A (4:27)

Thank you. It's great to be here.

B (4:29)

I am excited to talk to you today about injury risk. We're going to talk about biomechanics, particularly landing patterns and movement patterns patterns as it pertains to the knees, the hips, the ankles. We were talking just before we got started. I was telling you about my we call them our Betties, our perimenopausal Betties who are now moving from the cardio section of the gym to the weight section of the gym who are hearing me talk about sprint training and jump training for bone density. And of course that can have some. That comes with risk. Every movement comes with risk, especially if we don't have that motor patterning in it. So I thought we might just start with just some key biomechanics, like what happens in an ideal scenario when we are jumping and landing, when we are sprinting. What are some things that we want to consider for mechanics for the hip, the knees and the feet.

A (5:23)

Oh, I'm GLAD we have 90 minutes.

B (5:25)

Yeah, yeah. Not an easy.

A (5:27)

It's like.

B (5:27)

Yeah, that's. So just start with the most difficult question and four years right now.

A (5:34)

Um, so I guess at the basic level, they are applauding for you at P3, which is the lab in Santa Barbara where I just wrote up this book, Ballistic, about their mission. They've gone on this like decades of sorting out the answer to what you're saying, right? And they're. You're trying to use granular movement data. So it's like a million data points per athlete. And then they have thousands of athletes over the years and trying to match who ends up with an injury. And what did they move like six months before, a year before, et cetera. I think we're going to find over time, this is the right approach to answering your really good question from all of that. There are so many. There are more rows in the spreadsheet than Excel permits as they're studying this. And they're just trying to put all of this. Every potential thing. It could be Valgus, it could be hip angle, it could be ankle mobility. All of these factors, they put them all in and they emerge with really like the. The. Probably the tip top, number one riskiest thing that can happen is that you land on the outside of your foot and then have your foot roll to the inside, which does a lot of bad things. Upstream primarily. It puts your knee in a very dangerous position. And it. And in one study of NBA players, 100% of players who had a catastrophic knee injury landed in that manner. So that's a big one. The other big one that they're really worried about is you and I may squat next to each other like in the gym, and we may be the same height and squat the same amount and have our hips go back the same amount. But one of us might have the femur bone rotate inside your leg. Femoral rotation. That's very hard to picture. It's hard to even see. I can't see it. The people I wrote the book about can. So can the computer with the sensors that they use. And you can imagine with that bone rotating, it would put a little tension on the tendons and ligaments of your knee. And you can fix that. You can fix both of these things. You can change both of these things, and we can talk more about that. But I think in general, they're huge fans of everyone doing some kind of plyometrics, explosive movement. There's a reason the book is called Ballistic. And they're a fan of everyone doing weight training. And I just learned from you the term cardio bunny, which cracks me up.

B (7:48)

And Muscle Mommy.

A (7:49)

And Muscle Mommy.

B (7:50)

And Muscle Mommy. Yeah, Yeah.

A (7:51)

I think you want to get all this, right? They would say you to get all of this, to get that whole kinetic chain working symphonically, right? You want to bend your ankles, knees, and hips together synchronously and to absorb the force of landing. But I think those are the big keys, is to use those joints, to use them excitingly. Get a bit of movement in your life, get a little bounce, you know, get a little impulse, and the neurological process will unfold to make you better at that if you practice it. And I think that's the main. The main thing I learned from spending so much time at P3 in Santa Barbara.

B (8:27)

Yeah, it's an interesting. You know, you talk about repeating it and doing the same movement over and over again. There's something to be said about physical literacy. You know, we talk about being able to read or if you can speak different languages or any other skill. And I think that what is often missing. And of course there's budget cuts and, you know, without getting political and. But I think that there's an aspect of physical literacy that's missing in education. Like, we all learned about the geography and the history and, you know, whatever, whatever. But the. The spending cuts and the budget cuts, I think to physical education is far more detrimental. I mean, for learning, first of all. But I think that being able to acquire a new motor skill like this is why we often. I'll often joke on the show and say something like, you know, like, same squat, different shirt. It's like I. The reason why I have the proficiency in deadlifts or squats in the way that I do is because I've literally been doing it for decades. It's not because there's something special about me. It's not that I'm smarter than. It's just because I have done it 10,000 plus hours. I've just done it over and over and over again. And that motor learning, there has to be a certain amount of hours that you're putting into it. And so this is why I wanted to maybe talk. We can maybe start talking a little bit about hip. So the two things you said just to reframe it is landing on the outside of the foot and rolling to the inside. So that lateral translation and then that femoral rotation, that is gonna be putting tension or torque on some of the ligaments and tendons in the knee. Now for women who are the main consumers of this show, one of the more, you know, in addition to menstrual cycle and hormonal changes, but just in terms of structural anatomy, of course, we have a wider pelvic basin for biologically just to be able to grow and grow a baby and pass that through.

A (10:14)

A miracle.

B (10:15)

Yeah, yeah. To create another miracle of life.

A (10:18)

Yep.

B (10:18)

So that's going to translate to a larger Q angle. So this is basically just an angle. It's actually just two lines you'd go from. So for my nerds listening, my dark roast Betty's, it's the asis, right? The anterior superior iliac spine line down to the center of the patella and then the other lines going up to the tuber, the tibial tubercle, and you basically take an angle between those two. For men, it's typically about 14 degrees. For what women it's 3 or more. Like it's 17ish degrees for most adult women. I mean, there's some variance there, but that's a significant difference when you're landing and you have a wider hip. And that's. So all that to say, all that, like asis, all that anatomical jargon, all that to say is that women are more likely to be knock kneed. Right. So we are more likely to have our knees to have more medial stress on the inside part of the knee than on the outside part of the knee. And actually, interestingly, I was just talking to Stacey Sims and we were talking about this idea of this is why a lot of girls drop out of sport. Like when they're six or seven or eight, you know, pre puberty, they kind of look just like the, they run just like the guys, same speed, same capacity. And then as puberty hits, and of course we see men with the testosterone surge, but women's hips get wider and then their base of support comes down from like sort of the mid chest to about the navel area. We actually, our mechanics totally change.

A (11:38)

So I'm sorry, I can't stop you there. You mean by base of support. This is fascinating.

B (11:42)

Or our center. Our. I should, I shouldn't said base of support. Center of gravity is what I meant to say. I apologize. So for men, this is why it's very easy let's say for a man to do a pull up. And I think it's statistically significant that like 98% of women will not able be able to do one pull up because our shoulders are not as broad and our center of gravity actually migrates. Migrates downwards to our navel versus men where the ba. The center of gravity. I keep wanting to say basis support. That's wrong. Strike that. The record center of gravity is a little bit higher. So they're able to. They're able to do pull ups to the clavicle, pull ups to the sternum. And like women are basically with a neutral grip, can barely punch out one.

A (12:23)

That's fascinating. That's fascinating. So I want to thank you so much for you kind of nerded out there and I feel a lot of permission to be my natural self.

B (12:30)

Yes, please, nerd out. Yes.

A (12:33)

So one, there's a lot to. There's a. There's a lot that can I say here. So this guy, Haken Brom, I don't know if I'm saying his name right at the end of World War II, he's this researcher who really focused the world on Q angle, right? And he had an X ray machine and he was obsessed with people who dislocated their knee. And he went around and like did this 164 page classic study which showed that people who had extreme Q angles, who had big valgus collapse or more knock kneed, were much more likely to displace their knee. And then this Q angle got on the radar of every academic journal. And now there's been a. It's one of the most studied things in biomechanics, right? Is this Q angle. And so there was no reason for the people at P3 to doubt that when they started doing all these assessments with the sensors all over the body and getting a million data points per person. But they would put 22 markers all over the body, which I think the math is maybe something like 231Angles, right? One of which on each side was the Q angle. I did the math, I wrote the book, I'm working from memory now, I'm 50, I might have gotten it wrong, but it's something like 231 so. But what they noticed was like people, athletes would, would jump off an 18 inch box and land on these force plates with all these senses on their body and you would expect that this Q angle number would then correlate with injuries because that's what all the journals say, multiple injuries, right, are correlated with Q angle. And long story short, it doesn't affect injuries at all in their data. It's a non factor instead it's sometimes a marker for femoral rotation. Like if your femur rotates you might have a steep Q angle and then that's where the injuries come from. And there's actually if you look there, like I went through them all in the book, but there's every single study of like what causes ACL tears in women has a counter study. It's super frustrating, right? There's people about like the width of the canal that your ligament sits in or and on and on. But there are like women who actually tear their ACLs don't have steeper Q angles than women who do. It's super frustrating because the mechanism makes sense. But I think this is one example of how this granular movement data, so like Bradstrom was using an X ray machine and he has an angle that you can, a human can see with their naked eye, right? It's very easy for us to believe but it's been super frustrating in predicting and preventing injuries. Whereas this like you know, really big machine learning inspired million data points per assessment technique is unlocking a whole different view of what matters. And I think this might be one example of that is like if your femur rotates, big problem. There are other. Merely having valgus collapse does in fact correlate with like non catastrophic knee injuries in their data like wear and tear on the cartilage of your knee, etc, it's not good. They don't want you to have valgus collapse but it does not actually, it's not actually upstream of catastrophic knee injuries in men or women in their data which is a big difference from the historical research.

B (15:30)

And you know what's interesting there too talking about just contradicting research is the idea that collapsing the knees for a squat, let's say was typically viewed as bad. And then I've, I've also seen just literally the opposite where it's like actually you can, you can activate the glute medius if you do more of like an X squat. So on the, you know when you're coming down and you allow that valgum like you allow that knee knocking and maybe that's the femoral, it could be part of, it could partially be the femoral rotation but it seems like you can also activate some of the abductors of the hip when the knees are collapsing, which maybe is. It's a good thing if you're trying to initiate hip, if you're trying to train for hip stability. But I wonder if there's something to be said there as well. Like maybe with that increased Q angle, maybe we're able to train just naturally. Glute, medius and minimus maybe is just naturally stronger because it's always working to sort of externally rotate, let's say the femur. And then you're getting that, that protective effect.

A (16:30)

And I think there's. Yes, that could all be true. I, you know, this is 600 muscles that have to work symphonically. Right. And it's, it would be weird if there were a recommendation that worked for all of us. Right. It's literally, it's like an orchestra and it's like, you know, oh, the oboe's a little off key in this person, so it's causing that weird sound from their orchestra. Right. Like there's not like the medical journals are designed to be univariate analysis. Right. They're going to have, does increased hip flexion lead to problems? Right. And a lot of what they find in this, you know, kind of bigger machine learning based model is that these things don't function independently. My favorite example of this is weight. So if you have good landing form, which we can talk about more about that. But like if you have safe landing form and you weigh 300 pounds, then in their data weight doesn't affect your likelihood of injury. But if you have bad landing form, for instance, if you land on the outside of your foot or your femur rotates, then it's one of the leading factors causing to injury because it's putting more newtons of force on the ligament where you're supposed, not supposed to be directing that stress. Right. Does that make sense? So, so like there's no like in the, in the univariate analysis. Does weight cause the injury? The answer is no. It's not significant in the big study that would go in the academic journal. But in this like machine learning model with more variables, it's a huge factor. If you have any other risk factors, and I think this is kind of stuff is frustrating all of these ACL findings too. Right. So should you be squatting in an X pattern? Like, well, it depends how you move. Right. Does your femur rotate or not? Right. I think, I think there's a lot of these things where there's just not. It's just not a thing where I don't. We grew up with like, this is personal theory time. Like your p. Teacher wasn't a really philosophical person. Right. Like we grew up with the idea that body. This part of school is kind of dumb, you know, it's kind of simple.

B (18:20)

It's the break from actual school. Right.

A (18:23)

But it's a complicated. It's a super complicated machine. And like, you got to use your whole brain. And very few people really understand soft tissue stuff at all. Even your regular doctor doesn't know anything about movement and injuries. Right? Like I'm saying this to someone. I'm a doctor's son. My dad was a doctor and he would come to my. He would fly from England and pay $20 to go to my workout class, which was led by this woman named Eileen Vasquez, who was a physiologist. And she could look at how you move and say, I'm a little worried about this, that whatever. And she was right. She would like, fix the problem. But he was the doctor and who had won awards and stuff and he had no idea. Right. He didn't know how any of this stuff worked. So I feel like there's like this stuff super complicated. We are running our own little orchestras here. Mostly they work really well, but. But they don't work simply, I think. And when we ever. Anyone, anyone says, oh, everyone should do X, Y and Z thing, it's like, that's probably not going to pan out in the research in the long run, I wouldn't guess.

B (19:13)

Yeah, I couldn't agree with you more. I think that squatting and. And deadlifting actually are two of maybe the most technical lifts that I myself have gotten wrong for years. It's like ankle mobility wasn't there. Knees stopped flexing at certain points. Then I started like, you know, my chest started falling down because I was compensating. Like, there's so many things that can go wrong in a squat to your point where that you really do need that individual analysis and, and, and to be able to have someone either you filming yourself and have the ability to say, okay, I can see where my knees stop flexing there. I can see where my ankle mobility was changing. The way that my sacrum had to compensate at the bottom of the squat or whatever, or have somebody who has some knowledge give you some feedback while you. While you are squatting, eyes on your.

A (19:56)

Body, expert eyes on your body, I think is like, this is the problem. I mean, everyone I know does some kind of workout with their laptop open and But I'm always like, oh, man, someone's got to see. I mean, when I work out, I've gone through the P3 regimen, and, like, it's so embarrassing when I'm there. There's so. I have so many. I think of myself as, like, an athlete, but, like, they're like, could you straighten your leg? And I'm like, I thought it was straight. You know what I mean? Like, I have so many oddities of just, like, you know, to. I think if I just had a camera, I would be so clear how kooky my body moves. But, like, in real time, I'm like, oh, yeah, I got this. And they're just like.

B (20:30)

But you walk in there, you're like, I'm gonna show these guys what a specimen. Like, how I can squat.

A (20:36)

And soon they're like, can you stand next to the wall so you don't fall on another client? Actual thing that happened.

B (20:41)

Oh, my goodness. That's awesome.

A (20:43)

Yeah. Yeah. It's intimidating when you're doing it right. I feel like. Oh, Actually, to your point about language, you know, movement is like, language. I think it's literally like language where, you know, probably everyone listening to this doesn't have the full movement vocabulary they would like to have. I'm telling you, when you add vocabulary, it doesn't feel comfortable. It's like walking into a cafe in Paris and you're trying to use your phrasebook French to, like, order a coffee, and you're probably going to get embarrassed and like that. All of the times I've learned about how to use my body better, I'm kind of in a cold sweat like that, where I'm like, is this right? This feels weird. I don't know, am I supposed to use this muscle like this? And, like, that's what movement's like. When you. When you're getting into the outer reaches.

B (21:19)

Of your capacity, and there's always another level, you know, like, there's always another level where you're like, oh, yeah, I can really feel such and such muscle activating, or I can really feel a stability here. I really feel like I have. I've engaged my pelvic floor. Like, there's so many different levels, and it doesn't matter how long you've been lifting for, whether it's two weeks or 20 years, that. That's been my experience. Like, there's always something new to learn about your. Your own particular. As you grow, you get stronger, Your movement pattern changes. You're unlearning things as well. So that's that's the beautiful thing about it as well. If you're navigating perimenopause, you've probably heard me say to prioritize protein. It is the lever for muscle maintenance, for satiety and for day long steadiness. Maui Nui makes this easy and delicious. Their meat comes from 100% wild axis deer roaming freely on the island of Maui. So there's no feedlots, there's no antibiotics, there's no hormones and it has USDA inspection for safety. Harvesting is done to bring ecological balance back to the island, a choice that's better for the land and for your plate. And the numbers matter here. Almost 22 grams of protein per 100 calories. That is 44 grams of protein in 200 calories. And because every cut is aged 14 days, it's tender and consistent, which means that it's weeknight friendly even if you're not a chef. You can sear it, you can roast it, you can grill it. It's way more forgiving than other lean meats. And flavor wise, it's clean and rich and not greasy. After you've tried this, industrial beef just tastes heavy. Their ohana reserved age cuts are limited. When the subscriptions are full, they're gone. And right now, Maui Nui is giving you a free 12 pack of venison jerky sticks with your first order of 79. You can get your ohana reserve box by going to mauinuivenessin.com forward/better again, that's M-A U I N U I V e n I s o-n.com forward/better for the most flavorful meat in the world. Okay, I want to come back to actually, I want to talk about translation, but I want to talk about hip mobility versus instability. I think that we hear a lot of like, we should be mobile, we should be bendy, we should be flexible and pliable. How. And maybe this is like bringing in the land, the landing mechanics into the conversation a little bit. But what are some of the things that we want to be considering around whether or not. Or not our hips have good internal or external rotation, whether they're stable, whether they're unstable? What are some of the key sort of indicators if we're landing, let's say, or we're jumping from an 18 inch box to the ground? What are some things we want to think about as it pertains to the hips?

A (24:05)

Hips. Mm. I find while you're in a ballistic movement like jumping off the box, it's. It Happens too fast to even think about, and you probably want to just move naturally. It's like what they coach it be three. But I think in, in the lab, right, when you're at the gym or with your trainer or thinking about these things, they have sort of a shorthand you can do at home, a little test to test whether your hips are stable enough or mobile enough. The, the home test for if they're stable enough is, is really hard, let's just be honest. But they, if you can side plank with your body in a big X and your upper leg lifted, all 10 toes pointing forward, and just lock that out and hold it for 30 seconds.

B (24:41)

Oh, that's hard.

A (24:42)

Really hard. That, for me, that last part with the leg lifted makes it really hard. But if you can lock that out for 30 seconds, then Marcus Elliot, founder of P3, is willing to say that he's just going to bet that your hips are stable enough and to perform whatever you want to do.

B (24:56)

So, side plank, the top leg is lifted and the arm is lifted, and then all 10 toes are facing the.

A (25:01)

Forearm forward, forward body, big X. Lock it out for 30 seconds.

B (25:05)

Okay?

A (25:05)

Okay. I find I very few people can do that before, but once you give it a little practice, you know, you improve pretty fast. And that's a really good glute meat. Exercise with a glute meat comes up a ton in P3. That's like the, I think that's the best exercise for just isolating and bulking the glute meat, which is this great important muscle that's neglected in modern life. And then the other one for mobility is just sink into a standing figure four. So this is where you're going to put, like, for instance, stand on your left leg, put your right ankle just above your left knee, and then while balancing there, just sit low. And you want to get your hips below 90 degrees from your knee and really like, sink in there. And I, I, I asked them to give me this test so we could do a simple thing. But before I did, Marcus was like, I think if your hips aren't mobile enough, you already know that, which is probably true.

B (25:55)

Right, right, right, right. We used to do like a Trendelenburg test, which is just, I mean, it's not quite as complicated as the figure 4, but it's basically lifting one leg. And what you're looking for is to see whether or not the hips become uneven. Like you're looking to see if you get a dropping on the one side, which is a neurological finding, that the nerve, that innervates glute meat is not able to recruit the muscle fibers or that the muscle itself is weak.

A (26:20)

And then you get this weird gait, right? I know there's some NBA players had this. Yeah, yeah. So I think that, you know, their basic finding is that everybody needs help with their hips ever. Almost everybody they assess comes away with some kind of recommendations to improve their hips. And it's generally either in improving stability, which basically means lifting weights for your hips, which a lot of people don't do, or it's in mobility, which means. This is a dumb shorthand, but yoga, right? It means like, like you're doing the dual. You're gonna do a lot of difficult mobility type exercises. I'm in that camp, right? I'm a guy who needs hip mobility. Women tend to be more in the other camp where they need help with hip stability. But you need both is the main thing. We tend to work on the thing we're good at, right? So people, like, I go to yoga sometimes, and when I do, everybody there has, like, wildly mobile hips. It's awesome. But, like, they're working at the thing they're good at, right. They should probably go to with some weights, right? And do some sprinting, whatever. And vice versa, right. Like other people, when. When I go lift weights, those people should all be going to yoga, right? Cause they can't move in a big range. So I think that your happy hips, that will carry you into old age. Moving well, jumping around, going for a jog if you want to. Basically, hips that do what you want to do are going to be mobile and stable. So you need to work on both.

B (27:39)

Is there any data around internal versus external rotation? If there. If there is somebody, if we do need to work on mobility, do we find that it is. And maybe there's sex differences there, I don't know. But do we find, like, for women, maybe. I'm just guessing, but maybe more internal rotation versus external rotation? Anything like that?

A (27:57)

There is a section of the book where I dug into this a little bit, and I know that I think I'm right in saying I'm working from memory here that, like, I think they found that the work of improving external rotation is just more effective than the work of improving internal rotation. I'm not sure why, but, like, one of them is easier to move. And like, I think a lot of the limitations on internal rotation can be bony, right? So some people have a deformed femoral head or something. You're just not gonna.

B (28:20)

Or the acetabular cup is not Deep enough and you're hitting the tubercle or whatever.

A (28:25)

Yeah, yeah, Right, right. You know, the vocab of it. So I do think that, like, I do think there are answers to that, and I don't have them on top of my head. I think they're in the book of just basically, I think it's like you want to, when you stand up and lift your knee and they swing your foot, I think they want to get it. So you have about 25% of a circle between your, does that sound right? Like at a 25% of, of a pizza slice to the pizza, like from your knee, your, your shin going, like rotating into, rotating out. I think that's like the standard goal.

B (28:57)

Yeah, I mean, I'm, I'm just kind of drawing on my own clinical, like, what I would like. I would test internal and external rotation, and I would find for at least women, external rotations seem to be easier. Like, we can all sit in, like, but, you know, yoga, like, butterfly pose, where you just put your feet together and then, like, the knees can just open. Right. That beautiful external rotation of the femur in the hip. Internal rotation may be a little bit more difficult. So if you're kind of moving the knee into the midline and kind of challenging there, that might be a little bit, potentially. I don't, I, I'm, I'm asking because I don't know if there's any differences, so.

A (29:31)

Well, the other thing that I keep, I, I, I, I wish I had a better answer for you. The other thing I'll tell you though, is that a tremendous percentage of the time when people test poorly on hip, internal or external rotation, like the day. One guess is that they needed myofascial release and they do quite a lot of kind of painful stuff. They might teach you how to do it where, I mean, some of these things are, like, pretty awkward. Kind of grinding on a kettlebell, like, kind of stuff like up at the top of your groin muscle or. I watched a young basketball player get like, a 70 kilogram kettlebell on his quad as he sat on the floor, because he had super tight quads. And then after two minutes of that, he was, he like, lost all color in his face. He was uncomfortable. But then they immediately put him through, like, a whole complex of different stretches and lifting and move complex movements to, like, ingrain a new pattern of moving his hip flexors in a new increased range of motion. And it works. It's really, it's really pretty crazy. You can measure the difference over, you know, seven Eight weeks.

B (30:37)

Wait a minute. He put. He put a kettlebell, a 70K. Did you say kilogram or pound?

A (30:43)

It's like the heaviest thing in the gym. Yeah.

B (30:45)

Okay. And he just put that on his quad. And what's like is you're just trying to. Ischemically, like, what are you trying to do with that? You're just trying to.

A (30:53)

Yeah, good question. So they. So I guess the research on myofascial release is that, you know, it's inconclusive if it changes your range of motion over the long haul, but it isn't inclusive. It changes it for 15 minutes, right? It absolutely does. So what they're doing is they're. They're gonna put you through. Well, these are professional athletes who are used to doing really hard things. Right. So I don't think they would recommend that anyone listening to this put 70 kilogram kettlebells.

B (31:18)

Women that don't even weigh 70 kilograms that are listening to this, get your.

A (31:22)

Family to stand on your quad. So. So, I mean, he put it on there for two minutes each side. Well, backing up. He had in one. In one of the most basic tests they do is. And I'm sure you've done this before, is where you just kind of touch your heel toward your butt, right? And he had. He had lost a ton of mobility in that direction. He was only 18 or 19. And so they were a little like, huh, it's weird that you've lost all this mobility in this particular direction. And the change like that, they see as kind of a red flag for injury risk. So they believed he could achieve much more mobility because he'd had it hit months before, and so he'd gone off.

B (31:57)

Oh, this had. I'm sorry to interrupt you, but his decrease in mobility happened over a period of months, not years.

A (32:02)

I mean, I. I don't. It might have been a year, but it wasn't forever. You know, he. The first time he'd been there wasn't that long before. And so they take him over, they sit him down with his back against the cinder block wall, leg straight out in front of him, and bring him this. Bring him the heaviest thing in the gym and put it on his quad. And. And they were like, you know, you have to be very cheery as a coach. Like, hey, you got this. You know, you can see he's like, I don't think I caught this. And. And then as soon as they were done, they walk him over in front of the rig and had him kneel on. On a one. One leg on the Ground in front of him. And they put this, the biggest band in the gym, around the rig and then around his midsection to pull in like a giant quad stretch. Right. And it was such a big force that they were. There was a coach on each side holding his upper body from like shooting forward because they're pulling them so hard so that on both sides. And then they immediately went over and did I forget the movements? But it was like hinge type movements where he is going to use the quad in its bigger range of motion. And they did a whole, I think two or three rounds of all that. And the I. And I, you know, I, I didn't follow up on that particular guy, but I know that over time this kind of therapy does result in like, you know, a week later you do the heel test and it's. His range of motion is, has totally changed. Right. So this is the kind of stuff. This is where I say it's kind of personal because I. This is not a recommendation for anyone who doesn't have that particular problem. Right. This is what they do. There is they kind of assess each athlete and give them their own individual prescription of movement. The little app that they have, they send athletes away with prescription of like, I have my own little movement prescription. There's 600 videos. But, you know, they're going to give me the 12 for me or whatever, if that makes sense. Like, like, like just like you would with like a doctor would with prescriptions for medicine.

B (33:45)

Yeah. Okay, so we've talked a little bit about hip mobility versus instability. I want to jump over the knees for a second. I want to come down to the ankles. You mentioned landing on the outside of the foot and rolling to the inside. So this translation or this, you know, rolling, rolling your foot, let's say as a, as a predictor for injury, in particular with ACL tears. Let's talk about, first of all, how does something like that happen? Like, what are the mechanics that cause somebody to roll their ankle or to laterally roll and then come back to the midline? And then let's talk about re. Injury risk. Because when I would have a patient coming in, a basketball player or just like a runner who had rolled on, like jumped, you know, was running on grass or something, and there was a stick and wasn't prepared for it and rolled her ankle, the risk of injury rate in that first year after rolling the ankle, it was almost like, you know, depending on the severity of the, of the, of the injury, you know, somewhere between like 30 to like 70% chance of re injury, right. So if they had a really bad strain, like a really bad sprain, I would say that within the year we'd be doing another protocol because, you know, they thought that they were fine. And then the perceptive, like whatever the input coming up to the brain wasn't quite reestablished yet and then rolled the ankle again. So talk to us a little bit about translation, what that means and then maybe if we can integrate that into the landing mechanics conversation.

A (35:12)

A quick aside is I was that guy. I, I did that in, in college. I sprained my ankle so badly that the terrible. I went to NYU Health Services was like, it's one of the worst healthcare facilities on planet Earth. But, but the guys out there was like, oh, you just, you shouldn't do sports anymore. Like you're, you have sloppy joints. Like you just shouldn't do sports. And I was like, yeah, that's not, I was like, like 18 or something. Such a crazy thing to say. Anyway, I, they at P3 now, they, you know, they're more than a decade into collecting all of this crazy data on all these athletes, super fine grain data. And they now see how your feet hit the ground as like how you're put your hands up to catch a ball, right? Like you, of course you need active hands, right? Of course you have to get ready for it and you have to kind of like absorb it and you know you're going to have the muscles of your forearm are gearing up for it and everything. And, and, and I think that, you know, when I asked them, there's, you know, these incredible trainers and MDs and biomechanists that they have there, you know, what's going on with these landings. And it ultimately comes down to, in their view, it's sloppy. They're like, it's like you're just throwing your hands at the ball you're trying to catch and the ball bounces off your hand, right? This is an active thing. And it takes not just strong muscles of the lower leg, you know, all of these post tib and soleus and gastroc. And there are other ones too that you can name. I'm sure I can't. But we don't commonly work those out. And I think in many cases they're weak, which is a problem. But I think more commonly it's just neurological coordination of like all of, you know, these things happen in an instant, right? This, these, these landing moments are quick, quick, quick. And they're by far the biggest forces in sports, right? Bigger than any of Mount you Push into the bar when you're lifting weights. Like the forces of you landing is. These are all the biggest forces in sports. And so it's big force, unfamiliar muscles, sloppy landing. And of course that's going to cause a problem. Would you like me to kind of talk about how they do want you to land? Now? That's probably.

B (37:14)

Yeah, please.

A (37:14)

Useful. Okay. So.

B (37:15)

Well, I'm thinking about, yes, I'm thinking about women who I've said, listen, you need to sprint. It could be a bike sprint. Okay. But if you are, if you're thinking about sprinting, you know, on a track or on the ground, we do have to be thinking about how you land. And then I also kind of want to think about this in the lens of like hypermobility. Right. So if you have, if you are someone who sprained your ankle and maybe you haven't done the right rehab, what are some ways that you might think. And you know, I'm not asking you to give prescriptive, you know, it's like you're not a doctor, you're not playing one on tv. Like I'm not asking for prescription. But what are some of the things that we can consider when we're thinking about, okay, how do I actually strengthen these ligaments that have been damaged? And now we have this altered feedback up to the brain. Like where the brain can't necessarily accurately sense where the ankle is in space.

A (38:05)

Yeah, yeah. So I used to spray my ankles all the time, as I mentioned. And when I started going to like that kinesiologist woman would, you know, she ran essentially a CrossFit type high intensity interval training class with lifting. And I started, once I started regularly lifting, I stopped spraying my ankles entirely. I think, I literally think I just built the muscles of my lower leg up. Like, you know, when you're holding a heavy bar, you're stressing those little stabilizer muscles in your lower leg the whole time. What would they would recommend at P3 is, you know, everybody goes through this plyometric progression, right. So every, in the first assessment, there's a dowel on the floor and you are parallel to it with your feet together. And then you hop just like a little bunny back and forth over the dial sideways, right. As many times as you can in eight seconds. And that's pretty safe, I think. You know, it is. These are big forces, but I think most people can handle 8 seconds of back and forth and back and forth. And they're going to look at how you land during those eight seconds. And then now we're going to talk about what plyometric prescription you get next. But basically everyone who goes in there is jumping in one way or another.

B (39:12)

Can I interrupt? Can I stop you for a second? You are jumping laterally. You're jumping left to right, right to left. Okay. So you're utilizing the coronal plane.

A (39:18)

Okay, go on. And then, you know, it might be that for the next several months, your plyometric exercise looks a lot like jumping rope or jumping over a little tiny hurdles or they do some pretty cool stuff, actually, with, like, jumping where, like, you're going lateral, and then the coach will be like, switch. And then you. You switch which direction you're going. And some really awesome. There's a video of a volleyball player that I'll send you if you want. It's like, she's. Is the way that she moves is, like, thrilling to me. Like, the coaches are off camera, and she's just like. She moves like a. I mean, like, usually when you see a woman like that, it's like a wild animal, right? She just moves, like, so naturally and freely. And she's been practicing this for a long time anyway. So, you know. But the end of the line, if you keep progressing and they keep seeing that they, like, your landings, is, you know, plyometric boxes in a row. And like NBA players are. Are just. Just two feet together like little fleas going, boing, boing, boing. Not even touching the boxes, just clearing over them. And what they're looking for is the neurological firing of the whole system, which is being trained by all these plyometrics. And they. This is the big part where they're going to vary from a lot of other labs and trainers. They want you to land with toes up, with a dorsiflexed foot. And what they're looking for here is an active ankle, so that the giant force of landing passes efficiently and quickly from the ground into your Achilles and your calf and your quad and your glute. Right. So this whole kinetic chain is designed to take the huge force of landing, but they don't want to be interrupted by some plyometric coaches. Coach. Toes down.

B (40:54)

Yeah.

A (40:54)

Which means when your foot hits the ground, there's a lot of moving parts before it gets to your Achilles and your calf and your quads and your glutes, and it can get awry like the all. Okay. You're. You're the kind of geek who will appreciate this little fact, which is, like, so all of the biggest forces they've ever measured in this gym, which is, you Know again, thousands of athletes come from people landing toes down on the force plate. And then the next thing that happens in some cases is the heel slaps. Unbelievably hard, right? This is a bony surface that connects to your knee on the other end. So you have 80% of your weight is in your torso that's pushing down at the ground, and the ground is immovable. And now you're going to express this force through bone, through your tibia to your knee. And here's a really disgusting way to think about this, but it takes about 3,000 Newtons to fully sever a human spine. And they've measured even. There's a small woman, she's a friend of mine, she's 5. 5. Her name is Katie Spieler. She's on the pro volleyball tour. They measured her landing with 3,100 newtons. They measured an NBA player landing with 11.

B (42:01)

10 times. 10 times ground, 10 times forces of. Yeah, you just said like the Newton's required to sever a spine.

A (42:07)

Yeah, no, so she's about this, she's about at par. And they measure an NBA player with triple. With 11,000 newtons. So the point is that like you're.

B (42:15)

Oh, you said three. I'm sorry.

A (42:16)

Yeah, yeah. But the point is there's plenty of force. This is just stepping off an 18 inch box, right? So if you're dunking in the MBA, it's definitely gonna be way more. But they measured with 11,000 newtons. So triple the force to sever a human spine. So like, you don't want that force going through your tibia straight to your knee, right? Which could, you know, it might, it might be okay in your knee. Maybe it goes and causes trouble in your lower back, right. But you don't want to pass it up that way. You want to pass it up your body through soft tissue, right? And specifically through the soft tissues that are designed to take huge forces, right? So this would be Achilles calf. I say quad, you know, which. It's not the whole quad, right? It's. This is at the edge of my knowledge, vastus medialis, maybe. And certainly you want to get into the glutes, you know, because if you don't, a lot of people, a third of people don't deploy their glutes in their data, which is a giant cause of lower back pain is landing from running, whatever, without absorbing and force into your hips and glutes, noticing your hair.

B (43:17)

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A (44:49)

Now it's in your head.

B (44:51)

I'm like, which one am I doing? I don't know. But it's interesting too, because Plio's. And I asked this selfishly because both my children are. They're competitive. They play competitive soccer. So they're always doing these little drills, right? So they'll do like the back and forth drills and then they'll put a weight plate and then they'll jump up on the weight, down on the weight, and then across, up, down. Because, you know, there's a lot of cutting and there's a lot of lateral movement in soccer as there is in American football and many other sports like basketball, as you were mentioning. But I wonder as well the value, you know, as I think about women who are aging, having that, having the Achilles, have the ability to have that to hold that. I don't know exactly the word I'm trying to. The sentence I'm trying to say here, but what I'm Trying to say is like this kines, like this kinesthetic storage, you know, like to have it to be so springy to have it used to. I mean, if you are. There's a guy out of. I think he's, I think it's UC University of California in San Diego. And I think he talks about like when you've had a, A Achilles rupture. One of the things where he gets into fights with the ortho surgeons, where it's like actually an isometric hold is like one of the best things that you can do to retrain the Achilles, right? So it's like just like a 10 second isometric hold and then you release. And of course there's this whole like the.

A (46:04)

Why don't the surgeons want that? Because it's too risky.

B (46:06)

Because they think, yeah, they think that it's going to be like with the, with the contraction, that it's going to remove the sutures or the stapling, you know, whatever, whatever they've, they've done to secure it. So the, the, the 10 second to 22nd isometric hold just allows for that. Maybe tensegrity is the right word, but I'm trying to think of like, what's the layman's word of like, you know, being able to coil and then like being able to absorb the force and then release it. I mean, that's what the Achilles essentially is. So why, for women, why that's important? And this kind of gets into the hip flexor a little bit is this ability to decelerate. Right. So if you want to, if you're landing, of course the Achilles is gonna take a big, big chunk of that slowing down of that, of that velocity. But then we also. I kind of want to wrap this into like falling as well. We talk about women. Women are the ones who are falling and breaking hips and you see the cognitive decline and the death, death risk that comes from that. So maybe talk to us a little bit about the value of being able to decelerate and we can talk about the Achilles, we talk about the gastroc. But I would also like to wrap in the psoas of the hip flexor in there too.

A (47:09)

Yeah, so in their research here with NBA players, they found that, well, there's a pretty famous NBA player named James Harden and he was the highest scorer in the NBA when he came in with like 20 people into P3 to be assessed. These are people from his shoe company, people from his agency, people from his team, his friends. And when they assessed him, they found that he couldn't jump particularly high, he couldn't run particularly fast. He could, wasn't really explosive in any direction, but he was elite. He was out playing the best athletes in the world. And the guy, Eric Liedersdorf, who's the president of P3 now, had promised them he'd give a little preview of the assessment results before they left that day. The full results take a couple days. And so he has this trust in the one of all these people want to hear about how great James Harden is. And he's looking at the numbers and he is not a great athlete by most measures, but he's really good at decelerating. He's really good at stopping. And you know, this was seven or eight years ago now. I think it's a lot more cool but that he was like, hey, amazing news, James, like you're good at stopping. It's like not that cool, right? But they've since found that it is actually a superpower in every sport, right? It's, it is really like it correlates well with the athletes who do best. When James was there, very shortly after that, a 17 year old from Slovenia came in with his mom to be assessed and they were like, this kid's one of the best stoppers we've ever assessed and his name is Luka Doncic and now he's the star of the Lakers. Like he went on to have the. It is this kind of superpower of stopping in. Even in one of their clients is a, is a NASCAR team which has like pit crews. And they were saying that like these people, you know, so one guy in the pit crew has to race around the front of the car. It's a three meter curving race. And then put a tire perfectly placed so that someone else can screw it in place. And they're found that basically if you get the fastest runner, they're not anything like as good as the person who can decelerate really well. My personal theory is that when you can decelerate well, and I promise I'll get more to your point in a second, you can see like your head, your eyes are still. When you have a good chain of soft tissues that help you decelerate. Like James Harden can do these herky jerky moves in the lane and he can see the rim. Or similarly if you watch like a cheetah, there's like slow mo video of a cheetah running. Like their eyes, every predator's eyes are completely still while they're moving in these crazy ways because they have to see what they're doing right, I think. And so I think decelerating is, is emerging as this athletic superpower because, among other things, it lets you be stable. And I've even noticed I was in the gym yesterday doing my prescribed P3 workout. One of the things that I was doing was holding a heavy ball in the hand while I step up onto a high box and then step back down under control. If I slam down on the ground, then a. My whole head's bouncing around. It feels kind of disorienting. I might even have my glasses fall off. It's happened. But if you have actually practiced these muscles, right, I'm going to lower myself down, I'm going to put the ball of my foot down. I'm going to use the muscles of my lower leg to sort of land a little bit like One of those SpaceX rockets lands down on the, on the landing pad to get reused. It's just way safer, right? It's a way safer way to move. And so I think this is a great thing for all of us to practice. It's, you know, why we don't break. Well, I think isn't the same for all of us, but in general, it seems like the training has a lot to do with the posterior chain and the, all the muscles of the lower leg that we were just talking about. Right. A lot of us are just very weak and sloppy where at the point of contact where our feet hit the ground. And that's something that you can train. I can tell you one thing they had people doing, which I love. I've done this a bunch myself, is it's one of a million exercises they have that are relevant to this, but it's not something I've seen somewhere else. It's is hold a kettlebell in one hand, stand on one foot, bend your knee a little bit so you're in like an athletic position. And then just pass the kettlebell to your other hand.

B (51:20)

Yeah.

A (51:21)

Back and forth and back and forth. And for some of us, I've had, I've done this at dinner with friends. Some people can just do it. Not a lot of people. Most people are like, whoa. You're like, you know, you're all over the place. But then you do it for a month and you can just do it and you've like gained this. It's a nervous system training, right? You're just gaining a little bit of, of stability and how you put your foot on the ground. There's a million things like that, right? There are a million learnings like that, that come from jumping rope or from jumping on and off boxes or what your kids were doing or you know, these ACL prevention programs that they don't have enough soccer players do or 64% reduction in ACL tears in women. Right. Like they're training you how to land basically. Right. They're training this neurological function of how to, you know, do that lateral hop off the weight you were talking about. Etc. Right. This is essential. Right. To.

B (52:11)

But even whether you, you don't have to be a professional athlete like you need to. I think professional athletes have to know how to stop, but so do just regular everyday folk. Like we have to also learn how to stop quickly.

A (52:22)

We go down the stairs. Yeah.

B (52:24)

To go down the stairs. Right. Or to not, you know, if you, if you misstep. To be able to catch yourself like that, that's the, that's the real value in it. So I think. And so the question that I have as you were talking is, is it, you know, you were talking about your particular P3 workout, how you were stepping down slowly. Is it because we're biasing the eccentric. Is that what's, is that what we're trying to train up with the deceleration or does that maybe an adjunct or aside? Is that part of it or. No?

A (52:51)

Yeah, they, they do like, they one, one of the trainers there like really laments like NBA players are not, not sophisticated weightlifters by and large. Most of them didn't grow up like lifting heavy and this kind of stuff. So they can't do what they would like what trainers would like them to do is. Do you even. I don't even know what it's called, but like there's this like eccentric overload, I think it's called. Do you know what I'm talking about?

B (53:12)

Yep, yep. So talk about it a lot.

A (53:14)

Okay.

B (53:14)

It's like for, for hypertrophy, for muscle hypertrophy. Like you have to bias the, the long length of the muscle in order to create more muscle. Yeah.

A (53:22)

So this is where you put a giant. More than you can lift. Right, right. You, you lower down this massive load and then you like dump the weight or have one of those bars with like legs on it. Or there's different ways to do it. Right. They do it with the K, like.

B (53:33)

A pull up progression. Like you would jump up and then you would like slowly lower yourself down. For women, anyway, that's a really great way to do it.

A (53:39)

Do you know this K box? You know I'm talking about the K box.

B (53:41)

No, I've Never heard of a K.

A (53:42)

So this is a. It's a. A weightlifting device that works with a flywheel instead of, like a weight. And so it looks like a. It looks like a. Almost like a microwave. Right. It's a. It's a box that's about that size. You can stand on it, and then you would wear, like a harness, and it has a cable going into the thing, and it's. There's a spinning wheel that pulls the harness down, and then you have to fight it back up. But the cool thing is that it lets you, like, the more you pull up and the harder you're spinning this thing. And so it pulls you harder down the next time kind of thing. But it's a way to get a really heavy load, you know, and then. But then if you get to the bottom, it's too much force. You can just wait and the wheel will, like, release you, basically. Anyway, there. There. There are these different tricks to get heavy loads, but, yeah, they do want to, like, they definitely. I mean, again, this would not be the same for everyone, but they do put a lot of effort into this e biasing this eccentric thing, as you suggest. Yes.

B (54:37)

Okay, so come let's. Let's talk about the. So as muscle, then. Because I think that this. This also pairs into the Achilles that we're talking about when we're talking about falling. Like, learning how to fall well, so that you don't hurt yourself, I think is important. And with the psoas, I had Dr. Stu McGill on, who's just like one of my heroes, studied his book in when I was in chiropractic school. One of the things he was talking about is in order to. If you are. I mean, we all age it all. It's happening to all of us. But to preserve your fast twitch muscle fibers, particularly in the psoas, so that you can. If you are falling, that you have the speed to get the foot, like, so you can flex the foot and get it in front of you, because as your center of mass is going forward, you need to get that foot in front of you to. And then break and then put on the brakes, right? And then the brakes is like the glutes and the hamstrings, the ones that are all being eccentrically loaded there. So talk to us about why. The psoas is one of these muscles that I think a lot of body workers, you know, like chiropractors, physical therapists, massage therapists, were, you know, always kind of getting into the psoas, but talk to us about why? It's. I don't want to say a forgotten muscle, but, you know, when you go to the gym, you're like, I'm going to.

A (55:44)

Really.

B (55:45)

I'm going to work my SOAS today. My SOAS trend, like, everyone's like, no, it's glutes day. It's ham day. You know, it's quad day. It's whatever. So talk to us about the psoas and why it's so important.

A (55:54)

Yeah, we're. I make the case in ballistic that we're hip illiterate, right? Like, people. I. I went to school and we talked about, you know, my basketball coach talked about our ankles and knees all the time, right? But the hips are the center of how we move. It's the most powerful and second most mobile joint in the body. And it's like the translating between our heavy torsos and all this movement, right? And it's almost like forbidden to even talk about it, but, like, it's. That's ridiculous. Like, it's so important. And the psoas is probably the highlight of my argument here because it's a. It's one of the biggest muscles in upper body. It touches your spine, right? And it goes through, like, your belly, basically, and, like, around the front of your hip and then into your groin. And it's super important and powerful and strong and can do all sorts of stuff for you. And a lot of us suffer. Like, a lot of people have lower back pain. It might be because of your psoas. A lot of people have. Have, you know, an inability to move laterally. Could. Because yourselves or your. I know. I love your point about. I mean, so many people trip as they get older, right? Like, hit that little bump in the sidewalk or whatever, and they just can't get the foot out. Right. This is a super, super important muscle that we barely even talk about. I don't. I mean, since this book came out, I've had conversations with friends who were like, there's a chapter called soa. Like, what is that? You know, like, people don't know what it is. Meanwhile, to your point, about soft tissue workers, I went through this. So as release, the first of my life was like. I mean, I was in your tears. I was like, it's not. I mean, you've done this. Have you had someone really jam their hand in there?

B (57:23)

Yeah, I. I strained my psoas. I was ego lifting and just, like, lifting. Like, just thrusting, too. Like, I was hip thrusting. I was doing a one. Like, it was like a split stance beat, like One legged. And I was like, oh, I just got a PR. Why don't I just put £10 more on and see if I can. And then it's like, you know, pop. And then couldn't stand up straight for like two weeks. I've had someone. Yeah, it's awful. You shuffle like you're shuffling like an old lady. Like you're bent at 90 degrees. I laugh at myself now because I brought it on myself. But I. My, one of my closest friends, she's a chiropractor. We've been adjusting each other for years. Obviously I was going to see her for my care. And she tried to get on. She tried to get on it and I almost punched her. Like I was like, like my reflex to protect that area. And we, you know, we laugh about it, but like I. My knee, my other knee came up so quickly to get her off and she was barely touching my skin. Like she was just, she was not putting it. She's like, I'm just gonna flex. And my like, you know, fight reaction came right away. Like I was trying to protect a very, you know, tender, injured point on my body.

A (58:31)

Yeah, I totally believe that. I totally understand that. Like this guy Mike who did it to me, I. I went from. And we were having a pleasant conversation and he seemed like a nice man, you know, like. And then he took his eight fingertips. Like, I mean he's very strong, turns out. And I went through a whole bunch of emotions. I mean it was. It's weird, right?

B (58:50)

And somebody store so much. That's the other thing. That's the other thing. Like there's a lot of emotions in the hips. There's a lot of stuff in the hips. And the SOAS in particular. Like, I cry like cry for. From sometimes from the pain of having it worked out and released, but also just because of. We just put stuff in the hips.

A (59:07)

It's wildly personal. It's like there's no getting around it. And I mean I've. A bunch of people just can't do it, right? There are a bunch of people who like, they get their first whiff of a Soaz release and they're just like, nope, nope, nope, not going there. And it does feel to me. I mean, I'm. My family's English. I feel like we have this like, like the Suaz releases where you get the English out of like. I'm like, like English people. I. This is an unfair characterization. But like my English family, we don't really move our hips very much. And like. So Mike was kind of like, you know, let's release your English conservative nature, right? And more into, like, oh, I'm like, now my hips can move, right? And that's also. I got a shot at merengue now, right? I literally came out of that first one just feeling like I had a whole different. My hips had. My pelvis had moved to where it was supposed to have been my entire life. Right? But it's. You know, and somebody told me. And this is a. This is quasi scientific here, but basically, the psoas forms super early in the embryo. Like, it's one of the earliest, oldest things. And so it has literally stored all this stuff, right? Like. Like, a lot of our. And there's tons of nerves, right? There's like, these. These nerves going from your brain down your spine through this has some. Something complex. You probably know the name. But, like, it's. There's literally all of this activity beyond muscle activity going on with your psoas, right? And it's your spine and it's your hips, and it's your communication going to your legs, like. Yeah. And so Marcus, the guy from P3, he had this day where, you know, he's very sanguine. He meditates. He's like. He's very calm. He doesn't fly off the handle. But one day he was kind of mad, and he was mad because he had spent the morning assessing an elite tennis player, a guy who's, like, graduated from college and is hoping to be pro. He is a pro, but he's ranked, like, pretty low, and he's hoping to get really good. And I think he was 24 that day, and he had his first. So as release. And Marcus is like, he's been coached for more than a decade, right? He's put all of this resources into this, and nobody, like, his career was literally going off the rails because he couldn't move laterally because his anterior hips were so tight that he just couldn't move. And his coach would just yell at him to, like, be more athletic. He's like, he's super athletic, but he just can't. He's immobile. Right. And I think we're all a little bit that tennis player, right? Where we haven't grown up with good knowledge of our hips. I mean, obviously, you're an exception because of your training, right? But I feel like, by and large, so few people are really focused on these really important muscles, like the psoas.

B (61:41)

Yeah, yeah. And I think in perimenopause, too, I mean, we often see shoulder injuries we see frozen shoulder, but we also see frozen shoulder. Yeah, we see hip bursts. Like we see the bursa of the hip get irritated. We see changes in hip mobility. So this is why I'm really glad that we're talking about this as well.

A (61:56)

Let me ask you, is this hip mobile? Is this from using it too much or not enough?

B (62:03)

Oh, both. I mean, I think it really depends. But I would say that, that for a lot of people, you know, we sit at desks, you know, curled over like a shrimp for like eight hours a day.

A (62:14)

We're doing it right now.

B (62:15)

Yeah, you were doing it right now. I mean, I am, to my credit, I am sitting in cross legged. My legs are totally open. So I do have some nice external rotation.

A (62:23)

Yeah, yeah.

B (62:23)

But I, but I think for most people you can't sit cross legged at the office and things just kind of get locked in after. It's not, you know, it doesn't have to happen after a week. I think it happens after decades of being an office worker, working from home, wherever you are. So I love the idea of, you know, we were talking before, before we started recording, you said something to the effect of, you know, it's really natural to move. It's really unnatural not to move. Whenever I've been, you know, just speaking of emotions, like whenever I've been frustrated, I go for a walk. I just like, just lap the block. It takes me like seven minutes. And just that seven minute walk, I'm like, okay, I can totally deal with this problem or I, I totally have the capacity now. And it was just, just whatever it was, no blood in my brain, you know, like my prefrontal cortex had no blood left in it. So the walk, you know, kind of helps, helps it a little bit. I'm able to just listen to some birds and watch the leaves rustle in the tree. Like it's just whatever it is helps with me, helps with my emotional processing. But to your original question, I think you can have. I've cared for athletes and I've cared for, you know, the everyday person. And, and for the most part it's like you have to unlearn mechanics that if you are sitting at a desk, let's say 8 hours, 10 hours, 12, 16 hours a day, there's going to be a limit to the amount of rehab because you have to unlearn all of that right you times a 10 hour workday by 40 years. I absolutely can make some progress with you in our appointments together, but you also have to set it right so I can release things for you and things can move. But if you just go back to doing exactly what you were doing after the appointment without the rehab, and that's the single biggest sticking point that I ever had with patients was as soon as they started feeling better, the rehab would just drop off the planet, right? So I had a hard time with like compliance. And I used to really beat myself up about it. I'm like, I'm like the worst doctor. I don't know why I can't get people to like totally change 100% of the time, but it was really just for most people, like just get the pain subclinical and I just, I'll just get back to it and when it pops up again, I'll come back to you. Like that's sort of how many patients, unfortunately and very transparently and honestly, I felt like that was just like the governing desire. Omega 3s are crucial for your heart health and your brain health, but it can be so hard to get them from food alone. Most women in perimenopause and menopause are not getting enough omega 3 from their diet, and taking a supplemental omega 3 is essential for you for closing that nutritional gap. Omega 3s help lower triglyceride levels and blood pressure, contributing to better heart health, and they improve cognitive function and memory. They can also help alleviate menstrual pain and help to maintain healthy, glowing skin and hair. Each serving of AG1 Omega 3 is sustainably sourced from wild caught small fish and a hint of natural lemon flavor in the formulation makes it easy to incorporate as part of your AG1 foundational nutrition Nutrition plan without any fishy aftertaste. I personally take my AG1 Omega 3s first thing in the morning. Once I'm home from the gym, I grab my eggs from the fridge and the Omega 3s from the fridge door like clockwork and on repeat. If you haven't tried AG1 yet, they are bundling it with their Omega 3s for free. So it could not be a better time to start. It's something I've actually been able to stay consistent with and that's why I've been partnering with AG1 for so long. So subscribe today and get a one month supply of AG Omega 3s with your first AG1 order. And you will also get their welcome kit with everything you need to get started on your AG1 journey. So make sure to check out drinkag1.com forward/stephanie to claim this special offer. That's drinkag1.com forward slash stephanie.

A (66:13)

That's kind of how PT work. I was frustrated. Like, I went through the whole lumbar crisis during the time I was writing this book. And. And I love my physical therapist, Jen, but like her, you know, the insurance model basically is just get Henry back to work, right? Get him driving a car, get him back to the desk, and then we're done. Right? But I didn't. I wanted to get back to doing really fun things, right? And it took other efforts, but I think this is like, you know, Marcus is pushing 60 and he loves doing giant outdoor things, you know, climbing mountains and. And paddle boarding 30 miles at a time across the ocean and just all these crazy things. And, you know, to him, that's the goal. The goal is to do really, really fun, free moving things out in nature. And the price you pay to be able to do that is some, you know, prescribed work on it. If his particular issue is his right hip has poor external rotation, right? So you have to, like, maintain that. That he finds it very boring and tedious and he does it while he's watching tv, right? He'll like, oh, I gotta do my homework, right? Like, so, like, to him, the end goal isn't the homework. The end goal is really, really fun outdoor stuff. And I think that's where I just wrote this story for the Atlantic, like, called let your kid climb that tree. It's about, like, you know, just movement, vocabulary. And freedom of movement is a way to, like, you know, play is what you call it when people are exploring freedom of movement, right? And one of the people from P3 read the article and he's like, the only thing that's wrong with your article is the adults should be in that tree too, right?

B (67:42)

Like, yeah, yeah, yeah.

A (67:43)

And, you know, like, we should all be giving ourselves permission to go and do really fun things. And, yeah, you're going to have to go and see Dr. Stephanie and work on some stuff, right? There's going to be some issues. We all have issues with our bodies, right? I've got my own prescribed things. I do my workouts four days a week. I have four workouts a week that are prescribed for my particular. I was born with hip dysplasia, and I've got a little maintenance to do on that front, right? Everyone else has their own thing things, but I think. But mostly the focus for me isn't those four days a week. It's the other three when I get to go do whatever fun thing I'm invited to do, right? I'm a. I'm a yes man, right? Someone Says, you want to come on this hike or this kayaking thing or this. We go jump off this waterfall near here. I'm telling you, people love it. It's so fun. Like, everybody coming back from that is, like, bubbling and excited. And I think that's. That's where it really gets fun, is, you know, take your. Your fun impulse of walking the block and being in the fresh air and take it to the max. You know, like, what's the. What's the most fun thing you want to do? Let's go do that thing.

B (68:41)

I love that. And that comes back to our original conversation around physical literacy. Like, if your friends are like, hey, do you want to come and play pickleball? And you're like, I've never done it, but I'm sure I can, you know, figure it out. I think that. That, you know, that acquisition of new skills, new motor skills, I think is something that we should all be striving to in our lives as well.

A (68:57)

Absolutely. And also, just look to move. I mean. I mean, look, we have our printer up here in the attic, and I am getting older, and I'm forever like, oh, I forgot to print the document wall upstairs, and I have to go upstairs again. But now I've switched to, like, good, I'm glad I'm going again. Right? Just do more. Or like, you know, you're taking all this stuff to the beach and you didn't remember, like, fine, just walk back and forth five times. Who cares? Like, you know, like, it's like, move. This is what we did. I'm telling you, if we lived in the Stone Age, we would all be walking back and forth to the car 10,000 times. Right? Like, we just. So we were nomads, right? I think that, you know, the idea that we have some idea that if you're smart and efficient, then you're just gonna go. You're gonna go straight from the house to the car, and from the car, get a good parking spot and go right to the thing. And, like, that's not what your body wants to do. Your body wants to just have all these inefficient periods of just wandering around and picking things off the ground and bending over. And, like, you know, that's what your body is designed to do. And so I think let it have to happen.

B (69:53)

You know, I actually really like that point around. Your body wants periods of inefficiencies. I think that we're so wrapped up in, like, okay, so if I do this, I can save five minutes or I can. I love this idea of just being inefficient. This is part I was, I had Juliet Starrett on the, on the show not too long ago. Yeah, she's. She's phenomenal. And she was saying, you know, we just sit on the floor, like we just like move the coffee table. We sit on the floor. That's when we do our mobility work.

A (70:19)

Bit a little.

B (70:19)

I'm like adopting immediately because it's so easy because so many, like, I don't have time for my ability work. I don't have time for my, you know, whatever. And we have, I have my kids doing like their rehab on the couch with us. I'm sitting on the floor stretching my, you know, 80 doctors or whatever and.

A (70:34)

Doing that 10 minute squat test. You know, they started that whole thing.

B (70:37)

Oh yeah, yeah. I'll do the couch. I'll do the, I'll be sit doing the couch test, which is like that nice big quad stretch. Or I'll do like a full squat. Like a full squat and I'll watch tv. It feels great. And I just like, it's just the movement. It's just like you're just, you know, when I sit on the ground and after a couple minutes I'm like, oh, I don't, I just, I need to move now. It's like I just move. I don't. It doesn't have to be perfect. It's not efficient in any way. It's just, I'm just going with the flow. So I love that.

A (71:00)

Yeah, yeah, yeah. Your body kind of knows, right. If you listen.

B (71:04)

Yeah. This has been such a fantastic conversation. I love this. So talk. Tell us where we can find your book and where we can find more about you and your work.

A (71:12)

So I'm trying to, trying to like funnel everything to henryabbott.com, which is like my, my author website and it's. My last name is. Nobody wants to give me the last T. They always say a B, B, O T. But it's a B, B, O, T, T. Yes.

B (71:25)

Double T. Double B.

A (71:26)

Double B, double T. Yep. Six letters. So Henry Abbott.com and like when I'm on this show, I'll put that show up at all the things like to that thing and you can see all the updated things in the Harper, the Atlantic article, whatever. And then Troop.com is where I spend most of my career writing about NBA basketball. And that's where that happens is T, R U H O O P. And I'm not on a lot of social media. I'm still just Hanging on by a thread at that Elon Musk site. That's not. Not because I recommend it.

B (71:56)

Must say Twitter.

A (71:57)

Yeah.

B (71:58)

Is that what you mean? Oh, yeah. Or what is it called? X. Yeah.

A (72:01)

And it just gets sadder by the day. But that's just. Anyway, it's. That's her. I just heard some fair amount of.

B (72:08)

Time about the car. No. Okay, great. Well, we'll put your handle, your tool, your X, I guess. X handle there. Okay. And, yeah, this has been fantastic. I love. I love talking about injury prevention, and I think that you did a really great job sort of funneling this towards women who are. Want to be aging well and thinking about injury prevention there. So thank you so much for that.

A (72:28)

No, those are my best friends and my wife that we talk about this all the time. Yeah, this is. This is a home game for me. But no, thank you for doing this. Thank you for having a show where I get to nerd out a little bit and not be scared of using words like so as.

B (72:40)

Yeah, awesome, awesome. Thank you.

A (72:43)

Thank you.

B (72:45)

Welcome to the after party, where I tell you exactly what I thought of this episode and what my key takeaways were. If I liked the guest, didn't like the guest, I give you, I spill the tea, so to speak. And the afterparty, as we are all moving towards menopause. That's my loving term for Afterparty is my loving term for menopause. We all want to be there, and you're all invited, so that's where we are, and that's why we are here. So my takeaways here, this was, first of all, as you know, this was more of a Dark Roast Betty episode. So this was where I get really, really excited about biomechanics. And I caught myself saying anterior superior iliac spine. And I was like, whoa, girl. Like, trim this back. But I hope that you enjoyed it, and if you feel like it was just right up your alley, please let us know, because we can do more dark roasts like this as well. But a couple of my favorite takeaways was the the idea kind. I think one of the main ideas was that deceleration or being able to stop is a superpower. And we talked about this in a couple of different ways. So we talked about this in the context of the hip flexor muscle, the psoas muscle, or properly the iliapsoas muscle from our dark Roasters. He's right. Like, the psoas goes basically from your. From your spine and sort of wanders through the abdomen and then eventually attaches to your femur. And you need to be able to get that foot in front of you in order to break a fall. You also need the psoas to translate, to be able to move left and right. And so he created a very compelling case for why the psoas muscle is so key for being able to stop. And, you know, I think every sport, any sport that you're doing, you need to be able to stop quickly, change direction. But even if you're not someone who plays sports, I think being able to learn how to fall and to fall well, I think is very, very important. So there's that. And then the other aspect of deceleration that we were talking about was in the context of falling from, or jumping from a plyo box, let's say an 18 inch or whatever inch plyo box, down onto the ground and having the Achilles and then, you know, some of the structures on top of that, like the quads and the glutes, being able to absorb a lot of those ground reactive forces. So I thought that that was very, very cool. Learning how to fall, biasing the eccentric. Which is maybe why you hear me always talking about when you're squatting, when you are in the hole, basically when you are at the lowest part of the squat, that is the most important part of the squat, when the muscle is long and weak, because that is where you're going to gain and garner the most strength. I like the. The other thing I really liked was the. And I gotta, I actually gotta videotape myself now is the idea that training with the plyometric progressions with your toes up, so your toes being dorsiflex, like off the ground. I think I might be jumping with my toes down. Like, I think that may be a cue. Like, when he said it, I'm like, oh, damn. I think I. I think I do jump. Like, my toes are the first ones that hit the ground. So I. I really like that. And then I love the conversation around hip mobility and instability. I think that depending on your background, your fitness literacy will say you're probably going to have one of two things. I really like the example that he gave when he's like, whenever I go to a yoga class, you know, like, people are putting their, you know, legs behind their heads, you know, or whatever. It. Everyone's so bendy. He's like, but you're really training a strength that you already have. And so those yogis who are very bendy, very pliable, very flexible, would probably benefit from working, doing more strength training to create more stability in the hip because there is always a trade off between those two, right. So whether you are, you have a lot of muscle, when you start to get too much muscle, you start to trade off your pliability and your mobility, right? So it's like there's almost this like you should shaped curb almost where you almost become more debilitated, like the more muscle you have, I mean women, it's going to be very hard for you to get there. But if you look at bodybuilders, you know where their elbows are basically up to their ears, or you ask a bodybuilder, a male bodybuilder, I'm thinking of in particular like to scratch his own back. Like he's not going to be able to like internally rotate the humerus and kind of get the, get the arm to scratch his back. So you, there's sort of like, you know, you ride the maximal benefit of, of building enough muscle and you can get into it can, it can be negative returns as well. Those are kind of my favorite points. We were super, super nerdy here. And if you enjoyed it, let me know. If you didn't enjoy it, let me know. If you want more around injury prevention, let me know. I'm happy to do solo episodes as well. I have a lot to say. I spent 19 years in practice talking and doing all injury all day long. So if you found this episode helpful for you in any way, please feel free to leave us a five star review on Apple or, or on Spotify. We see all the comments, we see all the things that are left for us. So I hope you enjoyed this and until next time, I bid you adieu. All right, all right. I hope you enjoyed today's episode and I must give you the obligatory legal and medical disclaimer here. This podcast, Better with Dr. Stephanie, is for general information only and the advice recommendations we discuss do not replace medicine, medicine, chiropractic or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship that has been formed and the use and implementation of the information discussed are at the sole discretion of the listener. The information and opinions shared on this podcast are not intended to be a substitute for primary care, diagnosed or treatment. In other words, guys, be smart about this, take it with a grain of salt. Take this information to your primary healthcare provider and have a discussion with him or her to make the best choice. That is for you. Remember, I am a doctor, but I am not your doctor. And these conversations are meant for educational purposes only.