April 4, 2023 • 54 mins
Muscle inhibition is common after injury and surgery, and something that we always try to minimize.
Is this episode, I’m joined by Russ Paine. We talk about why muscle inhibition occurs, what we can do to prevent this, and how to tackle it down the road for people with prolonged issues.
If you want to get started with the mTrigger biofeedback device, don’t forget to head to https://mikereinold.com/mtrigger/ and use coupon code REINOLD for 10% off.
Full show notes: https://mikereinold.com/muscle-inhibition-and-biofeedback-with-russ-paine
Want to learn more from me? I have a variety of online courses on my website!
Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.
_____
Want to learn more? Check out my blog, podcasts, and online courses
Follow me: Instagram | Twitter | Facebook | Youtube
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
On this episode of the sportphysical therapy podcast, I am
joined by Russ pain.
Rusted the director of sportsmedicine rehabilitation at UT
physicians in Houston, Texas.
And this episode, we're going totalk about muscle inhibition,
why it happens, why it's socommon after surgery and some
things that you can do bothacutely to prevent it as well as
treated when you have it downthe road.
(00:21):
We're also going to talk aboutbiofeedback in the use of this
in these patients.
Mike (00:37):
Hey, Russ.
How's it going?
Welcome to the podcast.
Russ (00:39):
Thank you.
Doing good.
Mike (00:41):
Awesome.
Well, always good to have alongtime friend here.
Um, for those that don't know,uh, Russ, you've done so much
for our profession, the sportsphysical therapy for profession
over the years between yourpublications, all the meetings
that you've spoken at over theyears, you know, dozens per
year, probably over your, yourextremely long career.
Um, current Hall of Famer forthe Sports Academy, which is
(01:04):
impressive.
Very, very, you know, few peopleget inducted in the Hall of
Fame.
Um, you know, before we getgoing into this podcast topic, I
want to hear a little bit aboutyour journey.
Right?
I want you to express a littlebit of that so you can share
that because I, I, I think someof the young professionals.
They, they want to hear like,how does somebody like yourself,
how do you get from a new gradto the Hall of Fame of the
(01:26):
sports academy?
So, you know, not to startcompletely open-ended, but man,
I'd love to hear a little bitabout your journey,
Russ (01:33):
Sure, no problem.
Well, It's a simple formula, butnot so easy to, uh, institute
that, you know, that's why Itell, you know, I have lunch
sometimes with, you know, PTsthat want to do what I do.
You know, they come into theclinic and they see all the, the
m o B guys, B a and the NFLs.
How did you, how do you, how doyou get all those guys?
I said, well, you first thing Idid my first three years outta
(01:57):
PT school, I moved my family tofour different cities.
you know, I think positioningyourself, uh, and that's one of
my questions at the end with youis how do you
Mike (02:09):
Nice
Russ (02:10):
successful is position yourself so that luck can find
you
Mike (02:14):
Yeah.
Right.
Russ (02:16):
so I'm actually moved to my, my big move was moving from
Houston to Lake Charles, where Iworked with a real famous
orthopedic surgeon named DavidDure.
and so I po I didn't really knowhow big a name he was.
I just knew it was a privatepractice opportunity for me to
start, uh, you know, two and ahalf years outta school.
And so, um, I did that and I hadkinda like a five year plan and
(02:38):
he helped me tremendously.
So I think getting, if youreally wanna be involved in
sports pt, I still believe thatit's a team concept and uh, you
know, things are changed alittle bit cuz we're a doctorate
so of, of physical therapy.
So you have a little moreautonomy.
But it's a team effort when you,when you do, uh, sports,
physical therapy.
(02:58):
So he opened me doors for me.
I went to all the nationalmeetings.
I went to the arthroscopy, theacademy, the A O S S M, and then
I got involved and, and listenedto one of our great or tours of
all time Bob Manje and listenedto him and I said, if Bob can do
it, I can do it.
no, I'm just kidding.
(03:18):
Bob was a big groundbreaker andhe's sort of a mentor for.
And so then I started publishingbecause Dr.
Dres demanded that I proved whatI was doing in physical therapy.
So he really opened, and always,even in PT school, I, I worked
in research.
I just had an interest in, infinding out why.
And so that helped me.
(03:38):
Um, and through that, his, uh,his, uh, guidance.
I became integrated nationallywith Kevin, Kevin Will, and Bob
and, and Mike Boyd.
And you and, and a lot ofdifferent people.
So then I moved to Houston andum, worked under back in a
private practice, and then I gotan opportunity to join a bigger
(04:02):
group.
And at that point in time, itwas a Hill South Days and we,
um, I was in charge of this big,you know, 10,000 square foot
clinic and we hosted the, orsponsored the Houston Rockets.
So I became the physicaltherapist for the Houston
Rockets.
It was me, Keith Jones, AnthonyFone, three guys.
(04:22):
And then obviously Dr.
Lowe and Bruce Mosley were theteam physicians.
So I was running my practice.
I was doing the rockets.
I went to every home game and Itraveled with them a little bit
and I was lecturing at 25meetings a year publishing, and
then I had my own educational.
Uh, meeting that me and Kevinand Bob did three meetings a
year called r r Enterprises.
(04:43):
So I worked, you know, like Isaid, it's basically you do
things that other people are notwilling to do.
So I transitioned from that anddeveloped, I've been in Houston
since 1991 and I got involved intreating pro athletes.
A lot of it had to do with thatrocket's, uh, exposure.
Uh, then I started working on PJTour players, and I got to work
(05:05):
with the Astros.
I went to nasa and I was thereprobably about 10 years.
Once a month I'd go work on the,the, um, astronaut.
So some of it is, is, you know,skill level and, but most of it
is, is just doing things thatother people aren't willing to
do.
Mike (05:23):
Yeah.
Yeah.
And you know what, I thinknowadays too, there's, I hear a
lot from our PT students andsome young professionals that
are getting out there.
They're always, they're, youknow, they're worried about
work-life balance, which, which,you know, that's, that's a good
objective to have.
But they're, they, they fear,they fear like grinding in the
clinic sometimes.
And, and I think we.
(05:44):
Agree that that's not the bestway to do it, but people like
yourself, myself, the KevinWill, everybody that you, you
mentioned, I mean, we've alldone it at some point, and I, I,
I think the, the amount oflearning that you have in a high
volume clinic with the sportsmedicine doctors right upstairs,
for example, or across the hall,the amount of collaboration, the
amount of work that you get donein a short period of time is
(06:06):
just, uh, astronomical for howquickly your brain can, can
absorb new information.
It's almost like your experiencelevels.
Doubled or tripled in the sameamount of time that you can do,
and everybody always fears that.
Right.
So, you know, I, it was good tohear, you know, you know that,
that concept, you know, grindingin the clinic, these big
orthopedic clinics where it'sokay to be high volume
sometimes, right?
Russ (06:27):
Right.
Yeah.
I mean, there's absolutely noway that you can be independent
out in a freestanding clinic andlearn as much as if you're
involved with an orthopedic SURsurgeon on a daily basis.
So, I mean, uh, you know, Ithink you can be a great sports
PT in those settings, noquestion.
But you need some interactionwith the guys that look inside
(06:49):
the.
Mike (06:50):
right.
Russ (06:50):
Everything they do is looking through the arthroscope
and fixing things inside thejoint, and we look outside the
box.
And so we just kind of puttingthose two brains together makes
I think the best care for forpatients.
Mike (07:03):
Yeah, and, and the opportunities you get, I think
are also greater, right?
You can participate in grandrounds, you can go through the
educational sessions with thedocs, but then you get involved
in all their big projects,right?
Because.
The, the surgeons have biggerbudgets for these things.
They have bigger, you know,grants and research foundations.
They can get this, this, theseed money to do things like big
(07:24):
research projects that, that wewouldn't be able to do on our
own.
You know, and I would say that'sthe one thing that Lenny and I
talk about all the time, likeowning our own private practice
now, is we miss thecollaboration with doctors every
day.
Right.
And, and that's something that Ithink sometimes people take for
granted is how valuable thatcan.
Russ (07:42):
Plus, I mean, if, if you're in private practice or in
a free-standing clinic, it's agreat marketing tool for you
just to go and see patients witha physician.
And you know, you look atimages, you look at MRIs and
even radiologists.
Don't interpret the MRIs as wellas a sports medicine orthopedic
surgeon.
And you can't really learn thaton your own.
(08:04):
So, you know, just learning, youknow, and how they treat people.
And Dr.
Lowe and I have been doing ourTuesday morning clinic forever.
Which we stole from, you know,Kevin Wilkin, Dr.
Andrews who St.
Stoler from, you know, JackHouston, who started it.
And that's been, that's grown tobe a huge thing that Lane Bailey
and Jackie in our clinic havetaken it to another level.
(08:25):
So we have a huge Tuesdaymorning from seven till noon.
We, you know, evaluate all ofour a ACL patients.
He does 400 ACLS a year, soit's.
A big population, but it's fun.
It's a lot of fun.
And, and then we have all theresidents and the fellows and
all the key sports PTs in our,in our city get to come and
interact with Dr.
Lowe and communicate with him.
(08:45):
So it's, it's great care for thepatients.
Mike (08:47):
And, and just again, the massive volume of what you see
just helps you learn so, So muchfaster than you can if you're
just in an independent privatepractice.
Or even there's some PTs nowthat just wanna go right into
cash base, which is, you know,one-on-one, you might have five
patients one day, right?
And you, you just saw fivepatients before 8:00 AM right?
So it's, it's, you know, therethere's pros and cons that I
(09:08):
just, I tell people, look, the,the educational experience in
those environments are, are nextto nothing.
So don't, don't, don't, don'tforget that.
Right.
Don't, don't underappreciateThat, I guess is how I would
phrase it.
Russ (09:21):
Yeah, it is sort of like we cheat a little bit because we
see it every day and then welook back and we, you know, one
of your other questions comingup is, what, what have I, you
know, what am I evolving?
And, and I was talking to my PTtoday about it and I'm like, We
evolve every week and we don'tknow it,
Mike (09:39):
Yeah.
Russ (09:40):
we're, we're, we're evolving because Dr.
Lowe's techniques evolve and wechange the way we do things and
we're doing this stuff, and thenwe get a PD that comes at PT
that comes in, or a patientthat's been seen in another
place and say, why aren't theydoing this?
And it's because we do it everyday and it's just so natural for
us.
And nothing against the otheroutlying PTs, but they may not
see, but maybe 10 acls a year.
Mike (10:01):
Exactly right.
Right.
You have to be careful, likeit's people like yourselves that
have so much volume that youbecome the go-to resources for
that because you're, you know,it's, you can't surprise you
anymore.
Right.
We can't stump rust pain.
Right.
You've seen nearly
Russ (10:16):
Oh, we can,
Mike (10:17):
be you know what I mean?
Like.
Russ (10:20):
we're like the principal's office, you know, doctor Las
said, hi, dear.
I go See Rise.
He is the wizard.
But it may hurt you a littlebit, you know.
Mike (10:29):
Exactly right.
He may not say what you want tohear, but you know, you might
not be ready to run.
But that, that's awesome.
Um, well, yeah, I, I love thejourney.
I mean, obviously I've known youfor a really long time.
I've been fortunate to meet youthrough, through my mentor
Kevin, and we spent a lot oftime together at meetings.
So, uh, it's always good to hearthat, and I think that's always
good for young professionals tokind of hear about that journey
(10:49):
and, and, and what it takes to,to, you know, to get yourself to
that next level.
So I appreciate you.
Um, I, one of the things that Ithink, again, you bring a wealth
of information to is just howmany postoperative patients
you've worked with.
Right.
And that's, to me, one of thosebenefits of working with the
physicians again, is you see somany postoperative patients.
Right.
So what, what would you say inyour practice right now, what's
(11:11):
your percentage of post-opversus just the non-operative
pain type patient you have?
Russ (11:16):
I would say, um, you know, some of our baseball guys are
non-op.
you know, some of'em come in,you
Mike (11:23):
thank God.
Russ (11:24):
post-season to get ready for next season.
We're getting more and more ofthat.
You know, people have actuallyseen me in high school and had a
great result when they had alittle laberal, you know, tear
or something, and then they comeback now with their
professionals like, Hey, I wantsome more of that juice, you
know?
Mike (11:41):
right?
Russ (11:42):
But I would, I would say it's probably 50 50, something
like that.
Mike (11:46):
That's that's huge.
Russ (11:47):
Yeah, that's, that's, we see a lot of post-op and like I
say, we see a lot of the post-oppatients.
That are having trouble, youknow, that are, that have loss
emotion or they, you know,they're having swelling or they
have no quad and you know, andsome of the things we do just
work, you know, and the, thebasic fundamentals that I have
never gotten rid of and it'sjust crazy.
(12:08):
I look at my other pt, we go, Ican't believe you know this or
that, or whatever, but it'sjust, you have to get the basic
foundation of rehab principles.
One thing I want to say iscongratulations to you by the
way.
Mike (12:21):
Uh oh.
Russ (12:22):
taking on the helm of, of presidency.
And I love sports, physicaltherapy and I love our
profession.
And, you know, congrats to youand, and thanks for lead taking
the flag,
Mike (12:33):
I appreciate.
Well, I'm just, I'm, I'm givingback just like you guys did.
That's, that's how I'm, I'm,this is, it's my time.
It's my time.
Right.
And I, I'm already lookingforward to passing the baton
again.
Russ (12:45):
things getting all a sudden.
Huh?
Mike (12:47):
that baton is hot, but.
Russ (12:49):
The four by one a hundred, not the, you know, mile relay.
Mike (12:53):
Exactly.
So, um, well, let's talk aboutthat a little bit here again,
because again, I think one ofthe benefits of you is, you
know, you see so manypostoperative people, you see
those complicated patients,right?
I, one of the most complicatedthings that all the PTs want to
ask questions about to me ismuscle inhibition.
Right is they get stumped by itsometimes.
And, and it's, it's, it'samazing how common muscle
(13:16):
inhibition is after a surgery.
Right.
Um, let's start with that alittle bit and, and talk about
just muscle inhibition ingeneral and like why, why do you
think that occurs?
Why do you think that's socommon?
Russ (13:26):
Well, I mean, we can, you know, get, get a little dry here
for a minute and quote someliterature, you know, but I'll,
I'll try to make it simple.
But, uh, if you look atimmobilization, that's probably
the number one cause of muscleinhibition.
So there's been a couple ofstudies, one where they took
normal subjects.
And just locked them in fullextension for three weeks.
(13:49):
And then they had a second groupwhere they had a hinge brace and
they didn't do any exercise oranything.
And so the group that was lockedin full extension had, uh, 50%
loss in strength in three weeks.
Uh, the range of motion grouphad none basically, and they had
40% decrease in their emg, theimmobilization.
Mike (14:12):
Wow.
Russ (14:12):
you have four times greater strength loss in
atrophy.
So you had 50% strength loss andonly 11% atrophy.
So it's not like the muscle sizeis a factor.
It's a neurological inhibitionwhen your knees full, extension,
the muscles short.
So that's one factor.
The other factor is swelling andpain.
Obviously, we know that if youinject 30 ccs of saline into a
(14:36):
perfectly normal knee, your quadmg goes down 50.
Mike (14:41):
Yeah.
That's
Russ (14:41):
and that's a spinal cord reflex inhibition of the femoral
nerve, the Hoffman reflex, youknow, so that's number two.
And three is pain and swelling.
And then another thing thatcaused you to have inhibition is
unloading.
So if you have to gonon-weightbearing, you're gonna
lose 20% strength over a threeweek period, just from just not
(15:03):
putting your foot on the ground.
So those are all things thatoccur, and it occurs worse in
some than others, and I can'ttell you why that is.
So I don't, I don't, you know, Idon't, I, that those are the
factors that cause you to havemuscle inhibition
Mike (15:17):
Yeah.
So D, does it blow your mindstill to this day that we still
have some physicians that waittwo weeks to get people into to
therapy after they have surgery?
Russ (15:27):
Yeah, we don't see that obviously, but, um, some people
are worried about theirparticular procedure and they
immobilize them.
We don't hardly immobilize.
I can't think of anybody weimmobilize except maybe a, you
know, a dislocated knee with a MC L.
But even while though weimmobilize them, we allow them
to move their knee right away,zero to 30.
(15:49):
So there's, there's nothingunless you have a fracture that
we immobilize that's a A C L M CL or ligamentous type injury.
So we've learned that, you know,not only the, the atrophy, but
obviously articular cartilage,it's, it's not good for
articular cartilage either.
So, yeah.
Mike (16:06):
that, that's one of the things that Lenny and I didn't
appreciate when we, again movedfrom a setting like yourselves
where we're with a group ofreally amazing physicians to
being in the community and nowwe see people from every
surgeon, dozens of differentsurgeons all over the region,
um, how different everybody is,and we.
(16:27):
Every day.
The people that wait two weeksto start therapy always are
worse for months.
Right.
Like two, three months.
It seems like once you getbehind for two weeks, it's hard.
Right.
Russ (16:37):
Yeah.
I mean that's one of the factorsof prevention, which you'll talk
about next, is you gotta turnthe muscle on a S A P or you
start cascading down that, youknow, catabolic pathway.
You know, the anabolic is, iswhat we want and, and I know we
can't use anabolic steroids, butit seems like a perfect time to
use it, you know, and nobodywill do it.
Take on that study you.
Mike (16:57):
Exactly right.
Maybe
Russ (16:58):
I think one of the reasons that, uh, you know, physicians
are maybe hesitant is that theydon't have a Mike Reinhold or
you know, a go-to PT in everylocation where they are.
So they're afraid to movepatients, which I think is the
wrong thing.
But I think that'spsychologically maybe what
happens sometimes.
Mike (17:18):
Right.
Yeah.
And that's, I think that's afair assessment.
That, that makes sense.
You know, and, and I see thatthere's a lot of physicians I
know around us in the Bostonarea for some reason.
I don't know why the, thesurgeons have shared this Excel
sheet of every PT clinic, likein the world it seems like.
And they all give it to thepatients.
They're like, Hey, here you go.
Go to therapy.
And there's literally 80 pt.
(17:39):
It's like they just went to theyellow pages, right?
Which doesn't exist anymore.
It's so crazy that they do itthat way versus trying to have
some regional clinics that, youknow what, I really trust these
people.
I really trust this, this guy orgirl.
Right.
And you know, it, it'sdisappointing to see, but um,
you know, maybe, maybe one day,but,
Russ (17:57):
I think the other thing is that as a pt, if you see general
orthopedics and you get an A CL, the last thing you wanna do
is hurt someone.
So what do you do?
You err on the conservative sideand, and even though the
protocols there, you're afraidto move them, you know?
And in most cases, with mostsurgeries, Patient, I mean, the
(18:18):
physician finishes theoperation.
They take'em through a fullrange of motion and make sure
everything's good.
There's almost no reason not tomove the knee, you know,
passively to 90 degrees on most,most things.
Mike (18:29):
Right.
Yeah, yeah, exactly.
Especially passively, right?
I mean, there's like, yeah, I, Icompletely agree.
So we talked aboutimmobilization, we talked about
limited weightbearing, we talkedabout obviously pain, swelling,
those types of things.
Um, alright, what do we do?
How do we prevent this then?
So if you're a pt, you'reworking with postoperative
patients, what's, what's likethe bucket of things you do to,
to minimize or even prevent thisinhibition as much as we can.
Russ (18:53):
So the first thing that we do is someone's swollen and they
have an, if your knee is, you'vegot, you know, 90 ccs of fluid
in your knee, you're gonna havetrouble.
So we aspirate.
I mean, I don't, but Dr.
Lowe is very aggressive withaspirations.
I mean, if you got 30, 40 ccs offluid, the he'll say you're
allergi to needles, you know?
Mike (19:16):
Wow.
Russ (19:17):
uh, we that.
Very, very helpful.
And when I worked with Dres, hewas too.
I, I worked with a lot of topphysicians, uh, in Texas and,
and some of them do not like toaspirate.
They will just not aspirate nomatter what.
But luckily that's one thingthat we have that, that I think
is great in prevention of thecascade.
(19:37):
You, I don't think we figuredout how to prevent atrophy.
It's just, you know, it's there,but we can prevent the cascade.
Mike (19:43):
Right.
Right.
And, and and more importantlythough, like again, just like,
just like starting PT two weekslate, like the longer you let
that swelling linger, right?
The longer you immobilize it,the more and more you're gonna
get behind, right?
I think, I don't think peoplerealize that that effect is
almost cumulative to a nature.
Russ (20:01):
Yeah.
So turning on the quad is themost important thing.
It does so many things if youcan make a muscle, you know, so
that's, you know, that's.
Getting into ball feedback.
I'm a big ball feedback guy, youknow, so, uh, when the patients
can see their activity, it just,it just makes sense.
And we'll go over some, youknow, technical reasons why, but
when you turn on your quad andyou can, you know, force your
(20:24):
knee straight, you, you do a,like three things.
You turn on your quad, you helpforce active extension and you
mobilize the patella, you know,so turning on the quad is
extremely important.
And the worst place to turn onthe quad is with an in full.
Mike (20:39):
Right.
Russ (20:40):
But that's what we all do.
We put'em in full extension andwe put a pillow on or pad
underneath the back of theirknee and said, tighten your
muscle up.
I'm like, man, I'm crying.
I I can't do it.
You know, it's not working welltry harder.
You
Mike (20:52):
right.
It's,
Russ (20:53):
if, if you've got an ACL l yeah.
If you've got an A C L, that's apost-op and they can bend their
knee and maybe they're notbending all the way to nine of
us, sit'em over the edge of the.
Mike (21:02):
right.
Russ (21:03):
Send'em over the edge of the table if they can get to 60
degrees and they just have'em doan active knee extension.
So that's so much easier.
And we use the bottle feedbackwith that.
And it, it's, it's really hugeto, and then the other thing you
can do is put them in a 90 90position like we do with the
rotator cuff and just lift theirleg up in full extension like
(21:23):
you're doing a hamstringstretch.
And I'll have them try to lifttheir heel off of my hand and
that'll initiate the quad and agravity eliminated like we do
with rotator cuff.
You know, we start in thatgravity eliminated position.
So those are a couple of thingsyou can do.
And the other thing isweightbearing.
Mike (21:41):
Right,
Russ (21:42):
Weightbearing with a normal gate.
I don't let them get offcrutches until they can walk
without a limp,
Mike (21:47):
right.
That's huge.
Russ (21:49):
you know?
So why?
Why do people walk with the flexknee position?
You've heard my lecture athousand times.
You better know the answer.
Mike (21:57):
right?
Well, there, there's a lot ofreasons, but yes.
Russ (21:59):
there, there's one main one, So they walk with their
knee bent in a flex position.
Mike (22:06):
Because they're not turning on their quad
Russ (22:08):
Exactly.
Good job, Mike So when you're inthe,
Mike (22:15):
ever.
Russ (22:15):
yeah.
100%.
One outta one.
Um, so when you're walking, andlet's say it's your left knee
and you're in the stance phase.
When you swing the uninvolvedknee, you have to go from near
full extension to maybe 20, 30degrees, and that's an ecentric
contraction.
Mike (22:34):
Right?
Russ (22:35):
And most of the time they ain't got that.
They do not have that capabilityto go from full extension to
unlocking their knee to controlthat.
So that's the first thing wework on.
We do side to side weightshifting.
We have them put on thebiofeedback and we'll go from
full extension to a mini squatstanding holding onto the table.
We'll have them walk over cups.
(22:57):
And single imbalance with theirknee slightly flexed to control
that position and immediatelytheir gait pattern changes that
day.
But if, you know, if you don'tdo that, what they do is they do
all this stuff and they walkoutta the clinic with a bent
knee again,
Mike (23:11):
Right, exactly.
Russ (23:13):
and so they're staying in that position because it's
comfortable and it's stable.
Uh, so you've gotta get'em outof that, or they'll lose
extension and they'll never gettheir quad back.
Mike (23:24):
right, right.
Yo, man, if you start gettingtight and you start losing
extension, you're, oh, man,your, your ability to get that
quad back goes downsignificantly.
Russ (23:34):
Yeah.
I think the worst thing you do,and a lot of physicians are
guilty of this, is that get ridof those crutches, you know?
You walk around with like a pegleg and you're like, don't tell
where you're going to therapy,please.
You
Mike (23:45):
right.
Russ (23:45):
you look terrible, So I keep'em on crutches and go down
to one crutch until they canwalk with a normal fluid gate.
So I think that that's reallyimportant.
PFR is great.
I think BFR is another thing totackle.
Uh, we use BFR and biofeedback.
I don't probably use BFR as muchas I do biofeedback, but I
think, you know, both of thoseare great in use together,
(24:08):
especially someone who's got anarticular cartilage injury, you
know?
Mike (24:11):
Yeah, no, that makes sense.
And you, you'd be surprised athow many people that you have to
just go through that gatetraining that you just
mentioned, the the cup walkingand like the steps over the
call.
It's a single leg balance andyou almost have to, like, you,
you, it's almost like you haveto, to tell them that what was
once reflexive, you now have tothink about it a little bit.
Like, Hey, I re I want you tocontrol that quad.
I want you to stabilize.
(24:32):
I want you to contract and holdit there.
And then once they do it, itcomes back.
But when it's almost like, Theyturn it off, they just, they
don't use it for two, threeweeks and then now you're behind
the gun and you start losingextension on top of that.
And Oh, man, that's, that'sgonna be a tough, tough few
weeks for that person.
Russ (24:48):
We had a patient last week, uh, eight months post-op
acl, who's.
You know, division onecheerleader scholarship.
She's running on the treadmill.
She can do everything, but shecan't walk.
She was not able to walk with anormal gate because her, you
know, she was walking thisflexion E gate pattern.
She had full, pretty much fullpassive extension.
But, so we worked with her onthat and two days later she was,
(25:10):
you know, her knee, brain tookover.
Mike (25:13):
right?
Yeah.
Russ (25:14):
So your knee brain and your real brain don't get
connected and you lack thatcapability and that that comes
with the cortical input thatwe'll talk about.
And that's one reason why bebiofeedback works I think, is
because we initiate thatcortical input right away.
And that's one thing that youlose when you have an A C L tear
and injury or arthritis.
(25:35):
You lose that, that transcranialmagnetic stimulation that has
shown that you lose somecortical input going down.
So you have to, you know,overcome that.
Mike (25:45):
I feel like the trend right now in younger
professionals with ACL strength,Is loading and it's load, load,
load.
And I don't disagree with that.
I, I agree.
We need a load and we'veprobably been guilty of
underloading, underloading ourpatients for decades.
Right.
Um, but I wonder if they're notappreciating the neuromuscular
(26:06):
control that you've reallytalked about this whole time
indirectly.
And that ability to use thatquad, the neuromuscular
contractions versus just load,load load.
You don't wanna load somebody ontop of a poor movement pattern.
Russ (26:19):
right?
Yeah.
I mean, that's what we talkedabout earlier is like if you've
got 50% strength loss and 11%atrophy, it's neuromuscular.
Deficit in the first, you know,two to three months of, of, of,
of post-op care.
You're trying to reeducate themuscle.
You're not getting muscleatrophy when you're doing three
sets of 20, you know, so, sothat's really important.
(26:41):
Um, and, uh, you know, now wehave a way to measure it so you
can look at the emg and we justfinished a study with, uh, One
of our pt, Steve and Sugarlandand, and Lane Bailey, uh, and,
and Jackie all looked at ourpost-op patients and measured
EMG at six months.
And if they are in a supervisedprogram, uh, you know, our
(27:04):
protocol with our key PTs, wehave rided them of that
neuromuscular deficit by sixmonths.
They still may have a 15, 20%strength deficit, but at least
you've taken that off the table.
I saw a patient last week withDr.
Lowe.
and this girl was a year postopand she still had a 50% EMG
deficit.
Mike (27:24):
right,
Russ (27:25):
So you've gotta take that off the table and then get to
the other part.
But if you just keep bloating,like you say, and you never get
the base of foundation of, youknow, two things that govern
your, your dynamic stability.
One is MG and the other isstrength.
And so what we have to answer ishow do those two correlate?
That's what we're working onright now.
(27:46):
But for us, I mean, usuallywithin two to three months we've
got that conquered.
So that there in our product,the M trigger has got a two
channel product.
So you can test the normal andtest the involved, and you can
get a percent deficit within oneminute of their, you know, what
they, what they've got going onwith that.
Mike (28:05):
That's awesome.
You know, that it reminds me,um, of a conversation I was
having with Holly Silvers, uh,this summer.
Um, we were talking abouthamstring strains and we were
talking about, you know, therecurrence of hamstring strains.
And what she said to me was, shestarted, she, she's doing a lot
of research in this cause we'retrying to tackle this like in
football and even baseball, thatsort of thing.
And she's saying, you know,sometimes these, these guys,
(28:27):
they, they test out theirstrengths there.
But if you look at their EMGactivity while they're running,
it's not there.
Right.
And it's, and it's, and it'samazing parallel right here to
the postoperative patient, the,the postin injured person.
It's the same thing.
So let's talk biofeedback then.
So obviously that's a tool thatyou use.
You mentioned the M trigger,which is a device that you've
helped develop, which, um, wasreally, really cool to like see,
(28:50):
hit the scene like several yearsago now.
But let, let's talk a little bitabout like what, what is
biofeedback, cuz you've alludedto it a few times.
What is it and, and how to youuse it in your clinic?
Russ (29:00):
Sure.
Well, biofeedback is justbasically amplification of your
quad muscle activity.
So our product, you've got twoelectrodes, two channels, and
you just put it on the targetmuscles and then you can adjust
the sensitivity of the amplifierto make the patient work harder
or make it easier for them tomake a contraction.
(29:23):
You know, biofeedback in, in ourhands.
I wanted it to be a very simpleproduct that you can set the
settings and then you just openit up and hit play.
You know, this kinda was theknock with muscle stem.
You had like 5,000 settings, andyou know, what frequency and
what wave did you want to use?
But I'm like, I don't want that.
So anyway, biofeedback is, youknow, I think the reason that it
(29:46):
works is you have increasedcortical output.
So when you're contracting themuscle, every rep, you have a
goal and you have to get thatbar up to that goal each time
you can see your numbers.
So for one thing, it, itinvolves the patient energy, you
know?
So you're not just doing, youknow, 10 minutes of quad sets
(30:07):
and checking their email whileyou're sitting at your desk
looking at your computer.
They actually have to work, youknow?
And then there's the other, thisother thing called order of
recruitment.
So that means that when you makea muscle, you start with the
slow twitch muscle fiber, andthen you go to the fast twitch.
So as you, you know, do a reallyhard isometric contraction, you
(30:29):
establish that normal order ofrecruitment, which in turn
increases the rate of firing ofthe motor units.
And that's your goal is to getall the motor units.
And a motor unit is one littlebranch that goes to seven or
eight nerve fibers.
So you got about two or 3000 ofthose in your quad.
So we want all of those branchesto.
Alive.
(30:50):
You know, so that's, that's kindof a nutshell of how it works.
The other thing is it's visualand patients can, they love to,
they like the bar thing, butthey wanna see their number.
I'll get'em in there the firstday and they usually about, you
know, 200 or 300 s of normalnumber micro votes for a post-op
patient.
And I'll say, well, let's seewhere your other leg is.
Not to embarrass you oranything, let's just see where
(31:12):
you need to get to.
And it's usually about 2000 onthe other side, you know, so,
but each day they come in,they're like, okay, I'm at 1500
now look at this.
Within, you know, a couple ofweeks.
So I think the visual thing ishard to measure, but, uh, you
know, that that's kind of how itworks.
And we have games you play also,and the games are really cool
and they make you work.
(31:32):
I mean, I've got video of N F Lguys doing quad sets and, you
know, and, and playing one ofour games and I did show it on
his jersey and he's like,stripping and sweat, you know,
so it, it is been a fun tool forus.
And it's, it's kinda likelimited to whatever your, you
know, creativity.
Mike (31:51):
Yeah, no, and we obviously we've, we've been using it for
several years now and, and, youknow, for followers of my
website, I mean, Russ and I havetalked about this in the past,
so, you know, it's the m triggerdevice.
We'll, we'll put some info inthe show notes so you
understand, but, um, you know,I, I always, I, I always wonder
here too, cuz when I was comingoutta PT school, Biofeedback was
around a little bit, right?
(32:13):
But it was clearly on its wayout, and then it just
disappeared for a while.
You know what, what, whathappened?
Why, why, why did biofeedbackdisappear in your mind?
Russ (32:22):
It was just like the huge, uh, market for muscle stem just
overshadowed it, and no one wasreally using bowel feedback.
I, I don't, I can't tell you whyI've been using it since
Mike (32:33):
Yeah.
Russ (32:33):
probably late eighties.
Used a handheld little l e dlight that would go
Mike (32:37):
Yeah, I remember that.
I had one of those.
Yeah,
Russ (32:40):
Care EMG or something like that.
But, uh, there was just not amarket for it because a huge
market was muscle stem.
And it's purely, you know,mostly financial because you
could, you know, make money fromrenting muscle stem units.
It was insurance reimbursable.
Mike (32:56):
Hmm.
Russ (32:57):
and MP was a company that just did big guns with, uh,
muscle stem rentals and theymade most of money selling
electrodes.
And then once the insurancereimbursement quit, it just
stopped.
And so they also funded hundredsand hundreds of papers of
research, uh, because, you know,it was a profitable entity.
And that, that's the main reasonI think that, uh, Um, muscle
(33:21):
stem, overshadowed biofeedback,but now we're, we're, we're
making a little wave, you know,the biofeedback, uh, community
is seeing that the patients loveit, they're getting results.
So it's, uh, and our product islike four 50 bucks and we're
coming out with a rental programwe just started, so patients can
rent it for a month.
Not sure what the cost is, butit's gonna be about like a
hundred bucks a month.
Mike (33:42):
That's
Russ (33:42):
our, our product is like a retail thing, you know, it's not
reinsure.
Ensure it's reinforc.
There is the biofeedback code,but it pays like 10 bucks, you
know,
Mike (33:53):
Yeah.
You
Russ (33:53):
so we don't use it, but you can use a neuromuscular
reeducation code
Mike (33:57):
Right, right.
Russ (33:58):
not using that code.
It's, it just, it totally fitsinto that.
So, The main thing I think waspretty much financial, but, uh,
it's really fun to go to ourwebsite and see all the
different videos that peoplesend in that you're using it for
core and shoulder and calf and,you know, a little bit of
everything.
So it's, it's, it's been a lotof fun.
Mike (34:19):
Yeah.
All right.
Well, I, I know like a, sobecause of this, right?
We, a lot of people knowneuromuscular stem.
We all know what N N M E acidis, right?
This is a familiar thing formost people.
Uh, but you know, not so manypeople I think, are
understanding biofeedback alittle bit.
Like we, obviously, there's adifference, right?
One, it contracts for you.
The other one almost just tellsyou how much you're contracting,
(34:40):
which gives you.
Biofeedback.
Right.
Hence the name.
But tell us a little bit aboutthe, what's the difference from
the science and how it affectsoutcomes and, and impacts the
person's function betweenneuromuscular stem and
biofeedback.
Russ (34:53):
Sure.
Well, um, there's severalstudies.
Animal studies have been done tolook at this.
And, um, one study in particularlooked at muscle stem and they,
several studies have describedthis as a reverse contraction.
So when you get muscle stem, um,you don't have that normal
heinemann size principle whereyou go from a slow twitch to
(35:16):
gradually a bigger contraction,to a fast twitch.
When you use muscle stem, youget the largest.
You know, cable, electricalcable is gonna pick up the
signal first, right?
So the fast twitch muscle fibershave a larger diameter axon, so
the fast twitch picks it upfirst, and the slow twitch
almost doesn't even getstimulated.
(35:37):
So I think that's one reason.
Um, even some other studies showthat muscle stems stimulates
everything at once, but the twoor three studies show that it's
a reverse contract.
And so the normal process isslow twist to fast twist.
And so if you have an a C L tearand you get immobilized, the
slow twitch muscle fibers arethe ones that are most effective
(36:00):
shown by a couple of studies.
So if you're not waking thoseup, then I think you're not
getting the most beneficialtreatment.
The other thing is that musclestem is a distal application of
the contraction.
So your distally, your brain,your the muscle stem is your.
Mike (36:20):
Right.
Russ (36:21):
So you contract the muscle, you set the intensity,
you know, to where their hair'sstanding up and they get know,
oh, we got a good contractionhere.
Now work with it.
You're like, ah, You know, I'mtrying.
So and so I think what you losewith that to some extent is the
cortical input.
Mike (36:41):
right?
Russ (36:41):
So with biofeedback, you're using your own electrical
system that starts in yourcortex, goes down the pathways
to the femoral nerve.
And so I think that's one otherreason why we see I, you know,
I've been using it forever cuz Igot better benefits with
biofeedback than I did musclestem, quicker muscle return,
less atrophy and that type ofthing.
So that's kind of it in anutshell.
(37:04):
Um,
Mike (37:06):
So what to me, I, I'm gonna give you an opportunity
here.
Um, here's what I'm doing, andyou tell me if I'm wrong.
I, I, I'm still, I use both.
I'm still using neuromuscularstem at the very beginning, more
so than biofeedback when theydon't have good volitional
control.
And as that starts to improve,then I, I almost want to, you
(37:27):
know, start phasing out theneuromuscular stem and into the
biofeedback.
A am I doing that wrong?
Do you
Russ (37:33):
No, I think you, you know, I think that's fine.
I don't do that, but I'm, I'm alittle I'm a
Mike (37:39):
If I
Russ (37:40):
I'm a little more brutal, you know, I just make them, you
know, get their own contraction.
But, uh, I, I think a lot of PTsin our system that work really
closely with us do the samething.
I think that's perfectly fineto, you know, get them to feel
what, um, a contraction shouldfeel like with muscle stem.
But as soon as they get avolitional contraction and you
(38:02):
can pick it up on the amplifierfor me, that's, that's when you,
uh, switch
Mike (38:07):
to move.
Yeah,
Russ (38:09):
But if they can't make any muscle at all, then you can do
muscle stem or you can send'emover the edge of the table and
you know, have them doing theextension.
You know.
But I, you know, we, we haven'tturned a muscle stem unit on in
probably 10 years, you know,
Mike (38:22):
I was, I was gonna ask you that.
That's funny.
Russ (38:24):
been a lot.
We don't have a unit, but,
Mike (38:26):
that's
Russ (38:26):
but I mean, a lot of people, there's a lot of
literature to support musclestem, so I'm not knocking that,
I'm just telling you what I havefound successful.
You know, in our, in our, youknow, rebuilding of our.
Mike (38:38):
Yeah.
And you know, I mean, ifsomebody doesn't have, if they
don't have volitional control atall, you know, I, I, I, I
wouldn't mind doing that.
Like you said, even just thepatellar mobility and, and you
know, just getting the kneemoving a little bit, like we're
talking about the first weekafter a surgery, something like
that.
Like to me, I still see the usefor that neuromuscular st.
But you're right, like you wannaget that volitional control
going.
You want, enhance that as fastas you can.
Russ (39:00):
no, I think that's fine.
I think that's a,
Mike (39:03):
That's what I'm looking for.
I'm looking to be fine.
That's good.
I like that.
Russ is
Russ (39:07):
Mike
Mike (39:09):
We're we're gonna hang on, we're gonna end the podcast.
And Russ be like, you gotta stopthat That's,
Russ (39:15):
so far ahead of your time.
Mike (39:18):
All right, so we, obviously, we talked a lot about
the knee, right?
I think the knee is like the,the no-brainer.
Use this everywhere though,right?
Use it cuff sc a, like a calf.
Like where, where do you use it?
The.
Russ (39:30):
Well, the one thing that we've been doing lately is
really working on eccentrics.
And you know that, well, Ididn't mention that, but that is
one thing that has been provenin the literature, that
eccentric training is supposedlythe best thing to, you know,
inhibit muscle atrophy.
Mike (39:48):
Hmm.
Russ (39:49):
and that's not new information.
That was in the eighties.
And, and if you remember, allthe Akinetic devices implemented
eccentric modes into theirprograms, but nobody used it cuz
it was just didn't make, itdidn't feel right.
You
Mike (40:04):
Right.
Russ (40:04):
to resist knee extension as you're getting pushed down.
It just didn't work.
So what we do is we use, we use,uh, MTRA for.
Single leg squat slides whereyou've got that single leg thing
that slides back and forth andyou're doing a single-leg squat
and really emphasize eccentrics.
So we're doing that for quads,but we also, we have a, a great
(40:27):
hamstring exercise.
I think maybe you've seen itwhile I have a patient laying,
you know, on their back with herhead facing the door, and we've
got the tlx gray band up in thedoor coming down.
To the foot and we wrap the footaround that and, and then we,
the patient in that position,you know, mimics a running
position and we teach them tobring their knee to the chest,
(40:50):
reach out with their foot, andnow they're in that eccentric
position to train theirhamstring and they have to fire
their muscle.
Mike (40:56):
Yeah.
That's big.
Russ (40:57):
really interesting.
It's really hard to contractyour muscle during an eccentric
contraction.
And that's the fun part aboutthis, is you actually see what
you've read.
You know, you're always readingthe literature.
The eccentric, my cell doesn'trequire as much muscle activity,
but it really is hard.
But once you train them to firetheir muscle eccentrically, it's
amazing.
I've had so many chronic like.
(41:20):
Outfielders and MLB and footballplayers have had chronic
hamstring injuries, and doingthe eccentric training has been
real helpful.
We also use in the core, uh,Chris Galena, who I work with
now, he, he does a lot of ourlumbar stabilization program.
He won't do it anymore withoutusing the electrodes.
Mike (41:37):
I love that.
Russ (41:38):
you can find your T ffl, you can find your lower abs.
And we had a baseball playerthis morning and he is like, you
know, doing some of the corestabilization and we didn't show
him.
He said, you got it?
And he said, yeah, yeah.
And we showed him and the EMGwas at the very bottom and he
saw that, immediately fired it.
And he is like, oh my God, Ithink you could only do like
five reps.
So we use it there, we use it inthe scapula, uh, in the
(42:02):
posterior.
we use it in the calf, you know,eccentrically.
Uh, so you know, we use it kindof all over the place.
It takes a little bit of time,but it doesn't take long.
It's just another.
It's another tool to use and it,boy, I tell you, the results
are, are really fun to see thepatient's face light up and they
say, oh my God, that's a, like,if you do prom planks, you think
(42:24):
you're doing, you know, a reallygood contraction.
But when you put the electrodeson, you can really pull in the
muscle and, and it's, it's justa fun tool.
Like I said, you kinda live itwith your creativity and you
can, you know, another thing youcan do is a neuromuscular
deficit test.
you know, for a side to sideassessment, uh, built into the
(42:45):
program.
So it's, you know, there's a lotof different applications.
Mike (42:49):
yeah, you can quantify a little bit and, and record that
so that way you can, you can,you can document it for whether
it be insurance or just to seetheir progress.
I mean,
Russ (42:56):
Yeah.
You can document.
We've got a new program that we,we've got the beta, uh, version
now where you input thepatient's name and it'll store
the amount of work they performin a 10 minute period and all
that kind of stuff, you know, so
Mike (43:08):
Nice.
All right.
Well this is somebody withinhibition right now.
How many times has thishappened?
Right?
You haven't been working withthe person, they've been at a
clinic elsewhere, right?
It's four months after e c L.
Now you haven't been workingwith them.
They still have quad inhibition,right?
What, what do you do at thispoint?
Like does, does your strategychange for somebody that has
(43:30):
this chronic, prolonged inhibit?
Russ (43:33):
Uh, basically what we do with most of those patients, and
a lot of times they have loss ofmotion also.
So if you've got quad inhibitionin four months, you're gonna
have a stiff knee, most
Mike (43:41):
Right.
Good
Russ (43:42):
So we restart them back to the two week program.
We treat'em like a two weekpost-op patient and we go back
and Yeah.
And start over with the Quantasand I, I, I've showed at our ICU
meeting that girl that had thelighter Retin Acular tear of
her, her patella, and she, youknow, she was like three, four
(44:03):
months post injury and her kneewas stiff, but it was muscle co
contraction.
So I used the, you know, I usedthe one thing you can do with
the M trigger is put.
You know, quad activation andhamstring and use your quad to
inhibit the hamstring and viceversa.
So, you know, I will just, the,the first thing I'll do with
(44:24):
that patient is make sure weturn on their quad and uh, and
work on their motion.
Cuz if you don't have.
You know, full range of motion,you're gonna have difficulty
contracting your quad becausethe medial and lateral re
gutters of your knee are kind ofstuck, and so it's pulling your
patella down, your patella'santeriorly tilted.
So motion and strength have tobe a part of that problem that
(44:46):
we address.
Mike (44:47):
right.
Makes sense.
And then in treated likeeverybody else, but just
hopefully they progress maybe ata different pace.
You know,
Russ (44:53):
Yeah.
Yeah.
The one thing that Chris, my, myPT said today that he's learned
from me and that we see allthose problem patients that come
in is educate them about theirinjury.
Mike (45:05):
Right.
Russ (45:06):
So when you tell them, look, that discomfort and pain
that you're feeling is, is notyour graft.
This has nothing to do with yoursurgery.
Oh, really?
Because they think that whenthey've been there in end, they
feel all that pain anddiscomfort.
Oh man, my graft fixing to pullapart.
You know, don't tell'em this isgonna, well we're gonna do on
our treatment is gonna hurt yourfeelings, but it won't hurt your
(45:28):
knee.
so
Mike (45:31):
That's Stealable.
Everybody write that
Russ (45:33):
Yeah, for sure.
That's one of my, my old, uh,old sayings.
But, uh, part of it is they'reafraid and if you educate them,
and you and Chris, you know, he,he said that's one thing.
A big thing I learned from youis you, so many patients have
come in and they haven't beentold you had surgery with this
graft in your knee, had nomeniscus to tear, so all your
feelings scar your feelings,scar tissue.
(45:55):
And so you could, if you couldtouch your heel to your butt in
the next five seconds, itwouldn't damage anything,
Mike (46:00):
Right, right.
Yeah, no, that's, I, I I thinkthat's, I think that's good.
That's good feedback.
And that's, that's a good thingcuz I do think even two young
clinicians might be a littlescared too.
Right.
When that happens, they may
Russ (46:13):
just tell him to just go watch a knee manipulation if, if
he
Mike (46:17):
as aggressive
Russ (46:18):
I think you can go and go into the OR and watch a 10, you
know, five to 10 minute kneemanipulation.
Someone's got 60 degrees andit's, it is not gentle, you
Mike (46:28):
Right, right.
And that doesn't tear the graft.
Russ (46:30):
No, no surgeon, surgeon's doing it to his own patient.
Mike (46:34):
Right, exactly.
That's funny.
So, uh, awesome.
Well, great stuff, Russ.
I really appreciate you takingthe time out here.
Uh, before I let you go, I'mgonna end with the, with the big
high five at the end.
Five, uh, five quick questions,five quick answers.
Um, just want to hear a littlebit about, about you, a little
bit more about your brain, whatyou're up to.
But first question for me is,what are you currently working
(46:54):
on for your own professionaldevelopment?
What are you.
Russ (46:59):
I'm getting my lectures ready for the A S M I meeting
Mike (47:03):
You didn't send your slides in.
Caroline's gonna be mad
Russ (47:06):
uh, one thing I, you know, I've kind of learned a lot from
teaching and that's one point Iwanted to bring out to the best
way for people to learn is toteach.
Mike (47:16):
right.
Russ (47:16):
get a little bit lazy.
At my older age.
I'm worried about my golf swingor whatever, but when I have to
get up and lecture, I can BS 90%of the people, but it's 10% in
the back that I need to bone upfor, so it it, it, uh, lecture
or teaching, it helps me learn.
One thing I'm really interestedin with my patients is pitching
mechanics.
(47:37):
So I've, um, you know, we gotthe baseball ranch here and
we've got, uh, Tom House, one ofhis, his CEOs that lives in
Houston.
So I'm trying to learn aboutthat and I've, my best friend in
town is the number one pitchingcoach in town.
David Evans.
I know you know
Mike (47:52):
Yeah.
Wow.
Yeah.
Russ (47:53):
he's, I'm learning a lot from them about spiraling your
elbow and taking stress andtrying to teach young kids how
to throw with less stressthrough the elbow and shoulder.
Mike (48:02):
Yeah.
Yeah.
Russ (48:03):
that's, that's one thing I'm doing.
I'm writing a book, uh, asection with Rob Mansky.
I'm working on that and, andthen we're also working on
deceleration testing withfunctional testing.
So that's just a few thingsgoing.
Mike (48:14):
Yeah.
You got a lot going on.
You're, I, you gotta focus moreon your golf game than all
Russ (48:19):
I say those are ideas.
I mean, I have a you know, havepeople that you know, kind of
help implement those.
I do write, I do write most ofall the stuff though.
Mike (48:29):
Uh, what is one thing that you've recently changed your
mind about?
Russ (48:33):
Um, I guess, uh, recently I would say, um, Is the
eccentrics, you know, to, tobringing things back to really
with the, the biofeedbackworking on eccentrics with even
with our posterior cuff, uh,pitchers, instead of just doing
concentric, really teaching themto fire eccentrically.
(48:54):
Um, the other thing is lettingmy young PTs that I trust work
on my patients.
You
Mike (49:02):
You still working on that
Russ (49:05):
Yeah, I mean, we, we, we you know, I used to like be very
protective, but now, I mean, I'mright there with them.
I think that it's the only waythat you get better.
When I had students when I was aci, I'd throw'em to the wolves,
go get that patient, evaluate'em, tell me what you found.
Mike (49:21):
right.
Russ (49:21):
know.
So, um, I think, uh, I thinkthat's one thing.
The one thing that has notchanged is restoring motion and.
Mike (49:30):
I know, right?
Russ (49:32):
So many people pass over that and they get in a
functional movement and, whichis great, but that's icing on
the kink.
So, so those things that havenot changed.
Yeah.
Mike (49:40):
Awesome.
What is your favorite piece ofadvice that you give students
nowadays?
Russ (49:45):
Um, what I said earlier is if, you know, just say how, how
can I get involved in somethinglike what you do?
And it's, as I tell'em, you needto po you know, do some research
and position.
in a location where luck canfind you.
You know, people say, oh, hejust got lucky.
Well, yeah, okay.
So he got lucky because he wasthere or she, she was there, you
(50:09):
know, and in the rightsituation.
And then once you, you find out,you kind of have a gut reaction
like, this is where I need tobe.
Then you just put your head downand go, you know?
Mike (50:18):
I love it.
That's a good one.
I like that.
I think a lot of people, um,take that for granted sometimes.
So, good one.
Um, you've already alluded tosome of these things, but what
else is coming up next for you?
What are you working on now?
Russ (50:29):
Yeah.
So my big next, uh, last hurrahis gonna be, uh,
Mike (50:34):
This is the Swan song.
Russ (50:35):
Yeah, I think so.
I've got some grateful patientsthat are, uh, willing to help me
and I'm gonna establish aninstitute, uh, a nonprofit
institute, uh, not too far fromwhere I work now.
And so we're, we're kind of inthe planning stages of that so
that we can really have.
All the toys and bells andwhistles to put out some, some
fun research and, uh, and havea, a place to, you know, to, to
(51:00):
treat people maybe that havedifficulty, financial or
whatever.
Uh, but continue on what I do,but take some of my ideas and
thoughts and, and, uh, be ableto have, uh, research people.
And we've got, Craig Garrisonjoined us in Lane Beta.
We've already got a greatresearch set, but this will just
be my own kind of baby.
And then the other thing is to.
(51:20):
To try to shoot my age in golf,
Mike (51:23):
Ooh, all right.
That's getting easier and easierevery
Russ (51:26):
3 times, but I'm 67, so I need a little extra work on my
short game, I think
Mike (51:33):
Just wait a few years.
That'll catch itself up.
You'll be good.
Russ (51:36):
I hope so.
Mike (51:38):
That's awesome.
Um, I've got a long ways to gofor that, maybe for nine, but,
um, but we'll get, we'll getthere, we'll get there.
But, uh, um, awesome.
Well, Russ, how can people findout more about you?
Do you have a place where, wherepeople can.
Russ (51:52):
Yeah, I don't have a website, but, uh, a lot of, of
this information is on mtrigger.com, so that's the name
of our biofeedback device.
And I've got the LinkedIn thingtoo.
Uh, so you can just Google myname and LinkedIn and I'm there.
I don't really do that much onit, but other people help me
with that.
Mike (52:10):
That's awesome.
Awesome.
Well, Russ, thanks again fortaking out, uh, some time from
your busy schedule to join us onthis podcast and share your
research and your experience.
We really appreciate it.
Thanks so much for coming ontoday.
Russ (52:22):
Thanks buddy.
On this episode of the sportphysical therapy podcast, I am
joined by Russ pain.
Rusted the director of sportsmedicine rehabilitation at UT
physicians in Houston, Texas.
And this episode, we're going totalk about muscle inhibition,
why it happens, why it's socommon after surgery and some
things that you can do bothacutely to prevent it as well as
treated when you have it downthe road.
(00:21):
We're also going to talk aboutbiofeedback in the use of this
in these patients.
Mike (00:37):
Hey, Russ.
How's it going?
Welcome to the podcast.
Russ (00:39):
Thank you.
Doing good.
Mike (00:41):
Awesome.
Well, always good to have alongtime friend here.
Um, for those that don't know,uh, Russ, you've done so much
for our profession, the sportsphysical therapy for profession
over the years between yourpublications, all the meetings
that you've spoken at over theyears, you know, dozens per
year, probably over your, yourextremely long career.
Um, current Hall of Famer forthe Sports Academy, which is
(01:04):
impressive.
Very, very, you know, few peopleget inducted in the Hall of
Fame.
Um, you know, before we getgoing into this podcast topic, I
want to hear a little bit aboutyour journey.
Right?
I want you to express a littlebit of that so you can share
that because I, I, I think someof the young professionals.
They, they want to hear like,how does somebody like yourself,
how do you get from a new gradto the Hall of Fame of the
(01:26):
sports academy?
So, you know, not to startcompletely open-ended, but man,
I'd love to hear a little bitabout your journey,
Russ (01:33):
Sure, no problem.
Well, It's a simple formula, butnot so easy to, uh, institute
that, you know, that's why Itell, you know, I have lunch
sometimes with, you know, PTsthat want to do what I do.
You know, they come into theclinic and they see all the, the
m o B guys, B a and the NFLs.
How did you, how do you, how doyou get all those guys?
I said, well, you first thing Idid my first three years outta
(01:57):
PT school, I moved my family tofour different cities.
you know, I think positioningyourself, uh, and that's one of
my questions at the end with youis how do you
Mike (02:09):
Nice
Russ (02:10):
successful is position yourself so that luck can find
you
Mike (02:14):
Yeah.
Right.
Russ (02:16):
so I'm actually moved to my, my big move was moving from
Houston to Lake Charles, where Iworked with a real famous
orthopedic surgeon named DavidDure.
and so I po I didn't really knowhow big a name he was.
I just knew it was a privatepractice opportunity for me to
start, uh, you know, two and ahalf years outta school.
And so, um, I did that and I hadkinda like a five year plan and
(02:38):
he helped me tremendously.
So I think getting, if youreally wanna be involved in
sports pt, I still believe thatit's a team concept and uh, you
know, things are changed alittle bit cuz we're a doctorate
so of, of physical therapy.
So you have a little moreautonomy.
But it's a team effort when you,when you do, uh, sports,
physical therapy.
(02:58):
So he opened me doors for me.
I went to all the nationalmeetings.
I went to the arthroscopy, theacademy, the A O S S M, and then
I got involved and, and listenedto one of our great or tours of
all time Bob Manje and listenedto him and I said, if Bob can do
it, I can do it.
no, I'm just kidding.
(03:18):
Bob was a big groundbreaker andhe's sort of a mentor for.
And so then I started publishingbecause Dr.
Dres demanded that I proved whatI was doing in physical therapy.
So he really opened, and always,even in PT school, I, I worked
in research.
I just had an interest in, infinding out why.
And so that helped me.
(03:38):
Um, and through that, his, uh,his, uh, guidance.
I became integrated nationallywith Kevin, Kevin Will, and Bob
and, and Mike Boyd.
And you and, and a lot ofdifferent people.
So then I moved to Houston andum, worked under back in a
private practice, and then I gotan opportunity to join a bigger
(04:02):
group.
And at that point in time, itwas a Hill South Days and we,
um, I was in charge of this big,you know, 10,000 square foot
clinic and we hosted the, orsponsored the Houston Rockets.
So I became the physicaltherapist for the Houston
Rockets.
It was me, Keith Jones, AnthonyFone, three guys.
(04:22):
And then obviously Dr.
Lowe and Bruce Mosley were theteam physicians.
So I was running my practice.
I was doing the rockets.
I went to every home game and Itraveled with them a little bit
and I was lecturing at 25meetings a year publishing, and
then I had my own educational.
Uh, meeting that me and Kevinand Bob did three meetings a
year called r r Enterprises.
(04:43):
So I worked, you know, like Isaid, it's basically you do
things that other people are notwilling to do.
So I transitioned from that anddeveloped, I've been in Houston
since 1991 and I got involved intreating pro athletes.
A lot of it had to do with thatrocket's, uh, exposure.
Uh, then I started working on PJTour players, and I got to work
(05:05):
with the Astros.
I went to nasa and I was thereprobably about 10 years.
Once a month I'd go work on the,the, um, astronaut.
So some of it is, is, you know,skill level and, but most of it
is, is just doing things thatother people aren't willing to
do.
Mike (05:23):
Yeah.
Yeah.
And you know what, I thinknowadays too, there's, I hear a
lot from our PT students andsome young professionals that
are getting out there.
They're always, they're, youknow, they're worried about
work-life balance, which, which,you know, that's, that's a good
objective to have.
But they're, they, they fear,they fear like grinding in the
clinic sometimes.
And, and I think we.
(05:44):
Agree that that's not the bestway to do it, but people like
yourself, myself, the KevinWill, everybody that you, you
mentioned, I mean, we've alldone it at some point, and I, I,
I think the, the amount oflearning that you have in a high
volume clinic with the sportsmedicine doctors right upstairs,
for example, or across the hall,the amount of collaboration, the
amount of work that you get donein a short period of time is
(06:06):
just, uh, astronomical for howquickly your brain can, can
absorb new information.
It's almost like your experiencelevels.
Doubled or tripled in the sameamount of time that you can do,
and everybody always fears that.
Right.
So, you know, I, it was good tohear, you know, you know that,
that concept, you know, grindingin the clinic, these big
orthopedic clinics where it'sokay to be high volume
sometimes, right?
Russ (06:27):
Right.
Yeah.
I mean, there's absolutely noway that you can be independent
out in a freestanding clinic andlearn as much as if you're
involved with an orthopedic SURsurgeon on a daily basis.
So, I mean, uh, you know, Ithink you can be a great sports
PT in those settings, noquestion.
But you need some interactionwith the guys that look inside
(06:49):
the.
Mike (06:50):
right.
Russ (06:50):
Everything they do is looking through the arthroscope
and fixing things inside thejoint, and we look outside the
box.
And so we just kind of puttingthose two brains together makes
I think the best care for forpatients.
Mike (07:03):
Yeah, and, and the opportunities you get, I think
are also greater, right?
You can participate in grandrounds, you can go through the
educational sessions with thedocs, but then you get involved
in all their big projects,right?
Because.
The, the surgeons have biggerbudgets for these things.
They have bigger, you know,grants and research foundations.
They can get this, this, theseed money to do things like big
(07:24):
research projects that, that wewouldn't be able to do on our
own.
You know, and I would say that'sthe one thing that Lenny and I
talk about all the time, likeowning our own private practice
now, is we miss thecollaboration with doctors every
day.
Right.
And, and that's something that Ithink sometimes people take for
granted is how valuable thatcan.
Russ (07:42):
Plus, I mean, if, if you're in private practice or in
a free-standing clinic, it's agreat marketing tool for you
just to go and see patients witha physician.
And you know, you look atimages, you look at MRIs and
even radiologists.
Don't interpret the MRIs as wellas a sports medicine orthopedic
surgeon.
And you can't really learn thaton your own.
(08:04):
So, you know, just learning, youknow, and how they treat people.
And Dr.
Lowe and I have been doing ourTuesday morning clinic forever.
Which we stole from, you know,Kevin Wilkin, Dr.
Andrews who St.
Stoler from, you know, JackHouston, who started it.
And that's been, that's grown tobe a huge thing that Lane Bailey
and Jackie in our clinic havetaken it to another level.
(08:25):
So we have a huge Tuesdaymorning from seven till noon.
We, you know, evaluate all ofour a ACL patients.
He does 400 ACLS a year, soit's.
A big population, but it's fun.
It's a lot of fun.
And, and then we have all theresidents and the fellows and
all the key sports PTs in our,in our city get to come and
interact with Dr.
Lowe and communicate with him.
(08:45):
So it's, it's great care for thepatients.
Mike (08:47):
And, and just again, the massive volume of what you see
just helps you learn so, So muchfaster than you can if you're
just in an independent privatepractice.
Or even there's some PTs nowthat just wanna go right into
cash base, which is, you know,one-on-one, you might have five
patients one day, right?
And you, you just saw fivepatients before 8:00 AM right?
So it's, it's, you know, therethere's pros and cons that I
(09:08):
just, I tell people, look, the,the educational experience in
those environments are, are nextto nothing.
So don't, don't, don't, don'tforget that.
Right.
Don't, don't underappreciateThat, I guess is how I would
phrase it.
Russ (09:21):
Yeah, it is sort of like we cheat a little bit because we
see it every day and then welook back and we, you know, one
of your other questions comingup is, what, what have I, you
know, what am I evolving?
And, and I was talking to my PTtoday about it and I'm like, We
evolve every week and we don'tknow it,
Mike (09:39):
Yeah.
Russ (09:40):
we're, we're, we're evolving because Dr.
Lowe's techniques evolve and wechange the way we do things and
we're doing this stuff, and thenwe get a PD that comes at PT
that comes in, or a patientthat's been seen in another
place and say, why aren't theydoing this?
And it's because we do it everyday and it's just so natural for
us.
And nothing against the otheroutlying PTs, but they may not
see, but maybe 10 acls a year.
Mike (10:01):
Exactly right.
Right.
You have to be careful, likeit's people like yourselves that
have so much volume that youbecome the go-to resources for
that because you're, you know,it's, you can't surprise you
anymore.
Right.
We can't stump rust pain.
Right.
You've seen nearly
Russ (10:16):
Oh, we can,
Mike (10:17):
be you know what I mean?
Like.
Russ (10:20):
we're like the principal's office, you know, doctor Las
said, hi, dear.
I go See Rise.
He is the wizard.
But it may hurt you a littlebit, you know.
Mike (10:29):
Exactly right.
He may not say what you want tohear, but you know, you might
not be ready to run.
But that, that's awesome.
Um, well, yeah, I, I love thejourney.
I mean, obviously I've known youfor a really long time.
I've been fortunate to meet youthrough, through my mentor
Kevin, and we spent a lot oftime together at meetings.
So, uh, it's always good to hearthat, and I think that's always
good for young professionals tokind of hear about that journey
(10:49):
and, and, and what it takes to,to, you know, to get yourself to
that next level.
So I appreciate you.
Um, I, one of the things that Ithink, again, you bring a wealth
of information to is just howmany postoperative patients
you've worked with.
Right.
And that's, to me, one of thosebenefits of working with the
physicians again, is you see somany postoperative patients.
Right.
So what, what would you say inyour practice right now, what's
(11:11):
your percentage of post-opversus just the non-operative
pain type patient you have?
Russ (11:16):
I would say, um, you know, some of our baseball guys are
non-op.
you know, some of'em come in,you
Mike (11:23):
thank God.
Russ (11:24):
post-season to get ready for next season.
We're getting more and more ofthat.
You know, people have actuallyseen me in high school and had a
great result when they had alittle laberal, you know, tear
or something, and then they comeback now with their
professionals like, Hey, I wantsome more of that juice, you
know?
Mike (11:41):
right?
Russ (11:42):
But I would, I would say it's probably 50 50, something
like that.
Mike (11:46):
That's that's huge.
Russ (11:47):
Yeah, that's, that's, we see a lot of post-op and like I
say, we see a lot of the post-oppatients.
That are having trouble, youknow, that are, that have loss
emotion or they, you know,they're having swelling or they
have no quad and you know, andsome of the things we do just
work, you know, and the, thebasic fundamentals that I have
never gotten rid of and it'sjust crazy.
(12:08):
I look at my other pt, we go, Ican't believe you know this or
that, or whatever, but it'sjust, you have to get the basic
foundation of rehab principles.
One thing I want to say iscongratulations to you by the
way.
Mike (12:21):
Uh oh.
Russ (12:22):
taking on the helm of, of presidency.
And I love sports, physicaltherapy and I love our
profession.
And, you know, congrats to youand, and thanks for lead taking
the flag,
Mike (12:33):
I appreciate.
Well, I'm just, I'm, I'm givingback just like you guys did.
That's, that's how I'm, I'm,this is, it's my time.
It's my time.
Right.
And I, I'm already lookingforward to passing the baton
again.
Russ (12:45):
things getting all a sudden.
Huh?
Mike (12:47):
that baton is hot, but.
Russ (12:49):
The four by one a hundred, not the, you know, mile relay.
Mike (12:53):
Exactly.
So, um, well, let's talk aboutthat a little bit here again,
because again, I think one ofthe benefits of you is, you
know, you see so manypostoperative people, you see
those complicated patients,right?
I, one of the most complicatedthings that all the PTs want to
ask questions about to me ismuscle inhibition.
Right is they get stumped by itsometimes.
And, and it's, it's, it'samazing how common muscle
(13:16):
inhibition is after a surgery.
Right.
Um, let's start with that alittle bit and, and talk about
just muscle inhibition ingeneral and like why, why do you
think that occurs?
Why do you think that's socommon?
Russ (13:26):
Well, I mean, we can, you know, get, get a little dry here
for a minute and quote someliterature, you know, but I'll,
I'll try to make it simple.
But, uh, if you look atimmobilization, that's probably
the number one cause of muscleinhibition.
So there's been a couple ofstudies, one where they took
normal subjects.
And just locked them in fullextension for three weeks.
(13:49):
And then they had a second groupwhere they had a hinge brace and
they didn't do any exercise oranything.
And so the group that was lockedin full extension had, uh, 50%
loss in strength in three weeks.
Uh, the range of motion grouphad none basically, and they had
40% decrease in their emg, theimmobilization.
Mike (14:12):
Wow.
Russ (14:12):
you have four times greater strength loss in
atrophy.
So you had 50% strength loss andonly 11% atrophy.
So it's not like the muscle sizeis a factor.
It's a neurological inhibitionwhen your knees full, extension,
the muscles short.
So that's one factor.
The other factor is swelling andpain.
Obviously, we know that if youinject 30 ccs of saline into a
(14:36):
perfectly normal knee, your quadmg goes down 50.
Mike (14:41):
Yeah.
That's
Russ (14:41):
and that's a spinal cord reflex inhibition of the femoral
nerve, the Hoffman reflex, youknow, so that's number two.
And three is pain and swelling.
And then another thing thatcaused you to have inhibition is
unloading.
So if you have to gonon-weightbearing, you're gonna
lose 20% strength over a threeweek period, just from just not
(15:03):
putting your foot on the ground.
So those are all things thatoccur, and it occurs worse in
some than others, and I can'ttell you why that is.
So I don't, I don't, you know, Idon't, I, that those are the
factors that cause you to havemuscle inhibition
Mike (15:17):
Yeah.
So D, does it blow your mindstill to this day that we still
have some physicians that waittwo weeks to get people into to
therapy after they have surgery?
Russ (15:27):
Yeah, we don't see that obviously, but, um, some people
are worried about theirparticular procedure and they
immobilize them.
We don't hardly immobilize.
I can't think of anybody weimmobilize except maybe a, you
know, a dislocated knee with a MC L.
But even while though weimmobilize them, we allow them
to move their knee right away,zero to 30.
(15:49):
So there's, there's nothingunless you have a fracture that
we immobilize that's a A C L M CL or ligamentous type injury.
So we've learned that, you know,not only the, the atrophy, but
obviously articular cartilage,it's, it's not good for
articular cartilage either.
So, yeah.
Mike (16:06):
that, that's one of the things that Lenny and I didn't
appreciate when we, again movedfrom a setting like yourselves
where we're with a group ofreally amazing physicians to
being in the community and nowwe see people from every
surgeon, dozens of differentsurgeons all over the region,
um, how different everybody is,and we.
(16:27):
Every day.
The people that wait two weeksto start therapy always are
worse for months.
Right.
Like two, three months.
It seems like once you getbehind for two weeks, it's hard.
Right.
Russ (16:37):
Yeah.
I mean that's one of the factorsof prevention, which you'll talk
about next, is you gotta turnthe muscle on a S A P or you
start cascading down that, youknow, catabolic pathway.
You know, the anabolic is, iswhat we want and, and I know we
can't use anabolic steroids, butit seems like a perfect time to
use it, you know, and nobodywill do it.
Take on that study you.
Mike (16:57):
Exactly right.
Maybe
Russ (16:58):
I think one of the reasons that, uh, you know, physicians
are maybe hesitant is that theydon't have a Mike Reinhold or
you know, a go-to PT in everylocation where they are.
So they're afraid to movepatients, which I think is the
wrong thing.
But I think that'spsychologically maybe what
happens sometimes.
Mike (17:18):
Right.
Yeah.
And that's, I think that's afair assessment.
That, that makes sense.
You know, and, and I see thatthere's a lot of physicians I
know around us in the Bostonarea for some reason.
I don't know why the, thesurgeons have shared this Excel
sheet of every PT clinic, likein the world it seems like.
And they all give it to thepatients.
They're like, Hey, here you go.
Go to therapy.
And there's literally 80 pt.
(17:39):
It's like they just went to theyellow pages, right?
Which doesn't exist anymore.
It's so crazy that they do itthat way versus trying to have
some regional clinics that, youknow what, I really trust these
people.
I really trust this, this guy orgirl.
Right.
And you know, it, it'sdisappointing to see, but um,
you know, maybe, maybe one day,but,
Russ (17:57):
I think the other thing is that as a pt, if you see general
orthopedics and you get an A CL, the last thing you wanna do
is hurt someone.
So what do you do?
You err on the conservative sideand, and even though the
protocols there, you're afraidto move them, you know?
And in most cases, with mostsurgeries, Patient, I mean, the
(18:18):
physician finishes theoperation.
They take'em through a fullrange of motion and make sure
everything's good.
There's almost no reason not tomove the knee, you know,
passively to 90 degrees on most,most things.
Mike (18:29):
Right.
Yeah, yeah, exactly.
Especially passively, right?
I mean, there's like, yeah, I, Icompletely agree.
So we talked aboutimmobilization, we talked about
limited weightbearing, we talkedabout obviously pain, swelling,
those types of things.
Um, alright, what do we do?
How do we prevent this then?
So if you're a pt, you'reworking with postoperative
patients, what's, what's likethe bucket of things you do to,
to minimize or even prevent thisinhibition as much as we can.
Russ (18:53):
So the first thing that we do is someone's swollen and they
have an, if your knee is, you'vegot, you know, 90 ccs of fluid
in your knee, you're gonna havetrouble.
So we aspirate.
I mean, I don't, but Dr.
Lowe is very aggressive withaspirations.
I mean, if you got 30, 40 ccs offluid, the he'll say you're
allergi to needles, you know?
Mike (19:16):
Wow.
Russ (19:17):
uh, we that.
Very, very helpful.
And when I worked with Dres, hewas too.
I, I worked with a lot of topphysicians, uh, in Texas and,
and some of them do not like toaspirate.
They will just not aspirate nomatter what.
But luckily that's one thingthat we have that, that I think
is great in prevention of thecascade.
(19:37):
You, I don't think we figuredout how to prevent atrophy.
It's just, you know, it's there,but we can prevent the cascade.
Mike (19:43):
Right.
Right.
And, and and more importantlythough, like again, just like,
just like starting PT two weekslate, like the longer you let
that swelling linger, right?
The longer you immobilize it,the more and more you're gonna
get behind, right?
I think, I don't think peoplerealize that that effect is
almost cumulative to a nature.
Russ (20:01):
Yeah.
So turning on the quad is themost important thing.
It does so many things if youcan make a muscle, you know, so
that's, you know, that's.
Getting into ball feedback.
I'm a big ball feedback guy, youknow, so, uh, when the patients
can see their activity, it just,it just makes sense.
And we'll go over some, youknow, technical reasons why, but
when you turn on your quad andyou can, you know, force your
(20:24):
knee straight, you, you do a,like three things.
You turn on your quad, you helpforce active extension and you
mobilize the patella, you know,so turning on the quad is
extremely important.
And the worst place to turn onthe quad is with an in full.
Mike (20:39):
Right.
Russ (20:40):
But that's what we all do.
We put'em in full extension andwe put a pillow on or pad
underneath the back of theirknee and said, tighten your
muscle up.
I'm like, man, I'm crying.
I I can't do it.
You know, it's not working welltry harder.
You
Mike (20:52):
right.
It's,
Russ (20:53):
if, if you've got an ACL l yeah.
If you've got an A C L, that's apost-op and they can bend their
knee and maybe they're notbending all the way to nine of
us, sit'em over the edge of the.
Mike (21:02):
right.
Russ (21:03):
Send'em over the edge of the table if they can get to 60
degrees and they just have'em doan active knee extension.
So that's so much easier.
And we use the bottle feedbackwith that.
And it, it's, it's really hugeto, and then the other thing you
can do is put them in a 90 90position like we do with the
rotator cuff and just lift theirleg up in full extension like
(21:23):
you're doing a hamstringstretch.
And I'll have them try to lifttheir heel off of my hand and
that'll initiate the quad and agravity eliminated like we do
with rotator cuff.
You know, we start in thatgravity eliminated position.
So those are a couple of thingsyou can do.
And the other thing isweightbearing.
Mike (21:41):
Right,
Russ (21:42):
Weightbearing with a normal gate.
I don't let them get offcrutches until they can walk
without a limp,
Mike (21:47):
right.
That's huge.
Russ (21:49):
you know?
So why?
Why do people walk with the flexknee position?
You've heard my lecture athousand times.
You better know the answer.
Mike (21:57):
right?
Well, there, there's a lot ofreasons, but yes.
Russ (21:59):
there, there's one main one, So they walk with their
knee bent in a flex position.
Mike (22:06):
Because they're not turning on their quad
Russ (22:08):
Exactly.
Good job, Mike So when you're inthe,
Mike (22:15):
ever.
Russ (22:15):
yeah.
100%.
One outta one.
Um, so when you're walking, andlet's say it's your left knee
and you're in the stance phase.
When you swing the uninvolvedknee, you have to go from near
full extension to maybe 20, 30degrees, and that's an ecentric
contraction.
Mike (22:34):
Right?
Russ (22:35):
And most of the time they ain't got that.
They do not have that capabilityto go from full extension to
unlocking their knee to controlthat.
So that's the first thing wework on.
We do side to side weightshifting.
We have them put on thebiofeedback and we'll go from
full extension to a mini squatstanding holding onto the table.
We'll have them walk over cups.
(22:57):
And single imbalance with theirknee slightly flexed to control
that position and immediatelytheir gait pattern changes that
day.
But if, you know, if you don'tdo that, what they do is they do
all this stuff and they walkoutta the clinic with a bent
knee again,
Mike (23:11):
Right, exactly.
Russ (23:13):
and so they're staying in that position because it's
comfortable and it's stable.
Uh, so you've gotta get'em outof that, or they'll lose
extension and they'll never gettheir quad back.
Mike (23:24):
right, right.
Yo, man, if you start gettingtight and you start losing
extension, you're, oh, man,your, your ability to get that
quad back goes downsignificantly.
Russ (23:34):
Yeah.
I think the worst thing you do,and a lot of physicians are
guilty of this, is that get ridof those crutches, you know?
You walk around with like a pegleg and you're like, don't tell
where you're going to therapy,please.
You
Mike (23:45):
right.
Russ (23:45):
you look terrible, So I keep'em on crutches and go down
to one crutch until they canwalk with a normal fluid gate.
So I think that that's reallyimportant.
PFR is great.
I think BFR is another thing totackle.
Uh, we use BFR and biofeedback.
I don't probably use BFR as muchas I do biofeedback, but I
think, you know, both of thoseare great in use together,
(24:08):
especially someone who's got anarticular cartilage injury, you
know?
Mike (24:11):
Yeah, no, that makes sense.
And you, you'd be surprised athow many people that you have to
just go through that gatetraining that you just
mentioned, the the cup walkingand like the steps over the
call.
It's a single leg balance andyou almost have to, like, you,
you, it's almost like you haveto, to tell them that what was
once reflexive, you now have tothink about it a little bit.
Like, Hey, I re I want you tocontrol that quad.
I want you to stabilize.
(24:32):
I want you to contract and holdit there.
And then once they do it, itcomes back.
But when it's almost like, Theyturn it off, they just, they
don't use it for two, threeweeks and then now you're behind
the gun and you start losingextension on top of that.
And Oh, man, that's, that'sgonna be a tough, tough few
weeks for that person.
Russ (24:48):
We had a patient last week, uh, eight months post-op
acl, who's.
You know, division onecheerleader scholarship.
She's running on the treadmill.
She can do everything, but shecan't walk.
She was not able to walk with anormal gate because her, you
know, she was walking thisflexion E gate pattern.
She had full, pretty much fullpassive extension.
But, so we worked with her onthat and two days later she was,
(25:10):
you know, her knee, brain tookover.
Mike (25:13):
right?
Yeah.
Russ (25:14):
So your knee brain and your real brain don't get
connected and you lack thatcapability and that that comes
with the cortical input thatwe'll talk about.
And that's one reason why bebiofeedback works I think, is
because we initiate thatcortical input right away.
And that's one thing that youlose when you have an A C L tear
and injury or arthritis.
(25:35):
You lose that, that transcranialmagnetic stimulation that has
shown that you lose somecortical input going down.
So you have to, you know,overcome that.
Mike (25:45):
I feel like the trend right now in younger
professionals with ACL strength,Is loading and it's load, load,
load.
And I don't disagree with that.
I, I agree.
We need a load and we'veprobably been guilty of
underloading, underloading ourpatients for decades.
Right.
Um, but I wonder if they're notappreciating the neuromuscular
(26:06):
control that you've reallytalked about this whole time
indirectly.
And that ability to use thatquad, the neuromuscular
contractions versus just load,load load.
You don't wanna load somebody ontop of a poor movement pattern.
Russ (26:19):
right?
Yeah.
I mean, that's what we talkedabout earlier is like if you've
got 50% strength loss and 11%atrophy, it's neuromuscular.
Deficit in the first, you know,two to three months of, of, of,
of post-op care.
You're trying to reeducate themuscle.
You're not getting muscleatrophy when you're doing three
sets of 20, you know, so, sothat's really important.
(26:41):
Um, and, uh, you know, now wehave a way to measure it so you
can look at the emg and we justfinished a study with, uh, One
of our pt, Steve and Sugarlandand, and Lane Bailey, uh, and,
and Jackie all looked at ourpost-op patients and measured
EMG at six months.
And if they are in a supervisedprogram, uh, you know, our
(27:04):
protocol with our key PTs, wehave rided them of that
neuromuscular deficit by sixmonths.
They still may have a 15, 20%strength deficit, but at least
you've taken that off the table.
I saw a patient last week withDr.
Lowe.
and this girl was a year postopand she still had a 50% EMG
deficit.
Mike (27:24):
right,
Russ (27:25):
So you've gotta take that off the table and then get to
the other part.
But if you just keep bloating,like you say, and you never get
the base of foundation of, youknow, two things that govern
your, your dynamic stability.
One is MG and the other isstrength.
And so what we have to answer ishow do those two correlate?
That's what we're working onright now.
(27:46):
But for us, I mean, usuallywithin two to three months we've
got that conquered.
So that there in our product,the M trigger has got a two
channel product.
So you can test the normal andtest the involved, and you can
get a percent deficit within oneminute of their, you know, what
they, what they've got going onwith that.
Mike (28:05):
That's awesome.
You know, that it reminds me,um, of a conversation I was
having with Holly Silvers, uh,this summer.
Um, we were talking abouthamstring strains and we were
talking about, you know, therecurrence of hamstring strains.
And what she said to me was, shestarted, she, she's doing a lot
of research in this cause we'retrying to tackle this like in
football and even baseball, thatsort of thing.
And she's saying, you know,sometimes these, these guys,
(28:27):
they, they test out theirstrengths there.
But if you look at their EMGactivity while they're running,
it's not there.
Right.
And it's, and it's, and it'samazing parallel right here to
the postoperative patient, the,the postin injured person.
It's the same thing.
So let's talk biofeedback then.
So obviously that's a tool thatyou use.
You mentioned the M trigger,which is a device that you've
helped develop, which, um, wasreally, really cool to like see,
(28:50):
hit the scene like several yearsago now.
But let, let's talk a little bitabout like what, what is
biofeedback, cuz you've alludedto it a few times.
What is it and, and how to youuse it in your clinic?
Russ (29:00):
Sure.
Well, biofeedback is justbasically amplification of your
quad muscle activity.
So our product, you've got twoelectrodes, two channels, and
you just put it on the targetmuscles and then you can adjust
the sensitivity of the amplifierto make the patient work harder
or make it easier for them tomake a contraction.
(29:23):
You know, biofeedback in, in ourhands.
I wanted it to be a very simpleproduct that you can set the
settings and then you just openit up and hit play.
You know, this kinda was theknock with muscle stem.
You had like 5,000 settings, andyou know, what frequency and
what wave did you want to use?
But I'm like, I don't want that.
So anyway, biofeedback is, youknow, I think the reason that it
(29:46):
works is you have increasedcortical output.
So when you're contracting themuscle, every rep, you have a
goal and you have to get thatbar up to that goal each time
you can see your numbers.
So for one thing, it, itinvolves the patient energy, you
know?
So you're not just doing, youknow, 10 minutes of quad sets
(30:07):
and checking their email whileyou're sitting at your desk
looking at your computer.
They actually have to work, youknow?
And then there's the other, thisother thing called order of
recruitment.
So that means that when you makea muscle, you start with the
slow twitch muscle fiber, andthen you go to the fast twitch.
So as you, you know, do a reallyhard isometric contraction, you
(30:29):
establish that normal order ofrecruitment, which in turn
increases the rate of firing ofthe motor units.
And that's your goal is to getall the motor units.
And a motor unit is one littlebranch that goes to seven or
eight nerve fibers.
So you got about two or 3000 ofthose in your quad.
So we want all of those branchesto.
Alive.
(30:50):
You know, so that's, that's kindof a nutshell of how it works.
The other thing is it's visualand patients can, they love to,
they like the bar thing, butthey wanna see their number.
I'll get'em in there the firstday and they usually about, you
know, 200 or 300 s of normalnumber micro votes for a post-op
patient.
And I'll say, well, let's seewhere your other leg is.
Not to embarrass you oranything, let's just see where
(31:12):
you need to get to.
And it's usually about 2000 onthe other side, you know, so,
but each day they come in,they're like, okay, I'm at 1500
now look at this.
Within, you know, a couple ofweeks.
So I think the visual thing ishard to measure, but, uh, you
know, that that's kind of how itworks.
And we have games you play also,and the games are really cool
and they make you work.
(31:32):
I mean, I've got video of N F Lguys doing quad sets and, you
know, and, and playing one ofour games and I did show it on
his jersey and he's like,stripping and sweat, you know,
so it, it is been a fun tool forus.
And it's, it's kinda likelimited to whatever your, you
know, creativity.
Mike (31:51):
Yeah, no, and we obviously we've, we've been using it for
several years now and, and, youknow, for followers of my
website, I mean, Russ and I havetalked about this in the past,
so, you know, it's the m triggerdevice.
We'll, we'll put some info inthe show notes so you
understand, but, um, you know,I, I always, I, I always wonder
here too, cuz when I was comingoutta PT school, Biofeedback was
around a little bit, right?
(32:13):
But it was clearly on its wayout, and then it just
disappeared for a while.
You know what, what, whathappened?
Why, why, why did biofeedbackdisappear in your mind?
Russ (32:22):
It was just like the huge, uh, market for muscle stem just
overshadowed it, and no one wasreally using bowel feedback.
I, I don't, I can't tell you whyI've been using it since
Mike (32:33):
Yeah.
Russ (32:33):
probably late eighties.
Used a handheld little l e dlight that would go
Mike (32:37):
Yeah, I remember that.
I had one of those.
Yeah,
Russ (32:40):
Care EMG or something like that.
But, uh, there was just not amarket for it because a huge
market was muscle stem.
And it's purely, you know,mostly financial because you
could, you know, make money fromrenting muscle stem units.
It was insurance reimbursable.
Mike (32:56):
Hmm.
Russ (32:57):
and MP was a company that just did big guns with, uh,
muscle stem rentals and theymade most of money selling
electrodes.
And then once the insurancereimbursement quit, it just
stopped.
And so they also funded hundredsand hundreds of papers of
research, uh, because, you know,it was a profitable entity.
And that, that's the main reasonI think that, uh, Um, muscle
(33:21):
stem, overshadowed biofeedback,but now we're, we're, we're
making a little wave, you know,the biofeedback, uh, community
is seeing that the patients loveit, they're getting results.
So it's, uh, and our product islike four 50 bucks and we're
coming out with a rental programwe just started, so patients can
rent it for a month.
Not sure what the cost is, butit's gonna be about like a
hundred bucks a month.
Mike (33:42):
That's
Russ (33:42):
our, our product is like a retail thing, you know, it's not
reinsure.
Ensure it's reinforc.
There is the biofeedback code,but it pays like 10 bucks, you
know,
Mike (33:53):
Yeah.
You
Russ (33:53):
so we don't use it, but you can use a neuromuscular
reeducation code
Mike (33:57):
Right, right.
Russ (33:58):
not using that code.
It's, it just, it totally fitsinto that.
So, The main thing I think waspretty much financial, but, uh,
it's really fun to go to ourwebsite and see all the
different videos that peoplesend in that you're using it for
core and shoulder and calf and,you know, a little bit of
everything.
So it's, it's, it's been a lotof fun.
Mike (34:19):
Yeah.
All right.
Well, I, I know like a, sobecause of this, right?
We, a lot of people knowneuromuscular stem.
We all know what N N M E acidis, right?
This is a familiar thing formost people.
Uh, but you know, not so manypeople I think, are
understanding biofeedback alittle bit.
Like we, obviously, there's adifference, right?
One, it contracts for you.
The other one almost just tellsyou how much you're contracting,
(34:40):
which gives you.
Biofeedback.
Right.
Hence the name.
But tell us a little bit aboutthe, what's the difference from
the science and how it affectsoutcomes and, and impacts the
person's function betweenneuromuscular stem and
biofeedback.
Russ (34:53):
Sure.
Well, um, there's severalstudies.
Animal studies have been done tolook at this.
And, um, one study in particularlooked at muscle stem and they,
several studies have describedthis as a reverse contraction.
So when you get muscle stem, um,you don't have that normal
heinemann size principle whereyou go from a slow twitch to
(35:16):
gradually a bigger contraction,to a fast twitch.
When you use muscle stem, youget the largest.
You know, cable, electricalcable is gonna pick up the
signal first, right?
So the fast twitch muscle fibershave a larger diameter axon, so
the fast twitch picks it upfirst, and the slow twitch
almost doesn't even getstimulated.
(35:37):
So I think that's one reason.
Um, even some other studies showthat muscle stems stimulates
everything at once, but the twoor three studies show that it's
a reverse contract.
And so the normal process isslow twist to fast twist.
And so if you have an a C L tearand you get immobilized, the
slow twitch muscle fibers arethe ones that are most effective
(36:00):
shown by a couple of studies.
So if you're not waking thoseup, then I think you're not
getting the most beneficialtreatment.
The other thing is that musclestem is a distal application of
the contraction.
So your distally, your brain,your the muscle stem is your.
Mike (36:20):
Right.
Russ (36:21):
So you contract the muscle, you set the intensity,
you know, to where their hair'sstanding up and they get know,
oh, we got a good contractionhere.
Now work with it.
You're like, ah, You know, I'mtrying.
So and so I think what you losewith that to some extent is the
cortical input.
Mike (36:41):
right?
Russ (36:41):
So with biofeedback, you're using your own electrical
system that starts in yourcortex, goes down the pathways
to the femoral nerve.
And so I think that's one otherreason why we see I, you know,
I've been using it forever cuz Igot better benefits with
biofeedback than I did musclestem, quicker muscle return,
less atrophy and that type ofthing.
So that's kind of it in anutshell.
(37:04):
Um,
Mike (37:06):
So what to me, I, I'm gonna give you an opportunity
here.
Um, here's what I'm doing, andyou tell me if I'm wrong.
I, I, I'm still, I use both.
I'm still using neuromuscularstem at the very beginning, more
so than biofeedback when theydon't have good volitional
control.
And as that starts to improve,then I, I almost want to, you
(37:27):
know, start phasing out theneuromuscular stem and into the
biofeedback.
A am I doing that wrong?
Do you
Russ (37:33):
No, I think you, you know, I think that's fine.
I don't do that, but I'm, I'm alittle I'm a
Mike (37:39):
If I
Russ (37:40):
I'm a little more brutal, you know, I just make them, you
know, get their own contraction.
But, uh, I, I think a lot of PTsin our system that work really
closely with us do the samething.
I think that's perfectly fineto, you know, get them to feel
what, um, a contraction shouldfeel like with muscle stem.
But as soon as they get avolitional contraction and you
(38:02):
can pick it up on the amplifierfor me, that's, that's when you,
uh, switch
Mike (38:07):
to move.
Yeah,
Russ (38:09):
But if they can't make any muscle at all, then you can do
muscle stem or you can send'emover the edge of the table and
you know, have them doing theextension.
You know.
But I, you know, we, we haven'tturned a muscle stem unit on in
probably 10 years, you know,
Mike (38:22):
I was, I was gonna ask you that.
That's funny.
Russ (38:24):
been a lot.
We don't have a unit, but,
Mike (38:26):
that's
Russ (38:26):
but I mean, a lot of people, there's a lot of
literature to support musclestem, so I'm not knocking that,
I'm just telling you what I havefound successful.
You know, in our, in our, youknow, rebuilding of our.
Mike (38:38):
Yeah.
And you know, I mean, ifsomebody doesn't have, if they
don't have volitional control atall, you know, I, I, I, I
wouldn't mind doing that.
Like you said, even just thepatellar mobility and, and you
know, just getting the kneemoving a little bit, like we're
talking about the first weekafter a surgery, something like
that.
Like to me, I still see the usefor that neuromuscular st.
But you're right, like you wannaget that volitional control
going.
You want, enhance that as fastas you can.
Russ (39:00):
no, I think that's fine.
I think that's a,
Mike (39:03):
That's what I'm looking for.
I'm looking to be fine.
That's good.
I like that.
Russ is
Russ (39:07):
Mike
Mike (39:09):
We're we're gonna hang on, we're gonna end the podcast.
And Russ be like, you gotta stopthat That's,
Russ (39:15):
so far ahead of your time.
Mike (39:18):
All right, so we, obviously, we talked a lot about
the knee, right?
I think the knee is like the,the no-brainer.
Use this everywhere though,right?
Use it cuff sc a, like a calf.
Like where, where do you use it?
The.
Russ (39:30):
Well, the one thing that we've been doing lately is
really working on eccentrics.
And you know that, well, Ididn't mention that, but that is
one thing that has been provenin the literature, that
eccentric training is supposedlythe best thing to, you know,
inhibit muscle atrophy.
Mike (39:48):
Hmm.
Russ (39:49):
and that's not new information.
That was in the eighties.
And, and if you remember, allthe Akinetic devices implemented
eccentric modes into theirprograms, but nobody used it cuz
it was just didn't make, itdidn't feel right.
You
Mike (40:04):
Right.
Russ (40:04):
to resist knee extension as you're getting pushed down.
It just didn't work.
So what we do is we use, we use,uh, MTRA for.
Single leg squat slides whereyou've got that single leg thing
that slides back and forth andyou're doing a single-leg squat
and really emphasize eccentrics.
So we're doing that for quads,but we also, we have a, a great
(40:27):
hamstring exercise.
I think maybe you've seen itwhile I have a patient laying,
you know, on their back with herhead facing the door, and we've
got the tlx gray band up in thedoor coming down.
To the foot and we wrap the footaround that and, and then we,
the patient in that position,you know, mimics a running
position and we teach them tobring their knee to the chest,
(40:50):
reach out with their foot, andnow they're in that eccentric
position to train theirhamstring and they have to fire
their muscle.
Mike (40:56):
Yeah.
That's big.
Russ (40:57):
really interesting.
It's really hard to contractyour muscle during an eccentric
contraction.
And that's the fun part aboutthis, is you actually see what
you've read.
You know, you're always readingthe literature.
The eccentric, my cell doesn'trequire as much muscle activity,
but it really is hard.
But once you train them to firetheir muscle eccentrically, it's
amazing.
I've had so many chronic like.
(41:20):
Outfielders and MLB and footballplayers have had chronic
hamstring injuries, and doingthe eccentric training has been
real helpful.
We also use in the core, uh,Chris Galena, who I work with
now, he, he does a lot of ourlumbar stabilization program.
He won't do it anymore withoutusing the electrodes.
Mike (41:37):
I love that.
Russ (41:38):
you can find your T ffl, you can find your lower abs.
And we had a baseball playerthis morning and he is like, you
know, doing some of the corestabilization and we didn't show
him.
He said, you got it?
And he said, yeah, yeah.
And we showed him and the EMGwas at the very bottom and he
saw that, immediately fired it.
And he is like, oh my God, Ithink you could only do like
five reps.
So we use it there, we use it inthe scapula, uh, in the
(42:02):
posterior.
we use it in the calf, you know,eccentrically.
Uh, so you know, we use it kindof all over the place.
It takes a little bit of time,but it doesn't take long.
It's just another.
It's another tool to use and it,boy, I tell you, the results
are, are really fun to see thepatient's face light up and they
say, oh my God, that's a, like,if you do prom planks, you think
(42:24):
you're doing, you know, a reallygood contraction.
But when you put the electrodeson, you can really pull in the
muscle and, and it's, it's justa fun tool.
Like I said, you kinda live itwith your creativity and you
can, you know, another thing youcan do is a neuromuscular
deficit test.
you know, for a side to sideassessment, uh, built into the
(42:45):
program.
So it's, you know, there's a lotof different applications.
Mike (42:49):
yeah, you can quantify a little bit and, and record that
so that way you can, you can,you can document it for whether
it be insurance or just to seetheir progress.
I mean,
Russ (42:56):
Yeah.
You can document.
We've got a new program that we,we've got the beta, uh, version
now where you input thepatient's name and it'll store
the amount of work they performin a 10 minute period and all
that kind of stuff, you know, so
Mike (43:08):
Nice.
All right.
Well this is somebody withinhibition right now.
How many times has thishappened?
Right?
You haven't been working withthe person, they've been at a
clinic elsewhere, right?
It's four months after e c L.
Now you haven't been workingwith them.
They still have quad inhibition,right?
What, what do you do at thispoint?
Like does, does your strategychange for somebody that has
(43:30):
this chronic, prolonged inhibit?
Russ (43:33):
Uh, basically what we do with most of those patients, and
a lot of times they have loss ofmotion also.
So if you've got quad inhibitionin four months, you're gonna
have a stiff knee, most
Mike (43:41):
Right.
Good
Russ (43:42):
So we restart them back to the two week program.
We treat'em like a two weekpost-op patient and we go back
and Yeah.
And start over with the Quantasand I, I, I've showed at our ICU
meeting that girl that had thelighter Retin Acular tear of
her, her patella, and she, youknow, she was like three, four
(44:03):
months post injury and her kneewas stiff, but it was muscle co
contraction.
So I used the, you know, I usedthe one thing you can do with
the M trigger is put.
You know, quad activation andhamstring and use your quad to
inhibit the hamstring and viceversa.
So, you know, I will just, the,the first thing I'll do with
(44:24):
that patient is make sure weturn on their quad and uh, and
work on their motion.
Cuz if you don't have.
You know, full range of motion,you're gonna have difficulty
contracting your quad becausethe medial and lateral re
gutters of your knee are kind ofstuck, and so it's pulling your
patella down, your patella'santeriorly tilted.
So motion and strength have tobe a part of that problem that
(44:46):
we address.
Mike (44:47):
right.
Makes sense.
And then in treated likeeverybody else, but just
hopefully they progress maybe ata different pace.
You know,
Russ (44:53):
Yeah.
Yeah.
The one thing that Chris, my, myPT said today that he's learned
from me and that we see allthose problem patients that come
in is educate them about theirinjury.
Mike (45:05):
Right.
Russ (45:06):
So when you tell them, look, that discomfort and pain
that you're feeling is, is notyour graft.
This has nothing to do with yoursurgery.
Oh, really?
Because they think that whenthey've been there in end, they
feel all that pain anddiscomfort.
Oh man, my graft fixing to pullapart.
You know, don't tell'em this isgonna, well we're gonna do on
our treatment is gonna hurt yourfeelings, but it won't hurt your
(45:28):
knee.
so
Mike (45:31):
That's Stealable.
Everybody write that
Russ (45:33):
Yeah, for sure.
That's one of my, my old, uh,old sayings.
But, uh, part of it is they'reafraid and if you educate them,
and you and Chris, you know, he,he said that's one thing.
A big thing I learned from youis you, so many patients have
come in and they haven't beentold you had surgery with this
graft in your knee, had nomeniscus to tear, so all your
feelings scar your feelings,scar tissue.
(45:55):
And so you could, if you couldtouch your heel to your butt in
the next five seconds, itwouldn't damage anything,
Mike (46:00):
Right, right.
Yeah, no, that's, I, I I thinkthat's, I think that's good.
That's good feedback.
And that's, that's a good thingcuz I do think even two young
clinicians might be a littlescared too.
Right.
When that happens, they may
Russ (46:13):
just tell him to just go watch a knee manipulation if, if
he
Mike (46:17):
as aggressive
Russ (46:18):
I think you can go and go into the OR and watch a 10, you
know, five to 10 minute kneemanipulation.
Someone's got 60 degrees andit's, it is not gentle, you
Mike (46:28):
Right, right.
And that doesn't tear the graft.
Russ (46:30):
No, no surgeon, surgeon's doing it to his own patient.
Mike (46:34):
Right, exactly.
That's funny.
So, uh, awesome.
Well, great stuff, Russ.
I really appreciate you takingthe time out here.
Uh, before I let you go, I'mgonna end with the, with the big
high five at the end.
Five, uh, five quick questions,five quick answers.
Um, just want to hear a littlebit about, about you, a little
bit more about your brain, whatyou're up to.
But first question for me is,what are you currently working
(46:54):
on for your own professionaldevelopment?
What are you.
Russ (46:59):
I'm getting my lectures ready for the A S M I meeting
Mike (47:03):
You didn't send your slides in.
Caroline's gonna be mad
Russ (47:06):
uh, one thing I, you know, I've kind of learned a lot from
teaching and that's one point Iwanted to bring out to the best
way for people to learn is toteach.
Mike (47:16):
right.
Russ (47:16):
get a little bit lazy.
At my older age.
I'm worried about my golf swingor whatever, but when I have to
get up and lecture, I can BS 90%of the people, but it's 10% in
the back that I need to bone upfor, so it it, it, uh, lecture
or teaching, it helps me learn.
One thing I'm really interestedin with my patients is pitching
mechanics.
(47:37):
So I've, um, you know, we gotthe baseball ranch here and
we've got, uh, Tom House, one ofhis, his CEOs that lives in
Houston.
So I'm trying to learn aboutthat and I've, my best friend in
town is the number one pitchingcoach in town.
David Evans.
I know you know
Mike (47:52):
Yeah.
Wow.
Yeah.
Russ (47:53):
he's, I'm learning a lot from them about spiraling your
elbow and taking stress andtrying to teach young kids how
to throw with less stressthrough the elbow and shoulder.
Mike (48:02):
Yeah.
Yeah.
Russ (48:03):
that's, that's one thing I'm doing.
I'm writing a book, uh, asection with Rob Mansky.
I'm working on that and, andthen we're also working on
deceleration testing withfunctional testing.
So that's just a few thingsgoing.
Mike (48:14):
Yeah.
You got a lot going on.
You're, I, you gotta focus moreon your golf game than all
Russ (48:19):
I say those are ideas.
I mean, I have a you know, havepeople that you know, kind of
help implement those.
I do write, I do write most ofall the stuff though.
Mike (48:29):
Uh, what is one thing that you've recently changed your
mind about?
Russ (48:33):
Um, I guess, uh, recently I would say, um, Is the
eccentrics, you know, to, tobringing things back to really
with the, the biofeedbackworking on eccentrics with even
with our posterior cuff, uh,pitchers, instead of just doing
concentric, really teaching themto fire eccentrically.
(48:54):
Um, the other thing is lettingmy young PTs that I trust work
on my patients.
You
Mike (49:02):
You still working on that
Russ (49:05):
Yeah, I mean, we, we, we you know, I used to like be very
protective, but now, I mean, I'mright there with them.
I think that it's the only waythat you get better.
When I had students when I was aci, I'd throw'em to the wolves,
go get that patient, evaluate'em, tell me what you found.
Mike (49:21):
right.
Russ (49:21):
know.
So, um, I think, uh, I thinkthat's one thing.
The one thing that has notchanged is restoring motion and.
Mike (49:30):
I know, right?
Russ (49:32):
So many people pass over that and they get in a
functional movement and, whichis great, but that's icing on
the kink.
So, so those things that havenot changed.
Yeah.
Mike (49:40):
Awesome.
What is your favorite piece ofadvice that you give students
nowadays?
Russ (49:45):
Um, what I said earlier is if, you know, just say how, how
can I get involved in somethinglike what you do?
And it's, as I tell'em, you needto po you know, do some research
and position.
in a location where luck canfind you.
You know, people say, oh, hejust got lucky.
Well, yeah, okay.
So he got lucky because he wasthere or she, she was there, you
(50:09):
know, and in the rightsituation.
And then once you, you find out,you kind of have a gut reaction
like, this is where I need tobe.
Then you just put your head downand go, you know?
Mike (50:18):
I love it.
That's a good one.
I like that.
I think a lot of people, um,take that for granted sometimes.
So, good one.
Um, you've already alluded tosome of these things, but what
else is coming up next for you?
What are you working on now?
Russ (50:29):
Yeah.
So my big next, uh, last hurrahis gonna be, uh,
Mike (50:34):
This is the Swan song.
Russ (50:35):
Yeah, I think so.
I've got some grateful patientsthat are, uh, willing to help me
and I'm gonna establish aninstitute, uh, a nonprofit
institute, uh, not too far fromwhere I work now.
And so we're, we're kind of inthe planning stages of that so
that we can really have.
All the toys and bells andwhistles to put out some, some
fun research and, uh, and havea, a place to, you know, to, to
(51:00):
treat people maybe that havedifficulty, financial or
whatever.
Uh, but continue on what I do,but take some of my ideas and
thoughts and, and, uh, be ableto have, uh, research people.
And we've got, Craig Garrisonjoined us in Lane Beta.
We've already got a greatresearch set, but this will just
be my own kind of baby.
And then the other thing is to.
(51:20):
To try to shoot my age in golf,
Mike (51:23):
Ooh, all right.
That's getting easier and easierevery
Russ (51:26):
3 times, but I'm 67, so I need a little extra work on my
short game, I think
Mike (51:33):
Just wait a few years.
That'll catch itself up.
You'll be good.
Russ (51:36):
I hope so.
Mike (51:38):
That's awesome.
Um, I've got a long ways to gofor that, maybe for nine, but,
um, but we'll get, we'll getthere, we'll get there.
But, uh, um, awesome.
Well, Russ, how can people findout more about you?
Do you have a place where, wherepeople can.
Russ (51:52):
Yeah, I don't have a website, but, uh, a lot of, of
this information is on mtrigger.com, so that's the name
of our biofeedback device.
And I've got the LinkedIn thingtoo.
Uh, so you can just Google myname and LinkedIn and I'm there.
I don't really do that much onit, but other people help me
with that.
Mike (52:10):
That's awesome.
Awesome.
Well, Russ, thanks again fortaking out, uh, some time from
your busy schedule to join us onthis podcast and share your
research and your experience.
We really appreciate it.
Thanks so much for coming ontoday.
Russ (52:22):
Thanks buddy.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.