The Passion Project FT. Dr. Kyle Volstad

Episode Transcript
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Jonny Strahl (00:09):
Welcome to the Bender Continues podcast
introducing our guests fortoday's episode, the Passion
Project, physical Health.
Dr Kyle Volstad trained sportsand orthopedics physical
therapist, who is a SouthFlorida native.
He's a well-rounded athletecompeting in football,
basketball, baseball andvolleyball, going on his way to

(00:30):
earning all-conference in bothfootball and volleyball at
Quincy University.
Not to mention, kyle alsoparticipated as a tight end at
the NFL Super Regional Combine.
After earning his doctorate inphysical therapy at the
University of Miami, he went oncompeting a three-year
fellowship training program inadvanced orthopedics and sports

(00:50):
manual therapy.
Kyle is currently the founderand CEO of Athlete Restoration
Company, based out of West PalmFlorida, with over nine years in
his profession.

Ryan Selimos (01:01):
He continues to further his professional
footprint by serving as facultyfor a post-professional
orthopedic therapy fellowshipprogram for the Institute for
Athlete Regeneration, travelingall around the nation helping
other practitioners improvetheir skill set.
He's actively involved in thecommunity and educates clubs,

(01:21):
nonprofits and CrossFit gyms oninjury prevention and related
interventions.
Kyle is also a fellow podcaster, hosting the Driven Athlete,
helping driven and ambitiouspeople elevate their performance
, shedding light on best-knownhealth practices, lifestyle
habits and injury prevention.
With a unique athleticbackground, kyle brings a rare

(01:42):
perspective to the table and aparticular enthusiasm to accept
challenges, as he and his wife,nicole, represent an elite class
of practitioners serving as theonly fellowship trained
specialists in this region ofthe state of Florida.
Welcome, kyle.

Kenny Massa (02:00):
So thanks again for being here today.
We're really excited to talkabout physical therapy, excited
to talk about your credibilityand your history in the entire
physical therapy division ofhealth.
Obviously, we're talking a lotabout different health topics in
our segments, but specificallyfocusing on physical therapy

(02:20):
here today.

Dr. Kyle Volstad (02:21):
So thanks for being on.
No, definitely Thanks for theinvite.
It's funny like excited to talkabout physical therapy.
It's like dentistry, Like.

I want to go to the dentist, to really talk
about that.

It's interesting, yeah, I mean.

James LaGamma (02:32):
I think because we're athletes like we all.
Just you know we've gonethrough it, so we have a passion
for it.
We understand how our bodieswork and all the things that
we've had to deal with over time.

totally yeah, and we'll get into that today.
Each one of us have probablyworked with the person in your
field in one manner or another,because of the fact that we've
basically acquired injuries overthe course of our pushing
yourselves athletes active?

yeah, totally so.
I mean, for people like youguys like it's it, I would hope,
a little exciting, as I'm likethis is super interesting
because I push myself like if Ibattle my own injuries, it's
like, can you fix this stuff?
Like, is this, there's asolution?
You know like, how do I goabout it?
You know what I mean?

it's like, that's what we do, let's get after it
hell yeah, well, now that yousay that and that's what you do,
can you talk a little bit aboutathlete restoration company and
what makes your companydifferent than the typical
physical therapy facilitiesaround the rest of the country
or maybe even the globe?

Yeah, totally no.
I appreciate that question.
So, um, the name is definitelyunique in that that's who we try
to serve, and a lot of peoplewill ask, like, do you only work
with pro athletes or collegeathletes?
Right, like, cause I'm kind ofintimidated to come in, Like I'm
not really I'm not a profootball player, and it's like,
actually, the meat of ourschedule and the meat of the
people that we see the mostthat's all high demand are, like

(03:44):
the active, uh, athleticweekend warrior moms and dads,
um, professional youngprofessionals, um, and then
people who are in their, youknow, uh, aging athlete type of
phase of life, where they're,like I really want to maintain
my mobility and vitality,independence.
Um, like, what does this looklike when I become 75 and
advance into 80?
Yeah, like, because if I'm 65right now, or 62, and I'm

(04:07):
running 5ks or I'm doing thislike and my hips giving me
trouble, it's like, what doesthat look like 10 years from now
?
Does that mean I need a hipreplacement?
It's like, actually, you canavoid that stuff, you might not
need it.
Um, so, anyway, we we cater tothe active, motivated and
enthusiastic people that want toget better, they want to stay
active and they're super curiousand intrigued and interested of

(04:29):
like, oh this is cool, well,can you help me with my neck too
?
Or like, help with my shoulder,you know, can you help me with
all this stuff?
So that's what we like to workwith, and the clinicians that
we've brought on board in ourteam are motivated and
enthusiastic in the same way,because we get fulfilled and
thrilled with working withpeople who are motivated and
pumped too, versus the peoplethat, unfortunately, that are in

(04:50):
the insurance space which we'llget into in a minute.
Usually those type of patientsthey're really nice people, of
course.
They're great.
The clinical practitioners aregreat too, but they're usually
not super the same kind ofmotivation and stage of walk of
life you know what I mean wherethey're like I'm just here
because my doc told me to.
Yeah, so imagine like or likewell, I'm just in here to

(05:12):
satisfy my insurancejustification so that I can get
surgery and injection like in amonth, but I have to do this
first to show it doesn't workgreat.
So you just belittled ourentire career yeah, well what am
I doing here?
you, you know like what thatthat sucks, you know, but anyway
.
So the people that we see thatare like we're out of pocket,
right, so they're motivated andpumped, they're going to pay
attention.
You know what I mean.
Like, imagine if you were to gosee a practitioner that you're,

(05:35):
you know, really invested inwhat you do for your life and
you're like this is what we do,are specialists in this and like
, and guess what?
This is inflated, of course,let's say it's a thousand
dollars an hour.
Would you show up late or wouldyou be like, dude, I'm gonna do
early, I'm gonna have mynotepad and I'm gonna pay
attention.
Right, how can I say, like, dothis my life, you know, I mean,
I'm gonna implement this my life.

(05:55):
So those are the people that wetry to, that we cater with to,
and you know you attract who you.
You know you attract who you'rewith and your, your personality
and your, um, your vibe, youknow what I mean.
So that's who we've tried tocater to.
So we don't only just treatathletes anybody who's active
and athletic like.
You're an athlete and we wantto maintain your high level,
activity and your vitality,independence and enthusiasm, you

(06:17):
know.

So you touched on right there a couple of points
regarding the cash pay type ofprogram opposed to
insurance-based, and how itcould really change the
direction of the clientele thatyou deal with mostly from really
a mental standpoint of whythey're coming in and the why
and the result.
Is that a common thing forphysical therapists, that'd be

(06:39):
cash pay or is it more of aninsurance-based program that you
typically see?
Why did you structure towardsthe cash pay thought process?

No, definitely very, very dominated by the
insurance in-network type ofclinic setup for sure, because
insurance runs the world.
As you guys know, I can talkall day about this stuff.
There's a super interesting JoeRogan podcast on this.
I've listened to and I'm likemy mind was blown and I'm like I
had no idea how bad you know.
But anyway, um, but no.
So it totally changes the, thevibe that the um, the people

(07:11):
that would be interested, themindset coming in, right, it's
like here's a professional, I'mgoing to be one-on-one for an
hour, right, that's.
One other unique factor is thatwe're only one-on-one for an
hour with everybody.
So we spend a lot of hardmental effort on like let's
figure this out, you know,versus half assing it.
Or like oh, I got lunch in 20minutes.
Like yeah, so go over there anddo those things.

(07:31):
I'll be back in a minute.
And it's like what?
Like nobody wants to be here.
No, you're not getting a resultyou're looking for.
So I think a unique factor inaddition to that is our mindset
as in like imagine going to ahealthcare practitioner place
and they actually try hard, likethey actually put some mental
effort to like let's dive intothe matter and figure this out.

(07:51):
You know, versus like notreally caring.
And then on top of that, theback-end administrative type of
support.
Imagine you call and you getanswered with a human right away
and they actually have a goodattitude.
That's a breath of fresh air.
Versus waiting for 15 minutes,they don't answer.
They're going to give you acall back and you get a robot

(08:12):
and it's like push one for theextension or whatever.
And then when you do talk tosomebody, they have an attitude.
That's unfortunately a verycommon stereotype of healthcare
practices.
It's like I need help andyou're going to give me an
attitude, right, but the reverse, it's like a breath of fresh
air.
So, anyway, we try to embodyall that.

As a patient of yours in the past.
One thing that I would also sayis probably a benefit that I've
seen as a I would say, aproblem for many clinicians in
other facets not just physicaltherapy, but in other fashions
is the duration of yourappointment right.
Sometimes a clinician will comein and spend five minutes with
you and like here I'll write youa script.
You guys are invested andreally take care of a long,

(08:53):
short-term and a long-termapproach to getting you to where
you want to be, which is notcommon.
Well, I appreciate that.

No, we do try to.
That's what we for sure.
We try to invest, like othersmall business owners I've
talked with in the past therehave been our patients here and
I've been clients of theirs orother things like like
construction or plumbing or likewhatever.
And then talking to them andbeing like does anybody care
what they do anymore, like doesanybody care about their craft,
or like trying hard, doesanybody try?
Versus just half out bsing,just like I just want to make

(09:21):
the money and just like move on,you know, but anyway.
So we, yeah, an we spent anhour and the first steps, of
course, is to like get thingsfeeling better.
We explain, we try to explain alot of stuff and dive into the
education component, becausethen the education is really
huge, because the people that wework with they're invested and
they are going to do stuff Like.
They're like what can I not do?
What should I do?
What exercises, whatinterventions can I do on my own

(09:42):
at home?
Right?
Versus like do I have to dothis stuff?
You know it's like hey, did youmy shoulders to hurt?
So like, did you do some ofyour stuff we talked about?
I don't remember what we talkedabout.
I was like what are we doing?
You know what are we doing here, guys, but anyway.
So the cool thing is like withthis, like you said, like we, we
try to invest very hard and welive and die based on our
results.
Because once we are out ofnetwork and we're fee for

(10:04):
service right, we're cash.
So on the front end, people arelike why would I do that and
pay quadruple the amount of acopay or for free, when I could
go to this other insurance placefor free and see you guys Like,
why, right?
But so we live and die based onresults.
So, that being said, like a lotof people that are functional
and active and motivated,enthusiastic, I was saying the

(10:25):
typical standard progression forhealthcare is, for sure, like,
oh, I use my Blue Cross, blueShield or my Humana, that's what
you do, right.
So they go that route.
They don't get better, theydon't get the results you're
looking for.
It's like I'm still not able toplay three days a week sand

(10:46):
volleyball, right, go out to thedock.
And it's like you don't need todo that to live.
Why don't you stop?
I have an idea just rest forsix weeks, ice, take some advil,
just do that, but they're likeI don't want to.
Yeah, it's deflating number one.
And then number two it's likeyou're going to tell me how to
live my life and then it comesto us and was like awesome,
let's get after it, we're goingto modify some things.
Well, we got to work on yourscapula, we got to work on this,
we, we gotta work on that.
And that's where you're gonnahit harder.
You're gonna jump better, likewhatever, and they usually eat
that up.
And it's like you're gonna nottell me not to do it.

(11:07):
That's awesome, you know.
Versus like let's get after it,you know.
So I think that's another hugedifference agreed.

It's almost like a perfect match of y'all's
attitude because, you're right,you look at different industries
, people are more, they'remonotone, they're just the clock
and customers know that whenthey call in, it's like this
person.
You almost want to hang up andtry someone else because it's
just not what you're looking for.
But if you get someoneenergetic, it's like let's go.
Then you're motivated.
So you know that that's theattitude at your company and you

(11:34):
know that you've got those twoclient customer classes where
it's hey, you're just trying toget back to quote, unquote, live
your life.
And then your target marketalmost sounds like is those who,
yeah, I want to be able to livenormally, but then I want to go
do all those things I want todo and at a higher level.
Right, so they come in.
You've got it sounds like you'vegot the approach for that.
So do you see more wherethey're almost beating the

(11:56):
recovery timelines?
Is it more an aggressiveapproach?
Is it just that culmination ofof perfect match, like I guess
what's that story look like whenindividuals come in?
It's hey, it's going to be sixto eight weeks right.

Um, yeah, people, a great question, so a
short answer speedy recovery,for sure, like it's expedited
totally because we, like I said,a lot of us the education yeah
and people don't uh recognize oracknowledge that it's just
ignorant.
They don't know yet right, andI'm not saying they're bad
people, um, they f it up overand over again without knowing
what they're doing.
It's like I woke up and ithurts that that it's I'm meant

(12:30):
to be in pain forever?
It's like no, you're not, youdon't have to be unless you
choose to right.
That's another different realmof of, like the psychology
component, which I'm not apsychologist, but there's
definitely a lot of the mentalcomponent.
I think it's very underweightedbut anyway, so it's expedited.
For sure we can educate people.
We show them like your sleepingposition is contributing to
these things, lingering, or yourtraining is definitely

(12:53):
contributing to this lingering.
If you don't set your shoulderor your back or your hip up for
success before you work out withthese little mobility
interventions or activationrecruitment exercises, you're
setting it up for failure ofcompensation patterns to just
linger and forever faster.
You know what I'm saying.
So there's definitely theincreased expedited um results,
for sure, um, and a lot ofthat's the education, yeah, yeah

(13:14):
, but the uh, but anyway.
The other question was to saywas people usually ask okay,
cool, when could I be a hundredpercent?
Ultimately, it's up to you thatalso, it depends on some
factors and I just did a YouTubevideo on this of like, uh, or a
podcast um the severity, um theirritability level, um the the
nature of the injury, right, umall in the age of the person,

(13:37):
right.
That sets the stage of likeit's very, very severe and it's
been going on for eight years,right, and I'm 68 years old.
That's going to take a littlebit longer.
We understand the turnover isgoing to be a little bit slower
compared to an 18-year-oldathlete who sprained their ankle
mildly last week.
You know what I'm saying.
That's going to be fast, right.

(13:57):
Or a muscle strain, that waslike two weeks ago.
It's like, dude, you'll be goodin a week, right, just don't
overdo it right now, don'toverstretch it, right.
Um, and do these little things,um, yeah.
So the uh, the severity, theintensity of the pain, how long
it's been going on, the age ofthat person that all determines,
like, how long it's going totake to notice significant
improvements and changes.
You know.

So you almost have to dial them back, in a sense,
where they come in they've gotthat attitude.

They've got that energy they want to go five
days a week.
It's like we don't need thatLike love it or do you kind of
run with that?
Uh, a little bit of both, itdepends.
Yeah, um, the.
We definitely get a lot of someof the people that are like all
right, so if I do theseexercises 10 times, like just a
number, like it's just so youdon't forget, right, as long as
it doesn't hurt and aren'tmaking things worse, they're
like all right, cool, if I did ahundred reps, would that get me
better, 10 times faster, likeif I did it every day 10 times,

(14:49):
would that increase by tenfold?
And it's like oh no, there'sstill, you know, a healing time.
Cells and tissue take usuallysix to eight weeks to have a
good foundation of turnover tohave a healing potential, right?
So not necessarily.
But then the other end, right.
It's like if you don't F it upcontinually, you implement some
of these things.
We're not going to tell you torest because no one likes to

(15:11):
hear that in the boat that wework with Usually it's like just
rest.
It's like I'm tired of resting.
I'm like I'm going to lose mymind here.
It's like I've been resting forsix weeks and then they dive in
back to a hundred percent againand it comes back and they're
like doesn't, it doesn't work.
Yeah, it's like you just got tomodify.
That's what we said.
We just got to modify somestuff.
Right now, I'm not going totell you to stop.
I'm not going to tell you torest.
I'm going to tell you to modifysome stuff.

(15:32):
Right, and use your symptoms asthe indicator, as in, like you
did a workout I want you to workout.
I would probably avoid thesethings right now because it's if
it's vulnerable and it's goingto irritate it.
I'm pretty confident.
So and what you're telling me?
So I would avoid those thingsinstead, substitute these type
of workouts and exercisesinstead for your shoulder, your
back, like whatever body parts,the lit up thing, um, modify and

(15:54):
implement this instead.
Um, and then we can test thewater over time and elevate some
stuff, try some things.
It causes some issues.
Okay, we'll back it down rightand we can course correct.
In the meantime.
We just want to avoid theroller coaster of being like
super dramatic, yeah, of like Idid a intense, super hardcore
workout and it was too much andit lit everything up.

(16:14):
You're gonna take like.
You're gonna take this back.
We have to stop the bleeding atsome point and that's what
we're gonna modify.
So use your symptoms as theindicator.
Is it causing issues right nowversus the mindset of like, well
, I'm going to do it anyway andpush through.
We would expect that to causethings to irritate, for sure.
Okay, is that going to behelpful?
Probably not.
All right, okay, so stayunderneath your pain threshold

(16:35):
that night.
How did you feel the next day?
How did you feel?
Right?
And then use that as like anindicator of like.
I think I'm at a good spot.
I don't feel too bad.
I didn't light things up.
I did push myself in someaspects, but I don't feel worse.
Okay, cool, let's run with that.

Nice that's what we would run with.
Okay, yeah, does that makesense?

Yeah, yeah.

Love that.
So, kyle, obviously one thingthat's that's pretty noticeable
is, you know, we talk about themedical industry, we talk about
just physical therapy as a wholeand you've mentioned a few
things where essentially you'relooking for, or your business is
more focused on, a how can wereally help preventative but
also really help the motivatedathlete and or patient, whether

(17:16):
they're 60 years old, coming into get better right at the end
of the day.
So if you could just describeto us some success stories just
around advanced manual therapyand I'm sure there's multiple,
obviously being an expert inwhat you're doing but could you
just share some of the maybe theepiphany, some of the great
stories you've had?

Yeah, totally no good question.
So, in my opinion, I feel likethe main separator for
clinicians is their ability torecognize things and
differential diagnosis Right.
And that comes with humilitytoo, by the way, Like if you see
a practitioner, it's like I'veseen this a thousand times.
I know exactly what to do.
This is what we do every time,for this yeah.

(17:56):
I would be like I would justquestion it Right, and myself I
would be like what makes youfeel that way?
Did you consider potentiallythis out here might be a
contributing or this might alsobe a factor, but anyway, so that
comes through humility, in myopinion, um, and always diving
back into, like this wasinteresting, let me research
this.
So anyway, the differentiationand able to recognize some stuff

(18:16):
in the competency component.
And then the second factor iswhat you can do with your hands.
It's, in my opinion, um,because that, the, the manual
therapy, I think, is thegame-changing, separating factor
.
Um, joints, you can't alter andaffect um, some joint play and
some joint alterations andcompensations just with exercise

(18:36):
alone.
Um, some changes happen overtime, for sure, and we can't
address and intervene thosethings that have changed just
with exercise alone.
That's just what some of theresearch suggests.
So the, the factor that she'sgoing to change, that is a
manual therapy, right, so we canmobilize some joints and
intervene at the joint level.
Soft tissue restriction plays arole with that too.
So soft tissue, for sure, um,but the, the, the purposeful,

(18:59):
the, what I use is thepurposeful discretion I'm not
going to like.
We can do manipulations, forsure.
But we're not going to rack andcrack everything like a bunch
of wild cowboys, like we'regoing to pick and purposely
choose, purposely Like why am Inot going to manipulate here and
why am I going to choose tomanipulate or mobilize here?
That's part of thedifferentiation.
And then be able to executethat with a manual therapy.
I think those are the twoseparating factors.
So, with that being said, thereally cool moments that I live

(19:21):
for that we live, I think, isreally cool and fulfilling is
when somebody's been coming in.
Things haven't been working.
They're still in pain, right,if their shoulder, their neck,
their knee, their back, theirankle, whatever.
Right, and we test, we're likeall right, show me the athletic
movement that you do that causesa pain.
Right, if I do shoulder press,that hurts, all right.
So show me a shoulder raise,right, let me do some
provocative rotator cuff testing.
Right, probably the rotatorcuff.

(19:42):
It's not that hard to figurethat out.
The differentiating factor forus is like why did that happen
in the first place?
So it's not easy, it's not hardto figure out.
Someone has tendonitis, right,but like, but why?
Why is this individual battlingthis tendonitis?
We'll get that in a minute.
So we do manual therapy stuff?
Right, we'll intervene justwith some manual therapy, some
soft tissue stuff in the backend, and then we'll retest the same

(20:04):
movement literally 10 minuteslater, and they'll raise their
arm.
We'll do a shoulder pressprovocative test and it doesn't
hurt, like I didn't do anything.
We didn't even do an exercise,we just did manual therapy.
We did the same movement andthey're like I literally don't
feel any pain right now.
It's like you can't fake thatand there's somebody's maybe

(20:27):
already skeptical anyway comingin.
Right, it's like we do.
We intervene with some manualstuff, we retest the same
movement you did like literally10 minutes ago and now it
doesn't hurt.
That's a cool buy-in moment.
It's like yo, this is like thismusculoskeletal stuff can be
fixed.
There is a solution.
We didn't even do any exercisesyet, right?
So imagine if we did do someexercises.
Now that things are set up forsuccess, we can stabilize the

(20:48):
heck out of stuff and fix theunderlying compensation patterns
of why it became became aproblem in the first place.
Right, that's going to solidifythe changes, right?
Um, over a period of threeweeks yeah which is like three
sessions right yeahdon't f it up in the meantime.
It would be unreasonable tothink that you wouldn't notice
significant improvements.
Right, and that's so.
Anyway, the buy-in moments likethat, that's.

(21:08):
That's a cool moment that wehave, and there's plenty of
examples I can think of in myhead right now.
You know, just like, yeah, asimple one.
This guy came in with a shoulderrotator cuff, just it was.
Just his arm was hurting, right, my shoulder hurts, right, we
have to rule out some stuff.
If it's coming from his neck,it's his rotator cuff, actually
the painful tissue, maybe hisbiceps tendon, that's not that
hard to figure that out.
But where are we going tointervene?
Do some manual therapy stuff?

(21:30):
We've got a scapula movingbetter.
We did some soft tissue love tohis biceps tendon.
We probably dry needled hisrotator cuff, um, and mobilize
his scapula.
For sure we can reseat hisshoulder joint in a better
position.
Then it's like, hey, stand upreal quick, let's retest, stand
up.
It does the same movement andit's like what did you do?
Like, yeah, I don't even feelit.
I haven't felt like this inlike six months.

(21:50):
It's like awesome, let's gofrom there.
You know, that's so, that's, Ipromise you.

That happens very often listen, I appreciate you
being discreet, but kenny's beencomplaining about his shoulders
for years you could have justsaid it was Kenny.

He was one of those guys.
I think we needled you, for Ineedled you for sure, but um he
just.
I mean, this is you're amuscular dude, right?

He's jacked.

Don't make his head any bigger than he used to
be.

It's got to sit on those shoulders.
You know what I'm?

saying what guy doesn't like hearing that?
But anyway yeah, you're a verymuscular dude, so there's
definitely some changes thathappen right, and it sets up the
shoulder joint for not the bestsuccess for reaching overhead
and then pushing it, and thenusually for ex-athletes who are
now in their 30s or 40s, they'relike usually it just goes away.
This is pushed through it, butnow it's just not going away.

(22:43):
Yeah, but that's what we haveto intervene, you know, but
anyway.
So yeah, kenny was one of thosedudes, but, um, he did good.
He did good yeah.

We did needling.

We did um cupping Cupping.
Yeah, I'm a cupping fan, yeah.

Um.

I usually like I'm sure, if y'll put some
lotion on and we'll cup one cup,like across the fascial lines
and the functional lines, itsucks but it hurts, like it
doesn't feel good, but I'm likeit's pain with a purpose, it's
discomfort with a purpose tomake a change.
And usually active athleticpeople are like I just want the
result, like they just do it,just get after it, right?

(23:21):
Well, it's not going to feelgreat, but you're going to hate
me for the next 45 seconds, butthen it's going to make an
improvement and if we do thiscontinually we'll notice changes
.
Usually they don't want thefoo-foo treatment.
They're like I want results.
It's like all right, we'll doit, I'm not going to kill you
but it's not going to becomfortable.

In fact, real quick , before we move on, a lot all
these guys were were in mywedding, but the day before I
got married we did a cuppingsession and if you looked under
like my collar oh, we did.

Yeah, I had like.
Oh, I remember that I had likebecause you went golfing.
Do you like a bachelor partygolf trip too, wasn't it?

probably one of these guys yeah, yeah but we, I
just had like the red from marksfrom the cupping, from like my
neck to like my lat to your lat,yeah we cup the lats a lot on
people.

Um, post your rotator cuff for sure.
Um, it just restricts motion,it checks motion.
That we can, we can loosen up,we can mobilize that stuff.
But yeah, I'm a cupping fan.
Yeah, the reason is because itlifts and separates the tissue
right, so it can break upadhesions.
It can break up some fascialinterstitial tissue adhesions.
Um, it brings, it brings bloodflow, so it breaks up

(24:27):
capillaries.
That's why it's like a hematoma, that's where the bruises come
from.
It gets really red and purple.
Um, versus like scraping, right, like Graston, it crushes and
scrapes tissue.

So I know people get results from it.

Yeah, Um from it.
It doesn't feel great.

I'm like in my head.

here's a tissue that's already an area
that's lit up and vulnerable.
Crushing and scraping seems alittle aggressive versus lifting
and separating the tissue forthe benefit of breaking up soft
tissue restrictions.
That's where my head goes first.

Okay, Interesting, curious, just on that.
Is that a general consensus oris that something that you
believe in and just yourresearch and obviously years of
experience?

I would say more anecdotal, and the research
definitely is good on both, andthe Graston has good research.
The interesting thing is, fromwhat they're finding it usually
that the tissue and the jointrange of motion that you're
looking at retracts within 24hours.
So that's where the exercisescome in right, where it's like
we, if you scrape or cup or softtissue restrictions right, that

(25:36):
one session alone really isn'tgoing to bring lasting results.
Yeah, right, massage therapy isa great avenue to work on stuff
for sure, but unfortunately wehave a lot of people that come
from with us that have pain frommassage therapy, like I'm
getting massages.
That's great, it'd be a greatavenue.
We got to work on soft tissuerestrictions and they're very
valuable, um, fixing up andgetting resolution for a pain
issue that might not bringlasting results, and part of

(25:59):
that is the corrective exerciseswhich those choices come from
differential diagnosis andrecognition of like why is this?
Why is this person havingshoulder pain the way they are
versus somewhere else in theirbody or like another, or their
colleague or their friend?
And a great way that I for theclinicians that we teach.
So I'm also part of thisfellowship program for manual
therapy.
It's a the American Academy ofOrthopedic, manual Physical

(26:21):
Therapy, physical therapists,and it's a really cool clinical
education and advancement kindof direction that clinicians can
go.
So I finished mine seven yearsago, six years ago, six and a
half, and since then they'veasked me to stay on as faculty.
So I travel around differentplaces in the country to teach

(26:44):
these manual therapy conceptsand choices and things you can
add to your quiver toolbox.
And then the differentialdiagnosis as like the purposeful
discretion.
But the question we ask thoseclinicians and the clinicians we
mentor is like two, two, really.
Okay, there's a baseball playerthat has anterior shoulder pain
, right, it's not that hard tofigure out.
If he's a young, flexible dude,right, kid and or teenager,

(27:05):
right Early's not that hard tofigure out.
If he's a young, flexible dude,right, kid and a teenager,
right your early 20s, maybe it'sprobably the biceps tendon,
okay, anterior shoulder pain.
The long head of your bicep isa very small rope-like tendon
that has a very closerelationship to your rotator
cuff.
And it's an easy site forgetting lit up if it's put under
stress and strain constantly.
Okay, and the anterior capsule,and you have nerves all up in
that area, right?

(27:26):
So it's not hard to figure outthat a biceps, the biceps tendon
, is the angry tissue Cool.
They want to know, like, whathurts.
This is the biceps tendon, okay, cool.
How are we going to fix it,though?
Right, and if a practitioner ora clinician said, oh, it's just
overuse, they just need to rest,it's like that is a cop-out,
and the reason why I ask that ishere's an 18, 19-year-old

(27:48):
baseball player on a team, theteam of baseball players.
Is this kid just throwing 50%more than everybody else,
volume-wise, everybody else isthrowing, so why is this kid?
Why is Timmy getting this biceptendon pain and all of his
friends aren't?
He's got to be doing somethingdifferent.
If it was an overuse problem,that wouldn't everybody have

(28:11):
tendonitis come three monthsinto the season just from
throwing too much.
Problem solved, rest, and Itake idville and ice.
It's not the case, becausethere's plenty of them that have
no pain.
They're totally fine.
So then, what is timmy doingdifferent?
Something is mechanics right,I'm not a baseball pro or
pitching pro but there'ssomething biomechanics and pain.
That's what I do, so there'sgotta be something.
Biomechanically he's doingsomething different.
The core plays a role with that.

(28:31):
Lead hip internal rotationplays with that.
His external range of motion inhis shoulder, his scapula, his
T-spine, all those things playfactors and we can differentiate
and figure out what he's doingdifferently.
That's causing the biceps toovercompensate and that's where
the painful tissue is.
It's not the.
That's not the problem.
The angry tissue isn't theproblem, it's a victim.
It's getting overwhelmed andoverworked, right.

(28:54):
So with that being said, thenif we're going to dedicate and
direct all of our treatment tothat lit up tendon, it's not
solving the problem because it'snot the problem.
It it's not solving the problembecause it's not the problem,
it's just the fire alarm.
The analogy we give is likeimagine there's a fire going on
and the fire alarm is blaring.
That's the biceps tendon.
Okay, cool, I have an idea.
Let's duct tape a pillow overthe fire alarm so it makes less
noise.

(29:14):
Is that going to solve the fire?
Probably not.
What's going to prevent thefire from stopping and going
further and intensifying?
Yeah, when I just put the fireout right.

I appreciate that because you know you were stoned
.
A lot of big words there.
I was trying to follow then hegoes hey man, there's a fire, is
a fire alarm?
The fire alarm is not theproblem, don't try to fix.

I'm like okay, good, my bad.
Yeah, ask questions like I mybad reel me in.

It's actually funny.
You said the victim piece andthen you gave the analogy,
because I literally was justlistening to one of your
podcasts and you oh yeah, thiscomment oh, yeah, um, and and
you were kind of making thepoint that a lot of times
athletes they just make, theycompensate to get the job done
so they're doing somethingdifferent, even though they're
doing the same action aseveryone else, but that
compensation factor is basicallygoing to end up being the the

(30:04):
root cause, and you have to tryto identify what that is,
exactly, exactly.
But I do have a differentquestion.
You've piqued my interest as wewere talking about the cupping
and the grass and all thosekinds of things.
Yeah, um I you're probablyseeing a lot of stuff is coming
to market on um, you know allthese different tools like the
percussion massage machines thatactually seem.
I'm seeing cupping machines thatare coming out that are just

(30:26):
battery-operated.
It's kind of crazy what they do.
As you guys are going throughand exploring the tools that are
outside, are you suggestingsome of your clients for
long-term and other things thatmay be just based off of the
type of athletics that they'reinterested in?
Are you prescribing them someof these tools?
Yeah, good question, or is itreally something that should be

(30:46):
done by a professional?

Where's the line?
Kind of no, the tough thing isI don't hate those things, right
, it's not going to hurt anybody, right, unless they overdo it.
You know what I mean and thatthat's where we gauge like, is
this a zealot?
That's very zealous individual.
You know it's going to likedude, you're going to over-treat
it, it's going to you're goingto light stuff up.
You know there's there's a linethere.
Usually, no, we don't reallyprescribe that stuff.

(31:10):
I mean we would, if they'relike, they're very interested in
into it and we will like showthem, like, hit this area and
hit this area.
The reason is because theyusually don't do it right, want
to like cause a problem.
Um, we don't want motivationand enthusiasm to cause an
overuse injury or an overuseproblem.
I say that with a lot of myathletes.
It's a personality differences,right, um, we have a lot of

(31:34):
athletes, um, in the past thatI've worked with that have
chronic like knee pain after asurgery.
We usually don't see post-opcause they're going to go their
insurance and they get thefoo-foo treatment the first six
weeks.
Anyway, right, like we, you canget that, we can get both.
You know, maybe they come seeus simultaneously.
But anyway, um eight months inafter their surgery acl as an
example they're still battlingknee tendonitis.

Right sure are still 10 years later.

Yeah that's not an uncommon thing by any
means.
It's usually because theydidn't address some of the
compensation issues of likemuscle strength and it's really
a recruitment problem.
It's usually because theydidn't address some of the
compensation issues of likemuscle strength and it's really
a recruitment problem.
It's like a neuro, aneuromuscular recruitment issue,
not like a strength outputproblem, um, and a joint
mobility problem.
And then the mechanical problem.
The mechanics like their um,coordination of movement.

(32:18):
You know what I mean, um, butanyway, and those moments, some
of those athletes.
There's two types.
There's the people that aren'tdoing enough and they need to
step it up, like you need to domore, right, and we'll call them
out and be like you need to domore of this.
Dude, I can tell you're notdoing your homework.
Do you want to play basketballor not, right?
The second one is like we needfalling back.

(32:47):
If I don't continue, I'mgetting outworked, I'm getting
outpaced.
I got to get after it.
You know I can't take a weekoff.
It's like you know who takesweeks off sometimes is LeBron
Steph.
You know Steph Curry.
Sometimes I got to back, take aanyway.

(33:10):
So, to answer your questionconcisely usually not, they
usually don't.
I wouldn't be confident theywould do it right and hit the
right things.
I would rather hit prettypurposefully.
If they're already into it,then I'll show them and I
suggest some stuff.
But they're just soft Usuallythey're just avenues to work out
some soft tissue restrictionsand knots and soreness.

You know what I mean and and and.
When I kind of talk about likerecovery tools too, I mean
there's a there's a huge marketfor that.

I'm a huge foam roller person.
I love it, I think they'regreat Um that's the number
reason why I would suggest it.
I would be like do you like it?
Okay, yeah, so um.

I, I guess, I guess.
Um, my question really is isaround like the, is it, I guess?
Should people be looking forthe quick fix?
It's almost like, uh, I go to achiropractor and I've always
heard the term that they'recrack doctors, you know, you
just you kind of get thatinstant relief Like, yeah, I
just foam rolled my back, I feelgood, I can get my workout in,
whatever.
Yeah, or is it just better tonot think about the tool but

(33:59):
think about the movement patternand try to do the mobility
routine and make sure you'reprepping yourself to do the act,
not try to use the tool as thequick fix, as the savior, yeah,
yeah totally so.

Usually it seems like the root cause of
non-traumatic pain and issuesfor active people is from
repetitive micro trauma, microinjuries, or that happen little
things over many, many, manyepisodes.
So those, and it compoundsrepeated movements that cause
the same things to happen overand over and over again, not

(34:33):
knowing yet, and imagine likesomeone in their 20s they're
super young, resilient andhealthy.
They don't, they don't reallyfeel stuff, and it goes away,
yeah, but then they become 35and it's like this isn't going
away.
This is lasting way longer thanI remember, you know, like wtf,
bro, it's not getting better.
Well, you're also older and thesame things have been ingrained
in these muscles, in the softtissue, instead the joints, for
years and years and years.

(34:53):
So it's repeated movements andthen prolonged postures is the
other position.
So like prolonged postures.

Prolonged postures is the second component that
like why did this hurt out?

of nowhere, like I didn't do it I think a
car accident.
I didn't fall down the stairs,I didn't sprain my ankle, but
all of a sudden my knee hurts ormy back has been bothering me,
I don't know.
I tweak something.
How long has it been going on?
Oh man, probably like sixmonths, and now it's just
progressively more noticeable.
That's usually our bread andbutter, that's what we work with

(35:33):
.
That usually comes fromrepetitive movements and micro
injuries and microtrauma overmany, many, many episodes that
just now, the straw that broughtthe camels back right, no pun
intended, or prolonged posturesthat facilitate some of the same
changes.
And the most influentialprolonged posture is sleeping,
because we sleep.
How many days a week do yousleep?
Seven for hopefully eight hours, right?

(35:59):
So the positions that we put.
He's our non-sleeper.

Oh really, you're one of those.
I don't know how they do.
How do you guys do that man?
It's not by choice.

Johnny, what time did you wake up this
morning?
Let's not talk about that.
But yeah, so, like you know, wesleep seven days a week and
hopefully six to eight hours,nine hours, and that's a lot of
added um, potential irritationor set up for failure that might
contribute to issues or maybeactually, or maybe should cause
more irritation and problems,you know.
So anyway, um, yeah, so the itseems like for long-term fixes
for non-traumatic pain that,like it just came out of nowhere

(36:32):
.
I don't know why this hurts wehave to find out what the what
the compensation patterns areand the movement system
impairment is the msi.
That's what we usually go withand that's usually a combination
of mobility disparities in theneighboring joints and muscle
recruitment and activationdisparities in the neighboring
joint.
So if some things are very,very dominant and active and you

(36:54):
do something challenging overand over and over again, what's
the first things that are goingto contribute to turn on to help
the very strong, dominant guys,when the muscles, not the
dormant, less active, lessrecruitable guys, right.
So imagine, for like kneetendonitis, right, what's going
to get broken down and irritatedfaster?
The overtime workers that don'tget any rest, or the ones that

(37:16):
are in welfare and don't reallywork, the ones that overwork and
get over overtime constantly,that's your biceps tendon, your
patellar tendon, your kneetendonitis, all that stuff.
Does that make sense?
Or like the low back spasms?
So it's like, why is thathappening in the first place?
We have to fix that.
Um, the soft tissue tools andstuff can definitely settle
things down and get you.
If you're like tight and sorein an area, right then, and

(37:38):
you're not like battling anissue, great avenue.
I'm not going to tell you notto foam, roll right or use a
theragun or something like that,or hypervolt, um, and then same
thing with a chiropractor.
So like it has this place inmedicine, just like anything
does, and the number one thingthat I would ask is like, do you
like it?
Okay, then it's not going tohurt you, right?
If you're battling somethingthat's been going on for a long
time and going the same approach, but you're not noticing

(38:01):
results, if nothing changes,nothing changes.
Nothing changes, which is theway anything is, unfortunately,
so that means that something'sbeing missed.
We have to find a differentavenue or a brainstorm, and
differentially diagnose what'sgoing on and why aren't you
getting results.
Then Maybe we need to intervenein a different way.
That's the route I would go tobe politically correct.

(38:23):
I'm having a lot of aha momentsover here, but anyway so it's
interesting I'm not knocking onany professions or anything like
that, because there'sdefinitely physical therapists
that people are like I've beenseeing my PT for eight years and
he keeps my shoulder, or shekeeps my shoulder, good.
Or I've been seeing my chirofor 15 years and that's the
reason why I'm able to do thething I'm able to do, but it

(38:46):
able to do, but it still hurts.
I'm like, dude, it takes sixweeks to feel improvements.
Right, like three weeks, youshould feel like a noticeable
improvement after four visits.
For like that's what we expectas in, like I do feel
improvement.
Yeah, it's not hurting as bad.
I'm not able to go 100 yet, butI do notice from prior that like
I'm able to do some stuff andit doesn't hurt as bad.
We're on the right track.
Cool, nice.
Let's continue this trajectory.
Versus course correcting youknow what I mean.
Versus like it's been 15 yearsand my back feels the same, but

(39:10):
it allows me to do things I wantto do.
I would question that.
Let's investigate some otherthings Interesting.

Just want to confirm.
So you said, if you identifythe root cause and you believe
where it's coming from,confirmed.
So you said, if you identifythe root cause and you believe
where it's coming from, roughlythree to four weeks there should
be some type of improvement.

Yeah, interesting yeah, so, and here's
the reason why I say that solike, so people who are, they're
otherwise healthy, as in, likethey don't have other
comorbidities, right, they don'thave red flags, signs and
symptoms, red flags being likeunderlying diagnoses that we're
missing, right, one of thebiggest campaigns, because
physical therapy is a pretty newautonomous profession.

(39:49):
It used to be, in like the 80s,90s and early 80s and 90s, a
bachelor's degree and then youand you worked under the scope
of a physician, of a doc.
It's like, hey, I just want youto show them these exercises
real quick, right, and then theygo.
We're like we can there,there's like some science behind
this.
Then it advanced into amaster's degree and I got a
little more autonomy, which, ofcourse, in the in the realm of

(40:11):
money and power and ego, whicheverybody you know edits in
every field, was resistance.
Like you don't need to do that.
Yeah, this is, this is easy,it's an ancillary service, which
it was.
It was, and they were gettingmore science-y behind it and
they were like, let's advance itto a doctorate degree where we
can almost take the role of,like, a primary care provider

(40:32):
for musculoskeletal things.
That's under our scope.
I'm not a cardiologist, I'm nota neurologist by any means.
I'm not a medical doctor, I'm aphysical therapist.
I'm the first one to say that.
I'm not going to misrepresentmyself and call myself that I'm
not right.
But for the world ofmusculoskeletal issues and
biomechanics and pain frommusculoskeletal issues, dude,
that's our bread and butter,that's what we can get, and we

(40:53):
might be able to save you avisit to the primary doc, to the
orthopedic, to the x-ray, tothe MRI, to the injection and
then the fifth surgery, mayberight, but anyway.
So, with that being said, itwas a bachelor's and a master's,
they advanced to the doctoratedegree and there was a lot of
resistance and like this isdegree inflation.
You don't need that.
You're still under the scope ofthese docs, which was at the
beginning still true, and nowit's more autonomous, right,

(41:15):
interesting.
So with what you're saying, soa bold statement, you can get
somebody better in four visits.
I was like of course I'm notgoing to get somebody a hundred
percent better in four, but weshould notice improvements, yeah
, meaning that like we're on theright track and we're
intervening the right way.
So how can you be confident,then, that this person coming in
with left shoulder pain it'snot coming from a heart issue?

(41:35):
How do you know it's notcardiovascular?
One of these big campaign therewas a magazine article back in,
like the early two thousands,this orthopedic doc group who
was feeling threatened by theadvancement of sports physical
therapy profession.
A magazine article.
It was nuts and it was likethis person bending over with
pain and at the top it was likehow can you see the underlying

(41:58):
cancer in this person's backpain?
So can't a physical therapist.
And I was like whoa, there wassome, there was some steam after
that.
Right, nobody can see that yeahunless you have imaging, that's
the gold standard, right?
The argument is that, like well, the docs will be able to
recognize and differentiallydiagnose like this smells
different.

(42:18):
My brain is automatically goingtowards this might be something
underlying we're missing.
Let's get some imaging andtesting and refer you out,
whereas a physical therapistlike let's do some hamstring
stretches to fix, and me all thewhile they have multiple
myeloma on their low back, likea cancer thing in their back, or
a cardiovascular issue in theirheart, and they're referring
pain to the left shoulder thatlooks musculoskeletal but it's

(42:39):
actually a heart issue.
So how can a physical therapistknow that?
Right, it's red flag questionsand red flag screening that we
would then be like this doesn'tsmell right, let's refer you out
to a cardiologist, to a doc.
You know I'm saying let's getsome imaging to rule things out.
We would never be like I thinkthis is a cardiovascular.
You have left ventricularfibrillation, you know, like our
issue, or, you know, heartmurmur.
That's not what we do.

(42:59):
I'm not gonna know that.
But if not, if some of the redflag question that we can go
through be like this doesn'tsmell, right, this is outside my
scope, dude, let's refer youout to a doc and get some
further testing, because I don'tthink this smells like a
musculoskeletal rooted painproblem.
Does it make sense?
yeah so to answer your question,if somebody like we should see
improvement, improvements inthree to four visits, right for

(43:20):
sure.
As long as it's amusculoskeletal driven problem,
that's not an underlyingsinister pathology.
We're missing like a heartproblem or rheumatoid arthritis
issue right, or a tumor oncologyproblem.
That's not.
We can't fix that right.
We got to get back to imagingand get some other refer out and
stuff.
I'm saying so if it ismusculoskeletal rooted, the

(43:43):
person's otherwise healthy, likethey don't have a bunch of core
mobilities.
That's going to limit theirhealing potential.
They're not a crazy smoker.
They drink a bunch and they're68 years old and they're
morbidly obese.
They have type 2 diabetes,congestive heart failure, they
smoke, drink and they also havea heart issue.
They're going to be a littlechallenging of noticing results.
You know what I'm sayingQuickly, quickly, and that would

(44:04):
be like we could still fix yourshoulder pain.
It's just going to take longer.
But anyway, I hope that answersyour question.

No, that's a great perspective.

That's really good stuff there.
I kind of want to take thisinto a future state thought
process.
Obviously, as someone soenthusiastic as yourself and
wanting to help driven athletes,I would assume that you're
probably eager to learn more andyou're looking at different
innovations that are happeningwithin your field.
I actually remember on one ofyour podcasts you mentioned

(44:33):
about the fluid that's in thejoints and how you can
reactivate that over a very longperiod of time.
It seems like a very innovativepractice.
I know you kind of mentionedhow you might get a little flack
about that in that episode.
Um, because that's thealternative to a knee
replacement, which actuallyryan's uh wife just got a knee
replacement pretty, pretty earlyon.
I was gonna, I was gonna.

Yeah, your wife had a knee replacement, so I was
gonna ask you, you know, withthe age range of clients that
you see, yeah, you know what'sthe earliest you've ever seen
someone, that you've worked withsomeone for a knee replacement
oh man there was a guy that thisis back in houston um he had a
he got gunshot wound at his knee.

Okay, all right, all right.
And how old was he?
Yeah, he was like early 20s,mid-20s fine, we'll throw that
one out she was, but that's not.

Yeah, it's different she was 30 when she
got hers replaced.
She just had chronic kneeissues.
The joint just didn't sitproperly.
She played indoor volleyball,so all the jumping didn't help.
But at 15, her doctor told heryeah, your knee's about 50.
You're going to get it replacedbefore you're 30.
And sure enough, she just hadit done in November.

(45:41):
But we're in the roompost-surgery.
Everyone's got about 50 yearson us.
Then we go to the first PT andall she keeps hearing is wow
you're the youngest.

yada, yada, yada.
That is the youngest, for sure,but it was nerve-wracking,
because then you're thinkingyou're 30 years old.

We went back and forth on should we do this,
should we not?
But it was all about removingthe pain and now not.
But it was all about removingthe pain and now, yeah, like
she's doing her rehab, she'sdoing leg extensions, her uh
knee replacement, she's firingoff great, her quote-unquote
good knee.
That has similar problems.
She can't eat it because it'sjust it's grinding it's just
bone on, bone.

So yeah, I hear that all the time.
So like bone on bone, yeah, ona bone thing.
So yeah, that's definitelydanger question.
That's definitely the youngestI've ever heard.
I'm sure that, like we rightthe like the great thing is that
she is, she feels significantlybetter yeah, cool we would just
go.
We would just go from there andcrush stability and strength and
minimizing and compensationpatterns stuff for the best
longevity possible.

(46:37):
Totally, um, I wouldn't so thatI'm sure the docs talked about
it like they're usually a shelflife of the the prosthetics they
put in there.
It depends, you know what Imean.
But I mean max 25 years,something like that.
So a revision probably is inthe future if she's this young.
That's why they're like waituntil you're 60, because then

(46:59):
you'll be dead before you need arevision.

Could you imagine talking to somebody like that
In a long enough?
Well, like that's not.
Not a.

It is what it is right like we're a mortal
human beings, like on a longenough time horizon we're gonna
be dead, but anyway, um, that'sdefinitely youngest.
There's a life shelf on thosethings usually.
So revision might be in thefuture.
But to answer your question, togo off of what y'all were
saying, yeah, so I hear bone onbone very often and that doesn't
.
It's not the end-all be-all, asin like.
Well then, we're effed, I'meffed until I get a replacement.

(47:32):
So I'll just meander around andjust live with it until I get a
replacement.
That's actually not the case,as in like, and this is also the
psychology component which I'mnot a professional psychologist
by any means, and this is alsothe psychology component which
I'm not a professionalpsychologist by any means.
But I know that we can'tseparate the mind from the body
and there's a ton of interplaybetween the psychological

(47:52):
component and physical pain,right, somatosensory pain and
psychosomatic pain.
There's been proven that, like,there is emotional-based pain.
So we also have to have adelicate dance between that too.
I'm not saying your wife's likethat, I'm just saying in
general this is a part of theconversation, but that's
something we have to consider,sure, right?

(48:13):
So that's going to dictate myapproach and some of my talking
points with certain patients.
It's not always black and whiteas in like you have a rotator
cuff problem and then we need tofix the rotator cuff.
Yeah, orthopedic surgeons arevery black and white.
We call it like pathoanatomical.
There's a pathology, there's anissue of the anatomy.
So solution let's fix theanatomy and that will fix the

(48:34):
problem.
Not always the case.
Right, there's plenty of peoplethat have had disectomies and
they have pain on the other sideof their back afterwards, like
they're.
They get a lumbar surgery andtheir their pain switches sides
and they look at the image onthe afterwards like your back
looks great.
This doesn't make any sense.
You should be fine, right, butthey still have pain.
Explain that, okay, it'sbecause the structure doesn't

(48:57):
always dictate symptoms.
The structure of somebody'sknee and the bone on bone
structure, whatever doesn'tdictate what the progression is
going to be like or theirsymptoms.
Currently, because there's beenplenty of people that have very
arthritic looking knees that arelike I've seen knees that don't
look great, the people that arein like their mid 70s and she's

(49:18):
like it doesn't hurt.
I just I'm just not strongenough to go downstairs or
upstairs and stuff.
I remember this one lady inparticular.
She had a huge valgus deforming.
It was bent inwards andsideways like knock-kneed right
One knee and it was crunchy andit didn't sound good.
She was limited range of motion.
I was like my knee doesn't hurtthough, so I was doing a bunch
of things and exercising itdoesn't hurt, it's just

(49:38):
challenging because I'm notstrong.
I just need to get improvedstrength for my life and
independence.
I was like this is a classicexhibit A.
It's very interesting.
The other thing I was going tosay with orthopedic surgeons
that are dude, they're so smart,they deserve a ton of respect.
In my opinion, med schoolresidency fellowship is probably
like the hardest academictrajectory anybody could take.

(50:03):
It takes a ton of respect, hardwork, they get pounded, but
they have their diagnoses.
They have their box of windowof perspective and diagnoses
right and, with that being said,not everything is
pathoanatomical.
So if somebody is battling kneecrunchiness and irritation of
their knee when they do jumpingand stuff like that and they

(50:25):
were a previous athlete I'veheard a lot of times they come
back from a doc visit and theyhad an image and the doc says
you have the back of a 70 yearold, you should be in more pain
than you are.
I'm like what the fuck Like somuch?

Why would you say that man Like that will?

help nothing.
So I'm like oh, oh, oh, but youget paid when you have surgery.
This, oh my gosh, you get paidwith injections.
The more MRIs you refer,there's an incentive.
Unfortunately, the ethics Ican't not neglect, that plays a
role, right?
I'm not saying your doc's doingthis, I'm saying in

(51:05):
generalities, um, or like man,it's like okay, well, I have
this guy telling me that's in awhite coat, he's super smart,
he's a surgeon and he's wearinga white coat, that my back looks
bad and I have pain and clearlyon this image you can see the
herniated disc.
So let's schedule surgery nextweek.
So I skilled a surgery and hadthe surgery right.
Or my bone on bone.
My knees have a kneereplacement.
As long as your knee's effed up, you're going to be effed up.
So until you get a kneereplacement, you're effed.

At the end of the day, they don't get a paycheck
for turning people away.

That's my gripe with it.

Unfortunately, every profession is like that.
As an example, imagine, likepsychologists, right Mental
health, they have a mortgage andthey have bills.
I sure do right, so like wouldit would it be a benefit for
these professionals to solve alltheir problems, to have their
clients never come back againand they get paid session by
session?
I don't know right.
Well, we're in the same boattoo.

(51:51):
Like someone could argue thesame thing with us, right, it is
a business.
But anyway, with that beingsaid, I would always question
get second opinions, right, youcan always do that.
So the bone on bone thing andthis is the podcast talking
about, all right.
So synovial fluid, that's thefluid you're talking about.
Synovial fluid is thelubrication and nutrients of a
joint.
So your articular cartilage,which is the cartilage where, if

(52:15):
that gets worn down, that'swhere the bone on bone
suggestion comes in play thecartilage does not have a
vascular innervation and itdoesn't have a neural
innervation.
So there's no blood vesselsthat go to innervate your
cartilage and there's no nervesthat innervate your cartilage.
So that then suggests theycan't heal.
Right, the more blood flowavailable, the more potential

(52:36):
for something to heal.
So a muscle strain, dude, thosethings heal up quick.
There's a ton of bloodinnervation for that Cartilage
has very, very, very low or noneblood innervation.
So the thought was always itcan't heal then.
So arthritis is a progressivelygetting worse issue that won't

(52:57):
improve.
It's like as soon as you hit alevel it goes down.
It can't go up, there's aceiling forever and then it goes
down again and it's aprogressively worsening issue.
I'm just saying there are someresearch articles out there that
have found improvements inarticular cartilage, vitality,
brilliance and thickness.
On the imaging they call itlike brilliance or like the

(53:18):
signaling in thickness, and oneof the studies I was referencing
is like they were doing thistest.
It was an 11 year study ofthese dogs, these beagles that
they had in a control group,that they just were normal dogs
that live their lives, and thenthey had this experimental group
.
They put a double their weightweighted vest and they had them
run seven miles five days a weekfor 11 years.

(53:41):
It's like running's bad for you.
You're going to break down yourjoints.
There's a certain life shelf ofsomeone's joints and the more
you run, the earlier you'regoing to have arthritis.
So yeah, I mean you want to runand look good in the bathing
suit, but then at the same time,you don't want to break down
your joints.
Apparently that's not true.
Based on the empirical evidencethat I'm just referencing, it's

(54:02):
on me.
It's these other people that areresearchers.
This was up for a Nobel Prize,by the way.
They didn't win.
It was in the running.
You know what I'm saying?
It was in that conversationtalk.
So at the end of the 11-yearstudy, they sacrificed these
beagles.
That's where the ethics come in.
It was like, oh my god like youknow, I know, but they got
really good information of thatcontrol group that didn't do

(54:24):
anything a dog that's playednormally and the experimental
group double-weighted vest,seven miles a day, 11 years.
You would expect their kneecartilage to be broken down,
yeah, so they sacrificed thedogs, they opened up their knees
and they did investigativestudies.
The control group of dogs hadthinner, more brittle cartilage
and the running experimentalgroup had thicker, more vibrant

(54:44):
and brilliant cartilage.
It's like, explain that right?
I don't know right.
Well, it may be.
Then the kind of mechanics, thesynovial fluid and the
compression of their jointsstimulates your body to adapt to
it and if it's not anirritating and overwhelming
stressor and adaptation ofbreakdown will occur, but rather

(55:08):
it's like a healthy compressionthat your body will adapt to.
That causes, we would surmise,underlying subchondral bone that
grows forward up through thecartilage and it generates it
from the bottom up over many,many, many months and years of
time.
Right, so somebody that'sbetting art.
So that's what they'resuggesting, that's what the

(55:29):
article and research suggests.
So I'm like, oh, this is, thisis crazy.
So that the term motions lotionthat we use all the time, yeah,
your synovial fluid istriggered to be produced when
you feel friction, when thejoint feels friction on itself
and pressure, because it's likewe need to lubricate here and
that's where they get itsnutrition as well its nutrients.
So what they're suggesting isintermittent compression of your

(55:52):
joints, which is likeresistance training, not so much
where it's overwhelming and toomuch because that could cause
an issue.
Just like water, you can drownin water.
You can drink yourself too much, because that could cause an
issue.
Just like water you can drownin water, you can drink yourself
too much water.
Too much weightlifting there'sa detriment to that, of course.
But some on purpose,intermittently, with an
appropriate amount ofcompression and an appropriate

(56:12):
amount of stress over many, manyyears.
I'm talking like a minimum of12 months, two years, three
years where every time you workout, you leave and you're like
my knee doesn't hurt worseActually.
Months, two years, three yearsand where every time you work
out, when you leave and you'relike my knee doesn't hurt worse,
actually it feels looser.
Keep that trajectory over yearswhere your main goal is to not
hurt after you work out.
What they're suggesting is thecartilage would be improved.

(56:34):
Nuts, right I?

just had an aha because, like, I tore my 10
years ago, okay, and we talkedabout overcompensation.
So I tore my right knee, yeah,and my left knee for whatever,
no, I'm sorry, my right knee,excuse me, the one I tore To
this day.
If I am inactive, it will justget more sore and more stiff
versus me going and continuouslyworking out.

(56:59):
So it's all.
I kind of believe in the wholebugle thing here, like just keep
it going and it's going tostrengthen in that inactivity.
I'm talking, like you know,maybe a couple of weeks a month
and I'm like I don't understandwhy it's hurting.
I haven't freaking doneanything.

And then I go do stuff and it's like damn this
like it's feeling back tonormal.

So sounds like use it or lose it.

Oh, really, really David Goggins mentality right
there.

So, he's an extreme .
I'm not saying run seven hours.
He's extraordinary, he's superintense.

I love his mindset and stuff for sure.
But, yeah, so if you don't useit, you lose it.
It's totally true.
But with that being said, thatsometimes can deter people like
well, I'm too far gone.

It's not true.

You're going to make improvements as soon as
you start.
As an example, smoking as soonas you stop smoking, within
three weeks, noticeable tissueperfusion and oxygen delivery
has been noticed, and theresearch was insane.
It's never too late to stop orto start doing some stuff
purposefully.
The main question out like themain thing that I would present

(58:05):
with is like just don't make ithurt every time you exercise.

That's a great indicator.

So for patients that see us, they're
like my knee hurts, beenbattling an issue for a while
and every time I try to work outit hurts, right.
We definitely like modify somethings, modify the intensity,
modify your expectations.
It's going to take some time tosettle things down and then we
can progress and interveneappropriately.
And in the meantime let'sintervene some of the
compensation issues like that'syour workout is working, the

(58:34):
compensation issues and then ifyou want a six-pack or bigger
biceps, then do the auxiliarywork stuff afterwards, totally
right, as long as I'm causingmore pain, right.
But let's work on thesecompensation issues in the
meantime and exercise andworkout and I very confident
that people will be like my kneejust feels better, it feels
like it just feels looser.
You know right, totally so what?

(58:55):
I would also ask people that,like yourself, it's like I
didn't do anything and it hurts.
You're also walking, you'resleeping, you're picking up your
dog, your kids, you're gettingin and out of your car, you're
pivoting out of your car, you'rewalking upstairs.
And if there are underlyingcompensations, right, they're
minor, super minute stuff, butit plays a role because how many

(59:16):
steps do we take a day?
That's 10,000 reps.
That's a lot of reps that canmaybe ingrain and reinforce
issues, but then also just likeirritate stuff a little bit and
that compounds and adds up andit's like now it hurts and I
don't want to, I don't want toexercise because it hurts, right
?
So then it's like you try onceand it hurts again.
It's like I'm not meant to workout and that's it too far gone

(59:37):
so we just got to like intervenewith some stuff.
That that's where the manualtherapy comes in.
If we can set the joints up forsuccess, to move better and it
doesn't hurt with doing theselittle things right, then it
helps to encourage and reinforce, like oh, I can be okay, right?
So, at the meantime, resettingsome mental expectations of like
redefine right now what youcall a workout.

(59:58):
This is your workout, right?
As ex-athletes, I was the sameboat where I was like, if I
don't power clean, squat andbench, do dip, weighted dips,
I'm not actually working outright it doesn't count.
You know, I'm just like messingaround these bs exercises.
You know what a jerk, what ajoke I am like.
My self-value is directlylinked to my bench press max.

(01:00:19):
You know, that I used to be likethat, but anyway, it'd take a
while Because if my shoulderwould get bummed, my back would
hurt.
I'd be like, well, I'm going todo it anyway.
I'm not actually working outunless I do these things.
I had to redefine what myworkout was.
There was a dude we have to becareful.
What we see on Instagram forsure, influencers and Instagram
experts or whatever.
There are some solid sourcesout there.
In my opinion, we just got topick and choose and be

(01:00:42):
discretionary.
But there's this guy I saw onthere.
He said he's a dad, he's in hisgym working out and he's front
squatting like 95 pounds andhe's muscular and he's like I'm
never going to front squat morethan 95.
I don't need to.
I don't want to.
My goal is to just be able tokeep up with my kids and run and

(01:01:03):
play and not be hobbling aroundand in pain.
It just depends what your?

James LaGamma (01:01:06):
goals are.

Dr. Kyle Volstad (01:01:07):
Some people are like I want to run a 10 K.
I want to run five 10 Ks thisyear.
Like totally different, theboat that I'm in.
Like, of course, I want to beable to work a workout.
I want to feel confident.
My physique plays a role withmy confidence, for sure.
I want to feel strong.
I want to be a good role modelfor my kids, a symbol of
discipline and hard work andeffort, and motivate my kids.
Have my kids be proud of me.
Have my wife be proud of me.

(01:01:28):
Be at all those examples, mywife too, and working out as a
part of that.
So me only.
You know, doing simpleelliptical or assault by
workouts won't get me there.
So I do want to do some otherthings, but that's my goal.

Jonny Strahl (01:01:41):
Yeah.

But at the bottom line and this is what we
hear from all, most everypatient that we see, I just
don't want to hurt anymore.
We can get there and then we canprogress.
But there's a reason why you'rehurting.
The other podcast I was talkingabout.
Like there is a solution formusculoskeletal stuff.
Dude, there is a solution.
Things don't hurt for no reason.
And if we rule out red flagsand underlying sinister

(01:02:03):
pathologies that were that maybewe're missing and we can,
you're just.
You're inherently unhealthierperson.
You don't have a ton ofcomorbidities, you're not
smoking and drinking a ton.
This should get better.
Things don't hurt for no reason.
There's a reason why it'shurting If it's musculoskeletal,
musculoskeletal joint pain,right, um, that's.
We just have to figure it out,right.
But anyway, so that that's sofor me, like, yeah, from my it's

(01:02:26):
just my humble perspective andthe way I look at stuff I really
respected that dude who's likeI don't need to squat more than
95 pounds my value my lifedoesn't depend on my squat, my
front rack uh max you know, I'msaying I don't care what you
think, like if it's like I go toa gym or something like that,
or like you're not as much of aman because you don't work out

(01:02:48):
as hard as I do, yeah, congratsI don't care, you know, like I
have two plates on the bar.
Yeah, exactly, but but there isstill a competitive version of
me where it's like I gotta, Igotta, I want to look good, you
know, and I'll be confident andphysique and stuff.
It's just something I got tobattle and just weigh out your
pros and cons and your goals,you know what I'm saying but
anyway, that's a yeah, I love it.

Kenny Massa (01:03:08):
Look, I think there's no doubt that we can
keep you here for four hours.

It's already been an hour or more.

Yeah, I mean, we, we have tons of questions just
because we've lived a lot of thethings that we are, that you
talk about.
We've seen it from the inside,so we have a really simple,
direct correlation with anunderstanding of everything that
you, you preach and youpractice.
So, with that in mind, I thinkthat the a few takeaways that
we've gained today, for theguests who are listening, are
it's never too late to startright.
Right, you, you have theability at any point to to kind
of take that step forward, andtoday, for the guests who are
listening, are it's never toolate to start Right.
Right, you have the ability atany point to kind of take that

(01:03:44):
step forward and start to gothrough rehabilitation in any
way that that seems fit for you.

Right.

And then also that there's.
You know, there's certainthings that, like James brought
up earlier, where there's maybeeasier, like DIY or at home
resources that you could gainbecause your shoulder hurts.
But I think that everyone hasto look at things from a deeper
level because your shoulderhurting, it may be that fire

(01:04:13):
alarm.
It may not be the core problemthat you're dealing with, and in
many cases it's not.
So, seeking guidance from aprofessional or someone who
understands the physiology ofthe human body in a deeper
fashion could lead to a fasterrecovery process, because it
might not be the fire alarm thatyou.
The last six years I've beentrying to make quiet with that

(01:04:36):
pillow.

Yeah, exactly.

So seeking the correct guidance is really
important from someone who's aprofessional.

Yeah, at least get some concrete answers
Exactly and you know what Peoplewant closure.
You know they want some closure, yeah.

And a really good place to start is by going to
Kyle's podcast that he hasonline, the Driven Athlete
podcast, where he talks about anoverwhelming amount of areas
that are common areas forproblems and issues and he
brings guests on to talk aboutthose different things from
angles of high gradeprofessionals.

(01:05:08):
I know you recently had, orthat you're going to have,
someone at an Olympic level.

Yeah, she just came in last week and then I
had a pro tennis player on acouple months ago.
And then I have D1 footballplayers coming in next week.

So from high, high-grade athleticism to
general activities like postureand office posture, sleeping
posture, things like that.
So tune in to Kyle's podcast,because there's a wealth of
information that you could gainon that podcast itself Tons of
different episodes, dozens anddozens of them.

I appreciate that.
Yeah, thank you.
One thing that I'm somewhatnerd out on, I think, is like
the, the mental component, likethe psychology of just
performance and sports, but thenalso like for rehab and pain
pain science.
That's a whole differentsubject that we get into, like
with fellowship training andstuff.
Um and to, to pique yourinterest real quick, lil Wayne.

(01:06:03):
Lil Wayne quote this was thefirst thing they brought up in
our training Pain is an opinion.
Okay, pain is an output, it'snot an input, which is totally
interesting as an example.
Like real quick, like imaginesomebody gets like a shark
attack, somebody gets their legbit off.
Or like their quad like chunk,and at the time they're like I
feel like something hit me.
This is weird.

(01:06:24):
They're like that wasaggressive and it doesn't hurt.
And then they look down andtheir quad's missing and they're
like F, then things kick in.
This is interesting.

Ryan Selimos (01:06:35):
I can tell you straight up I dislocated my arm,
Put my arm down doing a puntreturn.
I got up arm.
Oh yeah, put my arm down doinga pump.
Return.
I got up.
Everything's fine, buteveryone's looking at me and I'm
like why?
And I look down and I see thatmy arm is over here and that's
when it all hit me.

Yeah, yeah, so the shark attack thing same.
Yeah, I did that with my finger.

Yeah, oh yeah.

But anyway, those are super aggressive examples
but demonstrate we can'tseparate the mind from the body
and, ultimately, pain.
It's been proved like it is athing.
Pain is an output.
It's not an input, just justsaying.
Or, if you want to get moreaggressive, pain is, pain is a
weakness, is weakness leavingthe body pain is.

The other one is that denzel from uh rim of
the titans is that what you saidno, water makes you weak great
movie every football season,like late aug.
I watch that movie just to getready for football season Nice,
just to get hyped up.

Well, now I'm going to think about the 75-year-old
lady who had basically bone onbone and had no pain.
I'm going to be like she had nopain.
Kyle said yeah.

Kyle said.

James LaGamma (01:07:37):
Kyle said she was good, dr Kyle.

Yeah exactly, oh God.

Thank you for being on today.
We really appreciate it, yeahtotally, man.

Thanks for the invite and the shout-outs and
stuff.
And if you all have anyquestions, like if you have any
questions at home, you all canreach out to us.
Our phone number is561-899-8725.
If you live, we actually justhad a phone call with they do in
Poland, by the way.
Yeah, so we do consults, youknow, we can chat, at least to

(01:08:04):
get some answers, um, or ouremail, which is team at athlete
rccom.
Those are great ways to reachout to us, but we're always open
to, um, to questions andguidance and stuff like that, if
we feel like we're a good fit.

And then conflicting opinions and
suggestions and comments,podcast ideas, like, we're
always open to discussionAwesome, and even, at the least,
drop a comment in the threadhere and reach out.
We'll make sure that you getpast Kyle's information in the
event that you're seeking some,some questions or some answers.

I appreciate that.

Awesome Well thank you.

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