Using exercise as treatment for nerve, back and knee pain

You know, I might use that as my diagnosis if I have to put ICD-10 on it, because it fits all the criteria that, you know, ICD-10 says, hey, this fits in patellofemoral pain syndrome, but I look at it more as like a sensitivity and X movement, sensitivity and X activity, right? And that's kind of treat that as opposed to treating patellofemoral pain syndrome. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. It's Dr. Sebastian, also your host for the Restoring Human Movement podcast. Thanks for joining me the movement movement. This is probably, hopefully, not your first time, because if it was, then you need to dig in the archives.

And sadly, very soon, this is the announcement today, Cody. You are, Cody's a co-host. We're going to go very quickly to once every two weeks in an effort to accomplish two things. Number one is give me a little bit of a break. Number two is there's literally 200 episodes. You guys should go listen to them. I'm giving you a chance. So, we have Dr. Cody D. Mack on today as the co-host. Yeah, how's it going, everybody? It's going great. And you got a nice sound today because you got that microphone. Yeah, man. Thanks to you. You know, you set a man up. That's for sure. You got to hear the voice. So, in case everybody has, this is your first time on the show.

This is intended on clinicians improving their skill set as well as making it easy to understand for patients. So, we all want our patients better. So, hopefully, this will give you some good insight and things to think about as you maybe develop your clinical skills. So, we don't have no idea what we're going to talk about today. We're just going to bullshit around. So, I can start out with something, though. We'll see if you have this. I was going to text you the other day on this. Actually, I was going to call you because I found out something that you might already know, but I thought, holy shit, this works.

So, me and Cody have talked about loading in the past. If you have not heard the other podcast you should talk about, you should go back and listen to them. Quite a bit. So, loading is kind of like, it's like, when can you start challenging these people a little bit rather than just doing passive cares? So, this week, I had three radicular cases, upper extremity radicular cases. One had complete numbness of the fingers. There was no intermittent anymore. There's another one, which was a shoulder-based radiculopathy. Okay. And Cody can't hear me. Oh, phone call. Okay. It's okay. Now you hear me okay?

Yeah. No, I can hear you. I got to run and do something real quick. Okay. We'll pause. All right. Pause. I locked my wife out of the house. Sorry. Good. She was like, my wife. My wife's outside with my daughter and I see her kind of like, I'm upstairs. I can see her down in the front yard. She's like, check your phone. I looked down. She's like, you locked us out. I'm like, oh, my God. Oh, no. I'm sorry. Hide a key. So, here's the three cases this week. Okay. Full hand, full hand, full hand, radicular, like change of sensation. Um, for first and second digit, no longer transient anymore. It was consistent over the last week.

Second case was radicular elbow, phantom, or your pseudolateral opocondylitis. And then there was a radicular end of the shoulder, which was simulating a rotator cuff. Tested really positive for labrums. Um, I did a bunch of openers and stuff with these people, but for the most part, what worked really well on all three was a half kneeling overhead, a band pull down. It took, it took the radicular symptoms of the hand completely away. It took the elbow pain completely away. Um, I had them buried deep into the, into the grip, not the fingertips, just cause there was actually the positive resisted third and fourth digit, um, test for the lab conylitis.

Um, and the shoulder one, like he couldn't do, he called it the BB gun position cause he had the arm up. Um, it took all that away too. Hmm. I'd never used it before. So half, you said a half kneeling, uh, vertical pull with a band. Yeah. With a heavy band, it was about 20, 30 reps on all of them. And then cueing them to, to pull the chest through, pull the chest through. Um, have you, have you tried it before loading? No, I, I haven't. No, not that in particular. Um, I get, uh, for ridiculopities, I kind of veered a little bit more towards, uh, an emphasis on like the distal kind of, um, kind of distal, um, um, um, grip, I guess, if you could say like more so of like, kind of like almost like a pincer grip or, uh, uh, using the fingertips to kind of facilitate, uh, some grip, uh, strength.

That usually for me, that decreases symptoms quite a bit getting into like bottom up kettlebell rack holds. Uh, that does it pretty well. I mean, I've done like horizontal pulling. I haven't done, I haven't really gotten into the vertical pulling per se, but I can see where that, that would, um, that might, you know, depending on the pattern too, you're not necessarily in, you're not really, you don't really care about, uh, in that scenario, you don't really care about, you know, how does it like scapular rotation look like? Cause you have quality upper rotation, are you getting good depression?

They might even be kind of like, even it might even finish with like a faulty kind of pull, like even shrugging up. Right. But that's still, that would take off some, some tension on a nervous system anyway, if they do that. So, yeah, well, yeah. And, uh, I think that, um, obviously I think if, if, uh, I think you're right with the pincer grip is for, I, at least in this case, I was, I was considered, I was considering reducing symptoms more so than building strength, at least in that case. Yeah. Um, but the, yeah, it was kind of nice. I was thinking, cause I was thinking about this, like, you know, like with, with backs, a lot of times if you allow the hinge, the hip hinge and you load it, it's okay.

And so it's, it's like a safety net position, like your, like your shortstop squat. And then for these, these hand symptoms, Bacotti's is positive. So overheads or sorry. So Bacotti's is relieving. Why not load the relieving position and just let it happen? 100%. So it may have just made the arm be an inflection like that. It's taking attention off the nerve root. And like you said, you're kind of move, you're, you're just loading, right? So you're, you're kind of altering with the, the, the brain's perceiving as like, like, I can't move, you know, I have to be, have this protective tone, so to speak.

Uh, but then you kind of play a little trick on it and you put it in a provocative, excuse me, a palliative position. Then you load it in the palliative position and maybe, you know, you're having a little bit larger effect from a, uh, uh, from a brain standpoint. That's really interesting. Well, I thought I'd give you the, I think it's the only original gem that I've had in a very long time. That's solid. Yeah. I like it. I'll try it next time. Uh, has something like that. But, but yeah, I was, I was really surprised. Think thinking back, actually, there was, I remember this one elbow case I had where the guy had elbow pain with pull-ups.

It was in the medial aspect. And so he had, um, he's like, yeah, I can, I took months off and I can only do three and I took a month off and I can only do three. I thought it would go away type of thing. And so in that case, cued the, um, wrap the rib kit, wrap around the rib cage thing. And that took it away. But I guess that was over also overhead for ridiculous in that case. So I don't know. Um, I thought I'd bring it up to you. Cause that's, we didn't talk about it. What do you mean specifically by wrap around the rib cage? So it was, uh, I, I don't know who came up with the cue, but like wrap the shoulder blades around the rib cage before you do the pull-up.

So basically cueing them to a hollow position or, or getting them into almost like a front lever to, to pack the shoulder blade on before they do the pull. Just displacing the chest behind the bar slightly. Oh, okay. Got it. Okay. Yeah. That's interesting. I never thought about that either. Yeah. It's a vertical pull. It's a decreased sensitivity. Well, so let me know. You see more volume. I like it. Try it. I like it. That's, that's the only thing I can start this off with today. I needed to make sure to sneak that in. Cause I don't know what to make of it. It just, well, you know, well, you think about it, you know, you, you, you gotta be creative like that because, uh, especially with upper extremity, cause you know, mostly, you know, a lot of people feel pretty comfortable.

You coming out of school, you don't really feel comfortable treating anything. Right. But then you become feeling comfortable, especially if you're doing an active rehabilitation or implementing it in your practice. Somehow you start to get really comfortable with, with treating low back cases and lumbar disc issues, radicular issues, uh, because McKinsey works really well. But, um, sometimes you don't feel as comfortable, uh, with, uh, with upper extremity, radicular issues or cervical issues, but you know, you gotta kind of get your brain, you know, uh, you know, for, for low backs for disc, you know, we'll put people in a split squat and load them there.

And they have absolutely no, no pain at all. Uh, just because of the orientation that now the pelvis is locked and we're, but we're still loading the lower extremity. We're not putting in a neural tension on, on any nerve roots, uh, as we, as we're, uh, going through the motion, but we're still loading the body. We're loading the, uh, you know, loading posterior chain. Uh, the core has to talk, communicate with the brain to, to, to, to maintain stability, so to speak. You know, why can't we, why can't we start being clever with that, with upper extremity? You know? Yeah. I think the challenge comes in with my challenge with upper extremity comes that it's not, it's, it's like open, it's open chain and it's not as controllable, you know?

Um, but I think that's the value of something, at least with this pull down, it's like, it's kind of more stiff than they are. You know, it's almost like, yeah, that's when creating tension though, is so key, you know, teaching how to create tension into implements with the, with the, with the hand, you know, and it's, you know, it's the hand's just so much more involved than the foot. You know, the foot needs to be involved on the ground when we're doing like, you know, squats, deadlifts and lower extremity movements and stuff. Uh, but like you said, it's close chain. It's a little bit easier to, and you have your entire body weight on top of you creating tension into the, into the floor, into the, if you have a shoe on into the shoe essentially.

Right. But the upper extremity, like you said, it's predominantly going to be open chain, but that's why the emphasis on, on the grip, creating, uh, creating a structured grip around whatever implement you're holding to help create that tension through the, uh, uh, through the nervous system to be able to create some stiffness and control the tension. You know, I think that, that kind of pushes you, you know, I don't know. I just, I just think it pushes you to, to a position to, to be more efficient with your upper extremity loading patterns. So probably someone's going to be listening and thinking, what's the hell are you talking about with tension?

What's this tension? What's this tension thing you talk about? Tension is king. So, um, you know, the, the ability to, uh, in all patients, I believe not just, you know, athletes or anything like that, even in grandmothers and grandpas, you know, uh, you need to be able to, um, to create what we call tension into, uh, into an implement or into the ground or whatever object that we're using to load. And what that means is it's basically create, uh, creating stiffness, uh, muscle stiffness, uh, recruiting muscles, um, uh, uh, in the upper extremity, lower extremity, doesn't matter where we're the emphasis is, but you're teaching your body how to create, uh, uh, controlled stiffness, uh, around a certain area when you go to perform an activity.

And so for the upper extremity, we can use grip, uh, as an example to create tension in the upper extremity. So we use, I, uh, Seb knows that I'm partial to a specific type of grip whenever, uh, I grab the lobster, the lobster claw, uh, man, it, it works, you know, it's, it's, it's a, it's a funny name, but, but golly, it, it just, it's the, to some people it can, you know, it could be, you know, I'll use it for grandmothers to, you know, to, to pick up a kettlebell that they didn't think they could pick up. You might use it for a radiculopathy case, uh, to, to kind of decrease sensitivity in the upper extremity, but you also might, you know, some people with back pain, uh, in low back pain, when they do perform deadlifts, uh, the limiting factor and them keeping the, the lifters wedge is their grip because they lose the grip.

They lose the, the lat post, so to speak. And, you know, and, you know, if you do a ton of reps and like that, that could probably not go such a good way for you. Uh, so, you know, teaching people how to grip a bar again, uh, could be, you know, could actually help their low back. Yeah. Well, I know that when I, um, talk to tension, uh, talk tension to people, it's, it's, it's kind of like a foreign topic to patients. Like they don't think about it much and especially if they don't have any lifting background or anything like that. Um, I, I, I do the, the Jean-Claude Van Damme angry punch scenario, just squeeze your fist super hard and act like you really want to end them, but you, but you won't cause you're a nice guy and you'll notice that your lats and your pecs and everything will start to light up a little bit.

So it creates tension throughout the entire limb. Yeah. You know, if you've ever seen, uh, uh, like, uh, a two or a three year old, uh, when they don't get their way, they, they, they might just kind of like scream and like full body, like full body muscle stiffness. And, and that's the, from creating tension through their whole body. I have a great story for you. So I'm, I'm, so my daughter loves the movie Moana. She loves the movie Moana and she loves the song. She's, she loves music. And so the, uh, I don't know if you've ever seen, have you ever seen Moana? Uh, no, I don't even know what, uh, what culture Moana.

It's a Disney. It's Disney. Is it the Hawaiian Disney? Yeah. It's, yeah. It's a Pacific Islander. Yeah. So anyway, that's beside the point. There's a, there's a song in there where there's this big crab in this culture. The name of the song is called shiny or whatever. So that has nothing to do with what I'm about to tell you, except for what she says. So I'm sitting there feeding her lunch and she just like, she looks up at me, looks me dead in the eyes, takes her fist like this. And she just goes, and she just creates full body tension and like her fist. She just are locked in her, like her lats are out and she's just like, and I'm like, oh my God, this is awesome.

And so like I recorded it and it's incredible. But like what she did, it was just pure as out of nowhere. Nobody taught it to her. Right. So I think our, we actually have the ability to create tension and, and we, you know, we don't use, you know, some people don't lift at all. They don't create tension into implements. So when they start getting older, you know, they don't exercise or anything like that. So you forget how to do it. Right. But maintaining the ability to create tension will actually allow you to, uh, I think obviously control it more, but also relax. So some people who are super type a, they're always go, go, go, go, go.

If you can teach them how to create tension, then they can come out of some tension as well as, I don't know. You know, I think it's, I think it's natural. It's a part of what we can, what we do. It's, it shouldn't be a foreign concept. It should actually be something that we always talk about. Yeah. Well, um, by the way, I just looked up shiny. Um, is it because he has a bunch of gold on the shelf? Is that what's happening? Yeah. He's got, he's got a bunch of treasure. It's a bunch of treasure. He looks very, uh, like he needs dental work. And have you ever seen flat of the concords? Uh, uh, no.

Yeah. It's, it's one of the, I forgot the guy's name. He's, uh, um, he's the, he does the voice for it. It's awesome. It's great. Oh, I was gonna look at flat of the concord next. Yeah. It looks like he has, don't go there. Do it later. Um, well, I can do all this stuff when you're talking here. Um, yeah. So I think tension too, isn't it? Like stretching, yawning, yawning in the morning, maybe like, like, you know, when you first kind of like wake up, you just kind of, that's full body tension right there. So it won't be a foreign thing for everybody, but okay. I didn't mean to tangent us about just tension stuff, but what do you want to talk about today?

You know, I don't, I don't, I don't really know what, uh, I have a topic in mind. Um, you know, as you know, I'm, I'm in a, uh, I'm instructor at Parker university at the chiropractic school here in Dallas. And, uh, my wife is, uh, is, is, is as well. And, you know, she hosts a Monday morning kind of, kind of coffee time, just, uh, with the students to kind of just kind of chat about stuff if they need to. And I actually, I actually rated the, rated the chat a couple of weeks ago. And, um, and this is, this is kind of where we're on the middle of this, you know, the, the, you know, COVID-19 right now, and it's kind of times are crazy and whatnot.

But, uh, I think hopefully, uh, if you can see a silver lining of this, what you and I try and preach, uh, day in and day out with our patients in terms of being active, uh, trying to maintain a healthy lifestyle and stuff like that. Hopefully in the end, uh, when all this is over, uh, it's much more prevalent. We're getting, we're getting more people with, you know, who are being active and it, and it kind of flips the script a little bit on, on kind of the current state of the health, uh, from the health standpoint, you know? Yeah, I agree. It's there, there's certain people are kind of forced to deal with things on their own or at least have some, I don't want to say responsibility, but like, you know, they have to, they have to do their own thing to help their own cause, you know?

Um, no one can, if, if all the, if all the, if all the passive care places and, you know, the, the people that kind of rub you and make you feel good, like our clothes, then what do you, what are you going to do? So, um, yeah, yeah, there was a, there was, there was, there was a lady, uh, um, who lives, I think she lives a couple of doors down from me and she was out walking. I was outside with my daughter and, and she's, she, uh, we just got kind of conversating. And she was like, well, I, I, I can't wait for my, my, uh, my doctor to open back up so I can, she was going to get some shots or something like that.

I was like, oh, okay. I was like, you're walking around pretty good. She's like, yeah, actually, you know what? I, the more I walk, the better I feel. Yeah. I was like, so just keep walking. You don't have to. I don't know. Yeah. I, I don't know if people don't, maybe they think like the answer is too simple sometimes with things like that. You know, like, um, I know that Allie, she'd been, she'd been dealing with the back stuff on and off and so on. And she was like trying to figure out, oh, should I do press ups or openers or what should I do? And I'm like, well, it makes you feel good. And she's like walking.

It feels pretty good. I'm just, I'm like, just walk more. I like, do what feels good. You don't have to do a corrective, right? You could just be, you know, find an activity that actually makes you feel better. And you do that quite often and you load appropriately, you know, I think, you know, with the, with the people who, who, who feel like, uh, you know, things can be like, uh, they, they look for like a simple answer when, when like a shot or something like that, when in fact, the simple, even simpler answer is actually like you just said, just find something that, you know, move more, what makes you feel better moving.

Go ahead and move, move more, but that's all from an educational standpoint. You know what I mean? Yeah. And so as, as doctors, you know, we need to be able to, we need to educate our patients on, on, and not, you know, create fear around movements per se. And I used to do that all the time. I mean, I did that the first like two, three years of practice. I used to tell patients with, you know, with low back, with disc issues, you know, I went, I went, I looked at him and I said, you'll never, you'll never move your spine again. You're never going to flex your spine again. You know, and like, and obviously I wasn't being a hundred percent serious.

Right. But it was, I was trying to use, trying to make a point of like, we need to calm this down. And what a, like looking back, I'm like, what a terrible job of educating, you know, even though like later and later visits, I'm like, I'm like, okay, now we can kind of be a little bit more liberal with our emotions and stuff like that. I still said it before. So they're still thinking about that. They still probably think like, oh my God, if I move my back, it's going to, I'm going to break, you know, you know, just kind of beat my, beat myself in the head, you know, the stuff, stuff he used to say, it's like, holy moly.

Well, that might, it might not be a bad thing though. Like, cause you know, like with, uh, for a while I was saying, like, I kept saying, I'm saying things specifically for a reason, you know, like this movement is not something you want to do right now, you know, and I keep trying to say it. They don't always hear it, you know, so maybe just taking the other route, if you're right, never move again, you know, and they're like, oh, that didn't sound right. I don't know. I guess it's different ways of communicating with people. It's people like certain types of jokes, not others, but. It's true.

I still think there's like, even looking at it deeper into it, I think there's still a way that we can communicate with those, those, those individuals who still aren't quite, they're not quite getting what we're saying of like, we're like, you know, you tell a patient, I don't want you to, we need to avoid this move, this type of movement for right now per se, right. They're not quite getting that. And so you feel like you have to be like, we'll never do it again, never, you know, and be more direct, you know, maybe that's their personality needs something more direct. I think there's still a way that we could try and communicate with those individuals to, to kind of get our point across.

That's much less, you know, much less like abrasive and impactful long-term and their, you know, in their, in their memory, you know, and honestly, I don't know if I would want to be, you know, remembered as the, you know, as like the, the little, the, there's a little Dr. D-Mac on their shoulders saying like, never move again, you know, and never move your spine again, as opposed to like, even if I was more of a blip on the radar, like, oh yeah, that one chiropractor helped me out really, he did a, well, a really good job, but, and there's no fear of moving. I actually think I might want to take that route as opposed to like Dr. D-Mac, you know, he's, he saved my back, you know, and, and then, but, but I can't move my spine again.

Yeah. I don't know if I want to create those limitations around that. Well, you know, if they, if they came back for their third, like second, third, fourth session, you could reverse what you said. Like, but so if they, like, even though you, you scared them on day one, you're, you're, you're, they just didn't complete their care. I don't know. Well, it's not like, it's not like figuring that they're going to, you know, you know, subconsciously, I think it has a little bit, a little bit deeper effect. Well, I know this, there's certain things that I, I, I, I've probably done the wrong thing in the past.

I was telling them too much and. Oh my God. All the time. I never, like, we never stopped talking to patients. Right. I know. It's like when they shut, say something and shut up. Yeah. I just let them, let them decide and digest it. Yeah. I've been calling it white picket fencing them. Like don't show up to a date and then tell people like, you know, I want like a five car garage and a white picket fence and my IRA is going to have this much money. It's like, just, it's not relevant at the moment, but it will be relevant later, you know? So I don't know. But yeah. So loading. Oh, so I guess we should, we should circle back on this because everybody, so Cody's going to be on a handful of times here in the future.

Again, we are, we're offering his strength conditioning stuff on the website. So it's on the P2 sports care website. There's no CEs involved, but it's on there. And a lot of people have asked. And I know a lot of, it's funny, like I wish I'd recorded. Um, actually I did record. I didn't release or patch it together yet. So I had some people ask that were, so they were interested in coming to, I put on some workshops recently. And so, and, uh, so I was surveying and I'm asking like, what do you, like, what do you need? Like, are you appropriate for the course or not? Or is the course right for you?

And, uh, quite a few of them, they're like, so I bought that DMAT course in the next day I went to the clinic. Like it was, they were students next day I went to the clinic and I taught someone how to deadlift and it took all their back pain away. And they're like, it was, it was great. Yeah. And so there's two things, if you guys don't know, there's, there's two things on there. There's lower extremity loading and there's upper quarter. So perfect for rotator cuffs and necks and ridiculous and lumbar disc and so on. So they're all offered on there. Um, but we want to invite you to go look at them, uh, because they are, they are very, very useful and they're affordable too.

So what would you, what would you add? Yeah. Really affordable. Really. Um, I can't believe people spend so much money on court. Well, I mean, I, I believe it cause I did it too. I spent thousands of dollars on courses. Um, how much money do you think you've spent on like maybe what's a course that you spent money on? Don't, you don't have to name it where you thought for that amount of money, I didn't learn hardly a thing. How much money have you burnt before? Oh, on a, on a, on a specific course like that. Yeah. You don't have to name it though. I was really, I was really picky and choosy, um, with what I took from a continued education standpoint.

Um, kind of like not like I didn't really take anything off the wall per se. Uh, it was most of the stuff that I've taken was kind of like tried and true, uh, multiple, you know, multiple people were like, yes, a great course. Um, I would say maybe even, um, in, actually in school with actually was part of the curriculum, but it was still part of my tuition. So that still counts. We had to pay extra as well. And so maybe, maybe that course, uh, was, was like a student discount for the curriculum. Yeah. It was kind of like, this is it. Yeah. There was, I had one like that too. It wasn't school.

Literally, literally, I'm not, I'm not kidding. Literally like 10 minutes into like the hands-on portion. And they were like, like, so the guy, the guy was like, this is it. One sec, one sec. You hear me? Okay. Yep. Okay. There you go. Literally one minute in, you said. Literally like, uh, like a minute into the hands-on section. The guy that was helping my group out was like, so it's literally this, this, this, and this. And that's it. I'm like. That's great. What? So, yeah, that was probably, that was probably the, uh, the one where I was like, uh, you know, it was, it was still kind of beneficial, but it wasn't, it wasn't that.

I would say there, I had a lot of courses I went to. I think that were, it was nice to hear. It was nice to hear the, the theory education and like the, like where things came from. I don't use them all the time or I use little parts of them, but I think going further down the route of like, I, there was a series of courses I went through that. It was like a diminishing return thing. It was like, I think I'm going to learn as much as I did the first time. And I was like, I don't. And actually probably too, like, I guess if I saw a Cody D-Mac, uh, lifters wedge video again, I think I would probably retain a lot.

That's too. I think I've seen it enough. So yeah, I wouldn't buy it a couple hundred times. Yeah. I think I'm just tired of your voice now. Um, yeah. Um, let's see. What is another thing? I'm trying to think of something else that maybe was a new loading thing that we hadn't talked. We talked about low back in the past. We haven't, we haven't really talked about knee. Um, you know, we did a little bit, I think, but somebody, somebody reached out with a comment and I don't know if I was off base by saying this or not, but, um, I mentioned internal femoral rotation of the knee and that being a driving factor in something like maybe condomleage patella.

And they said, no, the patella is not fixed. The femur, even though the sphere moves, I'm like, you're right. It can float, but I'm like, what's moving us or the clouds. Can you tell, you know, and it's like, it's all relative. So, um, what do you think about knee load, uh, knee mechanics in regards to, you talk about patella femoral. Man, um, well, it, first of all, it's just kind of, since I, I wouldn't necessarily look at it. I stopped looking at it as like patella femoral pain syndrome. And I started looking at, you know, I might use that as my diagnosis if I have to put ICD 10 on it. Um, because it fits, it fits all the criteria that, that, you know, ICD 10 says, Hey, it's this fits in patella femoral pain syndrome, but I look at it more as like a sensitivity and X movement, sensitivity and X activity.

Right. And that, that's kind of treat that as opposed to treating patella femoral pain syndrome. You know what I mean? Um, so I think, I think that broad diagnosis in of itself can, is there's, there's, there's a lot of driving factors towards it in that per se. Right. So, uh, you know, I gotta ask like what, when, when does the patient have pain? You know, is it, is it when they're running, when they're walking, uh, is it when they're squatting, as it, when they're exercising, is the foot in contact with the ground when they have pain? Uh, is it when they're running or walking and the foot's leaving is, is kind of in the swing phase, so to speak.

Right. Uh, then, then that, that kind of changes the, where I'm going to look in terms of like where I'm going to try and focus my exercise, uh, prescription per se. What do you, what are you thinking when it's, when it's swing phase? So actually when it's in the swing phase, I think it, I think that is, I think, I think that might be a little bit more of a, uh, a VMO thing. I think that actually, I think it does trickle into VMO, uh, uh, playing a little role. Um, maybe I don't, I, I, I can't, I can't put, put a huge stamp on that. I think it's something to consider though, but when the foot's in contact with the ground, I don't, I don't think VMO has a biggest part of, of, uh, patellar, patellar, air quotes here, patellar tracking issues, as we think, I think it's much more dynamic and especially coming up from the hips.

I'm kind of thinking, I guess with, with, with swing phase, I kind of think about like, there was a couple of patients I had in the past that they had this in regards to, um, there was a little bit more evidence to, to show that there was, um, they were like rotationally intolerant in the knee, I guess. And so the swing phase, it was kind of like, I would imagine like the foot just creates enough torque where it just doesn't like it, you know? Well, I mean, if you, if you're, you're lacking specific ranges of motion as well, you know, you have decreased, you know, just, you, you, you literally, you legitimately have it like a decrease internal rotation of the, uh, the tibia as you're going into knee flexion, that's going to affect mechanics around the knee as well.

Cause when you go into knee flexion and the tibia should internally rotate and femur should externally rotate. So, um, I think circling back on, you said they just can't, maybe can't do that activity right now. I think is what I heard you say something to the degree of. Yeah. So we might modify the activity, right? So, you know, I need to know when I'm treating a knee issue or any issue at all, I need to know what activities make them worse or what, what picks their scab, so to speak. What, what, uh, you know, what are they having trouble doing? I mean, actually, why are you in the office? Cause it's not, it's, you know, those people will say pain, but it's not really the pain.

It's the activity that that's the pains limiting, limiting, uh, limiting them, uh, doing. So I need to know that. And then we're going to, you need to test that and then see what that looks like. And, you know, and, you know, from a patient care standpoint, you're not going to, you know, you address the bi, the, the biomechanical issues, but, uh, but you, you don't necessarily coach them verbally from a biomechanical standpoint. You're going to coach them like a coach. You're going to use very specific languages, uh, let's use language, uh, use a very specific approach, um, and, and kind of have them start thinking about more about the environment, kind of to get them that we'll call the external focus per se.

Uh, maybe we can do that'd be more of an explicit learning strategy or learning approach, or we can even go full, um, dynamic systems theory and go use an implicit strategy where we might manipulate the environment. Maybe you do some type of manual therapy to them to kind of manipulate the individual constraint, uh, and then the movement that you'll get out of that's going to be different. Right. And so we have all these options that we can utilize at the end of the day, it all comes back to loading. So we got to load it and we got to load it. We got to load them, but you know, patients have knee pain.

We're not going to load them into pain. We'll find something else that loads, loads of glutes, uh, the hip musculature loads the quads. That's less sensitive. That doesn't hurt them. Right. And then we'll retest the thing that hurt them before, you know, their knee issue might be a, a frontal plane core stability issue. You know, we wouldn't know that unless we have, but we do the assessment. Right. And so I've had patients with left knee pain where we, we did a, um, you know, we did left side bridge and we create stiffness there and we, and, and, and, and lo and behold, their left, left knee pain goes away whenever we retest single leg squat or something, you know?

Yeah. I think, I think it's nice to like, I kind of go to like the, although it's, I think from a, I'm trying to organize my thoughts here for a second. It seems like a very easy, you know, solution sometimes to someone with back pain just to say, you know, just, uh, we'll just load the glutes, you know? And, um, but I think looking at it from like a, like an, um, like a, uh, movement variabilities type of approach of like, or movement strategies, it's like, what options do they have to get to the floor? And like, maybe that one that they're picking over and over again has become sensitive. And so something like loading glutes will then shift the load somewhere else and we can get them through that movement again.

And I don't see any problem with like removing that movement. Don't move your spine, you know, for a week. And then reloading that thing in, in a strategic way, rather than just avoiding it forever or just saying only, I only want you to move this way with your knee, you know? Um, a hundred percent. Yeah. And I think that's, that's the ticket though. It's like, you know, you're, you're making another strategy available for them to, uh, to move into that executes a similar, uh, the, the, the similar outcome, the similar task or the, or the goal, right? This, uh, pick something up off the floor or whatever.

But how we coach them, we can do that through an implicit strategy, or we can do that through manipulating an individual, uh, uh, you know, individual constraints. Like you said, like, you know, facilitating the gluteal musculature to, to help emphasize like a hip hinge instead of more of a lumbar spine hinge per se. Right. But that's, we're doing that non-verbally. We're doing that through an exercise, through coaching. That's just quality coaching, you know, and, and good coaches, uh, strength and conditioning and good personal trainers have been doing this for, for years, you know, that for years, but now like, you know, Nick Winkleman's book just came out, uh, the language of coaching.

And, you know, he's, he's been on podcasts to podcasts going back, like, you know, probably over 10 years, you know, even back to like strength coach podcasts, talking about like, you know, learning strategies and external internal versus external focus, that type of stuff. It's been around forever. It's been around for a long, long time, but it's just going to come into light in the therapy field, uh, and we still, you know, we're still battling, uh, still battling, uh, um, um, over queuing. Yeah. Oh, you mean, yeah, just, uh, just, just coaching them rather than queuing them. Just talking like, you know, just, just talk like people just talk, you know, and I used to do it too.

I used to, you know, I didn't, it was, I wasn't doing intentionally. I was just trying to like provide my patient information. And then like, I'm sitting there just, and what I was saying was probably correct. Right. But it's just, they just don't need to hear it. Yeah, they don't, they'll, it'll come out when they need to hear it. You know, it's not up to you to decide when they, they should hear what you think they should hear, you know, say what you need to say to execute whatever it is, and then just let it happen. Right. And whenever they ask the question to learn more, then go ahead. But you know, back in the day, I used to just, just, just talk, man, just blah, blah.

And it was, I'm sure it was all good information, but it's just over talking is useless. Yeah. Sometimes it provides rabbit holes for them too. They'll start to, they'll stop and they'll ask a question. Yeah. I guess the question's okay, but it distracts away from, um. The goal. Yeah. What's the goal? The goal is to keep the goal, the goal, you know? Dan Jones. Yeah. The, um, you know, the, the, the, the common thing that I hear from at least people that like, like the interns that have come through and, uh, some of the people that have reached out about, you know, like, Hey, what do you mean by that?

How do you load that? You know? And you know, like, where do you, they usually ask, where do you learn? How do you learn this? We didn't learn this in school. Where am I supposed to learn this? I honestly don't know a lot of workshops where you can. Do you? No, no. It's so, I mean, you just become a strength coach for like a year and, but, but they're not queuing specific to us, uh, pathology. Yeah, they're not. Um, I, you're right. I think it's, it's interesting you say that, uh, cause I've always kind of taken. You know, what I knew just from like experience with strength and condition and strength and conditioning I've had, you know, I was fortunate to have some really good strength coaches going through, uh, high school and college.

And then, you know, taking that and, and, and being able to, I don't know, I don't know how, I don't know where you learned it just to, to apply load to specific conditions and stuff like that. And I don't think it, and I don't, I don't think it, I think it boils down to eventually you're loading specific conditions, but you're not necessarily loading a condition per se. You're actually loading patterns, right? But, but your brain knows it has to put an emphasis on X pattern or X muscle group, because that'll help offload, uh, the, the condition area, you know, air quotes the condition, uh, but it'll also help, uh, or it might help decrease or build tolerance.

Uh, you load the area or air quotes, the condition to still, to keep building tolerance in those, um, you know, what was previously sensitive. Yeah. Right. And so I don't, you're right. I don't know if there's a real course out there that does it, you know, you and I just kind of do it. I guess it's just part of how we operate. It's just, yeah, it just happens. Right. It's just, it's how we operate it, you know? And, and that's what I'm, that's something I'm trying to actually kind of transition that I'm attempting to do in the, in my PT2 course at Parker is, you know, as, is not necessarily make it about know the conditions per se and what you need to treat and what you need to kind of help manage.

But like, it's, it's, you have to have these options of, uh, of exercises and you need to consider all of these, all of these, uh, components, uh, before you make a decision to, to, to provide a therapeutic exercise or an, uh, uh, a treatment, you know, option. Yeah, it's hard to, um, and I'm sure that in the course of like, you, I, you showed me your course curriculum and, uh, I thought, man, you're starting at the bottom, like at the bottom, like, like, you know, like everybody has different starting points of what they know. Like, I mean, you have to, you probably teach, you know, one person what, uh, you know, what a, uh, uh, a half kneeling position is, you know, versus somebody else is like, oh, this is so rudimentary for me, you know?

So, yeah, that's day, that's day one is, you know, half kneeling, uh, this, this is, this is a vertical pull. This is a horizontal pull, which is because some of them just don't know, right? And that's not their fault. You know, it's, it's, they just haven't been exposed to it, uh, and to, to where you, where they need to, you know, hopefully my course will just kind of get them to a position to where they, they start asking more questions about, you know, it makes them ask questions, uh, moving forward. Yeah. Well, there's, I, you said you're going to write a book one day, so there's going to be a, I said that I keep, I keep, you know, I, I feel like maybe one day, but I, like, I just feel like there, I don't know enough.

I don't feel like I'm at the point where I, I, I know enough to put truly to put the, the, the, the, the, the paper, right. Or, or, you know, the fingers to the keys. I just, I feel like I'm missing a lot and I'm not sure where it's at, uh, and I'm looking for it. I know what I'm interested in, interested in, and I know what I want to do from a learning standpoint, but I just feel like I'm missing something and I just don't know what it is. Uh, I haven't, maybe there should just be like, you just create chapters. And so at chapter five, you just leave blank, put pending, and then just start with chapter six.

You know, that way people know it's, it's a work in progress. You're not trying to be like an, I think, I think it might be a more of a, like a, something I'm missing is like a kind of a connector, so to speak. I don't know what it is. I don't, I honestly don't know what it is, but I feel like I'm just missing something. Yeah. Cody, thanks for being on. As always, uh, I think I mentioned to you that, that we've had a lot of requests to actually have you come on. You're the most requested person to come back. I know a couple of people have said, man, I've listened to all things hamstrings like three, four times.

You know, they, they just love the, uh, information you have, but also probably the conversation we have. I'm sure that I, I'm sure I dragged the best information out of you. Um, anyways, everybody's, as we alluded to in there, um, we are going to a number two next to, uh, it's, it's going to be, I don't know. I don't know if I'm going to release it next week or the following week, but we're going to start going to every two week periodically releases just for a while to give you guys a chance to go back and listen to the old episodes. Um, I'm not kidding you. Like there's some golden nuggets back there for clinicians and patients alike.

Um, I think we've had some really good conversations with people. I've tried to create, I've created a lot of original content as well. So, um, I'm not going to say I'm gassed out, but at the same time, I want you guys to go back and to go through the things that are, um, I think are very useful. So I'm going to slow, not hit the pause button, but I'm going to slow things down for a couple months here. Um, but I still want you to listen weekly and just go through and download a bunch of those episodes. Now, uh, next, the next episode is going to be part two, obviously with Dr. D Mac. Um, as we spoke about in there as well, he does have some courses that are, there's no accreditation, there's no certification.

It's just raw learning, just good old queuing, uh, and, and figuring out how to get someone to actual loading. And, um, those are on my website, p2sportscare.com slash products. You'll find, uh, if you scroll down, uh, there it's kind of like upper bars and red, red and black are kind of like the colors of this webinar series anyways. And, um, Cody has the low back one on there, strength conditioning for low back, the clinician's guide, as well as strength conditioning for the shoulder or upper quarter, uh, the clinician's guide. This is, uh, this is gold. I don't know how many times I've, I've said this, but if you've ever wondered, how do you get someone to incorporate exercise back again and get them to not have any triggering problems?

This is, this is your best bet. Um, as I, I wish I had, I'll release it sometime. I had recorded it, but one of the people I'd talked to on a, on a video call, they were a student and they said, I was in the clinic and, uh, yeah, I had somebody, someone came in and said they had pain deadlifting and I, I cued them out of it and they felt good, you know, and they were really excited. And the cool thing about when they told me that story was that it was a movement and activity the patient cared about and it was exciting to them. Like that's like bad-ass buy-in right there. Like that patient's coming back because you got them to do the activity that they want to do pain-free within the first day without even having to do a lot, a lots of, um, manual therapy, just teaching them how to do it.

So that's the definition of empowerment right there. So, um, I want you to go through and, and purchase those guides. Again, there's no CE. It's just the raw information. The next thing too, which I won't run on too long, but this is, um, I do think these are tools are, that tools are going to be useful to you. And I've had a lot of clinicians and students reach out and they're like, Hey, where do I learn all these things? And I don't know, since I'm clipping this later, I don't know if we'd spoken about it in this, uh, uh, part one or part two, but I asked go to you, where do you, where do you learn this stuff?

And it's like, I don't know. I don't know, you know, and, uh, I don't know either. I really don't know, like adding all the spokes and getting the fundamental information is obviously important, but some people really struggle to put things together too. So I've put together a, um, it's five part series, a five part series on patient care and how to get them into loading as well. I utilize a lot of the principles that Cody has in strength conditioning portion, but also too, there's examination, uh, um, dynamic testing, uh, first aids, uh, things like that. Um, and just logically going through a step-by-step approach of how you can get someone to a very empowering state.

We cover lumbar spine, shoulder, hip, um, cervical spine, and radiculopathies too. So please go through there and check them out. Um, they've been pre-recorded this time. There was, it was live at the time, but these are going to be evergreens and always available on the website. Um, it's, it's, it's what I would suggest that I would do to my younger self if I was getting out of school or even the first, second year in practice. So please consider it again. It's on p2sportscare.com slash products. That's called the five part patient care series. It's by myself. Um, it's intended to start at number one.

Number one is hip. Do not start at number two or number three or four or five or six because you will miss parts because I will be referencing stuff in number one. So please start at number one. All right. A lot of information there. So, um, thanks. And I will see you guys, if not next week, the following week, but you will be hearing me anyways next week because you need to go back. I suggest number 94 if you don't know where to go yet. Um, by the way, uh, iTunes tends to delete them after a hundred are gone. So you're going to lose some important stuff back there pretty soon. So go back and download them, listen to them, and I'll see you guys soon.

Thanks for being part, thanks for being part of the movement. Thank you.