Mark Bell's Power Project - Fix Back Pain in 3 Steps (and other PAIN hotspots) - Tom Walters || MBPP Ep. 978

Episode Date: August 30, 2023

In episode 978, Tom Walters Mark Bell, Nsima Inyang, and Andrew Zaragoza talk about effective ways people can get pain relief from common chronic issues such as back pain, tennis elbow and more. Follow Tom on IG: https://www.instagram.com/rehabscience/ Order Tom's Book: https://rehabscience.com/book/   New Power Project Website: https://powerproject.live Join The Power Project Discord: https://discord.gg/yYzthQX5qN Subscribe to the new Power Project Clips Channel: https://youtube.com/channel/UC5Df31rlDXm0EJAcKsq1SUw   Special perks for our listeners below! ➢https://drinkag1.com/powerproject Receive a year supply of Vitamin D3+K2 & 5 Travel Packs!   ➢ https://withinyoubrand.com/ Code POWERPROJECT to save 15% off supplements!   ➢ https://markbellslingshot.com/ Code POWERPROJECT to save 15% off all gear and apparel!   ➢ https://mindbullet.com/ Code POWERPROJECT to save 15% off Mind Bullet!   ➢ https://goodlifeproteins.com/ Code POWERPROJECT to save up to 25% off your Build a Box   ➢ Better Fed Beef: https://betterfedbeef.com/pages/powerproject   ➢ https://hostagetape.com/powerproject to receive a year supply of Hostage Tape and Nose Strips for less than $1 a night!   ➢ https://thecoldplunge.com/ Code POWERPROJECT to save $150!!   ➢ Enlarging Pumps (This really works): https://bit.ly/powerproject1 Pumps explained: https://youtu.be/qPG9JXjlhpM   ➢ https://www.vivobarefoot.com/us/powerproject to save 15% off Vivo Barefoot shoes!   ➢ https://vuoriclothing.com/powerproject to automatically save 20% off your first order at Vuori!   ➢ https://www.eightsleep.com/powerproject to automatically save $150 off the Pod Pro at 8 Sleep!   ➢ https://marekhealth.com/PowerProject to receive 10% off our Panel, Check Up Panel or any custom panel!   ➢ Piedmontese Beef: https://www.CPBeef.com/ Use Code POWER at checkout for 25% off your order plus FREE 2-Day Shipping on orders of $150   Follow Mark Bell's Power Project Podcast ➢ https://www.PowerProject.live ➢ https://lnk.to/PowerProjectPodcast ➢ Insta: https://www.instagram.com/markbellspowerproject ➢ YouTube: https://www.youtube.com/markbellspowerproject   FOLLOW Mark Bell ➢ Instagram: https://www.instagram.com/marksmellybell ➢https://www.tiktok.com/@marksmellybell ➢ Facebook: https://www.facebook.com/MarkBellSuperTraining ➢ Twitter: https://twitter.com/marksmellybell   Follow Nsima Inyang ➢ https://www.breakthebar.com/learn-more ➢YouTube: https://www.youtube.com/c/NsimaInyang ➢Instagram: https://www.instagram.com/nsimainyang/?hl=en ➢TikTok: https://www.tiktok.com/@nsimayinyang?lang=en   Follow Andrew Zaragoza on all platforms ➢ https://direct.me/iamandrewz   #PowerProject #Podcast #MarkBell #FitnessPodcast #markbellspowerproject

I've heard you say before that the best posture is your next posture. Let's get away from demonizing certain positions and movements and this is good and this is bad and let's encourage people just to keep moving. If you work at a job where you sit around a lot, it's not really a surprise that you're feeling a lot of pain since most of your day you're not moving. Forever we talked about how bad prolonged sitting was, so then everybody's like, well, I'm just gonna do prolonged standing. Eventually tissues usually get annoyed when you do that.

Tissues might calm down right away if you're just resting. That problem will usually come back as soon as you load them again. So if somebody's really sensitive to movement, maybe you just have them think about it first. Do you find patterns with back pain or is literally everybody like so extremely different that each person is like a brand new page in the book?

No, there's definitely patterns. No, you don't understand my back pain. Do you think myofascial release is all placebo and it just makes the athlete feel good? And because they feel good, well, okay, they're going to do better. I definitely don't think it's all placebo. Do tight muscles lead to pain in other various areas? Those theories haven't held up that well, but I do think you see a lot of people with back pain who have tight muscles. Once they start to feel a little bit better, is that part of the objective to do like maybe bodybuilding and do three sets of 10, get some good blood in

the shoulder? For sure. Getting that blood flow up, I think it's going to expedite the healing process. I liked one of the things I heard you say recently. Maybe this is something you've been sharing with people for a while, but it's something that we talk about on the show. We're huge fans of movement. We're huge fans of kind of microdosing movement. So some of the stuff you saw us do in the gym this morning, while that might not have been like a full on crazy workout, we're moving around and seeing us mess around with the kettlebell. easy workout, we're moving around and seeing us messing around with the kettlebell. We're messing around with some of the other things in there and we're doing some myofascial release and chopping it up and kind of stretching and doing mobility. And I've heard you say before that

the best posture is your next posture. You mind expanding on that a little bit? Yeah, no, I think just seeing you guys kind of, like I was saying, exploring movement and kind of being open to just experimenting with different things, I think is huge. And so many of us get in these kinds of ruts where we just do the same movements. We're in the same positions all the time. And really when you look at a lot of musculoskeletal problems, you know, that idea that your next posture or your best posture is your next posture, I think is kind of where the musculoskeletal world in terms of pain, especially pain is kind of shifting where let's get away from demonizing certain positions and movements and this is good and this is bad. And because really

we know people vary so much and it's kind of like, let's encourage people just to keep moving, like just trying to be static anywhere. I mean, if you look at anyone, even if they look perfect, like I've had lots of patients that'll come in over the years that they're really focused on having perfect, good posture and, you know, but they end up actually having more pain in that position, you know, and I'd have a lot of parents that'd be kind of annoyed with me a bit. Cause I'd be like, well, you know, like being their high schooler. And I'm like, if it, if it's slouching makes you feel better, like slouch if you need to, like just, but mainly just think about trying to keep moving your nervous system. I think there's even a Ted talk

on this about this neuroscientist arguing that the primary function of our nervous system and brain is movement. And I think, you know, we all know when you're not moving, you end up having way more discomfort and just you don't feel as good when you have to be more stagnant. And so I feel like with a lot of people who are coming to see me, of course, there's a balance with it. Like you don't want just people to just be dumb about what movements and the volume of movement for sure. You go bonkers and go too crazy. That can trigger things and flare things up so trying to find that balance encouraging people to move but also getting them to understand there is a capacity and you can improve that capacity over time you've got to find kind of that sweet spot for you where you're at right now

yeah and the differences between like a quote-unquote good movement and bad movement i think that um i think that there shouldn't be any bad movements necessarily. I think that you should be resilient, resistant, and even if you are in kind of a bad position, your body should be able to accept it because, like, why can your body get into these positions in the first place? I guess the area where I would have more restraint would be like in sport. If you're going to swing a golf club and – I mean you're – people might not understand. Like when you're swinging a golf club, like you're producing a lot of force. For sure.

And there's a lot of stuff going through your feet and your knees and your lower back. And that's where you might have to really pay attention to kind of where your neck is, where your shoulders are, where your feet are, how you're utilizing your feet. But when it comes to, you know, just going in the gym and training and practicing some lunges, some forward lunges, backward lunges, some step ups and things like that, you should be able to put your knee over your toe. You should be able to bend your neck down. You should be able to have your head up or to the side in some way that someone else might be like, I don't know what that guy's doing. That looks a little weird, but if it's not loaded, I don't really see the problem with it. I totally agree. And we talk

about this in the book, kind of looking at what are these factors that are associated with injury and biomechanics and posture. We get in there and especially in the biomechanics one, because you're right. If you, if force goes up on the system, I think you have to be more cognizant of what does your alignment and posture look like in this thing, you know? And so I'm often talking to patients about this. I just had someone the other day that was really when she was really worried. She has a kind of like an adductor strain, hip adductor strain. And she was really worried about just these basic kind of like lunging and leg press, these kinds of slow movements. And I was trying to convince, you know, trying to help her understand

that these things, even though there is some force and you've got some external load for sure, there's some extra force and they're the likelihood of injury in that it's pretty low, especially considering how much weight she was putting on it. But you know, yeah, if you get up into like the force is way higher, the load is the external load is extremely high or you're say an athlete where there's a lot of acceleration on your system where you're like running and changing direction or you're sprinting.

Yeah, like the force is going to go up and you have to be thinking more. You have to be more intelligent about what, am I putting myself in a position here where I can work to kind of minimize injury risk? Am I doing all the things we were talking about before? Am I warming up? Is my body, does it have the capacity to handle this, you know? And yeah, I think because this debate comes up all the time. For a while in the PT

world, there was kind of this group that was like biomechanics and posture never matter, you know? And it kind of went down that road. There was this group that was like, we should never like really rarely talk about these things, but for low loaded kind of everyday tasks, maybe that's more the case. But I think for sure, when you get into high force situations, that's where to me, biomechanics and posture and the person's capacity really become more important and relevant to think about. Yeah. You know, I'm curious about this because like, obviously we're going to talk about athletes and how they need to deal with this, but for the most people that work every single day, and we were talking a little bit about this in the gym, like if you work at a job where you sit around a lot, right? And then you do have your workout. And then the only time that you get

up and do things is maybe on your afternoon walk. And then when you're getting up to do your workout in the gym, it's not really a surprise that you're feeling a do things is maybe on your afternoon walk. And then when you're getting up to do your workout in the gym, it's not really a surprise that you're feeling a lot of pain since most of your day you're not moving. Like we have these rock mats that we stand on that kind of force us to kind of fidget around as we're podcasting. We have all these tools that help us continue to move, which is partially why we feel so good all the time. But what would your suggestions be to people, whether it's like the type of desk that they sit in at work or things that they can add to their environment that can help them start to move a little bit more than they typically do? Yeah, it's huge, right? I mean, this is the thing that I'm often diving in with people because it really, I think at the end of the day for musculoskeletal health, one of the best things you can do is just to move regularly.

And like we were talking about, sometimes you want to tell people like in an ideal world, you'd quit that job, you know, but that's just not a reality, right? Like, but I do think there are so many options now with standup desks. And we were talking about even the little, the desks that are just these kind of slow walking kind of desks. It's not a treadmill, but it's like, you're just, it looks like it kind of, it's just flat and you can walk. I think, you know, if you could be on your laptop and be getting some steps in, that would be huge. Uh, you know, maybe it's playing with different mats. Cause you, right. We were all talking before, uh, for forever, we talked about how bad prolonged sitting was. Then everybody's like, well, I'm just gonna do prolonged standing. Well,

that has its own share of issues too, where people develop back pain and knee pain, plantar fasciitis. All there's all, you're just loading your tissues in another way and you're statically loading them. And eventually tissues usually get annoyed when you do that. So you've got to be changing that stress frequently. And, you know, maybe it's experimenting with some of these other things like sitting on a, like a physio ball or something like that, or having a, you know,

I think the mats where you can kind of, um, you know, you see a hairstylist have done this forever, right. Where they've got those kind of soft mats underneath their stand. That's a profession where they stand all day and they end up having a lot of, if they're on that cement floor, have a lot of issues. So I think you're just trying to find ways to kind of change that stress on the system. And to me, those are the biggest ones for most people in kind of a traditional work setting is, can I just go from sitting to standing? And if I do have to sit at my job, maybe I can sit at like a, have a, some sort of reminder, maybe every 30 minutes I do like 10 to 30 air squats or something just to like incorporate a little bit of movement. I mean, so it, you know,

it's, it's trying to find strategies like that for people to just keep them moving and, and not to have that kind of stiffness, hypomobility kind of deconditioning, maybe try to off limit some of that stuff that comes with just being totally stagnant and relaxed all day. If someone's already in pain though, like they're experiencing, like let's just say knee pain or back pain, those seem to be super common. Do you feel like you need to almost give people permission to, like, kind of start moving again? Because I know for myself personally, when I had low back pain, oh, I have to pick this thing up. It's going to hurt. Let me see if I can avoid it or whatever it may be.

But, you know, the obstacle is the way. It actually was the thing that helped get me out of pain was like going through those motions and movements, but I just didn't have somebody to say, no, Andrew, you're going to be fine. Go ahead and do it. As a matter of fact, this is your prescription. Do you find that you need to like literally give people permission to kind of be in a little bit of pain and then kind of get through it? For sure. You know, and obviously it varies person to person and their personality, but you definitely, I think the general is that people in pain will want to avoid that thing. And I think not always their own fault. A lot of times it comes from like they saw a doctor because unfortunately doctors a lot of times tell people just to rest. You know, it's like just avoid that thing or don't ever do it again and just rest.

ever do it again and just rest. And we know in the research that while tissues might calm down right away, if you're just resting, they, that problem will usually come back as soon as you load them again, if you haven't exposed them to that threat. So, you know, back pain is the perfect example for it because back pain often, you know, usually a lot of times people will have some type of back pain develop because they were in a bent over flex position they're rotating they're lifting something like maybe they're picking their kid up or whatever they're dead lifting at the gym in Andrew's case it was a squat that was done behind my back that was encouraged by Charlie I think well so it was was it no so check this out it was programmed by Charlielie to be to be overwatched by smoky and i went in

it's a bad idea altogether five pound increments my pr was like 225 at the time i went to 265 and it's like oh no wonder why i fucking crashed he hit a lift i remember being like dude that was sick and i walk away and then there's still i come back in and now he's hurt yeah i thought that pr was like that was it we're to take that home and celebrate that. Did you feel right in that moment or was it? No, it was actually the very next morning I went to go grab the bar. I was like, oh, I kind of messed myself up yesterday. Let me go super light.

95 pounds on the bar. I was deadlifting with Ryan Soper. How many years ago was this, by the way? So context. Previous ST. So what, like four years ago, five years ago? Four or five years five years ago okay yeah but i mean like that was like the last straw i always had back pain but that was like where it was like debilitating yeah and as i went down i didn't even do the lift i just bent over to grab it and i felt it and i'm like i'm sorry ryan like

i have to stop and then that was just like a i don was just a couple years of really, really, really dark years after that for sure. And no radiating nerve pain is just local in your back? No, there was a lot of shooting pain. Oh, you did get some. I couldn't walk. It was bad. Yeah, would you imagine that probably, right, that was very debilitating, probably created some stress and worry about like, oh, dude, if I get in another position like this, am I going to re-trigger this and set myself back? And I think, like you were asking earlier, that is you really,

I think sometimes as a PT, most of what I'm doing is sort of acting like a pain coach. Yes. And really just helping people navigate. I mean, of course, there's like the manual therapy and giving people specific exercises, but a lot of it is just like reassuring people and helping them kind of poke the bear. We'll talk about like, you don't want to just totally run from that thing that had, you know, the thing that initially caused the injury, because you'll just end up becoming deconditioned to that movement. And then if you, you know,

you'd rather have the capacity, like you're talking about, if your joints have a particular range of motion, you'd like to be able to move through them and have that capacity and not get injured every time you do it. And if somebody totally avoids something, then their likelihood of injuring when they get into that situation again, it's so much higher, but you do have to help them kind of in these graded steps. I always talk about, it's like people have anxiety. Like if you are afraid of snakes, you don't just give that person a snake the first day, you know, like here's a snake, you know, so somebody has pain bending over, you don't have your first intervention be let's just bend over and pick this up, you might do things that are similar, similar, you know, in a from a biomechanics standpoint, maybe they lay on their back and

pull their knees to their chest, which creates lumbar flexion, but it's a different context. And maybe you or you sometimes even there's research just having people think about a movement fires a lot of the same motor circuits in your brain. So if somebody is really sensitive to movement, maybe you just have them think about it first. And then they do it in an unloaded way and you just kind of try to devise this graded exposure plan. But you for sure want to encourage them to get back to it rather than just like that's off limits forever. So I think you have a really hard job being someone that's trying to help people get out of physical pain. Because as far as I know, the most researched thing that helps people get out of pain is time.

And so the doctor saying, hey, you should take some time off kind of makes some sense in some ways. Because, Andrew, I don't think you – do you have any idea like what fixed your back? Your back is a lot better nowadays. Yeah, yeah. No, it's still like, I mean, you guys saw me outside doing some David Weck stuff, trying to get that decompression in there because I woke up feeling a little tight, went to jujitsu, everything was fine. But I got here and I'm like, yeah, we need to address this.

And now I feel great. Like, dude, it was the posture stuff with Gota, learning how to keep my feet straight while walking definitely helped because as I would walk and I'd pick my feet up and I'd, you know, walk how they instructed me, I could feel my back kind of some, some relief with every step. And I was like, Oh, well, this is amazing. Um, and then a movement doc showed me kind of like, okay, now that you're in your back chain, let's go ahead and start stretching it out and get in, you know, and start, uh, what's the opposite of back chain? I don't know, front, whatever it may be. That combination helped relieve the pain enough for me to start jujitsu. And then now

with jujitsu being on the floor a whole lot more, uh, it's, it's been like night and day difference. Yeah. So about, I don't know, say a year and a half ago, I would have been singing a different tune probably maybe even two years ago. And now it's like, I feel like I can kind of almost do anything again. So I like that story because you're like seeking out the whole time. Oh yeah. And that must be what you run into people seeking relief from pain. For sure. And I think, you know, it's people are, I, you know, if you look at like the research on different things, right, there's, there are some things that are studied pretty well. And there's

a lot of things that aren't studied for, you know, don't have much research. And I think you hear a lot of stories like this where people, you know, I think that's a good thing for people to think about is if I've got some pain thing, most things in the musculoskeletal system get better with just time. Like that's probably the best thing to know right away is like most musculoskeletal issues just heal with time. And a lot of practitioners will blame it on their intervention. They'll say, Oh, I'm going to take credit. Like it was this thing I did you, that's what got you better. But really, if you look at these conditions, they've studied them, you know, they will just, if you track them and some do go on a long time, sometimes it's six to eight months,

but people will just tend to get better. You have a group that you just track them with no intervention in time. And then you have a group where you have interventions, you know, of course the interventions, the hope is that they will kind of speed things up. And I think you meet a lot of people like yourself where I think it's a good message there. Like, you know, be proactive in this process and explore different interventions because there's so many different types of techniques and tools and things you can try. And if something is giving you some relief, everybody's pain experience is unique and what makes them better is unique. And it depends on where you're at in the healing process. You know, like I said, like, is it, does it have nerve symptoms? Is it just local to your back? And

you kind of try to, you think about the research and what things have evidence, but then you're okay with kind of exploring other things as long as, you know, they don't have some negative side effect or you know something like that then you just try to but i think it for a lot of people is really helpful to just know most things will just get better and maybe you do have a period of rest because rest usually does desensitize things and help them and then you just i think pain and injury rehab is too complicated sometimes and it's like really you could break it down to two steps it's like let's give this let's i'm going to focus in the beginning on trying to get this thing to calm down and desensitize maybe like a period of rest maybe some soft tissue work and mobility exercises

and then once i've moved out of that phase i'm going to try to build capacity and mostly that's going to be with resistance training type things so i'm going to put load on my system and try to build it back up so that that you hear this a lot like calm it down build it back up you know and if you can just think about that and just be try to stay positive and know that most things get better yeah that's exactly what i was going to say is um so like the the i calmed the pain down and then i build right back up but um i i do as like that one two combination because it's really hard for me to explain and i know how demoralizing it can be when somebody's like dude dude, how did you get out of back pain?

It's like, well, shit, how much time do you have? Like I worked with Stuart McGill. I did a lot of stuff from John Sarno or Sarno. Breathwork helped a lot actually, like getting deep into meditation. And so all of it kind of came together to help rebuild this back thing. But everybody is different and that's what's like really difficult. So for yourself, like, do you find patterns with back pain? Like, is there something that like, I've seen this before, it's probably going to work again or is literally everybody like so extremely different that each person is like a

brand new page in the book? No, there's definitely patterns. Okay. Yeah. You can kind of lump, you can kind of group people into like, you can start off by saying, oh, this person's kind of more on the hypo mobile side of the spectrum. This person's more on the hyper, hyper mobile. So you can kind of start looking at that. Like there's kind of a spectrum of that, but does this person fit into more of kind of

a stiff back, stiff hips or extremely like, like when I was, I've worked with contortionists before and like, like that's a very different, like they're very mobile, but a lot of amazing stuff in yourself and like a little box, crazy stuff, like their lumbar spines were so mobile, you know? So there are like in the physical therapy research, there are kind of these clinical practice patterns where you start to look at that. And that's one of the differentiators in the low back. Is this person more on the hypomobile side of the spectrum? Are they more on the hypermobile side? And then you start looking at, well, is the pain localized to their back? Maybe it's like their erector muscles. Maybe it's the facet joint. Maybe it's

their SI joint. Is it local to that region? Or does it have a, like a radicular type pain where it travels down usually the buttock and like hamstring region. So, and that will change your process a little bit, but you know, so you definitely see, even though everybody's pain is kind of unique, I don't want to make it sound like, cause that could be discouraging to people to think like, my back pain is so different and how am I ever going to find a solution? Really, when you start examining people and treating them, people do have very similar characteristics and you right off the bat kind of go slightly different directions really based on is it more localized to their back or does it have like a nerve quality to it? No, but you don't understand my back pain.

Yeah. Mine hurts worse than his. Yeah, exactly. It is tricky, right? You have to validate that with people because when I was a new PT, I used to kind of be more willing. You've got to give them some grace, right? For sure. I would shoot things down, even interventions sometimes.

I'd be like, dude, there's no research for that. You shouldn't even think about that intervention, which I was robbing people. I shouldn't have done that. Bro, your back doesn't hurt that bad. Yeah. Come on. It's all in your head. Scientifically, it can't be that bad. What kind of stuff did you shit on though? Well, it would be like, you know, things that I still don't, I wouldn't be, they wouldn't

be my first pick or even maybe a pick at all for rehab. Um, but you know, it'd be like a lot of passive modality type things where people would be like, Oh, the ultrasound really helps my back. And it's like, we literally have studies now where they don't turn the machine on and we get the same results. I picture you going out of your office and like screaming into a jar and then going back in and be like, you're right. That's great. You can totally do that. Exactly. No, like there are studies where they will take a group and have the ultrasound machine turned on and then they'll have a group where they don't turn it on but do the treatment and they get similar so it's like there are just there are interventions that are so placebo driven you know and just have like very zero efficacy and i think before i would have been like no that's bullshit

you shouldn't but now i realize who cares like if it's placebo and it's not hurting them. Yeah. Yeah. That's fine. But I'm going to also try to encourage you to do movement and strengthen and work on mobility, not just ultrasound. Maybe they said yoga really hurt, really helped my back. And you might be like, I just ran into three people that had just hurt their back, you know? But I guess if that's working for you, then amen. Yeah. And it's like who you get, right? Like a lot of times it's the coach or the instructor. Like there's plenty of bad PTs and there are probably people that I'm not a good fit with patient wise. Like maybe I pick an intervention and it flares the person up and they're like, well, this guy doesn't know what he's doing. And they go somewhere else and tell him like,

this PT did this with me and it made me way worse. So I think yoga is that way too. Like a lot of people will get bet, yoga will help them with back pain. But if you get an instructor who it's a big class, they don't listen to you. It doesn't mean that that particular form of exercise isn't good for back pain. It might've just been your particular situation. And I think that's, what's tricky with pain and life, right? There's so many variables and it's not a perfect experiment and trying to figure out all what factor was it that triggered the person, what thing helped them? And sometimes that stuff's hard. You kind of are just looking at, do we have a general positive trend over time?

Knowing there's going to be setbacks. It's not this perfect linear improvement. But just are you having a general positive trend over time? Even though we know you're going to flare up sometimes, there's going to be setbacks. But that's kind of what you're looking for. Let me ask you this. Because we've had so many people that have come onto the podcast who have talked so beneficially about myofascial release. And then we've had so many people that have come on and said,

you know, it just helps people feel better. That's pure placebo. Now, in your book, you have fascial release techniques that you do as a phase one and then a phase two and then a phase three, right? So as someone who's worked with people and you've seen what this can do for people, right? So as someone who's worked with people and you've seen what this can do for people, do you think that there's a placebo aspect or do you think myofascial release is all placebo and it just makes the athlete feel good? And because they feel good, well, okay, they're going to do better. I definitely don't think it's all placebo. I mean, I think there's a part, but that's like,

there's placebo in almost anything. If you believe it's going to help you, then it's probably going to help you, you know? So I think there's more and more manual therapy research. And for a while, manual therapy kind of went out of style. And my residency was in manual therapy after PT school. And so it's always been something that I had used. What's manual therapy? It's just any kind of hands-on, like it could be manipulations, adjustments, mobilizations. What's manual therapy is all placebo and you shouldn't use it at all. And luckily I think that pendulum's kind of swinging back and there is more manual therapy research showing that there are neurophysiological effects at the tissue that can change your nervous system and your pain experience. And it's not

all placebo based. And obviously it varies from person to person, like everything. But I do think, to me, a lot of times when I'm talking to people, I'm less likely to say, oh, I'm breaking up some adhesion because I just don't think there's as much research to support that. But I do think you're putting a new input

into the nervous system. And we know pain is a part of your nervous system. It has its origin in your nervous system. And other movements like exercise is another type of input of your nervous system. It has its origin in your nervous system. And I think if you, and other movements like exercise is another type of input into your nervous system. And I think a lot of times that might be the explanation is you're putting some kind of novel input into the nervous system and that changes the output. And pain is one of the main outputs from that system.

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Question about the way people feel. Because I remember I learned about my fascia release from supple upper years ago, right? Started doing it. It was very painful in many parts of my body, right? But over the years, it's literally stopped. It's not painful for me to do any fast release anywhere. And I definitely move better than I have in the past, right? So with people, if they're starting to do myofascial release

and they feel massive amounts of pain, what does that input mean? Is there a meaning to it? I know everyone, again, you have different trigger points and different things. But if it hurts and it's not something that you want to seek out and do because it hurts, should you be avoiding it or should you be trying to seek that out? Yeah. I think, uh, you know, if you have a lot of pain with something

like myofascial release and you haven't done a lot of it, it probably just means that your nervous system considers it more threatening, which doesn't mean it's like, you know, I think that's a good way to think about pain. Pain is usually associated with something your nervous system thinks is threatening. So, and the way, so like you explained, as people participate in any kind of movement, activity, myofascial release, whatever, that's threatening initially, if they keep doing it in kind of these gradual doses over time and stay consistent with it, usually things will kind of desensitize. Stretching same way right like stretching people who don't ever

stretch you have them start stretching they explain it as being very uncomfortable yes but when you've been stretching for years you get you develop sort of a stretch tolerance and i think it's true with myofascial release you get sort of like a pressure tolerance you know and that could be sports too like martial arts like if you doo, get being thrown in the beginning feels very threatening, but over time you're like, oh, this isn't so bad. Like you just, exactly. I like being thrown. Um, so yeah, I think, I think there's a lot of value. I don't think you need to, I don't want to be careful with people who are asymptomatic and totally healthy. I think that if you looked at how much time you're going to spend in your training, I wouldn't put all the emphasis, I'd put a little smaller emphasis on myofascial

work. You know, more of it to me would be on mobility and especially resistance training, you know, if I had to pick the things, but, you know, I do think there's a place for, you know, looking at where some spots, most of us have some areas where we're kind of hypomobile or particular range of motion, a certain joint we can't get into. When we were just looking at where some spots, most of us have some areas where we're kind of hypomobile or particular range of motion, a certain joint we can't get into when we were just looking at my hip, like, right, I have a hard time getting into some of these end range spots on my left hip. So I think that's an opportunity for me to be more diligent about incorporating some myofascial release, potentially mobility work. Um, so I think there is a place for it, but it would be, to me, it would be farther down the priority list of some of those other things.

When you have pain, it's definitely useful. But if you're just that asymptomatic healthy person, I think I would focus on the resistance training and mobility, probably resistance training at the top, then mobility stuff, and then maybe, and myofascial release is kind of in the mobility category, but I would think about it that way. Yeah, it seems like pain is a really awesome teacher. I heard you reference that before, and I've always felt like pain is a great mentor. It's going to kind of lead you in certain directions, uh, for yourself, uh, were you, uh, considering or chasing after, uh, being able to help people cause you were in your own pain or where did you think some of this stemmed from? Yeah, it started in the beginning because I'd had knee surgery in high school and I think was immobilized. It was back in the day when you, I just had, my patella was in two pieces,

my kneecap was in two pieces. I was just born that way. It was just a little piece, but it was kind of, that piece was in my patellar tendons when I'd land. You were doing martial arts your whole life. Yeah, it sucked when I'd land from jumps. Like in gymnastics, when I'd land from something, my knee would kind of buckle because of that. It just hurt. And so they just removed that piece.

It was a pretty easy surgery, but they put me in a straight knee brace for six weeks. And so I lost all this mobility. My quads atrophied like crazy. My knee literally looked like a volley box. There was no muscle mass when I came out of that. And I had a joint contracture. I couldn't flex my knee past 90 degrees. And so I ended up going to rehab. And so I think that was the place

I was kind of introduced to it. Um, but I hadn't had a lot of pain up to that point. I think now, as I've gotten older, I definitely feel, um, you know, where I've encountered different pain things and pain things that have lingered longer. I've definitely been more interested in kind of this pain science thing and helping people navigate that process. I think just because I've experienced it myself and, and just thinking about all these factors and variables that go into pain and not it being so simple, like I, because I think when you're a young person, when you're injured and you have pain, it usually is pretty simple. Usually it's like you strain something

and it gets better pretty quickly. But as you age that stuff, I think the recovery process can be a little trickier. And I tend to be a little more wound up and be a little bit of an anxious person. I've been that way my whole life. And I think that contributes some to me having maybe a little bit of an anxious person. I've been that way my whole life. And I think that contribute contributes some to like me having maybe a little bit of a predisposition to being more stressed and having pain things that will stay around and kind of fall into maybe more of

that chronic pain category. So yeah, I've, I've kind of become more interested in it just because of having dealt with some of it. Do you think that myofascial release might in some way be related to stretching in some way? I mean, if we're to kind of think about it, and maybe even lifting weights might kind of factor in there somewhere. But like if we're to take a piece of like chicken breast and have it on the table here and we're pulling on it, that would be a stretch. And what would it do? It would flatten out the chicken breast, right? It wouldn't be as thick. It wouldn't be as high off the table. It would be longer, right? And if we put a weight on top of it, it would kind of do the same thing. Yeah. I do think there are similar mechanical things. And I think, you know, it'd be

interesting to look at like, to eventually be able to know the mechanism, like how similar are stretching and soft like myofascial work in terms of what they do to your tissue and how that changes your sensitivity over time. In case people don't know, some people get mad about like the different practices. Oh, yeah. Myofascial release and stretching and static stretching versus, you know, other types of stretches. I know. I get in trouble about – people get annoyed at me because I'm very not specific with soft tissue work. I just – honestly, most of the time I just call it soft tissue mobilization because if you call it myofascial release, that's not an actual myofascial release technique. It's not that complicated. It's not actually breaking up an adhesion. Exactly.

You're literally just pushing on people. Everyone just settle down. We're just trying to have a conversation. Exactly. Just love to take this hand but I think I bet when you actually look at it as time goes on because to me

yeah like if you push on somebody you're flattening that tissue kind of like if it was stretched I think there is probably some of that and some of me thinks maybe it's just those particular sensors becoming less sensitive you know because, you think about stretching, they'll talk a lot about muscle spindles, your stretch, um, your stretch kind of sensors. And then, you know, if you compress something, you've got like Pacinian corpuscles and my,

you've got all these pressure sensors. And I think those probably desensitize and the resistance training thing you mentioned that has been an interesting area because eccentric contractions where your muscles are lengthening, contracting, have been looked at quite a bit for also reducing stretch sensitivity. And for rehab and stuff too. Exactly. Like you've got tight hamstrings. Well, try really focusing on that eccentric part of your deadlift. And some people become – that helps their flexibility way more than just doing a bunch of static hamstring stretches so it's it's interesting to see uh kind of these different

things achieving similar results in some cases but and it makes you wonder like how different are the mechanisms or are they actually who knows maybe they're really similar in in my own experience i don't have a lot of experience with actually just doing regular static stretching but i have been working on mobility i have been working on a lot of experience with actually just doing regular static stretching, but I have been working on mobility. I have been working on a lot of different exercises to help me achieve better mobility. Maybe I should just flat out just stretch or something like that, but I do a lot of movements that put me into a position where I feel like I stretch. But the difference to me in myofascial release and just stretching seems to be that during like a myofascial release, I can actually move. And it feels like that I'm making these like passes through the muscle

and it feels like I'm desensitizing or breaking up something that is now allowing that muscle to feel more free. Because as Nsema was pointing out, like there's certain spots on my body that I'll do myofascial release on, sit on a ball or, you know, put something into my shoulder or whatever it might be. And I'll do this for a few minutes and, you know, week one or day one, it might kill. Pain level is like seven out of 10. But, you know, two, three days later after doing this with some consistency and moving my arm in a particular range of motion, um, not only is my range of motion improving, but now the pain's at like a four and then a two and then there's nothing there. And then I'm kind of like almost mad that I can't get that same sensation anymore. Like there's nothing there. Damn it. All right. I got to go to the other side. side. Yeah. I think the cool thing about myofascial release, kind of like manual therapies, it's so specific. You know, you can be way more specific because if you just, like we were talking about, I've got this little hamstring tendinopathy I've been dealing with for a while. If I just go

stretch my hamstrings, I'll feel that spot, but it's so less, it's so much less specific. I mean, it probably has its place in the process, but getting on the ball or having somebody get in with their thumb, I feel like it can be so specific to the area where your symptoms are at. And I mean, to me, a lot of times, that's really where like myofascial release and manual therapy, the practitioner fit in is that you can get in somewhere that maybe you can't be so specific with,

with resistance training or stretching, something like that. But I do think there's a huge place. I mean, there's actually a guy on Instagram, flexibility researcher, I think is his handle, but he does a lot of cool flexibility research. It's crazy. Like the flexibility research, there's been some really cool new studies, even one where they showed that the Achilles tendon in people who did these dedicated calf stretching programs actually became stronger, not as much as the group that did resistance training, but more than the sedentary group. So it's interesting. I think we have these kind of

notions of what stretching does. And it's been interesting to see some of this new research on, whoa, like stretching could not only make you more flexible, but might also make your tissue stronger. You know, and it's like all the people will talk about like this mechanotransduction and putting force into it and how your tissue adapts because of that so i mean i definitely know when i was in high school and i was stretching all the time i definitely just doing long static stretching sessions i definitely that was when i was most flexible in my life and so now you know i mean i'm not taking myself into those that deep range of motion with my resistance training, but I'm for sure not as flexible now as I was back in the day. You said you can do a split on the chairs, right?

Like the Van Damme thing. Oh, it was, yeah. I used to be able to just sit there, Van Damme splits. That's amazing. Yeah. I feel like I would just hang out there all day. Just be like, Hey, what's up everybody? I was like, I'll do a podcast.

Answer the door like that when people come. Yeah, exactly. No, it's pretty amazing. It was cool. It was cool. I wish I, I needed,, what's up everybody? I was like, I'll do a podcast. Answer the door like that when people come. Yeah, exactly. But no, it was pretty amazing. It was cool. It was cool. I wish I, I needed, I should probably, it'd be cool to work on it again and try to get it back. Did you have pain back then? Or you don't remember? No, I had no pain back then except for injuries. Like, uh, just from kicking. I had, you know, just kind of injuries just from the tissue trauma, um, that knee thing. And then, you know, foot stuff from just kicking regularly, but, uh, no pain related to any, I mean, that knee thing, and then, you know, foot stuff from just kicking

regularly, but no pain related to any, I mean, I was like, I could train for hours and nothing ever hurt. You know, it's not that way anymore. You know, there seems to be like, we had Ben Patrick who came into the gym and he popularized like the knees over toes aspect into that deep knee, deep range of motion. Right. But it just seems that like, if you're someone who you can get yourself moving into large ranges of motion, and then you can add load into your ability to move into these ranges of motion. First off, the load helps you get a little bit deeper. If you're responsible to load or you don't load too heavy, you can progress that over time. And then even without that load, you can now get into those ranges of motion, but you're much stronger as you're getting to those ranges. So it seems like, yeah, you don't have to static stretch, but if you're

someone who loves training in the gym, you can use, I look at it as using weights to stretch. Yep. Yep. That's all there is to it. For sure. And I think if you are somebody that really likes static stretching, you should practice loading in those ranges too, because those are the people we worry about sometimes with injuries is that somebody, like if you look at people who are extremely hypermobile, who are just born that way, right? Like they can hyperextend their elbows and do all these things.

And I think they're there. Your injury risk is a little higher in those situations where if you have a lot of mobility, but you don't have the motor control and strength to control that range of motion, then you're asking for trouble, you know? So I agree.

Like, even if you, if you really like static stretching, you should still think about, let's put some load, even if it's just body weight, like I'm going to just try to actively move through these things and train my neuromuscular system to actually control those movements. Not just, can I get there like passively and hold that position, which nobody ever taught me back in the day. I was never, there were definitely cases, the craziest I ever saw, there was this gal on Cirque du Soleil that could go down in the splits, center splits, and then she could push into the ground with her adductors and stand back up.

I mean, you think about the adductor, like, that's crazy. Like, you know, people who can get… It's like a double Copenhagen. Oh, man. Exactly. Exactly. Like, to get into the splits, full center splits, and to be able to use your neuromuscular system to contract and pull you back out of that position, it was incredible. That was like the epitome to me of having that control.

Sensational. Sensational. I love that account, by the way. Sorry. What is that? Too buff for this? Oh, yeah. That's so good.

It's great. buff for this or something? Yeah. That's so good. Yeah. How about, uh, like, cause I've heard a lot. So when I was trying to figure things out, people were telling me like, Oh, your quads are so tight. That's probably why your back's hurting. Do tight muscles or tight limbs lead to pain in other various areas? Yeah. And I think the way we think about that is changing. You used to hear about things like upper cross syndrome and lower cross syndrome where there were these biomechanical sort of theories that like, okay, if you have, say, tight hip flexors and maybe a rectus femoris, like maybe one of your quad muscles, like if those are tight, they're going to pull your spine into extension and pull you towards anterior pelvic tilt. And that's going to be, you know, like that. There were these theories that, you know, if you have that, it was it was a cross. So like your back extensors and your hip flexors would go together as tight.

And on the other side, you'd have weak glutes and weak abs. And so then the cue was, OK, so we need to train people to strengthen and activate their glutes and abs. So they poster tilt and take their spine out of hyperextension. Those theories haven't held up that well. So but I do think you see a lot of people with back pain who have tight muscles, like you test them. I think the question these days is, is that actually, is the back pain because the muscle fibers itself are tight or is it because the nerve that innervates that muscle is sensitive? Because we have all these nerve tests now.

They're neurodynamic tests where you put people into positions and they look very much like a stretch, like a muscle stretch. Like you, if you were going to test somebody's sciatic nerve, you would have them lay on their back and bring their leg up straight. And it looks like you're taking them into a hamstring stretch and they might get a hamstring stretch, but the way you initiate it and carry it out is a little bit more specific in targeting their sciatic nerve and its branches. And so there is this thought now that say you have back pain and you stretch and it helps your pain.

Is that because the muscle fibers actually got more flexible and that took stress off your back and it's very biomechanical? Or is it more neurophysiological and you decrease nerve sensitivity and that holds your back knowing knowing all those nerves are coming from your low back. All the nerves in your legs start in your low back. So teasing those apart I think is kind of tricky. To me it's like sometimes it's like who cares? Like if it helps you, just do that stretch. Do you think there's also anything like what Andrew said there, people have you start targeting certain muscles.

What are the drawbacks of isolation? Because the group Functional Patterns, they do amazing work. They're dogmatic, but they do amazing work. And people, you cannot deny the results that they get helping people integrate full body movement and function into what they do rather than just isolating the quad doing something. How does the quad move with this type of movement with load right so when people are trying to attack things with pure isolation do you think that what should they be trying to think about because the main thing that i've been thinking about over the past few years now is how can i make everything i do how

can it include some form of movement and that's been something that's been super helpful for me, right? How should people think about this? Yeah, I think you want both things. And, you know, I think in terms of really isolating type movements, because that kind of is what physical therapy a lot of times is, is very isolated. Like we're going to move only in this plane of motion. We're going to target just this muscle and tendon.

I think that has a place, especially early in the healing process. You know, when you're like, if somebody has a hamstring injury, you know, you could of course just have them start, have them doing lots of like compound global kind of movements. And they probably in a lot of ways would get better that way. But I think starting out with the isolating, the really isolated kind of strengthening and mobility things for that injured area is going to ensure that you really build capacity in that injured thing. Because sometimes the problem with the really global movements is that people can compensate around the injury, right? Like you see this all the time with double leg kind of like squat patterns and where people, if you actually put a force plate underneath them, they look great visually, but you see they're offloading the injured side. And I think to me, whether it's like a really, like for a while, machines kind of went out of favor, right? In gyms, like resistance training machines, because people thought they were too isolating. And I think they really do have a

place. If you really want to target something specifically, an exercise that targets just one muscle group or two, or just moves in one plane of motion has its place for ensuring that you actually do it. Like if you're going to go to the gym and do leg extensions, you aren't getting a lot of other muscle groups. You're pretty much doing your quads. Like, you know, and that has, there's been so much more research. Like that one's a good example, like after ACL reconstructions or knee surgeries, or people have quad inhibition and atrophy, the leg extension is one of the things that's the best, which is kind of funny because for so long it was demonized. Leg extensions were.

But in rehab, they're one of the best for really making sure that you get your quads strong and you don't have, because we know if people go into the bigger global movements, that quad strength asymmetry can persist and then their likelihood of returning their ACL is way higher. Whereas if you make sure they do that specific thing, they actually get stronger there. So I think it's like, it really is helpful for making sure you target really specific impairments. Like if you have a strength impairment, a really isolating exercise is going to be good for making sure that impairment doesn't stay there.

And then as that goes away, you of, try to get back into the more global, functional, multi-planar movements. Yeah. You know, along the lines of what you kind of just mentioned there, I've been lifting with the bodybuilding style since I was like 13. But one thing that I've found that's been really helpful is like, I can, if I'm just standing here, I can target my hamstring. I can target my calves. I can target my triceps super easily. I know how to feel these areas. So it's something that like when I start doing other things, the ability for something not to necessarily be off and having access to it is just so helpful. And I think being able to like doing isolation work can help people with that because some people can't just sit there and fire their left glute.

They don't know what that function is or how to do that. But when you know how to do that, then it seems like a lot of things can be unlocked for you. That is a huge – that's a huge awesome point to make because I think that is true that isolating kind of exercises like that, like having a bodybuilding background, you learn your motor control because that is a huge part of rehab is having sometimes it's called sensory motor control it's like you have all this information coming from the sensors in your musculoskeletal tissues that's going to your brain and then that's influencing the motor program and we sometimes in rehab we'll talk about people being motor morons where they come in and they just have they they didn't grow up in sports or in some kind of athletic background and they just have no idea no awareness or control their body and i think know, when you do these really specific exercises, like in a bodybuilding

workout, you learn, you create this sort of mind muscle connection. And I think that I've noticed in my own life, cause that's kind of where I started. I don't look like you, but I was lucky that I had this like amazing strength coach in seventh grade. So I learned weightlifting technique in seventh grade and that was huge. Like it really complimented my martial arts. Like I just, you know, martial arts had its own amount of body awareness, but then to have the strength training part to it and learning how to think about those muscles and just be sitting there and being able to activate them. I think that was huge in terms of like injury risk.

It helped me prevent injuries just knowing I had in a movement, a bigger movement, I knew how to turn those muscles on better. And you see studies like that, right? Where they'll take people and they'll have a group, they'll look at like hypertrophy, right? And they'll say this, they'll just have one group where they're cognitively distracted and they'll have another group have that mind muscle connection. And you see, right? You see more, you see better change. You see an increase in hypertrophy in people who like are actually thinking about squeezing that muscle. I think that's huge.

That's a good point. And being able to get a lot of blood flow to the area. Is that something that you recommend? You know, somebody has a messed up shoulder or they're coming off of a surgery. I'm sure it's not like step number one, but once they start to feel a little bit better, is that part of the objective to do like maybe bodybuilding and do three sets of 10, get some good blood in the shoulder? For sure. Yeah. I think looking at it that way, sometimes we'll even just like say it's an upper extremity injury, just recommend that

people do some kind of aerobic exercise that gets their heart rate up because there are actually kind of cool studies where they compare, they took people who had neck strains and they compared how much blood flow increased with massage versus just aerobic exercise. And massage was like a two to three, it was like two to three X on the blood flow in the neck muscles. It was six to seven with just aerobic exercise. So I think, of course, when you think about, um, that's interesting. I never heard that before. That's really cool. Cause cause yeah, you're, it makes sense. You're, you're getting a full body pump cause your heart's pumping exactly so i think you know when you look at healing blood flow to me is probably one of the biggest things because you're getting right

that delivery of oxygen nutrients that's going to help move you through those healing phases and so yeah whether it's like getting a pump with a particular exercise or just doing something aerobic that doesn't you know you have to be careful to pick the thing that doesn't make whatever you have going on worse. But if you can find something aerobic, whether it's just walking, like a brisk walk, jogging, swimming, biking, yeah, sauna, like even all the research on sauna now, getting that blood flow up, I think it's going to expedite the healing process. Is it harder to fix someone's problem because of the injury or is it harder to fix someone's problem because they won't comply to what you're suggesting? Yeah, it probably,

I think because we're in California, a lot of times it's harder because they won't do what I'm telling them to do. You know what I mean? Because people are so active here. I think, you know, you see that in the research, right? Like the coasts, people tend to be more active than the middle part of the country. And so, you know, I'm sure the middle part of the country, like if people have a tendency to be more sedentary, that also would be difficult. I've worked in some of those states. In those places, it's difficult just to get people to adhere because they're not used to moving. So it's tough to get them moving.

Whereas I think here, I have a hard time getting people to adhere because I it's tough to get them moving, whereas I think here, I have a hard time getting people to hear because I can't get them to stop moving so much. And they just keep flaring things up, which I'm guilty of too. My injuries probably take three times longer than any of them should because I don't want to give up the stuff that I like doing that keeps flaring it up. But I think more often, if the person didn't get in the way, the treatment of the injuries is actually not that hard a lot of the time.

How do you handle adherence? Do you try to just give people one specific thing to do at a time type thing? Exactly. That's the way I've adapted over time. I used to, as a new grad, you'd give people nine exercises. Here's a psych paper

and you're circling all these exercises and the guy's like, yeah, yeah, yeah. And it never does. They never do it. Yeah. It's, uh, I think that's the biggest part of adherence. I think, um, some of it is taking the time on the education part of like why this actually matters. And I think understanding what the person's actual goals are and coming to you, which I sucked at asking people early on, I just would have my own goals of what I thought they should be getting out of it. Yeah. And I didn't actually ask them why they were even there and what they were hoping to get from me. Can't understand why they can't do the splits. Everybody should be working on the splits. But no, not nowadays. I think most cases I won't give people more than three exercises. Usually

it's one to two and it's just really specific. And then as I'm kind of checking, I think most cases I won't give people more than three exercises. Usually it's one to two and it's just really specific. And then as I'm kind of checking, I really think it's just coaching people, helping them navigate that process and sprinkling in a little bit of manual therapy and stuff like that here. But most of the time I actually don't see people for that many visits anymore. I'll do like the evaluation and maybe there's one or two follows, but some people are just the evaluation and I get them going and then I might text with them and just kind of help guide them as time goes on. But I think that's been the biggest thing for adherence is like, why are you doing it?

And I'm not going to give you as much because rehab actually feels like homework to most people. Maybe mix in a little philosophy. Yeah, exactly. Kind of how they should go about doing this every day. Yeah. Do you ever have any like diet interventions? Um, I, it's weird when you have a license to, I always am a little bit, I will definitely like say, Hey, you should go see a dietician or nutritionist if it seems really complicated. Same with like mental health, you know, but it's hard to not get into it a little

bit. I think I'm, and we even write about it in the book, Nutrition Factors. I think when it comes to the pain system, you know, thinking about inflammation, especially if somebody has a chronic or we call it persistent pain now. But like if you have a pain that's lasted a long time, then it's probably, there's more and more research looking at just systemic inflammation. If somebody has an injury, I definitely, just like say you just, you know, you sprain your ankle or something like that. I think that some of the nutrition factors, like just making sure you have enough calories to heal and enough protein.

I think a lot of, you see so much of that online now, I think on just how many grams of protein. I think most people aren't getting that. I mean, I know for me, getting a gram per pound is hard some days. So I will touch on those a little bit, but I try not to get, I'm just always a little careful not to get overstep my, you know. Do you have anybody, cause like the feet is something that we talk about all the time.

That has made a big difference for us. Right. So in your practice, when people come in, do you have them try to do anything at home for their feet in general? Because having really weak feet, which a lot of people do have, can fuck things up when it comes to the knees, the back, the way they move, the whole chain. So how do you have people handle that? Because that's something you need to progress outside of just rehab. Yeah, for sure. I mean, I think sometimes, again, being in California, we're probably a little lucky that we're barefoot a lot. sure. I mean, I think sometimes again, being in California, we're probably a little lucky that we're barefoot a lot, you know, but, uh, it was definitely foot strength and mobility and control

was not something I appreciated until being a little older. I think because I was barefoot all the time in martial arts and gymnastics, I was always balancing single leg and on my feet. And I remember I had this really, um, I had these kind of crazy developed muscles on the top of my foot. My, there's this muscle, little muscle called extensor digitorum brevis. It's this little muscle on the top of your foot. And mine was crazy hypertrophied because I always pulled my toes up to side kick. And so that muscle got like, look at this little soccer ball on the top of my foot.

And I think as I've been in PT longer now, I realized how much I took for granted all that barefoot training. And so I think for me, a lot of times, I totally agree with you because, you know, for a lot of these closed chain tasks, force is coming up from the ground. It's going through that foot first. And we know the foot, how, you know, pronation, supination, all these things can influence your knee. That can influence your back. I mean, all the way up the chain. So I think a lot of times for people, even before just kind of specific exercises, it's just encouraging them to be intentional about barefoot, like being barefoot.

And, you know, maybe it's like walking on the sand down the beach. Sometimes that's really easy, like just being on kind of an unstable surface like that and making your all those deep foot, all those muscles deep in the arch, making them kind of work. And, and sometimes even just doing like kind of funny little lakes and as they're called toe yoga, but like little motor control drills, like, Hey, can you just, can you consciously learn to like abduct your big toe, abduct your pinky toe, like just learn to control your toes. And I think there is a lot of value in that. And like you said, um, most people are in really supportive shoes and I don't, you know, it's almost like sitting, right? It's like you're hours and hours. If you're hours in one position, you are losing some capacity somewhere else. You know, there's deconditioning that goes on. If you're always in a supportive shoe, maybe a lot of the time that is the right thing for you. Maybe you've had a

past foot pain. Maybe you're really prone to plantar fasciitis and you know like this orthotic or this shoe helps me and that's fine. But you should also realize that always being in that means you're probably not training those muscles that much and having some time barefoot just to work them is probably valuable. What about the value of walking? Is walking sometimes part of the protocol? Yeah. Yeah. Yeah. Walking is often a big part of rehab.

You know, besides all the like cardiovascular benefits that get talked now, zone two cardio and all these things. But I think there's a lot of people where walking is one of the best things, especially if you look at like the lower quarter, like everything from low back down. There's a lot of that stuff that actually walking helps kind of introduce a low level stress. And a lot of people just feel better when they, I know for me, if I just get like a certain number of, if I am short on my steps for a particular day, my back will ache more, my hips will be feel tighter and ache more. And if I just am intentional about getting those 10,000 steps, I will just feel better. And I think it seems like such a simple thing,

but a lot of times in rehab, I literally am just encouraging people just to walk more. And of course, find the balance, because some people, if you have pain in your lower body, walking too much can stir that up. But it can be as simple sometimes as that can be a rehab program, is just go for a walk. I get a lot of people asking questions about shin splints

because I've gotten into running quite a walk. I get a lot of people asking questions about shin splints because I've gotten into running quite a bit and also just calves just like lighting up when they run. Any suggestions there? Yeah, I actually have had a fair bit of this because during COVID, I took up trail running, a lot more trail running and just running at the beach and stuff. And yeah, I think there's two things I would say. If you are in, if you're having symptoms right now, I do think and I've seen for a lot of people that soft tissue mobilization of your two calf muscles and then also i a lot of times find taking a ball and kind of flipping over and almost a kneeling position and getting my tibialis anterior if people are more likely to have anterior shin splints like a lot of people don't think about tibialis anterior now it's become more popular i think because of ben and like all that training but tibialis anterior was neglected for like a long

time there's just certain muscle groups that nobody ever changed, but nobody ever changed their neck. Nobody trains tibialis anterior. People don't do grip very often. Um, but that one, so rolling, if you have symptoms, I think that myofascial release, and then a lot of times if it's in the muscle, trying to stretch those two muscles can help, uh, kind of temporarily get rid of some of those symptoms. And then long term, uh, going back to Bell's anterior, nobody strengthens to be all sanitary. And now we're seeing it get better with the different like tip bars and things. But I think that's an excellent, a lot of people, most people are more familiar with like calf raises and strengthening a calf, even though

nobody really does it. Like how many people actually train their calves? It's of the regular population, like hardly anybody trains their calves and even less people know to strengthen their tibialis anterior, you know, but it makes so much sense. Like if you have muscles that oppose each other, you should be working both. So if your calf points your foot, well, you should be working the muscles that pull your foot up. And that's tibialis anterior and your dorsiflexors. So to me, long-term, um, in terms of a strategy to help reduce the risk of getting shin splints, it's going to be strengthening those two groups.

And when it comes to calf, the other big one that nobody does is soleus. And this has become more popular now, but it's a bent knee calf raise. Or you guys know, because of strength training, you know the soleus machine. But people who haven't been in gyms, they aren't used to, they've never seen a bent knee calf raise. But you can do it standing too, right? Where you hold onto a desk or something get your knee down to 90 degrees and then just do calf raises there and that one has been tied to a ton of running issues um achilles tendinopathy and runners has been more tied to soleus weakness um recently so and i've seen a lot of people with anterior shin splints where once they start strengthening the tibialis anterior they don't

get as many shin splints so and don't forget you're training the heck out of your feet too when you're training your calves. Exactly. Training your calves and your shins, especially if you're doing some of these exercises standing. And if you do calf races, I know they can be kind of boring, but if you're an athlete and you want some resilience in a lower leg, if you flex your toes and push your toes into the ground kind of aggressively, you'll get, you'll get into the calves easier. And I don't think you need a

lot of training. I don't think you need to spend like hours on this. I think it's just a couple sets and do that a couple of times a week and you should be good to go. That's a good thing to mention too, because in that posterior compartment, your calves are your toe flexors, you know, so your toe flexors and tibialis posterior. So that's a great cue. A lot of times you can help take some stress. I think if you look at it, maybe from a biomechanical, why is this happening? Why is it helping? If you're, if you're someone who struggles with, you know, shin splints on the backside or calf strains or Achilles issues, maybe activating those toe flexors can, they can help out and take some of the stress off your calf. And so I think that's a great, it just goes back to all that foot training.

Like just don't, it's like, I think a lot of people in their training, they've got like those supportive shoes and they're just not even, it's like their foot doesn't exist to their brain. Like they're not even thinking about all those, you've got five layers of muscles in the bottom of your foot.

So, you know, just being barefoot and thinking about that like little cues, like, okay, I'm gonna try and grip with my toes when I do this and just try to get your nervous system to engage your feet. It can make a huge difference up the chain. The Paris sandal version two is here. Last year, we partnered with Shama Sandals to make a sandal that all of you guys would like to wear out, but would also be functional for your feet because, well, flip flops fucking suck and they're bad for your feet. That's why we made these. But these are the version two.

Has a tan, vibrant sole, which will last you thousands of miles. A German leather footbed, which will mold to your foot with every step you take. So the cool thing about these sandals is that the more you wear them, the more comfortable that they become. Has a heel strap so that it doesn't mess with the way you walk and you can have your natural gait, which is why in these power sandals, not only can you walk in them, which we're all walking, you can run in them, you can sprint in them, you can lift in them, and they're going to be great for your feet. But now, rather than the

all black version one we had, there's a little bit of color to the baby. So now you look a little bit better in these. If you want to get them, head to powerproject.live. We appreciate your support and we are so fucking pumped to get these on your feet. One thing too is like, there seems to be that like, there can be a goal. I remember when we started doing this foot stuff

a few years ago, like when I would do certain things with my toes, my toes would just cramp up, right? And they were just like, whoa, they're not moving anymore. And she's like, oh God, I got to get them out of there, right? But as things improved and they got stronger, you can just like grab shit and then there's no cramping, right? Even things getting into the back chain. A lot of people, when they're trying to get into that back chain, like, oh my God, my lats and my back cramp up. That's not going to be, it's not going to be that way when your body gets used to getting into that range of motion. So what should people think about if that's happening with a lot of things they do? Yeah, no, it's so true. I see it so much in PT clinic with hamstrings because we'll

string test people on their hand, on their stomach. Okay. I'm like, hold it. Every single person, but the people who train their hamstrings with resistance training, they don't have that, you know, they just have the capacity. It's like their musculoskeletal system knows how to contract and shorten with force in different joint positions. And so they have that capacity and they don't cramp like that. So I think if people, you know, cramping can be for different reasons, right? Like hydration and electrolytes and all these things. But if you notice that you have cramping in specific position

or specific activities, I would say, you know, try to get into those positions and start gradually loading them. That usually to me is the thing that helps people the most with stopping that kind of stuff. So because a lot of times it's these muscles where like hamstrings, for instance, if you put somebody, your hamstrings are a biarticular muscle, right? They cross two joints. They move your hip and your knee. Hamstrings are a biarticular muscle, right? They cross two joints. They move your hip and your knee.

And in biomechanics, they'll talk about this thing called active insufficiency, where if you put the joint, both joints in a shortened position, the muscle can't generate as much force. It's like if you try to squeeze, if you take your, your finger flexors that are for grip, if you took one of these guys and measured your force output with your wrist and neutral and your elbow straight, and then you try to do it right here, you can't generate hardly any force here once your wrist is flexed because you're putting those muscles, those two joint muscles, into active insufficiency.

So I think that, like with the hamstrings, if somebody's laying on their stomach, their hip is in neutral, and then you're flexing their knee, and then you ask them to hold there because they're probably already kind of weak in their hamstrings. Then you put them in a position where there's even less.

The muscle can generate less force biomechanically. Anyways, they just cramp like crazy. And so I think it goes back to that argument of like, you want to take your joints through their full range of motion and be able to handle load through that full range of motion. If you can do that, you're going to cramp less, your injury risk is going to be less. This is why like all the controlled articular rotation stuff,

I think is really popular and it's good. Cars. Yeah like all the controlled articular rotation stuff I think is really popular is, and it's good. Like cars, all the cars like that stuff for most people, unless you have some injury that maybe isn't good for that. As long as you're kind of respecting your symptoms and trying to move your joints through their full range of motion. And can you explain that maybe taking SEMA through a arm car?

Yeah. Yeah. So it'd be a good range of motion over there. Yeah. So if you think about like – so say the shoulder joint. It's got – it moves in all three planes. It's a ball and socket. So you want to think about you might just take – you might be leading with your thumb first.

You might just go through a maximum shoulder flexion while thinking about kind of keeping your ribs down, kind of engaging your abs so you don't just extend to your spine. You see that in a lot of people, right, where they look like they have full range but they can't. So you don't just extend to your spine. So you see that a lot of people, right? Where they look like they have full range, but they can't. And then from there, maybe you can go, you can spin in to internal rotation. And then you could go back into extension and just take that ball and socket through its full available range of motion. You do it very slowly, right? Yeah.

And you don't even have to start there, right? Like we're mixing planes of movement together. I think for a lot of people, just learn what are so like if i my shoulder my shoulder should be able to go through 180 degrees of flexion 180 degrees of abduction out to the side i should have internal rotation external rotation i should have horizontal adduction horizontal abduction like you could just start just take each joint learn what movements it does and then just practice those i mean nobody does that yeah right we just take it joint, learn what movements it does, and then just practice those. I mean, nobody does that. We just take it for granted.

We're just doing our life tasks. And most tasks probably only use 50% to 75% of your available range of motion. And you automate certain tasks that you always do. It's like the way you get out of the car, the way you grab things, you just start automating that range of motion, and you never go farther than that instinctually. Exactly. It's like you don't notice until you have to like change a light bulb and you're like, no, I haven't done this in a while.

I'll never lift this high. Yeah. So I think you just, and I mean, I know I'm not always good. I could be better. I try to go through, you know, full range of motion, but I know like there are certain movements that I do on a really regular basis, like full squat, like Astrographs kind of squat. Like I know I'm doing hip flexion and knee flexion regularly, but how often these days

am I like really practicing my full hip abduction? Like how far can I bring my leg out to the side? You know, it's kind of fun too. Cause like when you find like a glitch, like a little glitch in the matrix, like you go to move and you're like, wow, that part really sucks. Like I'm not good at that. I have zero strength there. You're like, I need to work on that. Yep. And it's like, it can be an exercise, but like you said, it part really sucks. Like I'm not good at that. I have zero strength there. I need to work on that.

Yep. And it's like, it can be an exercise, but like you said, it can also be kind of a test. Like, cause really that's what we're doing in rehab is looking for impairments in people. And you know, you can have impairments when you're not injured or in pain. And I think whether or not that impairment is actually an impairment and going to lead to some problem, who knows, but why not address it? If you notice you have some asymmetry or you can't go through a range of motion easily or one side is weaker than the other, it's like, why not?

There's no real downside to working that. You might as well. I think it's part of the, you know, it's just part of that kind of movement hygiene, like almost like the flossing your teeth for your body. You're not the same way. I was just thinking that shit. Like this needs to become like, it's not that you have to go to the gym every day. There's nothing

like, resistance training is great, but how can you turn moving your body in all these potential different ranges of motion a daily habit? So that is just like, are you watching TV? Can you grab something and just move around and venture around and see what's tight and see what's not?

Like, if you can do that every day, just turn into a little habit that you do. So over time, like you might, you'll get yourself out of pain, but it's the habits of sitting for a really long time. Um, just, just these habits, it's just, they, they make pain worse for people. Yeah. Imagine if every time like people sat to watch Netflix, they got on the ground, just sat on the ground and worked through different movements. I mean, I know at home, because I'm a weirdo, and I'm sure you guys are like this, I'll put my foot on the couch. I'm doing Bulgarian split squats. I'm just moving. It eats me up to just sit on the couch and do nothing. And even lying on the ground, it can kind of be uncomfortable. So you go from one butt cheek to the other butt cheek, and then you like it can kind of be uncomfortable so you go from one

butt cheek to the other butt cheek and then you kind of lay a certain way and you keep moving anyway without even being super intentional yep yep yeah so i think a lot of times it just boils down to movement and i think you know one of the things it's tricky with a book called rehab science is that people think oh all these exercises are only for rehab and that has been such a hard thing i feel like i spend a lot of time trying to help people understand that, like, no, these are really just specific mobility, myofascial release, and resistance training exercises. They are the things I also do just to keep myself healthy when I have no problems. It's not like you only – but I think if you don't have some background strength and conditioning or rehab, you don't get that. I think if you don't have some background strength and conditioning or rehab,

you don't get that. Like you don't get all of us that's trained regularly. We see the, how much crossover there is between rehab movements and just, you know, going to the gym and working out. And so many of them are literally the same thing. So it's been trying to help people understand, like it's not just rehab,

it's just musculoskeletal health. Yeah. And so you can just go and pick things and work on them. You don't have to have some injury or pain issue. You're just working on capacities within your musculoskeletal system, which are mostly mobility and strength. How have you helped people through plantar fasciitis? That seems to be one I hear about a lot. Yeah.

Plantar fasciitis is kind of interesting, actually. to be one I hear about a lot. Yeah. Plantar fasciitis is kind of interesting, actually. There's been some more recent research in the last few years that's looked at, I feel like everything's kind of going to load, like this word load and how do you load tissue. And plantar fasciitis, there was a study that's been cited a lot now where they basically looked at how can we more specifically load and target the plantar fascia. And they basically found that a combination of high load stretching and strengthening for the plantar fascia had the best results, but they did it by putting the toe and big toe and dorsiflexion. So I actually have

a buddy in Australia that makes this little thing called fasciitis fighter. Do you guys seen this? Yeah. See if we can bring it up. Yeah. It's aitis fighter? Yeah, it's a little, it's kind of a pad looking thing. It has a little dome. Sounds kind of scary. Yeah. Fasciitis fighter. Yeah. The dome is just to put your big toe on.

So it puts your big toe in dorsiflexion, which they, so basically what happens is when you dorsiflex your big toe, all of us are supposed to have about 60 degrees of big toe dorsiflexion. When you do that, it naturally biomechanically tightens your plantar fascia. It's called the windlass mechanism. It helps to supinate your foot. So when you go to push off and gait, like you imagine when you go to push off, as you push off, your big toe is dorsiflexing as you push forward. So yeah, your toe goes on there and then you basically do calf stretches and calf raises like that on the fasciitis fighter. So right, I mean, of course, that's going to work your calf doing a calf raise there, but because the big toe is in dorsiflexion,

it puts more of the load on your plantar fascia. And so there's a calf raise, and then you also do bent knee and straight knee calf raises. So the combination of those two, high load stretching with high load strengthening, has the best evidence right now for plantar fasciitis. Of course, you also have to think about behavior modification. I think this is something we're always talking about rehab. It's like, well,

there's the interventions, but then there's also the modifying. Like if you are currently running, I don't know, 10 miles a day or walking a bunch and that's triggering, you might have to play with like the other things in your life that are triggering it. Maybe you dial them back a little bit. Rarely are we telling people you have to quit. Like you don't really, because then they just decondition, but it's like maybe dial the volume back, let the capacity build up with these interventions. But, and you know, there are still some people that don't get better with that.

And another intervention that has some research is shockwave therapy for plantar fasciitis. It's basically like ultrasound. I just got done bashing ultrasound. But it has, actually has real evidence withitis. It's basically like ultrasound. I just got done bashing ultrasound. But it actually has real evidence with it. It's ultrasound. It's supposed to be like a thousand times stronger. But it's basically kind of like an ultrasound

where they're sending these sound waves in. And for resistant connective tissue disorders like tennis elbow, plantar fasciitis, there is actually some study where they did placebo-controlled studies where they had a group that had a fake intervention and then the real one. And that shockwave does seem in resistant cases where they did placebo-controlled studies where they had a group that had a fake intervention and then the real one.

And that shockwave does seem in resistant cases to help some people with plantar fasciitis. I think our penis thing over here actually sends shockwaves. The Phoenix? The Phoenix does send shockwaves through the dick. I think people actually use it for rehab on certain areas, not just the weenie. Weenie plaque. Just put that on your foot and you've got it.

Yeah, exactly. Multi-purpose. i know i've gotten shock like actual shockwave not the phoenix penis thing uh on my back and it like took my breath away because it like hurt really bad but then the pain was completely gone for 10 minutes and then it all came roaring back so So whatever that was, it absolutely worked. It hurt like hell for the first couple seconds. And then I can actually relax and catch my breath again. Then I was fine.

And then I felt fantastic. But it faded away super fast. Was it shockwave or was it like electrical stimulation or something? It was some kind of – it was like – it might have just been the ultrasound thing. Because it looked like an ultrasound gun. But I felt it though. There was no denying – it had like an ultrasound gun but I felt it though like there was no denying what it had like the like a shocking sound to it like it was zapping percussion yeah I'm not sure what it was though it was yeah fucking wild there's so many different tools out

there most of the passive tools like that people will say that kind of thing where they have a temporary relief and then it comes back pretty quick I I mean, even manual therapy, most of the research on it is like, it's kind of short term, which is why you're just doing it in the beginning. And it's always complimented by exercise and movement, which has the better evidence. But yeah, I think there's a place for some of those things, but, um, that's what I'd say. Plantar fasciitis wise is kind of high load stretching and strengthening with that. And you can just roll, you know, if you have a towel or you have like a ledge in your house, you can do it that way. Just like a two by four is probably too big, but something like that where you can put your big toe up.

Those are the big ones. One thing I want to mention though is like this stoic mat thing, like we're usually standing on this during the whole podcast. I'm always standing on this. But with what you mentioned with the fasciitis fighter, I find myself stretching out the big toe on this thing, smashing all the toes on it, using my toes to grab these little rubbery things as I'm just standing here. And many people might find something like this hard, uncomfortable initially, but like now there's no stress on my foot standing on this every single podcast, every single day. That's a cool tool.

Like for foot health. Yeah. That's pretty sweet. Cause you could mobilize your plantar fascia on there and the muscles. You could do the big toe kind of stretch. You put your big toe up yeah like you can work all these different positions you could do calf raises while you're staying there with your big toe i mean that's pretty that's a pretty sweet tool i've never seen those before but that's just another example we were talking before like little things little tools you could bring into your daily life

to just encourage kind of movement and i mean i think movement really the value of it is that it's really stress. Like you need to have stress on your musculoskeletal system for it to adapt. And if you don't get the, this is like the thing I feel like we're always talking about now. It's like the dosage of stress is what matters. Just like the dosage of medication.

If you are underdosed, you're not gonna, you know, you're not gonna adapt. Like that's like the person is totally sedentary. They're just gonna decondition. If you're overdosed, well then yeah, you get into more of these like repetitive overuse issues. That's where a lot of like shin splints and tendinopathies come from. So you're trying to find that sweet spot and that varies over time. And it's a moving target. You know, if you're working at it keeps getting better, but I think

ultimately at the end of the day, you're just trying to be intentional about putting stress on your musculoskeletal system. It helps everything, muscle mass, bone density, connective tissue health, the discs in your spine. Everything adapts when you stress it in the right way. You mentioned earlier being an anxious person, loading yourself with stress via work and diving into a lot of stuff and writing a book. That's a tremendous undertaking. And then also, you know, your exercise, have you found that that's helped with anxiety and helped with other maybe stresses that you might view as more of a negative? Yeah, I actually, the mental

health side of things is a really interesting side. My mom's a psychiatric nurse practitioner. And so I spend a lot of time talking with her about mental health and just kind of just the crossover kind of from a neuroscience standpoint with people who have pain and people who have different mental health disorders. And I know for me and my own anxiety, there's definitely kind of a genetic predisposition in our family, bipolar disorder and anxiety. And I definitely have some of those tendencies. Um, exercise is probably the most powerful thing and how I manage that, you know, it just totally changes. Cause I, my wife is like the most consistent person every day, like consistent. I am so volatile. Like I thought I was normal until I started like hanging out with her. Like I, I just, I will have days where I'm like fuck yeah

everything is amazing I'm going to crush it and conquer the world and the next day I'm like what the hell am I doing I should just burn it all you know so I just am all over the map but I know if I'm having one of those days I'm getting a little better at being aware if I wake up and if I'm having one of those where I'm like

this is shitty what is going on if I go to the gym I tend to exercise in the mornings. Once I'm done the workout, that's all gone. Like there's something about movement that I think is one of the most influential things and kind of changing your mental state. And I always feel really inspired after it, it puts me back on track of like, I know what I'm working on and why I'm doing this. And I feel motivated. and why I'm doing this and I feel motivated. So, you know, but I, and I think that's not just me. There's so much research on what exercise does for your mental health. And so, and I'll notice too, I think sometimes I'm like a dog

where if I just exercise, it will take my anxiety down a little bit. You know, it's like, what do they always do with dogs? Like exercise them first. And then that's like our little kid. Yeah, exactly. Kids are the same way. Yeah. So I noticed that for sure. If I am a little stirred up and a little high on the anxiety, if I go exercise, it will kind of knock that down a few pegs and then I'll be more normal again. Has it ever hit to where it's like even just getting to the gym might be like the like a really big task and it's like holy shit and the thing that's gonna help me i can't even get to that have you ever faced something

like that oh yeah i mean there are a lot of times i don't make it to the gym because i do talk myself out of it you know but i reflect on the times when i do make it there which i'm usually pretty consistent about you know but you know so i recognize the times when i have gone there when i didn't feel like it afterwards. I wasn't always paying attention to this, but now I'll notice like, oh, my mental state is totally different. And the only thing that's happened between then and now is an hour of exercise and I'm totally different. So, yeah, but I mean, there are, I'm not going to lie. I think it'd be totally dishonest of me to say, you know, to say, there are times where that thing wins, and I will stay in it and sulk in it a little bit and just be in that poor, less productive mental state, whatever it is.

I definitely notice it. I didn't have that as much as I did when I was a kid. It seems like it's later in life now and maybe stresses and whatever. I don't know what it is, but, uh, I just, I felt like I was more consistent as a younger person. I feel like I was always high and now I'll notice I'll have times where I'm kind of low, which is unusual for me. And if I can just, so it's been kind of a learning process for me probably in the last three or four years of like, Oh, I recognize this is happening. I need to go to the gym or we're lucky we have a hiking trail warehouse sometimes i just get into nature and have movement with it

like if i just go for an easy hike if even if i don't have the motivation to go try and lift heavy if i just go hike sometimes hiking feels easier it's like i'm just going for a walk outside um that will change my mental state too i think just the movement getting my heart rate up being outside all those factors do you have any other techniques like outside of just the movement itself? Like, I don't know. For anxiety kind of? Yeah, like maybe take a shower, that sort of thing. Yeah, I think that the cold stuff is interesting to me from a mental health standpoint.

I'm about to get a cold plunge tank, so that'll be interesting to experiment with. Oh, you'll like it. Dude, I know when I've been on trips, the only thing I can compare is like you go to a lake somewhere and you go and jump in the lake in the morning and it's, you want to talk yourself out of not getting in there. But once you get out, you feel so unbelievable. So I think that I've heard a lot of people talk about that and seen a lot of people kind of writing about it and talking about how just cold plunge for kind of anxiety,ting your nervous system kind of so i think that would be um i've noticed that that has made a difference before i haven't experimented much with sauna when i've been i like to use sauna

but i can't think that i've done it enough when i've been like anxious or something to see if it changes um my state i think also just uh like non-sleep deep rest. Oh, okay. Right? Like sometimes that, just like a meditative kind of session will help pull me out of my own whatever potentially negative self-talk is going on. You know, I think I just saw Huberman and Lex talking about this the other day, but like even like prayer, like I think all these things kind of fall into this bucket a little bit of like mindfulness, meditation, prayer.

Um, sometimes where you can get out of your own head and have kind of a broader, like just get out of whatever thought pattern is making you feel that way. Um, sometimes if I can separate myself from that, that will also help the, I used to have this great little workbook. It was a cognitive behavioral therapy anxiety workbook. And I think CBT has a lot of research

in the physical therapy world too for pain, but just reframing people, reframing how they think about different things. And it definitely helped with my anxiety years ago when it was way worse. If I went through the exercises in that cbt book they would just help me get out of my own head and kind of think through a little bit better and that actually has been used a lot in pain too like people with chronic pain there are different books where

you can kind of help them reframe the pain and that helps them have less pain yeah yeah yeah the cold plunge is freaking awesome like when i know, I've kind of had to battle similar things, but like when I get in the cold, well, facing the cold plunge, I'm like, I don't want to do this. This is stupid. I'm not going to do it. This is, today's not the day. Like, I don't care. I'll whatever, be grumpy. But then you get into it because you're already standing outside in your shorts and you know, it's like, well, I'm the idiot that I made it this far. Yeah. You know? And then like, once you catch your breath and you look around, it's like the trees are greener for some reason. You know, like the sun is shining brighter.

And it's like, holy shit, today's awesome. You know, so, like, that quick chill, like, it really just flips the switch on everything. So it'll be, like, really cool to have that at, like, you know, your disposal whenever you need it. I'm excited to try it. I think it would be great for those days where I'm like, oh, maybe I just, there's a lot of things going on and I just can't, I don't have that hour to get to the gym or whatever. You know, sometimes things come up and it's, but to have that cold plunge and just

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i like what you said about going on a hike is you just talk yourself into like i'm going on a walk i think the same thing could be true with the gym you know i used to you know have very specific workouts doing very specific things very specific weights and now it's just like let me just go move it's way different thinking that way yeah When you just move, you start moving around, start to throw a kettlebell around, or you start to do some med ball work. And then the next thing you know, you're 45 minutes into like having a really good workout. So I found that that's been like a revelation for me and has been really helpful also just to kind of recognize all this is all made up, you know,

it's easy to get to, you get to make up exercises, you get to make up your own routine, your own program, your own way. And so why not just fucking have fun with it, move shit around and do what feels good. That's so true.

Cause I think sometimes if you're really rigid in your workouts, it feels like it's harder when you're not feeling really motivated. It's harder to get yourself. You're thinking about everything you have to do because of this rigid workout. I'm not going to do very well at this today because the expectations are so high. Exactly. But if you just said, I'm just going to go there and start moving. That's such a great, because I think I have heard people say that too with like walking and running. So just tell me about the other day. Maybe they were training for a marathon. Oh yes. He was like, maybe it was a day where I was supposed to do 13 miles. If you. Maybe they were training for a marathon. Oh, yes. He was like, maybe it was a day

where I was supposed to do 13 miles. If you think I've got to do a 13-mile run today, it sounds horrible. Oh, yeah. But if you think I'm just going to go for a run,

and then you just keep going. So I think that's true. I used to hear that. Sometimes somebody was telling me that the special forces, people will sometimes, if they've got to get

to a mountain, you aren't thinking about I have to get to that mountain. You're thinking, I'm just going to keep taking steps. I just got to do this. I just got to get to a mountain you aren't thinking about, I have to get to that mountain, you're thinking I'm just going to keep taking steps, I just got to do this I just got to get that distance and that distance and it makes sense, you just break things up

into more manageable chunks and eventually you get there but yeah, that's a great one with the gym, it's like instead of being quite so rigid with I've got to do this whole program today, all these sets and exercises, I'm just going to go there and start moving Can you go to row three, the middle, down you go to row three the middle down one two three middle this guy yeah perturbations if even that's how you say

it but a friend of ours joel seedman loves doing these and people grill the puck out of him because of it even on this show but but there there is used it. So what are you doing with this athlete here and why can perturbations be beneficial for people? Yeah. I mean, I actually shared this from someone else's account. This is from Kevin Wilkes account who he works a lot of athletes, but I, you know, perturbation does get just dissed a lot and I can see both sides of it. I think, you know, cause there will be a lot of people that something like this, they'll be like, this is stupid. Just do it on the flat ground. You know,

they'll say it doesn't make any sense to be in an unstable environment like this. You, it's not natural. It's not how you're going to actually transfer force. Some like research that's been done, right. Showing that, demonstrating that being on an unstable surface doesn't make you more stable. Yeah yeah so people will cite that kind of research it's like one of those things where you can then you can find studies where they take people have ankle sprains and they do perturbation training and it seems to have positive results so i think definitely trains the fuck out of your foot and out of your coordination i mean to me it's another one of those things kind of like the manual therapy discussion almost that if you've done

stuff like this you realize how challenging it is and to me i can's another one of those things, kind of like the manual therapy discussion, almost that if you've done stuff like this, you realize how challenging it is. And to me, I can't think of why that's negative. Now, look, maybe if you only have five minutes to do an exercise, maybe you maybe then you're making a quick decision of like, OK, the thing on the ground is better. Maybe it's the thing I should choose. But if you've got a little bit of time, these kind of drills, you know, like this one in particular, this guy had had a multi-knee ligament surgery and, you know, this rocker board is challenging his stability in that medial lateral direction. A lot of ankle sprains, most of them are in this medial lateral direction. I think there's a lot of value in learning to control your

body. You're just taking the ground-based constraints and making them more challenging, right? And so for years, for six years, I taught for a group called Red Cord. That's a Norwegian group that uses instability training to test people. And then it's like TRX, but it's a big system that hangs from the ceiling. You place people in different positions in these ropes and you test them. And the physios in Norway use this. Some clinics, that's all they use in their treatment. And you can unload people.

There's bungee cords. So I spent a lot of years using instability training with people with different problems. And so I think I see where it can have its place. I'm just, I think I've gotten to this mindset as time has gone on where I'm, I'm not so willing to just totally throw something out and say it never has a place. And Joel does do a lot of crazy stuff. He does. There's a lot of stuff on there that I probably wouldn't do. Um, but I still think there you're doing something. It's very challenging for your neuromuscular system

when you're in a very unstable environment. And I think if you put EMG on someone and looked at their motor output, it's going to be crazy high cause they're just trying to figure out, but it depends on like what your goals are. Like if your goal is to generate force, I don't think being in an unstable environment is you can't generate as much force because you just don't have that surface to stable surface to push off of. And maybe that's less functional overall. So, but if you have somebody who has a coordination impairment or motor control impairment and you know, maybe solid surfaces are getting too easy. I mean,

we do this all the time. We use uneven surfaces all the time in rehab. Somebody who's had an ankle sprain and solid ground is getting easy. Well, then you take them to uneven train. You have to, you have to navigate uneven train in life. You walk the grass,

you walk on sand. There's just, there are situations where you are in an unstable environment. So to me, there are functional aspects aspects especially of a drill like this that's single leg and has a certain degree of you know instability and with you know honestly like outside of the athletic context um the amount of people that fall as they get older like balance is something that people just sense neglect yeah If you are always on both feet, you never stand on one foot for anything.

It's like that could be just super challenging just trying to stand on one foot. So maybe through your day at some point, just try to stand on one foot for 30 seconds for a minute and then try to stand on the other foot for 30 seconds to a minute. Move around. It's huge.

Yeah, you see balance drop off so much for people. And yeah, there's this test we use in PT called the Berg Balance Scale. And it has all these different items you have to go through, and then it predicts fall risk. And it's the gold standard. It has the best research, but it'll put you in low, moderate, high fall risk. And the two at the end are the hardest, which are going to seem easy probably to most people listening. One is single leg standing. And in that test, they only have to do three seconds to get the maximum score.

Wow. You know, so we try to get, you know, people do 30 to 60 seconds, things like that. But the other one is tandem standing where can you basically step and go heel to toe and just maintain that where you're just, your feet are lined up, which challenges medial lateral stability, kind of like that guy was doing. But you're basically, you just have people, you just say, Hey, can you take a step forward, get as close to heel to toe as possible, and then just maintain that. A lot of older people can't. They fall to the side.

And when people fall to the side, they land on their hip, they fracture their femur, and it's like 30% of people die within a year after a hip fracture. So older individuals, you know. And string training is huge too. I think that's another place where resistance training, resistance training improves your balance. And you see a lot of power drops off as we age.

And for a lot of older people, it's not just the slow strength. It's if they trip, can they catch themselves, which is a power task basically. So can you generate force rapidly? So I think there's value in that. And you see more accounts doing this online where they have older clientele and they're having them do like box jumps. Maybe even it's like a lunge or something, but you're doing it more rapidly. and you see more accounts doing this online where they have older clientele and they're having them do like box jumps and, you know, maybe even it's like a lunge or something, but you're doing it more rapidly.

Yeah. Just to train that capacity that can I generate force rapidly, which, yeah, for that population is a huge one for reducing injuries related to falls. Yeah, box jumps or just jumping would be great to accomplish some jumping. And a box jump is kind of an interesting thing. It gives you like a target. It gives you something to jump up on. But I even think just jumping straight up just in the air and landing could be even more beneficial because now you have to deal with the landing.

Whereas when you go to jump up onto something, the landing is a little softer. And people don't ever think about the coming down part but to me i think that for older people especially the bone density and the benefits you're going to get from that eccentric landing which you would have to be very careful with and you'd have to start very slowly but being able to jump down from stuff you know i was jumping today with ken and, um, I, I would, I would kind of give Kenny like an instruction on trying to do some different things that he wanted, like some different challenges. Uh, so I'd say, Oh, you know, try to jump, you know, from here, uh, you know, off two feet and then land on one foot. And he would like do it. And then I asked him to like jump down from the box that he was on. And he, he kind of, Oh, before he jumped down from the box,

he said, should I jump up? And I stopped for a second and said, that's not like a, that's a normal question by an athlete. But if I was up there, I wouldn't ask that because I would just be like, okay, I'm just going to land. I'm not going to jump upward. And then he did the same thing a few minutes later when I asked him to land on just one leg. He's like, should I jump up? Should I jump out? And I was like, you see the difference on how his body feels and how he's interpreting the instruction versus like the way that I am

because I'm not as used to that. He's a former baseball player and a hell of an athlete and he's very strong. And then also, I think when you walked in, we were kind of finishing up and I don't know if you were able to hear, but like when I would land,

it would be a little bit more of a thud and when Kenny would land because he's able to point his toes down quite a bit, he's able to really catch himself and still not have his heels hit the ground at all. My heels weren't hitting the ground either, but my toes were like punching the ground and there was like a clear thud. And then when he landed, it just sounded quite differently. So I find it motivating. I think it's kind of fun. Now I have something to work on. Maybe I can figure out how to land like that and be more agile and be a little stronger in some of the jumping that I'm doing. Yeah. I think landing work is really useful. You

know, like you said, a lot of people just think about, they see those kind of videos of somebody jumping up and something. They only think about that concentric get up on the, which is great to have that power, but there's, you could maybe make an argument there's more value in working on the landing. You know, I mean, a lot of these, like if you look at younger people, a lot of the ACL tears are related to landing mechanics, you know, and what kind of position, like there you go, like we were talking about alignment and posture before, like there's a great example. Like when you have a bunch of force in your system, you're coming down from a jump, the alignment of your legs, are you falling into a dynamic valgus?

We know that that's a biomechanical characteristic that can predispose someone to an ACL tear, you know, and then the, um, and so you've got that, you've got kind of like the athletic injuries, patellofemoral pain can factor into that, uh, IT band syndrome, valgus kind of collapse. And then with the older individuals, like you were saying, there's actually been studies on this where they'll take just jumping programs. And if you're looking at bone density, that landing and jumping is huge. Some of these they'll take a group and they'll compare jumping to resistance training and look at bone density and track it over time.

And those are two of the best things you can do to help maximize bone density. And they just have people do simple stuff. It could be just jumping up there and landing it could just be doing jump rope like just trying to work on you know implementing those kind of landing like how am i landing and how good am i at transferring that force i used to go in this clinic in san barbo with another guy and we had a force plate and we would have people we would say we always said like try to land like a ninja yeah as our cue but we'd have athletes come in there and we'd have them jump and land on the force plate and it was cool because you could look at in newtons of force how

much they're hitting with and then look at different strategies to try and lessen like try to soften that strategy and a lot of them a big one was like you were talking about like coming down with the ankle plantar flex kind of hitting the toes and then being able to kind of rock through that foot and then and then softly have that force go up and knee flexion and hip flexion. And it was pretty neat to see, you know, just see people who had never really learned, who weren't really jumping athletes learn to land better. So I think, you know, and it's not just athletes. Learning something like that has benefits, I think, you know, and it's not just athletes learning something like that has benefits. I think for a lot of us, even just if you fall and you learned, you just know how to activate your body and activate your muscles and know how to, you have a strategy in your nervous system to kind of catch yourself. Yeah. Yeah. It's almost like the muscle activation stuff you were talking about earlier. It's like, you just have that motor circuit, you have a neuromuscular circuit for, there's something in there. It's not just like foreign thing you've never encountered before. And you've said that you like to sprint,

right? Yeah. Yeah. I need to do more of it. It's the one thing I think when we were talking about training different capacities, it's the one that I haven't been incorporating enough. And I'd had this hamstring injury, an upper hamstring injury where I didn't warm up and I ran uphill, sprinted uphill. And that was, you know, I'd always heard about hamstring injuries and sprinting. And I was like, not me. That's what we all think. And then it happens. So now I feel like I definitely want to keep training that cause I do not want to be the person who loses the ability to sprint. And then I have to do it and then, you know, hurt my hamstring again or something. So I actually have been thinking about taking out some of my long run days and there's a track, there's a college near our house. Just go up

there and just do like some 100 like on off, kind of like run a 100, a little lower capacity, just build that back up again. Yeah. But I need to get, I need to get it going again. Yeah. Can be torturous going out to the track. Exactly. Well, especially our track, this track, the, um, there was a group in Santa Barbara called the Santa Barbara Track Club. It was a bunch of Olympians, decathletes and heptathletes. So you didn't want to do it in front of them. You looked like such a...

What time are you guys here? I'm going to be there at a different time. Exactly. Oh, man, those guys were always there, I swear, doing my workouts. And I just, you know, you just look like you have nothing compared to them. Yeah, anytime there's a group of people with the term club around it you're just like i'll see you

guys later yep i'll come later wanted to have a friendly debate on it and i only say friendly because i have no stats evidence or any proof of it otherwise but um on this post you were talking about this not being able to really target the psoas um i know for me like if i've tried with like the pso right and like kind of almost approached it with like an art type of approach i feel a stretch i feel something going on yeah but in this post you're saying like do you really think you're getting it so i'm just curious like what's going on there i try to be careful not to not say you can't you know just because this has come into question if you look at how many things you have to get through to get to your hip flexors, but I don't think that means

you can't influence them because I still have patients where I use my hands to supposedly work on their hip flexors, even though there are a lot of things claiming that there's even some ultrasound studies where they push on people and look at it and show the depth that the hands are going to. And it looks like you're getting nowhere near But, you know, I think if you get way to the side anatomically, the hip flexor, you know, does come closer to the iliac. It's gross. It's not appetizing to you? I would eat that. If you come down the side of the pelvis right there, I mean, it is really deep, but I think,

you know, I think this is where sometimes manual therapy is a little bit tricky. it might not be that you're actually putting a lot of force directly on the muscle fibers themselves but maybe you're influencing the nerves that run through that region and you can't take placebo out so because you know for a lot a lot of times I think there you could make the case that when somebody feels something like something's happening in the area where their symptoms are they believe this is going to help me how much is that factoring into the situation i definitely have people where when i push on them i i'll have them lift their leg i feel like i can i feel their hip flexor something contracting it could be their abs too that's the other tricky thing is that maybe it's the abs contracting but it feels like their hip flexor pops up in your

hand that's how we always did it before it was, you'd have them lift their leg to make sure you're in the right spot. And, but the question is when it does help those people, is it because I'm actually touching their hip flexor and changing it through some tissue based mechanism? Or is it just they, there's some kind of placebo response where they're like, Ooh, he's pushing on a spot where my pain is and that's going to make it better. Yeah. It's hard to know. I try not to throw anything out at this point anymore. You know, I just think, uh, so I tried to put frame that as a question, like, can we actually, you know, cause there's a lot of people that have, I didn't actually include hip flexor myofascial releases in the book mainly cause I didn't want to get criticized for that because

I knew there'd be pushback from certain people. And I just, I was like, you know what, I'm just going to avoid this headache and just stick with stretches. The Hip Flexor Association of America. Those guys are everywhere. But then you hear someone like Goggins who says like hip flexor work solved his whole body. Yeah. You know, it was like he had all these issues and your hip flexor, your psoas is an interesting muscle. It's one of the few that attaches your spine to your, like your appendicular skeleton to your leg. I mean, it's an interesting muscle, how deep it is and how important it is in function. So, you know, you see a lot of people where interventions that target hip flexors, stretches, strength, strengthening myofascial release really helps people. So it's for sure one of the more interesting muscles.

Where can people get your book? The book is on Amazon. Barnes & Noble are kind of the main places people are looking for it. It's called Rehab. It's beefy. Yeah, it's almost 500 pages. I should think. Great job.

You can use it as your dumbbell too. But it's, yeah, Rehab Science, How to Overcome Pain and Heal from Injury. And, yeah, Amazon and Barnes and Noble are the main ones. Some people internationally located, there's a bookstore in the UK called Blackwell's that ships globally. So they're a good one. But, um, yeah, I mean, it was like a lot of the stuff we covered today, it was kind of the goal of the beginning is pain and injury science, helping people understand that stuff.

And then about two thirds of the book are rehab programs for the most common issues, pictures of me doing exercises. So it's kind of a all in one movement health book, but obviously people are going to think of it mostly as like a rehab physical therapy book, but I'm hoping people will also think of it as just like a resource where they could learn, um, different things to keep their system healthy. How'd you like that mind bullet? Oh yeah, I, I didn't, I was a little nervous about what it was going to do to me. It does taste horrible. Um,

but, we got the taste down. We nailed it. Yeah. I'm a curious, I'm always curious about these things. So, he went to the bathroom,

he said the liquid plant. Yeah. That was the goal. Yeah. Yeah. But, um, yeah,

thank you guys for having me on here. This is awesome. It was fun to, like I said, just, I've known about you guys for years. It's fun to just meet But, um, yeah, thank you guys for having me on here. This is awesome. It was fun to, like I said, just, I've known about you guys for years. It's fun to just meet and, um,

just really cool to be on this journey, meeting cool people and, just to be able to talk, talk about these topics here. We're here, how other people think about them. And, uh,

I mean, my hope at the end of the day is that the information just gets out there and helps people. Because I think the theme overall, when it comes to pain and injury is that the things that have the best evidence are education and exercise slash movement and those are things you have control over and don't need someone else for so if you have something that can help guide you through the process you can really self-manage and self-treat so that's kind of the that's been kind of my hope is just to get that message out and then give people a resource that helps guide them through that process. Strength is never

weakness. Weakness is never strength. Catch you guys later. Bye.