Preventing Non-Contact Lower Extremity Injuries With Biofeedback

This is session number 75 of the Performance Place Sports Care Podcast. What's your favorite food? Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. Thanks for coming again. This is Dr. Sebastian Gonzales, if this is your first time. You know, I like to start off the podcast with a little bit of something lighthearted, you know. This time, I think food is amazing. Food is one of the best things in the entire world.

And I've probably gone back and forth on what is my favorite food, but my mom can probably tell you that hamburger pie is top on the list. There's a couple of things that have come a close second recently, but hamburger pie is amazing. And if you haven't had it before, it's basically in a pie crust. It has ground beef. It has, I think, chives. Actually, honestly, I don't know how to make it. There's sour cream, but it's baked. And so this hamburger pie is like the size of like an apple pie. It's just flat. It's not like a cobbler. And so the top of it is, it's mainly that cottage cheese or cottage cheese kind of blend stuff.

And you put a hot sauce, salt and pepper on the thing. Ooh, so good. I can eat an entire pie, maybe one and a half on a good day. So just in one sitting. So that is my favorite food. What is your guys' favorite food? I'd love to hear it. Put it on social media for me. So we are going to have on a guest today. And we're going to be talking about, this is knee month, by the way. So if you haven't heard the other podcast, On the Knees, you just need to go back and listen. We're talking about knee pain today with Dr. Colby Kondo. Kondo, kind of like the condo in the apartment complex you might live.

So we're going to be talking about biofeedback and lower extremity conditions. And that's going to be knees, ankles, hips, hamstrings, and so on. And the reason you're going to want to stick around as a patient or an athlete is because you might be interested to see that you can actually look at tests such as the star excursion test. And then you correct that. And there's actually a high, a very high prediction rate of injury, especially in D1 athletes. So this is the stuff that, like, you kind of wish you knew before you had the injury. So let's just talk about it now. Let's just make it known.

And that's what, that's why you should stay. Okay, so doctors too. I would love it if you shared this with your patients. And if you haven't seen it already, if you have not seen it already, all the doctors, PTs, and trainers out there, if you're using, like, old type of information, which I think are great, but I think they're a little bit archaic, netters, spine models, Merrick charts, things like that. If you're still using those, but you're still getting the same types of questions from your patients, like, you know, what is the core? What is the hamstring? Which one is it? Should I do this?

Should I do that? Then I don't think your patient education is doing as much good as you want it to, because realistically, I think people have, they're a little bit more educated about asking those questions now, because there's so much information on the internet, and there's also a lot of misinformation. So if you agree with a lot of the topics that I have here, let me help you with attacking the senses with my modern sports medicine patient education platform, okay? Go on to ptsportscare.com slash shop and just put your email in there. You'll get all of my images for free, at least web-based ones, which are anatomy-based ones, updated from Mr. Netters, by the way.

I love Netters, but I think it's a little complex for patients to understand. There's a lot of things going on. So if you have someone with just a knee condition, you might just want to share the knee. So there's back stuff, there's core things, there's intra-abdominal pressure, there's pain triggers, there's lots, lots more to come. So if you want to share these with your patients, just go on there. They're original content from me, and they correlate to the podcast here. So second part, attacking the senses, if you're looking for your patient to become more educated and understand their care better so they have a better outcome measure, this is the point of the podcast.

So if you're looking to share these podcasts with people, do it. Right there on the side of your phone, it tells you how to share it. So get that link right there and have your office staff shoot it out to your patients who have knee conditions or the ones that you, in this case, you might want to be talking about biofeedback with. Lastly, if you, we do sell those images on prints, by the way, and I've been talking about it a little bit more this year because, to be completely honest with you, doing, when I created these things, I had so much demand from other doctors. I realized that we have, in our profession, a lack of content to share with people that we, I mean, rehab has changed so much, even over the past five years.

So we need to update our patient information. So people just loved it. And I want to be able to allow them to put it on their wall at their office. Now, there is a small fee with it. This is just a part of my business now. It is something that you guys, if you want to give back, and I mean, this is one way to thank me for any of the content that you've liked. I don't expect people to give me money or anything like that. But if this is something that you guys want, by all means, you can take those images and do them for free. Those are the web-based ones. But if you want me to send a print to you, that's part of my business model now.

This year, my goal is to sell 200 of them before my birthday in June. So if you want to assist me through that, that'd be amazing. All right? With that, what you're going to get is I'm going to actually create a Google Doc with all of the podcasts categorized for your office staff or you to send to your patients. All right? So you get those second and tertiary level questions that I think are important, but there's no need for us to have the same conversation about what is a hamstring? What about the hamstring tendon? Why does the pelvis correlate to hamstring injuries? How did I get this? Things like that.

So those are things that I think can be dealt with with podcasts like this. And if you agree with all my content, hopefully that you'll agree with what I'm saying. I don't bash a lot of things on the podcast, but I try to only give the most up-to-date stuff. So if you want to go through that, go to my ptsportscare.com slash shop and just put in your email and you'll get all the stuff as it comes out. So the guest today, again, Dr. Colby Kondos, he was referred to talking to me by a couple of the people I've interviewed. He's a good guy and I've spoken with him a couple of times, but we'd never met in person.

It's funny, we missed each other a couple of times on podcasting for a while, actually. We've been planning this for a couple of months because he just got a house and he's a handyman. He's a handyman. He's a bow hunter. He's a fisherman. I mean, gosh, he said his house overlooks like a lake in Grand Rapids area. So, I mean, I imagine just sitting in a tree blind listening to this podcast. Colby, for doing that. I'm glad I predicted it. So, anyways, so he's a chiropractic functional neurologist. He resides up in Minnesota, Minnesota, and he grew up in Wyoming. So I'll tell you a little bit about that.

But he was educated through the Carrick Institute and he has a ton of things to share on biofeedback and his experience. He's very direct, very straightforward, and that's one great thing about him as a doc is he doesn't beat around the bush. He just tells it how it is, which is what we need more of. So I'm glad to have him on and I do plan to have him on in a roundtable conversation coming up later this year on some of the neurology-based topics. So without any further ado, Dr. Colby Condos. All right, everyone, this is Dr. Colby Condos, spelled like the condos in your apartment complex. So, Dr. Colby, hey, say what's going on.

Not much, man. What's going on with you? Nothing much. I'm staring at a wall as we do this. I want a bigger studio, honestly, is what I want. Yeah, I think that's generally what all of us want is more space and bigger house, fancier cars, something like that, right? Yeah. I think people actually, I feel like your conversation is better if you can be staring out at a lake with like mooses around or something, you know? Oh, yeah. Yeah, man. I live in northern Minnesota, so that's actually a pretty good possibility for me. So in your area, so I've only been to Minnesota one time, is it kind of, is it rural where you're at or is it like?

Yeah, I live in Grand Rapids and it's like a town, you know, hovers between that 10,000 and 15,000 people range, depending on the time of year. As far as rural, well, I grew up in like a small, small town in southwest Wyoming, so I guess to me it's maybe a booming metropolis, but for most people, probably more rural. How many people lived in your, was there a lot of people that lived in your hometown? No, like 1,200, I think. My graduating class was like 38 kids. Wait, that's at a high school or? Yeah, that was my high school graduating class. Holy crap. So it was pretty small and that was like, you know, spread out.

It's more like a ranching community, so it was really, really spread out all over the place. So when everyone got together for like a school dance, did you like dance with only 10 girls and that was like you maxed out before you came back around again? Oh yeah, and like 10, of the 10, like 8 of them were my cousins, so. Better reason to leave town? Oh yeah. We almost call that homeschooling. Yeah, exactly. It's like, hey, I'll see you at the family reunion tomorrow. Yeah, right. To your whole class. So, Doc, I want to have you on today because you presented some nice research to me about how to prevent lower level, non-traumatic athletic injuries, talking about biofeedback.

Can you, so when we go through this a little bit, can you make it really simple for patients to understand, but also throw in some gold nuggets for doctors to really love? Yeah, man, absolutely. So you look at athletic injuries and a large majority of these injuries are non-contact injuries. And you look at it and it's like, well, that doesn't make sense, right? So you're looking at like football players and you're like, how is someone getting a knee injury with no contact? You know, when you think about football, you think, you know, big hits and stuff like that. But the majority of the injuries to the lower extremity, at least, are actually non-contact injuries.

So the clinical gem basically is, you know, when I look at how these non-contact injuries happen, the thing that sets me apart is, I guess, I ask why. You know, is it a functional imbalance? Is there some sort of like neurological bias going on? You know, so as I dove a little bit deeper in the research, I found that there was some some things that kind of added up to kind of pinpoint people who are maybe predisposed to lower extremity injuries greater than somebody else. One of the big interesting things that I found is it's more common in females and also the status of the athlete. So if it's like, you know, a recreational athlete, probably not as likely to develop a lower extremity injury as someone who's like a, you know, a starting level lineman in the college, you know, um, so I thought that was really interesting.

Um, so yeah, I mean, so higher level, like I know that once it was a division one, uh, study, so higher level have a higher potential of non-traumatic injuries, the lower extremity. Yeah. And, and actually on top of that, they actually broke it down a little bit further. So, you know, people who are getting the starting reps or who are like with, you know, the, the number ones were more likely to develop a lower, a non-contact lower extremity injury than someone who was like on the practice squad or was red shirting. Huh. Oh, so I guess we should let everyone know too. We do plan on going into some things they can test and do on their own later.

Right. So they hang around. Yeah. Yeah, absolutely. Um, actually I should mention it too that, uh, so I don't know if it's your end or my end, but you know, like, you know, you call those like, uh, you call those info lines and when it's dead time, it sounds like someone's typing on the computer. Is it, I don't know if that's your end or mine, but I hear it. Uh, Oh, I, I don't think it's mine. I'm not typing on my computer or anything. So you don't have a call center over there that said there's someone next to you just clacking away at like those old IBM keyboards. Oh yeah. They're trying to sound busy.

Like, Oh, this call, this call center is stacked. So, um, how did you actually decide that looking into, like, do you have a story where like you wanted to all of a sudden, what was the one thing where you thought I need to look into biofeedback for these injuries? Well, so the area of Minnesota that I'm in is like a hockey factory, right? It's just, there's always, you know, kids getting drafted in the NHL and there's always kids going division one, um, hockey out of here. In fact, last year, Grand Rapids took state and hockey and they had, you know, three kids that are D one to recruits. And I guess really the big part for me that made me interested in like maybe the care and prevention of like lower extremity injuries is, you know, some of these guys are missing valuable ice time or, you know, you have a star basketball player and they go down with a non-contact injury.

And one of the things that really, really piqued my interest in lower extremity injuries, as far as like non-contact stuff was when the Vikings starting quarterback, uh, Teddy Bridgewater went down with a knee injury that was non-contact. And on top of that, it was his non-plant leg, um, that got injured. So I was really like, well, you know, what, what is that? Why, why is that? So I guess that's kind of how I went off on this tangent about researching, you know, lower extremity, non-contact lower extremity injuries. Bridgewater was like, that was like when you're watching football in the, he was in the nineties, right?

Well, Bridgewater was like last year, he was their first round draft pick, I think. Oh, I, I haven't been watching football in last year. Yeah. A couple of years ago, but he, he went down, I believe last year with a non-contact, uh, non-plant, you know, in his non-planting leg, uh, injury where it was so grotesque. Like they, they actually thought they were going to have to amputate at one point, I think. So that, you know, you, I just wondered to myself, how is it that this guy is like performing at the highest level of football and he goes down with a lower limb, you know, lower limb injury with no contact and in a non-weight bearing joint at that point, basically.

So, so I'm sure you've watched that video a couple of times then. I'm sure there's one out there, right? Uh, not that I, not that I've found actually. Really? Uh, so just a lot of like, I guess, recounts of the incident by teammates and, you know, training staff and stuff like that. So how do you think, like, what do you think actually went down with that? Like, man, it gets so complex at that point because, you know, your body is just a receptor based system basically, you know, and you're always getting feedback from your body, especially, you know, like joints and stuff like that. Um, so what, what I believe happened, and actually I talked through this with a professor from the Carrick Institute, which is like the neurology, uh, Institute that I did my neurological diplomate training through.

Um, and basically what it comes down to is you think, you know, where the receptor based system, you know, inside of our muscles are muscle spindles, you know, we have gold, gold, gold tendon organs, you know, we have Meisner corpuscles, Pacinian corpuscles. We have all these receptors that basically provide a map of where that, you know, extremity is in space. And one of the, the important things when you look at the extremities is, is muscle mass, you know, um, basically sensitivity and gain are inverse. So if a muscle is concentrically contracted, the sensitivity of that muscle goes up. So you have increased spatial awareness of that muscle around that joint, right?

So Bridgewater is at the back of his drop, his left leg is eccentrically loaded because he's getting ready to throw, right? Well, when you eccentrically load that muscle, you're no longer getting those, those muscle spindles firing as high. So the gain, the sensitivity goes down and the gain goes up. And I think that he basically just lost awareness of where that joint is and it just dislocated. Okay. So with, uh, how would someone get awareness again for any eccentric, eccentrically loading muscle or joint? Man, I, there's, there's a lot of different ways you can do it. And that's where the biofeedback comes into this.

You know, even if it's, you know, firing loops in your brain via visualization, that's a form of biofeedback. You could have the patient doing, or the, or the athlete or whoever doing, you know, exercises using resistance bands or weight or whatever. Um, there's just a lot of, of strategies that you can use to really increase, you know, the awareness of, of the joint and the lower extremities using various forms of biofeedback. Yeah. So when you were growing up, when you're, I'm guessing you're playing hockey, right? No, I, cause I grew up in Wyoming. We didn't even have hockey. I wrestled or is there biofeedback for wrestling?

Is there, is there a ways that you can give me some examples, I guess, of, of ways you can use biofeedback with say wrestling. I'm guessing you didn't when you were younger, right? I did biofeedback or I, yeah, I mean, or did you do biofeedback when you're in high school? Well, yeah. I mean, I, when you wrestle, you think a lot of it is just visualizing, like before you do it, you know, I'm going to do this, this move. So you're going to do a fireman's carry, you know, what do I have to do to do that fireman's carry? You know, and then you can just walk yourself through stuff like that. And then we would do a lot of, you know, like guided meditation.

That's a form of biofeedback. You could use, I, we used to do a lot of, um, you know, drilling in the mirror versus yourself, you know, basically like shadow boxing, only not with a shadow, you know? So you're, you're using the mirror in your own reflection and you're watching yourself do these drills. Well, that's biofeedback, you know? So I, I did a lot of stuff like that too. I probably wasn't as into it then as I am now because, you know, of the profession I chose to go into. Yeah. So how did your, how did your coach, um, decide to add those things in? Because I, I don't think in, so I played high school baseball and just started in a college and we didn't, we didn't really do anything of that I could think of that really was of that nature, you know?

Um, he didn't do it a whole lot. I don't, I don't think that it was as maybe, um, big then as it is, is getting now. Um, you look at all these guys who are like, yeah, I have, you know, I go to specialized trainers that do biofeedback, you know? So it's getting, it's getting more notoriety now that the people who are in, um, at the elite levels are doing it. But I would say when he, he would do a lot of stuff like guided meditation with us before, you know, duels against the other team, he would do a lot of positive self-talk. Um, and then even, even when we were drilling, he would be like, I want you to think about what you're doing.

You know, I want it, I want you to really, really break down the movement and then do the movement, you know? So helped not a lot of injuries. That's good. Um, so I guess I'm, I want to be able to paint a picture for people or if you can paint a picture of when you, when you go to someone who's trying to design some biofeedback, um, exercise or activities for somebody, is there, is there a certain protocol that you usually have to go and see that they're deficient in something or is it just kind of like you just throw these exercises in and that stuff? Well, this is, this is where the research came in a little bit.

So there is, there's a paper that I found, it's called the star excursion balance test, right? So they basically took this, this study and they designed this study to figure out if people were more likely to get injuries to their lower extremities based on the findings, right? So what this test is, is it's basically got, you know, two overlying X's so that the lines go out at 45 degrees and you have the patient barefoot and you have them follow the certain planes of the X, you know, like anteriorly. And then you measure, you know, from the center of it to their furthest distance of their toe without placing their foot on the ground.

So it's also like a balance test. And then they found that people who, you know, had let, who had larger abergencies side to side in their anterior reach were more likely to develop lower extremity injuries than someone who was closer side to side. Okay. So just differences of side to side, not necessarily. Yeah, absolutely. I mean, it's the study also found that people are not going to cause any sort of damage by using biofeedback. It's never going to, it's not going to hurt anybody, but the, the consequences of not doing it were larger than people doing it who didn't need it. If that makes sense.

Yeah. The, well, I'm thinking about that test there. So you get the intersecting, uh, intersecting X's, the, so you want them to go along that the line to the end point of the line. Yeah. So as far as they, as far as they can reach without putting their foot down. Okay. So does it matter where they actually touched down or the path they take to get there? Is there that part of the, so it wants to be linear. I'll actually send you a video to a website that I found. Um, because when I first found it, I'm like, you know, what is this star excursion balance test? So I had researched it a little bit more and I actually found a website that kind of shows, um, how the, the exam is performed.

So I, I'll send you that link and you can link it in the bottom of the podcast or whatever so people can, can see that as well. But it's, it's really, it, it breaks down, you know, components when you break down the test. It's like a lot of spatial awareness of where that limb is that's being tested. Also testing, you know, balance on the other side. Yeah. So I know that you guys, um, or functional neurologists, they seem to really have, or so they do eyes, eyes open, eyes closed, different, uh, perturbing factors, right. For tests like is, this sounds like this test doesn't have eyes open, eyes closed, or can you add that to it?

And, um, that's something you could definitely add to. I personally, if I were to use this, like in my practice, I wouldn't, I wouldn't have it as a standalone test. I would do it in conjunction with a lot of other stuff like Romberg's or Fukuda's step test. You know, this is, this is basic, basically what I would do is I would use it to, as a conjunctive test. Okay. Yeah. I, I looked at that study you sent me. It was, uh, it was, it was interesting to see at the very end that said it was roughly about 82% accuracy with predicting injury. Yeah. Yep. It was great. Yeah. I mean, it's very, it was a very well done study.

It seems like they, uh, took a lot of, uh, initiative to make sure that there was no biases as far as like between examiners and stuff like that. So they took a lot of steps to make sure it was a really well done, uh, study. So when I was looking at that, I kept thinking, cause I do, I do a test similar like it. I actually, funny, I call it stars test here, but, um, it's actually not, uh, I don't remember where I saw it at. I don't, I didn't see it on the study, but I've been doing it for a couple of years, but it's mainly just single X. I saw, I told him 12, three, six, nine, so on. Um, and well, I've noticed that some of some kids, and actually I, uh, I sent this out, uh, to Dr. Mike.

I sent him a video of this one kid doing even a Romberg's test. And I couldn't tell if he was just a newborn baby giraffe or if he just could not like, like he was only like 14. It's just, he just seemed like he had no coordination whatsoever. So I was thinking like with a test like this, is there, you know, kids are growing and they seem to have no control of their limbs until they hit past puberty. Is, is there some type of, I know this was on D1, wasn't it? Is there, can this be done with youth or is there like a exclusion to it? Yeah, no, I, I think that it's valuable to everybody, you know?

Um, yeah, they're uncoordinated, but that can also maybe help guide you in the direction that you want your therapy to go with that particular, you know, individual. Um, my wife has a patient, my wife's also a chiropractor. My wife has a patient and, you know, this kid is like 13, 14 and the kid's, uncoordinated. He's always injured and this is, uh, some stuff that we've looked at implementing with him and he's, he's gotten some good results with it as well. Um, so I don't think that it really has an age limit per se, but I think that the way you apply your findings is going to, you know, dictate a little bit how you apply that.

Yeah. I saw the other study you sent me was on, um, it was basically on ACL prevention, right? Right, right. So can, can you go into a little bit with, I know neuromuscular training, has been around a little while for ACL injuries and, um, I did have someone else talking about it on a podcast as well, but, um, we, we were, we came to the conclusion that it seems like that the information has been out there, but then coaches don't always adopt it. Um, right. So can you, can you give me a little bit more on, on neuromuscular training and why it works with knee injuries and ACL and so on? Yeah. So, uh, when you look at that study, all right, I've read those two studies so much, it's kind of hard to, I can't remember what's in what.

Basically what they're finding is knee ab, abduction movements are what are causing ACL tears, you know, um, so I think it says like between 70 and 80% of all ACL tears are non-contact. So that just shows me that people don't really know where their joints are at in space or they're not loading, you know, they're not using proper biomechanics when they're performing a certain movement. And it also shows that, you know, females are more likely to suffer an ACL tear. Well, why is that? You know, they have a little bit more valgus, the very variabilities, um, in their lower extremities. So how would you, I'm, I'm way off topic here, I guess.

What, what was the exact question? I can't remember. I don't know. I have a tendency of doing long winded questions. Um, the, the, the last, the last dude I actually interviewed, I asked him like a three part question and he formulated it together into like a good essay. I'm like, dude, you, you're probably great at the, uh, AP tests in high school, you know, just writing random. Um, so, so I guess my, uh, I wanted you to explain a little bit with a neuromuscular training and why, like correlate into biofeedback and why it helps with preventing knee injuries. Right. So big thing with preventing knee injuries is going to be like, A, do they have an imbalance?

You know, what is the imbalance? What are some exercises or biofeedback mechanisms that we can use to correct those imbalances? And how do we implement them? That's kind of what you want. Yeah. Okay. So, you know, identifying it, you can use a variety of stuff, you know, like the scar, star excursion balance testing. That was a really good one. Um, you can go through, you can like visualize when they're breaking down, um, regular athletic movements, squats, jumping, stuff like that. Um, and then you also have to be sport specific. You know, what a soccer player uses is not going to be the same basic movement as someone who plays tennis.

You know what I mean? Um, so you have to look at the dynamic movements within the sport, I would think. And then as far as like implementing it, well, once you've identified in an individual what those imbalances are, you know, you can develop a set of strategies to kind of correct that. You know what I mean? So if you have a patient, for instance, say, say you have a patient who can't do the star excursion balance test because, you know, every time they stand on their left foot, you know, to reach, they fall. Well, is that because they're right? They don't have any awareness of where their right foot's at or is it left foot?

You know, I would, I would argue that, you know, standing on your left foot would be more of a left cerebellar test. So then you can explore other options to like confirm that, um, you know, okay. Yeah. She rotates to her left during Fukuda's test. You know, when you put her in a Romberg's stance, she falls to her left, you know, um, she has all these findings that indicate left cerebellar stuff. Well, then you can kind of add a junk therapies to stimulate the left cerebellum, whether that's like extremity adjusting or, you know, complex movements on the left. So there's a lot of different ways of applying biofeedback and it's just applying it in a manner that's really targeted.

Um, so I guess there's not one size fits all for every single patient unless you want to do, you know, you know, five exercises. Yeah. All five, you know, if you do five exercises with resistance bands, kettlebells, you know, putting them on a perturbed surface while catching a medicine ball in a squat position, like all that thing would benefit people and it's not going to hurt them by any means. But once you have the findings for the individual, then you can really tailor your treatment plan to that one specific person. And now a word from our sponsor, Health IQ. Did you know that higher levels of physical activity like running is actually associated with reducing risk of seven, seven different types of cancer?

And it's actually around 20% roughly. This is a big drop. Health IQ knows this and they know that you're an overall healthy person. So why not pay less for life insurance, contact them and take their lifestyle quiz to see if you qualify for special rates on life insurance. Health IQ is an insurance company that helps health conscious people like runners, cyclists, weightlifters, and vegetarians get lower rates on their life insurance. To see if you qualify, get a free quote today at health IQ.com slash performance or mention the promo code performance. Okay, so let me, that was a bit right there.

Let me just, I'm going to ask a couple of questions that probably people that are just general public are thinking. What is the cerebellum? Okay, so the cerebellum is a chunk of tissue at the back of your brain and it's really involved. We're just beginning to really, we're still getting new information all the time about how pivotal the cerebellum is to like cortical function and stuff. But, you know, as far as like what really the layman can think the one major function the cerebellum affects and dictates their everyday life is balance, you know? So if you have poor cerebellar function, you're going to have poor balance.

Okay, what are some things that can affect someone's cerebellar function, like say they have full control of it when they're younger, but all of a sudden they lose it? Oh, I mean, traumatic brain injury would be a big one. You know, there's people who have like an Arnold Chiari malformation, which would be like, you know, where you get part of their cerebellum going down through the hole in the base of your skull. There's a lot of things that can do it. Some stuff is just like a functional thing where they develop like, you know, one side develops a little bit harder than the other. I mean, you can go as far in detail as you want.

There's a lot of stuff. There's a lot of stuff with like, you know, immune reactivity that can affect the cerebellum. It's just, it's a can of worms. Okay. So it doesn't have to be a trauma-based thing. It could be... No, nope. Okay. Because I know that actually I've spoken to Dr. Mike about, by the way, everyone, if you want to reference, I think that's 30, no, I think it's 42. I'll put the link below in the show notes as well to the other interview I'm referencing. She was talking about Romberg's test, or you've spoken about Romberg's test. Can you explain that a little bit? Because you've said it a couple of times.

Yeah, so Romberg's test, you can do it on a perturbed surface or not. I prefer it to do on both. And then I actually like to do it with their eyes open and eyes closed because, you know, visual loops and stuff like that. Basically what it is, you have the individual take their shoes off and they stand with their feet as close as they can together. And you just observe the sway of the patient, you know, and it's really the initial direction of the sway that you're more interested in. And yeah, I mean, they sway into the side of, this is, you know, simplifying it a bit, but, you know, they sway into the side of the soft lesion or the, you know, the underperforming cerebellum, we'll say.

Got it. Yeah, I know it's a huge, a huge conversation, isn't that? Oh yeah, in itself, it's so crazy. Yeah, I texted a couple of people and I just said, because I was looking online, I was looking for, I don't know, I don't know why I was looking it up, but I looked up Romberg's test and it was, it was this really, I found a, I found a page that wasn't really amazing. So I wondered why everyone was searching it because there was a large search volume for it. So, so I text a couple of people and I said, can you tell me about Romberg's test and what you like and don't like about it? And they're like, can we do a phone call?

Like they, they wouldn't like text back because it was going to be so extreme. Yeah. It's so in depth. It's crazy. And it's so useful. It's such an easy test. I mean, you don't have to have any special equipment for it. You know, take your shoes off, put your feet together, close your eyes. Yeah. The, so going back to all that, the, like the stars, excursion test and so on, can you list, because I know we've, we've jumped around a little bit. Can you list a handful of things that can affect someone's performance on that? Yeah. So obviously because it's a single, uh, foot, you know, that's, that's holding the weight of the other extremity that the cerebellum can affect that, you know, um, somebody, you know, if you have, you know, tightness in the muscles, they're not obviously not going to be able to reach as far.

So, you know, two big ones would be changes in muscular tone. And then the other one would be it's changes in balance side to side. If I was to pick out two of the largest things that I think that could really influence that test, it would be those two. Mm-hmm. Okay. Um, and in regards to like, if someone were to implement some corrections into their program, how, how often do you think they really need to do it to see a change? And then, um, how long should it take really during the session? Well, you know, everyone's different. So, I mean, you covered neuroplasticity a little bit with Mike when I was listening to that podcast, um, which was awesome by the way.

Yeah, that was actually the highest, the second highest, uh, listened one, actually. Yeah, man. Mike is a smart guy. Um, but basically what you could look at, there's three ways of building, you know, neuroplasticity, we'll say, which is going to in turn affect this, you know, the outcome of this, of this test. And basically that's frequency, intensity, and duration. You know, it's just like going to the gym. If you go to the gym every day, probably going to get a pretty sick six pack, you know? If you go to the gym one day and you do 5,000 sit-ups or whatever, you know, yeah, you'll probably get some gains, but you're just going to be really sore.

Or you can go to the gym and try to do one sit-up with, you know, 800 pounds on you, which is also not going to build the six pack abs, you know? Yeah, yeah. So the more frequently somebody does these, obviously taking into account rest and recovery and stuff like that, but the more frequently someone does, you know, the targeted biofeedback, the better the results they're going to get. So during this, the study, I think they did it for three times a week for six weeks, I believe, and they had really, really good results. They had a drop in the occurrence of athletic injuries and stuff like that.

So I would say minimum three times a week, you know, would it be a good starting point to implement it. Okay. So that sounds easy. That's like, I mean, actually, I should ask, I'll ask you this. So I've looked at before on the, so the American College of Sports Medicine website, they have like a, like a very basic ACL prevention program. So when people look up things like ACL prevention, then how is this any different or is it the same or does it have aspects of each other, really? Probably both, right? They probably have similarities and differences. I guess the one thing I'm trying, that I think we need to take into a greater account is the individuality of the patient or the individual we're testing it for, right?

Is because, you know, the imbalances that you have are not the same imbalances I have. So why would we do the exact same, you know, program? But that being said, if you're doing one and you send it to me and I do it, I'm still going to get gain out of it, you know? You were just saying it wouldn't really hurt you, but it wouldn't help you as much as if we tested and found your deficiencies? Yeah. Or as if we tailored that specific treatment plan to the individual. Okay. Tangent question. What type of repairs are you doing on your house since we spoke? Oh, man, I totally bit off more than I could chew on this house.

So I'm a little bit of like, I guess, a handyman or a jack of all trades. So I bought this house that was built in 1906 and I completely gutted it, moved walls, rewired it, re-plumbed it, re-drywalled it. So right now I'm currently working on like the finishing touches on taping and muddying so that I can get textured and painted and refinish the floors. And it's been a total nightmare. And I had a baby during that time. So I'm like, what the hell am I doing? Oh, wow. Did you do like a whole like baby room and everything like that? That was like number one? Yeah. So actually, we're not even living in the house right now.

We're staying elsewhere while I'm doing this because it was such a major renovation, but I'm hoping that I'll have her buttoned up here in like the next three, four months. Are you doing it on your own or are you giving people pizza and beer to help you out? Oh, man, I'm doing most of it by myself. My father-in-law helps me and I got a buddy that helps me quite a bit. But for the most part, I'm on my own. Yeah. I, I, I, I've done some repairs. I think we spoke about like, I don't, I think the worst, the absolute worst that I would ever want to do again is mudding. Oh, it's so bad, so bad. It's so tedious too.

And I'm a little bit like a perfectionist. So I'm like, oh man, that's got a tiny little ripple right there. You're going to be able to see that. She's like, my wife's like, no, you won't. We're going to text you over. I'm like, nah, got to sand it. Put another coat on. I bet, I bet you have nightmares of that yellow sponge that you just keep wetting and just like, oh yeah. With your wet sand and you're like, man, I look, I look awful. I got all this dust everywhere and I'm just muddy. Yeah, it's the worst and you can't even like do it all in one setting. You have to just wait. It's literally like watching mud dry.

Yeah, literally. Plaster though, I think. Oh, it's so bad. Oh gosh, I feel like, I don't, I, I think we should go into maybe some, you said you had some corrections for people to do or some, I don't want to, I never want to give anyone like the idea that they can rehab their own stuff, but, um, what do you, what do you use with your people and do you have any examples of them improving from it? Yeah. So I use a lot of, uh, like mirror stuff. I use a lot of mirror therapy where I'll have somebody, you know, do a certain movement while watching themselves in the mirror and then I'm actually like guiding them through it using voice commands.

That's, that's a big one, um, because then they can kind of internalize that and start to apply that. I use a lot of bands actually. So I'll use, uh, like their bands and I'll make them do, you know, the athletic position while they're shuffling or whatever. And I'm talking them through it. We have a, um, like we've videoed people before why they're doing it and then they have them break down their own movements. Um, yeah, I mean, it's imagination is the limit. Basically, if you can figure out a way that you can, you know, prime that system, I guess, then the better results you're going to get and also doing it frequently.

Right. Yeah. Well, it almost sounds like you're having a, like I've actually had a guy do this, do this yesterday. So two people in the office have them to be happen to be doing the same, uh, same rehab and, or the same one rehab exercise at the time. So I'm like, Eric, this is what we're going to do today. And I said, look at that guy. What do you think he's doing wrong? So I was making him break it down. So is it kind of like you're having them build awareness of almost how to coach it so they can do it with himself? Yeah. So for instance, I had one, one, uh, my, my brother-in-law's in high school and I was helping their, uh, basketball team with an out off season weight program.

Right. So I'm like, I want you, there's this one kid, we'll call him Joe, you know, Joe's doing this and I'm like, you gotta do, you're going to injure yourself because your weight is too high and you have terrible form. Right. So what I made him do is I literally just made him do the movement with no weight in front of a mirror so I could show him what he was doing wrong. You know, I'm like, I want you to do it 15 times. Perfect. And then we'll think about putting weight on there. Well, after I had him watch himself do it and that, you know, that, that movement got ingrained, so to speak, he was able to do it with weight.

Now I didn't let him go up to the heavy weight that he was using, but he was able to do weight doing that movement appropriately. So it was, it was a squat is what it was when he was squatting. He was really getting like a medial deviation of his left knee. Well, when we took him out and I made him just do it in front of a mirror, I'm like, now watch that knee. Don't let him move. You know, don't let it go medially. And after he did it 15 times in the mirror, we added a little bit of weight. He's able to do it. And we kind of built up from there. Yeah. Was, was he, was he irritated that he was not up to his weight that he was already playing with or?

Yeah. I, I think that at that point, you know, especially males in high school, they always want to be like, you know, the tough guy. They want to do the most weight and stuff like that. And you just kind of got to preach to him. Like it doesn't matter the amount of weight if you're doing it wrong, you want to do it right. And also you don't want to injure yourself trying to look like, you know, a total stud in the weight room in the off season and not be able to play. Yeah, I agree. I, I have a couple of people that, uh, that have come in here that they, so they asked me to assess their, their deadlifting or squatting form.

So I just leave an empty bar and, or I give them a dowel first to start with too, sometimes. And, uh, so they do it really crappy and I'm like, what's the deal? And they're like, well, there's, there's not enough weight on it. I can't, I can't get any feedback. I'm like, I don't think, I don't think it really matters. You should be able to control your body weight or not, you know? Right. So, but I don't know, I don't know how many years it takes them to finally realize, or if it takes them one good injury to start respecting their body or not, but I don't know. Yeah. And I mean, people use biofeedback all the time.

They just don't really realize it. Right. So you're doing it right there. Yeah. I don't, I don't know. I'm doing it. I'm just, uh, I don't know. These fancy words that you guys have, man. I never use them. Well, and it seems like there's not one good cookie cutter answer for what is biofeedback. You know what I mean? Yeah. Bio, life, feedback, feedback. Yeah. I had this, there was an article I was reading. It was on external, internal, uh, cueing. And then there was another one. I forgot. I thought it was intrinsic. Um, but it was basically me telling you to screw your foot into the ground for talking about squatting.

You, you thinking about spreading your, uh, like turning your hips out versus not thinking about it and your body is knowing what to do. Um, and they were just saying it took so long. It took like professional athletes years and years and years and years of practice to finally be able to do stuff without thinking about it. Um, so I don't know if you have any experience with, uh, uh, timeline of when it finally kind of sticks. Oh man, I, like, I, I couldn't even venture a guess. I guess it depends on the person. Depends on their, you know, everything. Metabolic capacity of their brain depends on the amount of activation you get.

Depends on, I mean, there's so many factors that go into that. All's I can say is the more often you do it or like the more frequently, the better you're going to get at it, right? Yeah. With, with upper extremity conditions, what's your, what's your experience with biofeedback in, in upper extremity? Well, this is a, I guess this isn't, it's not necessarily an injury, but so I did have a, I have a patient that actually came in, she was referred to me by another physician, by a physical therapist and she had developed a frozen shoulder, right? And then on top of that, she also developed complex regional pain syndrome in that side.

And a lot of what I did with her was biofeedback, right? You know, 1.2 points. What does this feel like? You know, and then I would have her watch it in the mirror. So is this one, you know, is this one, one point or two points? You know, um, I'm going to draw a letter on your arm. What does that letter look like? And then she's watching in the mirror. Oh, that's an F or whatever. Um, and we got really, really good results with that. Um, yeah. So, I mean, you can, you can, I think that you can use it wherever you want to use it, you know? Wow. I, so actually, I know that this is the I will be off topic, but is what is, so can you explain complex regional pain syndrome?

Cause that one's like, like, I wouldn't even want that in my office. Like it freaks me out. It's, it's, yeah, it was, it was a difficult case for sure. It was fun though. You know, when you get those hard cases and you're like, all right, I'm just going to take it low and slow and figure my way through this. Um, so basically what it was is it actually started out with this particular patient as tennis elbow. Um, well then the tennis elbow, you know, slowly migrated up into the shoulder and then the shoulder, she developed frozen shoulder. And then all of a sudden she couldn't even use her right arm at all because like, if she tried to grab a pencil, it would shoot pain all the way up her arm.

Um, so as far as like what it is, well, I mean, it's a compartment that's, you know, in pain a lot. You can, can you even touch the skin? Uh, with her, I couldn't to start. No, no, no, no sort of like tactile stimulus or anything like that. She, she was an absolute wreck with that. Um, and it, it took me a long time. It took me like eight months to get it, you know, to where the point where she was functioning at like 90% of pre-injury status, we'll say. But prior to even coming to me, she'd had it for over a year. So it was like total nightmare for her, you know, she was, uh, she was, she's a high up professional and she was like, I'm thinking about quitting my job.

I can't do what I'm supposed to do. Like I'm falling behind, you know? So it was a, it was a really debilitating thing for her. Yeah. So explain how then biofeedback would help with that. So, you know, this is simplifying the case a little bit cause it was difficult, but with her, I, I, she had no sort of spatial awareness of where that arm was at. You know, one of the things that I found really, really interesting with her was when I would do a test where I would like, all right, close your eyes. I'm going to bend your hand up or down, you know, bend your finger, you know, I'm going to flex your finger, extend your finger.

I want you to tell me what I'm doing. I'm like, all right, what is that? And she's like, I'm not really sure. It was only almost like she developed a hemi neglect or she was starting to ignore that, that whole extremity. So then I would literally have her watch me doing stuff to it, you know, like at first it was really light. So I took a, you know, paintbrush and I would paint her arm and I'd be like, I want you to watch this. Now, should that hurt? You know, no, it shouldn't hurt. It's a paintbrush, you know, so I, stuff like that. And then we moved up to, all right, I'm going to take this paper clip and I'm going to touch you with one end of it or both ends of it.

You know, I'd bend it like a horseshoe, like one, one side, two sides, you know, and at first she couldn't do it with her eyes closed. So I would have her watch me and I would have her verbalize it. All right, that's one point. All right, that's two points. All right, one point, two point. We work our way up. I was really, you know, a big thing too, is I adjusted her extremities. You know, if you don't know where a joint is, there's not much better feedback than giving, you know, an adjustment to her fingers, elbow, shoulder, whatever you want to do. Now you have to apply that in a very, you know, delicate manner because someone with complex regional pain syndrome, the last thing you want to do is fire that up by giving them a big, you know, glenohumeral adjustment.

But yeah, I mean, we did a lot. I did a lot of stuff with biofeedback in her upper extremity via like vision and proprioception too. So what was her homework kind of the same stuff? You just give her a toothbrush and a, or paintbrush and a paperclip and she had to do that pretty frequently, I'm guessing, right? Oh yeah, yeah. I saw her a lot too, to start with. You know, in my practice, I like to see people a lot initially and then I kind of like to teach them to do a lot of the stuff at home so that they can, you know, not become extremely reliant on me. But it, yeah, I had her doing a lot of stuff like that.

I also had her doing some other stuff that I'd found during her neurological exam. Um, but that's probably topic for another podcast. So, so with that kind of case, um, I know that's an extreme case. Gosh, I feel like this should be like a whole, it should be like a whole different podcast. Um, with a case like that, and I'm sure she had lots of things going on. She probably had, um, probably want to move her arms. She probably had tissue tightness. She probably had a lot of things. Oh yeah. Why, why did you choose to work with the neurological system first? Um, because I guess that I think the way I see it is your brain sets the tone for everything, right?

Um, so it's like, if you have a, that, that, it comes back to that why question. Well, she's got increase in tone in the right side of her body. Well, why is that? You know, is it one day that she woke up and she's, her muscles were just like, I'm just going to tighten up for no reason. No, there's some, you know, their brain is the one sending the stimulus. Um, so that, that's really why, I guess it's like that whole top down thing. The brain sets the tone for everything. So if you can influence the brain, then you can influence the systems. Mm hmm. Um, so I'll, I'll migrate a little way from the, uh, the shoulder case since we were talking about lower, I guess the topic of this is lower extremity.

Yeah, it can be whatever extremity. How's that? Yeah. I always think actually when I was first, um, starting practice, like I, like I, it was easy for me to talk to patients about like lower extremity conditions. Um, because you can talk about closed chain, right? You can say this correlates to this cause of that and blah, blah, blah. But arm, arm, elbow, shoulder were a little bit tougher for me, especially wrist. Oh yeah. So. Yeah. You know, I don't know. It's, uh, I still have a hard time doing it unless they're going to, unless they're handstand athletes, you know? Right. Um, so, so going back to the, uh, the non-traumatic lower extremity stuff, then, um, what type of athletes, is there one of them that you can think about that would be an exclusion to this?

They would be excluded to benefit from biofeedback or learn how their body moves? No, I, I don't, I honestly don't think so, man. I think any, any athlete, especially one that wants to perform at a high level could definitely benefit from doing biofeedback. Um, you know, it doesn't matter if you want to be, you know, a swimmer or you want to be a badminton player, you know, hockey player, football player. It doesn't matter. You, you, there's athletic and dynamic movements involved in every single one of those sports. So I think that, I mean, maybe not for, you know, probably not going to develop a lower extremity injury in swimming, but it could happen.

You know, if you're doing a kick turn. Yeah, you're right. It, it, it definitely could happen. So, I mean, I think that any, any athlete could really benefit from, from doing stuff like this. You know, I remember we talked about on the phone, on the phone a while ago, it was, it was about matching where, let's just say we're talking about throwing a football to somebody. Wasn't it matching where the football was going versus where the eyes were tracking versus where they would step or something of that nature? Cause that was an aspect of, uh, we consider that biofeedback then? Well, I mean, you could, I guess.

That's the, that's the problem is like, no one has a good answer. Okay. I can't wait to have that on that three-way conversation. Just what does biofeedback go? Yeah. It's like, oh, it goes here. It goes to your parietal lobe. No, it goes to the occipital lobe first. Well, it goes, you know, temporal lobe through auditory stimulus. Well, it probably goes all three places. Yeah. So there's, go ahead, go ahead. Oh, there's just so many places. I mean, it goes all over the place and it just, it just depends on the way you want to utilize it. You know, you know, using biofeedback through, you know, proprioception or something like that is not the same as using visual cues.

You know, it goes to different areas, but it, if it works, it works, you know, who cares how it works if it works, I guess. Okay. Yeah. So for everyone that does that, that we're alluding to the idea that we're going to have a group conversation actually, and this would be the first one with, um, with all the functional neurologists that I've had on so far. So three of them, and we're going to discuss all these, uh, topics and you're going to be one of them. Yeah. I'm looking forward to it. I love Eric and I love Mike. They're both super fun guys. So it should be a good time. Oh, it should be amazing.

I assume this is, it's not to say like my job is hard to, to be the moderator, but I'm not going to have to say a thing. No, no, um, no, you'll probably have to fight to squeeze a word in edgewise. You're probably right. I'll probably have to, I'm probably going to go like, I'm just going to start snapping at you guys. Okay. Changing topics now. Um, is there anything that you think we've missed so far on, on this concept? Um, no, I don't think so. I think that the take home point that I want, like everybody that's listening to really know is that, you know, people can benefit from biofeedback, but I think that people can benefit more from targeted biofeedback.

I think that if you apply feedback based on findings of the particular individual, you're going to get better results than if you do a blanket treatment plan. You know what I mean? Yes. So that's about the only thing I would really like to emphasize, I guess, is that you don't treat, you don't treat the injury, but, um, after it happens, if you can prevent it, you know what I mean? So if you look at a patient and you're like, man, this guy has a really, really poor, you know, anterior reach during the scar, you know, the scar, uh, excursion balance test, you know, look at some stuff that can address that and look at for some possible causes as to why that can, can happen.

Because if you can correct why it's happening and adjunct to doing the therapies to prevent the injury, then you're just, you know, it's a win-win on both ends. Mm-hmm. So earlier we talked about giving them very, I know we alluded to it already with some of the mirror stuff and everything, but what are, what are three things that someone can easily do within five minutes or so? Uh, let's say five minutes each where they can work on biofeedback if they had a positive stars excursion test. Yes. Okay. So, you know, a lot of it would be working on their balance, I would say. And that would be like, you know, standing on a BOSU ball and watching themselves in the mirror.

Um, you could do one leg, then the other leg, then both legs and trying to do squats on there. I'd probably take you five minutes right there, right? One leg, other leg, both legs, squat on the BOSU ball. Yeah. When you do both, when you do one leg at a time, it takes forever. Yeah. So it's like, that's five minutes easy. Um, another one would be like doing box squats while watching themselves in the mirror, you know, make sure that there's no sort of deviation of the knee when they're, uh, when they're doing the, the movement do, you know, three sets of 10, that's like five minutes. Um, and then what'd you say three, three, three, yeah.

Um, then you could do stuff like a dynamic movements with kettlebell, or you could do, uh, um, you know, like a thera band and wrap it and really work the external rotators of the hip by, you know, wrapping the thera band around it and doing shuffles both directions, you know, that's probably five minutes right there. Okay. It sounds like, so it sounds like all of them really don't require too much weight or load, right? No, no. I think as far as like, I mean, obviously the, if you increase weight, it's going to increase the amount of feedback you get, right? Because you're recruiting more muscle spindles, you're, you know, the Golgi tendon organs, the joint mechanoreceptors and all that are firing, but it doesn't necessarily have to be with a lot of weight.

Okay. Um, I have only a few more questions for you. You ready for them? I hope so. Let's do it. Okay. What is your favorite dinner? My favorite dinner? Oh man, I'm a steak and, steak and greens kind of guy. My father-in-law's a butcher, so I get like prime cuts of meat all the time. It's awesome. Oh man. I bet you got, you got good meat up there? Oh yeah. Yeah. I love hunting too. So like venison steak's always good too. Have you ever cooked anything on like a, I guess these are other questions. Have you cooked anything on a salt block? On a, I have not. Yeah. I, I don't, I just tried recently.

I tried a couple of weeks ago and it was ground beef, which is a really not, or sorry, it was ground, it was a ground bison. And it, you're not, I don't think you're supposed to have everything touch the salt because it was the saltiest fricking meal I've ever had in my life. Like I couldn't do it. So I think you got to have really thick steaks. Yeah. That would be good. Yeah. Okay. And you would rather than, would you rather buy a steak from the, from a steak house or would you rather cook your own? Nah, man. I'd rather cook my own. Okay. Just, I, I, I agree with you. I don't see any point in going to steak houses.

They don't make steak as good as we do at home. That's right. So, uh, lastly, then how can everyone reach you? Do you have any social medias and so on? Yeah. So, uh, we've got a couple ways of reaching us. Uh, we have a website online. It's Northlakeschiropractic.com. Um, our Facebook page is Northlakes Chiropractic and Functional Neurology. Um, and yeah, those are the two best ways of getting ahold of us. Okay, cool. Are you, are you active on any social media? People reached out on that or? Ah, Facebook's about it, man. I'm like totally technology illiterate. Yeah. I think you're better off.

I, I only, I only respond to really one. The other ones I just kind of like let it fly. Like I'm sure we have a Twitter or something, but I, I don't know that I've ever like even turned it on. It'll take away so much from your mudding time. It's not even worth it. Oh man, I hate you so much. Now I got, just got to think about that for the rest of the day so I can go home and mud my house some more. Oh man, it's going to be amazing once it's done. And the only one who's going to see any of those imperfections is you. I know, but I'll see them and that's the problem. You better get a lot of wall art.

Oh man, yeah. Lots of paintings. A lot of mirrors for biofeedback. There you go. Okay. Actually, one more thing. Sorry. So is there, do you have any video references of any of this stuff or do you have any of them that, uh, in case people want to see the test? Yeah, so I'll, uh, actually I have it up on my computer. You can basically just Google star excursion balance test and there is a single leg balance test on there. I can also send you that link in an email so you can link it at the bottom of the podcast if they want to see it. Okay, cool. Okay. Um, just hold on right here then I'll come right back.

Okay. Okay, everyone. That was Dr. Colby Kondos again. You can reach him at northlakeschiropractic.com and if you're ever up in Grand Rapids, you should just stop by and say, Hey, I heard you on the performance-based sports care podcast. You, um, yeah, you like mudding, you like mudding your wall and just say, Hey, can I mud with you? So if you're looking for the show notes on this or any type of videos or studies and articles that we talked about, go into p2sportscare.com slash podcast slash pounder hashtag. I don't know what age group you are, so you might think that's a hashtag and then put the actual numeric of what podcast this is and you'll find all the stuff right there.

Now, if you're a doc, a PT or a trainer and you're looking for, again, that patient education stuff, go to p2sportscare.com slash shop and you'll be prompted to put in your email and you'll get everything I spoke about in the beginning of this thing. And lastly, I want you to remember to be good to each other. All right. All that golden rule stuff, that's the real deal right there. And what I like to tell people, what I like to think, actually, this is the way I think, is it's not what you take, it's what you leave. So I'm hoping I'm leaving this. Even after I die, these podcasts are going to be around helping people.

So it's not what you take, it's what you leave. Peace out. Talk to you later.