[00:00:02] Nick: On this episode of “In The RACK” podcast, absolutely, Nick. And I think it's just time that we call a spade a spade and just say that a lot of these PT clinics out there, especially if the utilizing traditional model, they just don't know. I mean, let's just be honest and say it. We hate to say that it comes down to ego but that's true.
[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, everyone. Nick and I are here “In The RACK” today for Episode Number 02. It is July 2nd, we're all here just sitting looking all American out as the 4th of July weekend is right around the corner. However, as you guys are listening to this podcast, you guys will probably already have had your 4th of July. So we hope that all of you and your friends and family had a great 4th, there is just one thing that we wanted to be clear on first, before we kind of get started on this episode. And that's just addressing the fact that we call ourselves doctors, it's not necessarily a bad thing. But we just wanted to kind of talk about that a little bit.
[00:01:35] Nick: It’s not that we don't like it. We went to school earned our doctorate in physical therapy. But where our healthcare system is at right now it's more of a sick care system than an actual health care system. And we believe that it needs a big overhaul, it needs a big change. So in referring to ourselves, as doctors in this insurance based model it almost makes you sound, unfortunately unapproachable, which shouldn't be the way it should be. And that's just why I think we're going to move forward and just break away from that. It's already an intro though. And we're not going to change that. Because if we change the intro now, I won't be able to get paid next month.
[00:02:19] Chad: No, you're still getting paid. It's all good. It's one of those things to where we just developed such a great culture here. You walk into our facility, and we're wearing T-shirts and shorts and sneakers. We're not wearing lab coats and shirts and ties. For us that just makes us feel less approachable. And it just kind of also brings more, it almost looks more serious enough for nothing. We're movement specialists like trying to move in in a white lab coat, or a shirt and tie with khakis, and dress shoes, that's not going to happen.
[00:02:53] Nick: It's clear that with the unapproachableness, it's not the fault of the doctor a lot of times. When you are going through insurance, and each year, you have to see more and more patients, doctors become the celebrity in a way and that you never get to see. You never really get to see it, you're waiting to see them and you only see them for a short period of time. That's because they have to see so many patients throughout the day, just to make the same amount of money that they made the year before or the year before that. And that's a result of the insurance company not the doctor themselves. So it's not really the doctor’s fault. It's the way the model set up.
[00:03:27] Chad: Let's not forget how unapproachable I probably already am anyways, I got a Mohawk and tattoos. And I'm just not your typical physical therapist. So for somebody to walk in the door and call me Doctor, it's can't be that easy. But secondly, we just want to be clear that with this podcast, you don't have to lift heavy to gain any benefit from this podcast at all. It's not a requirement to watch this podcast or listen to this podcast. So I don't want people to think that just because they're not heavy lifting.
[00:03:58] Nick: Most people should be using some form of resistance training throughout their lifespan. But that doesn't mean you have to do it the way we do it just to listen or the way you may associate typical “meatheads lifting”, but we do strongly believe that everyone can benefit from lifting weights.
[00:04:20] Chad: For sure, absolutely, totally agree. So let's get into today's episode. So today's episode we'd like to talk about training is rehab and rehab is training. What's the difference? Well, ProForm physical therapy, there's not a whole lot of difference. Besides the fact that with physical therapy, you're going to get just more hands on type of manual therapies that you would not normally get through training. However, the training itself is very similar. You walked into our facility, you wouldn't be able to tell the difference between a patient or a client or whether they're doing rehab or training. And let's just talk a little bit about how the traditional PT model might be missing the boat on this one a little bit. And I think a lot of this has to do with where the profession is going as a whole. And I really feel that we're trying to take this time to really, really harp on the fact that this needs to change. And if we keep going back and forth, we're never going to really know which direction that we're going in. So I really feel that as a profession physical therapy needs to start bridging that gap between training and rehab, so that we can best benefit patients and clients with getting them to reach their goals and activities that they want to get back to.
[00:05:37] Nick: Unfortunately, a lot of people think of those two things, training and rehab as two completely separate entities and we need to stop that. Because realistically, it's more of a spectrum, or a continuum, where you fall at some point on that line or that timeline, depending on a variety of factors, it could be a recent injury, it could be your sleep schedule, works crazy right now that your stress levels, there's a lot of factors that play a role other than just injuries or pain. And we need to think of people being on that continuum, and moving them more towards the training side, if they are more on the rehab side, or if they're on the training side, trying to keep them there. And that may not mean, training as in weightlifting all the time. It could be training as it pertains to their individual goals, whether they're a sport athletes, or some kind of recreational athlete could be something that has really nothing to do with it. The typical thought processes with training, it could be something like pickleball, my dad recently just got into pickleball, that wouldn't be considered something where someone needs strength and conditioning. But if someone wants to play that, they got to be able to move quickly, they got to be able to rotate, they have to be able to move forward, backwards side, everything. So you need to be able to move in a certain way. And in order to do that you need to prepare the body to do so.
[00:07:07] Chad: Absolutely, Nick. And I think it's just time that we call a spade a spade. And just say that a lot of these PT clinics out there, especially if they're utilizing the traditional model, they just don't know. Let's just be honest and say it. And we hate to say that it comes down to ego, but that's really what it is at the end of the day. Some of these PTs just can't admit to themselves, that they really just don't know how to progress some of these patients and clients. They have not been introduced to this hybrid model, as well as strength conditioning. And let's just say that they're not really doing strength conditioning. I mean, doing Straight Leg Raises until Week Six is absolutely absurd. I mean, wouldn't you agree?
[00:07:48] Nick: It's one of those things that when you come out of school with a degree or a license in the medical world, and I'm sure this is in other fields, but I just don't know those areas enough. You're almost afraid to say I don't know. But sometimes it takes even more courage to say that we don't know everything, there's so much. We know very little. The more you find out the less you know or something like that. But it's the type of thing that everyone's just kind of afraid to say, “I don't know, or I'm not too sure”. And in doing so we cause more harm, because we end up continuing on with the little that we do know. And if we just continue to plateau or stay in the same place, we don't progress along that continuum, or we end up making something up and doing something that might be totally wrong. And back to that what, Chad, was saying about the others. Some of these clinics just don't even get off the table, don't even progress. I actually just had a recent patient come in. And I think she's about 60. And she said, I'm just looking to be pushed hard in an athletic approach. And it really just kind of hit me. I was like, “Wow, that's really cool that you're saying that”. But it also speaks volumes to what the rest of the industry because she had gotten in numerous PT clinics, and never felt like she had an athletic approach. If you're human, you're an athlete. It doesn't matter if you're done with sports. Just because you're done with sports doesn't mean you stop being an athlete. If someone is walking across the street, they walk. They think the street is clear, they walk and a car comes whizzing by what are you just gonna go? Looks like my time's done. I'm not an athlete anymore. I can't move quickly anymore. It's crazy.
[00:09:37] Chad: Absolutely, man. I think this is another rabbit hole worth diving into for sure. I mean, your patients 60 years old. How many times have you heard of our older patients or just our patients in general just being told at you can never run again? You can never squat again. You can never jump again. You can never play golf again. All of these principles are loading principles. These are principles that people need to continue to do so they can get back to the activities that they want to do. Let's just be honest and say that's just absurd. And loading is just one of the main principles that we do here. And not for nothing but loading principles, it's like written fucking law man.
[00:10:20] Nick: For people who don't know Chad's referring to Wolff's law is for bone. And then there's, I think it's Davis's law that's for soft tissue. So muscle tendon, if we apply the load to the tissue, the tissue will get stronger, go figure. And those are the two laws that realistically no PT, strength coach, doctor, anyone in the healthcare field should forget, they should be underlying every decision we make. Because even if anywhere along the injury, there are times where we may have to offload to let things heal, let things calm down. But at the end of the day, that goal is to get back to progressive loading to restrict in that tissue, and hopefully gain it gained strength past the point which they had before, because that may have played a role in their initial injury anyway. So it really comes down to this question of capacity versus demand. You have a certain capacity that your body and the tissues can tolerate. And then we have the demand that we place on it day in and day out. If the demand surpasses the capacity, something could give way. If your capacity is higher than the demand, you're putting on it every day, you're in good shape. But if we don't stress the capacity, then we're not going to continue to keep the high capacity, your body's going to meet it back down where the demand is, because that's the way your body works. It wants to survive. It cares about efficiency and survival. So if we're not continually stressing the capacity, which we believe is very accomplishable in a training capacity, then your body's overall capacity will dwindle down. And soon the demand will meet the capacity. So we always need to be throughout the lifespan, stressing the capacity, making sure our capacity stays at a level that's over the demand. And sometimes blurring those lines where we test ourselves but not every day. We don't have to do that. And that's kind of the overarching theme of this whole podcast of PT, or therapy and rehab. Meeting that training at some point it needs to happen at some point, we need to get more on that training end of the spectrum, because otherwise we're not getting into the increasing capacity part.
[00:12:36] Chad: That's a great point, Nick. I feel like we need to start talking more about capacity and the demands that we're placing on the body. I feel like most people are overreaching, and most people are throwing way too much demand on their bodies and they haven't developed the capacity to be able to take those demands. And let's just throw a few examples out there. One for starters, what's the most common thing that we see besides low back pain is plantar fasciitis. And what do we normally see with a patient that comes in with plantar fasciitis that might have seen a doctor? Well, they're placed in a boot for six weeks. Let's talk about capacity and demand in this example, and say that if you're in a boot for six weeks that means that your capacity is absolute shit. But now all of a sudden, you take that boot off after six weeks, and you're placing all this demand on a foot that hasn't been able to touch the ground in six weeks. And what do we know? We get fucking pain again? Well, that's just great. So capacity and demand are super important if we can't load up these tissues and adapt these tissues to the demands that were placed into them, we're always going back and forth.
[00:13:46] Nick: He got really close to the microphone, because a little touch and go for a little bit. He wasn't actually angry.
[00:13:52] Chad: Dude, we were just talking about the perfect space between your mouth and your microphone. And if you can just stick your tongue on that microphone.
[00:13:59] Nick: Test the microphone, that's how you're close enough to the microphone. That's the quick test. Just make sure you have your own microphone. We don't want with everything going on out there. We don't want people sharing microphones not okay right now.
[00:14:12] Chad: I got a little taste on that one.
[00:14:14] Nick: But let's get back to it. Let's give you an analogy of considering a cup and the cup fills with water. So the cup is your body's capacity, and the demand placed on your body and its tissues is water filling the cup. If we don't have a high capacity, it doesn't take much demand to surpass or to overflow that cup. So we need to gradually increase the size of that cup. So in rehab situation saying acute injury, someone sprains an ankle. We may have to in the short term remove some of the demand. So we need to remove some of the water, so we need to take demand off the body that could be crutches. We take load off the foot of the ankle. But then at some point, if we do that too long the cup will shrink. So now over time, we can't take on as much water. So long term, we need to gradually increase the size of the cup or get more capacity. And that's what training, strengthen conditioning, this world of Strength Conditioning does it really, really well, they understand this. But unfortunately, in the world of PT, we miss this a lot of the times. We have a lot of, of clinicians out there that that miss this boat of at some point, we need to increase the size of the cup, they're doing a really, really good job when someone comes in and a lot of pain. And they can say, let's work on it, let's get your pain down and let's do some exercises that aren't painful. So we're removing the water, we're taking demand away. So the person feels really good because the demand is gone. But all the while their cup is shrinking. So their capacity is shrinking. So when they try to go back, just like Chad was saying, they get into this cyclical, this vicious cycle of the injury coming back goes away comes back, because all you're doing is you're just removing the demand. I feel better. I'm gonna go back. We’ll cut small. So it's not going to take much, much till you get hurt again. So it's that type of thing where capacity versus demand, it sounds simple. And that's simplifying a very complex thing in the human body. But it's okay to look for some simplicity in a world of complexity. Because if you're just looking at complex things with a complex thought process, it's just going to confuse the crap at it's going to stress you out. So let's look for a little simplicity behind what is complex, while respecting the fact that it is complex at the end of the day. So, Chad, let's talk about your training for a little bit. Because if people know what you look like, they know you have some experience in training and that is resistance training. He has zero training for his cardiovascular health.
[00:16:55] Chad: Cardio is just not my thing. Resistance training, yes. Cardio, no. Don't sign me up for cardio. I would say that my training first began probably 15 to 20 years ago. I was a sophomore junior in college and undergrad anyways. And that's when it really kind of took off for me. It wasn't until probably my third year in graduate school where I actually had my first injury. I was into powerlifting. And obviously, resistance training is, as Nick just said, but definitely noticed. My blowback started to ache on me and I was into power cleans and all that. And not to say that I didn't probably injure myself in that regard there but I'm not hugely in love with bees, but I remember I was outside one time with my wife, then girlfriend at that point, and there was this bee that was flying towards my face and I actually leaned back to try to swat at this bee and it literally felt this pop in my low back and I hope that's not nothing. And then I ended up waking up the next morning and couldn't move. But I still tell everybody that I was power clean and like 300 pounds and it felt a pop as power cleaner. But it was really just this fucking bee that just flew into my face and I just tried to swat it as best as I could.
[00:18:14] Nick: And to this day, he refuses to consume honey as a result. So you had that one kind of big injury. How did you get back into your training? Because you clearly liked training, you would be doing it a couple of years. How did you get back into it?
[00:18:30] Chad: Well, I was fortunate to have some great mentors, not only physical therapist mentors, but strength conditioning coach mentors and a little combination of the two and they not only helped me with the rehab side of things, but they also really ingrained the importance of these loading principles that we're talking about today. And how important it is for me to kind of get back on the horse so to speak. So I really never stopped bench pressing, squatting, deadlifting. I did make some modifications, but I never actually ended up stopping those movements as I was able to kind of push through them. Honestly, I would say that the position that probably gets me the most as time went on was just sitting for periods of time. If I had to sit for prolonged periods of time, forget about it and whether it was in an airplane or whether it was in my car for hours. I mean, it wouldn't also be uncommon for me to get pain down my leg as well. But I was very mindful of positions that my body did like and what my body didn't like. And with some of those signs that I was having my body tended not to love barbell deadlifts. So I would modify with trap bar deadlifts or even still to this day, I don't love front squats. So I will modify with either safety bar squats or back squats or even belt squats as it's just safer for my back and I can continue to load those tissues appropriately.
[00:19:54] Nick: So you just modified the movement instead of sitting in bed all day, that's a novel idea. So you changed your movement profile so to speak, and you modified certain movements. Have you tested the waters with anything in that time, maybe more so shortly after the injury more so than now, just because it's been it's been quite a few years?
[00:20:27] Chad: I did test it out in the beginning. And for me, I had what they call a neural tension signs, which is basically a fancy term. I've got nerve tension that runs down my leg So anytime I extend my leg, whether I'm reaching down to touch my toes, or trying to kick my face which I can't do anyways, that would cause me to have an increase in symptoms. So certain movements like say, for example, barbell deadlifts in the beginning, weren't great even trap bar deadlifts weren't great just because of that flexion based movement that I was doing was irritating my symptoms. So I would say that I did test it out in the beginning, I don't have any of those issues now. I can barbell deadlift now for sure. I don't barbell deadlift, as heavy as I used to. I'm not getting any younger, and I also getting my ass kicked by you all day. I don't have any issues with that stuff now. I can certainly load up my back like that. Now, I just have to be very mindful of the signs and symptoms that I am feeling because it's not unusual for me to feel those even till today. But if I catch it soon enough, it's not an issue.
[00:21:36] Nick: So essentially, Chad, just removed certain demands. So he removed certain drops of water and plugged in other drops of water, other different demands with similar effects that would continue to increase his body's capacity or his cup size. So his body could still tolerate certain things. Like you said, he still has issues with prolonged sitting, stuff like that. But realistically, should anybody sitting for prolonged periods of time, probably not, we all should be moving pretty regularly throughout the day. We were made to do that we were meant to do that. So we probably should move in some capacity at a regular interval throughout the day. So that's really good practice for any human or any animal for that matter. So there's Chad's kind of story on training and rehab. I think it's also important for us to say that Chad's training background is largely resistance training. He was mentioning deadlifts, all those types of movements cleans. And it doesn't necessarily mean that everyone's got to do those max out. And those should people be doing, hinging squatting, lunging all those types of movements in some form and capacity with some terrible type of external load? Yeah, probably. But it depends what your goals are, if someone wants to run a marathon, if someone wants to do anything cardiovascular endurance in nature, you need to improve your body's endurance capacity. So that would require you to ramp up the training and running in a gradual manner. If someone wants to get into something like Jujitsu, or some kind of martial arts that's gonna require you to gradually build up your body's tolerance to vulnerable positions, increase your flexibility, increase your endurance, your muscle endurance specifically for all those awkward positions as well as a lot of just grappling around on the ground and rolling around on the ground where heart rates up, but you're still using muscles and using the strength that you have. So it really just depends on your goals and what your desires are in terms of what you want to do for your recreational activities and your physical activity.
[00:23:51] Chad: That's a solid piece of advice. I think we just all start to need to think a little bit more about loading and loading principles and the benefits of loading our bodies. We're on Earth, we have gravity and ground reaction force that all contribute to these amazing benefits that we get from loading the body. We're humans, that's what's supposed to happen. And if you're listening out there, and you're not sure if you're being loaded enough, or if you're not sure you're getting what you need to get out of your therapy, whether you're going to physical therapy, or you going to strength conditioning, then you need to ask yourself, am I going into the right place? And you need to ask yourself if you're getting loaded appropriately, because if you feel like you're not getting enough, then you probably aren't, this is something that we constantly see in our facility all the time. And it's disheartening as a colleague in the PT profession, and it really sucks that's just the way that it's going but that's just what it is. And we just have to create better consumers for our patients and clients and knowing what they're getting and what benefits or the types of treatments and the training that they're getting, whether it's effective or not, or the most effective for them.
[00:25:07] Nick: If you're in a rehab situation right now, ask your therapist, is this going to help me get back to what I want to do? Is this enough to help? And if they can't answer, or they're not entirely sure, that's okay if they don't know that, but you may need to now progress to something else. You may be done with rehab there. You might still be more on that rehab end of the continuum. So you might need a different person to help at that point, and that could be at another PT clinic, or could be in a personal training or strength and conditioning capacity. Same thing with your trainer, if you're not in pain, or don't have any current injury, but you've been working with a trainer and you're doing the same things over and over and over and not either going up in weight changing exercises, doing things like that, it never feels uncomfortable that's not a good thing. Because we're at a plateau or at a standstill and your cup could be going the other way, your capacity could be going the other way, because we've tapped out every benefit from those few exercises in the last couple of months. So things have to change. So if you're not feeling that it's continuing to challenge you or stress you a little bit at least to some extent, then things need to change.
[00:26:21] Chad: I think we killed this topic for today, Nick. How's the saying go? Don't feed a Fed horse. Now that we're trying to be all PC and shit.
[00:26:29] Nick: Don't feed a Fed horse. If the horse is already Fed, just don't feed the horse. You're gonna make the horse fat, we don't want to fat horse. No one wants a fat horse.
[00:26:37] Chad: I don't think anybody wants a fat horse. I don't have a horse. But I imagine if I did, I wouldn't want it to be fat. So now we've got that under control. So let's give everybody a little sneak peek into what next week episode is going to be about. And for all of you that don't know, Nick, and I have a pretty serious foot fetish here, ProForm. Nick a little bit more than myself. Actually, Nick is just actually graduated from the foot collective, they have a foot nerd program. We all knew that Nick was a nerd but now it's official. He's got the diploma and everything. So now we definitely want to dive down some of those rabbit holes for sure. We definitely want to talk more about modern footwear. Take even a dive into the transition with our patients and clients that we use to kind of get them more towards natural footwear. And then just talk about feed itself. I think it's a great topic that not everybody is very aware of, and there's a lot of myths that need to be dispelled about it as well. So I think that's going to be a great opportunity. And we're looking forward to next episode for sure.
[00:27:40] Nick: Hopefully, we can give you guys some practical tidbits that you can implement right away to help improve the health of your feet and regain a healthy relationship with your feet really.
[00:27:51] Chad: Honestly, I'm surprised it took till Episode Three to talk about feet. We probably would have done it in episode one. But we did have to introduce ourselves. So there's that but anyways, this episode is coming to an end. We love to always finish up our episodes moral the story. Moral of the story is “Training is rehab, rehab is training”. And if you feel like you are not getting the training side of the rehab, then you need to go somewhere else.
[00:28:17] 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”.
