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.
♪ [music] ♪
All right, everyone. Welcome back to Pr!me Time and I'm stoked to take on a pretty big topic today. We're going to talk about, "Have I Done Irreversible Wear and Tear Damage to My Body?" So this is a question I get asked a lot and it really puts people into a tough mindset and unfortunate mindset.
It puts them into fear. It puts people into the state where they all of a sudden don't even feel like themselves anymore. They don't think that they can get back to doing the things they love anymore because they've got this visualization in their mind of a quite horrid picture. Let's say it's in their shoulder joint. Just for a second, imagine if this was your shoulder, what you would paint the picture as as to what irreversible damage looks like.
I know if I think about that I view that the cartilage is kind of gone. I might feel some bone on bone in there. I might see a labral tear, it might be red due to inflammation and pain. And we don't really talk about this kind of stuff in terms of what we visualize that to look like.
But quite honestly, that's the way I would picture it. And you might have your own kind of story on it, or maybe you have had pain, or may have been told this and you've already pre-thought about it. But I think the big takeaway right now is, A, this puts people into fear. And we also have to, you know, discuss the truth. We have to be honest with ourselves. If there was a significant trauma, let's say you're skiing, and you've really landed hard, and let's say you tore your ACL, and MCL, and LCL, and you really did a good number to that.
But the question is, did you do irreversible damage? We've gotten so much better in even our surgeries, you know? Even though I'm one to help avoid people from surgeries as best as possible, surgeries have gotten a lot better. So, you know, let's say that person that tore those three ligaments, they go into surgery. It's not really like they've done irreversible damage.
On the research in that case, they might have a chance to have more arthritis in 10 years, but is arthritis irreversible wear and tear damage? As we get older, we're all heading toward the same space. I think we tend to neglect that sometimes. We have to be honest with ourselves.
We are all heading to the same spot, right? We don't really like to think about that. What that does mean is that there will be natural wear and tear into our bodies, which is shown in the forms of arthritis, shown in the forms of disc degeneration in our spines, maybe even disc bulges, natural cartilage loss. Those kind of things.
I still wouldn't call that irreversible damage. Now, I know that I can't reverse arthritis, okay? I know I can't reverse arthritis. I know I can't go in there and put more cartilage, more disc height in there. There are some promising signs to stem cells, which I think is probably the closest thing that we get.
But even then, I think most people would agree, you wouldn't go back on an MRI and see that there's increased space in there. So where does that leave us? Well, I think it goes back to, what are we able to do, still? Despite MRIs, CAT scans, and x-rays, previous trauma, what are we able to actually do?
I think for me, this boils back to trying to regenerate confidence in movement. I try to get my clients away from thinking about that irreversible damage. Because it...you know, I've just realized helping people get back to doing their thing, the things they love, is so much more than just the mechanics of it.
So much of it is in between the ears. So much of it is our mindset. So I find myself constantly battling clients who are coming from other health professionals. A lot of times it is their doctor and the doctor has told them, "Listen, you know, Judy, you've got significant irreversible wear and tear damage in your knee.You're 65, you're not getting any younger.You want to get back to walking three miles, but you're going to need a total knee."
And granted, there are times when the arthritis is so significant and osteoarthritis has really flared up to the point that maybe she does need it, but I'm going to say that that's lesser than more often. I think that more often than not, she's able to actually get back to doing the things she loves with really good care. And maybe it won't be overnight.
Maybe it'll take 12 weeks to 16 weeks, and she'll have to put work in, and maybe relearn how to walk, and do some stretching programs, and really start to strengthen her body, but to maximize her quality of life without going underneath the scope, because she's trying to regain the confidence in movement. And she's not going to just give in to the fact that just because she's been active all her life, that suddenly just all of a sudden she needs a total knee surgery.
In fact, in this case, I would strongly encourage her, if nothing else, to go through six to eight weeks of care. You could call that prehab if you needed to, if she ended up going into surgery, but to try to maximize her prognosis or ability to get better even following her surgery. So we use that as a 65-year-old, but that could be the case of having a significant knee surgery when you're 25.
I actually had a hip surgery when I was 23, right? And if I were told, "You've done irreversible damage just by having a surgery." And I was told that I'd never squat below 60 degrees again. What kind of mindset is that? What kind of a life can you live if you're shackled in fear all the time because you've been told by someone who you had a lot of trust with, right?
They've got their doctorate and they sat there and told you. They looked at the MRI, or CT scan, or x-ray and they looked at that diligently and they showed you the results and they say, "You've got irreversible damage. You can't get back to squatting, and lunging, and working out again." Those are really impactful moments for people, where you've really got their attention.
You're in pain, so you're sympathetic system's up, which just mean you're kind of in the fright or flight stage, right, where you're caught up in that moment. So you really record that well in your brain and you'll record that for maybe ever, honestly. I mean, I've had clients that have told me 20 years after their back surgery, or their hip surgery, or their knee surgery, and as I started to examine them, it's like, "All right, Lawrence, let's see you do your squats."
"Oh, I didn't tell you, Chad, but I had a back surgery 20 years ago and he told me I'd never squat again.He told me that I've done irreversible damage.I shouldn't do that." It's like, "Well, how have you been moving around on a daily basis then?How are you sitting down?Isn't sitting down into a standard, 18-inch chair a squat?" "Yeah, it is. It really is."
So my take-home point is irreversible wear and tear really invokes a lot of fear, and I tend to help try to get people back to being confident in movement as best as I can. We want to acknowledge if there is a point where someone may need that MRI to see how significant and severe their arthritis is. There may be a point where that comes, but more often than not, we're able to help people really maximize their quality of life without going underneath the scope because of just doing simple things the right way, you know, kind of relearning how to walk or relearning how to stand.
We catch ourselves doing these small daily micro traumatic things that eventually add up and compound themselves, and we start to walk way differently than we did even 10 years ago. So overall, I want people to continue to be more confident. I want doctors out there, and even just health professionals, to be more aware of how profound it is when we tell our clients and tell people that, "You've done irreversible damage in wear and tear."
We've got one life to live. I want everyone to really, you know, attempt, if nothing else, to do the things they love, to be as active as possible. You've only got one life to live, so let's shoot for the stars. That's my motto. So thank you guys so much for tuning in to our podcast and vlog today. If you guys have any other questions or topics of interest you'd like me to tackle, shoot it at firstname.lastname@example.org, that's email@example.com, just feel free to shoot me an email.
Until next time guys. Thank you so much. ♪ [music] ♪
Hey, everyone. Welcome back to Pr1me Time. We are on episode number 15, and we're going to discuss how to avoid joint pain when engaging in your strength training regimen. I think this is a great question, a great topic because I know, at least for me, I wanna be able to continue to train as long as I'm standing on this earth. I want to continue to be as strong as possible, I want to be resilient, I want to be preventing future injuries as they occur. I know that we're not invulnerable because we are humans and things will happen, but, we do wanna keep pain, as much as possible, out of the equation, specifically joint pain. So, first off, I think we have to think about the diagnosis. How do we know that it truly is joint pain? I have to bring that up just because of the speculation that the diagnostic imaging such as X-rays and MRIs have shown us.
And what I mean by that is, they're starting to see information that MRIs are revealing where people may have fluid in the joint, they may have degeneration in the joint, they may have even arthritis. And they'll come to find out that the people are asymptomatic, meaning, they don't feel any symptoms. So, I've also seen, when training with clients and working with clients, they'll identify as, "Oh, yeah, that's my shoulder joint, that's my labral pain, that's my elbow joint pain, injured that a long time ago." And we have to first kind of think about the question, how did you know that that pain is coming from your joint? Have you been properly assessed by a specialist to determine to what extent that is joint pain? How do you identify joint pain? Well, for me, it's pretty clear. If there's inflammation within the joint, there might be some swelling.
Swelling is a pretty good indication that the joint is not too happy, and we might be able to pretty confidently say, "Yeah, this is coming from your joint." A lot of times too, if I passively move that joint around and take it to end range, and if I feel maybe a firm end feel, which means it's got a little give to it and the client has pain, and if I know that there was no muscle guarding, meaning, they weren't consciously or even subconsciously contracting that muscle, and there was pain with it, that might be a pretty good indication that there is some joint pain in there as well. I do have to mention too that the myofascial system hosts a lot of pain, a lot of discomfort, and it's usually first noticed by my clients when I start palpating it, meaning, touching it. And I start kind of fishing around and hunting, so to speak, where their pain is truly coming from.
Let's take the shoulder, for example. Let's say they point at the front of their shoulder, and they go, "Yeah, that's where my labral pain is. I did have an MRI two years ago. I've been having that shoulder pain on and off with my weight training regimen for a few years, and my doctor told me that that's my labral pain." I go, "Okay. However, have you ever been assessed by a specialist, a musculo-skeletal specialist, that will take the time to observe, and analyze, and assess if that truly is labral pain?" Because if it truly is labral pain, from my background, they're gonna have some pretty painful, catching and clicking, and there are some things called clinical prediction rules that can even help paint us a better picture, a better guess, if you will, as to what's truly causing that pain. And with a cluster of symptoms and signs, we can usually get pretty close.
So, after you start assessing that, and start hunting and poking around, all of a sudden the client goes, "Oh my God, that's my labral pain." And I go, "Really? That's it?" And they'll say, "Sure." And all of a sudden I like look down and I'm pointing and I'm touching their anterior dome, or maybe if I got really deep, I'm touching their bicep tendon, which does have an insertion onto the labral, especially the lateral long head. So, when we discuss how we avoid joint pain in my weight training regimen, we have to be sure that we truly are diagnosing it as it truly is, which is within the joint.
Let's say we get past that. Let's say that we've given it the diagnosis, let's keep it easy and say that there's shoulder joint pain. Well, now we wanna know which specific tissues are affected. Most common, I would say, in the weight training population, which is what I work with quite often, the labrum is irritated. So, we now have to think about what the labrum does, what specific motions bother it, what put it kind of at jeopardy, and then we have to compare it to your weight training regimen. What exercises are you doing? Who taught you that form? How much weight are you doing? What's your repetition and set scheme? What are your rest breaks? How long have you been doing that form? How often do you provide yourself, excuse me, intermittent rest breaks, meaning, throughout your mesocycle, or your two to three-month-long program, how often are you giving yourself rest days? All right? Maybe a rest week. When is the last time you ever took a rest week off? See, you start to get into these questions and you start to get some of the answers that pop up right away.
For example, sometimes my clients will say, "Well, shoot, I've been doing that exercise for two or three years. In fact, I can't ever remember not doing it." So, you get some kind of aha moments like that when you ask those kinds of questions. Sometimes it's based off the form, all right? Sometimes people are excessively using their joint and they're not truly using their muscles. I can kind of see that when I analyze movement based upon how much weight they're using, the momentum strategies that they're using. Sometimes people kind of jerk up the weight, and if they're unable to do it in a nice, timely, concise manner, I feel like there's a little bit more of a risk to be put upon the joints. Even then though, with regards to U.S.A. weightlifting techniques, so when you get into snatches and clean and jerks, if you do that stuff well, with great technique, you're still not really even at jeopardy for joint pain.
You have to have great flexibility, stability, mobility. I've talked about that before in a previous episode in Pr1me Time. You just simply have to train for what you wanna do. And if you do that well, and if you have the prerequisites, there's a good chance that you're gonna be able to keep your joint pain at bay. So, you have to be kind of cognizant of that. And you also have to take ego pill sometimes. For example, I used to squat way more than I could ever handle. In grad school, I remember throwing four or five on the bar, kind of going halfway down, and I would probably cry if I saw myself doing that nowadays, because it was probably butt ugly. And guess what? I remember having some joint pain back then. I remember feeling it within the joints, and that ache and discomfort.
Well, I needed to kind of relearn how to squat quite honestly. I had to take that ego pill. And, believe it or not, I feel stronger, I feel like I look better than ever, and that's because I've dropped the weight significantly. I'm going through a full controlled range of motion, and I'm sticking to realistic repetition schemes. I'm also undulating my workout programs throughout the year, which really helps. So, I go for strength, I go for power, I back off, I go for volume. And this can all be specific based off whatever sport or whatever you're going after.
Lastly, there are certain exercises that just are great for your body. The one that I think you at least have to be cognizant about is when you do a pull-down and the pull-down goes behind your head. Certain exercises like that are doable, but, for the majority of the population that I see working out and the majority of the population that I treat, they are probably just not ready to handle it. In that case, that person probably needs a slightly regressed version, where he simply, or she simply brings the bar to their chest, where it puts their shoulders at a better position. If you lack range of motion for certain exercises, you can be susceptible to pain. One other exercise that comes to mind is that standing curl with your biceps when your arms are out to the side and you're bring in your hand towards your head. I mean, that kind of resembles a therapeutic assessment for a SLAP tear, which is a labrum tear.
So you can kind of make these relationships based off of movements and how we would go after and test that particular structure. And you can go, "Hey, that exercise in that test, that special test for that labrum, in this case, looks pretty similar." Yeah, there might be a correlation in terms of load, especially if you don't do it right. So, that's it, guys. That's it for Pr1me Time. Let me know what you think as always at firstname.lastname@example.org, and tell me how you avoid joint discomfort in your strength training program as well. I think it's a great topic. I'm interested to hear what you guys have to say as well. Thank you, as always, for tuning in to Pr1me Time.
Hey, everyone, what's going on? This is Dr. Chad Kuntz. You're back with Prime Time, and we are on episode number 14 already. We're going to discuss what's the difference between flexibility, stability, and mobility. This is a huge topic, and I think if you ask a multitude of different providers, you'll probably get a lot of different answers. The reason that this is so prudent is because it's literally integrated in everything, whether it's a clinical concept behind the way you're stretching, whether it's a clinical reasoning or rationale for the type of exercise you're trying to do to get out of pain, you're gonna find this a little bit everywhere. So, let's just break it down and then think about the application a little bit. Flexibility to me is a passive range of motion. Passive means, if I take my elbow and I bend it as much as I can, that's the flexibility of a joint.
Flexibility is really important as a provider because it gives me a lot of information. In the physical therapy rehab world, we'll call that an end feel. We'll call that an end feel because it tells us a lot of information. There's a lot of different types of classifications we may have, for example, if I try to bring that elbow and bend that all the way, and you say stop before I can even move that elbow all the way and you say stop because it hurts, we call that an empty end feel, not that you need to know that, but what it does do is provide us a lot of information and say "You know what? There's a lot of inflammation in that joint," or, "Something is really bothering you. I feel like I could have pulled you all the way, but you stopped me." Or perhaps assessing the flexibility of that joint, I can push you all the way and it's got a nice firm end feel, the joints are approximating appropriately. That feels great. You've got great flexibility in that joint. So, that's a little bit about flexibility.
What about stability? Well, hopefully, stability is a little bit more of a common ground answer, a little bit of an easier answer to decipher. Stability just means that you're able to have a nice co-contraction around that joint, and it's able to tolerate force appropriately, and you're able to do that without creating any more pain, and it's able to handle a sum of force or load to the joint. And stability, just a little bit of a quick side note, is probably one of the most important features that we need that is often undernourished. I think a lot of times we're trying to stretch quicker than we are to stabilize.
And then there's mobility. I like to think of mobility as a sum of both flexibility and stability. For example, when you're trying to get that shoulder into that full range of motion at the top of shoulder flexion, it needs to have great mobility, because, not only should I be able to have passively taken that shoulder joint up into that full range of motion, but I also need to be able to challenge its stability at that end range. And if you get both parts equated and working together, I think that's what yields beautiful range of motion.
Now, certain different types of thought processes will say that certain joints need one or the other. Maybe they'll say, shoulders need great flexibility, thoracic spine needs great flexibility, lumbar spine needs great stability, etc. In my clinical experience, I don't think it's that easy. I don't think it has to be brought down to that level of dichotomy. I don't think it has to be one or the other. I don't think our body is that simplistic. This body is an incredible machine, I will never stop learning about it, because it's always gonna be teaching me a few things as I work with my clients. Let's take a squat for example. I think, at the end of the day, you have to have this beautiful harmonious balance of mobility interspersed throughout the entire body. That takes into account that you have had requisite flexibility, and that you've done some stability training to help you get into that range of motion. The body really is connected, and it feels like the entire body kind of speaks to different parts of it to make it work so that you can do that new range of motion. We don't often think about it, but in that squat, heck, even parts of your shoulder blade, some completely non-irrelevant muscles up there are playing a role. And they feed off of each other.
So, in that squat, whatever work that your ankle is not doing, your knee is gonna try to make up for it, if that can't do it, your hip tries to make up for it, if that can't do it, your lower back tries to do it. And it kind of speaks to itself all the way up, all the way through. So, at the end of the day, I look to improve optimal mobility almost anywhere and everywhere I can. That means it has requisite stability, which is a really important differentiating factor than just saying I want it to be flexible. Just being flexible doesn't do a whole heck of a lot, because to me it means it's passive, in that you can't really control that. I think one problem that sort of throw my yogis underneath the bus here, but, I think one problem that yogis have sometimes is that they only achieve flexibility and they'll just passively pull themselves into positions, but no one is actually controlling that. And so sometimes we have to go back in and refrain that and say, "You know what, I need you to pull back on the level of flexibility you're going after, and I need you to stabilize there and let's teach you how to improve upon the mobility you have to get into that position."
So, I think that's where some different clinical beliefs and concepts come into how you're going to achieve that range of motion. But, at the end of the day, I think you need to be strong in somebody's end ranges of motion, but we need to intelligently progress into those ranges of motion. So that's just my quick thoughts on flexibility, stability, and mobility. I think this is a conversation that could go on a lot longer, but I wanna hear your thoughts. What are your thoughts on the differences and applications of flexibility, mobility, and stability? Why don't you email me at email@example.com. That's firstname.lastname@example.org. Let's hear more about this topic, who knows, maybe we'll have a part two based off of some of the conversations that you guys bring up. All right, guys. Thanks for tuning in.
Episode 12 | When Do You Really Need A Corticosteroid Shot For Your Pain?
"Hey, everyone, this is Dr. Chad Kuntz and welcome back to Prime Time. We are on Episode Number 12 where we're going to discuss, when do you really need a corticosteroid shot for your pain?
So if you've been in pain at one time or another when you ran into your general physician, your sports and or orthopedic doctor, the topic corticosteroid shots probably popped up at one time or another. And for most of us, we trust the doctor. They've done their homework. They've gone through all schooling and so if they suggest that we need one, we're usually on board. I'm just here to help give you guys a little bit more information and background on my personal clinical side of things having seen the effects of corticosteroid shots, and understanding now the timing in which you could best benefit from a corticosteroid shot. And perhaps some of this information can be super helpful for you guys at home.
So first we have to know what a corticosteroid shot is. A corticosteroid shot mimics cortisol. Cortisol is produced by the human body from the adrenal glands that sit just on top of the kidneys. Every morning, it's usually produced more so in the morning than any other time, however, should you be in a lot of stress in fight-or-flight, that's when cortisol is produced. So cortisol has very strong anti-inflammatory properties. That is most likely the main reason that it is favored in a corticosteroid shot. Because oftentimes if you're in pain, you have a lot of inflammation, so you need to fight chemistry with anti-chemistry, so to speak, and so, therefore, you knock out the inflammation with an anti-inflammatory effect. However, did you know that corticosteroids can actually start to weaken cartilage? They can actually degrade tissue that we're finding out now, most recently. Did you know that you're only supposed to have up to three of these performed, per year, in the entire body, because of their strong effects, strong negative side effects? They can actually promote muscle wasting and they can actually promote a decrease in bone density. In fact, if you have an excessive amount of cortisol for prolonged periods of time you can actually end up with osteoporosis, which is a severe weakening of the bones. In fact, it has also been shown to lead to something quite nasty called avascular necrosis most oftenly seen in the hip. And that's when the hip actually doesn't receive enough blood supply and that's not a good situation. So for all of these reasons, we have to be really more so mindful of when that corticosteroid shot is performed. Now, of course, if you have a corticosteroid shot every now and then, you're most likely at minimal risk for all those things I've just said. However, if you are a diabetic, do understand that this is gluconeogenic, and what that means is that it'll actually increase the amount of glucose in your bloodstream. So if you are monitoring that quite diligently, you would wanna know and monitor the amount of glucose that you have flowing through your serum or through your blood supply because you wanna make sure that doesn't get out of hand.
So when or who is the right candidate for these corticosteroid shots? Since there are so many side effects, why is it being performed so often? These are great questions. I'm here to kind of help you guys sift through it a little bit and kind of give you my personal take on this. I think one flaw of... this is more so even the healthcare system, is that we're just so reactive. We're so reactive and we jump to the most extreme resolution right away. And I think one example of that is a corticosteroid shot. Let's say I have developed right shoulder pain. It came out of nowhere, I'm not sure what's going on, I'm going to call it a 5 out of 10 pain but it's really you know bothering my quality of life, inhibiting my quality of life. It's making it tough for me to pick up my kids and it's making it tough for me to work. What do I do? Well, a lot of times I think right now in the population, we go right to our general physician. General physician goes, you know, you probably need to see an orthopedic doctor. They refer you out, they might do X-rays, which in my experience, most often doesn't really show anything. And then they suggest well we probably wanna, you know, not perform surgery right now but you would benefit from a corticosteroid shot. People undergo that process, okay? Now a lot of times, it does probably help but what is it really helping? It's probably helping the inflammation but it's not addressing the root cause. So now you've put yourself up for some severe side effects or possible side effects, and you haven't even addressed the root cause of it.
In fact, I had this sweet lady that had a corticosteroid shot performed for her knee didn't even know that she could receive care for it. And she had a severe reaction to it in the sense that it kind of gave her, if you guys are familiar with frozen shoulder, it pretty much gave her that in her knee, to the point that she couldn't even bend her knee and she had a huge autoimmune reaction to it. So all of a sudden, she had really high inflammatory levels and markers in her blood throughout her body. And she didn't even know that her knee could have been treated by someone and she could have foregone the corticosteroid shot. I'm sure you could imagine that made her quite unhappy.
So the point I'm trying to get to here is we need to address the root cause to figure out what the heck is causing that inflammation first. And knowing that these have such serious side effects, isn't it worth attempting conservative care for just 30 days to see if we can discover what the actual root cause is, which by the way you're gonna have to end up figuring out anyway? And seeing to what extent we can decrease that inflammation in that joint or in that muscle or in that tendon without a corticosteroid shot and save you all that worry.
So if you are in pain, and even though it's pretty significant, at a minimum, I would say find a practitioner that you trust. Find someone that can give you one on one care. I would prefer you to see someone with no techs, no aides, no assistants or anything like that, and to find a specialist, to find the best, okay. Find the best healthcare provider or providers that can give you the time of day to give you a good subjective history. Have a discussion what's going on because there might be actually something quite a simple answer there. You got a new job, you're doing something and moving a different way all the time. You began a workout program and maybe it's a certain movement that's just simply causing some inflammation because you're not doing it right. Yet you're gonna go to an extreme and get a corticosteroid shot when it could be like, you know, a quite simple fix in just 30 days. Isn't that worth it?
There are some cases, some cohorts of people, where corticosteroid shots have been shown to be maybe and arguably the most effective. The one that comes to my mind is a frozen shoulder. So a frozen shoulder, kind of an idiopathic meaning, unknown cause that's going on. There are some relationships like if you're a middle age female, if you're diabetic if you have thyroid problems, you might be more likely to have a frozen shoulder. So that kind of person might benefit from a corticosteroid shot sooner rather than later. But I wanna be honest. I'd still wanna identify her and give her a clinical diagnosis of frozen shoulder. And I'd still wanna see if she could benefit from our care for 30 days and within that 30-day timeframe to see what effect we could make changes on it. And guess what if we can't make changes in those 30 days let's go ahead and let's go through that corticosteroid shot. In fact, that's quite a common recipe for me anywhere in the body. If you have pain and it's just been stubborn, we can't get rid of it, well, sometimes you do need to take that firehose and put out the fire before you can begin with mechanical improvements.
So, guys, I hope that helps. That's a lot of information. Corticosteroid shots are talked about all the time. We wanna have a little bit more information about this. We wanna have a little bit more autonomy in our own pathway for our health. We wanna be educated so that we can make the best decisions in our journey throughout that point in time. And that was really the main purpose about this Prime Time session.
So thank you guys for tuning in. Feel free to email me any questions at email@example.com again that's firstname.lastname@example.org. Thank you, guys."
Episode 12 | When Do You Really Need A Corticosteroid Shot For Your Pain?
Physical Therapy | Ballantyne | Pr1me Movement
Episode 11 | How To Help Your Child Achieve A Collegiate Athletic Scholarship
Hey, everyone. Welcome back to "Prime Time." My name is Dr. Chad Kuntz. I'm the founder and owner of Prime Movement, and we are on episode number 11. We're going to discuss how to help your child achieve a collegiate athletic scholarship. So, let's be honest. We could probably spend days discussing this. We'll try to touch the surfaces of this, still cover a lot of the main content and to just kinda give you the framework.
If you have additional specific questions, as always, feel free to email me at email@example.com as if I don't know the information offhand, I will find you the specific details of this. Because when you start to think about a very young child trying to achieve a collegiate scholarship, there can be a lot of specific research-based guidelines out there which are very helpful to help you understand how much you can actually do when you're going through adolescence, when you're going through puberty, all these kinda nitty-gritty questions that need to be answered.
I'm happy to do this discussion too because I understand how much it costs to attend, and get, and achieve a really good collegiate education. So let's just do it a little bit smarter, guys, because I've seen already enough...a lot of kids getting hurt because they didn't have the right educational framework when growing up and kind of going through the process of trying to achieve that collegiate scholarship.
So, parents, when the kids are really young, and let's just use the example that you want them to be a stud golfer, and you want them to achieve a collegiate scholarship for golf. Let's start with that. So when they're really young, let's say two or three years old, get out in the yard and just model the movement, help them see it, watch it, and do that frequently. See if you could do that almost every day, even as little as 5 or 10 minutes. The kids are sponges, and they will pick it up. And they'll just see the way you're moving, and that will be a great start for them.
Let's scoot forward to the young ages of seven or eight. They're actually allowed to begin strength training. No, you're not going to stunt their growth. No, you're not going to damage their growth plates as long as it's done intelligently. So really intelligently can be simplified to meaning don't push them to do one rep maxes. Keep it fun, keep it light. I like to use a lot of bands in these type of kids just to learn the motion because really appropriate strength training is done when the person understands how to move that way and how to fire certain muscles.
So I think bands do a good job kind of helping the person learn to feel what muscles are being used. You can, of course, start to use some weight with this. Just remember you're not powerlifting or bodybuilding with this. They're just starting to learn how to move weight, okay? They're just starting to learn how to use their body to move a certain force. I do encourage bodyweight movements at this age, too.
From that age up until 16, we'll say, but don't think that's a hard fast rule. We want to be cross-training with them or hybrid-training if you will. So for our analogy, that's golfer, while we want them to have a majority of their time golfing, we also want them to have purposeful, nonconsecutive rest breaks from golf so that they can either do more strength training for their desired sport to help facilitate better movement in that sport. And also, they should be encouraging, or you should be encouraging them to do other sports, so basketball, baseball.
You don't have to become the most invested in those other sports because you have to realize, "What's the big picture of why I'm having my child play in this basketball season? Well, I want them to learn other concepts. I want them to learn how to work as a team of five. I want them to learn how to move their body in different ways to become more agile, to have better balance, to have better coordination. And then I'm gonna have them play baseball, and I'm gonna have them learn how to swing their hips and hit that ball in a slightly different way and yet still develop that eye-hand coordination since the ball's moving, and then I contact the ball and I swing that bat."
So you start to kind of depict and understand how these other sports can help your athlete do what they wanna do, even better. I would say it's pretty fair by the time they are 16 and moving forwards that they can start to really dial in that sport. And if you wanna go "year around," and what my "year around" means is that you still have purposeful rest breaks built into that program. But at the age of 16 and starting to move forwards, you guys can most likely do that. Again, I can't put an absolute hard on that, hard rule on the 16, just because everybody's a little different. People go through puberty a little bit differently, and you just have to kind of see where the athlete's at.
Lastly, to help your athlete achieve that collegiate scholarship, of course, you wanna get in front of them. And there's all these kinda other angles, but let's keep it mechanical. I want that athlete to be strong, I want that athlete to understand how to move, and I want them to have been exposed to offseason workout programs. And I'm not talking about just throwing any slew of exercises at them, I'm talking about them working with an expert to dial in proficient movements that help them with whatever they're doing.
A hockey player versus a golfer player versus a football player are all gonna need and have different needs in terms of the strength and power movement. Even within the game of football, if they wanna become an offensive lineman, that's gonna feel a lot different than quarterback in regards to what that strength training offseason program needs to look like.
So many parents get so caught up in having that child or athlete only play in the sport, and they neglect all the strength training. It's like they don't really understand the benefits that that appropriate strength training can do to catalyze progress. And it doesn't even have to take up that much time or your money. That's the best thing. A lot of people would happily spend thousands of dollars on equipment but never spend hundreds of dollars on teaching their athlete on how to properly move in a weight training work out.
You do wanna find someone the best. In my experience, you don't wanna necessarily teach them just the random base stuff, high-intensity aerobic training exercises. You want strength training. You want these kids to get strong. You do want them to develop muscle. And, of course, the specificity of their sport will decide some of this, but you can save the high-intensity boot camp stuff kind of for later. You want to dial them in with specific exercises for their end goal in mind.
If you do that purposeful two to three months span of only working out and then you gradually get them back into the sport, you will absolutely witness the difference. They will feel the difference. So, if you adhere to those concepts as they go through the ages, you'll have a better chance of helping them get that collegiate scholarship.
Like I said, guys, this conversation can really go a 1,000 different directions. So, if you have specific questions on the appropriate methods to help them progress in their yearly training...so if it's a baseball player, the specific angles and what pitches they can throw at what ages based of their tanner level, which decides whether, at puberty, it can decide what level of function and movement they can do. If they wanna become a USA weightlifter, there are specific guidelines on how many reps, and how much pounds, and when they can be a competitor.
So I didn't wanna cover all that today because that would be days' worth. So if you guys have any specific questions on that in your child's sport, I'd be happy to pull up the research, send you the information so we can make the best decision for your child, so that, most importantly, we can keep them healthy, keep them safe. Don't get them burnt out or injured before they even make it to that opportunity for their collegiate scholarship.
Thanks for tuning in to "Prime Time," guys. We'll see you next time.
physical therapy | ballantyne | pr1me movement