#121 – Corrective Exercise Dosage & Selection | Guido Van Ryssegem ATC

by | Dec 14, 2018

#121 – Corrective Exercise Dosage & Selection with Guido Van Ryssegem ATC

Guido Van Ryssegem is a badass.

If you haven’t heard of him before, you may have heard of some of his contributions to the healthcare-fitness world. Just to name a few, Nick Winkelman studied under him and has become wildly popular. The sleeper stretch for throwers was a Guido invention.

I was fortunate to attend Guido Attractor State and Dynamic Systems Theory Workshop and I can say with confidence that it changed the way I treat certain cases dramatically. The easiest way to think of Guido’s work in reducing Attractor States, is figuring out what the body is “asking for” and then giving it proper dosage of the proper “exercise medication.” Or maybe simplest way is to just hear the conversation 🙂

Using the tactics Guido shares, I’ve been able to reduce many of my patient’s symptoms with a single corrective exercise within a matter of seconds.

Neck pain, back pain, knee pain, hip impingement and so much more are treatable with the CORRECT corrective exercises. If you want to see a patient buy into your style quickly, consider attended Guido’s course.

Simply amazing stuff.

If you’re looking for my Youtube Channel I mention in the Podcast, where I release extremely useful video on rehab, treatment and more DAILY, it’s right here!

Guido Van Ryssegem Bio:

Mr. Guido Van Ryssegem is owner and co-founder of Safe Recovery, LLC. He has been in clinical practice for 30 years and has been working in the strength and conditioning arena for 35 years. Guido is a practitioner, professional faculty and guest presenter at Oregon State University, and has published in the Asian Journal of Martial Arts, Clinical Kinesiology and the International Journal Of Sports Physical Therapy. Guido is also a guest presenter for the University of Oregon, Western Oregon University, Athletes Performance -EXOS, Perform Better and the National Personal Trainers Institute, and other institutions. He has practiced for the Kansas City Royals, Texas Rangers and the Baltimore Orioles. His expertise extends to his own Kinetic Integrations Exercise Specialist Certification (KIEP). He is a board certified Athletic Trainer (ATC), Registered Nurse (RN) and Strength and Conditioning Specialist (CSCS) while also certified by the National Board of Fitness Examiners (NBFE).

Guido serves as the Northwest regional coordinator for the National Strength and Conditioning Association (NSCA) and is a committee member for two National Athletic Trainers Association (NATA) task forces. He serves on advisory boards.

Guido’s motor learning and motor control systems and methodologies can be seen on MovementLectures.com, PerformBetter.com and MedBridgeEducation.com. He presents nationally and internationally on this methodology.

#121 – Corrective Exercise Dosage & Selection | Guido Van Ryssegem ATC

by | Dec 14, 2018

0:00:02 Sebastian Gonzales DC: Alright, everybody. Welcome on Guido, the major, the major, major Guido. The major guest, Guido Van Ryssegem. Ryssegem?

0:00:12 Guido Van Ryssegem ATC: Correct.

0:00:14 Sebastian Gonzales DC: That was a really… I heard the one with Chris Duffin and I thought, “Holy shit. They have a hard time saying his name, too. I’m glad I’m not the only one”.

[laughter]

0:00:23 Guido Van Ryssegem ATC: Yeah. Here’s the funny part. My wife’s last name is Adams.

0:00:26 Sebastian Gonzales DC: Is it really?

0:00:27 Guido Van Ryssegem ATC: I should have taken hers.

0:00:30 Sebastian Gonzales DC: Yeah. You probably should have. I’ve actually been talking about this podcast, leading into it. I know we’re recording it way earlier than it’s gonna be released, but I planned a lot of things around it ’cause I thought your content would be extremely valuable for people to learn, clinicians and patients. So, I thought we’d go over some attractor state stuff, if that’s cool.

0:00:51 Guido Van Ryssegem ATC: Yeah, that’s great.

0:00:52 Sebastian Gonzales DC: Okay. First, since you do have an interesting leading story, why don’t you tell everyone a little bit about yourself and just how you got to be what you’re doing.

0:01:03 Guido Van Ryssegem ATC: It’s kind of a long story. I’m an old dude. I’m gonna celebrate my 60th really soon. But basically, my mom was a nurse and I’ve always been interested in medicine, originally from Belgium. I get fascinated by science since I was in high school and get into military. There was still a draft in those days, and I became a medic for Commandos or Special Forces, worked in a military hospital in Brussels. But I think the most interesting part about myself is that at a relatively late age, I think I was about 17 years old, I watched a baseball movie on TV about The Negro League. And although I’ve been always involved in sports… I played a variety of sports. I actually was a premature baby and I almost didn’t make it. I was in an incubator for like two months and we had quite of a revolutionary pediatric doctor.

0:02:07 Guido Van Ryssegem ATC: He basically told my mom and dad that I have to get involved in sports and move and I would never develop all that fun stuff. I was actually anemic till I was about 16 years old, and my draft got postponed by two years because I was too skinny when I showed up. Until I finally was able to convince them that I could pass their physical requirements, you know, like 50 push-ups and 15 pull-ups and all that fun stuff. And actually the funny part is, although they thought I was not military material, I then eventually worked with our so-called Special Forces Commandos and basically had to go through the rigors of that training and I was in charge of their health as a medic.

0:02:53 Guido Van Ryssegem ATC: But anyhow, once I saw that movie, although I had no clue about the game of baseball, I just totally fell in love with it. And that summer, I was a leader of a scout group. And one of the kids had a baseball glove and a ball, and I basically asked them, “Where the heck did you get this from?” and lo and behold in my hometown Antwerp, Belgium, there were several baseball teams. And basically, I just threw myself on to that. While I was studying in nursing school, it became apparent that I just didn’t have the time to practice. And of course I got into the game quite late and even though I had to put a glove on my left hand, and all that’s fun stuff, and I started taking care of their injuries. And I started corresponding with Dr. Jobe, which was then the top leading orthopedic surgeon in the US, probably the world, dealing with baseball injuries. And he thought it was fascinating that some guy from Belgium was interested in baseball injuries and sent me a book and several articles. And for those that are young listeners here, these are the days that you had to write letters. There was no email, none of that stuff.

[laughter]

0:04:05 Sebastian Gonzales DC: You still have the letters from Dr. Jobe about the whole correspondence?

0:04:09 Guido Van Ryssegem ATC: I doubt it that I still have that stuff. But anyhow, studying the stuff that he gave me and analyzing similar sports, throwing sports like javelin and looking at track and field, running. And I basically started looking at baseball from the perspective that, “Hey, these are just athletes running around, throwing things, catching things. There’s gotta be a way for me to analyze this game.” And I basically, I wrote a manual, and I still have a copy of that, of I don’t know, about 30 pages or so on baseball injuries and baseball conditioning. And started applying that. So my role on our baseball team became so-called athletic trainer and then I actually became their strength coach. We won seven Belgian titles in a row and went to the European tournaments. And then I’m fast forwarding this story here but I met a guy from the Mariners in Paris during a European tournament. And we talked for maybe 15 minutes and this guy basically changed my life. Gary Thomson still lives in Seattle and we’ve been close friends ever since. I was able to persuade my wife that there was a unique opportunity for us to go to Seattle. We flew to Seattle. We had no clue where the hell that was. I had to go to the library and open up an atlas. And then say, “Oh my God, there’s this town on the West Coast in the United States and…

0:05:40 Sebastian Gonzales DC: Did you spin the globe and everything and just watch it like where the… [chuckle]

0:05:44 Guido Van Ryssegem ATC: Yep. Those were the days. There was no Internet, I mean there probably was, but it wasn’t accessible to the public. And we basically came to Seattle. I had an audition with their head athletic trainer, Rick Griffin, who retired last year by the way, and gave him a copy of this little manual and that same night he called me in our hotel room and said, “Hey, I think you got some information. You got some good stuff in there. Why don’t you come over to the King Dome?” I stayed there for about 10 days. It was the off season and my whole world just changed literally overnight and those 10 days changed everything. After 10 days, my wife and I had to go fly back home. And Rick said, “Listen, I think you’ve got some phenomenal potential. I can help you. I’m a graduate from the University of Oregon so is my assistant athletic trainer and it’s the best master’s program in athletic training and you should go there.”

0:06:50 Guido Van Ryssegem ATC: So we got a rental car and we drove to Eugene and literally almost six, seven months later, we sold everything we had. We moved to Eugene, Oregon. I got a dual masters there. I was lucky enough the first summer that a short season A-ball team had a job opening and I couldn’t believe it. They gave me the job after an interview. So I got my feet into professional baseball. Then graduated, went to the Rangers, Texas Rangers in the Florida State League, got promoted to double A. Then I got to the Orioles, got promoted to triple A and became their medical coordinator. So I lived a dream.

0:07:33 Sebastian Gonzales DC: Yeah.

0:07:34 Guido Van Ryssegem ATC: In retrospect though, I kept learning, and my family grew. I had two kids and I had to be home. I had to be a dad instead of being on the road, be gone all the time. So I took a job at Oregon State University and I really enjoyed that. Being back in the academic world was really inspiring to me and the last year and a half, I’ve been running workshops, clinics on my own. Spent a lot of time in Southeast Asia predominantly, China, Seoul and also Japan. At the same time, doing workshops in the US and Europe, and so forth. So that’s kind of that. [chuckle]

0:08:25 Sebastian Gonzales DC: Yeah, well, I think the first question is, was the beer good in Seattle when you came over? Did you think this is crap? This is a pivotal factor in my move?

0:08:33 Guido Van Ryssegem ATC: Well, we’re talking 30, I think 31 years ago the beer was pretty shitty.

[chuckle]

0:08:41 Guido Van Ryssegem ATC: The weather sucked. It rained all the time.

0:08:44 Sebastian Gonzales DC: You must have really liked baseball then.

[laughter]

0:08:50 Guido Van Ryssegem ATC: Right. But it’s just is… It’s just something I had to do and see if I was up to the par, and yeah, it just changed our life for the better. And we’re happy here. We’re all American citizens now. Our son actually served in the military. He was active in Iraq, as also Afghanistan. He’s got multiple decorations and… Yeah, we’re good old Americans now, I guess.

[chuckle]

0:09:22 Sebastian Gonzales DC: Nice. Welcome to the…

0:09:23 Guido Van Ryssegem ATC: And the beer got better.

0:09:25 Sebastian Gonzales DC: I know, it finally caught up, didn’t it? I don’t think I was ever actually… Well, I guess I was alive when beer was worse but it’s always been pretty good when I’ve been drinking.

[chuckle]

0:09:39 Sebastian Gonzales DC: I guess I should… The reason why I wanted you really on as well is… So when I went to your workshop and I think I mentioned in the introduction, I went to your workshop and Ben really just convinced me, I was like, “Who’s this Guido guy?” And he’s like, “You’re not gonna find anything really on the internet about him. You’re not gonna find anything else or really social media. You just need to trust me and come.” And I was like, “Well, what is it?” And I read the whole thing with dynamic systems theory and all this stuff and I’m almost like, “This is a lot of wording to me. Can you clean this up?” He’s like, “It changed my practice a hundred fold. Just come.” And I said, “Okay, I will.” And he was right. All the stuff that we went through was, as I would classify it, would be like you know how you go to PT and people say like, “Well, I was doing three months of PT, nothing worked.” Your stuff, it was the correct dosage and application of the correct exercise to do the thing within a minute or so and then whether it stuck or not was a different story, but I found that very intriguing and I never really saw corrective exercise in that light before. So that’s the attractor state, so would that be fairly… You can clean that up if you’d like to. [chuckle][laughter]

0:10:49 Guido Van Ryssegem ATC: No, I really appreciate the comments. Yeah, so did you want me to explain kind of what this attractor state concept is all about?

0:10:58 Sebastian Gonzales DC: Yeah, please do. And then also, too, if you could, give me some examples because when if we have people listening, I wanna make sure that they’re familiar of how to apply it.

0:11:09 Guido Van Ryssegem ATC: Sure, sure. So while I was at Oregon State University, I developed a concept there called kinetic integrations and it basically is kind of my starting child of workshops and lectures, etcetera, etcetera. As I was doing that, I wanted to come up with a methodology to either A, resolve injury that are mostly actually chronic and/or improve performance that was based on a neurological level. So I started studying more and more the principles of neuroscience. About, I would say, 10 years ago or so, maybe a little bit longer, I started noticing that young practitioners around me and also students started to hang in their head a little bit too much on to the Functional Movement Screen and I don’t mean that negatively, but they were misinterpreting that information and its methods and I started seeing more and more and more people saying things like, “If you had a knee injury and your knee caves in and that’s all bad and then you gotta do this and this and this. And if your FMS score is not that, that means it’s abnormal and then you got to that and that.”

0:12:31 Guido Van Ryssegem ATC: And it perpetuated itself into the performance world where people were starting to say things like, “If you don’t squat like this, if you don’t dead-lift like that, then it’s wrong and you’re gonna blow a disc in your back, etcetera, etcetera.” Well, through the years dealing with athletic populations of the variety of levels and non-athletic populations, of course, I noticed, as yourself, that you’d see a variety of movement patterns not necessarily them being bad. So in my response to young practitioners and students saying these things, I started doing a review of literature on what is movement, etcetera, etcetera. And I pretty much accidentally then ran into movement, the concept of movement variability and I have a workshop on that as well, what is movement variability, what’s good, what’s not. And then delving into that a little bit more, I ran into a concept called a dynamic systems theory.

0:13:33 Guido Van Ryssegem ATC: So basically, the dynamic systems theory, per definition, it would say something like this, “It’s a system of elements that change over time.” So that basically means that within the dynamic systems theory concept, if you change the environment, for example, the floor where your athlete or your patient is moving on, then also their movement pattern can change. We, as clinicians, often focus on the part of the dynamic systems theory part including manipulating the body. So mobilizations, manipulations, etcetera, etcetera. So there’s different ways to change movement through this dynamic systems theory concept. And then I ran into the concept of attractor state which in the simplified way, it means that our central nervous system is attracted to use specific muscles, restrict a range of motion at specific joints associated to performance and injury. And as an example, if you’re looking at the difference between sprinters and long-distance runners and you look at their quadriceps: Hamstring ratio, then the literature will show you that that the sprinter is predominantly… The ratio is in favor of the hamstring muscle group so they use basically more of their hamstrings than their quadriceps.

0:15:02 Guido Van Ryssegem ATC: And in the long distance runner, it’s actually the opposite purely because of their position. They’re standing a lot straighter and so forth. Of course, they’re running a lot slower too. So their quadriceps is being used more and in favor than the hamstring. And through my years that I was at University of Oregon and being exposed to track there, we already, way back… I mean, we’re talking 30 something years ago. Part of our rehabilitation was analyzing quadriceps: Hamstring ratios. We had isokinetic equipment. Of course, we had the data on healthy runners. And then if one of our injured runners got back into running, then we would use that data to at least approximate, let’s say 90% of that ratio, before we allowed them to race again.

0:15:49 Guido Van Ryssegem ATC: Well, the attractor state concept just made total sense to me, that performance, specific performance is creating central nervous system attractions. So the pitcher in baseball will over the season have a decrease in shoulder internal rotation and horizontal adduction. And if you look at the… If you look at the injuries in baseball pitchers, you often then see that attraction. So they have a lack of internal rotation, they have a lack of horizontal adduction. And if you resolve that with mobilizations, then often their symptoms will dissolve. So their impingement goes away, for example, and/or their velocity of throwing goes back up to where it’s supposed to be.

0:16:33 Guido Van Ryssegem ATC: Then if you look at injury perspectives, let’s say knee pain. In my practice, I noticed years ago that people with knee pain, often exhibit a lack of hip forward flexion. So they could have an anterior hip impingement problem, a lack of talocrural joint mobility, lacking mobility in their ankle to move appropriately. And of course then later on, the research has shown a lack of enough stiffness. I don’t like to use the word strength, necessarily. Lack of enough stiffness in the hip abductors, glute medius, minimus, etcetera, etcetera. So it got apparent to me, and of course to other people as well, that if you have an injury or you perform at a certain level that our central nervous system gets attracted to a lack of range of motion, for example, changing quadriceps: Hamstring ratios for example, and so forth.

0:17:36 Guido Van Ryssegem ATC: So in the last, I would say 15 years, more and more research actually shows that my concept of attractor state totally makes sense. And so, indeed, it can become really, really simple and convenient and not time-consuming to evaluate somebody from the attractor state concept, then mobilize whatever needs to be mobilized and suddenly, you know, see a tremendous change in either their symptoms or their performance level. And that doesn’t only work with baseball pitchers, injured individuals, but also some individuals, that are interested to perform at a higher level.

0:18:23 Sebastian Gonzales DC: Yeah.

0:18:23 Guido Van Ryssegem ATC: So another example was a hurdler from Peru. This is probably six, seven years ago, that I saw she was competing in Eugene at the pre-Olympic trials. 16 years old, and she goes and see a local athletic trainer. She complains of some diffuse hip discomfort. And basically mobilization and adding some neuro-dynamics to it, dissolved her symptoms immediately. Then giving her specific attractor state stiffening exercises, which in her case was stiffening up her back extensors, as also her glutes. She ran a faster run the next day than she’d ever ran before. Continued doing my exercises, a week later she went to Brazil and broke her own personal record again. And to make a long story short, this young lady… Unfortunately, I can’t disclose her name, but went to the Olympics and competed.

[chuckle]

0:19:23 Guido Van Ryssegem ATC: And became the fastest hurdler in her event in the whole South American continent. These are just, you know, some examples obviously, but as a clinician, I’ve been using this concept for over 15 years and the results are phenomenal.

0:19:40 Sebastian Gonzales DC: So just to go a little bit deeper into one of those examples. The hurdlers… I think it’s the simpler one ’cause you mentioned three parts there. You said there is a… You mobilized something. You did neuro-dynamics. And then you gave her some stiffness work for her extensors and her gluteal region.

0:19:58 Guido Van Ryssegem ATC: Yeah.

0:19:58 Sebastian Gonzales DC: I know that we’re gonna tangent off a little bit to talk about neuro-dynamics. But can you explain how that correlated to what she had going on there?

0:20:06 Guido Van Ryssegem ATC: In her… Well, first of all, I am a huge fan of the concept of neurodynamics. While I was working for the Baltimore Orioles we had an Australian pitcher who was in a minor league system. So I was their medical coordinator basically in charge of all the rehab and part of my responsibility was also to return athletes to full competition after their injury got dissolved. We had an Australian pitcher, he was a leftie. He built for a ball and he had this massive nerve root problem to where he basically almost lost complete function of this brachial plexus. So his grip strength in spring training was about 180 pounds, and when I saw him three days after his injury, he could barely squeeze 28 pounds. So he had massive loss of motor function as also sensory function.

0:21:03 Guido Van Ryssegem ATC: Now, this young man was a big prospect for our organization and there was a lot of money pumped into him. And basically the owner of the Baltimore Orioles which then Peter Angelos called me and said “We have at least a three-year contract on this young man. I really don’t care what you need to do, but he needs to come back. We have a huge investment in this young man.” At that point, this is 1996 I believe, yeah. David Butler in his book on neurodynamics was published in English and I got my hands on it through actually an English physiotherapist that I worked with in a clinic while I was in the minor leagues. Baseball you don’t have a full-time job. So in the off season I would work in a clinic. She didn’t know much about therapeutic exercise, I didn’t know anything about neurodynamics, and I got really interested in this concept, so I was able to persuade the owner of the Orioles for me to fly to Australia and I spend basically 10 days with David Butler in his clinic.

0:22:11 Guido Van Ryssegem ATC: I immediately noticed that his population was chronic pain and that my population was not, working with top athletes, and I basically made some changes around the techniques that I think are more productive for athletic populations. And then later on it became a big, big part of my evaluation. So part of this young lady’s evaluation noticed that she had a positive slump test for tibial nerve bias, and I basically did neural mobilizations on her, improving her range of motion and by her stride jumping over this hurdle, basically, by using the neurodynamics concept, you can also then immediately change that attractor state. So…

0:23:01 Sebastian Gonzales DC: That was the plucking, you went plucking on it.

0:23:03 Guido Van Ryssegem ATC: Well, I did not use plucking in those days, yet. I used more of a gentler approach, and then progressed it with her probably about three, four years after that to a more aggressive approach, which is almost a neural manipulation sort of such fast thrusting maneuver. Plucking I developed later on in my career as I started noticing that the skin area around these… Around these nerves that are not moving appropriately according to the neurodynamic concept was incredibly stiff, and then my interest in fascia came all in to play in this and so forth. So yeah, for years I just called it plucking because you’re literally rhythmically and relatively quickly pull on the skin.

0:23:56 Sebastian Gonzales DC: You’re probably really good at the base, the base guitar.

0:24:00 Guido Van Ryssegem ATC: Yeah, yeah.

[laughter]

0:24:03 Guido Van Ryssegem ATC: Sometimes as a clinician you just kinda of try some things out. And this has been a big part of my success as a practitioner, and I have held numerous athletes and non-athletes with this stuff. But basically it’s all still based on this attractor state concept, and then reading more and more on dynamic systems theory and central nervous system. In my opinion, when we have an injury that’s basically a threat to the system, the central nervous system is going to attract itself to protect itself, and these protective mechanisms are pretty much predictable. That’s the crazy part. So it’s like knee pain. Here’s the history and so forth, this and that and that has been tried already. Do an evaluation to rule out specific trauma or potential in my scenario as an athlete trainer, red flags, refer to a physician but most people that I’ve dealt with over more than 30 years as an athletic trainer, I don’t see that much of a real trauma in my athletes.

0:25:22 Guido Van Ryssegem ATC: There’s an insult to the system but damage done? No, not really, I would say although our training is often based on traumatology and the acute phase, let’s say you’re covering a football game and two athletes run into each other, the majority of the patients that we deal with are not having a trauma whether there’s a fracture or a dislocation or whatever but they’re having a pain state and in the days that I went to college, we were so focusing on damage and tissue healing phases and so forth and it was basically a traditional medical model and we’re more and more and more stepping away from that and more and more athletic trainers and other clinicians are moving away from the traditional concept, of it’s damaged and we need to protect this area and… No, no, no people need to move. And so this whole dynamic systems theory and attractor state concept has just been a major help for myself and especially for my patient populations.

0:26:36 Sebastian Gonzales DC: So with that hurdler then after you did some neuro-dynamic stuff, then just describe what the stiffness work was in the regions of interest ’cause I just wanna make sure that listeners can unveil the secret in there. ‘Cause after, going to your workshop, you see that it’s like… To me it looks like almost like we’re… When we’re biasing movements, it looks like we’re going a little bit back to old school Arnold but it seemed to work. So can you kinda paint a picture for everybody of what that looked like at least in her case?

0:27:13 Guido Van Ryssegem ATC: Yeah, sure. So again, to kind of sum that up, young lady high-level hurdler from Peru, 16 years old has been having some… I can’t remember if it’s right or left, I think it was left uncured hip discomfort and her coach started noticing that when she jumps over the hurdle that her stride is basically shortening. And so there was a change in her performance level and she has a hard time continuing to compete at her level. So upon evaluation there was the anterior hip impingement, number one knee was completely clear, ankle was completely clear and then I’m also a big fan of observation so observing the young lady when she is in her sports bra I noticed immediately that her lumbar spine, erector spinae stabilizer area around L5 L4 L3 was pretty much… Was poor and some of the literature shows infiltration of fats in multifidus in addition or a low back pain states. And then I also noticed that when I did her… What I call a reverse slump test and so my slump test is not the traditional slump test I kind of reverse it and that over the years I’ve noticed that doing this reverse slump makes it a lot easier for me to control them when I assess their slump test because these are often large individuals, they’re either tall or they’re very muscular and the traditional slump test just didn’t really work out for me too well and so using this reverse slump test system, I noticed that immediately that she had a positive slump test with a tibial nerve bias.

0:29:26 Sebastian Gonzales DC: I can’t wait to see a video of your reserve slump test. For some reason it makes me think like you’re sitting on the person… [chuckle] like you aren’t allowed to.

0:29:33 Guido Van Ryssegem ATC: No, no, no.

[laughter]

0:29:35 Guido Van Ryssegem ATC: No, for those that are listening that are familiar with the slump test it’s basically reversing the process. What I mean by that is that I put their ankle in neutral to begin with, so they get on the treatment table in a slump test position and then the last thing I move is actually their head and cervical spine and deflection. It allows me to control a lot better with their body is in space and having practiced with the traditional slump test, and this reverse slump test, I haven’t noticed a difference in the end result when I treat them and/or evaluate them. So meaning we don’t need to follow specifically this, let’s call it the traditional most common slump test protocol, but who knows? Right. I mean… We don’t have any research on it, but it’s just years of working with this as a practitioner and then seeing that it really didn’t make any difference between the traditional slump test position, and this so-called what I call reverse slump test position.

0:30:48 Sebastian Gonzales DC: Sorry, I can’t image you.

[chuckle]

0:30:50 Guido Van Ryssegem ATC: I’ll have to send you a little video on it. So basically that test was positive. Then I palpated the area around the tibial nerve where she was mostly complaining of tightness and restriction. And over the years I’ve noticed that the areas of restriction is often very stiff. So the muscle or muscle group, in that area often exhibits a higher level of stiffness. I use a machine called a myoton, which is a… Kind of like a… Almost looks like a gun and it measures tissue stiffness. And it just gives me an objective measurement of the amount of stiffness in that tissue and then after treatment I measure it again to see if that stiffness decreases. Now palm palpation, you feel it right away that there is a difference. But once I got introduced to this myoton piece, I wanted to see if I could have it objectively measured and it can.

0:32:01 Guido Van Ryssegem ATC: And that’s a whole other topic, is stiffness, which is one of my new interest now. Tissue stiffness, what is this? Muscle spasm is too much stiffness. Muscle inhibition is not enough stiffness. What’s enough? In a weight lifter like a Chris Duffin that I’ve helped using this attractor state concept as well, his back extensors are just massively stiff when he’s training and/or competing and it’s causing discomfort. And by basically using the attractive state concept on him and making him stiffer in his rectus abdominis, he noticed an immediate change and a more relaxed erector spinae muscle group and thereby because of that, he can do more repetitions. He can do more sets and eventually, of course, his volume of load goes up, and device performance increases. So this whole concept around attractor state doesn’t only work for, let’s call it injury or pain or restriction because of an injury, but, it could also affect performance quite well.

0:33:10 Sebastian Gonzales DC: I remember I saw Cody was using some on someone’s hamstring one time. I was shouting at him because as he moved his practice or as he moved to Dallas, I had took all of his patients so I wanted to shadow a bit and a lady came in with some knee problems and he assessed a little bit and stuff and lay face down on the table and he just… It almost looked like he was just ripping at her hamstring in half just keep going and going and going kinda how you did in the seminar and she stood up and she’s like, “Wow, it feels a lot better.” I know she had an injury with that, but it was interesting to see how quickly that could work in some situations.

0:33:48 Guido Van Ryssegem ATC: Based on his dynamic system steering attractor state or central nervous system is constantly let’s call it, re-calibrating. Right. It’s resetting itself consistently based on these three major factors body, the tasks or what you make them do and then the environmental input. And so there is no… In my opinion, there is no steady state, in our central nervous system. It’s constantly re-calibrating and looking at what is important to pay attention to you. And so I can talk for this for hours, but attentional state is a big factor there too, what did it pay attention to? Because the brain has a limited capacity to do tasks, remember tasks, and so forth, so things like muscle memory, don’t really exist. These are all just concepts that we like to use, but they really, they don’t make any sense from a central nervous system and a neurologic standpoint. So yeah…

0:34:54 Sebastian Gonzales DC: I’m guessing pretty much the same ’cause it’s patients are familiar with hearing it.

0:35:00 Guido Van Ryssegem ATC: And you’re absolutely right. I often tell practitioners that, “Hey, we need two language systems, a language where we communicate amongst each other, and that should be more scientific based and use the right terminology. And then, I understand that we need to have a language to communicate with our clients and our patients”. But I see more and more that the patient language becomes the practitioner’s language, even when they talk among each other. Like muscle memory. Brain doesn’t have a brain so there’s no memory. It’s the same thing with my paper on “The Myth Of Proprioception.” You know standing on one foot improves your proprioception. Really. So that was a two year project with one of my students, DM Kim, who’s now in Canada. He’s a kinesiotherapist. While I was at Oregon State University, he was interested in finding a topic for a paper. And I said, “Well, you know I’ve been doing some research on balance versus proprioception, why don’t we do something together?” Actually I gotta tell you that this Summer, the NSCA National Conference in Washington DC has invited me last week, to present on this concept.

0:36:20 Sebastian Gonzales DC: Oh nice.

0:36:21 Guido Van Ryssegem ATC: What is really proprioception, and so I think we need to be careful what we use as professionals, in our language versus when we talk to our patients.

0:36:33 Sebastian Gonzales DC: That’ll be interesting if your presentation in the concept spreads or if like… I know probably the trainers and coaches are gonna get it and the clinicians will get it but then if you propose it to a patient, it’s like getting them away from grandma wisdom, and stretching and bed rest for two months at a time and I wonder how quickly it will integrate into actual patient or athlete life.

0:37:00 Guido Van Ryssegem ATC: Well, maybe I’m fortunate that in… Probably in the last twenty years of my career, I kinda see problem cases. Clinicians are sending me their patients that they are struggling with. I think those patients are often already motivated to listen to a different concept. And that’s often what I tell them the moment they basically sit down in my office where I say, “Listen. You know you’ve tried the… Let’s call it “the traditional approach”. You’ve not had success. What I’m going to do with you, and what I’m gonna look for is something totally different.” And actually there’s very few patients that would bark on that scenario. And they’re all ears and then especially if I give ’em some examples. So they see me for, let’s say low back pain. They start saying, “Yeah, that’s exactly what happens to me. And that’s what I keep… ” Or they say something like, “This is what I’ve been telling my doctor or whoever before but nobody’s listening”. I mean, “Yeah, what you’re telling me makes absolutely sense because that’s what I am experiencing”. So I think it’s the way it is explained to the patient that makes the biggest impact. And often my first visit, which is typically 40 minutes or so. So the initial evaluation, I would say, I probably talk for 30 minutes. Just trying to explain to them.

[laughter]

0:38:29 Sebastian Gonzales DC: I can believe that.

[laughter]

0:38:31 Guido Van Ryssegem ATC: Just trying to explain them, what am I going to do and why it’s so important that they are compliant with their home exercises and so forth. It often involves a lot of drawing and chronic pain. I often then go online and show ’em a video on Graded Motor Imagery training, for example. How chronic pain, part of it is not the body. It’s again, this recalibration of our central nervous system and how it affects our daily activities, etcetera, etcetera. So a lot of it is, I would say, education. And then like you saw the examples and what we did in San Diego during the workshop, they’re simple. I mean you know it’s nothing hocus-pocus. There is no special equipment, most of the time, that you need. It does not involve any modalities. So it’s something that people can easily control. It takes maximum five minutes. They can do on their own. So I’d like to keep it as simple as possible, with the least amount of let’s say, equipment that involves a lot of bells and whistles.

0:39:42 Sebastian Gonzales DC: Yeah, it was really easy and just one of my observations was that I kept thinking the areas that we are seemingly doing stiffness stuff with consistently, it was… Like the phasic groupings versus the tonic. And so I think back to, well, what have I done in the past clinically, to help people out? And it’s like I’ve given them some of these things, but I haven’t done it at the intensity and looked for the… Because I think back to, Ben, not like Jiu Jitsu Bigfoot Ben, but Despicable Me Ben they had the crevasse, the grand canyon between the shoulder blades when dead lifting. And we have that video of you just like screaming at him to get to get his rhomboids going and then instantaneously after it was like you’d thrown a bunch of sand inside the Grand Canyon, he filled it up. But it was intense, I guess is my point and I’m always… In the past I’ve thought my patients are extremely fragile and you can really challenge them and you make a big result how you did, so…

0:40:51 Guido Van Ryssegem ATC: Yeah, of course in the examples that we did there in San Diego, they are basically two big guys, that lift weights and can handle me screaming at them. But yeah…

[laughter]

0:41:06 Sebastian Gonzales DC: But on the flipside, when you worked with Allie though you changed tones very quickly and I think when you saw that… Is it when you see the people who are tentative, you’ll change tones and treat ’em a little differently, right?

0:41:18 Guido Van Ryssegem ATC: Yes, absolutely, yeah. If I see people with chronic pain, they’re fearful. They have what I call an avoidance problem, so they’re afraid to step down stairs without holding onto the handrail or whatever. So they have this fear factor… And actually I’m gonna give you another little example associated with that. Probably 12 years ago or so, I saw an ex-professional ballet dancer, a female who was in her free time was skateboarding, she fell and tore her ACL. Looking at the surgery notes and the MRIs etcetera it looked like a pretty simple procedure, meaning there was no chondral defect and all that stuff. Rehab, apparently, went well until she had to reproduce the maneuvers she did as a professional dancer. Now, I’m not familiar with all the names of ballet jumps that they’re doing.

[laughter]

0:42:23 Sebastian Gonzales DC: We can make something up.

0:42:26 Guido Van Ryssegem ATC: Yeah. But anyhow, one of those jumps where they’re up in the air, their legs are kinda spread out and I don’t know, I can’t remember what it was called, but she could not reproduce. So the career basically was over. This is several years after the ACL surgery. She’s now a LA instructor for kids. And even years after this ACL surgery, there’s no pain, there’s really no structural limitation for her to perform. She noticed that, she still could not perform this jump. She’s scared. And every time she tried it looked absolutely horrendous, and she would be afraid to lose her balance when she landed on the floor, etcetera etcetera. And basically based on this dynamic systems theory, if people come back from pain and especially it’s chronic and/or traumatic, their visual field has changed. So what that means is this, a lot of our patients that stand on, let’s say, a plyo box, and when they look down, that it feels to them as if the distance between standing on the box and landing on the floor is large. Like they literally… One of them actually said, “It feels like I’m jumping off a building.”

0:43:50 Sebastian Gonzales DC: Oh, really?

0:43:51 Guido Van Ryssegem ATC: Yeah, and they’re only about let’s say four and a half to five feet off the ground. It’s not like I’m making them jump off a second floor window or something. So, that’s also why in planes the windows are very small. Crazy, right? Wouldn’t it be attractive if you fly in a plane, fly over some mountains or something, and that the wall, where the windows are, it’s actually all glass. Wouldn’t that be cool?

0:44:21 Sebastian Gonzales DC: I think we need to talk to Boeing.

[laughter]

0:44:26 Guido Van Ryssegem ATC: It sounds like a really cool concept, right? But what companies like Boeing have experienced is that when that plane now makes a turn people freak out. So although they know this is glass, I’m not gonna fall. When that visual field changes, you panic. So, the windows are small for a real purpose. Now, related to this young lady all I did was I asked her, number one, How did it feel like before your injury when you did that jump? And she basically said it. I felt like I was flying. And I said, “Okay, and I want you to think about that concept. I want you to fly, I want you to fly.” Now, the second thing I now did to change the attractor state and it’s based on science, is I made her look through her fist. So you make a fist and it could still allow a small hole in it, and I basically made her close one eye and look through that hole and we did a couple of jumps like that.

0:45:27 Guido Van Ryssegem ATC: So it changes the visual field. It’s like the small window in the plane. So suddenly now, she started noticing she tells me, “Oh, my goodness. I’m less afraid to jump off this box.” We’re still not doing this Ballet jump but I’m making her stand in the plyo box and making it taller and taller, while she’s jumping off. So I made her repeat 17 times, “I want you to fly, I want you to fly, I want you to fly.” And then we basically went into a larger room with space enough outside of my office. And I said, “Now, show me how you fly,” and bingo, she did that jump fearless, landed appropriately and cried her freaking eyeballs out.

[laughter]

0:46:13 Sebastian Gonzales DC: You guys still trade Christmas cards? I’m sure she’s really happy.

0:46:15 Guido Van Ryssegem ATC: Oh, yeah. Seven years of fear and change in movement pattern in an ex-professional ballet dancer, who should have had no problem with this whatsoever. So the attractor state concept is not just purely physical, it actually involves also our mental state, and some of the research has shown in people with chronic pain in general, there’s actually a change, in where myelin proteins is being laid down on neural connections within the brain associated with movement. So we’re talking our brain is changing when we have pain, and especially if it’s chronic, and as these attractor states that our central nervous system is restoring… Is using inappropriately, it actually becomes somewhat of a structural change within the brain, it becomes tougher and tougher and tougher to get out of that inappropriate attractor state, let’s call it.

0:47:15 Guido Van Ryssegem ATC: But the beauty is that you can change it. The brain is incredibly plastic as we know. And for the longest time, we thought making changes within the brain would take weeks of practice and all this other stuff, no, it doesn’t. Based on this dynamic systems theory concept an attractor state, for example, if I step out of my apartment, out of my house, and it has been freezing outside, and I suddenly slip. I didn’t have to learn to not fall on my face. I resolve immediately to an attractor state that has no learning whatsoever, does that make sense?

0:47:55 Sebastian Gonzales DC: Yeah.

0:47:55 Guido Van Ryssegem ATC: So one of the things we do or let’s call it our reflexive, there’s no learning involved. And if we look at babies for example, we don’t need to teach our little kids to roll over or sit up, or whatever. Actually, some evidence shows that if we would learn, teach them to walk, for example, that would often not be productive. Related to that, some people believe now, we have to go through these developmental phases, so we’re all messed up. Well, my wife and I travel quite extensively. This summer, actually, we spent two weeks in Kyrgyzstan, we did some horseback riding there and some climbing and stuff. So we always are interested in going to parts of the world that are not so touristy. Northern Myanmar for example, small islands in the Philippines etcetera, etcetera. You see a lot of these populations, including some of the Apaches here in Arizona on the reservations, their children never crawl. They pick them off the ground, they carry them, and often it’s because of environmental reasons snakes, scorpions, dirty floor, etcetera, etcetera. So these children do not go through our so-called classic developmental phases which I think is all White Caucasian biased by the way.

0:49:21 Sebastian Gonzales DC: Interesting.

0:49:23 Guido Van Ryssegem ATC: They stand, they walk and they’re absolutely fine. Go to the Copper Canyon, the Tour Mujeres the long-distance runners, right? We were there about 12 years ago. It’s the same thing, their children don’t crawl. They’re actually wrapped up.

0:49:42 Sebastian Gonzales DC: They swaddle them?

0:49:44 Guido Van Ryssegem ATC: I’m sorry.

0:49:45 Sebastian Gonzales DC: They swaddle them, they wrap them up like a burrito?

0:49:48 Guido Van Ryssegem ATC: Yeah, absolutely. Yeah.

0:49:51 Sebastian Gonzales DC: So how do you think all this comes together then? ‘Cause I know that probably some of the clinicians are thinking, “Well, you just blew my mind with that. What do mean, we don’t have to crawl? What do you think is happening?

0:50:02 Guido Van Ryssegem ATC: No, I think based on this dynamic systems theory and based on these cultural practices, you can see that our central nervous system has a tremendous amount of plasticity to learn, for example, to walk, and then later on to run and that we’re not necessarily have to go through these different phases.

0:50:25 Sebastian Gonzales DC: You gave some good examples, I think, in the workshop where you were talking about a treadmill and teaching someone how to run and I think… What was your thing? Movement will emerge?

0:50:38 Guido Van Ryssegem ATC: Yeah. Yeah, this is a study. It’s actually been duplicated a couple of times. So if you put, let’s say, five people on a treadmill and you rigged that treadmill up to a scenario where… That there is no… The factor of their leg length is not… It’s all the same. That basically means the treadmill speed is adjusted to their foot strike so a person is 6’5″, another person is 5’3″. When their foot strikes the treadmill, it’s exactly at the same time so the speed is adjusted to their leg length. So if you now gradually increase the speed of those five treadmills, blind study, so they don’t see what’s happening. They don’t see a speed increase. They only feel it at exactly the same time these five individuals will change their movement pattern from walking to jogging. And then if you then after a couple of minutes, decrease the speed at exactly the same time, they will change from jogging to walking. Some studies have been done with swimmers as well where you basically put them in a pool where you can control the speed of the water coming towards them and you will see that their freestyle technique will change exactly at the same time. And so based on this dynamic systems theory, basically means that you change the environment and the scenario, the treadmill speed or the resistance of the water and movement changes and it makes total sense if you tell people that, right?

0:52:17 Sebastian Gonzales DC: Yeah, yeah. Well, I think…

0:52:18 Guido Van Ryssegem ATC: Nobody stands next to you and next to that treadmill, says, “Hey, it’s time for you to start jogging now. You’re gonna fall on your face.”

[laughter]

0:52:24 Sebastian Gonzales DC: Well, I think a lot of us are accustomed to breaking down movements for people with multiple steps and making a little bit more complicated. It needs to be in like a simple thing like that seems like, “Holy shit, we can get people to run just like that?” I think your cueing is great. I do like your… I was sitting there with Cody when you told them how to put… How to get MJ to push off the floor [chuckle] the distal cueing. But I don’t know. I was thinking before with old people, I would just put… I would restructure houses. I would make it so their kitchen and restrooms are all upstairs. Just make them work up the stairs. [chuckle]

0:53:08 Guido Van Ryssegem ATC: Yeah.

0:53:09 Sebastian Gonzales DC: When are you gonna do a seminar again? I know Ben is… I don’t know. Have you and Ben worked on anything yet?

0:53:17 Guido Van Ryssegem ATC: Yes, I talked to Ben and there’s two potential dates in April. As far as I remember, I think it’s the 24th. We haven’t completely decided yet what I’m bringing in and so forth, but it might be proprioception. There was also an interest in kind of the way I do neurodynamics including and the plucking technique. And Dennis and I have been talking about this for over a year now, what a similarity there is between his technique and mine. And actually we’ve been kinda chitchatting around how we could potentially do some work together, but we’ll just kinda see how that evolves from there.

0:54:05 Guido Van Ryssegem ATC: But yeah, the plan is that I would come back in 2019 to San Diego twice. It might be, again, the same workshop ’cause there are some talk now on Facebook and so forth where people are sharing some of the information they learned in the workshop so we might see a bigger crowd next time. Otherwise, I have a variety of other workshops. One of them is called training the senses which was the last one I did. I performed better last year which was very well attended. So it’s kind of a split off again from the attractor state concept, can we augment our senses ’cause ultimately our central nervous system makes a decision based on the sensory information that comes in. Well, is it possible that we can either bias our central nervous to pay attention to one sense versus another and what would be the consequences of that. If you’re familiar with Nick Winkelman’s work on healing, for example. Nick is an ex-student of mine. Probably one of the most brilliant students I’ve ever worked with. He basically has made a career out of cues. What We Say Matters is a paper that everybody should read because it translates immediately into our patient population as also our performance population. And so by having the brain focus, the attention focus to shift from an internal cue using body parts to an external cue, external more performance-driven cue, movement changes even in the elite.

0:55:53 Guido Van Ryssegem ATC: And those of you that are not familiar with this concept Gabriele Wulf from UNLV has basically spent her whole career looking at research associated with cueing. And this is just the tip of the iceberg. We’re starting to learn more, and more, and more about how can we influence our central nervous system, and how it changes behavior? And then in behavior in our scenario would be our patients that come and see us to get help, as also our athletic populations that seek us for improving their performance.

0:56:42 Sebastian Gonzales DC: By the way, I’m gonna… For everyone listening, I’m gonna put some links into the show notes for a couple of these things. I’ll put What We Say Matters in there, your proprioception paper, so I’ll find the EXOS video of you doing some stuff, and a link to your seminars. I was telling, I was telling Ben and Cody that the world needs more Guido.

[laughter]

0:57:07 Sebastian Gonzales DC: And so whatever you present on, I would go to. And I brought a few people to that last workshop in San Diego. Jeremy flew from New Jersey, and Chris didn’t know what he was coming for. He just said, “I’m gonna go, ’cause you said it’s good.” And then so everyone that went thought, “Holy shit, this just blew my fucking mind.”

0:57:26 Guido Van Ryssegem ATC: Oh, well, I really appreciate that.

0:57:29 Sebastian Gonzales DC: Yeah, yeah, I think we do need a lot more Guido.

[chuckle]

0:57:31 Sebastian Gonzales DC: And so if people think considering doing this workshop, or not… By the way, I get nothing from this, but it will change your practice. So go find a Guido workshop. I’ll put the links on the show notes for that. Anything you’d like to add? You know, how can everyone reach you?

0:57:50 Guido Van Ryssegem ATC: I’m sorry?

0:57:51 Sebastian Gonzales DC: How can everyone reach you, if they’re looking to talk to you?

0:57:56 Guido Van Ryssegem ATC: Well, considering I’m spending a lot of time now in China, and Korea, and also Japan probably the best thing is either contact me by email, which is saferecovery, one word, guido@gmail.com, or just go to Facebook.

0:58:21 Sebastian Gonzales DC: Okay.

0:58:21 Guido Van Ryssegem ATC: And find me on Facebook, Guido Van Ryssegem, or my professional Facebook page called Kinetic Integrations, and just send me, send me a message. Phone is kind of tough, because being international… Yeah, so that’s probably the best way to do it. Also wanna say that I have a workshop planned in Portland, Oregon, on the attractor state. This is in a personal training facility, so the majority of the population will be performance driven individuals, and so the workshop will also be geared towards that. And that’s on kineticintegrations.com, as a advertisement. What else? I got something else going on in January.

0:59:12 Sebastian Gonzales DC: This should release on January, I think, 9th.

0:59:17 Guido Van Ryssegem ATC: Oh, perfect, yeah.

0:59:19 Sebastian Gonzales DC: It’s okay. Awesome, anything you’d like to add?

0:59:23 Guido Van Ryssegem ATC: There is a podcast that Chris Duffin did on me as well. So I think if you just Google my name, it’ll pop up. Because he was flabbergasted by this attractor state concept I did with him, and it made a huge difference for him. So he said, “Hey, more people need to know about this.” So I think about a year ago, after I saw him at EXOS, he did a podcast on me.

0:59:52 Sebastian Gonzales DC: Okay, yeah, I have… I did hear that one. Actually, so before I usually go in, and interview people, or talk to them on air, I go through, and try to get through all their content. So I’ve read nearly all your papers. And I was looking on podcast… I like to hear what you’ve already spoken about. And Chris Duffin’s was the only one I could find. So I’m gonna stick with my statement, we need more Guido. So…

[laughter]

1:00:16 Sebastian Gonzales DC: If we can get Guido on more podcasts, I think it’s gonna be a better rehab world.

1:00:22 Guido Van Ryssegem ATC: Yeah, I’m horrible about self-advertisement. [chuckle]

1:00:27 Sebastian Gonzales DC: You need to get on that. You can’t let Nick have all the propaganda.

1:00:33 Guido Van Ryssegem ATC: Oh, Nick is… He’s doing some amazing things there in Ireland, as you probably know. He makes me very proud. He’s like my second son. [chuckle] But yeah, the reason I do this now is I’ve stepped back quite a bit as a clinician, because I’m 60 years old. I wanna leave something behind, and I want more and more people to know about these concepts, so they can apply them, and help more people.

1:01:07 Sebastian Gonzales DC: Yeah, I definitely… As I’ve learned the… We only have so much time to learn and disseminate information. And I know for a while… Before… I’ve been in practice about 10 years. So for the first bit, I was working on information and then I started realizing that as interns started coming in they didn’t know some of the stuff that I knew, and I’m like, “Well, maybe a podcast, or articles, or videos, and so.” But then when you start doing that, you forget to learn stuff. So it’s hard to do both. [chuckle]

1:01:38 Guido Van Ryssegem ATC: Yeah, I’m one of those fortunate people, where it’s a blessing and a curse, where my hobby is also my job. So there is not a day that passes by without me reading. But like you said, it’s one of my quotes in my office. It says, “So much to learn. So little time.”

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