Fascial Manipulation: How it Works, and What It Can Do With Warren Hammer72 Minutes - May 2, 2018
Warren Hammer authored some of the first articles and books I read as I was starting into grad school. He’s been practicing using various soft tissue methods since the 1960’s… he landed on Facial Manipulation as his main tool. I couldn’t help but reach out to him to see what he has learned over the past 50 years of soft tissue work, clinical experience and research. You’ll enjoy his passion!
Here’s some topics we hit:
- What kind of injuries or cases can fascial work assist with?
- What is Fascia?
- Does fascia have pain receptors?
- Why does fascia get restrictions and what is the physical “sticking?”
- How is Fascial work any different than foam rolling, massage, ART, graston etc
- Explain the receptor system
- How can fascial manipulation assist in movement patterns?
- Research surrounding fascia work
Warren Hammer Bio: In Chiropractic practice since 1960. Subsequently obtained an MS degree and a diplomate in Chiropractic Orthopedics. Realizing the importance of soft tissue with respect to the treatment of joints I took many courses in soft tissue methods. Since 1985 I have lectured nationally and internationally on soft tissue methods. Some of the soft tissue methods taught were Cyriax’s Friction Massage, Strain/Counterstrain, Post Facilitation Stretch, Myofascial Release, Muscle Energy, Graston Technique, Mattes’ Active Isolated Stretch, Mulligan methods, Voyer’s ELDOA technique and others. Authored and edited three editions of a text “Functional Soft-Tissue Examination and Treatment by Manual Methods” and more than 300 articles on soft tissue subjects, some of which are peer reviewed. Became a certified FM instructor in 2013. Invited Antonio Stecco to the U.S. about 5 years ago to teach FM and the rest is history…
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Dr. Sebastian Gonzales is an expert in trouble shooting sports injuries and overuse conditions. This podcast is intended for sports medicine topics to become easier for patients and athletes to understand. Don’t get confused by what your doctor told you in your appointment. If you like in Orange County CA, book an exam with Dr. Gonzales, your Huntington Beach Chiropractor.
I really hate children singing.
Welcome to the Performance Place Sportscare 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.
Hey everyone and thanks for joining me again. It’s Dr. Sebastian Gonzales with the Performance Place Sportscare Podcast. By the way, I might change names pretty soon here ... we’ll see, I don\'t know yet, but I’ve gotten some feedback, not because they don\'t like the name, because it’s just not as descriptive as what it could be for the podcast, so ... I don\'t know if you have some suggestions, let me know, feel free; I am open to hear what you have to say, but anyway ...
We today are going to have on a doctor who has been around for quite a while, and it is Dr. Warren Hammer, DC. He’s a chiropractor, who really took a big venture into soft tissue work and eventually he landed into the fascial realm, so he will tell us all about fascia. Fascia manipulation is his specialty and that is a workshop series that they actually give, which he really wants a lot of chiropractors, PTs, and movement therapists to learn this kind of stuff. He will tell you a little bit about that today, but also too, I want you guys to realize how it can help you with your conditions with your patients as well, so if you\'re missing out on some of the soft tissue work, Warren Hammer is one of the great people to learn about it from because he graduated school, I think he said in 1960.
Back then, there was, I believe from what I understand, there was a lot more adjusting involved. There was some soft tissue work, but he has been through the whole progression series in soft tissue, and I read some of his articles back even before I was in chiropractic school. I read some of his articles and part of his book. It’s interesting to me and I really wanted to reach out to him so I can see what he had learned and why he landed on fascial manipulation as his main thing now.
So, in case you want to know, I really hate children singing. If you know me well enough, I think one of the worst songs in the entire world is that one song at Christmas time that has children singing, and if you guys don\'t really know what it is, it is The Christmas Shoe. I do not like ... I do NOT like The Christmas Shoe song. It’s not too bad, I mean it’s kind of slow and I don\'t really like it, and obviously it is a depressing song; it’s not fun, but either way, you get to the kids’ singing and I just do NOT like it. Perhaps it’s because when I grew up there was the Wee Sing series, which was just a bunch of cassette tapes you would put into your car and it would be a bunch of kids’ singing. The kids in the back would sing it too and I don\'t know if we actually listened to Wee Sing, but I feel like I heard it a couple of times when I was growing up and I thought, I don\'t like this ... It’s just children singing, I think it’s just too much trouble. I just do not do well with trouble. I grew up in the 90s and we liked bass. Treble just does not really sound good to my ears.
Now, just a couple of house-cleaning things before we actually get into it with Warren Hammer. I want you to remember to go on to review this podcast for me on iTunes. If you don\'t listen to iTunes, by the way, let me know what you listen on because I don\'t have an Android and I don\'t know anything about what you\'re supposed to listen to on an Android ... I should probably know that by now since we’re into now, what is it? You\'re going to find the show notes at www.p2sportscare.com/85 and we will have a transcription there, a player, and so on, so it’s going to be Session #85 and I still don\'t know how to listen on an Android device, how odd, huh?
Okay, before we go in, I just want to make sure, as I’m talking about it every week, I really do believe with a passion in these Patient Education Tools that I’m starting to make, such as this podcast, such as posters, such as infographics. I want you to share these things, so if you have not go on to my website yet, www.p2sportscare.com you will find “I’m a Professional,” and you\'re going to find a bunch of tools that you can use with your patients to help them understand what they\'re actually doing in your office. Because that’s a hard thing, you know, we have to know to be able to be empathetic with the patient, and we have to speak with confidence, but also too, they want to understand. They do want to understand. They want to get better. We can\'t just throw random treatments at them, at least I don\'t think so.
So as we get into Warren Hammer here, just to let you guys know, he has been around soft tissue for a very long time, so if you want to reach out to him, I will put a contact for him in the show notes, but if you want to reach out to him as well and take a fascial manipulation workshop, the website is www.fascialmanipulationworkshops.com and he also has a Facebook page as well.
We are going to get into a ton of stuff of what fascia is, why it glides, some center of coordination (what we call it), what actually it does in regard to pain receptors, how it’s a receptor system, how it goes and feeds the brain, some of where it tells the body where it’s at in space, what he feels about trigger points, and what he feels chiropractors now and PTs should be learning as they\'re getting out of school. So here we go with Warren Hammer.
Okay everyone, as promised we are going to welcome on Dr. Warren Hammer.
Dr. Sebastian Gonzales: Doctor, what’s going on?
Dr. Warren Hammer: Lots ... lots going on and you know I’ve been in practice since 1960, I can\'t even believe it.
Dr. Sebastian Gonzales: 60?
Dr. Warren Hammer: I’m more excited than I’ve ever been in my life because I’m investigating a method or a part of the part of the body that I realize is so important to the well-being of patients. It’s called fascial manipulation.
Dr. Sebastian Gonzales: I prefaced this before I had you on so everyone knows that we’re going to be talking about fascia today, so I thought you would be a great person to ask about everything detailed to fascia, not just easier stuff for the patients to understand, but also to get into some deep stuff for clinicians as well, since we have some listeners on.
Dr. Warren Hammer: Oh, that would be a great idea.
Dr. Sebastian Gonzales: Awesome. Well how did you get into fascia? Actually I read some of your articles when I was in school and I read part of your book Soft Tissue Exam ...
Dr. Warren Hammer: Functional Evaluation of the Soft Tissue ... I wrote three different textbooks, three different editions of the same book. The last one came out in 2007.
Dr. Sebastian Gonzales: That sounds about right.
Dr. Warren Hammer: Actually what got me going into fascia about 30 years ago, not the fascia I should say, just the soft tissue. I attended a seminar given by a physical therapist who worked for James Syriac in England. A lot of people don\'t remember him anymore, but he was an MD, an orthopedic surgeon, and he just revolutionized the world of soft tissue. He figured out how to evaluate individual joints and he emphasized, at that time, friction massage, which I still use at times on particular tendons and ligaments. He had pre- and post-testing and it was fantastic. I sat in that room for three days and my mouth was open like, “Why did I know this?” That literally, I think, was the real boost that I had in my life to get me into soft tissue; although, I originally took courses with Raymond Nimmo, receptor tone, all of that. I always seemed to take courses in soft tissue.
As a matter of fact, after a few years in practice ... I mean I went to Gonstead 21 times, I mean I’m a pretty good adjustor or manipulator, however you want to call it, and I was never really satisfied as much as I should have been or felt I should be using just manipulation.
Yeah, so I realized, “Wait a second, the joints are passive structure and they\'re moved by muscles, so what about the muscle system?” So I got into that and a lot of different techniques that I’ve taken.
About six years ago, I received a textbook from Luigi Stecco, a physical therapist in Italy, and it just so happened they had been teaching fascial manipulation in Italy at that point maybe 10 or 12 years ... not only Italy, but all over Europe. I looked at the book and I wasn\'t too sure what it was about, but it seemed very interesting. Eventually, I went to Italy and I was a guest in Luigi’s home. I watched him practice for three afternoons. His son was there, Antonio, who is a medical doctor, PhD, and he was like interpreting, but it was like amazing to me because I’m watching people come into this office, take a very adequate case history, and treated them, and it was like semi-miracles I’m watching here. I said to myself, I have to learn this stuff.
So the first courses I took were in Italy; they were teaching them in English, and then, because I was already lecturing on soft tissue, I said “How would you like to bring this to the United States?” They definitely wanted to, so I originally brought Antonio to this country and we set up seminars all over the place, all over the country.
Eventually like three years later, I became a certified instructor, and now there’s about four certified instructors in the United States and seminars are being given all over.
Dr. Sebastian Gonzales: Awesome.
Dr. Warren Hammer: As a matter of fact, seminars in fascial manipulation were given between 40 and 50 countries, 10,000 hours of instruction. It’s really starting to move and it makes sense. What makes sense to me is not only the results I see, but the literature that backs it up. I will say right now, I think there is more literature backing up fascial manipulation than all the soft tissue courses ever created ... and that’s a big, big statement.
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: There are a lot of places to go for the literature like www.pubmed.com .
Dr. Sebastian Gonzales: You said look up Stecco in there right?
Dr. Warren Hammer: Yeah, you put in Stecco C for Carla and Stecco A for Antonio, or just fascial manipulation, and you’ll get at least 120 or 150 articles. Nobody gets into PubMed by just writing an article. You have to come from a peer review journal and a couple of doctors have to decide if it’s adequate for the journal, at least their standard, so all kinds of articles. I mean Application of Fascial Manipulation in Chronic Shoulder Pain Anatomical Basis, Clinical Implications, Treating Patellar Knee Tendinopathy with Fascial Manipulation; I mean it goes on and on ... Expansions in the Pectoral Girdle Muscles into the Brachial Fascia Morphological Aspects, Spatial Disposition, Ankle Retinacula, which is filled with proprioceptor, etc, etc.
So that makes me feel happy, because a lot of stuff I’ve done and everybody, you know there is really not that much behind it and it’s something that somebody thought about and decided they’ll create a course. There are still a lot of good soft tissue courses around and I’m not saying fascial manipulation is the only course around, but to me, at this point, I think it’s something that everybody should become aware of.
Dr. Sebastian Gonzales: I had a couple of friends that went through the fascial manipulation course and I talked to them as we were setting up this podcast, and I said, “Hey, what was your opinion on it?” They said, “In regards to soft tissue, it was one of the best seminars that they had ever gone to,” and I think they’ve gone to Factor Active Release Graston and they’ve done a bunch of the stuff, but they were really blown away by the fascial manipulation course, so ...
Dr. Warren Hammer: Right. I would say I was the first chiropractors in the United States to use Graston.
Dr. Sebastian Gonzales: (laughs) Oh, yeah?
Dr. Warren Hammer: And I helped write the initial manual and I say it’s Graston technique, but I use it in a different manner now based on areas that I have found or that I have been taught that sync the more potent, and we’re going to get into that a little today I think, to tell you why those points are important.
Dr. Sebastian Gonzales: I think too we should make sure to differentiate as well because I know you’ve gone through a lot of soft tissue treatments and so on, but what is the difference between soft tissue and fascia because I bet a lot of patients are like ... I don\'t understand, you know, is it the same thing?
Dr. Warren Hammer: Well, I think what we have to do here is I have to give a short version of the anatomy of fascia.
Dr. Sebastian Gonzales: Okay.
Dr. Warren Hammer: Because a lot of people really don\'t realize what it is, but basically the first research conference, and they’ve had four international conferences on fascia. The first one was actually at Harvard (that’s where I actually met Antonio) but basically it is defined as the soft tissue component of the connective tissue system that permeates the human body, forming a whole body continuous 3-dimensional matrix of structural support. It actually interpenetrates and surrounds all organs, muscles, bones, nerves, and it creates a unique environment for body system function.
I usually tell a patient “You know if I took everything out of your body and left the fascia, you would see a 3-dimensional outline of your body.”
Just thinking about it from a philosophical point of view, you mean to tell me we have something that covers everything on our body? Anatomists even today still what they consider just a covering, they really don\'t realize what it is, and the biggest thing it is, basically to me, is that it is a sensory organ that literally reports to the central nervous system about what it is covering. Not only the muscles, etc, the musculoskeletal system, this even applies to the internal organs. With fascial manipulation you have a part 1, 2 and 3, and 3 has to do with functional fascial manipulation of internal dysfunction, but that’s another whole world right now to even get into.
First of all, I think we’re talking about anatomy, okay ...
Dr. Sebastian Gonzales: (Laughs) Yeah, yeah.
Dr. Warren Hammer: You can think of the fascia as having a superficial layer and a deep layer. The superficial layers have three of their own layers, but the main area is called the superficial fascia, which is a little elastic and you got all the superficial vessels and nerves in that superficial fascia. There are techniques that are very important that you are treating superficially to affect the lymphatics and to affect a lot of different things.
Then you have the deep fascia, which literally actually envelops all the muscles of the body. It is interesting that one of the main functions of the deep fascia is to transmit muscular forces at a distance. This is really sort of involved. Actually I would recommend from a great understanding of the fascia system is Carla Stecco’s text entitled Functional Atlas of the Human Fascial System. You can get it probably on Amazon. Carla only worked on unembalmed cadavers. I mean after three days, they weren’t adequate for her. You actually have some of the best views of the fascia anywhere in the world. This book which talks about the physiology of fascia, how fascia functions throughout the body should be in every medical school, every chiropractic school, fascia should be a core curriculum course, which we’re really getting in a couple of chiropractic courses right now, but it’s just an amazing book.
She used me as the English editor. She writes what I call Italian English and it took about a year and a half or so until we got that book out. It’s totally amazing and probably what I’m talking about is coming from that textbook.
Dr. Sebastian Gonzales: Are you fluent in Italian English now then? (laughs)
Dr. Warren Hammer: Italian English I’m fluent in, not much in Italian. My wife speaks fluent Italian, so that helped a lot too.
Dr. Sebastian Gonzales: Oh cool. I’ll put a link to that book so everyone can find that as well. So you mentioned the deep and superficial fascia and the deep fascia, before going on, yesterday I did a little bit of research just to see if I found some good pictures of these types of things we’re talking about. Is there a way you can describe if someone can visualize where the deep fascia lays?
Dr. Warren Hammer: Yeah, I want to do that. Thank you. There are two types of deep fascia basically. One is called the aponeurotic fascia and the other part is called the epimysial fascia. Basically, the epimysial fascia covers practically all of our body. It adheres very closely to the muscle, especially the muscles of the upper limbs, lower limbs, and a lot of the trunk muscle. Again, that does transmit a muscular force, but we’ll get into that. As a matter of fact, I always say if you look at a chicken and you see this glistening membrane on the surface of the belly of a chicken, that glistening membrane is epimysial fascia.
Dr. Sebastian Gonzales: Are we talking about live chickens here? Like if you defeathered them first? Because chickens don\'t have exposed bellies, you got to pluck them first, do you? I don\'t hang around chickens all that much.
Dr. Warren Hammer: (Laughs) Or you can look at a turkey, it’s the same thing. But what’s really important also is what they call the aponeurotic fascia. Now that’s really interesting because that glides on the epimysial fascia, so consider an arm or leg: you have this fascia that covers the muscle itself and this aponeurotic fascia that covers groups of muscles and this is very interesting fascia because it has two to three layers and in between is what they call loose connective tissue.
Now one of the things that we’re going to get into is that in order for fascia to move, it moves on loose connective tissue. One of the main ingredients in this loose connective tissue is hyaluronic acid. That allows the physiological sliding of the layers of fascia and that is a big key that I’ll be talking about.
So you have the deep fascia, superficial fascia, and you also have the internal fascia: they divide into visceral vascular and granular layers of fascia, which is taught in part 3. Here’s the thing you have to understand for I guess what we’re talking about today--We talked about the epimysial fascia, and that’s sort of a very thin, tough structure that surrounds the entire surface of the muscle belly and it actually helps to separate muscles from each other. It gives form to the muscle belly. Then underneath the epimysium is what they call the perimysium and this divides muscles into what they call fascicles or bundles. It provides a conduit for blood vessels and nerves, and the perimysium now is surrounding the bundles. Now we get into the bundles and you find that every single muscle fiber is surrounded by fascia and that’s called endomysium.
Then all these tissues are interwoven and they are considered like a continuous sheet of connective tissue that encases the muscle and it contributes to the tendons of the muscle.
One of the things we have to understand here is that all muscles have a fascial connection, so the most important thing I ever found out in my life was that the soft tissue, as I said before, is not just a protective covering, it’s a sensory organ. By sensory organ, I’m talking about in having receptors. For example, the most important receptor regarding our muscles is called the muscle spindle cell. Here’s the big news ... The big news is that a muscle spindle cell is not in the muscle; it’s in the layers of the, especially, the perimysium and some of the epimysium that has to glide when we move over our muscles, so that is really important.
Every time a muscle contracts or passively stretched, the nerve endings of the receptors, the Golgi tendons for example, but especially the muscle spindles, they are stretched and activated. So every time we move when a muscle contracts the fascia that is attached to it, they call it the myofascial expansions are stretched. When they\'re stretched, they stimulate the receptors. It’s the stimulation of the receptors that is so important for the function of the muscle.
Years ago, I said, “Well if joints weren\'t enough, maybe it’s the muscles.” Then I realized, “Well, it’s the fascia that has a tremendous control over the muscles.” The spindle cells, they inform the central nervous system about the continuing changing status of muscle tone, movement, and loss of elasticity ... so here we go ... (laughs)
Dr. Sebastian Gonzales: (Laughs)
Dr. Warren Hammer: When you eat some muscle, there are two main nerves: they call it the alpha motor nerve, which is a motor unit that attaches to what they call the extrafusal fibers (the muscles that do the contracting). Then you have another nerve, it’s called the gamma nerve. Now, the gamma nerve, which is 31% of the total motor nerve of muscles, has one main function, and its function is to stretch the spindle cell. I said this before, it should be fascial spindle cell, they should change the name.
Dr. Sebastian Gonzales: Yeah, they should change the name.
Dr. Warren Hammer: When this nerve stretches the spindle cell, the spindle cell now is stretched ... and remember these annulospiral end fibers, these are now sensory impulses that goes back to the central nervous system and tells the nervous system all about the muscle. In other words, just contracting the muscle is really not telling much.
For example, where is the muscle in space? I mean the spindle cell monitors muscle links and it signals the change in muscle links, and it forms the central nervous system of a continually changing status of muscle tone, movement, loss of normal elasticity, positions or parts, I mean where’s your muscle in space? The actual length of the muscle, the rate of change, the velocity of the length of the muscle ... The spindle cell wants to keep the skeletal muscles at a certain level of contraction regardless of the length of the muscle, so let’s face it ... That’s really important.
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: The biggie, as I say, it’s in the fascia, so here comes the gamma, and they say, “Okay, let’s do our jobs, stretch, so we can find out what’s going on.” Well, spindle cell might be saying, “You know I’d love to stretch but I can\'t fully stretch because something is preventing me from stretching.”
Dr. Sebastian Gonzales: That’s where we manipulate the fascia ... That’s where the fascial manipulation comes in and we have to effect that area.
Dr. Warren Hammer: Absolutely, because in these areas when we palpate it, we find that there is a densification, so that’s really getting into the fascial manipulation itself, because if the perimysial fascia and epimysial fascia are unable to glide, then the muscle spindles are prevented from changing their length. Now when that happens, some parts of the muscle will not function normally during movement. There will be a diminution of muscle force of particular muscle fibers. This will now alter the vectors of force acting on a joint. This will cause unbalanced movement of the joint and this has to result in uncoordinated movement and even eventual joint pain.
So the fascia houses the spindle cell and really it’s considered like a key element in peripheral motor coordination and proprioception. This has not necessarily been proven yet, but you can have people doing muscle strengthening ... well what if they have densification? What if their spindle cells are not firing off? That has to mean that all the fibers when they are working, the brain doesn\'t know, for example, how individual muscles are functioning, the muscle tells it. It sends back to the amount of attention to do the lifting, but there are fibers there that can\'t be working properly. I would love to see a study to show, after fascial manipulation, whether they are able to perform strengthening exercises themselves, and doing it in a way that they are working on balance boards and improving proprioception, people are using rowers and all of this, which is fine and it helps, but what if you had a way of going to particular points and freeing up densification? That’s really where we get into probably what are we doing with fascial manipulation?
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: I went to a fascia conference with a friend of mine; he’s a PhD chiropractor at the University of Pittsburgh and who was there but Zeke Freedmincer. He is probably the world’s leading expert on muscle pain and all physiology. We didn\'t ask him the question, but we sent an email and I actually had permission for that email and what he said in the email was actually in Carla’s book, and the question was ... Can fascial adhesions have an adverse effect on spindle cells? Now he doesn\'t even know about fascial manipulation. His answer was, “Structural disorders of the fascia can surely distort the information sent by the spindles in the central nervous system and thus interfere with the proper coordinated movement.” He said in particularly the primary spindle afference or 1-A fibers, any of the fibers that essentially go back to the central nervous system. “They\'re so sensitive,” he says, that even slight distortion of the perimysium will change the discharge frequency.
Well ... we have other proof of that, other than him saying that, but he’s saying that based on the literature, so that’s big news.
Dr. Sebastian Gonzales: Actually, so what I am hearing too and I know a lot of people are probably thinking ... Well, how does fascial manipulation apply to movement patterns or say Achilles tendonitis or things like that? It sounds like then, just to break things down for people is that the fascia provides a receptor system to tell your brain to tell your body where it’s at in space so you can move well, right?
Dr. Warren Hammer: Right. That’s proprioception. These are receptors performing normal proprioception.
Dr. Sebastian Gonzales: I know that I’ve had some people ask before, “How does tissue work help me move any better?”
Dr. Warren Hammer: That’s a great question. That, to me, is the main contribution in a way. Everybody talks about the kinetic chain, you know (singing) “The hip bone connected to the knee bone ...” and all that other stuff.
Well, you had a knee problem, now you have an ankle problem, okay let’s see where it’s tight, let’s see where it has to be stretched, let’s see where it has to be strengthened.
We actually went to the trainers at the Arizona Diamondbacks and the first thing we said was, “You guys are probably the best stretchers and strengtheners in the world!” But you notice you have a lot of recidivism why these problems keep recurring and why ... because you\'re doing it to uncoordinated muscle.
In fascial manipulation they have created what they call the myofascial unit. These units are in every segment (there are like 14 segments) like in your arm, forearm, wrist, shoulder, whatever ... and they use this myofascial unit, which is basically a motor unit (it’s the alpha motor neuron intersecting muscles), which is part of the myofascial unit; actually the myofascial unit is activated by the alpha motor neurons, etc.
Instead of discussing single muscles, nerves, or bones, fascial manipulation combines the muscle, the fascia, and the nerve together within this myofascial unit and it shows the connection of these units. For example, a limb or trunk by way of these units, and within the units are points. This is probably the most different thing to learn, but these are particular points and we call them centers of coordination. There are other points called centers of fusion, which are centers of coordination which fuse together, but that’s a little beyond us right now.
Dr. Sebastian Gonzales: Yeah, I actually wrote that down on my questioning series.
Dr. Warren Hammer: Oh, did you?
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: But here’s the thing ... Here’s the other thing that I didn\'t even mention ... what do you think is in the fascial system?
Dr. Sebastian Gonzales: Uh ...
Dr. Warren Hammer: You won\'t believe it! It’s the acupuncture system.
Dr. Sebastian Gonzales: Oh ... (laughs)
Dr. Warren Hammer: That’s where it is.
Dr. Sebastian Gonzales: I thought I was in school for a second there.
Dr. Warren Hammer: (Laughs) So frankly, I tell acupuncturists because more and more of them are taking the courses now, “Hey, it’s a great way of healing, but it needs a little more,” as far as I’m concerned. Number one, they talk about chi and energy ... Fine, but what is chi? Well, because it’s in the fascial system, I consider acupuncture as a connective tissue type treatment. It’s stimulating fibroblasts. You\'re having immediate effects within the connective tissue, I mean it’s faster than a nerve impulse and it’s a way of things changing and creating changes within the tissue. The thing is, a needle will stimulate a point. At that point, based on the connective tissue theory of spindle cells, etc, has to be freed, has to be broken down, otherwise it’s still there. Otherwise it’s still not functioning in a connective tissue sort of way, so something has to be done to that.
That’s so funny because a while back we had an acupuncturist come into the second session, and I said, “Well, how’s it going?” He said, “Great. I think my results are better.” I said, “Well, you realize you have to break down the densification?” So he says, “I am.” I said, “What are you doing?” He said, “Well after I’m through with the needle, I go in and I move the needle around. You know to break down some of the tissue.” I said, “That’s gonna to hurt someone.”
Dr. Sebastian Gonzales: (Laughs) They can always do that dry needling sparrow-pecking thing, just keep stabbing it.
Dr. Warren Hammer: (Laughs) Anyway, so what we teach is the location of these points, but the interesting thing is we do a very, very thorough examination based on history, as we all do, but we do it a little differently in fascial manipulation. We are interested in causation and I would say that the average patient comes in and they usually blame the last thing they did as the cause.
“Well, what happened?” ... “Well, I have a pain in my right shoulder.” ... “Okay, when did it begin?” ... “Oh about a month ago and I know what happened, I brought my shoulder back too far.” ... “Oh, really? Well how about the other three people you play with? Did they bring their shoulder back too far? Do they have that problem?” ... “Oh, no ... but I know I went further than they did.” And you get these things. You could have overuse though and there’s no question about it, or trauma, or poor posture, but the thing about it is ... in their history based on what goes on in the fascia, the fascia is the kinetic chain to me. Let us say this particular patient has a tennis elbow that hardly ever bothers her anymore, but she still may be a little aware of it or maybe 20 years ago she fractured her wrist. All of these things had to alter the fascia. All of these things had to alter the communication of those areas throughout the upper extremity. So basically what you have to find out about is ... is the shoulder? Is it due to the elbow? Is it due to the wrist? Or is it due to an old neck injury they had?
What we do is, we go over the 10 different actual acupuncture lines; they\'re not all exactly on the acupuncture point, but we are palpating now for density of one particular line. Maybe this patient on evaluation, when they bring their arm up laterally, has the most pain. You would think it would be the lateral line and probably 50% of the time it is, but it could be an internal rotation line or external rotation line, a medial lateral line, or it could be intermedial lines, so it’s about 10 different lines that we go through.
I will compare for example the shoulder with the elbow and wrist if I feel based on their history that they could be previous causes. Let us say that I find real density around let’s say the anterior line or sagittal line of the wrist and the elbow, and then go to that same point on the shoulder and the patient says, “Oh! That’s where it is!” But I’m finding that when I palpate, because we have to feel the density of tissue, that it’s smooth. There’s no density over the anterior point, but it’s very painful when I touch it.
But now I will go down to an anterior point, maybe around the biceps, or maybe in the forearm and oh my God, that is sensitive, and they never even knew they had that pain, but it’s been there. Of course, you\'re going to treat what we call balancing ... if you treat sagittally if you treat the front then you\'re going to look in the back too, but that’s the other stuff. Here’s the thing, you can treat this patient by way an elbow point and a wrist point and never touch the shoulder.
Dr. Sebastian Gonzales: So with the results on that, I’m sure you have had people in the same exact type of case that you don\'t even touch the spot or doing work with the spot that they\'re complaining about, you work elsewhere like the elbow or wrist?
Dr. Warren Hammer: Never touch that spot. I may never touch it.
Dr. Sebastian Gonzales: And they feel better?
Dr. Warren Hammer: Yep. Same thing.
Dr. Sebastian Gonzales: Cool.
Dr. Warren Hammer: All the time. You got an old knee problem or a low back case, or 10 years ago, he fractured his leg, so for 9 years he has had back pain. Well you know old pathways and if you could matchup say a lateral point in the leg with a lateral point in his pelvis or lumbar spine, and they are all densified, by just treating the leg point, you could immediately get a change in flexion and increase in flexion. That’s what the beautiful thing about this is. How do you know you\'re on the right line? Because with the shoulder patient, I may just treat a point at the wrist, a point by the elbow, and then maybe their chief complaint is when they brought their arm up into external rotation. “Hhmmm. If feels a little better.” Boy, that’s music. Because when I hear that, I say I’m on the right line.
Let’s say they put their arm back into external rotation and it’s the same. Well, I may treat a few more areas, if it still the same, then I’m probably on the wrong line. Maybe in bringing their arm up it was the external rotation, internal rotation, or horizontal plane that was involved. What I like about this, you\'re not just going where the pain is or you happen to palpate some nodular area, you\'re going to an area based on a sequence, based on a system, and knowing exactly where to go.
Dr. Sebastian Gonzales: So those points could be way ... let’s just use that shoulder case again, is it possible for the points that would have the greatest effect to be into the lower extremity or just really far away from the shoulder?
Dr. Warren Hammer: Yes. That’s part 2 where we teach spirals and diagonals. You can have a shoulder problem on the right side, right shoulder, and maybe the left leg was involved years ago. I actually had an unbelievable case like that and luckily it happened in front of the class.
Dr. Sebastian Gonzales: Get’s it going with that there.
Dr. Warren Hammer: I forget the peoples’ names in the class to prove it, but this guy had a shoulder problem with abduction. He would get about 90 degrees and it was painful. It was chronic and he was getting all kinds of therapy for it. We actually didn\'t think of a spiral. We worked along the upper extremity on certain points based on his history and he was able to maybe get another 5 or 10 degrees. Well he talked about his Achilles area and it was actually a point on the calcaneus. We have what you call retromedial, anterolateral, (we call it diagonals) and then we cross the body, and so we may hit a few points on the leg and then go along that sequence, which is a spiral sequence and then go to the shoulder area and find those points saying, “Hey, this looks like a spiral.” Well this was like one of those miracles and only happened once, but I worked on the lateral portion of his calcaneus; it’s called the retrolateral 2 test or foot. I just worked it and it was extremely sensitive and he didn\'t even know he had it. I’m just working on him maybe 3 minutes or so, trying to break down the density and try to free it up so that I feel the smoothness. I get up and say, “Let’s see if anything happens here.”
Well as true as I am talking to you right now, the shoulder goes totally up, across the 180, and I said to myself ... and everybody stood up and actually applauded. It was like a magic show, you know, (laughs), it was amazing.
Dr. Sebastian Gonzales: That’s cool.
Dr. Warren Hammer: But I haven\'t had that happen very often, but I have treated a lot of spirals and so has everybody else in fascial manipulation. We usually look at spiral situations where people are doing a variety of movements and using a lot of different parts of their body at the same time, and then they will have pain in a variety of areas, so there are certain things that you make you think of a spiral and that’s just part of our course that we teach.
Dr. Sebastian Gonzales: I had someone who was a doc that took your course and I asked him about fascia about a year or so ago, and I said, “Can you explain it really easily to me?” So he tugged on my shirt at the bottom at the waist and he’s like, “Do you feel that in your shoulder?” And I’m like, “Oh yeah.” So I keep thinking it as like a greenman suit, you know like those body suits? Just sensory wise.
Dr. Warren Hammer: Again, what you\'re talking about again, which I think is the most important is the kinetic chain because I feel that most people that come to your office, unless they’ve had a direct trauma to that area, would usually have some other area that might be the initial factor in their past. Sometimes it’s a little concurrent and it’s also with them, but very minor. Sometimes they totally forgot about it. These are problem cases because these are cases that sometimes you have a hard time treating because you\'re concentrating on the site of pain.
I always talk about the MD from Prague, very famous, and you’ve read a lot of books on soft tissue, and everybody calls him, he states, “If the doctor is treating the site of pain, is lost.” Obviously if you fractured your leg, that’s the site of pain. You\'re going to treat that. So many areas of pain don\'t have an actual apparent reason ... where does it come from?
So in all of our tough cases, think about it, it’s coming from somewhere else. What fascial manipulation gives you is the opportunity to figure out where else it could be coming from. If somebody didn\'t show a result by the second visit or some change, I’m questioning myself. I have to tell you at my stage of practice, I’ve cultivated a couple of orthopedic people and I know it’s going to happen, what does happen is they normally send it to the PT, and I am saying nothing negative about PT; I’ve learned a lot and still learn from PTs, but the thing about it was, it didn\'t work. So I say, “Alright, send in a hammer,” or something like that.
Now I don\'t get all those people well, but I would say I get 75% to 80% of them better. It’s so interesting. I mean I’m not a machine. I’m not doing the same thing over and over to people. It gives you a way to think. You become like a Sherlock Holmes. I mean you\'re analyzing, you\'re evaluating, and we have great support groups. You know we have blogs. We have people with Fascial Manipulation USA, got 200 to 300 of them, that we start questioning each other. We have master courses we just had recently. We have a guy named Stefano Cassaday and he had 4 years of school, but he hurt his elbow, so he found out about a guy named Luigi Stecco giving some courses. Well, he must’ve taken 8 courses before he graduated. That’s what he does. That’s all he does now is fascial manipulation. If somebody needs rehab and stuff, I think he throws them out, but he’s a great instructor too.
We just had him down for a master’s course in Scottsdale. He has taught all over the world. For example, he has been to Israel at least 20 times. As a matter of fact, they know have a fascial manipulation instructor, 2 of them in Israel, and they are PTs, and he states at least 200 PTs are using SM as one of their primary ways in evaluating patients. That’s big and it’s happening all over the world.
In Poland, you will wait a year before you can even take the course.
Dr. Sebastian Gonzales: Dang. It just sounds like the US is a little behind on it.
Dr. Warren Hammer: Yes, they are. I’m really disappointed.
Dr. Sebastian Gonzales: Why do you think that?
Dr. Warren Hammer: Well, I have a theory. I feel maybe 10% or 15% of people in every profession are willing to take the giant step and think outside of the box because when you do that you know you\'re making a living, and are happy, and you don\'t want to make a change, or sometimes they will take a course and take a few things from it, but that’s not doing fascial manipulation on your patient justice.
In the beginning, we had a waiting list; we had 40 or 50 people at a time taking seminars. Then it started to slow down. It’s picking up again.
Another one of my theories in fact is that you have somebody in town getting great results with fascial manipulation and they don\'t want to tell their fellow practitioners about it.
Dr. Sebastian Gonzales: That’s funny.
Dr. Warren Hammer: They want to be the only one in town. Whatever it is, right now, you can go to www.fascialmanipulationworkshops.com and you’ll see some courses and we even have in there advertising some other providers, like me, and there are about 3 or 4 of us in the US who run courses.
Dr. Sebastian Gonzales: I will put a link in the notes for everybody too. You have a Facebook group too as well on that right?
Dr. Warren Hammer: I might. I should pay more attention to things.
Dr. Sebastian Gonzales: Well, hopefully it’s running itself and everyone is talking to each other.
Dr. Warren Hammer: I know, I know. I just hadn’t got into it, but I know it’s a great source.
Dr. Sebastian Gonzales: Hopefully, this podcast will help the person practicing next to the fascial manipulation person, the only one in town, and he will go on and check out the course.
Dr. Warren Hammer: Right, right.
Dr. Sebastian Gonzales: That is the hard thing is like ... I’m sure there’s going to be some DCs or chiropractors listening to this podcast too. I mean you have gone so far deep into soft tissue work even from the beginning, why did you even decide to go that route? I’m sure back in the 60s, a lot of manipulation was taught, right?
Dr. Warren Hammer: Yeah. I mean there was a little bit going around. I think Nimmo was around then, in one of my early courses.
Why? I mean do you want to get political here? I mean.
Dr. Sebastian Gonzales: Sure.
Dr. Warren Hammer: I think in a profession, if we’re ever really going to move forward, we have to really get a lot of soft tissue into it. As a matter of fact, what I really love and it is just happening this year is the Manipolazione Fasciale (that’s my Italian) but it’s the Fascial Manipulation Association in Italy where I go every year and as a teacher you have to sort of go, and I want to. We have great lectures with Carla and all of them down there. They\'re doing research continuously.
Carla is an orthopedic surgeon and a professor of anatomy, and that’s why I’m telling everybody to buy that book Functional Atlas. The interesting thing about Carla, on an off-shoot here, I said, “Carla, why don\'t you put into the book fascial manipulation?” She said she’s not interested in promoting fascial manipulation though she’d like to. She said she wanted people to understand the way fascia works and what it’s about. So she mentioned zero courses there. Of course, she’s one of the top people in fascial manipulation doing a lot of research, along with Antonio.
So I was talking about the chiropractic confession?
Dr. Sebastian Gonzales: Yeah, why 15% only wants to step out of the box in any profession, right?
Dr. Warren Hammer: Yeah, and I think that’s true in most professions, but what really annoys me about chiropractic is seeing about the same percentage of people in this country that we saw maybe 50 or 60 years ago. We need something else. I still think manipulation of the spine and joints has tremendous research on it, equal to everybody, but you have to add something else. Obviously, the facet joint and everything that occurs from it is not necessarily the total answer.
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: Otherwise, we’d be seeing more than 5% or 10%; we’d be seeing more percentage.
Dr. Sebastian Gonzales: Yeah, remember the other day when we were talking about degrees, and I said, “Hey, I don\'t know if anyone really cares what degrees we have and stuff. You said, “You should do a survey or question your people on that.” Do you remember that conversation?
So I did actually and I thought I would share the results with you because just on the idea why I think we don\'t see a large percent of the population is because I don\'t think we know how to communicate extremely well.
Anyway, it was a Facebook one; it was “What Makes You Believe That a Doctor Will Help You?” Like it’s the right doctor for you, right? There were 4 choices; there was “a lot of degrees,” there was “confidence in speaking,” “empathy,” and “high price.” Which one do you think? There was an overwhelming one so far from what I saw. What would you pick? I told no clinicians to answer, so this was all patients.
Dr. Warren Hammer: Well, obviously it’s probably not degrees anymore.
Dr. Sebastian Gonzales: It wasn\'t degrees. That got one or two answers though, but there was one that got zero by the time I had looked into.
Dr. Warren Hammer: Really?
Dr. Sebastian Gonzales: It was actually “empathy” and it was extreme ... EXTREME, which I was surprised. I thought it was going to be “confidence,” but then high price was zero by the time I looked.
Dr. Warren Hammer: High price was zero?
Dr. Sebastian Gonzales: Like no one cared. I felt like I should have put low price, but I feel like that wouldn’t show value.
Dr. Warren Hammer: Nobody cares why they seek out high-priced doctors.
Dr. Sebastian Gonzales: I don\'t know. I feel it’s like more of a demonstration of value or I mean if empathy is the thing, I feel like if we can teach docs because they know all the stuff, but then how to relay it in patient terms and understand what they\'re going through, I feel like we’re going to get a better chunk of the population, but I mean that could probably apply to any profession in healthcare.
Dr. Warren Hammer: I think empathy is so essential. People have to feel that you care and they believe you can help them, but you have got to back that empathy up with something.
Dr. Sebastian Gonzales: Oh, for sure. Yeah, you get a case like you touched the Achilles and the shoulder gets better ... I mean that’s like complete 100% buy-in. Your price won\'t matter at that point.
Dr. Warren Hammer: So in my life, I went to Parker Seminars years back and I would get that feeling and as soon as he had them, it would die off. The only thing that ever gave me enthusiasm was feeling that I was competent, that feeling that I could the patient well, and I felt why I could get them better. Would you believe that I still have that nervous feeling, Can I get this patient well? I never feel 100% confident.
I gave a commencement address at 3 or 4 different colleges and I said, “Yay! You’re graduating and you think you know it all. Well, the only day you could think you know it all is when you get every patient that you accepted as a patient well, then you know it all. Therefore, you never know it all.” It’s a constant search for knowledge.
I mean I have given up reading a lot of books I’d like to read because I’m always trying to read more about fascia. I’m trying to memorize Carla’s textbook.
Dr. Sebastian Gonzales: Are you really?
Dr. Warren Hammer: It’s like my Bible. I read it every day, some parts of it. I only wish in my whole life I could remember what I used to know.
Dr. Sebastian Gonzales: Yeah (laughs).
Dr. Warren Hammer: It’s funny.
Dr. Sebastian Gonzales: Where did you do that commemoration speech? I don\'t remember who did ours, but ...
Dr. Warren Hammer: Well I did 2 at Bridgeport, New York Chiropractic College, and actually 3 at Bridgeport and before that, one in New York before.
Dr. Sebastian Gonzales: I think what you said is a good point. Not only just knowing that you can help everybody that you accept, but which ones not to accept and refer them out. I think that’s a good point you made.
Dr. Warren Hammer: Very much.
Dr. Sebastian Gonzales: Since there are other chiros, PTs, and other healthcare professionals probably listening to this, as we start to close up, what is one thing you would like them to know as they are graduating school in their first year of practice?
Dr. Warren Hammer: Well ... never be satisfied with your present-day knowledge, that’s for sure. You have a patient that did not respond, don\'t blame it on the patient. What else could you have done? Is there something else?
Parker used to teach I remember years back, 80-10-10; 80% gets better in spite of the patient, 10% might have got well because of you, and 10% never get better. Well, I never accepted that. I don\'t believe 80% of the patients do get well. I mean what do you mean by well? How do you define it? They feel good for six months or a year?
This is interesting, I will never forget this one. I was in Luigi’s office and Antonio said to me, “Most of these people have not seen his father for the last 2-3 years,” so if there is something better out there, maybe it’ll prove what you do. I mean why do we even practice? Well, it’s to help people get well. Not just to make a living, you know, I mean to take fascial manipulation, you really have to work hard. I mean it’s four 3-day weekends of part I and 2. Then if you take part 3, that’s 7 days. We’re going to have a part 3 in June in Atlanta and we have 2 medical doctors coming down who use this in their practice almost primarily, and it’s to treat functional problems of the fascia, not disease, not liver cancer or anything like that, but there is a whole functional thing that goes on. People are taking pills, and why do you have chronic constipation? Why do you have reflex? So many things. Again, it’s the fascia. It’s the effect on the autonomic nervous system, on smooth muscles, on the nerve endings, the fascia that covers organs ...
Dr. Sebastian Gonzales: By the way, everyone, I will put links to everything. I think this is going to come out in April actually, so I will put some links to the seminars as well that are coming in the workshops.
Dr. Warren Hammer: Great. You can just go to my website and you will see a few there. Go to www.fascialmanipulationsworkshops.com
Dr. Sebastian Gonzales: You emphasize the “s” a lot, is there another website that has no “s” on it?
Dr. Warren Hammer: That has no “s” on it?
Dr. Sebastian Gonzales: Yeah, the “workshops” ...
Dr. Warren Hammer: No, that’s my particular one. You can go actually to www.fascialmanipulation.com, which is actually the worldwide fascial site and go to English and they’ll show seminars.
Dr. Sebastian Gonzales: Yeah, if I Google fascial manipulation, this came up, so it was one of the top searches anyway.
What would you tell patients to realize as they\'re being treated by a new clinician or a different clinician?
Dr. Warren Hammer: To realize, and I tell them that I doubt very much if they had to come for a long period of time and they would feel a result within 2 or 3 visits for sure, and they will continue to get well, and this is not necessarily something they have to do the rest of their life; although, we are getting into maintenance a little bit in the fascial manipulation world, but it’s just getting results and getting people well.
You see people with conditions for months or years, and all of a sudden, they\'re experiencing relief. I mean all of a sudden now, the central nervous system is now aware of the muscular system, and in a very dynamic way. Things are now firing off. You know you have spindle cell function, dysfunction in the thigh, and that will affect the knee, that then will affect the leg, and it goes right down the line.
Dr. Sebastian Gonzales: I was thinking earlier that the ankle bone is connected to the shinbone and so on, you should just make a fascial song.
Dr. Warren Hammer: (Laughs) Should make a fascial song?
Dr. Sebastian Gonzales: Yeah, the deep fascia is connected to the superficial fascia ... (laughs)
Dr. Warren Hammer: Yeah, we could do that ... (singing) retrolateral fascia attaches to the retrolateral general ...
Dr. Sebastian Gonzales: I could see it now ... That could be your closing part of every fascial manipulation seminar.
Dr. Warren Hammer: (Laughs) Yeah, we’ll have a song.
Dr. Sebastian Gonzales: Exactly.
Dr. Warren Hammer: Is this is going to be on a recording?
Dr. Sebastian Gonzales: Oh, heck yeah, why not?
Dr. Warren Hammer: Okay (laughs).
Dr. Sebastian Gonzales: I mean I can cut it if you want me to, but everything so far has been golden, so you’ve made my life so easy, there’s no editing.
Dr. Warren Hammer: Oh, that’s good. I didn\'t talk about this, which is something I should mention here.
Dr. Sebastian Gonzales: Yeah, please do.
Dr. Warren Hammer: Okay, in order for fascia to glide, we talk about the aponeurotic fascia having layers that glide that’s on top of the epimysial fascia and in the epimysial fascia is where the myofascial units or centers of the points are, now in order for a glide to occur, you have to have a fluid for the gliding to occur in. We really feel it’s hyaluronic acid. You’ll find hyaluronic acid between deep fascia, underlying muscles, the epi, peri, the endo, it’s in every one of those areas where the fascia glides, it’s around vascular areas, neural areas, and it’s synthesized by a cell that Carla called a fasciacyte, and it’s all our cell membranes.
What happens is that when there is injury or whatever, the fascia molecules become entangled and the theory is, and there are some studies on it, that when what you are treating is not necessarily collagen fibers of the fascia, but you’re freeing up the molecules of the hyaluronic acid and allow you to become in the most fluid state so that gliding can occur.
As a matter of fact, Antonio Stecco has a great study called Evaluation of the Role of Ultrasonography in the Diagnosis of Chronic Neck Pain. He took ultrasound views. There were 2 muscles, he used the sternocleidomastoid and the scalenus medius, and in the chronic patients, they showed a thickening of the spaces between the collagen fibers, and then they used fascial manipulation on it, and they had pretty good results, but not in the results so much. What’s interesting is that he was able to figure that when the space in the loose connective tissue was thicker than 1.5 cm, you could almost make the diagnosis of a fascial cause, the thickening of the loose connective tissue altering the functioning of the fascia, so a lot of times, people think they\'re breaking up scar tissue. No, they\'re not breaking up scar tissue, they\'re breaking up a densification. I mean you can have scar tissue and you want to tear the fiber and you have fibers that are absolutely stuck to each other and there is no space, and nothing in there, but in fascial manipulation we talk much more about densification, about a lack of glide. You can palpate it. You know palpation is the chief diagnostic medicine we have, so where are we going?
I mean why just rub on a spot? The beautiful thing maybe we rub on the series of points and go back and forth until we feel the lack or freedom of the glide, the lack of density, and that’s essential. Because if you don\'t end up with the lack of density, what where you doing there in the first place?
Dr. Sebastian Gonzales: Yeah.
Dr. Warren Hammer: I tell that to massage people. I tell this to a lot of people. “Oh, it hurts over here,” so they rub over there. I mean or trigger points ... that bugs me the most. Random treatment of trigger points.
Dr. Sebastian Gonzales: (Laughs)
Dr. Warren Hammer: I mean I have a great orthopedic friend and he is a great doctor, but he’s only doing trigger points. I said, “Okay, you picked a trigger point in a trap and the patient feels better? That trigger point, could be, doesn\'t have to be, but it could be a myofascial or a center of coordination in the myofascial unit. How is that upper trap related to the scapula to the neck?”
Instead of treating one point, have the ability to look at the sequence, at the chain, because that one point, most of the time, temporary. It is rare that with fascial manipulation that we treat one point. We’re looking proximal and we’re looking distal. That’s the whole thing, as I said before, really getting into the kinetic chain.
There’s so much and getting back to hyaluronic acid, there injecting it in multiple knees know. It’s an important chemical that’s necessary for function and one of the tenants, I guess, of fascial manipulation is that we’re really freeing up the loose connective tissue, which is allowing the gliding of the tissue of the perimysium (for example) in which the spindle cell is located. So the viscosity of the tissue is what we are trying to change and you feel the change by the way of palpation, on the way of the abduction of the knee, and density.
Dr. Sebastian Gonzales: I’m looking at it right now, but I actually looked yesterday, there is a PowerPoint that I should just link to because it was public on here, but it has a bunch of slides on hyaluronic acid, sliding between tissues and organs, it cites the Stecco Study Analysis of the presence of hyaluronic acid in between deep fascia and muscle, so there’s a lot of pictures is my point. I might just put this on the show notes too for everybody.
Dr. Warren Hammer: I could send you slides, we literally have thousands of slides.
Dr. Sebastian Gonzales: Oh yeah, that would be great.
Dr. Warren Hammer: Sure.
Dr. Sebastian Gonzales: So then as we are closing the podcast here, then how should everybody reach you? Is the website good or is there any other way you like to be reached?
Dr. Warren Hammer: I have an email, firstname.lastname@example.org and I’ll be happy to answer anybody who wants to communicate.
Dr. Sebastian Gonzales: Awesome. That was great. There was a ton of great information and I think everyone is going to learn something from it, definitely a little bit more of a technical podcast, but you held my attention, so I’d definitely listen to this walking around.
Dr. Warren Hammer: Oh, you\'re probably the hardest person to convince anyway.
Dr. Sebastian Gonzales: No way, I’m easy (laughs)
Dr. Warren Hammer: I’m joking, I’m joking.
Dr. Sebastian Gonzales: Alright, cool. I’ll come right back to you.
Dr. Warren Hammer: Alright, thank you, it was a pleasure.
Dr. Sebastian Gonzales: Thank you.
Okay, thanks Dr. Warren Hammer for being on. That was great. By the way, if you have not ever spoken to Warren, he prefers to be called “The Ham” and I didn\'t know that until we started speaking, so you can call him “The Ham” or “The Hammer” so when you got a last name like that, why not?
So if you\'re looking for the transcription and show notes for this and any links that we mentioned on the podcast, go on www.p2sportscare.com/85 and you will find it all there, share with friends.
By the way, I had no idea about this until somebody came into my office and said, “I read that one podcast you sent me.” I said, “Read it? You read it?” He was like, “Yeah, I just don\'t like listening to that stuff?” I said, “You actually read that?” He’s like, “Yeah, I’m a speed reader. I can actually get through it faster than I could listen to it.” I’m like, “You’re kidding?”
People actually read these transcriptions, so I’m going to make a very good attempt to transcribe every single podcast that I do now; although, I do promise to transcribe the ones where I have an interview with somebody because I think I owe it to them to get the transcription done since they spent the time with me.
Again, if you\'re looking for the show notes, go ahead and get them on the website. If you have not explored the site already, there’s a ton of stuff on there, tons of articles, tons of videos, a ton of things that if you\'re wondering how I treat patients with X, Y, and Z conditions, or some of the stuff that I like, it’s all on there. Just go onto “I’m a Patient,” and look for the “Injury” section. If you scroll all the way down, you will find a large comprehensive article like the low back one, which is probably about 40 pages on a word doc, the core one is 30 pages on a word doc, and they are extremely comprehensive. I’ve had them proofread quite a few times, so if you find a spelling error, please do tell me.
Lastly again, go onto the website and find on the shop page if you\'re a doc, get those patient education posters. It’s something I strongly recommend. I’m just not selling people things to sell things, I mean I really do think these will help you and I think they will help you and your patient communicate better, which is what all of this is about. You heard me speaking to Warren about it, it’s patients want to feel like you understand. They want you to be confident with what you\'re saying and they care about your degrees, but not a ton, so it’s not about price, it’s about being understood, so these are tools for that. They are for the patient. They are patient centric. They are not throwing Netter’s Anatomy in front of them, because that’s extremely hard to understand; there’s too many things going on. Let’s just make it easy for them.
Okay, I will see you guys next week and don\'t forget to be very good to each other. Take care.
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