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E40 | Bill Hartman

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Bill Hartman, PT is the go-to guy in the fitness and rehabilitation industries when all other methods have failed. Clients from all over the United States and from countries such as Japan, Australia, Bulgaria, Canada, and the United Kingdom have traveled to Indianapolis, Indiana to seek his talents. Bill has degrees in Movement and Sports Science from Purdue University and Physical Therapy from Indiana University.

Bill is the co-owner of the Men’s Health Magazine Top 10 rated and Women’s Health Magazine recommended Indianapolis Fitness and Sports Training (IFAST) and IFAST Physical Therapy where he works with a variety of clients from high profile professionals to weekend warriors. He is a former columnist for Men’s Fitness Magazine, and he has also done a stint as the Men’s Health Muscle Guy while being a popular contributor to MensHealth.com.

Bill has been a featured speaker all over the United States and internationally including the Perform Better Functional Training Summit and the Boston Sports Medicine and Performance Group. Bill has contributed to some of the top selling sports training products over the last 10 years and is the co-creator of the industry topping Assess and Correct: Breaking Barriers that Limit Performance DVD.

Bill is currently a member of the Men’s Health Advisory Board and is a frequent contributor to Men’s Health Magazine. He is also a former member of the International Youth Conditioning Association Advisory Board and contributed a chapter to the Developmental Essentials: Foundations of Youth, the official textbook of the International Youth Conditioning Association regarding strength and power training for young athletes.

Topics Covered:

  1. Parallels between Bruce Lee’s martial arts philosophy and critical thinking
  2. Is the compartmentalization of learning necessary for “flow”
  3. How are models of thinking useful? How are they limited? 
  4. Does the current diagnostic framework in rehabilitation make sense?
  5. The influence of pathology on clinical reasoning in rehabilitation
  6. “Return To Play”
  7. Protocols vs. constraints-driven programming
  8. Can “clinical reasoning” be learned without experience/context?
  9. What should rehabilitation providers absorb/disregard from constructs like anatomy, biomechanics, pain science, #justloadit, manual therapy
  10. When to zoom in vs. zoom out in education

Links of Interest:

Submit Questions & Topics for the Podcast – https://resilientperformance.com/question-topic-submit/

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Episode Transcription:

Doug: [00:00:00] Alright, Bill. Thanks for coming on. So you’ve been out here before and we’ve had a lot of private discussions about, you know, models and clinical reasoning, and these are things that maybe can’t be captured or obviously answered in any kind of format, let alone an hour podcasts. But I also know that you’re also, a big fan of, you know, mixed martial arts and Bruce Lee.

So I think a good analogy to get this going is the idea that, you know, Bruce Lee created this system of systems that he called Jeet Kune Do he’s famous for saying, you know, take what’s useful disregard what’s useless. So when it comes to, you know, if we kind of like an, whether it’s like treatment and a clinical scenario, or, coaching and a performance scenario, we have this complex, chaotic environment.

The ideal is this flow state where you’re just kind of going, and then Bruce Lee’s case, you’re just fighting and you’re not thinking about, okay, I’m doing Western boxing now and now I’m switching to jujitsu. It’s very seamless, but do you think that even in the clinical setting, that that flow state being the ideal, where you kind of come to transcend these, these models and these different constructs, do you think it’s possible to achieve a flow state without compartmentalizing information and breaking them down into these very constrained boxes. So other words, I guess I’m asking, can we, is it possible to learn without doing that, in your opinion?

Bill: [00:01:26] That’s a really good question. You know, the way that we build our understanding, I think has a lot to do with why we, we compartmentalize in the first place.
So, so it is a defense. That’s the one thing that we want to recognize about compartmentalization is that it is, it is uncomfortable to try to hold multiple ideas in your head at one time. And so compartmentalization makes that easier for us. So it is, it is a reliever of stress. It is, it is a protection against trying to, rationalize to potentially useful, potentially equal elements and put them to use.

And so again, I think that’s what we have to recognize first and foremost, is that, is that, if we do recognize things as being so different, then the first strategy would be to compartmentalize. If we can start to look at things as one big entity you know, we’re where people would say that it would be more integrative, right?
So, an integrative fighting system of, of many systems that were brought together and, and instead of seeing them as, as separate things, if we can start to see things as being more unified than I, I think that that we don’t have to do that. But I think it’s also very, very difficult to, to build such a model from the ground up that it does take a great deal of time and it is still uncomfortable.

All you have to do is, you know, be a clinical instructor on the, on the first go round, and you will recognize the, the difficulty that, that students will have of grasping things in, in the reality of the clinic because as we as practitioners went through that ourselves, we become more comfortable because what we see is many things, having done things through repetition and, and an orderly fashion that allows us to, at a glance, we see something that, that it would take the student seven or eight different looks or different perspectives. We see that as one. But that was done through, a great deal of investment of time and effort, which was, again, it’s uncomfortable.

And so I don’t think we have to compartmentalize. I just think it might be one of those things that we do to try to make life just a little bit easier.

Doug: [00:04:01] Yeah. Because it’s very easy to look back retroactively at something like even traditional martial arts. I remember, and I’m sure you remember like the original UFC where like every guy had a style and it was like the TaeKwonDo guy versus the jujitsu guy versus the barroom brawler. But I don’t get the sense, and even going back to like Bruce Lee and that he never bad mouth. He doesn’t say like, Hey, judo is no good to jujitsu is no good. Kickboxing’s no good. Western boxing is no good. Like I don’t know if Jeet Kune Do would have been possible without those things and I’m sure that there’s going to be a point where somebody, you know, the next Bruce Lee is going to look at Jeet Kune Do as being overly robotic and constrained. So I guess, you know, there’s always like this idea of progress with models, but I think you’ve talked about this, like, I guess, how can we be like agnostic about models because, and you and I have had private conversations where we’ve talked about, okay, like we can, we can bash on certain things.

But even going fundamentally back to the concept of models, like, and you touched on it, but what’s, what’s good about them? Cause it’s really easy to say, okay, like the model doesn’t account for all of these contextual things, but fundamentally even using them in the first place. You mentioned kind of safety.
Can you elaborate on that a little bit?

Bill: [00:05:18] Well, again, it just becomes comfort. It’s like trying to hold multiple ideas. So if we, if we associate everything that we learn with what we have previously understood or what we think we understand, then then to add on to that. It’s always the comparison. And so again, so there’s an element of compartmentalization in that.

It’s like, I know this, I understand this. I am comfortable with this. For me to super impose something on top of that, I have to see the relationship to make it comfortable for me to take that bit of information in and then eventually to utilize it if I see it as too extreme. So if I see, you know, the, the, the, the battle between systems, then that’s where the discomfort.

It really starts to arise and then I become defensive and I push that information away even though something about that may have been useful. So what we want to do is we want to see these things like where the commonality lies. So if we’re talking about clinical reasoning or we’re talking about moving or we’re talking about working with humans, what we want to say is like, okay.

So if I have these two competing systems, but they’re both working with the same system, how do I draw these things together? And so then that becomes this, this commonality. So again, if we’re, if we’re in the clinic, we’re working with the human and movement, it’s like, okay, how does this system see this representation of movement.

How does this other system see this? And then can I draw some commonalities? The thing that you gotta be careful of this is just because someone has a system doesn’t mean that it, that it is valuable. And so we have to be very, very careful of that. And that’s something that you learn how to filter out. I think over time, this is where I build this, this bigger and bigger and bigger base of analogy.

And I can, I can identify things that were being extreme conflict with that. Where, I’ve, and you’ve heard me say this before, it’s like, you know, if you go to, to a course or something, and if they provide you some, some piece of information, if you don’t have a defense against that, you will absorb that as a fact.

Like you will take it in and, and so that’s a big part of this is constantly building your base of analogy. And I think that that probably what we’re talking about more than anything else is an evolution of, of learning really. It’s like I have to learn something to compare to and, and so maybe initially we’re looking at these things from a, from a compartmentalized structure.

And then as I start this, recognize commonalities and my base of analogy does grow now so does my filtering system now, like my BS detector, you know, is, is much more, accurate, if you will. And you know, if we want to use Bruce Lee as the example, he started with a martial art, he, I mean, it was a very, very specific, rigid martial art and it was his recognition of that rigidity, even though he may have been superiorly prepared within that, that art to defend against any number of things. He recognized that, that his restriction and depth of understanding of that one art allowed him to recognize the fact that there are weaknesses in, in restricting that, that perspective and saying that this is it.

We can never say that there is always, always a better model available to us. We just either haven’t been introduced to it or we didn’t recognize it ourselves yet.

Doug: [00:08:49] Yeah. And there’s a lot there to digest. So the first thing you’re kind of alluding to as all these models are kind of like dots on the map. And when you’re talking about as an overall framework that allows you to connect those dots. That’s essentially the BS filter that you’re talking about, right? Going back to like the Bruce Lee analogy, you know, he started out in wing Chun Kung Fu, and I think that what made him evolve was that he got in a lot of fights and he realized the limitations of that one model because he didn’t start out planning.

He started out learning a traditional martial arts. Then he got into fights where you realized like, wow, like there’s other things I have to be prepared for. And when we’re talking about like the clinic, I know people always talk about clinical reasoning. I don’t know how much it can actually be taught in an academic setting because you don’t have the context.

You haven’t gotten in enough fights. But you’re, you’re talking about like you’re seeing similarities, right? Because it can be very hard initially. Remember how overwhelming it was. You know, you’ve learned about the 10 different kinds of knee patients you’re working with. So it’s like the knee replacement person, the ACL person, the meniscus person, the instant, the patellofemoral tracking person.

After a while, you kind of realize that they’re fundamentally all really the same. They just have different constraints, right? So. And I think people get frustrated, myself included, because there was a point where like, you know, I’m going to all these courses, I just want it to expedite the process. But what really did it was I think just treating people kind of being in the arena, so to speak, and then just making sure that I wasn’t so dangerous that I was hurting people.

But you kind of have to make, make those mistakes. So, I mean, we started, we’re having kind of like an ideal, you know, conversation here. We’re not worried about like, regulatory constraints and legalities. Just for starting out utopian right. But in this utopian environment, I mean, if you want it to, to clone a, a PT that could work for you, that you could sell your practice to, would you start out having them take classes at an academic setting where they just watch you treat for six months or a year to get that context. And then so do you think we should start, we starting with the theory first and then the practice, the practice and then the theory to get context or is there a kind of a, a hybrid that we should be doing? Cause I think that the traditional programs are very heavy on theory initially, no context. And then you have to almost relearn that language in a contextual environment.

Bill: [00:11:09] So, so here’s, here’s the dilemma that you run into.  And again, I had my 25th student in the last eight years that just wrap things up not too long ago. And in the simplest of things that, that you would expect somebody to know and understand have been forgotten.

It’s not their fault, it’s just the way that the programs are structured where they, they throw you know, heavy duty doses of physiology and gross anatomy at you, and then it’s like, okay, here’s where stuff is. Here’s how this stuff works as a separate system. And then when it comes time to integrate all that stuff they have, they have, unfortunately, because of the way that they learned that out of context, it’s very difficult for them to remember or, or, apply it. And, and so, so what we’re talking about here is the difference between the stuff that you can write down, which is explicit information. And then the tacit, which is very very difficult to explain to anyone, because it is experiential, in its foundation. And so without that, without the tacit, then you’re just regurgitating stuff that, that will seem meaningless to you. Now you can get the answers right on the test per se, but, but when it comes time, so the real test where you’re working with the individual and you’re dealing in a complex atmosphere where there’s tremendous number of influences and a tremendous number of unknowns, then, the, the book learning, if you will, has a limited value.

It doesn’t mean that it has no value, just means it has a limited value. And so I think that that your, your mention of, of this hybrid approach of, of sort of, it’s, it’s kind of OTJ when you think about, it’s like, you know, it’s like, and you’ve heard me talk about the plumber thing before too, where were they learn primarily through an apprenticeship model where they are literally on the job from, from the get go. And, and I think that if, if we were ever going to evolve the profession that, that, that we are involved in be with the scope that we have, it would be so much more ideal to be in the clinic from day one, and to see these things in representation. Now when you do learn anatomy, you’re learning it within a context and then it becomes more meaningful.
And so that information is then retained. Yeah. Because again, we’re attaching something that’s very, very powerful, which is this experience. So there’s emotions involved which again ties a lot of things together, which you know, when, when it’s almost like a, like a forced upon you scenario of regurgitation where it’s like, okay, here’s a piece of information.

I want you to memorize this piece of information and then spit it out on the test. And if you spit it out the right way the way we want it to, you’ll get a really, really good grade. When the reality is, it’s like the good grades are, are basically, you, understanding how to manage outcomes in a clinic, and I won’t say to be successful because you just don’t know whether you’re going to be successful or not.

The goal is to take new information and be able to integrate that into the situation and then take the next step forward as successfully as you can and if you can’t, then obviously to determine, well, is there a reason that I cannot move forward? And then that’s when we start to send people to other people, right?

So I have to send you to the doctor, or I have to send you to some other form of profession that may have an influence in this situation. And now you become, the, the true manager of the situation.

Doug: [00:14:45] So that’s, that’s a great segue to the next thing that I wanted to talk about within the confines of like physical therapy and rehabilitation, where we’re learned a certain way of diagnosing.
And it’s typically the medical model because there’s like, for a variety of reasons, you know, many of them political. Physical therapists want to identify as medical providers. So they diagnose like medical providers when in reality, the scope of practice of a, you know, at least the non MD is that they can’t directly treat or address pathology.

All they can do is, you know, try to maximize function within the context of that patient’s goals and values. Right. And then, you know, things like the pathology might be a constraint, but you’re not addressing it directly. So to me, this is kind of where we start from, because if you’re not, if you’re a diagnostic framework or you know, our constructs are, I guess not conducive to the thinking that’s going to drive the right interventions, then you’re, if you’re starting from the wrong place, they’re going to finish in the wrong place.

So to what degree do you think physical therapy and rehabilitation needs to totally change the manner in which they diagnose? Because the reality as you know, I’ve seen tweets where it’s like. You know, if you’re a physical therapist, you need to know the difference between a type one and a type two impingement.
And I’m kind of like, I don’t actually think that I do at all. I just think that like as long as you have some kind of an idea of how to assess a joint and know what’s what’s possible, and you can feel like this is a, a pathological joint or not, and then you just work around those constraints. So to me it’s like, okay, how do we, how do we figure out if this person belongs in, in my office?

And just being able to identify pathology, it doesn’t even matter what it is. I don’t need to know what the exact pathology is. I think it’s more important to be able to identify it because if you think that’s the driver of the symptoms or the lack of function, then you refer out. Now, obviously it’s much less sophisticated to do it that way.

I don’t know if it warrants as many classes, but I mean, you know, in your ideal world, like how do we go about even what would be your diagnostic, systems, so to speak, in, in, in the context of rehabilitation, physical therapy, that kind of thing?

Bill: [00:16:55] Well, I think you actually hit on it in your statement that you said, we have to consider what’s possible.  And I don’t think that that, that representation has existed, at least not, not as well defined in the current system of education that’s being provided people in, in our aspect of care. So when you think about a, like a, a model that considers things separate, right? So if I, if I look at a muscle and fascia and bone and ligament and tendon and water and fluids and air and all of those things as separate entities that are not, again, like I said before, not as this integrated whole. If we don’t consider all those things, then, I will lack something in my model that may actually be, a source or an influence that is a benefit for me to consider. Right? If, if I look at an isolated structure like so I get a diagnosis from say a doc and it comes back and it’s like, okay, I have such and such a tissue change or whatever.

Okay. If that is truly the diagnosis, I mean, this truly the limiting factor I can do absolutely nothing.
It’s like so and so this is, and this is the battle that we fight when we do get those patients that do come from a physician with all good intentions, but they give them a label and they say, you have a, and then whatever that a is that that follows.

Then this person comes in and says, I have a herniated disc for an example. It’s like, okay, great. You want to see the MRI? No, not really. Cause it doesn’t really change anything from my perspective. It’s not that I don’t take it into consideration. It’s not that it’s not in an, you know, an, an element, in, in the back of my head as I’m moving forward.

But. That’s just a constraint. And then the question mark is, is it significant enough of an influence that it’s going to interfere with our ability to recapture what ever it is we’re trying to recapture? Whether that is comfortable movement or whatever, which is typical in our situation, why people would come to us.
And, and so, again, looking at what is possible, it’s like, okay, does this interfere? If it interferes. And, and we can eventually figure that out, I think to some degree. Then we, we have to also recognize like, okay, this is beyond my scope. I can’t do this. Right? And so again, I think that expanding the model, putting things into a much larger context where everything is working together, provides us an element of, of that understanding and allows us to look for, and I think you mentioned pattern recognition as, as being one of the primary elements.

That’s what we do. That’s what, you know, you go to a physician and you have like a sore throat or you know. Whenever they’re looking for signs and symptoms, they’re combining those into a situation. They don’t know why you have that. They just know that these symptoms kind of go together. This medication goes with the, with those kinds of symptoms.

And so what we want to do is we want to have a model associated with movement that is, that is similar and respect is like, okay, if I see these limitations, then I understand that I have these influences that are potentially, creating this, this presentation that I’m working with, and then how do I alleviate those?

Or how do I make the, the, the influential change to restore what I perceive as what’s possible? So, so I, I think that the, again, the restriction comes in and the model in and of itself, which is, I mean, 30 years into this is totally different from where, where, where I started, thankfully, thankfully. And, and I, but I think I could have gotten here sooner, with a, with a different structure as to how, how we, you and I learn.

We got an element of it near the end of our educations in the clinic where you were finally placed into this context and a mentorship sort of apprenticeship type of model. But imagine how good you could have been had you started there day one. And superimposed all of the explicit information and, and see it demonstrated in real time, in real life from the get go.  I, I can only imagine how much better you would be coming out as a clinician.

Doug: [00:21:24] Yeah, and I’m not saying this to be critical of the way that like medical doctors diagnosed because it actually, it works for them because they’re supposed to be treating pathology. Right? I’m talking about the direct access.

You know, you’re the first person to see this patient with hip pain, and it’s like, okay, what’s the diagnosis? Well, you get pinching in your hip when you squat, like, you know, and even with these diagnoses, like how do we define them? Right? Because you can define something like FAI based on an xray criteria.

But functionally to me, FAI is, can my interventions get this person to squat without pain? If the answer is no, and I and I assess the joint and it feels pathological, which is totally subjective, and something that I wasn’t able to, to detect until I assessed a lot of hip joints, no matter how much I could regurgitate the criteria on a multiple choice test.

So to me it comes down to is it pathological or not? And this is where the trial and error thing, and you talk about this, where you don’t know what the diagnosis is until you try something, because based on having treated however many hip patients, if the things that you do that normally work, that get that person to go into deep hip flexion without pain don’t work, and you still feel that same bony end-feel when you assess the joint, which is again subjective now, you know, okay, there’s probably a good chance that this is a pathological condition that I can’t influence with my toolbox, and then it goes from a functional construct to a pathological. I just don’t know how we rushed that. I mean, but I think the point of this conversation is that people need to be encouraged that like it actually is a lot simpler than it’s made out to be, but it’s also, it doesn’t make it easy.

Bill: [00:23:02] No. No, because we’re so, we’re, so what we do, so what we do is we actually just, we have to, we have to understand the probabilities, right? So somebody comes in with this subjective complaint of pain in the front of their hip crease, and it was like, okay, well what are all the possibilities? Okay. So if it, if it’s pathological, I’m of no use.

Right? So I can set that one aside. Initially. Right. And so now I’m just looking at, okay, what influences these possibilities. So based on my, my acquisition of information from the patient, from some, whatever evaluation you use, I determine what may be the limiting factors. I try to alleviate those limiting factors and again, based on probability.

So I have done a number of interventions over the last 30 years, and so I have built up some, some, currency, if you will, in regards to what I think will work under these circumstances. Right? And so there’s the three in the first year and 30 years it’s like, I’m just have more stuff. I’ve failed more times than everybody else, and therefore I am able to narrow probabilities a little bit more effectively than somebody that does not have the, the, the task experience that I do.

And that’s literally what we do because we have too many unknowns. We can’t identify things from the simplest of tasks, we can’t identify structures in and of our, on our own. I don’t have x-ray vision, right? There are certain things that will be a little bit more obvious than others, certainly. But again, even that’s acquired through through experience to identify, okay, what is more likely under these circumstances?

And so we’re always just playing with probabilities. And it sounds like it’s a, it’s a crap shoot, but it’s really not. Well, you know, I was talking to our, our buddy Brian Shawn about this, and he goes, he goes, but you kind of know when you do something because the rate of is is, is so much better. It’s like, well, I’m just better at narrowing the probabilities because I still don’t know what the ultimate answer is going to be.

But you know, if I would say that, you know, 76% of the time when I do something under these circumstances, I’m successful. I kind of know what I’m going to do. And when that doesn’t work, there’s a 24% chance that it’s going to be something else that I can’t do anything about. And that’s kind of how we work and we have to respect that.

It doesn’t mean that it’s, like I said, it’s not a total crap shoot and it’s not trial and error. It’s just, that’s how you manage complex situations is you have to understand how to take a piece of information. I intervene and I take that response as the next piece of information as to how I step forward.

And now I can further narrow those probabilities. And then we just go as far as we possibly can under those circumstances. And that’s, you know, and I, you know, some people would say that, well, that’s not black and white enough for me. I’m sorry. But that’s just the reality. We live in the gray, we live in unknowns, and we don’t even know what all the unknowns are under most circumstances.

Doug: [00:25:56] So that’s. That’s a great point where we don’t really know and there’s some humility involved. But at the same time, patients come to a medical provider because they want an answer. So you know, when somebody says, and I’m not talking about like the obvious case where you break your leg in a car accident and that’s why your leg hurts, you know, where it’s like obvious cause and effect.

So in these cases where it’s not obvious cause and effect, and it’s not like a clear pathological driver. How do you ethically navigate that when a patient asks you, why does my back hurt? Or why does my hip hurt? Like do you, do you say, I don’t know. Do you say, I don’t even know if that’s the right question because it doesn’t matter.

Cause I think fundamentally it actually. It doesn’t matter. That’s not in my head. Does it hurt?

Bill: [00:26:39] Yeah. It doesn’t matter so much. Right. But, but for them, they, they, one of the, if you look at the hierarchy of needs of the patient, one of the reasons that they come to see you is they want to know why. Right.
And I think it’s fair for us to say, it’s like we can narrow the possibilities and then we, and then we have to be incredibly truthful. It’s like it could be this, it could be this, it could be this. And if it’s this, then I can’t help you with that. Right? And again, that’s why, that’s why the experiential element of what we do becomes so important and so powerful.

And probably why it should start from, from the get go is so that people do get comfortable with that. Because as new students come out, they are afraid to admit that they are, they are unsure. Right? Because they think that that negatively influences the, the perspective of the, of the patient. You can be unsure, but you can offer up potential solutions that will be satisfying for that individual, right? If I can narrow it down, it’s like I can’t be certain of this, but here’s what happens under these circumstances. So as I move your hip into this position and you feel that discomfort, here’s what we know. We know that we’re closing that space, and so if that space closes too soon.

For this reason or that reason, then this is something that we’re going to be very, very successful with because in most circumstances, in most circumstances, we can address these things very easily. If it’s this, this, or this, then it’s going to be a much more difficult time, or I need to send you back to the doctor, and this is one of those scenarios where you would refer it back out.

So I think that’s the way that you explain these things. I think that there, that expresses it with an element of competence. It’s like I have narrowed it down to these things. Right? And I think that that becomes a very, very effective way and a very truthful and honest way to do it, rather than making a leap and saying, Oh, it’s this, as if everything is obvious and this is the difference between complexity and something that is very, very simple.
You know, it’s not like if you watch a basketball player come down and for a rebound and he lands on somebody’s foot and he gets an inversion sprain, you can speak with great confidence that you, that you’ve got a really good idea as to what just happened, right? You look at, you look at the cardinal signs and you say, okay, so it’s either a baby sprain or it’s a really severe sprain.

You saw it happen. It’s kind of obvious as to what this really, really is. But if somebody comes walking in up the street and they go, yeah, I just had this, this ankle pain that just kind of started, no, it didn’t have any trauma or whatever, whatever. It just kind of started on its own. That’s a totally different scenario, that, that we have to be comfortable with in stating like, okay, here are the possibilities.

Here’s what we’ve narrowed down through an assessment. Here’s the intervention I would like to do. It’s going to give us more information and allow us to be a little bit more certain as to what’s going on and whether we can be successful with this or not.

Doug: [00:29:38] Yeah, I think it obviously demands a level of trust from the provider because I found that I speculate a lot less than I feel theorized a lot less about why things hurt, and fundamentally I’ll say, look like,
you’re, you’re here because your hip hurts when you squat. The burden is on me to do things with you that allow you to hurt less when you squat. So without even theorizing about why the hip hurts, it’s like, look, let’s try a couple of things and you tell me if what we’re doing is working. Now I’ve got my like assessments and you can break things out and you can assess the hip and look for things like more flection and internal rotation.
But why are they there? And I kind of like letting them drive it. And then I, I, cause I think ultimately, it’s less of that they want an answer, then they just don’t want to hurt or whatever. The goal is like, I can’t, I can’t do X. Well, we have a process to get you from A to B and you’re a part of that process.

And ultimately, like you tell, you tell me whether you know what we’re doing is working or not. And that’s where like you can’t separate the intervention from the assessment for the diagnosis because with the right interventions, that becomes diagnostic therapeutic. And now if the interventions, you know, work so to speak, now that the patient’s probably less concerned about why, because you gave them an answer without answering.

It’s like, well, clearly you can get better without us knowing with a hundred percent certainty what the root cause is. Cause everybody wants a root cause. But oftentimes. There isn’t, but I don’t think I was confident enough earlier in my career to say, look like I don’t, I don’t really know. Let’s try some stuff.
And at the end we can, we can figure it out. We can get into the why more, but at this point it’s just pure speculation.

Bill: [00:31:18] Right, right. I mean, it’s just a matter of being process oriented. Right. Versus versus saying like, okay, I, what people see is, is based on their, their experiences and their, and their perspective.
So you’re a kid, you fall off your bike, you scrape up your elbow, you kind of know why the elbow hurts. Right? Again, we’re going back to the obvious situation. What, what, what the patient may be looking for in our situations now is they say, well, if I can attach a diagnosis to it, then that gives me the confidence that there is a solution.

And what we need to do to let them understand this, that you are now part of a process. And so everything that we do as an element of discovery that gives us more information. We’re narrowing, like you said before, we’re narrowing our probabilities and this was going to get us closer and closer to what you might consider the ideal outcome.

And again, I think that’s a very fair way to do this without having to make a leap into, to, sort of blame something, via diagnosis.

Doug: [00:32:21] Okay. And then as far as like, you know, protocols go, cause that’s, that’s a big thing in our field. Right? You know, I think initially the intent is like you don’t really know what you’re doing, so we’re going to give you a protocol.

So, you know, week two, you’re doing this. At week six you’re doing this. But kind of the more you go along, the more you’re like, wow, it’s actually more confusing to be that bounded by something. So, I mean, you know, and this is always, most of these discussions come down to you don’t want to be in the chaos side of things.
You want to be in the rigidity side of things. If you’re overly protocol-driven, you’re rigid. If you have no framework, no structure, no protocol, then you’ve got nowhere to start from. So how do you think we navigate that? I mean, you know, we’ve talked about this and our thought was kind of like, you should have the absolute like, do not do these things because they’re so like, Hey, for the first three weeks after a surgery, don’t do passive range of motion beyond that.

But as long as they’re not violating those absolutes, everything else is kind of fair game, but I think that it’s one of those, it’s a centralization problem, right? People don’t, aren’t comfortable delegating authority because you know, they don’t want to leave all of that gray. But how do we, how do we navigate that as far as protocols go?

Because it’s so overwhelming when you’re like, this person’s different. This person is different. I mean, right now I’m working with somebody who had a diving accident and has a cervical spine fusion, has some neurological constraints, and earlier on I would have been like, what am I supposed to do for somebody who has this level of spinal cord injury and now it’s like, look, I’m not going to magically make that, you know, facilitate that neurological return. That just takes time. That’s a constraint. And ACL surgery is a constraint. When a joint is a constraint, it’s easier to see the similarities now, but for a newer, for a newer person who doesn’t have the reps, what kind of guidance would you give them to navigate structure versus autonomy?
Bill: [00:34:10] Well, you just use, just use an extreme example of, you know, somebody breaks their arm. Okay, I have to protect that for a certain length of time. And then after that I need to slowly reintegrate that element back into this human.

But prior to that I, there are many things I could be doing. I have three other extremities. I have a body, I have, I have other systems that will influence this. And if I can create a favorable environment, then as soon as I am now able to reintegrate that, that, that element, in this case, the broken arm back into it, then I have everything that I could possibly have done in place that will produce a more expeditious, outcome as, as well.

And so I don’t see any difference in the broken arm example versus any other constraint. And so you take like any ACL, repairs, like, okay, there’s certain things that we know about this situation. Okay. So I know that there are certain stages where I need to be a little bit more protective, But beyond that, I, I have other elements of the system that are trainable to a very high degree under this circumstance. So as long as I respect the protective element, and understand graded activities, because that’s essentially a great portion of what we do when we’re restoring elements, especially in the fitness realm or, or the, the return to play, if you will, is that there are so many different things that I could be doing.

Whereas if I’m told that you can’t squat. You know, the classic, the classic stuff, you know, or, or they’re saying, do this or do that. When there’s so many things that could be infinitely more influential. Again, it’s literally, like you mentioned, it’s like, it’s just a constraint. It’s just something that we work around is something that we know is an influence that we respect.

And then we do everything else that we possibly can.

Doug: [00:36:13] Yeah. And that’s obviously like, you know, it’s a relationship issue between the surgeon and the rehabilitation provider where I can understand like if I was a surgeon and you went to school for that many years and that’s your good work, you don’t, you don’t want people screwing that up.

But at the same time, you know, we have providers want some autonomy and choice. And I think it just seems like the reasonable middle ground is like if you’re the surgeon, what are the absolute things that you just don’t want violated? And then at that point, if you have to micromanage beyond that, you’re probably referring to the wrong provider because ultimately, you know, you just can’t, you can’t script out the whole thing. I mean, I don’t, you can’t script the rehab

Bill: [00:36:48] Nore is that their role? Right, right. I mean, that’s, that’s our role and to have that understanding and, you know, it would be a, it would be a, a great world to live in if you did get an order like that, that, that, you know, gave whatever procedure was performed and said, just avoid this.

Doug: [00:37:07] Yeah. At the same time, it’s like, as a physical therapist, I’m not telling the patient, you know what kind of surgery they should push for when they go to see the MD. It’s like the surgeon should know more about that than me, and if they can’t make that choice, then I should refer to different surgeons, kind of.
So, you know, there’s these relationships that have to be navigated. You, you mentioned there the return to play thing, and it’s such a big buzz word and I don’t, I don’t get it. I mean, frankly, because return to play just means what did it take to play in the first place? But you had an injury, which is a constraint.

So how do we demystify this whole thing? Because it’s become such, it’s almost like propaganda at this point where I don’t, it’s become a meaningless sort of term, and I don’t get why all of a sudden because somebody, somebody got hurt. Now we pay attention to their preparation, but we didn’t before.
Bill: [00:37:54] Yeah, I don’t, I don’t see the big, I don’t see the big deal either.

Like I said, unless, unless there’s some element from, a procedure that is, unchangeable. Right, right. And those are symptoms, but again, that doesn’t really change the game very much at all anyway. It’s just another constraint to work around. You know, why is it different? Why is it different when you’re, you know, six months post ACL?

Versus, I just came off of one month, lay off, because I just started my off season. Right. And, and so I needed to rest. So again, we, we, all we have to do is we have to say, okay, for you to be effective in your sport, I need you to achieve these levels.

Doug: [00:38:38] Yes.

Bill: [00:38:39] And that’s it. That’s, that’s, that’s literally it, right?

Your ability to change direction, your ability to do, hop on one foot sprint at a certain rate, produce this much force. I mean, we’ve always done those things with our quote unquote healthy athletes and, and so I don’t think it is any different. It’s just like, okay, you’re just starting from this point a instead of the other point a, and then we’re still going to close the gap under those circumstances.

I think that that again, it, it becomes very protocol-ish to say that return to play follows this structure when the reality is people are going to progress at different rates all by themselves, and we have to respect that. And again, it always comes down to that, that N equals one thing. Because if we put everybody on the same return to play structure, it’s just like trying to put everybody on the same program and expecting everybody to have the same outcome when the reality is it doesn’t work that way.

Doug: [00:39:38] Yeah. I’m not trying to say that like getting a hip surgery versus a knee surgery there aren’t unique things we need to those procedures, but no one ever, no one ever acknowledges the similarities, right? Because if you’re a midfielder in lacrosse, whether you got a hip surgery or an ACL surgery, ultimately your sort of program or your scheme should funnel into the same thing.

So it’s just different in the beginning. But what we see is we see all of these, you know, like these linear things, none of which are connected. But if we’re talking about return to play protocols, like no one’s really talking about, okay, like there’s different constraints in the beginning, but they ultimately have to converge based on the demands of the game, the demands of the game dictate return to sport.

But it just seems like we’re reinventing the wheel anytime somebody has a procedure because we haven’t really defined well, what does it mean to be prepared in the first place? So maybe we’re just, you know, cause people are healthy. We just assume, well, like. We’re lucky they, they, they can play so they’re good.
But we haven’t really thought about like how do we know when they’re ready to play? And these are things that require, I think, a blend of objective and subjective,

Bill: [00:40:38] Right. Yeah I mean when things go successfully, we don’t ask enough questions. Yeah. Right. And, what we really need to do is establish a process.

And that process does not have to be unique. It just has to respect what the constraints are. And so people that are apparently healthy still have constraints. They still have secondary consequences associated with everything that they do. So not all good. All things that we apply are good things under every circumstance.
And again, we’ve always respected that from the fitness side of things, if we can call that, you know, preparing an athlete for their sport in general. But it always seems to be a little bit more special when, when they’re coming off of a rehab situation, when the reality is it’s, it’s really the same rules.

Doug: [00:41:31] Yeah. And I love what you said there. And again, it comes down to, to process because you know, when the outcomes are good, which in the context of rehabilitation is the guy didn’t get hurt, the girl didn’t get hurt, that we did a good job. But conversely, people can get hurt and you could have done everything right.

So I’m not saying outcomes aren’t important, but you know, like the aviation world, the military, like they’re debriefing after every mission, even the successful ones. And they’re trying to refine the process, which probably doesn’t happen enough in our field.

Bill: [00:42:01] So when you have the ideal outcome. What could we have done better? Yeah. What did we do wrong? Was there someplace that we could have saved time? Is there something else that we could have done with and gotten the same outcome? Like these are the questions that we ask when we screw up or when things don’t go as planned. When the reality is, is if we ask, just make it a process and not look at things as like, Oh, this was good, or this was bad.

It’s just like, this is just what was. It doesn’t change the way that we should perceive. These things will be much more successful. We’ll have many more answers. Most likely we’ll be able to narrow the probabilities even even better than we did before. And then we can apply these things regardless of circumstance.

Doug: [00:42:48] Yeah. And I think that we probably overreact when things go wrong and underreact when things go well, that’s like somebody gets hurt so we have to totally abandon everything that we’ve been doing. And if you have enough trust in your process, you’re going to realize that like you probably are going to take some casualties, so to speak.

Bill: [00:43:04] It comes down to decision. If it’s decision making, which, which again, it decision making should not be based on on a successful outcome or a failure. It is a process that you utilize to make a decision. So you could, you could do everything perfectly. And people, have a horrible outcome, you could do, everything incredibly poorly and that individual, for whatever reason, overcomes that and still appears to be successful. and so again, it comes down to refining your processes, and that’s where we need to be focused on. It’s, it’s not the good or the bad. It’s like, how did we arrive at these decisions? And then if we get better at making decisions in general, we will tend to have better outcomes.

Doug: [00:43:52] Yeah. There’s no better reminder of that than what’s going on now where with this virus, right? Like there’s so many unknowns, so we don’t even know what the outcomes are because you can give somebody an antibody test, we can’t even solely trust the results. So it’s really about like looking at processes under uncertainty and the, we don’t even know like what the outcomes are going to be because this is such an evolving process.

Bill: [00:44:18] So, but again, so, so there’s a key word right there. It’s evolving. It’s actually every time we get a new piece of information, we have to take that into consideration and then say, okay, how does this affect our, our perspective and how does this affect what the probabilities are? Because again, bought me a book not too long ago, from Annie Duke, who’s a professional poker player and, and what she’s talking about when we’re making decisions, he says, we’re playing poker. We’re not playing chess. Chess is very structured and has very defined outcomes. We are playing, we’re always playing poker.

So we always have a probability that we have a desire for, and one that we probably don’t have a desire for and both are still on the table. So even though I might have a 76% chance of having the outcome that I desire, there’s still a 24% that that I won’t. And it doesn’t mean that you made the wrong decision if you fall into that 24% it just means that there was a lot of influences here. There’s a lot of factors involved, and luck is a real thing. And so again, you could do everything right. You can make the best possible decision and still fall into that 24% failure.
Doug: [00:45:27] Yeah. And you could have a 19 in Black Jack, and if you don’t get another car and you could lose it, you know?
Bill: [00:45:30] But yeah. So that’s, so that’s unfortunately what we’re playing. But again, people are uncomfortable with that because it is, it’s in the gray and, and, and we do have to learn how to get comfortable with that because that’s literally how we work.
Doug: [00:45:45] Yeah. I mean, it’s easy for us to do that because we work for ourselves.
We don’t have to answer anybody. We don’t need like these BS metrics to justify it. And so I get in hierarchies and larger organizations how this becomes problematic because we kind of work in a utopian environment.
So I’d love to hear your thoughts on breaking down some, you know, some of these various models or martial arts, so to speak, in our field.
So kind of like, you know, if you were to ask Bruce Lee, what do you like and not like about Judo, what do you not like? And not like about Western boxing? We’ll start with, you know, our field. I can kind of anatomy a model or a pillar. That, that anatomical model and I know that you’ve got some, some, some passionate thoughts on this.
So what do you know, what does anatomy good for and not good for in the context of rehabilitation performance? That kind of thing.

Bill: [00:46:36] Well, so I talked about dead guy anatomy is a representation of how we actually move, and that’s just not the reality. It is a representation is, is unfortunately not the representation.

When, when you’re, when you’re looking at a cadaver and because of, I mean, all you gotta do is ask me like, what are you made out of? And they go, well, you’re, it’s like two thirds water. It was like, okay, well that’s a big deal. Right. I’ve never worked on a, on one of the, the fixed cadavers that had any water in it whatsoever.

So right away, right away, my perspective is different. So I look at these things and I say, Oh, look, if I pull on these things, there’s a bunch of levers there and so then we get the lever model, that’s associated with that. So then I immediately have a type of math that goes with that to calculate forces.

Well, here’s the problem with that. That ain’t reality. Not even close. And so now I have, I have a misrepresentation of how actually, how these things actually work, and therefore, when I even do calculations. So if you look at the biomechanical model, and they do, they use typical geometry to, to calculate out forces that exceed the tissue tolerance, right?

So it’s like, I remember the, If you, if you’re in the NBA and you perform a slam dunk and you land on the ground, it’s that term for this eight or 16 times body weight is the force. How on earth could you possibly withstand that if we’re using normal geometry? So we don’t behave that way. And so again, those forces are misrepresented.

So, so again, if we’re making decisions off of that type of a model right. Then we started with the wrong model. Our decisions will be wrong under many circumstances. It doesn’t mean it’s not useful under some circumstances. It just means that under reality, it’s just not. And so I again, I prefer to, to, to try to use something that it’s a little bit closer to what we actually are in regards to dynamics.

Which is, you know, the compressive and expansion element of how we move through space and, and we’re, we’re much closer to, Oh, I suppose a worm than we are a cadaver in regards to how we actually behave. which means that then the, the anatomy needs to be, learned in context. So we touched on this a little bit earlier.
This is why, you know, going through a semester of gross. Before you do anything, again, it’s nice to know where stuff is, but I could have an app for that. I don’t need, I don’t need to spend hour upon hour dissecting out when, when I could just say, okay, this structure is here because I want to do my little highlight thing.
You know my app, I know exactly where that is. But, but now move me into a context where, where I have somebody that is actually behaving in space and now I can say, Oh, I can see how this now relates. So again, much more useful representation than, than to to lay somebody on this lab. And like I said, pulling on tendons and saying, Oh, this does this.

So we’re going to call this a, it bends the toes. We’re going to call it flexor digitorum. Right. Which again, not very useful, especially when it’s out of context, because that’s not what it really does when you’re walking across the ground. Yeah. Sorry again. No, you, you go, you go.

Doug: [00:49:48] No, I mean with, with regards to anatomy, I just look at it like there was a point during my first semester of PT school when I could literally identify every muscle, nerve, blood vessel in the body, and I would heinously fail the written or the practical exams now and then I’ve been treating and I feel much more competent clinically. So if what we’re learning in that setting is truly useful, it should reinforce and if anything enhanced when you’re actually applying it, right. The application of that anatomy made me know the cadaver stuff less.

So even when it comes to things like manual therapy, if people are into that, we’ll talk about that later.
I don’t wanna get too deep into it, but it’s like to do a manual therapy technique. I don’t need to necessarily know what that’s called. I just need to know, like I can feel some kind of aberrant tone, I’m going to do a technique and as long as I know that I’m not on something that’s really bad.

Like if you’re dry needling somebody, you don’t want to dry needle the sciatic nerve, but it doesn’t matter that you’re identifying which deep hip rotator you’re on? Probably not, except for it allows us to speak a common language, but I just don’t know. To your point, I think that in terms of opportunity costs, cadaver…
A cadaver anatomy is just not a great use of time and resources when you can use an app. I think for like a surgeon, if you’re trying to do procedures on actual anatomy, on people under anesthesia, that’s a different story. But, you know, it’s a Rite of passage and it, so when a select people, it’s kinda like in the military, you know, because you have an untrained person, the way that they weed people out is they make you crawl through mud and run around with logs.

And it doesn’t have actually, once you’re, once you’re a qualified soldiers, so to speak, before guys are going to Afghanistan or Iraq, they’re not running around with boats on their head, they’re doing things that look like their job. And I think anatomy is just an imperfect proxy for selecting people that have the determination to make it through a medical program? No, I’m serious. It’s a, I think I’m trying to find something good about it. I think that’s what it does. It’s, it’s a, a Rite of passage. But I, you know, as long as we’re like acknowledged that and we’re not, you know, we’re agnostic. We’re not saying like, it’s really important because to your point, if we embrace that model too much, I think it can lead us astray.

Bill: [00:52:00] Right. And again, it’s like, it’s not that it’s not totally, irrelevant. It’s just that its level of relevance is, is, is limited. It’s just like any model, all models have a limitation. It’s like, okay, so this is a representation of something. Okay. But, but again, it ceases to be useful very, very quickly.

Right? And, and I think there are better ways to go about this, especially when, you know, we don’t work under those circumstances, right? We have to have people that are live and moving and, and, you know, working against gravity and forces and et cetera, et cetera. And so, again, that would be a much more. A useful representation if we would, would emphasize that.

It doesn’t mean the anatomy’s not important, but the begin like learning instruction by structure, by structure, but probably not terribly

Doug: [00:52:47] depth that we have to learn.

Bill: [00:52:49] Yeah. Yeah. It’s like, you know, I did flashcards for every muscle and nerve and you know, all through school just so I could get through that because you have to memorize it. You have to pass the test.

Doug: [00:52:59] So related to anatomy, the next thing would be biomechanics. If we talk about anatomy is kind of like. You know, just statically what’s going on with the body and the structures involved. Biomechanics is sort of the movement or positional manifestation of that anatomy. Now there’s a whole gamut of things, right?

There’s like the posture police where it’s like, you know, if you have a plum line and you’re deviant from the plum line, it’s causal of all these things, but then you look at some sports and while people have idiosyncrasies, there’s certain mechanical sort of truths that emerged. So how are our biomechanics useful, not useful to you clinically or in a, in a performance setting?

Bill: [00:53:38] Well, so it’s representative of, of the possibilities, right? So, so all I have to do is I have to have a representative model of what I’m shooting for, right? So again, the biomechanics are that representation. It’s like how do you know when, when movement is better, besides the fact that the patient says. Oh, that’s better.
It feels better. Do I have a representation that can provide me some, some measure of information to know that I’m on the right track? So what if they, if, if I recognize the fact that, okay, so based on my normative model, a full motion has been restored, this person still has, has a complaint, then that might just be one of those representation that’s now beyond my scope.

Right? So I have to have those elements. So, so biomechanics provides me that foundation of understanding of like, okay, under, under most circumstances, this is my norm, that I’m comparing what I’m seeing too. Right? And it, and again, it is foundational, whether you, whether you want to appreciate it or not and I would say that, that, from the biomechanics standpoint, is using it as that representation of what is possible, not as a singular representation.

So, so when you talk about things like, Oh, does posture matter? Yes. It does matter when it matters, right. Does it, does it, does a posture represent an absolute that somebody will, will feel a certain way? Absolutely not. That’d be, that’d be ridiculous to say something like that. But it may provide a piece of information in certain circumstances that becomes valuable, especially when we’re talking about the ability to change, which is, you know, making people more adaptive tends to make them feel better.

And so if I have somebody that has a representation where they demonstrate a lack of adaptability and it just so happens that they show up in a certain shape that might be useful. Right. But I, but I can’t rush out on the street and go and start pointing at people and go, Oh, you have this, you have that, you have this.
That would be kind of silly. Right. so again, it’s just information and we have to respect where it, where it is valuable and where it might not matter.

Doug: [00:55:46] Yeah. I’m saying try to, again, we’re back to the early deterministic, but also overly annihilistic is to say that it doesn’t matter, I think is also flawed. As well as you know, that it doesn’t matter.

Bill: [00:56:03] It’s just information. It’s just information. Is it useful? Maybe not right now. Is it useful later? Maybe it will be. Maybe it won’t be. I don’t know. It’s like I, I’m, I’m, I, you know, I’m totally comfortable with that. That fact that, okay. It’s just a piece of information.

Doug: [00:56:19] I think that there’s kind of a, a counter reaction counterculture to biomechanics because probably for the, most of the history of PT or rehab, it’s been overly deterministic. And so the reaction to that, and you know, maybe this is one of those things where you have to have an overreaction to meet in the middle.
I hope that’s not true. That just seems historically to be the case. So now we have the pain science.

So in your opinion, is there anything particularly special about pain that it warrants its sort of own science, if that’s even a thing. I mean, and again, I think there’s good things about it, but what’s what, what do you, what do you take from it that’s good.  And what do you sort of disregard.

Bill: [00:56:55] Well, I, I, I gotta I gotta steal something from Neval Ravikant when he was talking about, if you’ve got to put the word science in the title, it’s probably not a real science, right? All we’re talking about is, is an element of the human speciology so the pain science is no different from happiness, science or, or any other.
Anything you want to attach to it, right? It is, it is an element that is an influence. The reason that pain gets so much attention, and I’ve said this a ton of times, is because it’s an unpleasant sensation. You know, cause we don’t study. We don’t study joy the same way we study pain, right? I’m sure they do study joy to, to some degree, right?

But, but pain gets a lot more attention because it’s interrupts things to such a degree. And because of its unpleasant nature, we want to get rid of it. But if, if we, if we keep looking at it as if it’s something that is so different from everything else, then I think we’re going to be, we’re going to be lost.

What we want to look at as like, okay, when somebody has these situations, what are these adaptations? How does the system behave? What are the possible influences? But again, these are the same questions that I asked before because it’s just part of the process of this whole thing, right? And so it’s not that I would ignore it.
It’s not that I don’t value it. Right. But, but again, it’s just another piece of the, of the information that, that lets us know the status of this situation, right? It allows us to help. It helps us make decisions, but we can’t, we can’t. So, for instance, based on our scope of practice, people come to us because they’re in pain, but our scope of practice really doesn’t.

Doesn’t, set that as the, the direct outcome because we are movement related in our scope. And so once we have a representation of everything that we can possibly do, if the pain persists, that is no longer our situation. Right. And so they may need some other form of intervention to resolve that situation.

And so again, it’s just like I said, it’s just a piece of information. We try to understand it the best that we can. We try to understand how it influences the situation, but it is, again, one piece of information.

Doug: [00:59:06] Yeah. I mean it’s, it’s another constraint, just like getting ACL surgery that we have to work around.

And the reality is it’s, it’s subjective and very poorly understood. So I think to overly focus on it can be problematic because what is it that you’re chasing? And moreover, like if your identity as a movement professional is to work on functional outcomes, then how do you maximize function with pain as a constraint working around it?

I will say that what, what you know, those sort of models and constructs did for me was they made me more careful about what I should avoid saying to people. You don’t want to tell somebody, Oh, well you’ve got the back of a 90 year old, even though you’re 20. That, that obviously creates, you know, a ton of potential problems and then people internalize these things.

So I think that, you know, it did reveal some of the deterministic flaws in the biomechanical model, but if you take the pain science model too far, and now you’re giving lectures for an hour about ion channels and just talking, but you’re not doing things with people because they still need to be able to move and do things.
That’s why they’re in your office. I think you could take either of those things to the extreme, but you know, I think the key takeaway from that model for me was at least like a much more careful about what I say, and more importantly, what I don’t say. Because what we say can have you know, very profound consequences for people.

Bill: [01:00:26] And again, that’s just understanding, okay, how does this influence this situation? Right, right.

Doug: [01:00:32] It’s not unique to pain science. I mean, I got there and science people were emphasizing that, but it’s not necessarily unique to pain science, but I think that in the context of our field, they’re the ones that like are most, you know, kind of championing that message.
And I give them. I give them credit for that.

Bill: [01:00:47] Absolutely. I don’t deny it. We, we’ve, we’ve been through many situations, you know, together and, and on our own and, and again, seeking out those resources for that reason. It’s like, I need to understand how this is an influence. I need to understand where this is.

This is most valuable. I need to understand how to manage this. But I can say the exact same things about everything else that we have talked about as well.

Doug: [01:01:12] Yeah, I haven’t been, since you’re bringing that up, I’ll admit, you know, when I goofed up with you and I was your student and it was when I was like just reading this stuff and probably being a little bit too enthusiastic about it and we had a patient with a really arthritic hip.
When you get a hip replacement and telling him about like as a Migdal at all that like it actually backfired.

Bill: [01:01:31] Not very helpful.  It’s a powerful lesson learned. Yeah. So then.

Doug: [01:01:40] Moving on from biomechanics, pain science. I think kind of a, a hybrid of those two things is like the, the just load it model where kind of the ideas, you know, everything is a matter of progressive overload. It doesn’t so much matter how you do something as just, you know, you need to develop your tolerance.

So that extreme example of that would be, you know, dead lifting a maximum weight. Because you can do it with, you can try to, and you’re set up maximally around your lumbar spine as long as you progressively built up to it. Again, I think there’s good things about it because you are resizing progressive overload and not being overly deterministic about biomechanics, but I think it neglects biomechanics.

So where are you on the, just load it because to me it’s like, all right, well load. What? Because in order to determine what it is that you’re loading, you need it biomechanical or how components.

Bill: [01:02:35] Right? I mean, so if we’re, if we’re talking about graded activities and things like that, I think that that’s, that’s a little bit more straight forward then, then to…

I think when you, when you talk about, Oh, you just need to get strong, or, I don’t even know what that means anymore, to be honest with you. or did you put load on it? The thing that we have to, we have to understand though, is, is that when, when we are focused on one thing. That there are secondary consequences associated with everything that we do.

And so what are the secondary consequences of increased force production? So let’s just call it force production for the sake of argument. Cause that’s a little bit more of a, of a measurable concept versus like gym strength or something like that. It’s like what are the secondary consequences of that?

Right? And so again, so I have tissue tolerances they have to consider. I have, I have strategies that I have to consider. So I have behaviors that are, that are associated with, with me producing force. So I will produce force in very specific circumstances, in very specific ways. And so if, if I am, if my intention is to load a tissue to increase its resilience or, or, to enhance that structure. What are the secondary consequences? Did I take something away from something else that might be just as valuable if I’m talking about health or if I’m talking about performance, because there are many situations in performance where we slowly take things away from someone because you cannot raise performance.

It is very rare situation that someone would be great at everything. And so let’s just simple, simple gym strength or something like that. So if I raise your squat from 300 pounds to 400 pounds, what did I have to take away from you to do that? Did I take away something valuable in regards to your ability to move?

So for instance, if I have to sacrifice shoulder range of motion or hip range of motion to get you to bench press more squat more, was that useful? Was it helpful or or was that secondary consequence? A negative? So we have to be very, very careful in how we describe these things. And we can’t be, we can’t have that singular perspective of, Oh, you just need to get strong.

Because again, there are consequences to that, that may not be favorable under every circumstance. In some situations it may not matter. And in other circumstances it may matter a great deal. you know, if you took a golfer. You know, and you took away their ability to turn because you had to make them more stable to lift the heavy deadlift.

That’s probably a bad idea. Okay. Yeah. You’re raised their strength, you, so you loaded them, you raised their force output, but now you’ve also created a consequence where they can no longer access a position that they needed to perform, and now maybe you’re going to put load on structure or maybe they’re going to create some sort of compensatory activity.

And so maybe you just created a secondary consequence that is unfavorable. So I don’t have any issues with the concept of loading. I just think that we need to be a little bit more broad in our perspective as to what’s actually happening under the circumstances. And it’s not just that aspect, like everything that we do, everything that we do as a secondary consequence, right?

Me, me, reestablishing someone’s range of motion can reduce their force production. Sure. Do they need that to protect themselves? So I always have to consider these things. Right. So that’s why you have key performance indicators as you’re moving someone through a process, whether they be a rehab patient, whether they be, be an athlete that’s training for performance.

We have certain elements that we say, I need to make sure that I maintain this because it is representative of their resilience, or it is representative of their ability to produce more force, which is what I wanted in the first place.

Doug: [01:06:14] Yeah. And I think where it gets tricky, you know, cause I think to me like my interpretation of the just loaded movement is that, you know, the, the execution doesn’t matter so much as the progressive overload, but it becomes difficult when you’re trying to differentiate symptom relief from performance.
And because it’s a functional profession, we’re trying to achieve a functional goal, which is performance, but we’re also trying to reduce symptoms. So it’s not clear. Well, it’s not, it’s not a line, right. It’s a, it’s a spectrum. So like if you’ve got someone who, let’s say they just want to be able to run once or twice a week without pain, go for a three mile jog.

They don’t care about how fast they are. They’ve had no pain. If that person comes into eye care, how they run, probably not. But if someone, let’s say, has had a history of hamstring strains and they want to run it, max velocity. I’m going to care a lot more about how they do it. Because if we look at the best sprinters, yes, there are idiosyncrasies among individuals, but there’s also certain biomechanical patterns that emerge, right?
So I think you have to look at the individual, and again, it’s trial and error. Like you don’t. It doesn’t matter to what matters and you don’t know until you try, which is not satisfying, but that’s, that’s the gray that we live in.

Bill: [01:07:22] Yeah, and it’s always going to come back to that. Every, every discussion like this was going to come back to that.

It’s like, okay, yeah, there’s probabilities. Yes, it’s gray. It’s N equals one, right? It’s like, what? What are your needs? What are you present with? Right. And again, people want black and white answers. It makes them comfortable and we just need to get used to being uncomfortable and be satisfied with what we are capable of doing.

Doug: [01:07:47] Yeah. And I think reducing any complex human interaction to a hashtag is comfortable because it’s only gonna figure it out. But none of these things, you know, three minutes, not a hashtag. kinda, you know, I’m coming up on time here, but what do you think, for you, I mean, throughout your career you’ve had periods where you’ve like really zoomed in and gotten very like rehab, movement centric, and then periods where you’re zooming out. For you. I mean, I’m sure it’s kind of more of a subjective thing, but like what makes you determine when you’re going to do what.

Bill: [01:08:18] It’s kind of like, I hate hate saying this, but it’s just kinda like how the river takes me sometimes. Right? And th there’s certain things that, that capture your curiosity infinitely more so than, than other things.
But I think that the reason that you do go, go, go in and out is because you’re trying to say is like, okay, how valuable is this? And then you’re not certain of that. Or like I said, just sometimes it’s just fun. And, and that’s acceptable, right. To, to just dig into something and really, really get a grasp on it.

And, and I think that having been involved for, for three decades, the way that I learn now is just totally different from, from what I’ve done before. I actually picked up, what’s his name? Michaud’s Human Locomotion book this week, which is like a technical book that I haven’t touched in though.

Yeah. It’s a great little book. It’s like, and, and again, that’s why it’s still on the shelf, but it’s like I just grabbed it because I had, I had a question about something and I just needed to, I needed the technical side of things, but, but I think that the further you get into this stuff and you start to layer upon layer upon layer.

You know, again, like I was talking about expanding your base of analogy, there’s, there’s a certain element of, of like what else could be an influence here and what am I, what am I most confident with and do I need something else? And, and looking at the way that, that I’ve evolved my model over probably the last five years, six years.

And you, you’ve gotten a taste of it, cause I used to send you a bunch of stuff on a regular basis as to what I was digging into at the time, you know, so you saw some of that, some of that evolve. but, but I think that that you have to dig into certain things to say, is this valuable? You know, does this fit?

Is this in conflict? And so you have those questions that you have to answer. And so that’s when you do kind of dig in and then you can zoom back out and you say, okay, so this is the whole thing as a representation, right? Where are the gaps? And so a lot of these things are identified as I teach. So again, having had 25 students over the last eight years or so, every time you teach something in, you teach it a little bit differently and you say something out loud or they ask a question, it allows you to say, Oh, you know what?

I need to, I need to look a little bit deeper into that. And so you’re, then that’s your zoom in and then you kinda zoom back out and you say, okay, how does this affect everything else? And so I think it’s always going to be this back and forth kind of a thing.

Doug: [01:10:50] Yeah. And you kind of touched on it, talking about other things and models where everything comes to the expense of something else.

So I think zooming out actually allows you to connect the dots, get that BS filter, but you need dots to connect. And that’s the zooming in. I just found like for myself personally. To your point, like I just do what I enjoy and what’s going to be fun. And you know, when it comes to learning and anything else, because if you enjoy it, they’re going to retain it.

If it’s being imposed on you, like, which it often is in an academic environment, or it can just drain the joy out of learning. I find that I just like anything that’s important that I’ve retained, I didn’t even study for.

Bill: [01:11:33] Right.

Doug: [01:11:33] You know? And that’s kind of happening now. Like if I, if I want to read something, I’ll do it.
And I used to kind of, if I started a book, I had to finish it. Now if I start a book and I don’t like it, 10 pages in, I just stopped and I’m like, I don’t feel guilty about that anymore. It’s really, like you said, it’s kind of going with the wind, which, you know, very unsatisfying earlier in my life to have somebody tell me that.

But I think maybe you need a little bit of a base before you can even know, like gauge where the wind is blowing, so to speak. but that’s kind of the evolution of it.

Bill: [01:12:04] Yeah. But like, like I said, I, I, you know, the nice thing about learning is that there was always something else, right? There’s always a next, and…

your patient might say something to you, or a colleague might say something to you. And then that leads to curiosity. And then that leads to interest. And then that leads to the active investment of, you know, acquiring the information. And then it’s like, okay, does this fit? Does it not fit? Do I need to spend time on this?
Do I not need to spend time on this? And again, that. I, I, I’m in a constant state of that. I think we’re always seeking, right? because we’re always curious and we always want to know what’s next. And, and the thing that would be, that would challenge people is, is don’t, don’t just follow the current, because that, that’s a really bad way to go.

Is, just doing what’s popular. Because it, it, well, it may be useful. It also leads to just, what I call lateralization of information. It’s like people learn things that are not in depth, and then they pass that information on and then it becomes the world’s worst game of telephone.

And, and, you know, I said this before, it’s like you make a photocopy of a photocopy of a photocopy of a photocopy, and then by the time you get, you know, 10 of those deep, it’s just very unclear as to what’s really going on. And, and so I would prefer that people sought out the things that they are interested in.
That they do find useful. And not, not say that, Oh, just cause this is novelty, this must be important. Right?
Doug: [01:13:33] I think that’s, it’s a little bit of like, you know, David Epstein talks about this and range and even in the sports gene where, you know, obviously you don’t want to have no structure, but I think that our culture is very, very structure grind.

You need to know what you’re doing and have a linear path. And maybe what a lot of us could benefit from is just being okay being directionless. You know, and I think maybe in a culture that was like a little, you know, kind of the opposite that, that didn’t have any direction, then maybe it’s better to be told to have more structure, but like, I don’t know, we’re in a culture that celebrates getting up at three in the morning and stuff like that.

We probably could benefit a little bit more from like, yeah, just kind of go with the flow a little bit. And then if you do it, then you can reign yourself back in.

Bill: [01:14:17] Yeah. Nobody has to tell you what to study. Right?

They shouldn’t have to tell you what to study, right? You should just be interested and then seek things out and then, you know, it’s like you, if you want to go buy a shirt, you try on a shirt, you don’t like it, you don’t buy it.
Right? If you like it, you maybe you get another shirt. Yeah, so it’s kind of the same thing. It’s like, okay, I study this. It’s like, is this useful? Is this helpful to me? Or is it just a curiosity? You know, am I reading about, I’m reading about quantum physics. Okay. How useful is that to me? Well, maybe it is.

It helps me think a little bit differently about things, and so then it becomes useful. Am I going to directly apply it as, you know, am I going to be concerned about what, what particle is, is flowing through me at the moment? And it’s like, no, not really. It’s like, where is that useful?

Doug: [01:15:03] That was a, that was a lot of fun.

That flew by. I’ve got to put my mask on over here. Thanks for coming on. I mean, we want to do this for a while. We probably had so many conversations we wished we’d recorded and we got, so, yeah, that’s fine.

Bill: [01:15:18] Thank you for having me done.

Doug: [01:15:19] Yeah, absolutely. Thanks. Enjoy the rest of your weekend.

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E39 | Keep It Real Talk #1

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Hey everyone, and welcome back to the Resilient Performance Podcast! Today’s episode will feature our first ‘Keep It Real’ talk with Greg Spatz, Trevor Rappa, and Doug Kechijian.

Our ‘Keep It Real’ talks will consist of the three of us addressing questions sent to us via Instagram followers, blog readers, podcast listeners, and anyone else that reaches out to us.  We want to keep things as simple as possible for you and not over complicate things for the sake of making ourselves sound smart.

This is our way of ‘Keeping It Real’.

Topics discussed today:

  • Is aerobic deficiency syndrome a thing and how can one recover from it
  • Are there commonalities on mileage for runners training for say marathons vs half marathons
  • How can nutrition affect one’s rehab
  • What are the indications and benefits of soft vs stiff landings
  • Sorting out the intent behind the execution of certain prescribed movements

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Episode Transcription:

Greg: [00:00:00] Welcome to the Resilient Performance Podcast. I’m Greg Spatz. I’m here with Trevor
Rappa and Doug Kechijian.

This is our first, Keep It Real talk, is what we’re calling it. So just going to be the three of us talking about any, any sort of questions that were sent in from listeners, from blog readers, Instagram followers, whoever, found us and sent in some questions.

We’ll talk about anything that we have so far with that. And we call it ‘keep it real’ because of, one of our more influential mentors, Alan Gruver, we all did a clinical rotation as PT students with him in Arizona. It was just something that sort of like his mantra, his motto to live by in this world where everything can be so complicated in the field of rehab and sports performance or training and a lot of his, you know, we, we’d be in the clinic and asking him questions and we’d have to have these thought processes in our head of like, we need to do something really out there and special for this patient in front of us. And he’s, he would always just bring it back to, okay, well what do they need?

Keep it real and let’s just get them what they need. And no matter what it is or, you know, what clinical or, you know, con-ed courses you’ve taken, you just got to get the person what they need and let’s just keep it real. So that’s what we’re talking about when we say keep it real, and let’s just get into some of these questions here, but Trevor, Doug, anything to start?

Trevor: [00:01:32] No, I think that was a great explanation. Yeah, we just always about keeping it real and kind of keep things as simple as we can and not overcomplicate it for the sake of just making ourselves sound smart or just for the sake of making a more complicated.

Greg: [00:01:57] I don’t think they’re going to be too long, but we kind of take it from there. And if it turns into two different, two different Keep It Real talks, then so be it. Cool. So let’s go the first one, Doug, you want to talk about. This question is aerobic deficiency syndrome a thing, and if so, how can one recover from it? Is it high volume of slow cardio? You wanna just take that and run?

Doug: [00:02:22] Yeah. So aerobic deficiency syndrome. It’s funny because I actually had to look that up cause I hadn’t heard it worded in that way. But essentially what it means is if someone is training for like an endurance type event, that they’re doing too much high-intensity training and not enough of the lower-intensity or more aerobic type training.

So that’s kind of what we mean by aerobic deficiency syndrome. And again, I, I hadn’t heard it, where did it in that way, but, ultimately it comes down to like, what’s the, what the goal is? So for first of all, like even the aerobic system, right? Is that really a thing? Is it really a thing to say something as aerobic, anaerobic glycolytic, these are all like words and constructs that we create to make this idea of bioenergetics more manageable.
And you know, in, in biology, like when you know, an animals are running away from other animals, they’re not thinking like, well, is this aerobic or is it anaerobic? They’re just doing what they have to do to survive. And I think that it’s important to learn energy systems, but I think they have limitations.

I think that’s just like any other model. That’s one way to look at performance in this case conditioning or endurance through this, energy system lens. I think that in and for keeping it like really, really brief, the way that I would summarize energy systems is that you can call them whatever you want, but ultimately, depending on what your goal is from an output standpoint, that’s going to change the relative balance of all these different chemical reactions that produce energy.

And when we’re producing energy, there’s always a trade off between, efficiency and speed. So if you want to produce energy really, really quickly. Like you’re sprinting. You can only do that for so long before you burn out. If you want to be more efficient and not produce as quickly, I E are being more aerobic, which is what we typically associate with that.

Then you’re not going to be able to produce energy as rapidly. So there’s always a trade-off it just like any other—biological system. So with the aerobic deficiency syndrome, I know who asked the question without kind of getting like too personal, revealing his details and his goals. This is somebody who’s training for a, a military selection course where you have to do a lot of long-distance running.

And his training prior to us working together was a lot of like higher intensity type work, and then there are some systems that even say like, for even for like a, you know, an endurance event, whether it’s like marathon, military selection, that you don’t need to do any of the longer lower intensity type work.

You can just do intervals. And certainly, like for example, if you’re training for a marathon, you can, anybody can like finish a marathon. But the people who were winning the marathons tend to do a blend of high intensity work and low intensity work. I think the person who kind of explained this the most clearly from all the reading that I’ve done is Steve Magnes and Steve Magnes talks about when you’re training for endurance, it’s obviously context specific because endurance for a military special operations selection course is different than endurance for like a 400 meter runner. So that 400 meter runner, you know, there are people who train for the 400 and never run more than 200 meters in practice and are still pretty successful.

When people start training for the 800 and above, it’s kind of hard to just run 200 meters because you need more of a, an aerobic or a low end buffer. But what Steve Magnes says is you basically just take whatever it is that you want to do, so in this case, running training for a military selection course where you’re going to do anything from like, you know, six mile time runs to 20 mile, rucks or hikes through adverse terrain with external load or a pack.

So you have to support those energetic demands. On the high intensity end and the low intensity and you need, you need bandwidth because you could say like, oh, well if I want to train for whatever the 400 I could just do four hundreds and that’ll work to a point, which is kind of like saying intervals will work to a point, but if you don’t support the low end and the high end, then it makes it much, then you burn out without specificity.
So for aerobic, having a well developed aerobic system makes a lot of sense for a military selection candidate because you’re doing six mile run. So if all you’re doing is 400 meter repeats, you’ve never actually done run for the duration that you’re going to get tested on. So it’s probably a good idea if you’re training for that kind of a thing to do runs of even up to 10 miles, but at a lower intensity than what you would run when you were being timed.

If you’re only doing, you know, 400 meter repeats and then you put a ruck on and you go and walk 20 miles, like, yeah, this is the chance that you can do it, but are you really going to be prepared? So I think that, rather than looking at it as like being aerobic or anaerobic, I think that can be useful. But what’s more important is to say that like whatever event you want to do, you need to support it with lower intensity work and support it with higher intensity work.

And then as you get kind of closer to your competition or whatever it is that you’re trying to prepare for, then you can do more specific work, but you need, you need lower and higher intensity work on the front and the back end to support the specific work because the converse of that is like, there are plenty of people who all they do is, is, low intensity work.

But like, let’s say your goal is to run your recreational runner, and your goal is to run a 5k at a seven minute mile pace, but right now you’re only running 10 minute miles and you can do that all day. Like you can’t even run a seven, one seven minute mile, so how are you going to run three if you don’t have enough speed to develop the ability to run one seven minute mile?

So for that person who can run 10 minute miles all day, it makes sense to do some speed work, which again, is a relative constructs of speed work for somebody who wants to run a seven minute mile, might be doing 800 meter repeats at a 3:30 pace, and then you can manipulate the rest periods in between repeats.

You could, you know, demand a higher output on each repeat. There’s a lot of ways to manipulate that, but you need speed and you need lower intensity work to support the specific demands. So for someone who’s training for a true endurance event, like, like a military selection course, I, if I was preparing somebody, I would do way more than just interval work or high intensity work because having done this stuff myself, there’s, it’s just, it’s, it’s a unique stress to go out and walk for 20 miles.

And running sprints and doing like, a bunch of higher rep lifting, I don’t think as a way to adequately prepare for that. So yes, like aerobic work is important, depending on how you define aerobic work, but it really, it depends on your goal and some people are going to need a lot more of it. The lower intensity of like your event or sports, so to speak.

The more of that, like quote unquote aerobic work you’re going to need to do. So for a military selection course, I think that actually aerobic work should form the bulk of your training and it should be supplemented only in small pieces with higher intensity work.

Trevor: [00:09:15] How important do you think like, like from your own experience in terms of, you know, really getting a lot of that low intensity work in is just like the tissue tolerance sets.

You’re kind of building up and tissue capacity to handle your crazy, you know, 24 hour training periods where you’re on your feet all day and just kind of, you know what I mean? When you’re constantly moving and you really have to have a tissue, a high level of tissue capacity, do you think that’s important or you think it’s kind of overrated for something like this?

Doug: [00:09:39] I actually don’t think it’s overrated at all. Really training for like a military selection course in particular, like being able to meet the runtimes and the pushup times and the pull up times isn’t really that hard. The hard part is like being able to survive the training because the training is very, very volume-based and if you haven’t had.

If you haven’t stressed yourself enough in training where volume is the stimulus is the major stimulus, then how are you going to deal with that volume when you have to go to the course? So I think the tissue tolerance thing is, is a great point where like, yes, from like maybe like a physiological standpoint, like whether it’s cardiac output or like local muscular adaptations, like yeah, you can, you can run a bunch of four hundreds and like you’re not going to get, you’re not going to gas out.

On a ruck per se, but if your body’s not used to rucking for 20 miles, then maybe like when you do it, then like, you know, you have an overuse injury like in your Achilles or your lower leg, or even a stress reaction, right? Because if you’re not used to, for example, in a selection course, you run almost five, six miles a day, just just to get places, because you’re not allowed to walk anywhere. So that doesn’t even count as your actual run train. And you have to run to your meals. You’ve got to run to the dorms, all these different things. So you’re running almost like 30 miles a week just as your means of transportation.

So if you’re only doing lower intensity work, like now your, your body’s not conditioned for that kind of volume. So I think that what you said is that tissue tolerance is a huge piece. And that’s why like all these models you have, like your tissue preparation model, your physiological model, your cardiac model, they all kind of have to be addressed because physiologically I think you can, with lower intensity work, you can like quote unquote prepare, you know, from a conditioning standpoint for some of these longer things.

But then it’s also like the, even from like a technique standpoint, like, you could say that like these runners who are doing these, like, you know, slow runs multiple times a week, we’re at a really low intensity on, a lot of coaches will say, well, that’s just junk mileage. If that’s also, you know, they’re also developing the ability to run technically, they’re getting so many exposures to running, they become really efficient at running and they become good at running. You can almost think of it as like as practice a sport practice done at a low intensity where their sport is just to run, and then they can increase their output once they’ve developed that technique.
So, there’s a lot of components that need to be addressed that’s not just like you know, how do you, how do you test in a six mile run? It’s, are your tissues prepared for it? Are you biomechanically and technically prepared for it? And that’s why I think that like if you, if you’re playing a volume based sport, you need volume to know that you’re prepared for it.

It’s just basic stress inoculation and you’ve got to attack the physiology, the tissues, the mechanical stuff, you know, all of the above. And it’s also why, you know, like a lot of dancers, for example, do a ton of like low load, long duration stretching. And you could, people, you know, especially in strength conditioning can say, well, that’s a waste of time.

Just do dynamic stretching and PNF. But like, there’s probably a reason why, you know, dancers spend a lot of time static stretching, and until a strength coach is hitting their range, the range of motion as a dancer by just doing, you know, contract, relax and dynamic stretching. We need to kind of keep our egos in check because, you know, we can, we can make athletes worse.

And a lot of times like, we need to look at what athletes are doing in their sport that makes them successful. And there’s a reason why like distance runners aren’t just doing intervals. Why? If you look at like the training journals of even even runners who are more high intensity biased, their most of their work, like 70% or more is typically done at what we would consider a lower intensity.

Trevor: [00:13:12] Right.

Greg: [00:13:15] Great answer. That made me think of like some of this time motion analysis you see with like how far I think of the lacrosse player that you had done the postop rehab for and you programmed for and you wrote a case study about. And, and just like keeping it real and like what are they doing in their sport?
And we actually know because there’s all these people that are studying how many accelerations they’re having, how much are they reaching a top speed, and then the total mileage. And it’s like, okay, we know all this stuff so like who cares if it’s aerobic, anaerobic, whatever. Just make them be able to do those things and just keep it real.

Doug: [00:13:48] Yeah, because to your point, I mean, I’m not like doing blood gas and pulmonary analyses on people to know that when I’m working with them that it’s aerobic or anaerobic. I don’t, I don’t really think that it matters, but I mean, you could substitute low and lower intensity, higher intensity, like glycolytic work is basically like moderate intensity work.

Aerobic work is lower intensity work and then your higher intensity work is like more of your sprinting. So a lot of the models are kind of saying the same thing, but just use different, different words. So as long as we kind of, and Steve Magnes talks about this as long as we like see the commonalities between the models, it allows us to be less dogmatic about what we’re doing.

But you know, to be clear, to answer the question, like if you’re doing an endurance type sport where I would say like anything where your outputs have to last longer than like 60 seconds. You need to do aerobic work or you don’t need to, but if you want to be, I think as prepared as you can be, you should be doing a good deal of aerobic work, a lower intensity work.

Greg: [00:14:43] You see so many runners in the city. Are you finding like, are there certain distances, like let’s say a runner wants to run a marathon versus a half marathon, are you finding like commonalities for different runners on like the amount of mileage that they should be doing or what you might recommend or find yourself recommending like for per week?  How many miles?

Doug: [00:15:04] Well, it’s funny because the person that asked the question, like his training history was doing a lot more like, you know, like, like lifting for endurance, like higher rep lifting work, circuit type training, and then like low, like high intensity or higher intensity intervals, kind of like HIIT training.

So for him, we always talk about, even when it comes to like movement. Like we’re just getting people what they need and what they don’t have. And we’re trying to find like what have you neglected in your training to make yourself kind of a, a complete athlete? Complete again being relative to your goal.

So for this athlete, like he wasn’t doing really any aerobic work, so that’s what he needs because he’s neglected it. But for a lot of the other runners that I work with, they don’t do any higher intensity work. Like all they do is like, they just run like five miles a day every day the same route.

They don’t really try to manipulate their pacing. It’s kinda like the people you see at the gym where their workout is to like read the newspaper and go on the elliptical for an hour and like, that’s not bad. Right? Like if your goal is just to like kind of be healthy and avert disease, like that might be good enough.

But if your goal is to improve, you have to constantly be tinkering with something to get your body out of homeostasis. So for a lot of like the runners, the recreational runners I work with. And the clinical practice for them, they need to do more higher intensity work because they’re like, well, I haven’t improved my 5k time in five years.

It’s because you haven’t asked your body to ever run faster than what your goal is. So if you’re not running your, your goal pace, even at a like a shorter distance, you can’t expect to magically be able to take that goal pace and then expand it for a 5K or a 10K. So I think it depends on like what people aren’t doing.
I think most recreational runners tend to overdo it with the, with the mileage, but like the elite runners, they tend to have it figured out, like they’re doing both.

Greg: [00:16:50] typically find that you’re trying to reduce mileage with most of the people that you come in contact with. You know, being coached by somebody and have a program for them, it’s just like, Oh, I’m just going to go run because that’s what I do.

Doug: [00:17:02] Yeah. And it’s not even that they’re necessarily running like too many miles. It’s that, look, you’re running six days a week. It’s not that I can, I want you to like run five less miles a week or whatever, because if they’re not getting injured, I don’t really care. But it’s like, let’s just one or two days a week replace…
You know, just a longer run with something that we’re emphasizing speed for a shorter volume. So that again, cause you want to build the bandwidth. Like a lot of people say, okay I’m going to run a 5k so that it’s run three miles a day. That specificity works to a point. But there’s a reason why, you know, the best runners in the world aren’t just doing like doing meets three days a week.

They’re trying to support their specific distance on the front end of the, in the back end. And then depending on where they are on the season, they might kind of expand. Or, contract that bandwidth. But you need some bandwidth to support the specific work you’re doing. And a lot of the recreational runners aren’t, in my opinion, supporting the bandwidth on the higher intensity end enough.

Greg: [00:18:02]Nice. Think you that one up. That was nice.

Trevor: [00:18:03] Great answer. Douglas,

Greg: [00:18:07]what else do we have here? So that answered. Let’s see. A nutrition’s role in rehab. Just a general topic to talk about. Trevor, you want to take that?

Trevor: [00:18:20] I mean, I would say like this is definitely not our area of expertise, just as like simple guidelines.

Like I think, you know, in terms of healing from an injury, like your body has to have enough energy to be able to heal itself. And if you’re in a calorie deficit, when you’re, when you’re really trying to recover from even just training in general, like your recovery is going to be slower, you’re not going to heal as well, especially in terms of like just having a surgery.

So you’ve got to make sure that you’re eating enough. Yeah. Calories in general. But yeah, like I would say like we’re, we plan on having some actual nutrition experts on at some point in time to really kind of delve more into this advocate’s definitely a huge part of, of the rehab process and can make the rehab process a lot smoother.

If you really have, have good nutrition. But I would say like, as a general rule of thumb, it’s, you know, making sure that you are eating enough calories, enough fats, enough proteins, enough carbs to make sure that your body can actually have enough energy to fuel itself.

Greg: [00:19:12] And I remember, I mean, I know a lot of, a lot of times we’re working with high school athletes when we’re in New Jersey. When you’re in New York, it’s a little different, but it seems like a lot of the high school athletes that we see don’t actually really understand like how much they’re supposed to be eating and they’re not, they don’t realize that. Or maybe they know that they need to be eating more and they need more of whatever macronutrient.

But they just don’t actually realize how difficult it is to be eating the amount that they should be, where like, they might not be skipping breakfast every day just because they’re too tired to, you know, make it happen or, or whatever. So, yeah, I mean, that’s something that I always find is like, it’s, it’s hard to make the gains that we want either, especially in rehab, but even in like performance training with the other athletes that are in the gym.

It’s like this constant conversation of making sure that they’re eating something because they can have a good week, but then, you know, it’s easy to get out of that habit for sure.

Trevor: [00:20:05] Well, and how many of those high school athletes do we hear talk about how they’re like, they’re not getting stronger right now, or they are, it’s like they’re plateaued and it’s like, but I’m eating so much.

It’s like, okay, what’d you have for breakfast? I had four bowls of cereal. It’s like, okay, they may be calorically a lot of calories, but it’s not a lot of protein. It’s, it’s almost zero protein, so they’re just getting a ton of carbs without really getting any protein or anything else in their diet. I think like just, just that kind of thing alone, it’s like what people think they’re eating and what they’re actually giving themselves are often two very different things.

Greg: [00:20:37] And I’ve seen that recently with like a one patient that had an ACL surgery. You know, at this point, probably almost over maybe a year, maybe a little less than a year at this point. Like the goal is a lot of rehab is like you got to build your muscle. Like that thing is just dead and we got to build some muscle and get stronger.

And if you’re not eating breakfast or you’re eating just cereal, it’s probably not very helpful. So there’s a lot of like very simple things that we recommend. Like most people aren’t ready for all the detail that I’m sure like you’ve gone into with your coach, you know? But yeah, it’s always just smaller recommendations.
So, yeah, it’s a big role in rehab. I guess it’s the, to answer some of the questions. It’s very important. Yeah. Eat a lot of calories and enough to recover.

Doug: [00:21:48] And just to kind of add to that, I mean, with any of these like performance-based profession, there’s always going to be overlap. So like how do you go to a nutritionist and not talk about exercise?
I think it comes down to obviously like scope of practice, legalities and then like, what are you actually comfortable talking about? Like what are you educated about? So if somebody comes to me and asks a question about nutrition, I kind of look at it more of a screen. Like I want to make sure that I’m ruling out a red flag.

They’re not doing something to make themselves unhealthy. Like from a rehab standpoint, I think the biggest thing we’re looking for is, are people like getting enough calories. Cause I work with like even a lot of, like endurance athletes and some of whom like are on the continuum of disordered eating.

And this is like males and females. So if I think like that’s something that I’m identifying, that’s, you know, probably a strong chance it’s going to interfere with their recovery from an injury. And then like with a high school athlete, it’s like are you eating enough? But I’m not talking about like magic ratios, like this percentage carbs and this protein, but if you’re saying that you want to put on muscle and you’re eating like a thousand calories a day, you’re not going to put on muscle no matter how much you lift.

But I wouldn’t be comfortable if somebody was like 8% body fat and they were like, how do I manipulate my nutrition to get down to 6% I just don’t have the expertise in that and I don’t think it would be fair of me to try to speculate, nor am I trying to like resolve someone’s medical pathology. I think the biggest thing is.
I want to make sure that like nutrition is not the low hanging fruit. Like is there like a health issue? Cause if someone’s like healthy enough, I mean there are great athletes who eat McDonald’s five, five meals a day. So it’s like how much it actually matters from like a pure performance standpoint.

I don’t know. But I think that there is a point where like if you’re not eating enough. You know, it can cause health problems or if you’re eating too much, right? Like the extremes are really easy to, to identify. So I’m trying to like, identify extremes and if I identify an extreme, I’m not going to be the one to tell them how to change it.

But that’s what I would refer out to another provider. So it’s like, where can we identify an extreme when it comes to eating? But if it’s a really specific thing, like, you know, even like, let’s say an endurance athlete who’s like, how do I do my in race nutrition for an ultra marathon? I’m not the person to be to be doing that.
That’s Robert. I would refer out. So like performance versus health, I think is a big, a big thing when it comes to nutrition in the context of physical therapy.

Greg: [00:23:45] Yep. Cool. I want to do one more question before we talk about that one topic that we want to talk about.   So let’s talk about here, this question, soft versus stiff landing.

So what are, what are the indications and benefits of doing each type of landing? So I’m assuming with jumps, maybe postop, maybe not. It doesn’t really matter. Let’s just talk all about that. So soft versus stiff landing. So for me, it’s the ability to absorb force and then recreate it, right? So if you have a soft landing or absorbing your force and you’re giving yourself more time to absorb that force, loading your tissues probably and your joints a little bit more versus a stiff landing where you want to be bouncy and be more elastic.

Talk more about that. Trevor, you’re doing a lot of, you’ve done so much with changes direction, and that sort of delves into,

Trevor: [00:24:43] I think what you just said is exactly like the most important part with just considering kind of how to, why either one would be an important, and it’s like the forced time principle. You know, we can only produce force, like in terms of how much we’re interacting with the ground. So like you just said, if I’m lending really soft and giving myself a ton of time to absorb for, so I have a much smaller impulse to deal with versus if I land really sharp and I have a really like a relatively shorter ground contact time, I have more force to absorb rapidly, which is just harder to do overall and kind of need more strength for.

So initially I want to start somebody with more, you know, quote unquote softer landings where not the whole like land like a cat, don’t let me hear anything. But I want to give them time to develop their rate of force development and, and control the motion a lot more than having them try to do something really quickly or they’re probably just not strong enough and can’t handle that amount of force yet.

So we, again, we want to progress to a harder kind of landing and I don’t even think hard, like stomping your feet. It’s just kind of being sudden and being quick, learning how to generate tension really fast. So the, sounds somebody’s foot makes definitely kind of tells me what’s going on. And like one of the athletes I’m dealing with right now, is a few months after their ACL injury.

And you can just see the difference when we do skips in terms of how one foot hits the ground hard and that’s the one that is a non-injured extremity versus the one that hit the ground a little bit softer, which is their injured extremity. You see, you know, just in terms of how the foot contacts, they try to land differently on the leg that has an injury cause they’re trying to give themselves more time to absorb force.

So again, that’s the kind of difference between a soft and a stiff landing is just how much force are we having to deal with in a certain amount of time? We have, the easier it is to deal with that. For us, we’re essentially, by the softer ground contact or the, or the longer time, we’re giving them a longer runway to decelerate.

So if I’m jumping from a 12 inch box and I, and I have a soft contact, I’m giving myself a lot of time to absorb the force of fall into a 12 inch box versus if I hit the ground in a stiffer, kind of quicker tension position, I have to generate that force a lot quicker to stop my body. So again, that’s the kind of difference is just how much time am I giving myself to absorb and generate for us?
Doug: [00:26:53] Yeah. And I think it depends on what the goal is to, right. I think that if you look at someone who’s like characteristically a stiff lander and it’s very, very bouncy, they tend to be the people that we look at and say, these are the better athletes, right? Because, they have that gift of whether it’s like long tendon, short muscle bellies, where they just don’t spend a lot of time on the ground and a lot of sports that come down to speed.
You know, if you can produce force in a shorter amount of time, you tend to be able to create space and evade your opponent. But also like from a rehab standpoint, that’s where people are more at risk for injury. A lot of times the people that are like, quote unquote twitchier, and we talked to Lee Taft about this last week on that one call where we were like, you know, obviously there’s no way to look at an athlete and know who’s more at risk for injury because people have different strategies, but the people that tend to have these stiffer, more explosive landings where they reverse force more quickly, they tend to have a more like
joint centric versus a muscle centric strategy of changing direction and they’re probably more at risk for catastrophic injury, but they’re also faster. So the people, a lot of times with people that aren’t explosive are the ones that oftentimes aren’t as likely to hurt themselves because they’re not strong enough or fast enough to do it.

There’s obviously exceptions to that, but then it depends on the sport too, because if you look at it like Barry Sanders, right? Like, yes, he was explosive and twitchy to a degree, but he was also very, very powerful and like he could just stop on a dime using oftentimes a muscular strategy, where his knee and his hip would go into quite a bit of flexion because he’s accelerating and then all of a sudden stopping and stopping to kind of create enough time to evade an opponent and come up with a new strategy to, to get down the field. So and, and, and like linear sprinting for example, or like track and field and jumps you probably want someone who’s going to be a little more like, just purely springy and stiff. But in a, in a sport like football or a field sport, you probably want a little bit of a combination of both because I think in, in Trevor, you know more about this than I do, but like to change direction, you have to be able to, to load to explode. And if you’re just stiff all the time, you don’t give yourself enough time to bend, it can be hard to produce the right angles to change direction outside the sagittal plane.

Trevor: [00:29:07] Yeah. You know your example, Barry Sanders, and there’s a difference between like those kind of taller, longer athletes that are using relatively stiff straighter limbs to change direction versus somebody like Barry Sanders who, you know, call them like a Squatty body, but can, can actually flex at their ankles, knees, and hips to be able to get appropriate plant angles.

So they’re using, I would say like a concentric muscular strategy to change direction versus this kind of like stiff limb lock on all my joints. I’m trying to create static, muscular tension to be able to propel myself in the opposite direction. And like, like we were talking about with Lee, those are the people that they’re relying on, like passive restraints, like tendons and ligaments, and bone contact, more so than, than, you know, kind of more active stability and muscular tension.

And I think, you know, going back to the stiff landing thing, and we were talking about Barry Sanders and like the flexion angles that he gets when he changes direction. Like, when we see somebody… If I were to jump off of that 12 inch box, I can still land soft with my legs straight and I’m just absorbing force in my knees or my ankles or whatever joint I’m kind of biasing versus if I land soft, but I’m letting myself like hit the ground and then I’m flexing on my ankles, knees and hips.

I just use kind of two soft landings that have very different outcomes and different, different muscular, outcomes basically. So I’m using either like a really joint centric approach with that stiff landing or I’m going use muscular tension, but I’m still giving myself time to develop muscular tension by having a softer landing versus if I’m landing kind of like in a squat and I stick it right away where I’m not or once I touch the ground, I don’t move versus when I touch the ground, I give myself time to yield and develop for. So again, like, like you said, they’ll get just kind of why do we want one versus the other? And I think from a return to sport standpoint, like we want to start with the easier one first, which is a softer landing and eventually start progressing to harder landings that again, fit their demands and they’re going to be happy.

Greg: [00:31:03] And you brought up before with your, patient with the ACL that you’re working with now. It’s like more of a fresh, postop case right now. And you mentioned how she was more, wait, what did you say? You said she was more stiff on her surgical side. Right?

Trevor: [00:31:19] So kind of interesting.

Greg: [00:31:21] I can see it both ways. I have seen it both ways.

Trevor: [00:31:24] So there’s two things that we’ve been kind of see what, so we do, you know, as we’re getting back into our, like our running progression, I want see people like hop and skip a ton before we start to get back to actual running. Where are you have single limb support versus bought double limbs for it with a double leg hop or skipping, which is more like one and a half. So when we do double leg hopping, she yields on her nonsurgical leg cause she let herself absorb more versus when she’s uncomfortable loading her surgical leg, she kind of locks her knee.

Doug: [00:31:52] Right.

Trevor: [00:31:52] Versus when we do skipping, when she skips, she’s able to put down the nonsurgical leg a little bit more forcefully and abruptly. And then when she puts on her surgical leg, she puts on her toe a little bit more first. If she’s just giving yourself time to absorb force, because that’s the difference between having two feet on the ground where I can kind of save myself with my opposite side, or am I having to use my involved limb a lot more where I have to now give myself time to be able to dampen it.

Greg: [00:32:18] So it’s interesting both ways.

Trevor: [00:32:20] Yeah. And again, that just depends on the context and the person in general. So it’s just interesting kind of seeing those things, like what’s their strategy? And like we use our force plates in Jersey and you know, I’ve seen people with similar cases to this, case that we’re talking about where if we do an isometric mid-thigh just to see where they comfortable kind of generating force intention right now, and it shows which legs or so your left leg, left leg versus your right leg. So if somebody has a right leg injury when they do a mid thigh pull, we may think that the left leg will show more force, but it’s the right leg that shows that’s being the dominant force because they’re letting that leg serve as the break.

So they’re not exceeding what their force potential is with their opposite side. They’re using their involved limb as a break to cap wherever they are.  So, so it just kind of interesting to see like the strategies that people use. Cause some people you do see the opposite where they’re like, okay, this like hurts.

I’m just not gonna use it, but I’ll go hard on my other one versus alright, this like hurts. This is going to slow me down. I’m going to ride. Like I said, let let that be my governor and that’s going to be how much force I can actually have.

Doug: [00:33:28] Yeah. I think this also kind of like is very similar to the question about the aerobic system where you need to have bandwidth.

So depending on what kind of an athlete you are, if you just train the stiffness end of things and the force side of things and the sport’s going to dictate like how big or small that bandwidth is. But you always, you know, we hear about like the explosive strength deficit and like, you know, like where the counter movement vertical jump versus the non counter movement.

I kind of look at, look at it like, is it if you had a really, let’s say like stiff, springy athlete, like you don’t want to take that away from them. Cause that’s how, that’s usually what makes them good and better than everybody else. So you’re not going to like stop training that, but you’re just going to do enough strength works.
So that’s not like such a weak link that it can be exploited. So ultimately, like you’re, you know, you’re going to train plyos and you’re going to train strength, regardless. I think that as long as you’re exposing people to those things, like the things that need to shake out are going to shake out.

That’s why I don’t get as like, I don’t know about you guys as crazy about, well we have to find like this magic ratio between counter movement jump and non counter movement. Because a lot of times like the people that have, the really bad non counter movement jumps, they’re the best athletes anyway.

So are we going to, are we going to make them like more quote unquote explosive by, having them like do, do like squats or weight room work or is the weight room work really serving more as just, it gives them more muscular support so that like when they do hit an angle, they’re not used to hitting, maybe they’re not as at risk for injury because they’re not going to impinge all the way or get to end range.

I just think that like if you’re a field sport athlete, you need strength work and you need explosive work and it kind of, the sport itself kind of shakes it out, but I don’t know if there’s any magic ratio as far as that goes. Do you guys have any thoughts on that?

Trevor: [00:35:06] I would definitely

Greg: [00:35:08] you said it perfectly.
We’re doing everything with everybody essentially, and then just sort of prioritizing what maybe what they don’t have because of an injury or if they don’t have an injury, then I still like what they don’t have that they need for their sport, just whatever their goal is.

Trevor: [00:35:23] Like somebody who’s super springy, like.

They should still be able to like have a decent squat and be able to reach decent depth. And if they can’t, then it’s like, that’s probably a big red flag. And or could be a possibly a red flag for just what they have to be able to do on the court or on the field. So it’s like, I want to just spend more time, like we always talk about just giving them what they don’t have.

And same thing, somebody who has great mobility, like yeah, I want to stiffen them up a little bit cause they’re probably not good at transferring force.

Greg: [00:35:50] If you can dunk, you should probably be able to squat like that’s safe to say. And we’re just trying to get people over that range and bandwidth and

Doug: [00:36:00] like, we’re not talking about squatting 400 pounds, like we’ve literally said, who could like three 60 dunk?

But then when you ask them to like goblet squat like you know, a quarter of their body weight, like they can barely do it. So we’re just looking to like, again, avoid, avoid extremes. Same thing with someone who’s like, you know, who can squat 400 pounds. Like if they can’t do a depth, jump onto a 12 inch box that’s spending five seconds on the ground.

Like, that’s, that’s a problem too. So, and Greg, you see this with baseball where I’ve seen people who can throw 90 miles an hour, but like they literally can’t hold themselves in quarter pad without like, you know, their scaps popping up in the air. So it’s not like we’re not going to make somebody worse by having them do that.
We’re trying to achieve. We’re trying to make people, human beings before, like athletes. I don’t know if what we do makes people like quote unquote more athletic. I think we’re just giving them the raw materials to display whatever gifts they have so that they can self organize in a way that they see fit.

But if they’re missing pieces of that, then it’s really hard to self-organize. So that’s why, I mean, I don’t, I don’t really know if somebody is like sport changes, how I prepare somebody necessarily because everyone’s kind of ordering from the same menu, but it’s just maybe they use different proportions of different things, but it’s not like,

Trevor: [00:37:11] yeah, I think that like that last point that I like.
It just changes how much of it we’re doing. It’s like then you would spend more time in deeper positions with somebody if they really suck at that versus somebody who’s not springy, where spend more time trying to get short ground contact times and really get them to develop tension quickly. It’s always the same stuff.
It’s just the proportions change.

Doug: [00:37:30] Sure.

Greg: [00:37:30] It’s like we’re trying to make them better at what their sport doesn’t really require of them while also making them better at what their sport does require of them. Yeah. Both of them. We can talk in circles about this. It’s on both ends and we’re trying to.

Doug: [00:37:44] Yeah, no, but there’s a school of thought like, do you, do you try to take what like, especially at the elite level, like take what makes somebody really good and give them more of it or work on a weakness. I think that like if we’re talking about very specific, like on the field stuff, maybe you don’t try to work on somebody’s weaknesses as much because then you’re, then you’re like, you’re taking something away.
But in the weight room, like if you work on someone’s weakness, are you going to make them worse in the field? Like I don’t think that we make that much of a difference necessarily one way or the other. So I’ve been at that. It’s tricky because you can really justify either way. Like, right? You know, somebody who’s got a 40 inch vertical leap, like if you do.

You know, if you emphasize like, low ground contact time work, are you really going to make them? Are you going to add a lot of, you know, inches to someone’s vertical leap who can jump 40 inches? But at the same time you can make a case that like how much better are you going to make them if you do a ton of weight room work?

So I think you’re going to do both no matter what and then just hope that it shakes free and admittedly, like I don’t, I don’t have a great answer for how much of each you should do. It’s really just like a lot of guesswork and exposing people to a bunch of different things. We have a reasonable bandwidth relative to their sport and then hoping that they work it out on the field.  You know.

Greg: [00:38:53] Right? Yeah. All of this was one answer to one question about soft vs. stiff landing. So that’s awesome that we get these questions and just good question. Keep going with it. All right. So last thing you want to talk about, Trevor and I had a, just kind of had a discussion yesterday about a patient he saw and we were going to be talking about execution essentially.

Where we might see somebody who is doing some PR, they have an exercise list or they have a program that they’re given by somebody else. And we might give somebody the same exact program. It might be the same exact exercise lists like sets and reps, whatever it is, who cares? But the execution of each of those items on the list is what we are finding can be a big sort of determination in how people wind up doing either in their rehab or with deal with pain or performance doesn’t really matter. So you want to just talk about that a little bit and maybe try to, you can bring up more about the example from yesterday.

Trevor: [00:39:51] We were just talking, you know, so somebody, came in with just a general, you know, aches and pains kind of a thing.  And, and told me about where they feel those aches and pains when they’re training and all that good stuff. I did my assessment like we always do, and then gave them some correctives or whatever you want to call our movement prep to be able to deal with some of those, you know, mobility limitations that they had.

And like, almost the answer to every single one that I showed them was like Oh, I’ve done this before or I’m already doing something like this. But then, you know, we make these little bit of tweaks, like a modified pigeon stretch. They were doing a modified pigeon, but it’s like, all right, let that opposite hip rotate down towards the table.

And they’re like, Oh my gosh, it feels completely different. And there’s just so many little things I think we do from a clinical experience standpoint that gives us the insight into the, those little cues that we give our clients that really make the biggest bang for your buck with all the different exercises that we choose.

I think that’s one of the reasons why, we like to keep things very simple, but those simple things can be very effective if they’re executed really, really well, because I’m sure you guys, about to you, you’ve had somebody come in who was like, oh, I’m doing a couch stretch. I was like, okay, show me your couch stretch, and it’s their backs arched and their heads look in their eyes looking at the ceiling and they’re, their chest is six inches in front of their butt, and then we get them into a different position and it completely changes what they experienced and what they feel with the movement.

I just think that that value of making sure we’re doing the basics extremely well. Doing the basics of savagely well really makes such a huge difference, and it can save people so much time, rather than giving them 35 more exercises that are trying to do the exact same thing.

Greg: [00:41:22] Yeah. And it’s not always the person that they’ve seen.

It’s always like that person’s fault necessarily, because they might have shown it the same way that we would have shown it to the, to the patient or the client. And then there’s like a lost in translation there where once the client leaves or patient leaves and they go home, then when they execute it, they’re missing all the details because they’re not with somebody.

So it’s not the clinician’s fault necessarily could or could not be, but it could also be, you know, keeping things as simple as possible. Like almost like I try and find like, what is my one goal with this one thing that I want to do? So the couch stretch, like I want to stretch the anterior thigh. Like if that’s the one goal, like I’m not going to care about anything else and I’m going to try and give them person like one cue or like one thing for them to remember and like have them tell me like, what do you think has helped you feel this stretched the most?
And that’s what I’m going to type in that email that I sent to them because that’s probably what’s going to make it stick or make it more easy for them to replicate it. And then, you know, obviously besides the videos that we send people to, but.

Doug: [00:42:20] Yeah. Yeah. And that’s, you know, cause we can go off on tangents with like all this stuff.
And I think what this really comes down to with the execution piece, like, especially in physical therapy now, there’s like, everything’s like, you know, tribalistic and in two camps you’ve got like kind of the, the biomechanical camp where it’s like, everything has to be quote unquote, perfect. And then you’ve got kind of the just load at camp where it’s like, look, the execution doesn’t matter.

And I’m using the extremes to make a point. I’m not saying that everyone’s like this, but with just load it, the idea is like, look, it’s all about low tolerance. The execution doesn’t matter as much as developing a tolerance for a position and then just gradually building up that tolerance. But I think that like regardless of what you’re doing, there needs to be an intent behind it.

So even if your intent might not be necessarily pain reduction, right? Because pain, pain is a complex phenomenon, but it could be an, at least for my evaluation, I think we kind of treat similarly like I’m giving somebody something to do because during the evaluation, there was something that I thought was important that they didn’t have, whether it was for pain reduction or performance.

So it’s like if you are missing a ton of hip extension and you play a sport that requires hip extension, whether you heard or not, I want you to have that, because also like you’re a human being and you should have some amount of hip extension. You know, we’re looking for the extremes and a lot of really good athletes often test extreme in a not great way, whether they have pain or not.

So if we’re having somebody do a movement and the goal is to, promote hip extension, if they’re doing it, but they’re not actually actually extending their hip, they’re just going through the motions, then like we’re not, we’re not saying to be judgemental, like, Oh, you’re moving poorly. It’s like. No, we have an intent behind what we’re doing.

So to me, the execution always matters because you should have an intent, even if the intent is just the ability to tolerate load, like all right, well, depending on where you like the position you put somebody in that’s going to determine where the force goes. So like where are you trying to develop the ability to tolerate load?
What part of the body, what joint are you trying to buy us? Because the execution dictates where that force is going to go. So even if you’re in like the just load it camp, there should be an intent and intent behind what you’re doing. And that intention dictate the manner in which you teach the movement and the execution.
So I think execution is always very important. It might not be popular to say that now, because people can think of it as judgmental. It’s not judgmental. It’s like we’re trying to be purpose and intent driven, and if we don’t exercise execution, then what’s really our role as like movement professionals.
It’s kind of my opinion on it.

Greg: [00:44:47] Yeah, and I mean, I’m just now remembering a patient from yesterday who said she likes to do deadlifts at home and with her exercise program when she’s back at the gym. I’m just like, okay, let’s go over.. here’s the kettlebell. Like show me how you show me how you deadlift.

And it, it’s almost like two people, like if the same exact exercise and they’re just completely different things because of how the patient does them. So it’s more about like the details of, of how it’s done. We probably care more about than like what someone’s actually doing. Like you could squat or deadlift.
I could care less, but you better do it like really well.

We’re loading, we’re loading your lower body. We don’t, I think we would all agree, we don’t care too much about like quad versus hamstring dominance or glute dominance or whatever. It’s just like we want to load the lower body, like pick a dead lift or squat, but they should be done.
It should be done really well and that doesn’t really matter.

Trevor: [00:45:37] Well, so like I liked your point about like intent Doug. Cause I think, I think we would all say like, there’s really, we don’t believe in like a bad movement. Like, like I’m just like, this exercise is bad. Like a squat is not bad. Maybe how you’re doing it isn’t the best for you at this moment in time or whatever kind of rationale.

But it just about having that sort of intent behind the execution, like the, the dip thing that we talked about last week. Like we don’t really give a lot of people dip just for the sake of giving people dips. But if we do have. Like, you know, somebody who’s getting like a wrestler who’s going to get their shoulders and really crazy funky positions, like they gotta be able to control those positions and they should be strong there.
So that’s a case where we would give somebody that exercise for a certain reason, but that doesn’t mean that we don’t care how that dip looks. We still want to have that dip done with really, really good execution and just high quality movement that meets, you know, the standard of what a good dip looks like, whatever that is to the coach.

Doug: [00:46:27] Yeah. I think you have to allow for some idiosyncrasies with movement, like people are going to have their own signature. But I think as the provider, you have to have some standards, you know, and that the standards allow for some flexibility. But like, why are you doing what you’re doing? Even with going back to the intent thing, like people do like Jefferson curls, and there was a movement where people were like, physios were just saying, Oh, just everyone should do Jefferson curls just to prove that, like you can do it and not herniate a disc. But like, is that a good reason? Like are you doing something just to prove that it’s not bad or is there an attempt behind it? Like if you’re working with like a wrestler, let’s say you have to, you know, like throw somebody from like these disadvantaged positions and that exercise might make sense.

But like there’s a reason why like a power lifter who is like, their goal is to lift as much weight as possible and competition, even if they’re like lumbar spine visibly moves under load in their setup, they’re not trying to get their spine to end range. It might be, it might happen during the setup because they’re working at a maximum load, but no one is like deliberately saying that deadlifts over like 500 pounds.

Like, yeah, like let’s take your lumbar spine to end range and then rip it off the floor. So it always comes down to intent. And if your goal, like with the Jefferson curl is like, you actually want to bias the erectors, then like, then go ahead and do it. But if you’re doing it just because you’re trying to like, you know, be like a contrarian and oppose this like movement perfection thing.

We don’t get wrapped up in these like you should do it this way or that way. It’s like what’s the person’s goal? And everything else has kind of politics and kind of almost a waste of time, in my opinion.

Greg: [00:48:01] Yeah. Awesome. Well, I think that’s enough for, for this one.  You guys have anything, else? I think that was really good. I think we had some good questions and I’m looking forward to doing more of these. This is, this is good. Keep them coming.

Trevor: [00:48:15] Thanks, everybody.

Doug: [00:48:16] Thank you. Keep it real!

 

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E38 | Return of the Resilient Performance Podcast


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Welcome back to the Resilient Performance Podcast! Today, we wanted to introduce some of the changes that will be taking place on the podcast. Historically, we have interviewed people from a variety of fields.  We do this to try and make the themes a little more global and while we don’t want to change this, we still want this podcast and the content to transcend what we’re doing as sports rehabilitation performance professionals.

We’re going to increase the podcast releases to a more weekly format where we have more of an informal educational platform where we have round table discussions, present our own case studies, and even talk about things that we are working on with our athletes.

I would also like to introduce my partners and contributors to the podcast, Trevor Rappa, and Greg Spatz. We appreciate you taking the time to listen and we ask that you stay involved, ask questions, and leave a review on iTunes!

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Resilient’s YouTube Channel – http://youtube.resilientperformance.com/

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Episode Transcription:

Doug: [00:00:00] All right, welcome to the Resilient Performance Podcast. This is Doug Kechijian here. I just wanted to introduce some changes that we’re going to be making for the upcoming season. Historically we’ve interviewed people from a variety of fields, not just in sports rehabilitation and sports performance, to try and make the themes a little bit more global.
And while we don’t want to change that, we still want this to this podcast and the content to transcend what we’re doing as a sports rehabilitation performance professionals. We’ve also gotten much feedback from people saying that they would like a little bit more of the micro-level stuff. So how do we apply some of this information?

What do we do when we work with athletes? Because it’s great to have a bunch of abstract ideas and theories, but how do we make that actionable. So while we still want this to be kind of a broad podcast where people from a variety of disciplines and fields can get some useful information, we’re going to increase the frequency with which we release episodes so that we still want to have the traditional, you know, question and guess format, where it’s going to be a little more global.
But we want to release the podcast on a more weekly basis so that in the weeks where we don’t have a guest in a more traditional—podcast format. We want to have more of an informal educational platform where we talk with, you know, have round table discussions, present our case studies, and even just things that we’re kind of working on and just to try to tease out how to make our athletes better.

And again, just try to provide like an informal educational platform where people will get the big picture ideas, but also how to apply some of that information. So with that, I’ll, I’ll introduce my partners, Greg spats and Trevor wrapper and let them kind of introduce what it is that they’re going to be contributing to the podcast.

So I guess we’ll start with Trevor.

Trevor: [00:02:10] Yeah, I’m Trevor Rappa, and you know, I think one of the reasons we wanted to change up the format a little bit is because of the benefit that we had with our clinical and being with somebody whom we can kind of always ask questions through and get an idea of, of what they’re doing on a day to day basis.

I helped offer to learn. So as much as we love theory and we love learning more about this kind of global concept, ultimately, what makes somebody successful as a practitioner is what they do on a day to day basis with their actual clients. So that’s kind of, we wanted to go a little bit more in that route of having discussions between the three of us.

Like Doug, it was said about patients that we see but also got on other professionals, coaches and clinicians, to actually kind of go through case studies and talk about things that they do. Because we’ve always tried to be as authentic and as transparent as we can be. Because I think that’s one of the best ways to learn is to see what you’re doing on a day to day basis.

Doug: [00:02:57] Yeah. Then, Greg, you have anything to add about your particular piece and things that you know you want to add, or we’re going to act collectively compared to what we did in the past.

Greg: [00:03:08] No, I mean I think Trevor kind of hit the nail on the head there. We want to add in up a few different types of segments, a few different types of pieces of content where we’re bringing in other people having round table discussions.
And I think the cases are going to be fun to do. Cause I know, like in my head, I’ll do case studies throughout the week, just what do I want to do next? What do I, what did I do that I should have done differently?

Greg: [00:03:28] I think it’s just going to be fun to have it be bounced off of you guys and talk about a patient that’s progressing postop or is more towards a performance end of things. And how do we get them ready for their sport more so than sort of the clinical staff? But, besides case studies, and I think we’re going to bring on a different type of guests to where we’ll bring on other people who are, who are performing, you know, day to day with, with clients, with athletes, and hear about what they do and ask them to bring.

Their case studies, bring their videos of, you know, obviously confidentiality. If that’s needed to be protected, then whatever they have to do. But hopefully, they could bring in some videos to demonstrate things of what they’ve done with their patients or their clients and athletes. And I think that’s probably going to be the best way that we all learn.

Like Jennifer said, and we were able to, you know, have some great clinics, and we’ve learned so much from other professionals just through asking questions and being interested. So, I know we’re welcoming questions from anybody. I think it’s going to be good to have. We might take one question and talk about it for a half-hour.

We don’t know. It could be an entire episode based on one question. So that could be. That could be fun. And then, you know, Doug, you had already mentioned about bringing on PT students and trying to make it more of a, you know, how do the students turn into the clinician progression? I think that’s going to be interesting to do, and I think we have one that’ll probably be lined up soon.
So that’s exciting.

Trevor: [00:04:49] I think another excellent, good point. Sorry. You know, like we’re in a very fortunate situation that we had that there’s three of us and we can always, you know, in like a judgment-free zone, ask each other questions without the kind of being berated. Like, which is what happens when you go online, and you try to ask a question on the, you know, a PT forum.
If you’re kind of do a different methodology than the personal interest, your question, you get ripped apart and shredded. So it kind of creates this fear of not wanting to ask questions, and that’s not what. You know we’re going to be doing with this podcast, and I think getting other clinicians to ask questions about their cases, and just, you can get another opinion.

I’m like, you know, what would you do if somebody is missing XYZ or we want to improve this quality of like, what’s just some of the strategies you would do? I remember, like one of the things he told me that has always stuck with me was like, everything works.

So just because it’s not what we would do. It’s always fun to ask other people, like, what would you do in that situation? Cause their technique would work just as good as ours is or, or vice versa. But it’s just right to be able to have like an actual open dialogue about helping clients not about feeding our ego without how we answer the question.

Doug: [00:05:58] Yeah, a hundred percent and like part of the problems with a lot of the internet platforms is that they don’t allow for discussion. You’re limited with characters, and sometimes even when you read something, you can’t gauge somebody’s tone or demeanor. So we want to make this more interactive and while we kind of has our ideas for.

What content we think is relevant and exciting. We also want the content to be driven by the audience. So to Greg’s point, we’re going to be soliciting questions from listeners and audience members. We’re going to be reaching out to different, you know, organizations, whether it’s like physical therapy programs, strength conditioning staff, and even, you know, sports organizations.
And just like having these conversations with them and letting, letting listeners dictate the content. Because, you know, sometimes like we don’t always ask the right questions and. This is also equally informative for us, where like people are asking questions that we’re not thinking about, and if we don’t have the answer, it forces us to get better too.

So we, you know, I personally, as you guys know, I’m very tech inept, and you know, one of the things that I’ve benefited from over the last six weeks, one of the few things is that you know, you realize that there are platforms that are much more conducive to sharing information with a broader audience, including the one that we’re on now.

Zoom. So, for example, you know, if somebody asks us a question about, Hey, like what would you do with this athlete? Instead of talking through it, which we’re still going to do now, we can screen share, and we can actually like look at athletes and do movement analysis. And so we’re going to offer, you know, the video platform and the audio platform.

And depending on what’s convenient for you, you’ll have access to both. But I think that you know, we want to kind of step things up technologically to just to allow again, for, for just better dialogue all around. So I didn’t, you guys want to add anything to that.

Greg: [00:07:37] I did have something that I wanted to say I forgot to. So engaging. I was just sort of locked into those eyes. No, I can’t think of any.

Doug: [00:07:45] Yeah

Trevor: [00:07:45] yeah, that’s true. We want to make this like as positive of an experience for the, for the listeners and stuff for the viewers as we can. So we want feedback, we want questions, we want to know, like what are the things that, that you guys want to learn?

Cause like Doug said like there are so many times that somebody asks this question or like, you know, patients ask the question, I’m like, I never thought about that. And you got to come up with an answer kind of on the spot. But it’d be nice to be able to kind of spend time, like the look, figuring things out for ourselves because you know, we get better by.

You are getting by answering questions and asking questions ourselves. So, you know, I’m looking forward to just that process of seeing like what is, what are some of the things that other people are thinking about? Because it’s very easy to kind of get stuck in your own lane and not be able to have an idea of kind of what else is going on around you and being more open.

Having dialogue and discussion and asking questions is, is a great way to get better at that.

Greg: [00:08:38] Yeah, that’s what I was going to bring up was, you know, you might get stuck in your little bubble. Like if I’m seeing all these baseball athletes make it stuck in baseball.

Greg: [00:08:47] And I’m just rubbing elbows and I’m just thinking about baseball all the time.
Whereas like, you know, going to you guys who want more football or tennis or whatever sort of military background where you don’t have the, like, you’re not almost like so pigeonholed by baseball itself that you think of something that I don’t, I didn’t think of because I’m so focused on what’s already there, what’s already in baseball versus like, while in track and field I do this.
So have you thought about doing that? And it’s like, no, it’s. Yeah, you absolutely should do that. so I think that’s going to be cool to hear from different people and talking about different things and kind of kind of goes back to what all the episodes Doug’s already done on his own, where you’re asking people from, you know, the music or theater world about how to be excellent at what they do and, and, and how to improve performance, you know, bullying and then also like X’s and O’s wise.
And. you’ve had so many great guests on that, and hopefully we can get some of them to come back and kind of expand on some things. But, I think that kind of, you know, from the macro level down to the micro, I think it’ll be cool to see how it all, all feeds, feeds into each other. And, you know, one person talking about  something in a different field is going to help us, you know, clinically with our patients.

And that’s, I think that’s the focus here. We don’t want to keep things. Esoteric and, and complex or, you know, over overcomplicate things. We want to keep the complexity, make it applicable, change, change, something that’s too, too complex or is over complicated and turn it into something that we can use clinically.

Because everything somebody might talk about, it’s important, but it’s like, okay, how does that change what I do tomorrow with XYZ patient?

Doug: [00:10:22] The more people you talk to from different fields, you more, you realize that everyone’s trying to kind of solve the same problems and certain certain themes emerge.
And we’re going to make a clear delineation between like these are the episodes that are really more for the strength conditioning coach or the sports rehabilitation professional. These are the ones that are a little bit broader so that you know, the, the expectations are clear. But one thing that we’ve gotten feedback on is.

We do kind of these broader podcasts, which we think are still important. Even if we’re talking about like the sports performance world, like everybody thinks that things like load management and graded exposure are important. Or if it’s like desensitization when it comes to treating a pain patient and like these terms, you know, we all accept them as being like, these are legitimate, but no one, you know, especially with a lot of the forums, they’re not conducive to like, well, what does load management actually means?

So I was like in the past, you know, I haven’t asked PE coaches specifically, like, what do you do on. Monday, Tuesday, Wednesday, Thursday, and Friday, we’re going to have episodes where we actually address that. So we get beyond the abstracts. And again, it’s not like we’re not bringing on guests that we’re saying this is the best way of doing something, including what we’re doing.
But I think that the more we expose audience members and even ourselves to different ways of doing things. That’s the only way that we learn. And I think that like the reason that we kind of came around to this format is that our mentors have been really transparent with us. And that’s like the only way to learn, right?

It’s just that apprenticeship model. And now through technology we can connect to a lot more people and have a lot more mentors, and we’re all basically apprentice to that guest that’s on there. And you know, the nice thing about. Running your own podcast is that you can be the gatekeepers. So we’re going to keep things, you know, civilized and cordial.

We’re not gonna allow any trolls. And it’s, I think, Trevor, you made the point that like, we want to be able to ask a question and not get paraded. It can be a lot harder to do that, you know, on Twitter. But that’s not going to be the case here because first of all, we screen our guests. And second of all, if someone’s acting like a jerk, you know, we’re just going to press the mute.

Greg: [00:12:17] first rule of thumb, you have to be a good person, right?

Doug: [00:12:20] there we go. Absolutely. And I think that the reality is like even when you see people arguing on social media. They, most of them are good people and if you’ve got them in the same room, the discussion would be a lot different. It’s just that the platform isn’t always conducive to having a discussion because you don’t often feel the need to defend yourself.

And then when you say something, someone kind of, you know, like kind of champions to the other side and it becomes like, it’s almost like you’re on the playground and you really didn’t mean to get into a fight. But then all these other people are like. You guys should fight, fight, fight, fight, and that kind of spirals out of control.

So, you know, we’re going to be like the, the AIDS in the playground and try to get down to, you know, what are the questions that really matter, but do it in a way where no one’s jumping off the swing set and doing macho man elbows onto somebody else. That’s perfect.

Greg: [00:13:06] That’s right. Yeah. So, and we’re doing this, we’re starting this during this pandemic, right?

So we’ve been sort of locked up for seven weeks or so. getting back into some of the brick and mortar in-person therapy as it’s sort of being regulated, you know, regulations are being removed and we’re able to see people  based on our comfort and their comfort. What are some other things that you guys have done during the pandemic at home that that is new for us, or, you know, is, are things that we want to start, start doing more of.

Trevor: [00:13:37] I mean, I would say like for myself, just by, you know, having such a lightened caseload and is having more time in general, I’ve spent way more time just reading different books and kind of getting back into my own education.

Which is hard to do when you’re, you know, busy like we are in just seeing patients. You kind of a, you know, seeing patients still is, feeds into that staying in your own bubble more because you’re just doing the same thing kind of over and over in terms of seeing patients without. Kind of taking a step back and trying to fill your holes a little bit.

So I’ve done a lot more of, you know, reading some different biomechanics textbooks and things like that. Trying to just improve my understanding of a lot of things that I continually have questions on.

Doug: [00:14:16] Yeah.

Greg: [00:14:17] You’re working on like your own little project to, for like change of direction stuff, hopefully by the end of the year.

Trevor: [00:14:23] Yep. That’s the goal.

Doug: [00:14:26] Yeah. I think like, like forever said, just devouring con ed, which is something that, you know, when you’re doing the. Hours upon hours of patient treatment is much harder to do. And then on top of the documentation of the administrative responsibilities, so between that and you know, like I never before this for, it’s been a long time.

I really had time to actually talk to people. It’s always text messaging and emails and, you know, obviously this is not a replacement for talking to somebody in person, but I’ve actually had a lot more just conversations with people, whether it’s on the phone or even on, like on zoom or Skype. and it’s nice to, to talk to people.

It’s obviously, you forget that. Like, yes, it’s nice to have a very quick and accessible means of communication, but something is lost with that, that efficiency. So a lot more of those kinds of conversations, which is kind of the goal of what we’re trying to do going forward. And then beyond that, you know, working on more big picture stuff as an individual and as a company, right?
So like we’re starting to get into some digital education. We’re working on kind of like an online or digital therapeutic platform. That’s kind of like a triage or a screening filter for physical therapy and musculoskeletal pain. These are things that you just, you can’t do when you’re bogged down with the day to day patient treatment.

So I think, you know, like everybody else, we all struggle with like, we love what we do. We also want to work on bigger picture, broader initiatives, and how do we balance that? And I would say like before. Everything with this coven, we, we’ve been unbalanced from the standpoint of like, we were just totally hyperfocused on patient treatment because it brings income in and it’s hard to walk away from that.

And now we don’t really have a choice but to do other things. And there’s going to be a point pretty soon where we have to go back to the brick and mortar, but at least we’ll have been exposed to both extremes and now we can try to figure out a better, sliding scale or balance for ourselves.  Definitely.

Trevor: [00:16:08] I think that that point of balance is huge. Doug. Sorry, go ahead, Greg.

Greg: [00:16:13] You know, that’s, that’s always been, it’s been really hard for me to balance. I feel like I’m always thinking about stuff that we are doing or could be doing or should be, you know, whatever it is or have done. And I’m like always working or always on as opposed to, you know, making the time to, to do other things or like, you know, we, I’ve been video chatting with like family and friends, like on a weekly basis and it’s like, Oh wow.

This has been here forever and we haven’t done it ever. And you know, I might not see these people for months if, you know, they live in other States and it’s like I’m seeing them every week and it’s not going to be like part of part of life, which is cool. And it definitely sort of, you have to shift gears and, and, go in and out of work mode, which I like.

I need to be better at that for sure. yeah, I mean, in the first like five weeks or four weeks of the pandemic, I was working on our online course and just setting up all the webpages for that and getting all the videos prep for that. And. That was a lot of time and very time consuming. It was almost like I felt like I had to be doing that because I was home and like doing nothing besides that.
and, but I’m glad I did it because that’s like you said, Doug, like we’ve been, we’ve been working on this thing for, I think you, you’re recording your video in 2018 I think in December, I was like two years something we’ve, we’ve had sitting there for a long time and then it was just a matter of like, alright, we gotta get this thing done.  You know, we had all the video recorded and we just needed to have it all actually completely done and put in place for the end user to access it. So that’s been awesome that we released that. We’ve had some pretty good feedback from people, I think, and hopefully we’ll get some more. But’s, that’s our foundations course.

And I don’t know if you guys want to talk about that at all or you don’t have to, but

Doug: [00:17:59] yeah. You know, it’s, it’s the point is like, I don’t even know when that would have gotten finished if this, this pandemic thing hadn’t, hadn’t have happened because, you know, we, we had it on the shelf, but like, the editing was time consuming and you did a lot of the work for that.

You know, we’ve gotten some good feedback from coaches, coaches even, who were mentors. To us that we respect a lot. So I think that it’s applicable to novice coaches and to even higher level coaches because it’s really just like taking the basics and then how do you scale the basics? Cause everything comes down to basics anyway in fundamentals, you know, it’s kind of like pick and roll in basketball, right?

Like that you, if you execute that properly, it’s really hard to stop. And I’ve been in the NBA and like ultimately it’s about creating space and creating match-ups. And there’s only so many ways to do that. And just, but how do you, you know, apply those basics and connect those dots? But I think,

Greg: [00:18:47] yeah, that’d do it.

Doug: [00:18:48] Yeah.

Greg: [00:18:49] It might not be sexy either, which is like a lot of the stuff we do is like 90% of the stuff we do is a lot of the same things in there. They’re quote unquote basic, but they’re more just like foundational things that. Everybody needs to be able to do these things, to do, to, you know, meet, reach their goals.

And it’s like, okay, that’s, that’s where we started with this course is like, this is the foundation and we’re going to have these sort of like bounce off, you know, specialized modules after that. But, definitely like. Mastering these basics are like, I still need to be going through our own course and doing these things for myself.

Trevor: [00:19:23] cause I think everybody talks about, you know, everybody says at least that like, you know, the fundamentals are always key. And yet we’ve got to go back to your fundamentals and always know the basics and stuff, but they’re rarely ever kind of laid out. And. And described in like, what does that actually look like?

And us as coaches and clinicians, it’s like the only thing that we are consistently really, you know, using to assess is our eyes. And I think that’s one of the things that we wanted to show with this course is like, what does that look like? Cause that, that, that’s always a question of mine that I’ve had.

Like ever since I’ve been coaching athletes or, or in PT school it’s like, okay, like this is bad. Well, okay, that’s fine. But like what does that look like? So we try to show what, what is good, you know, quote unquote good cause it’s relative. What does a good squat look like? What does a good dead lift? What does a good split-squat, what’s good pushup is all the basic, basic things that we have to do as humans.

It’s like what does it actually look like? And I think that is ultimately. The foundation of where we have to start either as a coach or as a clinician, is just knowing what are we starting at, what are we looking for? And then we can coach from there.

Greg: [00:20:20] And I never even remember, like as a student thinking man, like all these top notch professionals, they must be doing some of the craziest stuff with their clients that like, I need to go.
Takes years and years of this crazy educational sort of system to actually be able to help anybody at all, and it’s really not that different when you people actually share what they’re doing. It’s like, Oh, that’s okay. Yeah, I can do that too. That was definitely know something that. I know, I know. I learned from Alan.

It’s like, it’s not always some crazy answer. Sometimes people just need to be able to extend their hip a little bit more and then things get better. And you know, that just sort of snowballs into like putting layers onto it. And then, and then when you do get these complex patients, you’ve, you’ve already got the low hanging fruit and it’s like, okay, now I need to dig deeper into other things I’m not currently doing or going to say that.

Doug: [00:21:05] Yeah, and I think that like one of the things that we’re going to be unapologetic about is that we do the same things with a lot of people, and we’re going to bring on guests where you’re going to be like, yeah, these guys are all kind of saying the same thing. And I think that like right now, we live in a time where, you know, we celebrate novelty for the sake of novelty, but like there’s a reason why certain things.

You know, tradition, it doesn’t always mean that something is good, but like there’s a reason why I like the way to develop athletes historically has been like, you do some kind of, you know, strength training. You sprint and you, and you jump, and then it’s like, it’s a recipe, you know, because there’s so many ways to make pizza, but some pizza tastes better than others, even though they’re all using tomato sauce and spices and dough and cheese.

But it’s like, how do you put those pieces together? So those basic building blocks are pretty much the same. it’s just how do you, how do you apply it for the athlete at hand? And, but again, like we’re not trying to be novel for the sake of being novel. But one thing, cause Trevor kind of sparked this when we talking about like what some of these projects are helpful for doing.

I know that like, you know, hosting the first two seasons of the podcast for me, when you have to ask people questions and be prepared and not sound like an idiot online, it forces you to think about things more clearly because you know, you’re, you’re the one asking the questions right? And you, you like.

You can only get so much out of a guest if you’re not prepared. What releasing some of these products has helped me with, and I think I could speak for all you guys, is like sometimes you just get in the habit of treating or doing things and you rely on your intuition. But you know that that can work a lot of the time.

But being able to like the fact that we wrote everything out, like we had, you know, we had movement categories and yes, like they’re arbitrary, but within each category we have progressions of like all these exercises. Cause sometimes I’ll be stumped and I’ll be like, you know, what am I supposed to. Do what this person, and it’s like, mom, just look at the list that I created.
Oh yeah. Like I can do that. But if you don’t have it written out and you don’t have it systematized, now you’re relying on intuition all the time. So like systematizing things has helped us, I think, keep ourselves honest. And you don’t want to be robotic and have to always. You know, rely on like looking at a piece of paper to do something.

But it is helpful because we all, we’re all human and we all kind of just forget stuff and get stumped. So that’s kind of the idea is I think going forward, like we want to systematize everything that we do, not just like the strength training, not just to change the direction work and the speed work and the conditioning, but even what we’re doing as a, as a business and hoping to just share that with, with everybody else really, because we know that if we share, then other people will share it.

It’s going to make us better. So there’s a selfish motive behind it, behind it too. Yeah. I think going  through that writing process and like the creative process and putting your thoughts to paper to the computer really is as like, even if we didn’t release the course, just the process of the three of us kind of going through and creating that process, or sorry, going through the process of creating the course together is, is immensely beneficial.

It’s like even if you’re not creating a product, you’re trying to release anything. Just, you know, kind of having one goal in mind and having questions that you’re trying to answer and actually not just thinking about them, but. Going through the process of creating it and putting it down is, I mean, it’s been so helpful for, for all of us.

Greg: [00:24:08] Definitely.

Doug: [00:24:10] Alright. Well, I think, that’s a pretty good introduction and we want to get going with the, with the guests and the content in future episodes. I mean, before, any parting shots where you guys, before we, wrap it up.

Greg: [00:24:22]I am definitely excited to get people engaged, get some questions, topics, get some, some different people on here. Get groups of people on here to do it all together. And you know, it’d be fun to get some, some friends and just bounce ideas off each other.

Doug: [00:24:35] Yeah. We’re limited by our zoom membership, right?
So whatever we have, or it’s 20 feet, I think that’s where we gotta come to

Greg: [00:24:42] 101 hundred so we can get maybe seven more of you. 97 more. Yeah. We’ll have some links in the show notes too. You know, like to the course. I dunno if, if anybody’s interested in signing up for our mailing list, cause that’s how we usually will like announce things or when we release things, we’ll send an email blast.

Everybody, it’s probably, it’s also on our social media. So it’s like you could pick whichever, whichever route you like to follow people on and hear from them. Cause it’s probably redundant to get on all of them.
Doug: [00:25:12] you’re welcome to if you’d like, we’ll include a link, In all the show notes where people can submit questions specifically for the podcast and it kind of gets consolidated into one place.

And you know, we want that to drive a lot of our content. So the more active the the audience is, the more active we’re going to be. And, you know, bring, bring episodes to everybody. Yeah.

Trevor: [00:25:31] Yeah. I would say ask questions. Please, please, please ask questions. That is exactly what we’re trying to take. The podcast is trying to help the listeners and help ourselves at the same time, but that ultimately starts with us asking questions and whoever’s listening, asking questions too.

So thank you for taking the time to listen.

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Case Study: Hamstring Pull In High School Sprinter

Case Study: Hamstring Pull In Sprinter

There are too many abstract discussions in the performance space these days about how to train and rehabilitate athletes. These circular arguments usually yield nothing substantive or actionable because providers spend too much time defending their ideology and trying to articulate why they are in the right instead of just being transparent and “showing their portfolio”. As an example, investors should demand that financial advisers share their own portfolios instead of pontificating about macroeconomic theory. Words matter but what people do when they have skin in the game reveals more about them than their explanatory justifications for said actions.

The point of these case studies is not to suggest that what we did in any of these situations is particularly good. If we’re being honest, we don’t always have robust outcome measures to suggest that what we do really “works”. More often than not, we default to the eye test. We coach and own our decisions. The intent here, therefore, is to be completely transparent about what we did when an athlete’s time, money, and readiness was at stake in hopes that other providers share their experiences and contribute to a more genuine collective conversation.

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Russ Roberts on the Resilient Performance Podcast

Russ Roberts Resilient Podcast


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Russell Roberts is interested in how the essential insights of economics can help us understand the world around us and lead better lives. He is a research Fellow at Stanford University’s Hoover Institution and host of the weekly podcast EconTalk–hour-long conversations with authors, economists, and business leaders. His latest book is How Adam Smith Can Change Your Life: An Unexpected Guide to Human Nature and Happiness (Portfolio/Penguin 2014). It takes the lessons from Adam Smith’s little-known masterpiece, The Theory of Moral Sentiments and applies them to modern life. He is also the author of three economic novels teaching economic lessons and ideas through fiction. A three-time teacher of the year, Roberts has taught at George Mason University, Washington University in St. Louis (where he was the founding director of what is now the Center for Experiential Learning), the University of Rochester, Stanford University, and the University of California, Los Angeles. He earned his PhD from the University of Chicago and his undergraduate degree in economics from the University of North Carolina at Chapel Hill.

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