April 16, 2025 • 62 mins
Carolyn McMakin, MA, DC - contact@frequencyspecific.com
Kim Pittis, LCSP, (PHYS), MT - info@fsmsports365.com
00:14 Weekly Check-In and Personal Reflections
01:37 Case Study: Guitarist with Neck and Arm Pain
06:35 Understanding Muscle and Nerve Function
24:10 Family Dynamics in Patient Care
33:09 Addressing Chronic Foot Pain
35:03 The Role of Fascia in Pain Management
36:40 Understanding Nerve and Fascia Interactions
40:28 Impact of Sports on Foot and Leg Health
47:21 Challenges in Treating Complex Conditions
50:16 Innovative Approaches to Stomach Issues
58:55 Upcoming Courses and Final Thoughts
**Evaluating Complex Cases through FSM**
Clinical scenarios often present with multifaceted symptoms, where the root cause might not be apparent. In such situations, FSM can be used to navigate these complexities. As discussed in recent applications, for a patient with persistent neck and arm pain, an MRI revealed disc issues at multiple levels. FSM facilitated a nuanced approach by specifically targeting disc pain, nerve pain, and associated facet pain. Practitioners are encouraged to consider not just the discs but potential secondary factors such as facet joints to provide comprehensive pain management.
**Addressing Neuromuscular Factors**
In patients with unexplained differences in muscle performance, such as grip strength discrepancies, FSM can be instrumental. Observations highlight the benefit of FSM in differentiating between fast and slow-twitch muscle contributions, as seen in musicians and athletes who display varying performance strengths without muscle atrophy. Utilizing FSM frequencies focusing on nerve and muscle integration can aid in balancing these functional differences and enhance performance.
**Facilitating Effective Rehabilitation**
Embedding FSM into rehabilitation practices allows practitioners to address both acute and chronic conditions effectively. By examining case reports, it becomes evident that frequency-specific approaches can significantly improve conditions like disc rehabilitation and muscle coordination. For instance, using precise frequencies for muscular and dural adhesions has shown promising results in restoring mobility and reducing pain. The use of video analysis can further complement FSM strategies by providing insights into habitual movements that may contribute to ongoing issues.
**Holistic Patient Management**
Consideration must be given to broader lifestyle factors and how they interact with the body's physical dynamics. Achieving objectivity in treatments requires practitioners to not merely focus on symptomatic relief but explore the underlying ergonomic and mechanical contributors to a patient's chronic state. For example, in musicians or other professionals exposed to repetitive strain, simple ergonomic adjustments are crucial alongside FSM treatments to maintain structural harmony and prevent recurrence.
**Bilateral Symptoms and Central Nervous System Influence**
Bilateral symptoms in patients often suggest a central nervous system component as a possible origin. Healthcare providers should consider treating the central nervous system and ensure the effective functioning of the dura and related structures. FSM methods can reduce central sensitization and improve neural dynamics, demonstrated by improved bilateral symptoms following targeted FSM therapy.
**Managing Conditions like Plantar Fasciitis and Fasciopathy**
Discussion highlights how tearing and scarring in soft tissues, compounded by repetitive stress, play a central role in chronic fasciopathies. FSM effectively addresses these issues by focusing on reducing tissue scarring and enhancing tissue vitality, thus improving overall fascia function and reducing chronic pain instances like plantar fasciitis.
Implementing FSM in Treatment Protocols
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
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Yay.
How you doing?
How was your week?
Is It's been a week so far.
Okay.
(00:21):
It's been one of those signs fromthe universe that sometimes it is
just what you think it is and to stoplooking for the complicated answer.
Okay.
Sometimes it's just a disc.
Oh, yeah , exactly.
(00:46):
And it's so funny when you have somebodythat presents so clearly as a C6, C7.
You're trying to find more.
Do you know what I mean?
Yeah.
So I wanna talk a little bit about thatbecause sometimes we go from that, and
I'm gonna use that kind of rollercoasterslide, about the learning curve.
(01:07):
We go through that phase of,okay, it's never the muscle.
Okay.
And then that's hard to, that's hard forsome of us to okay, it's not the muscle.
And then we start broadening ourhorizons and we start thinking of, our
little pokey wheel and our reflexesand dermatomes and myotomes, and
(01:30):
taking the long, complicated history.
Sometimes it's just a disc.
It's just a disc.
And I had a week where, especiallyyesterday, I had your voice in my ear.
It was great.
(01:50):
So there was this, thekid has to be six three.
Wow.
And he plays guitar and hehasn't, that's, he's a singer.
That's how he makes his living.
And he has arm pain, neck pain.
They, he's hasn't done a gig in threemonths and they did an MRI of his
(02:15):
neck and he has a 5-6 and a 6-7 disc.
It's okay.
I did the sensation, not a problem.
I did the grip strength.
His right hand, which is the one thathad the pain, nerve pain, was 77 pounds.
(02:36):
The left hand was 110.
Oh,
he's right-handed.
Oh.
And I'm thinking.
But his knee reflexes were normal.
His upper reflexes were normal.
His sensation was mostly normal And
someone wants to come in and say, hello
(02:58):
El?
Yes, Eleanor is helping.
And then he had facetpain at 3, 4, 2, 3, 3, 4.
So I'm treating Dispair andtreating the nerve 'cause I'm
thinking this right hand is weak.
(03:18):
Right.
Then he showed me video of him playingand he plays a harmonica and he sings
and it's like yesterday after I saw thevideo and how big his neck, it's like I.
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This, his referred painpattern, the place that hurt.
So after we treated the disc,the pain lowered down in between
the shoulder blades went away,but the it hurt right here.
And I looked at that slide thatsaid, disc referral, facet referral.
Yeah.
The three four facet that'ssore refers right here.
(04:05):
That's the upper one?
Yeah.
Okay.
So I set him up and treated somethingthat was going on his low back and then
thought about after watching the videoof him play, one of the things that
(04:26):
he does is he whips his head this way.
Just that, just a little jerk.
So as he is boppingalong, he just does that.
I thought,
what if it's just the facet painpatterns are the same, right?
(04:47):
What if it's just the facet?
And then I heard Kim's voiceand I ran everything on that
poor little trauma in the facet.
Yeah.
Trauma in the cartilage.
Yeah.
Inflammation in the cartilageand the bone degeneration.
(05:10):
54 in the cartilage and the bloodsupply and treated, did like
the supine cervical practicum.
But the other thing is thathe always keeps his chin up.
And I kept saying, tuck your chin.
Tuck your chin.
He and I thought hewas extending his neck.
(05:33):
All the time because of the disc?
When I'd work on his low back, he hada hard stop at 90 degrees, so I treated
scarring in the fascia in the dura.
What if the adhesions in the dura orwhy he wasn't comfortable tucking his
(05:56):
chin and putting his neck into neutral?
What if it was stuck up here?
I did scarring in the dura and pulled on.
He was asleep, so it was easy.
Just pull on his neck andtreat the Durham in his neck.
He stood up at the end of thetreatment, said, I have no pain in
(06:18):
my neck, but the place I thoughtof you was when I ran 2 94.
It's your voice was in my ear, andthen I read vitality and everything.
I love that I appear to you.
I do love trauma.
I, like musicians are not unlikeathletes as far as repetitive
(06:41):
mechanics that need to be at a veryhigh level in order to perform.
Yeah.
And even though it may not be thesame as, getting hit by a 300 pound o
lineman or, hitting into the boards,but like that little facet is getting
traumatized with that movement.
(07:02):
That's very exciting.
I figured out the grip strength thing.
Oh, I think we were talking aboutthis on the weekend, but you
definitely need to share this,
the grip strength thing.
When I watched the video, his mom.
It's a great family.
Like I've got mom, dad, and a kid.
They're my whole day, so she takesa video and I'm watching him.
(07:27):
He is really good at picking, so he isplaying lead guitar, so he is really good.
Very fast Twitch muscles on thisright hand the left hand does the
frets and that's slow twitch muscles.
So when you measure, when I lookedat his hands, they looked equal.
(07:50):
There wasn't any atrophy, not,I mean there wasn't any atrophy.
His right, his left handsupports the guitar and is slow
as he presses on the frets.
Grip strength is slow twitch muscles.
(08:15):
His right arm.
They're the same circumference.
There's no muscle wasting.
His right arm is fast twitch.
It will never have the gripstrength of the left arm because
grip strength is slow twitch.
(08:37):
Right.
And
yeah, it was really fun.
I have to jump, I have to jump inbecause when we're when we're assessing.
The speed and the strength andthe quality of a contraction are
dependent on a lot of things.
And we typically go to what'sweak or what's inhibited.
And in this case, nothingwas weak or inhibited.
(08:58):
There was no atrophy.
It's just a firing problem.
And it's not even necessarily a problem,it's just a firing situation because
of what this person does for a living.
Twitch doesn't grip it's grips.
If you're measuring gripstrength, as far as I can tell.
(09:20):
Lot lodging my way through it.
You're measuring slow twitch strength.
Yeah.
That's his left hand.
Yeah.
If other, you had to watchthe video of him playing to
see how fast his fingers move.
Video is so fantastic, and I get it.
(09:42):
We don't get to see video of motorvehicle collisions or some other things.
Those of us work with athletes.
We can watch game tape quite easily, butnowadays, like every parent is filming
their kid on the field or on the ice.
And so I feel like if I'm ever stuck, Ialways ask for video, especially if it's
a sport or activity, I may not know.
(10:05):
And even if it is something that I know,you do wanna see them in their element,
in what makes them happy, in what they do.
And that can really help paint a storywhen you're pulling everything together
because there's no way you would'vethought about fast twitch and slow
twitch from just a history or exam.
No.
(10:26):
And when you see gripstrength, that's 110 and 77.
Yeah,
that's bad.
That's like really bad.
So you found it on the exam for sure.
Oh yeah.
The reason behind it is you haveto still keep searching for that.
You assume that grip strength isinhibited because of basically
(10:54):
nerve problems and muscle weakness.
Yeah.
His arms were the same circumference.
This hand, his righthand was actually bigger.
And I spent three days.
What is up with the grip strength Ikept, I would treat the nerve and I
would expect the grip strength to change.
(11:14):
Always stayed the same.
And then yesterday, finally it was.
Fast twitch, slow twitch, and hewants to be able to build bulk.
He's an ectomorph, he's atall, skinny kid, and it's,
he wants to build slow twitch.
And it's so last night when we'retalking about his rehab, how to rehab
(11:38):
the disc, how to keep his chin tucked,how to sleep, what exercises to do
to get rid of the bone, spurs in hisneck and he wants to lift weights.
And I said, okay, you Kathleensays that it's hard to hear.
(11:59):
I don't know.
I hear
you.
It's, that's maybe turn yourvolume up on your end, Kathleen.
Anyway, so I said, okay,that's completely reasonable.
And.
We had to have this fast twitch,slow twitch conversation, right?
(12:21):
If you build bulk and do weightswith that right arm, you may start
transitioning some muscles from fast toslow, and at some point that may affect
your playing or the way you play mayaffect your ability to lift weights.
(12:49):
With that right hand, you have to choose.
I said, you can do anything you want.
I don't get to vote, but rightnow, the job you gave me when you
arrived five days ago was to rehab aperforming guitar player, a singer.
Yeah.
(13:10):
That's where I'm headed with this.
And so it's like thinkingabout all the features of it.
That's a great word.
Features and when be, oh, becauseof FSM and because of how we
get to think about an injury thetreatment takes on a life of its own.
(13:34):
But the post-treatment takeson a life of its own as well.
So it's not just see them for an hour ortwo in the clinic, give them a stretch and
an exercise and send them on their way.
You're encompassing this huge world of.
Stable, steady state of their ergonomics,their activities of daily living,
(13:58):
their profession, their stress, theirsleep, their nutrition, their blah,
blah, blah, blah, blah, blah, blah.
And this stable state for him,once again watching the video, it's
like you, you need to mo He used,
when you're singing in clubs, youuse a directional mic where you are,
(14:22):
it can't pick up extraneous noise.
Doesn't want amplify crowdsounds or the noise from the bar.
Right.
So you sang with your, the micright up against your mouth.
He had the mic stand set, so hehad to lean forward when he sang.
(14:44):
And
I said, stable state for your neck.
Is you need to raise the mic by aboutsix inches so you don't have to lean
down for the disc and you have to moveit so that when you are comfortably in
neutral, it's right up against your mouth.
So it needs to go six inchesup and six inches closer.
(15:09):
That stable state.
Right.
And he's going to needketoprofen and lidocaine.
He's been beating up his necksince he was 14, so 11 years.
So it's, I don't have an attachmentto, he's buying a custom care and
(15:30):
given the amount of degeneration inhis facets, that may not be enough.
You play a three hour set or.
Start rehearsing and forget tostop and five hours later you've
been doing this with your neckand you just put a little bit of
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ketoprofen and lidocaine on your neck.
And do you have a naturopath?
Somebody that'll prescribe it?
Yes.
No problem.
Okay.
So the stable state isa, has a lot of pieces.
It, yes.
Some pieces we can guide people in andout of, and some pieces, no chance.
(16:11):
It'll be a hard stop.
And then you have to have thoseconver, those honest conversations
of I can get you only so far,but then this is what it is.
And.
There's other avenues.
FSM is an adjunct just like everythingelse, like everything is an adjunct to
everything exercises, PRP, orthobiologics,like all of those are adjuncts.
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And not one is better than the other.
They're all just little piecesthat we have to navigate together.
One to ask you one thingbefore we go too much further.
So when we talk about, disc painand facet pain, we typically say,
flexion will make disc light up andextension will make facets light up.
But if you have a disc and afacet and a neck, what are we
(17:00):
seeing when we're doing an exam?
Are you seeing
both?
You can, he had pain in betweenhis shoulder blades, right?
His neck flexion was initiallywas 40 degrees at the end of.
Let's see.
I treated him Thursday,Friday, Monday, Tuesday.
(17:23):
So I treated him four days At the endof yesterday, his flexion was 70 degrees
and his extension was 70 degrees.
So before it was 40 degrees offlexion pain in between the shoulder
blades and his, the pain on his rightshoulder blade and right like that
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disc, the worst disc pattern wasthere in his right upper back, but his
extension was limited to 30 degrees.
And yesterday it was 70 and 70.
Wow.
So the range of motion andit was completely pain free.
(18:07):
And so any time you have afive six or six seven disc.
You are, I have to knockon something that's wood.
You are going to have a C two three facet.
It's why the supine cervicalpracticum is set up the way it is.
There's always, you always have tolook for, oh, Andy snowboards Paul.
(18:30):
So that was a good look.
So you treat the suboccipital muscles,you treat the dural adhesions,
you treat the epi cervical facet.
And I had separate machines runningon the five six and six seven discs.
So those I assume will heal.
(18:51):
And he loves anatomy.
He's got an anatomy book.
He got a massage book.
It's like he wants to know.
Yeah.
So we went and found pictures'cause I had to teach him those.
Tiny neck lift exercises that get themultifidi and the rotator to contract.
(19:12):
Yeah.
And I said, when you get these musclesto move, teeny, teeny movement, teeny,
teeny muscles, that's how you, becausetheir first day, their question was,
how do we get rid of the bone spurs?
That's easy.
And I, you hear that come outof my mouth and I'm going, no,
(19:34):
can't believe I just said that.
But it takes six months.
But we've done it enough beforethat we know it's possible.
Right.
And with bone spurs, again, theydon't just appear from outer space.
There's a mechanical reason that they both
saw.
Yeah.
But again, that you had I. Talkedabout that with just moving his mic
(19:57):
and moving everything closer to himthat he's not in that extent, I guess
that'd be flexion extension, right?
Yeah.
It's like he's ex extending the uppercervical spine to get to the mic.
And I did explain the rule.
In order to bail out a boat, thefirst thing you have to do is stop
(20:19):
shooting holes in the bottom of it.
So let's figure out how you're makingholes in the bottom of the boat.
Yeah.
And if we, I know that's one ofyour capitalisms, but if we look
at that principle, I think withall of our patients who come in the
door, you're probably doing 80% morethan most practitioners that are
(20:42):
just looking at what their symptomsare and trying to like, get rid of
the symptoms for just that hour.
And what we're doing islooking at the bigger picture.
And because I'm in a unique situationof having to get six or eight weeks
worth of work done in four days.
(21:02):
He had eight machines hooked up to himat some point 'cause his pubic bone was
exquisitely tend couldn't touch it tender.
And I went, that doesn't make any sense.
There was, the mechanism of injury washe was riding in a car and he in the
passenger side and he lifted his leftleg and then your pubic bone hurt.
(21:29):
I wonder what your si joints, Iwonder what your Dura is doing.
Yeah.
And SI joints were totally locked.
His knees stopped at 90 degrees,so we worked on the dura.
I adjusted his SI joints and thentreated his pubic bone passively.
(21:50):
There's no way to, all I have to do isone machine on quiet, the inflammation
on the cartilage, one machine on quiet,the inflammation and the periosteum.
One machine on torn and broken in theligaments and another machine on torn
and broken in the connective tissue andget the pubic bone to repair itself.
(22:17):
But in order to keep it repaired, youhave to get the SI joints moving, right?
Si.
Joints don't move.
Then all of the movement when you walk hasto come from shearing in the pubic bone.
Yeah.
I have four days.
I have three hour new patient andtwo hour follow up and the only
(22:40):
way I can do that is multitask.
So I have seven or eightmachines on every patient.
Repair the disc on a custom caredisc repair nerve pain down his arm.
Yeah.
Facet subacute on his neckand I was doing it by hand.
(23:05):
It's fascinating.
Yeah.
I facet subacute is one of my favoritemode bank protocols that is really good
out of the gate to use because I don'tthink I've really used the acute facet as
much as the subacute 'cause it's always.
(23:25):
Acute on chronic sort of situ acute on
chronic.
The only time you'll ever see anacute facet is when somebody gets
rear-ended right in your drivewayon the way into the clinic.
I got rear-ended on Sundaynight on the freeway.
Oh, that's bad.
It was a hit and run.
So that irritated memore than anything else.
(23:47):
Oh yeah, I could understand that was rude.
Yeah.
And the, I am Canadian, so itwas exquisitely rude to me.
Very rude.
My children were very like appalled.
My youngest said, who parented that person
(24:08):
thought that was great.
But s speaking of parenting when parentscome in with their with their children.
They have a, you're just talkingabout the family that came in.
So when somebody comes in andtravels with you, usually it's
like a team of people, right?
It's very rarely one person.
(24:28):
There's a spouse or partner orchildren or parents that come and I
feel like sometimes they can reallyhelp the situation and sometimes
they can hinder the situation.
You had a really goodidea of family dynamics,
right?
And while I'm all about getting as mu asmuch information as possible, sometimes
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it can become very confusing sometimesbecause the patient on the table will say
their symptoms are X, Y, and Z, and thensometimes somebody else weighs in on no.
You have more pain than that.
Or you have less pain or no.
Your pain is in the morningand it's not at the night.
How do you navigate those?
Those situations.
(25:14):
Okay.
And I know
it's very individualized because
Very, but I had a patient, the,I had treated the mom before.
Okay.
And so I knew her and she'sjust a wonderful person.
And then her, she brought her, I thinkit was middle school age, maybe 12.
(25:39):
Yeah.
And he is telling me his symptomsand she chimes in and talks over him.
Yeah.
And
I looked at her and I said, inthis situation, he's my patient.
I need to hear from him.
I can talk to you later, but Right.
(26:03):
And so that empowers the kid.
Yeah.
So he wasn't looking to her to askher to explain to me what he meant.
He was very articulate.
Yeah.
Very mature.
And so he's talking to meand she talks over him again.
And I looked at her and Isaid, I do have duct tape.
(26:26):
It's you either need to be quietor you need to leave the room.
And then once he's finished with hispart of the history, you can come in
and you can tell me your perception.
Right.
And once I framed itthat way, she was fine.
But I'm really clear about boundaries.
Yeah.
With people that come in with a partner.
(26:49):
And that's just, maybe it's apsych background, maybe it's
No, but I think it's valuable.
And so I was asking you aboutthat and, but, and so when
you have that situation where.
The patient is saying one thing and theother person in the room is main, is
maybe saying something contradictory,is the truth somewhere in the middle?
(27:12):
Whose side do you haveto listen to the patient.
Yeah.
And so you ask the patient and it'sokay, which one of you is correct?
Is her, is there her, his Yeah.
Vision.
What really happened?
Do you underestimate your pain?
(27:34):
It's, I'll usually actually justavoid the problem by having the
patient come in for the history.
Yeah.
By themselves.
Some parts of the history especiallythe part where I ask about have you
ever been molested, abused, or raped?
Yeah.
That is always done withonly the patient in the room.
(27:56):
And I'll ask the other.
Whoever else it is, mom, dad, partner,husband, wife, even the husband.
'cause there's no way to know for sure.
They're a patient that was, hasbeen raped, has already told their
partner and you can't out them andyou can't get the truth from them.
Right.
(28:17):
And it, it's just easier that way.
Yeah.
On the other hand, duringa seminar one time,
the patient is telling me I'm askingabout trauma and he said, oh, I've had
a couple of car accidents and I have myneck as this and that and the other thing.
(28:39):
And his buddy is sitting next to himand said, did you forget the part?
Were you, 'cause they were both firemen
where you
fell through the floor on the secondfloor and landed on your head.
On the first floor with 50 poundsof firefighting gear on your back.
(29:02):
Right?
Oh
yeah.
I forgot all about that.
Yeah, and sometimes, with athletes Ialways say, I very rarely listen to
their side of the story because withathletes and to some extent a motor
vehicle accident, you are not awareof the mechanism of injury because
you are focused on something else.
You have no idea which way theskater came and tried to kill you.
(29:26):
You have no idea which directionthe offensive lineman came because
you were trying to get to the ball.
You were running, you wereshooting, you were doing something.
So that's why like game tape can bevery helpful or asking the parent for
the video because the athlete sometimesdoesn't really understand the way,
the direction that they fell or again,going back to a motor vehicle collision.
(29:48):
I was sitting there talking to mydaughter when I heard the screech
of somebody trying to slam on theirbrakes and I looked in their rear view
mirror just to see the car hit us.
Again, I, but then I saw it,but most people don't see which
way the car is coming or howyou just can't gauge that stuff.
And that's where sometimes youfind out the mechanism of injury
(30:11):
when you start treating or whenyou do your physical exam, right?
It's you start treating somebody's neckand you go to 1 24 and 100 in the supine
cervicals and the left suboccipitalmuscles go smush almost immediately.
And the right ones are still a brick,
(30:31):
right?
Okay, I'm gonna guess your head wasturned to the right when you fell
right.
Maybe, probably.
It doesn't really matter becausethe tissue's gonna respond however
the tissue's gonna respond.
But you're right about the history.
Yeah.
You have treated yourself right away.
Did you?
I
did.
(30:52):
Okay.
I'm so proud.
There's
always, there's always a device at home,but it was for like I don't have any pain.
The impact was like pretty minimal.
I'm in a big SUV.
The car that had us was a very tiny car.
Like I said, I was just I appalledthat it was a hit and run.
Like that really bothered me andit clearly really bothered my
(31:12):
daughter who wasn't in the car.
She was with her dad,but it was how, yeah.
Yeah.
And it was probably somebody withoutinsurance, who couldn't afford to stop.
Or who was maybe intoxicatedor didn't have a license or
like it was something Right.
Usually, but
yeah.
(31:34):
I'm glad you didn't get hurt.
Yeah, no.
Just my feelings were hurt.
Yes.
And your feelings were annoyed.
Yes.
Let's go to the question that we have,
Lisa.
This one is, brings me to, so thedad of this family was, one of
his complaints was just wickedpain down one of his caps sorry.
(32:00):
One of his, the back of his thigh andin his butt and he loves doing yoga.
And then we go to John Sharkey's,muscles don't stretch, they tear.
So I have this yoga addict in front ofme that thinks stretching is a great
thing and I. Get rid of the pain in hisleg by treating, torn and broken in the
(32:25):
connective tissue and the nerve tractioninjury because it was right where the
sciatic comes down the back of the leg.
Yeah.
Yeah.
And it's
Muscles don't stretch, but I like yoga.
This is good, but muscles don't stretch.
They tear and there's, so then that ledto a whole nother, so Lisa, I've had
(32:51):
tight sore calves and a sous for almost mylife, despite doing yoga and stretching.
Do you want to tell her that thesous and the tight sore calves
come from the yoga and stretching?
Let's get through the rest ofthe question then we'll ask.
I sprained my ankle in high school,partially tore my Achilles ow in college.
(33:18):
Plantar fasciitis developed a heel spur.
Pain went away for many years.
Now it's back in bothfeet or unknown to me.
Reasons shooting painin my heel sore arches.
How can FSM and somethingelse address this?
A physical exam would be good.
(33:40):
Pain in both feet is fairlyoften just 40 and 10.
But the other question is with allthe things that get sprained and
partially teared, does that makeyou want to do a bait and exam?
Yep.
It's are you hypermobile or were youhypermobile at that age and shooting?
(34:08):
Pain in my heel and sore arches.
I go right to torn or broken inthe connective tissue and maybe
it's gonna be a physical exam.
Her patella reflexes are,oh, that's the other way.
I knew the kid's.
Disc wasn't that bad.
(34:28):
Patella reflexes were plus one.
Anyway, so physical exam will tell you
for sure.
What do you think?
So I have a couple ways to go.
So yeah, I used to always prescribestretches until you listen to the
bio integrity folks talk abouthow, yeah, there is no stretch.
It's just tear.
(34:48):
And I'm not saying I, I'm onone side versus the other.
There's definitely a lot of mobilitythat I like to include, but when you
start thinking about fibers tearing,it makes you a little bit more cautious
on how to support that movement.
With or without FSM.
So when I'm hearing aboutsomething that feels chronically
tight especially in the posteriorcompartment fascia is a huge component.
(35:13):
So there are fasci autotomies thatthey do to create more space in the
posterior compartment of the leg.
I have supported athletes that have hadthis by using a combination of using 1
24 77, 1 24, 1 42, so torn and brokenin the fascia and the connective tissue.
But then having a, I always call them likedueling pianos in my head, having another
(35:37):
machine using increasing secretions tothe fascia or the vitality to the fascia.
Because if two structures.
Can glide and move.
So like the soleus and the gastroc,the soleus and the adipose, the
soleus and the sheath that is there.
If all of that can glide, you don't needto stretch it because you're increasing
(36:00):
the smoothness of those layers thatare in the posterior compartment.
So I, when I hear that, I jumpto, she needs much more vitality.
And so 49 and 81 with thosestructures, and because there was
a partially torn achilles tendon, Iwould for sure use torn and broken.
But yeah, absolutely makes perfect sensethat you would have plantar fasciitis
(36:25):
because plantar fasciitis comes fromthe posterior compartment of the leg.
It doesn't happen from outer space.
Same with the Spurs.
And the other thing that I go to,especially with the fascist, is the.
The fascia folks.
Yeah.
Fascia is innervated.
Yes.
And if, can I give you thestatistic of the innervation?
(36:47):
Oh, tell me.
Tell me.
So Peter Twist told me, so our brainnerve muscle, that synapse travels
at approximately 175 miles per hour.
Our brain nerve fascia travelsat over 700 miles per hour.
Whoa.
That's fascinating.
(37:10):
Fascinating.
And yet makes so much sense whenyou think of the lattice and
how the fascia is not linear.
And nerves travel in a fascia nerve.
Fascia sandwich.
Yes.
So if there's been a tear, if anythingis ever torn right, it bleeds any place.
(37:31):
It bleeds, there's gonna be scarring.
Right.
One drop of blood fiber sticks.
Yeah.
And so you have to treatscarring, like down
scarring between the nerve and the fascia.
Yeah.
And think, and you lookat the anatomy book, the
(37:57):
piece of the sciatic thatgets to that splits off.
And forms the posterior tibial nerveat the fibular head goes, becomes
the deep and superficial peroneal nerves.
Yeah.
(38:17):
And then the one, those onethat goes off to the left.
Forms the posterior tibial nerve, andthen there's the anterior tibial nerve.
So if you look at the spider web ofnerves that go in between those three
(38:38):
or four compartments in the lowerleg that then travel down, and if
you look at that picture in netter
That shows the fourdifferent layers of the feet.
Yeah.
The arch of the foot.
The sole of the foot.
Yeah.
It's adhesions in the nerve tornand broken in the connective tissue.
(39:01):
Yeah.
It's just, it's, that's where I'd go.
But that's a lot.
Yeah.
Fascinating.
I would also like, just to add to, forposterior compartment gastroc sous I do
cite the one study in the sports courseabout intramuscular adipose tissue.
(39:22):
So intramuscular adipose tissueis not just the, we think about
adipose, we typically think ofthe spare tire around our middle.
We have adipose interlaced everywhere,and there's a very, the highest
volume of intramuscular adiposetissue and our leg is in the gastroc.
So really, so sometimes 3 97 can bevery helpful for those chronically
(39:44):
tight calves helping, which is whatwe use for sclerosis in the adipose.
And that might be helpful too.
I never have thought of that.
That's a good idea.
Yeah.
That's really cool.
Yeah.
Adipose is everywhere.
Little factoids, just, that'swhy we have these meetings is to
share all these little nuggets,
Share nuggets.
(40:05):
And it's for somebody else,it is simply a factoid, right?
For us, it modifies what andhow we treat and what and how
we think about the injuries.
This is really cool.
(40:25):
I wanna go back for a second too,before we go too far away from her.
What, typically when I seesomething that is bilateral, I
think of the cord right away.
Yeah, me too.
So your go-to is 40, but sometimes I thinkit's more 13, and then if I'm thinking
13 and 10, I'm also thinking 13 4, 43.
Because the cord and the dura,like the cord wouldn't just
(40:48):
have adhesions in itself.
The dura could be affected by it.
Yeah.
The 40 and 10, sometimes, like literally,I've had patients where their pain was in
their feet up to their knees, and it was40 and 10 was the thing that took it away.
That was just, oh wait.
(41:10):
Lisa,
oh,
she was a competitivefigure skater for 12 years.
Okay.
Yeah, that, so this, thosetriple toe loops really use
the gastro and soli a lot.
I, everybody knows I have my girls playhockey but they have a helmet and they
have all this, all these pads on them.
(41:32):
But when we would watch the figure skaterspractice before the hockey players, to me
that is just horr, no helmet, no padding,and hitting the ice at such velocity.
So I would imagine the falling,the impact, the compression in her
spine could have some scarring and
(41:54):
her legs and her Yeah,
just falling in general everywhere.
Everything.
Ice is like concrete.
Oh.
And because I do know a little bit about.
About skating.
The so competitive figure skaters,the, your, their feet and ankles
do not move and they do not developbecause of the boot of the rigid mold
(42:20):
that their feet have to sit into.
So sometimes, especially when we havekids that are doing skating sports
and not a lot of barefoot running orbarefoot training, those intrinsic
muscles of the feet that you weretalking about that we can see in
others, they don't develop properly.
So then, we developsome of those adhesions.
So thank you for adding in that nugget.
(42:41):
'cause that makes so much sense now.
And then when they stop skating,when they're 25 or 30, all of a
sudden they're wearing sneakers
Yeah.
That are
very flexible.
Yeah.
And those muscles in their feet.
That when you take the bones in the footand you look at all the layers of muscles,
(43:07):
nerves, arteries, and the way the bonesare designed the tarsals especially,
and the Alis are designed to roll.
Yeah.
It's just amazing.
Yeah.
She interjected that she playedlacrosse and field hockey.
(43:28):
Oh my gosh.
So a lot of impact from different areas.
But again, lacrosse and field hockeyare wearing cleats, and it's not
the same as barefoot movement.
It's very restricted.
We see a lot of these issues withsoccer players because the cleats
that they're wearing are not meantfor human feet, I'm convinced.
No.
And especially if they're playingon artificial turf, that's
(43:50):
another conversation that,
and that needs adult beverages.
Yes.
Yes.
And the.
When you look at lacrosse and fieldhockey, there is a lot of toe off
motion that, so she's overusingfrom the time her legs are growing.
That toe off movement andthe achilles gastroc soleus.
(44:17):
Yeah.
So Lisa hope you know where to start.
I would be running, torn and brokenon the connective tissue first.
And then follow up with scarring andthen vitality to the fascia for sure.
Exactly.
Oh wait, this is hilarious.
Artificial turf causes problems.
Question mark.
(44:37):
Question mark.
That, that might be a whole podcast.
That's No, it's yes.
And.
That.
Yes.
But we're not allowed touse language like that,
right?
Yes.
So
really quickly to just to summarizeturf locks in the feet and so when
(45:00):
the foot is locked in and cannotslide like it would on grass or
mud, and the other bones decide tokeep moving when the foot cannot,
this is where the acls are tearing.
And this is where the highankle sprains are happening.
In short, sober,
oh, this is a good question.
Yes.
(45:20):
Is there a frequency forthe endocannabinoid system?
It's here's the thing.
I think when we create that floatyfeeling, so like when this kid
was asleep during treatment.
(45:42):
There's a feature of cannabinoids back.
If you ever use THC, there's afeature of it that is time distortion.
So you think five or 10 minutes havepassed and it's been an hour, right?
(46:05):
When I go to Rome and Eduardo works on myneck, I fall, I'm asleep within the first
10 minutes and I wake up thinking it'sbeen 30 minutes and it's been two hours.
So I think that floaty feeling wecreate when we treat the nervous
(46:27):
system or we run concussion in Vegas,or we treat anything that makes the
patient floaty or stoned they didn'tmeasure the endocannabinoid system.
But I believe that when weincrease endorphins that we're
also increasing cannabinoids.
(46:49):
So no you don't wanna treat theendocannabinoid system that's no,
no treat, treat what imbalance
or pain that the patient has.
You treat that and the endocannabinoidsystem starts working again.
(47:14):
Yeah.
And I think that's whatmakes patients floaty.
Yeah.
That's my guess.
Yeah.
Last po last week we talked a lot about,there was a question about somebody
who had, was bringing in or the personwas coming in only was gonna give
them 30 minutes to treat mast cell.
And I had a couple people write emailsand we talked about it in the clinic last
(47:37):
week, and they're like, you guys werepretty adamant that was like a no go.
And I said yes, because and maybe10 years ago I would've been like,
sure, I'll run 40 and somethingand help with inflammation.
But it's just so much more thanjust turning down inflammation.
Mast cell is extremely complicated illnessand I feel like it is disrespectful to
(48:03):
everybody involved to just slap on amachine for and only have 30 minutes.
Like I just, I was verydisrespected by that.
It, that's not how treatment works.
That's not how good care works.
And it's also it's a setup.
The patient is setting you,and themselves up to fail.
(48:25):
Yeah.
And
psychologically from just adisrespect is a good word for it.
Manipulative and narcissisticis another word for it.
But it's, it didn't feel right.
Yeah.
I had that exact same feeling.
(48:46):
Like I, I wanna work with somebody thatwould love to spend the day with me.
Like they'll take whatever time Ican give them and I wanna give them
everything that I have and all of mymy wisdom and all the time I have to
text you in the middle of a treatment.
What is this?
(49:07):
And do you know how we are, right?
Yeah.
Just so I would really.
I've never had somebody that's I'm,I can only give you 30 minutes.
For me, it's the opposite.
Can I get another treatment this week?
Can I stay the whole day?
I promise I won't make a sound.
Just let me curl up inthe lobby for 10 minutes.
So I didn't wanna come across as beingrude or dismissive of the question.
(49:30):
I just didn't wanna dismiss that.
Like I said I felt I wanted, weneed to give our patients respect
and their illnesses respect.
And something as complicated asMCAS, I'm sorry, like 30 minutes.
And there's a way to respond tothat, which is exactly what you said.
MCAS is really complicated andthere's no way anyone could treat
(49:56):
MCAS and be successful, right?
With 30 minutes.
FSM is.
Because it can reduce inflammation andrestore the vagus to normal function.
But MCAS is really complicated.
Just the history is gonna take 30 minutes.
Yeah,
right.
(50:16):
I treated something this weekthat I've never seen before.
Oh.
Ever.
So the patient's complaintwas, you're gonna love this.
I can't gain weight.
Okay.
Because I can't eat.
(50:38):
Huh?
I eat three bites and I'mfull and it takes hours, six
hours for my stomach to empty.
And I, okay.
And the, she's already off gluten.
(50:59):
She found out.
She didn't even eat rice,so her diet's really clean.
It's very restricted.
So I felt her abdomen,that was the physical exam.
She had no body pain, felt herabdomen, small intestine was fine.
I got up to her stomachand it was li literal.
(51:23):
You know how when you come up offthe small intestine, you can find
the edge of the stomach, but it's,it loops down and loops over.
Her stomach was hard, that bigand you could feel the duodenum,
(51:45):
and she, part of her history was she hadgastritis because she was so anxious.
She got, she was a teacher,became a teacher after college.
And found out she hatedspeaking in front of groups.
Wow.
(52:05):
So she spent 15 years beinganxious, absolutely every day.
But at an early age, her diagnosiswas gastritis and I thought, okay,
if the stomach gets inflamed, ifinflammation causes scar tissue
(52:26):
every place else, I wonder.
So I treated the stomach forscarring, did a little bit, there's
a frequency for the stomach lining
and I ran scarring in the stomach lining.
That helped.
And I thought soft tissue fibrosis.
(52:51):
So I did fibrosis in the stomach liningand then fibrosis in the duodenum.
And her stomach got soft and theedge dropped down almost two inches.
It was almost normal.
(53:11):
Wow.
And I said, okay, it's five o'clock.
Your job tonight is to go eat morevolume than you would normally eat.
So stop when you feel full, butdon't restrict the amount you eat
(53:34):
because that's what you usually eat.
We need to stretch it whilethe scar tissue is soft.
And it worked.
It was really cool.
Back to Lisa.
There is an MCAS programin the custom care.
I use that.
(53:55):
I had MCAS for about three monthsthis year for some reason, and I
use it for acute MCAS, just, it'sjust histamine and everything.
The blood, the GI tract, the whatever.
Oh, speaking of which, I was doingthe basics on the stomach lining.
(54:23):
I got a histamine in the stomachlining and the stomach got hard again.
What?
Okay, wait a minute.
Histamine stimulate stomach acid, right?
(54:44):
The proton pump inhibitors areH two histamine, two blockers.
So I got off of that, raninflammation and softened up again
and I had to treat fibrosis again.
But isn't that weird?
Nothing is really weird anymore.
(55:05):
Is it?
Let's face it, I've given up on that.
I just, that is an interestingfinding that I will write down
and look for clinically next week.
That's in 30 years.
It's the first time I've evertreated the stomach lining.
Yeah.
Super interesting
because I treated thestomach for scarring.
(55:25):
Nah, a little bit.
Yeah.
But the stomach lining that,that was just fascinating to me.
That is fascinating.
So yes, Lisa, there is an MCA program.
Yeah.
What do you think it couldbe used like as a maintenance
program for people with MCAS?
(55:46):
Probably, but you'd also have to treat.
You have to treat the vagus.
Yeah.
And you, I would guess you alsohave to treat leaky gut, right?
Yeah.
There's no way to have MASunless you have leaky gut.
Yeah.
And there's no way to haveMCAS if your vagus is working.
Yeah.
And for me, the only time Iitched was when I ate yogurt.
(56:12):
And the only time I itched was when Iwent upstairs and both of my dogs had
a particular kind of staph infection.
Oh.
And the dog sleep on my bed in my room.
And I thought now that theirstaph infection is gone,
(56:33):
I don't have MCA anymore.
Wow.
I don't even,
I don't even, yeah.
'cause it's.
I know it hurt.
It's why does my headand it was only my head.
Right?
That itched and it wasonly upstairs in my room.
(56:55):
So I wash my sheets.
Yeah.
Like once a week and wash theblanket that my dog sleeps on.
Yeah.
That worked.
We have one minute toanswer Lisa's last question.
Oh, go on.
Speaking of stomach pain, haveyou said there is a connection
between stomach pain and Vegas?
(57:15):
I have a lot of sore spots on myabdomen at a C-section 17 and a half
years ago assumed it was becausethey put my intestines back walkie.
Yeah.
They are sometimes a littlecasual about with a C-section.
They don't.
Always, they don't takethe small intestine out.
(57:37):
They tend to pack it up.
Yeah.
But if you did that, you could createa little tear in a capillary someplace.
So it's a, the first thing I wouldthink of and treat would be scarring
in the vagus, in the abdomen.
(57:58):
'cause it's a nociceptor.
Yeah.
It's pain.
Pain nerve in the abdomen.
So maybe, yeah.
Yes.
And there are some surgeries wherethey do take out the intestines.
Yeah.
Or somebody whose job it is to takeout the intestines, keep them wet.
Only there's 22 feet of small bowel.
(58:19):
And when they put it back,they're not always tidy.
Yes.
So there's tidy.
It's 4 0 1 okay's that time.
Yes.
It was so fun.
So quick once again thanks everybodyfor your attendance and your
questions, and thanks for being here.
Yes.
(58:39):
You and I have fun even without thequestions, but the questions are helpful.
Yeah.
And I always like to see,30 people hanging out.
It's like drinking coffee, justsitting around in the clinic.
Yeah.
Doing that.
Oh, I'm so ex Oh, canwe, do we have a second?
We have a second.
Just a second.
(59:00):
Okay.
Yeah.
So can I tell him what wetalked about this week?
About, or do you want to tell him?
No, you can tell him.
Okay.
You tell me if I got it right.
Okay.
So Kim is going short version.
Is Kim is going to be doing morecourses and in Troutdale, which
(59:24):
means she gets to stay at my house.
And we decided that there really is aneed for not just the rehab sec. Yeah, the
rehab section, but we have to break it up.
You can't, we have tobreak it up into modules.
There's going to be upper body, shoulder.
(59:47):
Shoulder, neck.
Yeah.
Upper extremity, lower extremity,and then trunk and spine.
Trunk and spine.
Heart only.
You're gonna have to figure, so it's upperextremity is connected to the neck, so
those go together and lower it Anyway.
It's all connected to everything, butI think it's gonna be really beneficial
for everybody that we can take a deeperdive and really go through, not just
(01:00:12):
mechanics, but just the kinesiologyand the anatomy and just, some common
injuries and tie it together and geta really just yeah, a good thorough
understanding of what we're seeing
and how to get it better.
It's like with this kid, whenyou watch how he moved, he had
(01:00:33):
no idea where his serus was.
His right gap was, there wasno way to rehab his arm because
he had no, I, his lower trap inhis serus just weren't there.
Couldn't contract them,couldn't find them.
And
(01:00:54):
so then he got all self-conscious about.
Attracting 'em and it's look, onceyou find them and exercise 'em, it's,
you don't have to think about 'em.
The brain's gonna take care of it.
Yeah.
But that's the sort of thingthat is gonna be in all those
courses you're gonna teach.
I can't wait.
So excited.
I'll be so wonderful.
(01:01:14):
But so one last thing beforewe go we did put like the
last course the sports course.
We're gonna have one in California.
It's Santa Cruz, June 21stand 22nd, or 2020 first.
I have to double check on that.
In Santa Cruz.
Yeah, Santa Cruz.
So we have a practitioner that's gonnahost, it's gonna be he has got a beautiful
PT clinic in Santa Cruz and he wantedsome of his staff to take the course.
(01:01:37):
And we're just gonna have somefun at the beach for two days.
So come join us.
This is pretty fun.
This is cool.
Yes.
Okay.
We are officially fourminutes over, but whatever.
We have fun.
It's our podcast.
We can do what we want,
like the way you think.
All right, everybody.
Thanks for coming.
We'll see you next week.
(01:02:00):
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Yay.
How you doing?
How was your week?
Is It's been a week so far.
Okay.
(00:21):
It's been one of those signs fromthe universe that sometimes it is
just what you think it is and to stoplooking for the complicated answer.
Okay.
Sometimes it's just a disc.
Oh, yeah , exactly.
(00:46):
And it's so funny when you have somebodythat presents so clearly as a C6, C7.
You're trying to find more.
Do you know what I mean?
Yeah.
So I wanna talk a little bit about thatbecause sometimes we go from that, and
I'm gonna use that kind of rollercoasterslide, about the learning curve.
(01:07):
We go through that phase of,okay, it's never the muscle.
Okay.
And then that's hard to, that's hard forsome of us to okay, it's not the muscle.
And then we start broadening ourhorizons and we start thinking of, our
little pokey wheel and our reflexesand dermatomes and myotomes, and
(01:30):
taking the long, complicated history.
Sometimes it's just a disc.
It's just a disc.
And I had a week where, especiallyyesterday, I had your voice in my ear.
It was great.
(01:50):
So there was this, thekid has to be six three.
Wow.
And he plays guitar and hehasn't, that's, he's a singer.
That's how he makes his living.
And he has arm pain, neck pain.
They, he's hasn't done a gig in threemonths and they did an MRI of his
(02:15):
neck and he has a 5-6 and a 6-7 disc.
It's okay.
I did the sensation, not a problem.
I did the grip strength.
His right hand, which is the one thathad the pain, nerve pain, was 77 pounds.
(02:36):
The left hand was 110.
Oh,
he's right-handed.
Oh.
And I'm thinking.
But his knee reflexes were normal.
His upper reflexes were normal.
His sensation was mostly normal And
someone wants to come in and say, hello
(02:58):
El?
Yes, Eleanor is helping.
And then he had facetpain at 3, 4, 2, 3, 3, 4.
So I'm treating Dispair andtreating the nerve 'cause I'm
thinking this right hand is weak.
(03:18):
Right.
Then he showed me video of him playingand he plays a harmonica and he sings
and it's like yesterday after I saw thevideo and how big his neck, it's like I.
(03:40):
This, his referred painpattern, the place that hurt.
So after we treated the disc,the pain lowered down in between
the shoulder blades went away,but the it hurt right here.
And I looked at that slide thatsaid, disc referral, facet referral.
Yeah.
The three four facet that'ssore refers right here.
(04:05):
That's the upper one?
Yeah.
Okay.
So I set him up and treated somethingthat was going on his low back and then
thought about after watching the videoof him play, one of the things that
(04:26):
he does is he whips his head this way.
Just that, just a little jerk.
So as he is boppingalong, he just does that.
I thought,
what if it's just the facet painpatterns are the same, right?
(04:47):
What if it's just the facet?
And then I heard Kim's voiceand I ran everything on that
poor little trauma in the facet.
Yeah.
Trauma in the cartilage.
Yeah.
Inflammation in the cartilageand the bone degeneration.
(05:10):
54 in the cartilage and the bloodsupply and treated, did like
the supine cervical practicum.
But the other thing is thathe always keeps his chin up.
And I kept saying, tuck your chin.
Tuck your chin.
He and I thought hewas extending his neck.
(05:33):
All the time because of the disc?
When I'd work on his low back, he hada hard stop at 90 degrees, so I treated
scarring in the fascia in the dura.
What if the adhesions in the dura orwhy he wasn't comfortable tucking his
(05:56):
chin and putting his neck into neutral?
What if it was stuck up here?
I did scarring in the dura and pulled on.
He was asleep, so it was easy.
Just pull on his neck andtreat the Durham in his neck.
He stood up at the end of thetreatment, said, I have no pain in
(06:18):
my neck, but the place I thoughtof you was when I ran 2 94.
It's your voice was in my ear, andthen I read vitality and everything.
I love that I appear to you.
I do love trauma.
I, like musicians are not unlikeathletes as far as repetitive
(06:41):
mechanics that need to be at a veryhigh level in order to perform.
Yeah.
And even though it may not be thesame as, getting hit by a 300 pound o
lineman or, hitting into the boards,but like that little facet is getting
traumatized with that movement.
(07:02):
That's very exciting.
I figured out the grip strength thing.
Oh, I think we were talking aboutthis on the weekend, but you
definitely need to share this,
the grip strength thing.
When I watched the video, his mom.
It's a great family.
Like I've got mom, dad, and a kid.
They're my whole day, so she takesa video and I'm watching him.
(07:27):
He is really good at picking, so he isplaying lead guitar, so he is really good.
Very fast Twitch muscles on thisright hand the left hand does the
frets and that's slow twitch muscles.
So when you measure, when I lookedat his hands, they looked equal.
(07:50):
There wasn't any atrophy, not,I mean there wasn't any atrophy.
His right, his left handsupports the guitar and is slow
as he presses on the frets.
Grip strength is slow twitch muscles.
(08:15):
His right arm.
They're the same circumference.
There's no muscle wasting.
His right arm is fast twitch.
It will never have the gripstrength of the left arm because
grip strength is slow twitch.
(08:37):
Right.
And
yeah, it was really fun.
I have to jump, I have to jump inbecause when we're when we're assessing.
The speed and the strength andthe quality of a contraction are
dependent on a lot of things.
And we typically go to what'sweak or what's inhibited.
And in this case, nothingwas weak or inhibited.
(08:58):
There was no atrophy.
It's just a firing problem.
And it's not even necessarily a problem,it's just a firing situation because
of what this person does for a living.
Twitch doesn't grip it's grips.
If you're measuring gripstrength, as far as I can tell.
(09:20):
Lot lodging my way through it.
You're measuring slow twitch strength.
Yeah.
That's his left hand.
Yeah.
If other, you had to watchthe video of him playing to
see how fast his fingers move.
Video is so fantastic, and I get it.
(09:42):
We don't get to see video of motorvehicle collisions or some other things.
Those of us work with athletes.
We can watch game tape quite easily, butnowadays, like every parent is filming
their kid on the field or on the ice.
And so I feel like if I'm ever stuck, Ialways ask for video, especially if it's
a sport or activity, I may not know.
(10:05):
And even if it is something that I know,you do wanna see them in their element,
in what makes them happy, in what they do.
And that can really help paint a storywhen you're pulling everything together
because there's no way you would'vethought about fast twitch and slow
twitch from just a history or exam.
No.
(10:26):
And when you see gripstrength, that's 110 and 77.
Yeah,
that's bad.
That's like really bad.
So you found it on the exam for sure.
Oh yeah.
The reason behind it is you haveto still keep searching for that.
You assume that grip strength isinhibited because of basically
(10:54):
nerve problems and muscle weakness.
Yeah.
His arms were the same circumference.
This hand, his righthand was actually bigger.
And I spent three days.
What is up with the grip strength Ikept, I would treat the nerve and I
would expect the grip strength to change.
(11:14):
Always stayed the same.
And then yesterday, finally it was.
Fast twitch, slow twitch, and hewants to be able to build bulk.
He's an ectomorph, he's atall, skinny kid, and it's,
he wants to build slow twitch.
And it's so last night when we'retalking about his rehab, how to rehab
(11:38):
the disc, how to keep his chin tucked,how to sleep, what exercises to do
to get rid of the bone, spurs in hisneck and he wants to lift weights.
And I said, okay, you Kathleensays that it's hard to hear.
(11:59):
I don't know.
I hear
you.
It's, that's maybe turn yourvolume up on your end, Kathleen.
Anyway, so I said, okay,that's completely reasonable.
And.
We had to have this fast twitch,slow twitch conversation, right?
(12:21):
If you build bulk and do weightswith that right arm, you may start
transitioning some muscles from fast toslow, and at some point that may affect
your playing or the way you play mayaffect your ability to lift weights.
(12:49):
With that right hand, you have to choose.
I said, you can do anything you want.
I don't get to vote, but rightnow, the job you gave me when you
arrived five days ago was to rehab aperforming guitar player, a singer.
Yeah.
(13:10):
That's where I'm headed with this.
And so it's like thinkingabout all the features of it.
That's a great word.
Features and when be, oh, becauseof FSM and because of how we
get to think about an injury thetreatment takes on a life of its own.
(13:34):
But the post-treatment takeson a life of its own as well.
So it's not just see them for an hour ortwo in the clinic, give them a stretch and
an exercise and send them on their way.
You're encompassing this huge world of.
Stable, steady state of their ergonomics,their activities of daily living,
(13:58):
their profession, their stress, theirsleep, their nutrition, their blah,
blah, blah, blah, blah, blah, blah.
And this stable state for him,once again watching the video, it's
like you, you need to mo He used,
when you're singing in clubs, youuse a directional mic where you are,
(14:22):
it can't pick up extraneous noise.
Doesn't want amplify crowdsounds or the noise from the bar.
Right.
So you sang with your, the micright up against your mouth.
He had the mic stand set, so hehad to lean forward when he sang.
(14:44):
And
I said, stable state for your neck.
Is you need to raise the mic by aboutsix inches so you don't have to lean
down for the disc and you have to moveit so that when you are comfortably in
neutral, it's right up against your mouth.
So it needs to go six inchesup and six inches closer.
(15:09):
That stable state.
Right.
And he's going to needketoprofen and lidocaine.
He's been beating up his necksince he was 14, so 11 years.
So it's, I don't have an attachmentto, he's buying a custom care and
(15:30):
given the amount of degeneration inhis facets, that may not be enough.
You play a three hour set or.
Start rehearsing and forget tostop and five hours later you've
been doing this with your neckand you just put a little bit of
(15:50):
ketoprofen and lidocaine on your neck.
And do you have a naturopath?
Somebody that'll prescribe it?
Yes.
No problem.
Okay.
So the stable state isa, has a lot of pieces.
It, yes.
Some pieces we can guide people in andout of, and some pieces, no chance.
(16:11):
It'll be a hard stop.
And then you have to have thoseconver, those honest conversations
of I can get you only so far,but then this is what it is.
And.
There's other avenues.
FSM is an adjunct just like everythingelse, like everything is an adjunct to
everything exercises, PRP, orthobiologics,like all of those are adjuncts.
(16:35):
And not one is better than the other.
They're all just little piecesthat we have to navigate together.
One to ask you one thingbefore we go too much further.
So when we talk about, disc painand facet pain, we typically say,
flexion will make disc light up andextension will make facets light up.
But if you have a disc and afacet and a neck, what are we
(17:00):
seeing when we're doing an exam?
Are you seeing
both?
You can, he had pain in betweenhis shoulder blades, right?
His neck flexion was initiallywas 40 degrees at the end of.
Let's see.
I treated him Thursday,Friday, Monday, Tuesday.
(17:23):
So I treated him four days At the endof yesterday, his flexion was 70 degrees
and his extension was 70 degrees.
So before it was 40 degrees offlexion pain in between the shoulder
blades and his, the pain on his rightshoulder blade and right like that
(17:45):
disc, the worst disc pattern wasthere in his right upper back, but his
extension was limited to 30 degrees.
And yesterday it was 70 and 70.
Wow.
So the range of motion andit was completely pain free.
(18:07):
And so any time you have afive six or six seven disc.
You are, I have to knockon something that's wood.
You are going to have a C two three facet.
It's why the supine cervicalpracticum is set up the way it is.
There's always, you always have tolook for, oh, Andy snowboards Paul.
(18:30):
So that was a good look.
So you treat the suboccipital muscles,you treat the dural adhesions,
you treat the epi cervical facet.
And I had separate machines runningon the five six and six seven discs.
So those I assume will heal.
(18:51):
And he loves anatomy.
He's got an anatomy book.
He got a massage book.
It's like he wants to know.
Yeah.
So we went and found pictures'cause I had to teach him those.
Tiny neck lift exercises that get themultifidi and the rotator to contract.
(19:12):
Yeah.
And I said, when you get these musclesto move, teeny, teeny movement, teeny,
teeny muscles, that's how you, becausetheir first day, their question was,
how do we get rid of the bone spurs?
That's easy.
And I, you hear that come outof my mouth and I'm going, no,
(19:34):
can't believe I just said that.
But it takes six months.
But we've done it enough beforethat we know it's possible.
Right.
And with bone spurs, again, theydon't just appear from outer space.
There's a mechanical reason that they both
saw.
Yeah.
But again, that you had I. Talkedabout that with just moving his mic
(19:57):
and moving everything closer to himthat he's not in that extent, I guess
that'd be flexion extension, right?
Yeah.
It's like he's ex extending the uppercervical spine to get to the mic.
And I did explain the rule.
In order to bail out a boat, thefirst thing you have to do is stop
(20:19):
shooting holes in the bottom of it.
So let's figure out how you're makingholes in the bottom of the boat.
Yeah.
And if we, I know that's one ofyour capitalisms, but if we look
at that principle, I think withall of our patients who come in the
door, you're probably doing 80% morethan most practitioners that are
(20:42):
just looking at what their symptomsare and trying to like, get rid of
the symptoms for just that hour.
And what we're doing islooking at the bigger picture.
And because I'm in a unique situationof having to get six or eight weeks
worth of work done in four days.
(21:02):
He had eight machines hooked up to himat some point 'cause his pubic bone was
exquisitely tend couldn't touch it tender.
And I went, that doesn't make any sense.
There was, the mechanism of injury washe was riding in a car and he in the
passenger side and he lifted his leftleg and then your pubic bone hurt.
(21:29):
I wonder what your si joints, Iwonder what your Dura is doing.
Yeah.
And SI joints were totally locked.
His knees stopped at 90 degrees,so we worked on the dura.
I adjusted his SI joints and thentreated his pubic bone passively.
(21:50):
There's no way to, all I have to do isone machine on quiet, the inflammation
on the cartilage, one machine on quiet,the inflammation and the periosteum.
One machine on torn and broken in theligaments and another machine on torn
and broken in the connective tissue andget the pubic bone to repair itself.
(22:17):
But in order to keep it repaired, youhave to get the SI joints moving, right?
Si.
Joints don't move.
Then all of the movement when you walk hasto come from shearing in the pubic bone.
Yeah.
I have four days.
I have three hour new patient andtwo hour follow up and the only
(22:40):
way I can do that is multitask.
So I have seven or eightmachines on every patient.
Repair the disc on a custom caredisc repair nerve pain down his arm.
Yeah.
Facet subacute on his neckand I was doing it by hand.
(23:05):
It's fascinating.
Yeah.
I facet subacute is one of my favoritemode bank protocols that is really good
out of the gate to use because I don'tthink I've really used the acute facet as
much as the subacute 'cause it's always.
(23:25):
Acute on chronic sort of situ acute on
chronic.
The only time you'll ever see anacute facet is when somebody gets
rear-ended right in your drivewayon the way into the clinic.
I got rear-ended on Sundaynight on the freeway.
Oh, that's bad.
It was a hit and run.
So that irritated memore than anything else.
(23:47):
Oh yeah, I could understand that was rude.
Yeah.
And the, I am Canadian, so itwas exquisitely rude to me.
Very rude.
My children were very like appalled.
My youngest said, who parented that person
(24:08):
thought that was great.
But s speaking of parenting when parentscome in with their with their children.
They have a, you're just talkingabout the family that came in.
So when somebody comes in andtravels with you, usually it's
like a team of people, right?
It's very rarely one person.
(24:28):
There's a spouse or partner orchildren or parents that come and I
feel like sometimes they can reallyhelp the situation and sometimes
they can hinder the situation.
You had a really goodidea of family dynamics,
right?
And while I'm all about getting as mu asmuch information as possible, sometimes
(24:53):
it can become very confusing sometimesbecause the patient on the table will say
their symptoms are X, Y, and Z, and thensometimes somebody else weighs in on no.
You have more pain than that.
Or you have less pain or no.
Your pain is in the morningand it's not at the night.
How do you navigate those?
Those situations.
(25:14):
Okay.
And I know
it's very individualized because
Very, but I had a patient, the,I had treated the mom before.
Okay.
And so I knew her and she'sjust a wonderful person.
And then her, she brought her, I thinkit was middle school age, maybe 12.
(25:39):
Yeah.
And he is telling me his symptomsand she chimes in and talks over him.
Yeah.
And
I looked at her and I said, inthis situation, he's my patient.
I need to hear from him.
I can talk to you later, but Right.
(26:03):
And so that empowers the kid.
Yeah.
So he wasn't looking to her to askher to explain to me what he meant.
He was very articulate.
Yeah.
Very mature.
And so he's talking to meand she talks over him again.
And I looked at her and Isaid, I do have duct tape.
(26:26):
It's you either need to be quietor you need to leave the room.
And then once he's finished with hispart of the history, you can come in
and you can tell me your perception.
Right.
And once I framed itthat way, she was fine.
But I'm really clear about boundaries.
Yeah.
With people that come in with a partner.
(26:49):
And that's just, maybe it's apsych background, maybe it's
No, but I think it's valuable.
And so I was asking you aboutthat and, but, and so when
you have that situation where.
The patient is saying one thing and theother person in the room is main, is
maybe saying something contradictory,is the truth somewhere in the middle?
(27:12):
Whose side do you haveto listen to the patient.
Yeah.
And so you ask the patient and it'sokay, which one of you is correct?
Is her, is there her, his Yeah.
Vision.
What really happened?
Do you underestimate your pain?
(27:34):
It's, I'll usually actually justavoid the problem by having the
patient come in for the history.
Yeah.
By themselves.
Some parts of the history especiallythe part where I ask about have you
ever been molested, abused, or raped?
Yeah.
That is always done withonly the patient in the room.
(27:56):
And I'll ask the other.
Whoever else it is, mom, dad, partner,husband, wife, even the husband.
'cause there's no way to know for sure.
They're a patient that was, hasbeen raped, has already told their
partner and you can't out them andyou can't get the truth from them.
Right.
(28:17):
And it, it's just easier that way.
Yeah.
On the other hand, duringa seminar one time,
the patient is telling me I'm askingabout trauma and he said, oh, I've had
a couple of car accidents and I have myneck as this and that and the other thing.
(28:39):
And his buddy is sitting next to himand said, did you forget the part?
Were you, 'cause they were both firemen
where you
fell through the floor on the secondfloor and landed on your head.
On the first floor with 50 poundsof firefighting gear on your back.
(29:02):
Right?
Oh
yeah.
I forgot all about that.
Yeah, and sometimes, with athletes Ialways say, I very rarely listen to
their side of the story because withathletes and to some extent a motor
vehicle accident, you are not awareof the mechanism of injury because
you are focused on something else.
You have no idea which way theskater came and tried to kill you.
(29:26):
You have no idea which directionthe offensive lineman came because
you were trying to get to the ball.
You were running, you wereshooting, you were doing something.
So that's why like game tape can bevery helpful or asking the parent for
the video because the athlete sometimesdoesn't really understand the way,
the direction that they fell or again,going back to a motor vehicle collision.
(29:48):
I was sitting there talking to mydaughter when I heard the screech
of somebody trying to slam on theirbrakes and I looked in their rear view
mirror just to see the car hit us.
Again, I, but then I saw it,but most people don't see which
way the car is coming or howyou just can't gauge that stuff.
And that's where sometimes youfind out the mechanism of injury
(30:11):
when you start treating or whenyou do your physical exam, right?
It's you start treating somebody's neckand you go to 1 24 and 100 in the supine
cervicals and the left suboccipitalmuscles go smush almost immediately.
And the right ones are still a brick,
(30:31):
right?
Okay, I'm gonna guess your head wasturned to the right when you fell
right.
Maybe, probably.
It doesn't really matter becausethe tissue's gonna respond however
the tissue's gonna respond.
But you're right about the history.
Yeah.
You have treated yourself right away.
Did you?
I
did.
(30:52):
Okay.
I'm so proud.
There's
always, there's always a device at home,but it was for like I don't have any pain.
The impact was like pretty minimal.
I'm in a big SUV.
The car that had us was a very tiny car.
Like I said, I was just I appalledthat it was a hit and run.
Like that really bothered me andit clearly really bothered my
(31:12):
daughter who wasn't in the car.
She was with her dad,but it was how, yeah.
Yeah.
And it was probably somebody withoutinsurance, who couldn't afford to stop.
Or who was maybe intoxicatedor didn't have a license or
like it was something Right.
Usually, but
yeah.
(31:34):
I'm glad you didn't get hurt.
Yeah, no.
Just my feelings were hurt.
Yes.
And your feelings were annoyed.
Yes.
Let's go to the question that we have,
Lisa.
This one is, brings me to, so thedad of this family was, one of
his complaints was just wickedpain down one of his caps sorry.
(32:00):
One of his, the back of his thigh andin his butt and he loves doing yoga.
And then we go to John Sharkey's,muscles don't stretch, they tear.
So I have this yoga addict in front ofme that thinks stretching is a great
thing and I. Get rid of the pain in hisleg by treating, torn and broken in the
(32:25):
connective tissue and the nerve tractioninjury because it was right where the
sciatic comes down the back of the leg.
Yeah.
Yeah.
And it's
Muscles don't stretch, but I like yoga.
This is good, but muscles don't stretch.
They tear and there's, so then that ledto a whole nother, so Lisa, I've had
(32:51):
tight sore calves and a sous for almost mylife, despite doing yoga and stretching.
Do you want to tell her that thesous and the tight sore calves
come from the yoga and stretching?
Let's get through the rest ofthe question then we'll ask.
I sprained my ankle in high school,partially tore my Achilles ow in college.
(33:18):
Plantar fasciitis developed a heel spur.
Pain went away for many years.
Now it's back in bothfeet or unknown to me.
Reasons shooting painin my heel sore arches.
How can FSM and somethingelse address this?
A physical exam would be good.
(33:40):
Pain in both feet is fairlyoften just 40 and 10.
But the other question is with allthe things that get sprained and
partially teared, does that makeyou want to do a bait and exam?
Yep.
It's are you hypermobile or were youhypermobile at that age and shooting?
(34:08):
Pain in my heel and sore arches.
I go right to torn or broken inthe connective tissue and maybe
it's gonna be a physical exam.
Her patella reflexes are,oh, that's the other way.
I knew the kid's.
Disc wasn't that bad.
(34:28):
Patella reflexes were plus one.
Anyway, so physical exam will tell you
for sure.
What do you think?
So I have a couple ways to go.
So yeah, I used to always prescribestretches until you listen to the
bio integrity folks talk abouthow, yeah, there is no stretch.
It's just tear.
(34:48):
And I'm not saying I, I'm onone side versus the other.
There's definitely a lot of mobilitythat I like to include, but when you
start thinking about fibers tearing,it makes you a little bit more cautious
on how to support that movement.
With or without FSM.
So when I'm hearing aboutsomething that feels chronically
tight especially in the posteriorcompartment fascia is a huge component.
(35:13):
So there are fasci autotomies thatthey do to create more space in the
posterior compartment of the leg.
I have supported athletes that have hadthis by using a combination of using 1
24 77, 1 24, 1 42, so torn and brokenin the fascia and the connective tissue.
But then having a, I always call them likedueling pianos in my head, having another
(35:37):
machine using increasing secretions tothe fascia or the vitality to the fascia.
Because if two structures.
Can glide and move.
So like the soleus and the gastroc,the soleus and the adipose, the
soleus and the sheath that is there.
If all of that can glide, you don't needto stretch it because you're increasing
(36:00):
the smoothness of those layers thatare in the posterior compartment.
So I, when I hear that, I jumpto, she needs much more vitality.
And so 49 and 81 with thosestructures, and because there was
a partially torn achilles tendon, Iwould for sure use torn and broken.
But yeah, absolutely makes perfect sensethat you would have plantar fasciitis
(36:25):
because plantar fasciitis comes fromthe posterior compartment of the leg.
It doesn't happen from outer space.
Same with the Spurs.
And the other thing that I go to,especially with the fascist, is the.
The fascia folks.
Yeah.
Fascia is innervated.
Yes.
And if, can I give you thestatistic of the innervation?
(36:47):
Oh, tell me.
Tell me.
So Peter Twist told me, so our brainnerve muscle, that synapse travels
at approximately 175 miles per hour.
Our brain nerve fascia travelsat over 700 miles per hour.
Whoa.
That's fascinating.
(37:10):
Fascinating.
And yet makes so much sense whenyou think of the lattice and
how the fascia is not linear.
And nerves travel in a fascia nerve.
Fascia sandwich.
Yes.
So if there's been a tear, if anythingis ever torn right, it bleeds any place.
(37:31):
It bleeds, there's gonna be scarring.
Right.
One drop of blood fiber sticks.
Yeah.
And so you have to treatscarring, like down
scarring between the nerve and the fascia.
Yeah.
And think, and you lookat the anatomy book, the
(37:57):
piece of the sciatic thatgets to that splits off.
And forms the posterior tibial nerveat the fibular head goes, becomes
the deep and superficial peroneal nerves.
Yeah.
(38:17):
And then the one, those onethat goes off to the left.
Forms the posterior tibial nerve, andthen there's the anterior tibial nerve.
So if you look at the spider web ofnerves that go in between those three
(38:38):
or four compartments in the lowerleg that then travel down, and if
you look at that picture in netter
That shows the fourdifferent layers of the feet.
Yeah.
The arch of the foot.
The sole of the foot.
Yeah.
It's adhesions in the nerve tornand broken in the connective tissue.
(39:01):
Yeah.
It's just, it's, that's where I'd go.
But that's a lot.
Yeah.
Fascinating.
I would also like, just to add to, forposterior compartment gastroc sous I do
cite the one study in the sports courseabout intramuscular adipose tissue.
(39:22):
So intramuscular adipose tissueis not just the, we think about
adipose, we typically think ofthe spare tire around our middle.
We have adipose interlaced everywhere,and there's a very, the highest
volume of intramuscular adiposetissue and our leg is in the gastroc.
So really, so sometimes 3 97 can bevery helpful for those chronically
(39:44):
tight calves helping, which is whatwe use for sclerosis in the adipose.
And that might be helpful too.
I never have thought of that.
That's a good idea.
Yeah.
That's really cool.
Yeah.
Adipose is everywhere.
Little factoids, just, that'swhy we have these meetings is to
share all these little nuggets,
Share nuggets.
(40:05):
And it's for somebody else,it is simply a factoid, right?
For us, it modifies what andhow we treat and what and how
we think about the injuries.
This is really cool.
(40:25):
I wanna go back for a second too,before we go too far away from her.
What, typically when I seesomething that is bilateral, I
think of the cord right away.
Yeah, me too.
So your go-to is 40, but sometimes I thinkit's more 13, and then if I'm thinking
13 and 10, I'm also thinking 13 4, 43.
Because the cord and the dura,like the cord wouldn't just
(40:48):
have adhesions in itself.
The dura could be affected by it.
Yeah.
The 40 and 10, sometimes, like literally,I've had patients where their pain was in
their feet up to their knees, and it was40 and 10 was the thing that took it away.
That was just, oh wait.
(41:10):
Lisa,
oh,
she was a competitivefigure skater for 12 years.
Okay.
Yeah, that, so this, thosetriple toe loops really use
the gastro and soli a lot.
I, everybody knows I have my girls playhockey but they have a helmet and they
have all this, all these pads on them.
(41:32):
But when we would watch the figure skaterspractice before the hockey players, to me
that is just horr, no helmet, no padding,and hitting the ice at such velocity.
So I would imagine the falling,the impact, the compression in her
spine could have some scarring and
(41:54):
her legs and her Yeah,
just falling in general everywhere.
Everything.
Ice is like concrete.
Oh.
And because I do know a little bit about.
About skating.
The so competitive figure skaters,the, your, their feet and ankles
do not move and they do not developbecause of the boot of the rigid mold
(42:20):
that their feet have to sit into.
So sometimes, especially when we havekids that are doing skating sports
and not a lot of barefoot running orbarefoot training, those intrinsic
muscles of the feet that you weretalking about that we can see in
others, they don't develop properly.
So then, we developsome of those adhesions.
So thank you for adding in that nugget.
(42:41):
'cause that makes so much sense now.
And then when they stop skating,when they're 25 or 30, all of a
sudden they're wearing sneakers
Yeah.
That are
very flexible.
Yeah.
And those muscles in their feet.
That when you take the bones in the footand you look at all the layers of muscles,
(43:07):
nerves, arteries, and the way the bonesare designed the tarsals especially,
and the Alis are designed to roll.
Yeah.
It's just amazing.
Yeah.
She interjected that she playedlacrosse and field hockey.
(43:28):
Oh my gosh.
So a lot of impact from different areas.
But again, lacrosse and field hockeyare wearing cleats, and it's not
the same as barefoot movement.
It's very restricted.
We see a lot of these issues withsoccer players because the cleats
that they're wearing are not meantfor human feet, I'm convinced.
No.
And especially if they're playingon artificial turf, that's
(43:50):
another conversation that,
and that needs adult beverages.
Yes.
Yes.
And the.
When you look at lacrosse and fieldhockey, there is a lot of toe off
motion that, so she's overusingfrom the time her legs are growing.
That toe off movement andthe achilles gastroc soleus.
(44:17):
Yeah.
So Lisa hope you know where to start.
I would be running, torn and brokenon the connective tissue first.
And then follow up with scarring andthen vitality to the fascia for sure.
Exactly.
Oh wait, this is hilarious.
Artificial turf causes problems.
Question mark.
(44:37):
Question mark.
That, that might be a whole podcast.
That's No, it's yes.
And.
That.
Yes.
But we're not allowed touse language like that,
right?
Yes.
So
really quickly to just to summarizeturf locks in the feet and so when
(45:00):
the foot is locked in and cannotslide like it would on grass or
mud, and the other bones decide tokeep moving when the foot cannot,
this is where the acls are tearing.
And this is where the highankle sprains are happening.
In short, sober,
oh, this is a good question.
Yes.
(45:20):
Is there a frequency forthe endocannabinoid system?
It's here's the thing.
I think when we create that floatyfeeling, so like when this kid
was asleep during treatment.
(45:42):
There's a feature of cannabinoids back.
If you ever use THC, there's afeature of it that is time distortion.
So you think five or 10 minutes havepassed and it's been an hour, right?
(46:05):
When I go to Rome and Eduardo works on myneck, I fall, I'm asleep within the first
10 minutes and I wake up thinking it'sbeen 30 minutes and it's been two hours.
So I think that floaty feeling wecreate when we treat the nervous
(46:27):
system or we run concussion in Vegas,or we treat anything that makes the
patient floaty or stoned they didn'tmeasure the endocannabinoid system.
But I believe that when weincrease endorphins that we're
also increasing cannabinoids.
(46:49):
So no you don't wanna treat theendocannabinoid system that's no,
no treat, treat what imbalance
or pain that the patient has.
You treat that and the endocannabinoidsystem starts working again.
(47:14):
Yeah.
And I think that's whatmakes patients floaty.
Yeah.
That's my guess.
Yeah.
Last po last week we talked a lot about,there was a question about somebody
who had, was bringing in or the personwas coming in only was gonna give
them 30 minutes to treat mast cell.
And I had a couple people write emailsand we talked about it in the clinic last
(47:37):
week, and they're like, you guys werepretty adamant that was like a no go.
And I said yes, because and maybe10 years ago I would've been like,
sure, I'll run 40 and somethingand help with inflammation.
But it's just so much more thanjust turning down inflammation.
Mast cell is extremely complicated illnessand I feel like it is disrespectful to
(48:03):
everybody involved to just slap on amachine for and only have 30 minutes.
Like I just, I was verydisrespected by that.
It, that's not how treatment works.
That's not how good care works.
And it's also it's a setup.
The patient is setting you,and themselves up to fail.
(48:25):
Yeah.
And
psychologically from just adisrespect is a good word for it.
Manipulative and narcissisticis another word for it.
But it's, it didn't feel right.
Yeah.
I had that exact same feeling.
(48:46):
Like I, I wanna work with somebody thatwould love to spend the day with me.
Like they'll take whatever time Ican give them and I wanna give them
everything that I have and all of mymy wisdom and all the time I have to
text you in the middle of a treatment.
What is this?
(49:07):
And do you know how we are, right?
Yeah.
Just so I would really.
I've never had somebody that's I'm,I can only give you 30 minutes.
For me, it's the opposite.
Can I get another treatment this week?
Can I stay the whole day?
I promise I won't make a sound.
Just let me curl up inthe lobby for 10 minutes.
So I didn't wanna come across as beingrude or dismissive of the question.
(49:30):
I just didn't wanna dismiss that.
Like I said I felt I wanted, weneed to give our patients respect
and their illnesses respect.
And something as complicated asMCAS, I'm sorry, like 30 minutes.
And there's a way to respond tothat, which is exactly what you said.
MCAS is really complicated andthere's no way anyone could treat
(49:56):
MCAS and be successful, right?
With 30 minutes.
FSM is.
Because it can reduce inflammation andrestore the vagus to normal function.
But MCAS is really complicated.
Just the history is gonna take 30 minutes.
Yeah,
right.
(50:16):
I treated something this weekthat I've never seen before.
Oh.
Ever.
So the patient's complaintwas, you're gonna love this.
I can't gain weight.
Okay.
Because I can't eat.
(50:38):
Huh?
I eat three bites and I'mfull and it takes hours, six
hours for my stomach to empty.
And I, okay.
And the, she's already off gluten.
(50:59):
She found out.
She didn't even eat rice,so her diet's really clean.
It's very restricted.
So I felt her abdomen,that was the physical exam.
She had no body pain, felt herabdomen, small intestine was fine.
I got up to her stomachand it was li literal.
(51:23):
You know how when you come up offthe small intestine, you can find
the edge of the stomach, but it's,it loops down and loops over.
Her stomach was hard, that bigand you could feel the duodenum,
(51:45):
and she, part of her history was she hadgastritis because she was so anxious.
She got, she was a teacher,became a teacher after college.
And found out she hatedspeaking in front of groups.
Wow.
(52:05):
So she spent 15 years beinganxious, absolutely every day.
But at an early age, her diagnosiswas gastritis and I thought, okay,
if the stomach gets inflamed, ifinflammation causes scar tissue
(52:26):
every place else, I wonder.
So I treated the stomach forscarring, did a little bit, there's
a frequency for the stomach lining
and I ran scarring in the stomach lining.
That helped.
And I thought soft tissue fibrosis.
(52:51):
So I did fibrosis in the stomach liningand then fibrosis in the duodenum.
And her stomach got soft and theedge dropped down almost two inches.
It was almost normal.
(53:11):
Wow.
And I said, okay, it's five o'clock.
Your job tonight is to go eat morevolume than you would normally eat.
So stop when you feel full, butdon't restrict the amount you eat
(53:34):
because that's what you usually eat.
We need to stretch it whilethe scar tissue is soft.
And it worked.
It was really cool.
Back to Lisa.
There is an MCAS programin the custom care.
I use that.
(53:55):
I had MCAS for about three monthsthis year for some reason, and I
use it for acute MCAS, just, it'sjust histamine and everything.
The blood, the GI tract, the whatever.
Oh, speaking of which, I was doingthe basics on the stomach lining.
(54:23):
I got a histamine in the stomachlining and the stomach got hard again.
What?
Okay, wait a minute.
Histamine stimulate stomach acid, right?
(54:44):
The proton pump inhibitors areH two histamine, two blockers.
So I got off of that, raninflammation and softened up again
and I had to treat fibrosis again.
But isn't that weird?
Nothing is really weird anymore.
(55:05):
Is it?
Let's face it, I've given up on that.
I just, that is an interestingfinding that I will write down
and look for clinically next week.
That's in 30 years.
It's the first time I've evertreated the stomach lining.
Yeah.
Super interesting
because I treated thestomach for scarring.
(55:25):
Nah, a little bit.
Yeah.
But the stomach lining that,that was just fascinating to me.
That is fascinating.
So yes, Lisa, there is an MCA program.
Yeah.
What do you think it couldbe used like as a maintenance
program for people with MCAS?
(55:46):
Probably, but you'd also have to treat.
You have to treat the vagus.
Yeah.
And you, I would guess you alsohave to treat leaky gut, right?
Yeah.
There's no way to have MASunless you have leaky gut.
Yeah.
And there's no way to haveMCAS if your vagus is working.
Yeah.
And for me, the only time Iitched was when I ate yogurt.
(56:12):
And the only time I itched was when Iwent upstairs and both of my dogs had
a particular kind of staph infection.
Oh.
And the dog sleep on my bed in my room.
And I thought now that theirstaph infection is gone,
(56:33):
I don't have MCA anymore.
Wow.
I don't even,
I don't even, yeah.
'cause it's.
I know it hurt.
It's why does my headand it was only my head.
Right?
That itched and it wasonly upstairs in my room.
(56:55):
So I wash my sheets.
Yeah.
Like once a week and wash theblanket that my dog sleeps on.
Yeah.
That worked.
We have one minute toanswer Lisa's last question.
Oh, go on.
Speaking of stomach pain, haveyou said there is a connection
between stomach pain and Vegas?
(57:15):
I have a lot of sore spots on myabdomen at a C-section 17 and a half
years ago assumed it was becausethey put my intestines back walkie.
Yeah.
They are sometimes a littlecasual about with a C-section.
They don't.
Always, they don't takethe small intestine out.
(57:37):
They tend to pack it up.
Yeah.
But if you did that, you could createa little tear in a capillary someplace.
So it's a, the first thing I wouldthink of and treat would be scarring
in the vagus, in the abdomen.
(57:58):
'cause it's a nociceptor.
Yeah.
It's pain.
Pain nerve in the abdomen.
So maybe, yeah.
Yes.
And there are some surgeries wherethey do take out the intestines.
Yeah.
Or somebody whose job it is to takeout the intestines, keep them wet.
Only there's 22 feet of small bowel.
(58:19):
And when they put it back,they're not always tidy.
Yes.
So there's tidy.
It's 4 0 1 okay's that time.
Yes.
It was so fun.
So quick once again thanks everybodyfor your attendance and your
questions, and thanks for being here.
Yes.
(58:39):
You and I have fun even without thequestions, but the questions are helpful.
Yeah.
And I always like to see,30 people hanging out.
It's like drinking coffee, justsitting around in the clinic.
Yeah.
Doing that.
Oh, I'm so ex Oh, canwe, do we have a second?
We have a second.
Just a second.
(59:00):
Okay.
Yeah.
So can I tell him what wetalked about this week?
About, or do you want to tell him?
No, you can tell him.
Okay.
You tell me if I got it right.
Okay.
So Kim is going short version.
Is Kim is going to be doing morecourses and in Troutdale, which
(59:24):
means she gets to stay at my house.
And we decided that there really is aneed for not just the rehab sec. Yeah, the
rehab section, but we have to break it up.
You can't, we have tobreak it up into modules.
There's going to be upper body, shoulder.
(59:47):
Shoulder, neck.
Yeah.
Upper extremity, lower extremity,and then trunk and spine.
Trunk and spine.
Heart only.
You're gonna have to figure, so it's upperextremity is connected to the neck, so
those go together and lower it Anyway.
It's all connected to everything, butI think it's gonna be really beneficial
for everybody that we can take a deeperdive and really go through, not just
(01:00:12):
mechanics, but just the kinesiologyand the anatomy and just, some common
injuries and tie it together and geta really just yeah, a good thorough
understanding of what we're seeing
and how to get it better.
It's like with this kid, whenyou watch how he moved, he had
(01:00:33):
no idea where his serus was.
His right gap was, there wasno way to rehab his arm because
he had no, I, his lower trap inhis serus just weren't there.
Couldn't contract them,couldn't find them.
And
(01:00:54):
so then he got all self-conscious about.
Attracting 'em and it's look, onceyou find them and exercise 'em, it's,
you don't have to think about 'em.
The brain's gonna take care of it.
Yeah.
But that's the sort of thingthat is gonna be in all those
courses you're gonna teach.
I can't wait.
So excited.
I'll be so wonderful.
(01:01:14):
But so one last thing beforewe go we did put like the
last course the sports course.
We're gonna have one in California.
It's Santa Cruz, June 21stand 22nd, or 2020 first.
I have to double check on that.
In Santa Cruz.
Yeah, Santa Cruz.
So we have a practitioner that's gonnahost, it's gonna be he has got a beautiful
PT clinic in Santa Cruz and he wantedsome of his staff to take the course.
(01:01:37):
And we're just gonna have somefun at the beach for two days.
So come join us.
This is pretty fun.
This is cool.
Yes.
Okay.
We are officially fourminutes over, but whatever.
We have fun.
It's our podcast.
We can do what we want,
like the way you think.
All right, everybody.
Thanks for coming.
We'll see you next week.
(01:02:00):
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frequency specific seminarsfor entertainment, educational,
and information purposes only.
The information and opinion providedin the podcast are not medical advice.
Do not create any type of po doctorpatient relationship, and unless expressly
stated, do not reflect the opinions of itsaffiliates, subsidiaries, or sponsors, or
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(01:02:22):
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