Directional Preference, Nerve-Driven Shoulder Pain and Spinal Loading

When we started doing these tests, or the corrections of people, we did a little bit of head corrections, a little bit of nuances with pelvic shifts and so on, and I started thinking, I'm not that specific. You know, I probably could be. Like, I've had some good results of people, but there's also a couple people I can think of off the top of my head where I probably could have done it better. And so, actually, when I came back to the office the next day, or the next week, there's a patient that came in that he's one patient that, over the course of a couple times, I really didn't figure out whether he was triggering his problem forward or backwards.

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 Dr. Sebastian Gonzales with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This one, this podcast today, by the way, if it's your first time, welcome. Welcome to the podcast. What's up? I'm actually surprised by how many people who listen to podcasts, but I'm actually surprised by ones who are like, what's a podcast? It's like, you haven't heard a podcast yet? What do you listen to in the car?

Gosh. Like, I only drive about, like, five minutes to work or less, but when I go driving, to, like, say, a baseball game or something, like, I listen to a lot of podcasts. Like, you can dominate so many books that way, audible books and so on. But if it's your first time, welcome. This podcast is a, let's think of it as an advanced conversation for, or not advanced conversation, let's say conversation for advanced patients and clinicians. Or I try to blend that middle ground right there to have maybe a common terminology base and understanding. Because I think that we as clinicians tend to make things a little bit more complicated and techie.

We have a whole different language, and we need to make sure that we're blending it well for our patients. And patients, I think, although we need to keep it, I know that there's push to say we need to keep it on their level and keep it real simple. I think we can up the game a little bit, too. I think we can take a little responsibility on that side and say, you know what, I do know what a nerve in the back is. I do know what a disc is. I mean, these are just common things. There's structures and things and concepts that they should probably kind of know. So, I'm going to go through that stuff as well on a lot of these podcasts.

If, also, this is your first time, too. This one, we're up into the 120s already. So, there's a lot of great ones behind I Love 91, 122. Let's see, what is another one there? 94 is one of my favorites. So, go through and listen to those. They're amazing. Catch up. So, what we're going to do in this podcast today is I'm going to review some of the stuff that I learned the past weekend, which, at this point of the release of this podcast, it's now about a month or so later. I went to Philip Snell's Fixture on Back Course, and this one was in Phoenix, Arizona. I've been to it once before, and this time, so it was the second go-around, and so I've already heard stuff.

So, I'm going to relay some of the information that I learned, but more so, I'm going to learn, or I'm going to present the ideas of the things that I actually learned outside the course. Because, in my experience, when I go to courses, I'm very into the topic. I'm very into the content, and I'm writing stuff down. I'm writing studies down. I'm writing things down that will change my clinical practice from the content, from the presentation. Now, when I've already been there once, it's kind of like watching Justified the second time, which I am watching the second time. So, I can pay a little less attention and do other things and think about other things.

So, more relate it back to what I need to relate it to. So, there's actually, there was a couple times in the weekend where I was challenged a little bit with my complete understanding and comprehension of a couple different things. So, I'm going to go through some of the things that I learned just throughout the weekend from other clinicians and my experiences where I thought, damn, I could be better at that, and I could help more patients if I get better at that. So, there's, I think you'll be surprised at the things that we're going to go into. Now, first, before we get into that, I want to make sure to do a little house cleaning as well.

I do have a book, all right? You've heard about it. If you have not heard a preview of it, 123 is the podcast where I do a sample of the audio clip. Now, I need to make sure that you guys are aware of this book, all right? The people who have read it, there's already reviews up on Amazon, okay? They're real reviews. I didn't coach them through this. They just did what they wanted to say, okay? If there's negative reviews, there's actually one. There's one negative review already, and I'll share that with you as well. So, understand that this book is intended to be motivating for getting people to do what is needed to get better with their back, all right?

And sciatica, but more so their back. So, I don't know about you guys, but I've found that some people, like I have this one guy that he comes in, his wife has a ton of back pain, right? And I just, she's in an arm's reach. I just want to help her, but I can't, right? Whatever he said to her is not motivating enough to get her to change, and she's stuck kind of in this realm where she just doesn't do much, you know? It's kind of like an avoidance thing. And then they've kind of stopped talking about it, too. So, I think after going through my experience with back pain the second time, I started realizing all of the walls you put up and the, not I want to say distrust, but you get depression about what you have and wonder if you're ever going to get better.

And there's this whole whirlwind of shit, mental shit that you go through, that it's a big barrier for actually for you to get better. So, the book, the intention of the book is for clinicians to help their patients get their spouses into care. And you don't have to go to me. There is mentions of a course in there because originally the book was, it was a course, but then people didn't take the course. So, I had to split into two because, damn, they wouldn't do the course unless they actually were motivated to do the course. So, that's why the book is there. So, the intention is to get them into some type of care.

They can go see me. They can see you. They can see somebody else. They can go to a course. They can take McGill's back mechanic book, whatever, but they need to do something, all right? That's the intention of the book. So, if you are interested in listening to that, it's purely motivational. There's exercises in there, mental exercises, not physical ones. There's no recommendations for care of what to do at all, all right? I'm not joking. There is no stretches, no exercises like bird dogs. There's none of that stuff because that's not the intention of the book. So, I'll go through. I'll put a link in the show notes.

It's called I Will Beat Back Pain by myself, Sebastian Gonzales. Check it out. And if you guys have a good experience with it, just let me know. Now, if this is your first time to the podcast as well, I typically share a little story about myself, and then we get right into the content. So, I'll do that for you right now. You know, one thing you guys might not know about me is actually I have ringing in my ears all the time. I have tinnitus. So, this is a true story. I was about 16 or so. We went out to Big Bear, which is kind of, if you're down here in Southern California, it's the area that's kind of like wilderness, and there's areas that go four-wheel driving out there.

And there's a lot more people now than there used to be. But for the most part, it was back when I was 16, there's a lot more open space out there. So, we go out there and shoot shotguns and .45s and so on. So, one day, I went out there with my dad and a couple friends, and we were out there. We didn't have earplugs on. We were just shooting these .45s. And I don't think we were shooting for more than maybe an hour on and off. But ever since that day, I have ringing in my ears. So, people will ask me, like, hey, you hear that watch beep? I'm like, no, I don't hear any watches beep. Like, it is that pitch right there.

Crickets and watches beeping. I actually can't even hear them. So, actually, when I was younger, I had to probably when 16 through 18 or so, I actually had to sleep with the radio on a little bit. I think I went with Art Lebeau. Maybe some, it was like more of like boys and men type of stuff. More stuff that's kind of chill, not like hip-hop or anything like that. Actually, sorry, we had a rap back then. But I had to listen to something because the ring of the night was intense enough where it would drive me a little bit nutty. So, now I'm able to tune that thing out. I don't need to do that anymore.

But I do like white noise when I sleep. So, I like having the fan on, maybe for that reason. But either way, that's just something about me you might not already know. All right, let's get to the show. Okay, so, first off, I'll just tell you about Philip Snell's course because it was pretty darn good. And Jeremy Dinkins, who's probably listening on the other side here, he was the intern that I had this last year. Now, he's a doc. Congrats. Jeremy in New Jersey, right by the boardwalk, wherever the hell that is. He just started his practice. Congrats there. So, I'm glad to see that you're going to be helping people.

And you got that great review based upon the stuff that you learned at Philip's course. So, helping people with back pain everywhere. Now, so, he would even say that, like, you go to a course like this and it really blends things together well. And I know that coming from a background of doing mainly technique-based stuff back in my early days, I tended to think, how can I fit this person into this box of treatment? You know, and that's not always the case. It's sometimes it's that's the right treatment for the right person at the right time. But you implement it at the wrong time and it's not productive.

An example would be, I tend not to use tissue work on people with active disc injuries. All right? Because they're going to tell you that their muscles of their low back are tight, real tight. But it's a protective type. So, to stretch those things out, you would probably flex them and bend them forward, kind of like a position of a crapping dog. And that would just increase their amount of pain over time. Now, I'm not saying later this isn't useful, but in the beginning, it might be harmful because you're pushing them into the mechanism, which is creating their alarm system and their pain to go off.

All right? And if you've met anyone with sciatica, let's just say with a straight leg raise test, they can't straighten their leg. Kind of pushing them forward into that position, it might not be a good idea in the beginning, you know? Maybe later, after the actual thing is just a remnant, it might be a good idea. But at the current point, it might not be good. So, BILP's course really brings in aspects of different things like McKenzie's or Robin McKenzie's work and Stu McGill's work and some DNS and some strength conditioning. And it's a really good conglomerate of things and kind of when and where to use them and then when to not maybe use them and maybe when something else is more productive.

So, it's a really great course for that. Jeremy, but Jeremy will tell you, it helps you not just lay a guideline, I don't think. I think it's more of a critical thinking thing, for me anyways. I don't think it really coaches us into really following this algorithm as much as just think about what's going on with this person. Now, again, I've already been to the course once. The first day is a lot of research, which I love. It actually provides a lot of level one research for DISC and it really challenges an idea that I'm going to go into different podcasts about structure versus the alarm, okay?

Because a lot of people will tend to think that their back pain or their pain or their shoulder or their foot or their ankle, they're like, what's wrong with this thing? What could be going on in there, doc? What's going on in there? You're like, great. Well, it could be a lot of things. You know, the shoulders one where, actually, I do a test with some people sometimes where I hold them a bottle, my Nalgene, or not Nalgene bottle, it's not even a hydroflaster, it's a Takya, a knockoff Takya. So, I hold my thing, it's pretty heavy. And I say, look, hold that thing up for a couple minutes, what's going on?

And they're like, well, it's starting to hurt. And I said, where does it hurt? And they're like, well, my shoulder is starting to hurt, it's starting to burn. I said, was there anything wrong with that shoulder? And they're like, yeah, you know, like five years ago, I just tore my rotator cuff up. And I'm like, great, cool, let's switch hands because that was not the point of the demonstration. I wanted to show you what it feels like to get a muscle burn, right? Because the burn doesn't necessarily mean there's damage in the area. But in that case, I handed it to the wrong shoulder. And they, again, go back to this idea that something was, the reason why they had pain was something was torn or broken.

That's not always the case. I mean, you can push on something real hard, like the skin, and not even create a bruise. And at some point, it has that dull throbbing pain. You do an MRI on that, that's negative too, all right? So, there's not always a damaging thing. And there's not always a damage to the disc. And there's not always all these problems that people think that they have. They just see them really well on image, okay? They see them on image. And I won't go too much into this because I should probably do a whole podcast on this as well since it's a big topic. But for the most part, when we went through that course, they kind of presented the research on a lot of that stuff.

But the things that I really learned later were through conversation with other people. And by the way, if you're looking for that course, I'll put a link into it. It's a good course to do. And it's really affordable. And Phillip's a great guy. So, there's nothing I like more than giving money and promotion to people who are nice and cool, all right? Like, I love to support friends and family. And I even know that when I go to, I don't have any health insurance that really covers much of anything, just probably like all of you who are self-employed. So, I go to my optometrist who's a friend. And I'm like, look, I'll just pay you cash.

He's like, well, your insurance won't cover. I'm like, I don't care. I'll just pay you cash, right? I'd rather give money to a friend and keep money in the family than to someone else I don't know. So, keep it in the family. Phil, hope people book you after this. Yeah, book his course, by the way. You can have them over to your place if you get enough people. Now, the things that I actually learned on the side was that, number one, is that when we started going through some of the exam, a lot of times with people with acute low back pain, they respond to McKinsey's type of protocols. McKinsey extension, McKinsey flexion.

Let's not get into the nuances of which. But when we started doing these tests or these corrections to people, I started, you know, we did a little bit of head corrections, a little bit of nuances with pelvic shift and so on. And I started thinking, I'm not that specific. You know, I probably could be. Like, I've had some good results of people. But there's also a couple people I can think of off the top of my head where I probably could have done it better. And so, actually, when I came back to the office the next day, or the next week, there's a patient that came in that he's one patient that over the course of a couple times, I really didn't figure out whether he was triggering his problem forward or backwards.

I had a theory, and he seemed to really feel really good when you put him on his back and you put his knees up in the air and you kind of rock the knees into the chest. So, a little bit of rounding in the back tended to make him feel better. And I can get him to, like, a one out of pain. He was in pain a lot. When he walked in, like, he's hobbling, and he would do this every morning. And so, I found that that was relieving. We went into a quad rock, which is kind of like an on your all your fours position. And then I walked his hands out. It's kind of into, like, a knee push-up. And as soon as his back started to extend, because he didn't want to extend much of the hips, he had to stop.

And he had to take a little break. And then he would bend over a little bit, stand up and bend over, and that took his pain away. And the last thing was, I put him into, like, a deep frog position, kind of like a tree frog sitting on a tree. And that took his pain away, too. So, I'm like, I think observationally, he doesn't like to stand up straight, right? And he tends to get better when sitting down and relaxing. And then he rounds forward to take his pain away. He's got to be flexion intolerant. His pain has to be coming from bending backwards. It has to be. Although these people are a little bit more rare, I'm like, well, one walked in my office, and let's treat him as such.

So, over the past couple days, or over the past couple sessions, I've kind of worked off that premise. And we still haven't been able to reduce his morning time pain. He's getting better overall because we found some resets. But when I came back from the seminar, I started thinking, don't be a McKenzie rookie. You know, don't be fooled by the person saying after one or two reps that this is painful. And I started using a little bit more of the, by the way, I've never taken a McKenzie course. I've just been reading the book. And they kind of talk about going to repetitive reps. And don't be fooled by the fact that one rep hurts or two rep hurts or three or four or ten.

Just start going a little bit and just see if it works itself out. See if it desensitizes or see if it centralizes, goes towards the spine, or peripheralizes. And their rough idea, based upon the book, is that forward or backwards, they're going to probably more than likely be one of the corrections. And they're going to dramatically improve over the course of a week. Maybe not 100% better. And that's probably not the whole answer to the problem. Maybe we go into other things like the McGill work after that. But for the most part, they're going to feel better. And we're going to know clearly which direction their spine likes to go.

In case you're wondering how the McKenzie stuff works, I have no idea. I don't know. And I don't know if anybody knows, really. If you do know, feel free to message me. I personally believe the body has all these little resets that we just have to be keen to. People come in who have radiculopathies in the arm or numbness in the arm. They tend to have their arm over the head, which is Bacotti's side, right? Like people who have back pain, they come in with what they call minor sign. People who dislocate their shoulder, you never see them reaching for stuff in the air. They kind of curl up into a ball like a broken wing.

I think people's body inherently have these little reset buttons. Now the reset buttons tend to, I think they stay a little long, you know, and they become remnant. And that's what we might call our movement problems after that. But in the beginning, I think they're very helpful. So with McKinsey stuff, I think we're just kind of finding that reset button for a bit personally. But so anyway, so this guy, he came in this week and I said, look, I need to make sure that I got a real good handle on your case. I'm like, quite honestly, I don't know 100% if your back is like an extension or flexion.

You're showing me flexion and I'm putting you in flexion and it seems okay, but you're not really improving over the long haul, right? You're not getting the results I expected. And he still has every morning for the first couple hours, it seems like he has to, he's having trouble walking, he's having trouble getting around. In the afternoon, it seems like it works itself out. So, I don't want to guess. So I said, look, all we're going to do is we're going to start putting you into, let's put you down in the face down position first. So we kind of sat there for like 30 seconds or so. I said, how's this feeling?

He's like, good, great. By the way, he's improved a lot over the last couple weeks. It's just not to the liking that I would like. And I need to make sure that I know from a management standpoint clearly what's going on. So he was in that position for like 30 seconds. And my idea was to kind of make him kind of melt into the position rather than really take the initial shock as being the indicator that that was the position that was painful to him. So after that, I said, do you feel comfortable getting up onto your elbows? And he said, yeah, cool. I said, let's do it. So he just got onto his elbows, kind of like he's reading a book.

And I said, how's that feeling? He's like, oh, it's a little bit, you know, iffy in the back. And I said, let's just sit here for like a minute or so and let's just see what happens. So we're just talking, chilling, you know. And I said, how's that feeling? He's like, it feels pretty good now. And so I took my hand kind of around his lumbar spine and started pushing down towards the floor, just providing a little overpressure. So I said, how's that feeling? He's like, feels pretty good. I said, great. Let's go up onto the hands. Can you leave your belt buckle on the ground and start pushing yourself up like a king cobra real slow and just start working into the reps?

So he started working into those. And he's like, yeah, I feel a little stabby kind of around the sacrum area, around the tailbone or not tailbone, but the top part of the, I guess, general population might call that tailbone. But so you feel a little achy in there. So I ended up using some of Philip Snell and Justin Dean's dermal traction or skin rolling. So I grabbed the skin and that decreases pain with extension. So we went a little further. We kept going, going, going, going. And finally, he was all the way up to elbows locked, hands on the ground, just below the shoulders and just had a huge old swooping arch in the back into extension.

And he kept going. And I said, how's that feel? So we were probably in about 60 reps or so at that point. I said, how's that feel? He said, feels fine. And then I said, stay at the top. And I pushed in towards the sacrum to the floor and kind of pushing, emphasizing more extension. So loading that end range. I said, how's that feel? He said, feels fine. And so I started thinking, who else am I missing this on? Because I think, I think that's an indication that, I mean, he's clearly able to arch back. And I think about, I think about people with really acute, like, sciatica. You couldn't get him to bend forward more than a couple times before he'd light him up, right?

And that's a clear directional preference. And when you use that to our advantage, we can get these people better quicker, really quickly. And so I, we can retest that and confirm it. I didn't with this guy because I found some success on that. To me, that was enough indication that we should be going into extension, at least over the next couple weeks, and then start revisiting back and getting flexion back. But with some people, you can do repetitive forward flexion or like segmental rounding, like a forward fold like yoga. I don't like doing this because it's kind of provocative on people who are actually in pain.

But slowly, over the course of the reps, it will start to creep and it'll start to peripheralize. It'll start to go to the buttocks and then it'll go to the hamstring or the IT band. And it'll go to the medial knee or the leg or the calf or the foot. It'll start to creep. But the good thing is that with these people, if you feel confident with your, with your end range loading, you can just turn them around and have them do the press ups and it'll, it'll come back to center. So if you have these reset buttons, you can be a little bit more challenging in your exam without really tearing these people apart.

So remember, the body's pretty darn resilient. And although it's really uncomfortable for them to go through these exams, I think it's okay. You know, and just reassure them that you could, that you can reset this thing when need be. So through the seminar over the weekend, again, just my observation of, of McKenzie's, not just lumbar, but also cervical McKenzie's, I started realizing that I should be a little bit better at that. And it made me start thinking a little bit more about the McKenzie's of other joints too. And I, I don't know all the McKenzie's of other joints, but again, thinking about the concept of resets, it's, if it doesn't like one direction, go the other and start to pump the joint.

Um, someone who probably does McKenzie stuff or been to the course is probably going to think this is a bastardized version. It is. All right. I'm telling you that I don't know everything and I'm just learning. So, uh, if you have stuff to share, please share. All right. But that's something I realized that would be a really good, um, proof to the patient that I know what's going on. Because we don't always get the potential to, to do more than one, uh, interaction with a patient because they, they think, well, that didn't work for me. That guy's bullshit. Let's, let's go and leave. And I don't want to go back there again.

Let's try this other thing, you know, cause people who are in these situations with their back pain and their shoulder or their neck, and they're in a lot of pain, they, they're, they jump ship a lot. They're, they're like, it's like herding cats, man. Like I, I get it. And, uh, but it's our responsibility if we know what's going on to help this person. All right. And I've, I've heard of a couple of cases where people, when they jump around, um, you know, they go to one doc here, they go to 15 docs in a year. And, you know, sometimes you miss things like cancer because no one, the person never gets the, the doctor never gets the opportunity to figure out whether that thing is working or not.

And just because something's not working doesn't mean there's not a next step. It's not part of the process. So in this case, say this McKinsey didn't work. I, uh, I would want to see maybe an, an image, you know, to see if anything else is going on because our responsibility is to the page for patients is making better. But, and this is the analogy I use with, with a lot of patients who are, um, they seem like they're not revealing all the information and I don't want to call them directly out into it in it. But I, but I, I tell them, look, I, I, you came in today and you are a very complex, uh, being case, not necessarily your problems complex, but you have a lot of things that I don't know about you.

And it's like me picking up a fat old encyclopedia or let's just say a Harry Potter novel. All right. Say all those books of Harry Potter together in one book, you flip to a random page in the middle and I start reading. This is where we are today. Okay. You need to give me a little bit of time to figure out what's going on. All right. And I know a lot of you have probably been, uh, you know, watching a Netflix show with your spouse and you walk in and you're like, what is this show? What's going on? Tell me about it. You know, you need to be caught up or you can just go in the route through and read the rest of the, uh, the beginning part.

But sometimes patients don't have that, uh, they don't have that patience for you to pay you every single time for you to read, you know, the backstory. So I try to get it out of them real quick and I just let them know in the beginning, look, look, if you see me a handful of times in the beginning, I'm going to learn about you real quick. And although I write notes on you and stuff like that, I'm going to remember your stuff like the back of my hand. All right. Because at that point, I'm really, I'm not that I'm not interested later, but I'm really interested in problem solving with you. Uh, so the, the more you see me in frequency in the beginning, the more I'm going to learn.

And I know through the McKinsey, um, through the McKinsey book that I've been reading, they talk about, um, when the person's really acute or especially if they're non-responders so far, you see them in a couple of days, right? Because you need to figure out what's going on. So when they're responding well, that's when you can cut them loose a little bit and they have some skills about them. So anyways, yeah, the McKinsey stuff is something I, I, uh, think I need to spend a little bit more time on. And I think that's, um, one takeaway from this, uh, Fix Your Own Back course. Now, something else which I observed that I should probably be a little bit better, and I already knew this, uh, I just get bogged up in other things too, is that the, the concept of, of, uh, neurological considerations of, uh, ball socket joints.

And so there was a person that was at the course who was an attendee who had a shoulder thing that was just not relieving. He called it a bicepital tendonitis. And so he'd been doing some strength conditioning. He's been doing sick scapula work. He's been doing shoulder blade work and so on. So he's, and he's a strong dude. He's, he's jacked, right? I mean, he's, he's the, uh, picturesque model. Like you're, uh, who was that guy back in the day that, that, uh, NFL, um, he was a free safety for the Seahawks. He'd go modeling all the time because he was jack. He looked like him. So anyway, so he goes in with his shoulder and I took this on video for, um, just for promotion of the clinic who was, uh, hosting.

So Jeff Barron was the clinician on that part. So maybe he'll release this video one day. So the guy, he reached overhead and, uh, he, he had signs of more than just, uh, bicepital tendonitis. So we did the whole test and exam and I don't know how much, uh, Jeff might release, but for the most part, um, after not even treating the rotator cuff, not even treating the, uh, shoulder blade, not doing any tissue work. All we, all we really did was we did some McKinsey chin packing and we did some neurodynamics or improving slide mechanics of the nerves through the shoulder area by movement of the wrist and the head.

And I want to say it was about 10, 15 reps. Guy stood up, showed us the range. He's like, holy shit. I've been working on this thing for months. Right. And so he had a lot of questions and he's like, what's going on? You know? And, uh, so he's like, is there really an issue with the biceps tendon? It's like, well, you, you have an issue with the biceps tendon, but there's other considerations of why. And so my learning experience from this was that, and I've already taken clinical neuro neurodynamics from Michael Shacklock, Shacklock. And there's another one coming up this year, which is part two, by the way, if you haven't taken that, um, I think that he might be coming around in June, uh, for a part one.

So, uh, I think he's coming around in June for part one, but, uh, that one is amazing course and it's very, uh, detailed, but it kind of goes through when, so when people have shoulder conditions or bicep once and rather than go straight to the area and start tissue working on it, we have to be considerate of, of neurodynamic considerations. Is there a, uh, occlusion of the IVF that, uh, where the, where the nerve comes out of the neck? Is the nerve swollen? Is the slide decreased? Because the nerve is really the boss. The nervous system is the boss. It doesn't want to be stretched beyond 8% or so.

And so again, I, I knew this. I've already talked to, uh, Michael Shacklock in this podcast before. He's on 91. That was a great conversation. But it just let me remember that I need to refresh some things. So when I came back to the office on, uh, on a couple days ago, I had two cases that I tried this on. One person, uh, he was doing pull-ups in, in the office and from his initial pulling movement, before he even got really a lot of elbow break, it was just the shoulder blade kind of started to activate like he was going to a front lever. Uh, his right shoulder just jumped, you know, it just jumped upward.

So he couldn't keep his shoulder blades packed. And what's cool, what's going on? He's like, yeah, I see that. And so there's a mirror right in front of the pull-up area. And I said, I said, yeah, you see that in the mirror, right? And he's like, yeah, yeah, cool. And, uh, I'm like, what are you, what are you feeling up there? And he's like, well, I got a little bit of neck tightness and it goes kind of into my mid back a little bit. And he didn't have any shoulder pain. And so I said, reach your arm over your head. And he's like, well, yeah, I have, um, some loss of movement in the shoulder. Maybe it's a tight lat.

Maybe it's, you know, so on. And so I said, look, why don't we just try, let's just try that same sequence. All right. So we did this, we did the chin packing, the McKinsey chin packing or the fat face. Um, we did the little matrix thing and, um, I had him test after that. He's like, oh, it feels okay. Um, there wasn't a big difference. So that was with consideration that maybe it was at the spinal area, but we didn't really consider whether it was a nerve slide issue or not. So we laid on the ground and we did some nerve sliders, some specific high tension nerve sliders. He moved his head. I moved his elbow and fingers.

Um, and I left the shoulder stationary and we did about 10 reps. He goes up. He's like, wow, that's, it's all gone. And I said, yeah, crazy. Right. And so he did some pull-ups. He did about three reps. Good, good, good. The fourth one, it creeped back in again. So I don't think you can expect miracles on these things, but that was a case where just over a couple of minutes, I mean, he's had that for a while. And, and I just forgotten and we've done Turkish getups. He just can't lock that arm. You know, he can't lock that elbow. He tends to drift the weight forward a lot. And I mean, I can coach him to death about punching the ceiling, but he just couldn't keep it, you know?

So there was, there was a, sometimes I actually took him out of it. We did, we did half getups instead because I really want him to take him through shoulder range of motion with some light load and some perturbation. But I, I didn't really want to load too much on, on the shoulder if he couldn't stack it. So I learned something from that. And then later on, a couple of days later, there was another shoulder case that came in that she's been a big, she's been a big, like neuro-based case if I had to classify her. Like she just, she's got numbness into the fingers, which is reduced with decompression of the neck or pulling long on it.

The McKinsey work worked really well with her. She also has some neuro-consideration sometimes in the leg from the back. And she just ran, randomly started getting this shoulder thing and she golfs. And I thought, I was thinking, oh, we're going to get this real quick. We're just going to do this. And I did it and none of that worked, right? And so I was like, damn, like I, I thought this was going to be it. And what worked with her was I just held her shoulder blade on, kind of assisted shoulder blade range of motion and that took a lot of her pain away as well as some tissue work. So I kind of got two extremes on that and, um, but it was, it's a learning experience and I need to make sure that to check out on everybody.

So through this course, I really started to, um, challenge my competency of neurodynamics and, uh, I need to get better at it. And I'm probably going to do a little bit of, uh, um, testing on, I'll do more testing on people and challenge that, that nerve tension a little bit more and lock it out. And I know, uh, Michael Shacklock is really, uh, really hard on the, uh, the sequencing to really get the nerve tension. Cause you can have false negatives, uh, a lot. So that's something that I learned at the course again, by the way, um, notice that I'm learning a lot of this stuff, kind of the side things.

And I know that, uh, Jeremy, you're probably listening. Remember that one time I went to that course and I said, Hey, let's go out and eat dinner. And he said, I don't know. Like, I don't, I don't, I don't want to go out and eat dinner. I'm a student. I don't have any money. I'm like, I get it. Like, but you go to these courses, you got to go out after you got to go out. You don't have to get wasted. You don't have to drink, but just go co-mingle or mingle with people. And you'll start to learn really the, the off the record findings that people have and, uh, really what's working for them. And what's in the course is great, but it's also very focused and narrow.

So all these things that I'm, uh, talking about today are things that I, I, uh, I wouldn't have, I wouldn't have learned if I just went straight back to the hotel room. So the last thing is, um, considerations of loading of the spinal lever. Now this was something that actually, um, Philip was, um, he was at the airport when we got in as well as, uh, uh, uh, Ben, Ben, uh, Ramos, Ramos, Ramos. I think I've said your name's wrong so many times. I don't even know which way the right way is anymore. So someone's going to correct me here. Ramos, Ramos. Um, anyways, we're talking about spinal loading and, uh, strength conditioning and just the overall idea of, um, loading the spine.

So they're talking about some Mike Boyle principles and actually to, uh, to be, to be clear and honest with you guys. So back in like 2008 when I was still an intern, uh, the guy that I worked with, he was all about Mike Boyle. So, I mean, I read a bunch of stuff from Mike Boyle and, uh, that's where I really became exposed to some of the principles of strength conditioning. Uh, I read part of his book, uh, back then. And then I'm sure I ran into some of this stuff too that we talked about and I thought, huh, I should really be considered to that. But at that point in my life, it didn't mean anything to me.

All right. I didn't have enough patience to really consider it. So it was just kind of an afterthought. So it was kind of those things you read by in a book and really not come back to. So this is just an example of maybe just reread some of the things or read, be re-exposed to some of the things that you've already done. And you might find a little bit more, uh, golden nuggets in there. So we're talking about, uh, Ben, Ben was saying that he had some, some issues recently with loading. He was doing some back squatting and deadlifting and, um, he was having some more back pain, you know? And so he ditched it, excuse me, burped, uh, I'm going to keep it.

I don't like cutting this stuff. Um, but he said, he said he was having a couple of issues recently with loading. And so he took that out and he started doing more of the, um, non back squat style with, um, Michael Boyle, Michael Boyle style and, uh, he sort of feel better, you know? And he said, the only reason he really trains and loads is to do jujitsu and rolling. So, and I would say that he, I mean, I like lifting, um, but I'm, I'm not married to the idea of a barbell or a back squat, but it's just what I've come from and, you know, remember. So I really lift so I can feel good, look good and play baseball.

And that's really it, you know? So I was looking back at, I said, started interesting me because we started talking about spinal compression, uh, axial loading versus lever or moment arm. And so I was like, well, what are you talking about? Like a, uh, a goblet squat is spinal loading. He's like, yeah, but it's not, it's not using the spine as a lever. And so I said, so, but the back squat is using the spine as lever. He's like, yeah, it's the bar's way up on the back as well as the front squat. The bar's way up on the back and it uses the spine as a long lever with the weight towards the end.

And the torque point, the port, the point where you would feel most of the load in that situation is right on the low back. So people tend to have the same story. They're like, I back squat and I hurt my back back in high school. I front squat and I started hurting too. I did some clean, then I had to drop the weight. Um, uh, and by the way, uh, a front squat's a little bit, uh, it's, it's better on the moment arm than a back squat, but I'll use it in the same category for now, just as general thought. Um, or I was dead lifting and I hurt my back. So people tend to have the same story. So it really comes down to risk reward.

So we're kind of bickering back and forth a little bit about risk reward with things. And he's like, well, it's not worth it to, for some people to do that. If they're not married to the idea of doing a back squat, because some people come in and they're like, I don't care about lifting. I don't care about any of that stuff, but, um, I, I just want to feel better. And so a lot of us, me included, we just come from a history of lifting and working with barbells. So it's like, you know, we've got a barbell over here. Why don't we start back squatting? And the person's like, I don't know. And like, so is it really useful to, uh, put that person into that situation that really when they really don't care about it and we can do it a different way.

So am I, my argument with this was, well, I think we should back squat some people, but not others. And, uh, I said, the people that I would like to back squat are people who are going to be exposed to it anyways. So there's a couple of college or a high school kids that come in who are going to go to college and they're going to get thrown into a weight room with back squatting, front squatting, dead lifting, and so on. They're going to get it. I have a, I have a 13 year old kid who comes in right now and wants to really work on his cleans because they're at school and football. They're working on cleans.

So I'd rather than them exposed to some high tension movements to mitigate the risk with it. But with people who are like, just want to feel good, look good, and don't really care about how they do it, maybe throwing them, throwing them into a spinal levered movement might not be the best. So some ways to decrease this based upon Mike Boyle's work, uh, and I, he really shook everyone a little bit. I think it was back in 2014 or so that he started to be a little bit more vocal about this was that he would take people, he would load them, but he would load them with a vertical spine or a less of a lever movement.

An example would be instead of a back squat, maybe we do a goblet squat because you're a little bit more upright, or once you get a little heavier in the goblet squat, which will eventually challenge your ability to resist the forward, uh, failure, the forward spinal failure, maybe we go into a split stance. So you'll see a rear foot, uh, elevated split stance squat with heavy weight. Uh, you'll see split squats, uh, in deadlifting, you might see trap bar deadlift or, um, uh, goblet squat deadlift versus a barbell. Uh, so you might see a lot of those types of things with heavy weight. Because once we get to the point, we're actually starting to challenge the spine with heavy weight.

We give it the opportunity to not fail in deflection. Like when you hear with all that stories with, I got hurt back squatting or deadlifting and so on. Cause that, that barbell is anteriorly loaded. Um, and it'll kind of drag people into flexion. The further out it gets on the spine, especially with the back spot, it just has, uh, a torque moment, which is, is much higher than if you had it closer to the actual, um, point. And if you don't understand this, uh, just to clarify, uh, if you hold your arm out and you hold a, let's say a bag of coffee, that's about 12 ounces or a pound, you hold it there really far out from your body, elbow extended.

And at some point you're going to get really tired really quickly. And if you bring it in close to your body and you kind of decrease the amount of distance between your body and that weight, all of a sudden you can do it much longer. And so that the torque is different. So what I learned through this course actually was, we're actually walking to, we were at the airport at that point. Um, and then we were walking to dinner, we were discussing this. So this wasn't even anything in the course, but I thought it was really interesting. And it started really challenging my thinking because, um, number one, I need to go back and read some of the things I read before and thinking about, I should, I should have known this, you know, and cause I have people with back conditions that are, that are not married to the idea of going to a barbell, you know, and, um, there's no reason to push them there unless they're going to have some type of exposure or mitigating risk with that.

So with those people, we can just split squat them, uh, rear foot elevated squat them. Um, I'm still, I'm still a little bit more biased to a, a, a single leg, um, type of dead lifting or a single leg, uh, or SLDL, uh, as well as a, um, uh, lateral lateral lunge and rotational or, uh, lateral squat, rotational squat, but these are kind of lighter loaded. They're just to challenge hip range of motion. But, um, yeah, it made me really think, I don't, I don't know if I need to be married to a barbell. So if they ask, I might start to go into it, but I think for everyone for a while, I'm just going to see and use boils, um, boils a smart dude.

If you haven't followed some boils stuff, um, he's a smart guy. He has a lot of experience. And then, um, if I were to take the rough takeaways that I've seen from, uh, this no squatting movement, um, his basic ideas were we're not bunnies. We don't hop around the field. We don't hop around life. We, we walk. We have one foot or the other foot doing the work basically at all times, except for in walking, there is a little bit of bilateral or, uh, two footed, uh, contact, but at the same time they're split, right? So we're not hopping around like bunnies. So why train like that? Uh, second is that, um, he, he said he had some really good experience with, uh, explosiveness and vertical leap, uh, through a single, uh, single leg leap.

Um, so performance improved. I mean, I know this is a whole different side topic, but really I know that we're working, a lot of us work with, we call athletic populations. They're, they're normal Joes. They're people, they're people that have regular jobs. They're not people who are professional athletes. There's far and few between that actually specialize and work with professional athletes. Just be realistic here. All right. I have a, I have a sports care facility. I just work on people who are, are, are athletic minded. All right. They're athletic minded because they want to stay active and healthy and, and they want to feel good, but they don't need to be trained like a professional athlete.

They're different. And then there's inherent risk with being a professional athlete, um, with barbell work, uh, and squatting. There's always this thing about, do I need to go to pass parallel? No, that's a, that's a metric for a, uh, competition or sport. It has nothing to do with, with what we need to do. Um, someone, uh, someone recently said, uh, well, we talking about this, this depth thing. And I said, I said, you watch football. He said, yeah. I said, uh, what if I told you to go out and, and hit shoulder pads with people, uh, a hundred times today? How are you going to feel? He was like, well, I'd feel pretty trashed.

And I said, well, let's do it. He's like, well, I don't want to do it. And I'm like, well, because it can carry an inherent risk. Right. And that's something that's specific to that sport that we don't need to do in our training. So squatting pass parallel, I don't think, or let me, let me rephrase that loaded squatting pass parallel. I don't think we need to do it. And I don't, I, I, I, I think that, um, we need to be able to differentiate between loaded ranges and unloaded ranges. You should be able to squat into a deep squat without weight, kind of like you're, like you're just hanging out, taking a break, smoke a cigarette, cigarette, not that I smoke cigarettes, but you should be able to hang out down there.

I can't, it's something I need to get better at, but that's also not a way to squat a lot of weight. All right. And so things change a little bit when there, when there's load involved. So again, this is not to sound preachy or telling you guys how to practice or how you can work with your patients or if your patients, uh, who are, um, listening to this, I'm not telling you how to live your life. I'm just telling you the things I've learned and the challenges, the, uh, the thought challenges that I experienced over the last weekend. So the moral of the story is go out and meet other clinicians and meet other people who have the problems that you have.

And I think you'll be surprised because a lot of us, um, have, we have different experiences and different biases and, and those kind of creep are, creeps are, uh, into our recommendations of how to, to remedy problems. Now, I think that's all I have for that part anyways, but this is, this is something that I've been thinking about for a little while anyways. And, um, I've had, I've had some of my classmates who I talked to on the phone. They're like, um, we're just brainstorming stuff, you know? And this is very tentative right now. So, so don't be upset if this actually doesn't happen. So we'll talk a little bit.

And then, um, some of them have said, whoa, you know, stuff, right? You know, stuff. So why don't you just hold a little seminar on this? I'm like, uh, I'm like, I don't know if I know that much stuff. So, um, I'm a little bit unconfident with my ability to, to share stuff with people. Um, all those podcasts have really helped me with that. And they're like, yeah, really, let's do it. Like, why don't you hold a little CE program, a continued end program, and then we just hang out and, um, and that's it. And so I started thinking about that might be a good thing, but also too, in my experience with seminars like this, I realized that I don't know everything.

And I realized that there's a lot of people, there's a lot of the clinicians who, if I started talking about McKinsey stuff, they're someone who, someone else might exclusively do that only in practice. And they got way more experience than I do. Uh, same thing with neurodynamics, same thing with tissue work, same thing with a lot of things. So I think there's an opportunity here where I was thinking about doing a little seminar with, uh, I want to start with my classmates who graduated from, uh, LACC in 2000, fall of 2008. Uh, I would love to just get everyone together and consider it kind of like a reunion.

And I mean, I do, I would have to submit a criteria to the credentialing body or to the accreditation schools to be able to get CEs for this. But I thought of it kind of like a brainstorming session. I know the things that I can help people with and with the things that I can help, um, uh, share and maybe shed some light on, but there's other things which I'm going to be shitty at. And I thought, why don't we just use this maybe as a workshop where everyone kind of shares, uh, what they would maybe do with a certain type of case. And we just kind of learn from each other and we just try to challenge each other's biases.

And the only thing I kind of used as a disclaimer was that I don't want any, um, I wouldn't want any tissue work as a first jump at a solution mainly because I know it does work so well with decreasing pain and increasing range of motion. And we all kind of know that, but I want to challenge, uh, since we all tend to tend to jump to that first or a lot of us jump to that first. So I'm going to challenge our biases and start to realize that, holy shit, a corrective exercise can make it feel better. Holy shit. Just bending backwards can make them feel better. Maybe I need to consider what I should be picking for this person because maybe I start doing, uh, I recommend it a different way so they can do it more throughout the week on them on themselves.

So anyways, I thought about doing that. If you're the class of 2008 in LA, uh, LACC fall and you've been in my class, um, I'd love to hear if you, if you guys want to do this and I'm probably going to do it in June. And quite honestly, I know that, um, I've reached out to a couple of people already. I said, look, you're going to have to pay in advance. I'm not going to make it that much. I'm going to make it cheap and think of it kind of like a get together and just a bro down. And they said, well, why do I got to pay in advance? I'm like, cause I'm not too married to the idea to share honestly, cause it's a little bit of work to, to submit to the credentialing body and it's a little work to put something together.

So I'm like, I just want to hear that you're in it and I want you to act like you're a really, like you're a perfect patient. I want you to pay in advance. I want you to show up on time, not have any damn excuses. I don't want to. And so I said, no refund policy because if 10 of you, uh, are in, I'll do it. And I think we can have a really good time and learn from each other and just bro down, you know? But if five of you cancel, I will literally shiv you and it won't be worth my time and my effort. And also too, I'll probably lose money in the process because it costs money to put something like this on.

So I thought of that. If you're thinking this might be useful for your class and you want to learn stuff that I, um, know, and maybe you are interested in getting your class together and share, I thought about maybe doing it like a class style. So reach out to me if that's something that's interesting you. Um, I know that I see my classmates about like five of them once a year, we do a Vegas football draft, but I'd like to make it more often than that. I mean, shit, like one of my, one of my best friend classmates lives around the corner. I hardly see him, you know, and, um, I want to see what he's doing and I know we all get busy, so I thought this might be a really good excuse to do 12 hours of CE, uh, seminar style, and then just throw down.

And so anyways, I, I think I'll, I'll stop on that right there, but, um, uh, email me Seb, that's S-E-B at P2, sportscare.com. Um, if you think your class might be interested in, uh, if so, then, uh, I'll, I'll put it on for you guys. And, um, lastly, again, back to it, buy the book. I do mean by the book, by the book, by the book, it will be helpful. If you're not sure, ask me for a free copy and I'll send it to you. Okay. Uh, I'm open to sharing this stuff and, uh, it's intended to help a lot of people, uh, get through back pain because this is a stupid epidemic that I think we can all, uh, agree that it's, it's, uh, you, we can help people out with that.

So just ask me for a free copy and I'll send it to you guys. And then that's, um, if you like it, suggest it. All right, guys, I'll see you next week and leave people better. how you found them, and date an Eagle Scout. Later.