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Five More Mistakes When Using Exercise as Rehabilitation

Episode 234

35 Minutes – Jun 30, 2021

0:00 / 35:23

Chapters

Questions this episode answers

Is doing more rehab exercises better for recovery?
No. More is not better, it's just more. Do the one or two exercises you were given and change one thing at a time so you know what's working.
Should I think about squeezing my glutes during a bridge?
I'd rather you didn't. Follow the external cue, like spread the band. You'll usually feel your glutes working without thinking about them.
Why do I feel better right after rehab exercises if I haven't built strength yet?
Movement itself can calm things down. Strength and endurance take weeks to months, but greasing up the joints can help the same day.
Should I use a mirror to check my form on rehab exercises?
I don't like it. Watching yourself changes your focus from feeling to looking. Use the cue that worked and remember how it felt.
Should I rest completely with a patellar tendon problem?
Not completely. I might ask for about three days off squatting while you keep training everything that doesn't bother the knee, then we start loading it again.

More is not better. It's just more.

Young athletes want back fast. I get it. I played high school baseball and rushed back from an injury because I felt I was losing my spot.

Dan John says more is more, not better. A friend refined it on a boat one day: more is not better or worse. It's just more.

Here's what I see. You get one or two exercises. Then you add icing, heating, massage, needling, cupping and a copper bracelet. Just do the one. A lot of people got into this situation by doing more in the first place.

Think like an engineer. Change one variable and see how the body reacts. If you change ten things and come back worse, neither of us knows why.

Less is not nothing. Say you have a patellar tendinopathy (jumper's knee). I might ask for three days off squatting while you keep training everything that doesn't bother the knee. No pistol squat. No box squat. No strap. Just don't squat for three days. Deload to reload. Load can be therapeutic, but the pendulum has swung too far. Someone who hobbles in with a torn ACL is not a case for creative loading.

Stop trying to "contract your glutes"

On a banded bridge the cue is "spread the band." People hear "contract my glutes." No. Spread the band. What do you feel? Your glutes. Good.

Thinking about which muscle is on or off internalizes the exercise. I want you focused on how your body reacts to the outside environment. Nick Winkelman has an excellent book on the research behind cueing.

We will pull an exercise that should help if it makes you think too much. One woman did great on the banded bridge. A more direct single-side drill for her squat shift took two minutes of confusion. After a 30-second break she was lost again. She wanted it for home. I said no. We kept the easier exercise.

Good cues are memorable. Max has people read the faint serial number on a rare hundred dollar bill so their head gets closer to the knee. Others: crush oranges (from Dan John), squeeze an Oreo between your cheeks, break a quarter into nickels. Always age and person appropriate.

Exercise does more than build strength

Strength and endurance take weeks to months. So why do people leave feeling better for hours or days? The movement itself.

A man with back pain did door jamb squats, holding the frame and moving up and down to grease the hips. Afterward he could extend backward with almost no problem. Was it hard? No. Did it build strength? No.

You still need strength and endurance. If I recall correctly, one of the few predictors of future injury is past injury. "My shoulder hurt, I rested it, it went away." Will it come back? Probably. Rest took the pain away. It didn't reverse the adaptation that caused it.

Use the window after your exercises

Warming up for baseball and leaving the field doesn't make you better at baseball. Once your exercises have you feeling good, use that green light.

A coachable man with a low back disc came in able to bend and touch his toes again. After a warm-up we did split squats, then half-kneeling single-arm band pulldowns to challenge anti-rotation. Without enough support through the core, the lats can pull you into lumbar extension, so we tested it. He was fine. We skipped what his testing said would bother him: sit-ups, toes to bar, burpees. Load around the area.

A soccer player cleared for kicking started with lob shots, then punchier shots. Not an athlete? This is laundry and dishes.

Skip the handout and the mirror

People tell me they got 15 exercises on paper. They didn't know which to do, how long, or if they were doing them right. Paper doesn't work. One-on-one coaching does, because what you retain in two minutes is not what you retain next week.

If you want, we film a short video with the cues that worked for you that session. Do less, not more. Don't think this, do this. Here's your homework.

Mirrors shift your focus from feeling to watching. Remember the feeling of the cue instead. Sometimes we have people close their eyes, or picture a moment they felt good, like hitting a baseball.

Key takeaways

  • Do the one or two exercises you were given, not ten extra treatments on top.
  • Change one variable at a time so you know what helped.
  • Follow the external cue, like "spread the band", instead of trying to fire a muscle.
  • Movement can calm pain the same day; strength and endurance take weeks to months.
  • Use the good window after your exercises to reintroduce real activity.
  • Coaching and a personalized video beat a sheet of 15 exercises or a mirror.

At a glance

Conditions and injuries
  • Patellar tendinopathy (jumper's knee)
  • Low back disc injury
  • Back pain
  • Recurring injuries
Anatomy involved
  • Glutes
  • Patellar tendon
  • Lats and lumbar spine
  • Hips
Symptoms described
  • Pain with squatting
  • Pain bending forward
  • Pain with kicking
  • Shifting to one side when squatting
Treatments and exercises
  • Banded glute bridge with external cues
  • Door jamb squat
  • Split squats and half-kneeling band pulldowns
  • Gradual return to sport movements
  • One-on-one coaching and personalized videos
Episode Transcript

This transcript was generated automatically (whisper.cpp large-v3-turbo) and may contain errors.

Hey guys, before we start the show, I want to introduce again the premium version of the podcast and I've been pushing it a lot lately because I think it's fantastic. This premium version is very affordable and it's all the things you guys have been asking for when you email me. Gosh, I wish you would do more case presentations. I will here and mainly because this show is also for lay public. We don't go into all the positive tests and things like that. So we'll do that in the premium version. It's about 15 minute versions every Monday they release and they're super fresh as if I'm getting out of the exam room or at least in the same day, at least same 24 hours.

So I remember what's going on. Client privacy is protected as always, but we go over positive orthos, neuros, what we did, what worked, what didn't work, what the patient presented as. And so we can hopefully all just improve our knowledge over time. There's things that we do incorrectly or inefficiently that we'll even share as well. So go on there, scroll all the way down, hit premium on your podcast player, and it'll auto-populate into your podcast player. Really cool, huh? All right, let's get on to the show. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery.

And now, your host, Dr. Sebastian Gonzales. Hey guys, it's your host, Sebastian, for the Restoring Human Movement. Thanks for joining the Movement Movement. This is your first time on the show. You have missed a lot. It's about 235 episodes now, I think. And so you've missed a lot of great interviews and content over the past few years. And so, because of that, I did reduce the podcast frequency to once every two weeks to give not only myself a break, but also to give you guys a chance to catch up because there's new listeners all the time. Now, the point of this podcast is to improve our client-patient outcome.

Strength coaches, trainers, clinicians, doctors, PTs, chiropractors, all listen to this show. Also, lay public. So, lay public, this is an introduction into maybe some things that you weren't aware of in your rehabilitation and your recovery from musculoskeletal injuries. So, we cover a lot of topics in this podcast, such as hips, shoulders, knees, and general theory, stuff like we're going to cover today. This is part two of the mistakes when using exercise as rehabilitation. Last week, or sorry, two weeks ago, we did part one. I covered the first five things. There's obviously a lot of things because there's another one coming soon.

There's a lot of things that people do or at least have questions on that will, I don't want to say just rob them of the benefit of using exercise as rehabilitation for an injury. But it's just, it makes it inefficient and they get frustrated and so on. And so, I'm going to share the things that have worked well for me over the years. Our clinic is, I'd say it's 90% rehabilitation and exercise, even into weight training clinic and using that as a therapy for people. We do adjust people sometimes, we do tissue work sometimes, and we obviously examine people very thoroughly. But most of our suggestions is person, that the stuff that the people can do on their own.

And we want them to do on their own for their own, getting them to become self-reliant, depend upon their body again, and not use this as a crutch. So, I'll just share the things that work for me. Obviously, I'm not a research junkie and I'm not going to pull out research to prove all these things. If you guys want to do that on your own, by all means, start your own podcast. So, last time we covered the five major things that people make mistakes on when using rehabilitation as exercise. I'll just cover those really quickly. Number one is pushing through pain. As we mentioned before, it should not hurt or duplicate the problem.

It should be effortful or not painful at all. Number two, focusing on reps and sets. We talked about using a perceived effort maybe as a better measurement tool than just going off reps and sets because everybody's different. And also, the weight might provide a change. Also, time under tension. Number three, doing things that are too easy. It kind of doubles down to that last one is that if your rehabilitation exercises are too easy, your body won't adapt. Number four, not having a single focus. This comes down to coaching cues and using videos as the only tool that you're using to rehabilitate or having someone who's doing poor coaching.

Okay, I want you to sit down and cross your legs. And then after you cross your legs, put your toes over each other and cross them too. And then look up to the ceiling. Now, stand up. It's just too many focuses. How about just sit down, stand up. Good, you did a great job. Great, sit down, cross your legs, stand up. Good, great job. Obviously, this is not an exercise I would pick, but just an example. While I think about the fifth, let me sip this coffee. I'm not sure if you guys know I used to own a coffee roasting business. Surprisingly, I've learned that majority of, at least the U.S., their flavor palette for coffee is burnt, like your mainstream coffees that you probably get.

A lot of it is 25% charcoal, according to the roasting standard anyways. So, consider your light roast next time or go to a local roaster, inspect their beans. And if it looks like they're shiny, ask for something else. Number five, not having one-on-one coaching. As I mentioned in number four, there are some negatives to doing things without anyone coaching you, such as one is not having single focuses and not having unique focusing cues to you. Also, you're totally dependent upon yourself to do your own exercise selection, scale and progress, regress your exercises, accountability, motivation, Q&As, and so on.

And there's nothing better than using someone one-on-one, especially someone who's good. They can be efficient, they can be friendly, they can calm some of your doubts, some of your fears of movements and exercises when you're using them. Because some people use exercise as rehabilitation and they end up feeling worse afterwards, which is not a great thing. In the weight room, they kind of saying is, I think for strength coaches, they kind of say, weight room injuries are unacceptable. We're not making, in this case, say if you're trying to make a football player better, the weight room is accessory.

It's a supplemental. It's helpful, but you're not making them into a weightlifter. So, if they're going to get hurt, try to get them hurt in the game or something like that. Now, in today's, we're going to cover the five different ones, which might have some semi-overlap. I think you're going to see that already, but just different Q&A points that we get. Number one is, thinking more is better is a big mistake. Number two is, thinking, quote-unquote, contract my glutes or any other muscle that we're talking about. Number three is, thinking exercises are only for building strength. Number four is, doing the exercises and then doing nothing.

Number five is, looking on sheets of paper for the exercises or into mirrors. I'll cover each of these in turn. I'll do my best to cover them thoroughly. So, if there ever is a question later and someone's like, well, I don't, I'm not sure why I wouldn't use a mirror. I'll say, great, this is a podcast that you should hear. And I'm hoping clinicians will do the same. If you have patients who are asking questions and you really want to answer them, use this as a resource, maybe for them. I certainly use it for mine. So, number one is, thinking more is better. I've had this many times over the years and actually just this week I discussed it twice with people, with new people that came in because they're, they're, especially young athletes, they're looking to get better as soon as possible.

And I understand, I played high school baseball, I feel like I almost lost my spot because I was injured and so I was kind of rushing myself to get back. So, you know, why not do more? More is better, right? Well, Dan John is the same, it's more, not better necessarily, it's more is more, more is more. My friend refined that term to, we were, we were boating one day and he said, you're right, more is more and more is not better, but can be better. And I said, you're right. So, he refined it to more is just more, more is not better or worse, it's just more. And so, when people are trying to rehabilitate their own body, they think, well, you gave me this one or two exercises to do, those are probably good.

I'll do them at home. I was also icing and heating and walking and squatting and I was going to this massage therapist and then this acupuncturist did some needling on me and then I decided to buy some cupping. And I heard about this one copper bracelet you can wear. No, just do one, do a little bit. You don't always have to do more. A lot of times people get in these situations by doing more anyways, in my opinion. One sec, sip a coffee again. Is that my tailspin mug, by the way? So, thinking more is better is not always a great thing. I tend to think a lot of times, so your triathletes, your runners, people who are in the gym five days a week, they're always doing a lot anyways.

And I'm not saying that some of the stuff that they're doing is not helpful and it's not okay because I certainly don't like to pull them off of all activity because it deconditions the person, the athlete, and it makes it harder to recover while we're looking for a certain tissue to recover. Remember, the athlete's recovery time is not the same as the tissue's recovery time if it is an issue in the tissue. So, say, let's do an example. Say we're trying to rehabilitate a knee. Well, the knee, say we had an actual tendinopathy and we wanted to make it feel, give it about a couple days rest before we actually start to progressively load the area.

And so, you know what, let's just do, you know, three days rest on that knee and I still want you to go in the, in the, and do all the stuff in the gym minus the stuff that bothers your knee. Well, I can't tell what bothers my knee. Well, then this is a whole, maybe a whole different conversation now that it gets a little bit more complicated. But if the person's like, well, you know, I do shoulder work and pec work and pull-ups and that's all good. I do core work and that's all good. Deadlifting feels good. Squatting does not. Great, cool. Don't do squatting. But do you think if I maybe tweak the squat and I do like this pistol squat or I do this box squat?

No, no, just, just don't squat. But I heard if I put a patellar tendon strap around it and then I squat like a certain way. No, just, just don't, just don't squat for like three days. It's fine. Well, I heard if I did some turmeric and then some ice combined with like pixie dust and no, just don't do that. Just don't squat for a couple of days. Do the things I told you to do. I know they seem simple. And then when you come back, we'll, we'll start, we'll probably start squatting you. Does that sound good? Okay. So sometimes people make it a little bit more complicated than it needs to be. And quite honestly, sometimes the tissue is not ready for load.

I know there was a, uh, there was a push, I feel like over the last couple of years where all these, uh, personal trainers and chiropractors and so on. And, you know, I'm kind of on the same side of that, but I'll say the pendulum swings both ways where they're kind of saying like, well, you know, like when in doubt, load it, you know, broken bone, load it. You know, tissue, tissue, tissue damage, load it, label tear, load it, um, and so on. And I do agree the load can be therapeutic, but also there's a situation. Imagine someone walked in and they, or they didn't walk in and they hobbled in because they actually tore their ACL.

Is this a time to load this person? No. Is this a time to get creative about loading this person? Probably not. This might be a surgical case, but let's just say we moving back to this tendinopathy, this tendinopathy or the patellar tendon jumping jumpers knee or whatever we want to call it. It might require three days rest or deload to reload. Um, I don't, we don't necessarily have to, uh, always get super creative about deload in the area. The fact of the matter is we need to reduce the pain in the area and we need to then integrate back in some load. And so sometimes just doing less is the easiest way to deload the area.

And, um, I know how it is to have a problem and it's mind numbing. People just tend to think too much of it. They fuss about it. You know, you walk out to get, you know, your, your book out of the car and then you're thinking about your knee. Just stop thinking about it. Uh, I know it's normal to think about it. I, I, I feel the same thing, but, um, it's exhausting. So I know this will sound again, simple. A lot of these things are simple is do less than do more, but more is not always better. And the more things you start to add in, the more complicated it will get for you. Also the person guiding you.

Um, lately I've been telling people that, uh, if they're, I asked them what they do for a job and, uh, someone will say, uh, someone recently said, uh, I'm an engineer. I said, great. Then you're familiar with scientific method probably. And said, yeah. I said, what is it? You know? And, uh, they're like, oh, just, you know, change something and then see how it reacts. Right. Single variable test. So right now we're changing one thing basically, or, or minimal things to see if it works. If you want to continue working with me on this, I need to see if this works or else I don't have any information or work off of.

And if next time you come back in and you're like, well, I feel a lot worse than I have no idea if it made it better or worse because you decided to do all these other things too. And so, um, I know it comes down to trust sometimes, but I'll just tell them, look, uh, I've, I've, I've worked with people like you in this situation. Many times this typically helps just trust me. And so doing less is sometimes better. Okay. Don't do more, don't try to go crazy with it. And, um, as I mentioned in part one, pushing through pain is not necessarily helpful. Let's go on to number two and sip coffee. I realized that coffee really does get cold quickly in a, in a real mug.

Uh, Yetis are great, but I kind of like the feel, the mouthfeel of the actual cup personally. Number two, thinking of contracting my glutes. So, um, we had someone recently come in and we've had this a lot over the years where they're starting to internalize some cues. I mentioned this last podcast too. And so we had them do something called a banded bridge and the cue is spread the band. And she said, Oh, so you mean contract my glutes? And we said, no, I meant spread the band, but do you want me to contract my glutes? No, I just want you to spread the band. It will help you maybe contract your glutes, but don't think about contracting your glutes.

Just spread the band for me. Did you spread the band? Yeah. Great. What do you feel? My glutes. Good. Spread the band. Um, it's, it's, uh, I think it's been maybe over the years, people been coaching this fashion to think about using something, or maybe it's because they've been reading articles about glute amnesia, which, uh, I've put it out, put one out too. Uh, or they're thinking about, well, my hip flexor is on and my glute is off and my pec is tight and my lower shoulder blade is off and on and off and on and off, which isn't, I don't think it's a necessarily bad way of thinking about it, but don't internalize the exercise, you know, and just think about how the body is reacting to the outside environment.

We talked about external cueing last time. So, um, there's a great book by Nick Winkleman, which, um, I believe it's what we say matters. I re I don't recall. Actually, I should probably look that up. I'm about 75% through reading it. Um, and it's excellent. It goes through a lot of the research, uh, surrounding internal electrical cueing and how to make things simple for people. Um, we have actually pulled exercises away from people that we think are going to be helpful. Because we see them internalizing it too much. And so I'll give this scenario. We just, we just had was, um, again, we had the glute band a bridge and it worked very well.

Um, they felt their glutes working, which is what we wanted. There was no pain. They actually felt better afterwards with their problem. And that's what we wanted. And so we kind of thought we saw her kind of lateralizing on a squat, meaning she would shift to one side squatting. And so it was kind of like what we call like a non painful dysfunctional thing we're looking at. They might be contributing factor. And so she shifted away from one hip. And so we like to sometimes do a more direct exercise for that one side. And so we tried that one and we said, uh, we just said, smash the floor. And, uh, Mary Lou put her finger on the, on the ground.

She'd smash my finger. So we shuffled the cues a little bit and we, and we said, reach, touch Sebastian. And, uh, she's like, well, so you're asking me to do what, you know? And it was about two minutes of, of kind of disarray in the exercise. And finally she started to take the cue and she started to feel it in the right area. But then after we stopped for about 30 seconds, started again, she was confused again. So she said, I can do this exercise at home. I said, no, let's not, you know, let's not because you're thinking you're, you're, you're having to think too much. You know, I don't want to blame them in thinking too much because some of the exercises are a little odd.

We put them in precarious situations, but it, it should, it should be easy. It should be simple. And I don't want her to think about contracting her glutes or moving her hip or anything. That's the, I just wanted to do the thing. And so in this case, we use the exercise, which was easier. So she didn't have to think about quote unquote, contracting her glue. And this can happen with a lot of exercises too. Um, as you guys improve with some of your queuing, if you are working on it, I commend you. We work on it all the time. We try to make them fun. Uh, Max has this really good one, uh, that, that he's been using.

That is a, it's a dollar bill. Um, and so we're doing one where it's kind of like a crunch maneuver, but we need their head to get a little closer to their knee. And so he was saying it's a rare a hundred dollar bill and it has a serial number on it. Read the serial number to me. It's a really, it's a really, uh, faint. Serial number. So they have to get close. You know, if you can't read the serial number, then, then, uh, then, then this exercise is a waste. And so it's fun to get creative. And I've actually had people over the years, they say, um, they'll actually come back and they'll say, I remember that one thing that was, uh, that was so memorable.

That was a memorable cue. Um, orange is crushing, which I took from Dan John. Um, and what's another one that people like Oreo cookie, squeeze an Oreo cookie between your butt cheeks. Like you're trying to squeeze out the white, um, or break a quarter into five dimes or five nickels. So there's, there's a lot of different ways to get fun with it. Obviously, uh, age in person appropriate. Um, and two, we don't use all the same cues with, with the same people. It's age in person appropriate, but whatever's memorable to them. Um, and, and you can kind of read them a little bit, or at least I feel like we can.

And so we've, we've never offended anyone with a cue that I'm aware of. Um, and it seems to work well. So number three and a sip of coffee. Thinking exercises are only for strength building. So exercises used as rehabilitation, they can work in a few ways. Um, they can build strength, but obviously as we know, strength does not happen overnight. It comes over time. So why would we think that strength in, in this case, say somebody came in today and then they did some exercises and they feel better when they leave or they feel better for the next week. How would that relate? Um, the strength is something that you're trying to strive for.

Endurance is something that you might have to strive for. They don't come overnight. So what's the benefit and why do people actually feel better after leaving? Leaving offices, using exercises, rehabilitation, why do they feel better for a couple of days or a couple hours? Well, uh, I think it's a little bit more than strength is the thing. So strength. So strength is only one part of what you're going to get. I tend to think the actual movement is more helpful than the strength or endurance, especially for a lot of people who are in pain. Um, sometimes just greasing up the joints where general movement as therapy is actually helpful.

Um, we had a gentleman come in the other day where he was having some back pain and, um, we chose to give him a door jam squat, just put his fingers on the railing of the door jam and you let him use it kind of like a tracker beam and come up and down and up and down mainly just to give a little bit more of a patterning or a greasiness to the hips and shoulders in that case, because if he was using his spine too much in the movement, then it might start to say something to him. And I have to believe that it did. So after doing those exercises, he was able to extend his back backwards or his body backwards without really any problem at all.

So did that build any strength? No. Was it hard? Not really. Like he was talking to me a bit throughout the whole time. Um, and did it build any endurance? Certainly not. Um, strength and endurance is going to come over the course of. Weeks to months. And it's something that we should be striving for. I believe, I think everybody requires some amount of strength and endurance to feel good and just be generally physically prepared and, um, not be a higher risk of having problems. Again, uh, I think people, uh, I, people have relapses of problems a lot. Uh, I think if I recall correctly, one of the only things that we can use as a predictive tool for someone's future injury is past injury, meaning my foot hurt today is probably going to hurt in 20 years.

Will it come back? Um, probably. And, um, I, I feel like I'm the stereotype, but I feel like I've not seen a lot of people actually do a lot of good rehabilitation. Um, and, and I, I observed this just from talking to friends and family, um, my shoulder hurt. I just rested it. It went away. Will it come back? Probably. You didn't do anything. You know, you just took, you just took the pain away, which nothing wrong with that, I guess. But you didn't build any support and reverse the adaptation of why it's happening that way. Um, unless you slip and fell, that's a whole different story. Um, that's actual mechanism of injury that can merit the trauma and merit the problem that you didn't actually do anything for.

Um, but buildup conditions or conditions of disuse conditions of, um, under utilization or over utilization happen over the course of time. And they can also, they can come back again if you don't do anything to reverse adaptation. That's my belief. So, um, I think a lot of people will have reoccurring injuries. It can obviously go away. I don't think it'll be something of a detriment to them or, uh, put them on disability. Um, some people will, but the, uh, using exercise, building strength, building endurance are helpful, but they're not the only thing. Um, we can use exercises very effectively as a way to reduce pain, the way to, um, decrease the need for, you know, uh, medications and icing and heating and avoidance of, uh, uh, activities.

Um, and I think we all kind of know that from, if you're an athlete, you go and warm up general movement sometimes helps. So let's go on to number four and that sip of coffee. Number four, doing exercises and then doing nothing at all. So we've seen this a lot over the years is people will do the exercises and then they'll go home and do nothing. And maybe it's on our part that we don't really explain much, or it's the fact that maybe they kind of had their exercise of the day. They might say, or maybe they have some depression, maybe they're busy at work. There's a lot of variables why this could be, but I think it's a mistake to have a time where you are doing exercises that make you feel good.

As I mentioned before, people feel better after doing warmups or people, people feel better after doing general movements, greasing things up. And then they don't use that to explore other movements. Uh, I get, I'll try to find an example here. If I were to warm up for baseball and then just leave the field, am I getting better at baseball? No, I'm just getting better at stretching or warmups. Um, if our goal is to improve someone ability to, uh, pick up objects without having their back hurt, we might do some glute priming exercises, some bird dogs, some side planks and so on. And now they're feeling pretty good.

Well, let's use that. Let's use that support that we just created there, whether it be strength or endurance or whatever it is. Um, we're going to, we're going to use that now green light movement to build some resiliency in it and challenge the body. So the body knows it's okay. And so we will typically do that in our office, which is why a lot of it looks like strength conditioning. Uh, we had a guy come in the other day, he was super coachable, um, after removing the initial problem, which, which was, uh, uh, he had, he had like a low back disc. Um, we reduced the pain associated with the disc.

It seemed like, or he wasn't flexion tolerant anymore. He can bend over and touch his toes. And so he's like, I'm feeling so much better. Like, what, what do we, what do you want to do today? And so we went through a little warmup or greasing or priming or, you know, four exercises as we can say. And we still have time where like, how do you feel? He's like, I feel great. And we said, great, let's split squat. We did split squats, uh, challenging his legs a little bit. And I said, you okay with do more? And he's like, yeah. So we did pull-ups or, uh, sorry. Um, we didn't pull downs. We did a single, single arm overhead pull downs, like from a band half kneeling and mainly to challenge anti-rotation.

Uh, cause as we kind of know the lats, if you don't have adequate support within the core area, the lats will put them into lumbar extension and it might irritate his back or it might make him feel good, you know? So we tested it and he saw, and he was good with that. And so we could have even went further. We could have deadlifted him. We could have had new pushups. We could have had new, a lot of things because we had already primed it up. He's very coachable. We had the time, uh, and he didn't have any ill effects from the exercise. Now, um, for all of you listening out there, they might think, well, that sounds like it might bother his back.

Well, when you know the mechanics of what his, what bothers his back, um, by doing adequate testing, then you mitigate the mechanics that might bother it during the exercises. Like give an example. I might not have given him sit-ups. I probably wouldn't have given him toes to bar. Uh, I probably would not have given him burpees. There's certain things that I would not have given him because of his, uh, issue that he came in for, but we can certainly load around the area, um, and build strength or at least get on the path to building strength. We didn't build strength on one session. So using that time after doing the exercises, the help is a perfect time to build, um, strength, endurance, or just good, uh, reintroduction into activity like baseball, like soccer.

Uh, we had a, we had a girl come in. She was fantastic to work with. Uh, she did her core work or whatever we suggested before, and we cleared her to start kicking. Uh, she recently had pain, uh, with kicking. And so, um, we cleared, uh, lob shots first. Uh, and after that we cleared like more punchy shots, uh, kind of a long stroke versus a punch. And so introducing back in the movements is what will get the person back into the sport. Or if you're not an athlete, get you back into normal life. You're doing laundry, doing dishes, and so on. Those are things that will, you're going to have to do anyways.

And so doing them after your, after your ex says that make you feel better is actually a good thing. Let's go into number five. Number five is looking at sheets of paper or into mirrors for your exercises. Now I'll start with the sheet of paper. This is something that, um, I don't get as much anymore. It must be like a dying art, but, um, I've, I've had, well, we have in our intake form, um, you know, what do you want from us and what do you don't want basically? And, um, they're like, I got in sheets of paper with 15 exercises on it. I didn't know if I was doing them right. Um, I didn't know which ones to do.

Some of them hurt. Some of them didn't. I didn't know how long to do them and so on. And so sheets of paper that whoever they received it from, um, either it was too many exercises or it was inadequate coaching or inadequate retention on the person's part. Who knows? Either way, the sheet of paper didn't work. Um, so a lot of times that one-on-one coaching is required and what they retain within a certain time period, like a couple minutes is not necessarily what they'll retain the next week or the next day. And so that is the power of one-on-one coaching. It's very helpful. Um, and the person is changing things based upon your abilities.

So sheets of paper, in my opinion, are kind of a waste. Um, my, uh, when people come in to see us, we suggest if they want to do a video, they can mainly just so they can see, oh, that's the, I remember that moment. I remember that exercise. Let's do that. But, but we use cues that worked well for them in that session. If we do another video later, we will use cues that worked well for them in that session because the cues might change and the progressions might change. Um, and obviously we can give them, we have videos of these exercises as well in our, uh, we have a Google drive file that we can share the links to people, but it's different cueing and also it's different focus points.

And so we're trying to make the exercises unique to what they need to succeed over the next week as they're doing their exercises and so on. Also in the first session, a lot of times it's a, uh, first and second, second session. So a lot of times, um, a lot of information, um, we boil this down in the video. And say, look, this is what's going on. This is what you got to do. Do less, not more. Don't think this, do this. Uh, here's your homework. Come back next week. And we try to keep it as simple as we possibly can. Um, let me address the mirrors now because, um, we've, we've had people, uh, who have trying to do the exercises using mirrors to watch their form.

And I think we might've done this to them on accident where, um, there's an exercise that isn't working and they don't understand why we keep stopping them. So we'd shoot a video and show them on our phones and we'll, they'll say like, Oh, that's what I'm doing. Yeah. It doesn't feel like I'm doing that at all. And they say, well, how am I supposed to do this at home? If I can't see myself, well, you use the cues we gave you because after showing you what we're, what was going on, we then gave you a cue and actually things worked out well. And so remember the feeling in what you're doing during the cue to the environment to get the response out of your body.

Don't think about watching yourself because it's going to change the dynamics a little bit. So, um, using mirrors is, uh, I don't like the idea. Uh, it changes the focus on watching you in the mirror versus actually feeling what your body feels. Um, in some exercises, some activities, we'll actually have people close their eyes to feel better on the floor or on their feet. Um, we've had people before use, uh, kind of a mental approach a little bit where we're saying, okay, so I want you to close your eyes and I want you to take yourself back to the moment where you felt good. Do you remember what you were doing?

Yeah, I was playing baseball. Okay. How did it feel to hit the ball? Oh, it felt good. All right. So remember where the ball went. Remember what the players did. And so taking the back more to a mental moment of when they felt good. And maybe we can use those movement patterns they already have ingrained in their body to express in the exercise. If I was trying to get this person to swing or so on. So, uh, I hope this was helpful to everybody. I know that it seems like my podcast has been getting shorter and shorter. I don't know if it's because I'm, I guess, getting more efficient here or if, uh, I'm being lazy.

I can't tell. Um, but I think I hit a lot of these points pretty well. Um, if you have not subscribed to the podcast already, please do so. Um, you will get the other one as it comes out on the same series of exercise rehabilitation. Um, we have other ones in the archives, which I mentioned last time, which Cody DMAC is on. I want to say there's one way down in the hundreds and so on. If you can't find them by the way, on iTunes or Spotify or whatever, um, you can go onto our website. Uh, cause iTunes, I think only shows the last hundred episodes. So if you're looking for everything we have p2sportscare.com, you see a tab at the top around the hamburger that says podcast and just put in what you're looking for in the search bar.

Uh, we spent a lot of money to redesign the website, to make it very user-friendly. And so we're continuing to change it every, uh, every month or so to, uh, make things even more user-friendly, easier to find and so on. There's easily like 200 pages on the website. With articles, with videos, with podcasts and so on. And so use the website is, is a wealth of information. I've spent years building the content in there, researching things, writing articles, paying, um, copywriters. Although you'll find errors all over the place. Apparently copywriters miss things too. Um, it's not easy to edit the stuff that I write since it looks like I was born in a, uh, different country apparently based upon the, must be dyslexic or something because it looks fine to me on paper.

Um, but there's easily things that look like I have not passed fifth grade probably. So, um, subscribe to the podcast, uh, clinicians subscribe to the premium podcast. And I will see you guys next time on the restoring human movement podcast. Thanks for joining the movement movement. See you next time.