9 Things Chiropractic Students Should Know Before Graduating

This is session number 72 of the Performance Place Sports Care Podcast. Josie's on a vacation far away, coming round and talk it over. So many things that I want to say, but you know I like my girls a little bit older. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Now, how many of you actually finished that song in your head through the cold intro right there? Because I know I did. I just want to use your love tonight.

Yeah. That's one of my favorite songs. I don't know why the heck... If you haven't seen the music video for The Outfield Your Love, you're going to realize how... Actually, sorry, don't see it. It's kind of like... It's... What is it? Is it Journey? Separate Ways? No, not Journey. I can't think of it right now, but Separate Ways is one of the videos that you should probably never watch because the song is so much better if you don't actually know what the video is doing. So, yeah. The Outfield Your Love, I can't tell you how many times that I go into a bar with a band in the back and they're like, You know what? There's going to be an 80s, 90s cover band tonight.

And I'm thinking, Sweet. You know? 80s, 90s cover band is one of my favorite things. Like, I would rather see that than someone actually doing their own music, sadly. And I know they're trying to make it, but at the same time, I want to hear some 80s, 90s stuff, you know? So, I always classify 80s cover bands as two types. Number one, there's ACDC types. Number two is Duran Duran types. And what I mean by that is, so if I requested something like the Outfield Your Love, which I'm just going to lose my shit over, then they can either hit the notes or they can't. And obviously, you can tell I can't.

But there's the Duran Duran ones, which they just do it really lower. And it's, I mean, it's not bad. It's still good stuff. But it's not what I want to hear. Welcome to the Jungle or The Outfield Your Love. Anyways, that's my thing. So, if you have not been listening to the podcast this month, you probably have no idea that this is the very end of the hamstring month. And this is the second time that we've done actually an entire month of stuff based around a certain type of injury. I might tangent that a little bit in the future here because I'm realizing that we could have gone many different ways with the hamstring route because if you heard Brennan Gassamia last time, we talked about kind of how you can't separate the body into one certain exercise or activity.

If you heard in session number 70, if you heard Nate Helming, you kind of heard some of the same stuff. So, the body is just a really big comprehensive unit. And a lot of times the area which is the most either deficient or actually a lot of times the most overworked tends to scream out, break down, and then we have these itises, osises, tendonitis, things like that, or rips and tears. So, I think in the future I might go a little bit broader on some of the topics here. Either way, though, I think this was a good start to the year. So, if you have not already, I want you to go to iTunes and review it for me.

Tell me what you like and don't like, okay? Once you've done it, actually, if you've done a rating on there, just email me, info at p2sportscare.com. I'm still going to do that monthly drawing for a soft, super soft blue Performance Place t-shirt. It is the one that I wear. Seriously, I wear that shirt nearly every single day of my life right now. And I like it. So, I think you'll like it too. Now, in this one is, this podcast is going to be a little bit different than the other ones of the month. And I'm going to try to tie some things together of other things that we learned from the other podcast in this month about hamstrings.

But also, too, I had someone reach out just recently. And this was about a different podcast, but he had, I think, something really good to say. So, he's an exercise science student and he's in school and he wanted to learn about some things that I learned during school and how they kind of changed once we got out into the workplace, as well as some other types of common sports injuries and how to rehab them and so on. And what I started thinking about was that, because we started doing the YouTube video, or I started doing YouTube every single day this month, and I'm looking back on the editorial calendar right now, about the first nine days was deadlifting tips because we were talking about hamstring stuff.

There was hamstring assessments. There was one called the Rocky Lens. There's active straight leg raids. There's Valsalva's test. There's intra-abdominal pressure. There's so many things. There's so many exercises and assessments that you could possibly do, but then when would you use them, you know? So, I kind of realized that stepping back into, like, the patient's perspective or the listener's perspective is there's all these little things that they're seeing, but piecing them together is a whole different story. So, I thought today for that listener, as well as anyone in school or anyone who's wanting to know, how to piece these things together, by the way, you should go see a doc because these conditions can be complex, as you probably learned over the recent weeks, especially in session 69, there is hamstring conditions.

So, today I'm going to go over a little bit of that stuff, just kind of bringing things together, and as well as having some tips for the students out there to make sure that we have good healthcare providers in the future. Now, for those healthcare providers, I want to remind you that I am setting off on, and I'm really pushing this, the Modern Sports Medicine Patient Education Program. And I'm trying to attack all the senses. I use my netters, I use skeleton models, things of that nature as well, and oftentimes I pull up things on my phone and show them referral pain patterns from certain muscles or entalgic positions, things like that.

But I feel like I should just really have it, you know? Like, I love my netters, but even I showed a friend, and he's like, that's just so complicated. And I'm like, good point. So, I grabbed one of the posters that I made, the graphics I made off the wall, and I said, how's this? Can you understand what's going on with your shoulder now? He's like, oh, yeah, I get a little bit better. So, that's kind of what I'm trying to do. I'm trying to correlate YouTube videos that are, I guess I can't really say I'm programming for them because they're small bits. Funny, YouTube people are funny. You've got to hold their attention span a little bit quicker, so those are quicker videos.

They're not extremely comprehensive, but they're really useful if you're trying to show something like a crossover. I'm trying to do that, as well as these listening ones. If you have a patient or if you are a patient, you don't understand a topic, there's no reason not to understand anymore, okay? All this stuff is out there for you guys to digest and learn. And lastly, as we have some of the visual things for the office, those are things that I'm making in poster form. So, if you're looking for all this stuff, all you have to go is to go into ptsportscare.com slash shop. You put in your email.

You get a bunch of free graphics that you can share on all your social medias, put on your sites, and so on. If you want it in your office, it's going to cost something. But when you do get even one poster for your office, I'm going to give you access to organization of things like these podcasts and so on. So, there is no guest today. This is only me, and I hope you like it. So, I want to express a bunch of gratitude for everybody listening. Thank you, thank you so much for spending an hour out of your day to listen to me. And I hope my information doesn't change too much over the years because I don't want these things to be valid for a long time, but we all know it probably will.

Now, a couple of the topics I'm going to go over today. I'll just go quickly through them. By the way, I do plan on having a checklist. I am going to make checklists for some of these podcasts or topics that are a little bit more comprehensive. I know you're walking your dog or running or biking or something right now where you can't write it down. So, you can always go to the checklist, speed2sportscare.com slash checklists, that's plural, and then you'll find what you're looking for there. I will direct them directly from the podcast, or you can probably, I'll put a search on there or something so you guys can find this stuff.

But anyways, this one is going to be classified as, let's say, things that I learned checklist. How about that? Okay, number one, so proximal stabilization for distal mobility, all right? That's something I have wanted a lot of patients to look up because they do have a lot of questions about that. Number two, and this is for those docs out there or therapists or trainers who are getting started, ask around to rent a room. You'd be surprised how many people are looking to rent rooms. I even have a room to rent as well. By the way, hit me up for that if you want it. I'm surprised how many people just say, look, I didn't know it was out there.

There's no excuse for that. Number three, let's see, what did I write down here? Communicate well. Okay, no matter how well we understand things as clinicians or even as people who are training with other people, if you understand things well, it doesn't mean your friends or workout partners do. So we have to be able to communicate it well. Clinical correlation is number four. By the way, I guess I don't know if I said, these are things that I learned after school that I wish I would have known in school or wish we had been taught. Number five, patients don't always know what we're talking about.

And that goes back to the communication thing. They will nod and say yes and so on. But a lot of times they're blown away. And this happened with when I took my dog in, I didn't understand dog anatomy. And I was like, yes, yes, yes, yes, yes. And I went home and went to sleep. Okay. I was really tired. I was just overwhelmed. And I just wanted to get out of there. Number six, creating buy-in. We'll go over that when we get there. Number seven, we cannot separate regions of the body when we rehab. And that's going to go into some of these YouTube videos. I am going to make a strong attempt. Actually, I did.

I'm making an attempt already to put some courses together. Because I like putting all these small little pieces out. But at the same time, unless we're working towards a certain goal, they're kind of useless. But, I mean, when I'm looking for something like what is an active straight leg raise. And I want to show somebody, those videos are extremely useful. So, I'm just exposing you guys to it. But it's not a comprehensive program. Number eight, we train movements, not muscles. That's an important one. Number nine is I wish I knew how to recreate systems. So, why don't we start back at number one right now.

Proximal stabilization for distal mobility. Now, this is a lot of verbiage for most people. But I'll break this down a little bit for the patients listening out there or the clients. Sorry, non-medical. So, proximal means closer to the midline. And it's in relationship to something else. It's kind of like this Coke can is to the right of this Pepsi can. But if we're saying that there's also a Sprite can to the right of it, that means the Coke can is to the left of the Sprite can. So, it's in relationship of it. It's a directional. So, proximal means more to midline. If we're talking about the ankle and the knee, the knee is proximal.

When we're talking about the knee and the hip, the hip is proximal and the knee is no longer proximal. Now, it's distal. Okay, I'll say it one more time. Distal means further away. Proximal means closer to. Midline and nothing really gets more midline than the torso, pillar, or trunk. All right? So, the spine is really the most proximal you can be. So, when we say proximal stabilization for distal mobility, and it can get more complex than that, by the way. But the reason why I wanted to know this, or I should have known this in the beginning, is because when we have things like ankle conditions come in, we, sometimes we just look right at the ankle.

And if they didn't really blatantly turn it, but they just have this itis down there, then we have a responsibility to look higher. A big responsibility to look higher. We cannot just locally address the issue. We have to globally look at the function of the limb. Sometimes people call the lower leg, or sorry, the leg, the lower extremity, they call it a whip. So, the ankle is just the end of that whip. Now, we have to be able to control the upper end or the proximal end. So, I usually demonstrate this to people when they come in with shoulder conditions. And I have them drive some weight into the air.

One of my favorite exercises, which you can actually find. Let me see if it went live or not by the time this podcast comes out. It looks like it has. So, it's episode 27 on YouTube. It's stability, or sorry, it's a dead bug with a kettlebell driver. So, all this means is I'm using a kettlebell, I'm driving it to the ceiling with a single hand. And a lot of times people take this very lax, and I say, no, push that thing to the ceiling. I want you to force it through the actual ceiling. And when they do this, all of a sudden they tighten up, right? So, what I'm looking for is the midline to become stable or firmer so we can affect a different joint.

Now, I might do this in a case of a hamstring condition, which is why I put it on this month's of the YouTube channel. It's because if I'm looking for an easy way to trick people into stabilizing their torso while moving the hip, then this kettlebell driver in a dead bug exercise is a really good, easy way to do it. Now, we can do it a couple different ways as well, but what I typically show people is I have them push me with their hand. We're seated. I say, push the hell out of me with your hand. Force me across the room. And I say, now, can you please do that without stiffening your torso? And they can't.

And the same thing happens with the lower extremity or the hamstring, the hip, the knee, the ankle. It's the same stuff. So, if you're asking, like, what exercise should we do for the hamstring? Well, that's going to eventually lead into one of the things later, which is we don't really work muscles. We work movements. So, the answer is, well, there's a lot of things we can do. But for the most part, we need to check the middle, the midline. We need to make sure that stabilization from the midline is proper. And this can go with, this drops into things like breathing, bracing, exhaustion. Do you lose form?

In podcast 62, we talked about functional capacity with Richard Ulm. And it goes into that as well. So, we have to make sure we have control there to be able to properly affect the movement in the outer limbs or outer joints. Now, that brings up another thing, then. Should we do passive stretching? At least this is my opinion. I don't really give a lot of people a lot of passive stretching unless I think there's an actual reason for it. I don't give it for pain management, typically. I don't give it to increase joint range of motion really that much. More so, let's go back to that dead bug exercise where I had the kettlebell to the ceiling.

By the way, if you don't know it, I will reference to it on the show notes. But if you're not on the YouTube channel already, you need to be. Just subscribe to it. You're going to get these every single day. They're like two-minute, five-minute videos at the very most, most of the days. So, where was I going with this? Oh, so if I'm looking to increase range of motion of the hip, then I need to also stabilize to do it. So, would I rather give a partner in hamstring stretch or would I rather give them something like an active straight leg raise, which I know I have in here somewhere. Where is this exercise?

So, we are going into E18, episode 18. So, that's an active straight leg raise, quote-unquote, stretch. We're activating the torso. We're doing the hip flexion on our own. We have the knee straight. And if we know this is a hamstring condition, we have to improve hip range of motion. Then I'd rather do it from an active component rather than a partner stretch. There was a great study that Stuart McGill put out. I believe, I forget what year, but I'm sure I could find it. I believe it was they compared passive stretching, compared to torso stabilization, compared to torso stabilization, and ball socket work.

The last group won. Hands down. So, sure, you can go ahead and stretch, but realistically, we need to stabilize proximally. Go read some articles on proximal stabilization to distant mobility. I think you'll get an idea why this is one of the things which I wish I would have known in school because then it really changes how you recommend for people because they're going to come in and say, well, what should I stretch? Well, nothing right now for this. And I know some healthcare providers might disagree with me on this, but this is my standpoint now. I would have recommended a lot more active care in the beginning.

So, that is a big, big thing, which then also creates some type of independence for the person. I don't believe in creating dependency. I want to get people self-sufficient if there is, and that's based upon their goals, all right? If they want to be trained or if they want to learn to move better, I don't chase them out. But, if their goal is to get out of pain and move better, just without even putting weights on, then a lot of times that can happen fairly quickly. It's really dependent upon the person's ability to retain the movement and movement corrections. Now, number two, ask around to rent a room.

And I can't stress this enough. Funny, actually. So, actually, my first room that I rented, getting out of school, and this would go for, you can rent space and time, too, for trainers. The first place that I rented out of school actually was, it was $1,000 a month. It wasn't cheap, but here's the great things with it, is it was month to month. I was able to come in on days where the other doc wasn't there. I was able to learn from the other doc in regards to clinical-based stuff, as well as how to run a business. I got a lot of great things there. I had access to a weight room. So, all of it was fine and dandy.

$1,000 a month, I think I probably could have found less. So, I was there for about three to four months, I think, in the beginning, and then I ended up moving. But considering what I see here, at least from my standpoint, and I know a lot of docs have gotten out of school, a lot of trainers and so on. I've had a handful of people ask me to rent a room. I do have room for rent, and it is so cheap, so cheap compared to what I would have gotten when I got out. And that's considering, too, that was almost 10 years ago, so now we've got inflation. One even has a window, for God's sake. It has a window just like my office.

It's as big as my office, and it's well under a grand. And they have some access to weight room, and they're actually open, free. I'm not in the office every single day. So, the reason I bring this up is not to sell my own office, by the way. If there's someone out there who's looking to open a spot and looking to learn how to run a business, I'd love to have someone who is using this as a launching point. But here's the point, is that if you don't look, you're not going to know. And I've actually put this exact listing on every single chiropractic school classified listing that I could find. There's about 10 in the entire country.

It's so funny that no one actually rents. No one even calls. So, this tells me that either one, number one, I put it in the wrong spot. Or number two is that no one's looking. And I think that's really disappointing, because I really do believe that as a healthcare provider, there's, you've got to find someone who practices like you, or someone you want to practice like with, or practice like. Number two is you've got to have a little bit of room to grow. And I've had a lot of friends who have been contractors, or sorry, employees. And about four years after school, they realized that they wanted to practice a different way, and they were just kind of stuck in it for a paycheck.

So, I really think if you're going to create that freedom, then you need to be able to take a little bit of a leap of faith, start looking around, find a room. You can even rent them from gyms. So, there's people all over the place looking to drop their overhead, and they're not going to snuff at. You stay, and you're going to stay there for six months, and just offer them some money. So, as long as you're not a terrible roommate, they're probably going to say yes. And now, a word from our sponsor, Health IQ. Did you know that higher levels of physical activity, like running, is actually associated with reducing risk of seven, seven different types of cancer?

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So, number three, let's see. Communication. Communicating what you, let's see. Apparently, I didn't write this. I dictated this on my phone, actually, when I was driving in. So, here's what I'm going down the road with this thing, is that no matter what you know, no matter how smart you are, no matter how clinically smart you are, and this goes for even other different types of professions, too, if you can't communicate and you can't market what you know, or your personality, or yourself, or somehow get your goals, or get what you're going to do to communicate to what the person's goal is, you're not going to see anybody.

And I really wish I would learn this in school because I, I mean, actually, I started writing a lot of the articles that I did when I was in school. So, it was kind of a way for me to retain some information, and I still do that today. When I go to seminars, I actually write a synopsis afterwards, and actually, if you haven't read my new core, the new core article, then, or new core training article, then that one actually is something I wrote after I went to the Perform Better Summit in 2017, just a handful of months ago, so this is how I learn, but also, too, so I take that, and I send it to an editor who will ask me questions of things they don't know, and also, I'll have other people read it to make sure the terminology is not too medically, and you even know that the whole point of this podcast is to make it so you guys can understand what your medical, or your therapists, or your trainers are talking about, because sometimes we speak in a different language, and it's not because we mean to, but it's because, I mean, human body and anatomical terms are actually Latin.

They're Latin. So, I mean, it's kind of like an unfair playing field already, but that doesn't mean we can't make an effort to communicate that. I mean, I really think people have the ability to learn the terminology. Granted, there are some concepts that we can just make into some easier terms, but most people know what the biceps are, the Achilles, the hamstrings. They know this stuff. So, it's not like they completely don't know what their body is doing or what some of the terms sound like. So, what I would suggest is really homing in on how your people speak, how your target market speaks, how your mother, how your sister, who are not in the medical field, speak about this type of thing, about whatever type of condition you're speaking about, and get them to ask a question or two and say, well, I don't even know what vascular is.

And I really, I actually had this before, I was doing a presentation in an office, and someone asked about arm numbness or hand numbness, and they said, well, what could that be from? I'm like, well, it could be neurological, it could be vascular, it could be a couple other things, but for the most part, I'm not sure right now. And they raised their hand a little bit later, and they said, what's vascular mean? And I thought, and that's when I started to realize, holy crap, we really do speak a different language. So, it doesn't matter what you know, if you can't communicate what you know to the person to make an educated decision, then you're not going to help anybody.

So, now we're on to number four. This is clinical correlation. And this one, this is something that they did speak a little bit about at school. It's making sure to know what your exact diagnosis is before you actually start to treat. But I think it's something that a lot of patients or clients or general population need to understand as well, is that things have to be clinically correlated. It has to make sense, right? We had a saying in school that was, when you hear horses, or sorry, when you hear footprints, think horses, but every once in a while, it's a zebra. So, we have to clinically correlate things, and I'll say that with a hamstring, since we're on hamstring month, if there's numbness, tingling, it's in the hamstring area, and it goes down on the foot a little bit, it could be the hamstring, but realistically, it's probably a nerve root or it's some type of spinal-related condition, and it could be a handful of things up there, but again, it is, we got to, it has to be correlated.

Now, if we do an MRI on the hamstring, and it shows that there's a tear in it slightly, a little one, and then we see there's still that numbness, tingling in there, especially into the foot, and we didn't MRI the back, then I still think we should ignore that hamstring finding. There's incidental findings, there's normal variants that some people have, and this is what we find a lot of times with, and you probably heard Stuart McGill talk about it in episode 67, he says that not a lot of these x-ray findings are pain generators, or I think we're talking about degeneration, if I recall correctly, we did that one a little while ago, but we see this all the time, and it's funny, I have patients that, I never realized how much an image, can affect someone's mental mindset, so they, all of a sudden they say, I have this, or what is, they really want to understand what that means, and it's, it's almost, it's almost like if I'm, if I'm doing repair on your car, and there's a small crack in the windshield, but your, but your engine won't start, so throughout the report, I say, well, your Cali converter is messed up, and your starter's messed up, and, but there's a crack in the windshield, and you gravitate towards that crack, you're like, well, how do we fix this crack, and this happens a lot, a lot, with many different types of conditions, and I keep saying, look, the crack, I'll explain the crack to you, but realistically, the crack has nothing to do with what's going on with you, well, how do we address this crack, like, do I need to be concerned about the crack, no, don't worry about the crack, okay, and this is what we find with, with findings on images that are non-symptomatic, yes, it's kind of, we should address the crack, and perhaps we, perhaps addressing the crack is part of what is the overall servicing that the car place is going to do, that the auto mechanic's going to do, but it doesn't make it so the car starts, and this kind of goes along lines with, with, let's just say with that, with that MRI we're talking about with the, with the hamstring, is there a little hamstring tear, yeah, is it old, kind of looks like it, is there numbness into the foot, yes, okay, well, then we need to address a lot of the spinal stabilization, or back stuff, or things that we saw on 63 with Stuart McGill and Brian Carroll, 66 is a good reference with Seth Meyers, 67 with Dr. Stuart McGill is another great one, these are all things that we need to address first before we look at that hamstring, now, if you're pressing to really address that hamstring, you're kind of taking control of your own health care, which is not always a bad thing, but this is, thinking back to what we, what, what we learned in school, I guess I would pick and choose what I would tell people, and how I would say it, and say, yeah, there's maybe a little finding on the hamstring, don't worry about that, we have to address the nerve condition because of X, Y, and Z, but if you show them that, in that imaging, or if you tell them to read it in detail, let them see the report, they'll see a lot of big words, spondylola, blah, blah, blah, osteo, blah, blah, blah, and all of a sudden, people lose their mind, and they start focusing on that stuff, because it sounds like it says moderate next to it, it says moderate next to it, it says, what's another one, advanced, I believe it says on there too, so there's a lot of these things that will light people up, and it's all language thing, but realistically, back if I would have learned what I need to know in school, I would have learned how to be lighter on certain words, or findings, and not on others. Now, going on to number five, I guess we can kind of tie that in a little bit too, and this is not going to, I don't want this to sound like I'm trying to diminish what patients know, but a lot of people don't have any really good idea of what their body is doing, how it moves, how it works, how stabilization is part of a hamstring injury, how midline stabilization has to do with the shoulder. I had people ask before, what does weight have to do with my back pain? I had a guy recently that came in that he had he woke up with shoulder pain every night, and we had to address some of his sleeping positions, some of his postures, some of his loads, to make sure that the shoulder had proper stabilization to it, and for a couple days, he had a lot, a lot of questions, and after he finally found some success, then he really started to buy into the idea, but I think sometimes people believe they understand more than they do. I think a lot of times that clinicians or sometimes trainers think that the people know less than they do, but I think there's just a gap, and that's why I'm trying to build a lot of these podcasts and videos and articles, because I think we should be bridging that gap. I think everyone, if they're going to make an educated decision about their health care, then they really need to know something about their body and what the most common or what the most useful things are out there currently.

So, that is something that I probably should have learned in school. I remember I spent a lot of my early years using big words to describe people's conditions, and I could have definitely made it a lot easier, but other people, I just assumed they didn't know as much, and I didn't explain, and I think lack of understanding or a lack of valuing their care or respecting their condition harmed them in the long run. Now, number six is creating buy-in, and I first talked about this in session 33 with Davis Koh. I think we talked about it one more time, but buy-in is a very, very, very important part of health care, managing people, training people, weight loss with people, getting people to basically do with what, I don't want to say what we want them to do, but doing the right plan of attack that they've asked to accomplish to get to their goal. I've always said that I like working with the human body because for the most part, things are fairly clear. I mean, there's some unknown things, but it doesn't really change a lot over the years, you know? Like, there's great studies that come out that show that if you do A, B, and C in this order, there's a really high probability of something getting better, but when the person comes in, when the patient comes in, they oftentimes, they'll do A, but not B, and definitely not C, and, or maybe they'll do B, but not C, or sorry, they'll do B, and C, but not A. So, what we really need to get these people better, and I wish I'd have known this in school, is that we have to create buy-in. We have to get them to feel that they're on the right track, and this isn't a scare tactic by any means, but I am sure that people have, people in different professions have the same type of thing. They have some type of buy-in.

In this realm, it's really easy to get quick wins with people with some postural modifications. It's really easy to get a quick win, or especially with shoulders, to do tissue work and get them to raise their arm over their head, or to clear an impingement. So, these things are things that I oftentimes do on day one. I used to do them a little bit further down the line because I felt like it was more important to explain, and probably in terrible complicated terms, why their shoulder is painful, and why they need to do this, and what the exam findings show, and so on. But really, what they want is they want to know that things are going to be okay, and that things are going to feel better. So, we had, there's one test I like to do with shoulders. It's a scapular assistance test, which I'll have the patient reach over their head in a certain plane of movement, and I'll say, when does it hurt? Just go to the point to where it barely starts to hurt, and they say, okay, right there. So, I push their shoulder blade a little bit to lift it, and to open the space where the impingement occurs, and they say, well, that feels a lot better. I say, cool, great. So, I'm going to let go right now. Let me know how it feels. They're like, oh, it came back. So, what that does is it shows that we are on the right track with knowing what can improve it. I tell them the reason why that happens, and then I show them how to do that same mechanical movement on their own without their own hands. I want their muscles to do the work, and I always say it's a, it's, it's synthetic stabilization or synthetic movement. So, now we just have to get the body to do what my hand was showing the body or assisting the body to do. So, another way to actually get people to buy in, and I find this with hip conditions, which I am going to do a video on this coming, it's, I think it's a ways away, and when you guys are listening to this, it might not be. Let me, let me take a little peek here.

I think it's in, it's past February. It's in, it's in March already. So, you see how far ahead I get on these things. It's actually going to be 77. So, once you mark that, it's actually, it's a femoral acetabular impingement test. And what I use this for is that when people come in and say, well, I've had hip pain, it's in the front, it's in the crease, it's in the groin, it goes down the middle of the thigh, not past the knee. It hurts when I sit. I can't run. I'm really frustrated. So on, right? And they wonder, because this is so irritating to them, and they're wondering if they're going to need surgery. Should I get an MRI? Should I get an arthrogram? And so on.

And I say, look, why don't we just do a real quick test? And if it looks like that we can clear that impingement, then I think we should probably start with rehab. So, I lay them onto their back. I bring the knee into the chest. It's into a scour's position, we call it. It's kind of like where your knee is crossing midline. Or it's, for a lot of times, people just bring their knee up to their chest where it starts to pinch. And I just have them hold it there slightly. They gently, they don't pull it into their chest. They just kind of hold light pressure onto the knee to make sure that it's not moving and to make it so it's a passive movement. So, after that, I say, okay, push into my fingers, which I now I'm stimulating some type of pressure chains in the abdominal cavity or in the torso. And I really haven't pushed into that. And I say, does that make it better?

And if it does, we're basically all we're doing is we're lifting the acetabular rim, we're moving the pelvis, we're moving the ilium, which the ilium controls the socket mechanics of the femur or the bone socket. So, this just shows me that this is a truly rehabable case. And I'd rather start here. What it shows the patient is, holy crap, that was great. Now, how do I do that? So, that's that buy-in. And one more buy-in, an easy one, which I just sent out an email last month on this. And I do have some videos coming out as well on this is postural changes, how to sit into a car, how to sit in a chair, how to get off the ground, how to sleep in a bed. These are things that like if someone woke up the next day, and they felt better based on the recommendations that I said, they're going to say, holy crap, this is correctable. It's very enlightening to them. It's very empowering. Or if I get them to sit, and one way to improve actually standing, standing is an easy one, get them to stand, have them soften the knees, have them soften the hips, and sometimes anti-shrug or shrug downward. And a lot of times this will address, this will help out with how their back feels. So, the answer is not to stand like that all the time. But again, it's buy-in. We need the people to understand that they are on the right track, to not forget that they have control over their injury, and to not immediately jump to what they knew from past truths like surgery, or hey, maybe you need to get an image on this. And I'm not saying there's not a time and place for imaging because I even have an old diagnostic ultrasound in my office, but there's a time and place. It's not on every person because remember what I said earlier. Those people see those images, they see the report, and they start to panic. And they jump back into that false thing, and they're like, well, this isn't going to get better. There's something wrong with me. There's something structurally wrong with the area. Something's torn. Something's frayed. There's an itis. These are things that run through their head. But things that we can do as healthcare providers is get them to calm that. Get a little bit of control. Let's anti-shrug. Let's soften the knees. Let's, let's push the hips back slightly. How does that feel? Okay, let's dial the pelvis. Does that feel better? Yeah, it feels a lot better. We had, I had two cases this week exactly like this. And they've had pain for like five years. So, they, they feel a lot better. But next time they come in, sometimes they forget this stuff. So, you just have to re, kind of re-up the same thing because we're, we're going over a lot of past truths and past habits we just need to break. So, if I would have known that in school, I probably would have implemented things like that a little bit earlier in my practice. I do it a lot more now. But in, in the past, I wondered why people only came one time or two times. And I think it's because they, I was down the process, which is going to take a little bit longer than they actually comprehended. Now, I show them that the process is actually can happen sooner. I back up a little bit, work on stabilization or rehab-based stuff or small exercises later, but give them those mechanisms to control their pain. So, now we can get a little bit further with their care and really empower them. Now, number seven, we cannot separate the regions of the body. The body works as one unit. I kind of touched on this a little bit earlier. But you should really listen to when I question on 71, Brendan Gassamiya. We say, how do we isolate the hamstring?

You know, is there a couple of exercises you like from the hamstring? And you'll see him kind of like jump around a little bit because these, we cannot really just work on just one area. The whole body works in a unit. And I like to think about bench pressing versus pushing a car. When you're pushing a car, you're using your legs, you're using the torso, using the arms, and you're leaning and pushing the car away. And a bench press is more of like a, although the entire body is used, yes, we can just say, oh, why don't we say a bench press versus a push-up. Push-ups, we can feel it's basically a plank when your arms are moving. When you're benching, you have your back stabilized on a bench.

So there's, I personally like in that order, I would probably like for functionality, I'd probably like a car push or a sled push, and then a push-up, and then a bench press. So, and there are variations to that. I'm not going to stick in stone with that because it's based upon the person's goals. But I do believe in training the body as a unit. And I have this conversation many, many times during the week with people. What does this work? And that leads us into number eight, which is we train movements, not muscles. Well, which exercise does this work? Or which muscle does this exercise work?

Well, we're not doing a muscle. We're doing a movement. We have coupled movement is one way I explain it to people. I say, hey, I want you to put, I stand close to them. I say, push me away. So they push away. Okay, I'm like, what muscle did you use? What muscle is that exercise for? And they, sometimes they answer pec. Sometimes they answer tricep. I'm like, well, there was a lot more than that. You had your torso, you had your shoulder blade muscles, you had all the muscles in the arm, and also the wrist and the fingers and the hands. There's a lot of things that happen there to accomplish that movement. Now, why don't we break those up? I'm going to have you do an exercise where every single one of those muscles has that sound. Well, I don't want to do that.

Unless, unless you say the ones that are, they aesthetically want to change biceps, deltoids, things like that. Now, I'm not going to say that single joint approach or trying to isolate a muscle or just blast a muscle is not productive because again, it is goal dependent. If you're looking for hypertrophy or muscular growth, then you need to crush that muscle to some degree. All right. But I did have a patient come in one time and he, he told me, I want to, can I do bicep curls? And he had a, he had a shoulder thing going on and I said, well, why do you want to do bicep curls? And I usually ask him this because I, I want to, I'm kind of baiting him into this conversation because I want to make sure that we come to an understanding. Well, and he says, so I want to get big biceps. And I said, okay, well, I wouldn't do bicep curls. I'm like, I honestly never program in bicep curls unless I'm with a couple of friends that I don't really want to, uh, spend time explaining training or movements.

And I just want to have a good time. So we do bicep curls and bench. And that's the easiest thing. That's what every guy of 35 year old needs, knows how to do. Cause he learned how to do a couple things in high school. So we do that. Um, so he says, what do you do for your biceps? They're pretty big. And I say, no, I don't do any of that. I'm like, I do pull-ups. And he's like, pull-ups make the biceps bigger. I said, yeah, they do. I'm like, but you train the entire arm. So we went down this whole conversation. Um, we're not just training muscles. We're training movements. And then when it comes into rehab, we are not just training the hamstring. We're training the entire limb as well as the torso. We're in training the hip. Okay. We're not just training the, to rehab the ankle. We're also training the remainder of the limb as well. All right.

If I tend to rehab a shoulder, I might have them push a sled. I might have them deadlift. There's a lot of things I might have them do because the body works as a unit. We cannot just do a single muscle or actually, I guess we can, but it's not extremely productive for what we're looking for. The typical motions that I like to train are, we have a push, a pull, a hinge, a squat, a lunge, a carry. Um, and I might've missed one in there, but for the most part, people understand squat. Carry is just grab an object object and walk around with it. Dan John started making these extremely famous. And I don't know if anyone did them before Dan John, by the way, Dan John is 61. Great. That's a great podcast. Um, those are extremely helpful because there are very unique human motion. All right. You will train a lot of things in that as well as stiffness. Lunges, I believe are unique. Although people might argue with me on this is because to get to the ground effectively, uh, and getting light objects off the ground and to get low, oh, I think lunging is a very productive way to do it. So I think everyone should learn how to do a lunge. Body weight lunge, especially they don't need to crush the weight with it, but they need to lunge back. Pushing or sorry, hinging is basically deadlifting. Everyone's afraid of deadlifting or a lot of people are. And I understand it's, it's freaky, but you're deadlifting your kids off the ground all the time. You're picking up dogs. You're picking up a lot of things, even light objects. You need to learn how to deadlift something. And it's not the, it's not the point of deadlifting, but it's learning how to move objects. And I had a girl that came in the other day that she actually, I started doing some movement training with her and we, I, I didn't load her a lot because she was young at the time.

She was, I think in eighth, ninth grade at the time. And she came back now and she's a junior. And so we started doing some carries as well as some, uh, kettlebell work. And she is, uh, it was, it was fantastic. She, I handed her a 35 pound kettlebell and actually I put it on the ground. She picked it up perfectly. She did her work. She put it down perfectly. And I told her mom, like, this is amazing. This is absolutely amazing. Like half the time we have to show people how to put an object down safely. It's not just the exercise it's putting down of the object. So something like that is extremely, extremely useful because she didn't just double hand lift it. She single hand lifted it and she had perfect form with it. So when you pick up things, you pick up babies, you pick up groceries. This is, these are movements that you're going to have to learn. And this is why people hurt themselves picking up pencils and cell phones and all these small things is because they don't know how to move their body. So we're doing movements, not muscles. And the last two are, are ones that I, I have a little bit of issue with, um, because I think, people don't do them extremely well, but I think about doors. So if I'm going to, if there's a door stuck, I'm going to, I'm going to push it open. I'm going to lean into it with all my might wedging.

All right. So I'd rather push a sled than do a bench or do a pushup. Now pulling, same thing. I would set my feet, lean away and then pull. And I think about, um, uh, what is it? Tug of war. Tug of war, you wouldn't just use your arms. You'd use your entire body and sit back and you drive with your legs. That's a pull for me. All right. Now I guess there's the unique one, the pull up, which you don't have contact with the ground and I'm okay with that. But at the same time, I still do believe people should do things like a tug of war, tug of war or a sled pull. Um, I do have some videos on some of these things I'm mentioning, by the way, um, I'm going to reference as many as I possibly can. But, um, typically if you're going to see if the month, by the way, there's a whole, in the beginning of this month, there's a whole entire thing on deadlifting tips. So you should just go back and look at episode one through 10 nine. Um, but whenever you see something with a hip, there's going to be some type of squat lunge or deadlift with it. Whenever you see something with a knee, you're probably going to see the same thing. Shoulders, you're going to see all the stuff I'm talking about. So when you finally see a chunk of time where those articles or sorry, where those, uh, podcasts and videos are there, just look around it. There's going to be other things as well.

Lastly, this is the last part of this is that this is mainly for, uh, the clinicians out there and the trainers is you have to recreate your systems or reduplicate yourself. And this is something I really did learn early. Um, I made my first videos and not that the videos are good anymore. I made them back in 2008. I think, um, I was not even graduated yet. Um, I was just making videos on some of the rehab exercises that we had learned. I remember there was a bridge in there. There was a lunge in there, a squat. I think there's a lap pull. Um, there was a, there was a psoas stretch. There was a lot of things that, um, I mean, I don't use all of them anymore, but the point is that as I start to hire people or I start to reference things to people, um, duplication of myself or at least having some type of system in place is nice. Um, I, I totally believe that when, uh, when I do a hire, I want, people to learn, have a certain skillset. I want them to be extremely competent in a couple different things. And that, that comes down to trainability number one, but there's, it's easier just to hand them a couple references, such as here are some exercises that I like to, to know here are some, or that I'd like you to know. Here are some, uh, some communication or some language that you should know. Here is our theory on the core as well as the pillar.

Here's our theory on back conditions. And that is how you create more of a seamless, um, single theory to environment. And I, I don't think I'm not going to hire, um, another doc currently. And I know a lot of offices will have a couple different doctors, but I really believe that, um, there is a way to get patients to become the other doctors. And not that they will know everything that you know, but they should know when they're sitting the wrong way. They should know when a hamstring feels like a hamstring and when it feels like a nerve. So there are things that I would rather spend time teaching and create a system around education of that body region of the entire theory of how the body works or whatever it is. I believe that that should be made early on and it might change over time. But I think when, if someone to podcast interview me about a couple different topics, I I'm, I'm pretty solid on what I'm going to say. And it's because I have my system really dialed in. I've written it up. I've done podcasts on it. I've done articles on it and, uh, videos on it. I'm not going to say it doesn't change, but at the same time, I know the flow of things. I know that if, if someone can't squat down, I'm going to box squat them. If they can't box squat, then I'm going to quadruped rock them. So there's a lot of different things that, uh, have theory behind them of programming. So when you guys see all these random exercises online, there is a reason for them. They might not be put into a, uh, into a system right now. I do plan on doing that later for everyone to kind of observe at least my thought process on how to program, uh, corrective exercise for people. But for the clinicians out there who are just starting to learn, you really need to, to be able to relay your system and theories to other people. You need to, well, you need to understand them really well yourself. And it's kind of like journaling. You should do stuff like that to organize your thoughts. Now I know that was a lot of information, uh, but I will have the checklist out there. Don't remember, don't worry. There is p2sportscare.com slash checklists. Uh, that's plural.

And gosh, what am I going to call this one? I really need to, I'm going to dial this in right now. Okay. I think I got it. Let's go with school recap. And so it's going to be school recap checklist. Um, I will have it in there for you guys. And so don't forget, go on, review the show for me. The show notes are on a line as well. So just go to p2sportscare.com slash podcast slash pound. And this is going to be session number 72. And that is where you can find all the links, the articles that I've referenced as well on there. Anything that I talked about in the show. Now, lastly, I really want you to go check out the posters, uh, that I created. I spent a lot of time on these things and I'm actually considering the very near future. Uh, actually, uh, I'm kind of halfway through this right now is that actually when I started drawing, um, Looney Tunes, actually, when I was a kid and actually had a couple of people buy stuff from me. Um, I remember I drew a wolf and a couple other animals. I drew a, I think it was a lemur or something like that.

Someone bought them and they put them in their baby's, uh, room when they were modeling for the baby to come. But so these are all ones that I have right now are the, they're illustrations from the computer. But as I'm starting to realize that creation of these things through graphic designers are really tough. Um, and the reason is, is because, and this is probably why Frank Netter's made all of his own drawings is because to communicate, uh, anatomical orientation, um, insertion origin, as well as how to create these things into more fluid like diagrams is extremely hard, extremely hard. I actually had, I was doing one on the core, um, encompassing the pillar system from core performance and I had it. Basically, I was creating a water bottle or sorry. Uh, yeah, it was a water ball at the time. Um, I might change that a little bit. So I wanted to show muscles on a water bottle, but still knowing that it's a water bottle as well as a diaphragm on top, pelvic floor, rectus abdominis, um, all the muscles of the backside and so on, as well as the muscles, that, uh, the water bottle from the balsaca joints, the hip flexors, the glute max, uh, the rectus somoris, the lat dorsi, so on, and even into the rotator cuff. So I wanted to encompass this all around a water bottle. And I actually had, I, I, I had such communication issues with the graphic designer that finally I just, I paid her half of the, half of the fee. And I said, thank you for your time. Um, but this isn't working out. Are you, how are you feeling about this? And she's like, I don't like this project at all. And so we just parted ways. But so be in that whole process, I drew this thing already. And then we're just making it into a colored version that go, that can be more of a computer-based version. But I think I might just start drawing them as my point. I mean, I've drawn lemurs and all this other stuff, so I might start drawing them. So keep an eye out for that. Uh, I don't know how they're going to look, but hopefully I can get them pretty good. But I'm creating this all so you guys can show patients so you can better communicate because you can see communication is a really big thing. So go on there, check it out. Don't worry. Um, I will share it with all the foundational group, uh, when they come out as well, you know who you are. So I'm going to close out with this, be good to each other. You know, I like the golden rule and leave everyone better than how you found them. I'll see you guys. Talk to you guys next week.