Chronic hip flexor tightness that came from the low back

And then so she got up, she walked around, she sat, she jogged around the office, and she was so damn happy. Like, so her symptoms decreased by like 75% just at that point in time. She still felt a little bit, which is completely normal, but I want to see a reduction of about 30% or so. And so it was great. And so this, in this case, I think with her case, this was basically a missing link in her problem. Like no one had, or in her recovery, no one had suggested the appropriate first aid process. So we can desensitize this region of the body. 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 everyone, it's Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. If this is the first time in the podcast, welcome. This is about a 45 minute to hour 15 long format. I'm going to attempt to keep them under an hour going into the future here, but it's long format. Let's put it that way. And so thank you for spending the time with me. If this is also your first time and you're wondering what the heck this podcast is all about, I think it's a great question. So this podcast is intended for clinicians and patients alike. It's intended to blend the line between our communication styles. And imagine that me and you, a clinician, are having a beer at a bar. Let's go with a New England, sorry, a New England Brewing Company IPA. That was good the other day.

And we have a friend who is a tech junkie. He is a video game programmer. And he's talking the bar with us and we're talking about cases and he doesn't know what we're talking about. And so it's kind of, it's kind of messed up to not like explain things. And so we try to keep things at a lower, um, in terminology so he can understand, so he can understand what to do with his problem because he's got that problem. So just know that's the intention of the podcast. I'm not trying to make it super technical, but I do interview people at times and I do do solo podcasts so we can start exploring things that are, um, a little bit more patient friendly.

And so this is a patient friendly podcast today, and I'm going to reveal some of the case studies that I've gone through in my clinic. And, uh, the reason why I did this is because recently I've asked some people what they want to hear on the podcast in the coming future, because this is, I don't know what episode this is, but I'm sure we're around 155. Or something like that. And so I've done a lot on this podcast already. I've already interviewed a lot of people. I've learned a lot personally. And by the way, if you're trying to learn more as a clinician, just dig back in the archives. There's a ton of great stuff back there.

I've learned a lot over the last couple of years. And so I want to make sure that I'm, I'm presenting what you guys want to hear about. And so some of the past ones with Cody DMACC where we talked about case studies were really popular. And so I'm just going to go off these case studies, uh, today that, um, have been, uh, helpful to people who have shadowed me, but also to, to get you guys to pretty much figure out how, how the bits and pieces go together and where you can plug in certain types of care and so on. I recently went to a workshop by, uh, Scott Morrison. Yeah. He's a DPT and he was, uh, it was called slopped and will loading by the way I don't get anything for plugging that.

Uh, Scott, it was a good, good workshop. And so, uh, I learned a couple of things in there, but it was funny going through the first day. We're going through a lot of, uh, thought process or thought processes and feedback loops and things that we can do with these people. But really not until the second day we did, we get into case, uh, some case studies and bringing it back in together like that, bringing the case studies together really helps me at least, uh, apply things, uh, in clinic because I see how they're being used in the real environment. Uh, as I explained it to a friend, it's, it's, uh, case studies for me are kind of like, like I know what an egg is, but I never knew you can put an egg on a piece of steak.

I didn't know that could be done. And so I'm trying to reveal how to utilize things like that in people's cases today. So if you're a general population, um, person, you're going to, you're going to get still information from this cause you're going to see that there is hope for you. And there's different ways to, uh, deal with some of the things that maybe you not might not have thought of yet. And also this is your first time to the podcast. Uh, this is where, um, I tend to reveal a little bit about myself via personal story. Uh, just so you guys can get to know your hosts. I believe everyone should know their hosts kind of like everyone loves Leno or Letterman, Letterman or Conan or whatever.

Um, hopefully you're going to like me and that's why you'll come back and learn with me. So let's get into that personal story and then we'll start getting into the other stuff. Now, if you did not know already, uh, I owned a coffee business about two years ago. We were coffee roasters. And so we actually developed this relationship with a, uh, green coffee importer. If you don't know how this works already, basically there's coffee farms. There's people who import coffee and they're called green bean importers and then there's roasters and then there's buyers just, or shops or buyers just like you.

And so basically we'd go to this big old warehouse where there was tons of coffee, like literally probably tons of coffee. Um, just sitting around these big bags and the bags are, I think are about 120 pounds each or so. And so, um, back in the day, uh, we would buy big bags, those 120 something pound bags and, uh, we would roast them. And, uh, now though, I don't want to roast it. It's just a little bit of work. And so, um, we developed a relationship with the place. And so I usually just give them a little order and I say, Hey, look, uh, I'm going to buy some coffee for me and my friends. Um, can I do 90 pounds?

And so I go and buy like 90 pounds of coffee at a time. So it's like $800 worth of coffee. But the cool thing is, is that, um, if you've already been to the store and you've been buying coffee that is, um, expensive, um, or good coffee, real good coffee, it'll run you about like for a 12 ounce, not even a pound, 12 ounce. It's probably gonna run you about 20 something dollars. I think, um, intelligentsia is around $22 per 12 ounce. And so, um, we get them in five pound bags and so they'll partition them up like that and I can get them for around eight, 50, nine bucks a pound. So cool. And so I'll get 15 pounds of coffee at a time personally.

Other people buy some too. And so, um, once every about two months or so, uh, I'll go through and just go through and get coffee. And so we'll have coffee for a long time. And you might be wondering, well, does this stay? Well, yeah, it's in a sealed bag. So it stays pretty darn well. And so, um, I, if you didn't know about me, I am a coffee snob. I'm not afraid to say it. And I only buy the good stuff and we go through and get, if you have not had a naturally processed coffee yet, that's where they actually, the coffee does, is not shed of the fruit and dried in the sun. It's actually dried with the fruit around it.

And so there's so flavorful. So good. They taste like a passion fruit or blueberry or raspberry or like not intenseness, but there's hints of it. And so if you wondered about like, oh, maybe I should get some raspberry cream. No, just get good coffee. All right. And you can get it. But if you get together with some friends, talk to a local roaster or a local green bean importer that roasts because they can cut out the middleman. You probably get a pretty good deal on that stuff. So check that out. Here we go into the content. Now, the first case study I'm going to go into today is going to be for a chronic hip flexor type of pain or tightness that was with a runner that I had.

She was a half marathoner, marathoner type. You know, I would consider her more as a recreational type of athlete. She was in her mid-40s. She ran five days a week. She just loved running, you know. And so, by the way, this is on this whole case study. I actually wrote it up on my website. And so if you go to the first page, p2sportscare.com, it kind of lays some of the stuff out in case you're wondering what specifically I might have done that I might not have talked about. And so the interesting thing with this lady is that she was she had this hip flexor tightness and even stuff around the sit bone when she ran for about 10 months.

Like, it seemed like nothing really took it away. She tried resting. She tried a bunch of stuff. And although I didn't dig really deeply into her history about what exactly the types of rehab or what exactly all the types of manual therapy and corrections that she did, she had tried a bunch of stuff. And she was kind of at wit's hand with this kind of thing. And so if you don't work with runners, they're an interesting bunch because they don't just exercise on their own. It's not like they're going to the gym alone. They go to groups a lot of times. This lady is a little different in particular because she liked running on her own.

But a lot of times runners go to groups. And so the observation, at least in my observation, is that a lot of their friends are there and they get really depressed when they can't actually return. And so I tend to not take running away from them unless I really need to. And I really strongly encourage them to go to their group and at least interact and go have coffee after or eat after or whatever because I think those relationship bonds and having someone really happy that they're going to recover and that they have their friends is a really important thing because the spiraling effect, at least in my opinion, a lot of these times, these people that have these ongoing things.

I'm not going to say 10 months is extremely chronic, but for the most part, when people tend to have problems that they feel like they have no control over, a lot of times they get depressed. And so depression never helps the issue. And so I don't want them to spiral. So I just want them to go back and at least assume all the normal parts of life if they can. When possible, I try to get them back to running within the same week, at least in some way, shape, or form, or at least load them into some type of corrective exercise or strength training thing. I don't love to go the corrective exercise route unless I have to, mainly because it's kind of like you're doing rudimentary basic stuff.

And although I know it's needed to patchwork them into an actual program or back into running sometimes, I don't like to do it unless I need to. You know, and actually before I start, I should probably lay out the formula that I kind of work with through on these people. And so first off is if you've already heard me speak before, I try to put people in boxes of kind of where I believe I should start their care at. And so the thing is, if you don't know where to start them in a certain part of their care, then start somewhere, take a reasonable guess based upon your examination, and just start them there.

And the thing is, if they get a little worse or you did too much, then maybe that's too much, you know. You might not be harming them, but they might feel some pain. And that's not a thing that's uncommon. But if you notice in this case, if she hasn't been doing anything and she's been resting and taking over the counters, like it's not, she's not getting better anyways. So you might as well try something. And so usually I have like four boxes I kind of put people through in here. Is number one, do they need first aid or not? And so if they've had like an acute issue or they have an acute inflammatory process happening with like a tendon, then there's a time period where we need to unload this person, use bracing, use first aid processes.

What I'd categorize also in first aid processes would be end range loading or McKenzie type of stuff. I would also categorize neurodynamics in there, pain modification, icing, taping, things of that nature. And so even manual therapy is kind of more in there for me. And so kind of like our passive care stuff, our ice, our heat, our stem, like this is okay to do in there, but not everybody needs it. And I've been actually surprised over the last couple of years of how many times you can bypass that if you find something else a little bit higher up the scale. So the next thing is you can put them into a corrective exercise.

And the corrective exercise, the intention is to build a buttressing support within an area of the body that you find it might be driving the symptom. So an example of that might be a low diagonal sit. It might be a clamshell. It might be some type of DNS work. It might be a single leg bridge. It might be a lot of things. So usually when I kind of talk to people about stuff, about the corrective, is it corrective or not? Or because corrective, a lot of times you'll do it multiple times throughout the day. And a lot of times I'll say, look, treat it like a bank account. All right. Make a bunch of little deposits throughout the day and just make sure that that area is really primed and doing its job.

And they'll say, well, what about these other exercises you gave me? Because I might take them in the next box. And I'll say, well, those ones look like they were a lot more effort, right? And they were foot on ground. Those ones are going to be a little bit more for our two-day-a-week, three-day-a-week type of strength conditioning. And so that brings us to box three is strength conditioning. I usually adopt the Dan John model when at all possible, push, pull, carry, squat, hinge. And I usually break them up into single leg, single arm varieties when at all possible. Because based upon the work of Mike Boyle, I don't think we are bunnies.

We don't jump around all the time. So bilateral two-legged movements are not necessarily a need to go to really quickly for me unless it's dictated by the person. And so a lot of times I'll take them into, I don't know if it's a technical term, but I call them cowboy squats. And so rather than doing a split squat and putting the leg way back, I'll sink them down and just kind of like a cowboy poking a fire. And so you get into that little crouch position like you're trying to hide behind a rock. So that might be an example of that. I might take them into a single leg deadlift or a hinge. And you can progress this with isometrics, with concentrics, with, or sorry, with isometrics, with eccentric, with concentrics, with loads, with speeds, and all that type of stuff.

And so there's lots of ways to modify what we're attempting to do with this person. But for the most part, if we find that their symptoms are intermittent and they're coming and going, I think there's a lot of windows of opportunity right there. So let's get back into what, let's call this person Julia. So what Julia was doing, again, so she had a hip flexor pain, which was going on for about 10 months, that also correlated with, quote unquote, sit bone pain. And usually when people use these things, these terminologies, the hip flexor and the sit bone, I don't really correct them until we start getting into stuff.

And if I have a good change in symptoms, they might say, well, what the heck was it? And then I'll talk about it a little bit more there rather than just correct them up front. And so she was taking her, she first went to her primary care doctor and he suggested resting and over-the-counter medication. So we've all heard this before. A lot of times just take it easy type of approach. There's nothing wrong with that, but doing it beyond about five days or so is kind of a problem. And also we do get some deconditioning or disuse the more we rest this person. And I guess bed rest is different than actually walking and ADL rest.

But for the most part, if we're looking at somebody who's trying to return to a certain sport, return to a certain activity, in this case, she wanted to run again or run marathons again. So I don't necessarily love resting her too much, but we certainly can deload the tissue. And if this was her hip flexor and it didn't tolerate landing, then or if it was her sit bone area, not tolerating landing, maybe we can get her running in a pool with deep water running. Over-the-counter anti-inflammatory medications, there was someone who explained this to me as a – I think their doc did a really good job of explaining this.

And they said, there's a fire there. I'm going to put water on it. And so when one person came in and said their doc explained that to me, I said, look, that's a good idea. You know, like I got nothing wrong with throwing water on it, but realize that that fire could come back if you don't address what's starting that fire. And so the spark and the fuel analogy I used in that case. But she basically tried rest with no avail, and she actually – she didn't like taking medication, so she didn't actually take it, but it was suggested to her. And so next she tried and went to a physical therapist that was really highly recommended by her friends.

And she really just did it mainly because her insurance covered it. And so there was the deductibles she needed to address and all that type of jazz. And I think this is an important part – it's funny, going through this case study, it's – I know we're going to talk about what I did to help her. But at the same time, the psychology of what the people go through is really important in this because this is the typical progression. Primary care doctor suggests don't do something and – or avoidance of activity and then plus take the anti-inflammatory. Next, they go to something that is usually covered in-network with your insurance.

In this case, you went to a physical therapist. I'm not bashing on physical therapy at all. It just – it just not – it didn't end up working for her. But a lot of times you'll see it's covered in my policy. I still got to pay the deductible and copay. And so a lot of times they won't see that there's actually money involved there, although it's kind of more like a nickel-and-diaming effect. It goes – it leaves her pocket a little bit slower. And so under that therapist's guidance, she tried a couple remedies for a problem. So she did roughly a 15-minute routine consisting of stretching, glute-strengthening exercises, and hip mobility drills.

When she was in the office, she ended up getting tool-assisted work. Like it kind of could have been grassed in, A-stem, something like that – or sorry, factor. It could have been any of that stuff. And so I don't know exactly what it was, but she said they were using a tool with her. But for the long story short, she was there for quite a few months. She was frustrated by the progress and ended up just looking elsewhere. So she ended up visiting a chiropractor after that, and the chiropractor was, again, suggested by a friend. By the way, notice a trend here. A lot of times people are suggested by trusted friends, which is okay.

It's just how it tends to go. The friend had sciatica, and so the guy had helped her, so she suggested that she go there. And so she received adjustments there and tissue work a couple days a week. It was partially covered by her insurance, but she was there again for about three months, and she saw very little improvement. So the frustration just kind of builds on these people. So basically this whole time, it's been roughly about six months now. She hasn't really been running, you know, and it's frustrating to people because they don't have a solution in sight. They don't know what to do, and so they start shooting the dark and figuring out things, you know.

At this point, she went to a Runner's World forum and figured out that maybe she can get her hip loosened up by just doing something called Active Release. And so when you go into forums like that, like Slow Twitch, Runner's World, there's usually someone in there who's tried Active Release, which has worked for them. By the way, I've done Active Release for many, many years, and I don't know if I'm still current in certification right now, but actually, I actually took a certification before I even started chiropractic school. I think it was back in 2000, God, it might have been 2005 when I first went to one.

So I had a very strong bias towards Active Release therapy going into school, and so I've been utilizing it for years. And I was working in a clinic that mainly did a lot of Active Release as well, and so I saw it helped with a lot of people, but there was things that it just didn't help with. And so it was interesting, though, when I was in that clinic, how many times people come in and they think that this is the last resort. And you guys probably hear that with a lot of your patients that come in, or you're trying various different things for, or they're asking for a certain thing, is that they tend to think that one thing is going to be maybe the magic bullet.

And so she went and had Active Release at a place, and they were 15-minute sessions. They're very aggressive tissue work a lot of times if you haven't had it before. There's other types of tissue work out there, but for the most part, in my experience, Active Release does work for a lot of things, but just not everything. And so this costs her a little bit to do. Typically, Active Release is not covered with insurance. And so you see the progression of mentally what's going on. So she went to something that was easy at first. She went to her doctor and tried something that was 100% covered. Then she went to a PT that was under her policy.

Then somebody was partially insured, her chiropractor. And then now things are starting to get real frustrating to her because she started to end up paying out of pocket. And so over the course of time, the rough estimation I did in my head was she spent almost about $3,000 without really having a good success. And so when she eventually came to see me, she was like mentally beaten up. And it was, in my interpretation, like I told her, like, look, you've had a lot of tissue work done. You've had a lot of adjusting done. You've had a lot of glute work done. I'm not going to do the same thing. And so actually, a lot of times in these cases, I'll just ask people, just show me.

You know, if you're doing exercises, show me. Tell me about them or something. And that way I'm not reduplicating. It was a possibility that we just got to do a little bit cleaner. And so in a case like this that's had really good tissue work already, I'll typically tell the person that if tissue work would have worked, it would have worked already. Okay. And I don't mean that in a negative way about tissue work or manual therapy. It's just like, let's just state the obvious here. All right. If really good tissue work was done, and this was a scientific study, and there was no result, and the dosage was appropriate, there was no result, and there's no change.

And so there's nothing wrong with that, but I think it's important to ditch certain types of care when that certain type of care was working. And so when she came in to see me, I examined her pretty thoroughly. If you've shadowed me before, which some of you have, you realize that I spend at least about 30 minutes or so just like BSing with the person, figuring out what's going on with them, developing a relationship, because I think it's really important. You develop the relationship, you develop trust, you figure out what their frustrations are, what their goals are, and so on. And so this is really important to get them into, actually, the next part, which is the examination.

It's because when I go through an exam, a lot of times I'm looking at a bunch of things, and even going through lower extremity cases, legs, hips, so on, and then you've got to check your upper extremity myotomes, dermatomes, and DTRs, and reflexes, all that kind of stuff. Sometimes they're not always, in my observation, they're not always understanding why we're doing that. And so they're answering tends to become less frequent, it becomes less involved, and so they're kind of like, they might think, dude, I came to the wrong place. And so usually I develop that relationship really early in the beginning, to a point where I say, at any point, you know, like you asked me if you got questions, I want you to know that I'm collecting data points.

All right, and so a lot of things I'm going to be testing for are going to be very seemingly unrelated to anything to you. I don't expect you to understand why I'm testing them, and I'm testing them. But allow me to test them, and by the end, I'm going to figure out whether this is hip flexor syndrome, hip FAI, labral tear, scar tissue development, a back issue, a nerve issue, or whatever your concerns are. And so I want to make sure that they leave knowing that I've checked them for everything, beyond reasonable doubt, and figured out what we should do with them. And if everything goes well, and I tell them this is an accordion plan, is I'm going to look for their safety net or something which turns their symptoms on and off like a switch.

Now, if they don't have symptoms coming in the office, it's a little bit more challenging because we can't turn them on always. Because they might be someone who's very high function, who's someone who only can feel it after running for five miles, but we don't have time for them to run five miles. And so we can still collect all those data points through the history and examination. And so with her, I basically went through and figured out that her symptoms into her hip and into her buttocks region, actually, it was, they were more nerve-based in origin. And the reason I say it was, is more nerve-based in origin is just, is number one, just observationally, I guess I didn't reveal all the parts of it, is that she feels pretty, she feels stiff in the morning, roughly, like the regions feel more painful in the morning.

She also feels some IT band, quote unquote, issues. And also, too, when we eventually tested things, bending forward, lumbar spine flexion aggravated it. Rotation in either direction aggravated it. And to top the whole thing off is that she actually had positive slumps test, which was her symptoms. If you don't know what slumps test is, is you're seated rounding a little bit at the spine and you extend the leg and the toes and you basically wind up a nerve in the leg. And so this increased her hip flexor, quote, or hip flexor slash high adductor slash sit bone symptoms, you know. And although we could say, yeah, maybe the sit bone is the hamstring attachment in there and extending the leg increases it, when I put her foot down, just plantar flexed her foot or pointed her toes, then her symptoms decreased.

And so, logically, we can say that the hamstrings don't go that far, right? And so, but a lot of times people, and I feel like a lot of times my job is to get them to come to the second appointment. Not because I'm trying to milk their pocketbook or anything like that, is that a lot of times the retention from the first one is really, it's not low, it's just mediocre. And so I want to get them off to the races, and so my job is to figure out, show them beyond reasonable doubt that what they believe is not correct. And I don't mean that in a mean way, but if I let her walk out and think this is only a hip flexor problem or a sit bone problem, yet it's nerve-based and she has positive slumps test, then I'm not doing her any favors.

And so, if I see that their belief of it is a little bit skewed, then I want to make sure that they understand that it's not that. And so, usually in slump test too, we have something in neurodynamics called the contralateral effect as well. And so, as I had her into the slumps position in leg up and her symptoms were triggered, I brought the other leg up and wound that nerve up in ankle extension, or sorry, ankle dorsiflexion, knee extension, hip flexion, passively, and that reduced her symptoms. And she was just blown away. She's like, I don't get that. I said, let's do it a couple more times.

And so we did it twice more and it reduced symptoms every time. It's like, leg up, hey, that's better. Leg down, oh, it came back. And so we kept doing this to make sure that she wasn't like a fluke. And so the last thing we did is actually that she had been in the slumps position there and we did the head differentiator. And so I had her look up to the sky and then her symptoms went away again. And she's like, dude, I really don't get it now. I've been having my hip flexor work done for I don't know how long with tissue work and it's not getting any better. I don't understand why this is happening either.

And so I think the moral of the story so far is spend your time doing a really proper examination because although something might feel tight and the patient directs you to that region and said that they've read up on X, Y, and Z and they believe it's there, don't just put your hands on it yet. See if you can tease that thing out and make it so it becomes reduced and increased with differentiating factors, meaning areas of the body that are not connected to that spot by a muscle or a tendon I think are really good things to check. You know, if I had a headache and I start moving my foot and it reduces it, that doesn't make any sense from a muscular standpoint.

And not everybody's problem is muscular. All right. And so we're just teasing out what we need to do with this person. And so based upon this premise and a couple other things, I concluded that she mainly had disc-derived symptoms. And so we can call this a herniation and protrusion and blah, blah, blah. But for the most part, she was able to reduce her symptoms completely in extension. And it's funny, though, too, because when you think about what the person's been doing for reducing a hip flexor problem, she's probably been stretching her hip flexor, which most of the time when people do it sloppily, it ends up having lumbar extension from that half-kneeling position.

And so it's going to make her feel better momentarily. But if you don't reduce it completely from a disc perspective, or let's just say segment, we'll say segment or nerve here. Because it could be disc, it could be nerve in this case. But overall, we're talking spinal-related versus muscle-related. And so it's funny when I think people end up getting into these little loops where they start feeling good but feeling bad again because they stretch the area that puts them into extension, and they feel better, and then they run again, and they don't do anything else to reduce that problem, or they don't do it with high enough frequency, and it comes back.

And so I've thought about this actually before, is that it's funny. Like, why do you think the body, when it was, I guess, quote-unquote designed, it made it so a back condition could make it so your hip flexor feels tight and you want to extend, right? What safety guard happened there? You know, like, the body's so intuitive. Like a Bacotti sign is one where someone comes in with a nerve root pain in the arm, and they put their hand on their head, like, this makes me feel better. Like, no one coaches them into that a lot of times. They just find it. And so I guess in contrast, in this case, she might, her hamstrings could have gotten tight, and she could have been stretching and flexing her spine at the same time, too.

And so I think it's interesting, the safeguards of people. Anyways, the way I treated her with this is, you're wondering about those boxes, is, number one, the first aid I gave her was, we did some end-range loading into lumbar extension. And so I just had her do this multiple times throughout the day. I told her 10 reps every hour or so, and the intention was to take this away about five days into her intervention. And so I've found a lot of times that, at least in my observation, is the McKenzie's or end-range loading protocols, I think, last a little bit too long. And they're a first aid, in my opinion.

And they're useful when they're useful, but I think we need to get ourselves out of them as soon as possible because I don't want them to spend a bunch of time extending either, at least in these ones. Now, a very quick break from our sponsor. ProChiroOnlineCE.com is the place developed by myself, Phillip Snow, and Ben Ramos as the online CE platform for DCs. By the way, PTs might come later. But currently, DCs, to get their online education hours without having to struggle through useless information, useless, outdated information. Because if you've been a chiropractor for a while, you've probably been through some of those ones online where you're like, dude, this is nothing new.

Like, I literally just burnt my money. And so we're looking to mitigate that problem, and we believe that we did. We've curated some of the best presenters on certain topics. You can check out all the presenters on the website because they're changing and we're adding modules. We gather them together for certain topics. And so I can personally testify that as I went through and edited all these things, the information is solid. It is game-changing. They're clinical pearls, and you will learn something. Okay? As one of our participants mentioned, he said he would have taken the video courses that he's paid for regardless of the CE hours or not.

But if you're like us, you've been to all these different types of workshops before that don't offer CEs. And by the end of the year, by the end of your birthday year, you're struggling to gather all these CEs, and so you go online, and this is an ever-going process. We believe we've solved this problem. So go through ProChiroOnlineCE.com and test out modules. They're 10 minutes for free on every single one. If you like what you see, buy it and check it out. If you don't, no hard feelings. Okay? So I hope this changes the game for all you guys, and now we're going to get back into the show. And so typically in the first day in this examination, what I did was I had her find something that was painful.

And so at this point, walking, sitting, and jogging, that's what she did prior to the intervention. So a lot of times I'll test to see. I'll just say, you pick your outcome measure. You pick your test. I want you to know beyond reasonable doubt that this is actually helpful or not. And so we went down, and we did 30 reps of low back arching. And then so she got up, she walked around, she sat, she jogged around the office, and she was so damn happy. So her symptoms decreased by like 75% just at that point in time. She still felt a little bit, which is completely normal, but I want to see a reduction of about 30% or so.

And so it was great. And so in this case, I think with her case, this was basically a missing link in her problem. Like no one had, or in her recovery, no one had suggested the appropriate first aid process. So we can desensitize this region of the body that drives the symptoms to the hip flexor and the adductor and the sit bone in this case. And so the plan of attack with her was I was going to return her to running as a sprinter, all right, mainly because in the examination, I actually cued her into a hard brace, an abdominal hard brace. And that reduced her symptoms as well. And so I knew that bracing was probably going to be a critical point in her stuff too.

And so returning back into running in this, at least in this case, is a lot of times this, so this person was about a 10-minute mile runner. And a lot of times at that pace, the ground tends to eat them, right? They just kind of, they kind of fall into the ground and there's not like big rebounding steps and it's not explosive. And so it's really hard to get bracing, in my opinion, with that because there's not a lot of stiffness in the system. And so I usually return them back as a runner in full bouts of sprint or return them back as a sprinter and go full bouts of sprint and then full recovery.

I tell them to go into a park typically and I have them set up some cones, about a 60%, 70% sprint based upon what their problem is and their training and their age and so on. And I tell them to accelerate through the cone and slow down like a football player, like a cornerback. And I want them to walk back. She was also supposed to perform the daily, I think at this point we did the big three, the McGill big three. So it was a daily spinal rehab. The exercises should take no more than five minutes and usually we'll do an 80% perceived effort zone where they are supposed to absolutely smoke themselves for that period of time.

Typically, this is looking for an adaptive change while you take a little bit of a break. There's going to be five to 10 seconds on, about just a touchdown, like two, three seconds off and go back again. And so the goal is to decrease the amount of risk while with them falling apart possibly by flushing the area with blood and getting oxygen into the muscles. But also, too, taking the muscles towards fatigue. And so you take them to fatigue, then we get an adaptive change. And I think that's what we're looking for with these people. And also, too, I want to build strength within the hips and also manage a little bit through coaching strategy and hand her off to a running coach because she did have somebody who was running, doing the running coach stuff with her.

And so the exercise I suggested on day one for her is that we did, number one, we did some end range loading lumbar spine protocols in extension. All right. She was supposed to do that 10 times, 10 times an hour, every every hour she's awake. And so people people laugh like when they say, oh, was I going to wake up at night and get it and do it? And I said, you'd be surprised. People do. And so I say things very deliberately to people because I want them to understand what I'm asking for. Also, we got bird dogs because that's driving lumbar extension and also it's getting ball socket dissociation from the torso to the hip and shoulder areas.

So and also we're driving that lat glute type of connection there, that sling, which reduces the tendency to flex, which was driving her symptoms. And we did side planks and actually we didn't sorry, we didn't do the actual third. We didn't do the McGill modified curl up in this case, but I did do an isometric single leg stance hold or what would look like a single leg RDL? I call it a frozen skater. We do an isometric single leg stance one. And this is mainly to get the hips a little bit more primed into biasing towards the frontal plane. So if I take her into a double leg one, then she's going to just be in sagittal plane, forward, backwards.

If we take one away, she has to drift, her foot has to drift across midline towards the zipper to acquire single leg stance or else she'll fall over. Sometimes people do this weird torso lean, which I do correct because I want the chin, the sternum, the zipper, the belt buckle, the foot kind of lining up right there. And if they lose that, then I have to coach them through it a little bit right there. But a lot of times they'll feel the outer side of the hip or the gluteal region light up on this. And that's what I want. And it's funny actually teaching this to people is that I remember this one lady.

She was an interesting one where we went through a bunch of sessions and she was a non-responder to me. I had to refer her out. But eventually I found that I was trying to get her to load into a single hip. And I was trying to bias the movements towards the glutes because the glutes help reduce internal femoral rotation, valgus collapse, pronation, blah, blah, blah. But it also supports the spine. All right. A lot of times people are really good at the other spots. And so this is something that just typically has high payoff for me. And so for her, when I questioned her finally, what are you, where are you feeling?

And she's like in, in the buttocks region. I said, can you point? And so she points right at her quote unquote sit bone. And I said, oh, okay, I'm sorry. That's wrong. Like I don't, I don't want, that's not where I want it. And so some people feel it in the thigh. Some people feel it in the back. Some people feel it in the outer hip, which is what I want. And sometimes people feel it in the sit bone area, in the hamstring. And so when I ask them, do you feel it? And they say, yeah, yeah, yeah. It's burning. I say, where? And they'll point and they'll say thigh. And I'll say, great, stop, start again.

And so a lot of times I'll have to cue them a little bit more into a sassy, sassy hip, like a runway model. Like you get a little bit more to the side. Or you can just put them on a wall and tell them to push the hip pocket towards the wall or the side pocket to the wall. That tends to work too. But with this person, this is all we really did on day one. And so I gave her home-based protocols because I wanted to empower her. I didn't do any manual therapy whatsoever. I did not do any adjusting. I did not do any tissue work. I didn't do any ice, e-stem, any of that stuff. All right. And so I left her with a little bit of symptoms because I wanted her to be able to modify what she's doing based upon the symptoms she feels.

And the conversation as it goes when she's walking into the office is, hey, you are in complete control of this thing. You're in control of your own destiny. Okay. All I want is these things right here. If you cannot remember them, let's do a video. You can video me right now and I will show you all of them very quickly. But here's what I want to happen. All right. If you do not do them, I will not have any data collected to see if it was helpful or not. Because basically all we're doing with this stuff is we're testing to see if a theory is productive or not. We're doing a trial of care. All right.

There is no quick fix. There's a trial of care. And what's going to happen over the next five days is you're going to notice yourself progressively getting better or progressively getting worse or nothing at all. All right. And so that's good information for me. And it helps me direct you to the right thing for you. All right. I picked wrong before. I have. And so I typically tell them the story of the guy who came in who got worse when I suggested one thing. And then I said, great, cool. And we did the exact opposite the next time. And it worked. And so the information they're gathering them in the next five days or so helps me.

And so I typically want to see them within a week or so to see what has, number one, been retained, what's the end result of that trial of care, and to see if it got better or not. And so, like I said in the beginning, I have no problem with tissue work or adjusting or anything like that. But a lot of times it will desensitize and modify pain in the area so we don't have that outcome measure that we're looking for. All right. We have to observe them. We have to see what we're going to do with them, provide a theory or devise a plan, and then check back to see if the plan worked. And so, in my opinion, with this person, what I'm attempting to do is drive a long-term adaptive process.

All right. She didn't get this way in an accident. All right. The other hip did not tend to get tight either. Right. She has the same amount of mileage about her. And so the way they get this way, unless it's trauma-based, it's typically not by accident. Trauma-based is a different story. But I personally don't see a lot of trauma. And so I tend to drive them towards this right here is a beginning program. All right. You're doing first aid stuff. You're doing corrective stuff. And we need to get you into a resistance training environment. And get you back into running as soon as possible. All right.

I don't like to change a lot of variables on day one. And so I don't want to give them multiple ways to reduce their symptoms. I just want to try one because I'm going to see if I'm testing that theory correct. But I think I can double down on that hard brace that I tested in the first examination. And I think that worked. All right. And so what we found is that day two, she came back almost in tears. Like, not because it was painful, because it was good, right? She was like 90% better within three days, she reported. And so it was a really cool thing to see. Because at this point, the transition of what she believed was going to work in her problem was no longer just foam rolling and tissue work and stretching and so on.

Like, she saw that there was other things. And so this really gave me a good window of opportunity to talk about resistance training with her. Now, I typically address resistance training as, again, the Dan John type of model. And when I talk to people about it, I say, look, the things that we did last time are really good at reducing symptoms, but it does not make it so it does not come back. And this is not like telling them to be fearful about it or anything, because I tell them that I've had back pain before. Sometimes I'm expecting it to come back at some point, but it doesn't mean it needs to be terrible and last for 10 months, right?

It'll just be a little thing here and there. And so it's the anti-fragile model. And so I think resistance training builds resiliency and resistance against the same types of forces which created this problem in the first place with her. And so usually what I'll do with somebody is, again, I'll go into that Dan John model, but for the most part with this lady, if I can recall correctly, I think I went into the hinge first. Since she had already had the experience with the skater, and by the way, typically on the second day, I'll say, show me everything we did on the first day. And so we blow through it in about 10 minutes or so.

I plan about 45 minutes or so for the second appointment because it's about retention. I need to make sure this person is doing all of their stuff. After that, it gets much shorter. All right. I'm not going to stay in business if I see somebody for 45 minutes every time. And so it gets much, much shorter. But in the beginning, I tell them, I need to make sure that this is, we're on the right track. And so I'm spending extra time for it. So I tell them to show me everything. And since she had the experience of the quote unquote frozen skater already, which is a hinging pattern, I typically start to thaw them out.

And so a thawing skater, which is basically now she's going into a come up, come down, find the hip. Good. Stand up again. Sink down into the hip again. Find it again. And so the cues I typically use on this, if you have not seen me on Instagram already, by the way, you should. The frozen skater is a part of, I'd say probably 10% of the videos because I use this so damn much. And so the ones I tend to use on that is either number one, copy me. Second is what does it look like when you're skating? And they can mimic. Or third is I say, look off a cliff. And by the way, there's a pond behind you.

Can you tap your toe in the pond like you're taking the temperature? And then I'll drive them into the frontal plane, which is, hey, get sassy in the hip. You know, runaway models are sassy, get sassy in the hip. And then I might add a little bit of rotation or kind of roll the belly. Grab the belly and start to roll your belly button or your zipper onto your thigh. All right. What I find is a lot of times if you go too quickly into that rotational plane is that people tend to roll, they tend to go sagittal and then rotational. I want sagittal frontal rotational and the rotational is a refining technique to get the most that I can out of that glute max and the glute group.

And so sometimes they come back doing it very poorly. In this case, she did it very well. And so I started to thaw her out. And if I can thaw her out and she has good competency with that and feeling it in the right area and her cueing looks and the movements look good, the cueing looks good. She has no symptoms. By the way, always check in to make sure to see if symptoms reappear because sometimes they do. She might have to take them into a safety net on that. If symptoms did reoccur in her, I'd probably take her to right to the floor or I'd probably say, what are you going to do about that? And if she went to the floor and did 10 crappy pushups, I'd say, great, cool, let's proceed.

And so that provided a safety net and I know that she knows what she's doing. And so I hand her about a 12 kilo or 26 pound in America kettlebell. And so I do a contralateral opposite side hold. And so I have her just, I tell her, I want you to skim, literally skim this by the inner part of your knee. And I want you to stop before you hit any calf muscle belly. All right. I don't want it to go to the ground. And so they'll skim it sometimes. Other times they'll float it. And I said, what did I say? I said, skim. I say things very deliberately for a reason. I'm not choosing the word skim because I want to be fancy.

I want you to literally touch your knee on the way down. And so what this does is this drives them into the frontal plane a little bit more. And so we're crossing midline. And so I believe I did that with her. So that's a hinge, a single leg hinging pattern. Also too, with runners, I like to take them into a carry when at all possible. If their symptoms are being driven by extension of the lumbar spine or they have like a nerve root issue, which a lot of times, by the way, if you have not already figured it out, a lot of IT band issues that are not actually into the knee, they're just into the thigh, they're actually probably L5 radiculopathies.

And so probably what they're doing is they're leaning towards that side and extending too much. And if you look at runners at the end of their races, they're typically not rounded forward. They're not flexion based. They're arching. They're falling apart. And so in this case, she was more flexion intolerant. And so I gave her a carry. And so I gave her, I believe a farmer's carry first, and she looked pretty darn good with it. And I told her to walk the line like Johnny Cash. That's a Dan John one. And just walk as if they're late for an airplane. That's a Stu McGill one. And so if they look pretty good, I tend to take them to the thing that they do the best, but it's still a little bit uncomfortable and challenging.

And so I put her into a suitcase hold, which is a single sided one. And so I took a weight away. I actually regressed the weight a little bit. I think I started with 235s maybe. And so I shed a little bit of weight, gave her 26 and had her walk. Why did I decrease the weight is because it's more challenging to do a single sided hold than a double. And I'm providing a little bit of an opportunity for me to not trigger her. And so if it looks good like that, I just increase her time and let her go about that. The last thing I tend to add with people, at least I don't think I did it with her necessarily because I think she, we, we did this a little bit more of a circuit, by the way.

I tend to drive rather than just like stay in the same thing the first time, or rather than to stay in one thing and just drive it home and go to the next thing and drive it home. I tend to do a circuit. I tend to go into, I say, Hey, show me, show me 10 of those skaters. Cool. Great. Go, let's go walk the hallway. Well, I didn't do the skaters well. And I said, don't worry about that. We'll come back to it again. And so every time, every round is a little bit more of a clarity that we can provide and get a little bit more deliberate with queuing because people tend to retain what you did prior.

So you can build upon that, but I wouldn't throw 15 queues at her once. I try to just add one or two at a time. And so we're just cleaning things up. If it doesn't look like she's mastering the thing, I'll scrap and go straight to a different exercise. I'm looking to see if I can get a challenge to get the hip to cross midline so we can challenge that gluteal region so she can load into that side with that exercise. And if she's not doing, I'll scrap that exercise completely and take it into a regress model. But if she is, then I'll progress it. Also too, the farmer's carrier, suitcase carrier in this case, if she keeps her feet a little bit more walking like on a two by four, then she'll also be crossing midline.

And so we're driving some of the same stuff with just different movements and different loads. And so typically what I take them next is into, again, that crouching squat or like you're a cowboy, like you're behind a rock and you're trying to hide from someone shooting at you. All right. I've done split squats in the past. I do like them. But a lot of times with this, this one's been, it's been working for me recently and I really liked it. And so I have this pole in the office. It's a weight bearing pole. I can't move it. It just happens to be there. So we make a lot of good use out of it. And so since the hard brace really worked well in her, I have her actually put her hands on the pole and I have her to start to crush the pole a little bit like she's trying to squeeze a little bit of orange juice out of the pole, if it was an orange.

And so I have her track that down and have her take a knee. All right. Five seconds, descent. At the bottom, if she has to have help from the pole to get up, use the pole, that's fine. And we'll start to creep her down into position again. Sometimes people have really good mastery of this on one side and not another. That's a big outlier. So I like to drive this because I want to get something knee dominant and hip dominant in this person to get a lower body load. The carries, at least for me with runners, is a lot of times it's the vertical stacking of the spine, at least in this case, as long as she's staying upright and walking with some intention, the load into the spine region is actually fairly low, especially if she's doing a farmer's walk.

So I like to do this. And also, too, it's helping them get into the point where they're getting into a single leg. Although walking, there is double leg stance. We're getting to the point where we can train, quote unquote, hip drop. Because if somebody is then compacted into the side and creating those radicular symptoms, which create those phantom hip flexor, IT band, piriformis type of stuff, or ongoing calf pain or plantar fasciitis. By the way, these can all be nerve-based from the spine. If you have not investigated already, you probably should. By the way, ProCiro. Check it out. It covers a lot of that stuff.

And so suitcase carriers are really, a suitcase or a farmer's carrier loaded carriers as a category is a really easy way to address this without having to give a bunch of silly exercises. So when in doubt, I attempt to make it as easy as possible. Just do this and we'll progress on stuff later. I'll be honest with you, I don't get a good result with seeing people one time. Two times is better, but one time, a lot of times they lose the idea of what we're trying to do. And I like to have the second one a little bit closer in regards to, say, a week because I want to make sure that I'm attacking the area and I'm attacking what they're doing with some good intention rather than just having a big, long gap of time.

All right. Usually I'll see people about five, six, seven times or so for this spread throughout months. And the reason for this is because let's just say if we have this girl right here, like she has come in a handful of times because usually what happens is, hey, I'm feeling pretty darn good. Should I be doing anything else? Well, do you have a strength coach? No, I don't. Okay. Well, so let me help you out a little bit with some more conditioning because the stuff you've been doing, is it getting easy? Yeah, it is. Cool. Let's recalibrate your weight or make it a little bit more challenging.

So the area continues to adapt. The thing that I think we all realize is that if you've been through chiro school or PT school, you know about the said principles or that the tissues, bones, muscles, tendons tend to adapt to based upon the load or the chronic load that you put upon them. And so if we just give this one person a corrective exercise and that's it and let them go about their life and they do it for two weeks and that's it, I don't think we're not providing a good long-term adaptive change. And so again, this person did not get this way on accident. And so I like to have some intention behind the resistance training and make sure that they have something that they can do to be happy and healthy.

And if they revisit things after six weeks or so, they're probably going to need to change your program because the area is already kind of adapted to it. And so stuff that I used in her case over the next few times is we did a sumo deadlift. We did it with a kettlebell. We did 44 pounds or 20 kilograms. We did single leg deadlifting, which I just mentioned. We did goblet squatting. We did those cowboy squats. We did single arm dumbo rows. We did crawling and pressing progressions and we did loaded carries. And so there was a bunch of stuff that we did and I just layered upon layer to make it so it was something that she could remember.

Because again, if they can't remember it and you're giving them good stuff, it's still not going to produce any good result. And so this was an amazing case for me. I had a really good time working with her. She was very outgoing. She was very open with her communication and she listened to what I was suggesting. And I think the hard part about a lot of times when you're working with people that if you don't develop that relationship in the very beginning, if you make a suggestion, you intend for them to follow the suggestion and they're not thinking that you're just blowing smoke or trying to milk their insurance or whatever they think that you're trying to do.

The trust has to be there. And I tend to be very lenient on people's stuff that they want to do if I don't think it's harmful to them, but I want them to know too, that if I, if, if I'm, I'm trying to be like a, I guess like a stern father in this, you know, if I really mean don't do crack, I'm going to tell you don't do crack. Right. But if you want to go play around and like, you know, like, like eat sugar, go ahead. You know, like I'm not going to be, I might say don't, don't eat sugar. Like, but if, if I sit you down and have this hard to hard conversation, I'm doing it for a reason. And so I don't like to, I don't, I don't like to cry wolf that much, but in the beginning, I really attempt to lay that foundation of a relationship there because I want them to know that I'm serious about helping them get through this.

All right. I'm the guide. I'm guiding them through this. All right. They're doing the work. I'm guiding them through it. They should be empowered. They're in control of their own symptoms. They're resilient. They can get better. And this is not going to be the end of the world. They're going to be running again in no time. They'll be fine. Right. Most of the time. But if I said, I want to go get an image done, I mean it. All right. And so I've done a better job recently with ridiculous cases that I'll just tell them, look, I want to see two, two times a week for two weeks. And I'm looking to see a definitive change.

All right. Because I want to make sure that over the course of this time, you're not getting worse. If you're getting worse, I need to send you out. All right. But if you're not doing your homework, if, if I'm not, if I haven't suggested the right thing or whatever it might be, and we let time lapse, then I'm not going to be helping you out either way. And so I really try to be diligent with people about this stuff. Now, back onto this one case. How did I return into running? Again, I like the sprinting or return as a sprinter type of protocol. Even sprinters, though, when they return to sprinting, they don't go 100%.

All right. And so I think it's a noteworthy thing. She was a 10 minute mile pace. So I just had her, again, start to go a little bit more intentional with her steps, let her arms set her pace, fall into her sprint. We actually did a little bit of, it was like that trust game where they kind of lean forward and I'm holding up with one hand and then I let go and they go. All right. I want them to lean into their sprint, fall into their sprint, and then drive their arms, pound the nail. Whatever cue you decide to use could be helpful in this person based upon what they're showing you. And so a lot of times I'll take them out and have them run actually and see if their symptoms have come back or not.

In this case, her symptoms had not. So now what I actually take this person into programming for them for their mileage and stuff like that, I personally prefer not to, you know, I want to get them to the point where they can do various different types of speeds of running because I want them to, I want them to be able to, to do their training program, but I don't want to create their training program because I'm not a running coach and I never will be. And so she had a running coach and that's what the coach is for. Now, co-managing with the coach and saying like, Hey, she's going to have to do a little bit more interval work, speed work.

She might do some run walk for a little bit. And also by the two, she's been out for 10 months, roughly out for 10 months. Let's not expect her to do anything spectacular in two months when she has that half marathon that she was really targeting. All right. I think setting these realistic goals are important. And that degrade that happens, that decondition that happens throughout the body happens. And from what I understand, it's, it's, it's a, it's a one for one pace. If it takes you, if you're deconditioned for a month, it's going to take you a month to really return back to everything. And so that person who is, has not really been doing much of a workout, they haven't been running, they haven't even kept their cardio up and been down for 10 months.

I think that's a, it's a different conversation than somebody who, um, just got something recently, uh, who, who decided to do deep water running and swimming during that time, or maybe go on a bike and they, they have their race in a week. And that's a little bit of a different story. Now allow me lastly to, uh, explore what I probably would do a little bit different in this case. And so I, uh, again, I recently went to a workshop by Scott Morrison and he provided a little bit more detail of how to produce an adapt, adaptive change. Um, and by the way, if you guys are looking for, uh, Scott's information, uh, at Scott with one T, uh, Morrison with two S's, just Google him.

He's a PT, uh, DPT up in Oregon. So, um, the, the idea though, that in his workshop, that was kind of interesting was that to produce an adaptive change, we need to be working towards failure and that doesn't have to be with high loads. It can also be with volume. And so we can modify time, volume reps, so on, um, to, to be able to get that effect out of them. And so in some of these cases in the beginning, like usually with the corrective room, uh, stuff on ground with like a diagonal sit, um, I'll, I'll load them pretty aggressively and I'll, and I'll get them to just literally smoke. Like they need to be tanked.

Uh, and I'm looking for the, the, the tone change, but a longterm, it doesn't always produce an adaptive change in the musculature and the attendance and so on. I'm just trying to get to load on, load them onto a certain side. I need to build the trust, remove the, remove the subconscious threat. Um, so, but Scott brought up a, an interesting point where, um, we need to get them towards failure to produce that change that we're looking for a longterm. And so he provided a couple of different ways to do this. Um, and so I'm going to start to, uh, to start to use a couple of these and I'll describe them, um, roughly.

And I'll tell you my experience with experience with it so far, cause I haven't really used them yet other than one time. So actually yesterday I did one called, um, it was called my reps and the goal of my reps is, is hypertrophy, uh, uh, hypertrophy and strength endurance via stimulating reps due to motor unit recruitment. And so the idea of how to do it. And so yesterday I did some, I did some lunges with it. And so today, by the way, I'm not really that sore. Um, so I don't know if it was just I've been conditioned for lunges or it was actually, that would be a nice thing because, um, after talking with Scott about it, he says, is there really any negative repercussions to doing this with these people, even in people who are injured?

And he said that basically the, uh, it's, it's, the, the risk is very low, but the reward is very high because we're going to try to get this person to, uh, reach failure in some way, shape or fashion in this safe way, at least one time a week. And then we'll start to take them out for, for months, you know? And so the rough idea was that, um, you pick a load that you can do between eight and 20 times roughly, by the way, this might be wrong, Scott, um, cause I'm just learning this, but I'm going to share what I know. And so, um, you want to maintain tension during each rep. And, um, so it, and you basically go through these, these reps until you feel, you feel like you've reached your max.

And so you just kind of hang out there then for three to five, three to five breaths or 30 seconds roughly. And the next one you're going to go and you're going to go until, um, uh, I think the thing is that actually this is the way I intend to use it at first is you're going to go not necessarily to failure, but you're going to do mini sets. Um, and the goal is going to be half of the reps that you did prior. And so in this case, if I did 18, then I would do nine. And then after that, you do the same rest. It's three breaths for 30 seconds roughly. Um, oh, I guess I do see, I'm looking off piece of paper right here.

So perform mini sets with zero or one rep in reserve. And so those would go to failure or just one rep in reserve. And so the mini sets as you come through is the goal is to hit nine roughly ideally, but if you can't hit nine, then you stop and that's your last one. If you hit nine, then you keep going the same rest period. And so when I did this yesterday, man, I was smoked and this was like under five minutes of work and it was just a massive pump. And so it was cool. Um, and so the way I think I'm going to start using this in the clinic is that, um, I think some of my, my conditioning plans have, or my strength conditioning plans have gone a little bit long, uh, and probably it's my own fault because, um, I tend to take a bit of time with my patients and they get used to just spending time and hanging out and just taking breaks.

And so this is a really easy way just to smoke them, you know, within, um, a short amount of times you're getting the adaptive change that you want. Uh, and you, um, you get the job done so then they can still keep messing around and talking if they want to. So a lot of times people won't push themselves as hard unless you push, uh, push for them. Now I'm going to tend to use that, but I don't know if I'm going to really use it with things like, uh, like hip hinging, unless you know, with a barbell hip thruster or something like that. Lunging, I think is nicer. Um, something like a deadlift though.

I don't know if I'm going to do that necessarily with this person. I'm probably going to something else. Um, mile reps though, uh, in, in my interpretation, it's, it's entry level. Um, and so a lot of times we can use it with people, uh, who have sustained injury or who have been out of, uh, commission for a little bit of time. Now, the next one is oxidative, which I haven't really done yet. And the goal was to, uh, build strength endurance via slow twitch, uh, hypertrophy, increased lactic acid buffering and mitochondria. And so the method was a 303 or 202 tempo. Um, and so you, you basically don't lock out or pause.

And the way I kind of envisioned it is like, you'd be going on Instagram and you see people doing those little silly exercises where they don't really lock out and they're just midway through range. And they're, you, they're using a large compound movement like a squat and they're just kind of hanging out mid range. Right. Um, Ben Ramos was, I was talking to him about this and I said, how do you use this? And he said, I usually put people up on blocks, put both feet on the block, have them hold the kettlebell, not up, but down, let them dangle it and then have them maintain a, a, like a deep range and oscillate through that range.

And so the work is about 30 to 40 seconds. The rest is about 40 to 90 seconds. Um, and so it was three, three to five sets of this. And he said, you just get absolutely just smoked and just a massive pump. And so I'm going to try to do this on people because, um, I think where I've been falling apart is, uh, thinking more movements rather than always adaptive change to the area that it's of, of concern. Uh, and I, and I need to do that for people. And so if you guys have any information on this and how you utilize it, I'd, I'd love to, to learn more. Now it's funny. I thought I was going to get through two cases on this work on this thing, but I'm just going to get through this one.

And so probably over the course of time, I'm going to do some more case studies. Uh, and so just keep an eye out for them. Uh, if this was interesting to you and you want to share it with another colleague, please do. Um, uh, the only way that this, so we're about a hundred through 160 episodes. And the other way really this thing is promoted currently at the time of recording this podcast, we might change that pretty soon, uh, is word of mouth. Um, and so if you want to see the show continue and can you continue to learn stuff like this and it's helped you in any way, shape or form, please share it.

Like really do. Like I don't make any money on this podcast. Like I've said multiple times, uh, I, I attempted a sponsor earlier, um, in, in the year last year. And it's funny, they actually didn't pay me. They did sell on the contract and it was more of just testing. So I actually still have not made a penny on this podcast. Um, but, um, the, uh, you might see something coming up very soon, uh, via some social media ads. I'm just going to test this stuff because I really want to see if this podcast can take off. I, I, I feel like everybody that I've spoken with about it seemed to really enjoy it.

Uh, and I'm not saying that in a conceited way. I just, I, if I put the time in, I want to, I want people to, to experience it and learn from it just like I have. So, um, please share if you can. And if you don't know how to share, um, scroll down into your podcast player and there's probably a little, that little box and upward arrow thing and just directly email it or text it to a friend right now and they'll watch it when they want to watch it or they'll listen to it when they want to watch it. So, um, as always, uh, lead people better than how you found them. If you're dating, dating Eagle Scout, uh, go check out the pro Cairo online CE platform.

I do make money there, but I'm not in it for the money. This is really, it was a lacking thing in the industry that if you guys are wondering with this case study like this, you're like, I don't know what the heck he's talking about. And I've never utilized stuff like that. And I would have done something different. Um, or if you're having trouble with these types of, uh, things, um, or you have failed cases. I fail cases too, by the way, but if you want to reduce the amount of failed cases, learn some, learn some of the tools of the trade and learn how to plug them in. And so those are all in, in the pro Cairo online CE.

And if it is your birthday month, you're going to need them anyways. So make sure to check with your state to make sure that it is something that works for your state. Because I think there's about eight U S states that don't actually do online stuff, but you'll probably know that already. So pro car pro Cairo online CE, I'll see you guys next week.