The five-step pyramid for effective pain and injury care

when you get up to that level, it narrows, things narrow. There's not a lot of options, but, and there's not a lot of need for variation all the time. But when we're talking about an FAI, say on the right side of the pyramid, and then we're talking about a lumbar spine, disc herniation, the center of the pyramid, they kind of have different history examinations, working diagnosis, differentials. They also have different first aid safety nets. They have similar corrective exercises and stuff in step three, but they're kind of going to get a squat, right? You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey guys, it's your host, Sebastian Gonzales with the Restoring Human Movement podcast. Thanks for joining the movement movement. If this is your first time, welcome to the show. Welcome. It's about a 45 minutes, hour long format where we basically cover many things clinical from communication to, I mean, fun things you might not already know about how to restore human movement, as well as random business stuff that is helpful to the business owner of the movement community. So there is a lot back in the archives. I encourage you to strongly go back and learn with me or over time because I've gotten better as a business owner and a clinician and I think a person just by doing these podcasts. So please follow the journey with me because it's like you jumped in the ninth inning and you thought, you know what, I'm just going to watch the end of the game. No, you should watch the whole game. It's the buildup you should look for. So the way this style of this podcast kind of flows, I try to keep things as simple as possible, mainly because we speak a different language. Like patients don't understand what the hell we're talking about. We don't always understand the way they're describing things. And it's just easier just to kind of meet in the middle somewhere. So think of it like we're just having a nice beer. We decided to go to Huntington Beach Rip Brewery. That's R-I-I-P Rip Brewery. I got an amalgamator because I really like it. Actually, no, you know what? You got an amalgamator because you went to Beachwood and brought it over. What an a-hole. And I got a Danny Kaye and our friend who is an electrician got a Super Cali. By the way, if you don't know what those beers are and if you're in Huntington Beach, you should go to those breweries. Support local. Support your local brewery.

So we're all just BSing about what's going on with the electrician's health. So think of it like that. As every podcast, I started out with a real quick story about myself so you can understand who your host is and hopefully you like me enough to follow along with me and trust me with some of the recommendations I make. So we're going to get right into that short story and then we're going to get into the content of the day. So recently, I spent a big chunk of time doing a lot of just deep work, a lot of just very focused work. It was about Friday, Saturday, Sunday of just like, just wake up, just start doing it, just go until about six, seven o'clock and, you know, take a walk here and there. But for the most part, it was a lot of different projects, a lot of moving parts going on, starting online workshops as well as putting on webinars such as the one you're hearing today as well as a different one that I did following that too. So there's a lot going on, a lot of moving pieces. And so I have this, I guess it's not a hydroflask bottle, it's a different bottle because it's got a screw top. It's called a Takya, made here in Huntington. So I got my Takya bottle, usually to screw the top, unscrew the top cap, the zipper cap, and then just kind of put it up way above my mouth and just poured in like a waterfall. That's just like how I do it. This time, I must have set my mind and Ali was watching me from across the room and I unscrewed the actual big lid and just dumped all the water right on my face. So I think at that point, I realized that I was overworked. So don't overwork yourself, take the breaks when you need it. And yeah, don't do too many projects at one time. Let's get into the show. Now, as we get into this, before I actually put on the audio from the webinar, I guess I should explain the premise of this. So actually on Instagram, I was promoting a SI joint pain webinar, mainly for general populations because we have an SI joint program that we've put together that we'd love to introduce to some of these people because there's a lot of people out there with ongoing pain in the SI joint area related or unrelated to the SI joint itself is totally a different side story. But I wanted to get general population to listen to the webinar and make an informed decision about what they should do next. I mean, even if they decide to do our program or not, it doesn't matter. Like it's, it'd be nice to guide somebody the right direction. They just have not been informed correctly, I think is why they keep having ongoing pain. I know that probably a different story too, but I think everybody has, their body wants to get better. It's just, they're just a couple of weeks away. And in my experience of working with people, they are literally only like two weeks away from feeling at least halfway better.

And then it's a little bit harder from there, but not everybody even has those easy wins involved. So I promoted this thing on Instagram and then I started getting all these hits of people putting their email in waiting for the webinar link to come in a couple of days. And so I looked at the list and it was like a bunch of students from SCU. And I'm appreciative that you guys were listening and wanting to learn from me, but it wasn't for you guys, you know, and I don't think I was clear enough on that. And so I realized, Hmm, they're wanting to learn something, you know? So I, I started emailing a couple of them and I said, look, this, this isn't for you guys. Um, I'm going to take you off this list. You don't, I mean, you could watch it, but there's only a hundred seats. So let's not take them away from the people that it's intended for just cause you guys want to learn something. But you know what I'm going to put on a workshop or a webinar just for you guys. And so within about a day, uh, I whipped up a nice thing that I have, which you've probably heard if you've heard the podcast before, which is the five steps to effective patient care, which if you have not heard already, just go back in the last, um, just scroll, scroll around. I know I did one on the box system back in, I think October, November. And I talked about over the last, I think a couple months, I've certainly talked about it once or twice. So, um, the webinar though goes over the five step system that I basically use to plug in the treatments that I use in the methodologies that I use, um, versus just, um, sticking into the single dogma of a certain type of care, you know? And so, um, in this workshop, I address those five steps that I use with people and where I plug in those modalities. Um, someone asked on there, what, where do I put FMS and where do I put, um, McKenzie's and where'd I put dermal traction? And so, well, okay. So, uh, SMS was part of a diagnostic and movement assessment. So that's step one. And so what about those other two? Well, those are kind of first aids. They're not good long-term solutions, but they're, they're good to reduce pain really well. That's step two. So, um, as we go through this, I encourage you guys to actually, um, I'll put a link, uh, to where you can actually get access to the video itself.

And that is, that is something I'll probably do again in the future. It was, it was fun. I had a good time doing, I think I could have said everything better. Uh, but it was the first time it was on the fly. So this is the audio from that. Um, again, listen all the way to the end. If you have interest in, um, learning more about this. So, okay. So, so first off, as we start with this, um, just let everybody know that, um, the system that I'm going to present today is I'm not trying to reinvent the wheel really with anything. I'm just trying to organize things for people. Um, the idea kind of came about where I started training interns and having interns in the office. And I found it very confusing, uh, even to organize my thoughts. And apparently I had a system that worked. I know Kyle and, uh, Dawne Costantino and Sarah and Nathan were very helpful in organizing, organizing of this, um, because training them was, it was challenging and it was very challenging to relay my thoughts to, um, other people who came in shadowed too. So I thought it might be actually easy to kind of automate the, the onloading process of interns by creating a system, let's just call it. And so by that, I call it the five-step, um, uh, effective patient care system basically. And I started making these, um, ideas of how we would, would use certain types of therapies, uh, corrective exercises, loading strategies, and, and whatnot into certain case presentations. So I'm going to go over the general theme today. Um, by the way, if you guys have any questions, uh, there is a Q and A box at the bottom. Uh, again, I'm a novice at webinars on zoom. So, uh, I think it's at the bottom of your thing. And so answer, uh, ask any questions at the bottom and I will spend a little bit of time at the end, uh, answering those. But what we'll be covering today is basically the five steps, um, uh, treatment plan theory, how to use what you already know, as well as how to kind of plug things in. Um, I, I don't think a lot of you actually need more strategies of care. I'll start with that is because I know a lot of people will go in like, maybe I should learn this technique and that method and so on. It's like, I know that for, for me, I had a long history of, of learning. I knew a lot of manual therapy.

I didn't need more manual therapy. I was already adequate at it. So, um, hopefully through this workshop too, or this, I guess, webinar, you'll, you'll understand maybe where you should spend your next CE dollars at, like knowing where you're competent and then maybe where you need to plug in, uh, to, to fill the voids of the system I'm talking about. So the first off here is that, um, my belief is that, that patients should be able to manage themselves. Okay. We're basically guides. Um, we can, we can show them what to do, but they need to do the work on their own own. So it's a teamwork approach. Uh, I, I call this effective care, effective treatment mainly because, um, I know there's an expected timeline and, uh, based upon what the person's presenting with, where, where we're going to get into the right spot, but also too, it's, it's effective in the fact that, um, it's meeting the patient's unique goals and it's nurturing independence, not dependence. I strongly urge you guys to not treat to where you're nurturing dependence, but also have a good, have a reason for your care, like have a reason and a path, like just doing the same thing over and over again for the same person. And for everybody, for that matter, your clinic, I think is complete BS. Um, and, and it, and it lacks ingenuity, like it lacks intention. And so I think what we can do best for the patients is create an effective treatment plan and restore attainable loss of function. Um, when I say attainable, I mean that, um, when people say they say they, uh, they're, they're out of pain, their knee doesn't bend anymore. And they're like, it's okay. I'm out of pain. If we can regather some of that function that is attainable. Again, if you have a, a, a knee that's completely like riddled with OA and there's a, there's a change of bony structure, maybe you're not going to get all that back, but if there's a way to get it, you'll actually a lot of unlock a lot of movement strategies for that person. Now to give you a basic parameters of where I've come from my education. Um, and this, none of this is just toot my own horn, but I want you to understand of, uh, where my biases lie.

I was valedictorian of LACC 2008. I like to think that valedictorian is smarter than this, than the, or sorry, saludictorian. Apparently I can't do this right. Saludictorian is better than valedictorian because the valedictorian had to do a presentation and I was definitely afraid of public speaking at the time. So, uh, I thought I pulled off the goal. I've done the DACBSP program. I've done tons of ART sort of certifications. I've taken TPI's level one through three, which exposes you to FMS and SFMA and all that stuff. Phillip Snell's fixture on back course, which I know a lot of the students at, uh, SCU just, just did recently a very, a great course, uh, shack locks neurodynamics. I've taken upper and lower, um, upper and lower twice. Uh, Koichi Soto was a good, uh, he was a good, uh, introduction into, uh, more than just general strength conditioning. Um, I've looked at some of Liebenson's work. I've read through McGill's work. I've never taken a former McGill class. I probably should. I've read both crisp manuals. I strongly suggest you read all those books, the MDT books or, um, McKenzie books, Dan, Dan, Dan John ism. I'll call it because, um, he's got podcasts and free stuff. I've been to a workshop in a lot of the level four. I'm going to talk about today is a lot of Dan John ism. Um, and I had a lot of great docs to learn from and shadow, and I'm fortunate to be a host of the podcast restoring human movement. And I learned a lot one-on-one from people. So I get to do a lot of Q and a like this. So that's a lot. I, my clinical skills have really improved over the last couple of years. Now, when I created, this is a rough parameter of what people should be doing in their care. And I've presented this even to patients via virtual consult like this. Um, it's easier to pull up on a computer and say, look today, we've done steps one and two, you should live in steps four and five. And so, um, it gives them a good, um, game plan of what the expectations are. Now it might look like things are, uh, it long ways away for them, but it's really not. And I'll explain things as we go through here, but, um, and I'll explain each step in turn today, but I, I made it a pyramid because if you, when, when you get into strength condition, let's just, let's just say, and we're talking about Dan John ism, it's a push, pull, carry, squat, hinge. There's five movements with some variations, variations along load based upon the person's goals and tolerances and so on. But pretty much everyone's going to get a squat of some type right now. Does my, when you get up to that level, it narrows things narrow. There's not a lot of options, but, and there's not a lot of need for variation all the time. But when we're talking about an FAI, say on the right side of the pyramid, and then we're talking about a lumbar spine disc herniation, the center of the pyramid, they kind of have different history examinations, working diagnosis, differentials. They also have different first aid safety nets. They have similar corrective exercises and stuff in step three, but they're kind of going to get a squat, right? And we get into step five. They're going to want to play with their kid. Like this, things tend to migrate together. And when I have patients who come in, say for a hip, then they come in for like, like, uh, like a foot, they're like, well, what do I do for the corrective exercise? And I'm like, remember those, remember those ones that we did, the single leg stance ones, you're probably going to do them again, but I'll cue it in a little bit of a different way because the intention is different, but you're probably going to do a squat in a single leg deadlift again. So at least what happens here is people tend to live in steps four and five. It keeps them strong, mobile and enjoying life where we step in as healthcare providers is steps one, two, and three.

And now we have to migrate them up towards the other, to the other spots. Now, based upon how acute chronic subacute they are, it's, it's, it'll, it'll depend on how long during each bracket. Now for step one, I call it clustering data. All right. I think of it kind of like chicken shit bingo. All right. But rather than the first shit, we basically go through and we're going to wait for like 30 days for the chicken to shit and wherever it starts to go, say it lands all on number six. Number six is our, is our diagnosis of a disc herniation. Sure. 67 might be a facet syndrome, but the chicken only shit once in there. So it's all the data is lying on six. Like why not follow six? It's the highest probability based upon the information we know. We don't know a solid diagnosis. I think as much as we want to say, we know the diagnosis. We don't know until it's gone.

All right. We don't know it until we've confirmed that we've treated it effectively. So when we're clustering data, there's a couple of ways to do this. There's observations of habits. How does the person walk into your office, by the way, a lot of this step-by-step thing, I started thinking when I, when I created, I'm like, Hmm, McGill's system of, of basically getting people, uh, for disc is simple. We can do this for all the parts of the body. All right. Um, uh, Dawne Costantino, I don't know if you're on here. Dawne Costantino, Dawne Costantino, my, uh, uh, associate doctor mentioned it the other day. She's like, what would you do for a neck? I'm like, same thing we do for a back, but just a little different region, you know? And so it's the same kind of stuff, right? Observations of habits. What are they doing when they walk in, when they get out of the car, when they sit down, when they walk down the hallway, when you're talking to them in the exam room, are they standing or sitting? Are they wincing? Are they leaning? Right. This is part of the clustering data. And so that's a lot of chicken shit on number six. Taking the history is also gathering data. We know that I'm not going to dive into that too much here. Orthopedic exam. Nice. But at the same time, we have to differentiate the orthopedic results. Recently, I did a Faber's test. Uh, it was Faber's test. Some somebody with, uh, SI joint region pain, let's just call. Right. And so they, they said, Oh yeah, that's painful. Right. And so what I did is I, you can see, you can observe that their spine drifted because as their hip comes out to the outward flared position, that is Faber's test, it actually dragged their spine into rotation. And so noticing that I pressed down on the opposite side, ASIS, and then I said, Oh, it went away. That's a differentiating examination. Um, there's lots of differentiating examinations you probably learn at school, such as slumps test and neural tension tests of the upper extremity, but there's other ones you can make up too, based upon the observations you see. Obviously the differentiating of the test is better distally from the problem or proximally furthest away from the problem, but we got to get what we can take here. And if I was going to take that Faber's test, yeah, we have a positive Faber's and, um, and circumduction and all that stuff with that hip, but it's because the spine's rotating. So let's just take that chicken shit, put that on six rather than on 67 neurodynamic testing. If you guys have not taken neurodynamics by shock lock, you should, I don't get paid anything to talk about this. Okay. Um, or promoting any type of, course, but when to have all the tools in your, in your clustering data tool belt, you should probably take neurodynamics and you should probably take something like, like in the Gil course. All right. You know, a lot of the stuff in school already, but there's lots of other versions of tests that you can probably use that will help you significantly differentiating the, uh, the, the information. Um, by the way, uh, questions will we answer at the end? Cause, uh, I don't know if I can jump back and forth yet. So step two, uh, first aid and safety net. Now this, by the way, is the green, does the green mean weed now? I think so, or maybe it's just another country of first aid. Either way, when I looked up first aid pictures, all of them were green. So apparently weeds going to run the world. Uh, step two is going to be our safety nets, or, um, I like to use a couple things, positions of comfort, um, or, uh, things that they are doctor established first aid. So doctor established first aid, maybe in a low back would be a lane face down on your belly. Or a lot of times patients will demonstrate a control system. They'll demonstrate a, a position of comfort where you, where they're like pacing around the office. You're like, dude, are you okay? They're like, I just got to sit down. And then they, or they slump down and they kind of go into like a, uh, like a first, uh, um, sorry, a shortstop squat, like the McGill shortstop squat.

That's a demonstration of first aid. When you do first aid, all we have to do in my experience is dose it. All right. The body's not stupid. All right. People who come in with ridiculous symptoms in the hand, they go like this sometimes. And they, and you're like, why are you doing that? And you're like, they're like, because it makes my hand feel better. The body knows what it's doing, what it's doing most of the times. I even wonder too, with like rubbing, like people rub their body when it like, when they got hit with like a beanbag or something, it's like something must be inherently in there. Why not just let it happen and let it happen more. As long as we know that it will, that it's reducing the person's problem. You can do a movement audit in this section. And typically when we're doing a movement audit for a step two, we're looking for a 30% reduction in pain when using the right strategy. And it could be doctor established strategy. It could be the patient strategy. And it's definitely dependent upon acute, subacute, or chronic. All right. As a general rule, acute cases, like someone came in as, as like they burned their arm, like in the sun, nothing I'm going to do is really going to be extremely helpful. There's a, there's a normal inflammatory period.

It's just happens. That's the body. Okay. So subacute is much more. I love subacute. Chronic is a little bit more wishy-washy. Not everyone requires first aid or a safety net, but what it does is, and there's why I like to go this route first is figuring out number one, it confirms a little bit more of my working diagnosis. If I know that a, if we have a disc patient coming in and I extend them a lot, it's probably, it's, it's probably going to be a disc. Probably. I mean, maybe, right? Um, if that per, if I have the person been backwards and it makes them worse and they're 15 year old, a 15 year old tennis player, and they have a positive storks test, maybe that's confirmation that is gathering more data. Like maybe we have a PARS defect there. So this is a nice opportunity also to, to provide the literal safety net to the area. So you can explore more things. If the person does not have trust in you, you can't explore more things. So allow them to have the control system.

And again, why I call this the safety or the first aid is because it is about a five to 10 day period. It just, that's just what it takes. All right. Um, the, the timeframes changes, we go upwards, uh, on the pyramid, but, uh, you might send someone home with a step two, step three and step four in the same day. All right. This does not take a whole heck of a long time all the time, but it's dependent upon the person's problem. So, uh, an example of a couple of things, methods that I like for first aid is I, I like using MDT. I like neurodynamic openers. Um, and I like, um, or, or offloaders and a lot of, a lot of things can fall into this category. And although I don't tend to use as much manual therapy as I used to, there's certain, certainly you can use things like, imagine, imagine someone has a shoulder, a shoulder problem and you have to put it in a sling.

And that's the only way it feels better. There's nothing wrong with a sling. There's nothing wrong with a knee brace or tape or manual therapy or, um, laser light therapy, whatever you want to use, as long as it accomplishes the goal of reducing the person's problem and giving them a safety net that they can use at home. I don't care what it is. And so the, a lot of those methods that you've learned that you already feel good at and competent at, I'm not telling you to scrap them. I'm telling you to just plug it in, know where it has a place, because if you treat this person, like this as step two forever, I think you're doing them a huge disservice because you got to get them to three, four and five, because they should live in four and five. Now, again, I want to emphasize, not everybody needs a first aid. A lot of people do. And especially people who are chronic need this.

Now the second step is our three, which is corrective buttressing and breaks. And this one's been challenging for me to communicate because, um, when it comes down to it, when I know a lot of students have mentioned to me, we learn a lot of corrective exercises, but we don't know when to use them. Well, so these are the situations where I might use them and why I would pick what I would pick. Um, again, it's important to realize too, not everybody needs a corrective exercise. And I think the danger that our profession has got into with corrective exercise is that we start making people act only like babies, or they have ongoing on floor exercise for like six months. Like, no, like this is a stepping stone into an ADL loaded movement. They have problems bending over to pick something up, teach them to bend over and pick something up and teach them to navigate load throughout life. So this is a stepping stone. It is a way to patchwork in some of that, um, either strength or endurance or, uh, um, uh, uh, muscular shit. What am I talking about now? Um, uh, movement patterns, whatever you need to do to get this person to get onward and out of this. That's what we need, but don't make corrective exercise harder just to make it harder. All right. Now the ways that I would probably use this is let's just say, let's say we're talking about a low back disc again, corrective, because a lot of you have probably come from Philip Snell's course, corrective patterning.

So we've had people, uh, Mikey was on the, uh, I did a podcast on this recently, Mikey, it didn't release yet, but when I got schooled by Mikey at the office, and so someone came in with a fairly clear disc. And so I, I, I went down the route. I picked butcher scene and breaks. All right. So I picked some bird dogs, some side planks, some, um, McGill modified curl up. I did a glute primer. The person moves around for the movement audit. They're like, ah, I can't really, I don't know. And so Mike's like, you know, here, here's a dowel. He gives them a dowel for the back of their head, mid back and butt crease to simulate contact of the spine. And he taught the hip hinge out of the seat. And the person's like, whoa, that's better. Right? So Mike took the corrective approach, which in that person was the correct approach because it had a immediate in-session symptom decrease with the movement that they pick. Again, I didn't go through the movement audit thing, but typically we'll have people, Hey, forward, backwards, sideways, sideways. If we're talking about backs, pick a movement that bothers you, maybe cool. We're going to do that again in a second. After we do this one thing, whether it be, um, a first aid, whether it be a step three, whatever it might be, but it should have a 30% improvement or more. And it could be a step forward, by the way, I'll get to that in a second. Um, but just know the intention of what you're doing, but you're seeing would be following along that McGill co-contraction model. You ever wonder why side planks make people with low back disc feel better or ab wall stuff that guy wire system. Uh, or maybe we can even say the DNS like intra-abdominal pressure model might work again. That's co-contraction and buttressing up the spine to decrease the amount of flexion, uh, or, uh, a triggering flexion in this case. Now, another one we can use is again, building the brakes on the system is if the triggering movement is forward bending of this spine, then maybe we need to build a brakes for extension. And this is using the Guido Van Ryssegem again model where we just smoke the posterior chain. In this case, maybe I'll use a, um, maybe a dead or not dead bug. We'll use a bird dog and we'll go into the glutes and the erector group is the tone has physically changed a protective tone change. So the person can't fully go forward. I usually describe this like you've gone to the gym, you've done way too many bicep curls and you can't move your elbow into full extension again. It doesn't last forever, but there's a protective window. So corrective buttress or breaking system. The point is have a purpose. Don't just give them random shit. All right.

Selection of a step three exercise should have a purpose based upon what we know or what we think is going on with the working diagnosis. Again, if your step three doesn't work, maybe you did it poorly, you chose wrong or you have the work wrong working diagnosis. So if there's not a 30% immediate reduction of symptoms, I would regress to step two and re or reevaluate data in step one. There's a possibility we could have missed some spots there. And, um, someone had mentioned recently, they said, I rehabbed the shoulder for a labral tear, but it's not responding. It's been months. What do you think? I say, I think, I think you got the diagnosis wrong, you know, and go backwards.

Just retest is all, you know, I, I retest every couple of visits with some people because their symptoms change. So I give them a little bit of a different correct, uh, step three or step four. Now on to step four, your strength training or your resistance training. Uh, this is the start of where I would consider my office's maintenance care, everything that we've talked about so far, step one, same day, step two, they're probably gonna be done in a week, five to 10 days. Step three, based upon, we know about at least, um, endurance building of say the core with this area, six weeks, I think it's fair if they're doing it four to five days a week, you know, they're building a bank account system. Like they're doing, they're just doing the work, but it doesn't mean you have to drill it in every time and change it every time.

That stimulus they have, uh, for step three, it just needs to, you can just change it based upon, uh, a perceived physical exertion. Um, into step four though, this is there. It's not uncommon for me to get people here within the first or second day. Not always the first day, just cause the first day I'm still building some trust. And if I load them here, then they might get provoked and they might not come back. And I've said before many times that my number one goal on day one is to get them to come back because you can't fix anybody fix. I'll quote since we can't say that you can't fix anybody in one day. You have to create a, in a chronic state for the body adapt to adapt to. They didn't get that way in accident. There are some of their past habits. So we need to change something and build a stimulus for adaptation.

And that's what step four is all about. And so I know everybody's, or a lot of people are really interested in the correctives and the diagnosis and the exam. And honestly, half the time, like if we're talking about like which type of hip impingement we're talking about, I don't really care because when I've gotten to the point where I'm in step two and step three, they're already feeling better. So does it really matter? I mean, you need to know generally what we're looking at, but how nuanced do we got to get really? I don't even know if it's that important anymore. Um, but I know that people want to know their diagnosis, but really at the end of the day, do they just want to feel better? They really want to know it. Right? So imaging and everything down there might not always be merited unless they're actually not responding. So step four, push, pull, carry, squat, hinge. If you're not familiar with Dan John, please get familiar immediately. He has a podcast, which is stellar.

He has so much free shit online. Um, Dan John university go through there. Uh, and I strongly suggest Dan John's intervention. It provides the move. It provides a, the, the matrix, which is a good starting point of figuring out how to scale the push, pull, carry, squat, and hinge. I will typically go bilateral or unilateral on this or probably actually probably both. The reason for unilaterals is because when you have a load on one side of the body, now we have a lever, a moment arm that changes and now the body has to stiffen on the side. And what we know from Lisa McGill's work from the, uh, from the spine is that we want to have some, some stiffness of the spine when we're moving the ball and socket joint. And so something like a suitcase carry load on this side, stiffen this side or co-contract around it, and then start moving the ball and socket. So these exercises can be extremely therapeutic if you know how to plug them in. Usually I'll, um, I'll change the implement or the load based upon the person's capacity by all means. Do or so do not make this a CrossFit workout. Do not make this a workout that you feel that you would like to do make it a workout or make it a challenge that is appropriate to the person's problem. And I don't know how many people, I think we might've gone too far with the, got a problem, load it, right? No, you load it when it looks appropriate to load it. And we've probably gone. So the pendulum swings both directions on this. So the load is, is not always, doesn't always need to be high. It has to be enough to be a challenge to that person that they can still do well. And so the implement, meaning Dan John has a kettlebell here. It could be a sandbag. It could be a barbell. It could be a baby. Like it doesn't matter what it is. It just has to be doable for the person. Sometimes they won't be able to hold this thing up because they're, uh, because their bicep has a problem and maybe you have to do it from a low hang position. So there's a lot of different ways to, to use these exercises in a therapeutic setting. Now I'll give you an example of, of maybe how we would use something like this. Um, so I had someone do a standing, um, they were doing, uh, I don't, um, not a, not a trend delenberg.

They would bring, bring their, bring their knee, uh, hip flexion, standing hip flexion, basically like a marching pattern. They're like, yeah, yeah, my hurt. My hip really, my groin really hurts when I'm doing this. Okay. Here's a kettlebell. So I hand them a kettlebell. They march again, no pain whatsoever. So we're building a, we're building a support system and kind of using a step four, which is a higher level of a step three to accomplish the same goal. Uh, I think Liebenson had a good quote, strength, uh, rehab is strength training when you're injured. So we can certainly put people in here, but you need to have a system in play. Um, and I think I mentioned too, it's make it based upon your goals because I've, I've made this mistake many times where I assume the patient's goals are my goals. Um, or that they should hit a certain standard. Um, standards are not everybody's standard and it's not everyone. It's not everyone's capacity. Um, the depth of a squat will change based upon the problem. Uh, also too, uh, I only want to be able to lift as much for me as a patient. I only want to be able to lift as much as I need to on a, let's just say deadlifting. I don't need to, I don't need to deadlift 250, 300 pounds. If I was going to do that in real life, I would be, I would not be a dumbass that it helps them. I asked somebody to help me to lift whatever the hell it is at 250 pounds. So make sure it's within the person's own goals. If it's your goals to lift 300, 500 pounds deadlifting, deadlifting, then that is your goals.

And then that would be, um, that would be the clinician's decision to see if it's safe or not. And then progress on that route. So low movements, loads, pace, progression should be selected according to the working diagnosis. All right. If you see that the person has pain with walking, uh, and it's a, it's back pain, maybe you speed them up a little bit because that'll, that'll help out with that static, uh, uh, the static effort that it has to over, the low back has to overcome every time they stop. Right. Um, the movements, again, the depth, maybe the depth of the hinge is not appropriate for that person who's flexion intolerant using the data collected in the examination and the patient's response to steps one and three will help assist you in choosing the appropriate exercises. So again, um, step two and step three, if they have not, if it's challenging enough in there, do not put them into step four, or maybe you just pattern step four. There's nothing wrong. We just can maybe go through a hip hinging pattern. If this is a, if we're working on a hip hinge, by the way, hope everyone knows a hip hinge is not a deadlift is not necessarily a hip hinge is not a deadlift. A deadlift is a hip hinge. Okay. A squat is a, not an exercise. It's a movement. Hope we all can agree on that. So, uh, this step can be used as soon as day one, and it can be used in place of steps two and three. Um, interesting people I've had over the years. I remember one guy that, um, I did steps two and three and it was not working very well. And as soon as I just loaded him, um, just kind of doing a general physical preparedness type of approach, he felt better. And so some people, especially deconditioned people, you don't necessarily need to go down tinkering down all this other stuff.

You can just get them to like, they're, they walk in holding a, holding a, like a dog, maybe right. They're holding a dog, right? They're carrying something already. Don't scale them back into nothing. So make sure that you're observing what their capabilities are already. The last thing is step five. And I don't, this is something I need to improve on a little bit in, in my own clinical practice is talking to them about what they want to return to. And so the reason why I put this at the top of the pyramid here is because a lot of people will hang out in steps three or four. And it's like, Hey, you want to Kyle, do you want to go play baseball today?

And you're like, nah, my, my ankle, like I can, okay, you want to go lift today? Yeah, I'll lift, right? Lifting is very comfortable to Kyle, but maybe he doesn't want to, maybe he doesn't want to sprint. So playfulness is kind of, I like it to consider like breaking the rust off of the robot and it exposes us to, is to movement for variability. And I'm sure a lot of you've heard the term. Now we can make up funny dances about it. We can do a bunch of yoga flows about it, or you can just let them go out and explore like this guy pushing this, this old guy on the, the, the cart is like, I'm sure this isn't perfect form, but you don't need perfect form, especially if the load is low. And so I like to think about if I'm going to the batting cages, there's a perfect swing. And then there's a swing that works for different balls thrown.

And so my body's reacting to the object. And so I like people to usually use things like reactional sports. Um, so pickleball is a nice one, catch butterflies, chase squirrels, but just live life. You know, I don't think a lot of people aspire to live in the gym. And then when they get asked to do something, they say, I don't know, you know, so the goal is to, to decrease fearfulness of movement and to stop all this BS of I'm too old for that. You know, I've thought it before. I've had a hamstring tear once in a strain twice. And I thought like actually the first time after I did it, I was in the outfield, I dove for a ball in my, my left fielder said, uh, before I could even get up, like I even felt like the thong, I looked around for a second ball, like someone shot me type of thing. It bruised.

Um, and so he, he, before I even get up, he's like, yeah, we're getting kind of old, huh? And I was like, don't tell that shit to me. Right. Maybe you're getting too old for this. But after that day, I've still played six years of really not having any issues playing baseball with that hamstring. Actually, it's the other one that's been giving me an issue. So I like to think of it like make your worlds, worlds your oyster and, and get people to live the way they're intended to live. You know? So I think people should live in steps four and five now. Um, just a couple of things cleaning up here at the end and I'll take the questions. Then the reason, the reason why I put this on again is because I want to show you that I think there's a framework that we can all use and use the stuff that, that we all know how to use. Um, I know that from, from interns experience, they get a lot of tools, they don't know how to organize them. And I proposed before, but we didn't get anybody really interested. And I thought maybe they don't understand that the reason why we're doing this is because I think, um, I mentioned disc in this, but how about shoulder? How about neck? How about ridiculous symptoms? How about hip FAI? Um, I'd like to put on a step-by-step virtual workshop since apparently nobody can go to actually workshops in person anymore. So all that money that you spent, you got refunded for all your stuff, like your symposiums and your, and your manual therapy courses.

Um, you're not going to, they're not probably not going to happen for a long time. I can almost guarantee that. Um, but anyways, I'm going to put on some virtual workshops just like this. I'm going to go step-by-step on things that you'll see commonly. And again, I guess I didn't mention this in the beginning. I'm not good at everything. I'm not good at everything. I'm just telling you the things that have worked well for me. Um, even a wrist and stuff I'm not easily good at, but I did have a virtual consult the other day of a, of a true de Quervins. And so I was able to help her and she, I got an email confirmation. This work actually had her pick up a chair.

We did a lobster carry. Oops. We did a lobster carry just like this, but the thing wasn't there and we smoked it to high hell. Um, and she, she had a 30% reduction of her symptoms immediately. And then within three days, she had no de Quervins anymore, at least from what I know. So step-by-step, I'm not good at everything. And I'll tell you what I'm not, what I'm good at. I'll tell you what I'm not good at, but I'm good at quite a few things here. Um, regional and condition dependent. Um, I'm, I'm considering doing them like an hour, hour and a half, two hours, something like that. I don't know. I've never done this before. I'm just, I think it'll be useful to everybody. The stab reality is like, I, I mean, I've been 10 years into practice, 11 years now.

I'm tired of people practicing like, like they, like they have not learned anything different. All right. I've met a lot of people and I've, I'm sure you guys have had a lot of, uh, patients come in your office where they're like, Oh, I went and did this. And you're like, Oh gosh, I really wish I want our profession to get better. And so again, this stuff is stuff that's worked well for me. I hope it organized my thoughts. And so I hope that it helps you guys. I would rather die thinking that I've contributed something to the profession where it's not just like someone practices for 20 years in their office, learn these killer things to do, and then didn't share because they're stuck in business. So I'm hoping to do that. And that's the whole point of the podcast really, by the way, if you don't subscribe, you probably should a lot of free shit in there. These are the things that we're going to cover. Um, hip, shoulder, cervical, lumbar. I know lumbar has been killed to death, but if you don't know lumbar, then you're, you're going to have problems. Uh, I didn't know lumbar for probably five, six years and I was in practice and it was very frustrating, uh, upper, uh, upper extremity radiculars and lower extremity radiculars. So now we're going to go through the Q and A time.

Um, I will stop this presentation and go into see what you guys put in there. So, uh, let's see what we got. Q and A. Hmm. Only one question. Shit. Okay. I'll answer that. So how do you talk to your patients? How do you talk to your patients to buy in without insurance? Okay. I'll answer this. Can someone ask me a clinical question? All right. I'll answer this, but we're not talking business here. Um, without what buy in without insurance. Um, it is going to be based upon what if, what you can do the same day. Okay. And obviously it changes based upon if you're on the phone, if you're on the phone, it's a little bit of a different story, but you have to create a relationship on my podcast.

I did a whole podcast on this called ring ring. And so I think it was in October or November or so I strongly suggest you guys practice playing the ring ring game and just commit to spending about 10 minutes on the phone and learning what their pain points are. So if you can do that, you'll have better ground to stand on and understand why they might not want to spend their money on you when they're willing to spend it on something like their purse. Notice their purses when they come in, because there's a lot. So, um, but we have a lot of, we have a lot of, um, testimonials and whatnot, a lot of YouTube videos. And so, uh, I think probably more people come to us with insurance mainly because of clout. I'm not saying I'm any better, but it's just clout. Okay. That one answered. Um, what do you do to keep your patients coming back when you get them out of pain the first visit? So showing them the game plan of what to do again, that pyramid is it's easy to get people out of pain. It's harder to keep them out of it. And so usually I'll say, let's just say we're talking about press-ups because press-ups are an easy, easy example for low back. I think we all know that the press-ups as first aid is like, it works, but if you do it forever, you're asking for a very different type of, uh, uh, painful type of other symptom, uh, that will come about at some point in time. So do me a favor, come back next week. I will revamp for a better long-term program. I, I usually have no problem whatsoever getting into the second visit. It's communicating later that they actually need to do some of the hard work. Like the hard work is not in the first couple of weeks. That's easy stuff because strength conditioning, the adaptation, we all know adaptation takes time.

And so usually when I get towards step four and they're feeling really good and I don't have to re, uh, readdress any of their first aids and their correctives are kind of dialed in used to, by the way, the correctives usually are used as a warmup later. Um, then I'll say, come back in a month, two months. And it's based upon what their capabilities are. Um, I remember I had one lady before that she's like, she's like, uh, so, um, give me one thing to do for my shoulder. And we're at the end of the session. I know her very well. She'd been coming. Um, or I shouldn't have been coming for years. She was actually a patient at one of my, in my PPR office. So I've known her for years. And so, uh, I said, uh, okay, do a rowing machine at the gym. And so she's like, uh, so the row, is that kind of like when you like check demonstrated? I'm like, okay, please come back.

I'm not giving you any help by leaving you in this limbo period. Okay. So I explained those purgatories of first aid and correctives. All right. You've been to an office where you've done a shit ton of corrective exercise forever. How'd that go for you? Let me get you to something more sustainable. All right, Raul, you say patients should live in step four or five, but what if they don't enjoy weight training at all? What's your game plan? Good question. Um, so I would reconsider what weight training is in this point and just, that was the pyramid is very general. Um, but you can probably just get them to, you can trick them into stuff. Um, and it's, it doesn't have to be high loads. I think is the important thing to say, you know what, once a week, I want you to go to the store. Um, don't drive your car there, just walk there. And here's a bag. I'm going to give you a reusable bag. There's two of them. I want you to buy all your canned goods and your milk and everything. Um, at that point in time and walk it back to your house. What are we accomplishing there? Well, so they probably got to put them down every once in a while. So you're doing a hinge.

They have to do a farmer's carry to get there and back. Um, maybe they have steps at their house and they're walking up steps with a load. So you're, that's more of a knee dominant, a small knee bend. So I think generally you don't have to throw everybody into a strength conditioning circuit, but I think it's, I think it's really nice to do. Um, and that might be my bias coming out, but I think it's, I think it's, I think it builds a nicer buffer or sorry, I'm going to stop using buffer. I've said buffer for a long time, but people don't know what a buffer is unless they've been through chemistry. It's a bumper. All right. If you don't want to damage your car, create a bigger bumper. And so that's my bumper system. Okay. Alexandra, uh, in step two, basically palliative positions. Yes. Um, and so, uh, usually when I do a palliative position for people, um, they like, cause cause they, they can use their pain as a guide on this and they're like, you know, I only feel a zero out of 10 pain when I'm laying down on my belly or, uh, for cervical complaints. A lot of times they'll put their, like, they'll go into a frog's pose. They'll just relax, relax on the ground. And so it might take us, uh, like 10 minutes to figure out an office tinkering with this and that and so on. But if you just ask them what makes you feel better and they do it, maybe then you would say like usually with a static position of comfort or palliative position, I'll tell them to do that 10 minutes or sorry, 10 minutes total throughout the day, broken up 30 second bits. And so the goal is to cool it down and build it up. I think it's a Greg Lyman thing. Um, but, uh, usually with Bacotti, same thing.

Give me 30 seconds every couple hours until you've hit 10 minutes in the day. Usually that'll reduce symptoms pretty good without having to do anything else. Um, who are the people who do not need first aid? Um, I'm not sure if it was clear to me. The people who don't always need first aid is like, um, someone who is, well, number one, someone who doesn't respond to it, maybe, uh, uh, acute, usually acute people. I won't necessarily push first aid on because, um, there's their, their pain is, is, is, is it's a line, right? There is no, there is no undulations based upon, uh, mechanics or positions. So those were a little bit more, more challenging, but someone who is, let's just say someone who has knee pain, who has 20 pounds overweight, what we can just probably do is get them to be more fit, you know, and that would be a longer term one. Maybe a, maybe a short term first aid for this person might be like, you just give them a knee brace or you tell them to in this, in this situation, I don't, I'm not a believer in don't bend your knees past your toes, but tell them don't put your knees past your toes and your squat. You might teach them a hip dominant movement.

And so now we, now the whole, now the whole system will get a little bit more muddy is teaching a hip hinge, a step three, step four, or first aid in that position, in that condition. So I know teaching a hip hinge with people with knee problems will get them to feel better, but is that something you want to dose throughout the day? Maybe you do. So if you dose it throughout the day, you treat it like a first aid, you give them wall taps. Hey, I want you to give me like five to 10 wall taps every two hours just to drill in the pattern. Hope that was helpful on that. Um, can you explain to me more on buttressing, what that is and how it would look clinically maybe for an, uh, lumbar spine disc.

So buttressing is like a, so the McGill guy wire system is creating co-contraction around the joint. Um, in the example I gave about the de Quervins, um, or let's just talk about foot when we have, uh, Achilles tendonitis people, or sorry, let's say tendinosis. Since a lot of these conditions are not actually an itis, since there's no swollenness or bogginess to it. Um, usually the, usually the intrinsic foot muscles are kind of off. And so I use that theory based upon the hand of these ones crossing the joint, maybe doing a little too much work. Uh, so I told her, let's not think of overwork.

Let's think of underwork. And so let's just load those things up and it'll help support the area because it'll co-contract around the joint. For some reason, those muscles might be doing too much extra work. And we're talking about the lumbar spine, buttressing would be, I would, I would buttress up the entire area. So the actual hoop mechanism of the core might be, um, it will offload the area of interest and actually in regards to the lumbar spine, it'll actually decompress the spine because it'll perk it up. Um, how do you progress or how do you progress or increase load of a exercise during step four? Um, good question. So let's just say we're talking about an overhead press. That might be the easiest. So putting someone into a standing overhead position, we'll say a barbell, um, that might be pretty hard. All right. Especially someone with a shoulder condition or a neck one, because the barbell is very unforgiving. It locks you into position. You don't move it into position. Maybe a regression is a kettlebell overhead press. Maybe a regression from that is you take them out of free space a little bit more, put them into a tall kneeling position, a low kneeling position. They can't handle that. Maybe you put them onto the floor. I do, I do something called a, uh, downward bear, which is a rocking back. It'll look like a downward dog, but the knees are bent because I don't care about, uh, use the hamstring tension gets in the way. And so I'll have them load overhead, but on the floor, a fair and feedback from the hands will give you a lot more, uh, um, and even the feet will give you more body awareness. It'll give us more movement competency in my opinion. Um, and so maybe if that, uh, downward bear, that static position is easy for them, you take them into a pike press, uh, still, still same position, good kinesthetic awareness. And now we just load and load them a little bit more. If this person is struggling with having ongoing stuff, you make sure that you, um, by the way, when I, when I load people, I say, you should probably feel it here. And so, um, I'll say you, you should probably feel here and also you should feel it in a broad area of effort, not a pinpoint because they'll usually say, well, uh, I feel it. Yeah, I feel it. Well, where do you feel it? Oh, in the spot where I came in for no, no, no. Okay. That's wrong. None of these should hurt. They should feel effortful.

They shouldn't feel painful. Okay. So in that instance, I might say, you want to, you want to feel this in the shoulder, but if you feel in the area of concern, mention something and I'll scale you back. But based upon the progression of that, if they do the, if they do the downward bear, well, maybe I progress them into a, um, a pike, a pike press, or maybe a bear crawl, even something more, more horizontal push. Uh, how do you, how would you introduce loading into a low back person with acute disc? Um, I'd probably split squat them first. Um, mainly because it's been dependent upon how trusting I am. The person is aware of their mechanics. If you do an elevator movement, uh, up and down, you can get them into a vertical spine loading position versus a creating the spine as a moment arm. Remember it doesn't, spine doesn't have to move to create a torque moment. It just has to be loaded. Think of it kind of like your, or, or it's like a sheer, uh, a sheer load further down the moment arm. Uh, I like to use the analogy of having a flat tire and I, um, there's been a lot of times where you get the flat tire and you just try to jack the thing up, you know, and you get that little stupid thing that comes with the jack. And finally someone comes along with this big old pole and you crack the thing loose. Uh, the, the moment arms bigger. Uh, and so if you're exposing that doesn't mean there's just because the nut didn't move, didn't mean there wasn't a torque on it.

And so when you introduce loading into the spine, if you don't trust the person or if they're having re aggravations or their suit, actually she said acute, if they're super cute and they can't get off the floor, I might do a stallion. Okay. A stallion is like a bent knee version where you're just going up and down from your knees, uh, of a hip hinging pattern. And if I felt like I wanted to add a weight, I would, but you know what? Think about the, what's the goal of that period in time? You got to settle the disc. We're not going to load them in that, in that case necessarily for a step four, but I load them into a step three. If they're acute discs, they're probably flexion tolerant. I could probably do, I could probably do bird dogs. I pretty probably do side planks. I might not do a modified McGill curl up yet or a, uh, a buttress plank, but I might depend upon what they feel. Um, also an acute disc on day one, if it's hard to get them to move around.

So if there's a timetable involved, um, you might not want to do that on day one. What type of take home, uh, home, home material do you provide your students with rehab for rehab exercises? Do you allow your patients to film themselves? Uh, every person afterwards, I say, I say, look, let's do a video. And they say, I don't know. And I say, look, if you email me later and ask me to send you a video, I won't. And I give them this story that it's going to take a lot of time extra. Just do it right now. I can do it all right now for you. I will do the exercises. You just hold the camera. And so they get to go home with that. And these are pretty appreciative.

How long do you typically wait for your order or for you to order images for a patient who is not getting out of pain within the first few visits? Uh, how do you choose? Or so I guess that one, um, it's, it's really dependent upon number one, the red flags. Um, if there is red flags involved, I will image, um, sometimes immediately. Um, but the, um, for people who aren't getting out of pain, it's, if I can, I need to question the person and see, are they doing their homework? Do they have a control system? And that's why in step two, I said, does the person demonstrate control? You know, um, we have, we had a person recently who, um, beyond reasonable doubt, it looked like their hip was driven from the spine in the low back. And so they'd come in and they would just round their back a ton and like all their movements to just ton around. And, uh, I was talking to one of the interns and I was like, every time we do a disc protocol on them, they get better for a period of time. And then they did come back and it gets worse. Um, think of how much time throughout the day they're doing the rounding and we're doing the extension and the supportive stuff. So figure out if the person's unknowingly not helping you before you go too much to imaging. Um, a question too on that is how do you choose someone to load your first visit? If you're suspecting a disc, um, again, uh, how much I trust the person, how much they're trusting me, how acute they are. Um, but, um, I've loaded people as soon as day one, uh, many times I get them deadlifting from blocks if that's what they want to do. Um, because some people too, they're coming in because they want to deadlift.

All right. And you could be like any other small office. If you're like, Oh gosh, I'm going to do the same BS care again. I'm not there. I'm not supposed to be deadlifting. Like you said, and so on, you know, like, so, uh, I just go with what the interaction tells me. And if I think it's safe, but there's been a lot of times where I'll talk to them like a heart to heart conversation. I'll say, look, it's not in your best interest right now to do that. I'm not going to have you not do it forever. But right now during the first aid, I'm getting you out of the sun. When you have a sunburn, if you keep going out in the sun, you're going to make this harder on yourself than me and we're on a team. Okay. So please just remove yourself from the sun for a couple of days. Next time I see you, we'll explore the deadlift. You've touched on this a bit. Um, but you, can you explain that now? Um, uh, you've, uh, question is, uh, you've touched on this a bit, but can you expand on how SFMA, neurodynamics, McKinsey, MDT, et cetera, work together throughout the, throughout the next, throughout the five steps? Um, so SFMA, if we're talking about the, I guess, algorithm with it, um, I don't use a ton of it. Okay. I use parts of like a general movement screen in my examination, but that would be probably step one. And so I'm guessing if you're using SFMA, you'd probably use it in step one, the implement, uh, what you're planning on doing with that person, the implementation of the corrective exercises then might be your step two or three, um, neurodynamics. Again, neurodynamics would be an assessment, partly step one, also to the, uh, the treatments of neurodynamics would be used in step two, probably, um, opener sliders and tensioners usually, uh, McKenzie, um, uh, uh, McKenzie would be mainly like step two, um, uh, dermal traction, mainly step two and, um, soft tissue step two, adjusting step two, um, DNS step three, um, like any funny movement that you've seen on Instagram or YouTube with some doc, I usually say the patient just, if you've seen some, some doc on YouTube or Instagram doing some funny things with bands and bridges and, and all that kind of stuff, that's a step three. If it looks like you're building some muscle, it's step four. So I think I've answered all the questions here.

Uh, at this point, if you guys are interested in that, the workshops that I'm talking about, um, message me, uh, independently, you can do it on my email, which is info at P2 sportscare.com. Again, info at P2 sportscare.com or message me on Instagram. That is at performance HB. It's at performance HB. Um, I, uh, I only want to share this with people who are, who are, who are interested really. And just as these webinars, things go, it's, there's always some dumb ass sales pitch in the end of it. Um, just talk to me if you're interested. Um, I'm going to offer things per module and bought per package if you want. So, um, I think it'll be exciting for everybody to, to, to learn maybe some thought provoking things throughout it. And you don't have to agree with me through all of it. Um, I'm just hoping that you can framework your stuff together. I'm not looking to reinvent the wheel. I'm looking to, to help organize the spokes. Uh, and if you are not, um, if you don't have all the spokes in place, such as you haven't taken or even familiar with, um, at least my spokes anyways, my spokes for step two might be, uh, uh, might be some, um, end range loading or your McKenzie's because I'd never taken a former McKenzie class, but I've taken, I've read the books. Uh, I use some of the protocols from Chris. I use some of the protocols from McGill, uh, and I use some neurodynamics too. So if you haven't, if you don't have all the spokes, um, I can't provide you with all those spokes because that would be some copyright infringement, but I can help you organize your folks pretty well. And so, um, I hope this was helpful to everybody.

And again, um, there's some hands raising here. Um, let me just read the comments on the side. Um, let's see. Uh, when do you want to keep patients coming back? Oh, okay. So I think I answered all these things. Uh, thanks for coming to the webinar guys. Um, let me know your feedback and again, message me info at ptsportscare.com or at Instagram performance HB. Talk to you guys soon. Nice. Thanks everyone for listening. Uh, again, that was a section of only one that I did. I'm going to, I probably by the time this releases, I might've done more of them. I'll probably just update the website with the one that is the most, uh, exciting.

Let's say that in the one I'm most proud of, but I am recording them all. So all the questions will be different. And I, uh, I want you, I want you guys to have an opportunity to go really watch it. Cause I think the visuals are what helps. Um, it's nice to hear everything, but the visual are visual is what helps. Um, there's a pyramid that I posted a few times on social media, which is basically that big red pyramid. So if you're interested, there's going to be a link at the bottom of the show notes. Or, um, if you go onto my website, I take that back. We won't do on the website. We'll do it on, we'll just do it via email. Just email me info at p2 sportscare.com again, info at p2 sportscare.com. Uh, and we'll send you the link to the, uh, to the opt-in. Uh, I know the opt-in sounds funny when I just give you the, the, the, the URL, but there's a lot of other little parts that will come through that. So I want to make it easiest on not only you, but I want to make it easy on myself too. I don't want to do all the little, you know, little parts over time. So I'd rather just put you through the little system and, uh, you'll get everything you need in there. So, uh, please go through that, click the link. You won't be disappointed in the, and again, the whole point is to create, um, a structure for everybody. I'm not trying to reinvent the wheel at all. Um, and I'm not trying to fill in all the spokes because there is a lot of great courses. Uh, I did get a question later about, um, well, how do I build those skillsets? How do I build those spokes? And I said, here's some, like I said, I didn't take all these courses. I did some books. Um, you know, McGill's low back disorders is a, is an amazing read and what it's under probably a hundred bucks. Uh, the crisp books from Don Murphy, the red and blue one, get both of them. They're also a great deal. Um, clinical neurodynamics by Michael Shacklock is amazing too. Uh, we also do, uh, we did start to offer some of the, well, actually, well, there's Dan Johns is, I think Dan Johns is under 50 bucks that video. Um, if you just go on to, I think it's on Lee Draper's site. Um, also too, which I didn't mention on there is we started offering some of Cody D-Max, um, strength conditioning modules, which is, uh, it's a, it's on my website. Now we we've closed pro Cairo. Uh, Cody has struck a deal with me to have me have it on the site. So we have, uh, flexion intolerant low back, which is an offer offer on there as well as the upper quarter. Um, and that is people wondered, well, what, when do I use this? It is basically almost all of step four and part of step three. So it's a big chunk of what we do of what I do. Um, and using those methods, you don't need, you don't even need to touch anybody to make them feel better. Um, it's nice to get the exam done, but, uh, using those methods, coaching them, you don't need to touch them and they feel better. And you've created a adaptive, uh, or a, or a situation where they are, their body has to adapt over time. And then we're kind of reverse engineering this whole thing. So if you're interested in those from Cody, just go onto the store of my website. That's p2sportscare.com. Uh, and that will just scroll down. There's a bunch of stuff prior to that because I don't primarily, that's not how I make online money is selling to you guys. Um, but for, for clinicians, you scroll all the way down, you'll see a couple modules that are specific to the clinician. So, um, thank you guys for listening and I'll talk to you next week.