The Art of Manliness - #371： The Best Ways to Rehab From Injury

00:00:00.000 brett mckay here and welcome to another edition of the art of manliness podcast whenever you

00:00:18.760 experience an injury or have a niggling pain in your lower back you probably decide to completely

00:00:22.880 rest up so that whatever ails you can heal and recover but then the pain doesn't go away so

00:00:27.500 introduce some light isolation movements to help with recovery but the pain still doesn't go away

00:00:31.500 so you rest some more and pretty soon it's been months or even years since you've done anything

00:00:35.080 that resembles real exercise my guest today argues that if you want the pain to go away you got to get

00:00:39.660 off the barker lounger and under a barbell his name is dr darren deaton he's a physical therapist

00:00:44.280 crossfit coach and a starting strength coach and today on the show darren and i discuss the common

00:00:48.600 myths people have about the safety of barbell training and why family practitioners and physical

00:00:52.400 therapists contribute to the existence of those myths darren then explains why strength training

00:00:56.220 is the best tool for rehabbing an injury and why the reason you have a bad back in the first place

00:01:00.660 is because your back isn't sufficiently strong darren and i then discuss his overall philosophy

00:01:04.540 and approach for rehabbing patients utilizing barbell lifts as well as other physical therapy modalities

00:01:08.960 we then get into specific injuries that barbell lifters and runners experience and how to rehab them

00:01:13.340 we end our conversation discussing the effectiveness of practices like dry needling and electrical stimulation

00:01:17.860 and recovering from persistent pains and injuries after the show is over check out the show notes at

00:01:21.840 aoweb.is slash deaton darren deaton welcome to the show thanks thanks for having me so you and i we

00:01:36.600 met a few years ago at a starting strength seminar because you're a starting strength coach who is

00:01:43.140 auditing the seminar so it's one of the requirements and so we've interacted before then but you've got

00:01:47.600 interesting background besides being a starting strength coach tell us a little more about yourself

00:01:50.920 and what you do sure so i've been a doctor of physical therapy for 28 years i'm the founding

00:01:57.000 partner of a orthopedic and neuro physical therapy practice group dallas for north texas area i'm also a

00:02:04.140 starting strength coach i think i've been a starting strength coach since 2012 or 13 and i'm on starting

00:02:10.660 strengths staff on the seminar staff teach at some of the seminars i'm also a usaw sports performance

00:02:17.600 coach coach and also a crossfit level what they call level three trainer so i've gone through three different

00:02:26.440 levels of their coaching training so i've had a varied background in fitness my wife and i actually met

00:02:33.140 over 30 years ago when i was actually 31 and a half years ago when i was 19 years old in a health club

00:02:41.380 i was a personal trainer of sorts and she worked there also and that's that's kind of where we met

00:02:47.720 there in the junior college too when i was taking some summer classes so so i've been in the fitness

00:02:52.780 industry in the uh for you know over 30 plus years i've been in physical therapy for close to that too so

00:02:59.620 the background that i have in relationship to the the lifting community is uh more specifically with

00:03:06.500 starting strength i'm also a starting strength online coach on the starting strength online coaching

00:03:12.380 product that matt reynolds started a little over a year ago which is a great product for lifters who

00:03:19.100 don't have access to a personal coach one-on-one in a physical presence it's great to have good eyes on

00:03:26.820 coaching so that's that's about my background i think that i'm a little different in the sense that and

00:03:31.500 so are my clinics i have two partners in my practices we have four different locations here

00:03:36.620 in the area and in our practice we have a barbell rack or a squat rack i guess you would say a power

00:03:43.940 rack barbells bumper plates steel plates and we use a lot of traditional barbell training in our

00:03:51.460 clinics for strength training because we feel like it's probably the most effective tool that we have

00:03:56.080 in our hands so that's that's pretty much it all right so barbell training your primary

00:04:01.280 practice which is weird because you're a physical therapist i've been to the seminar i've i've in at

00:04:07.040 the seminar rip like pretty much went after a physical therapist like they don't know anything

00:04:11.220 so how did you a physical therapist get into starting strength barbell training particularly

00:04:16.420 starting strength so basically i went to the the starting strength seminar i think in 2012

00:04:23.320 that's when i got my certification i got this my certification at the same time you know i attended the

00:04:28.800 first seminar sat for the platform test passed the platform test and the exam and then became a

00:04:34.120 strength coach but there was a period of time there for probably at least three to four years where i did

00:04:41.120 very little within the community of starting strength just because of my practice life was busy

00:04:46.160 i had crossfit gyms but as a you know i was i'm a big reader when it comes to strength

00:04:51.840 and so i kept reading you know i've read starting strength the barbell method and then also practical

00:04:58.120 programming and then several other texts and it just continued to intrigue me so i continued to follow

00:05:03.240 it and later i i ended up getting involved again back with the starting strength community i'm now on

00:05:10.360 staff as a staffer do staff some of the seminars but you know if you as you know when you go to the when

00:05:16.900 you go to the seminar pts are not held in a very high light and and in a lot of ways that's to be

00:05:23.100 they earn that because of the way that we have talked about strength training and barbell training

00:05:28.760 within the medical community so it's hard it's hard to survive as a pt in the starting strength

00:05:34.400 community you have to have pretty thick skin but i think that it makes sense to me barbell training is

00:05:41.980 very methodical it's very predictable and also from a science standpoint when you think about physics

00:05:48.460 and moment arms and loads and force production it you it just makes sense to a to a didactically

00:05:55.840 thinking mind someone who is very analytical it makes sense and so i couldn't get rid of that

00:06:00.920 the more that i learned the more that i got around other starting strength coaches and and mark

00:06:06.020 ripito the more i realized that this this is really the method that i want to promote as the

00:06:12.340 primary strength training model both in my clinics and also in my gyms so let's talk about some of the

00:06:18.840 myths that exist in the medical field but particularly the physical therapy professions we've had jordan

00:06:24.040 feigenbaum on the show who's a medical doctor also starting strength coach we talked about some of the

00:06:28.160 the myths that even just like family practitioners have about barbell training in particular but what are the

00:06:33.840 the big ones you see in the pt world about weight training or barbell training in particular well

00:06:41.060 first i think i think the average consumer or client of a of the medical community needs to understand

00:06:47.360 that when it comes to strength training when it comes to the development of strength pts probably pts

00:06:55.040 definitely get more academic training than medical physicians both deos and mds do but physicians get very

00:07:03.120 little um education when it comes to strength training endurance training just just anything

00:07:09.600 outside of of medicine and so the idea that a physician would be the expert in that field or even

00:07:16.600 you know the the physical therapist um is is probably not accurate but a lot of the misconceptions that

00:07:23.520 are out there is first of all when it comes to the barbells that it's you know the movements are

00:07:26.960 dangerous that you should isolate movements that you should do individual exercises that are smaller

00:07:33.680 movements and there are some cases where we have to be careful with patients when we're talking about

00:07:37.840 the rehabilitation side post-operative care injuries where there's structural issues then there are

00:07:43.840 certain times where we have to be careful about how we intervene with those exercise activities but

00:07:48.800 there is a significant difference as you know between exercise and training and so i think it's i think

00:07:54.480 it's important that people recognize that that the barbell is is probably in my mind at least and i think

00:08:00.560 in a lot of the minds of a lot of strength coaches and several pts i know and physicians like like jordan

00:08:06.480 and austin baracki he's also a physician dr jonathan sullivan and that would be that the barbell can be a

00:08:12.480 great tool it's very safe a lot of people think it's not safe but it's extremely safe it promotes

00:08:18.480 compound movement versus isolated movement and we know that compound movement is safer to the

00:08:25.040 joint because it stabilizes the joint it stabilizes the surrounding tissue if that makes sense gotcha

00:08:30.160 yeah so i mean whenever i've preached you know hey to people you need to get started with barbell

00:08:35.280 training i've had a lot of guys particularly older guys in their 40s or 50s they say they've got a bad

00:08:40.320 back is that something that can prevent people from barbell training if they you know have got a

00:08:44.800 a bulging disc or something like that what what goes on there what's your prognosis as a physical

00:08:50.240 therapist no i i think that the last thing that someone needs to do is stop strength training when

00:08:55.120 it comes to the back injury you know a strong back is a healthier back and we know that through the

00:09:00.880 literature now and through research that a back that's weak hurts more backs that have larger muskature

00:09:07.920 better stability and support it supports the the tissue that's been damaged it supports the disc

00:09:14.560 the ligament and structures and the the spine itself so you know i i don't tell too many people

00:09:21.200 this but most of the people that that hang around with me my circles know this but two years ago i i had

00:09:28.240 four low back surgeries in the same calendar year so i had three laminectomy disectomies at the same

00:09:35.360 level and then i eventually had a lumbar fusion at l4 l5 so as a pt you know that's you know when you

00:09:42.160 think about that as the the myriads of patients that i've treated all these years it's that was

00:09:47.760 pretty discouraging but i had a condition called spondylolisthesis i had an unstable segment the

00:09:53.520 only way to finally take care of that was through surgery so and i'll just tell you that getting back

00:09:59.200 under the barbell over the last two years has been the best thing that i could have ever done for my back

00:10:04.960 the other day i i squatted for three sets of five my my old pr for a single rep prior to back surgery

00:10:11.360 i'm dead lifting for a set of five what i used to pr and so you know when i talk to clients specifically

00:10:18.640 patients but also members that were within our gyms or when i have one-on-one clients through strength

00:10:23.440 training sessions i tell them you know there's a lot of misconception out there about lifting weights

00:10:28.320 and bad backs if you're a physician or within the community that you hang around with if they tell

00:10:34.000 you you know you don't need to be lifting heavy weights anymore the one thing we hear all the time

00:10:38.720 is that you've probably heard this right don't don't lift more than 10 pounds right

00:10:43.600 i mean don't lift more than 10 you're never to lift anything more than 10 pounds and don't ever

00:10:48.320 bend over you should squat with your legs only well you and i know that that's that's not the proper

00:10:53.520 way to use the hip in the back it's a lever so it should be used as a lever that back needs to stay

00:10:58.720 straight but the hip is the driving force for that the hip the glutes the hamstrings and so what we

00:11:06.640 try to do with our patients now and our clinics and what i try to do with my strength training clients

00:11:11.920 is help them understand anyone can lift a barbell and get stronger in the hips and low back a lot of

00:11:19.360 back pain is what we call non-specific low back pain and the best way to treat that is with strength

00:11:24.400 training yeah i think that's a great point because i've read that in other places that there's like

00:11:29.200 research on like home depot employees who wear those back braces they tend to have more back

00:11:35.760 injuries than people who don't wear the braces right because they they're basically relying on

00:11:41.280 that belt to act as an exoskeleton for them so they get a week back and then whenever they're at

00:11:46.240 home with the thing off and they pick up a load of laundry they pull their back and then they they're

00:11:51.680 out for a while yeah i think there's this mindset or this thought line that's created that it can be

00:11:56.880 pretty pervasive and that is you know you're you shouldn't use your back this way or you shouldn't

00:12:01.520 use your back this way and i think they develop a mindset that you you have to be careful with

00:12:06.560 your back well sure you have to be careful with a lot of things but but being careful and assessing

00:12:12.240 risk is different than um being uh just cautious about things you know i mean some people are just

00:12:19.120 so overly cautious they develop weakness and i i'll give you a good example i had a patient this

00:12:24.240 morning that i treated that's a post-op shoulder patient and it's very similar to to you know the same

00:12:29.840 situation with the back patient and that is his physician told him i don't ever want you to lift

00:12:34.880 overhead again with your shoulder and so my question to that doctor might be and to that patient might

00:12:40.720 be well did did he feel like did the physician feel like that he got a good repair in your shoulder a

00:12:46.320 good what we call purchase of the hardware or the tendon or whatever he repaired in the shoulder

00:12:51.920 well the patient said yes he said my shoulder was the perfect shoulder to perform this procedure on

00:12:57.120 so if the shoulder joint is designed to raise up over your head why wouldn't you go back to

00:13:03.680 strengthening it in that method and use it it just functionally makes sense well the same with the

00:13:08.960 back the only difference is with the back a lot of people don't know how to lift they don't recognize

00:13:15.200 how to use the hip and they definitely do very little strengthening on a day-to-day basis when it comes to

00:13:20.320 the low back so what does let's say someone who's never lifted before they've got an issue like that

00:13:27.120 either an issue with their back or a shoulder i know shoulders are very common with folks

00:13:32.800 as a practitioner and as a coach like how do you go about introducing them to barbell training well

00:13:39.760 would you know it matters where i see them if i see them in a clinical environment the approach is

00:13:45.520 it's similar but the you know i'm in my medical world there if that makes sense um there are some

00:13:52.160 you know let's say a physician has uh ordered pt for the patient prescribed pt and i'm seeing them

00:13:58.240 because they had a lumbar sprain and strain or they have a bulging disc or what they would call a

00:14:02.400 quote-unquote bad back i might treat them a little bit different but we still go into education we talk

00:14:08.000 about using the hips as a lever we talk about using the the back in a straight angle that the back stays

00:14:15.040 in a nice locked straight position when we lift and then we go through and we start teaching them

00:14:20.160 how to deadlift how to back squat i teach them the overhead press too because that builds the the

00:14:25.440 midline stability the core strength and then we gradually also add other assistive exercises in

00:14:31.440 also but a lot of people when they think of spine strength they think of the abs right right i'm going

00:14:37.200 to do sit-ups to get my abs strong right the problem with that is that that's not how the spine

00:14:43.520 and the abdominal wall actually functions on a day-to-day basis in the human body it's mostly

00:14:48.880 an isometric muscle group it's a it's a group of muscles that stabilize the spine through isometric

00:14:55.280 contraction throughout the day and then when you volitionally want to use the the spine to lift

00:15:00.320 something heavier then you valve salva you tighten up keep that back nice and straight and you you hinge

00:15:06.640 at the hip and so those are the kind of things that we teach the number one thing is is i educate

00:15:11.920 them on the front end that this is the proper way to use your hips and your back you can be lifting you 0.86

00:15:18.800 can get strong over time and you can get stronger probably than you ever thought you could be

00:15:23.920 but the biggest limiting factor is going to be their mind we've got to change their mindset

00:15:28.560 so we gradually work them through their rehab program if they're a patient

00:15:32.320 we put them then i put them into a barbell program give them some basic level programming they

00:15:37.040 can either do that on their own in a local gym or they can then come and see me as a strength coach

00:15:42.560 and we'll work with them one-on-one and then put them on a program also gotcha okay so the bottom

00:15:46.720 line is if you have an issue and you've been leery of getting into strength training but you've been

00:15:50.720 wanting to don't be afraid go in it go seek professional advice but what do you do like you go to a pt

00:15:56.800 who's not a starting strength coach and they're gonna give you the typical advice of here's a soup can

00:16:01.520 and you know do a shoulder like what do you do if that's what they prescribe well i mean in every

00:16:09.840 community there's there's a differing level of expertise in every single community and you know

00:16:14.160 years ago i've been in the fitness industry my wife and i met when i was 19 years old in a health club

00:16:19.920 where i was a quote-unquote personal trainer i'm not real sure what i knew back then but i was a personal

00:16:25.200 trainer but you know in every industry we have varying levels of expertise and so i wouldn't

00:16:33.680 say necessarily because a physical therapist is a licensed pt that they actually possess the knowledge

00:16:41.120 or the experience base to do the type of strength training that that i think is effective or that you

00:16:49.520 might think is effective now based on the fact that you do starting strength um so it's kind of

00:16:55.520 difficult sometimes you you're not real sure what you're going to get yourself into but but i can say

00:17:00.320 this and if you're a patient and you've been treated for low back pain and you're not getting the results

00:17:06.000 that you want from your physical therapist and and or your doctor whoever you're seeing your

00:17:10.160 chiropractor whatever medical professional or alternative medicine person you've you've sought um you can go to

00:17:17.600 startingstrengthonlinecoaching.com and you can you can seek out a starting strength coach and and i can

00:17:23.680 say this that every single coach that's on that staff has an expertise level on how to do barbell

00:17:30.000 training and could probably help you work through your black back pain and getting back to a healthy

00:17:37.120 strong back where you can live a successful lifestyle that's one thing i know for sure so in a in a local

00:17:43.760 sense if you're dealing with a physical therapist that you feel like you're not making the headway

00:17:48.240 that you want to make then reach out to starting strength online coaching you could also reach out

00:17:53.440 to me and i could hopefully find you someone in your area that's a little bit more strength minded as a

00:17:58.240 therapist you know most most physical therapists they mean well and i think there's a lot of great

00:18:03.680 physical therapists out there that are very strength minded today and we do see a trend in the world of

00:18:08.960 physical therapy to move toward a more active strength training mindset a more preventative

00:18:16.080 mindset but we still have a lot of physical therapists in our community too that they're just

00:18:20.080 not effective in their ability to create true muscle hypertrophy strength and adaptive change in the

00:18:26.320 patient so when we had jordan feigenbaum on the show dr jordan feigenbaum on the show and you know he

00:18:31.360 he highlighted the research that basically shows that weight training is probably one of the safest

00:18:34.720 activities you can take part in like soccer is you're more likely to get injured playing soccer

00:18:41.040 than you are lifting weights with that said it is possible in the in the process of your training to

00:18:47.600 get banged up experience injuries some hurts so in your experience as a coach and as a physical

00:18:54.800 therapist practitioner what are the most common i don't know if you want to call them injuries or

00:18:59.520 just dings to the body that you see whenever someone's barbell training and i think the same

00:19:04.960 the thing we see the most probably low back sprain and strains a lot of times you know if you're

00:19:10.400 training with if you're doing any type of training it's not it's not if an injury is going to occur

00:19:16.160 it's really it's really when when in your training career your training life are you going to get

00:19:22.000 injured i mean you can get injured bending over and pick picking up a pencil and and probably it has

00:19:27.920 happened through cumulative trauma over time improper lifting lack of strength in that segment lack of

00:19:34.320 activity in your lifestyle maybe a sedentary lifestyle so you know there are a lot of things

00:19:38.880 in life that that cause injuries but the the most common injuries that we see would be low back

00:19:44.400 sprains and strains shoulder sprains and strains that would probably eventually kind of show themselves

00:19:49.520 as rotator cuff injuries most likely groin strains like a you know an adductor strain through squatting

00:19:55.760 hamstring strains and sprains and then also sometimes we see some bicep tendonitis elbow

00:20:01.120 tendonitis from barbell training just like we do any other type of training but like you said the

00:20:07.920 injury rate in barbell training is extremely low and and this is a this is an interesting just little

00:20:14.400 tidbit of information years back it's been two or three years back i was doing some studying on

00:20:19.440 olympic weightlifting and and you know what olympic weightlifting that would be the clean and jerk and

00:20:24.160 the snatch so that's a dynamic effort that's speed-based this power-based strength-based but

00:20:31.840 there's a lot of movement in a very broad range of motion okay so it's even less predictable than

00:20:39.600 barbell weight training where you're doing let's say the press the bench press the back squat and the

00:20:46.720 deadlift but i was doing some studies i was doing a study probably two or three years back because i was

00:20:53.200 talking to some parents about using olympic weightlifting for dynamic effort explosiveness

00:20:59.760 for younger athletes and at the time i believe it was the american college of pediatric medicine

00:21:06.640 had come out with a position statement working with dr kyle pierce who works with the usaw to

00:21:13.680 support they eventually said that if if a child if an adolescent was going to strength train or do a

00:21:20.320 strength training program then a safe way to do it would be something like olympic weightlifting

00:21:27.680 because number one it's coached number two it's predictable and number three it's something that can

00:21:34.000 be linear based you can gradually increase the loads over time as technique improves and as strength

00:21:39.280 improves and expertise and so you know i think about that in this format if if olympic weightlifting

00:21:47.840 is that safe for that young population how much more safe would just classical barbell training be

00:21:56.880 where it's there is not as much speed there's not as much dynamic effort it's more a controllable

00:22:03.120 motion so that's the one thing i love about barbell training is i know that when my client walks into

00:22:09.440 the gym or into the clinic that next day i know exactly what they're going to do how they're going to do

00:22:15.760 it i know the set and rep scheme there's there's no unknowns and to me to be able to do that and to

00:22:23.040 track that over time day in day out there's this gradual progressional linear model that's developed

00:22:30.160 that creates strength and the other thing is the connective tissue the connective tissue gets gradually

00:22:36.000 stronger over time so the likelihood of an injury is much less apparent than if i just went in and did

00:22:44.880 some random exercise workout if that makes sense right so you just go into the gym you like go to

00:22:49.520 all the different machines at a random whatever she just yeah and i i think i think people have a

00:22:56.000 misconception about barbell training because let's face it you go into any larger globo gym you go into

00:23:00.880 any facility and and you see people doing things that that well you know now based on on being trained

00:23:07.760 in a classical barbell program and having a great coach you know now that that there's a certain way to

00:23:13.440 lift a barbell there's a skill right it's it's not random it's very specific and it's very methodical

00:23:20.320 well there's a lot of stuff that goes on in gyms that you just you just have to roll your eyes at

00:23:24.400 it's just it's it's not good training it's not training at all it's exercise and like rip rip says

00:23:29.600 you know it's exercise is getting hot sweaty and tired but training is outcome driven

00:23:34.080 it's it's specific and we we're doing something to create a change in the human body

00:23:39.440 whatever that change is whatever that physiological change is but but that's the beautiful thing of

00:23:44.720 barbell training and and that's why i think it can be so effective in a rehab model too is because it

00:23:49.280 is predictive because the patient or the client gradually increases over time just like they

00:23:54.960 would in any other rehabilitation program we just happen to be using the barbell more often

00:23:59.440 our clinics all four of our clinics that we presently have have barbells in them

00:24:03.360 we have you know standard weights i guess you would say plate weights we have everything from

00:24:07.760 fractional plates to 45 pound plates and then we also have squat racks power racks in each one of

00:24:13.920 our clinics and so our therapists use that some therapists would use it more than others but you'll

00:24:19.440 see that most of my patients use the barbell rack almost every single patient will have some application

00:24:24.320 with it so there's a lot to unpack there with some of the stuff you said i want to go back to the

00:24:28.880 kids in weightlifting because that's a question we often get the kids people want to get their kids

00:24:33.760 with weightlifting but they probably heard the the rumor that the old wives tell that when you say 0.86

00:24:38.960 that's what they're called nowadays like that you know it stunts their growth because it somehow

00:24:42.160 damages growth plates is there anything true to that or is that a bunch of bunk no i mean that's a bunch

00:24:47.040 of bunk i mean i think there is a an age as they're going through their stages of development

00:24:52.320 their skeletal development where we have to be more careful than than other ages but you know with with

00:24:57.840 younger clients let's say clients that are 12 13 14 and and not all let's let's just say 13 14 year

00:25:05.120 olds not all 13 year olds have the same skeletal development as all all 13 year olds there there's

00:25:12.080 a difference they may be a little bit farther into puberty they may have more skeletal development

00:25:18.480 they may be carrying more muscle mass you can have a you can have a 13 year old that that's very

00:25:23.200 underdeveloped and you can have a 13 year old that's that's you know six foot one inches tall

00:25:27.760 and 200 pounds and and very developed uh physiologically or physically in regards to skeletal

00:25:33.360 structure so you know the key thing we do with younger clients is first of all we teach them form we

00:25:38.800 teach them how to move the barbell and that's built off of repetition and coaching so in cueing and

00:25:44.400 teaching them so we teach them first we cue them and we coach them through all those movements to make

00:25:49.200 make sure that they're sound and safe let them have fun while they're in the gym and then a little

00:25:53.920 bit later in life then we gradually start adding load and put them into a novice linear progression

00:25:58.800 but i i think the safest method to develop strength in some of these younger athletes which is not being

00:26:04.320 done very well in high schools today would be to put these these young athletes these 13 14 year old

00:26:11.120 athletes into a sound novice linear progression and then just gradually increase that strength over time

00:26:16.800 if if these strength programs would do that by the time these kids got into high school

00:26:22.400 some of the numbers would be unbelievable in regards to their strength capacity and and i think that

00:26:26.880 would roll into their ability to perform their sport you know you know when it comes to what people think

00:26:32.960 kids need for their sport that we don't need to train them specific to their sport when it comes to

00:26:38.720 strength we just need to get them strong we get them strong then the the sport specific coach can deal

00:26:45.920 with all the sport specific issues that come with that that uh that that sport but our goal as strength

00:26:53.520 coaches is to get them a good foundation of strength and then they can use it for whatever they want to

00:26:59.440 use it with so let's backtrack so you said some of the most common injuries that you might experience

00:27:04.000 while barbell training is spring backs lower back pain bicep tendinitis something i've dealt with

00:27:10.400 shoulder stuff so what happens let's say you get the back thing like you you're doing a deadlift

00:27:14.560 and while you're pulling you tweak your back do you freak out like what do you what's what are the

00:27:20.240 immediate steps you should do to start rehabbing that should you stop training all together what's

00:27:25.440 your approach well the last thing i want to do is is stop a client whether they're a patient or just

00:27:30.560 a strength client from training or to stop moving you know i i my the other starting strength coaches

00:27:36.160 and just some of the people that know me and in professional circles i always use the term

00:27:40.960 motion is lotion you know you you got to stay moving it's good for the human body we want

00:27:45.680 increased blood flow so there's a there's a misconception that you injure your back well

00:27:50.000 you should stop doing anything for them sometimes a prolonged period of time and that's that's farthest

00:27:54.240 from the truth now we know that that you should probably get back under load now how you get under

00:28:00.240 load and when you get under load and how much you load is determined based on what type of injury it is

00:28:06.160 is it an injury or is it just hurt you know i mean there's a lot of little tweaks that occur along the

00:28:10.480 way you get a little sprain and strain here you get a little soreness here you know you get a little

00:28:15.760 hurt quote unquote well that's different than being truly injured so what what you want to do first

00:28:22.240 is you you want to seek the help of someone who has um you know a diagnostic background you know i

00:28:28.320 prefer that you you seek you know a sports medicine physician if you if it's a minor injury or a minor

00:28:33.840 sprain and strain then it's something probably that you can take care of yourself you want to ice the

00:28:38.320 injury directly after the injury you want to stay moving though and you eventually want to get back

00:28:43.360 underneath that bar so you know the key is if if you're barbell training as your as your strength

00:28:49.040 method but the key there is we do need to get in some of these cases some form of diagnosis done

00:28:56.160 and i just say that as a i'll put my white coat on there that's not my strength my strength coach

00:29:02.240 coat but you know if i put my white coat on then an accurate diagnosis up front is important but

00:29:08.800 let's say you went to your family doctor or a physical therapist based on what state you live

00:29:14.560 in and you got the diagnosis of a lumbar sprain and strain you know they're going to tell you stop

00:29:19.360 lifting for a while don't barbell train and that's that's not what i would have you do what i would have

00:29:25.920 you do is we would gradually go back into lifting and we might even use a rehab method called the

00:29:31.840 star rehab model the star rehab model is using a higher rep scheme with lower loads and body weight

00:29:38.000 loads to gradually increase the blood flow to that area just infuse that area with blood flow so that

00:29:44.560 we can increase the nutrients increase the healing agents to that area and then we just linear progression

00:29:50.400 gradually increase the load over time get you right back into training very quickly and instead of

00:29:56.960 just kind of hoping the body heals in a roundabout way we force the body to heal that makes sense let's

00:30:02.000 talk about tendonitis because i see this one this probably pops up for older guys in particular because

00:30:07.520 when you're young you're supple right when you get older you're a little stiffer and things aren't as

00:30:12.400 pliable so what's your approach to well first of all why does bicep tendonitis happen and what do you

00:30:18.560 do to train around it well any any tendonitis can't it matters what we're talking about here there's

00:30:24.320 there's three stages of tendon injury we've got tendonitis tendinosis and tendinopathy so a tendonitis

00:30:32.160 is basically just inflammation of the tendon there's been an inflammatory process there might be very little

00:30:38.160 damage actually done to the tendon but the tendon's inflamed through an over stretch and over strain or

00:30:43.280 overuse it could be you know overuse swinging a hammer or or it could be from lifting a tendinosis

00:30:51.120 is once we've had several tendonitis or we've had several smaller injuries then there's an actual

00:30:57.920 structural change to the tendon belly itself and the tendon cells that are in there are you have some

00:31:04.560 scar cells in there now and it's just not as healthy of collagen because collagen tissue is what your

00:31:09.440 body's made out of and the tendon cells are not as resilient that's what happens with some older

00:31:14.960 athletes or older lifters they get tendonitis from overuse or this sprain or this strain and then it

00:31:22.240 ends up being a tendinosis so once it gets warmed up it feels really good but before you get it warmed up

00:31:29.120 or maybe on a cold day or something like that it's achy and uncomfortable but once you start using it it

00:31:35.600 feels pretty good then the last thing would be like a tendinopathy and that's where the actual tendon

00:31:41.280 tears and there's a structural uh weakness in the tendon and eventually the tendon could rupture like

00:31:47.840 in you know like a a bicep rupture distal bicep rupture or a patellar tendon rupture achilles rupture

00:31:54.400 that would that would be the the worst thing that could happen because it completely detaches

00:31:58.000 so the way that i treat tendonitis tendinosis and tendinopathies is a little different based

00:32:05.680 on the severity of the injury so the rehab model is going to be different based on the severity

00:32:09.680 but let's say we're dealing with just a classical tendonitis the first thing we want to do is we

00:32:15.280 want to make sure that we're using that tendon we may have to reduce the loads for a period of time

00:32:20.960 because of the the structural inflammation that's there so we're going to use things like ice deep

00:32:26.640 transverse friction massage sometimes it's appropriate sometimes to use a corticosteroid

00:32:33.200 injection in that area or to use things like antiphoresis where we use a topical steroid

00:32:38.480 they also might be taking inseds you know non-steroidal anti-inflammatory drugs to reduce

00:32:43.200 the inflammatory process in the tendon but the last thing we're going to do is not use the tendon i'll

00:32:48.800 tell you this is a really interesting case i was treating a guy this morning or one of my colleagues

00:32:53.520 was treating him and we were just talking about him together and kind of working together on him

00:32:57.600 but he's had a medial epicondylitis which is a tendon inflammation of the medial elbow it's also

00:33:04.880 called golfer's elbow and um uh he basically has had this for about two or three years he's had

00:33:12.320 multiple injections to the area this is obviously a tendonosis he's got some adaptive tissue changes in

00:33:19.120 that area so what the therapist and i have been working on is to start doing some eccentric chin

00:33:25.040 ups with him start doing some eccentric curls with him and starting to really load that tendon

00:33:31.200 with eccentric activity higher reps body weight loads and lower loads but just really flushing that

00:33:38.160 tendon belly with blood expanding that tendon with blood products and um and lubrication so that

00:33:45.360 it can heal itself as best possible we also recommended something like an elbow sleeve with

00:33:50.240 them to keep it warm so that when he's at work and he's not using it we're keeping that body temperature

00:33:55.360 in that area a little warmer and what he's noticed over time is that it's actually getting better it's

00:34:00.720 improving so that's you know the number one thing we want to do is we want to keep these patients moving

00:34:07.280 we might have to or these lifters moving we might have to alter load and weight reduce it but we're

00:34:13.600 probably going to use a higher rep scheme with more sets and we're going to use um eccentric training

00:34:21.840 too along with that and then all the other things that we talked about inseds and ice and friction and

00:34:27.920 some of the alternate you know the the sideline therapies that we can use we could use e-stem on

00:34:33.360 it those types of things darren do you uh treat a lot of runners by chance i mean we treat a fair

00:34:39.200 amount of runners in our practice um we see we see quite a few what do you think are the most common

00:34:44.240 injuries you see with those guys oh probably achilles tendonitis is real common plantar fasciitis

00:34:50.960 is real common uh you know some of them will get some non-specific knee pain we'll get some achy knees

00:34:56.560 from having a little arthritis in the knees hip flexor sprains and strains um sometimes they'll get a

00:35:03.200 a little patellofemoral pain from from running within proper form or if they're running hills

00:35:08.000 or trails those types of things it is your general philosophy towards those guys too is like keep

00:35:12.240 them moving like you're not going to stop running you might just change the way you train yeah i think

00:35:17.040 with a runner it's it's it's a similar philosophy the number one thing i'm going to do is i'm going to

00:35:20.800 look at their strength base too if if they're under strength and runners are classically weak as

00:35:26.480 athletes if they're if they're if they lack strength which they probably do i'm going to put them in a

00:35:31.920 classical barbell training program and so we're going to get them under the bar and we're going

00:35:35.920 to get them stronger because a lot of times runners have injuries because of form breakdown and form

00:35:41.360 creep throughout their run you know they get tired they like the stamina that they need to run with

00:35:46.560 proper form we may do we may need to address their form you know we need to address the way they run

00:35:52.240 their shoe wear but with a runner what i might look at is volume two a lot of runners are or can be

00:35:58.880 classically over users they can over train so we're going to look at how much they're running

00:36:06.640 and one of the things that we that i've done over the years and and some of this came from my

00:36:10.960 background with crossfit and that is learning how to use high intensity interval training or interval

00:36:16.400 running to improve aerobic and endurance capacity without running the high volume that a lot of runners

00:36:23.760 or that a lot of triathletes or endurance athletes normally uh use so so we'll work on you know instead

00:36:30.880 you know let's say in the past they've used three long runs a week or five long runs a week we might

00:36:35.840 then come in and change their training model let's say let's do some high intensity interval training

00:36:40.080 on this day let's do some sprints or let's do some uh let's do something like the assault bike and

00:36:45.520 maybe do uh interval sprints on the assault bike and give your give your you we're we're still working the

00:36:51.760 hips and legs we're still working their cardiovascular system but what we're also doing is give their body

00:36:56.480 a little rest from the pounding if that makes sense so the thing we look at with runners would be

00:37:02.080 we check out their training program the volume that they're running we look at their form and then what

00:37:08.080 we're going to do is probably put them into a strength program because it's predictable get them

00:37:12.880 strong maybe make sure that we're strengthening that connective tissue and then we can do all the

00:37:17.200 things that we talked about earlier with tendonitis and and other injuries using modality care and

00:37:22.560 physical therapy care to reduce the inflammatory process along the way and get them back to running

00:37:29.200 this is a personal question related to running because i i experienced this and so like i think

00:37:34.320 two years ago about two years ago no year and a half ago i did some like wind sprints for like the

00:37:39.760 first time in a long time and i like boy that's painful it was pain like so yeah i think i what

00:37:45.920 happened was after like the day the next day on my left like hamstring like up near my butt 0.90

00:37:52.800 it was just this pain it just hurt all the time and i think it was like a some sort of

00:37:57.760 tendonitis like the hamstring is there a tendon there yeah by chance yeah yeah and it was like

00:38:03.520 for like i mean pretty much it's just until fairly recently like the pain went away but it took like

00:38:09.120 a long time so like what do you do like if you're a runner and you get tendonitis there because i think

00:38:14.160 it might be a hard place to treat yeah i mean the the hamstring the hamstring comes up to what's

00:38:19.040 called a conjoined tendon it's a very it's where the hamstrings all convert back up in there and

00:38:24.000 they attach on the ischial tuberosity it's a sit bone it's what you sit on and so if you're yeah it

00:38:29.840 really flare up when i was like on a long road trip i was like i'd get out of the car i would just hurt so

00:38:34.160 bad yeah you go to stand and you're like oh my gosh that's killing me yeah you start you start

00:38:38.960 having to use that hamstring again but yeah i mean something like sprinting is is is perfect to

00:38:44.880 injure that if you haven't been sprinting and here here's the here's the the thing you got to

00:38:50.160 watch sometimes is that when you're doing something like that like high intensity interval training

00:38:54.960 sprinting there's a ton of sport hormones going on in your body your your body temperature you know

00:39:00.720 i mean you've got everything warmed up everything feels great and and really a lot of those hormones that

00:39:05.600 are rushing through your body at the time they're designed to reduce pain they're they're designed

00:39:10.080 to reduce the the the nocioception the pain response in your body so you know then you get a

00:39:15.360 little overuse and there's an inflammatory process you may have not torn the tendon but you may have

00:39:21.360 irritated its origin or the insertion down near the knee when you're talking about the hamstrings

00:39:27.920 and there's an inflammatory process so you know it swells down in that area and with the swelling

00:39:33.920 and the the damage to the tissue comes pain and so you know i mean you probably did the best thing

00:39:39.920 you could do as you you know you previously ran and you just said recently you got rid of it and i

00:39:44.960 bet your barbell training has been great for developing the strength of that origin of that tendon

00:39:52.400 so with something like that the number one thing we want to do is we can treat that area there are

00:39:57.040 things we can do we can do dry needling to that area we can do east end to that area we can go up

00:40:01.920 and friction massage we can stretch it we can do strain counter strain work where we do eccentric

00:40:07.440 dynamic loads on it but you know what i would do with a patient that has that i'll give you a good

00:40:12.480 example i had a young football kid that saw me several years back he played football for a very

00:40:19.360 large high school locally and he wanted to get rehab for a hamstring tear or sprain strain that he had

00:40:27.200 had he'd have five different hamstring sprains in the last two years as a football player well his

00:40:33.760 brother was already playing at a division one college he had great genetics so the goal was

00:40:38.080 to get him back to play playing at a level where he could participate in the in the college combine

00:40:43.920 and hopefully get a good school bid to go play football so his dad brought him to us one of my the

00:40:50.160 other therapists who's one of my business partners was actually treating him and i just filled in one day

00:40:54.240 for him and and i got to talking to the dad got to know him a little bit and so we we did the rehab

00:40:59.040 on him and the way that we rehabbed him was we had him do good mornings deadlifts back squats weighted

00:41:05.280 lunges you know we really worked on developing the tendon strength at its origin at that sit bone through

00:41:13.040 eccentric and concentric weight training so as time went on his father contacted me and said hey he wants to

00:41:20.640 get stronger so i think it was december a year ago he started strength training with me and so i think

00:41:26.720 we started him in the first week of december he was back squatting 275 for three sets of five when we

00:41:32.000 finished with when i finished with him in february i think he did three sets of five at 4 30 on the back

00:41:39.200 squat i think he was dead lifting close to 500 pounds and he went and sat for the college combine and

00:41:46.000 got a got a bid to go play football at a school so you know i think that the key there is is that

00:41:52.800 we we've got to sometimes give the human body it's based on the severity of the injury so in a case like

00:41:58.960 yours if you had torn that that tendon from its origin you know if it had been do you know the grades

00:42:05.920 of the tears brett the different grades of tears i don't okay so a grade one would be a minor tear

00:42:12.880 there's really no structural damage to the tendon where it originates on the bone it's just an

00:42:19.760 irritation there's an over stretch a grade two there's a very small tear zero to 25 percent of

00:42:26.000 its fibers a grade three 25 50 of its fibers up to 75 of its fibers and then a grade four would be a

00:42:34.640 complete rupture of the tendon and so or just barely hanging on there so you know if someone came to me and

00:42:41.120 said they felt a pop up in there and it was very painful and they had very poor hamstring strength

00:42:47.920 very poor hip extension and knee flexion i want to make sure what we're dealing with there i might

00:42:53.760 even get an mri of that or a ct scan just to figure out what what level of tear or injury are we dealing

00:43:00.560 with does that make sense no yeah that makes sense but yeah i think you did exactly what you should have

00:43:05.440 done um you know running doesn't make you a stronger runner it makes you have better aerobic capacity

00:43:12.400 potentially and it makes your you know your your feet are able to handle the pounding better you

00:43:18.000 know your body you know you get chafing in the right spots and you know you got to do some mileage

00:43:22.480 but i think also a stronger runner is a faster one so you mentioned some alternative recovery or

00:43:29.680 rehab tools i mean it seems like in the past i'd say five years there's been more attention paid

00:43:36.560 to sort of rehab and recovery you know i remember when i started you know training in high school

00:43:42.400 barbell training then it basically was like if you hurt go sit in the ice bath and that was it now

00:43:48.240 there's all this stuff which like is your as a practitioner like what stuff actually works

00:43:54.160 and why does it work you know you mentioned dry needling like what is that cupping is another one

00:43:59.120 and what does those do and do those actually do anything what what do they do for rehab and

00:44:03.600 recovery so so i've got to give away all my secrets and tricks right no you got just a few of them

00:44:08.960 right okay i can't give away my my my snake oil tricks here you know no i think you know unfortunately

00:44:17.600 there's a lot of things that that are being done in clinics today that there is not a lot of research

00:44:22.400 to support some of those things i i try to stick with the ones that i know you know in in

00:44:28.960 medicine we use this thing called evidence-based practice and basically it's a it's a three-pronged

00:44:33.920 stool and think of a stool that's sitting on the ground it's got three legs one of those legs is 0.91

00:44:39.120 research you know research and data and for most of the physical modalities or treatments that are

00:44:44.800 out there we still lack the quality of research that we would like to see for support of a lot of those

00:44:51.920 modalities we we we have some pretty good data out there but we we still we still could always use

00:44:57.920 more data the second stool leg the second leg would be clinical experience the the person that's actually

00:45:05.760 treating you what kind of experience and anecdotal and observational evidence do they have as a

00:45:10.880 clinician to say that hey i've used this on on you know 100 clients and it works i don't care if the

00:45:16.960 research supports it or not or if the research is less supportive or minimally supportive i've seen

00:45:22.640 this work and then the third one would be the the patient value or the client value in the client

00:45:28.160 experience if a client came in to me and said i've had ultrasound every single time this is flared up

00:45:33.200 and ultrasound helps i'd be remiss if i didn't use ultrasound even though i might think that ultrasound

00:45:39.440 is not going to be as highly effective as another method because the patient has built a value in that

00:45:44.640 treatment does that make sense yeah that makes sense sure so so we we take if we take that approach

00:45:50.720 then some of the things that i think that are very effective on an evidence-based model at varying

00:45:56.480 levels of evidence not all these things have the same level of evidence but the number one thing that

00:46:01.920 we know is the most supported by the literature would be resistance training even in the physical therapy

00:46:08.800 world we know that resistance training using load and weight with set and rep schemes and and we would

00:46:16.720 vary that resistance training with three different variables that would be volume intensity and

00:46:21.920 frequency volume how much are they going to do of it frequently frequency how often are they going to do

00:46:28.720 it you know based on recovery and things like that based on their injury or or whether they're if

00:46:33.840 they're not a patient you know based on their training model and then also intensity and intensity

00:46:39.760 could be based on the set and rep scheme it could be based on the load you know there's a lot of

00:46:44.960 things that can that can vary the intensity but generally that's the load base of the of the scheme so you know i

00:46:51.600 think resistance training would be the first thing and a lot of people think that's old school a lot of

00:46:55.520 people think that's kind of boring but but i think that resistance training would be is the most

00:47:00.000 effective method for us to rehab for me to rehab clients today the second thing would be able to

00:47:06.560 use my hands i do joint manipulation on patients sometimes using joint manipulation in the spine

00:47:13.520 and the extremities we don't really know why that works there's a lot of theories that are out there why

00:47:19.840 that works but but i generally get a very good response using joint manipulation with certain types

00:47:26.160 of patients and certain types of diagnoses we use electrical stimulation e-stem in varying forms some

00:47:33.920 of its contractile based where we actually cause a muscle contraction we're not we're not trying to

00:47:38.560 get the muscle stronger because that's kind of a debunked theory but what we're trying to do is get good

00:47:44.560 muscle contraction and then we also might have the patient volitionally they can they try to contract

00:47:50.160 the muscle and then we stimulate the muscle also with muscle stem at the same time

00:47:53.840 uh so we're getting that combined effect and then we might use e-stem 2 for pain control or for

00:47:59.920 pain mediation so that they can do more activity and be more active and move more and then we use

00:48:05.440 things like dry needling dry needling is a great technique i mean dry needling is the western form of

00:48:11.680 acupuncture and we know acupuncture has has some has good benefits um but as a therapist that's

00:48:18.880 certified in dry needling i use dry needling for the physiological effect that it creates

00:48:23.680 increased blood flow um increase um firing of the local receptors in the in the region the

00:48:30.320 improvement in reducing trigger point activity and and helping the muscle to relax there's a dry

00:48:35.760 needling technique that we use on the knee that uses a nine point technique where we put needles

00:48:40.640 in nine different locations around the knee and on an osteoarthritic knee i can put that that

00:48:45.600 system on them i put the nine needles in the knee combined with a low current electrical

00:48:50.800 stimulation and they get a great relief in knee pain and so um we use we use things like that too

00:48:57.040 and so there's other things that we could use you know and there's some modalities that that are used

00:49:02.320 in the sports medicine world today and there's really just there's very little research to support

00:49:07.200 those things and i try to stay away from those things so it sounds like what the dry needling does

00:49:11.280 you're basically creating an inflammation to drive blood there to treat another a subline inflammation

00:49:17.360 right yeah i mean theoretically that would be it you're you're and and we would generally use dry

00:49:23.200 needling when the primary healing primary healing model has failed to heal the region so what we're

00:49:30.720 trying to do like you said is we're trying to create another incident that's that the body would see as

00:49:36.080 an injury right and that incident what we're trying to do is is influence the body to increase the blood

00:49:42.560 flow it causes a small inflammatory process that's more controllable and then hopefully through

00:49:48.400 exercise and activity and education we can get the patient moving again and get the inflammation down

00:49:53.120 you know inflammation causes pain structural damage causes pain and so we're trying to get the

00:49:59.360 inflammation down get the structural damage to heal but the best way to get that area to heal is to

00:50:05.840 put that tissue under movement if it's if it's you know if it's a contractile tissue like muscle tissue

00:50:12.880 tendons tendons we really wouldn't consider a contractile structure on its own but it's part of

00:50:18.160 the contractile element because it's attached to the muscle so the muscle attaches the tendon

00:50:23.680 attaches the muscle to the bone and the ligaments attach bone to bone so in those scenarios we're trying to

00:50:30.240 get blood flow to all those tissues so the human body can heal itself okay so it sounds like a first

00:50:35.840 first thing you're gonna do rehab is continue with resistance training at a different level you

00:50:41.120 know probably modify the level or the intensity and then if that doesn't work you might you incorporate

00:50:46.960 some of these other practices or these other other methodologies yeah and i'll probably combine it

00:50:52.480 together you know if a client comes in and they're having some pain then i'll then i'll probably do

00:50:58.320 and that's based on the severity of the injury if if the injury requires a period let me give

00:51:03.520 you an example let's say someone comes in in there they have a post-op rotator cuff repair they they

00:51:09.680 rip the rotator cuff off the bone it's just been repaired before three or four anchors they're in

00:51:16.320 their post-op period there's certain precautionary measures that we have to take during that period

00:51:21.200 because there's a there's a structural integrity issue there that we just have to be careful with so

00:51:26.320 we don't re-tear the tendon before it has a chance to purchase into the bone does that make sense yeah

00:51:31.680 that makes sense so in that scenario what i'm really doing is i'm trying to give them pain

00:51:37.600 mediation first so let's say they come in one day post-op well the first thing we're going to do is

00:51:41.840 we're going to start using gentle gentle passive range of motion we're going to clean the post-op

00:51:46.880 wounds up we're going to dress them then we're going to use ice and e-stem to increase the blood flow to

00:51:51.520 the area along with that range of motion and then give them a home program and send them on their way

00:51:56.560 as the the tendon heals and opportunity allows itself then we'll start to load that tendon

00:52:04.000 gradually over time through kind of a passive to active assistive to active range of motion model

00:52:10.160 and then add resistive range of motion whenever it's appropriate so there are times when you're

00:52:15.760 talking about fractures or structural integrity issues where a ligament's been severely damaged

00:52:22.320 where we got to be careful with with motion we still want motion but the motion is going to be

00:52:27.920 controlled in regards to its range and its volume and how much load we're definitely going to put

00:52:33.360 through it but with all clients i'm probably going to combine those modalities and those techniques

00:52:38.240 together so a good example would be they come in we do some exercise training with them that day

00:52:44.320 and then we finish the session with ice e-stem whatever else we're going to use that's a that's

00:52:50.080 what you would consider an adjunctive modality and how do you know when a patient's like they're good

00:52:55.120 right because a healing the healing process it's sort of like a muddled bleeding you know it sort of

00:53:00.480 bleeds to moment to moment like is there like a moment where you realize yeah you're good to go

00:53:04.640 you can just go back to what you've always what you did what you were doing before that kind of sounds

00:53:09.040 like the the the magical looking glass there or something i wish i had that exact answer to the

00:53:16.000 exact time i i know at this time and at this minute you healed but here's what i teach our

00:53:21.840 our new therapists that come out when the dpt's come out of schools and they come into our practices

00:53:25.840 one of the things that i we've actually uploaded into what we call our clinical toolbox for our

00:53:31.120 therapists it's an evidence-based compendium of articles and different text sections out of books that

00:53:38.000 i've read or other therapists have read over the years one of them is a pathology text and and what

00:53:43.680 i did was i just copied the pages that pertain to the healing timelines and time frames for different

00:53:50.800 types of human tissue so it doesn't it make sense that a tree grows at a certain rate right that certain

00:53:57.920 plants grow at certain rates and certain animals grow at certain rates and humans grow at certain rates

00:54:03.520 and they also heal at certain rates we we can generally say that that most muscles will heal

00:54:09.520 within two to four weeks and will be pretty structurally strong unless it's a severe tear

00:54:15.120 with a with a lot of bleeding and you know there's a lot of damage to the muscle but when you're talking

00:54:20.080 about your average brain strain you're talking about two to four weeks and when you're talking about

00:54:24.320 tendons and ligaments you're probably talking somewhere around six to eight weeks before it's it's healed

00:54:29.840 fairly well and we can load it even more and more and more when you're talking about bones then it's

00:54:35.360 it's age dependent based on how old the person is but generally we're talking about you know most people

00:54:41.360 are in a cast for somewhere between three to six weeks based on the severity of the fracture so the

00:54:47.440 first thing you want to look at is what what tissue am i dealing with here so let's take the case that

00:54:52.800 you had where you most likely had a small tear or disruption of the origin of the hamstring tendon

00:55:00.640 at the the sit bone right when you were running well in the in that scenario if you came into my clinic

00:55:07.840 and you could produce a strong contraction but it was painful then i know how to grade that in regards to

00:55:16.800 damage and i can give you a general idea how much damage is in there before we even look at an mri

00:55:23.200 now let's say you produce a very weak contraction and it was extremely painful and i thought you had

00:55:31.280 a pretty good pain tolerance because you know a lot of it is neuroscience and pain behavior right

00:55:35.440 some people are just generally more durable than others and they tolerate things more but let's say

00:55:41.120 i knew you as a as a as a friend or a client a lifting client you came in and i knew this guy's tough

00:55:46.640 this guy's tough as nails and you came in and you produced a very weak contraction in the hamstring

00:55:52.960 and it was extremely painful then that would give me cause to want to seek further diagnostics

00:55:58.240 because i'm thinking this is probably a grade two to a grade three tear or strain and spring does that

00:56:04.400 make sense yeah that makes sense so let's say you came in and you could produce no contraction of the

00:56:10.080 muscle you couldn't extend the hip or flex the knee very well at all and you had less less localized

00:56:19.120 pain but just more diffuse pain in the general region but it wasn't quite as painful as i would

00:56:25.440 have expected it to be now i'm really concerned because the muscle's not contracting in the manner

00:56:30.240 that it's supposed to the muscle's not functioning and i'm thinking that one end of the muscle may not

00:56:35.760 be attached does that make sense there yeah yeah so so then from that standpoint we're going to rehab

00:56:42.400 you based on the severity of the injury you know in some of these cases they're surgical but once you

00:56:47.120 come into rehab we look at those time frames and this is a great example would be like a post-op acl

00:56:52.960 injury or rotator cuff injury and we have some general time guidelines that we follow

00:56:59.040 in in some of those injuries you you're going to find that most physical therapists are very very

00:57:04.720 conservative on those timelines and because we're in the medical industry and there's that

00:57:09.600 approach avoidance and you know kind of you know clinician do no harm physician do no harm model and

00:57:15.360 there's a lot of medical liability there we have to be careful um so i kind of put on two different

00:57:20.880 hats one hat as a physical therapist and one hat as a as a strength coach and so once you can

00:57:27.520 reasonably handle body weight load then we gradually load you over time when i feel like

00:57:33.200 you're competent in your movement you're handling loads frequently then i'll just send you on your own

00:57:39.200 way and let you train yourself and and just follow up with me with me when needed it's great well

00:57:45.120 darren this has been a great conversation packed with information is there anywhere

00:57:48.080 anywhere where people go going to learn about to learn more about what you do well unfortunately

00:57:52.000 i'm old so i'm in my 50s and i'm not quite quite caught up with the whole social media trend but

00:57:58.800 i'm kind of dysfunctional there but but um yeah they can people can get a hold of me if they'd like to

00:58:04.160 at my starting strength online coaching email which is d deaton at ssonlinecoaching.com

00:58:13.040 or they can get a hold of me through my rehab email address which is dld

00:58:18.960 at riata therapy that's r-i-a-t-a therapy.com and i still have my my crossfit fort worth website up

00:58:27.520 it's for strength and conditioning crossfit fort worth hopefully within two months i'll have a small

00:58:32.800 i plan to open a small boutique barbell gym in my local community where i'll mostly be doing um

00:58:38.960 barbell training but also some conditioning on a need basis specific a need basis so but i'd love

00:58:44.960 to hear from guys if you just have a question a concern you need more information that's the best

00:58:49.760 place to get a hold of me in those email addresses awesome darren deaton thank you so much for your

00:58:53.840 time it's been a pleasure thank you bro appreciate it my guest today was darren deaton he is a physical

00:58:58.400 therapist as well as a starting strength coach you can find more information about what he does at

00:59:02.640 starting strength online coaching also check out our show notes at aom.is slash deaton that's d-e-a-t-o-n

00:59:09.280 where you can find links to resources we can delve deeper into this topic

00:59:23.200 well that wraps up another edition of the art of manliness podcast for more manly tips and advice

00:59:27.440 make sure to check out the art of manliness website at artofmanliness.com if you enjoy the

00:59:30.880 podcast i've gotten something out of it i'd appreciate it you can take a minute or two to

00:59:34.080 give us a review on itunes or stitcher helps out a lot if you've done that already thank you please

00:59:38.000 share the show with your friends it's how this show grows it's word of mouth as always thank you

00:59:42.080 for your continued support and until next time this is brett mckay telling you to stay manly

The Art of Manliness - January 16, 2018

#371： The Best Ways to Rehab From Injury

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