[00:00:01] Chad: On this episode of “In The RACK” podcast.
[00:00:04] Nick: For example, your doctor said, this is the worst knee I've ever seen. I can't tell you how many fucking times I've heard that, or the worst hip I've ever seen. I'm like, man, because the last person I just saw from that same doctor says the same thing about the last person I just saw. Did you see him before or after? I'm not really sure but we hear this all the time. And I get it like, I'm sure it's some sort of.
[00:00:30] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, welcome to “Episode 05” of “In The RACK” podcast. I'm your host, Chad. And I am getting reckless today in the rack with the one and only foot guru, Nick. Today gonna get a little reckless today “In The RACK”. In fact, we're actually going to call this series of episodes “Reckless In The RACK” go figure. This is something that a few of our patients actually brought up to us. And we thought it was actually a great idea. So we were just going to run with it. And basically what reckless in the rack means is flex story time for us. Actually, last episode, we talked about this a little bit, instead of that we're gonna have little story time and talking about some stories that our patients and clients tell us. And some of them are pretty outrageous, some of them are pretty good. But we want to elaborate on some of these stories, and this is good. Because the best part is one of these stories actually might be your story. So this might be actually a good lesson for you. So see if you can connect with some of these stories, and seeing if maybe this might kind of jive with you a little bit.
[00:01:57] Nick: And just to clarify as well. In talking about other reckless situations, we're not necessarily trying to signal anyone out or say that we're better than anyone placed us on a pedestal, that's not what we're saying. We are trying to give examples of what we feel is either patients being misguided or misled, or the provider didn't do a comprehensive job in our minds. And we were in a fortunate situation to then help them. This is something that we feel we are constantly learning every day. So we want practitioners, other providers out there listening to this, we want you to do the same we want you to because we can do better as a whole. So we want you to go continue to learn, continue to better yourself, because you can only help people. As much as you help yourself, you need to be in a good place with your own health in order to help people with their health. And if you're listening to this as a potential patient client or a current one advocate for yourself, if you are seeing a doctor, it doesn't matter doctor, physical therapist, anyone even if a personal trainer, make sure if you don't feel they're asking enough questions, or you feel something might be playing a role in whatever you have going on, and they don't address it, you bring it up. That's okay to do. You can absolutely do that. So just wanted to clarify all of that before we get into it.
[00:03:26] Chad: Because we don't want anybody to have hard feelings. And it's not a personal attack at all. We are all on the same side. So we just want to make sure that we're not stepping on anybody's toes, but give it a listen. So here we get our first example of the day, who's our first example that day?
[00:03:43] Nick: Our first example is Keiser.
[00:03:45] Chad: Keiser, that's a good one.
[00:03:46] Nick: We're actually not naming real names.
[00:03:48] Chad: This guy's not name is Keiser.
[00:03:50] Nick: So this person's name is Matt Keiser. That's the nickname we're going with. If you're not familiar with what a Keiser is, it's a piece of exercise equipment or a company that makes exercise equipment. So anyway, Keiser had a foot issue, a recurring foot issue actually. Keiser was dealing with recurring stress fractures in the metatarsal head, so the ball of the foot essentially. And Keiser had seen numerous practitioners, podiatrist and all these specialists was given orthotic after orthotic recommended certain “stability shoes”. All these things that they had done to try to help cushion that foot for Keiser to take some load off as many tarsal heads. Keiser was also a runner. So Keiser kept running, it kept happening. Keiser wasn't really having much pain with running a little bit, but a lot of the pain was actually occurring at work, but no one ever really asked. Aside from running, they just assumed it was running. So as we got to digging in, Keiser was seeing me and I had kind of bring the worksheet in and the worksheet figure was a clog and had about a 35 millimeter drop from heel to toe. So if you imagine that that's placing the heel up so high that now all this downward pressure force of gravity is being placed on the ball of the foot. So normally, if you're standing on the ground flat, you would have 50% of your weight on your heel, 50% on the front of your fleet, so 50% on the back for 2% up front, if you jam that heel up, well, now we've just placed a greater percentage on the front could be 75-25 Could even be 90-10, who knows. But this issue is likely recurring, because 8, 10, 12 hours a day, this individual Keiser was just hanging out on the ball foot all day. So we dug into that a little bit recommended a different pair of shoes, ideally, zero drop for work. And obviously, those stress fractures that we were dealing with, in that time, had healed and going forward, less pain at work, less issues at work, was back to running, pain free, all that kind of stuff. Haven't seen any stress fractures since crossing your fingers hoping that they don't come back. But we'll see. So we haven't heard yet. But good news so far, we're trending in the right direction. But nonetheless, big thing there is don't just assume something is caused by running because running gets a bad rap running it. So many runners deal with injuries, it's not always running, it could be something else going on. So we have to dig a little deeper get into the weeds a little bit more with some people, depending on what their activities are, what their work is all that kind of stuff.
[00:06:35] Chad: Nice. Speaking of digging into the weeds, I actually just saw this kid the other day, we're gonna call him Rogue. And if you guys aren't familiar with Rogue is, it's also exercise equipment. So I actually had a different patient in mind for this, but I ended up picking this guy only because I thought it would be great for this podcast, and it's fresh in my mind. So this kid's 14 years old, and he's a big wrestler in sophomore in high school are going to be a sophomore in high school. He initially injured his lower back when he was wrestling, he actually got slammed on the ground on his back. So he began having lower back pain probably over the last couple months. And he was seeing PT, I think two or three visits. I think he said, “Nothing really changed”. And he said, “He really gets most of his pain when he's squatting”. And it's not like when he's always squatting, it's after his seventh or eighth rep of the first set. So I sat down with them. And I said, “Listen, can you just describe to me because I'd like to do this because I'm curious?” So I always ask and besides all my other evaluation questions, my question is, what did that last PT do with you, or what was your last PT experience? Because I want to know for two reasons. The first reason is, I want to know what they did with you to see if we're kind of on the same page, or to see what they did with you, because that obviously didn't work. So I'm obviously not going to do that. Whether it be exercise or manual, I'm interested in all of it. So he came back and he said, “They actually just gave me a bunch of stretches”. So I said, “What did they give you for stretches?” And he said, “Mainly just my lower back”. I said, “So can you just show me with those stretches are?” And if any of you guys are familiar with these stretches are, it's Williams flexion program. It's basically every type of flexion exercise that you could do knee to chest, all this other stuff, which is pretty much standard. It's part for the course. So I wasn't totally shocked to see that. Not to make this sound horrible. But I bet this therapist that whoever that he saw, probably gives Williams flexion protocol to almost every single low back pain patient that walks through the door, whether they're 14 or 80 years old. And that's a harsh thing to say but that's the truth. And that's the reality, and that's just what it is. This kid's a 14 year old wrestler and he gets Williams flexion exercises when he clearly said, “I have pain when I squat”. That's the only time he has pain first of all. So here's the red flag for me as a 14 year old restaurant wrestler has low back pain, but only when he squats. So what the fuck you think I'm gonna look at? I'm probably going to look at him squatting. Get him “In The Rack” baby. So I said, “Just let me know, if they actually watched you squat”. And he said, “No, they didn't watch me squat”. They actually just assessed my mobility and just gave me stretches. And I said, “That's really great” because the only time you have pain is during squats. So that makes a lot of fucking sense. So this is why it's so important that we need to bridge this gap between training and rehab because how can we best help our patients and clients if we're not addressing the actual reason why they're coming to see you? So this doesn't mean that I didn't perform my normal evaluation. I did dig a little bit deeper there. So the big thing that we like to find out is what's the root cause of the problem something like this and low back pain is probably the most common thing that we tend to see. So let me just give you a little hint for all the people that are listening. And if you're a provider, or if you're a patient, if you have a patient or you are a patient with low back pain, odds are it's not the low back that caused your pain and let me just explain that. So in the last episode, or maybe the episode before that, I might have talked about the knee being a follow up with a low back is the same thing. So because the knee is in between your hip and your ankle, it does whatever the hip and the ankle say, just like what the low back does. The low back is in between your upper back and your hips. So who the hell do you think's gonna tell that low back what to do, it's either gonna be the hips, or the upper back. And I looked at this kid's hips, and they looked fine, his upper back was not great. He was lacking a lot of extension mobility there, which when you think about it, during a squat is pretty detrimental to the lower back. Because if he's not getting a lot of extension there during the depth of the squat, or during the eccentric phase, as he's going down towards the ground, he's gonna get a lot more trunk flexion forward bend. So what's that going to do, that's gonna place a lot more stress on his lower back. So that was the first thing that I noticed. Now, the second thing that I noticed, because he has pain when he squats and I'm looking at his squat, he's also got a limitation and his ankle mobility. I would say the one thing that I notice mostly is that he had a lack of dorsiflexion, which is basically your knees over your toes kind of thing when you're actually squatting down and your knees start to kind of creep forward, and your ankle starts to flex forward, that's what we call dorsiflexion. So those are the two things that I noticed. And of course, I hadn't take his shoes off, because that's what we do here. Nobody, nobody trains their shoes on here. So I had to see for myself what was going on there at the ankle on the foot come to find out not only is the upper back limited, but the ankles are also limited, which is also adding stress to his lower back. So to sum this up, when he went to PT, he was told he needed more low back flexibility, when in actuality, he actually needed more ankle and thoracic spine mobility. Crazy, sad, disappointing, but it's true that's the reality of it. So I had him go through a whole routine of squats, we kind of modified his squats, we gave him some mobility exercises for his upper back and ankles. And don't you know it, he had no pain squatting, when he left, so I gave him those exercises to leave. But the moral of the story here is if you're treating as a provider, a site of pain whether it be the knee, the hip, the ankle, whatever, because that's where the pain lies, and you're only treating it for that reason, that's bad reason to treat that. So I want you to dig a little bit deeper, and find out why. Why is this kid having pain? What's the root cause of this problem? And for this kid was not as low back. So that's my example for Rogue.
[00:12:55] Nick: And now we're gonna have to take a break is that was cardio for, Chad. Now, that's a huge point. It's not to say that you shouldn't also treat the area where there's pain, you might have to calm some of the pain down in that area. You should be looking elsewhere it is of course as well. Next one, we got TRX. If you don't know what a TRX is, get yourself one. It’s a great home tool for exercise. So TRX came to me a few months ago, she had a fall on an outstretched arm. So actually fractured shoulder and elbow. And like I said, this was a few months ago. And the shoulder was slightly displaced, but not enough to where they wanted to go in operate. The elbow was non-displaced just a clean fracture. And they wanted to handle conservatively. So she came to PT, we started out nice and easy as things were still healing. And as weeks go by, she has follow up appointments and images show that it's not healing the way they want it to. So now these fractures aren't healing. And the doctor that was treating the elbow happened to say that, “I don't want the physical therapist stretching the elbow because an elbow super stiff”. The reason was is because the elbows like leather, so if you stretch it, it's just going to return back to its normal position. Now I'm no leather expert, but I'm pretty sure leather is the exact opposite. If you stretch the leather out, it doesn't return like an elastic. So that was very confusing. But nonetheless, we dove deeper into this patient's history and come to find out, TRX is a plant based eater, that's a whole other topic for a podcast. We'll get into that, that's not the point. But when we got into her daily intake, I just approximated it, it was anywhere probably around 800 to 1000 calories, which is not enough for functioning well. So her body's clearly not going to heal well, if she's malnourished like that. Let alone her protein intake was probably very, very low. So in terms of the kind of building blocks for the body, the tissues of the body, she didn't have adequate pools stores of them in the body at all. So her body has been struggling to heal from inside because of this lack of nutrients. So now we started to kind of troubleshoot that and talked more about that gave her some ideas for whatever her reasons are for being plant based. Let's find some strategies to get more protein and get more calories in really. So like I said, that'll be another podcast. But needless to say, the leather thing was really confusing. Anyway, when someone tells you if it's been a few months the fracture is struggling to heal, there's something else going on there. We have to dive deeper. We can't just say, “Your joints are just stiff, you just don't heal well”. Le t's take a little bit more. We can't just keep taking images of the joints, and then say, “Let's operate because now they want to operate”. And if this person's joint bones aren't healing now, and we go operate, say they want to do a joint replacement on the shoulder, because that small displacement isn't healing. Well, do we think that replacement is going to take very well, if her bones don't heal well to begin with? That's probably not a very good surgical candidate. Again, this isn't to come at surgeons in particular this is just saying, we need to look at this comprehensively, we need to look at the individual and not just this, we can't have a myopic view on this injury in this situation. We have to say, “What's your sleep habits? What's your nutrition? What's your job, your stress like?” all that kind of stuff. So we got to dive deeper with everybody, we can't just do it just because this one person had it, and they had this weird thing going on. Now, you got to do with everybody.
[00:17:18] Chad: I would agree. And this is going to be a common theme for sure that we're going to be seeing, because we're going to be doing these, we're gonna kind of sprinkle these episodes in, and you're gonna see that the common theme is going to be either, it's going to be pretty much all providers just giving out information. It's not only wrong, let's be honest, but it's damaging to patients. And we can kind of go down that whole rabbit hole of mindset. But we don't have time for that. But what we will say is, this is something that we call pain science. Pain science, for all of us know what that is, it's when you say, for example, like your doctor said, “Man, this is the worst knee I've ever seen”. I can't tell you how many fucking times I've heard that, or the worst hip I've ever seen. I'm like, “That's so weird”. Because the last person I just saw from that same doctor says same thing about the last person I just saw, did you see him before after? I'm not really sure because we hear this all the time and I get it. I'm sure it's some sort of a marketing type of tool that they use or scarcity tactic or whatever you want to call it. But at the end of the day, it's damaging to the patient. And the patient can all they can think about now is, “Oh my God, might that's the worst knee that the doctor has ever seen”. This knees, I've got to be in more pain. Now all of a sudden, they tell themselves they're more pain or they tell themselves that something's wrong when really there probably isn't something wrong or something that the doctor said that, “It couldn't be fixed or PT won't work or whatever it may be”, they have all of these ideas in their head now. And this just really makes it harder for us as providers to help them kind of move forward because now they're just so brainwashed and just stuck from what they were told by either a friend or a doctor or whatever doesn't have to be doctor it could be anybody and that kind of goes along with this next guy. And this next guy, we'll call him [inaudible 00:18:59] in for all of you guys that don't know what [inaudible 00:19:00] is also an equipment company but they make a lot of cool shit. We got all their steel mesas and kettlebells and all that cool stuff. But anyways, he came to me about a few months ago, this guy is in his early 70s and probably one of the nicest guys I ever met. He comes in. He's got a classic sciatica that you would typically see in somebody like this. Doctor said, “Why don't you just go to PT strengthen up that back, and see how it goes?” I think the doctor kind of made it sound like it was kind of “Just do it”. Like kind of fluffed them, whatever. So he said, “I'll give that a go”. And he was recommended to us by somebody else. So he's like, “I heard great things about you guys. So I'm gonna go check it out”. So when I first met him, one of the first things that I asked him, “What is your main goal? Like, what do you want to get out of this?” And he said, “Chad, all I want to do this summer is be able to get back to fishing”. I'm like, “Wow, that sounds like a pretty good goal”. All I said, “Why can't you fish right now”. He's like, “I'm gonna get so much pain, I can't do it, I just can't swing” because he doesn't just do regular fishing. He does like fly fishing. So I'm not big Fisher, but I've seen that on TV and it looks pretty aggressive. So there's a lot of whipping and rotation, whatever. So I started for about three visits, and he was making some steady progress. Actually, the pain down the leg was pretty much gone. So we pretty much dissolved all of his sciatica which was great. It was centralizing up to his low back which means that that pain was actually making its way up, which is actually a good sign, which we had many conversations about. And this is common, and it's not everybody gets that, but some people do. So we had a little bit more discomfort in his lower back, but that's okay. He had no pain down his leg, which he was so psyched about. So we did kind of push him a little bit more in that last visit that I saw him but that third visitor so because he wanted to get back to fishing, so I'm like, “Alright, we gotta try to make this as functional as possible”. So we started doing some gentle rotational exercises in there, some overhead stuff, just some easy strengthening, but stuff that we could make as authentic as possible to whatever fly-fishing would be to him. So he happened to have an appointment with his doctor following that last PT appointment. And he came back and he said, “Chad, I got bad news”. I said, “What's the bad news”. He goes, “My doctor wants me to put the PT on hold”. And I said, “Why do you, you’re doing so good?” He told me, “I told them what I was doing, because he asked me, I told him, I was doing some rotation this and that”. And he goes, the doctor said, you shouldn't do rotation actually rotations bad for you. And you've got so much to notice in that back, it's only going to make you worse, when in essence, it was actually helping him. And he just associated that low back pain, because I don't know if the doctor didn't know what the situation was or what his signs or symptoms were before he actually saw him. But he kind of made it seem like the pain in his back was as a result of rotation, which is actually as a result of centralization of his low back pain, which was a good thing. So I thought about that for a second. And I said, “My response to you is going to be, aren't you want to get back to fishing?” I said, “How can you go back to fishing when you can't rotate?” Rotate is a pretty functional movement. It's actually something not only with fishing, it's something that we do all day. Like, you just got out of your car and walked into my facility, you had to rotate to do that. This is something that you have to do every day. So I don't understand why he's saying this. And he goes, “He's very old school”. And this is a generational thing I know. And I wasn't going to convince him otherwise. So it was one of those things where he was just basically at the point where I'm just gonna go on hold. I'm just gonna see what happens. And I said, “Alright, that's fine”. I said, “I'm here when you're read”. And he goes, “Are we gonna do a rotation stuff when I get back?” And I said, “Absolutely”. Because that's what I'd be doing you a disservice my friend. So he goes, “Well, maybe we'll just go a little lighter when I come back next time”. I said, that's fine. I said, “You call me when you're ready”. So it's very disappointing to hear stuff like that. Not only that, but it's also makes me worried for him, because I'm not sure that he's going to move much now at all. Now that the doctors kind of made him think that just movement in general is bad. We just got to sit on the couch and just live the rest of our life like that, that's crazy. This guy's nearly seven, you still got a little bit life left live. He’s got to get out there. He's got to move. So I think with all that nonsense in his head, I'm hoping he gets over it and I'm hoping he comes back. But that's just the stuff that we deal with on the day to day basis. It is what it is. But it's common theme for sure.
[00:23:40] Nick: And I think that was a good point you made there about the practitioner maybe didn't know and was kind of searching for an answer. And for any other providers listening, doesn't matter what you are. If you don't know, don't make something up, that just sounds good. It's okay to say, “I don't know”. And if you aren't gonna make something up, don't make something up that crazy. Just don't do this. Like just make something that's a little less intense. But it's okay to say, “I don't know”. Patient’s consumers, they're all seeking answers. But you're doing them a disservice by giving them an answer that you actually don't know that is potentially wrong. And in the same situation it's okay to say, “I don't know, I'm going to look into that”. Now, I'm gonna go talk to my colleagues about this, whatever your answer is that you can make it so you're still working on behalf of the patient, or the client. But don't just make something up in the moment because you want to save face and be like, “I have this big degree. I have to know this”. Now, you don't. No one knows everything. And in today's world, there's so much going on. There's so much that can influence pain, all this kind of stuff. There's so many factors. So, for someone to know everything is crazy, it's crazy. And people want answers. But we'll give them the answers over time as we gain more information and are able to put together the appropriate answers or more accurate answers. Maybe not the perfect answers, but more accurate answers.
[00:25:14] Chad: I feel like, there's that. What would you call it? It's almost like that anxiety that the patient has for you to be like, “Listen, I want a diagnosis. I want to know what the hell's going on. Just tell me what it is. Don't tell me fibromyalgia”. That's a topic for the podcast. I didn't mean to do that. I just came out. So anyways, that's four good examples. I think we'll stop at four. We'll kind of see how it goes. We'll see what you guys think. And actually, we got some stuff coming up, though, in the next episode. So what we got broke the next episode, Nick?
[00:25:51] Nick: We're gonna start to get into a little bit of nutrition next episode. We're gonna take a couple common thought processes about new nutrition in our current state of health and debunk some of them, whether it's something that we've been conditioned to think over the last couple of decades or it's just something that's become mainstream in recent years. We're going to maybe not fully debunk all of them, but we're going to just give you the other side and let you determine on your own what you feel is best.
[00:26:23] Chad: Nice. That'll be a good one. And maybe we'll sprinkle some other stuff in there for you guys. Because everybody's always ask them, what do you guys take? What's the best supplement to take? Maybe we'll sprinkle that in there for you. But anyways, moral of the story here. So we hope that some of these stories connected with some of you guys, whether you're a patient or a healthcare provider, these stories are crazy. But they're not only crazy, they're reckless. And that's why we call this “Reckless In The RACK” and it's reckless as nobody take this personally. It's reckless as a provider to be telling patients, this type of garbage. And listen, if you're a healthcare provider and you're listening, we just asked that you don't be reckless with other people's health. Now, for all of you patients that are listening, you shouldn't put up with people who are reckless with yours.
[00:27:20] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.
