Unknown Speaker 0:00
Alright everybody I am here today with the V Chan. I met Naveed what we just say four years ago was 24 years ago next month. Yeah, yeah. So we met through a dry needling course at banner hospital system in Phoenix, Arizona. And we connected over tacos Qi was it good gave me the the recommendation for the best taco place I've ever been to. And we've stayed in touch over the years with dry needling. And he also has a cash practice in Phoenix where he works with a lot of strength athletes. So definitely some things in common there. So today, we'll talk a little bit about dry needling and I, you know, he's doing some awesome stuff in the emergency departments with with dry needling. So I want to definitely dive into that experience and what you guys are doing there, and how that maybe relates to opioid usage and those kinds of things. And then we'll get right into the strength athlete side of it, because that's what we're also doing on a day to day. So thanks for joining us. You want to introduce yourself and then we'll get in.
Unknown Speaker 1:02
Yeah, absolutely, man, Nick, thank you for having me. I'm happy to be here. Good. Good. Talking to you. Good catching up. Yeah, like, like Nick said, I'm a physical therapist based out of Phoenix, Arizona at banner University Medical Center, actually started the first physical therapy program within the emergency department setting at the banner University Medical Center in Phoenix. One of the first things that my director at the time had me do because he was he was a big fan of tri needling and, and a big proponent of it. And he, he thought he could help a lot of people. So my first continuing ed course out of PT school was the course with Nick was integrative dry needling, which I really enjoyed. And I've, I've had a part of my everyday practice and sin. I really enjoy it. Since then, next month, it'll be four years in the emergency department setting. I'm really happy with what I've developed there, the growth I've put there, and you know, the things we can do for patients outside of just, you know, pen medication and anti inflammatory and maybe unnecessary X ray. So yeah, happy to be here and happy to talk to
Unknown Speaker 2:09
you. I guess I didn't realize that was your first CEE course coming out of school?
Unknown Speaker 2:13
Yeah, man, I was like, I got I literally got my license, like two weeks before that course. And before I even started, my boss was like, hey, just so you know, we signed you up for a dry needling course, that's going to be two weeks. So I was like, Yeah, that's awesome. That's exactly what I wanted.
Unknown Speaker 2:29
Yeah, that's cool. What I mean, I don't know if you can remember back that far. But what do you think is starting out? Like? You know, the question is, people ask, sometimes from a dry needling standpoint, you know, should you have a bunch of experience before you do dry needling? Can you jump right into it? I have my opinions. What do you you know, what was your experience with
Unknown Speaker 2:46
that? You know, I've heard both, I've heard both guys. People say like, Hey, you really want to get a, you know, a year or two or a couple years of experience in using manual therapy and their acts and, you know, really honing in your, you know, whatever, whatever skills you have before you take a dry needling course. You know, I don't think I I don't think it hindered my progress. I think if anything had added to it, my anatomy got really good. And my clinical skills got really good at taking that course with you. I'm happy I did it. I don't think I would have waited any longer than I did. And it gave me it gave me something to use with patients right away that, you know, the providers couldn't do I think there was one actually emergency department physician assistant that did take a IDN course before me, but she wasn't using it. So it was it was really cool to, to, to combine that with, you know, traditional medicine within the emergency department. So I was happy I took it when I did. Yeah, I don't really see any reason why you wouldn't.
Unknown Speaker 3:46
I mean, I'm obviously biased. But I think every every new grad should take that course right away. It's, it's such a deep dive into pain science. And as much as I feel like our profession is trying to avoid treating pain. That's what people come to see us for right is to get out of pain. So if you can do that, with needling or cupping, or whatever, man, you know, whatever techniques you use, but man, it's just such a big Headstart. So what are you guys doing in the emergency department? Because you would probably know the stats on this better than me, but is that I mean, around in here in Ohio. I don't know of anybody doing physical therapy in the emergency department, let alone dry needling. So what are you guys doing? And is that where is that as far as like the the rest of the profession?
Unknown Speaker 4:29
You know, um, emergency department. Emergency Department, physical therapy is still kind of a growing field within the US. It's really big and in Australia and New Zealand and the UK and Canada. They're almost primary provider roles in the emergency department. And I do know a few in Australia that do use dry needling within the emergency department. I remember 2019 We actually had our first annual emergency department physical therapy conference and there was about 30 of us And I was the only one that raised their hand when they asked who does dry needling? And they were just shocked. They looked at me and they were like you do dry needling. I said, Yeah, I'm actually to the point that, you know, provider physicians or PDAs, will come up to me and say, Hey, I think that patient could use some dry needling if you have a second for whatever it is with like a ride neck, or paravertebral spasm, or something, they're actually requesting it now. So I do know, here in Chandler, Arizona, about 20 miles east of where I'm at, they do, they started implementing dry needling. And I'm hoping it grows because I think it's, it's pretty fascinating. I know some other some other types of physician friends that are starting to get into the jumping on board, and they see the benefits of it.
Unknown Speaker 5:45
Where were some of the other people from that were PTs in the emergency department.
Unknown Speaker 5:50
Um, you know, there's, there's a really strong presence and Colorado and Denver and Colorado Springs, there's a ton of emergency department PTS, there's quite a few in Arizona, and Flagstaff and Tucson here in Phoenix. And it's a growing, it's a growing, it's a growing field, there's probably I think, 40 to 50 full time at therapists in the country, which is kind of crazy. Because, you know, I think the first the might have been 2007 was the first first paper that was published regarding emergency department PT. So to see the growth, it's, you know, it's nice, slow and steady, but it's still growing. And you know, I like what we can provide. The skills kind of vary from physical therapists, some people just treat it like inpatient PT, where it's just for, you know, dispo planning, like sniff placement or home health placement. But I really like being that primary care that Orthopedic Specialists that can go in there and help with the diagnoses or the differentials and treating the patient and their yes, that aspect, right?
Unknown Speaker 6:53
That's what I was curious, like, what is your day to day role in that setting? Like, April 1, or is it like any case,
Unknown Speaker 7:04
so kind of combination of both, we actually, I think last year, in the middle of pandemic, when it was getting kind of crazy. And the emergency departments were getting full, I started this, I spoke to our medical director, I spoke to our medical director about creating a triage protocol where, you know, we have these lower acuity patients, and I will see lower acuity patients like I'm not going to, I'm not going to dry needle like a seven year old lady with a hip dislocation, right. But someone comes in with, you know, just out of a motor vehicle accident, or someone comes in with some type of lumbar arrangement, or, you know, they get up and they can't move their neck in a certain direction, we can get those patients in, treat them really fast, I'll do a quick evaluation, I'll talk to the either the physician session or the physician about what I think they need. And you know, what I'm what I'm seeing with the patient, they'll kind of do a look over, and then we'll start the treatment and get them out as fast as possible. We do that, and then also after the fact, you know, sometimes people have kind of a weird presentation, where, you know, they might have this left arm pain and this chest pain that, you know, their first thought is a heart attack, and it ends up being some type of, you know, radiculopathy, or some type of like, referral pattern from some trigger points or something. And, you know, that'll be after the fact where one of the physicians say, like, I think this is muscle, but I'm not sure. Can you take a look at this for me? And then I'll go in and I'll train him. Yeah, yeah, I really enjoy it.
Unknown Speaker 8:29
Yeah, I mean, that's, that's such an awesome setting. And what kind of results are you seeing as far as seeing people that soon after the injury or that soon after the mechanism, you know, like, I would say, traditional PT, a little different in the cash world, but in traditional PT, right, they got to go to the emergency department, then they got to go see their primary care physician, then I got to see a specialist. And then finally they get to pt. And it's already been four weeks. You know, I mean, it's crazy. And we're starting to see some revenue, like research published on revenue as far as total medical expense, whether you get physical therapy first, or you go through that kind of cycle first. What are you guys? I mean, you're living it. What are you seeing as far as when, when you're able to get to somebody in the emergency department? And that setting?
Unknown Speaker 9:15
You know, isn't the Norm Yeah, definitely not the norm. And, you know, there's some patients that are just you know, they're so hot, their pain is so out of control. They're so inflamed, whatever it is, I can't do much for them. But there's some patients you know, they're coming in with chronic pain or maybe it's some type of like lumbar derangement that we see really quick results for and you know, that I can treat very quickly, I'd say it's probably, I don't know 60 to 70% of the patients I treat, I can treat there and see some pretty significant results with in like, you know, the 3045 hour that I have treating them in the emergency department versus them having to wait, and there are some patients like say you Some type of whiplash disorder right after the right after the accident, like an hour after, then there's not much I can do for them. And there's, you know, I really don't want to dry needling or do any type of you know, manual therapy just because they can't tolerate it. So it really depends on the on the patient. And but I'd say a fair amount, you know, there's some interventions I could do that could give them some comfort.
Unknown Speaker 10:18
That's pretty cool. Are they combining? Like some type of a steroid protocol with a dry needling? Are you seeing any of that?
Unknown Speaker 10:26
I'm sure. So yeah, it's kind of you know, the, the really the, there's a big push against opioid usage, which is awesome. And, you know, the, the pretty much nearly, I don't say nearly all, but a good majority of the patients get some type of muscle relaxer and anti inflammatory like, like a, like a toradol, injection along with some type of muscle and muscle relaxer, that may or may not help. And then on top of that, I'll go see them. And then I'll add whatever interventions I want. Sometimes it's companies, sometimes it's dry needling, or manual therapy, things like that. It's usually that combination. And sometimes a providers will ask me for some feedback, like, what do you think they should use? Or what do you think they would need that would be helpful with with that treatment? Or, you know, referral after?
Unknown Speaker 11:12
Yeah, that's pretty cool. I mean, I'm hearing some of these pain Doc's are doing, you know, they're going for an injection, and then they do whatever the injection is, and then they're actually manipulating the hypodermic needle to create some of that, yeah, tissue lesion. So it's interesting to hear that, you know, get your toradol get that thing Calm down, and then do some Googling for kind of that longer, you know, four or five day turnover. Pretty interesting. Are you aware of that data? Oh, good.
Unknown Speaker 11:39
So I just, uh, just a quick aside, there, actually some of the older school, the old school Doc's, they'll do like trigger point injections, or they will do that, and, you know, with lidocaine or something like that, where they see it, and you know, either in the sub stack or in the low back, and then they'll have me go in and drive you laughter. And we see some pretty cool results. A lot of the newer Doc's or the younger, PDAs. They don't really do that. But you know, with some of the the old school Doc's that still, you know, implement those type of interventions at we saw some pretty cool results with
Unknown Speaker 12:06
that. Yeah, I was talking to a group of podiatrist, this was probably three or four years ago, maybe more than that. And they were telling me, like, yeah, we do we do the Lidocaine injection, but really, we're in there manipulating them. Yeah. And they think that did more than than the actual it. And this was before. You know, we're doing an introductory talk on dry needling. Right? So Oh, that's cool. They've been doing it a long time. They just didn't call it dry needling. Sure, yeah. That's interesting. Are you aware of any data on cost? Like this banner? Are you aware of any of the whether you're there or not kind of what it costs the average patient? I mean, I don't know that that exists. I'm just curious.
Unknown Speaker 12:46
So they're, they're working on it. Because you know, the one of the reasons that the the growth is kind of exciting son and with the emergency department, because with these huge hospital systems in the emergency department, the bottom line is always okay, how much money is this going to cost or how much money is gonna say, there was some pretty cool data, I think it was out of Illinois, that was, it was like on the verge of being published. And it was, I think it was around. I want to say about $300,000 a year that the hospital saved, because emergency departments tend to be like, a black hole as far as money. Like they don't, they don't make money in the US, unfortunately. But I think it was about $300,000 Saved annually with the emergency department. Physical therapists in that setting, which is a substantial amount. And that's, that doesn't, that's not just, you know, musculoskeletal orthopedic injuries, that's also like, you know, dispo placement for, you know, going into a patient getting into a skilled nursing facility or getting home health or not having to be admitted, but it was a combination of the three that you know, it saved them a substantial amount. I mean, I don't know any hospital based physical therapist or making $300,000 a year. So it saved them a good amount of money. Having a PT in, in, in, in the emergency department. I was originally when I started the they wanted to see how much money how much money we would either make or how much money we would save in the hospital setting. With me there, it kind of this the data kind of fell apart and they didn't want to continue doing the research, but it ended up my initial calculation was it would have made the hospital close to 450 to $470,000. Had they been charging for the physical therapy evaluation in the emergency department? So it was up substantial amount? Yeah,
Unknown Speaker 14:42
it's a chunk. Yeah, I mean, obviously, like you're saying, I don't know what the rates are in Phoenix, but they're not they're not 100 150,000 Even so yeah, yeah. I mean, no, you're you're talking about chunk of cash. The in for people that that aren't aware part of the role of Physical therapists in hospitals is discharge planning as far as where that patients get. That's what that's what he was referencing there. You know, does the person get to go home? Do they need to go to a nursing home rehab facility? That's, that's a big chunk of what they do now in the emergency department is part of that, deciding if they get admitted to the hospital, is that part of that roll?
Unknown Speaker 15:20
Yeah, absolutely. That's probably about a third of what I seen maybe 25% is, you know, we'll call them failure to thrive patients where, you know, they don't have anything wrong with them. They don't, they're not in like, diabetic ketoacidosis, or not having a heart attack, nothing like that. But they're just, we call failure to thrive. They're not, they're not sick enough to be admitted for any reason, but they certainly aren't safe at home. So they'll come in, they get they get taken to the emergency department, and we save money by, you know, doing the evaluation there and hopefully getting them into a rehab facility, or getting them set up through other some other type of resources. That's, that's not my favorite part of the job. But I'm more of a ortho PT, but it is it is an important part of the of the role in my in my setting.
Unknown Speaker 16:06
Right. And then the other thing we had talked about kind of right before COVID happened, you guys, we're looking at reduction of opioid usage. Yeah, whatever happened to that? Remember, right, that was before COVID. Right, that
Unknown Speaker 16:21
that was right before COVID. And that, again, that fell apart to that it was actually started with a pretty cool story, the, the medical director, so that was a he's a physician in charge of the entire emergency department. He, he's kind of the director for all the other physicians. We had this woman come in, and she had this, it was I forgot what it was. I forget what it was, but it was some type of like, like thoracic spasm. And he was like, I want to see what you can do before I give her any medication. And it was just kind of just out of curiosity, right. So I got in there, she couldn't breathe, or like her inner inner intercostal muscles were like in spasm, she could barely move. She was in tears. I did some dry needling. And in the sub SCAP region, I did some manual therapy did a quick minute thoracic manipulation, some, some PNS patterns, we got our page, we went from a 10 to maybe a three without any medication. And the medical director was just blown away. And then after that, he was like, I really want to see what we can do as far as reducing opioid usage in the emergency department. Unfortunately, you know, COVID, hit, everything came to a halt, we're kind of just barely hanging on right now. But that was kind of the, the beginning of that. And that's what he wanted to see. And that I thought that was pretty cool. We have a couple stories like that specifically with a medical director.
Unknown Speaker 17:47
That's awesome to hear. I mean, I'm always blown away when when people look at research, and oh, there's such and such doesn't work and this and that. And then you hear those stories. And obviously you and I have lived those stories. And it's like, there's definitely situations where manual therapy and dry needling, like have that type of an effect where you can take some of these pain down, you know, 70% in a session, right. And that's more than you're going to do with with most medications and awesome to hear. I hope you guys get that study going to get because I was pretty excited when you were telling me about it. It's Game Changer stuff, right? Like if we can reduce the need and usage and still show that that people are getting out of pain. Right? Because that's, that's the other side of it. It's like, you know, people want pain relief. So if if that's a way to do it, man, that would be so cool. So absolutely, hopefully this COVID stuff. I don't think it's going anywhere anytime soon.
Unknown Speaker 18:39
I don't think so either man. But I think we're just kind of start working our way around it. And I really hope to get that you know, that research off the off. off the floor. There was actually a pretty cool story I wanted to share. So it was with the same medical director and we had this guy. He was he was in chronic pain for like 10 years man, awful low back pain. He was his older guy. He'd been to the game and I'm sure you've seen patients like this are just in constant pain. And he came to the end couldn't do anything. And he was a miserable dude. He was yelling at the nurses. He was young, the doctors. The doc gave them you know, a single, single Percocet, just to kind of appease them didn't do anything. He was super angry. And I and this is when I was first starting. And I just walked up to the mat. I walked up a medical director was like, Hey, man, can I see him? Because at this point, they didn't really understood understand what I do in the emergency department. So I was like, it was yeah, have at it. So I go in there and this was maybe this was maybe like a month after I took your course. And I was talking to him. I was talking to him. I you know, I was like, I'm not sure how much I could help you but we could try and see what happens. And I'm working on them do as I'm driving. Those are his pivot tables and getting in his MultiFit i and he's just laying there and the Medical Director walks in and And he didn't know I was doing this. He just sees like, you know, 10 needles in this guy's back and it's just his jaws dropped. He's just like, What? What the hell are you doing? And then, and then he walks out. He didn't say anything to me. And I take I take all the needles out, I did some manual therapy, work them a little bit. He's like, Hey, man, I want to talk to I want to talk to my doctor again. And I walked out, I didn't realize this, the doc is ready to call security guard to escort this guy out. Because he was he'd been such a jerk to everybody. Oh, geez. And the medical director walks into the room. He's like, this is the best I've felt in 10 years. I just wanted to let you know that. This is amazing. I don't know what that guy did. But I just wanted I just wanted to let you know that I'm gonna go. And the the director was just blown away. He didn't he didn't realize and that was kind of the, the it was cool. Because two things we helped this patient that been in pain for so long. And then two, I finally got some, some buy in from some of the physicians that what I do is not just, you know, hocus pocus are whispering sweet nothings in the patient's ears.
Unknown Speaker 21:01
That's so true. That's an awesome story. I mean, for so many reasons. That's an awesome story. a month, a month of a month out from learning how to do it. Wow. Yeah. You're talking two months out of school? Yeah, you've you've changed this guy's pain in whatever, half hour? And then yeah, yeah. I mean, that's just, that's awesome. That's a cool story. So with that in mind, and Part A, so you got this emergency room, part of what you do? And then you also have your own your own private practice, correct?
Unknown Speaker 21:35
Absolutely. I'm kind of how. So, you know, in PT school, I had a, I had a director that was very pragmatic, or not a director of professor that was very pragmatic with us and said, Hey, you really need to understand insurance reimbursements. And, and how to get paid by insurance and how to get, you know, your units. And she showed us this exercise where the, she was standing on a foam pad and had a baseball tied to a band. And she was to me, she's like, showing us this. And she's like, and you could do this for a baseball player. And you could charge for neuromuscular education. And I was just kind of blown away. Like, that's the dumbest thing I've ever seen. Like, why would you like, what is that doing for the person and then there and then I went to, obviously, in a clinical rotations I was I was, I was at an outpatient sports outpatient clinic. And, you know, I got really good at insurance fraud. And I really got really good at seeing 30 patients a day. And I realized, this is not this is not what I had in mind when I signed up for school. And this is not how I want to treat patients. I don't want to see patients for 10 minutes and tell them to go do like some yellow external rotation by themselves. I wanted to do my own thing. So maybe Niecy, I met you in January, I opened up a clinic inside of a gym in April. And I kind of just started working. Before that, I'd been competing in strongman and powerlifting for about five years. So I was kind of already kind of in the community already. And I know you see, these guys are constantly in pain, they always got something wrong with them. They're trying to work around injuries. And their bottom line is I want to get healthy enough to keep lifting, I want to compete, I want to do whatever. So it was it's been awesome. Because I understood the language, I understand what they needed. And I understood how to how to get them better and how to work around whatever injury they had. So that started in April of 2018. It's been kind of grown ever since I really enjoy it. So I graduated December, January, February, March started in April. So about five months.
Unknown Speaker 23:46
How long did you last at that first job?
Unknown Speaker 23:50
Oh, you mean the clinical rotation?
Unknown Speaker 23:51
Oh, that was a clinical. Okay. Okay. That's what I was trying to figure out. I was like, Were you there a week?
Unknown Speaker 23:56
No, dude, I was there. That was the longest 10 weeks of my life, man.
Unknown Speaker 24:00
Oh, yeah. I experienced a clinical somewhat like that. And honestly, my first job was kind of like that, where, you know, you're managing your schedule more than you're managing patients. You're, oh, go go ride this bike over here because it's gonna be good for you. But really, I just need follow chart and I got to do this. I got to do that. Right. I mean, it's, it's ridiculous. Unfortunately, it is what it is. And I know a new grad PT has been practicing for a year, and he's burned out he's done. He's like, ready to quit the profession. He's one year out.
Unknown Speaker 24:31
So I mean, I got I got classmates that are looking in case management jobs or private like medical sales job because you know, these, these mills and these like really like better push and seeing be 40 patients a day. They're killing them. And that's, I don't think that's what the practice should be. And I kind of actually from you learn from you. And when we're in that course, and you've already had your cache gone for a while, it's like he's he You made it sound a little too simple. You made it sound a little too easy like it He's just gonna jump in. But I really, Man, I'm really happy that I did that. And I'm able to treat patients and in a way that I want that I'm not worried about units I'm not worried about oh, did we do that for eight minutes? Oh, did we do this for 15? When's my next one coming in? Oh, I'm going to get them on a bike like go have this person do that. I'm just they get an hour of my time, I'm able to do what I want with them. And, you know, we see some pretty good results with it.
Unknown Speaker 25:22
Yeah, I must have been still naive at that point, if I made it sound too simple. Because, I mean, it's still it still has its its unique challenges, right? And I can only imagine your day, right? Cuz you're working a full time gig. And then doing this on top. Right. So yeah, I mean, you're busy. You're hustling? Yeah,
Unknown Speaker 25:44
yeah. But I mean, if I didn't, if I don't, I don't I think I didn't enjoy what I did. And if I didn't have you know, the the autonomy I did in the emergency department and the autonomy I did. I have within my own clinic, I don't think I could work as much as I do. But you know, I really enjoy both. And it's pretty cool. When you you know, you have a guy that's two weeks out of a competition, and he did something to his back or you did something to it shoulder, and you can get them, you can get them good to go. And he's able to compete, he's able to hit a PR he's able to, you know, finish third or whatever he wants. It's a pretty it's pretty damn good feeling.
Unknown Speaker 26:20
Yeah, agreed, obviously. So you do dry needling, what are your other manual therapies? Like what are your other kind of specialties?
Unknown Speaker 26:27
So I finished a there's a pretty, pretty decent, pretty decent. He's a pretty damn good physical therapist here called Tim Farron. He's a orthopedic fellow. He's been. He was physical therapist of the year here, I think, in 2017, but he has a course called Phoenix manual therapy. And he teaches that along with Jesse Ellis, who's the director of health and performance for the Portland Trailblazers, so I consider those two guys mentors and I went through a Ceylon tea course, a manual therapy course with them. So I learned a lot. It's all Maitland and Paris trained. And that was a huge game changer for as far as you know, my treatment and my manual therapy treatment and also my clinical reasoning. I also started diving into the MBT model, I've taken two courses so far. I really enjoy that in my clinic. But also I'm seeing pretty good results. And I'm actually working on an article for under emergency department, resident magazine, on how to how physicians can implement some of those interventions, whether the manual therapy interventions or the repeated movement in one direction intervention to those I would say those are kind of kind of my my foundations as far as treatment, I really enjoy those. I wouldn't say I'm like a strong Maitland guy a strong McKenzie guy like learning both.
Unknown Speaker 27:51
Yeah, my. Again, I always think it's interesting how people find the same paths but in PT school, our instructors were Maitland and we're also Maitland instructors are orthopedic guys. So we got a pretty heavy dose of Maitland orthopedic stuff, and it just fits in right like you find the comparable you mobilize it, whatever you're actually doing when you mobilize something by just it's another way to get to get to some of those comparables, how are you mixing those together? Like in your mind? Let's say somebody walks in with back pain, you got a powerlifter back pain? What's, what's a session or what's a process look like for you?
Unknown Speaker 28:34
You know, for back pain, especially, especially for back pain, I'm really kind of leaning in towards the MBT model. But you know, it doesn't work for everybody. I think actually that guy, Tim Farron, he has a quote about Mackenzie's like, well, McKenzie got right, he got really right, but some of the stuff that just doesn't make sense, you know, so I go to that, go down that treatment model of you know, repeated motions, sustained motions, if there's a directional preference. And I work through there and I kind of I don't try to force it and I don't try to I don't call them I think they call them non responders or mechanically inconclusive, something like that. I don't stop there. I kind of start working towards towards the main lock Maitland model and see if there's anything that's not moving as well. Finding that asterik sign and trying to repeat it, trying to repeat it or trying to oh, I don't know what that was. My back to back. Sorry, I got a call. Okay. Trying to see if we can, you know, find an asterix model and going through that clinical reasoning as far as the mainland approach. I like combining the two I don't think one works for everybody. And I like having a combination of both because what's that brief Bruce Lee quote, take, take what's useful and throw away the rest, like whatever I can apply for that patient in front of me. I try to do and I don't think one model fits for everybody.
Unknown Speaker 30:00
I agree I tell people all the time, like, if the press ups are going to work, they're gonna work and they're gonna work really well. But yeah, then sometimes they're not gonna do anything, right. But when the press UPS work, UPA kind of back the front moebs also are going to work like, then they're going to work really well. So, or a sideline, rotational mode or whatever, but you're gonna find one of those two are also going to work and then do some press ups. And do you need all those people cube back pain?
Unknown Speaker 30:28
Um, yeah, almost, I wouldn't say almost always. Sometimes, like, you know, the biggest thing is, especially in the emergency department, I always kind of talk to them first about, you know, what we could do for them. And I give them some options we can do, we can do manual therapy we can do, we can do this, we can do dry needling if you're comfortable with it. And I always my really my only contraindication for most people is, are you apprehensive about needles? Yeah. And I'm always surprised man, I've had guys, you know, you could tell they just got out of, you know, they did at least five years in some prison and they got some tattoo on their face. And they're like, no needle scare me. And I was like,
Unknown Speaker 31:03
what? But I'm right. Yeah. Tattoos are not a sign of if they're okay with needles or not?
Unknown Speaker 31:10
No. No, but yeah, I am. I wouldn't say all always. But there's a pretty good majority of those patients. I will dry needle, because I you know, I get some pretty good results with them.
Unknown Speaker 31:21
Yeah. Yeah, I, I'm careful with the acute disc. Like if I think it's a real hot disc, I'm a little careful, because I've seen them kind of spasm react on top. I don't know exactly what that mechanism is. But I've seen that a few times. But um, but yeah, a couple weeks out. No biggie. Yeah,
Unknown Speaker 31:40
it's like a really acute radiculopathy. Like, I've seen some guys, actually, I've had, I've had a few. It's weird. I've had a few physicians that come in right away, like hours onset. And those guys I won't do because, you know, there's not much you can do aside from you know, getting in positions of comfort. I won't do that. But you know, these kinds of spasms that come in are these deformities, where they have this like lateral derangement those I can, I can get some pretty decent results with dry needling
Unknown Speaker 32:06
very quickly. Yeah. All right. The people that don't treat shifts with repeated motion also kind of boggle my brain, like, if somebody's got a lumbar shift, like, just give them some side guides and let's move on.
Unknown Speaker 32:19
Yeah, man, it was a patient I just saw, you know, I think two weeks ago, she came into my clinic, she had gone to this chiropractor. She'd gone to this chiropractor who treated her for like a year for this lateral shift. And she was like, it was obvious man. And it got better after a year. And then six months later, it came back. The guy was too busy. So she came to me. And I get, you know, just just as lateral shifts. We ended the tree with some dry needling and some other some other some table treatment. But just cycline she's like, I got better within 15 minutes. And that guy took a year. And I'm not bashing chiropractors, because I refer to chiropractors. I have friends that are Cairo's
Unknown Speaker 33:00
but a lot of Cairo's that do McKenzie. Yeah, there's a ton of cars. And
Unknown Speaker 33:04
there's special courses for MDT courses for Kyros. I was just kind of boggles my mind. Like, what was he doing for a year?
Unknown Speaker 33:11
Yeah, I've had a few lateral shifts that don't respond to repeated motions. But for the most part, man, they just work. Yeah, yeah. That was like gonna ask you doesn't matter. What do you do? First, you have manual therapy, like joint tissue work first or needle first.
Unknown Speaker 33:31
I'm trying to think I usually I usually do manual therapy first, just to ease the nervous system ease issues and kind of getting them comfortable with some with hands on stuff. And then I'll usually finish up. It depends. That's usually for low back. For if it's like extremity if it's extremities, if it's like the neck, I might do some needling first just to ease them up. If they have like a really, really stiff trap or that like they're they got some type of torticollis going on. I might do some needling first, just with some Easton attached to it, just to get them to calm down of it. But yeah, I almost always do it. I guess it varies on the patient.
Unknown Speaker 34:11
Yeah, I mean, I would say the same i i mix it up from depending on the person, but I get that question in courses all the time. So I'm always curious, you know, you've been doing it for years now kind of where you've ended up as far as what comes first? Yeah, given that we're in kind of a similar model, practice wise. Do you do a lot of exercise stuff? How's that look in your practice?
Unknown Speaker 34:32
Oh, yeah, almost always. There's there's not a patient that doesn't do exercise stuff. We'll do the manual therapy first and once we get that, you know, increased range of motion and we got that reduced pain we always ended with Alright, this is what we're going to do the rest of the session or this is what I want you to do every day once you're out. I don't really like the come in here three days a week model. I like you know, I like to patient being independent like and I don't think we need to wait way too long. waste a lot of time with me watching you do like hip cars and me watching you do some, you know, thoracic rotation. I want you to do this on your own because I can know I know you're, you're a big boy, you're a big girl. You can be independent with this. But yeah, there's nobody that leaves my office and isn't getting some type of homework.
Unknown Speaker 35:17
You mentioned the word cars. Have you done the FRC course?
Unknown Speaker 35:21
I haven't done the FRC course. I've done the FRR courses. But man, I really love it. I really love those that the end range training, controlled articular rotations, things like that. They're just really pricey, man. Like, I think the two of the FR courses were about 20 808 or 2800. Total.
Unknown Speaker 35:42
That was that was 13 or 14 apiece. Yeah. Yeah, for two days for a two day course.
Unknown Speaker 35:46
For a two day eight hour course.
Unknown Speaker 35:48
Or if you want to do it online, it's the same price. It's the
Unknown Speaker 35:51
same price online and it's shorter amount of time. Yeah. And there's
Unknown Speaker 35:54
no cure, cuz I was good. I was gonna do what I need a few CPUs for the end of the year here. I was like, that's what I've been wanting to take. And then like,
Unknown Speaker 36:04
yeah, man, it's, it's like, Man, can I justify this? Like, but you know,
Unknown Speaker 36:09
I'm gonna take it, I
Unknown Speaker 36:10
think it's great material. Yeah.
Unknown Speaker 36:13
I'd rather do it in person, if I can do it in person. So I'm probably gonna wait till I can. I'm curious about it, though. Since you've done it. Like on the surface, it kind of just looks like in range isometrics. And then range kind of a center kind of stuff. And is there? Is there more to the theory? Or is it mostly just kind of N range?
Unknown Speaker 36:36
To me, I think it's just n range isometrics. And it's really forcing those and re it's really forcing that full range of motion. To me.
Unknown Speaker 36:47
There's that's what it you know, watching it on YouTube. That's what it looks like. Yeah.
Unknown Speaker 36:51
That's what it looks like to me to the FR has a little bit more to it.
Unknown Speaker 36:57
Is the FRR. Is that the the manual therapy one?
Unknown Speaker 37:00
Yeah, that's the that's the functional range release course, that's a manual therapy one. And that's open to is actually pretty cool. I did at the UFC Performance Institute. And they had guys from a therapist from the Air Force from like two or three different NHL teams, they had the therapist from for the UFC Performance Institute. So it's some some pretty high level clinicians taking the courses. Yeah, they're just pricing and but I really, I really enjoyed the models. And I really like given those two patients.
Unknown Speaker 37:26
What's the manual therapy? Is it mostly just like soft tissue work? Or is it joint based?
Unknown Speaker 37:31
Mostly soft tissue work? Mostly, like, it's really good. If you want to get really good at palpation muscles and things like that. It's pretty awesome.
Unknown Speaker 37:38
Yeah, I will talk me into wanting to do it now. Good to hear. What, you know, we'll wrap this thing up here. So what are some things that you tell your strength athletes? Like? What are the things you're seeing a lot of, you know, we got a pretty, pretty decent following of Olympic weightlifters and a few power lifters. But what are some of the things that you see in you're going to work with your athletes the most?
Unknown Speaker 38:05
You know, it's all it always comes down to patterns. Man, I see a lot of like label injuries. And a lot of, I see a lot of hip issues. And I see a lot of limitation in rotation, internal rotation with a lot of the a lot of the powerlifters, a lot of the strongman ends up causing some issues down the road, whether that's, you know, some type of material impingement, whether that's some type of like, label issue, same thing with the thoracic spine, these guys come in, and they're like, and almost every panel of every strong man, I see they have like limitations in their thoracic spine. And that's causing a lot of issues down the chain or up the chain. So that's kind of I almost thought like, I get so many shoulders, I get so many hips, and it's almost always it's almost always a threat. As far as shoulder issues, and that's what I'm kind of I kind of work on that night. I mean, almost everybody has almost every athletic. I don't say almost every but a vast majority that are coming in with shoulder issues tends to be stemming from the thoracic spine.
Unknown Speaker 39:03
So what do you think that is? I mean, there's a part of me that says that stiff thoracic and adaptation to being able to back squat and deadlift a lot. Right. I mean, that's probably part of where that comes from. Why do you think it turns into an injury? Like, are they trying to do overhead work? When I guess I'm just, you know, at what level do we go, your body's adapting to be stiff for your power? Sure, versus you need the mobility to be able to do you know, whatever and overhead press? I mean, if it's strong, man, I get it, if it's powerlifting. How do you how do you how do you make those decisions on an elite level person?
Unknown Speaker 39:39
Um, you know, I don't see I haven't seen a detriment or a negative in fact, on like a page, like on a on a person's performance. So a lot of guys are like low bar power lifters, and they're really cranking into external rotation but they don't have it and they don't have it in their shoulders, spine. They got full 180 degrees position, but it's a thoracic spine. That's just stiff as hell. And you know, that might be might add to their performance in the benchpress to have a really stiff, you know, thoracic spine. But I'm not. I'm not convinced it's like a detriment to the performance that they get an improvement in mobility. Excuse me? Yeah, I don't really see that. As a detriment, I mean, it's obviously adaptation to the sport. Everything gets stiff, hips get stiff, low back F, like most of these guys don't have lumbar flexion. Most of these guys don't have any thoracic extension. But if we can improve it just enough, they don't need to be Gumby. They don't need to do back bends, but they need to, at least to get some of that torque off the shoulder and the elbow. Now, it makes sense, when they're back squatting, when they're bench pressing.
Unknown Speaker 40:42
Right, right. Right, right. Yeah, it's an intriguing, especially when you get to the real high end people. It's an intriguing question to me. You know, if you're just training for life, and that's a different scenario, but if you're an elite, you know, where does that come from? We the hip, external rotation and missing internal is become one of the things that I just don't know if I'm looking for it more. I'm just finding it more or I'm aware of it now. I don't know. But I don't know if it's a Is it the squatting? Right? So we're always turning out when we're squatting and dead lifting? Or is it life where we're always sitting in a posterior tilt hip, external rotated position? And now we're missing internal? What are your thoughts on that?
Unknown Speaker 41:23
I'm kind of boat now. I'm kind of checking my seating make sure I'm not saying I shouldn't rotation. I kind of I think it's a again, it's adaptation like I see MK like most of these guys, I don't have like this. I think it's it's kind of what's that, Gary, what's a great cook, quote, putting a loading, loading on dysfunction or something like that, where, you know, these guys already have this lifestyle where a lot of these guys have sit down jobs, where they're sitting there, they're working it, they work at a desk, like, you know, eight hours a day, and they're sitting in that position, and they're trying to get into, you know, a good squat position, and they're not able to, so they're sitting with their knees out, toes out. So they're never good. There's no need for them to get an internal rotation. But it's causing some issues down the road if they're kind of ignoring it.
Unknown Speaker 42:12
Right? Yeah. And it's just something I'm trying to put together in my own head and make sense of it. I kind of couch it to clients as, look, if you're sitting all day, and this is the position your pelvis is in and your hips sexually rotated. Well, when you go to walk, run, jump, like, you're just used to being there. That's what you've trained the most. So that's where your brain goes first. Right? Like that's your pattern. That's your activation pattern at its best that because you do it the most. So how do we train out that pattern? Because certainly, I can put a mulligan belt on their hip and give them some internal rotation and it's gonna last an hour, but I can give it to him. Yeah, so how do we, you know, what is the best way with when you have an athlete that is sitting all day in that position, then they're their training is in that position? What is how do we get them to sustain that hip internal? That's the that's the beast. What's your I mean, what's your move? What's your exercise? I just wanna go. Where do you
Unknown Speaker 43:09
Yeah, um, I usually will always have them. You know, obviously, we can't walk around with them with a mulligan belt. I'll usually haven't do some, you know, hit distractions and working on going back to FRC and getting them in that 99% 9090 position. With and pails and rails and that's
Unknown Speaker 43:29
what in the FRC terminology is 9090 sitting with your legs kind of one in front of the other one behind or is it laying exactly your feet on the wall? It's the first one
Unknown Speaker 43:38
No, no, it's sitting up. It's the first one. It's like sitting in like Shin is parallel to femur femurs parallel chin. Yeah, holding that position and really trying to improve internal rotation in that position. Although the other 9090 position I think it's from PRI does kind of does do the same thing. Yeah. Yeah. So I'll have them do that. And I'll have them sit there and actively train internal rotation. And, you know, we see some pretty good results as far as reducing hip pain. Just just doing that.
Unknown Speaker 44:08
Yeah. So I used to use that one all the time. And then I just kept finding that my people that had hip pain, like they would still pinch their, you know, I mean, like, oh, yeah, still, they'd still just jam up. And then it's like, alright, well, how do we get control this position? Went down the PRI world, I've done a lot of the PRI stuff. It works but it's complicated.
Unknown Speaker 44:30
Very complicated, complicated. I think. I think I had a friend tell me, he's like, you can't just take one course and get it you have to take all 200 of them or whatever it is.
Unknown Speaker 44:41
Well, I know somebody that's taken like some of the courses nine times each. And he's, he's very competent. Like he's incredibly, you know, smart. But my question is always can you translate if you have to take it nine times. Can you translate it to a client right, like Yes. Knowing what you know your background, if it takes that many times to understand it, oh, how the heck am I going to teach a client that in 30 minutes? Yeah. I mean, it's tough, it's tough. I've been doing a lot of like split stance work, because then I can mess with. Right, I get them in like a gait pattern of, you know, lunge position type deal. And now I can internally rotate one side, and then when I see the other foot blow out, so if I go hip internal rotation with extension, the knee behind, then I'll see that lead leg externally rotate, because they don't have the range. So they're just compensating, and I can correct it. In, in my mind, it's a little more functional than sitting in a in a hip 9090 on the floor. So that's, that's what I've been playing with the most recently. But I think that's that's a tough one. Always a tough one. Yeah, absolutely. Because you just see, they just compensate the other, right, you internally rotate one hip, but then the pelvis just rotates and moving that way, right? Oh, look at all the internal rotation I got, well, no, you just you just shift the grip. You just shifted your hips. And so how do you block that? And then not only how do you keep that from happening, but how do you make sure when they go home and do it? They're not? They're not cheating? Yeah, so those are, yeah, whatever. Those are the eternal struggles, I guess. But we've been doing pal off presses in that split, split launch position. Oh, yeah. It's a little gnarly. It's kind of cool.
Unknown Speaker 46:26
It is, man. I like I like the split. I like the split squat position for so many different things, man for rows for pressing. One, it's forcing, like a lot of stability, a lot of trunk stability, a lot of control. And like what you said, it's forcing into that internal rotation and they can sustain that knee position. It's, it's not an easy position to do. And I see that a lot in strength conditioning, too, is they're really pushing that foot squat position. With different things, either the forefoot loaded or that forefoot loaded position or you know, isometrics in there. It's, you know, it's it's a powerful position, especially for athletes.
Unknown Speaker 47:03
You've seen a lot of the isometric stuff. Now, I feel like Boyle was the first one to, you know, we're going back, I don't know, eight or nine years Boyle. When was that article where he was like, no more back squatting for my athletes. He was doing all Bulgarians. It's got to be remember that
Unknown Speaker 47:19
12 Maybe 13. I remember everybody losing everybody losing their mind. They're like, How dare you back squats are that and now like, I don't, I don't really see a lot of, you know, high level strength coaches with high level athletes doing, you know, bilateral back squats? Unless it's like a hack failed? Or if it's like a trap bar or something like that. A lot of them are going. So you know, I hate to say it Michael Boyle is right.
Unknown Speaker 47:43
I mean, he's Yeah, he's a big name for a reason, you know, seen as weak. But I mean, there's still something to back squatting. You know, I mean, there's it loads the system there. No doubt about that. Sure. It's, I feel like in the elite level world, we're seeing a lot more trends, the at least on Instagram, right, you're seeing the trends of balance exercises and these crazy rotational drills and it's a lot less of the traditional strength and conditioning and more like fancy stuff. Yeah. Do you think that's because people are trying to be Instagram famous? Or do you think it's legit training?
Unknown Speaker 48:18
You know, I know some pretty some of the pretty high level stuff is, you know, it's it's not necessarily I want to bash on him. But I do think it's fluff. It's just novelty. For the sake of novelty. Say, there's not I mean, there's so many split squat. Right? Yeah, it's it's something that it's just to keep person entertained. But I think there's nothing wrong with just a traditional Bulgarian split squat. It doesn't have to be a Hatfield with on SSB, with the front leg four footed on a hat on Eric's pad. And you're holding isometric five seconds, and you're calculating the velocity of the bar. I mean, it's like too much man. Like, how is that guy going to reproduce that when he goes home for the weekend? Right? And is is that just being Instagram and how useful is that when he gets on the court or on the field? I think some of the some of that is that but I also think, you know, I have this discussion session with some PT friends was you know, some of these traditional lifts like the back squat doesn't necessarily always carry over to you know, athletics, like a heavy heavy back squat or a heavy heavy deadlift might slow a wide receiver down, might slow like a sprinter down. So they need they need to keep that you know, relaxation or being able to contract fast and relax fast, which is a lot easier with lighter loads a lot easier with a plyometric versus, you know, alright, we're gonna do a five by five on on a front squat really happy?
Unknown Speaker 49:44
Yeah, well, like you're saying you're seeing that you're powerless, right? They're super stiff. I think there's got to be in my opinion, you know, again asked me this in a year I'll probably change my mind but there needs to be some base level of strength, right? Like if you don't have a certain amount of body weight to strength ratio, there's gonna be issues in performance. But then at some point there, there's probably a rate of diminishing return, right? Like, if you got a 400 pound back squat, does it matter if it's four or five or 415? You know, for an athlete, maybe maybe it does, maybe it doesn't. Once you're at that certain number of the 2x body weight or two and a half X body weight. At that point, maybe it doesn't matter anymore. You just got to maintain that strength and start working on all those those fine stuff. And maybe that is where the specialty stuffs coming into play. Yeah, I think that's interesting.
Unknown Speaker 50:34
I mean, it goes back to what was that milk is Mel Sif and Super Training. I think he was talking about shot putters, and I think that I could be wrong. I could be way off on the number but he was or, yeah, we shot putters, and he was like, the point of diminishing returns is like a 440 pound benchpress. So it's like, yeah, these guys gets a 440. Which isn't, like outlandish, like a guy like Chad Wesley Smith. But as low as 500. Yeah. But after that, it's just like, it's not going to make any better. So like, you know, you see a guy who's I don't know, I remember, you know, back in this is way back when like Shaq was doing like heavy deadlifts, and heavy squats. I don't know how much that helped him, or how much you know, he needed that strength. And how much that translated to the field. But you see these guys that are on the other hand, like I'll have these guys are come in. They're 15 and 16. They can't do a goblet squat with a 50 pound dumbbell. But their their parents want them to do crazy plyometrics and crazy. I was like, Dude, he doesn't have knee control. He can't even he can't even run without knee valgus he can't like there's he has like the the trunk strength of a jellyfish like what are you worried about plyometric right now for?
Unknown Speaker 51:45
Well, that's the downside of all the Instagram stuff, right? Their favorite athletes doing a single leg squat on a BOSU holding a bamboo bar. So when you put them on a stable surface, and they're just doing a Bulgarian they're bored. Yeah, exactly. But they're not. They're not at that. They don't have that training history. So yeah. Yeah, that's the downside to it. I mean, what's with all the loose? Right? I'm in Cleveland, right? What's with all these soft tissue injuries? Do you think that's a powerlifting? Problem? Do you think that's an under training problem? We're sensitive to here, because we've seen a ton of them. But yeah, your speculation, right? You have no idea what those people are doing for training. But in general, what do you what are your kind of overall thought?
Unknown Speaker 52:29
Um, I mean, it's probably a combination of both, like, guys just don't have that tissue tolerance, but also guys aren't taking care of themselves. So they're not getting that manual therapy, they're not getting the soft tissue work that they need. They're not recovering well. So maybe that comes back into the overtraining aspect of it, or the program is just not where it needs to be.
Unknown Speaker 52:48
Yeah, it's such a complicated question. Yeah. So that's a complicated question. I'm, there's two years ago, I think I just saw on my Facebook, where they followed, it was a girl sports game, I think was field hockey. Um, and the only variables related to injury was sleep and nutrition. Which, yeah, makes sense. I mean, they were all on the same training program, right? So he kind of eliminated that. And then the girls that weren't getting enough sleep, or weren't eating well got hurt. So you gotta be able to recover. Right? Yeah, to be able to recover.
Unknown Speaker 53:17
And that's kind of where elite sports is going right now is no all low management. They're just, hey, where where are these patients are? Where are these players at? What's their HRV? What how do they recover? What was their nutrition? Like? Okay, then they can do ABC in the gym? Oh, they didn't do any of that. So, you know, today's a recovery day for them, whatever it is.
Unknown Speaker 53:35
I've my personal, you know, this is a sign I'm getting old. But I'm kind of in this model of like, what does the active adult need? What does the average adult need to stay healthy and live long and so when you see this load management philosophy on these elite genetically just monster athletes, and they're watching every little thing, and then you're you know, your average 40 year old is doing Orangetheory eight days a week and CrossFit five days a week and yoga? I you know, like, how do we load manage the the regular adult? And what's that line? You know, because some of that stress relief, right? It's, it's, I'm sure, like a logical piece, and it gets real complicated real fast. I feel like and then we undertrained people, so then you got the other side of it, but kind of fun thoughts.
Unknown Speaker 54:27
Yeah, it's kind of I think it's kind of hard to man, man. It's funny, man. Like, I'll go to my clinic and my clinics in kind of an affluent area where I'll see that guy. He's like, Oh, yeah, I did. I did. I do yoga every morning. And then I come in here and I do my strength training. And then I'll get, I'll do my Pilates an afternoon and he's training like, four hours a day. And he's doing all these crazy things. And he's not recovered. I was like, Yeah, dude, no wonder you have tennis elbow on both arms and you can't like your shoulders on fire and, like, Dude, you're not recovering. But then on the other end, I'm in the emergency department just begging someone to walk like half a mile a day?
Unknown Speaker 55:01
Yeah, yeah, that's which messages which message is more important at scale? I don't know. I don't know. But you know, the business, the person doing the four workouts a day is also probably some kind of business person that's also working 1216 hours and always sleeping for four.
Unknown Speaker 55:16
Yeah, exactly. That's that you nailed it.
Unknown Speaker 55:18
That's the other. That's the other problem, right? Yeah, I mean, it's that balance is, you know, I guess if you had to pick you're going to be on the too much movement, but side of that equation, for sure. But yeah, no, no. Yeah. That's something that is just become very interesting to me as of late.
Unknown Speaker 55:39
Absolutely. Man, that's a pretty interesting thought. Yeah.
Unknown Speaker 55:42
Yeah. What is what is the right? So when you have a specific sport, I think it's easier, right? Like, if you're working with power lifters, like, they got to be strong period, like, they don't need to run a mile. They don't need to do this, they need to be strong. But if you just want to be, you know, the best 45 year old, the best 60 year old, the best 70 year old? What's your training look like? What's the frequency look like? What's the recovery look like? What's the load management? What's the stress? Man? You know, like, yeah, for just being an adult? Yeah.
Unknown Speaker 56:12
And that's, you know, that's a good question. And I think it comes person to person, but it's, it's pretty cool. And, you know, just the average guy who's, you know, a lawyer at a day actually cares about that kind of stuff, and wants to get to that ideal, like, you know, help for them. And they, you know, they come to you, they come to me, they go to a strength coach of, hey, how do I get here? And I think those are fun people to work with, because those are the people that actually, you know, want to be optimal for whatever it is they want to do.
Unknown Speaker 56:38
Well, and that's the other side of having a cash practice, if you will, is that most of your people? I mean, 99.999% are there because they just want to be better, right? Like, that's, yeah, absolutely. You're not getting any you're not getting any fluff. You're, you're treating people that want to get better. Which is awesome. All right, man. We're coming up on an hour. Let's wrap things up. I appreciate your time coming out. That was or getting on the call. That was awesome.
Unknown Speaker 57:04
Yeah, man. Thank you for having me. It was good. Catching up. It was good chatting with you. I don't get I don't get these kinds of conversations pretty often, man. So it was
Unknown Speaker 57:11
a lot of fun. Yeah, it's good. Well, that's the other part. When you're in a cash practice, right? You get you get to talk to yourself a lot. So we do zoom calls.
Unknown Speaker 57:18
Yeah, absolutely. Man. We do this once a month.
Unknown Speaker 57:20
Yeah, we'll pick up another one. We will pick a deeper topic on the powerlifting side or something like that, and really try to dive into getting into the science and nitty gritty of something. That'd be fun.
Unknown Speaker 57:30
Yeah, absolutely, man. Thank you for having me, Nick. This was awesome. Yeah, it's great. All right. We'll
Unknown Speaker 57:34
see you next time. Awesome, man. Thank you.
Transcribed by https://otter.ai
