Rebuild Your Body: How to Train Movement Patterns, Not Just Muscles | Dr. JJ Thomas

Rebuild Your Body: How to Train Movement Patterns, Not Just Muscles | Dr. JJ Thomas

Author Name:Dr. Gabrielle Lyon

Youtube Channel Url:https://www.youtube.com/@DrGabrielleLyon

Youtube Video URL:https://www.youtube.com/watch?v=UfPS1Md-sL8





Title: Rebuild Your Body: How to Train Movement Patterns, Not Just Muscles | Dr. JJ Thomas

Author Name: Dr. Gabrielle Lyon

Description: Sitting up straight isn’t fixing your posture, and treating isolated pain rarely solves chronic injuries. In this episode, Dr. JJ Thomas sits down with Dr. Gabrielle Lyon to break down a system-based, primal movement approach to physical health, mobility, and injury prevention.
Learn why traditional physical therapy often misses the root cause of pain, how sitting 6–10 hours a day drastically increases mortality risk, and how incorporating simple "movement snacks" and foundational primal patterns can completely restore your physical capacity.

See a sample of the exercises mentioned in this video:    • Movement Exercises with Dr. JJ Thomas  

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⏰ Chapter Timestamps
00:00 – Posture Myths & Why Sitting Up Straight Fails
02:18 – Treating Root Causes vs. Bandaging Pain
06:48 – The Hazards of Sitting & Reframing Movement as Health
13:39 – The 7 Primal Movement Patterns Every Body Needs
25:28 – Scapular Stability, Pelvic Health, and Primal Movements
39:12 – Fixing Glute Amnesia & Activating the Posterior Chain
51:57 – Why "Overuse" Injuries Are Really Underuse Problems
58:34 – Dry Needling & System-Based Movement Resets
1:13:53 – Dialing in Hormones, Protein, and Metabolic Health


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Transcript:
(00:00) We've created conveniences in our society so that we don't need the movement necessarily, but biology didn't get the memo. Really, the pain is the alarm. And so, what we have to figure out is what is the signal? Like, what is causing that alarm to go off? Often in medicine, [music] we keep just just taking the batteries out of the alarm.
(00:20) >> Posture is a real thing. And I've seen posture get worse over the last 10 years. If you can train good patterns, you probably can train bad patterns. >> That's exactly right. If you have poor posture, deciding to sit [music] up taller is never going to really move the needle for you. >> It's not that one muscle group or that one body part.
(00:41) We can help that tissue heal [music] through multiple mechanisms. Really, patients got better faster when I started treating this way. [music] So, for those of you who don't know, JJ is my physical therapist and my friend. And actually, funny story, you were my patient first, and then we both became each other's patients. >> That's right.
(01:06) When I met you, I was training biceps alone, maybe some leg extensions, probably doing some shoulder raises, and you were like, gee, it is no surprise how many injuries you have because you are not thinking about the body in terms of systems. Is that true? >> That's true. >> What are we doing wrong? >> I think part of the problem comes from as a medical society, as a as a medical world, we dive in deep to try to get answers.
(01:34) And so we hone in and we get very specific and we analyze data in a way that helps us be very specific with an answer. But when we do that a lot of times we lose the forest through the trees. >> Like up until I sat with you, it had always been, "My hamstring really hurts. Can you fix my hamstring?" And you were like, "Gee, it's actually your shoulder and [laughter] your neck.
(01:52) " And I thought to myself, um, wait, >> she's either crazy or really smart. >> Totally. It's exactly what I thought. And I was like, wow, she's also jacked, so she must know something. It is an example of what I think many of the listeners or viewers are going through is that they might have neck pain and then they think it's their neck or they have shoulder pain.
(02:09) They hit 40 and all of a sudden they have frozen shoulder which it must be their shoulder. But you know what really struck me about your philosophy is that it's not that one muscle group or that one body part. That's right. And that really the pain is the alarm. And so what we have to figure out is what is the signal like what is causing that alarm to go off.
(02:27) Often in medicine, we keep just just taking the batteries out of the alarm rather than actually looking into the rest of the house and saying, "Okay, is there smoke here? Is there smoke here? Are there multiple fires?" And so that's where we use movement to analyze where the fires are. >> And in traditional physical therapy, because you trained as a traditional physical therapist, is it typically taught as in isolated systems? So for example in medicine we might learn about the whole body but once you become a
(02:56) specialist or you then go through medical training you decide for my husband he might look at the genitals. Yes that's a dig to Shane but for a physical therapist is it trained in systemsbased approaches. >> I will say when I so I graduated PC school 25 years ago >> just last year. >> Just last year when we were taught it was look above and below a joint.
(03:18) So definitely not a systemsbased approach. I think we're starting there are starting to be uh continuing education courses that focus on this more and more um and some have gotten some publicity which is great. I can't speak to what the current programs are speak are teaching in terms of systems or in terms of treating the body as a system from a movement standpoint.
(03:40) Um I couldn't speak for all of them. So I'm not sure on that one. >> Uh the reason I ask you that particular thing is because it seems as if it's not a standard approach, >> right? And that is what you were saying in the beginning is that >> when something hurts, a person doubles down on getting out of pain, which is exactly true, >> right? >> Uh maybe they'll be told to not move.
(04:01) And one of the things that struck me is that I'm like, JJ, my shoulder is killing me. I have this I don't know if I have some bicep impingement. >> And I said, well, I should probably just rest it. And she and you said, no, you actually you have to train it. >> Yes. And you have to train it in particular ways to improve that.
(04:20) >> That's right. We have to load the tissue appropriately. Something else I wanted to go back to though is a perfect example of how in medicine we try to hyperfocus on how to fix a problem and we use science and research to do that which is helpful in many aspects. But for instance, a lot of the science and research supports eccentric loading for say a hamstring tendinopathy which you had a very chronic hamstring well tear do tear and tendonopathy associated associated with it.
(04:50) So yes, we want to eentrically load that >> and what is that for the listener? >> So that's where muscles contract and they shorten and they lengthen eccentrically. So when a muscle is under load and you shorten, so for instance, uh hamstring curl, when you're bending the leg back, you're concentrally contracting it.
(05:08) When you're resisting that return to extension, you're eccentrically loading it. >> Eccentrically loading. So there's the uh concentric, which is the contraction like a bicep curl. Con concentric. And then if I'm going down, say like on a preacher curl, and I'm letting my arm go down, that's eccentric. >> Exactly. Okay.
(05:26) So there's a lot of science and data supporting that 10 denopathies need eccentric loading to help them repair. That's great. But you know for your own example how that only got you so far because we weren't solving the question of why did it tear in the first place? Why did it become inflamed in the first place? And so that's the next step that I want to encourage clinicians and the general public to look for is like okay are we just going to keep bandating injuries here? Let's use let's find another method to go beyond that and actually a
(05:59) ask and answer why. >> We know that I have a tendonopathy which is a chronic tendon injury um and it gets thickened right it gets thickened and the scar tissue forms. If I don't correct the movement pattern that got me there even though I can get myself out of pain will I ever fix it? >> You will not.
(06:23) And that's why so many people get frustrated and end up just quitting or finding finding another procedure, you know, lots and lots of bouts of PRP. And PRP, I'm a proponent. But again, we can help that tissue heal through multiple mechanisms. We can, you know, eccentrically load it. We can give it PRP.
(06:44) We can potentially use stem cells or other things. But again, if it's going to come right back if we don't fix the reason it became inflamed in the first place. It's a really good example of root cause medicine that is somewhat overlooked because everyone moves. You know, I was looking at some statistics. Are you ready for this? You're ready.
(07:06) Um, adults are sedentary 6 to 10 hours per day. >> I know. >> 6 to 10 hours per day. >> I know. >> And then think about that. Then you sleep eight, but who sleeps eight? Pretend you sleep eight. Say you sleep, you know, six. Yeah, >> right. Most people are sitting all day and 80% are insufficiently active even if someone is going to drop their kids off or walking down the block.
(07:35) And then I'm going to leave you with one other statistic. 82% of leisure time is spent watching TV. >> Those stats are, dare I even say, like they're alarming. They're alarming, but with a problem, you have the opportunity for a solution. So, we have the stats. We also know that increased sedentary time or increased time spent sitting is directly tied to mortality.
(08:02) So, there's actually another stat that I can piggyback off of that one where for every hour over seven hours of sitting, the increase in mortality, the risk of increased mortality goes up by 5%. So for those 10-hour people, they have 15% higher risk of mortality. >> It becomes a challenge if someone were to get injured.
(08:25) Say for example, if you're in your 20s, you get injured, it seems as if people bounce right back. And then midlife it these injuries become chronic. So, as we think about setting people up, you know, parents are listening to this, people in their 30s and beyond are listening to this. If you were to say, "Here are the five movements, and they might not exist.
(08:52) The five movements that you need to do to pre prevent from any type of injury, what would they be?" >> I believe we need to reframe the way we're thinking of movement altogether. So in our society currently we think we look at movement as something that supports health right like we think exercise for example how the question is often how much should I exercise a day how many days a week should I strength train how many days a week should I do aerobic should I do yoga and if so how often they want to know how much should I exercise or how much should I move
(09:25) that's an afterthought that's like a supportive concept where my perspective is that movement is actually has the potential to be a driver in health Understanding this concept comes down to understanding how our bodies and tissues heal in general. And I'm getting to answering your question in the sense that our tissues don't just automatically repair themselves, right? Our biology, our bodies are built with internal repair mechanisms, but that mechanism has to have a stimulus.
(09:55) And that stimulus often comes from our external environment. That stimulus could be movement. That stimulus could be sunlight, our sleep habits, it could be our nutrition. It ties directly with your question as to especially as people age, how what is the best way for them to move? I have an acronym that I'll share with you. The word is more.
(10:17) And so the first M stands for movement, recognizing that it's a driver of health rather than supportive. The second is often O. We need to move more often. And this ties directly to the the stats you pulled on our sedentary time. On the flip side, the solution to the problem, there are plenty of studies that identify small movement snacks like getting up and squatting 10 to 15 times every hour as being able to improve metabolic processes.
(10:50) So, especially glucose uptake and hormone regulation. And even um the same activity 20 squats every hour can actually change amino acid regulation as well for protein synthesis. Again, if we change our perspective on movement and we move more often, we have the capacity to change some of these seemingly damning stats.
(11:09) What you said which really struck me was the question people ask is how much exercise do we need for health versus health requires movement >> as the primary driver. So it's the movement first >> which then goes back to this idea that >> you talk about movement patterns and you have a physical therapy clinic called Primal Health.
(11:35) Primal >> Primal Primal Physical Therapy. I know because I have some sweatshirts and a [clears throat] beanie which is very cute. Are there movements that we have to do every day? For example, when you come over to my house, I rarely see you sitting >> on a chair or on a sofa, you laying down doing work in a prone position.
(11:57) You're right. Kind of up as upward. I guess it would be upward dog, something like that. >> It's like a Yeah, just prone propped I call it. And at any given moment, I might see you bear crawl. It does make you a very popular house guest. [laughter] Uh bear crawl across the floor. Are there a handful of movements that we have to do so we don't forget how to move? >> And this ties directly to why I named my practice primal.
(12:21) If you think about how our bodies evolved, >> really movement was integral to survival. In fact, it wasn't they the two were inseparable, right? We had to >> What do you mean by that? Meaning in order to survive in in our ancestry, you know, years and years ago as we evolved, we had to move. We had to squat over a fire to cook our food.
(12:41) We had to flee from danger and run quickly. We had to carry water potentially to our camp. We had to climb objects to see where, you know, if there was danger or a storm coming, we had to reach up to grab fruit off a tree. We had to do these movements. And through that movement and our biology was in sync. And now in as we stated earlier with sitting with our lifestyle in modern day world all these conveniences we're sitting right now a lot of it is social norms too I think um we've normalized sitting so much that we've removed
(13:12) >> the stimulus >> connection yeah we've removed that connection movement is no longer integral in surviving our environment we've created conveniences in our society so that we don't need the movement necessarily but biology biology didn't get the memo. Like biology still needs those those movements.
(13:32) So when I'm writing a program for my patients or my athletes >> or myself >> or you >> or you're writing it going, "God, I know she's not going to do this one, probably this one. Take this [laughter] one off. She's probably going to double up this day." >> Oh, no. But when I'm writing, I'm going off of the seven sort of seven foundational movements.
(13:50) And that's I'm I'm always looking for a squat, a hinge, a push, a pull, a carry, a reach, and a rotate. Those are the seven four. >> To be honest, I not everyone says the reach, but I know because of my movement pattern background that overhead shoulder stability is critical to pelvic stability. >> What does that mean? >> Because our body is dependent on these chains of motion.
(14:15) These basically we need a couple things to move efficiently. We need stability in all three planes of motion. The frontal plane, the sagittal plane, and the transverse plane. Sagittal plane is essentially forward backward. Frontal plane is lateral motion and transverse plane is rotation. So the shoulder piece of that if we're not training overhead shoulder patterns were not linking those fascial planes to potentially the pelvis or the other parts of the body.
(14:41) That's the other half of the primal concept that I didn't tell yet. Primal also refers to primal or developmental movement. So if you think about when we first earned the right to run, walk and jump from zero to three years of life, we went through developmental milestones. You and I were just talking about this. >> And those milestones, you you don't effectively and efficiently go on to the next, >> you know, baby.
(15:06) You have to earn your milestones. And you don't run and walk and jump efficiently unless you've gone through each of those. Modern day conveniences have essentially taken some of that movement signal out of the narrative. And so we're losing those patterns. >> Our body's narrative. Our body's narrative. >> Our body's narrative. Exactly.
(15:25) So movement being a primary driver of health and wellness and essentially physical capacity needs input. And we're getting input as I said constantly from our environment. So, when we don't use these patterns regularly, the body thinks, "Hey, maybe I don't need this pattern. JJ just sat for 10 hours.
(15:46) Maybe I'll just tighten her hip flexors and tighten her pecs and, you know, maybe she's supposed to be in this forward head posture." So, that's where moving often, adding resistance training is the R for more and remembering how we evolved where movement and survival were together using pattern-based movement. What I'm hearing you say is that people could consider themselves healthy.
(16:10) If we think about movement as a diet, >> there's our macronutrient components. There's our protein, carbohydrates, and fats. If we look at movement as if it was a nutrition plan, >> one could be overindexing on those basic movements like when I came to you doing a uh bicep curl, a leg extension, but if we're never moving in the sagittal plane, we're moving side to side, which you wouldn't really in any kind of bodybuilding compound movement that I can think of off the top of my head, but even a squat is >> well, it's still frontal plane.
(16:49) >> It's in the frontal plane. >> But here's what the thing is. No matter what you're doing, whether you're running or squatting, you need stability in all three planes. Some more than others. So a single leg activity like running or lunging has higher demand on lateral stability patterns, right? >> But you're 100% right.
(17:06) This is what's >> but we're not training it. But right, this is where my athletes often get confused or my athletes get surprised is really what I want to say because what I tell them is you don't need to run more to run faster and you don't need to run more to get like you're running great, you're putting all the time in and they on some level know they are but injury prevention is the same as sports performance.
(17:29) So and injury prevention comes from making sure you have threedimensional stability patterns >> and that is something that we're not training when we go to the gym typically, >> right? I bring this up and people are going to be if you guys are listening to this I strongly encourage you to watch this.
(17:45) JJ is very very fit and we did our challenge. So the forever strong foundation challenge which it was a lot of patterns and we filmed in a very hot 85°ree garage but no one's having bad memories about that. When someone looks at you they might be sitting at home thinking I am not an athlete. I do not look like JJ. I have never been super fit.
(18:07) And JJ does work with Olympians and, you know, allstar NBA players and a very impressive list of athletes, but you also work with the 40-year-old mom. >> Yeah. People think that the sport performance and injury prevention is an elite movement or an elite program, but the foundational things that you do for the athlete, they're still the same foundational things that you do for the 40-year-old woman.
(18:35) And that's right, >> I would love to nail down perhaps a few things. And I'll I'll even just kick one over to you. There's a lot of stuff online that's talking about frozen shoulder, that a woman hits menopause and gets a frozen shoulder. And as you're talking, I can't help but think, yes, there are the biological changes.
(18:55) A woman goes through menopause, God willing, that she's made it that long, and perhaps her muscles and her tendons are not responding. But I can't help but think that if perhaps she does these type of primal movements that it might not be, again, I'm just saying I'm bringing up it might not be a menopause. >> You're 100% right.
(19:19) I clear the menopause component, the hormonal nutritional component with my patients regularly. >> What does that mean? >> Um, honestly, you opened my eyes to all of this. Like when I read your first book, Forever Strong, before we even met, so many things clicked with me because I do I I live every day. I see patients with miracles in the way they can move in response to the movement patterns that I teach them or retach them really because their body really knows it. They just have to be reminded.
(19:48) But there were some there was a small population of people who I was giving the right movements to and they weren't responding. And so then it became a standard of mine. What's your daily protein intake? You know, have you had your hormone levels checked? These things became standard. But yes, there's the flip side too that there are people who get their, you know, their blood levels are all in normal range and they're doing everything they can and they still have these tendinopathies and it goes back to our hamstring example.
(20:15) If we don't fix the patterns, if we don't fix the foundational stability patterns. So, for example, in a frozen shoulder, one of the primal or foundational movements that I would be looking for is scapular stability. When I say scapular stability, specifically in kind of a groundbased posture would be one of the first movements I would check on them.
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(22:05) [music] manicora.com/dion to save 31% plus $25 worth of free gifts. Can we go through some of the movements that are really important? >> Yeah. One of the concepts that's important within the movements goes back to like we had a we we were with one of your friends the other day and and she's pregnant. She said, "I hope I'm okay.
(22:26) I hope I can get fit afterward." And I said, "Follow your baby's movements, right?" So, the movements follow the patterns. We need head control. We need scapular control through and and I normally start people I check them there first because we're going to get spinal erector muscle the back back side of the muscles the spinal erectors from the head to the tailbone there.
(22:47) So that's one of the very first foundational movements if people are not comfortable there. >> And what is it? Is there a name for that? >> I call it prone propped or 3 months posture. It's something that three months old, threemon olds often, you know, tummy time. It's essentially tummy time. >> That's perfect. >> And we build off of that.
(23:03) >> Is that why you lay on the floor and do your work? >> Yeah. So I uh >> adult tummy time. >> Adult tummy time. Yeah. And actually, if you my my clinicians in my practice, you'll see I'm not the only one in my practice. My other clinicians will, you know, if they have downtime and they're writing notes or they're answering emails, they're they're often on their stomach tummy time as well.
(23:21) >> I love it. >> Yeah. Because of the sitting stat that we just talked about, we don't get enough time uh where the posterior chain, our spinal erectors are actually the back posterior. >> Exactly. Posterior chain, our spinal muscles, the back muscles, they go from your tailbone all the way up to your neck. They feather like scaffolding.
(23:38) And because we sit so much, we don't challenge them enough. >> Is there a recipe? For example, if you are sitting five hours a day, you should be in the prone position on the ground, five minutes for every hour. >> So, I actually created a 10 exercise program that is intended to help break up every hour that someone is spent sitting.
(24:01) So, I actually wrote it for an 8 hour day. So, I want the first exercise to be done pre-sitting down to work. And what is that? You just have a band by your desk and you do each of these motions. squat, hinge, push, pull, reach, rotate. >> How long does that take someone? >> So, it's one minute each. So, it's a 10-minute investment in your 10 eight hour day.
(24:21) >> And if someone does this, because um we're going to go back to these primal patterns. The first primal pattern is head control. There's a whole list of primal patterns that one needs to do to make sure that they in essence futureproof their body. All of these patterns are something that an individual has been able to do since birth over a period of time.
(24:43) They were born with an innate ability. >> Yes. >> To be able to execute these movements appropriately. And if they pull forward those motions, those movements through adulthood, the second half of their childhood, then they essentially should be able to live a life that is one of physical freedom.
(25:06) Is that fair to say? >> Yeah. Greater physical capacity. The the wrench in there is that past injuries and trauma do they throw a wrench in the plan a little bit, but we do the best we can. It's really all about giving our bodies information. As I said earlier, movement is one of the ways that we give our body the stimulus to heal.
(25:25) So, if we sit all day long, we don't really give our posterior chain a stimulus to be present and be active. And we see that through everything from changes in the brain to how our tissues respond to how our muscles respond. >> Take me through the second one. So there is the um head control. >> Yeah.
(25:44) So when a baby learns to move, we encourage and we facilitate head control, scapular control. Then they start to reach and rotate. They're looking for their mom. They're looking for the toy. They're looking for whatever. They start to reach and rotate. That stimulates the next progression, which is a rolling pattern. And then only after they have that do they progress up to all fours and start to work towards crawling.
(26:02) And then only after they have that do they start working towards pre-crawling and pushing up towards a squat and a stand. And only after they're strong and stable there do they begin to run, walk, and jump. But one other thing to consider is that it's not realistic for everyone to get on the floor all day long.
(26:18) In fact, the the 10 exercises that I wrote for a desk for someone at a desk job incorporate a band but with these patterns in mind. So for instance, I substituted uh prone propped position with um with a forward band raise bent over to get the spinal erectors firing. So there are some things we can do to substitute potentially.
(26:40) Um but I still encourage people to change positions when they're working if they're working from home going from tummy time to maybe a half kneel position. If you can get a squat in, that would be great. >> Everyone can do that. Yeah. I mean, unless you're a surgeon in the operating room or in a surgical room, probably not. >> But I think that um the input's really important as you're talking about the core movements that we forget.
(27:03) What is scapular control? I'm so glad you asked that because we throw that around all the time and people don't know really what I mean by that and maybe even some of medicine doesn't know. Our muscularkeeletal system has the bones as our skeleton and then the muscles sling to create stability. Essentially, my theory is that it's it's to for survival.
(27:24) Again, it's for to create movement, but also to support our organ systems. It's it's all for survival. Anyway, the scapular muscles, the scapular stability muscles anchor to the abdominal muscles, and that anchors to the to the pelvis. So, the reason I believe the scapular stability is a precursor to being able to roll and crawl is that you can't have pelvic stability unless you have scapular stability.
(27:49) So there's a muscle called serrus anterior which protracts the shoulder blades. >> What do they need to be able to visualize as we're talking? >> So in a straight arm position, scapular protraction would be this forward motion like a punching motion with a straight arm. Okay. In a groundbased posture in a three months or tummy time posture, they would be on their elbows pushing the floor away.
(28:10) Now the beauty of what that does from a mechanical standpoint is that serrus anterior muscle that does that it anchors it literally it feathers and anchors to the abdominal muscles which tie on the other end to the pubic bone of the pelvis. >> The serrus anterior is it where you would see the ribs? >> Yes.
(28:31) In really strong lean people you know how you see those finger-like those finger-like muscles that come onto the ribs. That's serus anterior. It comes from the ribs and comes actually under the scapula on the front side all the way to the inside border of the scapula. >> So why are we talking about this is because you were saying that when you address the scapula it's really important for abdominal and pelvic stability.
(28:58) >> Exactly. >> And someone cares about that and I'm just throwing this out there. I'm assuming as a fall risk. Are there reasons why people would even care? Yes. >> About this? >> So, this also goes back to you one of the questions you asked earlier, which is JJ, what what are some postures or positions or exercises that people should do more often in order for for them to move better and become uh have a lower risk of injury.
(29:26) And one of the most important pieces, I believe, is getting weight bearing through the shoulders because we're missing that in today's world because we're sitting so much. And what would someone have done before? When you say weightbearing, are you saying you're not saying hanging? >> No.
(29:42) Well, hanging is great, too, but I'm saying getting that scapular press through the floor is one of the the foundational pieces of movement that we're missing as a society because of our modern conveniences and uh just less time on the floor. >> That's really interesting. From a anatomical utility, why would we have ever needed to do that? say beyond growing up, would that movement be inherent to say a push-up or is it more of a crawl? How do we bear load in the position that you're talking about naturally, ancestrally? >> For me, it ties more to the
(30:17) developmental piece that we learned to be upright through that window of scapular stability. So when you say scapular stability, if we build from the ground up, the scapula is important for also pelvic health, abdominal health, but were there actions to improve? So if someone is thinking uh about doing these primal movements, >> what do they need to be doing? >> Honestly, just getting on the floor more, changing some postures with the way you spend your rest time is is a great start.
(30:51) So um there are I use movements that are more fun. I prescribe movements that are more fun than like I do the three months posture one but I also use these animal type motions bear monkey frogger which you know because you do them um and that gets your >> you know I don't >> wait what are they and why are we [clears throat] >> you're really good at backwards bear actually and you make me proud they're animal based movements but really what they do is they get our arms they get input onto the um from our arms into the ground again which basically our bodies
(31:17) repair based on demand. So if we're not getting our arms on the ground, we're not telling our we're not giving our body the biological signal that says, "Hey, my arms are still important. My scapular stability is still important." >> So a bear, it's a bear, monkey, >> bear, monkey, frogger, or like the basic ones. There's other ones.
(31:34) There's gorilla. There's all kinds of >> Well, you got to take me through one. And all of these do the same thing or they all do different things? >> They all do different things. >> How often should someone bear, monkey, frog, or crawl? I use it often as a warm-up to movement to to my exercise. So, if you could do it every day, it partly depends on how much how many other things you're prescribing throughout your day and how long you sit, right? I like your nutritional analogy.
(32:00) We want a well-rounded movement diet. And so, if you're spending 10 hours a day sitting, then you 100% need to do groundbased movements or primal based movements every day. >> And the first one is scapula or let's just pick one. scapular stability. >> So, I'd say that's a goal and we could get scapular stability through lots of things.
(32:19) Actually, all three of those motions, bear, monkey, and frogger, will give us scapular stability. >> And scapular stability is defined as what? >> As the scapula moving, staying stable on the rib cage while the glenoumeral joint moves. Essentially, I would say that's a good fundamental, but the precursor to it is that link between scapula and core.
(32:42) If someone is listening to this and they're thinking scapular stability, what the heck are these ladies uh talking about? I'm going to tell you I don't really know. So, I'm going to guess here. If I were to raise my arm up and I shrug my shoulder, that would be someone who doesn't have scapular stability. Cuz instead of being able to raise my arm up, I'm using my uh I don't know, sternoclymastoid and all these other big muscles I fully forgot about.
(33:07) But in order to prove that I do have it, I would paint the picture of keeping my shoulder blade in place, which is essentially my scapula, and do the motions that you're talking about, which would be perhaps an overhead raise. So, it's it's a little hard to clarify on a podcast because there is some scapular motion that should that is expected and should occur a reasonable amount, but exactly as you described the person who has a lot of excessive shoulder motion when they go to raise or honestly I can usually tell just by posture. Like a lot
(33:41) of people if if they don't have a good scapular position to start with, if they have this like forward rounded shoulder posture, >> everyone check yourself really quick. >> Yeah, exactly. everyone's sitting up taller, then you're not going to have scapular stability because you're not even in the foundational position.
(33:55) >> If you catch yourself slouching >> and you have got your shoulders run rounded forward and you have bad posture as I'm doing now, which I'm going to hate looking at this. That is what you're saying is if you're doing that right now, quick everybody check, you have poor scapular stability >> 100%.
(34:21) Okay, that is you guys can all assess in your natural position >> if someone does or does not >> and they know it. I mean, when I post Instagram stories or reals that say like, "Do you stand like this?" I get so many DMs from friends and people like, "Oh, that's me. Oh, I have the dad sideline stance. I have this. I have that." So, most people already know.
(34:40) But I think something that's important to cl to follow that convers this conversation up with is another misconception people have about posture is that it's something that they can sit up and fix. Posture is really a reflection of your underlying stability. So it's really evidence of what your stability patterns are.
(35:01) So if you have poor posture, deciding to sit up taller is never going to really move the needle for you. >> You have to say that again. Yeah. Because posture is a real thing and I've seen posture get worse over the last 10 years because of electronics. >> 100%. >> Um and so it seems as if we are training a pattern.
(35:20) If you can train good patterns, you probably can train bad patterns. >> That's exactly right. >> Say again the posture. >> Posture is the evidence that tells us what is happening stability-wise. Do you have the stability to be upright? It goes back to the primal or developmental or functional patterns. >> If someone doesn't have good scapular stability, which stability is a really weird word if you think about it, because stability, if we were to think about it from a definition standpoint, >> is your ability to be, I suppose, stable
(35:53) under load, >> but with >> or any force really against any force. I would say >> if someone has instability, you know, when I think about if I go to do a squat and my hips are shifting, to me, that's being unstable. >> But scapular stability, it seems as if the only way that one would be able to address it or to be able to see it is if a they were doing a movement like overhead and the other things like the whole shoulder is moving, it's not supposed to, and then slouching down for the purpose of this conversation. If
(36:24) someone has poor stability and they do not fix it, is there an expected outcome that they will feel? >> Oh, they'll continue to decline. >> But will they have hip pain then? >> Oh, they'll have shoulder impingement. >> Okay, tell me the next. Tell me what we get to look forward to if we don't fix this. >> So, shoulder impingement is one of the primary ones.
(36:42) I mean, the reason the tendons get impinged in shoulder impingement is most often because the scapula or scapula, if you're doing one side, rides out on the rib cage. The suppinatus tendon comes under this the acchromium which is the top of the scapula and attaches onto your armbbone. So when someone has a forwardly placed shoulder blade scapula that tendon which already doesn't have a great blood supply gets impinged.
(37:11) Same thing can happen with a biceps tendon in front if the shoulder blade is riding forward. Because let me say this, anatomically, for those of you that haven't taken anatomy, anatomically, the shoulder blade sits here. The there's a uh a bony cup, if you will, that the armbbone sits in off the shoulder blade.
(37:32) So, when the shoulder blade rides forward, you're impinging the muscular attachments that attach onto the armbbone itself. So, that's one. Another one is headaches. Um, lots of neck dysfunction will come from rounded shoulders from from scapular uh weakness or or poor stability in the scapula because when you have rounded shoulders, I want to look up to see the world.
(37:54) Now my head is an extension. My sub oipital muscles my my muscles at the base of the head get it get closed down. Blood supply becomes decreased. um other other movement adapt adaptations happen and you get chronic headaches that also can cause TMJ issues because the upper neck and the jaw are very closely linked mechanically.
(38:16) So forward head position upper neck can cause jaw problems. >> People are going to get neck pain then they're going to get head pain. They're also going to have a weak pelvic floor. I'm assuming. >> Exactly. Yes. >> And a a weak pelvic girdle. I don't even know what that means but that's you know that thing.
(38:32) I mean it leads to incontinence issues and exactly >> you you mean to tell me that if you train your scapular stability >> you might have less >> incontinence >> urinary incontinence. >> Yes. >> Both men and women. >> It's got to be done together. Yes. Because the the this is actually >> we're going to dive into but but pelvic floor is a really poor word because you can't have a room with only a floor.
(38:57) Like the reason the pelvic floor is a thing is because there's three other walls. The top of the wall is the diaphragm. The sides of the wall are the abdominal muscles and spinal erectors. >> That's a really good point. Yeah. >> And people call it pelvic floor. >> And people call it the pelvic floor. And then patients want to know why I'm giving them scapular exercises for their pelvic floor.
(39:14) And I'm like because you can't have a floor without a wall, without a room. >> Wow. You just blew my mind. >> Yeah. >> If someone is listening to this and they started with shoulder instability, do you feel shoulder or scapula instability? Like I said, most people are aware if they have poor scapular positioning um or poor posture at the very least.
(39:34) And I would I would argue that most poor posture has a shoulder component. >> And here I I was able to put together your statement. You'll never be able to fix your posture by just fixing your posture. >> Exactly. You'll never do it. >> You'll never >> You'll never do it. >> And no one wants to be that person. No. >> That is slumped over.
(39:51) The way in which you address scapular for a nuts andbolts action items. >> One way to improve which everyone should be doing >> scapular stability is to be being on the floor. And we don't mean just you know I don't know sitting on the floor. You're talking about >> being on the floor more clearly having your hands Yes. >> on the floor in some kind of movement position.
(40:18) >> Yeah. or static posturing, even just any input to your shoulder blades where they are at the rib cage, whether it's if you're doing, you mentioned push-ups earlier. Most of my patients, I encourage them to do push-ups where they add a plus push-ups with a plus. So, it's a four-step push-up.
(40:36) It's retract, come down, push, and then protract. Retract, come down, push, and then protract. >> Would that be a way for them to practice? >> Yeah, it's a great way. What is the next movement that we have to look at? >> Another very big one is posterior chain activation. So we talked about this earlier meaning the backside of our bodies, the spinal erectors, the muscles that feed um everything actually from spinal erectors to the glutius maximus and the and the glutial muscles and hamstrings.
(41:06) So all of that is posterior chain. And going with your theory, if I just chose a glute exercise, like let's pretend I just chose a glute exercise based on your theory that it has to be a movement pattern. I wouldn't just fix my glute amnesia, would I? If I was just doing a kickback or a isolated >> glute movement. So, here's where I really like isolated glute movements is if you need hypertrophy, if you need actual change in muscle mass, then then doing those isolated exercises have their place.
(41:43) But if you're looking for a movement to give your body efficiency and give you better posture and really for me movement what it does is it increases physical capacity. And that's we talk about like when I opened Primal, what were my goals? So, I looked at the physical therapy world and our main goals were reducing pain and I looked at the fitness world and our main goals were improving strength.
(42:06) But neither of that solved what I think is the bigger problem, which is physical capacity. The average American lives to be 7 79, but the last 12 of those years are often spent in physical disability, chronic um chronic disability or or loss of independence. So, I want to help people with physical capacity.
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(44:03) Aside from these foundational movements, right, the bear crawl, the monkey, the frog, what would be an example? >> I mean, if I had to pick one, bear crawl hits a lot of things because, like I said, two of the biggest underused patterns in our society are involve scapular stability and posterior chain. The bear crawl we use is straight arms and straight legs, the basic bear.
(44:23) And so, you're in this sort of A-frame position that looks like downward dog to people, but it's slightly different because there's an emphasis on the shoulder push. What that position itself does is it engages spinal erectors from head to tailbone and it engages scapular muscles.
(44:39) So it's a high ticket item for somebody who wants to make fast changes in their posture. >> That is probably been the exercise that has had the single biggest impact >> on my shoulder pain. So if you are someone who has shoulder pain or an impingement again for from my perspective it it really seemed to help. >> Yeah. >> What about this posterior chain? Who needs a butt anyway? >> Everybody needs a butt.
(45:02) I mean, survivalally, right? We need We need a butt to run. We need a butt to walk. So, there's different postural classifications I'll put in, right? There's like the desk worker posture, and then there's what I call like the sign the sideline dad. And moms do it, too. So, it's essentially where your hips translate forward.
(45:18) So, you know the guys, they're like standing there trying to look like they're not stressed out while their kids playing and their like shoulders are back, but meanwhile, their hips are in front of them. And that's glued amnesia. I don't know if I've seen that. Okay. >> Yeah, that's someone whose butt muscles, their posterior chain are not working well.
(45:35) I've cued actually in some like, you know, I've worked with you on your top of your deadlift because of your hamstring thing, hamstring injury, your previous hamstring injury. I think for a while you were kind of avoiding that top of the range of hip extension and you were going into this shear of the pelvis and you've gotten so much better at it.
(45:52) But as a result, your glutes are starting to fire and work better. There's uh you know the desk worker which everyone is familiar with. And then there's like kind of the the the muscle meatthead who really doesn't train in in patterns but trains a lot of front body often times and they end up like kind of here.
(46:08) >> Oh, totally. You know, that's like the And by the way, she just flared out her lats. That's like the Would you say it's almost like Popeye where they're only training >> uh universal chest day on Monday? >> Exactly. What is the first step in improving that posterior chain? Because in my mind, and I think in most people's minds that are not in this space, meaning in your >> physical therapy, primal movement or athletic performance, think I'm going to go do a squat.
(46:37) >> Oh yes. So the biggest thing we need to do is get parallel to the floor in some way, shape, or form. >> Will a squat improve my posterior chain? >> This is where it gets interesting. Only if you use overhead shoulder resistance. So I do prescribe an overhead banded squat. I've given it to you before uh which will fire posterior chain but I would say the easiest action item.
(47:00) >> So your answer is no. A regular squat >> a regular squat will not I mean some posterior chain will be active but if you want to highlight posterior chain a squat is not your money maker. >> Sorry. >> We've been misled. >> Yes. >> Muscle and fitness in the doghouse. No, but that's um it's a really big deal because I think that there's going to be a lot of men and women that have been doing these movements and while they're still training, it's almost as if, let's say, for example, you're eating protein, but the only protein that you're eating
(47:29) is white fish. >> Exactly. >> And you're missing all the other nutrients. And so if someone is going there and doing a squat, but they're not training the movement pattern >> right >> beyond that up and down squat, then they're not activating the posterior chain. >> They're not getting the top half of the posterior chain.
(47:48) So they're going to get glutes, right? And as I said, there's a place for isolation, but you're not going to in that position being upright, you're not going to really get the spinal erectors. >> What does someone do? What's the pattern? What's the movement? So I would say the biggest action item I can tell people is incorporate movements where they're they're parallel to the floor.
(48:06) So a bendover row will get spinal erectors from head to tailbone. uh a renegade row, a um an RDL position, um where single leg RDL where you're doing like a rear foot elevated, any RDL position really, as long as you're almost parallel to the floor because gravity is now pushing your head down and those spinal erectors that go from your pelvis up to your head have to fight to prevent that collapse collapse.
(48:29) >> For the bear crawl, you actually cover ground. So you go from point A to point B. Is there a point A to point B movement that will activate or improve this posterior chain that we should all be doing? >> Yes. So bear crawl is one I' I've bear crawl is actually great at it because it also incorporates glutes a little bit.
(48:51) Another one I really like is more of a pulling motion and I call that body bag drags. So you're essentially in a plank position and you again you from point A to point B you pull your body in a plank position across the floor. >> Kind of set that up for me. So you're in a plank position.
(49:07) If you're on hardwood, you need to put a towel under your feet and then finger >> Oh yeah, I've done this before. >> You've done this. So f So if you can either do it on elbows or full plank. And so if if my patients are in full plank, I always cue them finger spread elbows straight. And that's important because if elbows are bent, then shoulder rotator cuff muscles will be more active than serrus anterior than the scapular stabilizers.
(49:31) So there is a little bit of, you know, art to it, but at least you're parallel to the floor, meaning your spinal erectors are all active, and then you're pulling your body across the floor. >> You know, the wheelbarrow, >> that movement, the wheelbarrow. So I want everyone to imagine when you were in uh summer camp and someone is holding your your legs up, but this is the same as that except no one is holding your legs up and you put a towel on the the floor.
(49:56) At least this is what I was doing. And the movement, you're actually pulling yourself in a plank position with your arms. >> Exactly. >> And that helps with posterior chain. >> Yes. Positionally, it's feeding an input that our daily habits are not giving us. >> I mean, I don't know. Most people are probably doing that. >> Definitely not.
(50:13) >> Said no one ever. >> That's right. >> Okay. What else is a huge deficit for people >> from a movement pattern perspective? Well, it's like I said, we need all of those planes. So the other pieces that I think are missing when I look at my patients and their deficits are rotation and anti-rotation.
(50:30) So again, most people, especially actually people who are trying to do the right things, people who are trying to be fit is they're they're working off of traditional programming that is very straighted. And so >> most people, I mean, that's what we see in our clinic. How would someone add in a rotation? The nice thing about all of these exercises, they can be regressed.
(50:52) So depending on the person's um level of of fitness, they could do basically a standing pulley rotation. So one arm is in front of them and the other arm pulls straight arm almost like you're drawing an arrow behind you, although that would be more of a pull this way. So I guess it's a I like a straight arm rotation.
(51:12) That's the uh transverse plane. It makes me think of the presidential fitness test and just those basic that even as we think about quote PE, I don't think they add in a bunch of these movements. >> I don't think so. I was actually thinking about that. I was thinking uh I couldn't help myself after the dietary guidelines got changed.
(51:31) I was like, and reading all these studies that show how we have the capacity to change metabolic markers, biomarkers in our blood, glucose, insulin, amino acid, um, utilization just by interspersing every hour. I was like, man, I would love to program something for children to do in school. It helps with cognition, learning, and memory.
(51:51) >> It was actually a great idea, >> right? >> It's a great idea. I would love to say make it a standard where in school at the end of each class before they go to their next class they do squats and then they do a push-up variation or at least something like it. >> I love it. Yeah. >> How does someone know if they're good at rotation? M >> you know you well I mean you know if you if your posture is bad >> oh if you have the motion >> it that's obvious but I might for example me I might not know if I'm trying to do a self assessment
(52:23) >> if I'm actually good at rotation or not. >> So I should back up what one of the things I was going to say with this rotational exercise. You can do it in kneeling you can do it in tall tall kneeling half kneeling or a lunge position depending on what your level of fitness is. Regardless of how you are, you're facing the pulley or the band and then you're going to uh pull pull with one arm to rotate behind you.
(52:46) Ideally, your arms will end up like an airplane propeller top to bottom. So, ideally, you'll have enough trunk rotation in a healthy moving individual where your front arm and your back arm are in alignment. Most people don't have that. So, thinking like the arms of a clock, let's that's a good analogy. Okay, so you imagine you're a clock and you want one arm to be at 12:00 and the other arm to be at 6:00.
(53:11) That would be a decent indicator of good trunk rotation >> and everybody should improve that. >> Yes, because if we don't use those patterns, we lose them. I mean, the use it or lose it phenomenon is a real thing. But here's a cool thing is if you're limited in rotation, you can also train anti-rotation to improve it. >> And what's that? >> I would program it for my patients like this.
(53:32) Instead of doing a regular goblet squat where the weight is right in front of you, I would do a single arm goblet squat. And that way my body has to resist side bending which links with rotation. So those uh side muscles will stabilize and that will give them more capacity to be able to rotate. All of this makes me think about where someone needs to start.
(53:57) If you have bad posture and you go to the gym and you train that, do you further deepen poor posture? Where does someone >> who is a 45year-old woman, maybe they're in our challenge or they're not, and they are like, "Listen, I've done cardio always. >> It's time to start lifting weights." They go, they meet with a trainer, they go, they use the machines.
(54:27) But is that where they should start? >> I think if you really have postural issues and you dive into a workout program of any type, the cool thing about our bodies is it's going to sound an alarm. Hopefully, people don't wait for that point. >> Oh, I see what's happening. They hurt. >> Yeah, they hurt.
(54:43) That's why people hurt because the body is like you're not moving efficiently and now you're you're asking me to ex to create a capacity that exceeds my I'm sorry to meet a demand that exceeds my capacity. And so that's why people get injured often times especially from what this is another concept. What people think of as overuse injuries are often underuse injuries in my opinion.
(55:05) >> Explain. So overuse injuries happen because we're underusing the patterns that balance them. So >> makes perfect sense. >> Yeah. So all especially these chronic tendinopathies, tendonitises, um shin splints, stress fractures. >> Give me let's take shin splints. >> Yeah. >> As an example, because I've always thought about these overuse injuries >> that people should rest, but you're saying as a doctor, again, this is what I've been trained medically, that that's not um the right potential answer.
(55:35) Right now there's in in every case obviously there's there's an inflammatory phase that we do need to respect in certain conditions. However, even within that inflammatory phase I go back to the first concept we talked about earlier which is why are we inflamed and we have a window even in an inflamed state we can treat the underlying causes and respect the inflamed area.
(55:58) So I describe it to my patients as relative rest. So the most common muscle involved in a shin splint is called the posterior tibialis. The posterior tibialis controls foot pronation in the in the lower leg like fallen arches essentially. So that's what that muscle does. It becomes overused when other muscles are underused and not stabilizing you to propel yourself forward in running for example.
(56:22) >> To summarize, I think this is brilliant. The overuse injury is actually an underuse injury of other muscles. That's right. Looking at movement as a primary driver of health versus something that supports health. So if I was to look at movement as a support to health in a posterior tib tendinitis or shins splint case, I might train that muscle specifically which everyone has done, right? What is it called? It's the >> it's inversion. So ankle bands.
(56:50) You're doing you know the ankle exercises. >> I've had shin splints. When I've gone to the physical therapist, every single one of them has given me a band to do what is it? It again, it's >> inversion. It's basically the opposite. >> And ever. >> Yeah. And that has value, but what's really going to move the needle for someone is teaching and training that muscle in a way that it it has support >> from the other threedimensional planes.
(57:19) So one of my so in a in a highly inflamed person I would put it in a pretty low load state. So I would put them probably in half kneel in a half kneel position where their leg is ground is bearing weight through the ground but not a lot of weight. And then I would incorporate uh maybe a medicine ball rotation or lateral movement or a pulley rotation or lateral movement to get those muscles firing in a very low in a a lowle state.
(57:48) And then if they do well with that, I would progress them to more of a lunge position. And I would just hold it. So now posterior tib is active and stabilizing, but I'm creating forces around it to teach it to stabilize and teach it that it has support essentially. And then I would progress it from there. >> Wow.
(58:11) You know, I'm sure everyone is thinking this seems really complicated to then develop a program. How does it all fit together? Which is a huge question. >> People that have injuries need guidance and that's where you want to look for a professional that's trained in P that's looking at patterns. If you have an ongoing injury, I would say a physical therapist or a chiropractor who's trained in the muscular sketal system and and as it relates to movement.
(58:39) Yes, strength and conditioning coaches are also often very well educated in this. maybe not in the injury recovery aspect as much. Um, >> but I don't think that this is a normal approach. Is that fair to say? >> I struggle to say it's not because it seems so simplistic to me. But I'm always surprised when I talk about these concepts and people are and people are surprised.
(59:00) >> So, but I will say there are more and more people that I see starting to train in these patterns. I mean, Jud Leonard trains in these patterns. Um, Phil Daroo trains in these patterns. So I would say there's people out there who are aware of this. There's a company uh DNS, dynamic neuromuscular stability.
(59:19) They have very similar concepts >> to the primal concepts in the sense they look at developmental patterns as a hallmark of movement ideals. My daughter always seems to notice when I look tired or worn out. Kind of love the zero filter honesty of kids. And like a lot of you, my work life balance [music] feels more like a motorized teeter totter most days.
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(1:01:02) Mondays is I don't know chest and back. Tuesdays is buys and tries. Wednesday is whatever shoulders have their own day because they are just training in individual body parts. What percentage do you think would end up with an injury because they are training just the body parts? I think close to 100%.
(1:01:24) Really because our body isn't meant to function like that. Our body needs that integration. We need those patterns. >> If you could wave a magic wand that everybody was doing aside from the squat, push pull, but the actual movements, would there be a handful that you want everybody to do every day? >> Yeah, but they're really hard to describe on this podcast.
(1:01:45) Like I can show the videos, but I have a handful of my favorites, maybe eight of my favorites. A handful or 20. Now, [laughter] all of my my favorite movements get a lot of check a lot of boxes at once. >> Well, I've noticed and I've trained with you quite a bit. It's never I mean, I always I don't know what to expect because I'll give you an example, the starfish.
(1:02:07) I don't know if that's >> star plank. It put me in positions that were um just what it sounds like a starfish in ways that I hadn't thought about crossing arms or moving that worked almost every body part. >> Yes. >> Even though the load wasn't tremendously heavy, >> right? >> And I felt just much better in >> and I will say the star plank variation I gave you is in I incorporated a row.
(1:02:34) So there's a bodyweight star plank and then the one I have you doing regularly is we have you in front of the pulley and we do the row as well and that's because I wanted to get posterior chain with it. So I incorporated the row. So you're positionally uh for those listening you're in a side plank position as you go from this side plank position as you you descend and you create a hip hinge.
(1:02:58) So now we're getting a hip hinge. We're getting lateral stability. And then you use your glutes and core to come back up. And as you do so, um, everything becomes in alignment. >> What about other tools? Now, to be fair, you use a lot of manual therapies, for example, like dry needling. You were talking about some laser, which I was, you know, when JJ says she's going to do a a massage or treatment, it's not like it doesn't feel good.
(1:03:23) You're not going to be happy about it. But what I did feel, and I'd love for you to just touch on dry needling >> and some of the other modalities because you are kind of what one would consider an OG of dry >> needling. That's right. Thank you. >> How did you get to dry needle? >> Oh, this is a good story. So, my physical therapy mentor, I started with him when I was 14 and he was great and he was already looking at patterns.
(1:03:48) I give a lot of credit to him because he was ahead of the curve on that. We did a lot of aquatic therapy. So I started my career doing a lot of water therapy and we also treated a lot of athletes and that is one of the first things that led me to understand how important these patterns were because in the water I was surrounded by resistance.
(1:04:07) So yes the water helps with the buoyancy but it's also can be a resistive medium. So I was able to train people in patterns in this resistive medium of water and I could see that they were getting greater change than what I was doing with the same patients on land. So it was really interesting. That's where I started.
(1:04:22) But he actually referred a patient to me for uh shoulder pain. This poor guy had like nine surgeries. Uh saw 10 different doctors. He saw all of my mentors and everyone that I would send to when I was stuck with someone. And he had chronic shoulder pain. And uh so my mentor said to me, "Listen, JJ, maybe if you treat him in the pool, you do manual work in the pool and then follow it up with training, pattern based training is what we were doing, then he'll get greater relief." I got him in.
(1:04:52) He got he was only getting one day relief with a trigger point release prior to seeing me. Got in the pool, we did our thing. He got two days relief. I'm like, you know, celerating. And then we plateaued. I couldn't get him past that. So, we knew there were overused muscles involved, but I couldn't seem to get him to where he needed to be.
(1:05:10) So, I called my friend in Atlanta. I said, "What can I do for this guy? Nobody else wants to see him." Docs literally were like, "I don't know what to do with him." >> How old was he? >> Uh, he was in his 50s. So my friend in Atlanta said, "Have you tried dry needling?" And I hadn't. There were only 300 country uh 300 PTs in the country at the time doing it.
(1:05:27) So I went and learned for this patient and it did give such a strong central input that it it helped move the needle again. And dry needling actually is I get also credit dry needling with one of the reasons why I was able to really confidently say these patterns are important. 2009 I trained in dry needling. 2012 >> 2009 so that's >> a long time ago 17 years wow and I double certified because there was no one doing it in my I was in Delaware at the time and I was like oh I guess people are going to be asking me questions I better know what I'm talking
(1:05:57) about so I took two certification programs simultaneously and finished that in about a year and then I loved it so much I started teaching it so in 2012 I started teaching with a company where we used a pattern we used a movement assessment um that looked at the whole body um select ive functional movement assessment is what it's called to teach patterns in our um in our clinicians that we're learning and I was going to teach just the one muscle of the quad and one muscle of the adductors to needle so the adductors are the groin
(1:06:27) >> why would someone get their groin dry needle >> well it depends on who you're working with right but for this is exactly what I was going to tell you is oftenimes I will treat at a site remote to where your pain is first this is because of pattern based movement this is also because overused muscle are really underused muscles.
(1:06:47) So for instance, this clinician that I was about I was about to teach how to do the quad and the adductors, I said, "Okay, let's look at move your movement head to toe. We looked at neck rotation. Neck rotation was very poor. It was like 30° and it should be closer to 80." And I was like, "Okay, well that's interesting.
(1:07:01) So we'll just keep going." Nothing else was really bad. His squat was actually pretty good. >> Get him on the table. I was like, "Well, let's just teach the quad and the adductor." I teach him and I I do one maybe two needles in each muscle and he stands up and his neck rotation completely normalized and that's because his limitation was a neck stability limitation along a pattern a line that connected to his adductors and and quads.
(1:07:27) Wait, so you needled his adductor? Yes. His groin area? >> Yes. because you had put together that it was his he was having shoulder and neck problem. >> No, this was a clinician. This was the And so the the the beauty of this story >> the clinician was the one who got the >> he didn't even have he didn't even have pain but his neck range of motion was terrible.
(1:07:49) >> But the whole point is that instead of needling his neck >> Yeah. >> you needled his groin which then improved >> his neck rotation. And this is one of the first times that I was confidently I saw the cause and effect relationship. And I was like, "Wow, why are we treating muscles? We need to treat movement.
(1:08:08) Why are we treating parts? We need to treat patterns." I treated his hip and his neck range of motion got better. And then I started testing it. I started like, "So now patients often come in. I rarely will needleer the needle their pain sight or address their pain site first. I want to see all the underlying things that communicate first.
(1:08:27) So if I suspect a relationship, which I have a movement assessment process that I use, which you've experienced, depending on what I see with that movement assessment, I'll needle somewhere else. And the needle is just a really strong input that So, as I said before, uh our body, our biology will repair and maintain tissue based on the information we're giving it.
(1:08:48) That information can be movement. That information can be maybe words or cues that I'm giving. that information might be a needle. >> So, it's atrophy of the movement pattern essentially. >> That's a great Yeah, I've never thought of it like that, but that's a great term. I love that. >> Dry needling was not really a thing when you started.
(1:09:08) There was 300 providers that were qualified or technically certified to do it roughly in the US. Physical therapists in the US. For those that don't know, dry needling is it looks very terrifying. It's this long I mean, how long is it? Cuz it's >> depends. So, we have shorter ones for the face. It's very thin. >> It's only terrifying when you're the one on the table.
(1:09:26) >> Yeah. Uh, no. It's actually not even >> doing that for the face, but they look like ginormous needles. And basically, it is like a trigger point or or it essentially is this input that all of a sudden and I've had it done where, you know, I've had so much pain in my hamstring and you've actually not needled the hamstring directly.
(1:09:48) Where would you >> It depended on your movement. So we did do actually remember the first day I treated you. We did shoulders first and it improved your squat. >> Yes. >> And you were like, "Oh, this is I think that was the first moment where I saw the face where you were like, "She's either really smart or really weird.
(1:10:03) " We all recognize that it's really hard to talk about exercise instead of doing exercise or to show the physical treatments without doing it. We are going to do it. For those of you who are listening and watching, we'll link to it on the show notes. If you're listening to this Apple podcast or if you're listening to this on YouTube, we will include a a special link so that you can watch it.
(1:10:27) I was really shocked that my squat had been cuz I have hip dysplasia. One hip is really ground down and then the other hip is like a 20-year-old hip. And hip dysplasia is simply that my hip, right, my femur and the joint doesn't sit in the anatomically correct position. So, it's genetic. I was born like this.
(1:10:48) cuz I woke up like this and um I was having a ton of I think well definitely hamstring hip pain but also shoulder pain >> and you treated my shoulder and my squat got better. >> That's right. So the way we do the movement assessments is like I said I'm not going to treat the painful sight. I will I want to hear where the patient's pain is obviously and I always do a test that will re sort of reproduce their limitation um so that when I treat a remote area and it gets better they understand the correlation because that's really important otherwise they
(1:11:23) just think I'm weird. >> Well you might be a little weird but >> weird but not for that reason. >> Is it because of some some kind of sling? How would one know to treat the shoulder to to get to the >> one of the reason? Oh >> or something like that. So there's the correlation comes from how we're formed essentially.
(1:11:41) Part of that is our fascial slings. Part of that is our the way our nervous system communicates. But the second question you asked me is how would one know to treat that? And so I can give another patient example. Uh, one that comes to mind immediately is again earlier on in my career when I was first starting to notice these movement patterns and how I've really patients got better faster when I started treating this way.
(1:12:06) When I started treating the underlying movement deficit versus chasing the pain, so to speak. And this one uh older gentleman came in and he told me how to look for this. He said, "JJ, I can't turn my neck well." And I do have neck pain, but I can't turn my neck well. But only when I'm sitting. Only when I'm sitting.
(1:12:23) If I'm sitting and driving, I can't I can't turn my neck well. Or if I'm sitting at the end of the night with my wife on the couch, I can't turn my neck well. But if I stand If I'm standing, I can turn. Great. I remember at that moment thinking, huh? Well, it's not his neck then. What else could it be? Well, when he's sitting, his posterior chain is on stretch.
(1:12:40) meaning I was just going to say his glutials and his low back essentially maybe his ham his hamstrings could potent depending on how tight they are but posterior chain meaning the back side of the body in sitting is under tension versus standing that's one of the only different things. So now as a regular part of my movement testing involves looking at someone's rotation neck rotation in sitting versus standing.
(1:13:06) If they have posterior chain involvement or tightness in the back of their body, then it will be worse when they're sitting. Now, there are people that move better when they're sitting and that's because the front of their body tightness is causing deficits in their neck. >> If someone is sitting there, which which is crazy. >> Yeah. >> You're sitting there and you're turning your head.
(1:13:24) You turn your head to the I'm trying to do it. >> side. >> Yeah. But if I stand and then it gets better, >> then it's my posterior chain, not my neck. >> Is that right? >> Exactly. I mean, there may be a neck component, but if it improves, then you can 100% guarantee I'm treating >> the lower the posterior chain first because I want to see that relationship.
(1:13:45) And with this gentleman, he was again early on in my recognition of this pattern, I I said, you know what, that can't be from your neck because your neck moves fine in standing. He said, that that's kind of what I thought. So I said, "Let's treat let's treat the low back." So we teased out the low back. We teased out the posterior hip.
(1:14:02) We treated it and his neck got better. I didn't need to touch his neck at all. So it was it was countless like, you know, n of ones of this for a while. And now I just know how to now I know how to analyze the motion and I I know what result I'm going to get just based on the movement assessment.
(1:14:18) And then having a tool like needling, which you were asking earlier, you were like, how does something like needling work? It's really a reset. It gives what the science shows is that it gives a structural, biochemical and electrical reset to the muscle. Structural meaning those muscle fibers they can they can get contracted stuck kind of shortened.
(1:14:37) So it gives a structural reset to that. Electrically they see changes on EMG when we get that a twitch response in in the muscle with needling. And biochemically there are biochemical changes that help with the muscles to repair themselves. >> How long does something like that last? How long does it last depends on how you're uh prescribing the movement correctives to be able to fix the patterns, right? Because I can reset a muscle, but if then, you know, if the problem is coming from someone sitting 10 hours a day and they're not getting
(1:15:08) the movement part of their diet that they need, then it's not going to get better. Just like we talked about earlier, >> someone comes in, their neck is really stiff when they're sitting, but it's fine on rotation when they're standing. You identify that it's related to the let's just say the adductor.
(1:15:28) You put a needle in the adductor. You get a twitch and then the patient sits down and can turn their neck. >> They stand up. They go about their day. But one of the other things that you do is that you put someone in movement right away. >> That's right. what this person had say a bad squat or whatever it is. >> You put them in those positions for what purpose? >> To reinforce the muscle activation.
(1:15:56) It comes down to giving the biology the information it needs. So basically when muscles repair themselves, they have the cells to repair, but they need a signal. They need information on what abilities and areas are important to repair. So by putting them right in that movement, the muscles will repair it.
(1:16:17) Also neurologically, we're telling the nervous system. So the brain has areas that it it receives input and that helps give it output. When we put you in certain positions, it actually makes changes in the brain so it can call on those positions faster. So uh those are two significant reasons why why we would do that.
(1:16:39) >> What if you don't get a twitch? The twitch has been scientifically shown to be very helpful in the response um from a cause and effect relationship in those three biochemical structural and electrical changes. Um there are other ways you some clinicians will attach electrical stimulation to it and they'll kind of prioritize the electrical signal to try to secondarily have those other effects.
(1:17:06) Um and that can work in certain scenarios. Um, the twitch isn't always critical, but I will say that I do see a greater clinical effect when I get that twitch response. And the twitch response won't happen unless there's just there's a active trigger point, by the way. >> Oh, >> so the >> I didn't know that. >> Yeah.
(1:17:28) So, it's also um diagnostic in a sense that we're treating an area that potentially needs it. >> I do feel like a pin cushion at times. Uh, it just means I probably have a bunch of dysfunctional muscle. >> Um, yeah, but whatever. >> And I also treat only treat you at a like most of my patients I treat at minimum if they're local, I treat them once a week.
(1:17:48) So oftentimes you and I are getting together every four to six weeks and it's sort of like >> pin cushion. Yeah. Yeah. >> Time to catch up. Four to six weeks of work. >> Your practice, your primary site is in Philadelphia. >> Yes. Binmar, Pennsylvania. It's a mile from Villanova. It's just outside Philadelphia. >> We'll link to all that stuff in the show notes. Uh actually in our YouTube.
(1:18:08) Look at that. We're so fancy. We're linking to it. Are there any other tools that you think are really valuable? And by tools I mean that you personally use that you could speak to, whether it's a laser, whether it's >> a red light. Um also supplementation. We should talk about nutrition because I I think like I said, you filled a gap for me clinically that my patients needed that until I read your book, Forever Strong, your first book, I was missing that piece a little bit.
(1:18:38) My patients needed that because and and not that I'm going to be the one to prescribe their diet necessarily. I can give them general, you know, I ask them, are you getting your body weight and protein? And have you had someone check your blood work for hor hormonal balances and other potential flags? >> Can we touch on this? >> Oh yeah, absolutely.
(1:18:58) >> Can I show your before picture? >> Yeah. >> Whoa. >> Okay. And then her after picture, which is extraordinary. And to be fair, when I met you, you were training very hard and consistently. >> You've always been athletic. Is that fair to say? both your kids are. You've got kids that are athletes as well. >> Exercise has always been a part of my life because I learned very young that it helped me focus and it helped me mood regulate and it helped me.
(1:19:28) So even in PT school and even like we do two day two and three day courses for continuing education. I would run at lunch because I knew if I wanted to focus that second half I had to. I had to. >> Um so movement exercise has always been a critical part of my life. Um, so it never felt hard. You know, I remember when I first met you, you were like, "Wow, you exercise a lot.
(1:19:49) " And I think what you were thinking is your muscle tone should be better for the amount of work you're putting in. >> I thought that you were obviously very fit and you moved really well. When I got your blood work, uh, and I'm going to just put this lightly for for people, I was very surprised >> and your hormone status was very low.
(1:20:12) Um, your estrogen was low. Also, your thyroid was a bit off. There were things that I was so impressed with how you were functioning despite having blood work that was just what I would consider and I can say this now >> totally >> because we've addressed it >> and there has just been over the last year a complete transformation.
(1:20:41) Thank you. I remember you saying and I do I believe this is true. I remember you I remember you said I don't know how you're not exhausted all the time. Like I remember you looking at my blood work and we were discussing it together and you were like you you were like JJ you didn't tell me you're exhausted.
(1:20:56) I was like well I'm not really exhausted. I get tired but I just figured I work hard. And you're like no no based on your blood levels you should be exhausted. And but I remember the next thing you said is your your fitness level has saved you. like your fitness level is what has gotten you to be able to be less symptomatic.
(1:21:14) >> Oh, totally. >> And I do think that's true. I think and it's also I think why I'm sort of an exercise addict. Looking back, that's part of why I needed exercise so regularly was because it was my metabolic sink. I had no sink. >> No, you had no sink. In fact, you had like um >> No, what's the opposite of a sink? a little cup or a puddle or a plate.
(1:21:37) >> I had a plate. >> Um, but I think what is so inspirational is that even though your thyroid was low, even though your hormones were off, you had put in so much work, but your body wasn't reflective of it. And then once we were able to address your hormones and able to address your thyroid and these other pieces, it didn't take long before there was and you guys can judge for yourself a complete transformation.
(1:22:05) >> Oh, it didn't. It was 11 months before I made it was eight it was really eight months where I was like where you and I were like, "Oh, you were cute. I'd come visit and you're like, you're looking good." did you know and then >> there was this this transformation and it's so inspiring for people because if they are struggling >> that there is always a reason >> that's right I feel that way and that is why I'm so happy to be here today because it's the same it's like you you gave me information that it's like I
(1:22:34) started the podcast with a problem just means that we find a solution like we identify a problem the problem for me my hormones were off my diet I I cleaned up my diet, too. I mean, >> you did. >> I did. I my diet I say I cleaned it up. I was a healthy eater, but I didn't really measure my protein. I didn't really critically look at what I was eating um until I read your book and then I was reinforced through that through you.
(1:23:00) >> And to be fair now, and we should touch on your diet because again, if you guys are looking at JJ, she's very fit and it doesn't take a ton of effort, >> right? Because what people have to understand is the first phase is predictable and the first phase requires a tremendous amount of effort >> and once an individual puts that effort into place as their body responds there's a lot more freedom on the other end.
(1:23:30) So, >> Jaco talks about discipline equals freedom. And people don't want to hear this, but rigidity up front >> equals flexibility later. >> That's right. >> The more rigid you are up front, >> Yeah. >> the more flexible that you can be later. And your nutrition was higher in carbs and fat than it was in protein.
(1:23:54) And what we did was you weren't you were more of an erratic eater. >> And what we did was so for example today we went and trained. You typically train fasted but after there's a breakfast and if it isn't let's say a high protein breakfast cuz you're running to wherever you're going. We'll add in perfect amino with maybe yogurt.
(1:24:16) I don't know if you had some Well, I know that you didn't have breakfast because your breakfast is still in the fridge. Um >> No, I had yogurt. remember what you're getting? Yeah, I had a bar first thing because we were I we ran out and then I had yogurt right afterward. So, I had my 40 grams in the morning, >> which is incredible.
(1:24:33) >> And one of the things that you do is you now are really diligent on that first meal. >> And then the second meal, you know, I think you can take it or leave it. And then that third meal also has on the back end roughly 40 g of protein. And for someone listening, it's not super complicated for you and you don't have to think about, well, what is this exact measure and how many carbs is this? And what kind of bar did you have this morning? >> I had a David bar.
(1:25:01) I had the s'mores David bar. So good. Feels like dessert. Actually, >> my my kids actually love that. >> It's so good. First thing I had that and then we trained and it was not David's fault that I felt nauseous and training. >> I was impressed. Is she Is she going to puke or not? >> I was close. [laughter] I was really close.
(1:25:18) And then we got back, I wanted that extra 20 grams. So, I got I had um high protein yogurt, Greek yogurt, and a little bit of honey. I put a little manuka honey in it. >> How do you prepare for travel? Cuz you do travel with Again, you work with some professional athletes, >> which >> I travel with the Sixers. I >> Yes.
(1:25:34) Are you allowed to? >> I can say that part. Yeah. >> Okay. So, she travels with the Sixers. Very tall. By the way, we are the same size, 51. So, that's hilarious. >> It's kind of fun. >> Um >> they're great. >> What do you travel with in terms of your own nutrition? The way I create discipline in my life is by habit stacking.
(1:25:50) So I've instilled habits in my life. One of them when I travel I always bring my perfect aminos. I bring I bring bars and I always bring manuka honey too. So I do those three things and I always have my electrolytes on the plane. Like I get come in with my bottle water. I put it on the plane. I just associate traveling with needing the electrolytes.
(1:26:08) Um that's what I do when I travel. >> So there was no excuse for you trying to barf when we were doing sprints. >> No. I know. No excuse. I I I don't even want to hear that. Um >> I know. [laughter] >> What about when you're home? What about dinner? What is that like? >> Oh my gosh. My husband cooks so often. It's Well, we So, our boys, we have I have three kids.
(1:26:25) Oldest is my daughter Avery, who's going to start jiu-jitsu, but my uh two boys, >> she's a astrophysicist, something like that. >> She's a aerospace engineer major. >> Yeah. Close. >> Uh and then my two boys are wrestlers. And uh so we as a family have gotten into really good habits with preparing dinner.
(1:26:43) And I will say my husband does most the cooking and uh he's very good about it. He we have a meat and a starch and it's usually a healthy clean starch and vegetables and that's it. I mean I know one of the barriers you mentioned earlier is sometimes people are like oh how much pro you know how much protein do I eat? I always try to make I'm getting I'm getting like a fist size at least of protein. Yeah.
(1:27:03) >> And that's you know somewhere between 25 and 30 grams hopefully. Um so that's um that's how I go. Do you think there there's one big change nutritionally? >> What I tell my patients is the game changer for me was was actually calculating my protein. >> How much were you at before we were working together? >> I was under I was under 100 before and I'm over I'm I'm actually probably closer to 130 a day.
(1:27:27) >> That's especially for as active as you are. Yeah. >> I would put you that's where I would put you. >> Yeah. So I'm above body weight but um I feel good with it. I've there are times where I'm like my you know >> you are not eating you are not overeating protein. >> No I know and that's the thing is I look at how I feel and I look at how I look and I'm I'm doing well.
(1:27:45) I'm going to stay with my 130. That's the biggest game changer once I started measuring my protein >> daily. I realized my sugar cravings went down. Everything else kind of fell into place. Oh yeah. Remember I used when I when my kids were younger I used to have cereal every night. Oh my gosh. >> I forgot about that. >> Cereal every night.
(1:28:05) And then and uh that was really actually even right before I started working with you, I was probably still having cereal every day because I had these sugar cravings at night and I just thought I mean >> how bad could it be? But meanwhile I was just you know I might as well just drank some sugar cups >> and your lipids were needed improvement.
(1:28:21) There was we kind of are making light of this but you had significant cardiovascular risk factors. >> I think of that often like you actually saved my life. I mean because I was doing everything right and had you not uncovered the metabolic dysfunction in my body then who knows because I did I had cardio cardiovascular risk factors >> and they're changed.
(1:28:43) >> Yes, they are. And you had a family history >> Yes. >> of um cardiovascular disease early. Surprisingly early. >> It's not dissimilar your concepts and the way you're putting them together than the inception of muscle medicine. That's right. I know. That's why I was so drawn to you. When I read your first that is that was why I sought you out because uh when I read your first book, I was like, I think I need her to help me, you know.
(1:29:09) >> Well, I'm really excited for you to help the world. And this idea that it's not the exercise that we need. It's actually the opposite. It's the exercise is the driver. >> That's right. >> Not that we need this as a supplemental thing. >> That's right. >> But it's the primary driver. And I'll say one last thing on that is that if we compare muscle centric medicine with my uh concepts on our reframing of movement, I have another analogy.
(1:29:39) If we think of muscles as the metabolic sync, I can also compare it to like if you think of it from a financial standpoint like like let's imagine it's a bag of money or it's a bank account. Our movements throughout the day help tell us where to invest the money. So that's where when I say it's a primary driver, our movements are going to dictate where we're investing our money.
(1:29:58) >> Well, I love that. >> Thank you so much for doing the challenge with me, the Forever Strong Foundation Challenge. >> Love it. >> And I will link to where people can find you and we will share more of our story and our work together. Thank you so much. >> Thank you so much. >> [music]