#685: Dr. Shirley Sahrmann — A Legendary PT Does a Deep Dive on Tim's Low-Back Issues, Teaches How to Unlearn Painful Patterns, Talks About Movement as Medicine (or Poison), and More

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Me.
So
Hello, boys and girls, ladies and germs, this is Tim Ferris, and welcome to another episode of the Tim Ferris Show, where it is my job to deconstruct world class performers from all different disciplines. My guest today is Shirley a Sarman PTPHD.
But before we get to her bio, let me just explain. Shirley is a
Legend.
in the physical therapy world she has
influenced some of the top performance coaches in the world. She's also 85 years old, going on 86, and is not only razor sharp mentally, but in excellent shape.
Physically so she walks.
The walk. So let me get to the bio and I'll also give you a bit of one-one on some of the terms that we'll use in the conversation.
Shirley A. Sarman, PTPHD, is Professor Emerita of Physical Therapy at Washington University School of Medicine in St. Louis, Missouri. She received her bachelor's degree in physical therapy and her master's and doctorate degrees in neurobiology from Washington University.
where she joined the physical therapy faculty and became the first director of their PhD program in movement science.
Shirley, and she asked me to call her Shirley, became a Catherine Worthingham Fellow of the American Physical Therapy Association in 1986, and in 1998 was selected to receive the Mary McMillan Award, the association's highest.
Honor.
She has also received Washington University's Distinguished Faculty Award, the Distinguished Alumni Award, the School of Medicine's Inaural Distinguished Clinician Award, and an honorary doctorate from the University of Indianapolis. She has received as well the Bowling Earth.
Orthopedic Clinical Practice Award from the Orthopedic Academy of the APTA. She has served on the APTA board of directors and as president of the Missouri chapter.
Her books.
are iconic. They have been the initial domino that has
toppled over, so to speak, the enthusiasm, the ignition for many people to get into the field.
of movement science and physical therapy and performance coaching. Her first book, Diagnosis and Treatment of Movement Impairment Syndromes. You may have heard Eric Cressy mention this. It was a hugely influential book for him, has been translated into seven languages. Her second book, Movement System Impairment Syndrome of the Cervical and Thoracic Spines and the Extremities
has been equally influential in promoting movement diagnosis. And in this episode, we do a deep dive on low back pain. And that is something that for the first time really
I have been struggling with for the last let's just call it nine months or so. Could be a bit longer.
And we do get into the weeds with regard to anatomy.
particularly as it relates to the back stuff that I mentioned. So I'd like to go over a few terms before we start the interview, so you don't have to wonder what they are.
And
Feel like you need to pause to look them up.
You can get through the interview without listening to my definitions, but some of them might be helpful. Also if you're a kinesiologist or professional.
Please excuse these very simplistic and possibly slightly off definitions, but they'll help a lot of people. So the first one is the iliac crest. What is that? That's the uppermost border of your pelvic girdle. So you can think of the pelv girdle as that large bony ball that you see in the middle of a skeleton hanging in a science classroom or something.
You can feel
Your Iliad Cress, if you press your thumb.
into the top of your hip. That sort of bony ridge is your iliac crest. The tensor fac latte.
And I've heard many different pronunciations of this, and the fact of the matter is no one really speaks
Latin correctly'cause we don't know if it was
You know.
Vayne.
Vedi Vichy or Wayne Wedi We Chi.
For those who get that reference, I came, I saw, I conquered. So anyway, it is better known
And abbreviated as the TFL for a lot of people. So the TFL is a muscle at the outside, a very outside portion of the
thigh at the very top. So you could think of it also, people think of it as a hip muscle sometimes. You use it to balance your pelvis
When standing, walking or running, if you ever give someone a piggyback ride,
And I must get super sore on the side of
Your hip.
That is probably at least including the TFL.
You also use the TFL for
abducting your hip or pulling it away from the midline of your body compared to abducting with two D's, which would be pulling it toward the midline. One way that I remember that abduction, it's like an alien abduction taking you away. So moving the
Say leg away from body abducting.
Bringing the thigh in.
adduction. So like an adductor machine at a gym, one of those.
Susan Summers, thigh master type machines would be that. We also talk about muscles that assist in lateral rotation.
Lateral rotation is rotating away from the center of the body, medial rotation is rotating towards the center. So imagine
If you turned your feet outwards to look like you were duck footed, that would be lateral rotation.
out to the sides, and then if you turn them inward.
To be pigeon toed, that would be medial rotation of both femurs inward.
All right, SOAS major. I also mentioned SOAS major. That's spelled P S O A S major. That is a large muscle that joins the upper and lower parts of the body. And it also contributes to a lot of lower back pain. It connects to the inside of the lower back. And if you were to take
Say your
Four fingers.
and move them four inches to either side of your navel and then press in
Say four inches, that would probably
touch your SOAS major, which is why
Massage therapy that addresses it can be so uncomfortable. For you chefs out there or hunters or people who might recognize this, this would be the equivalent of your tenderloin.
So if you're wondering what a tenderloin is.
It is this muscle that
in many animals. And there may be other ways to use that butchering term, but
So as Major Tenderloin.
There you have it, used mostly for posture and so on.
We also get into stenosis as it relates to my spine. So stenosis is an abnormal narrowing, and I have some stenosis around L four, L five.
Which is in the lumbar.
spine or lower spine, which puts pressure on some nerves there and causes all sorts of pain. The thoracic spine is more of, say, the middle of the back
And kinda you just think between the shoulder blades for simplicity. Okay. Last
And I could say not least, but who knows? These are all kind of equivalent and useful.
You have supine versus prone positions. Supine is lying on your back. Prone is lying on your stomach. If you've ever wondered what a supinated grip is or a pronated grip.
Supinated is palm up, and you can remember that because if you want to pour soup into your hand, you have your palm up. Okay, so that is supine. And honestly.
Learning the basics of anatomy and the basics of some medical terminology is I think one of the best
absolute best investments you can make in your health because then you can talk the talk with professionals and they take you more seriously, they give you better advice, they give you the straight scoop.
So this is all a very good investment of time. You can find a glossary of these terms and more in the show notes for this episode at Tim.blog. And I do want to mention one other thing. If you want an incredible rotating view.
of different muscles like the QL. We talk about the quadratus lumborum. That's sort of this squarish rectangular.
muscle in the lower back area that is sort of the grand central station.
Of all sorts of things.
If you want to see anything, the SOAS major, check out the Essential Anatomy 5 app for iOS and Android.
And uh
You can see all of this. You can also see the circulatory system and all sorts of other things. It's a great app.
Really enjoyed it. And there are short YouTube tutorials that I recommend taking a look at if you end up downloading it. And that was referred to me by professional drummer Dave Eelich, who helps people improve their mechanics, technique, and much more. And uh there you have it.
So if you want a video to go with this, I did record video of this conversation and I get up and walk around and she does an assessment with me live. You can go to my YouTube channel, YouTube.com slash Tim Ferris to R S to S, and that will have some helpful graphics and so on overlaid into the video. Okay, that's quite a bit, guys, but
I think it is a helpful prelude.
And now, without further ado, please enjoy this wide ranging conversation with Dr. Shirley Sarman.

Doctor Sarman, Shirley, welcome to the show. It's so nice to have you.
With me today and I can't wait.
To ask.
A whole host of different questions. So thank you for making the time.
My pleasure.
And I'd like to begin
Perhaps with
the connective tissue that led to you being on the show today, which is a friend of mine and a well known
Suppose
The label performance coach could be applied. He also has a background in physical therapy. Eric Cressy, he works with many major league baseball players, has a high degree of success.
With pitchers specifically.
But he has written and he also mentioned to me that
That
Diagnosis and treatment of movement impairment syndromes.
Is probably the book, and I'm quoting him here, is probably the book that has influenced me more than any other in my career. It's worth every penny. I'm curious.
Why it is that this book
Seems to have been so revolutionary for him and many others.
What would you
Say
Explains that.
Or differentiates that book.
the one big objective in it I've actually been a physical therapist for
Over sixty years.
And during all of that time I've been through
different eras of
Changes in physical therapy.
And where I've sort of gotten to and is how movement basically induces pathology.
And part of that
Trying to explain that.
And how it works.
is also developing diagnostic categories that direct physical therapy treatment.
So
What this book was about was a first attempt to really put together
diagnostic categories that are based on on movement.
and movement as an inducer of musculoskeletal problems.
Also kind of working on the on the background of
What are the tissue adaptations that that contribute to this?
So it really was an organizational attempt.
Two.
identify for
In the first book we covered the
The back
And the shoulder.
And the hip and so I guess
The shoulder is one of the
Things that he must have been.
particularly interested in if he's dealing with pitchers.
And the shoulders really quite
complex because you've got that shoulder blade as well as the glenohumeral joint and
It's not as easy as muscles just turn on or turn off.
appropriately, they've got to really be well coordinated.
So I think that
putting together this kind of information in a in a way that could be understood by a whole variety of people. In fact, I was so slow in getting it out that I was
Grateful that there was the
Internet and
Amazon selling things because if it would have only been sold
In medical bookstores, no one
Like Eric would have ever.
Found it.
Ha
So that was one of the advantages of
Being a slow rider.
And of course I I learned more.
Well all that was happening too.
How did that
attempt or maybe not attempt, how did that organizational approach
And also
the maybe reframing of movement in the way that you just described differ from what
Came.
before or what was predominant at the time.
To be perfectly honest with you, Tim, it's not like this insight has been taken over by
even the the large majority of the people in my profession.
It's still a bit of a struggle to
have people move in this direction for
A whole variety of reasons.
But typically in
Even though I wasn't there when physical therapy was f first started, I wasn't too far behind.
But typically the role of the physical therapist was the doctor
figured out what the problem was, made the diagnosis.
And the physist really provided
Treatment for
What I think could fairly be called the symptoms or the consequences.
of that problem. In fact I am old enough that I actually saw polio patients.
The uh vaccine had just come out about when I was
Entering physical therapy school.
So we had a role in
Providing the therapy.
Far.
the doctor's identified condition.
And that's very different.
than what I'm proposing or have proposed with this book. And I think the other thing that that's so important about all this and
I'm sure you you are
A reflection of this is that
In the old days no one thought lifestyle had anything to do with your health.
I always like to point out the story my my family cooked with so much Crisco I don't know how my blood flows.
And if the green beans were too healthy, we had bacon grease to put on'em. You know?

But I I was I was very fortunate I worked with a
physician for a while who
who was really leading the way and showing about the role of exercise and nutrition.
He did what that's really called translational research.
showing the the cellular changes in animals and then also running studies in older people.
And it was like
An amazing
Insight for me to realise that
Your lifestyle had something to do with it.
So I think that's behind
what's slowly emerging as seeing
movement play a different role. It's
I think what I'm liked
Get across to people. It's not inevitable.
what's gonna happen to you that you can do things.
Buy a lifestyle.
To improve.
What your outcome's gonna be.
I would love to come back to
I believe, and I don't want to misquote you, but something you said, which is the treatment of symptoms. So many
offices are treating symptoms, perhaps not root causes. And I've read
Uh and you can't believe everything you read on the internet, so please correct me if I'm getting this wrong.

Describe low back pain.
as not a diagnosis, but a symptom. And could you just speak to that? Because I as someone who currently for the last maybe six to nine months
has had a very perplexing constellation of symptoms that
I describe as low back pain.
This I think will resonate with many people who are listening. So would you mind elaborating on low back pain as a symptom and not a diagnosis? No, I mean just what you're saying. You're saying slow back pain. You're just telling me that you've got pain and you're telling me where you've got pain. That is clearly a symptom.
Yeah, right.
I am from Long Island, so sometimes I ask the silliest silliest of questions, but gotta start with the best. So um even without an MD degree.
But
Where I would be looking at that problem and I have an idea of what your problem is.
Wow.
Okay, already.
Just because we can talk about that.
Okay. I mean I don't want to sound too too glib about about it, but
What I would be doing is naming
Your low back pain.
by the movement.
That
most consistently
Causes your symptoms.
And by changing that movement.
reduces or eliminates your symptoms.
Then I'm talking to you about
The
a real cause of the problem. Now it's not going down to the tissue level and saying, Well
You know, it's a disc or a facet joid or
And you're the rest of it.
But
Here again, in some ways.
When you have a problem like that, you can't say in the back but one tissue's at fault because
A lot of tissues have to change if you're having pain coming from your
Back region.
So
The expertise of a of a physical therapist.
needs to be what is the movement that's either causing or exacerbating.
That problem.
So I'm curious to well, maybe we can we can dive into you said I that you thought you might know what my
My issue is That's because I know you're a big exerciser.
I just
Yes, indeed. And and do you know I mean, do you want me to just give you a ballpark idea?
I do. Okay. Absolutely.
Well because
Would you believe that abdominals can get to be too much?
Like
Over developed.
I you know, it makes some intuitive sense, but it's not something you hear many people talking about. I know, I know. Even within the community of physical therapists, people are
really exercising big time. I mean, uh
High intensity exercise is is super popular. I I'm all for it because it'll increase our patient load.


But
One of the things that happens when your abdominals
are overdeveloped because what happens when muscles hypertrophy they they become stiffer.
And muscles are like springs.
So they have a I mean I'm using the mechanical word of stiffness.
And so when the abdominals get to be too much,
They
Increase the compression on your spine.
And so
the way you can check me out on this is if you look to see if you take
A deep breath if you go from maximum exhalation to maximum inhalation.
You should be able to change the circumference of your ribcage about
Two and a half to three inches.
And if you can't really do that.
then it means that the stiffness of your abdominal muscles is so much it's adding to the compression.

And then if you have any kind of asymmetry, if for example
If you put your hands on your iliac crest and one iliac crest is slightly higher than the other.
Then you're basically your your spine is in a side bend.
And if it's in a side bent and you're squeezing on your vertebrae, they're not happy because they aren't
Lined up as optimally as possible. Do you see what I mean?
I do. Absolutely. Okay. So that that's the ballpark idea.
That also reflects how we're looking at these problems. What it is it about
The way you move, what is it about the way you've exercised or done things?
That caused the symptoms.
I would love to spend more time on this, selfishly, of course, because the reason I am sitting and not standing for this interview is because of this lower back pain. So so it's worse when you're standing than when you're sitting?
It is
Worse when I am standing. Now I do have, I guess we'll we can jump right into the weeds. I have a transitional segment, if I'm using the right terminology, in my lumbar. So I do have quite a bit of excessive lower back sway or atypical lower back sway, which is people.
D you mean an increased curve?
Increase curve, yeah, like lower doses and
kind of guts hanging out. And
With that interior.
Pelvic.
Tilt, right? Standing and slow walking, say walking through a museum.
tend to
Aggravate it.
the most my brother has the same thing.
Although
In the last six months or so, when I sit on a very hard surface, like a hard
Bench or something like that.
Yeah.
also causes this pain. I have had imaging, but maybe we could talk about imaging, how you see some people who look like they've gone through a multure on their back MRI, but they're asymptomatic and then you have the opposite. So I do have some
Denosis around like L four, L five, but
The
pain feels to me localized around the SI joint.
the relief, if this is helpful, I know we're getting a little technical for some folks, but the relief that I've had in the last week was actually from seeing a chiropractor. There's a high degree of variability with chiropractors, but he works with a lot of athletes.
And he put me on a machine that
provided some traction and he said, I think it's actually that you may have a disc
pressing on a nerve that runs past the SI joint. So you're misattributing the cause to the SI and
I've had quite a bit of relief, but to answer your question, standing slow walking.
Combined with standing, like going through a museum or a cocktail party, sitting on hard surfaces, those are the three things that hurt.
Brisk walking does not hurt. And actually that type of and this is a primitive interpretation, but sort of repeated stretching of the hip flexors if I'm getting enough terminal hip extension feels really good.

Those are a few of the the things.
Have you put your hands on your pelvis to see when you're walking?
If it rotates.
I have not.
I would love to know how to do that properly.
It's not rocket science.
You know where your pelvis is, you know where your hands are.
Just
Because
very often when your hip flexors are are not even just not short, just stiff.
Stiffer than your back.
As you walk it rotates your pelvis and that's where you're gonna be getting your symptoms from.
And evidently when you go fast enough,
You're not staying static and you're
Causing enough equal movement.
But
That would be the big thing.
Can can when you when you stand up.
And you're in this anterior tilt, can you contract your abdominals enough to get out of the tilt?
I can.
Yeah.
And then does that decrease your symptoms?
It does decrease my symptoms. So if my back is bothering me, I'll very often do basically a forward fold or a full squat and then round my back and get into that flexed position.
The flexed position and even mild extension does not bother the back. If I do a compression test, like a heel drop test, or I pull myself into a chair, it's standing straight up and with compression that shows that that type of intolerance. And I get that pain kind of directly on the lower spine.
The other thing to try, Tim, is w when you stand up
Put your feet apart.
Separate them out and see if that changes your symptoms.
What is that doing?
Number one is this little thing I referred to before, if one iliac crust is higher than another
And it's a test for what we call relative stiffness.
So one of the big hip flexor that's problematic is called the tensor fasciolata.
Yeah.
Mm-hmm.
And it's an abductor.
So if you put your
Feet apart.
So your hips are abducted, it takes the stretch off of that band.
Uh.
Mm-hmm. And any kind of asymmetry that you would have, particularly with the transition vertebrae.
would be playing into the symptoms. Do you see what I mean?
I do.
And then if you put'em together and your symptoms increase.
Then you would know that that's what's playing a role.
In doing this.
So I'll add a a few more things just because this is a rare opportunity to get to talk with you about this. So my
TFL.
is very
tends to be very tight and sensitive. Yeah, that's that's yeah. The pure form is also very tight. Uh piece of this that may or may not be helpful, but what gives my back also some release is working on the very specifically the iliacus and then some of the adductors so on the inside of the thigh. No, I don't know how you do that.
Tell me what that means.
Well having someone really dig
uh into the ab abdomen to have me say extend the leg. Oh, it's not you working on it, somebody else's No, it's somebody else working on it. Um and then it's not very pleasant for people who are listening. And then some of my adductors, I don't know if it's Magnus longus or whatever, but
Also very tight and seemingly potentially weak. But to come back to the height, maybe the asymmetry of the Iliak crest, my right side seems to get hiked up a lot and doing wall sits.
to try to press them maybe back into some symmetry seems to alleviate some of the symptoms as well. I don't know if any of this makes any sense.
You've just confirmed one of my thoughts is
that if your right iliac crust is higher than your left.
But then I would also bet that your right TfL is stiffer than your left.
So
If that's playing a role, then when you put your feet apart, your iliac crust should level out.
That should help with your symptoms. So historically when I've been recording podcasts, I basically end up in that really wide stance.
And so I think I'm composite is now is that
I mean that's useful for maybe
Temporarily relieving the symptoms if I'm recording a podcast in terms of corrective measures.
Let's just say using your have you ever tried anything where you're in the quadruped position?
I have actually a long time ago I did a lot of movement in quadruped position, but I would be curious to hear what you have in mind.

Stays higher than another and I I'm not
To be perfectly honest with you, I haven't quite figured it all out yet, but there's some adaptation of the other
hip muscles and
I've just found that
If you do this.
In quadruped, you just rock back.
Mm-hmm.
Often it will.
Improve the asymmetry.
Uh. So basically being on hands and knees?
Hands and knees, right and and let your hips drop.
to about ninety degrees. You don't have to go back all the way. You just need to go back a a little bit and go back by easily pushing with your hands.
Because otherwise if you activate your hip flexors.
It could pull it.
Contribute to your
Okay.
Can you tolerate prone?
Yeah, I can tolerate prone.
And then you need to just do like
Just flex your knee.
And then you need to laterally rotate your hip. So you're letting your
Your knee flex to ninety degrees.
And then let your foot go.
in towards the other leg.
That's lateral rotation.
Yeah.
And that kind of motion will help to
Elongate.
The T FL.
I too. Interesting. And you're doing that leg by leg.
Oh yeah, yeah, one leg at a time. One leg at a time. Okay. Yeah, yeah, and do everything by
Bilaterally.
Mm-hmm. Yeah. Okay.
Very interesting.
Try those things. Let me know. I will.
I will do I will do both of those. So let's if we zoom out.
Just for a moment. Thank you for that, by the way. We may come back to it. How would you describe
the movement systems syndromes approach, so the MSS approach. What would the sort of lay description of that be?
In two thousand thirteen the
American Physical Therapy Association.
adopted the movement system as its identity.

And to me what's really important about all of this is
Then it's a way of trying to say to the public
That there is a body system
Called the movement system.
Mm-hmm. And it's not like the traditional
Anatomically.
Define systems like the
Cardiovascular system or the
musculoskeletal system or the nervous system. It's a
System of systems.
But that's just like
In my mind.
The immune system.
Which nothing is more important in medicine these days than the immune system.
And it's a system of system. It uses many of the different organs.
In its function. Metabolic system is the same way.

And so
When you think of it as running from
subcellular on all the way up to how do you move in your environment, movement is is critical.
When movement stops, everything stops.
And so I think it's a very good thing.
In some ways to me it's a like a parallel to the
nutrition system.
Because
We take for granted.

Doing it.
And yet
There's right ways and there's wrong ways.

And so the whole idea of this is to realise
That their movement does involve a a system.
And just like we were talking about before.
movement if you have a lesion in a system, like you have rheumatoid arthritis or something, or you have a stroke.
then you've got pathology in your movement.
But
As I indicated
Movement.
can also induce pathology. In fact we know if people don't move enough
They develop.
The metabolic syndrome.
And other other kinds of things because for lack of movement.
So
How important it is to move. This is related to the lifestyle issue.
And doing it right.
One of the things I always love doing with with patients was saying, So who taught you to walk?
Then they say nobody and I say, That's the problem.
Just because you're doing it doesn't mean you're doing it right. You're just doing it. Just like you. If you're walking and you're getting lumbopelvic rotation, that's playing into your problem.
Right. And also if I don't have the I don't which I don't think I do, this is one pattern of diagnosis with with me that I think is accurate that I don't have much terminal hip extension. So when I walk, I'm using my lower back to fake
Hip extension. Yeah.
See, that's what I'm saying you and you really can't do that.
I mean
There's no way you won't keep injuring your back if you keep walking like that.
And how do you re-pattern
Or
help people to adopt so that they can use it subconsciously new motor patterns or new movement patterns. Right, because I've been doing this for God knows how many decades.
Well, not that many who don't look that old. Thank you. Thank you. I appreciate that. My new best friend.
How do you help patients to get to that point where they've changed something as fundamental as how they walk?
In my mind it's twofold. In one we know it takes a while, just like if you're learning a sport or you're
learning to do anything, it takes time and it takes attention.
And it takes specificity.
And so one is just like we're talking about with you.
What are the most important kinds of exercises? What are the
Issues that are
an impediment to doing it the way you should do it.
What are specific exercises that can help you?
And minimize those.
And then
What's really important is showing you in your everyday activities.
What you should do.
For example, if you already know that
You're
Hip flexors, you're calling it the iliacus.
is problematic, then even when you're sitting, making sure you're not
Pulling with your
Hip flexors to stay forward. I know. I've been watching you.
Ha ha ha.
It's how you even roll over or get out of bed.
We go through every one of these things teaching you in your everyday activities.
So that it does become
Automatic, but you know, it obviously takes participation on the patients or the subjects part.
as well to learn it and then you know it's gonna take time.
I think it's important for people to realise they can't just
Dude.
ten repetitions or three sets of an exercise and then they're gonna move differently.
I think that's been part of what
been picked up in my in my book is that
You have to
Bring people along, show them how to do that.
And that
Exercise won't change the way you move, you have to change the way you move.
And that can improve how muscles function.
Mm-hmm.
You mentioned the SOAS. I'd I'd actually like to come back to the SOAS. In my particular case, because I have been an aggressive athlete or was for several decades and accrued an impressive number of fractures and surgeries and so on. I get manual uh I get manual therapy once a week. Some type of soft tissue treatment.
And what I found for me personally is it seems like so as major and so on, when someone does a manual release, for whatever reason, when they get sort of inside that
pelvis a bit more to what I've been told is the Iliakis, that's when I feel the most symptomatic relief.
for my back, but the SOAS seems to hold some importance. I don't know if you could speak to that, but in terms of
the role of so as over activity.
as it relates to
Back pain.
Is that something that you still feel is something people pay too little attention to?
I don't think it's always the cause, but it can certainly be an exacerbator because the psoas attaches to the lumbar vertebrae.
And it also attaches to the intervertebral disc.
It's a muscle that's constantly pulling on your back and pulling it.
In sort of a translation motion.
Iliacus is attached to your pelvis.
So it it's not directly acting on the vertebrae the same way the the psoas is.
In fact,
truly have a herniated disc and they're in that
A cute face.
I I
Try to have them do
Nothing w with their Ilioso. If they wanna lift their leg up, use your hand to lift your leg up.
To put your shoes on or to
cross your legs or get into the car or something if you're sitting down already.
So you
Minimize.
that used. And just like we were talking about in quadruped
If you
Or in quadruped and you want to rock back.
You will probably use
The soist to do it.
And that's why I suggested to you to push with your hands
So you go back and you don't use that muscle. Well, these are small samples of what I'm talking about.
As far as identifying
What are the factors that are contributing?
And how do you change that in your everyday activities?
Yeah. What would be some other
repeating culprits that you see. Let's just say someone has
The symptom.
of low back pain, you take them through an assessment or identify that they have an overactive psoas, what might be some other low hanging fruit with respect to
Helping them to identify common
Patterns.
or positions that contribute to that over activity.
In some ways.
I I would be looking more specifically at
Which particular movements do it?
Okay.
Try to identify. For example
It would be hard for me to believe this, but
If you're
hip flexors. And it makes a difference. Like the Tensor Fashionada is a hip flexor.

But it has a rotational component that's much stronger than the
than the psoas does. The psoas has more
Anter pull.
Yeah.

And I will tell you that
In my
judgment and I don't think I'm way off on this.
At least seventy percent of the people with back pain it's because their hips not moving optimally.
And you said it yourself.
My hip is not moving and then it bothers my back. Well, that's exactly what goes on.
And it doesn't take some big structural fault to have that.
Just a difference.
in the passive tension.
So
Usually with younger people if I'm gonna generalize about back pain.
It's related to
They're spine flexing because when you're younger you're more flexible.
Mm-hmm.
And I think the other thing that's tied to that while we're talking about the hip is they're identifying more and more that
Yep.
what they call thermal acetabular impingement.
Hips aren't flexing.
as much there's structural changes going on.
So if your hip only flexes ninety degrees, then you wanna bend over, you're gonna do it much more in your back.
Because your hip's not doing it.
So I wanna all the things that
Relate deflection.

In the older person.
then it's more related to extension, just like the stenosis thing.

That's when you really can't extend
That's why you see old people walking bent over.
Why they need a walker.
When they're bending over.
And then
The element of rotation.
And because it's not just
Is it one iliopsous that's problematic or both of them? One tensor that's pulling more strongly than the other. And that's the passive tension, not just the active tension.
And that's what you have to know.
I'm
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Now, you were asking about my breathing and the the deep breath. When I met with
Eric and I could be totally screwing up this terminology. So you you may need to rain me in. But he had me take off my shirt and he I think it was at a very low, it might be high, but infrasternal angle. So I have a bit of a depression in the chest.
I have a very minimal ability to
Expand my rib cage. I'm a bell breather and
I've had a number of people note
That
It's likely when I breathe I kind of
rotate my entire rib cage backwards, which also causes that excessive
Exactly. That excessive hinging at the at the lumbar. What do you do with somebody who's got this
Type of
Predicament.
Or pattern.
Usually as I was saying before, if if your ribcage doesn't expand
Then
It's often because your abdominals are too tight.
And so one of the ways is to
Elongate them.
So
Arms up over your head and taking a deep breath.
Mm-hmm.
And just
you probably know that with breathing you've got two modes of movement. One they call pump handle and the other
Is a bucket handle.
I'd love for you to elaborate on that.
Yeah. Okay. Well pump handle means your the front of your chest, your sternum is going up.
Like a
And bucket handle is like the sides expand.
Mm-hmm.
And so
With arms up overhead you want to really think about
Lifting your chest as well as
Pushing your ribcage out.
Laterally, you mean. Yeah, laterally. Like it's all going up.

And then
Yeah, yeah. Can you can you do that? Can you take
Yeah. Yeah, it's sad.
Yeah, I don't have much. It doesn't do much.
Yeah, no.
Yeah. That's what you need to do. And then here's the other thing that
If you stand with your back against the wall.
And then you try to do
A side bent, but
But but
You wanna make sure the side bend you're moving through
that the axis of rotation is through your chest, not in your lumbar spine.
Yeah, make my symptoms worse.
And you wanna be sure.
Tim, that you don't
Just pull yourself over. You wanna try to fall like you've got a
Heavy elbow.
In other words.
Don't contract the muscles on the same side.
But tried it.
Get these to elongate.
So like they're falling over.
More passive.
Elongation rather than an active contraction.
No, you're not gonna go real far.
Initially.
Unless you got a really heavy elbow.
Yeah. So the axis of rotation should be or the fulcrum should be the middle of the chest. Yeah, right. And don't I always like to say
I don't care how far you go, I care how you get there.
And so don't push it for big range and just make sure you're not
moving your lumbar spine and that you're doing your thoracic spine.
And are you breathing in those positions or is this stretching your intercostals or what is the the objective of the objective is to elongate those abdominals that are not.
The other thing is just even when you were doing this, you don't have any symptoms at all when you're sitting there.
Right now.
I have a little a little tightness in my low back. I am sitting in in a chair with lumbar support.
Why do you do that when you
Yeah, too much lumbar curve anyway.
Well, because I've noticed that for whatever reason, symptomatically I get relief with a small amount of of lumbar support. If it's a flat back chair.
And I end up kinda c falling forward and flattening my back. It it ends up
Hurting me much more lately. Yeah, because you're getting a translation motion. But
Okay, what if you put your arms up over your head and take a deep breath? Does that decrease your symptoms at all?
I would say uh n doesn't noticeably I don't have any severe symptoms right this instant.
But
Doesn't worsen it.
For sure.
Yeah, but it doesn't make it any better either.
It might lessen it slightly.
the degree of pain right now, I would say, is pretty low. So it's hard for me to monitor. And again, if you look at it from the standpoint
The more you move someplace else besides your back.
the better off you're gonna be.
Yeah.
Definitely.
That's
Part of the whole strategy is make sure
Because usually the problem is
that motion that's problematic is occurring during all of your activities.
The body follows the rules of physics, it takes the path of least resistance.
So if it's easy to move there, it keeps moving there.
And that's what you're trying to change to make it easier to move.
In other places.
Where you should be moving more.
This seems to me to be very, very, very important. So would you mind just saying that again, just reiterating
that the body follows the path of least resistance. So if you have a worn groove, you have to in its leading to pathology, you need to sort of grease a different groove. Could you could you just speak to that because I it strikes me doing a beautiful job yourself. I don't think you need me
Well, you know, I'm I'm great at pontificating, I just need to change my movements. Okay. Father superior. Um, I just you know, I I I talk a good game. I just have to fix my movement badness and my breathing. But I I like how you phrase it. I mean it's the body is going to take the path of least resistance.
That's it exactly.
I'm gonna follow these
These exercises I will do I'll experiment with the elongation. I wanted to add
one more data point which is
If I do for instance
Pilates classes with someone who's very technical. If I'm in that flexed position, which tends to be more comfortable for my back.
If I'm experiencing a lot of symptoms.
I
Um supine, yes. Okay. You're supine.
Yep.
And then what are you gonna do?
Well, if I'm doing basically what I'm what I'm trying to sort out for myself is if
the overly contract abdominal resting state.
can contribute to the symptoms of experiencing what I've also experienced is if I do a workout that seems to be focused or is focused on a lot of core musculature and pelvis work and so on, that my low back doesn't bother me for a few hours after that workout. And I don't know
How to
interpret that, maybe these things are not at odds. Maybe they can both be true for different reasons.
Well, I I mean it depends on what your work out is. What would be bad in the long run is if you're doing a lot of holding your legs up and moving those
Moving those around.
Well you're
Supine because again you're gonna be using your iliopsoas and it's gonna be pulling on your back.
The big thing is for you to be able to contract
I'm getting the picture from you that I didn't have before that
Here you are it with an increased lumbar.
Curve.
And that your lower abdominals aren't as taut.
In lower abdominals I mean external obliques, not just the ones that are
Or lower.
And when you contract
Those muscles.
That they tend to
Flatten your back and decrease your symptoms.
Yes.
Okay. And so that would be to me.
What the advantage is when you're
Supine and starting to do the exercise.
What would be
Not the long run good is if you're holding your legs up
and trying to do something with your legs while you're holding that position.
Because you're
You're building in too much activity from the
Ilios show us.
So
If anything, in that position, I would just have you slide your leg down and try to keep your pelvis from tilting.
Put your hands around your
I I'm sure you probably know what
A S I S are.
Anterior superior iliac spy.
I do on the front of the front of the hip. Yeah. Yeah.
And
Just make sure they don't tilt. For people who are wondering, could you just describe what that is?
It's a little bony prominence on the front of your
Your pelvis.
And
Some of your major hip flexors at attached there.
But it's also an indication of what your pelvis is doing as far as
Tilting forward or tilting backward.
And w in your case what you want to do is not have it tilt forward.
So the importance of that exercise would be
That you can move your legs.
without your pelvis tilting anteriorly.
I wouldn't put a big load on them.
I would only have them slide down.
Like you're sliding your heel along the supporting surface.
Get it all the way down on one leg with no tilt.
See if you can do the same thing with the other.
If you have difficulty from what we've talked about before.
If you take them out in abduction.
You should be able to get'em down easier.
Because your tensor is gonna be
Pulling on your pelvis as well.
Right. So for people listening, if I'm interpreting this correctly, if your legs are separated, so you're more your legs end up more in a snow angel type of position as opposed to directly
In front of your hips.
Predominantly a diagnostic or is it also a training?
Move that slide.
All the above.
I mean that that's the nice thing about going through an exam in which you're looking for this path of least resistance, the the motion that is occurring too readily.
Because it'll occur too readily.
With all of the activities.
It goes back to what we were saying before.
Then you try to make sure that your
Either not getting that motion or you're moving where you should be moving.
when you're taking people through the exam, and I think this is what's so valuable.
Because you're also showing'em how to be in charge of their symptoms.
Because nothing is more scary than
Then
Here comes the pain, what did I do, how did I do it, how do I get out of it.
And if you're showing people
If you go this way it hurts. If you
Do it this other m way, it doesn't hurt.
And that's helps also with people.
following the program that's recommended because
Their symptoms are they're in charge of them.
And they know what to do.
To decrease them.
This personal experience has been incredibly frustrating, kind of horrifying, because it's the first time in my life. If if you tear a labrum in your shoulder or you break a
break an arm or break a collarbone. It's oftentimes reasonably straightforward or it seems that way. Whereas with this lower back pain, I would feel better for three days and then I would wake up and I would just be in incredible like eight out of ten, nine out of ten pain. And I could not identify what the cause was
And there have been times when my QL and my external obliques and so on are so locked up in the paraspinals that I can stand for a few minutes and I have to sit down.
Find something soft. And that's not the case right now, but the recurrence of symptoms has been
so unpredictable on some level. And a friend of mine who's in medical profession said, Oh, how long have you had that? And I said, nine months. And she said, Well, you technically qualify someone with chronic pain. And I was like, oh my God, is this the new normal? This cannot be the new normal.
Which is why I appreciate you taking so much time speaking about this. When someone comes in
And they
Have not identified.
anything. They come to you for help or someone who's trained in your system.
What does the exam
Look like
What does the session look like?
First is it's looking at what they look like.
I mean, for me, it's just like if I saw you standing, I would know a whole lot more than
Just looking at you sitting.
Because
All of these things that we've talked about
Indirectly I would see
Immediately. So one is just looking at alignment.
And
Believe me, that's that's a roadmap to a whole lot of things.
And
I think it it's also worth noting that
It's why people stand the way they stand is to minimize energy expenditure.
So you can see what the passive tensions are.
Which are reflective of how hypertrophy the muscle is.
And then it's simple motions, Tim,
Have people forward bend.
Does their back flex too much? Does it not reverse its curve?
With you and how
How much do their hips?
Flex.
And typically in men, there's more of a problem of
Excessive lumbar flexion.
than there are in women just because
The center of gravity is higher, the hips are stiffer.
Excellent.
So
How do they forward Ben?
How do they rotate?
Because many people will twist and
Rather than be really be able to rotate.
And uh then side bending.
Does it hurt? Where do I see the Now by twist, you mean their pelvis follows them instead of that sort of No that see that's that's the other thing that's interesting is because
I'm sure with you they people have looked at what your range of motion is in your hips.
But when you're standing, you don't have that same range of motion. Your pelvis won't rotate
On your femur's the same amount.
So one, does your hips not move and therefore you have to move
in your back more because your pelvis isn't rotating.
Or is it asymmetrical?

And then the other thing is that actually, ironically, if your abdominals are really good
Instead of sort of
rotating off more of an axis, though it's not perfect.
Your trunk shifts over.
Because if your trunk shifts over in a twisting motion,
It's because your abdominals won't elongate.
Easily.
And then
Which one of these motions causes symptoms?
When I see that it's bad.
I will correct it. For example,
If you had pain side bending.
I put my hand
Above your iliac crest.
Have you side bent again?
And if I've blocked it and you don't have pain, then I know that that motion occurring there is causing your pain.
The movement of the pelvis.
Or the LE crest.
The movement in your back.
And the same thing if
If you bend over and there's no pain, but you come back up and you lead with your back rather than your hips, you
And that causes pain, then I know
Again that extending is causing your symptoms.
And then
If your symptoms as you have reported.
Get better when you bend over.
Again, I know that extension's causing your symptoms.
And then I go through little tests.
In supine to see
The length of the
hip flexor muscles.
I look to see what your symptoms are in supine.
If you have symptoms.
Just like you sort of suggested.
If we flex your hips and knees, you ought to be more comfortable?
Than when they're down straight?
If I abduct your hips?
I know that
What's causing it that way. Do you see what I mean?
So I will passively move your hips to see what the range is?
Make sure it's passive, and then I'll have you do it actively to see if that elicits symptoms.
Show you how to change it.
So I'm going through an exam.
Looking for that movement that shows up consistently.
If I stop it or improve it?
Symptoms go down. So we do s in supine.
Sideline.
Chrome.
Quadruped.
Sitting.
Watch people walk.
Everything that gives them pain, they get in and out of their car.
How to roll.
How to go up and downstairs?
Whatever activities we give them pain and go through them with them.
Is the assessment largely the same for athletes versus non athletes?
That's a really interesting point because
In some ways.
People have a hard time because I'm looking for little baby things. You know, ironically, there's really good research that's been done by by Linda Van Dillen.
And
These movements that cause the symptoms.
occur very early.
And they're only a few degrees.

And so sometimes with athletes I've had the issue that
Well, these are just baby things and they don't really matter.
But they do matter. You gotta stop that.
And then you can build on on bigger ways. There's
A therapist by the name of Robbie O'Hashi.
Who's put these into
It's like a
Movement spectrum. Oh that's not the exact words I'm
blanking on it right now where you do
Isolated exercises.
combined exercises and then
putting them together for your sport, you know, whether it's tennis or
Whatever. And he's seen a lot of athletes.
And that's the whole idea is that
You would get somebody to
correct the little bitty movements and then you build on the more complicated, the more demanding movements.
Do you have an opinion of
I've not experienced this personally, but something called DNS. I think it's dynamic neuromuscular. Neuromuscular stimulus. Yeah. Yeah. And and because it seems like they build based on some
sort of motor skill development chronology from childhood. So you'd do you'd start with supine or prone and then move to
Like one uh two crawling or something like that quadruped and then
Do you have any perspective?
On this.
To be perfectly honest, I think you're already grown.
So
I
Okay, got it. Yep.

Certainly. If my shiny paint would as any indication, then yes.
Looking at your well shaved head I
I'm always reminded of what my father used to say who was also bald from an early age.
And he would always say grass can't grow on a busy street.

That's hilarious. Definitely gonna use that. Yeah, I know. No grass cannot grow on a busy street.
Yeah.
I don't think you need to stage it like that. That's why I go through the the whole exam and look at the
sort of the finished product that needs some fine tuning.
The thing we talked about in the beginning and that
movement causing pathology.
And the fact that it's really your everyday activities that cause it.
In the first place.
And so that's why you've got to
change the way you're doing basic things. Do you know I mean
And look at that.
Because
That's what caused the problem, that's what you need to change.
What is I believe you call it Colapso Smash O?

Where did you get
Well there there are two.
There are two forms here. It relates to this fact that what we talked about already that the spine
Suffers from
Compression type things.

And in the older individual without muscles, it's collapso smash o.
And younger individuals like yourself or others who have done a whole lot of abdominal exercises, I call it squeezeo smash up because
Because the passive tension from those muscles is adding to the compression.
And the older people are people who are
Hypermobile.
Then it's kind of collapsing down without enough support.
So
You know, it's not good if you don't have enough muscle and it's not good if you have too much muscle. It's what's in between that's most important.
How do you find the Goldilocks?
Amount of No pain and they look great.
Keep keep fine tuning.
And you know the other thing is
You know, obviously we aren't all built the same. I think
That's one of the other important things is looking for structural variations and building that into the assessment. That's the part that's tricky.
People don't always pick the right parents and when they find out it's too late to go back.

All right. So let's talk about perhaps other common
Pathological patterns. I've read that uh you've said or written, perhaps, that most people wear their shoulders too low.

Could you uh speak to that and perhaps also mention what corrective measures can be taken?
What does it mean for people to wear their shoulders too low?
Well, it it means that they should
sit up at a angle that is about
Six degrees.
Or so.
higher.
And
Often you see when y y you don't look so bad.
But when people have done a lot of weight training, that's one end of the scheme, you'll see that their shoulders look
really dropped. They look lower.
So that the end of their shoulder isn't sitting up.
If you know the
There's the cervical vertebrae between
C six.
And
C seven you should have.
That's about the level where your shoulders should be.
If you
Way down.
Are
You can look at your clavicle and you see that there's not this six degree angle.
Oh, I see.
So the clavigle should from inside to outside have roughly a sixty degree upward angle. It should have a little tilt to it. Should be
Upward angle.
Right, right. So it could be too low.
And then
The other way I I like to talk about it is just the weight of the world, the husband, the children, you know, the bra straps.
All in that.
Pulling down.
And women's shoulder girdles aren't as stiff.
What's important about this is it's not only a factor of what it does to your shoulders, it also does
A number on your neck.
Because the muscles that help to hold your shoulder blades up attach to your cervical vertebrae.
And the really big important thing on trying to address that is
Using
I think the muscle that's called the ser that's named the serratus anterior.
Is it serratus anterior?
Attaches to your rib cage.
And it can act like a sling.
So attaches to your rib cage and to your
Shoulder blades.
So it's like a sling that can help to hold your shoulder blades up.
And take some of that load.
Off of your
Cervical spine.
As well as put your shoulders in the right position.
And having
your shoulders sitting at the right position is important for
the glenohumeral joint for all of the shoulder joint motions to work.
Without
subjecting them to too much injury.
So it seems like perhaps in weight training, I don't know if this contributes to the the slope shoulders and maybe the flat or downward angle of the clavicle, but
The advice to depress and retract your shoulders.
Is
common right for any number any number of exercises. And I recall meeting with Eric and what he has a lot of his athletes do, and this is very individual dependent. So I'm not making a blanket recommendation and I'm not speaking for Eric.
But for instance, as he has someone maybe retract on some type of standing pulling motion with, say, some type of cable machine, he'll have them reach forward with the opposing side. And it seems to me that there's less of that kind of fixed depress and retract.
retracted position in in a lot of what he recommends.
Is
working on the serratus interior, doing exercises for the serratus interior enough to correct that downward sloped angle in people who have that.
That's the current state.
Of affairs?
Number one is
Also you have to be sure when people have worked out now it depends upon again what their
work out routine is if there's somebody that hangs and does chin ups
One of the things can be the Latissimus Dorsey.
It's this big muscle.
And people do lap pull downs, et cetera, or they do climbing things or hanging things.
And that muscle will pull your shoulders down.
So you gotta make sure that that muscle hasn't gotten too short.
And that you can get your arms up over your head in the first place.
Number two is
What you really want to do is use the upper trapezius.
And
The exercises where you're down here is using
The Romboids.
And the middle trapezius.
And just for people who are listening, this is like a a rowing motion.
Yeah, anything that where your arms are below
your shoulders or at the level of your shoulders
You're using muscles, they
Pull your shoulder blades together.
But particularly the rhomboids.
Downwardly rotate.
So it's gonna make it more difficult to get your
Scapula to upwardly rotate.
And to get the upper trapezius to work.
So one of the things
that is probably more effective.
Is actually
I I like to start people off. And I think that's the other thing that
When I look at what
recommendations there are on the Internet.
They never show people where to start. It's like do this exercise. Well
Not everybody's ready to do that exercise. They've got to get ready to do it.
The way that's recommended.
But if you
Can face the wall.
And slide your arms up the wall.
And then once your arms get to shoulder height.
Particularly when they're lower, then you shrug a little bit.
To get them up.
And then you try to lift them off.
While holding your shoulders up. How far are you standing from the wall?
And that's it.
Oh, right. Okay, got it.
Mm.
Right up there facing your elbows are flexed. You're sliding the little finger side of your hands up there.
And then
If you just let your shoulders drop, you've gained nothing.
But
You've got to.
Also hold them up as you lower your arms.
Keeping your shoulders up as you do this exercise. Right. Keep keep them up. Get them up to where they should be worn, not
Closer to your ears than your iliac crest.
Got it.
And that would be so you're looking to keep the shoulders in the position
Where the clavicle is an.
Yeah, slightly. Yep, yep.
Th the other thing is it it it just makes such common sense. You can't spend the rest of the day have them hanging down either.
So
You should have a chair that has armrests on it so that they're up
When you're
You got your arm rests up. If you have to stand a lot, you can put'em on your hips, if one shoulder in particular is problematic.
You can support it with the other hand.
I mean so
Again.
Exercises will mean nothing if you don't follow through if
You're doing
Even twenty minutes of exercise, but you're spending
twelve hours with your shoulders hanging down, it ain't not gonna work.

Yeah.
What is your
position on and I know there are many different types, but
Stretching.
This can be a controversial, sometimes polarizing topic.
But could you elaborate on how various forms of stretching should or shouldn't be used?
in healthy and rehabilitating populations.
Number one is really understanding what you're meaning by
By stretching.
I've talked about this as we've gone on through this, but
I keep using the term stiffness because
I feel like I was sort of misled during my
early days as a physical therapist when I didn't.
Use my own
sense of looking carefully.
Because
We were told that certain
movements occurred.
Because the muscle was too short.
And it needed to be stretched. I'll give you an example.
the example we talked about already.
If you're on your back and you slide your legs down and your pelvis tilts forward.
Your hip flexors are too short.
Well actually what it is is the struggle between
the tension from your abdominals and the tension from your hip flexors.
So stretching your hip flexors.
is not gonna fix the lack of tension in your abdominals.
And so what I find is that most often there aren't muscles that are short
There's a relative stiffness problem.
So improving
The stiffness of your abdominals.
Will elongate.
Your hip flexors.
Yeah, it's a relationship, not just an isolated muscle.
That you need to stretch.
Right, and it it it isn't the length of the
Hip flexors, that's the problem.
It's the passive tension from those muscles.
Because when you're sliding your leg down
That muscle isn't that active anyway.
And if it's related to the length of the muscle, it shouldn't occur until you get to the end of that muscle length.
And that's not when the tilt occurs. So there's all these things that just don't make sense.
So what I found through these numerous years of experience I've had is
Is that
There's many more problems with relative stiffness.
than there is with
Muscles really being short.
Yeah.
If it's really
Short.
Then you also need to find out what's making it short.
Because it doesn't just like oh I think I'll go short today.
It's a matter of what is your activity.
when I'm teaching courses I have a great picture of a

Really short.
He has big curve like you're talking about an increased lumbar curve.
Clearly his hip flexors are short.
And he's a cyclist.
Well, you usually don't see that kind of alignment in a cyclist. You usually see a a flatter back.
But
If I didn't let him use toe clips, he couldn't move the pedals around.
So he moved the pedals.
By flexing.
Rather than pushing.
So
That's why his hip flexors were short.
So it wouldn't matter how much you stretched him, if every time he went
Out to ride the bicycle.
He's using his hip flexors all over again in a shortened position.
So he's basically in that rear half of the rotation of the pedal, he's pulling with his hip flexors. Right.
Instead of
More pushing than just the lifting.
So
What is it that people are doing?
that's causing that muscle to get short.
other examples and and again, I find it so interesting about what intensive weight training's doing because
If you're lifting, I I've actually examined young women who are lifting
twice their body weight.
Well, you know, how many muscles do you use if you're lifting twice your body weight in a deadlift?
Like every little muscle you've got in your body.
Well what happens is you in end up training all of those muscles to come on.
And they don't just go off. So they walk stiff legged.
Because
There is too much activation of these muscles.

And so
They can't stand and have muscles relaxed.
'Cause everything comes on. It it doesn't say, I'll only come on when I'm weight training.
You've trained them to come on.
And now you've got
Much more.
Output transcript:
For a given muscle.

than you would otherwise.
So it's
It's too much, so you've got to learn.
Also how to
not activate them.
As much as you're learning how to
activate'em. I'm I'm not against any of this. It's just that you need to know what all the
Additional
Factors are.
that take place with this training.
So it's a long answer to the question about stretching, but
My big point is
You've got to figure out
What's making it short?
Then if you need constant stretching
You've got a problem with what's active what's making it short.
That has to be addressed.
So I've been advised and it seems to help a bit.
But to do a fair amount of say
hip bridging or glute activation.
alternated with, say, hip flexor stretches. And
If I have in addition to that
the stiffness in the abdominal muscles contributing to this
low back presentation, right? These symptoms I'm experiencing. Could you just remind me of how I would then work on that abdominal
Stiffness. I could do the overhead breathing and the side bends.
That's for that's stiffness.
Again, what you're telling me, and again I haven't seen you
Standing but also on video. Okay.
Would you like me to stand?
Yeah. Please, please.
And I can tilt the camera as needed.
Okay. And just yeah, pull up the shirt so I can see.
Okay.
Now turn sideways for me.
Oh yeah.
Oh.
No, no, no. I mean you y I don't know what you're talking about, your tummy sticking out.
Oh, well, yeah, I mean like if I wanna look kind of
In my second trimester I can do this.
Is that
Which one's the real you?
This is probably the real way.
This is the real me. This is this is how I would stand. If I were standing at an event, I would probably try to tuck my hips a bit
Yeah, but but you see.
You you you don't have an increased lumbar curve.
You've got an increased thoracic curve.
The you'd be like the kyph kyphosis on the back of the yeah.
And and part of that kyphosis.
Yeah, right right up there.
Yeah.
And part of that kyphosis comes from your
Rectus abdominis pulling down on your
Thoracic spine. Interesting. Right here.
Yep, yep.
Yeah, and see when you when you lean back like that
I'm telling you though.
The rectus and the and the other abdominals become your anti gravity muscles, so they're constantly being used.
Meaning that I'm lean I lean back and then these are pulling me.
Forward.
Yeah, you lean back to get away from those but
You need to
Yeah.
The rectus needs to be a little bit longer. Okay.
This needs to be a bit lower.
for you to do that is to to do the quadruped thing and then let your thoracic spine go down.
No so that would be almost like the cow no, no, the cat of the cat cat, I guess. Sort of.
As I'm on my hint and you just all you need to do is think about
Letting your chest go towards the floor.
And like you feel the load on your shoulder blades. Mm-hmm.
Okay.
Now let me watch you just easily like you're gonna contract your tell me to pull it in.
Yeah, see you do sway back na uh, okay, stop.
Mm.
Yeah, this
No, you you you did lean back.
Yeah, if I'm gonna but like I will don't don't that's it. That's better. That's better.
Yeah, do you have any symptoms like that at all?
No.
There's a little bit of tightness here, but it actually
Uh it doesn't it doesn't bother me right now.
Yeah, okay.
Yeah, and and it looks like your hips are fairly straight, so
Go ahead and turn put your back to me so I can just see
Put your back to me for a minute.
And put your hands on your Iliad crest.
Getting my my index fingers on my A S A S I with with your hands like that, it looks like
They don't look so bad to me. Let's do what we talked about before. Put your feet apart and let's just see what happens.
Does that if that changes your symptoms at all?
Yeah, it uh it seems to help. I'm wearing very slippery shoes, so I'm doing a little bit of it is it better?
Yeah.
I would stand this this week.
This would help.
If I was recording a podcast. What would help even more is if I put my one leg up on something.
If I stepped up. Yeah. Yeah.
Does it matter which leg?
Right leg because where I where I feel most of the pain is sort of localized around this bony process here.
Right.
Right. Yeah. So that is gonna be the the t tensor on that side. Now let me do one more thing. Just bend over and come back up. From the side like this.
Yeah.
Well.
Yeah. See now you need to to work a bit on how you come back up from forward bending.
So that it's
And don't worry about going over that far.
Okay.
You need to come up with your hips and less back.
As you
Finish off your back you sway back.
And do too much back extension. Oh, when I get to the top, you're saying.
Yeah, about about the last. Um hinge more at the hip? Thirty, forty percent. Is that what you mean?
Just just think about going over and coming back up.
By making your hips extend. Okay.
Hold it there.
Now hips. Just come back up with hips. Hips. Hips. Hips.
Yep.
Yeah.
That was better. Yeah. Just yeah, and try not to let your back sway back. You
You use the momentum of your upper back coming back.
To finish up and that's not good.
Okay.
Got it. Yeah. Anything else that I can yeah, I mean I can do more, certainly. This is yeah helpful.
If you can easily practice
You've got those the lower abdominals are the external obliques. They're the ones that tilt your pelvis.
And if you just easily practice
Tightening those, but don't work hard at it.
So that you sway back.
So this is the external obliques and then what was the other musculature you mentioned?
I'm saying don't sway back, just easily try to tighten them so you get a little bit of a pelvic
Yeah.
Yeah.
Plenty. Yeah, okay. Now are you good that way?
Yeah, I'm good. I'm good.
Yeah. And this would be in a standing position when I would have just a little bit of tension in the external obliques.
You do that as much as
As much as you can.
Yeah.
'Cause you see it limitates your symptoms. That's all you need to do. Yeah. And then work on that
Little increased thoracic hyphosis.
So uh or
Or I'm I guess reducing this kyphosis by lengthening. Yeah, if you decrease that
Then you won't sway back so much.
And and if this
If your rectus abdominis elongates better, you won't have that
Tendency for a thoracic hyphosis.
elongate the rectus abdominis for people listening, this is like six packs, right? The stuff running down the the f the front of the abdominal.
Oh sorry, I yeah, that's right. I'm I forgot about the microphone over here. That to elongate
the rectus abdominis I could uh
Get in that quadruped position.
And d basically drop my chest to the floor as I'm pushing my hips backwards.
Just in that position, just let it go down.
It's amazing how much you can improve your alignment and it looks like you you could change pretty readily.
And the big thing so we we started off because you were doing the the the bridging exercise.
I I wouldn't be tempted to do that.
Okay.
One, you'll do a much better loading of your gluteal muscles by that bending over and coming back up with your
Hip extensors. Yep.
And if you tighten it there, there's also a tendency for the glutes to actually
Posterly tilt the pelvis, but the spine doesn't go along for the ride.
Could you say more about that, please?
This is one of my guilt trips because many years ago I was working uh to get the point across. I'll tell you my little story. Yes, please.
I was working with this older woman, I thought old was my age now.
And so she did have spinal stenosis.
And I was working on sit to stand, so she didn't have any symptoms.
And I had her
tried to tighten her abdominals and she was doing pretty good. And then I said, Okay, now
Let's tighten your gluteal muscles as you get up.
Well
She did that and she got pain shooting down her legs.
And the reason being
That
You're
Gluteal muscles.
as you know, attached to the pelvis. So if they posteriorly tilt the pelvis
But if the spine doesn't want to go along for the ride.
It stays there and you get a translation motion between you.
Where the
Pelvis is moving and the vertebrae are not moving.
Out from under the spine in a sense.
Exactly. Not a good idea. Now if your spine moves
Easily, then that's all right.
And and you can get the same effect if if you would put your hand
where your spine is and tighten your glutes, you'll see your spine doesn't move.
You see what I mean? If it
Wants to go along for the ride, it'll go along for the ride, but
The problem is those people where it doesn't wanna go along for the ride and you're gonna be one of them. Mm.
So in in what ways do I need to be careful then?
I mean I just don't think that's a good
A good exercise for Got the bridging.
The bridging. I feel especially if I do bridging single legged, but even double legged. I remember it's it's been recommended to me by a number of PTs and I'm and I've told them all like guys, this really bothers my back. It Yeah, yeah, and it's arching your back. It's not a good plan. Yeah.
Okay, I'll skip those. I would skip those. I w when do you have time to do all this? I don't. I don't that's that's honestly surely been one of the compounding
factors that has been so frustrating is not only am I getting very often
Entirely different.
Diagnoses.
But I also get
thirty seven different programs and there's just no way that I can fit them in and many are probably conflicting also.
Right.
I've found the movement focused approach to make a lot of
At least intuitive sense to me. If if our entire conscious experience of reality is model on a brain that is evolved to move us through space, it just seems to make sense.
That that is
the variable to pay a lot of attention to because it's not just a variable, but a system of systems, as you put it, much like the immune system. So it it makes a whole lot of sense. Now you just mentioned older woman, but she's now my age. Would would you mind
Sharing your age, but also your own self care.
I suppose routine. What do you do to keep as sharp and
As in shape as you are. I would love to know more about that.
Next month I'll be eighty six years old. Incredible. It's just amazing.
I would never guess in a million years.
I'm so lucky. I'm so fortunate too because I don't mind saying both of my parents had dementia.
And uh I've now exceeded their ages both in life and in dementia.
Right now I don't know that I have any. I would not think you have any.
Very, very good.
As I told you that
Number one.
choosing to be a physical therapist. And and also I was very fortunate because
Growing up
I refused to grow up and I played sports in my day.
It's when are you gonna grow up and stop all that stuff and
That was very good. We also didn't have air conditioning and we only had one car.
So instead of
paying more for a bicycle than a car. I had to ride a big old bicycle and ride it everywhere.
So I h happily, you know, laid down enough bone and enough muscle to
In my early years and then
The physician that I encountered.
who was part of the Department of Medicine at Washington University in Saint Louis. His name was John Holesy.
He started bringing in the lifestyle issues.
And
As a physical therapist, even though I got a PhD in
neurobiology'cause I wanted to solve the motor control problems of the stroke patient.
I stayed very physically active.
I started really running and
doing things when I started my PhD studies and after encountering this physician.
And learned a bit about nutrition.
Breaking all the family tendencies.
And then again, learning about musculoskeletal problems, even though I was really interested in working with neurological patients, people with spinal cord injury.
Head injury.
Stroke.
I had always had this tendency to look at
how people moved and I totally tried to figure out why they were moving the way they were moving, et cetera.
And got involved with musculoskeletal patients and they started getting better.
So I had to figure that out.
And then I applied my own.
ideas to myself.
I don't know how
Folks who you want to get up, but there really some funny stories connected. Oh yeah, no, we love funny stories around here.
Well,
And it really related to
to doing this quadruped.
Little exercise.
So one sort of funny story was
I was really poor going through getting my PhD'cause I didn't have any income and
Just living off of a a minimum amount of money.
Yeah.
And so I didn't
Get it.
Buy new clothes very often.
And I had a pair of slacks that I was
wearing for a long time and
A friend actually took me out to play golf and old it was an older woman at that time and
We're out playing golf and she says, You know, surely
You got your pants on backwards. And I said, You know, I'm working on my PhD. I think I ought to be able to know how to put my pants on.
And so
We started looking at the darts and sure enough I had'em on backwards. Well before
Before my alignment was such
that they looked all right. But now that I was doing this quadruped exercise
They didn't look all right. They w they were looking funny because I had changed the curves of my back.
And my buttocks.
And so that's why th she caught the idea that
I wasn't wearing my pants right.
Which quadruped movements were these? It's just the idea of being in quadruped and just letting your back go down.
And then rocking back.
Yep.
I tended to
ride the bicycle I was a catcher for three different softball teams
So I was really in a posterior tilt with a really flat back.
And I had never really
Gone the other way.
And just for people who are listening, if you don't know, uh just to imagine, if you imagine the pelvis as a bowl of soup, posterior tilt, you're kind of pouring soup out the back of your pelvis. Just for people folding it in the middle. Yeah, yeah, right.
Yeah, got it.
Okay.
And so your back your whole back goes kind of flat then. Mm-hmm.
And when you're pushing your hips back, you were facilitating more of a natural curve in the in the lower back. Well, I was yeah, getting my hips to bend and yeah, letting my back go down. So I was getting more of a
Hm.
And I think also decreasing a bit of a tendency towards a thoracic hyphosis.
Th the other thing that was really an interesting I used to bowl.
You know, like with a bowling ball. Yeah.
And while I was in my PhD program, which took me six years
I didn't have any money to bowl.
And so when I went and got my bowling ball out again.
I had to change the finger grips.
Because I had stretched my finger flexors out.
And so the the finger grips no longer fit me because my fingers were
So could you explain that? So your grips had been molded to fingers that were my fingers were always flexed from everything I did.
Right.
And I never really thought about stretching them out. And so when you're in quadruped
Oh right.
Right, okay, I see. Right. Instead of so for people who are listening,
because we're making movements with our hands and gestures with the hands. Instead of being in sort of the keyboard position, we're gonna make the video available as well, but some people will only hear audio. So instead of being in sort of that keyboard
You know, hawk talon position when you're in quadruped.
Right, as if you were doing a a push-up, but not that push up position. If your hands are flat on the floor, then you're gonna be stretching.
Those flexors.
Stretching across the wrist and across the fingers. Yeah. Mm-hmm. Yeah. Got it. So you have to change your bowling ball. That's wild.
Yeah.
And then the other thing is I had always worn my shoes off
So that they were going off to the side and
After I did this

This quadruped rocking I didn't
walk in the same way and I didn't have my
Shoes weren't worn off to the side from Oh, interesting. So worn off to the side you mean the shoes on the inside were worn or on the
Yeah, the like the outside of the right and the inside of the left.
So there were all these little
Changes that took place just from
Improving my alignment.
So

Full question, so what do I do these days? Guess what? I still do
quad. I don't go all the way back and sit on my heels. And I also want to tell you about one thing people need to know about for the that exercise.
And then I do push ups, modified push ups.
And then in prone and I think
Then if you could do this carefully it'd be good.
is improne I flex my knee.
So that my leg as much as possible is falling on my thigh.
You're laying down on your chest.
You Yeah, I'm laying down, face down, bend my knee.
Well you bring it up.
J
to fall back on my thigh.
Because I don't want to hold it bent at ninety.
In other words, if you bend your knee, you can go to ninety degrees. If you go more than ninety degrees.
Your leg is falling on your thigh. I see. Your lower leg is sort of falling under your hamstring.
Yes. Okay, got it. Okay. That's your thigh. Yeah. Yep.
And so y right, and so you're And so then in that position.
Then I lift my thigh off of the floor. I do hip extension.
But not high. There's only ten degrees of motion.
Mm-hmm.
It's a way to use your gluteal muscle.
Mm-hmm. Because you can't if you use your hamstring you'll get a cramp.
Yeah.
You get a bad cramp in your hamstring.
So
Just a little bit of hip extension to use my gluteal muscle. How many repetitions are you doing on each side or just do ten repetitions on the
on one side and then ten repetitions on the other.
And you're doing roughly ten repetitions of the quadruped
Rocking.
As well. I'm not sure if that's the right amount. Yep, and fifteen push ups.
Fifteen modified push ups. Modified is your knees are bent, I don't go to my toes.
Mm-hmm.
Got it.
Okay.
All right. And then
Still in the prone position.
Knees flexed to ninety degrees and then I do hip rotation.
In both directions.
Letting my
lower leg come in and then go out.
Right. So just if I can translate and please uh correct me if I'm getting this wrong, but you're bending one you're laying on your chest, one leg bent to ninety degrees, and basically a windshield wiper.
With that lower leg on each side. But I do both at the same time.
Oh, you do both at the same time. Okay, I see.
Yeah, so they're not quite you know, one's maybe eighty, the other maybe seventy.
Because it doesn't take all that long.
And then with my
Knees extended straight with my
lower extremity straight.
I alternate doing hip extension, but I think about using my gluteal muscle.
I think about activating my gluteus maximus.
And again only about ten degrees of hip extension.
And then
In that same position I do hip abduction.
In other words
One leg out to the side.
Ten times.
'Cause you use your
Glutius medius and that better if you're
working against gravity and extension than you do when you're
Soupine.
Supine, you tend to recruit the tensor too much.
Oh, I see.
Mm-hmm.
Got it.
And
Is there anything that that follows that
Abductor work?
Then I go supine.
Turn over.
And I think this is really
You know, I'm pretty good about not having a kyphosis, but
In supine I a deductible.
Pull my shoulder blades together and slide my arms up over my head.
So that my arms are all the way up over my head as much as I can. And I'm on a hard floor.
And I'm starting for with my hips and knees bent.
Arms up overhead and then slide one leg down, slide the other leg down.
And
Believe me, for an older person who's got
A tendency towards collapse oh smash o

Just getting yourself as stretched out as possible.
Is so important.
Mm-hmm.
Yeah.
I mean really.
Sounds like for me with my kyphosis that would also
be important.
Yeah.
The biggest worry is gonna be with the older person.
Yeah.
If you have a kyphosis.
You're not gonna be able to get your arms
on the floor all the way up over your head. And you don't no pain. You don't want any pain on top of your shoulder,'cause that's not gonna be a good plan.
So they may need to have a pillow up there.
When they're first starting.
So their arms don't go all the way back.
'Cause you want to avoid
Any kind of pain on top of your shoulder.
But happily I can I know how to do it. I can do it.
And then I do actively
Hip and knee flex, bring one knee towards my chest, put it down, and the other one.
And ten times with each leg.
And then
With one foot on the
Floor.
I do a straight leg race.
I don't
Tighten all my
thigh muscles so that my knee is perfectly straight.
And I turn it out a little bit so that I don't use
The tensor.
But if I rotate it out, you'll use the
Show us more.
And I think about tightening my abdominals.
I have had a
significant problem.
And I don't want to
put too much stress on my lumbar spine.
From the Ilios OS.
I want to use it.
But I
Wanna protect my back. That's why I have one foot.
On the floor.
I see. That's why you're doing one leg at a time.
Well, yeah, it's certainly one leg at a time.
Reiterate. So given the
Yeah.
why you would want to engage the SOAs instead of the
T FL.
In this case.
I mean it's a good muscle to use, I need to be able to flex my hip.
But the tensor
It has a real thresh low threshold for activation. I mean, interestingly enough, if you would scratch the bottom of your foot, the first muscle to go off will be your tensor fascia lata. No kidding.
Wild.
I've tried to contact the World Health Organization because all over the world the tensor is run amok. But they they don't want to listen to me. They're not returning the calls. You know, I know. And it's this little bitty wimpy muscle, and you say, How can it cause so much trouble? But it sure does. You know, it plays a role in what happens to the knee, it plays a role in what happens to the back and
The hip, I mean, it's an evil thing.
But uh
Oh yeah.
But you know, an interesting thing, one of my colleagues was doing a study and we actually
had a student that did not have a tensor fascialata.
No. Just
Yeah, we we we didn't throw out a school or anything. But but anyway, I I couldn't wait to do all the tests that we do to look for the length of the tensor.
And she was a you know a fair
Athlete.
So it wasn't like
It had been sitting not doing anything, if it was there.
And I did all the tests and they were negative, which was kind of
supportive to me that
Indeed.
The tensor does.
Do things that we're going to do.
Aren't so kind to the rest of the body.
So anyway, all that to say that's why when I do the straight leg raise I try to laterally rotate my hip.
'Cause I'd rather use the SOAS.
And it's not causing me any problems. Clearly, if I thought I was
Injury myself, I would not.
Would not do that.
And then I do one other thing with
one leg straight and the other foot on the floor so that my knee is bent, my foot's on the floor.
I let my leg go out to the side.
And that's my way of trying to work on controlling rotation with the trunk.
My leg goes out to the side, it wants to rotate your pelvis, but
Contracting your abdominals.
Prevents that rotation.
So
That's another way I'm
Trying to work my abdominals.
And then I stand up and I'm so proud of myself because
I can get up from the floor without any difficulty.
And many people at my age are many years younger than that can't do that.
And
Put my back to the wall and then do what I was telling you to do, arms up overhead and do
Do the little side bend thing.
And you do this every day?
I do.
Three to four miles a day.
Amazing.
Sometimes ride a stationary bike.
Mm-hmm.
Well
These are things I'm paying more and more attention to. I'm so impressed.

But let me tell you one thing now, Tim, that the quadruped, as much as I love it, and I think
It's important whether you have a shoulder problem or cervical problem.

Excera.
Is that one of the things that's a problem though.

Is
And it can be h be for several reasons.
But again, the tensor is one of them.
If you rock back.
And your hip
immediately rotates.
In other words, I found this in some patients that
As you rock back, your hip should just flex.

But
If you are monitoring.
The femur.
You can sometimes see that it immediately rotates.
That is really bad.
And the reason why it's really bad.
is because it's rotating your knee joint too. And that's a good way to set yourself up for an A C L tear.
Anterior cruciate ligaments.
And I think people should be monitoring that.
Anybody that's
Doing that.
One of the things that helps is if you slightly laterally rotate your hips.
You know, many people, particularly men, come with what we call femoral retroversion.
Do you know what that is?
I don't mm mm.
You probably have it.
Femoral retroversion.
It's a structural variation.
And so
The femur
As you know, has
Uh a head and neck on it.
It's angled.
Well it's also rotate it on the shaft.

And in the
Ideal world.
The average, not the normal, the average.
is that that rotation is fifteen degrees.
So the head and neck
of the femur are pointing fifteen degrees forward.
Now many men, it's not rotated.
So what it means is that when you're doing your hip rotation
You go out a long way.
But you don't go in.
That's true for me, for sure.
My internal rotation is terrible compared to my external rotation.
But that's because you came that way.
And it should never change.
No, I mean it.
And so you and and men need to know that. And so
In fact that's a problem because if your tensor is really
develop you could be sitting in hip medial rotation when you shouldn't be.
And if your glutes are really good.
That'll also immediately rotate your hip.
When you're sitting.
That's a problem.
But one of the ways to if you're trying to do the quadruped thing
is to
Turn your hip out a little bit.
when you're in the quadruped position. So your feet would come together a little bit closer.
Right, more of like a wrestling partier position.
Yeah, I don't I don't know I never Yeah, I can I can pick up the slack on on explaining that then.
Okay. So the right, right. So from the feet to the knees, it would just be making a very, very, very slight V shape. It's not a V shape. The lines would converge, in other words. Right.
Yeah. Your feet would be a little bit closer together. Yeah, exactly. Mm-hmm.
Yeah.


You're funny. All right. So y that makes a lot of sense to me and I'm certainly comfortable with that. What would it mean or how would you read the movement pattern that I have
of sitting and having my legs sort of spla open. That's also something really it alleviates my low back symptoms. If I'm sitting in a chair, oftentimes I'll take my shoes off.
and fold them up on top of the chair. Restaurants hate this, by the way. So I do get chastised occasionally, but it alleviates
So my lower back.
Issues.
You're getting it four and aft because you're probably in this one of the syndromes I have of the hip that I've described of the hip because
If your tensors really develop.
It's gonna be holding your femur in medial rotation when you're standing,'cause it's pull taut then.

If your glutils are really well developed.
When your hips flexed
To ninety degrees they become medial rotators too.
So they're h trying to hold your hip in medial rotation and you're probably getting that twist on your back.
So when you laterally rotate
Your hips.
then you're taking that pull off of them.
Taking the pressure off of it.
Yeah, you're you're not getting that extra pull on your pelvis.
From those
Gluteal muscles being pulled so tight.
And that's where you should be. That's your
You're normal.
Thing because you have femoral retroversion.
See and and that's why that's one of the things that's bad is because, you know, like
Well, people go in and they're taught deadlifts and they say, Well make your feet point straight ahead. Well
Many men, in particular, shouldn't have their feet pointing straight ahead.
Because
they have this femoral retroversion. And also when they do things that rotate like play golf.
Their feet should be turned out.
Because if they're straight ahead, they're at the end of their media rotation range.
So then it'll be the knee or the back or the hips that are gonna go.
It's also interesting. Yeah. It's like the back is attached the back bone's attached to the pelvic bone. You know, and and I think to me that's what's so valuable about
being a physical therapist or looking at people because
I can't like an orthopedic surgeon just look at the knee or I can't just look at the hip.
Because it's the result of all of these interactions of the body.
That's what's so important.
Mm-hmm.
And in a case like mine where if you look at family photos.
Right. Especially on my mom's side. The feet point way out. I mean all a lot of the guys stand up.
Like you know, they they stint like ducks.
And
Now at the same time.
I have been told and I
Agree with this that if one were to watch me walk
I have probably because I have at times the the feet pointing out
Very little
sort of glute hamstring assisted hip extensions. So I tend to
bend at that lower back. Maybe I'm misdiagnosing things, but how would you sort of make sense of that? Would it be bad for me to try to point my feet
a little more straight ahead so that I get better hip extension using the gluteal muscles and the hamstrings versus the lower back, or is that gonna be setting me up for knee problems?
It usually if you're not using your glutal muscles in that it's because you're
You're swayed back.
If you sway back, your line of gravity is behind your hip joint. Right.
Right. And if your grav line of gravity is behind your hip joint, you don't need your gluteals.
Those other muscles.
So
If you reduce that kyphosis.
Which isn't bad. It's it's just
Not
helpful for what your condition is. Your
And then you go forward. And then the other thing is
If you also push off, in other words, when you're walking.
And this could be another way in which you're you're reinforcing what your tensor's doing. If you tend to walk
By pulling your leg through.
Rather than pushing with your feet and letting it swing through.
And if you push with your feet.
You'll activate.
The extensor is more.
So the two things
The things that maybe
contributing to and I'm not saying this is for sure because I'm obviously not
Analyzing you but
Let's say if we paint a scenario that
You're sway back with a kyphosis, your line of gravity is behind your hip joint.
I always call it
then the gluteals are do not have good definition. I call it missing for lack of action.
And so then then you pull your legs.
forward with your hip flexors, you're just reinforcing
The overuse of the of the tensor.
But if you
decrease your kyphosis, so your line of gravity is a little more
Running through your hip.
Rather than
Wait behind it.
And you roll over your feet and you push with your feet.
So you roll over so that you're pushing with the ball of your foot.
And your leg swings out, you'll use your gluteals more.
Just pushing instead of pulling.
You want to chase your center of gravity, not pull it.
Mm-hmm. Yeah, this kyphosis has been with me since I was a little kid and it's
I've tried foam rolling, manual release, strengthening the mid back, but I have not worked on elongating the rectus.
You know, there's a condition called Sherman's disease.
Which isn't really a disease.
If you had it particularly it it happens in your teenage years
Where you get a
You've heard of it.
No, I haven't heard of Sherman's disease, but uh ever since I I would say since I've been like twelve, thirteen, I've had this kyphosis, lordosis combo. Well then you probably got Sherman's disease.
Uh.
Okay.
Have to look it up.
It's uh S C H E U E R M A N N.
And it's kind of a
Idiopathic compression fracture of the thoracic spine. It means you won't get rid of it.
Oh man. Okay.
But I think if you d just don't sway back more.
And just stay forward a little bit.
If you can make peace with that.
Well, I can try to work on the elongating of the Well it's it's not gonna change.

The big thing is don't let it get worse.
Right.
Yeah. If that's if that's what you have, yeah.
I'm not saying that's what you have, but I'm saying.
It's possible.
Yeah, d because it happens around the teenage years.
So what would be the keys to not letting it get worse, would you say?
Don't have an increase.
You can still do the same things, Tim, but
Just don't say I I will be absolutely perfect. I have to settle for kinda perfect instead of absolute perfect. Well, most of us don't get that close, I think.
Further away than I would like to admit. So surely this has been such a great conversation. I've we've covered so much. I've taken copious, copious notes. And
Certainly people can find your books, The Diagnosis and Treatment of Movement Impairment Syndromes, which has been translated into seven languages, as well as your second book, Movement System Impairment Syndromes of the Extremities of the Cervical and Thoracic Spines, has been very influential in promoting uh movement diagnoses. Is there anything else you would like to
mention anything else we should talk about? Anything you would like to draw attention to with my audience? Anything at all that you think is worth saying or
Discussing before we
Begin to wind to a close.
It's probably just a little repeat of all the things we've been talking about. Uh it's been really
great and generous of you to o allow me to discuss your your issues. But you know, it what's really nice is here you are somebody that's worked so hard to
address all of these things with all the discipline that most people don't have.
And it's still hard to get a straightforward story about what's going on and how best to suit your and that's what worries me a lot. Number one is
I look on the internet for exercises and
Most of them people can't do and they're not taking into account
the variations in how people are. I mean
Here, you've been through all this exam and nobody said you have femoral retroversion.
Which
You need to know.
Because you came that way, you need to stay that way.
So I would like to see that there's more
Respect for how
Difficult.
Exercise is. It's not like
Here's the way everybody should go out and do this one thing and then they'll all will be well.
I'd like to see this recognition of
movement is is complicated.
As anything else that the body does.
That there is a movement system, a physiological thing.
And
that we should have diagnostic categories so that
People
When they're consulting a physical therapist.
get a diagnosis just like when they go to any doctor. I mean that's to me why you go to a doctor.
Just to get a diagnosis or find out what condition your
You're working on.
I think that would do a lot to help reducing all this variability in
in in treatment.
And I think helping people to understand how it's the way they do their everyday activities
That causes the problem.
And that those can be changed with with good direction.
I can't help but say this too, uh
I help a good friend who's actually
On a dementia floor I go to
help feed her twice a day.
And I look at all the other people.
Older people that are in assisted living.

And
The majority'em are there because they have physical disabilities.
I'm older than most of them.
And I think if people
had a chance to address these things early on and with the discipline like you show

We could cut down on improve the quality of life.
I know you've interviewed Doctor Attina.
And
You know, much of what he says, you know, medicine three point oh or something.
And if we did that with more care on exercise,
and knowing how to do everyday activities and not just take'em for granted.
I think uh people could have longer, fuller lives.
And um
Yeah.
Be as fortunate as I am.
Agreed.
Greed, agreed.
What a great conversation. I've learned so much and I've taken so many notes. I have a lot to dig into. It's g also given me some renewed optimism in terms of

exercises that I can work with, movements, I should say, that I can experiment with.
I hope you'll get back to me.
If I can help further.
I will.
Going along I would be more than happy to
Thank you.
Do this a little more formally.
Yeah, I absolutely I really appreciate it. We can do it on Zoom. I mean we can do it.
And that's.
Yeah.
That I would uh I would very much like to do that. So thank you for the very kind offer and thank you for
So kindly taking the time to ha have this conversation. I think it will be really helpful to people.
As my dear friend Michael said, you are tremendous. I've really enjoyed talking to you and you do have a
sense of enthusiasm and how to ask the right questions. So to make it fun for both of us. Thank you so much. And for everybody listening, we will link in the show notes to everything we discussed as usual at Tim.blog slash podcast. And until next time
Be just a bit kinder than is necessary, not only to others, also to yourself. And as always, thanks for tuning in.
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