Feel free to check out Chris Howard at https://fitnesstogether.com/waxhaw or head over to Fitness together's page at https://fitnesstogether.com.
Physical Therapy, Pineville, NC.
Hey everyone, welcome back to PR1ME Time. This is Dr. Chad Kuntz, and as always, thank you so much for tuning in. I'm really excited to talk to you guys today about how you can help yourself return back to playing golf and/or tennis after a rotator cuff surgery. In fact, quite a few people end up having to, unfortunately, have a rotator cuff surgery as we get older. And I pick both those sports. It's kind of a country club kind of idea. You know, you're signed up as a member to one these country clubs, golf, and tennis, they're both sports that you can really truly play without really any age limit. You know, golf specifically, it's one of those fun things you want to try to shoot your age one day, right? So if you're 80, you're trynna, you know, shoot an 80 score, and tennis, there's even different leagues as you get older.
So it's just one of those things that a couple of those sports that you can just continue to play as you get older, it keeps you active, keeps you socially active, keeps your head with it, keeps you moving. And so, I want to help you guys, you know, continue to play both those sports even after sustaining a rotator cuff surgery. As you can imagine, and maybe as you are kind of going through it. Depending where you're at, you might be starting to ask yourself, "Man, I'm not so sure I can even play those two sports again because those sports both are so heavily demanding on my shoulder to actually do what they need to do." And, rotator cuff surgeries are really intense. Okay. Rotator cuff surgeries are very, very challenging. I worked with what feels like hundreds, if not maybe thousands at this point, of rotator cuff surgery repairs or protocols.
And honestly, some of the challenging components about it, it's because everyone is a little bit different. You got to take into consideration that the injury you had, your athletic, your athleticism, your range of motion, your strength, the quality of that joint, all of those factors go into the surgery, make a pretty significant impact. And then the surgery themselves, I feel like, the surgery themselves are consistently changing. We're kind of in this time period where different surgeons are playing with different types of protocols and different types of ways to perform the surgeries. So, you're going to get, you know, a little bit of a different angle on that. And then also, I have to kind of do justice to inform you that, you know, not every rotator cuff tear is created equal, right?
They really divide them, and I'm not going to get too far into it, but, they divide the rotator cuff tear into length and width, length would be, you know, small, it would be less than one centimeter. Medium would be between one to three centimeters. Large would be between three to five centimeters, and massive would be greater than five centimeters. So, there's a length component that you've gotta be considerate of. And then there's also a depth component. If I remember, I want to say the depth was either less than one centimeter, which was small, medium would be between one to three centimeters, and a large depth rotator cuff tear would be between three to five. And then, you know, furthermore divided into different types of classifications. So you have to kind of think through that. Now, the good news in terms of simplicity is that most of you, if you had a rotator cuff tear, hopefully, most of you it would be only or isolated to the supraspinatus. So, the supraspinatus is a muscle that sits kind of on top of the shoulder. It's your primary muscle that helps drive your elbow up and away from your body into what I call abduction, and it does some rotation as well, it does some externor rotation.
Now, typically that is a rotator cuff tear. Or that is a rotator cuff that's involved solely in the tear. The next level up, if you really did a good one, you'd also have a tear in the infraspinatus, that's usually round number two. And round number three would actually be the teres minor. Okay? So that's if you really did a massive tear. And if you did the complete shebang, you really did it all, you'd have the subscapularis involved too. Alright, so, rotator cuff tear surgeries and getting you back to playing those two sports with golf and tennis. Now, first off, just to get range of motion, just to get, I'm not gonna even say pain-free range of motion, but just to get full range of motion, where you can actively lift your arm up above your head. We're looking at usually 12 weeks. All right?
We're looking at 12 weeks just for you to be able to get your arm all the way up overhead. And, I've talked to, you know, quite a few surgeons and some of my clients and they say, you know, "My doctor said I really shouldn't even expect to get all the way up overhead in terms of my range of motion again." So, I think, you know, the pain is just so intense for most of my clients following that surgery. Some of you are lucky, you know, some of you get through with it and you're like, well I'm moving pretty good. It's not a problem. But, most of the time, the pain in the shoulder is very intense when trying to get into overhead motion again. I feel like you have to be somewhat crafting to kind of work with the joint to try to get into pain-free overhead motion as much as possible.
The slings make it tough. I feel like a lot of people are having trouble sleeping at night, which doesn't help with the recovery process, and people are just generally uncomfortable because most often it's even their dominant arm and the arm is kinda stuck in the sling. But, nonetheless, guys, we're looking at about 12 weeks to have full range of motion, and you should be incorporating some level of some strengthening exercises, usually around two months post-op. And again, there are varying different degrees, but we're looking somewhere around six to eight weeks after you had your surgery that you're starting to incorporate some at-home strengthen-base exercises. What we're really here to talk to is what's after that, what's required after you just get your full range of motion. And as you'll hear with a lot of my stories on podcasts, and as you just hear me out, getting your confident in that sport-specific range of motion is so important, and we've got to justify it.
We've got to be able to justify it mechanically that you can, you know, swing your arm as fast as you want. Let's just use a tennis serve, for example, that's a really aggressive move for the rotator cuff. So, as you go to toss the ball and as you go to reach up to swing that, and your arm's way overhead, your rotator cuff, remember, has a purpose to compress the joint and depress the joint. So, you can see, if you're watching this on a visual, you can see my hand's away from my femur, excuse me, from the head of the shoulder. It pulls it down, it pulls it, if you can imagine this on the podcast, if you're listening in, it pulls the head of the shoulder down away from the acromion so it actually gives you that space, and we need to keep that space as you reach up overhead.
A lot of post rotator cuff surgery clients who are trying to get back to playing tennis and golf, they have trouble with that overhead move because if the rotator cuff isn't firing properly, if it's not strong enough, if it hasn't learned to kind of co-activate and co-stabilize, the head of your shoulder will actually slide up north. It can run into problems like the subacromial bursa, subdeltoid bursa, hopefully they've done debridement near the surgery so there's no osteophytes or bone spurs hanging off, but, you could potentially kind of start banging back up into that acromion in the future, causing yourself another bone spur.
So, getting the shoulder and the rotator cuff to actually fire and get strong overhead is going to be incredibly important for you, particularly with the tennis serve. Now, with regards to golf, when you go into the backswing, the rotator cuff has to shorten and you have to have a lot of range of motion when you're golfing and you go into your backswing. If you take a look at a professional golfer, when they go back into the backswing, they have about 80 to 90 degrees. That can be very challenging in my experience for a lot of rotator cuff surgeries for you to get to that full motion. I find though, that there's a lot more guarding than there actually is mechanical justification for you to not get into that end range of motion. Meaning, it's not like you've got a bony block or something that limits you from going there.
A lot of times, this is musculoskeletal, that your muscles like your lats, like your pecs, heck, even your anterior delt. These muscles get really tight, and they don't allow the head of that shoulder to move where it needs to. It kinda locks it up, if you could imagine gears to the watch, right? The gears work all together in order for that watch to tick. It's kinda like putting a monkey wrench in between that and all of a sudden it can't move and you just find yourself stuck, and you're thinking to yourself, well, maybe something went wrong with the rotator cuff surgery itself, or maybe he didn't clean it out right. Now, a lot of times the body is very protective. It's guarding. It's not really trusting the body to be able to go back into that full range of motion. So, loosening up the tissues, getting stronger, again, being specific to that golf swing position, where you're reaching back, practicing that exercise, can be incredibly important.
And then, for the golf follow through, your muscles, your rotator cuff muscles need to learn how to go on to stretch safely, okay? A lot of times, in my experience working with these clients, when I try to really start stretching it, they get apprehensive. It's kinda like they visualize themselves maybe almost wanting to think that the rotator cuffs will tear again, right? And so fear plays a big role in the body holding yourself back from getting this full range of motion. So, what happens if you don't truly get those full ranges of motion and then you go out and you try to swing a big driver without warming up because you're scared but you still want to do it. You know, that's actually when you're at risk to hurting yourself. You know, you're actually at a much better chance to confidently, intelligently, yet aggressively get into these sport-specific motions under, of course, the health care supervision provider that you're working with so that you have that confidence.
And then, with regards to golf, start slow, you know, work with your provider, but there's nothing wrong with even just grabbing a putter and just, you know, banging away a hundred putts and just starting there. If you're really trying to get back in the game of golf. Next step, you know, just work your way up the ladder, start with your sandwich and start small. Start with 15 balls. If you're, you know, clear to do it, but you're still kinda nervous. Start with just 15 sandwich shots and start at like 50%. You know, you're barely swinging through it. Work your way up into the pitching wedge, 9-iron. And this doesn't even have to be on the same day, right? It's not like you have to get a hundred bucket of balls and then work your way all the way up to the driver the first time you get in the driving range. You could do that over the course of weeks. Now, obviously, sooner is better, you know, for me, personally, and if I was clear to go, I'd want to go play 18 holes with my buddies right away.
But we do have to do it somewhat intelligently and objectively to prove to ourselves that we're ready to take that next big step. So, you know, working your way up to 7-iron. And let's just say you felt a little uneasy, you felt a little twinge with the 5-iron, well, I'd stick up to the 5-iron, you know, 5-iron below, 6-iron, 7-iron, 8-iron, etc. And I would get really confident and comfortable there and kinda work with my provider and say, "You know, why did I feel that twinge? Did I swing harder? Do I not have the strength yet to be able to justify that much more leverage and that velocity?" And really kinda just, detail it out, figure out why wasn't I able to do that the way I wanted to pain-free instead of just saying, "Whoops, I can't do this again. You know, I guess I'll just have to hit a 6-iron off the tee every time."
But do your due diligence, and work with the provider to see what does it take? I'm a big fan of recording these motions, getting a slow-motion visual. Maybe something changed. If nothing changed, then we know it's strength related and it's time to get back in the gym and keep working out and strengthen that baby for maybe, you know, let's say two weeks and let's go after it again in the range. Let's get out that 5-iron, let's see if I can do it pain-free. Chances are you'll be able to.
Tennis, what's great about this is that we can kind of emulate and mimic the same things as what I just said with golf, which is kinda why they go together. There's kind of this transverse plane, this rotational movement required in both of them. So, with tennis, you know, analogous to the backswing of a golf, you're gonna go into the backswing of your shot. If your right arm, it's reaching back, you know, with your right arm, you want to take that slow, you might want to only do that, you know, 50% and the initial contact with the tennis racket into the ball can be challenging. So you might want to just start babying it. You know, just where you just make a little bit of contact, start with slow speed. You may not even hit over the net, like maybe you're just hitting it into the side of a wall, like a practice wall, you know, that you're hitting into. The backswing, the backhand for a tennis player can be challenging. Kinda like the follow-through for a golfer because you're putting those muscles on stretch.
And not only are you putting muscles on stretch, but you're actually asking your muscles to come out of that with some form of velocity. So I find that a backhand is probably more challenging than forehand for my tennis players because they have to put the muscles on stretch and then generate force. So, for you, you know, you're gonna have to learn how to just get into that pain-free stretch position and then just work on slowly coming out of it. Another nice way to practice this, if you can, is getting into a pool. And this goes for both my golfers and my tennis players. Grab, there are different types of things you can buy, but something that adds little resistance into the pool. You know, where you're just creating a little bit of turbulence and resistance and you're going back and forth, just kind of mimicking that forehand and backhand, or backswing, or back part of your swing or your fore swing, as you're coming through.
And that can give you actually a little bit of resistance where you actually have to generate some force, but you got some buoyancy to support your arm. So, there's something to be said about kind of aquatics training which I would guess somewhere between even a couple months post-op and thereafter would be a great thing to kind of interject to add in just some movement. And again, some sport-specific movement. Because if you're, one, you know, that just goes around everyday life, grabbing your coffee, newspaper, you know, driving, all of a sudden you get on the tennis court, you have it warmed up, you're late, and you're up next to serve and you're, you know, three months post, or say four months post-op or six months post-op surgery. That's still a lot for you. You know, that's still a lot.
So, just kinda something to keep in mind. So, we've talked about a lot so far, and I just want to also mention the importance of a proper warmup as we're kind of seguing from that. I know for me personally as a golfer, I haven't dabbled too much into tennis, but as a golfer, I've seen the tendency for golfers to just get out onto the tee, they're late and they just start swinging it. And not that you even have to make a big social like event that you're warming up when you get out there with your guys. Because I know how that is guys or gals might pick on each other, but, you know, it could be super simple, just grabbing an elastic band and you're welcome to kind of email me, shoot me a message if you're kinda interested in a warm-up. I'm sure we could get you some videos. But, the point is here that you need to be able to just have a simple five minute warm-up, particularly for golf, just to kind of get the blood flowing in there, get some confidence, make sure things are feeling good.
As well as for tennis, I think I like to kinda get a little bit more of a warm-up in tennis. I'm thinking more 10 to 15 minutes, a little bit more dynamic guys, and get the blood flowing. And again, just making sure that you're safe. I think, after rotator cuff surgery, you just wanna put a little bit more WD-40 on the shoulder, if you know what I mean. A little bit more blood flow into there before you really get out there and get aggressive. I just think that's really smart, as well as a cool down, right? You know, just spending a few minutes, five minutes afterwards stretching, maybe chatting with your guys about how the game went, or how the tennis match went. Just do yourself a favor, making sure you do a little cooldown. It's not uncommon for people to be a little achy and sore, whether they played 18 holes of golf or they play three sets, doubles even or singles.
And that's where you can either use a combination of ice or heat. If you want to take a little bit of Advil, you know, to kind of keep it down. But, the point is, guys, in this modern day and age, if you have a pretty significant rotator cuff tear and you have surgery, the fact is that you should still be able to go out there and compete. You should still be able to find a way to compete at some level and modify things. And then, let me also just kind of leave you with this thought, guys. It's really important for both these sports for you to have addressed your entire kinesthetic chains limitations. What I mean by that is, for instance, if you're having trouble with your backswing in, actually yeah, in Golf, you know, it requires your whole body to move.
It requires your hips to move. It requires your knees, your back, your trunk, your rib cage, hopefully not your neck, right? Because for golf you chin should stay down, but, you get the point. Really the entire body should be as primed as possible to help assist, in this case, your rotator cuff surgery so that your rotator cuff surgery doesn't have to do as much work. Same thing for tennis. If you're going to toss that ball up and go for that serve, your spine better have really good extension. Your hip strength may need to be really strong into hip extension. Strong quads, strong legs, strong core. So, think about also the way that you want to now assist your shoulder as much as possible. Chances are, most likely, you're not 100% or not what it used to be, but if you can support it by straightening up everything else around your body, heck, you might even do better than before because you've actually strengthened the weak links that you had in your games.
Does this take work? Does this take an offseason strength and conditioning program? Does this take time, money, and energy to work with a provider, to work with you over time, to figure out how to break through all these limitations? Absolutely. So, at this point, it's just how badly do you want to be able to continue to play as you get older at your country club or whatever it is and enjoy life and playing with your kids or the grandkids. For me, there's no price on that. Health is everything to me. It truly is and it continues to show itself like that as I get older. So, guys, if you guys have any additional questions, please feel free to reach out to me at ChadK@pr1memovement.com. It's been my absolute pleasure, and have a great rest of your day. Thank you.
Hey, everyone. Welcome back to "Pr1me Time." Dr. Kuntz here as always, and we're gonna go over kind of heavy topic today, but we're gonna tap into the best we can. It's for those of you who are feeling old and broken, and you're not sure what you can do anymore. I understand even in my, we'll call it 10 to 15 year progression from working out, having gone through some trials and tribulations, life in general becomes much more than just musculoskeletal. What I mean by that is it becomes much more than just injuries that you occur. Those alone can be challenging in terms of really the psyche component. You know, because I've had a couple times where I've tweaked my back or my shoulder, you know, I played baseball up until the time I was 18, never really was taught how to throw correctly. And I know that there's been some labral damage on my right side. I remember my velocity going down in my senior year, had a skiing accident, my left shoulder, etc.
And so as you continue to work out over the course of years, yeah, you feel a little bit more banged up. To some extent, even when you're trying to do the best you can, I can tell you right now, I know for me, personally, I've only been probably really properly correctly working for maybe five years out of the 15 or so. However, it's even more than that. Life and just stress as we get older becomes really challenging. The psyche component of feeling old and broken, I think, again, it's the accumulation of stressors, not just the injuries. And the accumulation of fatigue, I think, eventually just builds up on us. And there can be some level of wanna be breaking point where it's like, man, just how much harder do I keep fighting? And I think we all kind of run into that at some point. Like, how much hard do I really need to keep fighting to stay active, to be who I really am?
The flame goes through tornadoes, it goes through big hurricanes, it gets challenging sometimes. And so that big flame where everything was feeling sky high, for a lot of us things would feel great, felt vulnerable. When you're 18, big flame of who we are now. Keep working hard and feel great. Yeah, as you get older that will get absolutely challenged. Absolutely challenged. And I've seen it with a lot of people I worked out over the years, just those who have kind of fallen off. It's kind of like the movie Avatar. Most of you should have seen this movie by now, so I don't think I'm spoiling it. And End Game where all of a sudden, like half the people disappear. That's kind of like the mentality, I think, I see as I continue to persevere, and work out hard, and battle through life. Because man, life can be tough sometimes. But keep battling, keep staying on gym, keep working out. And all of a sudden, you look around you and half the people that you knew were kind of by your side and maybe not lifting partners, but there was kind of this aura between you and your friends. They were continuing to strive forwards and people getting knocked out left and right. Maybe it is injuries, maybe it's just life, maybe it's a divorce. Maybe it's a business that went sideways. And all these accumulations of tough life stressors add into the feeling to the perception of feeling old and broken.
So, all right, let's say you're 45. Maybe you've gone through divorce, and you've had let's just say for example, hip pain and knee pain, even back pain that's coming up. And you're trying to work out, but you're getting to a point where you're like, well, what the hell? Is this even worth it? Am I just hurting myself by trying to go the gym anymore? Because this feels ridiculous in terms of all the crap that you gotta put up with. Maybe you're icing yourself all the time, not getting the workouts in that you used to, maybe your even diet's kind of gone downhill and you've had some X-rays and maybe an MRI, and you're kind of seeing the changes in arthritis, maybe that low back pain's turned into a bulging disc. You see what's purportedly told as grade three osteoarthritis in your hip and you're kind of wondering, what the hell is this even working? I'm not that same 20-year-old that I used to be. Well, it was really easy back then to get your work out.
So from my advice to you, because we work with a lot of people that are actually pretty similar to that, I can tell you right now, I'm sure at some point in my 40s or 50s, that thought will happen, I think it's actually pretty normal. I think it's good for you to hear that it's pretty normal for a lot of people to hear that and to say that. But I think it starts with go find a specialist. I think it comes back to, and I'm not gonna just say physical therapy at this point, I'm gonna say someone who can really sit down, have a great discussion with you, and learn more about your injuries. Because I think the impact, the trauma, whatever started those injuries, gives us a little insight as to the quality of your movement patterns. And really how you've been training. Your training can be only off in terms of the idealistic setup. If it's only off by just two degrees, you gotta think about kind of the analogy of shooting towards the moon. And let's say the moon resembles being 50 years old and being incredibly healthy and feeling great. But let's say just because over the years of your training methods, and they've been a little off, they're not quite right, maybe some old school patterns of thought, maybe just movements that aren't quite right for your body, or the form that's not right for your body, you're off just a couple degrees. Well, guess what, a couple of those degrees off as you initially set off on your journey from the Earth to the moon, you could be off hundreds of thousands of miles. And those hundreds and thousands of miles equate to those pains that you're feeling, most likely, including your hip, your back, and your knee, what have you. And maybe even sometimes we just get unlucky and there's trauma. Maybe you had a car accident, maybe you had yourself a skiing injury or something like that. So that too is thrown in there on your journey. And now you're even further hundreds of thousands of miles off, you've accumulated more pain.
So let's take at that moment, you're 45 or 50. And now instead of aiming at the moon, you're hundreds of thousands of miles off. Now, to kind of get back on track, it's kind of like, let's start from square one and let's just learn about what your journey has been like. So that's where again, learning about your injuries, learning about what's happened, learning about how you've trained all matters. And then it really matters to go into a really great full body movement assessment. Because I've learned over the course of my years how ridiculously everything is kind of conjoined in the old stupid saying, the knee bone connected to the hip bone. It's so true, man. It's so true the different types of slings and myofascial chains and all these connections from joint to joint, that even have a relationship further down the road from left ankle to right shoulder. You know, it can really be that connected even depending on the type of movement you have. So it starts with really assessing the whole body and understanding your impairments. Where are your weakest links, and what are we doing to clean those up? I think it's as simple as that.
Stop perpetuating the pain, have an open mind that, hey, we are gonna really slow things down, we're gonna really address those movement patterns that you had at the gym that might have been worsening your pain, we're gonna really clean those up, slow it down. And we need to re-initiate with a plan that will get you back on track. So a lot of times, again, you have to have that open mind and that willingness to slow down on all those exercises that were making things worse, and be open-minded about receiving new exercises and new way, new shape. And you might be upset in the sense that man, I used to always do squats at 205. But yeah, John, but look at the form that you were doing it, you were really hurting yourself by doing that form. So what I need for you is to be open-minded that you're gonna go down into a squat. In fact, you're not even doing 90 degrees, because you don't have the mobility to do that, you're gonna go to 45 degrees, and you're gonna just do three sets of 20 high reps, slow pace, you're gonna have to start there. Because that's where your body's ready for. That's what your body is capable for. Now, right there, that's a moment for that person to have a decision. If they can accept that, in terms of that's what they need to get back toward the moon, great. If they can't accept that, and that's just not who they are, they're rough and tough John, and they've never only had to do air squats, well, that's a psychological barrier and that's okay. But they need to know that. And that's where some level of change fatigue can even play a role. If I'm asking you to change up this and that, maybe they just don't have the energy for that, maybe they're just too tired from work, it's building up on them, they're stressed at home, finances are frustrating them as well, you see. So if it's just one more additional piece of energy that I'm adding in there that also has to change, that might be tough for them. So that's that kind of big elephant in the room, I think, as I talked about a lot, but really, what's our mentality in between the ears, and how does that psyche going to help or hurt us when we're feeling old and broken when we need to make changes and a decision?
So if you can understand that, you need to be patient. Yes, maybe years worth the movements you were doing was harmful. If you can swallow that down. Maybe you were mistold by someone, maybe you were mistold by, who knows, a PE trainer, or PE teacher, or a trainer that you worked with five years ago. If you're working with a specialist, you have to understand that you might have been mistold certain things in the past and now we gotta break those habits down. And I find myself addressing that every day. Let's break down the bad habits, which by the way, are incorporated in simple stuff like how are you sitting? How are you walking? How do you bend down to grab that pin that you dropped? It's actually quite amazing to just see very fundamental movements, and how they play out because when you're working out, those movements will only be exacerbated or exposed. And therefore, they can be more harmful, because you're loading it usually with weight. So yes, if you're feeling old and broken, be open-minded, be open-minded that you need to slow things down, see a specialist, and that you may be on a long journey.
Because now that you're hundreds and thousands away from the moon, and you're gonna have to change direction, you're gonna have to go around the moon a few times before you can slow down and then sit on it. There'll be a lot of energy used there to change inertia, which by the way is its own topic in itself. Anytime you change inertia, that's really hard for people, people are creatures of habit, we'd like to sit in the same seat in high school every day, even when we didn't have mandatory sitting, you liked to sit in the same chair every day, when you read your newspaper, when you look at your phone, and you hold it in the same way every time. So if you break inertia, that's work for the body, that's work for the brain. Your brain's really consumed about one thing and that's saving energy. Because that's all it knows. Only up until the last 200 years have we now had enough nutrition and food, and well, to the point that obesity is an epidemic. But the brain's not really caught up. So it might take who knows, I'm not a master, or understanding on evolution, but it might take thousands of years before our brain really catches up and understands, hey, movement quality actually really matters. Just think about that for a second.
So yes, long story short, guys. Be open-minded, know that you're gonna have to change inertia, know that you're gonna have to change up a lot of things and a lot of bad habits that will take a lot of energy, and that you're gonna have to really drop the weight with a lot of your exercises, probably learn a new exercise regimen, you're gonna have to learn how to regularly incorporate de-load weeks or rest breaks in your workout programs, you have to alter workout programs and understand too you almost always be on the fight of trying to continue to fight your weaknesses and your impairments. We just wanna minimize those impairments to the point that they're not causing pain. I think it's as simple as that.
So for those of you that do feel old and broken, you've tried everything, maybe you've tried physiotherapy before, tried chiropractic use, maybe you're trying to hold off from surgery, maybe even contemplating stem cell use or PRP, and you're just lost. Maybe you've [inaudible 00:12:44] up, feel free to reach out to me, feel free to shoot me an email at email@example.com, that's firstname.lastname@example.org. I would love to just know about the scenario that you're in and how we could potentially help you as well. I know it's not easy by any means, and I know I can't save everyone because sometimes you just can't save everyone. But I'd like to know that maybe 80% to 90% of those of you out there, we can at least give you some direction. And maybe it's not as bad as you actually think. That's the other conundrum. You were told by your doctor 20 years ago that that back's about to go, you'll never be the same, you shouldn't work out anymore. Maybe we're gonna have to get through that barrier because maybe I'll disagree after I analyze you and say, "You know what, it's actually not that bad. It's actually these muscles that are really tight, that we need to loosen up. We just need to get over the fact that you've been fearful of this movement for 20 years." Do you see how that can be another psychological barrier that we've kind of talked about that limits your ability to not feel old and broken?
So I guess to kind of sum it up, a lot of this is in between the ears, you know, we've talked about breaking inertia, being open-minded, being told by the doctor that you should never do this again. A lot of this is in between the ears and it does take a willingness, openness, and a mindset shift, in addition to, of course, the musculoskeletal mechanical things that need to happen to get your pain below the threshold. And that's really all we need to, find enough weaknesses, address those to get to the point that your body can handle such a way to get the pain below the threshold so you just don't feel it. All right, easier said than done. I get it. But that's kind of the paradigm. All right, heavy topic. Feel free to chew through that and think about it. Listen to it again if you need to. My name is Dr. Chad Kuntz, thank you so much for tuning in to "Pr1me Time."
Pineville Physical Therapy, NC | Pr1me Movement
Hey, everyone. Welcome back to "Pr1me Time." Today, we're gonna get into a pretty hot topic. What's the difference between physical therapy and massage therapy? And it's a question that's popping up more and more and to some extent I think it's actually more relevant than it ever has been. I think there used to be such clear lines about what we do and what our place and our role is in healthcare. And as we progress through the years, we're seeing some blurrier lines, not as black and white as we want it to be. So, I think it does call for the time today to kind of walk through it and discuss and understand that even though I'm a physical therapist, I'm not gonna be necessarily only supporting the therapist role in here. In fact, that's half the reason I wanna talk about it. So, it's created this transition from the point that we had such clear lines to where we're at now.
Well, I think part of it is actually just the autonomy of massage therapists or bodywork specialists. I've seen just in the peanut gallery observing in my area an implosion of different types of massage therapy. It used to be very clear and simple. It was massage therapy. You go to a maybe traditional corporate place, and you pretty much knew what you're gonna get there. But, now, with some level of increased entrepreneurship, there are a lot of massage therapists that are kind of finding their own niche and their practice. And there's a lot of sub-specialties making it very blurry. In the case that, if you just go to find a massage therapist, or bodywork specialist or whatever they call themselves, it's kinda like you're not quite sure what you're gonna get with them. And to some extent, I actually think that's a good thing because you're adding in some variety, you're getting some sub-specialization. And I think you're gonna get a lot more diamonds in the rough because you're gonna find specific types of niches out there that can really actually be helpful.
Now, along with that, the implosion of that also means that I find a lot of people may be going above and beyond maybe what they could or should be doing. And that's really where a physical therapist could step in, such as really prescribing therapeutic exercises that will significantly help them in their process, prescribing strength and conditioning workout programs, prescribing self-mobilization, both joint in tissue-based at home, that the therapist is qualified to do. And so, you are seeing a little bit more of that from a massage therapist role. Is it good or bad? I really can't speak for massage therapy. At the end of the day, I just want the client to get the best experience possible. I just want there to be some level of credence and understanding as to what our roles are in our healthcare.
Now, flip over to physical therapist. I'm gonna just come out and say, I'm really, really disappointed with the direction that my practice has gone. And really the reason behind that is the volumization of insurance space care. You know, if you're responsible for seeing, and I've been there, responsible for seeing three to I've even heard of upwards of five people in an hour, you're flooded with documentation requirements, we're getting more and more stringent. You're on the phone talking to insurances yourself all the time. You might be responsible for handing people off to tech or to an aide, doing laundry, I mean, literally, all kinds of stuff. That leads it to very...or lack of skilled type of care. It's totally unskillful if I have to see three people because I think something that is fading away that's something that physical therapist needs to really maintain its strength on is our hands-on care, our joint mobilizations, our manual therapy is kinda what we call it which is a composite of any type of deep tissue massage and myofascia massage and all the different types of even words come out at this point, active release type of therapy, I mean, all that landscape we should continue to strive for improvement on because I truly think in my own experience, you really can just have your hand in one of the cookie jars, you've gotta have your hand in all the cookie jars to provide someone the best opportunity to get from point A to point B. What I mean by that is, I think a lot of physical therapists find ourselves all in either just [inaudible 00:04:57] therapy, very passive. People are just staying on the table. And we're only doing the hands-on work. And then you also have the type of therapists that are only exercise-based. That leaves room for massage therapists to even step in because there's a need there. People know it. There's a need for their tissue to be worked on as well as the strength and conditioning requirements and putting it all together with improving the workout so they can get back to doing the things they want. So, heck there's a lot of people that have gone to traditional type of physical therapy, and they'd seen, you know, not only one provider who was dealing with two or three other people at the time, but they have seen multiple different types of therapists throughout their plan of care.
So, every therapist is playing catch up, right? And that does not leave for a good continuity of care nor result. So, you find these people on these gaps and these voids who've tried maybe going a typical route but they went through the volumization of care, didn't really help. So, why not maybe just go down the street? Try a massage therapist. And sure they'll pay out of pocket but they're accustomed to doing that of course because really insurance hasn't played a role in there. So, that also means massage therapists have a lot more free will, that what they can do. So, a lot of psychical therapists we've been bound down by what insurances think we should be doing and how we should be doing it, isn't that crazy? We have a doctor degree. But yet we're being told what we can or can't do based upon the insurance, if you have an insurance-based setting. Here at Prime Movement, we found a way to help people get reimbursed and bill for them. But we're not gonna be bound down by what the insurance thinks I need to do. Every moment of my life I'm always thinking about how I can improve the quality of care I give someone. Heck, I'm a madman. I'm always trying different stretches at home. You can ask my wife, she's like, "Yeah, he's...we'll be putting our kid to bed and Chad will be doing some weird stretch over there. I don't know what the hell he's doing." Like I'm always playing around and thinking about different types of ways, manual therapy stretching exercise, to improve the quality of care I give. So, why would I let someone behind the seat in Georgia who's working for an insurance tell me who lives every dying breath for physical therapy for the best quality care? Why would I let them tell me what to do? See massage therapists, they really haven't had that role. So, there's been like I said, an implosion of opportunity for them.
Now, I actually think, more times than not, we can work synergistically. I definitely think the two practitioners have to be on the same page. Most people just think automatically, "Okay, I'll kinda go see my physical therapy and go receive my massage therapy and it should just work out." It really depends on who the heck those two people are, and what their paradigms are and what their thought processes are. There's a lot of different types of thought processes in terms of how to help someone move forwards. If those two providers, and this could even be filled with therapist to physical therapist, massage therapist to physical therapist, or even two massage therapists working kind of synergistically with someone. If those people don't agree and kind of stay in the lane that they know they're responsible for, that can not...at times that won't be helpful. And in fact, they're...they could hold someone back from really improving because they're maybe both doing tug of war and they're pulling the wrong way. I think at times, it can work beautifully. I just think that there has to be communication between provider to provider and an openness and a willingness to kind of work with each other. That's happened with myself several times before, "Hey, you know, whoever, Joe, you'll be working massage therapy. I've noticed that, whatever, Luanne's neck is continued to be really tight." And I'm actually responsible for breaking down the movement assessment, the quality, I wanna see the range of motion, I wanna see what's happening at the neck, I wanna see the mobility in their joints, I wanna feel the tightnessess is in really their upper quarter, as well as the strength deficits that might be playing a role. How are they doing a shoulder press? How are they doing rows? How are they carrying weight? What do their ergonomics that look like? We can take care of all of that.
Now the massage therapist could also do some complimentary work, soft tissue work, whatever they're skillful...skilled training unit is and they can work on that person. That doesn't mean that the physical therapist can't too also work in terms of their hands-on care. But, in my opinion, I think physical therapists have a much bigger, broader role where we've got our hands on a lot of different cookie jars, as I've kind of just explained. And if I know I can rely on massage therapists to do their job and really focus from massage therapy perspective, I think that can work wonders. I've had it in the past. And I know a lot of other people too where the other massage therapist may try to go above and beyond and try to provide some level of therapeutic exercise. And it's kind of a debate as to whether they should be doing that or not. I know they probably have good intent, they're trying the best they can. But are they really allowed to do that? Is that really in their scope of practice? But, I wouldn't mind it as much if the exercises were a complete inverse relationship as to what I'm trying to give them.
Let's just say for the neck, and we're working with that person, Luanne, I think I said, who's got really tight neck and let's say I want them to bring their chin forwards, stretch out the upper back part of their neck and the muscles on the back. And my therapeutic exercise and ergonomics and sleeping patterns are all built around that. However, they go to Joe or whoever and they do the massage therapy but they're told that they should find a little pillow, put it on their lower part of their neck, and they should be extending their neck. And they need to continue to do that. Boom, we've got a total conflict right there, in terms of what that client now thinks they need. That leaves them frustrated, it's almost impossible for them to really make the improvements that they're looking for. Because they've been told such differences. And now they feel like the healthcare system hasn't worked for them when it should have. Now, guess what, maybe they failed, "physical therapy," they failed massage therapy. They might do massage therapy once a month as they fade-out of everything, [inaudible 00:11:38] says maybe it's more affordable to them. And it manages the pain a little bit but doesn't help them much more. Now, they're caught in the web of healthcare. And now they might be looking at surgery or what have you. That's really impactful. That's really profound.
So, I definitely think there's an opportunity for massage therapists and physical therapists to really work together. I think it depends on the quality of every person that kinda works together. And really the openness and willingness and using their strengths together to try to help someone. So, I don't think it has to be kind of this binary relationship in this competitive nature. In fact, I myself as a...I'm a huge collaborator. I'd love to be able to have just this huge network of people. And I've been working up into that in terms of Kairos massage therapist, but I'd like to continue to build that. And I think a lot of physical therapists should have that opportunity to build up this network of people that we can trust and work with. But, come survival, come entrepreneurship, and come hazy lines for massage therapists I think it gets challenging.
So, I mean, I think long story short, I think physical therapists and the volumization of insurance and the lack of quality of care that we are providing from more so generalists than specialists is doing our service a huge disservice to clients. It's failing them. It's one reason I've stepped out to create Prime Movement, because the general scheme of physical therapy is going downhill. We're commoditizing our services, selling our services for less and less, negotiating with people, negotiate with insurances less and less. Whereas, you've got this boom of massage therapists who are becoming more so entrepreneurials. They are providing more value. People are used to kind of going to work with a massage therapist. They're expanding their roles. They really are. They're pushing into that. And all of a sudden people are like, "Well, why go into a system that is going to just put me on the bike, half ass, work on me and work on my knee for five minutes, and then go through the same routine set of exercise that I already know how to do. This seems silly. Hell, I'll just go to massage therapist, at least that's one on one for hell, you know, 30 minutes up to an hour and a half depending on who they're working with. And hey, they're trying to give me some exercise and they seem pretty knowledgeable. So, hey, why not?" You see that's kind of what we're running into.
How do we fix it? Well, I'm really not sure. I know for us at Prime Movement, we're trying to lead and pioneer the revolutionary model for providing premium rehabilitative and therapeutic care. We're not allowing ourselves to be bound down by what insurance says. We want to provide every skill set that we possibly can with every practitioner, utilizing their strengths. We wanna be open and to provide the therapeutic exercise, the strength and conditioning workouts that people need. And I would love to know that massage therapists can step in, I know exactly what I'm gonna get from them. They're not gonna get conflicting opinions. Not that I'm always right. Not that physical therapist are always right. If we're really not sure, let's get on the phone and let's talk about it. But I think just the nature of how busy people are nowadays, that's tough to do, but I love for massage therapists to step in and do some accessory work, hell even once a week, twice a week. In an area that maybe we find is recalcitrant, which means it just keeps coming back. They've developed movement patterns that have perpetuated or worsened that tightness in their neck for forever. Maybe stress kicks in, and that too creates tightness in that area. Maybe working with a physical therapist, we're just not there yet, in terms of truly addressing it, because there's so many other weaknesses in ergonomics, in daily habits that are making it really hard to get that tissue to feel the way we want to so that they're pain-free doing the things they love.
So, absolutely go work with a massage therapist and go see them, because we know what we're going to get out of them. You know, and then I think ideally, sure, go see a massage therapist as you need after our plan of care's done. There might be kind of a "physician model checkup" where you come in once every six months or three months or heck even a year, just to make sure that those movement qualities and everything and sustaining. This should be a collaborative model. Unfortunately, it's not as I've said earlier, because of the two different models of care that I think are pretty profound in terms of physical therapy, as well as massage therapy.
So, big topic guys, I hope you take away from that, that I'm not pointing the finger at massage therapy, if anything I'm taking ownership for the lack of quality of care that physical therapy is giving. I in some ways support massage therapies and their entrepreneurship and the progression. They don't really have limitations or at least for what I'm seeing those who are being audited pretty routinely. So, they're kind of being amorphous and ever-changing to their scope of practice that I don't blame them. However, I would like there to be clear lines, more understanding of what we're gonna get the different types of massage therapists so that I know from a physical therapist perspective, we can really work together and collaborate without giving conflicting opinions and I think it really boils down to that.
Let me know what you guys think, I'd be super interested to hear what you think on this. And maybe I'm way off, who knows? Maybe I'm right. Shoot me an email at email@example.com. I love to hear more about it. If you're watching this on Facebook, feel free to comment below and like I said, if you're listening to this on our podcast, feel free to shoot me an email at that. Love to have a conversation with you. So, thank you guys so much for tuning in again today. Have a great rest of your day.
Hey, everyone. Welcome back to this Pr1me Time episode. Thank you so much again for tuning in. Again, my name is Dr. Chad Kuntz, the founder and owner of Pr1me Movement and Pr1me Time. And today we're gonna really dive in the topic "Is It Safe To Return Back To Squatting And Deadlifting After A Back Injury?" Big topic, and I know as a sports therapist, this is a topic that comes up quite often. And even having worked with a lot of different clients who "tried physical therapy" elsewhere, have tried to see a chiropractor, whoever else, I would say 90% of the time or so, people are unable to get back to working out with traditional care. And I think a lot of times even health professionals can get a little bit nervous about sending people back into the gym, doing squats, doing deadlifts after back injury.
Certainly, and not to throw all the orthopedic physicians underneath the bus here, but I can't say personally that a lot of times orthopedic physicians seem stoked to allow their clients to go back underneath the bar for a squat or deadlift. And so we find ourselves in this conundrum. I know if it were me, if I wasn't a therapist and I was just everyday Joe Schmo and getting tossed around the healthcare system, and I would be distraught if I couldn't get back in the gym, especially with confidence in doing some deadlifts, doing some squats. Those are just not only great exercises but every day functional movements. I don't care how you wanna break it down. If you need to sit down when you go to the bathroom, you are doing a squat. If you need to pick up a heavy gallon of water or something off the ground, you are technically doing a deadlift. So, that will come to haunt you no matter what.
So, guys, is it safe to get back to squatting and deadlifting after a back injury? Well, first, a few different things. We could probably spend a lot of time on this but we have to know what the back injury was, how bad was it? What was actually the problem there? So, from a pathoanatomical perspective, was it a disc bulge? Was it a disc herniation? Did we have a more severe case like with a disc extrusion or the outer annulus is torn and now you've got some nerve problems? From a statistical standpoint, that's gonna be much more severe having a disc extrusion, right, where the outer annulus, is torn versus a disc bulge or let's just say disc degeneration. These are really common things that asymptomatics or those who don't have pain. So, you're not gonna very easily convince me that you can't get back to squatting or deadlifting just because you've got a disc bulge or disc herniation. There's just too many people with no pain who present with that.
Maybe you've got a spondylolysis, which is a small fracture in your lower back, or spondylolisthesis, where you've got some slippage of the vertebrae in the back, where do all these things come into play in terms of your ability to get back into squatting and deadlifting? But what if it was just a strained muscle or what if the facet got irritated? You see, I'm just making a point here. We'd really have to understand and respect the fact that what has happened from a pathoanatomical perspective. Now, just to give you the CliffsNotes review version there, if you have an extrusion where the outer annulus is torn and that is pressing on the nerve root, most likely you're gonna have to probably get that debrided or cleaned out. That's where it's okay to let the guys with the surgical scopes get in there and probably clean that up because sometimes if you've got just a bulge or a part of the disc, I should say, sitting on the nerve root and it's just...it's moved locations, it's deep and lodged in the intervertebral foramen, yeah, there are times when you're gonna need to go in there and get that cleaned out.
So, that even leads us to potentially returning back to squatting or deadlifting after surgery. So, let's say you had a disc where you had an extrusion of the disc and it was torn and it was just really bad scenario, let's say you had to go in and get surgery. Surgery opens up a whole other can of worms, whether it's just a debridement, a laminectomy, do they fuse it? What was the surgery done in there? So, we've got to take all those things into consideration as well before I get you back underneath the bar. A lot of times more people than not are terrified to get back into doing some of those motions after they've had surgery, and I don't blame them. I actually do think it's possible to get them back at some level doing some squatting or deadlifting because a lot of times people have really significantly limited hips or they've overcompensated by trying to use their back to doing squats or deadlifts.
The reality is a lot of times these people who overuse their back doing a squat or deadlift, when they fuse that, they're told to not move that as much or they're told to stabilize and they're like, "Well, I can't do a squat now because I used to overuse my back." So, I do think with people who even have had surgery, they're thinking back to doing squats or deadlifts, there has to be a lot of relearning that has to occur in there. And I think that sometimes just the barrier is that we have to, form a root perspective, reteach the subconscious brain how you can actually do a squat or a deadlift because you haven't moved like that maybe ever. Now, you've got that rod in the case of surgery or fused disc, your body has got a lot of guarding around that space anyways so now you really got to get great hip mobility. So, then you've got to relearn and redo maybe, I don't know, 20 years worth of compensations in your hips. You've got to loosen those up before you can get back to even squatting or deadlifting.
By the way, just to close loop on the spondylolysis or spondylolisthesis that I mentioned earlier, you can absolutely get back to doing deadlifts with a small fracture in your back. Of course, this is gonna be a long time, it's gonna have to heal, reteach you how to stabilize a spine. But I hope people get back to deadlifting or squatting after something like that. The slippage or the spondylolisthesis question, so, can I get back to squatting or deadlifting after that? Well, to some extended degrees, how much slippage there is. So, it's, I believe, a grade four scale. So, grade four would be it's completely slipped off, that would probably not be good. You would probably need to go in there and get that aligned, which would maybe potentially get you back in that surgical question again. But yes, you can get back to squatting or deadlifting with nearly anything I've said so far. Some roads are more traveled than others, some are difficult, some are longer. In most cases, surgery, if you end up having to go through surgery, I think that's gonna be a much longer road in order to get back to deadlifting.
And there are certain levels of continuum in terms of the degree that you're able to get back to doing deadlifts and squats like you used to. So, maybe you're not that 400-pound deadlift behemoth again. And let's say you've had a couple of low back surgeries and fusions and all kinds of nasty stuff, well, then heck, let's just see if we can get you back to 200-pound deadlift. So, let's see if we can do that, cut that in half. Does that make sense? So, all that is underneath just the pathoanatomical standpoint. Then we have to approach this from a psychological perspective. The back is just an interesting area because it's not like the rest of the hand, for example, I can look at my wrist, I can fully identify it, I can turn it around, toss it, move it. I feel pretty comfortable because I can see it and that helps me from some level of fear. But with the back, you don't ever really get to reach around with your neck and look at your back and examine it and get that personal relationship with it. It's this big broad area, we don't have very good neurological sensation built into that area. So, meaning, we just don't feel really well in that back, and it just has a certain level of fear tied into it when you hurt it.
So, I'd say with a lot of my clients when I'm trying to get them back to squatting or deadlifting, there is a huge component of fear and sensitization when I start to help people move again. So, what that means is that the sensation they should feel is not always equivalent to the perception that they'll feel. Usually, their perception is much, much higher because their fear is really high, they're in the fight or flight or sympathetic stage. Like, if you're getting chased down by a bear, you would feel and notice everything, and that's what happens to us from a sympathetic perspective. We start to really narrow in and zoom in on the area of pain because we're nervous. There's analogy like you've got a lot of motion detector headlights right in your low back, the ones that are sitting outside your garage or whatever, and even if someone just steps outside, the lights will pop up. That's what happens to us when we start to get back to working out in general, but more specifically, with squats or deadlifts. And I use the analogy like those motion detectors would even pick up the slightest little leaf that goes by in your back. Your body will pick that up because it is on high intense alert.
So, a lot of times when I help get people back to squatting or deadlifting after a back injury, we need to really build a lot of confidence. We need to accentuate that. A lot of that starts with just getting a lot of repetitions in. If your body is on alert, so if it's on guard and it's looking for anyone it needs to attack, we wanna give it a lot of repetition. So, overtimes, your body's ability to be on guard slowly relaxes. It's like, "Do I have to be on guard if nothing bad has happened for quite some time? This guy has done 50 repetitions with maybe not a full range of motion deadlift, but let's say even 50 or 75%, nothing bad has happened." That'll eventually tell the brain, "We don't need to worry as much." We can finally decrease the level of perception and make it somewhat equivocal to the sensation which it should be.
So, that's all on the first block of this. We really need to figure out what the pathoanatomical problem was, we need to see how they're presenting clinically, we need to see how they're handling it psychologically, we should say, and, of course, the person's ability to do deadlifts in the first place. So, have they been doing this for one year? Have they been deadlifting for 5 years, 10 years? What level of an expert are they? So, you got to take that into consideration. What's their overall just health and fitness lifestyle? Are they eating good? So, you can see there's a lot of other systems that go into it. But let's just put that on pause for a second.
The next step regardless of all that is to help to teach people to properly deadlift again. A lot of times people who are deadlifting or squatting with poor form, so not only are we trying to reteach them how to move, but we're also trying to correct usually years and years worth of compensation at the same time. Most people are over-utilizing their back and they're getting too much range of motion from their back, both, I could say arguably, in squats and deadlifts.
For me, I'm usually trying to stabilize like hell the low back during squats or deadlifts, which means, most oftentimes, we've got to get a little bit more range of motion than they might expect or for what they're accustomed to from their ankle, their knees, and especially their hips. A lot of people are really tight in their hips, and if we can mobilize the hip and loosen that up, all of a sudden, they're probably doing the deadlift or a squat the way that they used to. But just so many people are so tight in their hips, they try making up for it in their back. So, what I like to do is to just start to slowly introduce these motions, squatting or deadlifting.
I like to start with just half the range of motion with, of course, no weight, and just start to give them a lot of repetitions on that the very early acute stage when they might be really nervous about this, they're psychologically nervous about this. I'll send people home doing 500 deadlifts or squats, depending which one we're attacking, and I'll just have them go through half the range motion. A nice, slow, good control and heck even doing that, I'll give them a little bit of a workout just because their reps are so obscenely high. But I'm also trying to reingrain this new type of form or technique. So, from there I just slowly increase their strength, I slowly increase the intensity. And there is no rush. And I know a lot of us wanna get back to it like yesterday, but really at the end of day, we wanna make sure we do this the right way because the worst thing that can happen is a recurrent injury that keeps setting them back and probably starts to defeat them more mentally than anything else. So, if you get recurrent, strong back pains after you've tried and tried and tried again over the course of a few years, you're eventually gonna just give up. There's gonna be a type of fatigue that sets in, where your body is just gonna be unable to keep trying to come back from this injury. So, I really take that with a lot of respect. I do not want my clients to come back from recurrent injuries.
Now, with the spine, particularly, our younger generation, but it can be a little bit older too, if you have a very flexible body and a very flexible spine, that type of person is more so predisposed to recurrent injuries. So, it's all the more reason to continue to focus on stabilizing spine like hell and getting great mobility from the ankles, from the knees, and especially from the hips and maybe even upper spine so that we're continuing to get the mobility there while we can stabilize the spine to help them get back to working out. Now, I do also have to say just a couple of musculoskeletal components, definitely a weak core can be a huge component to this. I do have to say just a shout out, if you're anthropometrically built, where you've got a long torso, it depends on the movement squat or deadlift, but I generally have to say that's increasing their lever arm for their core to have to stabilize a lot more work. So, you might find that that type of client will need to do a little bit more accessory work to stabilize their core under load so that they don't go into an excessive extension moment but that rather they can keep a neutral spine.
A neutral spine, I think that's something that almost everyone has to work with with a professional to figure out what that neutral spine looks like. But a neutral spine is incredibly important for both deadlifts and squats to make sure that we're not asking, for example, our lower spine to do all the work, which is usually what I see. We wanna make sure that each segment in that spine is doing its job and it's got a great linear and straight position to it rather than overarching or, at times too, over flexing or over rounding. And then just a couple of other thought processes on this. The hamstrings, those are a muscle group that can get tight, especially if you're everyday weight lifter and you're working out your legs and hamstrings, those muscles get tight. It wants to pull your lumbar spine into flexion or rounding. That means you're gonna have to work even harder to get your spine into extension.
So, you might find that loosening up hamstrings, heck even loosening up your calves can help improve your ability to get back to doing both of these. And these are such big topics because you've got to think about how many stinking joints and muscles, tendons, and ligaments, and bones are all involved for a successful movement, whether it be the squats or the deadlifts. So, you've got to just take that into thought how ridiculously complex these movements are. And rehab, in general, can be complex because it throws a monkey wrench in your body's ability to do its normal motions, you've got to relearn how to do things anyways. So, when you're thinking about relearning how to do a squat or a deadlift, you're talking about some of the most complex movements out there. So yes, it does take time.
At the end of the day, I do absolutely think it's possible to get you back to squatting or deadlifting after a pretty severe or even minorly insignificant low back injury. I think the psychological component is often very underrated, undernourished, and missed in the health and fitness world because so many people forget the ability... Well, I should say so many people just lose the ability to be confident in movement. And that's something here with the Pr1me Movement that we are ridiculously passionate about, it's making sure that people can get back to doing the things that they love with confidence. Otherwise, it doesn't feel right, it doesn't feel like you're who you really are, and it doesn't provide the same level of reward.
All right. So, yes, I think you can get back. There are certain cases that are tougher than others. Like I started with this podcast today, some journeys are longer and more difficult to travel than others. The more tougher cases would be maybe severe spondylolysis, a severe spondylolisthesis where you've got huge slippage. If you're dealing with severe neural tension, we don't really talk about it much today, but even sciatica can be a tougher one but it doesn't always have to be. But the fusions too tend to be the tougher cases, but it doesn't mean you guys can't get back to doing this.
There are success stories all the time with people getting back, having come back from a really nasty back injury. The best thing I can say is to continue to try to stay ahead of the curve, try to stay away from surgery as best as possible. There are, like I said, a few times when you just have a mechanical thing going on, like maybe a serious fracture or maybe you're in a car accident. There are times, of course, when surgeries may occur. So, I understand if you have to go through with that, but try to fight the good fight, not get into surgery. If you do, know that the war is not over. You can most likely still get back to squatting or deadlifting. You're gonna have to just really be patient and work hard and understand that you're gonna have to really relearn how to move from top to bottom to do both of these very complex movements.
So, from Dr. Kuntz over here at Pr1me Time, thank you guys so much for tuning in. With any other questions or comments or anything else, please feel free to reach out to me. And thank you so much. Have a great rest of your day.
Pineville Physical Therapy, Pr1me Movement. www.pr1memovement.com
All right guys. I am stoked for this big time Pr1me Time episode. Welcome back to the "Pr1me Time" podcast and vlog series. We're going to really dissect and analyze how you guys can continue to work out as you get older without pain. What a huge topic. If we can really figure this out. Holy cow, just the amount of money it would save alone in surgeries, the amount of money healthcare would not be burdened with would just absolutely be insane. There's no way I could cover everything about this. That topic alone could probably be its own podcast. But we'll do our best to kind of summarize some of the most important, I should say findings or thoughts around it.
You know, I've even seen in my, I guess now about 13 years of working out, definitely some changes in my own body. Even though I'm still relatively young, a lot of you who listen out that are even in your 40s or 50s as I'm right around 31 right now. Some significant changes still to be found. And so I can only assume as I get older that I'll continue to fight the good fight and really have a personalized understanding of what kind of limitations may come about me. I think, first and foremost, it should be obvious, but still stated, the importance of form and really understanding what form needs to look like and feel like in your body is so ridiculously crucial. And I should also say this, what I've learned is that you really have to, not only professionally mastered what form needs to look like, but also personally, and really that speaks to the even trainers and fitness professionals out there, is that, listen, we're all continuing to learn more and more about form.
Heck, even when I was going through my graduate years and kind of just starting the process of learning, from a professional standpoint, movement qualities compared to now, 1000% different. I do think, you know, having continued to work out, I'm continuing to be cognizant of my own body, what the best form needs that look like, the best activation, the best cues that need to happen. And it's been exponential even for myself. And you're talking about a guy that lives and breathe this stuff, and I've been doing it for 13 years, and, listen, I still continue to learn about what the best form needs to look like. I should also say too, it's incredibly important, if you can, to review your own form. Maybe you'll set up a camera and you'll record some exercises, maybe you'll work with a fitness professional to record some exercises and break it down.
I actually have done that in part indirectly just by recording some videos for some lectures or for a YouTube series. And I'll sit down and look at that and I'm like, oh my gosh, you know, I had no idea that I was doing that with that exercise. So, even for someone, I guess I'll call it on my caliber, where I feel like I've got really good proprioception or understanding where I'm at space. Listen, we've got a lot to keep track of. And when you pull out like a squat, or an overhead squat, or a Bulgarian split squat, or something where it's multi dynamic, you know, multi-joint, multi-planar, it's a big complex movement, you're talking about a masterpiece, an artistic masterpiece that has to be in production for you to be able to dial it in. So I think form should be obvious, but it's something that I really encourage everyone to go above and beyond with and really spend time doing that.
Heck, even push-ups, something that seems so simplistic. As I started to learn it, I started to see a lot of people's low backs were arching, so I had to go in there, correct there. And then I started to be aware that people's weight distribution, whether it's through their hands or through their toes, made a difference. Heck, even the amount of, I guess, for you guys, the amount of ankle movement that they have when doing push-ups, or in the fancy world, Dorsi flection. The amount of, you know, rocking back onto the toes or heels or onto the hands, that makes a difference. Elbow position makes difference. Hand position makes a difference. Scapular position, and the scapular or shoulder blade control when going through the push-up makes a difference. Neck position makes a difference. You see how ridiculously complicated that can be just to do a push-up, which is something that we're all pretty familiar with, or our maybe PE teacher taught us. Like, holy cow.
And so, when you go through like let's say a high intensity workout program, you've got 10 exercises on the plate, you're running around rapid, you're just trying to get a good workout in. You've raced there after work, you didn't have time to warm up, and then just dive into this. You could see now, as we contrast the idea of a purposeful focus push-up to 10 super set, high intensity aerobic program. Holy cow. Absolutely. There's a chance for kind of "error" there. And actually the accumulation of those kind of micro level errors, that's what adds up. That's what sneaks up on most people. Most people who work out don't have a major incidence or a major traumatic moment, unless they go skiing or something like that outside of weightlifting, which can happen. But, most people, even like cross-fitters and even Olympic weightlifters, you know, these guys are doing pretty big ballistic dynamic movements.
Unless they're going for a major PR in a, you know, competition setting, they really don't ever have a traumatic moment. So, what does that mean? It means the accumulation of small kind of micro tears or poor movements, they add up. And as we get older, it should be said, we're all heading for the same place. We're all heading six feet under. And although that sounds somewhat morbid, what I want you guys to take away is that we will all get stiffer at some level. We will all get tighter in almost every sense of physiology. There's some form of decrease, or at least in a point where it's going to be, you know, not helpful. That's just the reality of it. So, sorry to break it to you, but that's where we're all heading. That being said, that means it's going to take that much more work as we start to decline.
Heck, V02 Max. The ability for your pulmonary system and your lungs to maximize what they can do. We literally start to decline after the age of 20. Just think about that for a second. That means, from there on after, we have to train that much harder to try to maintain and upkeep our pulmonary system. It's really the same to be said to some extent with the musculoskeletal system, testosterone can start to decrease after age 30 and 40, and, yes, women, this is for you too. We all like to talk about too much testosterone because, right? You start to think about becoming bulky or hairy, stuff like that, which really isn't true unless you really were to go on steroids or something like that. Yes, you need, you know, testosterone. But, the point is, as we get older, physiology stands in the way and it starts to decline.
So, a couple of things need to be said. We need to be working out in a way where we're changing up our workout programs somewhat consistently. So, for those of you that are gym warriors and you do the same workout program for the past two years, you're at risk for some significant adaptations to that workout program, which isn't necessarily good. So like if you always do even push-ups or pull-ups, ab crunches, squats, let's say you do those four exercises for two years. Yes, to some extent there's going to be some negative outlook on that. Is exercise great and beneficial? Yes, let's hold that aside. But those compensations and those adaptations that your body has undertaken to master those four exercises, they will come with some cons. They will come with some tightnesses that you're going to need to address.
So I think, the need to continue to change a workout program every so often is incredibly important. I would guesstimate as early as every 10 weeks for a lot of people. Secondarily, the point I would like to make is that, we actually need rest breaks. So, for 80% to 90% of America, I'm trying to get their ass off the couch and get working out, for probably the 20% that are listening in right now, I need to probably tell you, back off a little bit. Give yourself more rest breaks. It doesn't necessarily mean in between each exercise, but it could mean, it could mean after 5 weeks of really working out hard, or after 10 weeks. Heck, I've talked to a lot of people that haven't taken a week off in two or three years. Are you kidding? All right, and especially for those who are doing the same workout program, you are really wearing out a particular part of the tendon or of the joint, or of the fibers that's going to eventually give out and then that's going to be your limiting factor that causes your pain.
Now, conversely, we also have a subset of people that are doing a lot of high intensity aerobic training programs, which means they're doing a lot of super sets all the time, all the time. And while that can be great to attenuate fatigue, you too may also need to be mindful of overreaching, where you're just giving your body and taxing your body more than it can handle. And then if you continue to do that, overtraining can be very real, where it starts to affect the neural system, your psyche even, and the physiological system. So there is that to be said. So, form, I think modifying your workouts and altering and undulating your workout programs can be incredibly important.
We can't rule out the importance of diet here too. I think there's something to be said about finding kind of the gamut of nutrition that's right for you. There's more information out there than ever, which is amazing. So, if you have to go get tested to see what you're actually digesting well and how the digestive system is working out for you, that really needs to be addressed. Also too, you know, the hormonal system, a lot of my middle to older women going through menopause, there's going to be some significant hormonal changes in there, and that can really start to affect your ability to work out, perhaps even pain. So, I think that's a good place to even address to make sure that you're hitting this from all angles. And then also, I think just consistency, being perseverant as you work out. You know, life gets just ridiculously busy as we get older. I've already started to taste that with a young daughter, owning a business, we don't necessarily have too much family in the area, taking care of a house.
I mean, it's crazy, ridiculously busy. So, sometimes that in itself just gets in our way from doing the workouts that we need on that consistent basis. And if you slip up enough of those, there too, it's a slippery slope. You've missed enough workouts, you've trailed off a little bit, all of a sudden a muscle tightens up, you go get a massage, doesn't get better, and all of a sudden it becomes pain. So, working out consistently obviously helps keep you strong. It can actually help keep good flexibility too, especially if you're going through a good full range of motion, which I strongly encourage for various reasons, but it can actually encourage good flexibility too. And a lot of us don't think about that.
A final point that I like to make is, what I've personally and professionally seen is just the ridiculous importance of addressing your myofascial system. You can stretch all you want, you can probably squat as many times as you want, but at the end of the day, sometimes you just can't get through the pain because it needs to be kind of broken up, it needs to be loosened up from someone else's hands. I'm just going to say it like that. I've tried it on myself as well. I've seen it and heard it a thousand times. I think there's a time and a place for foam rolling, Lacrosse Ball, there's all kinds of cool new gadgets. I saw something out there the other day to help you release your iliopsoas. I think that's all good and I think that absolutely can be included into your workout program and probably should be included, foam rolling, you know, what have you, to desensitize the tissue, to help loosen tissue up, keep the blood flow, good recovery practices. Absolutely.
But, I've just seen it too many times where people come in to me and they've been stifled, limited in their workout program because of maybe a pain in the shoulder or hip. They've tried the stretching and rolling it out in massage therapy and no one's quite been able to just find their tight spot, loosen it up with a gauntlet of different type of modalities. If you guys have paid attention or observed our podcasts, you've probably seen the terrific trio I've talked about, where I use a form recipe, if you will, dry needling, dynamic cupping, and a hands-on care where I really get into the deep tissue, that has just been instrumental for me to help a majority of my clients get back to working out. In addition of course to helping them find good range of motion and switching up their workout programs too.
Something else to just that kind of comes to mind. A lot of people, especially influenced by social media, they see all these people just doing these amazing, ridiculous things on social media. And of course they want to do that too. What they don't see is probably the ridiculous amount of years of work that that person has done to be able to achieve whatever they're showing you on Instagram, let alone Photoshop and all the editing. So what happens is, people want to jump right to the king of the castle, you know, the toughest movements possible. They just simply don't have the prerequisites for it too, you know, I have seen a lot of people that want to go right into the big back squat, maybe on a big front squat, heavy, heavy lunges and they may not even have the core prerequisites. They may not even have the range of motion, let alone the form, right? They're just too limited from trying to go from couch to a really big workout program.
So, I think that covers a lot. You know, I'm really just passionately devoted to helping people continue to work out, because I really do feel like, if you can have a consistent workout program of some sort, I really do feel like it's just the best thing out there. Because, let me just kind of finish with this, if you're on the fence about it. No matter what, at some point, you will be forced to workout. And what I use the example is, let's say you haven't worked out all your life. You just been that person that you don't like working out, or maybe you know someone that, it's just not been in their DNA, that they've never really wanted to do it. They said it's just not for them. Well, let's say they're so deconditioned to the point they're so weak, and let's just exaggerate it, that they really can't even roll over in bed.
Maybe in an older population you might see that, but they're just so weak that they can't literally roll over in bed. Guess what their workouts going to be? Their workout, at the most regressed level, is to roll over in bed, a one rep max rollover in bed, that's their workout. The point is, it will catch up to you no matter what. It will catch up to you. So, why not try to fight the good fight, get ahead of the curve, stay away from pain, and obviously the plethora of benefits for almost literally every system in the body is ridiculously beneficial. If we can just continue to move and work out. So I'll leave you guys with that. Thank you guys so much for hopping on this riveting topic on Pr1me Time. I had a blast. As always, if you guys have any other feedback, questions, or comments, feel free to shoot me an email. I'd be happy to include that on one of our next Pr1me Time episodes. Just shoot me an email at
firstname.lastname@example.org. That's email@example.com. Until next time.
Hey, everyone, welcome back to Prime Time. I'm stoked to talk to you guys again today. My name is Dr. Chud Kuntz here. I'm the founder and owner Prime Movement as well as Prime Time. And last time we covered part one of "The Terrific Trio," where we talked about cupping primarily. And we kind of really delved into that. We talked about how it's little bit more of you need to be an artist with the pink brush and to really utilize that appropriately, not cupping as all created equal. That's kind of what we're talking about today, but we're going to talk about dry needling. And there's certainly been a buzz in the air and probably the last few years and rightfully so, just because therapists and practitioners are starting to get their hands on it. It's kind of this hot fad, like let's try this out. Let's see if this works for me.
So, I just wanted to give you my perspective on and how I've been using it since I've been using it for a past couple of years. And, you know, to a fault, I think sometimes people feel like it's a miracle drug, it's a miracle pure pill, and that'd be nice if you could just hop in and, you know, have a miracle pill and then everything's good. That certainly feels nice to think that way. Certainly at times it can feel profound in terms of how great it can work. But I just want to kind of give us the whole picture here rather than just singing and praising and bending our knees to it and holding our arms overhead to it. But, you know, dry needling actually kind of started, not quite as rich of a history compared to cupping, right? Cuffing, we're talking about 1500 BC. Needling really kind of what they call wet needling, where they injected with an analgesic of soar or saline or whatever it may be.
That actually started in the 1940s, when they started to look into fashional trigger points. That's really the first time that, from what I could tell is when we started to really get into trigger points. And it wasn't until like the early 1980s. I think one number I saw was 1979 when they started to do these injections into intramuscular myofascial trigger points. And I think it was by accident, they actually forgot to put the analgesics, yet they still had a great result. That was a pretty aha moment, I believe, to the health world there. I bet there are some pretty stunned faces like, "Hey, did you get the analgesic in there Fred?" "Oh, crap. No, I didn't." "Hey, I still feel better. Holy cow. That's nuts." You know, I've met with something like that. So, since then where we're starting to notice the power of the mile fastest system and how it can refer pain into certain areas, you bet there's been a budget buzz about it.
So then it's going to be, what can we do to help decrease these trigger points, whether the active and they are creating pain right now or even acted. And so the awareness to this whole field has just gotten so much bigger. You know, one of the main reasons that we've continued to discover the importance of the myofascially system to really help try to prevent surgeries from pathway anatomical reasons. So check this out. So the subscap, that's just an example. It's one of the four rotator cuff muscles and it sits underneath the shoulder blade, with them also gets really tight and hypertonic. It could actually recreate pain to the backside of your shoulder. So, prior to all this, you might go into the MRI or extra. You got pain in the back of your shoulder. No can figure it out. MRI shows arthritis in the backside of the shoulder shows a small cyst, and it shows that your labor is irritated.
What do you think they're going to do? I mean, they're probably going to give you a corticosteroid shot and then they're getting to said, well, obviously you've got some forms of impairments on the X-Ray,and MRI. You need to get in for a surgery to get this cleaned out. The problem is that we've kind of noticed, and I've seen this personally, that person might go on to have that surgery. They're regaining full range of motion. They're doing their physical therapy and working through the exercises. And 12 weeks later they'll like, "You know, guys, I still have my pain." Like what do you mean? The same pain that I went in for surgery it's still. Crap. You know, in that case, in the example that subscapularis is actually recreating that pain in the back of the shoulder. So you could see how important it is that we investigate what your myofascial system looks like.
And that's really been the direction I've headed in terms of my clinical career to be very heavy in terms of what the myofascial system, the musculoskeletal system is doing because there seems to be a lot of pain that's evading traditional healthcare that needs to be addressed. So, just to kind of get into it, dry needling is wonderful and in a lot of different ways. I tend to use it to help initially decreased sensitivity. So, let's just say I'm working on the pack and I'm barely put my hands on you, and you're kind of jumping around and you go, "Oh my God, it's so sensitive." I might actually start with like a small little needle and just kind of working into that a little bit. And I might just do one. I might literally just do one depending how sensitive you are, where I just go into the muscle for 10 to 30 seconds and then I'm done.
I will just introduce the concept of what dry kneeling can feel like to your body, to your nervous system to try to calm it down. And really, I kind of use it in that way as a form of desensitization, and probably at part just getting into your neuro-muscular system. So as some of you might remember, you've got the parasympathetic system and then the sympathetic system. Sympathetic system is going to be more of your fight or flight, right? Bear's coming at you, your sympathetic systems up and you're running like hell. That's kind of what happens when you've been in pain for a long time. Your adrenal glands keep running, your norepinephrine and your adrenaline's constantly elevated. So if you're constantly elevated, it only makes sense if I touch that pack and you jump, that's because your body's in fear, and it's been in fear and spending that sympathetic system fight or flight for a little while now.
So if I interject a strong stimulus like a needle into you, you bet you're going to jump up through the roof, right? But as we keep doing that two, three, four or five times in different sessions, you're going to be able to tolerate that much, much better. You're going to be able to tolerate that weird sensation and it is a weird sensation. Just to kind of take a quick pivot on that, the sensations I've seen or all over, people can feel it. Like if I'm on the chest, let's just keep that, they might feel it go down in their arm, might kind of feel like oof, like kind of a zinger. Like holy cow. They might not even notice it off a little bit. And then they feel the muscle jump. If the muscle jumps that's actually what we're looking for an involuntary contraction, is what we're looking for.
And I kind of like to describe it as to my clients. Imagine that your body's just got all this harnessed up, neuro-muscular system bound up in that muscle, kind of like it's inside of a balloon. But if I go in there with the needle and pump that balloon, all of a sudden you've got this huge quick cascade of the neuro-muscular system leaving that balloon and it kind of supercharges that muscle and then you get that muscle to jump. And most often soreness will fall away that and then they'll get some relief later on, because we hit a spot where it's kind of bunched up. So, kind of just going back where we started, it can be great for the sensitivity, it can be great for the neuro-muscular system. And I really like it to facilitate muscles by turning them on or off. So, we'll stick to the packets.
It's easy there. The pack tends to be pretty dominant muscle, an internal rotator. And sometimes it can kind of over dominate the rotator cuff. Specifically it's war with the subscapularis, because both of them are kind of competing for internal rotation. Yet the subscap does a great job at stabilizing the shoulder, the pack does a horrible job in doing that and it's just got this huge poor effect. It'll pull your shoulders forward. So, if you got rounded shoulders, chances are your packs quite dominant that. So in that game, I want to facilitate the subscap by turning it on so that there would actually be a cool case to go into the subscap to dry-needle that, and then with the pack I would want to do that to really turn it off. And in that way, I want to help kind of reframe that system in the shoulder that I am facilitating a muscle on that I want and I'm kind of turning the muscle off.
And I think that's kind of a great way to look at it. So, how do we actually go about it: And how is it similar to acupuncture or not? So, we tend to use the same needles. They're all a lot of different forms of acupuncture out there. So that's a little unfair for me to say. And there's actually a lot of different forms of dry needling. Generally speaking, acupuncture, they would do it for a different intent. They might do it for your energy, for your CI, for your meridian lines, for cell vibration and they go in very superficially. It might be just generalized trigger points, not necessarily shoulder-specific. We'll keep hammering away at that. And so they might do it all over your body and then just kind of leave you there for 20,30 minutes. Again, that's very generalizable for you. Acupuncture is out there.
If I've offended you, let me know, but I'm just trying to get people a generalized idea about it. Now, with the form of dry needling like I use, I tend to go after in between anywhere from 10 to 15 seconds where I interject the needle. I'd send to have a depth that can get to the rich deep parts of the muscle belly or tendon. So, it's not necessarily a short one all the time. It has to be relative to the muscles that you're going into it. But I will go in and out, kind of pissing it, in and out, in and out, in and out, trying to search and seek and find the tightest spot and arguably the most sensitive spot. That's of course if it's more of an active trigger point in the acute-like phases rehab. For doing more like ongoing care and recovery, I'll go deeper even into spots that aren't necessarily tender but where I can feel like a tightness to it. So, I'll go in and out and that process will last up to like I said, two minutes or so, and I'll keep going as long as that muscle keeps twitching, because if that muscle keeps twitching, I know that I'm kind of allowing the nervous system to get what it needs out of there and I'm kind of flushing that system out from a neuro-muscular perspective. Once we've done that, I'll stop and I'll take it out. I like to wear gloves on this particular type of style. And then afterwards I'll just have someone kind of moving around and see how they feel. I know for me when the people do it to me, I tend to respond very sore. I might be like, oof, I might have a hard time kind of moving it.
There's a small percentage of people like 10% to 20%, I would say that feel wonderful after moving it, and they have immediate improvement in the range of motion. And that's kind of the fun part. But generally, I would say with dry kneeling, I wouldn't expect a result right away. You might be more sore, kind of covering it up. As you know, our our petitions throughout the day, I think then you'll start to feel that improvement. But I would say a smaller percentage than that now feel that immediate like, holy cow woman and they can feel a lot better, at least with a style that I do it. But usually the process here with dry kneeling is that it does take a few days in my experience before you can really start to receive the benefits of it. But again, that's my style. I will continue to work around the most about what dry needling.
I'm going to work around the area that you have pain. And I tend to not do both sides, unless I kind of get clearance from with you, just because again of the soreness. There's some types of dry kneeling where they'll actually hook E stem into it. There's different types of practitioners, different models of dry needling. So, if I were you or you're receiving dry kneeling care, just feel free to ask your health care practitioner, "Hey, where did you get, you know, certified? Who is your practitioner through? What's your paradigm thought?" Because there are just some different thoughts out there and you just never quite know nowadays who's actually doing it, who's doing it the right way. There are some precautions like the lung field, if you're doing it around the trunk, that you want to be careful, that the practitioners should know what they're doing.
So that's why you just want to double-check. You don't want to cause spontaneous pneumothorax. That would not be good. So yeah, don't worry about that. But you should talk to your clients and your practitioner and make sure they know what they're doing. And then y'all, the practitioner has to be careful about the nerves and the arterial system as well. The vein system, they are really, try not to hit those. They do happen from time to time. I may leave some bruising. So that again, that's just where you want to have the conversation with them. Following up, dry kneeling, you walk them to do ice or heat. I definitely advocate that you continue to move it throughout the day if you just hold your arm there because I needled you throughout the full day and you sleep on it, you don't move it much, it's going to be really, really sore.
So, I encourage active movement. I want you to keep moving it throughout the full day or the next 20, 40, 48 hours. I tend to like heat more than ice, just because you're working on muscles. Muscles tend to get kind of tighter. You want some more blood flow in there. You want some vasodilation, you want some relaxation. So, heat tends to do a nice job, just to kind of get into that and start opening it up, to loosen up. And that can be nice for some recovery. And I really think too, just to be really successful, it really all starts with the setup. You really need to know that the client that yourself feels comfortable. You know what to expect. You guys are on the same page. He shouldn't just be having someone jump right in there and just going without your consent. There'll be times as you start to get into it that you're going to be like, "Whoa, whoa, whoa, whoa, slow down, slow down."
And that person working with you need to be respectful of that. That's why when I get going, I say, "Are you ready?" "Yes." "Good." And we start. We start going into it, "How are you doing? How are you doing? You know, I found a really sensitive tight spot. You okay if I keep going?' And they're like, "Yeah, go ahead." And that's when I go into it. We'll see the muscle bounce and twitch a few times and they say, "Holy cow, am I hurt? Hurt so good, keep going." I pulled out. I keep some compression on that area just to keep them a little more comfortable transiently after I come out of there and I let it rest for about 30 seconds to a couple of minutes. And then I might have that conversation with you. "How do you feel about going into that again? Because I thought that was very therapeutic, and I bet if we did that one or two more times that, you'll get even more benefit out of that."
So, it should look and feel something like that to have that conversation with it. And you should be really, really comfortable before you even start with the dry kneeling. Because if you're not, I can guarantee you you're going to be tensing up. That's not going to have a good response. It'll probably hurt more than it needs to. So, this is just some fine points that I've noticed in my kind of dry needling career, I guess I can say that I've helped people get the best response. Oof, that was a lot of stuff guys. That was part two. Would be really delved into what dry kneeling is all about, what it looks like, what it feels like. It isn't much more of an art than you may anticipate and not all dry needling is created equal, just like cupping. There are a few different paradigms and schools of thought, I think you should know that.
And I think you should really kind of question your practitioner as to what they're doing and why and really be investigative in that way. And no, it's not a miracle drug or a miracle cure, but I think working through it and having different practitioners kind of give it a try and you, and you might find that one person does it better than the other, and chances are they'll probably help you receive the better care. Next time we're going to really delve into hands-on care because I think a lot of people have no idea what really good hands-on care can even look or feel like anymore. When I say that most people think about draw, excuse me, most people think about massage. And so, we're going to delve into that next time because I think that's a whole other landscape most people aren't familiar with, with really good therapeutic care. That is it. I entirely, it was a great day, and we will see you next time for Prime Time. Thanks, everybody.