October 30, 2025 • 50 mins
In this powerful episode of The Body Pod, host Hailey sits down with Dr. Tom Walters, physical therapist, creator of Rehab Science, and social media educator to over a million followers, to unpack why traditional physical therapy and rehab models often fail—and how to fix them for good. You’ll learn how to heal smarter, not harder, by understanding the science of recovery, strength training, and pain management. Dr. Walters breaks down the insurance-based rehab system, the latest research on tendinopathy, mobility, and load management, and how to build resilience through heavy, slow resistance training. This episode is perfect for anyone struggling with chronic pain, overuse injuries, or midlife fitness plateaus.
We cover:
Whether you’re a physical therapist, fitness coach, athlete, or someone dealing with pain, you’ll walk away with actionable tools to understand your body, manage pain, and train for lifelong movement and health.
We cover:
- Why traditional rehab fails and what evidence-based recovery looks like
- Strength training for pain relief and injury prevention
- Women’s health and midlife fitness strategies
- Psychology of pain — why pain doesn’t always mean injury
- Smart prehab for knees, shoulders, elbows, and feet
- A preview of the upcoming Rehab Science app for guided exercises and mobility tools
Whether you’re a physical therapist, fitness coach, athlete, or someone dealing with pain, you’ll walk away with actionable tools to understand your body, manage pain, and train for lifelong movement and health.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone. My name is Haley and this is Laura
and welcome to the Body Pod. Welcome back to another
episode on the Body Pod. Today, I have the privilege
and pleasure of interviewing doctor Tom Walters. Tom is the
(00:22):
founder of rehub Science and dedicates his time to teaching
people about human movement, pain, and how to most effectively
recover from injury. He specializes in the treatment of musculoskeletal
pain and movement disorders, combining kinesiology, education, manual therapy, and
an individually tailored therapeutic exercise to treat orthopedic conditions. He
(00:48):
is a board certified orthopedic physical therapist and strength and
conditioning specialist based in Santa Barbara, California. In addition to
his clinical practice, he also runs one of the largest
world's largest social media accounts dedicated to physical rehab, which
is at rehab Science on Instagram. And he's the author
(01:09):
of my all time favorite book, Rehab Science, that we
will be discussing today. So without further delay, let's jump
into this discussion with doctor Tom Walters. Welcome everyone. I
(01:29):
have doctor Tom Walters with me today and we are
covering If you are watching this, his book rehab science,
which Tom, I'm going to say, this is literally like
my bible. I have used it so many times. I
think I told you I have a client that lives
right by you and we were working through some elbow
(01:50):
tendonopathy and I was so glad to see that I
was doing most of the things in this book. But
I was like, Tom, what do you think about this?
Because these tendonopathies can take for ever. So before we
get into that, let's go ahead. And I wanted to
touch on something that you said at the very first
of your book, which is, in many ways the rehab
(02:12):
model is broken. So can you tell us a little
bit about where you started in your journey as a
physical therapist and then what kind of led you to
kind of doing your own thing.
Speaker 2 (02:23):
Yeah. Well, first off, Haley, thanks for having me on.
This is amazing to get to Thanks for buying the
book and mentioning it. It really was the goal to
create a resource that people could self manage their own
pain issues and injuries because most of physical therapy right
there is a manual therapy. My residency was in manual
therapy where I'm using my hands to work on people,
and that can be good in the beginning for getting
(02:44):
people out of pain. But most of the evidence revolves
around exercise and movement, and those are things people can
do on their own and you can teach them in
a book or some resource like that. So it's been
so fun. It's been out for two years, and it's
been really cool to see people using it in that
way and kind of like solving on their own. So
but yeah, thinking about Yeah, the intro of the book,
we start kind of talking about the rehab model being broken,
(03:08):
and not that the interventions are broken and don't work,
but just the model that it's delivered through. And I
think anybody listening to this who has insurance and goes
in the medical system with insurance recognizes immediately the limitations
and physical therapy is no different. We basically, you know,
physical therapists. I only lasted two years. I've been a
(03:28):
PT for eighteen years. I was only in an insurance
model for two years because of just the limitations placed
on you and how that impacts the quality of care
that you can deliver. I mean, the clinic I was
at was actually better than a lot of other clinics.
We would see people for an hour when they first
came in and then every follow up session was thirty minutes,
so it actually wasn't better. But I had a lot
(03:48):
of friends to people every fifteen minutes. So you're sting
thirty people a day, There's just no way you're really
having enough time to talk with them about their symptoms,
like all the back history that might be related to
their pain. Like we just there's so many factors that
go into pain, in your stress, your sleep, your nutrition,
Like there's no way you can cover that even in
(04:09):
a thirty session. You just can't catch up with people.
So a lot of physical therapists are kind of shifting
out of the insurance model and going towards cash pay
clinics and trying to figure out ways to better serve patients.
But yeah, in terms of my background, I was an
athlete all growing up. I was a martial artist and
a gymnast, so I had a lot of which tied
in really nicely with physical therapy because I was always
(04:29):
barefoot and I just a lot of movement control, you know,
so a lot of body weight training. I'm really thankful
for all those years in martial arts and gymnastics just
because it really did kind of help me learn sort
of like applied kinesiology in a way like canesiologies study
of human movement. And before I knew that term or
what went into kinesiology, I kind of just learned about
(04:53):
my body and how to control my body and how
to strengthen it and all those things. And basically it
had knee surgery in high school. I had a not
a real serious surgery. I just I actually had my kneecap.
I was born with it in two pieces. It's called
a bi partape ptella, and it would hurt me when
I land from jumping like in gymnastics. When I land,
it would hurt on the front of my knee, and
(05:14):
it was a very small little piece, and so I
just had it taken out and then everything was better.
But that was I went to physical therapy after that,
and so that was sort of my first exposure to
using exercise to rehabilitate the body. I was always just
used to performance and how do I get a longer
jump higher, things like that. So then I went I
did an exercise science degree in college, so my bachelor's
(05:36):
degree is an exercise science. I was really most passionate
about exercise physiology exercise science, and then went to in
the US, you do a three year doctorate in physical therapy.
You have to have a bachelor's degree and then you
go do that. And so I did that and mostly
focused in orthopedic physical therapy. So it's all the common
conditions people are used to thinking about, like back pain,
neck pain, you know, tennis, elbow plantar fasciitis, all these
(05:58):
meniscus tears. It's like all the things most of us
are going to experience. So, yeah, that's been kind of
that was kind of where I started and got it.
How I got into PT.
Speaker 1 (06:09):
Okay, well, I love it, and we're so glad that
you now have this. I mean, what is your Instagram?
You have like a million and a half followers or something. Bananas.
But when I started reposting, I mean, I'm so lucky.
I don't even know how I fell upon you, but
however I did, and I started following you and that
I posted something, and the people that I look up
(06:32):
to most in this space that like they are they
all commented on my story and they were like, Tom
is the best. I've been following him for years. Where
have I been? So let's dive in. Let's dive into
the book. So for the reason you wrote this book,
as you kind of just talked about, when we look
(06:54):
at it and and there are a lot of things
outside of maybe a cute and acute injury. Most of
the women that I work with are coming in with
with chronic tendinopathies, So, you know, outside of a skiing
accident or something like that, some of this stuff. And
(07:17):
I have a program called Foundation Happens where we cover
a lot of the uh, you know, the commonly weak
links that nobody wants to target because everyone wants to
use the big prime movers and push pull and do
the deadlifting and do the back squad and they want
to start lifting heavy, which the message is getting out
to women that they need to lift heavy. This is
(07:37):
all great, but do it too soon, too fast, and
every single time there's a tendinopathy. So do you see
this in your practice? And is there a difference between
someone that's maybe twenty or twenty five versus someone that's
like forty five, fifty and beyond.
Speaker 2 (07:58):
Yeah, definitely a difference. And it's of what I see
in my practice too. It's mostly connective tissue disorders teninopathies
like you're talking about, especially for the people who are
active or haven't been a lot very active and then
suddenly get active. It's usually tendinopathies. It's there, your tendons
are Your tendons and ligaments are connective tissues, so we
kind of think of them generally is just connective tissue disorders.
(08:20):
I mean, of course, some people do have muscle strains
and other more severe injuries of something traumatic happens, but
most people who are just kind of exercising and start
to develop pain, it usually is a tendinopathy, and it
does come down a lot. In the physical therapy world,
we talk a lot about load management, So it's managing
how much load you're putting on your system, how intense
(08:42):
that load is. So like like if you imagine you're
going to pick up a strengthening program. If you just
go and you haven't been doing any strengthening forever or
for the last few years, and all of a sudden
you just go gangbusters and you're doing an hour of
string training every day, you're likely to develop tenopathy. Or
if you just pick up running program and just start running,
all you need to build into these things. Your your
(09:04):
muscle skeletal system has this great ability to adapt but
it's kind of slow. Your cardivascar system adapts a lot faster,
you know. So a lot of people get into trouble
where it's like their heart and lungs can handle what
they're doing, but their muscle skelet system takes a little
bit of time to catch up. And so, and it's
for sure different with age. Like you mentioned, I'm forty
three now, my body just takes it takes a little
(09:26):
longer to recover. It's easier for me to tweak something.
If I don't have a good warm up, I should
never warm up. I just jumped into everything. So I
think in your nineteen when you're in your teens and twenties,
you see people will develop teninopathy, but they have to
really be pushing themselves way higher volume. It's just it's
(09:48):
excuse me, harder to trigger those kind of issues in
younger people. As we get older and changes in connective tissue,
changes in hormones, like all these age related changes, you
just see way more tenpathies and they're just way easier
to kind of flare up and get triggered. And I
always tell people the nice thing about tenanopathies is there
(10:08):
I would say they're seriously annoying, but they're not serious,
like they're not It's not like an injury that you
need to worry a whole lot about in most cases,
like you're going to tear something or something's really broken
or damaged. It's just more that they're painful and that
can obviously really limit you in life. So you have
to figure out how to manage them. And a lot
(10:29):
of that is kind of figuring out how do I
manage the load on my system and kind I kind
of take baby steps, kind of kind of break my
exercise down into steps or gradually get into something so
that I don't make those tendons kind of get angry.
Speaker 1 (10:43):
Yes, and so the muscle usually adapts much faster than
the tendons and the ligaments. And I think that at
least from what from my view, this is what happens is,
you know, people are feeling great and they're they're getting
excited and they're motivated. So a lot of women at
this age are coming back from having children, you know,
(11:05):
having jobs. Now they're dealing with aging parents. There's nine
million things, and so they're finally coming around to making
themselves a priority again. And so there is this excitement
and motivation to get back in and start training, and
they're hearing these messages. But I'm always you know, on
my app like slow down, Like if we're in this
(11:27):
for life. Sure, a tendinopathy might not, you know, be
something that is going to completely sidetrack you forever. But
it's a setback. And and as women at this age,
we just if we can avoid setbacks to the best
of our ability, let's avoid those setbacks. So do you
ever look at like if you you see people once
(11:49):
they have the tendinopathy. But is there like a prevention
strategy where like some prehab that you would say, oh,
if people just did this for this elbow tendinopathy or whatnot,
you could probably save a lot of these tendinopathies that
pop up.
Speaker 2 (12:07):
Yeah, for sure, there's a ton you can do. I
think at a base level it is sort of like
the accessory complementary type strengthening exercise. As you mentioned teninopathy.
The best research for preventing and treating teninopathy revolves around
strength training. You know, It's what we call resistance training.
If you're just it's any kind of external force that
your system has to resist. So people tend to think
(12:27):
about as strengthening. It could be body weight. A lot
of it's body weight. Actually sometimes it's banned. Sometimes it's dumbbells,
but that type of exercise has the best evidence. Basically
it if you think about when you strengthen your everyone
thinks about it's obvious. Then your muscles get stronger, But
your muscle's attached to tendons, and a tendons attach your
muscle to a bone. So when you put tension through
(12:48):
a muscle, you also improve the strength and capacity of
the tendon. And that's tendons or what where teninopathy comes from.
So if your tendons are more resilient, they're less likely
to develop teninopathy. So at a base level, from a
prehab standpoint, Yeah, just being kind of intelligent about thinking about, Okay,
(13:09):
what are the tendons that most likely develop teninopathy? What
movements and muscle groups am I going to use in
whatever exercise program I'm starting? And then you know, for
a period of time as you're maybe before you even
start that program or in the early stages when you're
going slow kind of like you're saying, gradually getting into it,
it would be adding in some of those strengthening exercises
(13:31):
that target the tendons that are most likely to develop teninopathy.
So there are things like the achilles tendon, the elbow tendons,
you know, like the tennis elbow and golfer's elbow, the
rotator cuff tendons, the patellar tendon on the front of
your knee, especially if you're doing a lot of jumping
and squatting and things like that. Oh, the glute tendons.
Gluttendons are a big one, especially I see lots of
(13:53):
females with glue tail teninopathy. So on the outside of
the hip. People can imagine there's this kind of bone
on the outside hitm. We used always think of it
as birsitis, but a lot of females, especially around kind
of the menopause stage, end up developing glue till teninopathy. So,
but there are a bunch of there are exercises you
can do, stringthing exercises that target all these tendons and
will make them more resilient. So just adding something like
(14:13):
that at the early stages of your training program, or
even like a few weeks before you start the training
program can do a lot in terms of reducing their
chances that you get a teninopathy and have those setbacks.
Speaker 1 (14:26):
Yes, okay, so let's break this down because everything you
just said was on my list of these common the
common injuries that without fail. And so anytime someone comes
to me and they're looking at my programs, I will
always preface the conversation. I'll say, have you ever done
like a foundation program or a general preparation phase or
(14:49):
or anything, because it's great that again you want to
start lifting, but have you ever you know, what have
you done? And when they tell me their their program
or maybe they haven't done anything, it always is petel attendon,
low back. Uh, I would killes tendon, but like planto fasciitis,
(15:10):
elbow tendinopathies, rotator cuff. So that's pretty much. Do you
find that synonymous in males and females or do you
see more in females or what? Do you think?
Speaker 2 (15:21):
They're really pretty close between the genders. I would say
the one that stand the ones that probably stand out
to me a little bit more in females probably are
like plantofasciitis, the glue tail tendinopathy. The other ones I
wouldn't say in my mind they're pretty even between the
male and female.
Speaker 1 (15:40):
Great and probably Okay, So if we were to go
to elbow tendinopathies, how would you treat that once somebody
has one? And can we do some of those exercises before?
So just give an example of maybe a couple of
exercises of what that looks like.
Speaker 2 (15:56):
Yeah, So, when you're thinking about teninopathy in the elbow,
most people are going to be familiar with the terms
tennis elbow and golfer's elbow. It doesn't mean that you
had had to get it playing those sports. It just
tennis elbow is lateral tendinopathy. It's on the outside of
the elbow, so, and it has to do with our
wrist and finger extensors. So they're the muscles that kind
of lift your wrist up there on the top of
your form. Those attached on the outside of the elbow,
(16:18):
and then on the exact opposite side of your form
are your finger and wrist flexors and those attached on
the inside of the elbow. People will get pain at
those two spots on their elbow. The you say it
hurts on the inside of the elbow or the outside
of their elbow, and so when you think about the
research being most supportive of resistance training if you had
pain in the outside your elbow. Example exercises would be
(16:38):
things like risk curls. We call them wrist curls. So
you're holding a dumbell, your arms kind of supported on
a table so that your hand is hanging off the
edge of the table, and then you're just holding a
dumbbell and you're lifting it up and kind of squeezing
your wrist extensors. Another on, another muscle that attaches out
there is our muscle called our supinator, and it turns
your palm over so that you're Alma's facing up. We
(17:00):
always just say like you're holding a cup of soup,
so your palms facing up. So superinator rotates your form,
but it attaches on the outside of the elbow too,
so we do these banded exercises or even holding the
end of a dumbbell where we have to rotate and
strengthen supinator. So those would be two examples for the
outside of the elbow. The inside the elbow is kind
of just almost the exact opposite. You'd flip your form over,
so you're starting with your palm facing up, arms support
(17:23):
on a table with your wrist hanging off, you hold
the dumbell and you do these kind of wrist curls
where you're lifting up and down. And then on that
inside the elbow, you have a muscle called pronator terries.
That one turns your form over so that your palm
is down. So the same kind of do you use
a band or a dumbbell to rotate and strengthen pronator terries?
Speaker 1 (17:41):
Yeah? Perfect? Okay, And does grip strength play into that?
Can that help that?
Speaker 2 (17:47):
Yeah? Big time. Grip string thing is an amazing one.
There's all kinds of grip tools, like the little squeeze balls,
there's the traditional grip strengthening devices. Yeah, especially for it
can help with both types of elbow to anopthly. But
it's going to be really relevant to gal the inside
on the inside of the elbow because it's you're using
our finger flexers when you squeeze something and those muscles
run up your forum and their tendon attaches on the
(18:08):
inside of the elbow. On the media epicondo, that kind
of bony spot on the inside of your elbow.
Speaker 1 (18:12):
Yeah, oh well, that's the one. That's the one that
I had of my client and I was like, this
has got to go away. It's not going away.
Speaker 2 (18:20):
You're so annoying too, right, Like you said this at
the beginning, ten and off. But these can last a
long time. They can be super resistant. There's even some
research showing that, like Planofasciatus said he came out recently
and said it can last up to a year and
a lot of people. So you know, and you hope
that with rehab you speed that process up. But some people,
I mean, I've had people over the years that it's hard,
right because you have this thing that's annoying, but you
(18:41):
don't want to give up the exercise that you love
so and you wouldn't tell people that be completely sedentary
and give it up. You're always trying to find that
load management concept of like how much volume of exercise
can they tolerate without totally flaring the tendon up. But
you would never tell them to completely rest. That's what
doctors used to tell people. And tendons don't get better
with rest. They will, they will in the acute phases,
they'll kind of calm down, but as soon as you
(19:03):
stress them again, the teninopotly will come back. The only
way to make it permanently go way is to gradual strengthening.
Speaker 1 (19:09):
M Okay, so if we move down to let's say
the petel attendant. So if someone were just coming in,
there's I mean, you're the expert, so you tell me.
I usually use like some isometrics like a wall squat
hold something like that, but then also like ecentric more
(19:34):
eccentric work with a heavier weight and then you know,
lifting the assisting the leg backup or the arm back
up and then going down again like that. Do you
see are those common approaches or do you have any
other ones that you would use?
Speaker 2 (19:48):
Yeah, that kind of framework works really well for a
lot of people with teninopoly where its you start with isometrics.
Isometrics are if people don't know that, it's a where
your muscle's contracting but your joints not moving. So it'd
be like if you imagine you did a bicep curl
need has held it halfway and didn't move. The muscles
still working, the tendon's working, but there's no movement, so
the muscle fibers aren't changing in their length. And isometrics
(20:10):
have kind of cool research showing that they kind of
if you hold an isometric for thirty to forty five
seconds and you do four or five reps like that
each day. It has a similar kind of effect to
like taking ibuprofen. It's a hypoalgesic effect, so it kind
of helps knock pain down, and it's really useful in
the beginning stages when it hurts too much to move
through full range of motion, but you can just have
the person hold, so like that pateeller tendon example, doing
(20:31):
a wall sit. Everybody's probably had some experience with like
wall sit and how brutal they are for your quads,
but they're a great one for isometrically loading your pateller
tendon in those early stages and then usually when people
start to feel better there, then we'll go to like
the ecentrics, and so that's where you're only doing half
of the exercise. It's the part where the muscle fibers
(20:52):
are lengthening. Our muscle fibers are all strongest with eccentric contractions.
So if you imagine that bicep curl example, again, it
would be the down phase of the curl, So like
you might put your arm in the top position, pass
the dumbbell to your hand with the other arm and
then slowly lower it and then when you get all
the way to elbow straight, you take the dumbbell back
with the other arm reset and so you're just or
(21:13):
like the squat, like if you're doing a Pateeller tendon
you would only do the down phase of the squat.
That's the eccentric portion for the quads. So sometimes we
do an exercise like this called a decline squat, or
even a bench like I will sometimes give people an
eccentric bench squat. So what they do is say your
right leg had the Pateeller tenonopathy. You'd stand in front
(21:33):
of a bench. You'd do a single leg squat. You'd
start standing only on your right leg. You'd lift your
left leg off the ground. You'd do a single legg
squat all the way down ice and slow sit on
the bench, put both feet on the ground, stand back
up with two legs. So the concentric part you do
with both legs, and then when you're at the top
you do the eccentric part only on the painful side.
So the research has kind of changed. It's interesting. We
(21:54):
used to always do that where we'd go isometric, eccentric
and then full range of motion. They're just saying that
the isometrics and eccentrics might not matter that much for
a lot of people, and that you can just do heavy,
slow contractions through full, through whatever range of motion that
person can do. So you might be modifying their range emotion,
but you just the key thing with tendons is that
(22:15):
it's heavy and slow, like it has to be. Yeah,
that if it's too light, it just it won't create
the stimulus for them to adapt.
Speaker 1 (22:24):
Yeah, so quite different, a different tempo than you know,
muscle's life, a little bit quicker, but tendons really like
that slow, heavy, yeah work. I love that. So if
we move on to rotator cuffs. So this is the
biggest area for that I see for women, and mainly
because of just the nature of female having breast mass
(22:46):
in the front and nothing in the back, and so
there's not a lot of I see, there's very very,
very few I would say maybe one percent of females
maybe up to three percent that have good scapular mechanics,
which then plays into you know, clicking of the shoulder
and all of the stuff, and then rotator cuff it
kind of goes kind of in the same family. A
(23:08):
lot of the times.
Speaker 2 (23:10):
So do you see that as well, Yeah, for sure,
you know that whole kind of all the biomechanics, the
mechanics of the of the shoulder blade definitely can feed
into people having rotator cuff tenopathy. What happens your rotar
cuff is four muscles and the one that probably ninety
percent of the time develops tenopathy is a muscle called
(23:31):
super spinadas that it runs across the top of the
shoulder and then it goes If you fill the top
of your shoulder, is kind of a bone right at
the top, and that's called your chromine. It's actually part
of your shoulder blade. Right underneath the a chromine is
where the super spinadas tendin runs. So it's it's got
this kind of roof on top of it that protects it.
But the problem is is that there's only one centimeter
(23:54):
of space there, so that tendin is in there and
when you lift overhead to call it impingement syndrome. So
people would tend to experience this pain when they reach
above shoulder level. And for a long time, the theory
was that the ball at your shows a ball and socket.
The ball would sort of ride up and pinch the
super spinatus tendon underneath the a chromia because there's only
(24:16):
that one centimeter of space, and so for a long
time we called it impingement syndrome. It turns out it
actually doesn't fully explain some people that is a major
driving factor the biomechanics, but almost a large percentage of
humans have some impingement on that tendon, and a lot
of people don't develop pain. So it just turns out,
like a lot of things in the body, it's more complex,
(24:37):
and now it's just called subochromial pain syndrome, but it
relates to super spinaas tenopthy rotator cuff teninopathy, and it
follows a very similar kind of treatment plan to the
elbow tendinopathy and the pateillar tenopathy, where you're gradually putting load,
you're gradually strengthening super spinatus and its tendon, and there's
specific therapeutic exercise for that. Just like we were talking about,
(24:58):
this is like you start to realize with each of
these tendons, if you incorporate these specific therapeutic exercises that
strengthen those tendons, you're going to be much less likely
to have these issues. When you get into an exercise
program that is working on the big prime movers and
not as focused on the little muscle groups.
Speaker 1 (25:16):
Yes, one hundred percent. So do you see if we're
if we're looking at okay, somebody's doing they're either prehabbing
or potentially they're there rehabbing. What do you think. I
guess this wouldn't work on the prehub side, but for
the rehab side. What do you think of PRP injections?
Are they helpful? Is it kind of maybe? Maybe not?
Speaker 2 (25:40):
Yeah, I think it used to be for a while.
A couple of years ago I would have said I
would have been more likely to say they're kind of
up in the air, and we don't really have a
lot of great research to know for sure. But I
think PRP especially is coming around more where I see
more evidence supporting it for pain relief with different joint
and connective tissue issues. So I often recommend to people
(26:04):
if they have a stubborn teninopathy and they want to
try something else, to try something like PRP, or if
they don't want to do something invasive yet. There's something
called shockwave therapy. Shockwave therapy is sort of like a
really powerful ultrasound, and there is some research supporting it
for like planar fasciatus resistant tennis elbow, some of the
tendons that are a little more exposed that you can
(26:27):
kind of hit with the shockwave. So that's another intervention
that some people can try. Always in the beginning, the
main thing is trying to modify their behaviors, work on
that load management, and then strengthen. And then if it's
just really a frustrating case and it's lasting a long
time and really interfering with life, then yeah, things like
PRP and shockwave are worth looking at.
Speaker 1 (26:47):
What about BP one fifty seven, I.
Speaker 2 (26:50):
Still just don't see It's funny. Somebody just DM me
yesterday about their peptide company, and I just I'm still
not I'm not one hundred percent. Yeah, even stem cell
see a lot of pushback even from surgeons on stem cells.
So I just don't think there's enough. I think a
lot of that stuff is probably highly placebo driven, and
maybe peptides. I think there's probably a lot of potential peptides.
(27:12):
And I also don't sit around and read that research
a ton, so there could be somebody might say, no,
there's a great study on BP one five to seven.
I just when I wrote the book, we covered it
in there. My co author Glenn was super into peptides
and they're just at that time wasn't really compelling evidence
for peptides yet.
Speaker 1 (27:30):
Yeah, So if we look at the different phases, So
you have three phases in your book, can you talk
about those and what we would do in each phase,
what that would look like.
Speaker 2 (27:41):
Yeah, I think it's an it's a there's different there's
kind of three different phases you can look at whether
you're looking at healing or you're looking at treatment, and
they kind of go together. But you know when you
first have when you first have an injury, people are
going to go through an inflammatory phase right away. So
(28:01):
and this is where you need that inflammation. Like we
sometimes think of inflammation as bad and like systemic inflammation
that's there all the time isn't great. But when you
first have an injury, you need inflammation because your immune
system is coming in and sending macrofages and different cells
and to clean up injured tissue and kind of remodel
the area. So that usually lasts a few days. In
that window, what would be kind of like the acute
(28:22):
pain stage with people. We're doing a lot of things
that are like soft tissue mobilizations, kind of like you
might think of like self massage, so like if you
had plantar fasci edis, it might be where you take
a massage ball and kind of massage the plantar fash
on the bottom of the foot. Some people have seen
that some people will take like a water bottle, like
a plastic water ball that's got frozen water in it,
like can kind of do an ice massage on the
(28:44):
body of foot. Ice is even kind of changing where
there's been some questioning of should we use ice in
the inflammatory phase because there's been some research showing that
it can slow the inflammatory process, which might slow the
healing process. The same with ibuprofen. Like ibuprofen and all
leave these these nonsteroidal anti inflammatory drugs, they slow the
healing process. So we even now try to encourage people
(29:05):
like if you can the pain's not killing you, try
to not take anti inflammatory medication, just let it go
through its normal process. Implement things like gentle soft tissue
mobilization's gentle mobility exercises, Like if you had an ankle sprain,
we'd have people kind of just do like the ankle
alphabet exercises and kind of move their ankle back and forth,
like the just keep it moving because blood flow is
(29:26):
what you need. You need blood flow to come in
there to bring oxygen and nutrients. So that's kind of
the first few days, maybe up to a week, depending
on this ferry of the injury. And then you move
into more of like a fibroblastic type phase where the
body's starting that rebuilding process, and so like that might
be where like if you had a really severe injury,
start forming scar tissue and things like that, and or
(29:49):
you had a muscle strain and the muscle fibers are
healing things like that, or and in that phase in treatment,
we're starting to look at impairments. So does somebody have
a range of motion restriction, do they have a strength impairment,
Do they have like a balance or kind of we
call it motor control, like a motor like an inability
to coordinate and control their body. And so in the
(30:11):
rehab world, and that's what in my book, the three
phases of the program. Phase one is focused on pain alleviation.
Phase two is addressing impairments. So you're looking at range
of motion impairments mobility impairments, So those would be stretches
and mobility exercises. You might be using a tool, like
if it was your shoulder and it hurts for you
to lift your arm to go through four range of
mass on its own, you might use a golf club
(30:31):
or like a broomstick, so your other arm can kind
of help guide that. Or sometimes people have seen wall crawls,
like where you can kind of crawl up the wall
and you're using an external object to sort of take
some stress off of the painful tissues and it allows
you to go. So you're just because like with the shoulder, Okay,
So here's a great example of females. Females are much
more likely to develop frozen shoulder. Yeah, and a lot
of cases that starts from a rotator cuff ten andopathy.
(30:55):
But what happens is people get rotator cuf ten andopathy
and then their initial reaction to the pain is to
hold their arm like it's in a sling and not
move it, and then they develop frozen shoulder. So you
have to keep the mobility going, and this is true
with so almost every condition in the muscle skeletal system.
You want to respect the pain, but you have to
keep the area moving and so something like a rotator
(31:18):
cuf to monopoly will give people range of motion exercises
that don't cause a ton of pain, but just keep
them moving through as much range of motion as they
can tolerate, so they're less likely to develop something like
frozen shoulder. And then the last stage of healing, the
timeframes can vary depending on the tissue that was injured
just because of blood flow. Different tissues have different supplies
(31:40):
of blood flow. But in that phase, kind of the
last remodeling phase, it's focused mostly on string training. You know,
you're trying to just build the muscle scletal system, even
though it's not simple like a card is very mechanical,
and string training has the best evidence for so many
things because it makes all of your tissue stronger. Your
bones get denser, you build muscle mass, your tendons get stronger,
(32:01):
even your ligaments and the discs in your spine become
more resilient with string training. So it's really the best
thing that you're doing at the end of rehab, and
you hope the person will continue with because it's going
to protect them over time.
Speaker 1 (32:15):
Yeah, so if we look at pain specifically. And I
know that you've been on a lot of podcasts and
you've talked about pain. You have a chapter in your
book about pain. This is hard because we know that
there's a pain threshold that's different for everyone. I mean,
I even without an injury. I will have some women
(32:37):
in there that I'll be training and they'll be on
the leg press and they're talking to me the whole time,
and then all of a sudden they're like, I can't
do another one, Hayley. You didn't even slow down, and
you were talking to me unwinded the whole time, but
in their head they were tapped out, like no, no, no,
the pains there like the second they feel anything. So
let's talk about pain and what that looks like from
(33:00):
a mental like psychological component, and then actually how pain is.
Speaker 2 (33:07):
Yeah, pain is so fascinating. It's probably the thing I
geek out on the most. But it's such a personal,
subjective thing, which is what why The treatment of pain,
which is all I do, is very fun and kind
of tricky because it has so many influences from what's
the messages that you're actually getting from your body, Like
we have these little they're called danger receptors. They're the
(33:30):
technical term is a no sceptor. But you have these
little nerve endings all throughout your body that detect danger,
and if they're triggered to a certain level, they'll send
a message to your spinal cord up to your brain
to saying, hey there's danger down here, pay attention.
Speaker 1 (33:43):
MM.
Speaker 2 (33:44):
So you have that side, you have all the messages
coming from your actual physical body, and then you have
all these psychological and emotional factors that go in and
and pain is so interesting because we used to think
pain came from your body, you know, that was the
old model. Like if you're sitting doing leg press and
all of a sudden your quad start burning and then
you have knee pain or it hurts in your quad.
(34:06):
We used to think that was a pain receptor in
that area sending a message to your brain saying, hey,
there's pain here. And that there's been a huge development
probably over the last I mean thirty to fifty years
looking at oh pain is actually you have those receptors,
those danger receptors, but pain actually is sent from your brain.
Your brain has to look at all these different things,
(34:29):
your emotional state, your psychological state, what you believe about
what's going on. You're kind of like like social support,
like how threatened you might fill in the environment you're in.
Does it feel like a dangerous environment? Do you feel
safe there? Past trauma? Nutrition, sleep, Like do you have
inflammation systemic inflammation, like maybe you have a metabologist, or
(34:51):
do you have like hormonal changes that are feeding into
your immune system and your nervous system and how you
perceive things. There's so many elements that go into pain
perception and a person's pain threshold that it can be
really tricky to help people navigate that. And so it's
a it is such an interesting I have so many
(35:14):
cases where, you know, because I'm just talking to people
and asking them about there, they're reporting their pain to me.
And it's so interesting. Sometimes people will tell you ask
them on a zero to ten how much pain I
experienced in like ten out of ten, and they're just
sitting there. If you were ten out of ten, you'd
be like usually sweating, like it's like somebody stabbed you,
like this is a life or death. Like, So it's
interesting what people will perceive from a pain stand. But
(35:39):
we've actually, in some ways in physical therapy tried to
move away from just asking a zero to ten scale.
Sometimes it's just like I would just use mild, moderate severe.
It just because it's so subjective and personal, it can
be challenging trying to figure out if you're only using
pain to navigate things. It can be kind of a
tricky you know it just it makes it tricky. You
almost need other objective kind of things you look at
(36:01):
in the person to determine how you move forward. But
you know, somebody who's exercising and saying that, and is
displaying no symptoms prior to that, and all a sudden
they can't do anything more. I think sometimes the psychological
and emotional side of how something feels is a major driver.
(36:24):
I think a lot of people stop because of mental
factors and not because it's actually their physical body, you
know you It's it's amazing how far people can actually
push themselves if they can get beyond the mental Some
of the best studies in the world on people who
have the highest pain tolerance are endurance athletes. Endurance athletes
like people who run marathons and iron Man races and
(36:46):
these one hundred mile races. They have the ability to
push past those messages they're getting and their brain telling
them to try and stop. And I think not that
you have to go be like that, that we all
need to be like that, but I think it's something
we probably need to keep in the back of our
head when we're training, like, is my body actually injured
(37:07):
and I'm in like really severe danger. Am I experiencing
a dangerous level of pain? Or is this just like
I'm really fatigued and my brain's trying to get me
to quit m.
Speaker 1 (37:18):
That's interesting too, because you also see people identify with
you know, if they've had back pain. I mean, I
had back surgery when I was seventeen. I was a
gymnast too, and I had back surgery at seventeen, and
I could very well now, you know, just be like, well,
(37:38):
I have a bad back. I have a bad back.
I've always had a bad back. Do you see that too,
that you like, somebody really identifies and they're just like, no,
this is what I have and this is who I am.
And so then all it plays into that feeds into
that loop of maybe I have pain, but talk about
So there's been multiple MRIs, but you pull any a
(38:02):
bunch of people off the street and half of them.
You look and think, well, you probably shouldn't even you
should be insignificant pain. But they're you know, they don't
know any different, and they don't even they aren't mentioning it.
But what does that look like? I mean, that's a
whole psychological component too, or what do you think of
(38:22):
those studies?
Speaker 2 (38:23):
Yeah, I mean the first part you said is so true.
The psychological piece is something I spend a lot of
time trying to talk with patients about because some people
have such limiting beliefs about pain, and that one you
mentioned is a huge one. Like I've had an accident
when it's early earlier, so I'm just now I'm going
to have a bad back. Or I got in a
car accident my you know, hurt my neck and it's
just always going to be this way. Or my parent
(38:45):
had a bad head back pain, so I'm just doomed
to have it because they had it. People have these
very limiting beliefs around pain, So I spend a lot
of time trying to push back on those gently with
people and just kind of plant seeds on just helping
them understand pain. I think helping people understand what pain
is and how the pain system works can help them
(39:05):
sort of reframe. It's a big part of like the
treatment of pain is helping people reframe how they think
about pain. And so you know, that component is so huge.
And the mirisa, there's tons of these tons of mirisas
I highlight these all the time. They basically take asymptomatic people.
So these are people without pain, bring them in do
an MRI. They've done these on the shoulder, the knee,
(39:27):
the spine. So and it's almost like half of the
population have things like meniscus tears, discarnations, and disk bulges,
labral terrors in their hip and shoulder. And these are
people without pain. So it's ranges from thirty to like
forty five percent of the population have these things. And
so when people you know, we actually are very apprehensive
(39:50):
to have people get MRIs now in rehab because there's
been studies showing that when people have an MRI and
they see something on it, they will kind of instantly
worry about it, and that worry will negatively impact their
outcomes in rehab. And it's been shown that now we
know almost half the population has these, so there's no
(40:11):
way to prove that that thing you see on an
MRI is the cause of your symptoms, and it doesn't
really change what you do in rehab. Now, if you
had like these really severe symptoms where you're more of
a surgical cannon than an MRI is useful. But I
kind of tell people now, like, don't go get an
MRI if you're not planning to have surgery, because what
we do to treat that is going to revolve around
(40:33):
your symptoms and how you move, your mobility, your strength,
your symptoms. I'm not basing my treatment on that MRI.
It's really on how you function. So people just have
to a big part of the education we work on
people now is separating pain from injury, because most people
have this belief that pain means something's damaged in their body,
and in a lot of cases that's not true. You
(40:55):
can have pain and absolutely no injury. There's a lot
of people who go have MRIs who have severe back
pain and have nothing, no findings. So that's equally as
discouraging actually to a lot of people because they're expecting
to build to blame the symptoms on something. And then
you can have people who have sphere injuries who don't
experience pain. You know, you have lots of these stories
from like situations like with different athletes where they're like
(41:16):
in the heat of the moment in a sport and
break a bone or something and don't even they tear
a tendon, they don't experience any pain. You hear lots
of stories of this from like soldiers in wartime situations
where something really severe happens, they don't experience pain at
the time. And you can think of less severe things too,
like all of us have probably like woken up and
saw a bruise and we don't remember anything ever hurting
or how we got it. So all the time, yeah,
(41:39):
that's an injury. There's injury. The injury happened in your
tissues healing, but you don't recall having pain. So pain
and injury are different things. And I think the main
thing for people to know is that pain does not
always mean that something's damaged in your body, especially when
you're talking about something like teninopathy, which so many of
us are going to have. Like teninopathy is not you
wouldn't really categorize that as an injury. It's more of
(42:00):
a pain condition. It's more of like a sensitivity. It's
not a like you actually damage something.
Speaker 1 (42:06):
Okay, that's a super important part if we move down.
So one other area that I want to talk about
the feet. So the feet, there's a lot going on there,
but also you know, I'm going to lump like ankle
in there as well. This is a commonly weak a
(42:27):
weak spot that I see in women as well, not
only with maybe a tendant opathy or without. But it's
the balance, the proprioception and the balance that starts to
decline as we age as well. And you know, do
you recommend, like when weightlifting, like a minimalist shoe barefoot,
(42:48):
do you prefer a padded shoe? What's your advice on that?
Speaker 2 (42:53):
Yeah, I think at the end of the day, you
have to kind of figure out where your starting point is.
If somebody has never worn a minimalist shoe or done
a lot of training barefoot, I think you just also
have to think of it like you're the rest of
your training. You have to gradually get into it and
give your tissues time to adapt to it. But I
think ultimately I'd love to see people doing most of
their training in a less supportive shoe, you know, something
(43:16):
that's more of a minimalist style. I mean, I grew
up only doing things barefoot, so like I have all
these weird muscles on my feet. I'm sure you do too,
from gymnastics, Like I have weird hyperture feed muscles on
my feet because I was always barefoot and holding my
foot in funky position, especially like in martial arts, I'd
be kicking and you have to hold your like I
just did a lot of foot training. I didn't even
realize I was doing a lot of foot training, but
(43:38):
I think you know if you're someone who's been in
a really supportive shoe. The problem with really supportive shoes
is that they feel great, and they might be useful
for like a really stressful competition, like if you had
to go run a marathon or something. Maybe you use
it in an event, but in the rest of your
training you want. The problem with those types of shoes
is that they support you so much. It's almost like
(44:00):
having a brace on your foot. And we know we
wouldn't eBrace other parts of our body because we know
the body atrophies and deconditions. It's why you don't want
to be in a sling for too long or have
a knee brace on for too long. You're you're not
having to use your neuromuscular system as much, and so
people don't think of that with their shoes because we're
just so conditioned to just, oh, you just wear shoes
(44:21):
and that's what you do. And I think more people
are becoming aware as more of these minimalist shoe companies
are coming out and we're seeing more research showing that
just even wearing a minimalist type shoe or being barefoot
helps to strengthen your foot. And you think about females,
like females are more prone to something called post your
tibilis tendon dysfunction, where their tiblis post your muscle, it's
(44:41):
tendin can basically sort of break down, which leads to
progressive flattening of the arch. So you hear this sometimes
females around kind of menopause timeframe where that tendon related
to hormonal change that the tendon kind of starts to
deteriorate and to generate and their arch gradually flattens. And
so I think there's a place for all humans as
(45:04):
we age, but especially females, to be incorporating movements and
exercises where you are challenging your foot, whether it's barefoot,
or being in a less supportive shoe. But just think
I just have to gradually work into it. It might
not you probably don't. You don't want to just just
(45:24):
jump straight into one of a shoe like that if
you're not used to it, because it will end up
causing probably a lot of arch and foot pain. So
you have to gradually give the tissue time to change.
If you are going to switch over to like say like, okay,
I want to start using minimalistic shoes for most of
my daily activities. Well, you might only be doing fifteen
minutes start at the start, or maybe an hour in
(45:46):
the day, and then you go back to your other
shoe like you're just trying to slowly build up that capacity.
Speaker 1 (45:52):
Yeah, and this is all again, this is all in
your book. So let's move on to your app. Can
we announce that? Can we start talking about that?
Speaker 2 (46:03):
Yeah? Thank you, Yes, I'm so excited about it. I
think it's gonna be The book has been out two years,
and the book has helped a lot of people, you know,
But the feedback I always get when it comes to
exercise and movement, it's helpful to that video, and I
think this is why I like my YouTube channel on
Instagram account are so popular. Is it's okay to have pictures,
But a lot of people just ask me, like could
(46:23):
I get rehab and prehab programs in video format? A
lot of people just want like an exercise library, like
we were talking about these exercises, like imagine that'll be
a part of the apports, like you can go in
and just find exercises for your foot and ankle like
that you could just incorporate to work on mobility and strength,
and so that'll be a big focus of it for me,
is to just create these video based prehab and rehab
(46:45):
programs so that people can start working on these things
before they begin a program. Most of the people will
probably come once they're already in pain and injured. But
a lot of the education for me is like trying
to get people to think about re hab ac sizes
is not just rehab that you can keep doing them
after to reduce the chances that it comes back. So, yeah,
(47:06):
I'm pumped about it.
Speaker 1 (47:07):
That's awesome. And when do you anticipate the app to launch?
Speaker 2 (47:11):
I think it's going to take about right around like
forty five to sixty days, So I'm hoping that two
months max, So maybe maybe sometime in October.
Speaker 1 (47:22):
Okay, well, good keep us posted. In the meantime, I'm
super bummed that our time is almost up. But in
the meantime, I mean this again, show the book for
anyone who's watching. This book is incredible. But as you said,
the app is so nice because I'm not lugging this
to the jam.
Speaker 2 (47:41):
That's the problem.
Speaker 1 (47:42):
But it just I mean, it literally breaks down every
single tendinopathy or issue. And I have used it so
much for just flipping through and saying, okay, well this
breaks it down, tells me exactly what you do in
phase one, phase two, phase three. So I love it.
Where can where can people find you right now if
they're not familiar with you. I did mention your Instagram
(48:04):
but at the first but go ahead and just tell
us where to find you before the app comes out.
Speaker 2 (48:09):
Yes, thank you. I'm at Rehab Science mostly on Instagram
and YouTube, so Instagram is kind of quicker. If people
are on that platform, they know it's kind of quicker.
I have a lot of posts that are just like exercises,
like you could find a planner fasciatus post kind of
flip through carousel style and find exercises for that YouTube,
I do a little bit more. I'm narrating talking through
the exercises, so it's just a little more detail. But
(48:29):
they're both Rehab Science. The book is called Rehab Science.
It's on Amazon and Barnes and Noble. My website is
rehabscience dot com, so people can find me in those places.
And if people want to like DM me on Instagram
and tell me, say hey, I came from the podcast today.
That really helps me have some context. But I try
to answer dms. So happy to help people because sometimes,
like on that platform, it's hard to find a post
(48:51):
that relates to what you're looking for. YouTube is a
little bit easier because I have playlists. You could go
to the hip playlist or the ink on Foot playlist
or the elbow playlist and you can all that can
do We've talked about today. I've covered these all in videos,
and there's exercises you can just start with. And like
I said, the book, the book is like a textbook,
so it's a little bit. That's the annoying part is
carrying it to the gym. But it's a lot of
people use it as a home reference and they just
flip open and it's like you've got three phases. You
(49:13):
have a program, you don't have to go do the
pt save the money ongoing. It's like thirty eight bucks
on Amazon's It's it's like one Copey and you have
a resource that you can treat your whole body with.
Speaker 1 (49:23):
Oh, Tom, it's amazing. And so I'm guessing that the
app is going to be called Rehab Science too. Yes, yep, same, okay, awesome. Well,
I look forward to having you, as we had discussed before,
in something special for my audience. But thank you so
much for what you're putting out in the world. Thank
you for your expertise. And I have to say you
are such a nice guy, and that is so refreshing
(49:46):
in this space. This is it's so refreshed, refreshing in
the in the fitness kind of arena for someone like
me who's seeking out guests. So thank you for your
time today and your expertise, and we look forward to
having your app come out.
Speaker 2 (50:01):
Thank you so much. It was a pleasure to be on.
I hope this helps everyone in your audience. And yeah,
thanks again.
Speaker 1 (50:06):
Thanks for listening everyone. If you enjoyed this episode, please
consider giving us a five star rating and sharing the
body Pod with your friends.
Hi everyone. My name is Haley and this is Laura
and welcome to the Body Pod. Welcome back to another
episode on the Body Pod. Today, I have the privilege
and pleasure of interviewing doctor Tom Walters. Tom is the
(00:22):
founder of rehub Science and dedicates his time to teaching
people about human movement, pain, and how to most effectively
recover from injury. He specializes in the treatment of musculoskeletal
pain and movement disorders, combining kinesiology, education, manual therapy, and
an individually tailored therapeutic exercise to treat orthopedic conditions. He
(00:48):
is a board certified orthopedic physical therapist and strength and
conditioning specialist based in Santa Barbara, California. In addition to
his clinical practice, he also runs one of the largest
world's largest social media accounts dedicated to physical rehab, which
is at rehab Science on Instagram. And he's the author
(01:09):
of my all time favorite book, Rehab Science, that we
will be discussing today. So without further delay, let's jump
into this discussion with doctor Tom Walters. Welcome everyone. I
(01:29):
have doctor Tom Walters with me today and we are
covering If you are watching this, his book rehab science,
which Tom, I'm going to say, this is literally like
my bible. I have used it so many times. I
think I told you I have a client that lives
right by you and we were working through some elbow
(01:50):
tendonopathy and I was so glad to see that I
was doing most of the things in this book. But
I was like, Tom, what do you think about this?
Because these tendonopathies can take for ever. So before we
get into that, let's go ahead. And I wanted to
touch on something that you said at the very first
of your book, which is, in many ways the rehab
(02:12):
model is broken. So can you tell us a little
bit about where you started in your journey as a
physical therapist and then what kind of led you to
kind of doing your own thing.
Speaker 2 (02:23):
Yeah. Well, first off, Haley, thanks for having me on.
This is amazing to get to Thanks for buying the
book and mentioning it. It really was the goal to
create a resource that people could self manage their own
pain issues and injuries because most of physical therapy right
there is a manual therapy. My residency was in manual
therapy where I'm using my hands to work on people,
and that can be good in the beginning for getting
(02:44):
people out of pain. But most of the evidence revolves
around exercise and movement, and those are things people can
do on their own and you can teach them in
a book or some resource like that. So it's been
so fun. It's been out for two years, and it's
been really cool to see people using it in that
way and kind of like solving on their own. So
but yeah, thinking about Yeah, the intro of the book,
we start kind of talking about the rehab model being broken,
(03:08):
and not that the interventions are broken and don't work,
but just the model that it's delivered through. And I
think anybody listening to this who has insurance and goes
in the medical system with insurance recognizes immediately the limitations
and physical therapy is no different. We basically, you know,
physical therapists. I only lasted two years. I've been a
(03:28):
PT for eighteen years. I was only in an insurance
model for two years because of just the limitations placed
on you and how that impacts the quality of care
that you can deliver. I mean, the clinic I was
at was actually better than a lot of other clinics.
We would see people for an hour when they first
came in and then every follow up session was thirty minutes,
so it actually wasn't better. But I had a lot
(03:48):
of friends to people every fifteen minutes. So you're sting
thirty people a day, There's just no way you're really
having enough time to talk with them about their symptoms,
like all the back history that might be related to
their pain. Like we just there's so many factors that
go into pain, in your stress, your sleep, your nutrition,
Like there's no way you can cover that even in
(04:09):
a thirty session. You just can't catch up with people.
So a lot of physical therapists are kind of shifting
out of the insurance model and going towards cash pay
clinics and trying to figure out ways to better serve patients.
But yeah, in terms of my background, I was an
athlete all growing up. I was a martial artist and
a gymnast, so I had a lot of which tied
in really nicely with physical therapy because I was always
(04:29):
barefoot and I just a lot of movement control, you know,
so a lot of body weight training. I'm really thankful
for all those years in martial arts and gymnastics just
because it really did kind of help me learn sort
of like applied kinesiology in a way like canesiologies study
of human movement. And before I knew that term or
what went into kinesiology, I kind of just learned about
(04:53):
my body and how to control my body and how
to strengthen it and all those things. And basically it
had knee surgery in high school. I had a not
a real serious surgery. I just I actually had my kneecap.
I was born with it in two pieces. It's called
a bi partape ptella, and it would hurt me when
I land from jumping like in gymnastics. When I land,
it would hurt on the front of my knee, and
(05:14):
it was a very small little piece, and so I
just had it taken out and then everything was better.
But that was I went to physical therapy after that,
and so that was sort of my first exposure to
using exercise to rehabilitate the body. I was always just
used to performance and how do I get a longer
jump higher, things like that. So then I went I
did an exercise science degree in college, so my bachelor's
(05:36):
degree is an exercise science. I was really most passionate
about exercise physiology exercise science, and then went to in
the US, you do a three year doctorate in physical therapy.
You have to have a bachelor's degree and then you
go do that. And so I did that and mostly
focused in orthopedic physical therapy. So it's all the common
conditions people are used to thinking about, like back pain,
neck pain, you know, tennis, elbow plantar fasciitis, all these
(05:58):
meniscus tears. It's like all the things most of us
are going to experience. So, yeah, that's been kind of
that was kind of where I started and got it.
How I got into PT.
Speaker 1 (06:09):
Okay, well, I love it, and we're so glad that
you now have this. I mean, what is your Instagram?
You have like a million and a half followers or something. Bananas.
But when I started reposting, I mean, I'm so lucky.
I don't even know how I fell upon you, but
however I did, and I started following you and that
I posted something, and the people that I look up
(06:32):
to most in this space that like they are they
all commented on my story and they were like, Tom
is the best. I've been following him for years. Where
have I been? So let's dive in. Let's dive into
the book. So for the reason you wrote this book,
as you kind of just talked about, when we look
(06:54):
at it and and there are a lot of things
outside of maybe a cute and acute injury. Most of
the women that I work with are coming in with
with chronic tendinopathies, So, you know, outside of a skiing
accident or something like that, some of this stuff. And
(07:17):
I have a program called Foundation Happens where we cover
a lot of the uh, you know, the commonly weak
links that nobody wants to target because everyone wants to
use the big prime movers and push pull and do
the deadlifting and do the back squad and they want
to start lifting heavy, which the message is getting out
to women that they need to lift heavy. This is
(07:37):
all great, but do it too soon, too fast, and
every single time there's a tendinopathy. So do you see
this in your practice? And is there a difference between
someone that's maybe twenty or twenty five versus someone that's
like forty five, fifty and beyond.
Speaker 2 (07:58):
Yeah, definitely a difference. And it's of what I see
in my practice too. It's mostly connective tissue disorders teninopathies
like you're talking about, especially for the people who are
active or haven't been a lot very active and then
suddenly get active. It's usually tendinopathies. It's there, your tendons
are Your tendons and ligaments are connective tissues, so we
kind of think of them generally is just connective tissue disorders.
(08:20):
I mean, of course, some people do have muscle strains
and other more severe injuries of something traumatic happens, but
most people who are just kind of exercising and start
to develop pain, it usually is a tendinopathy, and it
does come down a lot. In the physical therapy world,
we talk a lot about load management, So it's managing
how much load you're putting on your system, how intense
(08:42):
that load is. So like like if you imagine you're
going to pick up a strengthening program. If you just
go and you haven't been doing any strengthening forever or
for the last few years, and all of a sudden
you just go gangbusters and you're doing an hour of
string training every day, you're likely to develop tenopathy. Or
if you just pick up running program and just start running,
all you need to build into these things. Your your
(09:04):
muscle skeletal system has this great ability to adapt but
it's kind of slow. Your cardivascar system adapts a lot faster,
you know. So a lot of people get into trouble
where it's like their heart and lungs can handle what
they're doing, but their muscle skelet system takes a little
bit of time to catch up. And so, and it's
for sure different with age. Like you mentioned, I'm forty
three now, my body just takes it takes a little
(09:26):
longer to recover. It's easier for me to tweak something.
If I don't have a good warm up, I should
never warm up. I just jumped into everything. So I
think in your nineteen when you're in your teens and twenties,
you see people will develop teninopathy, but they have to
really be pushing themselves way higher volume. It's just it's
(09:48):
excuse me, harder to trigger those kind of issues in
younger people. As we get older and changes in connective tissue,
changes in hormones, like all these age related changes, you
just see way more tenpathies and they're just way easier
to kind of flare up and get triggered. And I
always tell people the nice thing about tenanopathies is there
(10:08):
I would say they're seriously annoying, but they're not serious,
like they're not It's not like an injury that you
need to worry a whole lot about in most cases,
like you're going to tear something or something's really broken
or damaged. It's just more that they're painful and that
can obviously really limit you in life. So you have
to figure out how to manage them. And a lot
(10:29):
of that is kind of figuring out how do I
manage the load on my system and kind I kind
of take baby steps, kind of kind of break my
exercise down into steps or gradually get into something so
that I don't make those tendons kind of get angry.
Speaker 1 (10:43):
Yes, and so the muscle usually adapts much faster than
the tendons and the ligaments. And I think that at
least from what from my view, this is what happens is,
you know, people are feeling great and they're they're getting
excited and they're motivated. So a lot of women at
this age are coming back from having children, you know,
(11:05):
having jobs. Now they're dealing with aging parents. There's nine
million things, and so they're finally coming around to making
themselves a priority again. And so there is this excitement
and motivation to get back in and start training, and
they're hearing these messages. But I'm always you know, on
my app like slow down, Like if we're in this
(11:27):
for life. Sure, a tendinopathy might not, you know, be
something that is going to completely sidetrack you forever. But
it's a setback. And and as women at this age,
we just if we can avoid setbacks to the best
of our ability, let's avoid those setbacks. So do you
ever look at like if you you see people once
(11:49):
they have the tendinopathy. But is there like a prevention
strategy where like some prehab that you would say, oh,
if people just did this for this elbow tendinopathy or whatnot,
you could probably save a lot of these tendinopathies that
pop up.
Speaker 2 (12:07):
Yeah, for sure, there's a ton you can do. I
think at a base level it is sort of like
the accessory complementary type strengthening exercise. As you mentioned teninopathy.
The best research for preventing and treating teninopathy revolves around
strength training. You know, It's what we call resistance training.
If you're just it's any kind of external force that
your system has to resist. So people tend to think
(12:27):
about as strengthening. It could be body weight. A lot
of it's body weight. Actually sometimes it's banned. Sometimes it's dumbbells,
but that type of exercise has the best evidence. Basically
it if you think about when you strengthen your everyone
thinks about it's obvious. Then your muscles get stronger, But
your muscle's attached to tendons, and a tendons attach your
muscle to a bone. So when you put tension through
(12:48):
a muscle, you also improve the strength and capacity of
the tendon. And that's tendons or what where teninopathy comes from.
So if your tendons are more resilient, they're less likely
to develop teninopathy. So at a base level, from a
prehab standpoint, Yeah, just being kind of intelligent about thinking about, Okay,
(13:09):
what are the tendons that most likely develop teninopathy? What
movements and muscle groups am I going to use in
whatever exercise program I'm starting? And then you know, for
a period of time as you're maybe before you even
start that program or in the early stages when you're
going slow kind of like you're saying, gradually getting into it,
it would be adding in some of those strengthening exercises
(13:31):
that target the tendons that are most likely to develop teninopathy.
So there are things like the achilles tendon, the elbow tendons,
you know, like the tennis elbow and golfer's elbow, the
rotator cuff tendons, the patellar tendon on the front of
your knee, especially if you're doing a lot of jumping
and squatting and things like that. Oh, the glute tendons.
Gluttendons are a big one, especially I see lots of
(13:53):
females with glue tail teninopathy. So on the outside of
the hip. People can imagine there's this kind of bone
on the outside hitm. We used always think of it
as birsitis, but a lot of females, especially around kind
of the menopause stage, end up developing glue till teninopathy. So,
but there are a bunch of there are exercises you
can do, stringthing exercises that target all these tendons and
will make them more resilient. So just adding something like
(14:13):
that at the early stages of your training program, or
even like a few weeks before you start the training
program can do a lot in terms of reducing their
chances that you get a teninopathy and have those setbacks.
Speaker 1 (14:26):
Yes, okay, so let's break this down because everything you
just said was on my list of these common the
common injuries that without fail. And so anytime someone comes
to me and they're looking at my programs, I will
always preface the conversation. I'll say, have you ever done
like a foundation program or a general preparation phase or
(14:49):
or anything, because it's great that again you want to
start lifting, but have you ever you know, what have
you done? And when they tell me their their program
or maybe they haven't done anything, it always is petel attendon,
low back. Uh, I would killes tendon, but like planto fasciitis,
(15:10):
elbow tendinopathies, rotator cuff. So that's pretty much. Do you
find that synonymous in males and females or do you
see more in females or what? Do you think?
Speaker 2 (15:21):
They're really pretty close between the genders. I would say
the one that stand the ones that probably stand out
to me a little bit more in females probably are
like plantofasciitis, the glue tail tendinopathy. The other ones I
wouldn't say in my mind they're pretty even between the
male and female.
Speaker 1 (15:40):
Great and probably Okay, So if we were to go
to elbow tendinopathies, how would you treat that once somebody
has one? And can we do some of those exercises before?
So just give an example of maybe a couple of
exercises of what that looks like.
Speaker 2 (15:56):
Yeah, So, when you're thinking about teninopathy in the elbow,
most people are going to be familiar with the terms
tennis elbow and golfer's elbow. It doesn't mean that you
had had to get it playing those sports. It just
tennis elbow is lateral tendinopathy. It's on the outside of
the elbow, so, and it has to do with our
wrist and finger extensors. So they're the muscles that kind
of lift your wrist up there on the top of
your form. Those attached on the outside of the elbow,
(16:18):
and then on the exact opposite side of your form
are your finger and wrist flexors and those attached on
the inside of the elbow. People will get pain at
those two spots on their elbow. The you say it
hurts on the inside of the elbow or the outside
of their elbow, and so when you think about the
research being most supportive of resistance training if you had
pain in the outside your elbow. Example exercises would be
(16:38):
things like risk curls. We call them wrist curls. So
you're holding a dumbell, your arms kind of supported on
a table so that your hand is hanging off the
edge of the table, and then you're just holding a
dumbbell and you're lifting it up and kind of squeezing
your wrist extensors. Another on, another muscle that attaches out
there is our muscle called our supinator, and it turns
your palm over so that you're Alma's facing up. We
(17:00):
always just say like you're holding a cup of soup,
so your palms facing up. So superinator rotates your form,
but it attaches on the outside of the elbow too,
so we do these banded exercises or even holding the
end of a dumbbell where we have to rotate and
strengthen supinator. So those would be two examples for the
outside of the elbow. The inside the elbow is kind
of just almost the exact opposite. You'd flip your form over,
so you're starting with your palm facing up, arms support
(17:23):
on a table with your wrist hanging off, you hold
the dumbell and you do these kind of wrist curls
where you're lifting up and down. And then on that
inside the elbow, you have a muscle called pronator terries.
That one turns your form over so that your palm
is down. So the same kind of do you use
a band or a dumbbell to rotate and strengthen pronator terries?
Speaker 1 (17:41):
Yeah? Perfect? Okay, And does grip strength play into that?
Can that help that?
Speaker 2 (17:47):
Yeah? Big time. Grip string thing is an amazing one.
There's all kinds of grip tools, like the little squeeze balls,
there's the traditional grip strengthening devices. Yeah, especially for it
can help with both types of elbow to anopthly. But
it's going to be really relevant to gal the inside
on the inside of the elbow because it's you're using
our finger flexers when you squeeze something and those muscles
run up your forum and their tendon attaches on the
(18:08):
inside of the elbow. On the media epicondo, that kind
of bony spot on the inside of your elbow.
Speaker 1 (18:12):
Yeah, oh well, that's the one. That's the one that
I had of my client and I was like, this
has got to go away. It's not going away.
Speaker 2 (18:20):
You're so annoying too, right, Like you said this at
the beginning, ten and off. But these can last a
long time. They can be super resistant. There's even some
research showing that, like Planofasciatus said he came out recently
and said it can last up to a year and
a lot of people. So you know, and you hope
that with rehab you speed that process up. But some people,
I mean, I've had people over the years that it's hard,
right because you have this thing that's annoying, but you
(18:41):
don't want to give up the exercise that you love
so and you wouldn't tell people that be completely sedentary
and give it up. You're always trying to find that
load management concept of like how much volume of exercise
can they tolerate without totally flaring the tendon up. But
you would never tell them to completely rest. That's what
doctors used to tell people. And tendons don't get better
with rest. They will, they will in the acute phases,
they'll kind of calm down, but as soon as you
(19:03):
stress them again, the teninopotly will come back. The only
way to make it permanently go way is to gradual strengthening.
Speaker 1 (19:09):
M Okay, so if we move down to let's say
the petel attendant. So if someone were just coming in,
there's I mean, you're the expert, so you tell me.
I usually use like some isometrics like a wall squat
hold something like that, but then also like ecentric more
(19:34):
eccentric work with a heavier weight and then you know,
lifting the assisting the leg backup or the arm back
up and then going down again like that. Do you
see are those common approaches or do you have any
other ones that you would use?
Speaker 2 (19:48):
Yeah, that kind of framework works really well for a
lot of people with teninopoly where its you start with isometrics.
Isometrics are if people don't know that, it's a where
your muscle's contracting but your joints not moving. So it'd
be like if you imagine you did a bicep curl
need has held it halfway and didn't move. The muscles
still working, the tendon's working, but there's no movement, so
the muscle fibers aren't changing in their length. And isometrics
(20:10):
have kind of cool research showing that they kind of
if you hold an isometric for thirty to forty five
seconds and you do four or five reps like that
each day. It has a similar kind of effect to
like taking ibuprofen. It's a hypoalgesic effect, so it kind
of helps knock pain down, and it's really useful in
the beginning stages when it hurts too much to move
through full range of motion, but you can just have
the person hold, so like that pateeller tendon example, doing
(20:31):
a wall sit. Everybody's probably had some experience with like
wall sit and how brutal they are for your quads,
but they're a great one for isometrically loading your pateller
tendon in those early stages and then usually when people
start to feel better there, then we'll go to like
the ecentrics, and so that's where you're only doing half
of the exercise. It's the part where the muscle fibers
(20:52):
are lengthening. Our muscle fibers are all strongest with eccentric contractions.
So if you imagine that bicep curl example, again, it
would be the down phase of the curl, So like
you might put your arm in the top position, pass
the dumbbell to your hand with the other arm and
then slowly lower it and then when you get all
the way to elbow straight, you take the dumbbell back
with the other arm reset and so you're just or
(21:13):
like the squat, like if you're doing a Pateeller tendon
you would only do the down phase of the squat.
That's the eccentric portion for the quads. So sometimes we
do an exercise like this called a decline squat, or
even a bench like I will sometimes give people an
eccentric bench squat. So what they do is say your
right leg had the Pateeller tenonopathy. You'd stand in front
(21:33):
of a bench. You'd do a single leg squat. You'd
start standing only on your right leg. You'd lift your
left leg off the ground. You'd do a single legg
squat all the way down ice and slow sit on
the bench, put both feet on the ground, stand back
up with two legs. So the concentric part you do
with both legs, and then when you're at the top
you do the eccentric part only on the painful side.
So the research has kind of changed. It's interesting. We
(21:54):
used to always do that where we'd go isometric, eccentric
and then full range of motion. They're just saying that
the isometrics and eccentrics might not matter that much for
a lot of people, and that you can just do heavy,
slow contractions through full, through whatever range of motion that
person can do. So you might be modifying their range emotion,
but you just the key thing with tendons is that
(22:15):
it's heavy and slow, like it has to be. Yeah,
that if it's too light, it just it won't create
the stimulus for them to adapt.
Speaker 1 (22:24):
Yeah, so quite different, a different tempo than you know,
muscle's life, a little bit quicker, but tendons really like
that slow, heavy, yeah work. I love that. So if
we move on to rotator cuffs. So this is the
biggest area for that I see for women, and mainly
because of just the nature of female having breast mass
(22:46):
in the front and nothing in the back, and so
there's not a lot of I see, there's very very,
very few I would say maybe one percent of females
maybe up to three percent that have good scapular mechanics,
which then plays into you know, clicking of the shoulder
and all of the stuff, and then rotator cuff it
kind of goes kind of in the same family. A
(23:08):
lot of the times.
Speaker 2 (23:10):
So do you see that as well, Yeah, for sure,
you know that whole kind of all the biomechanics, the
mechanics of the of the shoulder blade definitely can feed
into people having rotator cuff tenopathy. What happens your rotar
cuff is four muscles and the one that probably ninety
percent of the time develops tenopathy is a muscle called
(23:31):
super spinadas that it runs across the top of the
shoulder and then it goes If you fill the top
of your shoulder, is kind of a bone right at
the top, and that's called your chromine. It's actually part
of your shoulder blade. Right underneath the a chromine is
where the super spinadas tendin runs. So it's it's got
this kind of roof on top of it that protects it.
But the problem is is that there's only one centimeter
(23:54):
of space there, so that tendin is in there and
when you lift overhead to call it impingement syndrome. So
people would tend to experience this pain when they reach
above shoulder level. And for a long time, the theory
was that the ball at your shows a ball and socket.
The ball would sort of ride up and pinch the
super spinatus tendon underneath the a chromia because there's only
(24:16):
that one centimeter of space, and so for a long
time we called it impingement syndrome. It turns out it
actually doesn't fully explain some people that is a major
driving factor the biomechanics, but almost a large percentage of
humans have some impingement on that tendon, and a lot
of people don't develop pain. So it just turns out,
like a lot of things in the body, it's more complex,
(24:37):
and now it's just called subochromial pain syndrome, but it
relates to super spinaas tenopthy rotator cuff teninopathy, and it
follows a very similar kind of treatment plan to the
elbow tendinopathy and the pateillar tenopathy, where you're gradually putting load,
you're gradually strengthening super spinatus and its tendon, and there's
specific therapeutic exercise for that. Just like we were talking about,
(24:58):
this is like you start to realize with each of
these tendons, if you incorporate these specific therapeutic exercises that
strengthen those tendons, you're going to be much less likely
to have these issues. When you get into an exercise
program that is working on the big prime movers and
not as focused on the little muscle groups.
Speaker 1 (25:16):
Yes, one hundred percent. So do you see if we're
if we're looking at okay, somebody's doing they're either prehabbing
or potentially they're there rehabbing. What do you think. I
guess this wouldn't work on the prehub side, but for
the rehab side. What do you think of PRP injections?
Are they helpful? Is it kind of maybe? Maybe not?
Speaker 2 (25:40):
Yeah, I think it used to be for a while.
A couple of years ago I would have said I
would have been more likely to say they're kind of
up in the air, and we don't really have a
lot of great research to know for sure. But I
think PRP especially is coming around more where I see
more evidence supporting it for pain relief with different joint
and connective tissue issues. So I often recommend to people
(26:04):
if they have a stubborn teninopathy and they want to
try something else, to try something like PRP, or if
they don't want to do something invasive yet. There's something
called shockwave therapy. Shockwave therapy is sort of like a
really powerful ultrasound, and there is some research supporting it
for like planar fasciatus resistant tennis elbow, some of the
tendons that are a little more exposed that you can
(26:27):
kind of hit with the shockwave. So that's another intervention
that some people can try. Always in the beginning, the
main thing is trying to modify their behaviors, work on
that load management, and then strengthen. And then if it's
just really a frustrating case and it's lasting a long
time and really interfering with life, then yeah, things like
PRP and shockwave are worth looking at.
Speaker 1 (26:47):
What about BP one fifty seven, I.
Speaker 2 (26:50):
Still just don't see It's funny. Somebody just DM me
yesterday about their peptide company, and I just I'm still
not I'm not one hundred percent. Yeah, even stem cell
see a lot of pushback even from surgeons on stem cells.
So I just don't think there's enough. I think a
lot of that stuff is probably highly placebo driven, and
maybe peptides. I think there's probably a lot of potential peptides.
(27:12):
And I also don't sit around and read that research
a ton, so there could be somebody might say, no,
there's a great study on BP one five to seven.
I just when I wrote the book, we covered it
in there. My co author Glenn was super into peptides
and they're just at that time wasn't really compelling evidence
for peptides yet.
Speaker 1 (27:30):
Yeah, So if we look at the different phases, So
you have three phases in your book, can you talk
about those and what we would do in each phase,
what that would look like.
Speaker 2 (27:41):
Yeah, I think it's an it's a there's different there's
kind of three different phases you can look at whether
you're looking at healing or you're looking at treatment, and
they kind of go together. But you know when you
first have when you first have an injury, people are
going to go through an inflammatory phase right away. So
(28:01):
and this is where you need that inflammation. Like we
sometimes think of inflammation as bad and like systemic inflammation
that's there all the time isn't great. But when you
first have an injury, you need inflammation because your immune
system is coming in and sending macrofages and different cells
and to clean up injured tissue and kind of remodel
the area. So that usually lasts a few days. In
that window, what would be kind of like the acute
(28:22):
pain stage with people. We're doing a lot of things
that are like soft tissue mobilizations, kind of like you
might think of like self massage, so like if you
had plantar fasci edis, it might be where you take
a massage ball and kind of massage the plantar fash
on the bottom of the foot. Some people have seen
that some people will take like a water bottle, like
a plastic water ball that's got frozen water in it,
like can kind of do an ice massage on the
(28:44):
body of foot. Ice is even kind of changing where
there's been some questioning of should we use ice in
the inflammatory phase because there's been some research showing that
it can slow the inflammatory process, which might slow the
healing process. The same with ibuprofen. Like ibuprofen and all
leave these these nonsteroidal anti inflammatory drugs, they slow the
healing process. So we even now try to encourage people
(29:05):
like if you can the pain's not killing you, try
to not take anti inflammatory medication, just let it go
through its normal process. Implement things like gentle soft tissue
mobilization's gentle mobility exercises, Like if you had an ankle sprain,
we'd have people kind of just do like the ankle
alphabet exercises and kind of move their ankle back and forth,
like the just keep it moving because blood flow is
(29:26):
what you need. You need blood flow to come in
there to bring oxygen and nutrients. So that's kind of
the first few days, maybe up to a week, depending
on this ferry of the injury. And then you move
into more of like a fibroblastic type phase where the
body's starting that rebuilding process, and so like that might
be where like if you had a really severe injury,
start forming scar tissue and things like that, and or
(29:49):
you had a muscle strain and the muscle fibers are
healing things like that, or and in that phase in treatment,
we're starting to look at impairments. So does somebody have
a range of motion restriction, do they have a strength impairment,
Do they have like a balance or kind of we
call it motor control, like a motor like an inability
to coordinate and control their body. And so in the
(30:11):
rehab world, and that's what in my book, the three
phases of the program. Phase one is focused on pain alleviation.
Phase two is addressing impairments. So you're looking at range
of motion impairments mobility impairments, So those would be stretches
and mobility exercises. You might be using a tool, like
if it was your shoulder and it hurts for you
to lift your arm to go through four range of
mass on its own, you might use a golf club
(30:31):
or like a broomstick, so your other arm can kind
of help guide that. Or sometimes people have seen wall crawls,
like where you can kind of crawl up the wall
and you're using an external object to sort of take
some stress off of the painful tissues and it allows
you to go. So you're just because like with the shoulder, Okay,
So here's a great example of females. Females are much
more likely to develop frozen shoulder. Yeah, and a lot
of cases that starts from a rotator cuff ten andopathy.
(30:55):
But what happens is people get rotator cuf ten andopathy
and then their initial reaction to the pain is to
hold their arm like it's in a sling and not
move it, and then they develop frozen shoulder. So you
have to keep the mobility going, and this is true
with so almost every condition in the muscle skeletal system.
You want to respect the pain, but you have to
keep the area moving and so something like a rotator
(31:18):
cuf to monopoly will give people range of motion exercises
that don't cause a ton of pain, but just keep
them moving through as much range of motion as they
can tolerate, so they're less likely to develop something like
frozen shoulder. And then the last stage of healing, the
timeframes can vary depending on the tissue that was injured
just because of blood flow. Different tissues have different supplies
(31:40):
of blood flow. But in that phase, kind of the
last remodeling phase, it's focused mostly on string training. You know,
you're trying to just build the muscle scletal system, even
though it's not simple like a card is very mechanical,
and string training has the best evidence for so many
things because it makes all of your tissue stronger. Your
bones get denser, you build muscle mass, your tendons get stronger,
(32:01):
even your ligaments and the discs in your spine become
more resilient with string training. So it's really the best
thing that you're doing at the end of rehab, and
you hope the person will continue with because it's going
to protect them over time.
Speaker 1 (32:15):
Yeah, so if we look at pain specifically. And I
know that you've been on a lot of podcasts and
you've talked about pain. You have a chapter in your
book about pain. This is hard because we know that
there's a pain threshold that's different for everyone. I mean,
I even without an injury. I will have some women
(32:37):
in there that I'll be training and they'll be on
the leg press and they're talking to me the whole time,
and then all of a sudden they're like, I can't
do another one, Hayley. You didn't even slow down, and
you were talking to me unwinded the whole time, but
in their head they were tapped out, like no, no, no,
the pains there like the second they feel anything. So
let's talk about pain and what that looks like from
(33:00):
a mental like psychological component, and then actually how pain is.
Speaker 2 (33:07):
Yeah, pain is so fascinating. It's probably the thing I
geek out on the most. But it's such a personal,
subjective thing, which is what why The treatment of pain,
which is all I do, is very fun and kind
of tricky because it has so many influences from what's
the messages that you're actually getting from your body, Like
we have these little they're called danger receptors. They're the
(33:30):
technical term is a no sceptor. But you have these
little nerve endings all throughout your body that detect danger,
and if they're triggered to a certain level, they'll send
a message to your spinal cord up to your brain
to saying, hey there's danger down here, pay attention.
Speaker 1 (33:43):
MM.
Speaker 2 (33:44):
So you have that side, you have all the messages
coming from your actual physical body, and then you have
all these psychological and emotional factors that go in and
and pain is so interesting because we used to think
pain came from your body, you know, that was the
old model. Like if you're sitting doing leg press and
all of a sudden your quad start burning and then
you have knee pain or it hurts in your quad.
(34:06):
We used to think that was a pain receptor in
that area sending a message to your brain saying, hey,
there's pain here. And that there's been a huge development
probably over the last I mean thirty to fifty years
looking at oh pain is actually you have those receptors,
those danger receptors, but pain actually is sent from your brain.
Your brain has to look at all these different things,
(34:29):
your emotional state, your psychological state, what you believe about
what's going on. You're kind of like like social support,
like how threatened you might fill in the environment you're in.
Does it feel like a dangerous environment? Do you feel
safe there? Past trauma? Nutrition, sleep, Like do you have
inflammation systemic inflammation, like maybe you have a metabologist, or
(34:51):
do you have like hormonal changes that are feeding into
your immune system and your nervous system and how you
perceive things. There's so many elements that go into pain
perception and a person's pain threshold that it can be
really tricky to help people navigate that. And so it's
a it is such an interesting I have so many
(35:14):
cases where, you know, because I'm just talking to people
and asking them about there, they're reporting their pain to me.
And it's so interesting. Sometimes people will tell you ask
them on a zero to ten how much pain I
experienced in like ten out of ten, and they're just
sitting there. If you were ten out of ten, you'd
be like usually sweating, like it's like somebody stabbed you,
like this is a life or death. Like, So it's
interesting what people will perceive from a pain stand. But
(35:39):
we've actually, in some ways in physical therapy tried to
move away from just asking a zero to ten scale.
Sometimes it's just like I would just use mild, moderate severe.
It just because it's so subjective and personal, it can
be challenging trying to figure out if you're only using
pain to navigate things. It can be kind of a
tricky you know it just it makes it tricky. You
almost need other objective kind of things you look at
(36:01):
in the person to determine how you move forward. But
you know, somebody who's exercising and saying that, and is
displaying no symptoms prior to that, and all a sudden
they can't do anything more. I think sometimes the psychological
and emotional side of how something feels is a major driver.
(36:24):
I think a lot of people stop because of mental
factors and not because it's actually their physical body, you
know you It's it's amazing how far people can actually
push themselves if they can get beyond the mental Some
of the best studies in the world on people who
have the highest pain tolerance are endurance athletes. Endurance athletes
like people who run marathons and iron Man races and
(36:46):
these one hundred mile races. They have the ability to
push past those messages they're getting and their brain telling
them to try and stop. And I think not that
you have to go be like that, that we all
need to be like that, but I think it's something
we probably need to keep in the back of our
head when we're training, like, is my body actually injured
(37:07):
and I'm in like really severe danger. Am I experiencing
a dangerous level of pain? Or is this just like
I'm really fatigued and my brain's trying to get me
to quit m.
Speaker 1 (37:18):
That's interesting too, because you also see people identify with
you know, if they've had back pain. I mean, I
had back surgery when I was seventeen. I was a
gymnast too, and I had back surgery at seventeen, and
I could very well now, you know, just be like, well,
(37:38):
I have a bad back. I have a bad back.
I've always had a bad back. Do you see that too,
that you like, somebody really identifies and they're just like, no,
this is what I have and this is who I am.
And so then all it plays into that feeds into
that loop of maybe I have pain, but talk about
So there's been multiple MRIs, but you pull any a
(38:02):
bunch of people off the street and half of them.
You look and think, well, you probably shouldn't even you
should be insignificant pain. But they're you know, they don't
know any different, and they don't even they aren't mentioning it.
But what does that look like? I mean, that's a
whole psychological component too, or what do you think of
(38:22):
those studies?
Speaker 2 (38:23):
Yeah, I mean the first part you said is so true.
The psychological piece is something I spend a lot of
time trying to talk with patients about because some people
have such limiting beliefs about pain, and that one you
mentioned is a huge one. Like I've had an accident
when it's early earlier, so I'm just now I'm going
to have a bad back. Or I got in a
car accident my you know, hurt my neck and it's
just always going to be this way. Or my parent
(38:45):
had a bad head back pain, so I'm just doomed
to have it because they had it. People have these
very limiting beliefs around pain, So I spend a lot
of time trying to push back on those gently with
people and just kind of plant seeds on just helping
them understand pain. I think helping people understand what pain
is and how the pain system works can help them
(39:05):
sort of reframe. It's a big part of like the
treatment of pain is helping people reframe how they think
about pain. And so you know, that component is so huge.
And the mirisa, there's tons of these tons of mirisas
I highlight these all the time. They basically take asymptomatic people.
So these are people without pain, bring them in do
an MRI. They've done these on the shoulder, the knee,
(39:27):
the spine. So and it's almost like half of the
population have things like meniscus tears, discarnations, and disk bulges,
labral terrors in their hip and shoulder. And these are
people without pain. So it's ranges from thirty to like
forty five percent of the population have these things. And
so when people you know, we actually are very apprehensive
(39:50):
to have people get MRIs now in rehab because there's
been studies showing that when people have an MRI and
they see something on it, they will kind of instantly
worry about it, and that worry will negatively impact their
outcomes in rehab. And it's been shown that now we
know almost half the population has these, so there's no
(40:11):
way to prove that that thing you see on an
MRI is the cause of your symptoms, and it doesn't
really change what you do in rehab. Now, if you
had like these really severe symptoms where you're more of
a surgical cannon than an MRI is useful. But I
kind of tell people now, like, don't go get an
MRI if you're not planning to have surgery, because what
we do to treat that is going to revolve around
(40:33):
your symptoms and how you move, your mobility, your strength,
your symptoms. I'm not basing my treatment on that MRI.
It's really on how you function. So people just have
to a big part of the education we work on
people now is separating pain from injury, because most people
have this belief that pain means something's damaged in their body,
and in a lot of cases that's not true. You
(40:55):
can have pain and absolutely no injury. There's a lot
of people who go have MRIs who have severe back
pain and have nothing, no findings. So that's equally as
discouraging actually to a lot of people because they're expecting
to build to blame the symptoms on something. And then
you can have people who have sphere injuries who don't
experience pain. You know, you have lots of these stories
from like situations like with different athletes where they're like
(41:16):
in the heat of the moment in a sport and
break a bone or something and don't even they tear
a tendon, they don't experience any pain. You hear lots
of stories of this from like soldiers in wartime situations
where something really severe happens, they don't experience pain at
the time. And you can think of less severe things too,
like all of us have probably like woken up and
saw a bruise and we don't remember anything ever hurting
or how we got it. So all the time, yeah,
(41:39):
that's an injury. There's injury. The injury happened in your
tissues healing, but you don't recall having pain. So pain
and injury are different things. And I think the main
thing for people to know is that pain does not
always mean that something's damaged in your body, especially when
you're talking about something like teninopathy, which so many of
us are going to have. Like teninopathy is not you
wouldn't really categorize that as an injury. It's more of
(42:00):
a pain condition. It's more of like a sensitivity. It's
not a like you actually damage something.
Speaker 1 (42:06):
Okay, that's a super important part if we move down.
So one other area that I want to talk about
the feet. So the feet, there's a lot going on there,
but also you know, I'm going to lump like ankle
in there as well. This is a commonly weak a
(42:27):
weak spot that I see in women as well, not
only with maybe a tendant opathy or without. But it's
the balance, the proprioception and the balance that starts to
decline as we age as well. And you know, do
you recommend, like when weightlifting, like a minimalist shoe barefoot,
(42:48):
do you prefer a padded shoe? What's your advice on that?
Speaker 2 (42:53):
Yeah, I think at the end of the day, you
have to kind of figure out where your starting point is.
If somebody has never worn a minimalist shoe or done
a lot of training barefoot, I think you just also
have to think of it like you're the rest of
your training. You have to gradually get into it and
give your tissues time to adapt to it. But I
think ultimately I'd love to see people doing most of
their training in a less supportive shoe, you know, something
(43:16):
that's more of a minimalist style. I mean, I grew
up only doing things barefoot, so like I have all
these weird muscles on my feet. I'm sure you do too,
from gymnastics, Like I have weird hyperture feed muscles on
my feet because I was always barefoot and holding my
foot in funky position, especially like in martial arts, I'd
be kicking and you have to hold your like I
just did a lot of foot training. I didn't even
realize I was doing a lot of foot training, but
(43:38):
I think you know if you're someone who's been in
a really supportive shoe. The problem with really supportive shoes
is that they feel great, and they might be useful
for like a really stressful competition, like if you had
to go run a marathon or something. Maybe you use
it in an event, but in the rest of your
training you want. The problem with those types of shoes
is that they support you so much. It's almost like
(44:00):
having a brace on your foot. And we know we
wouldn't eBrace other parts of our body because we know
the body atrophies and deconditions. It's why you don't want
to be in a sling for too long or have
a knee brace on for too long. You're you're not
having to use your neuromuscular system as much, and so
people don't think of that with their shoes because we're
just so conditioned to just, oh, you just wear shoes
(44:21):
and that's what you do. And I think more people
are becoming aware as more of these minimalist shoe companies
are coming out and we're seeing more research showing that
just even wearing a minimalist type shoe or being barefoot
helps to strengthen your foot. And you think about females,
like females are more prone to something called post your
tibilis tendon dysfunction, where their tiblis post your muscle, it's
(44:41):
tendin can basically sort of break down, which leads to
progressive flattening of the arch. So you hear this sometimes
females around kind of menopause timeframe where that tendon related
to hormonal change that the tendon kind of starts to
deteriorate and to generate and their arch gradually flattens. And
so I think there's a place for all humans as
(45:04):
we age, but especially females, to be incorporating movements and
exercises where you are challenging your foot, whether it's barefoot,
or being in a less supportive shoe. But just think
I just have to gradually work into it. It might
not you probably don't. You don't want to just just
(45:24):
jump straight into one of a shoe like that if
you're not used to it, because it will end up
causing probably a lot of arch and foot pain. So
you have to gradually give the tissue time to change.
If you are going to switch over to like say like, okay,
I want to start using minimalistic shoes for most of
my daily activities. Well, you might only be doing fifteen
minutes start at the start, or maybe an hour in
(45:46):
the day, and then you go back to your other
shoe like you're just trying to slowly build up that capacity.
Speaker 1 (45:52):
Yeah, and this is all again, this is all in
your book. So let's move on to your app. Can
we announce that? Can we start talking about that?
Speaker 2 (46:03):
Yeah? Thank you, Yes, I'm so excited about it. I
think it's gonna be The book has been out two years,
and the book has helped a lot of people, you know,
But the feedback I always get when it comes to
exercise and movement, it's helpful to that video, and I
think this is why I like my YouTube channel on
Instagram account are so popular. Is it's okay to have pictures,
But a lot of people just ask me, like could
(46:23):
I get rehab and prehab programs in video format? A
lot of people just want like an exercise library, like
we were talking about these exercises, like imagine that'll be
a part of the apports, like you can go in
and just find exercises for your foot and ankle like
that you could just incorporate to work on mobility and strength,
and so that'll be a big focus of it for me,
is to just create these video based prehab and rehab
(46:45):
programs so that people can start working on these things
before they begin a program. Most of the people will
probably come once they're already in pain and injured. But
a lot of the education for me is like trying
to get people to think about re hab ac sizes
is not just rehab that you can keep doing them
after to reduce the chances that it comes back. So, yeah,
(47:06):
I'm pumped about it.
Speaker 1 (47:07):
That's awesome. And when do you anticipate the app to launch?
Speaker 2 (47:11):
I think it's going to take about right around like
forty five to sixty days, So I'm hoping that two
months max, So maybe maybe sometime in October.
Speaker 1 (47:22):
Okay, well, good keep us posted. In the meantime, I'm
super bummed that our time is almost up. But in
the meantime, I mean this again, show the book for
anyone who's watching. This book is incredible. But as you said,
the app is so nice because I'm not lugging this
to the jam.
Speaker 2 (47:41):
That's the problem.
Speaker 1 (47:42):
But it just I mean, it literally breaks down every
single tendinopathy or issue. And I have used it so
much for just flipping through and saying, okay, well this
breaks it down, tells me exactly what you do in
phase one, phase two, phase three. So I love it.
Where can where can people find you right now if
they're not familiar with you. I did mention your Instagram
(48:04):
but at the first but go ahead and just tell
us where to find you before the app comes out.
Speaker 2 (48:09):
Yes, thank you. I'm at Rehab Science mostly on Instagram
and YouTube, so Instagram is kind of quicker. If people
are on that platform, they know it's kind of quicker.
I have a lot of posts that are just like exercises,
like you could find a planner fasciatus post kind of
flip through carousel style and find exercises for that YouTube,
I do a little bit more. I'm narrating talking through
the exercises, so it's just a little more detail. But
(48:29):
they're both Rehab Science. The book is called Rehab Science.
It's on Amazon and Barnes and Noble. My website is
rehabscience dot com, so people can find me in those places.
And if people want to like DM me on Instagram
and tell me, say hey, I came from the podcast today.
That really helps me have some context. But I try
to answer dms. So happy to help people because sometimes,
like on that platform, it's hard to find a post
(48:51):
that relates to what you're looking for. YouTube is a
little bit easier because I have playlists. You could go
to the hip playlist or the ink on Foot playlist
or the elbow playlist and you can all that can
do We've talked about today. I've covered these all in videos,
and there's exercises you can just start with. And like
I said, the book, the book is like a textbook,
so it's a little bit. That's the annoying part is
carrying it to the gym. But it's a lot of
people use it as a home reference and they just
flip open and it's like you've got three phases. You
(49:13):
have a program, you don't have to go do the
pt save the money ongoing. It's like thirty eight bucks
on Amazon's It's it's like one Copey and you have
a resource that you can treat your whole body with.
Speaker 1 (49:23):
Oh, Tom, it's amazing. And so I'm guessing that the
app is going to be called Rehab Science too. Yes, yep, same, okay, awesome. Well,
I look forward to having you, as we had discussed before,
in something special for my audience. But thank you so
much for what you're putting out in the world. Thank
you for your expertise. And I have to say you
are such a nice guy, and that is so refreshing
(49:46):
in this space. This is it's so refreshed, refreshing in
the in the fitness kind of arena for someone like
me who's seeking out guests. So thank you for your
time today and your expertise, and we look forward to
having your app come out.
Speaker 2 (50:01):
Thank you so much. It was a pleasure to be on.
I hope this helps everyone in your audience. And yeah,
thanks again.
Speaker 1 (50:06):
Thanks for listening everyone. If you enjoyed this episode, please
consider giving us a five star rating and sharing the
body Pod with your friends.
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