Mobility Indicators & Adaptation
One of the constant underlying concepts that we're gonna keep talking about today is this notion of adaptation, and that if you understand this, this gives us a kind of a scheme and a framework to sort of understand what's going on and what happens when we sort of have a mis-adapation or a mal-adaptation, right? And what we wanna kind of get to the bottom of is making sure that you understand that as a human being, you're designed to constantly adapt to your environment. You are a beautiful machine that just is adapting to different stimuli. Exercise is a stimulus, true, that makes you weaker, true or false? I know that's a trick question. You know the answer that exercise makes you weaker. I can test this. We can do max pushups and then one minute later and I can test you again, and do you think you'll do more or less mass pushups?
Less, okay. So exercise makes you weaker. What happens is that you have this adaptation to stimulus and that's what makes you stronger. So that's...
why we have to make sure that we're really, really hammering on all of the aspects of this adaptation piece, so that we're making sure that we have a full and normal and healthy adaptation response. What happens when you sit all day long, for example? Your body is like, bam, this is the new paradigm, let's go. So take a look at this. Let's do a first thought experiment of the day. At home, this is for you. I want you guys to look at the palm of your hand. Go ahead. It's gnarly, isn't it? The ball of your foot, also gnarly. Now if you've dissected a palm of a hand, which I have, it's very difficult to dissect. The skin is thick, the tissue is robust. This is a surface designed to resist sheer, designed to resist deformation. It is a beautiful, beautiful high leather. What you can do with your hands is remarkable. Your feet, same thing. If you're a busy active person, you'll take 10,000 steps a day. 10,000 steps! How many steps in a 400 meter run? 720. Think about your feet as a surface that can withstand 720 impacts and only running 400 meters on top of the 10,000 steps you take in a day. It's a phenomenal amount of wear and tear on the surface. Now, here we go. Here's the thought experiment. Think of the most beautiful person in the world you can think of. So let's just say that Brad Pitt and David Beckham had a baby boy. And that boy grew up to be a man. And he looks a little bit like you're a partner, maybe. I'm just saying. Now picture his butt in your mind, you've got it? (audience laughing) It's beautiful. As a physical therapist I can appreciate this. So the issue is, now you've got that person's butt in your mind, Angelina Jolie's butt, whatever. I don't need to go there. But the concept is does it look like the palm of your hand in any way, shape or form? Does it look like the ball of your foot in your mind? Do you imagine that that beautiful person has the butt of a gibbon or of a baboon? A big calloused, gnarly, deformation, sheer resisting piece of meat. No, that would be very creepy. And the first make out you'd be like, "What's going on here?" Well, it turns out your butt is a non-weight-bearing surface. Oh, that makes good sense. And so right now you're undergoing a complex process of where we take tissues and under high pressure and high temperature, about 100 degrees. You weigh, let's say, you're an adult-size male. You're about 180 pounds, right? 190 pounds, good, 200 pounds. I didn't wanna overshoot you. You're on live TV, that's 10 pounds. (audience chuckles) So here's the deal, we take high pressure, high temperature, and that's how you laminate surfaces, isn't it? So what's going on now, if you're slightly dehydrated is that you're undergoing a process called butt lamination. And so what happens if you sit eight hours a day? What happens if you sit one hour a day? What's your process to get, I know. We tried to get stools for the audience. But it didn't work out, because the height. And so all day long, I will personally smash you later so to get you unglued. But what's happening is that all of these layers get smashed. Your femurs are getting pressed into the wrong position. And your body is slowly saying, "Hey, we're gonna adapt." We'll talk about this a little bit further when we look at applying some of these basic principles that we're gonna learn to sitting. But one of the things that happens is as a modern human, you're forced to sit at some point. And so having a scheme and a template to understand that you're adapting to this shape, adapting to this posture. This could be playing in to what's going on. We wanna bring some consciousness to whatever your kind of basic processes. Does that make sense? One of the biggest adaptation errors that we see is that we think... Or let me back up. How do we know if we have a problem in movement? How do we know? What's our body do? Hey, bam, you guys are all in pain. What's in the box? Pain. So if I take pain as my chief diagnostic tool, this is a problem. And it's a problem for three reasons. The first, in terms of adaptation, as a human being I'm designed to not hear pain signals. Now hear me out. The movement pathway and the pain pathway in the brain are the same pathway. And so what ends up happening is that if you're moving around, you can't even hear the pain signal. Can you imagine from an adaptation evolutionary response how valuable this is? You fight the tiger, raagh, you carry the meat back, boom! And you're like, "I didn't even feel that, "it was great." And someone's like, "You got scratched." Like, whoa, I got... Now and then you die of an infection. (audience laughing) The key is that if you're moving around, and you guys can relate to this at home, where the rubber hits the road. Have you ever laid down in bed and you start to relax and about three minutes later your shoulder starts to throb or your lower back is (hums). And you're like, "What's wrong with this bed? "Something's wrong with this bed." What you're really thinking is, what's really happened, is that you're not getting the moving signals anymore, you're getting pure pain signals. And so if we're lying and waiting for pain to kinda punch through our consciousness, to tell us are we in a good position, bad position, we may already be too late, because we're not getting the signal in time. So we wanna try and not use pain. The second reason, and that everyone probably here can relate, and the audience can relate, is that you guys, most of you have spent some time as an athlete training. And training, exercise, training, competing is by nature uncomfortable. Yes or no? Yes, the suffering is pretty hard. In fact, we go to like, people do these zombie running races now, where like not only are they running hard, but they're scared and running hard. Like we sorta like to be uncomfortable right? And so the problem is you've spent a lifetime down regulating your pains for signal and ignoring that stuff, because you know that being uncomfortable is nature. Giving birth is an uncomfortable process. And you can take an immense amount of pain. The third reason that pain is a terrible diagnostic indicator is that once the adrenaline is going, things sort of smear out of focus. How many of you guys have ever been in a fight? You don't have to raise your hand on TV, but it's pretty awesome. I know. (audience laughing) And fighting is a dirty secret, right? One of the producers here just started boxing. And one of the secrets about fighting is that once you start fighting, you actually don't feel pain anymore. Why? Because the adrenaline's going. And when the adrenaline is going, you feel great and you can feel the impacts and the concussion. And you know it's bad. And you're probably gonna hurt tomorrow, but right now, I feel awesome. And exercise, or competition, is really no physiologically different. It's not. Once the norepinephrine starts kicking and you're feeling good, you now absolutely don't hear those pain signals. So by the time pain has punctured in to my consciousness, I have a problem. The other model is just as we couple this for a second, is that we also tend to rely on this concept of sort of task dominance. Did I complete the task, yes, no? I made you some toast, but I burned down the house. And this novel concept is that, hey, what we've done forever, said, hey, there's no pain and I got the job done, good work. When I was a physical therapist, I'm always lecturing about or hearing the word functional and is it functional? And are you functional? Is this functional fitness? I'm not into functional. Functional means you can get off the toilet and do your bra strap. We're into optimal. Can you do everything that a human being should be able to do? Can you perform through range of motion and motor control? Everything that a human being should be able to do. And when I talk about this, I say, are you normal? Which is I'm a human being, full power, or am I dis-normal? And I had to start using this word, dis-normal, because Juliet, my wife, and I started to get into some fights about this. 'Cause she was like, "You tell people they're not normal "and it hurts their feelings." And she's like, "'Cause I'm not normal and I'm normal." and I was like, "Well, that's true, "you're dis-normal, you're un-normal." Or in the parlance we say anormal, dis-normal, right? And what we really found out was she was right. That really is not the right language. The language is are you working at your full physical capacities? Do you have availability of these full physical capacities? And what's happening is that many of us don't, but we're still the best athletes in the world. We're still the best mamas in the world, we can still go around and do what we need to do because we've been relying on the fact that, hey, I completed the task today. It didn't hurt. That must be good enough. And this is a basic type one error. We're not looking. It's like saying, hey, I'm a Ferrari. If I hit the brake on the hand brake 10%, I'm still a Ferrari. I'm still gonna beat you in your little Yugo from 1987. One of your wheels on the Ferrari's kicked off a little bit. Tires smoke sometimes, it's not a big deal. I just let it cool off, it's no biggie. So now you've got wheel out of true, you're still a Ferrari. Are you working at your full capacity? What this gives us is that this gives us sort of this idea of talking about adaptation errors. And when we look at pain, this is what we call a significant lagging indicator, in engineering terms, lagging indicator. My father-in-law is an engineer and he's like, "You know what you're talking about? "You're talking about lagging indicator." Something about happens after the fact. You're going through the assembly line, boom, and then you found out you had a defect. But it's already too late, because you're a human being. Your knee may never hurt until you have a hole in your kneecap. Now that's a difficult bell to unring, isn't it? So the idea is that we wanna move beyond lagging indicators. And some of these lagging indicators are swelling. I literally will ask people about their knee pain. And I was like, "Well, what happened?" They were like, "I don't know, I just woke up "and my knee was like that." Like, "Are you kidding me? "Did you see your knee? "It's like a baseball, it's like a watermelon. "What happened?" "I don't know, I just woke up, it was like that." And the problem is that this is another one, Numbness and tingling, people can relate to. What if I'm holding my camera so long that my hands go numb? What's happening in my body? I have a clue to the blood supply, to my nervous system, my nervous system is freaking out and it's making me numb. Some point, at some issue, you guys have undergone some numbness-tingling, whether you were holding your babies for a long period of time, or you had to sit for long periods of time and your foot gets a little tingly, whether you were overhead squating one too many times. You can start to see that we need to identify, not wait for the numbness and tingling to set in to think we have a problem. 'Cause this is an issue. We'll also see decrease in force production. And we'll see decrease in range of motion. And what we wanna do, again, is switch our whole paradigm away from the set of lagging indicator. So how do I know what a good position is? The chief leading indicator, how do I know if I'm moving well? And the answer is position. And so what I wanna do is I wanna flip this concept of lagging indicators into a leading indicator. And this leading indicator is position. Do I understand what a good position is, yes, no? Can I identify that inefficiency? And when you start to understand this, because the body base basic principles of movement, over and over again. It's a very, very simple machine. It's like the iPad. You swipe the iPad and all this technology erupts, right? But it's just swiping the iPad. You don't have to even understand all the complex physiology underneath it. You need to hold the iPad and swipe the iPad and it goes on. So what we we do is if we start looking at position as a leading indicator, then I can diagnose and prevent problems in real time. Instead of waiting for the wheel to fly off the car and the realize I have a problem or until I've herniated a disk and realize I have a problem. Are you guys slouching or you in a good position? Oh, everyone drink, one drink, all right. Here we go. It's a shot of wheat blood grass, whatever that is. (audience laughing) So here's the deal. If we break out the constituents of positions, we're gonna take it into two pieces. The first is what I call motor control. Does the human being understand what they're supposed to do and can they do it? Yes or no? So here's an example. One of my friends is a brilliant, brilliant guy. We're at Disneyland, he's talking about his daughters. And he's like, "My daughter walks like a duck." 'Cause we've been talking about the dangers of duck walking. And I'm like, "It's true, she does." He's like, "What do I do? "Do we talk to you? "Do we talk to a pediatrician? "What do we do?" And I was like, "Have you asked her "not to walk like a duck, yet?" (audience laughing) And he was like, "It can't be that easy." And I was like, "Well, give it try." And he's like, "Hey, Eva, honey, "can you just walk with your feet straight, "not turned out anymore?" She's like, "Sure, dad." And the problem was fixed. (audience laughing) And he's like, "It's that simple?" I'm like, "It's that simple." So do people know what to do? Because you guys are smart. You're smarter than me. People have been brilliant out there. So do they understand? Your right foot is turned out, your left foot is straight. Can you see the difference there? Oh, feet are straight, that's (chuckles) better. I like that. So this motor control concept comes to us, and, guess what? It's really just the expression of technique. This is what we're talking about. People have worked out the technique for us ages and ages ago. I know what the stable shoulder is. The best Olympic lifting coaches that I know tell me that I slam my armpit forward. Mark Burgener, my sensei. Put your armpit forward when you go overhead. Why? 'Cause he knows that's the better position for the shoulder. How? Because they worked it out over 100 years of Olympic lifting about how to create a stable shoulder. Do you think the yogis figured something out in the same way? Yeah. People have been noodling around with their bodies for a long time. And this is that concept I was talking about with the yoga class is that if you start to understand the position and principles behind the position, then you understand that technique is really the expression of physiology. Technique is really about, hey, why are people solving this set of problems using the same framework, the same chassis? The second aspect of this is the biomechanics. And what's great is that, oh, hey, this is day one. Oh, motor control. Do people know how to move? Because you can just correct a lot of problems by knowing how to move. We'll talk about that in a second. And two is about biomechanics. And the expression of fixing your biomechanics comes through with mobility. Can I perform basic maintenance when I have tissues that are stiff, or a hinge or a lever that doesn't work? What's preventing me from expressing the motor control that puts the body into a good position? And suddenly this isn't such a daunting task. Can I identify what a good position is, yes, no? And then what's keeping me from that position when I'm compromising my position because I'm wearing body armor? I'm an officer. I'm wearing body armor and sitting in a car all day long, and I've got the utility belts and I'm in a wretched position. How do I undo that? One of our... As a case study, I was working with a young captain who flies a Black Hawk helicopter. And he just was getting brutalized in the seat after these six and seven hour missions. What ended happening was he was like, "Hey, Kelly, I prioritized my spine like you said. "I worked my shoulders at the limit. "And then when I got out, "I did the preventative maintenance." He's like, "It took me 18 minutes to undo that flight. "That's how long it took." which is simple idea, right? If I have to sit in a car for a long period of time, or stand at work and do something, then maybe I have to program some thinking, some basic maintenance into undoing that. Does that seem lie a reasonable idea? And it is reasonable idea as long as you understand what to look for. So what we're gonna do is try to shift this concept from lagging indicators to leading indicators. And we're gonna put this position. Are you in a good positions, yes, no? And this becomes very easy to see once you can identify it. And you should be able to look at anyone after this course, and in two seconds be like, "Bad position, good position." Whether they're in the Olympics, whether they're walking down the street. And you're gonna be horrified and also impressed with how much crap the human body will put up with. It's pretty remarkable. It's a remarkable bit of engineering. So as we talk about lagging indicators for a second, and we talk about adaptation errors, I would be remiss if we didn't start building a relationship. I'm going to be clear. The aspect that we're measuring and interested in is human performance. And that doesn't mean that I can lift a million pounds or run a million miles. That's the performance of the human being. What's the optimal expression of you in the environment? Imagine if you had more energy, 'cause you were more efficient, took your hand brake off, and then when we got home you weren't tired and you could play with your kids. That's nice expression of this, don't you think? Or, hey, I, you know, I'm winning more races because I'm running more efficiently. So performance, and we measure performance or the change in performance a couple ways, with wattage. We measure it with reps. You can measure it with power. You start to see where I'm going with this? Time, these are observable, measurable and repeatable phenomenon. And from the scaled model, I wanna be clear, we're not chasing everyone away who's watching who's not a lead athlete. In physical therapy, we have this test called the timed up and go. And the timed up and go looks like this. It's a measure for is someone at risk for falling? Ready for this? It's radical. They get up out of a chair, they walk three meters, they turn around and they sit back in the chair. And you time that. And guess what? Based on your performance of the function, not the correlates, not do you have enough hip range of motion, ankle range of motion, it's the expression of actual, the movement, that tell us about the capacity and the function of the human being. Isn't that a radical concept? They used to do it and they were great. You'd be like oh, that was pretty good, like A minus, not likely to fall. But then someone is like, "let's just put a clock it." because as soon as we start measuring performance and measuring outcome, then we could start to make observations about the changes in that performance. If I'd trained, I was a little bit stronger, could walk a little bit faster. And, guess what? We found that it correlated with risk, fall risk, but it also correlated with increased power output. there was famous hammer thrower named Litvinov, who's Russian, I think, one of the greatest hammer throwers in the world, and he had a workout that he would perform, where he front squatted 400 pounds for like seven reps and then he would run 400 meters. So let's think about that for a second. His functional test, and you could measure his fitness and where was in the season was he performed seven get up out of the chairs, with 400 pounds. And then he walked very fastly, 400 meters. And then he could measure that and measure outcome. So that's what we're knowing is that really what we wanna do is shift this away from paying yes, no? That's the lowest form of this conversation. We wanna go into the optimal performance. How do we measure performance? With wattage, with time, with output. And so when we start making a relationship here, and I just put adaptation in this corner, then it's important that we understand that there's some relationship between adaptation and performance. This is why we theoretically eat a certain way or try to drink water. Why try to get enough sleep. Oh, these are the adaptation errors we would be remiss if we didn't talk about. And this is the problem is that people are not connecting this dot very well, that eating a plate of cookies feels good, but I'm not going to run this fast tomorrow or be as sharp mentally. I can measure that performance. And they do measure that performance. Did you see this, there was a great study, recently they came out with this guy, they kept him awake for like 80 hours and he was killing it, taking all the tests, he's like, (chuckles) "I own this." And they were like, "Great, and now you're gonna take "the same test you just took, but sit down." And soon as he sat down, he was like (groans) "You guys gassed me." (groans) And he blacked out, literally. So what happens is we make these adaptation errors about sleep. We make these adaptation errors about sitting. And this, as we know it, plays a huge director our performance, but it also plays havoc on our biomechanics. And this is why we spent so much time talking with people about, "Are you sleeping enough? "Are you drinking enough water?" what's going on? And we know, for example, that if you're one to 2% dehydrated, one to 2% dehydrated, this equals a five to 10% decrease in VO2 max. That's your cardiac output. That's how effective your lungs generating, wow, the force, that cardiorespiratory capacity, your VO2, that work model that we all kind of slave to. So you're slightly dehydrated. I know you wanna take a sip right now, go ahead, it's okay, (mumbles). You good, you okay? I have that mind control over you, right? (audience chuckles) And so imagine that if I'm one or 2% dehydrated and I'm carrying a big pack, I'm racing a race, I'm giving someone a very, very unfair advantage. We also notice that when people are dehydrated, their tissues start to get clammy. They start to get a little bit sticky. And it's difficult to be deployed. It's difficult to work at a desk. Difficult to run and around and just be conscious of this. What ends up happening is we have adaptation errors because I'm not the Buddha yet. I'm working on it. But I still like myself a cookie and I forget to drink water and sometimes I skip a meal, 'cause I"m hustling and I have to sit. And all of a sudden, my body starts to adapt to that model. And so what we wanna understand is that if I start seeing errors on this side, this adaptation errors, I'm also gonna see errors in my biomechanics. And a lot of what we have to do is simply program to that. You wouldn't drive your car and wait for it to blow up and then add oil, would you? Isn't that a ridiculous concept? Or how about this one? You're a Marine, you're amazing. And you get into a fire fight. And you just wait for your weapon to jam and then you're like, "Let me just take this apart right now." This is nonsense. Who would ever operate like that? No one would, right? And that's what we do with our bodies? Why? Because we're busy, human, creative beings. What we need to do is create a template. What we're gonna do is give you a model and a schema to be able to fix this stuff. Let me give you an example. Any of our trusty volunteers? Does anyone have a tight ankle? No tight ankles? Everyone's got full range of motion in their ankles? Come here, Dave. Sure, choose the big, ugh. Let me have you on your stomach. Okay, I'm gonna touch you now, but for an instructional purpose only. Now you see, that's not creepy, right? (audience laughing) Don't be creepy. I'm undressing you now but that is creepy. Okay, so here we go. I'm gonna take this off. What we're gonna do is we're gonna look at his ankle range of motion here for a second. 'Cause I want you guys to understand the relationship sometimes, if I fall behind, or what's going on with my biomechanics, as it relates to my performance? 'Cause we're gonna delve into this a little bit more. So if I put his ankle in neutral here, that's just neutral. That's the best expression of the ankle. We have a fancy term for it, but we're gonna call this best ankle position. And I-- No, don't help. If I dorsa flex him, or bring his toes up, like you bring your toes to your nose, notice that he stops and he doesn't look like he's at zero. Is he at zero yet? No, it looks like he's not quite to level, is it? It's like he has negative range of motion in that direction. Now he can push into that. (grunts) He's working hard there. Now let's talk about some things for a second. What if you had negative range of motion in your wrist or your elbow? What would eating look like? Can you imagine how weird that would be? Your neck would be killing you, your wrist would be killing you all the time. You're out to dinner, you're like complaining bitterly of your neck pain. And your friends are like, "Bro, what's going on with your elbow?" And you're like, "It's not my elbow, it doesn't hurt." So here's the deal. He's missing all of this range of motion. He can push into it really hard (grunts) and he's still not at full range of motion. Now bring your hand to your face. This isn't a test. Is there any resistance in that? Can you imagine if there was resistance bringing your hand to your face? How weird that would be? Ooh, stiff, PR. Well, what's happening is he has to work hard. How much work is being done right now? Do you guys know? How much work? If we measured work? You're working, right?
[Man in Tan Shirt] Little bit.
Little bit? I mean, you're flexing that toe down. Bring that toe down. Come on, work it, work it. So no work has been done. No weight has been moved, no force has been displaced. It's costing him internally to run this system. Now let me show you something. Relax that foot. If I turn this foot out a little bit, does that change his range of motion? Yes. And so what ends up happening is that when I default to this other position, suddenly, and you can start to see, actually, he's got a little bit of a growth here on the outside of his heel, 'cause now his Achilles is coming down and all of a sudden it spins a little bit. Can you guys see that? So instead of tracking straight, (squeaking) it comes off to the side now and there's a pulling a little bit, what we call obliquely, or off-axis, it's not going straight up and down. So I have this very, very powerful steel cable and all of a sudden that steel cable isn't working perfectly straight. Can you come up with a mechanism for why he might develop symptoms in this region? Can you come up with that idea? Yeah, his Achilles, in this big powerful engine, 10,000 steps a day, 720 meters, steps when he runs, and all of a sudden this thing isn't perfectly straight up and down. And guess what this foot is? This is the duck position for walking, isn't it? So now look what happens. His plantar fascia, the connective tissue in the bottom of the foot, where people get this diagnosis called plantar fascitis, it's all twisted up, isn't it? Is it working straight and beautifully? Negative, it's all twisted and mucked up. So now I'd ask his tissues in the bottom of his feet to accommodate for that. Now, interestingly enough, when people develop a lot of bone spurts in the ankle, that happens right here in this part of the ankle joint. What happens is that as people work around this problem and collapse those two joint surfaces, they bang together, and start to create a little problem there. So when people get an ankle impingement, what they talk about, or having a bone splint in their ankle, this is usually the spot, interesting. If I walk like this all the time, you'll notice that women and men also, I have a awesome picture of a bunion I'll show you later. (audience laughing) It's awesome. I'm not saying I'm geeky about these things, but this is an awesome picture. And now you have a mechanism for why he's walking over that toe and destroying this toe joint, isn't it? We can identify, do we all agree that picking something up with a rounded back is a bad idea? Okay, so we need to also shift that paradigm a little further to say picking something up with a collapsed arch and a collapsed foot is also not a reasonable idea. Does that make sense? Are you guys following me on that? Okay, so look what happens. His ankle bone is connected to his shin bone, conveniently, via the shin bone. And when he turns his foot out, one of the things that happens is that the knee turns out a little bit, too. And what you'll see is that if I turn my shin out a little bit, this is the tibular tuberocity. This is where my quadriceps insert, right here on the bottom. You can feel that on yourself. And if I turn my foot out, are my quads going straight again? No, can everyone see that they're suddenly having to go off axis? Can you come up with a mechanism for why I might get some patella femoral pain, or why my knee's not tracking correctly, or I get knee pain here? I have a hinge joint that suddenly has a rotation in the middle of the hinge joint. And now this poor tendon is pulling off axis all the time. This is a mechanism for injury when we see a lot of dislocated knee caps, for example, in young people, jumping and landing. Now here's another model, ready? Take your finger, middle finger, put it over your index finger for me. If you're playing at home, this is what I want you to do. Pin the bottom of that for me. And what I want you do is I want you to externally rotate your wrist. And notice that your finger becomes tighter. Does that make sense to you guys? So what happens is you wound up, this finger in the front is your anterior cruciate ligament, it's your ACL. That's the one that I think that guy RJ3 just tore. Oh, interesting, curious, we'll talk about that a little bit later on. And what ends up happening then is that when his foot is straight, he can create stability through the hip, those tissues wind up. But what happens if I unwind the foot? Do those two ligaments unwind a little bit? They become lax? Well, what happens is that knee suddenly has a little bit more slop-in. Now we've put that athlete at injury, or susceptible to injury or risk, or if the foot turns out and the knee comes in, the foot turns out and the knee comes in, suddenly this ACL starts to be a problem, isn't it? How about this? Here's the shin bone, we call it the tibia. And he's got his meniscus resting right on top of it. Here's his femur spinning beautifully up and down and range of motion. Everything's hunky dory, love it. Meniscus is seven times more slippery than ice on ice. Do you think that God and evolution has given you extra meniscus to party with? Or do you think you need all of your meniscus? I'm guessing that it's all of it is the answer. So imagine if all of a sudden you just go ahead and turn your shin out a little bit and now your femur goes. Is your femur tracking the meniscus correctly? You know, how do we tear the meniscus exactly again? Oh, now I have this femur cheese grating my meniscus or if my shin comes forward and then I turn out? It's like shucking an oyster off a shell. No big deal, it's cool, right? What we know is that if you can't create enough torque, you may not have any of these problems. I'm just saying I wanna show you the upstream and downstream implications. But if you can't create any stability through this foot, what happens to his back? We know he can't create as much stability there, too. And what's the problem? This is the problem. Doesn't it seem like we should just fix this in the first place? So the question is can you identify this good position or bad position, yes, no? You don't even have to be responsible for the implications later on. All you need to know is are my feet straight when I'm walking and standing, yes, no? And if they're not, you need to figure out why. And that's the question I wanna ask. Why am I moving the way I'm moving? "Hey, Eva, can you get your feet straight?" "Sure, dad." Boom, problem solved. But what we have is an athlete who's capable of generating freakish amounts of force. What's your best dead lift? (Man on floor speaks off mic) Yeah. (Man on floor speaks off mic) 405, that's weird, I dead lift 406. It's convenient, I'm just saying. So, look, he's still a amazing athlete, right? He's an extraordinary human being. And this should not be a question about pain, yes, no, this should be a question of system optimization. Are you running at full power, yes, no? Do you, can you being a human being? Can you keep your hand on the box and figure out what's going on? Let me show you a quick trick. We're gonna come back to this later on. But I wanna show you why we think in systems. One is I have to know that there's a problem, and we're gonna fix a problem. So if I wind up his ankle here, I take this very complex tool, called a lacrosse ball. Now notice, does the skin slide over his Achilles at all here? That's weird. Now let's just check. Touch your face. Does your skin slide over face? Weird. You can check with your doctor to make sure your skin should slide over your face. Check your elbow, does it slide? Yeah, check, that's awesome. It totally slides, I love that. Weird that it wouldn't slide, in fact. So imagine if your skin doesn't slide over the tendon is this the problem? And what's one of the problems that sets up from adaptation error. When I'm slightly dehydrated, when I sit for long periods of time and don't clear out all of the muscular or all of the residue, or all of the lymphatics or the drainage in my legs, because I'm sitting and I'm not pumping that stuff out with my muscles through the lymphatic system, then that tissue tends to pull. I'm around. I'm dehydrated. My tissues, instead of being like layers of silk, cold silk sliding over a steel spring, it's like wet grilled cheese. Womp-womp, sorry, bro. Don't touch my cheese, bro. So here's the deal. I'm gonna go ahead and grab this lacrosse ball. I'm gonna wind up his skin. He signed a waiver, don't panic. You can do this at home. And I'll I'm doing is taking up the skin slack and I'm just giving it a pop. And I'm just freeing up the skin from the surface underneath. Pop, pop. And I'm just winding up the skin and giving it a little tack. Very simple. Pick up the slack, move it a little bit. So I don't have to push hard. I'm just trying to push down. Just trying to get the skin sliding. This is what we're attempting to do when we work on our sliding surfaces is, oh, does it slide over the bone? Nope, so let's make sure it slides over the bone. And I just give it a quick freeing up of the skin tissue. If I was a physical therapist and I was billing for this, you could imagine what they would say, "You whacked him with a ball?" (woman laughs) And I'd be like, "Yes, "fascial release with percussion, obviously." (audience laughing) But I just call it ball whacking. So hey get to some of that ball whacking. And I just unglue this, unglue these bits here. Doesn't take very long. Sometimes it's hard to do by yourself, but you can have a super friend. I have not seen anyone's spine come out of their face when they ball whack their skin. You can talk to your doctor if you think it's unsafe. Now that quick minute goes by. Does it look different? Yeah, you can see a difference, right? The interesting thing is what? Does it change his range of motion? Oh, yes, it does, absolutely. You can measure that. So here's the deal. I didn't stretch his calf. I didn't mobilize his ankle, Didn't work on his plantar fascia, I worked on one aspect of the system. 'Cause I was aware that this part was tacked down. He had a sliding surface problem. I could identify what the stable position was, or the best position and I can test and retest that position. Now here's the deal. Does this ankle range of motion matter at all? What matters? Movement. Did I test or retest any movement with him? So how would I express this change? It's not about pain. He may or may not have had ankle pain. In fact, I don't think he did. He just said he knew his ankles were a little tight. So he's running around minus 100% ankle range of motion. No pain, still getting the job done. Isn't that a model for pain, yes, no, task completion, yes, no? That's where we need to go. We need to be a little bit smarter than the way we're thinking about this stuff. Do guys have a question in the back?
Yes, indeed. Judy Stohl is wondering what other objects you can use if you don't have a lacrosse ball? What is it about that ball that makes it a good use for it?
Ah, great question. So the lacrosse ball costs a dollar. They're ubiquitous. I'm sure any kind of ball would work. I'm not gonna say I've done this with a beer bottle, but I've done it with a beer (chuckles) bottle. 'Cause anything that can just grip the skin. I'm sure you can even do it with kind of a soup spoon, anything that was just create a little tack on the skin and give it a quick pop. Right? Does that make sense?
[Man In Black Jacket] And can you do it to yourself?
Absolutely. We'll show people later on tomorrow how to tape two balls together. It's a little bit tricky, but absolutely. Everything we wanna do, you should be able to try and be able to fix yourself. I believe, and look, not be all metaphorical or metaphysical here, but Buddha, Jesus, Mohammed, they're all like, "Hey, you should probably practice "with a whole bunch of other people." And one of the things is that you're not some like lone she-wolf in the wilderness taking care of your babies. You have friends. You should exercise with your friends. Hey, can you come over and whack my ball? (audience laughing) I mean, that's weird. But it's true, it's true, you get the idea, okay? So here's the deal. Come stand up for me real quick.
You've got about 20 minutes until our first--
Great, thank you very much.
No problem. We'll get someone in to take care of that.
No problem. Mind that. Okay, so here's what we wanna do. What we really wanna do is tie this into a movement. So will you go ahead and squat for us real quick? 'Kay, just one more time, let's squat again. Nope, this time we're gonna squat. Okay, right, this time we'll squat. What are we seeing?
His feet are turned out.
His feet, oh, no, it's not so bad. His knee's coming forward first. We'll talk about this in a second. So I don't want that knee to come forward first. Your body obeys a basic principle of what we call load sequencing and load ordering. So if the thing that moves first in range loads maximally in range. So if I wanna crush my kneecap, what should go first? If I'm missing range of motion in my ankle what maybe should I not use up right away? My ankle range of motion. You following me? So just have a little bit later, we'll cover this later. Just delay that. So how about this way. If your knee, hand touches my knee, someone will die. (audience laughing) You will send a tribute forward like the Hunger Games. There we go, better. Now you should arrive on a better position. Here's the question. Can you tell the difference side to side?
Yeah, this one (mumbles) here.
In what way?
It's not getting caught as early.
Ah, there we go. So now we can see a change in performance. Does this make sense? Perfect, good job being the first guinea pig. Okay. What happens when you express this in children? Oh, I just gave you a model and a mechanism for how we potentially see ACL problems, right? Foot turns out, knee, how is it that we've seen a 400% increase in ACL injuries in kids, what? 12 to 14? 400% in the last 10 years. Yeah, that's no big deal. We're elite. We have the internet. What's going on? Why are kids getting injured in a freakish rate and why can't we identify that? Well, I'll tell you one of the problems is that as parents, as adults, and as coaches, we don't identify that this is a problem. Why? Because that kid is still the fastest on the team. But when she cuts, (squeaks) there's the problem. Does that make sense? And this is where we're going. Look, have you seen some of these statistics about the number of childhood injury rates? This primer, one of the book is the primer for girls. This is the primer for kids, this is the primer for you and your family. Whoa, whoa, whoa, whoa, whoa, three-and-a-half million kinds hurt playing sports? That's it, just three-and-a-half million. And the question is can we stop that? The rates are astronomical. And what we wanna ask is how much of this is preventable because we're just in a better position? And the answer is a lot. Wow, okay. So why are we gonna hammer movement first? We're gonna hammer movement first for a couple reasons. The first is that oftentimes the problem that we're having is because people are moving poorly. So the easiest thing to fix in the movement. I don't have to program anything, change anything. If you're moving incorrectly, that's moving correctly. And that suddenly will resolve a lot of the tissue dysfunction that we have. I literally just had a guy come in to my office, sit on my table like this, talking to me. I'm like, "So." He's the captain of a fire team, he's awesome guy, great athlete. And he's like, "Yeah, my back is killing me." And I was like, "Look, are you just toying with me or what?" Like, "Are you fighting left-handed for a reason? "Like what's going on?" And, really, he's like, "What?" I'm like, "Well, of course you have back pain, "you deserve it, look at your back! "Man, look at the bones, man!" So why movement first? So when I correct the movement problem, oftentimes those things just remedy themselves. The second reason is that if I'm working with someone, then if I get 'em working at the limits of their range of motion, then what often happens then is that I get them protected maximally. I put them in the best position possible for them, which gives me the maximum buffer from bad mechanics. So there's a big drop off. If my foot turns out a lot, then I'm really susceptible. If my foot only turns out a little bit because I'm conscious of it, then I'm more likely to be able to buffer this bad mechanic, and may never even raise its ugly head. So we position, position, position, movement first. That's what day one is. And day two, as we tie this in is that if you know what position to be in, then mobilizing that position is easy. It's almost an academic exercise, because you can identify what your positions are, yes or no. Does that make sense? Okay, so this is why we're hammering the position first off. Real quick. I wanna illustrate this quick model dysfunction. And we're gonna get into some quick video. And the reason I wanna talk about this real quick is related to those last slides about injury and the injury rates. One, there's a big category called pathology, which is the domain of medicine. This is why you have a brilliant physician, is that things do go wrong with a human being. We get diseases, we get sick. Medicine is amazing at solving this. We're really, really good of the pathology. And, fortunately, this counts for 1% of all the typical problems, the musculoskeletal problems I see. The reason I wanna throw this at ya' is as we start to working through these things, we're solving our own problems. If we get into this conversation where we say, "Hey, do you have night sweats, "dizziness, fever, vomiting, nausea, "unaccounted for weight loss and weight gain, "numbness-tingling, changes in your bladder "or bowel function?" Something is wrong with you. You're not sore from squatting. Your knee doesn't hurt. There's something going on, call your doctor. And I'm always running this sort of sub-program, sub-loop in the back of my head. Someone comes in like, "Oh, I feel terrible." I'm like, "Well, night sweats, dizziness, "fever, vomiting nausea? "Are you sick or did you tweak your back running yesterday?" There's the difference, right? 1%, two is catastrophe. This catastrophe model also accounts for 1% of all the problems I see in the gym. And with the typical friends, I'm talking about my friends and family, right? Every once of awhile, you're jumping out of an airplane at night, downwind in the dark and you sprain your ankle. It totally happens, I get it, right? Some 300 pounds lineman rolls into your knee while you're holding your baby. So I get it, right? It totally happens. (audience laughing) So sports med is really good at putting this back together. But the big category, this 98% category is preventable. And the first one is what we call overtension, overtension. It is the system just under too much tension? What we saw was an ankle that was under overtension, wasn't it? The ankle didn't move because some biomechanical aspect of that was just keeping it tight. Couldn't get my hand to my face. This is an overtension system. This generates a lot of dysfunction. So what I need to do is feed slack, take the breaks off. Make sure that that tissue is stiff unstiffened, and make sure that it has full range of motion. And four is what I call this open circuit fault. And the concept here, with this open circuit, the open circuit fault, is this. We define functional movement as working from a wave of contraction, from trunk to periphery, from core to sleeve, from axillary skeleton, to peripheral skeleton. And I have to be organized at the trunk first before I can generate peak optimal force. Does that make sense? We've heard that before. This is an old crossfit definition. And it's a definition that's been in the training sphere forever. So the concept here is if I'm disorganized at the trunk, can I move optimally outwards? No, so I need to make sure I'm fixing the trunk first, okay? This open circuit means this, that I generate a position of peak force and stability and then I can generate the maximum force. But, what we see regularly is that people can generate freakish amounts of force in a bad position. So if I don't get into an optimally organized position, spine neutral and brace and integrated, and I default to some other shape, I'm still stable in this position aren't I? I'm rock solid stable. In fact, I've seen people lift heroic weights with a rounded back all the time. Just go and watch anyone lift their kid up, right? Now watch this. Now I'm super stable. This is a position where most of us are spending our day on the computer. Ah, mouth open, even. (audience laughing) What's happening is you're just doing what we call hanging on the meat. You're in this bad position where you're defaulting to relying on your mechanics or your tissues to support you instead of being optimally integrated throughout the system. And this is where we see most of the problems occur in the human being that are catastrophic. I overextend, bone on bone. I mean, it looks like I'm not gonna hurt my back, but this is the yoga posture, we're like, whoa. I'm forward bend. I mean, I'm like a big stripper right now. (audience laughing) Like you'll never get this image out of your head, Eric, ever. Or at home, ever. (audience laughing) So the key is can I identify these positions? 'Cause this feels stable to me. In fact, what's going on over there? You're like, "Oh, I'm not gonna slouch. "Oh, God, it solved the problem." But I'm really in some strange biomechanical position. If I was walking down, you'd think that was weird. So stable position, unstable position. I leave the circuit open, my body looks for stability. Ankle collapse, knee collapsed, hip impinged. There's that ACL tear. Shoulder coming forward, resting in this position, internally rotated. These are open circuits and my body is relying on the robustness of the tissues that keep me protected. Can I identify those positions, yes or no? Are you following me? Are you tracking? Kids with cerebral palsy have a diagnosis of damaged motor control systems. How do they walk? They're brilliant. Kids are cognitively intact. They just have a damaged motor control system. But they figured out, collapse the ankle, oh, there's that missing ankle range of motion. Impinge the knee, have the open valgus knee strain impinge the hip over, boom, stable. Kids can walk just fine leveraging their tissues until they wear out. Okay, so this is our models of dysfunction. I want you guys to understand that those three and four are all about preventable disease. That means that most of the things that afflict us, that million non-combat related orthopedic injuries, we should be able to resolve that, we should be able to eat into that, right? We mentioned RG3, that catastrophic injury? Did you see the subway commercial right before he jumped? His knees actually touched before he jumped. Hi literally, oh, yeah, you can go back and watch it. We couldn't put it up for various reasons. But I'll tell you that his knees come in before he jumps. This is his position he's practiced. Practice doesn't make perfect, practice makes permanent. So if he jumps and his knees come in, what happens when he cuts and his foot his turned out? His knee comes in. What happens to his ACL? Can we identify that position? Now it's not such a mystery, is it? That was an expensive error, wasn't it? So let's play a little game.
Quick reminder, Kelly, we have about 10 minutes to break. And I think you said you had videos that you wanted to show us.
We're working on it, thank you very much.
Beautiful, got your back.
Don't push me, man. (audience laughing) Okay. You could imagine that I asked for a whole week of this show. And they're like, "Kelly, "we're gonna give you two days to start." All right, so here's the deal. We have intensities of diagnostics. So if I take a position. How do I challenge position? What's it look like when you're in a good spine and you're carrying your twins around, what are you doing? Carrying a load. I hate to say it, but your babies are just loads, right? (audience laughing) So the easiest way to challenge the robust is so the position is to carry something or put it on your back. That is why we challenge your position in the gym with a load. Or you're carrying two heavy bags, or you're carrying your camera equipment. Let's look at that as a load. It's a challenge to your position. What's another way of a challenged load? Hey, why don't you carry those babies up the stairs for me, that'd be great. A lot of stairs. And that's what we call cardiorespiratory demand. Cardiorespiratory demand really impacts my ability to be in a good position. All I need you to do is have you run around the building and then show me you can be in a good position And you're gonna be like (panting), "I don't wanna pick that up anymore." Like it's really difficult. And guess what? Doesn't that look like sports? I need to run down after the ball and then spontaneously generate a lot of force and cut. Oh, no wonder! So if we put some cardiorespiratory demand in there, that's a problem. What about some metabolic demand? What happens when my muscles start burning because I'm working hard. Show me what you look like at the end of a 5K. Show me the robustness of your positions the end of your yoga practice. Not when you're fresh and awesome. Show me who you really are when you're in your worst self. And it's difficult. For my tactical athletes wearing 100 pound pack and body army and (grunts) and a weapon. Man, they look broken at the end. And those high heeled boots they put you in, not cute. What about stress? What if I'm actually in competition. Does that seem to matter? Hey, you're world champion of the world, good, let ms come up here and prove it. And let's do it on fire. (audience laughing) Right? You're not very good at it all of a sudden. What happens if I add speed? Oh, no! Speed kills, doesn't it? Good, do it, now do it faster. Again, again. Guess what? This is a working definition for intensity. This is what happens when we train for power. And this is our model. A lot of good models out there. This happens to be a good crossfit model. What we're doing is we're exposing the robustness of a position, standing, sitting, picking anything up to these different demands. And suddenly we can see what's going on. This video of Caroline is at age of 11 months. She's my daughter. She can't walk and she can't talk. But we know some things about her, right? We know that her knee shouldn't come forward first when she squats, she should load her hips and hamstrings first. That's how we optimize function. Her knees are going outside to create a stable foot and a stable hip. She goes really deep when she squats, but her knees come forward, so what does she do? She gets her knees back to vertical before she stands up again. Interesting. So she's wired to be this way. Let's try again. And I wanted to see what happens here. We'll talk you through this. My wife thinks I'm a little obsessed, 'cause I don't show my daughter's head, it's not important. (audience laughing) She's taking a wild west style stance she's obviously gonna be a power lifter. Boom, hips and hamstrings get loaded, we talked about that with you, with Eric. Knees forward, not with Eric, sorry, Dave. And do you see how vertical that shin was? How far her knee was out? And watch this. My daughter's squatting, eating at the same time, that's next level. (audience laughing) Now watch, as she reaches back, oh, look how vertical the shin is. She's minimizing, she hit her knee and maximizing hip function here. Watch how straight her back is. Whoa, that's so sick. (audience laughing) Not an accident. So why aren't we maxing the physiology? Well, it turns out it's about teaching and learning. So we just need to be in a good position. I wanna show you that this athlete is jumping. And we call these little train wrecks. Now watch what happens. As she's jumping in, do you see her knees collapse every single time? So what is she practicing here? Knees in, ankles collapse, in fact, you can see her get worse as she gets tired. So we start to add a little, oh, it's getting worse, it's decaying. Her Achilles were coming, oh, how does she step down? Can you see it? These little concepts. The problem sometimes is that we don't know what to look for when we're watching athletes move and we wanna see it. So I tell you what, let's do this. We're right where we can take a good break. The table is set. Can we be in a good position, yes, no? Can we identify those positions? Do we understand that my combat stance is my everyday stance? And who I am moving through the environment in the world is gonna be reflected in everything that I do. We like to say, one of my friends, Brian Mackenzie, says, he's like, "There is no place to hide." We are gonna find out who you really are physically, because we're gonna challenge you to some set of circumstances in our training where we can find the problems. And here's where we wanna go. Can I be in a good position, yes, no? And when I start exposing you to these things, suddenly the errors start jumping out. It's hard for me to watch you play basketball and know what's really going on. But if I start putting you into some of these very basic formal shapes of movement, squatting, pushup, burpee, getting up and down, reaching into the crib, reaching in the bag, picking up. I can suddenly start to understand what's going on and I have a diagnostic tool. Turns out, for exercise, the stimulus for adaptation is also the diagnostic tool. When I explained this to my mother-in-law, she'll be so pleased I'm saying this, I'm giving her credit. She was like, "Oh, it makes the invisible visible." And I was like (sighs). (audience laughing) That is so clever, Janet. And that's what we're gonna do.