Offloading musculoskeletal and nerve pain with movement

what cues will work for this person, what cues won't work, what exercises might work, what first aid might work, what scab picking stuff they might be doing, and then how to get them to a movement-based correction in the safety net if we can. If we can't, by all means, we get in there with our hands and address the problem, start moving things around, and that's maybe the person's correction. But at the same time, we need to make sure that we are figuring out the why. Why is this thing happening with this person? Why did this diagnosis present itself when there was no actual trauma involved? 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, this is Dr. Sebastian Gonzales, again your host from the Restoring Human Movement podcast. Thanks for joining the Movement Movement. And if this is your first time, welcome. I tend to break these podcasts into two different groupings, by the way. The first grouping is for patients, or let's say lay public. And the other grouping is for clinicians. And most of the time, these podcasts, which this one's going to be a little different today, most of the time the podcasts are based upon kind of like we're all three having a beer, and the two clinicians are talking, and the CPA behind you is like, hey, what does joint mean?

And so we explain joint, or whatever it might be. And so I like to have it so everybody kind of understands what's going on with your care. Patients are able to ask doctors questions. Doctors are able to communicate in a very simple way so that everyone gets along, and so that people get better. And so that was the goal of the podcast here. And this one in particular today is going to be a little different because I've been requested by a couple people to, a couple clinicians to go over some of the stuff I'm going to cover in the first hour or so of my workshop I'm going to do in June in 2019.

June 8th and 9th if you're still interested. I don't know if there's any spots left or not, but there could be. So either way, email me if you're interested in that kind of thing. That is info at p2sportscare.com. So the reason why I wanted to go through this today was because a couple people asked, hey, I'm only free on Sunday. Can I just come by for Sunday? I'm like, well, you could, but you're not really going to get the context of how to apply that kind of stuff because I think we as clinicians learn a lot of different things and methods and treatments and so on. And it really comes down to can you apply it or not?

And so the application is what I want to relay to you guys. And if you haven't heard already about this workshop I put together, I didn't put it together because it was something I wanted to really do. I don't have aspirations to be a public speaker. I actually didn't have aspirations to really do a podcast either. So it was mainly because I talked to a couple classmates and I said, hey, why don't we just get together and do some CEs? And I'd love to see you guys and let's just do it. And so I thought, well, I can put something on. You know, it can't be too hard. And so I thought we'd get some classmates together, which by the way we got about eight to ten classmates of my graduating class, 2008 of SCU, fall, by the way.

We got together and we're just doing this. And so after that I had some open spots. So I said, hey, why don't you guys on the podcast come by too? So I thought it'd be a really great group of people and we'd all learn from each other. And although I'm the one presenting, I'm required by CE law to have something to present. So that's why I'm putting this together. But I'm going to learn from you guys too. And so anyways, we're going to go into that first hour today just so you can get an idea if people do decide to come in on Sunday, what you're, what we've kind of already gone through. And so I'm not intending to hide anything here with this, but honestly, the, it is a workshop.

It's on a lecture. And so the workshop part is that you have to do it to feel it. And a lot of stuff we're going to go through on day one as well as day two is going to be more the workshop portion, but I have to lay the framework in the beginning and some of the clinical pearls that I've learned over the years. So if you want to take this journey with me today, stay tuned and listen. First, if you have not been to a podcast like mine before, then of mine before, then I tend to share a little bit about myself via story, a rant, something I like, something I hate, whatever it might be. Just for a couple of minutes, you get a feel of who I am.

Kind of like you like Jay Leno or Conan or Oprah. Maybe you like all three, but you probably like one better. And so I'm hoping that you like me so you stick around and learn more from me. If you have not heard a lot of the other podcasts, by the way, there's tons of great information back there. I've interviewed a bunch of people, Stuart McGill, Dan John, Michael Shacklock, Tom Michaud. By the way, if you're a clinician, you haven't heard those names before, you need to listen to them. So go back on the P2 Sports Care website, use the search bar and just type in those names that you're interested in or topics and you'll find podcasts.

So they're all there. This is about 140 or so here. So I've learned a lot over the years. And let's get into that story. Then we'll get straight into the content for the first rough hour of what we'll cover in the workshop. So this is probably a good story that I don't know if I've told anybody, but I know that the office staff and the patients that were here at the time know this one pretty well. So when I first moved from one clinic to another, it was within the same building. This was about probably four, three, four years ago, I think now. And so the current building that I was in or the current office I was in, like everything worked.

Like we had, there was public bathrooms. We didn't have bathrooms inside the clinic. But at some point they closed the bathrooms and they were attempting to move me over. And so they put an outhouse outside and there was no bathrooms in the entire building that worked. But there was that outhouse out there where there was the honey hut or the porta potty rather. So not really the best situation, but we had a lock and key for it. So it was our own private one. And so eventually to move, to make the entire building become remodeled, they needed to move me to demo the area where the office was. And actually when they demoed that office, I stood on top of the other building and saw them just take a crane to it and just tear everything apart.

It was so sad. But I got videos of that too. And so when we got into this new office, they said, hey, look, we're not totally done with this office yet. There is no internet and there's no bathroom. Like the bathroom was there, but there were toilets there, but there was nothing connecting the toilets really behind it. It was just a toilet. And behind into the wall, there was just nothing. It was just an empty pipe. Actually, a cutoff pipe. There was no major tubing yet because we can walk around the building and kind of see that. And so at some point the internet guy came in. He's like, look, I'm going to set up your internet and all this jazz.

And I said, great, cool. How long is this going to take you? And he said, oh, a couple hours. I said, cool. I'm going to go around the corner real quick, get some coffee and do just, if you need anything, just tell me. So I was over there around for about 30 minutes or so and I came back. And so the guy was gone. His truck was here and he just wasn't around. I didn't see him. And so he came out of the bathroom and he said, hey, man, your water's not working. And I said, oh, did you use the bathroom? And he said, yeah, yeah. I said, number one, number two. He says, two. And so lo and behold, this guy, he takes a dump in a toilet that has no water in it and there's no water running to it and there's no pipe on the back.

And so he's like, oh, I don't know what I do about the thing. And I said, you know what? I'll be right back. And so I went and grabbed some gloves and some paper towels and a bag. And I said, you're going to have to deal with this because he didn't look. Like there was literally no water in the toilet. And so he went in there and fished the thing out and then takes it with him and he's on his way. And probably for the next month, like me and the staff were really, we didn't want to go in there and look. But we did take the liberty to go in and just stuff a bunch of paper towels in there to make sure that whatever stink was in there was not coming out.

And so finally, when we got our water, someone had to go in there and deal with it. And we drew straws. I lost. And I had to go in there and clean it all out. So that was the story about the guy who took the shit in the toilet that was not connected to anything and then left it for about a month. So be thankful that you have a bathroom. Now on to the content. Okay, so as we start into this content or the first part of the lecture, I just want you to first know that this is available on video. So I'm going to record this because I want you guys to see some of the slides that I'm pulling from. And 100% disclosure, I'm still writing this.

Okay, this might change a little bit. But for the most part, this is my way of practicing. So if you guys are wondering about skill sets of doing presentations and so on, I have no idea. I have a rough flow of what we're going to talk about here. But most of it is probably going to be storytelling. And so if you guys are looking for the information or the video on this, then I will put a link in the show notes and it will probably be on YouTube or something to that degree. So let's see where that link takes you. And so I'm going to first start by sharing my screen and we're going to go over the PowerPoint presentation that I had put together.

And so I called this workshop Offloading Musculoskeletal and Neurological Pathology. And I came to find that people don't tend to know what I'm talking about by offloading. By the way, since this is a lecture format, I'm going to take sips of water and so on because I think this is the flow. I'm simulating my own flow. This is what I want it to be like. So offloading pathology or pain generating structures is kind of the way that I've started to practice over the recent years. And what I mean by that is offloading is kind of like someone stepping on your hand. And as you take the foot off your hand, eventually the person starts to feel better.

But it's really hard to get this person to feel good over the long term if you are not taking the symptom trigger away, okay? It's nice to do first aid and all that kind of stuff. But I really think we can do this for musculoskeletal pathology as well as neuro-based pathology within certain settings. And so first off about this workshop is it's an open forum for discussion. I don't pretend to know everything. And although I am presenting on stuff, I'm going to be presenting on stuff that works for me. I also want to know what works for you. What is working for you? I have no idea. And actually, you know what?

I should probably, well, actually I can, I was looking at my screen share right here and I'm sharing my entire screen. I'll probably just crop it. So this will probably work better for everybody anyways. So I'm going to be sharing what works for me. And I want it to be an open discussion because I know going through a lot of workshops, people are promoting their style and they're promoting their algorithms and so on. But really what it comes down to is what works for that patient. And I remember going through one workshop where we had this little flow that we're going through, this algorithm. And I, this is the second workshop I've gone through that, through that one body.

And I raised my hand at some point and said, look, so I had a patient that they passed all these things. What do you think? And they said, that's not possible. And I said, what do you mean it's not possible? What do you mean it's not possible? They're like, oh, you did something wrong. And I remember going through Michael Shacklock's neurodynamics course and it was interesting to see this. And we did some of the case studies in there that came in. He basically puts them into a couple categories, right? It's like, is this a neurodynamic problem or is this not? Because you can easily have one or the other and it doesn't mean that your solution has to be a coverall.

It doesn't have to do, it doesn't have to help everybody. And so we have to be able to use all these little tools as we learn throughout the course of our clinical reasoning process or through our building of our skill set. We just figure out which ones work for which people at what time. And so I'm going to be presenting on what has worked for me and what seems to, and I'll even ask any of the holes of what I don't know. And so I don't think there's any wrong answers here. There's only personal experiences. So I think every person responds to different types of methods. And so I do want you to share yours as well, okay?

By the way, I've not had these created yet. But since I want everyone to come over for tomahawk steaks after. By the way, not everyone's getting their own tomahawk steak because it's too damn big for everyone to eat. And so I have little gold tomahawk stickers that I'm going to be having ready for you guys. And think of it kind of like you're in school and so you've got these little gold stars. And so when you do something well, you get a little gold star. Although I'm not going to have a certification for this workshop, everyone gives you your little gold star via those little certifications, right?

And so I don't have that, but I am going to give you gold stars. And here's the deal. Since not everyone has their own tomahawk steak, if you are coming over for tomahawk steaks, I'm probably going to have, since it's going to be about 15 to 20 people here, I'm only going to have about three or so because usually about, unless you're just a complete pig, that usually about three to four people, four people roughly, it works well for one tomahawk steak. So I might do a fourth. We'll see. We'll take a share of hand, a hand count and see who's coming over. But for the most part, not everyone's getting a bone.

And so the bone is literally the best damn steak meat you've ever had in your entire life. And so if you get enough gold tomahawk stickers, you're going to get the tomahawk bone. Okay? I'm not going to lie. I've only had two of these bones throughout my entire life because people, I have a general rule, when people come over and they haven't had the tomahawk steak bone before, I give it to them and there's only one per steak. So it's a true experience. I've only had one person ever not like it. I remember there was one dude. So he was at a Super Bowl party and so we just said, hey, eat this. And he said, no, I don't really want it.

I'm like, dude, eat this. There's only two in the entire house. Eat this. And so he did and he just shut his mouth. He sat, stood in the kitchen. He was just chilling there for about five minutes and just would not open his mouth for a conversation. He said, dude, this is the best thing I've ever had in my life. And so I'm hoping you guys have that same experience. So you want to get your same, you want to get your tomahawk. Stickers, the gold ones. And so I guess what I'm talking about with this thing is that I want you guys to actually participate. And that was my way of getting you guys to participate.

So, by the way, you ever been to a seminar? I've been to a bunch of seminars where they cost about a couple grand and they don't feed you more than like yogurt. I think it's bullshit. So you guys are going to get tomahawk steaks when you come to mine. I'm going to get beers and whatnot. This is all for after. And I thought about crab legs. I'm not quite sure yet, but I believe that we're all here to hang out. So let's make it a good time. And so what we're going to cover in this workshop is just ways to unload pain-generating structures with movement-based corrections and building supports or buttresses.

I'll go over into this concept of buttressing and so on a little bit later. But for the most part, I want you guys to understand that I'm not against the idea of tissue work at all. I use it. I use it on a daily basis. I use adjustments. I use manual therapies. I've suggested stretching and mobility and all that kind of stuff. But also, I don't want you guys to muddy the water with this thing. And as we go through the idea of at least my theory of examination with people, I wouldn't just suggest someone with a red flag. I wouldn't adjust someone's neck if they had RA. I wouldn't adjust their mid-back if they were osteoporotic.

And so I think figuring out what this person is going to respond to, we can still help them in a very quick way. Corrective exercise and active care doesn't have to be a theory that takes forever to actually come to fruition. And I understand manual therapies and all that kind of stuff. They do have an immediate result. But they're not always long-lasting. And I think it's really based upon whether the person needs that type of correction at that point in time or not. I know some of you might lash back at me on this. By the way, again, this is when you're coming to the workshop. This is where you have a chance to say your piece.

I want to hear everybody's experiences. But the rules of this workshop, because I want to help you develop a skill set which has worked well for me, is that I don't want you to muddy the water. And I don't want you to use any time we go into a case presentation. I don't want you to think about what you would do with manual therapy, stretching, pastoral modalities, chiropractic manipulation, and that stuff. Okay? What I want you to do is think about your differential diagnosis, and I want you to think about how to prove and disprove them. Okay? Example. So, say we have someone with low back pain, happens at night, or worse at night, it's a dull ache in their spine, they're 80 years old, they pass history of cancer, all that kind of jazz.

Then your theory might be, or your differential diagnosis might be, some type of cancer. However, we don't know if it's truly that or not yet. So, you have to prove or disprove your theories before you can actually help these people. And so, I call it killing off your darlings. I forget the actual root of that term. I think it was based upon storytelling or writing novels. But I think we have an opportunity to help people, maybe not with the cancer example, but for people with, let's just say low back pain or knee pain or some type of musculoskeletal thing, then musculoskeletal based, then we have to create some theories of how that actual differential, or that actual diagnosis that you landed upon could be offloaded.

Okay? Why has the tissue been overloaded in the first place? If patients don't tend to understand what I'm talking about with this, oftentimes I'll just, I'll take my knuckle and start really like kind of hitting them really slowly in the elbow. And I'll say, how long until I start to form a bruise here, right? And if I keep going, that bruise is going to be there for a very long time. And so, really, why is that bruise occurring? You're also going to get pain in that area, too. And so, why is that pain occurring? And I know probably a lot of you have already gone through this, yeah, what's the root cause and blah, blah, blah, but really, no.

What is it, right? And I think when you figure that out, you're going to get people who are responding really well to the offloading strategy. You might not have, like, I've had a lot of patients where I don't have to do any tissue work or adjusting at all. We don't have to recommend ice or heat or stretching or any of the stuff that I used to do a lot more prevalently. And there's nothing wrong with still doing it, but I want to make sure I'm not missing out on certain parts of suggestions that I can do for these people. And so, I like to consider patient empowerment whenever possible. I like them to feel that they can do it at home, they're in control of their own symptoms, and they can reduce things at will, all right?

Part of, I don't know if you guys have had a real bad problem before, but I tend to think the hardest thing is thinking that you're actually not in control. And so, not being in control, it's tough, it's stressful. It'll make it so you don't sleep. It'll make it so you have the sympathetic response. And so, I want them to feel like they're in control. Now, maybe they can't do everything for themselves, but certainly they can find positions and postures that would reduce a mechanical problem. Maybe if you have a non-mechanical pure problem, let's just say an inflammatory-based, systemic inflammatory-based condition, or you have a chemical response there, then maybe those things won't have as much improvement.

Example, I always tell people that if I were to stab you in your leg, it doesn't matter what position and posture I put you in, there's a local chemical response, or there's actually a damaged thing there currently. And so, there's that five-day period where that kind of has to happen. So, but when we're working through this in the workshop, make sure that we're considering what can empower the patient first. Maybe they can't adjust themselves, and so maybe we don't go there first. And so, we're going to go through a lot of strategies today, which are ways that we can empower the patient and show them that they have control, but also, too, that their strategy for improvement over the long haul could be something like resistance training.

Okay, I don't think we can, I don't think a lot of people can argue the benefit of just general physical preparedness. Like, people who, how many times have you read stories about people who are like, they're like, I had knee pain, and I tried X, Y, and Z, and nothing worked, and I thought about having surgery, and then I just started doing some weight training or running, and it felt better, right? At some point, movement is medicine, right? Motion's lotion. And so, I think when you kind of get them in towards that and make them realize that resistance training doesn't have to be your personal records for CrossFit or Instagram or powerlifting, because that's what they see these things as a lot of times.

And so, that makes it very challenging to get them into that part. And so, the last rule of this workshop is don't be a D-bag, okay? I understand everyone's coming from a different point of view here, but this is for adults only, okay? Be an adult. Be able to communicate like an adult. And respect your peers. And so, I'm going to make sure that everyone is aware of that, and I will pull rank on you, okay? If you're being an a-hole, I'll tell you about it, all right? And I want to make sure that everyone's aware that we are learning from each other, good or bad, this whole thing is an experience.

And so, as we cover this, I'll say my biases in my development of how I practice now is, first, when I got into stuff, I first started with active release mainly. And I actually did active release well before actually going to chiropractic school because I worked with the guy who was like the ART guy. Like, people also found their chiropractors, but they also found their ART guy, you know? And I'm sure there's a lot of other guys out there, but at this point, we were the clinic of ART guys. So, people loved that, and they went there for that, and we had a good response with a lot of people. Now, we coupled that as well with resistance training, and it was really helpful for my back injury in high school.

And so, when I went to this guy in high school, I actually worked for him eventually for like six years after that, all the way through chiropractic school, and I actually did some of my PPR there, too. So, it was really helpful. But it also kind of pinned me into a very narrow way of thinking because when someone came in, it was kind of like, how are we going to fit them into this box of doing this one thing versus expanding? And again, I'm very grateful for my experience there, and I learned a lot of stuff, and I still use a lot of the stuff. But at the same time, some of the things that I treated back in the day with that same style, I don't treat the same way now.

And so, the first five years of practice, I really was weighed more heavily on tissue work and ART really than anything else. And so, I kind of lost also the relevance of resistance training through recovery because I kind of thought it was a small piece when I went through it personally. But at the same time, I would go in there for active release for like, I think we did about 10, 15 minutes worth. But also, too, afterwards, I stayed for about 20, 30 minutes and just got lit up, like, with resistance training. Like, we did use some machines, but also we used free weights and whatnot. And, like, I remember leaving there with, I was driving this little stick shift BMW at the time in high school, and I could literally not get my clutch down in a smooth way because my foot was just shaking because I was working so hard.

And so, my PPR had a full gym, and I was kind of under the impression in my first few years with this that if I didn't have all this equipment, then I really couldn't do all the same rehab stuff because I didn't have all the machines, I didn't have all the weights, I didn't have all the toys. But as I kind of tended to learn eventually is that I really didn't need all that stuff. And as I go through all this stuff today, I'm going to show you how to do this with minimal equipment because I think it's a barrier for a lot of people. So, after about five years in a practice, I met another local doc.

This was Dr. D, Dr. D-Mac. He went to Logan. So, he had a different background than I did. I went to SCU. And so, we both worked on athletic professionals, basically. And we started to really bro down, had some beers throughout the weeks and so on, talk business and clinic and so on. And we bounced cases off each other. And I kind of noticed a pattern forming as I tended to use him as a go-to person for low-back case advice because I wasn't excelling in low-back cases for whatever reason. And actually, I probably know why now, but at the time, I didn't really know. It was like, huh, these are just really hard for me.

And so, I had some acute low-back cases that I was just striking out on. I really didn't feel like I was extremely confident in doing it. And so, I wanted to ask him questions on that. Chronic ones, I really did, I did much, much better on. And I had a lot of people who came in with chronic low-back issues that were like, oh, dude, like, you were the only person who could help me after I've tried X, Y, and Z. But the acute ones, like the newer ones, or the ones that couldn't, like, really move, like those really, like, hard-pressed ones, those ones are tough for me. And so, after too many beers one day, I asked him, hey, man, like, how much do you think you know about back issues that I don't because I'm not getting all these, you know, and you seem to have a good confidence with it.

And so, he basically said about 15%. After asking him now, and I said, dude, you remember saying that? He's like, no, I think I said 50, maybe, but I'm like, oh, I heard 15. But the 15 was motivating because after a conversation about that, I was like, what the hell does this guy know about backs that I don't, that he thinks I only know 15? And so, I thought, either these are bullshitting me, or it's truthful. I don't see any reason why to think it was bullshitting at that time unless he had to weigh too many beers and maybe I had too many to interpret what was going on. But anyways, after that, it was kind of like a three-year push to figure out what I needed to learn.

And I'm still refining it now. And so, basically, I found out over the course of those three years or so that I really didn't know as much shit as I thought I did. And it's funny because I felt so much confidence with working with certain types of cases. But as I'm starting to find out the stuff that I really didn't know, it really opened Pandora's box for the other stuff, which works even better in some of those other cases. And so, Pandora's box, as it started to open, I really started to feel extremely confident with assisting people with low back types of conditions. And I was even able to get people to the point where they'd feel 50% improvement within two days without adjusting massaging or tissue work.

And so, as I started to go through this kind of stuff, I started to learn more and more things which I didn't really know. And I guess I should probably flip through the slides. So, there was, again, here's that slide on ART. Here's me and Dr. D having a beer. And so, for the first thing I really did when I started going through and trying to figure out what the hell was going on is that I went home next morning and I immediately went on to PubMed. And I thought, you know, I just realized now that as I'm doing through this style for you guys, you're seeing all these click add to title things. So, ignore those, please.

I'll have them in presentation mode when I'm actually doing it in person, right? So, what I first started to see was that when I went through PubMed, I learned things that I, I don't want to say that I kind of already knew. I just, they were, they were very research-based and I'm not going to say research-based is really bad. It's just very black and white and there's a lot of things that we use now that I've learned that we really don't, we don't know if it really works based upon research. And so, I think there's a little more to it than that. But anyways, I thought going over into PubMed was a great way to start.

I came across some really great articles. A few of them were by Stu McGill and a lot of them were actually when I was coming to back, back stuff. And so, one in particular that interests me, it covered core endurance. And so, I decided to Google more of Stu McGill's work. And so, I eventually found some of his free papers on backfitpro.com. By the way, if you have not been to that site, it'd be a nice place to start. And so, he had some really well-written, informative articles and just blow-your-damn-mind type of stuff if you haven't read them before. And so, the fishing rod analogy and the iBeam was exactly what I needed to hear to figure out that I didn't know exactly what I was doing in regards to spying biomechanics and rehab.

And so, what I eventually did was I eventually bought his book. And so, the book, if you haven't read it already, it's like 70 bucks. It's not that much. And so, I read it twice. And I think as I started to apply, actually, as I started to apply some of this stuff, I started to realize I needed to go back and read some more. And so, it was really helpful in improving my physical exam with low-backs, but also figuring out the tolerances of what the person could do. And so, it was really helpful in regards to when someone's like, hey, should I do X, Y, and Z exercise, or can I still do this? I'm like, well, you can, but that's high reward, high risk.

So, maybe you wouldn't respond well to kettlebell swings, but we can certainly have you deadlift from a block. And so, programming in this way, I was able to help, it helped me a lot with confidence with communication with patients, and especially when I was trying to figure out their pain-triggering activities. And so, the rough takeaway that I had from McGill's work, at least from low-back disorders, was that postures and loads can and will trigger people's conditions if they're important at that time. And by the way, postures and loads, I don't think they're always important for people's conditions.

A lot of times, I find that they are. I'm going to take a sip of water here. Okay. So, the first aid plan, as well, a first aid plan should be implemented. What did I write here? Geez. A first aid plan of attack should be implemented and then taken away. And so, this kind of resonates along with that right thing for the right person at the right time for the right condition. And so, I believe that definitely the first aid is a thing that needs to be taken away. And so, we don't wear band-aids for our cuts forever. We just eventually take them away. And so, there's lots of aspects in there that I think that we are very – a lot of times when people drop out of care, they end up doing their first aid for a very long period of time, which they don't need to anymore.

And so, the third part is the buttressing concepts or the co-contraction concepts, which we will go into a little bit later. And so, his work was really important for that kind of stuff. So, as I started to really use more of low back disorders types of stuff, I thought I would actually go shadow some people too. And so, I know this is a really shitty stock image of someone doing some chiropractic stuff. But I thought, yeah, this is what I might find in shadowing sometimes. And so, I decided to shadow other people. And it was really useful. And so, I shadowed Cody one day, that's Dr. D-Mac, and I was interested to see his direct cueing style.

And it was really useful. And kind of figuring out that cueing, it can be extremely direct, but also too, it's different for different people. And so, after learning the McGill style of examination and correction for low back stuff, the success for low back pain in my clinic jumped exponentially. I mean, it was way, way better. And so, I was able to get them out of pain within a single session and actually giving them some very – just by giving them some simple homework. And I really didn't have to adjust them or do manual therapy at all. And I remember in the past that I had some people who they went on the table for like – so, we were doing ART on them with a flexion distraction table.

And they were fine on the table and they stood up to get off the table. And they couldn't get off the table. Like, they lit them up. And so, now I realize what I was doing wrong with that kind of stuff. And I – again, nothing against tissue work and so on. I just don't need it with these types of cases. And so, I'm able to get about 95% full function within about five to seven days or so. I would roughly estimate – full function, I mean ADLs. And so, we're still working through a lot of stuff with these people. But at the same time, I didn't – I wasn't really having to do any – I don't want to say any work.

But I was just guiding them. It was great. And so, it was easy. It was really easy shit too. And so, we used a lot of McKenzie extension, modification to postures, McGill Big 3, daily walking. And these are the same – it's funny. These are the same people I would have done tissue work on and adjust in the past. And I just – there's no need for it, in my opinion, at least this point in time with these people in my clinic. You guys might use them. Again, this is the workshop. If you guys want to disagree, you raise your hand and you get a gold tomahawk. And so, I worked with this for a couple months and I ventured out eventually into figuring out how to apply McGill's stiffness principles in athletic motions.

And because it was – I'm not going to say it's lacking in there, but it was just a need for a different book and a different application. And so, for that, I went to Koichi Soto and Craig Liebenson seminar, which worked really well. It was a two-day seminar in LA. It was like $600. And so, this is Koichi. It's really hard to find stuff on Koichi. So, you're going to have to find a seminar if you want to go to him. But it was basically – it was based upon lateral agility and power. And so, some of the takeaways that I had in that workshop, it was really nice to apply these. And I still use a lot of these today.

His hip function keeps – it keeps better when taught through closed-chain corrective exercise. So, it's nice to do clamshell and jangepondus stuff, but at the same time, it doesn't equate to real life until you get the person's foot on ground. And so, I think the standard resistance training that we typically see with people is like, hey, man, you got this back issue. You got this knee issue. Why don't we get you deadlifting, right? And so, I got no problem with deadlifting, but it is a forward-backward sagittal plane movement. All right? Also, it's double leg. And so, through athletic movements, we're actually changing direction by changing the amount of pressure we put through different parts of the foot on a single foot based upon which direction we're going.

So, it's all about the vector. And so, knee orientation of squatting in that regard and hinging is dependent upon the vector of movement of acceleration and deceleration. I know it's a mouthful. But for the most part, if you're attempting to jump upward, your knee would be over your foot with squatting or let's just say the second metatarsal or the second toe. And so, if I was changing direction like I was running away from a zombie and the zombie was on my right side, I would push off my right foot, lean to my left, and now my knee would be inside of my arch. Okay? So, it's no longer an upward-downward squat anymore.

And so, these are okay. It's okay to show people these forward-backward movements, sagittal plane, but it's lacking. And especially if you want to get the person back to a sport, then you're going to have to consider what type of things is this person being exposed to in sport. And so, rehab, in my opinion, it's rehab back into a sport requires exposure to venom in a controlled environment. And so, we have this venom, anti-venom analogy is they're going to experience venom. They're going to experience poisons and variations of movements throughout their sport that is really hard to control if you have not been exposed to it yet.

So, slow exposure to venom in a controlled environment is what I tend to do with that. And so, that seminar was really amazing for that. Again, hard to find. So, but if you look up Koichi Sato, S-A-T-O, I think it's, sorry, Koichi, if I got that wrong. But just look them up. You might find some. Or just email me. I'll see if I can find a link for some stuff too. And so, the incorporation of these vectors of movements into some of the principles of rehab was groundbreaking to me. And so, I was able to teach some of, teaching some exercises like deadlifts were useful for picking up buses. But really, it didn't simulate a change of direction skill in soccer.

And so, I tended to expose people to it in the frontal and transverse plane after that. And I think many sports injuries, the even non-traumatic ones, like the ACL, deceleration, change of direction injuries, they happen because the person is not able to control their power leaks. And so, I like to have the athlete be able to align their torso, knee, hip, ankle, foot, and to be able to spring away from the ground in the vector of desire. And so, I think lack of exposure to do so is typically what we get, or even fatigue. So, there's probably more variables in that as well. Man, it's hard to, how am I going to talk for 12 hours?

This is going to be really tough. So, this might be the only seminar I do. So, I started to use rotational and lateral squats with athletic low back rehab cases. And I started to kind of incorporate a little bit more with knees and feet and hips as well. So, exposure to Liebens and stuff eventually exposed you into DNS. And to be honest with you, I didn't really want to do DNS, okay? I can care less about getting people to move and act like babies. And by the way, babies, they're babies. Come on. Like, I think it's ridiculous to think that babies have it all figured out. They're barely been born.

Like, so I, for years, I fought this DNS thing to the death. And finally, I thought, you know what? I'm just going to go. Like, there's no reason to, like, be the D-bag and form an opinion on something you haven't tried yet. And so, as I came to find, after spending about a G in L.A., is that the DNS application was really less about babies and more about being able to support the ground contact. And more about pushing the ground away as an early point into improving hip and shoulder ball socket mobility with the torso remaining, getting stiff. And so, we call it ball socket disassociation. And so, it was a good foundation for more closed-chain exercises that I like to use for a lot of people with shoulder and hip.

And I guess, well, we can go even further. Neck, back, and spinal cases. And so, that was helpful to me. Again, the takeaway was pressing the floor away cue. And also, joint centration co-contraction of the joint of interest. And so, an example of that would be, I like to start a lot of shoulder cases with DNS-based exercises and load it a little bit. And I'll explain loading in a couple minutes here. But for the most part, the co-contraction makes it so the joint becomes stable, all right? Really forceful co-contraction, which we will cover later, it makes the joint really can't move. And when McGill goes over this in his low back disorders book, we talk about co-contraction.

And it's about making it so the lumbar spine is stable enough so it doesn't get sloppy. And so, the same thing happens with all these other joints. And if you've been through FMS and SFMA and all that kind of stuff, they talk about mobility, stability. But it's basically about stable enough to not trigger a symptom while still being able to do the required range of motion. Because every joint, I think, has a gradient of stability and mobility requirements. And every time you add mobility, or sorry, range of motion, you're going to sacrifice some stability. But you've still got to have a range in there, which is helpful for that person.

And so, again, I didn't really want to do DNS too much. But after doing it, I would definitely suggest people go to at least one seminar with the exercises. They're nice to see. And they do cover some interdominal pressure cueing as well. And so, very quickly thereafter, I started to dig into more strength conditioning cueing. Since the whole point was really to get people to what they want to do, right, without having any issues. And I'm down with crawling on the ground like a baby and being in corrective exercise and dead bugs and bird dogs and so on. But really, in my opinion, those are intended as a medication to get people back into doing things foot on ground or more ADLs or loaded movements.

All right? And I'm not saying everyone's goal should be able to be a weightlifter. It's just being able to move your body through space as a normal functioning human. If people tended to do handstands, walking to work, I'm down. I'll teach more handstands. All right? If people tended to crawl to work, I would teach crawling all day. But it's all about, for me, it's if we can get them to move successfully with their body weight and probably a little bit more. Because they're going to be carrying groceries and babies and carts and so on. Right? And so, many people that have neck pain with push-ups, I've seen, I've been able to see them successfully reduce their symptoms within under a minute.

And I do this mainly with cueing ground contact. And so, what I decided to do was re-watch some of the Dan John work that I actually started. I looked at some of it when I was still entering into chiropractic school, but it really didn't mean as much at that point. And so, I read a few of his books in the past, and I heard him speak at the beginning of D.C. school, and I heard him perform better and so on. I just needed a refresher. And so, at this point, it was really useful to me to see the standard way of, or the very simple way of cueing and application of a resistance training program for someone who's really not hurt and then cater to someone who is hurt.

And so, if you're wondering who Dan John is, just go to, look up Dan John on YouTube and you'll see. His stuff can be really complicated if you want to make it that way, but for the most part, it's pretty damn simple. And so, I re-read Dan John's intervention, Easy Strength, Can You Go?, and probably all of them together, like $100. And so, just go through there and read it. The takeaways that I had in there was you make it simple. You fill in the holes of people's training, and surprisingly, or actually, I'll retract on that. So, make it simple, okay? People have a tendency of making exercise and corrective exercise or loaded movements too complicated, in my opinion.

It doesn't have to be. You can get away with a few simple cues, and eventually, if you can reduce the person's symptom with a loaded movement, it might just happen with one cue while you allow the other, let's say, sloppy motion to exist, all right? And I'm not saying that that sloppy motion is, or the imperfect form is something you want to leave forever, especially as the weight gets higher. I think your margin of error for the perfect movement is lower as the weight gets higher. But that's kind of the difference between, like, there's a proper way of driving a sports car, and there's a proper way of driving, like, a Hot Wheel.

They're different. You know, they're different applications, different forms. And so, I would, but I would make it simple when using corrective, or I guess we can call this corrective exercise, but when using loads and movements for people's problems. Second is, if you fill in the holes in people's training, surprisingly, a lot of them get better without even having to think too much. And so, an example of this, I had a guy who came in with a, who had a knee problem with squatting. And so, he fussed about the squatting for about 10 minutes. I said, look, okay, let's just do these other things.

Let's come back to it again. And so, we did a hinge, a push, a pull, and a carry, and came back and tried the hinge, or tried the squat again, and it didn't hurt. And he's just blown away by it. And so, I think they, they think they all marry each other. And also, I think volume over intensity, I think, is an important takeaway from that as well. And so, as we start going through this workshop, you're going to see, I will go over a lot of these principles and show you how I like to cue them. And just, I know we're glazing over right now, but I want to show you, these are the people that I've learned from, so that you guys can go to the source if you'd like.

Okay. So, the Dan John work really patched my, it really patched my, my treatment plan together really well. And so, I, I don't tend to like to have people come back for tissue work and adjusting as like a maintenance plan. But I would like them to refine and change their exercise program and their resistance training program so they don't feel crappy anymore. And so, one of those principles in there is that things tend to work for about six weeks or so. And so, after that, they're going to need to come back for a little bit of that or hopefully they've already gone to a strength coach and they're under their care, but they're not always there.

And so, old bat cases who were stuck in McKinsey Extension and McGill Purgatories, they, I, then now they had an exit plan. Okay. And, by the way, McGill Purgatory, I don't mean it, McKinsey and McGill Purgatory, I don't mean it in disrespect. It's just sometimes people just only do McKinsey Extension forever. And sometimes people say, hey, I'm just going to do the McGill Big Three and walk forever. And I think there's more to it than that. And, by the way, McGill's work does go into more. And so, but this is the quote unquote Purgatory, as I call. And so, as we go into Dan John's work, there's the push-pull-carry squat hinge and then we go into unilaterals.

And so, we're going to cover some of that easy stuff today. And those are really easy win points for people. So, at this point, I tended to load people into movements that were missing. And they tended to, I tended to do so on day one and day two. And so, these fresh cases were coming in. It's like, hey, my back really hurts. And I'm like, great, cool. Why don't we try single leg deadlifting just real lightly? And so, they're already starting to load, you know. And they got better dramatically faster than it finally did the other parts. And so, but at the same time, someone who's a laying on the ground type of back case, I wouldn't use it for those types of people.

And so, just some examples of how loading through this progression can be helpful for your patients. And so, people with knee pain, with squatting, with or without weight, you build a hinge in the carry. And they tend to get better. Obviously, these are, there could be small things in the middle. And you might need to apply first aid or scab picking approaches, which I will cover later as well. And so, people with shoulder pain, with pressing, I tend to load them in a horizontal pulling movement and a bilateral carry. And then scale back the pressing to a high-tension push-up plank. And just hold the position.

And they tend to get better. And people who with groin issues with squatting or quote-unquote sports hernias, which I did do a podcast on a couple weeks ago, I tend to load them in a high box squat, not too heavy, but just to see if we can reduce the symptoms. Because a lot of times, they're doing squats already, which I'm okay with. We just might change the range. And then I have them crawl, do a one-arm press, or a prone DNS exercise. Again, this is kind of marrying all things together, while patterning the squat with a door jam or a goat bag squat. And so, these are ways that, these are things that I've been able to help people through loading very early in care of people.

And I find that it's very empowering for them. And so, these are examples of people that I probably would have done tissue work on in the past. And they probably would have come back with 50% changes within a week. Or, sorry, now they do. And they're loading the entire time. And so, they stay in the sport. And if they're running, they keep their mileage up, right? And if they're lifting, they keep their loads up based upon the suggestions that I've given. And a lot of them, they can drop their mobility routine that they're doing on a daily basis as a warm-up. And because a lot of times, the threat is reduced in the area.

And so, treatment suggestions as well. This is, we're going to go on into the next one. This is Clinical Neurodynamics. This is Michael Shacklock's work, which I was introduced to a few years ago. And I'm still working on this quite a bit, actually. And his courses are really hard to find, by the way. And I think, by the way, there's one in Arizona. I don't get any money for this, by the way. Arizona in August, I think. So, go find, search his name and go find that. And it's 2019 if you're there. They sell out real quick. And there's very limited spots. So, I think you should, if you're interested in this part, you should probably go there and just sign up now.

So, his courses are hard to find. Honestly, I'd start with the book. It's around $70. His course is around $1,200, at least the time I'm recording this podcast. And so, I had some really amazing takeaways with his is that, number one, the nervous system moves. Without motion, our body perceives threat in the form of common musculoskeletal conditions that we typically see. And the funny thing is, is that, so, we're able to trigger a response sometimes on people. Let's just say an IT band issue or a calf tightness or a wrist pain. If you can duplicate the symptom in office with a neurodynamic test, then, and reduce it with something that is away from the spot of pain.

Let's just say, with a wrist issue, you move the neck or let the shoulder depression go away. And their symptoms go away. And then you push down again with, or you move the neck or the shoulder back into those positions and it comes back again. We're not looking at a musculoskeletal problem. We're looking at a neurological-based one. And so, I've been very surprised over this experience of learning from him is that I'm surprised how many people that come in. I'd say easily 50% of the people that I see who have tried other forms of care, who are not getting better. IT band issues, hip flexor issues, medial knee pain, inner arch pain or the quote-unquote pineofaschitis, shoulder pain, shoulder blade pain.

They're neurodynamic or nerve issues. And so, when you treat them as such, they get better really quickly. So, we will cover that a little bit later. So, motion is lotion is number two. Make sure the nervous system moves as well as everything else. And I love the term. Also, normal structures and normal circumstances should not hurt. And so, this is a big kind of a concept that I probably won't cover into too much detail. But for the most part, normal stuff with normal circumstances should not hurt. And so, if we're looking at someone with like a, let's just say a sciatica issue or a radiculopathy, that's a normal, say it's a normal nerve.

And they're doing normal stuff, it shouldn't hurt. It could. There could be outliers, but it shouldn't hurt. Now, if you have a normal, you have a normal nerve under abnormal circumstances, then it might hurt. And so, abnormal nerves, or sorry, normal nerves under abnormal circumstances, like let's just say they were sitting on their, they were sitting on their wallet. What's that one we learned in school? Piriformis syndrome by sitting on the wallet or sciatica by sitting on the wallet. Like nerves don't like pressure and tension beyond a certain point. And so, that's a normal nerve under abnormal circumstances.

Simple stuff. Take the circumstance away. Then you have abnormal structures or abnormal nerves, or let's just say, let's just jump into, let's just jump into a, let's just say, Achilles tendon. You have an abnormal Achilles tendon in normal situations, such as normal walking, then that hurts. Then maybe we have to address the abnormal structures, right? And a lot of times, structures will become abnormal because of chronic ongoing issues. And so, abnormal structures under abnormal circumstances typically will hurt. And so, there's different realms in this with people, and I tend to explain this to people often in my office, is that normal, I don't want them to think their stuff's abnormal, but it's very common for people to think their stuff's abnormal, their structure's abnormal, or something's broken, something's torn.

And so, it's a very easy way to empower the patient to let them see that they don't need surgery all the time. And last thing is, rule out neurodynamics before concluding you have a musculoskeletal-based problem. And so, I like to start neurocentrically with that. Now, as we go into, actually, let me explain a couple cases that really worked well with that. There was someone that came with a three-year case history of lateral elbow pain from golfing. It was literally gone about two minutes after doing the testing. We could turn it on and off like a switch, and that was all neuro-based stuff. It was a normal nerve under abnormal circumstances, and it was in the shoulder blade.

And so, we reduced that significantly. And then we took them into a loaded process where we can improve the loading of the shoulder blade so it didn't sacrifice the nerve. Second one was we had a two-year history of left groin pain after a cycling accident, gone within about five minutes after the full exam, and 90% reduced within two weeks of care. And these are people that I've seen so far—so, these three people I'm mentioning—these are all people that I've seen in the past that I did a bunch of tissue work, a bunch of corrective exercises, and there was nothing. And so, after taking this course with Michael, I said, screw it.

I'm going to hit these people up. I can't believe I failed their cases. I want to bring them back in. I know more now. I can figure this thing out. And so, I did. And they were really happy. We were still in a good rapport. They were, like, friends to me at that point because I'd seen them so many times with little results, but they saw that my intention was good. And so, the last one was two years of periscapular pain reduced within about two weeks of care. And, again, before, it took a very long time, and I was unsuccessful. And so, I used to beat the snot out of these people, and there wasn't any really lasting success.

So, the improvements of my ability to work with the nervous system and get this stuff moving reduced a lot of people's symptoms. And so, after that, you basically just – I tended to marry them into the Dan John principles and loaded corrective exercise, and we're fine. And so, an important part of this is that as we're offloading symptom-generating structures, especially if it's neurological-based, then it's important to realize that the stuff that we typically learn in school, such as numbness, stabbing, shooting, electrical sensations, are not the only reasons for neurological complaints. Like, you could have a dull ache, right?

Or you can have a chronic tightness, and these can also be neurological complaints. And the last thing, which is this is a dermal traction method. This was invented by Philip Snell and Dr. Justin Dean. Or, basically, you can bastardize and call it skin rolling. And so, skin rolling was – it was worked on peripheral nerves. And it was really crazy to see that just something as simple like grabbing the skin and rolling it through your fingers reduced people's symptoms by nearly 50% and more, right? And it was interesting for me because, again, these are people that I used to really beat the snot out of, right?

Upper trap tightness, pain with neck rotation, hip flexor pain, quote-unquote. You just grab the skin around there and have them move it, and holy crap, the shit goes away, right? And so, you're subjecting – I was subjecting people to a decompressive technique of pulling the skin layer up to address the superficial neurology, stuff moving under the skin, versus compressing. And so, again, that's just a testament that the nervous system is king on this stuff. And the last thing I covered, at least recently, was I went to Guido Van Reisingen's seminar on how to use – I would call it how to use corrective exercise to reduce people's, let's just say, muscle memory.

I don't like that necessarily, but I tend to think of it as an advanced form of Vyonda's work and your tonic, phasic, and so on. But we basically went through Guido's stuff. I didn't know what it was. A buddy told me, just go to it. And I was like, dude, I had no idea what this was for, but I trusted his judgment. And Guido revealed a lot of the principles of the attractor states to me, which is very helpful. I did do a podcast with him. I think it's number 122. And he takes specific loading to a whole new level. And so, I think – and I have a friend go to me with this as well, a colleague. Chris went to it, and he was blown away as well.

And so, I'll be covering a little bit of that idea in the workshop. But I really think that if you guys are interested in any of these people individually, you should probably hit them up directly because I'm just going to be showing you kind of applications, how they work for me. But I'm definitely not going to be getting into the weeds with things, and they would teach you way better. And so, this is just kind of a big conglomerate. Think of it like a – what do you call it? A collage. A collage when you actually put all your pictures together. It's a collage. We're not going into too much detail with each.

The intention is to open Pandora's box. But Guido's stuff, I think, is an advancement of how to reduce things like upper and lower cross syndrome, generally speaking. Sorry, Guido. I probably bastardized that thing as well. But for the most part, I know it's a long-winning story, but I wanted to give you the opportunity to get the information from the sources and be able to – I want to emphasize that it was a long journey. It was like easily over three years. I couldn't get the timeline right. But the stuff we go over through this weekend, at least from the lecture, is I want to make it productive.

And I want you to spend time doing it, and you're going to screw up a couple times. And I don't expect you to get it perfect this weekend. I want you to just experiment and learn. And so I think it's okay to load people. I'll be clear about that. I think people are more resilient than you think. I think people in pain tend to forget that as well. They're very guarded, and they're afraid. And I've forgotten that in the past, and I have had injuries of my own, and I know what it's like. And so if you know the theories of what you're trying to correct from what you tested, then you can use whatever methodology you want with this.

And I don't suggest being married to the ideas of the things that I've presented in here. But I want you to understand that as long as you're testing and proving and disproving your theories, then that's fine. And so someone with high function and high confidence, I might take them to a Dan John principle and a high-end shacklock slider type of thing. And someone with low function, low confidence, because they are afraid of getting hurt, I might take them to a McKinsey stuff and give them basic clamshells and walking. And this is all based upon what the patient's going to respond to. And so, again, tissue work, I'm down with it.

But at the same time, as I've learned by opening Pandora's box, I think that we need to consider that each person is different. And all of the things that we learn, all the tools that we learn, it's going to be based upon the patient's problem at that time, what it's like at that time, what the person is willing to do, and how long they've had it, and so on. And so patient care is not standardized. And we have the N equals one type of thing, which you probably heard from other people. And so I don't want to steal it. Other people have been saying it. But I do believe in the N equals one. We do have principles which kind of carry over to a lot of people.

But working with the people is unique. And that's what I want to stress going through this workshop is I want to give you a lot of tools to work with. And I want you to really dive into the other ones which you're interested in. And the sad thing is, the very sad thing, again, is I've been through practice 10 years now. And it took me over five years to find these other tools. And because I was kind of stuck into one thought process. And I know how it is. You get out of school. You got a business to start. You got people who want certain things. And you give certain things. And they come back because they like that you gave them what they wanted.

But I think really if the raging fans, the raving fans that you get are the ones that you really make better. And you don't have to see much again. And so I think people are different. Their conditions are slightly different. People have past beliefs of what will and will not work. And they've tried different treatments. And, again, have different timelines since their conditions surfaced. So everybody's a little bit different in that regard. And probably the last slide I'm going to cover today before we actually go into the application. Which, by the way, there is a lot more slides so far. I think this is slide 26.

How many slides do I have so far created? I have 220. And so there's going to be a lot more in the workshop. But for the most part, I'm going to take you guys through at least my experience of how I work with patients with through first history taking and then through examination. Not the stuff you learned in school, but the other stuff that you wish you would have known. Let me correct a little quotation mark there already. And then ways to get people into loading because I know how this goes is people say, like, you know what? Like, my practice is working well for me right now. And I am doing these specific things.

And I see people within a under 50-minute time frame or 30-minute time frame, whatever it might be. And they're like, I don't have time to implement that stuff. It takes too long. Well, I'm going to challenge you and say that if you can't get someone to feel better with a corrective exercise in under a couple minutes, I think you need to reevaluate what you see corrective exercise is. Or, again, corrective exercise could be deadlifting. You just clean up the form and decrease the trigger because they're going to go out and do it again. And so, I think that if you reevaluate that, you're going to see that you might blow the patient's damn mind.

And although they came in to figure out maybe if tissue work is going to be helpful to them, I think you might wow them first by proposing that we try something else first. And so, actually, I might go through a couple more slides. So, history taking, I call it history hunting. And so, number one, ask what they think it is. A lot of patients, they're in there and it's a big lecture. You know, ask them what they think it is and get some back and forth. Number two is ask what they think will fix it. And you might be surprised. They're like, you know what? I know what I know will fix it. I know that exercising will fix it.

You know? And so, in that case, you have a very good entry point into trying these things with people. And you would not have known unless you asked. Number three is ask them what their actual goals are. People are going to say, well, I don't want to be in pain. I know, but why? And so, I think developing this rapport in the beginning is important because the goal of getting out of pain is not a very good one, in my opinion. And if we're not getting people to their actual goals, we're actually not able to, we don't know what their actual goals are. We don't know how to guide them. And so, if someone came in and said, look, really, my only goal is to get in, is to feel good enough so I can walk my dog.

I care about my dog. My dog's crapping in the house. I need to make sure to walk my dog. Great. Cool. I don't need to teach you how to change direction aggressively, right? But if someone said, look, I just want to get out of pain so I can play soccer. I want to be a professional soccer player and be a badass person in Europe that everyone knows my name and I want to have like supermodel girlfriends. Okay, good. We have a lot more to do, okay? And also, I got to co-manage you with somebody else. And so, lastly, they might have some fears and concerns about what they have to do. Some people might say, well, according to question two, I know that I have to do exercise, but I'm afraid I will hurt myself when doing it, right?

Or our concern is, well, care costs too much. I don't want to come forever. And now we think of all the chiropractic PT stereotypes, right? I don't want to do it for three months at a time. I don't want to be roped into treatment plans forever. I don't want to get my bones cracked. And so, these are all things they might not ask you because they just met you. It's kind of offensive, you know, to stereotype you. And so, I tend to have people frame things or I frame things with people. And when I examine them, I tell them, look, I understand what's going on with your concerns, right? And I had this one lady one time where I did not do a good job of this.

And I told her like, I told her late, she had some knee issues and I let her into hinging patterns and to reduce pain with squatting. And so, by the end, she was not doing, she didn't have any pain with squatting with her knees, but we didn't do any tissue work on her knees. And so, at the very end, she looked kind of distraught. And I was like, what's going on? You know, like, are you good? Like, is this not interesting? Or like, is it working? And she said, yeah, but you know, when are we going to do something for my knees? We've been working on my hips the whole time. And at that point, I probably should have framed it better and said, look, the problem I see with your knees is X, Y, and Z.

I've already ruled out the concerns that you had about your chondromalacia patella, your cartilage going away. I've already ruled out any joint derangement. I don't see that your knees are going to explode when you walk out the door. You said you wanted to run again. So, I'm okay with you running right now, but I would actually like to train you a little bit more as a sprinter for now. And so, but I stress tested the joint down there to let you know that I've looked at it. And so, when you leave the office and you start Googling things, if you do, or you talk to a friend and they're like, hey, you know what?

You know what it could be? It could be that you have an ACL strain and you start Googling it and you see all these freaky things and you start freaking out. Just know I've looked at all that stuff. And so, if there's one thing in particular you think you're going to be Googling when you leave here, maybe you can just tell them what it is and I'll look at it, right? And so, by looking at that, I feel that your knee condition is coming from your hip and your torso not doing their job. And so, allow me to prove that to you and let's go out there in the weight room a little bit and try some stuff for the hip and then we'll just try a movement, try and pick a movement that you think is painful while it's squatting.

Oh, good. Do deep squat. Cool. All right. We're going to test that in a couple minutes here, but let's try these things first and if it's better, great. Then we know we're on the right track and we know that tissue work is not going to be your only thing, all right? I'm going to give you more stuff to do and just know that I have your best interest in mind and I think you'll be running with by the end of the month, right? And so, that's framing it for somebody and I don't want them to be confused, but I want them to understand that I've looked at things with them. And lastly, as you go through examination, which I didn't finish this slide yet, I apologize, is obviously you've got to roll out your red flags, but lastly, or probably the next part is that I look to see, again, what will make the change for the person.

I care about the diagnosis. I really do, all right? I formulate my dip dies in my head. I care about it, but at the same time, knowing that you have a, say, plantar fasciitis doesn't mean you know how to do anything about it for the person. They're different skills, okay? And so, if you have theories of what will work with this plantar fasciitis, this workshop is the place to address it, all right? We're going to go into all that stuff about figuring out what cues will work for this person, what cues won't work, what exercises might work, what first aid might work, what scab picking stuff they might be doing, and then how to get them to a movement-based correction in the safety net, if we can.

If we can't, by all means, we get in there with our hands and address the problem, start moving things around, and that's maybe the person's correction, but at the same time, we need to make sure that we are figuring out the why. Why is this thing happening with this person? Why did this diagnosis present itself when there was no actual trauma involved? Perhaps trauma was involved. But most of us see people who are, let's be realistic, we all talk about how we want to work with our professional athletes, and here's how the professional athletes do it. Realistically, I'd say a strong 95% of the people that we see as chiropractors and PTs are not professional athletes, okay?

And they're trained differently. They're rehabbed differently than professional athletes. They're different demands, different goals, they're different people, and it's one, okay? And so, I want to be realistic about this with people, all right? Is what do they need and what will work for them based upon their goals and what we found in the data point collection of the examination, all right? The examination and the history are all about, I tell them I'm opening a book. You are the book. You are like the Bible. You're big. There's First and Old, New and Old Testament, all right? If I jumped in the middle there, I don't know what's going on, right?

I can guess, but until I guess and test these theories, I don't know. But really, as I start to see this person a couple more times and make sure that these data points that are collected in this area are actually providing fruit, then I don't know if I'm doing the right thing or not. And I kind of say with people, it's like, look, I think I know what's going on with you. Here's my theories, but I won't know until it works, all right? If it doesn't work, tell me. This is a give-take process. I don't know your book. Let's figure your book out together. You've already read it 20 times through, right?

Give me the cliff notes. Be nice. And sometimes they forget to do all the cliff notes, right? It's because this is a trust thing. You don't reveal everything on the first date. It takes a trust. And so, again, I don't like holding people for a very long time with care, but at the same time, it's about learning more about that case, all right? And I think this is why a lot of people like to do resistance training with me after. They're like, there's this guy who took the time to learn all about my body and my case, and I feel like he has the best handle on recommending exercise, right? And so, like, a lot of people like training with their friends.

It's because the trust, all right? This is all about trust. And so, I like to have them work with a strength coach when at all possible, but sometimes they're resistant to that, and it's a whole other exam and history process for them, and that's on their side. I can help through it, but at the same time, I can't help develop a relationship. And so, this is the, I'll stop screen sharing now, this is the basic workshop flow in the beginning. Okay, that was about an hour. I'm exhausted. Now, back onto the podcast stuff here is, again, if you're interested in this, by all means, hit me up. Again, I don't know if this workshop is going to happen more than once.

It was a little bit of effort to get it accredited. And honestly, it was a lot of work to write it. It was more than I thought it would ever be, just getting friends together for, you know, a class reunion, having some beers and some steaks. And so, as I'm starting to see with the content, I think I have something maybe to provide. And so, again, I'm not going to assume I know everything, and I think if you guys are listening to this podcast long enough, you understand that I'm still learning. I've been 10 years out of practice, and I'm still learning. And so, for all I know, I changed these slides before I even present.

And so, but I do want to know your guys' information as well, and there will be Q&A times, and there will be lots of breaks, and there will be people sharing their stories. And so, I'm hoping that we all do learn from each other. And if you're interested in this, or if this has already passed, or there's no spots open again, just reach out, tell me you're interested in having it for you and your classmates. I really think this, our profession, as well as PTs, let's just say movement specialist correction professions, I think we could do a better job of learning the stuff that we don't know early.

And what's that thing, like with high schoolers, like, you know, they kind of already know everything. We're the same, I was the same way, like, we kind of already know everything, unless you're extremely humble, and I was kind of, I kind of wasn't, right? And so, now I think I'm more humble with this, and I realize that I could learn more. And so, I'm hoping that you guys are on board with this, with me, and any of the people that I've mentioned, or even myself, if you want to have us in your area, or if you think you've got a group of people who want to learn, maybe just fly these people out, you know?

Some of them are, or host a seminar, I don't, I'm not saying create a seminar series in regards to hosting seminars, because I know it's a hard thing, but I know that I would like to share with as many people as I can, as long as it's helpful and useful, and I'm helping further the conversation. And so, by the way, that steak that's going to come, I'll tell you what, again, this seminar seminar is, it's cheaper than you think it is, and it's cheaper than any seminar you've ever taken, unless it was a crummy one, and your food's going to be way better. People are going to be better. And so, I look forward to seeing you guys, and I'll listen, or next week on the podcast, we will get into some more cool stuff.

And again, as always, lead people better in how you found them, and if you're dating, date an Eagle Scout, because they have rules and ethics, all right, they've been coached to become cool young men, and I hope I'm not, I hope I'm not going to shoot myself in the foot with that one day with a news story. So, anyways, I'll talk to you guys next time. See you later.