September 26 2024
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Welcome to the True Sports Physical Therapy Podcast, with your host, Dr. Yoni Rosenblatt. In this special episode, we take a look back at some of the most impactful moments from past episodes, featuring highlights from top experts such as Kelly Starrett, Mike Reinhold, Caleb Burgess, Judd Lionhard, Quintin Willey, and more.Megan Sackhoff Beener, Eric Hinman, and Brandon Parker. This episode is packed with valuable insights on topics ranging from sports rehab, training, and entrepreneurship to cutting edge physical therapy techniques. Whether you're a new listener or a longtime fan, this Rewind episode offers a chance to revisit the key lessons and advice shared by our incredible guests.Get ready for a powerful compilation of knowledge and inspiration. Let's jump right in. Let's get a, a little bit more clinical if, if that's the business side. Clinically speaking. Gimme something that you've changed your mind on in the last five years.I don't know if I've changed my mind. Um, I went back, so there's a few things that I think are. Reservoirs of capacity and performance that are untapped because it's, be it, heaven know breath is one of those. So if you followed our work for a long time, you can see that I've become very interested in the amount of volume you can move in and your ability to maintain that volume.And it turns out, Greg Cook said for a long time, if you can't breathe in a position, you don't own that position. But we expanded that to say, Can you, not only can you ventilate, but can you maximally ventilate in those positions? So we ended up using breath as a way of understanding positional competence, ventilation via two max.We saw a lot of opportunity there and then also weighs into the nervous system to de threaten, to de sensitize, to help people down regulate, that we could take all the classic PNF contract relax, add in some breathing, add in some, you know, loaded isometrics, which are what, if you're doing like, um, um, Static hold on a roller, because you find like a trigger point or an area of sensitivity or whatever it is you want, and I just have you flex in there, that's an isometric contraction.That's all you're doing. You're just putting a different load, instead of lengthwise, you're putting a vector load into the tissue, asking that tissue to contract around that single spot, integrate the breathing, and suddenly, we can get a lot of stacking done where we can get people feeling better right away.Does that resolve their movement dysfunctions sometimes, but sometimes it just makes them feel better and assets that feel better tend to do better. Yeah. So breathing is a big one. So, okay. So breathing you've added, um, as an example, I came out of graduate school a million years ago and I'm teaching people, okay, let's squat in front of the mirror and make sure your knees look straight ahead.Don't let them go past your toe. Obviously that's gone to the wayside, right? First, it went to the wayside with Kelly's Tourette and driving his knees out and creating torque off the ground. Now knees over toes has changed. I'd say as a profession or outlook on that thing, is there anything like that that sticks out to you where you used to do something?Yeah, absolutely. So one of the things I didn't do a good job of is explaining that we were never coaching these out. We were coaching these out to maintain an arch and extra rotation is an isometric function. contraction and it's how the whole body creates stability. So if you want to have a stable pelvis on femur, that's done through an external rotation movement.That's why you do monster walks and why you try to get people's clamshells better is that you're trying to teach the tissues to be able to create a force that makes the pelvis more stable on the femur. You know, and so one of the things that was happening is we were seeing people turning their feet out and collapsing their arches and just, I was like, what is that?You can't jump maximum that position. And actually you're contributing to the problem and epidemic of ACL injuries and lower extremity injuries. And we're seeing more and more the research is coming out. They're like, wow, that foot turned out arch collapse. That Achilles has a lot of translation and a lot of sort of lateral vectorization, plus the loads on the posterior horn of meniscus, plus, I mean, just, you know, keep checking the boxes.It's less effective. Again, I think one of the things that we've gotten better at it, and I inherited this language from Mulligan, movement fault. And if you see the book, it says movement fault. It's not a movement fault. It's, it's, it's a strategy or a compensation. Like you're, you're using that. Um, I don't think that there are bad positions, comma, that position sucks.That position is less effective, that position has less transferability, that position challenges tissues in a way that, you know, eventually is not going to be as effective. So I can say, and equivocally, that position is dog shit. But it may be the only position you can get in. So let's ride this horse today, comma.There's probably a better position. So we're always teaching to the highest expression of the movement. And one of the things that we saw was when I started, you know, I was working with this young, I don't know, like five or six years ago, working with maybe longer working with this young, like shit hot, Paddle sports team, and I was teaching them to respect their squatting based on their foot position and their foot balance.And I was also coaching my daughter's teams at the same time. And all the traditional coaching cues around squatting I found weren't as effective for children because they weren't good at being cues and taking those cues. They were really good at feeling. So what we started doing, for example, is saying, Hey, look, I need you to keep, you know, 50 percent of your weight on your front of your foot and 50 percent of your heel and keep your ankle right in the middle of your foot.Every kid could look down, make those corrections, feel the changes. And then they all squatted and I was like, Whoa, Whoa, Whoa. That's perfect squatting. And I didn't actually cue squatting. I just said, keep that balance down. And based on your anthropometry or the load or your position, you will have to have higher degrees of tension.So if you're going to squat with a really upright torso, your knee is going to look a lot more out than if you're squatting with a forward lean, because there's more demand to keep the pelvis connected to the femur. And so. You know, if you're what you're seeing is like in when Ben Patrick squatting, there's very low torso demand.So and that foot can be very straight, but it's still roughly the same organization knee is tracking little toe or towards the outside to maintain the integrity of the foot. So we threw out like all of the knee stuff because I was like, that's like me coaching your bench press based on your elbow. This doesn't make any sense.More elbow in more elbow out. Yeah. Like, why aren't you teaching a feeling? How can we get people to tap into their interoception so that they can connect the skills more effectively so that when I'm teaching squatting, I'm really teaching a step up or a jump and land or an Olympic lift or receiving position or so that that foot position transferred beautifully to some of the other things.So that's something we evolved on and I'll say we can continue to evolve because we're still practicing. I'm still. Working with the Niners and the All Blacks and the English National Soccer Team, the Brazilian Women's National Soccer Team. And I have two college teams over at Cal and I have a team at San Jose State.And I still am where the rubber hits the road trying to re evaluate, re assess what is essential and how do I solve this problem in a more elegant way. So I'm still a user very much. I love that. Yeah. And so you still have your hands obviously in the clinical side, which, which certainly resonates with.everything you say. I think you make a great point with trying to teach these complex movements. If you start getting too microscopic or myopic, it's impossible to stack those things, right? And so I think that's your example of like, just squat, like keep it, keep your weight even and squat and the body's going to find a way to do it.I see that a ton with all my baseball stuff. When you're teaching back to throwing return to throw, it's less about keep your elbow here, keep your wrist here, keep your fingertips here. It's like, Here's a couple of drills. This is going to cue you to do it appropriately. Okay. Get on the hump and throw.Right. And you're apps right now, we're mo, we're mo monitoring speed and volume. Right. How, how fast am I throwing? How heavy is the thing I'm throwing? How much volume am I throwing? Yeah. And what we can start to do there is, you know, I, I don't know anything about baseball. I've just worked with like s teams.Yeah. And so Cy Young Award winners, but I don't get into the mechanics. I understand what the essential shapes are. One, one of our friends calls it. Kino types, like if you kind of that classic stop motion, you could see essential pictures. That's Stuart Millen's language. We talk about archetypes. What is it the body should be able to do?Well, you don't have hip extension and inter rotation of the hip in extension. I can't even tell what's going on. And so, you know, oftentimes what we see yesterday, I was working with some swimmers, some Olympic swimmers from San Jose state. And one of the things we found was a lot of those athletes really were lacking capacity in the anterior line.So they had a hard time creating global extension. And when I put them under a little bit of extension load, but turned off, couldn't squeeze their butts. Right. Which meant that they ended up hinging in the thoracic spine to solve that movement problem. And then that shoulder lost its rotational capacity.And that's a problem if you're a swimmer, right? That's why that streamlined position being able to kick. So if you don't under have a root language, you can chase, I think your distal pectineus is stiff. And let me activate, like you can play that game, but if you can't see the components, For the whole, and you don't have a mover language, it turns out that strength and conditioning is a really elegant way to understand what you're seeing in complex movements, because that's what we knew is that if I can get you into these shapes, it transfers better.Now we can start to say, well, what are, what's fundamental or how much of these essential shapes should I have as a benchmark or a vital sign? Now we suddenly have movement, vital signs that everyone can understand. That is how we dig ourselves out of this. I love, yeah, I love that. And, and I think the truly skilled clinician takes that complex language and dumbs it down to the athlete.So that not that they can't understand it, but when you're moving 150 miles an hour, they shouldn't have to try to understand. Oh, you can't just be able to groove it. Right. You can't. So I think, I think that's a skill in the great sports PT to UCL surgery and rehab. Tell us about, uh, what's new and, and kind of educate us on this internal bracing technique.Oh, yeah. No, that's good. That's actually a good topic. The internal brain. So, um, hex, you know, the last several decades, you know, we've, we've had a gold standard for, for Tommy John procedures or UCL injuries and, and overhead athletes, mostly baseball players. But we've had a gold standard with the reconstruction, right?And it's very reliable outcomes. You know, you could argue 90 plus a percent success rate, especially if you're done in the right person and not a young kid or something like that. Um, but it's been, it's been really good. Yeah. The problem is, though, if you look at the sport of baseball in general, the amount of injuries that we're seeing, especially Tommy John and the elbow, just continue to skyrocket.It's actually enormous. It's, you know, it's absurd when you actually look at some of the epidemiology of them and how they're, uh, they're continuing to hurt themselves. But the, the, the typical person now is becoming younger and younger. So when I first started, you know, 20 plus years ago, the, the person that would get a Tommy John injury was, you know, in their thirties, you know, more of a wear and tear type injury, like just chronic degeneration over a career.And now, you know, you know, your listeners know, it's high school kids, college kids, sometimes even youth kids. Um, it's just different now. So, you know, this reconstruction procedure is a big deal. Um, uh, luckily, as we got better with surgical technique, right, and the, the advent of kind of some new things, like this internal brace, right, which is essentially just like a, like a fiber tape, like a piece of tape, we'll call it, right?Um, that was, uh, starting to be applied in other areas, like the ankle, for example, like a, for a chronic ankle sprain, where you could repair a ligament with this, this new tape. Um, and we've had some really, really, uh, smart physicians, like Buddy Savoie, down the line. It belongs at. Jeff Dugas in Birmingham, Alabama, they've done a really good job trying to now incorporate that into the elbow.And what we found so far is that if you have the right type of Tommy John injury, meaning not everybody's candidate for the internal brace, but if you don't have this crazy chronic degenerative tear, it's not torn in half, but you just have some, you know, essentially like a, a non functioning, like it's just, just, it's just not stable enough type ligament.You can, you can add this internal brace to it and actually have some pretty successful outcomes. And the benefit is, is, is the rehab is a lot faster because you don't have to have full reconstruction and turn a tendon into a ligament, right? That, that takes time, right? So our return to play is a lot faster.So it's pretty exciting. Yeah, that, that's awesome. So dumb it down a little bit, right? We talked about making things simple. So this is, you would, the ideal candidate is only an attenuated ligament. Yeah. Well, so it's, you know, when you look at, when you look at a UCL, right? So, you know, in, if you tore your ACL in your knee, right, kind of just pops in half, right?You're skiing, you twist your knee, it pops in half. That doesn't really happen as much with the, the Tommy jaw ligament. Uh, sure. Could you do that? Absolutely. Don't get me wrong. But what happens over time is you almost see like if this is the ligament kind of attaching into the bone, what happens is that it almost starts to just kind of like peel off a little bit on the articular side.You see that a little bit and it's not a full blown tear, but essentially what happens is it, it, it is essentially not functionally stable, right? So if you can go in there and repair that or, or if just one side comes off and you just want to put it back down and then reinforce that with the, with the internal brace, I think you have a higher chance of being successful.Okay, and then walk me through how that rehab differs from our original UCL approach. Yeah. So, with the original UCL approach, there's, there's a bunch of things you're concerned about. Obviously, the tendon has to turn into a ligament. That takes time. That takes weeks, you know, before that even happens. So, the structure of the, the ligament, you know, has to, has to heal over time.That's important. But there's also big bony tunnels that the physician puts into the elbow, right, both proximal and distal. There's some big bony tunnels. And, you know, if you go too fast with that, you certainly don't want to fracture one of those or crack one of those. That would be, that would be really bad.So, for us, like, the procedure there is more complicated. It's a bigger surgical procedure. Um, with the brace, because we're not reconstructing anything, we're just repairing it and then reinforcing it, theoretically, it's stronger sooner, so you can go a lot faster. So, you know, I, I still am, uh, I don't want to say anxious, because that's not quite the right word, but, you know, when we look at the protocol and we start bringing people through the process, we're always like, gosh, this is, this is really fast.Like, why, like, how are they, how are they tolerating this? Thanks. But they do. And, and when you, when you have a new surgical procedure and you have to write a rehab protocol for it, you have to base it on your, your understanding of basic science, physiology, that sort of thing. And you have to do your best guess with that.Um, and essentially what we've done is, you know, we have people, they can start throwing, You know, you know, no later than three months a lot of times and with the Tommy John procedure, they're starting to throw give or take at like probably closer to the five month mark, right? So we have people that are two months faster just with that, but then the throwing progression is so much faster too.It's about half the time it could be. So, you know, people are back six, seven, eight months instead of, instead of 12 to 15. Um, that's a pretty big deal. That's a really big deal, especially if that's how you earn your living, you know, being on the bum. So now you're treating patients strictly virtually, right?Um, and, and you offer an online, um, a virtual evaluation. So walk me through that evaluation and then see if you can highlight maybe one of the struggles that, that there is in virtually assessing a patient, especially for a manual therapist. Oh yeah. Yeah. So like, just to kind of, I keep going back, I'm sorry, I'm giving history here.I like, uh, I was trained, uh, in a, after I finished school, we did a res, I did a residency, which was, we did like, we kind of focused on a lot of pain science stuff, but a lot of, a lot of movement stuff, but a lot of like hands on, like the bang for your buck, like manual therapy stuff, not like everything, but just like the bang for your buck, like this is stuff that usually works based on, I guess, our instructor's opinion and what the research shows and would help us for exams, um, which was still great.It was, it was probably. The most valuable thing I did was that residency. Cause I tell you how to like critically think and stuff like a lot of critical thinking. But then we did a, I did a man, uh, orthopedic, uh, manual physical therapy fellowship and sports fellowship the next year. So that was like hardcore, like every possible thing you can imagine manual therapy.And I, I could have paid to get the FAO MPT after that. And, and. Been credentialed to have that. But at that point in my life, I was like, I didn't have much money. And I was like, I don't really want to pay for this. I'm like, am I going to really like, I'm not going to teach any courses on manual therapy. I didn't plan on doing that.So it's like, I have it, but I never paid for it. So with that being said, it sounds funny because I have that experience and I still think manual therapy is awesome. Um, but. Uh, virtually like the way that I look at it, I think part of it was I got that, I got that education in school too. Um, but also residency and fellowship, like really hard on like critical thinking and like movement quality.And like, how do you like problem solve on the fly? And so I realized like a lot of my exams I was doing in person, like, yes, there was still a lot of stuff I was doing, like passive range of motion, like checking, Um, with joint mobility or like how sensitive somebody is to palpation or joint glides or whatever.And, um, but I realized like, honestly, that wasn't like a huge part of the pie as to like, what I really thought was going to be the meat and potatoes of what they needed long term, like maybe in the short term to get them out of pain relief, it was huge on the first few visits or whatever. But when we're talking like long term improvement, um, for the majority of cases, I was like, you know what?I can find this stuff out by just. Checking the patterns of how they move, how they're, what their pain behavior is like having a really, really good subjective exam, um, and stuff like that. So of course there's limitations. Like I always tell people, like, I wish I could transport everybody to see me right here from all around the world.But with social media and stuff, I had people start to reach out, like, Hey, where are you located? I'm like, honestly, like, if you're not going to fly out to see me, like. We had to do something online, so it kind of forced me to start doing that. I, I'd al, I had worked with people that I had seen in person through like, almost like personal training while I, before I did all this stuff.And so I did that virtually and I, and I knew a lot of personal trainers were doing that and like, making good living off it. I'm like, that's really convenient. So I, I, I, I had this thought in my head that I always wanted to do that. And then as my. My social media and people got to know me from all around the world.And they're like, you know, I'm not really happy with where I'm going in person, like remote places, even in the U S like they're in a remote area. They have like one option. They don't like their chiropractor, the physical therapist, whatever, or they've tried certain things. And they're like, I just want to, I like your approach.So I started doing things more virtually and that actually worked out. It's worked out really well. It's been a lot of learning, but I mean, If you have a really, really good subjective exam and you know what to look for, um, you're going to find out in the majority of what you need. I think the biggest limitations besides some hands on stuff that might help me a little bit is.If I'm just, if I was in person, I could like walk around. I could cue them differently. Like, no, no, no. I want you to move like this. And it could be a lot quicker. Like I could get through a full exam a lot quicker in person and just like, boom, boom, boom. Like, here's what I need. I can just feel something as I'm putting them through range of motion versus like teaching them what I want them to do and showing them, and that just takes a lot of back and forth, but with reps, it's gone a lot better, but even still, even though I haven't done an in person exam now for almost a year.Wow. I know I'd be able to fly through it still compared to virtual. Um, but. That's probably the biggest limitations. But again, it's not, if it's something where I think someone really, really needs to see somebody in person, very rarely people reach out to me where I actually think they have to see somebody.But if I think like, you know, it might be beneficial. I might tell them to go see someone near them for a second opinion, or just to get a more thorough workup if I think it's appropriate, or, or like if it's something where it's like more of like a. Like they need some diagnostic testing because it might be a surgical case.Um, or I asked him certain questioning that makes me think like, Oh, I don't know what your, how good your prognosis is. Um, then of course I'm going to refer them to either another PT and orthopedic surgeon or whatever, just to get rule things and rule things out. Yeah, it's, and I've learned so much from following so much of your content.I think you have such a well rounded approach and really a unique approach. And one of the things that you harpoon with your athletes is preparing them for, um, high level training, high level movements. And I've heard you say that the term warm up is a misconception. So tell us, how would you categorize you preparing your athlete for a workout?Well, like warm up, like it kind of, um, alludes to like warming up the body, right? Um, I think that's like way over simplistic and it just misses a lot of very important categories. So, you know, it's not like our body's our car, right? Like we need to warm up our car, like, um, it's, it's far more complicated than that.So it's like movement prep and just prep and tissue prep is, you know, a much more accurate and specific term, but I mean, you can throw out warm up, but as long as like in your head, you know, that is far more detailed than just warming up the body. Um, So it really goes into tissue and joint specific work and patterning.So, you know, get the athlete focused. That's number one, focused on the task at hand. Um, get them mentally attuned to what they're gonna have to do. Kind of give them a little bit of a rundown of what you plan to do that day. Um, elicit some feedback from them, see how they're feeling. Make sure they're ready for the training in case you have to do any change of planning.I mean, all of that should be done at the beginning of the session. Like, don't you have the athlete get in there and start jogging or something? That's crazy. Um, and then it's just like, you know, very joint specific. You know, I love isometrics, joint specific holds. Put a joint under tension to get the tissue and the tendons ready to go.Like, I'm a big fan of isometrics early in the workout. So, you know, like two things go into force, right? And one of those is acceleration or speed. And that is the one that has the biggest impact on how much stress a tissue, a joint experiences. So why don't we just take all of the speed out to begin with, find the joint angle that hurts, have them hold that for a while.see if it still hurts. If not, if it starts to go away, then we can increase the joint angle and then start to add some speed and load from there. Um, so just tissue prep. And then after that, it's just whatever sequence or movement you're going to do to that, that day, find something that kind of mimics that pattern so that they can get their body moving and the sequence and the pattern that they're going to have to do at a slower speed.Well, dude, I love the attention to detail here when you're talking about warmup, I think far too often actually walks into a facility. And it's like, okay, let's do some band walks and then get rolling or even worse. Let's just raise your body temperature, um, with something not so specific. Um, and that's your general warmup that it, that it sounds like, um, can be far better.So I love the attention to detail you have in prepping your athlete. You've come up with a beautiful sequence that you call the slow, the flow, the go, the grow, the show. Now, it's a little wordy for me, Judd, but can you just walk us through what those terms mean to you? Yeah, sure. So backing up just very briefly, like the job, like a lot of people go into a gym and jog as a warm up.That is an impact. People forget that jogging is impact. The last thing, especially as a trainer, if you're a trainer, this is, unless it's a very young, healthy kid, even then, I don't know, If you're a trainer and you start with an impact form of warmup, that's almost unforgivable. So like, no impact at the very least.All right. And then going into what we're gonna talk about, like, you know, things don't have to be complicated. You can be detail oriented, but this stuff can be very simple. It doesn't have to be very complicated or hard to understand. Right? So kind of my deals, like I try to find the essence of things, right?And, and try to maximize economy of time and efficiency. And so there's a lot of different ways to skin that cat. And so we just have to kind of find a way. where we can dumb it down and make sense. And these things don't have to fit perfectly in these, you know, slow flow grow or go grow categories. But, you know, there's things that like tend to have characteristics about them that may make them more suited to one or the other.If that makes sense. So it's not like an exercise is firmly in this category and it's firmly not, it's not that detailed, you know. But basically the, the slow is what we just talked about, right? And then it's just very, no movement or very slow movement, finding the pattern, finding the joint angle, getting the tissues ready.Talking to them, getting their breathing up, things like that. That's kind of the slow. Um, all of this should take not very long, five to 10 minutes, maybe. And then the flow is like you pick up speed and that's when you can't start focusing on those joint. I call them flows, man. Um, it's really just sequencing, right?Cause cause limbs move in a sequence. Right. And it's just getting the body to move in the appropriate sequence on the, on the planes of motion that it's going to have to experience and then building speed slowly from there, that's kind of the flow, right? Um, and then, you know, after that we go into the go.So the go is just athletic type movements that are, if possible, ground based in nature that involved joint sequencing and core involvement, but have an emphasis on the body part or muscle group that you're working that day. So it's basically the athletic move. And there is some like growth stimulus there, too.I guess single arm pushup or something I put in the go category or like a kettlebell upright row or high pull. I put in the go category, you know, hang cleans, medicine ball throws, I'll go category. And then within that go category, like I flow them through that as well. Like it starts out faster and lighter and it'll progress heavier more towards the grow category as we go along, if that makes sense.Yeah. But it makes a lot of sense. Yeah, I mean, they have power and strength and hypertrophy elements to them. It's not completely isolated. It's just focused more on athletic performance, type of movements, things like that, that, that kind of goes. I mean, I think, I think that makes a lot of sense. Sorry, cut you off there.I love the way you look at it really, um, holistically or systemically, right? Like long gone, at least from this are the days of let's prepare an athlete to bench by moving one joint at a time. You're incorporating the entire body. And I love that with a lot of your movements, because I think as sports PCs, we get so isolated on here's the pathology, here's the joint that is at an issue.Here's what I'm going to attack. Whereas as I'm learning this strategy that you're kind of putting forward, we got to prepare the entire system, nervous system included to make sure that we get the maximal effect, I guess, of whatever our intervention is going to be. So. And I also totally understand the gradient you're talking about where there's a lot of gray area where things don't just live in one category, but you're, you're accomplishing multiple things with a given movement.So I love that. So then walk me through the grow in the show. Yeah. So as trainers, like we don't train muscles to be stronger and more powerful. That is not the be all end all of what we do. Right. We train our athletes to move like athletes and then prep their tissues within that system, right? So, you know, somebody can look at it.Well, this isn't the optimal exercise for chest or pectoral strength or size. Okay. Yes, it's not. Okay. Gotcha. That, that, that time will come in that workout. Don't worry. Um, But it teaches the body and it gives the trainer me an opportunity to see the athlete move and make sure that their body, their core, their hips are working to support that peck muscle to elicit the athletic effect on the field that we want.So just because it's optimal for the muscle group does not mean it's always optimal for that athlete. I don't need the athlete to have the strongest pecs possible. I need them to be able to use their pecs in the best way possible. And that requires more than just the pectoral muscle. Yeah. So, and so, and then moving on and then, you know, we, we flow, we flow through that, that go, um, spectrum that too takes 10, 15 minutes to work out.Right. Then we get into the grow now by grow, I maybe mean muscle size, but mainly I mean, strength. These are the heavy, more conventional strength building exercises. Like, you know, as far as like the athlete can do it anyway. So like if they can do a back squat, if they can do, you know, a conventional deadlift or a conventional bench press, it's that kind of thing.In that strength spectrum. So the traditional, you know, one to six rep range, probably, um, north of 80 percent of the wonder at max, it's like, I'm not inventing the wheel here, you know, and, but here's the thing with strength, man. And as people don't get, it's, it's about like minimal effective dose and not taking time doing extra that has diminishing returns.So why would I spend two hours working on Peck strength, chest strength, pressing strength when. 80 percent of that benefit after the warmup comes in the first 10 minutes. So the flow, the, the, the flow, the flow and the go all get that peck muscle ready to go, um, for the grow. So I don't, at that point in time, I don't need to spend a lot of time warming this athlete up for like, let's say a bench press, um, I can do.One, maybe moderate working set to make sure they're the patterns, right? And then I can just do two good, solid working sets of bench press and in the 80, 85 percent one rep max range. And that is the stimulus I need for chest ring. I don't need an hour for chest ring. Yeah. And I think, I think that's, that's, that's really unique.And then, and then as they get into the show, that looks like what? Show is just like more hypertrophy, so a little bit of strength, but it now just shifts more towards hypertrophy. This is just like for the general athlete. So some athletes, honestly, the show is like joint specific stuff. Like, you know, if it's a sprinter, the show would actually be like a Nordic hamstring curl, which is not really show, it's still go, but it's, we're kind of giving it away from the compound lifts, giving the central nervous system a break and really focused on like really targeting load on that hamstring muscle glued a little bit, the hamstring muscle.So the show doesn't really fit there, but for the general population is like, all right, man, you worked your athletic abilities, you know, you got your muscle strength and now it's time you can do a little bit of bodybuilding at the end. Once again, in optimal doses, you know. Yeah, and so your optimal dose is there when you're attacking hypertrophy is?Well, I mean, you can spend a little bit more time in the hypertrophy range because we kind of need it more than strength and power. Honestly, the body needs to be a little bit higher and the frequency, right? Um, but, and it also doesn't tear down your central nervous system as bad. So, you know, you can spend is like 15, 20 minutes in this if you want.Because a lot of it too is going to be like single joint movements and stuff and you can superset those so you know, okay, so that's awesome, dude. I wish I wish more of this was seeping out into the sports PT ether. Um, it's so different than than your textbook approach. And, and I also love that. You're applying sound athletic and performance principles to general population to the general population and treating them like athletes.And I think that is a huge pitfall for sports PTs where we get either some joint specific or so demographic specific. We're not teaching these cats how to move efficiently and appropriately. And I think this, this form really speaks to all of them. So that was my whole intent is to dumb this down to the bare essentials.It's understandable for people, right? It doesn't have to be perfectly correct, right? In order to work. So, you know, a lot of this stuff, people do it in different ways. So I'm not saying my way is the only way to do it. But it's like this like French contrast and things like that that just normal people just don't understand that and they also don't have the the facilities and the wherewithal to be able to do that on their own.So it's just not accessible to normal people. So just take all this complex kind of obtuse and kind of. You know, a lot of it, like it helps maybe a little bit, but for the general population, it's not the be all end all and just taking what really matters and like giving it to people so they can see benefit.Yeah. Yeah. I mean, I love that. And I mean, you make the, you make the point that the athlete or the client might not have access to these things, or they may not understand those things. I would argue the same thing to the clinician. I think a lot of PTs are missing a lot of these nuts and bolts to look at the athlete.So systemically, and to get them moving appropriately and, and really great bang for your buck. How do you, um, let's say begin your exposure therapy. That's a better term. There you go. Sure. I use it. I use violate cause that is a, the words of JP Canario and, uh, uh, the Laura Mosley, Peter O'Sullivan, and a lot of their pain rehab, you know, related papers.So yeah, so let's, we'll change that term to exposure based therapy. And I think one of the easiest ways to do it for a hamstring is. Changing all of your drills into more vertical based drills. And that's where we start. So that could be just marching up and down. I don't look for the athlete to cover ground quickly.If let's say I want this drill, like an a March, which is just basically standing upright, I'm picking my knees up to as high as I feel comfortable pulling that knee up, it's going to be different early on, especially for more sensitive hamstrings. You know, maybe they only pull their knee up. 50, 60 degrees off the ground and their other side, they're able to pull up all the way, you know, that's fine.I don't mind. I'm just going to move with what you can, what you feel comfortable with. And I'm not concerned. Like, let's say for doing that a March for 10 yards, I'm not concerned with how fast you get there. I just want you to take as many steps as it takes go through that position because ultimately I'm trying to build resilience in a capacity.Now, now we go into total, just GPP mode of putting The same way that I would prep a healthy athlete, there's going to be a period of time where drills are taking like the majority of my training time because we just need to build them up. Like, I don't take a healthy athlete and just sprint their boots off the first day that we're out there.I'm going to go through some drills. I'm going to condition them into some things, into some postures. And they also get a feeling of the types of language and the interaction that I get. With them, the types of things that I say to them and they have abilities to communicate and ask questions to me while they're going through these drills.I think that's important. You're developing this, this therapeutic relationship as they're going through something that may be scary. So I'm having them march in place, more vertical based stuff. If that's fine, you know, maybe we'll do something like a hundred yards worth of that, if that's really. Scary for them.And, you know, I'll break that up. Maybe like 10 sets of 10 or, you know, maybe we'll do 150, go like 10 sets of 15 broken up into a couple of different sets. Um, and sometimes that might be as far as you get in a day, you know, that was a lot and anything more than that, you know, for those little bit more sensitive hamstrings with a little bit more fearful athlete, sometimes that's where you're going to get on the day.And that's okay. As long as I'm accumulating some great volume there, you know, Um, I think that's the goal. And then, you know, you might go into something like a little bit faster marching, a little bit more skipping. Like I'll, I'll literally like, I want you to skip and just make it more up and down. I need you to just push your, you know, hammer and nail straight down to the ground.Don't worry about traveling downfield. Your body will do that for you. So don't worry about getting to the line. I just want you to accumulate great touches to the ground that are specific to sprinting and jumping. So it's more of like an extensive polymetric type workout. And then after that, we might do some.Almost high knee type things. And even early, if they're not able to get through a full range of motion with the high knees, I'm still wanting to reciprocate gate. I still want them to feel what it's like to pick one leg up and put the other leg down and put force into the ground again and again and again and again and again, so that they gain more confidence.They gain more feel that tomorrow when they come to rehab, they know what they did yesterday and they know about, you know, right where they're at. Like I, I tested my waters. I found that limit. I know what I'm capable. And now I know that to that level, I don't have to be afraid. That's a big win. I just pushed the margin of what they feel like they can be exposed to.And then that next day, can I push that margin just a tiny bit more? Can we just get a little bit faster in the same drills? And ultimately I think you can be very liberal with how much volume you do here, because it's so low intensity. Their hip flexors might be on. fire from picking their knees up, their calf muscle might be just absolutely on fire foot cramping.And that's fine, you know, because I'm exposing you to something that I can be confident. I am building this athlete up and what an awesome thing for an athlete to walk away from a training session sore. in, in muscles that feels like I'm actually training. Like, Holy cow, what a massive overhaul of what rehab can be for them where they're not just doing something, even though it is a little bit rudimentary and boring, it's like, man, I'm putting in work and a lot of the guys I work with, that's all they want to feel like.They're just want to like, yeah, I'm, I'm in rehab with Q, but like, we're putting in work down here, man. Like, and I want guys like dripping, dripping sweat. I want them to feel it. feel like they are working hard, that they're getting something out of it. Even if we're totally working around an issue and not necessarily working through it, you know, I want them to feel like they're, they're, they're just savages and, and that's an easy way with a young athlete to do that.Awesome. If you saw them, like you gave me an example, you're seeing me in UNC, right? So you get them, they want to get them. They too, you see them every freaking day. And if you're seeing them in private practice, are you giving them any homework after you move them through that stuff? And what does that homework look like?And when? Do you actually start loading the tissue? Yeah. So, um, I, I actually made a hamstring protocol thing specifically for that, just like give athletes, um, and it to, to have on their own. And so basically like, let's say we got to, um, you know, a hundred yards worth of marching. We got to a hundred yards worth of vertical skipping and maybe we did a hundred yards of high knees.That's all we did. And that was on, you know, maybe a Monday of the training, right? First, first training session or rehab session of the week. And I'm not going to see this person for another week. I may say, Hey, I want you to repeat this at least X amount of times before I see you again, probably every other day at the minimum.Um, but you know, at least four or five times. I want you to repeat this same thing before I see you again. And obviously that process might go a little slower because I'm, I'm seeing them less frequently, but then when they come in, they're like, yeah, I've been doing this. And man, like it feels so much better than the first day we did it.Like I can do all this stuff easy. Awesome. Well, today. We'll go through less volume of that. Maybe we'll do half the volume of those things. Let's get into some like five yard accelerations or let's get into some 10 yard, easy rolling accelerations. I'm not looking for high speed. I'm just looking for great positions and just give me what you got today.Let's do that. And like, then it becomes again, same homework, right? When you go home, I want you to complete this at least four or five times, you know, in the next week of what we did today, you're doing half the volume here. I want you to just give me a good. You know, 10 by 10 or 100 yards, or maybe you go up to 150 yards worth of these easy roll in 10 yard accelerations.Here's kind of, you know, the parameters I want and boom, they'll do that on their own and they come back and you just slowly progress it, you know, from one phase to the next. I think what is your progression criteria is distance. So, um, with, with even training healthy athletes, we know that in about 10 yards of all out sprinting, you're only going to attain maybe about 70 percent of max velocity.So you can do an awful lot of volume there because you're only training within 70 percent of a, of a 1RM theoretically. So think about this, like in the weight room, you know, if I'm moving 70 percent of my 1RM, you can accumulate more volume there than I could at 80s, 90s and so on of a 1RM. So it's the same idea.Once you get out to about 15 yards, you're looking somewhere between 75 and 80%. Once you're getting to 20, you're looking between 80 and 85%. Once you get to 30 yards, now you're hitting into that 90 percent or higher of max V for most athletes that will fit about 95 percent of athletes. Now, younger, more untrained athletes, they may hit higher velocities of their max V relative earlier in that process because they don't have as high of a ceiling, you know, like.A, a kid that's not used to training very often or hasn't really run much, you know, sure by 15 yards he might be moving pretty close to, to what he's capable of putting down. So you may have to gauge that a little bit based on the experience of the athlete. But those are some general parameters that I look at, and I'm going to gauge the dose of what I give that person based on what percentage of velocity I feel like they're able to attain.And for the athletes, like the division one level, or people who are used to sprinting, usually at about 10 yards you're gonna see. a about a 70 percent effort. And typically I'll tell athletes, Hey, on these first couple, I'm not so concerned with you really projecting out and covering ground each step.You can be a lot more vertical and a lot more prancey, you know, kind of more bounty up and down. And then as it feels more comfortable and you feel more comfortable. Yeah. Then you just slowly increase that tilt. To whatever degree you feel and boom, pretty soon, you know, and you could take measures of time if you wanted to, if you wanted to break out a stopwatch or timing gates or even your phone and just show them what it looks like and how many steps it takes them to get to that 10 yards or things like that.You know, those could be really easy, low tech ways of showing progress. demonstrable progress from week to week or month to month of like, Hey, look, you know, you started, you're really upright. And, uh, you know, it took you about eight steps or dying 10 steps to get to 10 yards. Like, look at you now, like, look at this angle, look how much ground you're covering.Look at these slicing scissoring motions of the thighs. Like you're covering ground a lot more efficiently. How does it feel to you? You know, and subjective feedback, I think in these cases is very valuable. We made note at the very beginning of this talk that, um, subjective patient understanding or their feel.Of how ready they are to return to sport is just as predictive as MRI. So it's okay to just use subjective findings of like, Hey, what percentage do you feel like you need to be at to play? What percentage do you feel like you're at now? That's a fine that's a fine measure and you could even write that down that subjective feedback is is Valuable so I treat that as almost an objective measure if an athlete's telling me they feel like they're at 75 Sweet.What are you two weeks from now? Oh, man. I'm at 85 percent dude This is awesome. We're making progress, baby. So that's awesome. Yeah, my, my number one fear, because I, I kind of faced the same challenge when I, when I started my practice is if you go cash, you know, like if I'm, if I'm going to see Dr. Megan and I'm paying cash, how much does it cost to see you?Uh, it's one 60 per visit. If they're doing like multiple visits. Okay. So if I'm seeing you multiple times, I'm paying 160 bucks. I want to see Dr. Megan. I'm not seeing anyone else. And then my question is, or my question then was, How do I scale this thing? So what's your vision and horizon for how you scale a cash practice?Yeah. So, I mean, the reason that I was able to go off on my own initially this quickly was because I had that virtual, like I'm working virtually with people in more of the consultation, like strength conditioning setting. So as far as like in person at this point, I don't plan on Scaling it just because I don't need to.Um, and I like the freedom that I'm going to have to like raise my own kids and work from anywhere and like all that kind of stuff. Um, but I would say it's, it's really important to have a business coach. First of all, and I do have one, his name is Ray Gorman. You should also have him on if you have not heard of him.Um, you can talk about that. You can talk about that later. Yes. He. Was absolutely like pivotal in me being able to like feeling that I actually could do this and go off on my own. Like he gave me those skills. Cause let's be real in PC, it's going to learn anything about business whatsoever. Um, I mean, we learn a little bit.Yeah. Yeah. Right. Yeah. We don't really learn, um, how to, especially to be like an entrepreneur. Right. We learn, you know, other stuff for sure. Well, let me cut you off for a second, Dr. Megan, because. The business education that I got in graduate school, um, we had to submit a mock business plan. And my business plan was the practice that I work in now, 10 years later with 50 PTs and 14 locations.And I said, okay, this is where I kind of want to go with it. And I got a C on that paper. So they tried to teach me, um, but I shouldn't have gotten a C on that. But anyway, okay. So, so, okay. You didn't get much business lessons there in graduate school. And neither did I. So you found a business coach. What else was imperative to starting your own practice?Having relationships with people. Like feeling like, I mean, and again, like I said, Instagram, Expedited that for me on like a bigger scale, but like everywhere I go, every gym I join, I'm, I, I don't, I'm like that person that like doesn't like to talk to people in the gym because I'm usually pretty focused, but I always end up doing it anyway.Like I meet people, you know, and people will talk to you about their injuries or their daughter's injuries or their wife or like, Oh, I'm trying to get my wife into strength training, but she's scared and she always gets injured, blah, blah, blah. Um, so I think definitely having relationships within your community, especially if you want to have, um, like an in person cash practice is so important.And then also having, having either having a niche or having something about yourself that people are drawn to specifically to you, because you know, PTS are a dime a dozen. Um, and definitely not every PT could do. Their own practice, let alone a cash practice, just because they don't have, like, they don't do anything different than most PTs, you know?Um, so I think having, having a niche and having just a, I don't want to say a following, but just a, a group of people that recognize you for what you have to offer specifically. Yeah, yeah, it's so important to have a Rolodex and to have a network that you can come back to and tap into and it and it also lends some street cred to say like, Hey, Dr.Megan is different. I want to pay cash to see her where you come up with 160 bucks. Um, well, basically when I was working with my coach Ray, he told me to choose a number that made me borderline uncomfortable because I am the person that'd be like, Oh, let me do all these things for you, but Oh no, you don't have to pay me.It's okay. I'll just do it for free. Like that's me, which is terrible. I know. Um, I'm good at, I'm great at selling myself on accident, but when it comes to like asking people to pay me, I'm absolutely awful at it. So, um, that was the number that we came up with. So the actual evaluation, and again, this is like, if it's.You're just doing an evaluation, which is never what happens, right? You usually have a plan of care. Um, it's two 49 and then one 99. If you're just doing like per session for like follow up visit. And then the one 60 is just like a discounted rate. So usually what I tell people is one 60 because they're not usually just buying one visit.Um, so that's, and just looking at the like the area that you live in is really important. Like what people are willing to pay and then also what the cash rate at the clinic values to work at. So for 45 minutes, the cash rate was like one cause like one 40 or something like that, which. That's cash rate, but you're not getting cash care in a normal insurance based physical therapy clinic.But if you choose to pay cash, cause you don't want to even bother with your insurance. You're paying like one 40 for 45 minutes. Um, I just, I, and I feel like, you know, my visits are an hour, give or take, but if we need to take more than that, that's fine because I don't have like back to back clients and, you know, we can spend the time that we need to.And you can, we can communicate outside of work and, or, um, the clinic and all that stuff too. And then a lot of the time when I work with someone in person, I don't see them that often. I see them as often as we need to. And then I. Sometimes we'll, instead of like an HEP, we have what's called a prescriptive exercise program, which is essentially like an HEP, but you're like, I take over like all of their training and incorporate their rehab into it.So I'm their strength coach. In addition to working with them one on one if necessary. And again, like I said, not everyone needs that, like hands on hands on care or that, like, Live in person, queuing and programming. Exactly. And a lot of time upfront they do, but sometimes I have a lot of repeat customers because people, you know, they just, you know, athletes in the area.They wanted to work with me on one specific thing and then they, you know, that got better, but then something else starts bothering them. Like I just saw a girl on Sunday and we fixed her in like five minutes. And then we just ended up like tinkering around the rest of the time. It was kind of cool actually, but that's awesome.Okay. So how did you overcome that? How did you overcome? Your fear for asking for payment or remuneration. Like, um, I think that's a huge obstacle for a lot of PTs. And by the way, Cairo's are awesome at that. PTs suck at that. So how do you overcome it? Yeah. Well, to be totally honest, I'd still struggle. Um, but it helps, it helps to get burned.Cause it makes you like, More frustrated with like wasting your time. Right. Um, but I will say like when it comes to my like programming, like virtually when I'm working with people, I have a lot easier time charging when I charged for that because I've been doing it for a really long time and I've gotten repeated results.Like it is really hard as a new grad who also just started her own cash practice. To decide arbitrarily that she wants to charge a certain amount of money, even though I recognize like, I'm, I'm good at what I do, but I'm still like a new grad PT. Like that's just the reality of it. Right. Um, so I think that for just advice for people that are listening, if you're worried about charging something, charge borderline, what you're uncomfortable with.Obviously be realistic with where you live and like who your clientele are because also it's like at the end of the day, do we want to help people or do we want to just like have like as high of rates as possible? You have to decide like, do you want to see more volume? Do you want to see less volume?Because that's going to determine what you charge. Um, but that way, you know, your, you have the flexibility to like offer discounts for things if you want to, or You don't feel like you're going to start to feel resentful if you feel like your time is being wasted. Right. And also like when I, when I go seek a provider out, like I am fine paying like a premium fee because I know what I'm, the care I'm going to get is going to be premium, you know?Um, so you have to think about it that way. You don't want to be affordable for everyone because then everyone can come in and, and see you. Um, I think, I think it's also, well, I, I'm sorry, I was going to say, I think it's also so imperative that you have this. Thought through prior. So, you know, you're at two 49, one 99 or one 60.So when that patient says to you, how much is this going to cost, you're not running through calculations in your head, you have practice your pitch, like, and, and you can remove yourself emotionally to just spit out the line to say it's two 49. It's 249. It's not, uh, well, what can you afford? Or how do you feel about it?Here's the Megan script. It's 249 for your evaluation. I think there, I think there is a lot of, a lot of wisdom there. Yeah. Thank you. Um, what was I going to say? Oh, the other thing I was going to say, I think one of the biggest things that we need to overcome. Just in the PT world, I think we have a lot more PTs that could just go out and start their own practices as if the population at large, like our client understood what good PT looks like and what bad PT looks like.And also just like, if they realize like, Oh, how much do I spend on Starbucks every month? Or like, Oh, what do I spend on my eyelashes or my hair or my nails? Like. Literally, there's so many things that we just throw money at that, you know, are worth it to us. And it's self care. Like I'm all about self care, but like, you have to think about PT as that being that as well.And like, You might as well, in my opinion, you might as well not go to PT at all. If you're going to see a PT, that's like in a mill, like it's probably a waste of everyone's time. Yeah. I'll say that it's a bold statement, but I think that's totally true. And I think, you know, I, I just had a patient come to me with his kid and I said, okay, here's how much it costs to come to true sports.And he said, well, you know, they didn't charge me that at the hospital setting I was at. I said, they, they don't rehab the athletes. So, so it is what it is. Like you could go to the standard mill setting or hospital setting or whatever, but you're not going to be surrounded by med balls. You're not going to be surrounded by other athletes.You're not going to be in an environment where you can run junk throw. And maybe, maybe that's okay. And I think as the clinician, we have to be okay saying. It might not be for everyone, but it will be for the people that see the value and take it seriously. And, and a postscript to that is that patient went back to their hospital setting and then came back to me two weeks later and said.Dude, this is worth it. Like that was a mess over there. So you have to be, you have to be comfortable. What is it that gave you the gumption to start taking risks? Sets and wraps and everything in life is sets and wraps. So the more risk you take, the more you're more comfortable, you're going to be at taking risks.It's kind of like cold exposure. You know, we all know that cold exposure is uncomfortable in the moment, but the more I've done it, the less I fear doing it. You know, I know how I'm going to feel. I know I'm not going to die. And I know I'm going to feel better afterwards and, you know, taking risks in business is, is the same, you know, it sucks to lose money.You're going to lose money here and there. Um, but ultimately to succeed, I mean, you have to practice taking risk often. And, you know, I've also learned through time that you can't. You can get to a point where you can start to attract opportunities when you really understand your lane. And like, I know what my lane is.I know what I enjoy doing. I know what I'm good at. I know what I'm not good at. And I know how to partner with people that are much better at, you know, some of the things that are necessary to build a successful business. Um, but again, like those things all came from just putting myself out there and taking those risks.And the first few things were super scary. And now it's a hell of a lot easier for me to. You know, put money into a company or, you know, but I had my barometers too of, okay, I failed doing this, you know, this, these types of people didn't work for me. These types of opportunities didn't work for me, but it was really just from, you know, doing it and being really hands on, uh, mentors certainly help.You know, I always tell people that if you want to get somewhere faster, find someone who's already gotten there and, you know, Befriend them, develop a relationship with them, obviously add some kind of value to them. So they'll, you know, add value back to you. But, um, you know, I've always been, I've always surrounded myself with mentors and, you know, I keep a list of a hundred people that I want to interact with on a regular basis.That, um, I feel like I have flow state conversations with, and they provide me with value and I can provide them with value. So your network is so important. Your environment is so important. If you want to be a tech entrepreneur, you know, go to New York city, go to Austin, go to San Francisco, like you're going to be so much further ahead than being in, you know, the country where there aren't other tech entrepreneurs.So environment is crucial too. Now, you, you mentioned your network. How do I get a guy like Eric Hinman, if I want Eric Hinman to be my mentor, to respond to an email or a phone call? To become my mentor. Yeah, really good question. So I like giving really detailed examples with this. I had a gentleman recently reach out to me, um, who has started a ski company.Um, he's managing a brewery right now and just had an interesting life. And he messaged me and kind of told me his story. And he said that he had recently seen a podcast I was on where I talked about delegation, automation, and elimination in order to do what you can do and you can do best. And, uh, he referenced that and said, I want to be delegated to, I'm looking for, you know, that next chapter in life that brings me satisfaction.And. We'd love to just jump on a 15 minute call with you and, you know, know that any help that you need right now, I am open to be delegated to, I just want 15 minutes of your time. So add some kind of value when you reach out, share a personal story, you know, give some background on, you know, don't just say, Hey, can I steal 15 minutes of your time?Like there's no context behind that. Um, so give some context. I think that's super important. And if there's some kind of value you think that you can add, that's great. And then share your personal story. So I get a little understanding of. You know who you are. Yeah. I love that. I also like that. He mentioned a little bit about you, just that he showed that he did some research, right?Um, if I had a nickel for every time I got an email saying, Hey, I want to get into sports PT. Um, can I have a job? Like, tell me that you know who you're emailing, not for my own ego purposes, but because it shows that you give a damn and that you chose to reach out to true sports, let's say, because you value X and I know you stand for Y.Right? So, um, that's, that's just like a, another tidbit. Now you mentioned, um, knowing what you're not good at. What's the best advice to learning that? Um, so over time I would make lists of times when I was completely present and in the moment and just felt like I was either adding a ton of value or getting a ton of value.And then I did the same for when my mind was wandering. I was Doodling. I wished I was somewhere else doing something else with someone else. And, you know, you start to be come mindful of, you know, when you feel like you are really serving and when you don't feel like you're serving. So that helped a ton for me.Um, and you know, also like the things that I'm not good at, I don't like managing people. Um, I don't like customer service per se. Um, I like community events. I like early stage in companies. Um, and I had to like do a lot of these other things to realize they weren't for me and, you know, could I develop some skill around it?Probably, but it would be a lot harder than developing the skill of connecting people, which I'm already just, you know, I enjoy and I'm really good at, um, you know, I love being around people. I'm a type a personality. I'm not the person who wants to sit at the computer isolated and, you know, work on spreadsheets and some love that.And, you know, for me, I did it and I realized like, damn, I'm just, I wish I was somewhere else doing something else. So that was my barometer. Am I completely present in this where I feel like I'm adding a lot of value or getting a lot of value or is my mind wandering? Yeah. Um, Well, I just heard you say you just took time to evaluate how you felt.It's almost like you were cognizant to take a step out of that rat race and say, how do I feel? Where do I want to go? And to evaluate which direction you wanted to go in. Does that sound right? A hundred percent. Um, how'd you learn how to take a step out of that rat race? That's something very honestly is difficult for me.Um, I think it requires solitude and it requires stillness in your mind. And through my iron years, I practiced a lot of that. Um, you know, I was training 25 hours a week, running, biking, swimming, all, almost all of that alone. You know, I had my own training plans, so, um, I wasn't with others and. You know, just being outside with my heart rate elevated with complete solitude, no distractions.I was really able to almost unlock this psychedelic experience of, you know, how I wanted my life to look and what I wanted my days to be like. So I think that is important to create that solitude for yourself, whether it's going for a walk in nature or. Traditional meditation. Um, I, I think that's how you get there.And again, you know, going back to the sets and reps, like you need to practice it in order to get good at it. And, you know, I never practiced traditional meditation, but I did practice a lot of solitude and a lot of exercising with no one around me. And, um, you know, that allowed for me to just develop this mindset where I'm not constantly distracted.I can focus on one thing at a time. Okay, so, now, are you, when you do your joint manipulation, when you do your manual therapy intervention, is it based on, uh, physical assessment? Is it based on radiographs? How are you assessing? Alignment. Yeah. The word alignment. So, um, I, the whole, the whole obsession with alignment is, it's insane to me.I, at the end of the day, you look at a human body, you're going to see so much asymmetry. It's insane. You know, I mean, if you, you can take it a step further, look at your kidneys, one's higher than the other. You have a liver on one side. Right. So like you're going to eventually see, uh, you know, our, another thing is sports related adaptations.Do you see a picture? Oh my God. Their internal rotation is God awful, but that is a sports related adaptation. If I was obsessed with symmetry as a goal, we got to fix that. You were undoing what the body just specifically adapted to. So therefore you're actually ruining their performance, right? So I'm not too gun ho on symmetry.I am. If we take it a step further and talk about like motor control and strength, I am a little bit more cognizant when it comes to that, because, you know, we strength is what the number one thing we could do to protect ourselves from injury. And of course, motor control helps with strength, depending on what range of motions you're doing.Um, but When it comes to me adjusting somebody, it's just hands on it's fine. The restriction by restriction, I just mean like, they can't really move that well right here and quick adjustment, and then they send them on their way. I tried to downplay the adjustment so much so that it's kind of like an afterthought intentionally, because.If you want to temporarily decrease your pain, you can do a small warm up set, right, of whatever movement that you're preparing for, or if you want to temporarily increase your range of motion, once again, small warm up set, or you can also roll on a foam roller, which, you know, that has a whole host of myths attached to that, but I still think it's a tool that we shouldn't throw out the window, you know?And you would say also you could manipulate a joint, a passive manipulation. Is that where you're going with that? Like how you can, an athlete can use that as well. Hey, I can manipulate that neck, give you a little bit more range of motion. There are a host of other ways you could do it, but it's just a piece of the puzzle.Right, right. And you know, my preference is I try to, I don't, I don't like, I'm not a quote unquote afraid, but I do try to stay away from adjusting the neck. I just really don't think it's worth it or necessary per se. Um, Uh, there's plenty of other modalities that can get the same job done. And you're not risking that one in a million chance of the vertebral dissection.Right. So, um, once again, it's all about like risk reward and why risk anything if it's going to, you can get the same job done. Right. Yeah. I love that. Now, uh, walk me through the way you're structured your in person practice walks in. Uh, for an evaluation. How long are they with you? What? What does that evaluation consist of?And then what does the treatment look like? Yeah, right on. So, I mean, it's very similar to my origin story, right? So, uh, hour for the first visit. I used to do hours across the board, but I felt like it was almost cumbersome. You know, it's just like we already got everything we got to get done. Um, so they see me for the first visit.We unpack everything we can, and I'm probably speaking maybe five minutes, that whole 60 minutes, right? I am listening to everything that they have to tell me. And then from that circumstance, that's going to give me the runway that I need, or at least the direction I need to take to see what's truly going on.I mean, I'm sure you're, Your schooling has also told you that 80 to 90 percent of the diagnosis is in the history, right? So, I mean, at the end of the day, if you listen to them, you only need to like perform maybe one to two tests, you know, so after, after getting the conversation done and validating the pain experience, then I'll do the one to two orthopedic tests, which we know the spin and the, you know, it's not that great, you know, so we're just doing it to confirm our thought process.And then from there, it's just, we talk about potential. Treatments, right? So my treatment would be, Hey, look, I think that you can benefit from these particular movements. Um, and in during the time of movements, you have the option of doing these things for pain management. You know, I'm well aware that, you know, myofascial release can reduce pain temporarily.And if you feel like that's worth it to you, we do offer that service here. You know, we do have all these other things that you can do once again, symptom modification. Um, but if you are just that type of person that would prefer just to do these exercises, And then maybe ice or heat the knee at home and then come back to me once you master those exercises, then that's perfect.Then they'll come back to see me for a half an hour, which will probably be in a couple of weeks. And then from there, I'll just make sure that they displayed mastery of those exercises. They're well informed about what's going on, and then we'll progress them. Now, let's say they didn't, they're not doing good, right?I give my patients full reign to message me on Instagram. Once again, not the best business model because I am busy, but they're like, Hey, look, the, my, my, when I'm squatting, my knees hurting. Okay. Let's make this knee dominant movement, more of a hip dominant movement. Spread those legs out, point those toes out.Now the shin angles more neutral, and now you don't have to worry about that niche year as much. Right. So it's those, I think that play by play, making sure that they can get to me when they can gives a invaluable. service for people because they're not alone when trekking through their pain journey, you know?
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