2: squat all the way down ice and slow sit on
21:42
Speaker 2: the bench, put both feet on the ground, stand back
21:44
Speaker 2: up with two legs. So the concentric part you do
21:46
Speaker 2: with both legs, and then when you're at the top
21:49
Speaker 2: you do the eccentric part only on the painful side.
21:52
Speaker 2: So the research has kind of changed. It's interesting. We
21:54
Speaker 2: used to always do that where we'd go isometric, eccentric
21:57
Speaker 2: and then full range of motion. They're just saying that
22:00
Speaker 2: the isometrics and eccentrics might not matter that much for
22:04
Speaker 2: a lot of people, and that you can just do heavy,
22:06
Speaker 2: slow contractions through full, through whatever range of motion that
22:09
Speaker 2: person can do. So you might be modifying their range emotion,
22:12
Speaker 2: but you just the key thing with tendons is that
22:15
Speaker 2: it's heavy and slow, like it has to be. Yeah,
22:19
Speaker 2: that if it's too light, it just it won't create
22:22
Speaker 2: the stimulus for them to adapt.
22:24
Speaker 1: Yeah, so quite different, a different tempo than you know,
22:27
Speaker 1: muscle's life, a little bit quicker, but tendons really like
22:30
Speaker 1: that slow, heavy, yeah work. I love that. So if
22:34
Speaker 1: we move on to rotator cuffs. So this is the
22:37
Speaker 1: biggest area for that I see for women, and mainly
22:42
Speaker 1: because of just the nature of female having breast mass
22:46
Speaker 1: in the front and nothing in the back, and so
22:49
Speaker 1: there's not a lot of I see, there's very very,
22:53
Speaker 1: very few I would say maybe one percent of females
22:56
Speaker 1: maybe up to three percent that have good scapular mechanics,
23:00
Speaker 1: which then plays into you know, clicking of the shoulder
23:03
Speaker 1: and all of the stuff, and then rotator cuff it
23:06
Speaker 1: kind of goes kind of in the same family. A
23:08
Speaker 1: lot of the times.
23:10
Speaker 2: So do you see that as well, Yeah, for sure,
23:13
Speaker 2: you know that whole kind of all the biomechanics, the
23:17
Speaker 2: mechanics of the of the shoulder blade definitely can feed
23:20
Speaker 2: into people having rotator cuff tenopathy. What happens your rotar
23:25
Speaker 2: cuff is four muscles and the one that probably ninety
23:29
Speaker 2: percent of the time develops tenopathy is a muscle called
23:31
Speaker 2: super spinadas that it runs across the top of the
23:34
Speaker 2: shoulder and then it goes If you fill the top
23:37
Speaker 2: of your shoulder, is kind of a bone right at
23:38
Speaker 2: the top, and that's called your chromine. It's actually part
23:40
Speaker 2: of your shoulder blade. Right underneath the a chromine is
23:43
Speaker 2: where the super spinadas tendin runs. So it's it's got
23:47
Speaker 2: this kind of roof on top of it that protects it.
23:50
Speaker 2: But the problem is is that there's only one centimeter
23:54
Speaker 2: of space there, so that tendin is in there and
23:58
Speaker 2: when you lift overhead to call it impingement syndrome. So
24:01
Speaker 2: people would tend to experience this pain when they reach
24:04
Speaker 2: above shoulder level. And for a long time, the theory
24:08
Speaker 2: was that the ball at your shows a ball and socket.
24:11
Speaker 2: The ball would sort of ride up and pinch the
24:14
Speaker 2: super spinatus tendon underneath the a chromia because there's only
24:16
Speaker 2: that one centimeter of space, and so for a long
24:19
Speaker 2: time we called it impingement syndrome. It turns out it
24:22
Speaker 2: actually doesn't fully explain some people that is a major
24:26
Speaker 2: driving factor the biomechanics, but almost a large percentage of
24:30
Speaker 2: humans have some impingement on that tendon, and a lot
24:32
Speaker 2: of people don't develop pain. So it just turns out,
24:34
Speaker 2: like a lot of things in the body, it's more complex,
24:37
Speaker 2: and now it's just called subochromial pain syndrome, but it
24:39
Speaker 2: relates to super spinaas tenopthy rotator cuff teninopathy, and it
24:45
Speaker 2: follows a very similar kind of treatment plan to the
24:48
Speaker 2: elbow tendinopathy and the pateillar tenopathy, where you're gradually putting load,
24:52
Speaker 2: you're gradually strengthening super spinatus and its tendon, and there's
24:55
Speaker 2: specific therapeutic exercise for that. Just like we were talking about,
24:58
Speaker 2: this is like you start to realize with each of
25:00
Speaker 2: these tendons, if you incorporate these specific therapeutic exercises that
25:04
Speaker 2: strengthen those tendons, you're going to be much less likely
25:07
Speaker 2: to have these issues. When you get into an exercise
25:10
Speaker 2: program that is working on the big prime movers and
25:13
Speaker 2: not as focused on the little muscle groups.
25:16
Speaker 1: Yes, one hundred percent. So do you see if we're
25:21
Speaker 1: if we're looking at okay, somebody's doing they're either prehabbing
25:24
Speaker 1: or potentially they're there rehabbing. What do you think. I
25:28
Speaker 1: guess this wouldn't work on the prehub side, but for
25:31
Speaker 1: the rehab side. What do you think of PRP injections?
25:35
Speaker 1: Are they helpful? Is it kind of maybe? Maybe not?
25:40
Speaker 2: Yeah, I think it used to be for a while.
25:43
Speaker 2: A couple of years ago I would have said I
25:45
Speaker 2: would have been more likely to say they're kind of
25:48
Speaker 2: up in the air, and we don't really have a
25:49
Speaker 2: lot of great research to know for sure. But I
25:52
Speaker 2: think PRP especially is coming around more where I see
25:56
Speaker 2: more evidence supporting it for pain relief with different joint
25:59
Speaker 2: and connective tissue issues. So I often recommend to people
26:04
Speaker 2: if they have a stubborn teninopathy and they want to
26:06
Speaker 2: try something else, to try something like PRP, or if
26:09
Speaker 2: they don't want to do something invasive yet. There's something
26:11
Speaker 2: called shockwave therapy. Shockwave therapy is sort of like a
26:15
Speaker 2: really powerful ultrasound, and there is some research supporting it
26:19
Speaker 2: for like planar fasciatus resistant tennis elbow, some of the
26:24
Speaker 2: tendons that are a little more exposed that you can
26:27
Speaker 2: kind of hit with the shockwave. So that's another intervention
26:30
Speaker 2: that some people can try. Always in the beginning, the
26:34
Speaker 2: main thing is trying to modify their behaviors, work on
26:37
Speaker 2: that load management, and then strengthen. And then if it's
26:39
Speaker 2: just really a frustrating case and it's lasting a long
26:42
Speaker 2: time and really interfering with life, then yeah, things like
26:44
Speaker 2: PRP and shockwave are worth looking at.
26:47
Speaker 1: What about BP one fifty seven, I.
26:50
Speaker 2: Still just don't see It's funny. Somebody just DM me
26:52
Speaker 2: yesterday about their peptide company, and I just I'm still
26:55
Speaker 2: not I'm not one hundred percent. Yeah, even stem cell
27:00
Speaker 2: see a lot of pushback even from surgeons on stem cells.
27:02
Speaker 2: So I just don't think there's enough. I think a
27:06
Speaker 2: lot of that stuff is probably highly placebo driven, and
27:10
Speaker 2: maybe peptides. I think there's probably a lot of potential peptides.
27:12
Speaker 2: And I also don't sit around and read that research
27:16
Speaker 2: a ton, so there could be somebody might say, no,
27:18
Speaker 2: there's a great study on BP one five to seven.
27:20
Speaker 2: I just when I wrote the book, we covered it
27:22
Speaker 2: in there. My co author Glenn was super into peptides
27:24
Speaker 2: and they're just at that time wasn't really compelling evidence
27:28
Speaker 2: for peptides yet.
27:30
Speaker 1: Yeah, So if we look at the different phases, So
27:33
Speaker 1: you have three phases in your book, can you talk
27:36
Speaker 1: about those and what we would do in each phase,
27:40
Speaker 1: what that would look like.
27:41
Speaker 2: Yeah, I think it's an it's a there's different there's
27:45
Speaker 2: kind of three different phases you can look at whether
27:48
Speaker 2: you're looking at healing or you're looking at treatment, and
27:50
Speaker 2: they kind of go together. But you know when you
27:53
Speaker 2: first have when you first have an injury, people are
27:58
Speaker 2: going to go through an inflammatory phase right away. So
28:01
Speaker 2: and this is where you need that inflammation. Like we
28:04
Speaker 2: sometimes think of inflammation as bad and like systemic inflammation
28:07
Speaker 2: that's there all the time isn't great. But when you
28:09
Speaker 2: first have an injury, you need inflammation because your immune
28:11
Speaker 2: system is coming in and sending macrofages and different cells
28:14
Speaker 2: and to clean up injured tissue and kind of remodel
28:17
Speaker 2: the area. So that usually lasts a few days. In
28:20
Speaker 2: that window, what would be kind of like the acute
28:22
Speaker 2: pain stage with people. We're doing a lot of things
28:25
Speaker 2: that are like soft tissue mobilizations, kind of like you
28:28
Speaker 2: might think of like self massage, so like if you
28:30
Speaker 2: had plantar fasci edis, it might be where you take
28:32
Speaker 2: a massage ball and kind of massage the plantar fash
28:34
Speaker 2: on the bottom of the foot. Some people have seen
28:36
Speaker 2: that some people will take like a water bottle, like
28:40
Speaker 2: a plastic water ball that's got frozen water in it,
28:42
Speaker 2: like can kind of do an ice massage on the
28:44
Speaker 2: body of foot. Ice is even kind of changing where
28:46
Speaker 2: there's been some questioning of should we use ice in
28:50
Speaker 2: the inflammatory phase because there's been some research showing that
28:53
Speaker 2: it can slow the inflammatory process, which might slow the
28:55
Speaker 2: healing process. The same with ibuprofen. Like ibuprofen and all
28:59
Speaker 2: leave these these nonsteroidal anti inflammatory drugs, they slow the
29:03
Speaker 2: healing process. So we even now try to encourage people
29:05
Speaker 2: like if you can the pain's not killing you, try
29:08
Speaker 2: to not take anti inflammatory medication, just let it go
29:11
Speaker 2: through its normal process. Implement things like gentle soft tissue
29:14
Speaker 2: mobilization's gentle mobility exercises, Like if you had an ankle sprain,
29:18
Speaker 2: we'd have people kind of just do like the ankle
29:21
Speaker 2: alphabet exercises and kind of move their ankle back and forth,
29:23
Speaker 2: like the just keep it moving because blood flow is
29:26
Speaker 2: what you need. You need blood flow to come in
29:27
Speaker 2: there to bring oxygen and nutrients. So that's kind of
29:31
Speaker 2: the first few days, maybe up to a week, depending
29:34
Speaker 2: on this ferry of the injury. And then you move
29:35
Speaker 2: into more of like a fibroblastic type phase where the
29:40
Speaker 2: body's starting that rebuilding process, and so like that might
29:44
Speaker 2: be where like if you had a really severe injury,
29:46
Speaker 2: start forming scar tissue and things like that, and or
29:49
Speaker 2: you had a muscle strain and the muscle fibers are
29:51
Speaker 2: healing things like that, or and in that phase in treatment,
29:57
Speaker 2: we're starting to look at impairments. So does somebody have
30:00
Speaker 2: a range of motion restriction, do they have a strength impairment,
30:02
Speaker 2: Do they have like a balance or kind of we
30:05
Speaker 2: call it motor control, like a motor like an inability
30:07
Speaker 2: to coordinate and control their body. And so in the
30:11
Speaker 2: rehab world, and that's what in my book, the three
30:13
Speaker 2: phases of the program. Phase one is focused on pain alleviation.
30:16
Speaker 2: Phase two is addressing impairments. So you're looking at range
30:20
Speaker 2: of motion impairments mobility impairments, So those would be stretches
30:24
Speaker 2: and mobility exercises. You might be using a tool, like
30:26
Speaker 2: if it was your shoulder and it hurts for you
30:28
Speaker 2: to lift your arm to go through four range of
30:29
Speaker 2: mass on its own, you might use a golf club
30:31
Speaker 2: or like a broomstick, so your other arm can kind
30:34
Speaker 2: of help guide that. Or sometimes people have seen wall crawls,
30:36
Speaker 2: like where you can kind of crawl up the wall
30:37
Speaker 2: and you're using an external object to sort of take
30:40
Speaker 2: some stress off of the painful tissues and it allows
30:44
Speaker 2: you to go. So you're just because like with the shoulder, Okay,
30:47
Speaker 2: So here's a great example of females. Females are much
30:49
Speaker 2: more likely to develop frozen shoulder. Yeah, and a lot
30:51
Speaker 2: of cases that starts from a rotator cuff ten andopathy.
30:55
Speaker 2: But what happens is people get rotator cuf ten andopathy
30:57
Speaker 2: and then their initial reaction to the pain is to
31:00
Speaker 2: hold their arm like it's in a sling and not
31:01
Speaker 2: move it, and then they develop frozen shoulder. So you
31:05
Speaker 2: have to keep the mobility going, and this is true
31:08
Speaker 2: with so almost every condition in the muscle skeletal system.
31:13
Speaker 2: You want to respect the pain, but you have to
31:15
Speaker 2: keep the area moving and so something like a rotator
31:18
Speaker 2: cuf to monopoly will give people range of motion exercises
31:21
Speaker 2: that don't cause a ton of pain, but just keep
31:23
Speaker 2: them moving through as much range of motion as they
31:26
Speaker 2: can tolerate, so they're less likely to develop something like
31:29
Speaker 2: frozen shoulder. And then the last stage of healing, the
31:33
Speaker 2: timeframes can vary depending on the tissue that was injured
31:36
Speaker 2: just because of blood flow. Different tissues have different supplies
31:40
Speaker 2: of blood flow. But in that phase, kind of the
31:43
Speaker 2: last remodeling phase, it's focused mostly on string training. You know,
31:47
Speaker 2: you're trying to just build the muscle scletal system, even
31:50
Speaker 2: though it's not simple like a card is very mechanical,
31:53
Speaker 2: and string training has the best evidence for so many
31:55
Speaker 2: things because it makes all of your tissue stronger. Your
31:58
Speaker 2: bones get denser, you build muscle mass, your tendons get stronger,
32:01
Speaker 2: even your ligaments and the discs in your spine become
32:04
Speaker 2: more resilient with string training. So it's really the best
32:08
Speaker 2: thing that you're doing at the end of rehab, and
32:11
Speaker 2: you hope the person will continue with because it's going
32:13
Speaker 2: to protect them over time.
32:15
Speaker 1: Yeah, so if we look at pain specifically. And I
32:19
Speaker 1: know that you've been on a lot of podcasts and
32:21
Speaker 1: you've talked about pain. You have a chapter in your
32:24
Speaker 1: book about pain. This is hard because we know that
32:30
Speaker 1: there's a pain threshold that's different for everyone. I mean,
32:33
Speaker 1: I even without an injury. I will have some women
32:37
Speaker 1: in there that I'll be training and they'll be on
32:39
Speaker 1: the leg press and they're talking to me the whole time,
32:42
Speaker 1: and then all of a sudden they're like, I can't
32:44
Speaker 1: do another one, Hayley. You didn't even slow down, and
32:47
Speaker 1: you were talking to me unwinded the whole time, but
32:50
Speaker 1: in their head they were tapped out, like no, no, no,
32:54
Speaker 1: the pains there like the second they feel anything. So
32:57
Speaker 1: let's talk about pain and what that looks like from
33:00
Speaker 1: a mental like psychological component, and then actually how pain is.
33:07
Speaker 2: Yeah, pain is so fascinating. It's probably the thing I
33:10
Speaker 2: geek out on the most. But it's such a personal,
33:13
Speaker 2: subjective thing, which is what why The treatment of pain,
33:16
Speaker 2: which is all I do, is very fun and kind
33:20
Speaker 2: of tricky because it has so many influences from what's
33:24
Speaker 2: the messages that you're actually getting from your body, Like
33:27
Speaker 2: we have these little they're called danger receptors. They're the
33:30
Speaker 2: technical term is a no sceptor. But you have these
33:32
Speaker 2: little nerve endings all throughout your body that detect danger,
33:36
Speaker 2: and if they're triggered to a certain level, they'll send
33:38
Speaker 2: a message to your spinal cord up to your brain
33:40
Speaker 2: to saying, hey there's danger down here, pay attention.
33:43
Speaker 1: MM.
33:44
Speaker 2: So you have that side, you have all the messages
33:46
Speaker 2: coming from your actual physical body, and then you have
33:50
Speaker 2: all these psychological and emotional factors that go in and
33:55
Speaker 2: and pain is so interesting because we used to think
33:57
Speaker 2: pain came from your body, you know, that was the
33:59
Speaker 2: old model. Like if you're sitting doing leg press and
34:02
Speaker 2: all of a sudden your quad start burning and then
34:03
Speaker 2: you have knee pain or it hurts in your quad.
34:06
Speaker 2: We used to think that was a pain receptor in
34:08
Speaker 2: that area sending a message to your brain saying, hey,
34:10
Speaker 2: there's pain here. And that there's been a huge development
34:15
Speaker 2: probably over the last I mean thirty to fifty years
34:18
Speaker 2: looking at oh pain is actually you have those receptors,
34:22
Speaker 2: those danger receptors, but pain actually is sent from your brain.
34:25
Speaker 2: Your brain has to look at all these different things,
34:29
Speaker 2: your emotional state, your psychological state, what you believe about
34:32
Speaker 2: what's going on. You're kind of like like social support,
34:37
Speaker 2: like how threatened you might fill in the environment you're in.
34:42
Speaker 2: Does it feel like a dangerous environment? Do you feel
34:44
Speaker 2: safe there? Past trauma? Nutrition, sleep, Like do you have
34:48
Speaker 2: inflammation systemic inflammation, like maybe you have a metabologist, or
34:51
Speaker 2: do you have like hormonal changes that are feeding into
34:53
Speaker 2: your immune system and your nervous system and how you
34:56
Speaker 2: perceive things. There's so many elements that go into pain
34:59
Speaker 2: perception and a person's pain threshold that it can be
35:05
Speaker 2: really tricky to help people navigate that. And so it's
35:11
Speaker 2: a it is such an interesting I have so many
35:14
Speaker 2: cases where, you know, because I'm just talking to people
35:18
Speaker 2: and asking them about there, they're reporting their pain to me.
35:21
Speaker 2: And it's so interesting. Sometimes people will tell you ask
35:24
Speaker 2: them on a zero to ten how much pain I
35:25
Speaker 2: experienced in like ten out of ten, and they're just
35:27
Speaker 2: sitting there. If you were ten out of ten, you'd
35:29
Speaker 2: be like usually sweating, like it's like somebody stabbed you,
35:32
Speaker 2: like this is a life or death. Like, So it's
35:34
Speaker 2: interesting what people will perceive from a pain stand. But
35:39
Speaker 2: we've actually, in some ways in physical therapy tried to
35:41
Speaker 2: move away from just asking a zero to ten scale.
35:43
Speaker 2: Sometimes it's just like I would just use mild, moderate severe.
35:46
Speaker 2: It just because it's so subjective and personal, it can
35:51
Speaker 2: be challenging trying to figure out if you're only using
35:53
Speaker 2: pain to navigate things. It can be kind of a
35:55
Speaker 2: tricky you know it just it makes it tricky. You
35:59
Speaker 2: almost need other objective kind of things you look at
36:01
Speaker 2: in the person to determine how you move forward. But
36:07
Speaker 2: you know, somebody who's exercising and saying that, and is
36:11
Speaker 2: displaying no symptoms prior to that, and all a sudden
36:14
Speaker 2: they can't do anything more. I think sometimes the psychological
36:19
Speaker 2: and emotional side of how something feels is a major driver.
36:24
Speaker 2: I think a lot of people stop because of mental
36:26
Speaker 2: factors and not because it's actually their physical body, you
36:29
Speaker 2: know you It's it's amazing how far people can actually
36:32
Speaker 2: push themselves if they can get beyond the mental Some
36:36
Speaker 2: of the best studies in the world on people who
36:38
Speaker 2: have the highest pain tolerance are endurance athletes. Endurance athletes
36:42
Speaker 2: like people who run marathons and iron Man races and
36:46
Speaker 2: these one hundred mile races. They have the ability to
36:50
Speaker 2: push past those messages they're getting and their brain telling
36:55
Speaker 2: them to try and stop. And I think not that
36:59
Speaker 2: you have to go be like that, that we all
37:00
Speaker 2: need to be like that, but I think it's something
37:02
Speaker 2: we probably need to keep in the back of our
37:04
Speaker 2: head when we're training, like, is my body actually injured
37:07
Speaker 2: and I'm in like really severe danger. Am I experiencing
37:11
Speaker 2: a dangerous level of pain? Or is this just like
37:13
Speaker 2: I'm really fatigued and my brain's trying to get me
37:15
Speaker 2: to quit m.
37:18
Speaker 1: That's interesting too, because you also see people identify with
37:27
Speaker 1: you know, if they've had back pain. I mean, I
37:29
Speaker 1: had back surgery when I was seventeen. I was a
37:31
Speaker 1: gymnast too, and I had back surgery at seventeen, and
37:35
Speaker 1: I could very well now, you know, just be like, well,
37:38
Speaker 1: I have a bad back. I have a bad back.
37:40
Speaker 1: I've always had a bad back. Do you see that too,
37:44
Speaker 1: that you like, somebody really identifies and they're just like, no,
37:46
Speaker 1: this is what I have and this is who I am.
37:49
Speaker 1: And so then all it plays into that feeds into
37:52
Speaker 1: that loop of maybe I have pain, but talk about
37:57
Speaker 1: So there's been multiple MRIs, but you pull any a
38:02
Speaker 1: bunch of people off the street and half of them.
38:04
Speaker 1: You look and think, well, you probably shouldn't even you
38:07
Speaker 1: should be insignificant pain. But they're you know, they don't
38:10
Speaker 1: know any different, and they don't even they aren't mentioning it.
38:13
Speaker 1: But what does that look like? I mean, that's a
38:17
Speaker 1: whole psychological component too, or what do you think of
38:22
Speaker 1: those studies?
38:23
Speaker 2: Yeah, I mean the first part you said is so true.
38:26
Speaker 2: The psychological piece is something I spend a lot of
38:28
Speaker 2: time trying to talk with patients about because some people
38:30
Speaker 2: have such limiting beliefs about pain, and that one you
38:34
Speaker 2: mentioned is a huge one. Like I've had an accident
38:36
Speaker 2: when it's early earlier, so I'm just now I'm going
38:38
Speaker 2: to have a bad back. Or I got in a
38:40
Speaker 2: car accident my you know, hurt my neck and it's
38:42
Speaker 2: just always going to be this way. Or my parent
38:45
Speaker 2: had a bad head back pain, so I'm just doomed
38:47
Speaker 2: to have it because they had it. People have these
38:50
Speaker 2: very limiting beliefs around pain, So I spend a lot
38:52
Speaker 2: of time trying to push back on those gently with
38:55
Speaker 2: people and just kind of plant seeds on just helping
38:58
Speaker 2: them understand pain. I think helping people understand what pain
39:02
Speaker 2: is and how the pain system works can help them
39:05
Speaker 2: sort of reframe. It's a big part of like the
39:08
Speaker 2: treatment of pain is helping people reframe how they think
39:11
Speaker 2: about pain. And so you know, that component is so huge.
39:15
Speaker 2: And the mirisa, there's tons of these tons of mirisas
39:19
Speaker 2: I highlight these all the time. They basically take asymptomatic people.
39:21
Speaker 2: So these are people without pain, bring them in do
39:24
Speaker 2: an MRI. They've done these on the shoulder, the knee,
39:27
Speaker 2: the spine. So and it's almost like half of the
39:30
Speaker 2: population have things like meniscus tears, discarnations, and disk bulges,
39:34
Speaker 2: labral terrors in their hip and shoulder. And these are
39:37
Speaker 2: people without pain. So it's ranges from thirty to like
39:41
Speaker 2: forty five percent of the population have these things. And
39:44
Speaker 2: so when people you know, we actually are very apprehensive
39:50
Speaker 2: to have people get MRIs now in rehab because there's
39:56
Speaker 2: been studies showing that when people have an MRI and
39:58
Speaker 2: they see something on it, they will kind of instantly
40:02
Speaker 2: worry about it, and that worry will negatively impact their
40:06
Speaker 2: outcomes in rehab. And it's been shown that now we
40:09
Speaker 2: know almost half the population has these, so there's no
40:11
Speaker 2: way to prove that that thing you see on an
40:13
Speaker 2: MRI is the cause of your symptoms, and it doesn't
40:16
Speaker 2: really change what you do in rehab. Now, if you
40:18
Speaker 2: had like these really severe symptoms where you're more of
40:21
Speaker 2: a surgical cannon than an MRI is useful. But I
40:24
Speaker 2: kind of tell people now, like, don't go get an
40:26
Speaker 2: MRI if you're not planning to have surgery, because what
40:29
Speaker 2: we do to treat that is going to revolve around
40:33
Speaker 2: your symptoms and how you move, your mobility, your strength,
40:36
Speaker 2: your symptoms. I'm not basing my treatment on that MRI.
40:39
Speaker 2: It's really on how you function. So people just have
40:43
Speaker 2: to a big part of the education we work on
40:46
Speaker 2: people now is separating pain from injury, because most people
40:49
Speaker 2: have this belief that pain means something's damaged in their body,
40:52
Speaker 2: and in a lot of cases that's not true. You
40:55
Speaker 2: can have pain and absolutely no injury. There's a lot
40:57
Speaker 2: of people who go have MRIs who have severe back
40:59
Speaker 2: pain and have nothing, no findings. So that's equally as
41:02
Speaker 2: discouraging actually to a lot of people because they're expecting
41:04
Speaker 2: to build to blame the symptoms on something. And then
41:08
Speaker 2: you can have people who have sphere injuries who don't
41:10
Speaker 2: experience pain. You know, you have lots of these stories
41:12
Speaker 2: from like situations like with different athletes where they're like
41:16
Speaker 2: in the heat of the moment in a sport and
41:18
Speaker 2: break a bone or something and don't even they tear
41:21
Speaker 2: a tendon, they don't experience any pain. You hear lots
41:23
Speaker 2: of stories of this from like soldiers in wartime situations
41:26
Speaker 2: where something really severe happens, they don't experience pain at
41:29
Speaker 2: the time. And you can think of less severe things too,
41:31
Speaker 2: like all of us have probably like woken up and
41:33
Speaker 2: saw a bruise and we don't remember anything ever hurting
41:36
Speaker 2: or how we got it. So all the time, yeah,
41:39
Speaker 2: that's an injury. There's injury. The injury happened in your
41:41
Speaker 2: tissues healing, but you don't recall having pain. So pain
41:45
Speaker 2: and injury are different things. And I think the main
41:47
Speaker 2: thing for people to know is that pain does not
41:49
Speaker 2: always mean that something's damaged in your body, especially when
41:52
Speaker 2: you're talking about something like teninopathy, which so many of
41:54
Speaker 2: us are going to have. Like teninopathy is not you
41:58
Speaker 2: wouldn't really categorize that as an injury. It's more of
42:00
Speaker 2: a pain condition. It's more of like a sensitivity. It's
42:03
Speaker 2: not a like you actually damage something.
42:06
Speaker 1: Okay, that's a super important part if we move down.
42:10
Speaker 1: So one other area that I want to talk about
42:13
Speaker 1: the feet. So the feet, there's a lot going on there,
42:18
Speaker 1: but also you know, I'm going to lump like ankle
42:21
Speaker 1: in there as well. This is a commonly weak a
42:27
Speaker 1: weak spot that I see in women as well, not
42:30
Speaker 1: only with maybe a tendant opathy or without. But it's
42:33
Speaker 1: the balance, the proprioception and the balance that starts to
42:37
Speaker 1: decline as we age as well. And you know, do
42:41
Speaker 1: you recommend, like when weightlifting, like a minimalist shoe barefoot,
42:48
Speaker 1: do you prefer a padded shoe? What's your advice on that?
42:53
Speaker 2: Yeah, I think at the end of the day, you
42:55
Speaker 2: have to kind of figure out where your starting point is.
42:57
Speaker 2: If somebody has never worn a minimalist shoe or done
43:00
Speaker 2: a lot of training barefoot, I think you just also
43:03
Speaker 2: have to think of it like you're the rest of
43:04
Speaker 2: your training. You have to gradually get into it and
43:06
Speaker 2: give your tissues time to adapt to it. But I
43:08
Speaker 2: think ultimately I'd love to see people doing most of
43:13
Speaker 2: their training in a less supportive shoe, you know, something
43:16
Speaker 2: that's more of a minimalist style. I mean, I grew
43:19
Speaker 2: up only doing things barefoot, so like I have all
43:22
Speaker 2: these weird muscles on my feet. I'm sure you do too,
43:24
Speaker 2: from gymnastics, Like I have weird hyperture feed muscles on
43:27
Speaker 2: my feet because I was always barefoot and holding my
43:29
Speaker 2: foot in funky position, especially like in martial arts, I'd
43:32
Speaker 2: be kicking and you have to hold your like I
43:33
Speaker 2: just did a lot of foot training. I didn't even
43:35
Speaker 2: realize I was doing a lot of foot training, but
43:38
Speaker 2: I think you know if you're someone who's been in
43:41
Speaker 2: a really supportive shoe. The problem with really supportive shoes
43:45
Speaker 2: is that they feel great, and they might be useful
43:47
Speaker 2: for like a really stressful competition, like if you had
43:50
Speaker 2: to go run a marathon or something. Maybe you use
43:52
Speaker 2: it in an event, but in the rest of your
43:55
Speaker 2: training you want. The problem with those types of shoes
43:58
Speaker 2: is that they support you so much. It's almost like
44:00
Speaker 2: having a brace on your foot. And we know we
44:03
Speaker 2: wouldn't eBrace other parts of our body because we know
44:05
Speaker 2: the body atrophies and deconditions. It's why you don't want
44:07
Speaker 2: to be in a sling for too long or have
44:09
Speaker 2: a knee brace on for too long. You're you're not
44:12
Speaker 2: having to use your neuromuscular system as much, and so
44:15
Speaker 2: people don't think of that with their shoes because we're
44:18
Speaker 2: just so conditioned to just, oh, you just wear shoes
44:21
Speaker 2: and that's what you do. And I think more people
44:23
Speaker 2: are becoming aware as more of these minimalist shoe companies
44:25
Speaker 2: are coming out and we're seeing more research showing that
44:28
Speaker 2: just even wearing a minimalist type shoe or being barefoot
44:30
Speaker 2: helps to strengthen your foot. And you think about females,
44:34
Speaker 2: like females are more prone to something called post your
44:37
Speaker 2: tibilis tendon dysfunction, where their tiblis post your muscle, it's
44:41
Speaker 2: tendin can basically sort of break down, which leads to
44:45
Speaker 2: progressive flattening of the arch. So you hear this sometimes
44:48
Speaker 2: females around kind of menopause timeframe where that tendon related
44:52
Speaker 2: to hormonal change that the tendon kind of starts to
44:54
Speaker 2: deteriorate and to generate and their arch gradually flattens. And
44:58
Speaker 2: so I think there's a place for all humans as
45:04
Speaker 2: we age, but especially females, to be incorporating movements and
45:10
Speaker 2: exercises where you are challenging your foot, whether it's barefoot,
45:16
Speaker 2: or being in a less supportive shoe. But just think
45:19
Speaker 2: I just have to gradually work into it. It might
45:21
Speaker 2: not you probably don't. You don't want to just just
45:24
Speaker 2: jump straight into one of a shoe like that if
45:27
Speaker 2: you're not used to it, because it will end up
45:29
Speaker 2: causing probably a lot of arch and foot pain. So
45:32
Speaker 2: you have to gradually give the tissue time to change.
45:36
Speaker 2: If you are going to switch over to like say like, okay,
45:38
Speaker 2: I want to start using minimalistic shoes for most of
45:40
Speaker 2: my daily activities. Well, you might only be doing fifteen
45:44
Speaker 2: minutes start at the start, or maybe an hour in
45:46
Speaker 2: the day, and then you go back to your other
45:48
Speaker 2: shoe like you're just trying to slowly build up that capacity.
45:52
Speaker 1: Yeah, and this is all again, this is all in
45:54
Speaker 1: your book. So let's move on to your app. Can
46:00
Speaker 1: we announce that? Can we start talking about that?
46:03
Speaker 2: Yeah? Thank you, Yes, I'm so excited about it. I
46:06
Speaker 2: think it's gonna be The book has been out two years,
46:08
Speaker 2: and the book has helped a lot of people, you know,
46:11
Speaker 2: But the feedback I always get when it comes to
46:13
Speaker 2: exercise and movement, it's helpful to that video, and I
46:15
Speaker 2: think this is why I like my YouTube channel on
46:17
Speaker 2: Instagram account are so popular. Is it's okay to have pictures,
46:21
Speaker 2: But a lot of people just ask me, like could
46:23
Speaker 2: I get rehab and prehab programs in video format? A
46:26
Speaker 2: lot of people just want like an exercise library, like
46:28
Speaker 2: we were talking about these exercises, like imagine that'll be
46:31
Speaker 2: a part of the apports, like you can go in
46:32
Speaker 2: and just find exercises for your foot and ankle like
46:36
Speaker 2: that you could just incorporate to work on mobility and strength,
46:39
Speaker 2: and so that'll be a big focus of it for me,
46:42
Speaker 2: is to just create these video based prehab and rehab
46:45
Speaker 2: programs so that people can start working on these things
46:50
Speaker 2: before they begin a program. Most of the people will
46:52
Speaker 2: probably come once they're already in pain and injured. But
46:56
Speaker 2: a lot of the education for me is like trying
46:57
Speaker 2: to get people to think about re hab ac sizes
47:00
Speaker 2: is not just rehab that you can keep doing them
47:03
Speaker 2: after to reduce the chances that it comes back. So, yeah,
47:06
Speaker 2: I'm pumped about it.
47:07
Speaker 1: That's awesome. And when do you anticipate the app to launch?
47:11
Speaker 2: I think it's going to take about right around like
47:14
Speaker 2: forty five to sixty days, So I'm hoping that two
47:18
Speaker 2: months max, So maybe maybe sometime in October.
47:22
Speaker 1: Okay, well, good keep us posted. In the meantime, I'm
47:27
Speaker 1: super bummed that our time is almost up. But in
47:30
Speaker 1: the meantime, I mean this again, show the book for
47:34
Speaker 1: anyone who's watching. This book is incredible. But as you said,
47:37
Speaker 1: the app is so nice because I'm not lugging this
47:40
Speaker 1: to the jam.
47:41
Speaker 2: That's the problem.
47:42
Speaker 1: But it just I mean, it literally breaks down every
47:45
Speaker 1: single tendinopathy or issue. And I have used it so
47:49
Speaker 1: much for just flipping through and saying, okay, well this
47:53
Speaker 1: breaks it down, tells me exactly what you do in
47:54
Speaker 1: phase one, phase two, phase three. So I love it.
47:57
Speaker 1: Where can where can people find you right now if
48:01
Speaker 1: they're not familiar with you. I did mention your Instagram
48:04
Speaker 1: but at the first but go ahead and just tell
48:07
Speaker 1: us where to find you before the app comes out.
48:09
Speaker 2: Yes, thank you. I'm at Rehab Science mostly on Instagram
48:12
Speaker 2: and YouTube, so Instagram is kind of quicker. If people
48:16
Speaker 2: are on that platform, they know it's kind of quicker.
48:18
Speaker 2: I have a lot of posts that are just like exercises,
48:20
Speaker 2: like you could find a planner fasciatus post kind of
48:22
Speaker 2: flip through carousel style and find exercises for that YouTube,
48:25
Speaker 2: I do a little bit more. I'm narrating talking through
48:27
Speaker 2: the exercises, so it's just a little more detail. But
48:29
Speaker 2: they're both Rehab Science. The book is called Rehab Science.
48:32
Speaker 2: It's on Amazon and Barnes and Noble. My website is
48:34
Speaker 2: rehabscience dot com, so people can find me in those places.
48:38
Speaker 2: And if people want to like DM me on Instagram
48:40
Speaker 2: and tell me, say hey, I came from the podcast today.
48:43
Speaker 2: That really helps me have some context. But I try
48:45
Speaker 2: to answer dms. So happy to help people because sometimes,
48:48
Speaker 2: like on that platform, it's hard to find a post
48:51
Speaker 2: that relates to what you're looking for. YouTube is a
48:54
Speaker 2: little bit easier because I have playlists. You could go
48:56
Speaker 2: to the hip playlist or the ink on Foot playlist
48:58
Speaker 2: or the elbow playlist and you can all that can
48:59
Speaker 2: do We've talked about today. I've covered these all in videos,
49:02
Speaker 2: and there's exercises you can just start with. And like
49:04
Speaker 2: I said, the book, the book is like a textbook,
49:06
Speaker 2: so it's a little bit. That's the annoying part is
49:08
Speaker 2: carrying it to the gym. But it's a lot of
49:10
Speaker 2: people use it as a home reference and they just
49:11
Speaker 2: flip open and it's like you've got three phases. You
49:13
Speaker 2: have a program, you don't have to go do the
49:15
Speaker 2: pt save the money ongoing. It's like thirty eight bucks
49:18
Speaker 2: on Amazon's It's it's like one Copey and you have
49:20
Speaker 2: a resource that you can treat your whole body with.
49:23
Speaker 1: Oh, Tom, it's amazing. And so I'm guessing that the
49:25
Speaker 1: app is going to be called Rehab Science too. Yes, yep, same, okay, awesome. Well,
49:30
Speaker 1: I look forward to having you, as we had discussed before,
49:33
Speaker 1: in something special for my audience. But thank you so
49:37
Speaker 1: much for what you're putting out in the world. Thank
49:38
Speaker 1: you for your expertise. And I have to say you
49:42
Speaker 1: are such a nice guy, and that is so refreshing
49:46
Speaker 1: in this space. This is it's so refreshed, refreshing in
49:50
Speaker 1: the in the fitness kind of arena for someone like
49:54
Speaker 1: me who's seeking out guests. So thank you for your
49:57
Speaker 1: time today and your expertise, and we look forward to
49:59
Speaker 1: having your app come out.
50:01
Speaker 2: Thank you so much. It was a pleasure to be on.
50:03
Speaker 2: I hope this helps everyone in your audience. And yeah,
50:05
Speaker 2: thanks again.
50:06
Speaker 1: Thanks for listening everyone. If you enjoyed this episode, please
50:09
Speaker 1: consider giving us a five star rating and sharing the
50:12
Speaker 1: body Pod with your friends.