The Four-Block Rehab System: First Aid, Correctives, Strength, Play

Probably the thing that was most challenging for me to really teach people was that I didn't really have a good understanding of my own workflow. And so over the course of the last few months, since I've been doing a little bit more presentation, I started to learn that I need to be a little bit more organized. And I think it's helpful for the patients as well to understand what is asked of them, what is suggested they do at home, their homework, and where they're going with things more in a organized partition format. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales.

Hey guys, it's Dr. Sebastian Gonzales. Can't even say my own name this time. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the movement movement. This podcast, if this is your first time, welcome. This is about a 45-minute to hour-long format where we go over many conditions and thoughts based upon the movement therapist-based industry. And so if, again, this is your first time, I try to break this down into very simple conversation, when at all possible. Some are a little bit more complex, but I'd like to think of it kind of like me and another clinician are having a beer at a bar, this time having a West Coast IPA from Green Flash, and you are having a... Has anyone had Kirkland Light? It's terrible. But you got one somehow. And our friend, who is a computer technician, is sitting next to us as well, and he doesn't understand anything we're talking about. And so we decided to make it a little bit more simple.

In simple terms, we don't get all snazzy like we got in school. So the communication here is, I think, what will bring us all together, help more people, help us interact with our patients better, and get our patients better faster. So if you have not already gone through the past podcasts, I've learned a lot over the last two years doing this. So please follow along and journey with me. I've interviewed a ton of great people. I've clarified a lot of my thoughts in there that are hopefully helpful, but they've helpful to you, but they've been helpful to me to organize my thoughts. So if you're also not familiar with the order of this format, order of this podcast, I typically share a little bit of a short story about myself, because I want you to know and hopefully love your host, and I'll do that via a short story very quickly here, and then we'll get into the content today. The content today is revolving around, actually, it was an audio clip that I took to help train my interns and staff. And so I've really struggled with organization of my own workflow at the office, at Performance Place. And as I start to encounter more young doctors and present and teach more, I realized that I should be able to organize this better. And so in an effort to duplicate my process that has worked pretty well for people so far, I put it on audio right here. And it's organized to a four-block format, as well as some patient interaction tools. And what I'm attempting to do with this is I want my interns to be onboarded very quickly, feel very confident about what they're learning and what they can apply and have good patient communication. And so that's the idea behind it. I'll probably make some more we'll see which ones I share. But this one turned out pretty good, I think. So I thought you guys should get some use out of it. So let's get on to that personal story, and then we'll get right into the format. Now, recently, I had a barbecue. I didn't host the barbecue. Someone else hosted the barbecue.

And so my buddy's like, hey, why don't we get some tomahawk steaks today? I said, yeah, we get some tomahawks. It'd be great. Go get some tomahawks. And then let's do it. Let's barbecue. And so he, it was in the morning time. He didn't get the chance to go to the store. And so his wife went to the store. And so she came back with, he's like, hey, she got some, but she didn't get it. She didn't get a tomahawk. I said, what'd she get? She's got, she's like, oh, I, she got a tri-tip. I said, tri-tip. I'm like, most people aren't going to scoff at a tri-tip. But you know what I call a tri-tip? And he's like, what? I said, I call it a poor man's tomahawk. So it's kind of got the same type of marbleization, or actually not same type, but let's say same percentage. It's just not the same. It's not a tomahawk. If you've never had a tomahawk steak, dude, it's like butter in your mouth. So good.

So I love a good tomahawk. Tri-tips are okay. Maybe it's just the way I make it that it makes it okay. But I, again, it's that poor man tomahawk. So don't think they're the same. Here we get on the, here we go to the content. Now, recently, since more interns have come on and I've realized that my teeth in the style could be improved, I started to think that maybe an audio format like this would be helpful on onboarding new interns as well as new clinicians or new employees, just to kind of be able to understand the thought process around some of the recommendations that I'll give. And so ideally, if we're all going to work in the same clinic, then we need to know what is happening with these patients. Not necessarily from a physiological perspective, but for the most part, what is being expected that they do in just a rough format so we all have the same language. And so probably the thing that was most challenging for me to really teach people was that I didn't really have a good understanding of my own workflow. And so over the course of the last few months, since I've been doing a little bit more presentation, I started to learn that I need to be a little bit more organized. And I think it's helpful for the patients as well to understand what is asked of them, what is suggested they do at home, their homework, and where they're going with things more in a organized partition format. I learned from Andy Galpin the concept that people just tend to like organization and they like partitions. And it's kind of like the days of the week, like seven days of the week, like Monday, Tuesday, Wednesday, and so on. There in the universe is really not any of that. So, but people tend to like it. It creates some type of conformity.

So when we're recommending to patients, I think first off, we need to understand what the stage of their problem is. And so a lot of people, if they have like a, like a regular old, say Achilles tendonitis, that is actually a tendonitis, so it's boggy and swollen and so on, then there is a need for a first aid process to occur there, which is our block one. I'll cover the blocks here in one second. For the most part, most people take care of their own block one in cases like this. And for a lot of different conditions, they can, they take care of their own first aid. If your foot hurts, don't stand on it. And that's a, that's an easy one, you know, with that reactive tendonitis, because you unload that thing for three to four or five days, and then you start to reintegrate, load into it. However, when we get, start getting into people who have these kind of buildup types of conditions that don't have any real signs of, of, of acuteness to it, such as your IT band syndrome, such as your, uh, piriformis, your hip flexor tendinitis, your, uh, groin issues.

These ones just kind of, it's a really slow progression. Uh, and so a lot of times people don't actually implement the, the, the appropriate first aid strategy. And so this thing just tends to linger. So here's how I suggest presenting things to patients. And also to, um, if, if I'll ask you, since this is a training module, um, if I ask you to lay out a thought process of how you would manage someone with, with a certain, a certain type of condition, I'm going to be asking you roughly for a block system. And so block one is first aid, what you need to give this person to, uh, reduce their symptoms. Okay. Block two is your corrective exercise. I'll explain, uh, these in detail. Uh, block three is your resistance training, or, uh, in this case, I like the Dan John push pull carry squat hinge with variations. Uh, and then fourth is returning to, uh, play quote unquote play, not necessarily sports, not exercise, but play. And so here's how these things will kind of come together. And so first aid block is a definitive thing, a single thing that you want them to do to reduce their symptoms. And this might not necessarily keep it gone forever, but it will decrease, um, the sensitivity of a structure. Let's just say if we have someone who has a bruise on their shoulder and their brother keeps punching their arm, uh, an appropriate first aid right there might be wearing a padded shirt. It might be stay away from your brother, or it might be having, having punched, having punching the other arm. And so we're trying to desensitize the region because, um, the overall belief at least here is that people are really resilient and the body really wants to heal. It's just, we're not giving it enough time to heal. And so you have those overload types of conditions, those overuse conditions where we're not giving the area an appropriate amount of time to heal, um, to the workload, to, um, to, to the workload over time or, or single bouts. And, um, it's, it's not necessarily, uh, the, the loading is more, uh, it's more so than the recovery time will allow. And so we just need to allow a little recovery time. And so the way I typically explain block one to people is I said, look, we, we found your safety net and we'll use it through the examination. I'll look for something that, that decreases their symptoms, um, very well within a very short amount of time. And let's just say if, um, I'll usually ask them to, can you demonstrate a movement or position which irritates your problem? And I tell them, don't pick a stretch.

And I don't like to pick orthopedics tests when at all possible. Um, because they're kind of take people to end ranges in some cases. Um, and, and I think people can always at some point challenge a stretch a little bit further and they might not feel that there was a big change with the first aid. And what I'm looking for is not a, not a huge, like a hundred percent change on the first day. I'm looking to see that there's a reason to progress down this path. I'm looking to see that the trial of care will be productive. So I need to see what bothers you to do, uh, what bothers your area to do, um, pick, pick a movement, just pick something. How can you irritate it? And so some people might say, I have to run outside a little bit. Good. Go do that and come back. And how long do you have to run? Oh, about one block. Cool. Run a block, come back. Ideally, we don't want that a hundred percent because it'd take forever to do this examination. But if they say, yeah, crawling bothers me, sitting bothers me, squatting, squatting with, um, you know, a hundred pounds, but, um, but 90 pounds doesn't bother me. Um, maybe sitting cross-legged. These things are all, um, useful. And so we say, great, go ahead and test that. Remember what that feels like. And we're going to do this one correction. A lot of times my corrections are, um, end range loading base or, um, opener neurodynamic or, uh, opener based. I have done sliders too.

Sliders typically I won't introduce too much on day one, but, uh, usually neurodynamic openers or some type of, um, uh, end range loading type of protocol. Now we can use other things, but these ones in particular are very, uh, patient empowering in my opinion. And you could use tissue work or percussion instruments or adjustments or whatever, but I'd strongly suggest don't go to that first, at least not in this clinic, because we're on the mission of patient empowerment. And the easiest way to do that is to get them to see that they can reduce their own symptoms with a movement or position, uh, or a movement based reduction.

And at that point we just see that it's looks like a favorable outcome and now they have to dose it out. And so I explained it like an antibiotic treatment. I give you the first pill a day, you go to the pharmacy, you go get the, all the other pills and take them for five days. And so it's their responsibility to do this. However, now we're in that. So this is that block one, right? Those block ones down that you would use for different types of conditions. Um, and, and know them, know that they work or don't work because some of them don't work. All right. And, um, this first aid process is it's commonly overutilized for too long.

And so I'll typically tell people that if this position is painful, say we picked a modification of, of position, like, um, don't like don't slouch. And so currently for five days or so, we're going to be a little bit more neurotic about posture, but at some point we're going to reintegrate your bad posture and it's okay to sit in bad posture. It's just not okay at this point in time. And so that first aid process is, it's unique in that it will be taken away. As soon as possible. Uh, an example would be if I had to cut on my elbow. All right. I don't bend my elbow quite as much cause I might stretch that, that scab up while it's starting to, uh, form.

But at some point you need to bend your elbow normally. And so we need to let them know that in the beginning that these things will come back. And this is a first aid period of time. So be very clear about that block one, because if you're not, they will tend to think that was their fix, but they're frustrated that their body's broken. The thing keeps coming back. Now, usually on the first day in the examination, I'll look again for that first aid, that safety net, that block one. And I'll clearly explain to people, if you don't remember anything else we do today, remember this one thing. And so I need, I want to see them back again in a week anyways, because I'm going to see how well they retained, uh, what I've asked them to do. Are they doing it? Are they doing it well? Did they have a problem doing it? And they stopped. Um, also too, if I showed a corrective exercise, which is our block two, they might have just forgot how to do it, or maybe they're fearful. We don't know. And so the second time is mainly about retention.

So they're going to come back and they're going to, they're going to demonstrate everything we did on day one. Show me that opener, show me that end range loading, show me that bird dog, whatever am I to ask. Um, and honestly, I don't even look at the notes prior to, I look what their condition is, but I don't look to see what it was that we did until they say, I have no idea what we did. And at that point I I'll, I'll show them, but they're paying me to show them the same thing over again. And I'm very clear on day one is we second days about retention. I need to see that you're my, my opinion will not change about your problem unless you do these things. Cause it is a trial of care. You need to test the information and the real change will happen of what, with what you're doing at home. And then I need to integrate different things next time as your condition starts to improve. If it doesn't improve or you didn't do the things, my opinion did not change. I'm going to ask you to do the same stuff again. I say in a nice way. Okay. But our block two, um, when you're considering how you would manage a problem with somebody is remember the block one is their first date and needs to be taken away. Block two is your corrective exercise or what we're trying to do in this case is the corrective exercise is an exercise that people need to get away from as soon as possible as well. A lot of times people end up using them for their warmups, for their runs or their lifting or whatever, which is fine. However, um, a lot of times I think people are married to this idea that they're like, Hey, I went to the PT for my nothing against PTs. They just tend to have a story happened, tends to have, tends to happen with PTs is, Hey, I went to PT for my hip bursitis and they gave me this sheet of exercises and I've been doing them for two years. Great. You should have changed them a long time ago. Um, and maybe they didn't report back. Maybe the PT didn't want them to come back because they wanted to keep them. Uh, they thought the corrective phase was appropriate for that long of a time. Who knows? Either way here though, is the clear, the clear distinction usually between, uh, corrective and resistance training is if it looks like a silly exercise that someone asked you to do, um, on a sheet of paper, uh, from a clinic or you've gone on Instagram and you see these people doing these fancy things with bands and balls and they're on the ground and that's probably a corrective exercise. And a corrective exercise is a medication in this case. All right. It's a medication that is intended and prescribed to get them to increase tone in a certain area to decrease symptoms from coming back. Okay. Their first aid a lot of times will decrease the symptom. However, in phase two or your block two, your, your, uh, intended tone change in this case is intended to buttress and build a little bit more resiliency within that person. All right. It's not a long-term plan. It's a building block to getting them to something else, which is a better long-term plan. So an example of this would be somebody who has, um, uh, uh, IT band based pain, but it's from an L5 radiculopathy, um, nerve root based pain. Um, yet it is driven a lot with running or extension squatting down seems to get rid of it.

This person might respond really well to an opener, um, at first in block one, but block two, maybe we do frontal plane challenges or, or, uh, crawling. Right. And, um, I might not bird dog this person at least immediately because they're really good at extending. They have more extension tendencies. However, someone with a discogenic or segmental type of problem in the back, which is driving that same similar symptom. Maybe we do end range loading, uh, lumbar extension, and maybe we do bird dogs on that same day. And so it's all revolving around what you think, uh, the problem could be, what the symptom is, uh, what, what structure is generating the symptom. And you'll know this within your exam beyond reasonable doubt at least. Um, and, and what is driving the symptom to continue? What is driving that structure to become sensitive? Still? The analogy that we did prior is the bruise is generating the problem, but the brother hitting the area is the driver of the problem. So these are the way we would use corrective exercises. And I don't think we need to have a whole bunch of exercises in our bank.

We probably need about 15 or so that we need to bias differently based upon the person's problem. Okay. And that will just come through experience. Um, I taught a workshop on it. If you did not attend, I'm sorry, you should have come. Um, but the, it's all about how you cue it and you need to ask the person what they're feeling in it. Um, people will tend to say, yeah, yeah, I feel it. I feel it. It's tight right there. It's tight. Okay. Where do you feel it? And they point with a single finger to the spot where the symptom was. In this case, say someone had a hip impingement in the front of their hip and they, you have them do a squat and they're like, yeah, yeah, I feel it right there. Right.

Where do you feel it? In the front. Okay. Restart. Let's do, let's, let's do it a different way. Let's do a quad rock. Hey, yeah, yeah. I feel it. Feel it. Where do you feel it? Well, in the front. No, no, no. Okay. All I want is you to feel that you're moving through range. I don't want you to feel anything in this case. And so let's widen the feet a little bit, bring the feet a little bit, or bring the feet a little together, widen the knees a little bit. Oh yeah, that symptom went away or that problem went away. And so communicating with them what they feel is important, yet you need to cue them externally when at all possible. Push your pockets to the wall behind you. Stay away from my hand. Things like that. And so the different types of cueing that you'll probably pick up in the office here. I tend to use ridiculous cues whenever I possibly can because people tend to remember analogies and stupid conversations like open the pickle jars versus maybe just turning the hands out would be an internal cue. And so develop your own if you'd like. But if you like mine and they work, I strongly suggest don't try to reinvent the wheel. It's really challenging to be able to make up cues on the fly unless you have done it for a little bit. So please adopt the ones that I've been doing. I borrow from people all the time, but I make my own ones as well. And so you'll start to figure out which ones work for you and which one works for that patient because not all cues work for all people. And some of them are very relatable to an industry. I wouldn't tell most people to hide their ribs because it's an internal cue, but that tends to work well with dancers, ballet dancers. So it's dependent upon the industry. A baseball player would know what fielding a ground ball would be like in a ready position or shortstop position, yet someone running track and field might not. But they might know about, hey, what do you like after 400? How do you rest and recover? And they might go onto their hands. And so that's relevant to them. And so make sure you remember who you're talking to.

And just trial and error this stuff. But again, observation, that's why you're in here. That's why you're shadowing. That's what I want you to take away from it. Now your block three is your resistance training. And again, I follow typically the push, pull, carry, squat, hinge, Dan John type of thing. If you have questions on this, Dan John interventions is a good start. There's a lot of scaled stuff in there. You can probably even Google Dan John intervention and look at, or Dan John intervention chart. And there'll be a look at images and there'll be a chart there, which kind of goes through a rough, like what a pushing progression might be and scaled down and so on. And I'll take you through some in the office here. But for the most part, typically we'll start people, we'll start people moving towards a single arm, single leg option whenever possible, because life occurs with singles. Sport occurs with singles, unless we're talking about weightlifting, which then a lot of people's recommendations for your block three, your resistance training, starts to look a lot like powerlifting. And I don't have a problem with powerlifting, but at the same time, I don't necessarily need my track athletes to powerlift when we are getting, when they're single, they're single limb athletes. All right. Even with baseball, it's like you might be kind of in the ready position on two feet, but when you feel the ball, you're kind of staggered. Most life and sport happens with staggered stance and single arm, single leg movements. All right. Now, when you get into stuff into the upper extremity, such as the shoulder, then you have a bunch of variation. We have a horizontal push and pull. We have a, we have a vertical push and pull upward and downward. And so based upon what you're trying to get from the person, you might have to scale that.

And a lot of people with upper trap tone or problems within your quote unquote six scapula category, a lot of times we'll use the overhead variety first, whether that be standing, kneeling, or even on their back, but their arm will be relatively overhead. People within the hip category, I like to first start within the frontal plane or the sagittal plane. Then we go into frontal and then transverse. So, um, these I'm trying to treat the ball and socket joints like a ball and socket and kind of off that McGill model with the, uh, torso stiffness and ball socket dissociation from a stiff or relatively stiff torso. These are important factors when we're going into strength conditioning or your resistance training block three model. Now, which one to recommend first? Well, this is where you got to create creative a little bit. And I want you guys to work on building your theoretical models with these people. Hip impingement typically increases with squatting, but it's okay with hinging back pain. Sometimes they don't like hinging because they form that spinal hinge, but maybe we take them to a squat or maybe, or split squat because it drives a little bit more extension, uh, versus take them into a goblet squat or straight into a hinge. Maybe they tolerate the hinge and, um, you just have to move that hinge into the hips more in the beginning. Um, if there are a lot of times people with lateral types of conditions into, into the thigh or like your IT man or your people who don't, uh, that I've kind of started with openers with in, especially in the running population, a lot of them have issues with single leg stance or hip drop. And so if that hip drop occurs and they create closure in that, uh, intervertebral foramen and it challenges, um, what they feel in their thigh. And so maybe we work them into a single leg stance more into a running gate type of thing, or I just have them carry, um, uh, carry heavy objects, farmers carries, suitcase carries, and just scale it based upon the person's abilities. Uh, we had a guy come in the other day that he had, um, ridiculous symptoms. And so we started into a farmer's carry at some point. And, uh, it was ridiculous into the leg by the way.

And so I had him carry, I was being conservative to 25 pound weights, uh, down the hallway. And so we didn't have a problem. And so we asked him about his daily activity. And he said that he typically, uh, grabs a bucket, 10 gallon buckets of, of water and, um, and puts them in stuff and said 10 pounds or sorry, uh, 10 gallons, 10 gallons. That's about, that's about 80 pounds. And so he's already suitcase carrying 80 pounds. So I said, screw that. Let's go to 35, 45 and let's see how he does on a suitcase, single hand carry. And he did fine. Um, he had a little bit of challenge at the end and then we cued some belly stiffness with it and that went away. And so it's dependent upon what the person's already doing. Don't give them something that is already very easy for them.

This should be challenging. As a rough parameters, I tend to have people do something challenging for them, but they can still do well. If we're talking about, should they do it perfectly? Well, if their symptoms, uh, are not there, then you can get a little bit more liberal with coaching yet, if their symptoms occur, they need to be very conscious of the biomechanical effect of that exercise. See if you can reduce it or just change it, uh, into something else. Uh, I had a gentleman one time who he had problems with squatting in his knees. Um, he, we, we did a hinge, a carry, a push in a pull, and then we squatted again and it went away. And so don't be afraid to kind of ditch a little bit. Uh, and don't, don't fuss with the thing too much if it's not really, uh, getting the result because we need to make sure that we got to keep trust with the patients.

Now a very quick break from our sponsor. Prochiroonlinece.com is the place developed by myself, Phillip Snow, and Ben Ramos as the online CE platform for DCs, by the way, PTs might come later, but currently DCs to get their online education hours without having to struggle through useless information, useless, outdated information. Because if you've been a chiropractor for a while, you've probably been through some of those ones online where you're like, dude, this, this is nothing new. Like I literally just burnt my money. And so we're looking to make it, mitigate that problem. And we believe that we did. We've curated some of the best presenters on certain topics. You can check out all the presenters on the website, um, cause they're changing and we're adding modules, uh, on, on, we, we gather them together for certain topics. And so I can personally testify that as I went through and edited all the, edited all these things, the information is solid. It is game changing. They're clinical pearls and you will learn something. Okay. As one of our participants mentioned, he said he would have taken the video courses and paid for it regardless of CE hours or not. But if you've, if you're like us, you've been to all these different types of workshops before that all that don't offer CEs. And it's by the end of the year, by the end of your birthday year, you're struggling to gather all these CEs. And so you go online and this is an ever going process.

We believe we've solved this problem. So go through prochironlinece.com and test out modules. They're 10 minutes for free on every single one. If you like what you see, buy it and check it out. If you don't know, hard, no, no, no, no, no hard feelings. Okay. So I hope this changes the game for all you guys. And now we're going to get back into the show. So that's just a general idea there so far, but, uh, let me recap here. We have block one, which is your first aid, know the appropriate first aid for the person's problem. All right. We will cover some of these in office, but as you've noticed that I've gone a little bit more towards niching down this business to where we're mainly working with, um, endurance based people, runners in particular, be nice marathoners, um, uh, mid thirties and forties into that range is perfect. Uh, they typically lack some strength conditioning. So there's a lot to teach on that end, but they have a lot of issues into the pure formus or outer hip or groin or outer thigh. Um, this is not, it's not high level, radicular, but a lot of times it's that. And so I'll know, uh, all the typical, um, correctives for that person or the, sorry, the typical first age of that person. Now know your correctives. The intention is to create a change of tone momentarily to buttress the area to help decrease the amount of neuroticism they got to have through their first aid and their recovery. Block three, pick some resistance training, which will not make them into a resistance training athlete or physique athlete. You're trying to make them into a better athlete for the purpose and goal that they're asking for. The number one thing is do not create a weight room injury. All right. Do not give them something who that is something that cannot do well, or that's challenging. It has to be challenging, but they need to be able to do it. Well, roughly 80% or so. What we're attempting to do within this realm is create a chronic, uh, state or a chronic challenge to create an adaptive process. You're going to get neurological change. You're going to get a muscular change. You're going to get movement changes. And so although in block two, we've done something like a corrective exercise that made them feel better. We did not make them stronger. All right. The stimulus was not enough, uh, for enough time to create a change. And if we're considering things like say osteoporosis, what do they tell you to do? They tell you to do body weight stuff for a, uh, a long duration time, like the rest of your life, start walking, start lifting weights and so on. And so we're looking for a longterm adaptive change. It's important to talk to the patient about this in the beginning is that although we're talking about quote unquote, longterm with that it, by the way, I don't always get into this on day one because I believe in the white picket fence thing.

Don't go on a date and tell people about like all your, your dreams and aspirations to have a white picket fence and 15 kids and stuff like that. It's not relevant yet. It will be relevant, but in the beginning, you're just getting to know somebody. And so make sure that you're not, you're not flooding them with stuff. But, uh, in the second and third interaction, you start getting into this stuff. Remember, remember that they know that this, these changes will not happen overnight. They don't need to do them here, but they need to do them. All right. And so we're trying to make a change in that person to help them accomplish their goals. If their goal was to just hang out on the couch and chill and watch TV, we probably wouldn't even get into this. But if they're asking to, um, to do a marathon and it seems like every time they get past the 20 mile mark, they fall apart. Maybe this is something we need to start addressing. Okay. And the third thing, or sorry, the fourth thing, uh, after the resistance training, and this is important for people who, uh, who think that resistance training is the end all, which again, these are all little purgatories.

The fourth thing is play. All right. And I do mean play. I don't mean sport. I don't mean exercise because a lot of people will come in and they'll say, look, I just want to run this race. Good. You can, but I want you to experience a variety of movements with low loads. Go catch butterflies, go play with your kids, you know, um, uh, croquet, bend over, grab, bend over and grab stuff that is not in a weightlifting way. Um, go swim. And I'm not talking about a freestyle. I'm talking about variations of strokes, kind of just playing the water, do what kids do. All right. And so the analogy with this is that we've, we've reduced the symptom by, by modifying stuff. We've helped buttress the area through phase two or block two block three is we're starting to create strength within a region, but in the process, we made you into a darn robot. And number four play is resist is breaking the rest off the resistance training robot. Okay. Nobody should be only resistance training. There should be a variation of stuff. Yeah. Running can kind of be into this category, but again, it's just one single thing. Run backwards, run sideways, you know, play tag. I tend to go towards things that are reactional based. Um, I, I typically say in baseball, uh, I go into the batting cages. I have no idea where that ball is going to go. And so it creates, it brings out a wide variety of movements for me that I typically don't get exposed to throughout the week. Um, now is that a single sided issue where I'm, where I'm only swinging on one, uh, one arm? Maybe, um, let's do the other side too.

A little bit, uh, from the other side, I'm not good at it, but I certainly try. Um, and that's probably not the only thing I need for resistance or for a block four. Any, anyways, it's, it's more than that. I should go out and play stuff in this, for this reason, I picked some volleyball. I think hitting around a volleyball and you're reacting to the ball, um, is going to be a useful thing. You can play pickleball or whatever, like let people pick. I think the challenge in, in block four is that I think a lot of people, as they start to, uh, get out of, um, adolescence, they start to forget what, what they enjoy. And so if you ask them, Hey, what would you do if you, what would you play? Um, if you, how would you play, uh, if you could do anything you want to with your body? You know, and a lot of you will be like, I don't know, like I used to play volleyball, but you know, I don't, I don't know if I can do that again. Sure. You can just try, you know?

And so, uh, people tend to forget. And a lot of times people will default into, well, I want to run again. Why do you want to run? Cause I want to lose weight. Well, let's, uh, you know, maybe you do something else like, cause that running wasn't, wasn't anything you really liked for this person. Um, why don't we try something else? And with swimming, it's like, go back to swimming. Yeah, sure. But don't be, don't do selfish strokes. Don't do freestyle, do, you know, survival strokes, do, uh, egg beaters, you know, uh, rescue somebody or whatever. And so these are important parts in the, in the patient experiences is, is taking them through these blocks in my opinion. Now, not everyone's going to go through these blocks, but, um, it's important when you're programming for them that they understand, uh, what is expected of them and how to organize these things in your head, in their head. Now, the second part of this is a conversation. I think it goes more towards the patient experience and we'll throw away all the blocks right now. We'll just talk about just patient interaction. Now I've been thinking about this a lot over the last, um, few months is that, you know, why do people come here? Why do people go to other people's offices? Uh, why do people like Disneyland and it's about the experience, you know? And I know that, um, I pick an airline. I pick JetBlue because I really like how easy it is. I like that they don't charge you for extra crap.

I like that, you know, they have pop corners on there. I like, it's the only place I ever get those on the plane. Um, I, I, I like how seamless things are, you know, it's just easy. Like, I feel like they treat everyone like they're equal. There's not first class, although I think there is now, um, I like that everyone's kind of equal and there's not this like snobby, like, uh, boarding a type of thing. It's just, you, you board based upon like where your seat is, you know, uh, from the front and back of the plane, at least at Long Beach. So I just like it. And so when people come in here, they need to know that they're going to get better. They need to know that you're taking care of them and you're watching out for them and they need to have a good time. Okay. And so when they come in typically, um, so I don't want to be the front man on everything. Uh, they need to be greeted at the door. They need to be, if we're late, you need to offer them to buy a cup of coffee from around the corner. Um, when they come in, they know that they can go ahead and grab a mat and just start out versus sit in the waiting room. Uh, when you're working with them on the floor, um, and doing corrective exercises or loading, it's not just about the exercise. It's about making sure that they have a good connection in their interaction too. And so I watched a workshop one time by, I think it was, uh, Rooney. Um, and he basically said that you're, um, if you're a trainer, they need to walk out feeling better mentally than when they walked in. And so sometimes that's just the personal connection. Um, but either way, it's like, we're, we're a show, you know, although we're doing a service, we're a show. And if you're sitting on your phone and texting people or, or you had a bad day so far, uh, that's, that's not the patient's concern. That's not why, um, that's not a good reason to ditch out on giving them the attention that, that they are here for. And so just make sure that you know that they could easily go somewhere else. And there's a system in play where people need to feel good walking out physically and mentally better than when they walked in. And so you'll see that when I work with patients, I'll joke around a little bit. I'll talk to them about their day. Um, I'll be watching their movements and correcting them when need be. And so, um, when, when we go into a new teaching strategy or, or say we're going to a new exercise of that day, uh, then I'm a hundred percent pinpoint on that. If they tangent me and want to talk about something else, I'll talk about that. Um, but for the most part, when we're talking about the exercise, I'm trying to get something out of it right there, but I want them to explore and make some mistakes too, especially if they're not acute or, um, really having any major problems right there.

We're just building that block three. So usually I'll pick one exercise that is different than what we've done prior or maybe two. And at the same time, I'll pick something else that they, or I'll let them pick something else that they feel comfortable with. Hey, what would you like to do today? Well, I'd really like to go and, um, really explore that squat again. Okay. We can do that. Okay. I want to, I want to, I want to build the hinge too. So let's do these two things. We'll circle around a little bit. I'm going to let you make your mistakes and I'll start adding cues along the way. Um, just let me know if there's any problems along, along the way. And I'll give you a little bit more free range in the squat, but just know I'll be, I'll be watching you. Um, and, um, if I see any problems, I'll let you know. So, um, it's an experience. And I do believe that each person, um, every time they come in, if they've been coming in with some frequency, they want some consistency. Um, ideally if I treat them prior and then we go out in the weight room, we start implementing some corrections or some loads. Um, I want to do that for that person every single time, but there are instances where I've flip-flopped that and I don't like doing it because I think it's people are used to what they're used to. And when you have those long-term clients, um, who just want to come in more for your block three type of care and all their acute symptoms are dissipated, that's okay. All right. I tend to give them the option. They can go to a, they can go to a strength coach or they can come in or they can do it on their own. I don't care, but the suggestion is still there. And a lot of times people will feel, uh, they feel comfortable that we've examined them. We know their condition well. Um, and then they like maybe the way we programmed, maybe they like that each time we come in, uh, they come in, there's a, there's something a little bit different and new to learn. And so I don't have a lot of thoughts on this because I'm still developing this part of the, uh, the business is that I want to develop something which is more consistency.

All right. But I do know one thing for sure is that we are there for them. We are a show you need to build, you need to build trust with them. You have to, um, give them attention. All right. Uh, don't play with your phone. Um, don't leave them alone. If you are sitting behind the front desk and you're letting them be a little bit more liberal with their movement, make sure that they know that you're watching. Okay. They pay a lot of money to come in and they could easily do all their workouts all on their own. So make sure that you are there with them. Someone is there with them. It's okay to step away for a second, but make sure that they know that you're there for them.

So I hope this was helpful, but, um, I will develop, uh, more thoughts along the way. And there, there will probably be some, uh, changes in the way I explain things. But for the most part, this is the most that I know now, um, in regards to programming for people, for their problems and breaking things up in a partition, uh, sure. They might've heard things a different way. Again, I might say things in a different way in the future, but, uh, for the most part, this is kind of how I do it now and change things might change a little bit. Um, but if you have any questions, just, just let me know. Hope that was helpful to everybody. And as I said, I don't pretend to know everything, uh, at any point in time, I'm always learning more. And that's just the way I can organize my thoughts the best right now is in that format, that four block format. So, um, also too, if you have not already visited so far, there's the pro Cairo online CE platform. And I'm telling you, it is extremely good. Uh, it's one of those types of things where, although you can go there for your, for your continued education online, by the way, a lot of States offer online, um, or sorry, they allow online California. I know you could do 12 online, um, hours in addition to your other 12 that you got to do in person somewhere, but you can, you can do online hours. And so, um, if you have not been to other types of online curriculums, they're just a lot of times very boring and it's not, um, in my opinion, up to date stuff. And I mean that in a, an honest way. And I'm not trying to bash them. It's just that when you go through ours, um, by the way, I'm, I am a partner in this, so I do make money out of that. Um, but it is legit. I mean, if you're talking about like, I know a lot, uh, we're talking about the, the four blocks here.

A lot of times I think our, our profession is very good at block one. We're very good with our hands at reducing symptoms or symptom modification. Um, your end range loading, your openers and your neurodynamics and so on. You get into corrective all, all of a sudden, like people know correctives, correctives, but they don't necessarily know how to apply them all the time and for what purpose. All right. And I mean this again, again, in a nice way, I'm not bashing anybody. There's, there's great clinicians out there, but there's people that struggle with the application there because there's not a lot of places to learn it. Uh, and then in the resistance training, especially using that as, as a, um, a corrective approach and look as loads can be extremely therapeutic. You'd be surprised how many people can go through block three and not even hit block one or two. And, um, so within that pro chiro online, uh, we go through a lot of the corrective loads and a lot of the exercises as well as up to date, um, assessments that you can use for, of course, uh, we don't have cervical, uh, live yet, but there's gonna be several cervical upper extremity coming in module two. Module one is based upon, uh, segmental back or flexion intolerance back or discogenic types of conditions. Um, and so we have some great presenters on there. And so we have to pay a bit of money to our, or we wanted to pay a bit of money to our presenters because our presenters are really good. They're like the experts. They're actually really good. It's just not some random person throwing stuff on paper and making you sit in front of your computer and just, just hang out and wait till your time lapses and take a test. There is a test at the end, by the way. Um, but it's really good people with some really amazing information. And I can tell you from two years ago when I started this podcast, I had not heard about a lot of them and it's just mind blowing when you get in there and, and, um, start learning this kind of stuff. So, uh, please go through and check it. Um, Pro Chiro Online Facebook page also has a lot of free versions.

Um, and if you go through the, uh, actual course website, um, every module has a 10 minute section for free. So there's nothing to lose there. And if you don't like it, you can always, uh, I, I think you can return it. I don't know for sure. I got to check with the guys on this. Um, but, um, you just won't get your CEs, but I believe you actually scratched that. I shouldn't say that until, uh, until we've talked about that. Sorry guys. But, um, I do believe you guys are going to love, uh, the information. So Pro Chiro Online CE. And as always, I'll see you next week. Uh, leave people better than how you found them. If you're dating, date an Eagle Scout. Someone asked me why one time and I said, cause Eagle Scouts typically they're trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, brave, clean, and reverent. Scout law. You know, they're just cool. Like no one gives them credit. They're like outstanding guys most of the time. So that's why I'll talk to you guys soon.