Barbell Shrugged - How Chiropractic Therapy Can Prevent Injury and Improve Performance in CrossFit - EPISODE 31

Episode Date: October 24, 2012

http://www.FITR.tv  CrossFit and Chiropractic Therapy, Injury Prevention, CrossFit Movements w/Brad Cole.  In this episode of the Barbell Shrugged podcast we are joined by chiropractor Brad Cole to discuss chiropractic therapy, injury prevention, and CrossFit movements.  For more episodes of the podcast visit http://www.BarbellShrugged.com

This week on Barbell Shrug, we talk to Dr. Brad Cole, chiropractor, about injuries, injury prevention, and CrossFit movement. What's up guys, it's CTP and you're listening to Barbell Shrug. Make sure you check out our video versions of all these podcasts on our website, fitter.tv. In all of our video versions, we include TechniqueWOD, which is our series of technique instruction videos for CrossFitters, free previews of some of the seminars we put out, and then sometimes come out of the studio and have special video segments such as cooking in the kitchen with Brandy that one time and out in the pool with Lucas and who knows what the next thing we'll do is. So make sure you check out our website, fitter.tv, and watch the videos as well.

Hey guys, this is Barbell Shrug. I'm Mike Bledsoe here with Doug Larson and and our guest dr brad cole chiropractor um first i want to talk a little bit about maximum mobility so a product we have in our store you can check it out uh it's a seminar where doug basically walks you through a system on trying to figure out which joints that you have are screwed up and how you might want to fix that that's a good way to put it yeah super simple all right um i want to talk uh so we have brad cole here he's a chiropractor he treats a lot of crossfit athletes here in memphis so we screw him up and he fixes them yeah something like that and uh what are you in business that's right well what's the name of the clinic you work at

it's cold pain therapy group okay cold pain therapy group yep um why why would we want That's right. What's the name of the clinic you work at? It's Cold Pain Therapy Group. Okay. Cold Pain Therapy Group, yep. Why would we want to go to a chiropractor versus maybe like a physical therapist or something like that? That's a great question. Yeah, let me just roll it back just a little bit. So you talked about me seeing and treating a lot of CrossFit folks. And basically what I do is look at movement. And there's a lot of PTs look at movement, there's a lot of DCs look at movement, and other trainers look at movement. And that's what you as coaches do. You look at movement, and you optimize the movement. I

optimize it to get people out of pain. And you guys optimize it to get people performing better. And so when a CrossFitter is having some problems that they can't work around with self-care or something that's popped up suddenly after a heavy lifting session, something's swollen, they can't move quite right, that's when I look at it because I can remediate it and back off a little bit. Unfortunately, as a consumer bit. So, um, if you, you know, unfortunately as consumer, as, um, uh, athletes out there, uh, when something happens, they take a step back and say, well,

where do I need to go to get it fixed? You know, ER, a primary care doc, vet, DC, PT, massage therapy, acupuncture, because all of these services are in silos they're all kind of independent and you've almost got to pick what treatments you want and then go try that um but when it comes to pt and chiropractic um you know some people think about chiropractic it's just you know getting joints popped and you know and worked on that way and that's it and if that doesn't help then you gotta got to go somewhere else. Now, I think it's kind of an oversimplification. It's like saying a PT, all they do is stretch it and put a hot pack on it.

And all the PTs out there are cringing right now, of course, because it's a lot more involved than that. And so the distinction between chiropractic and PT in the state of Tennessee and, you know, here when it comes to practice law, there's not a lot. So the hard part for the consumer now is to try to figure out who out there, DC, PT, doesn't matter, whatever, who's good at movement, at fixing movement problems, because that's usually, you know, what causes these, you know causes these pain problems. All right, guys. So in regard to the difference between PT and chiropractic, how different is the school? The school, yeah.

I mean, what's the focus for you guys? I mean, because everyone does think chiropractic, crack in the back, spine, and then when you think about PT, I feel like it's like maybe post-surgery or something like that. That's what I think of. Oh, exactly. Yeah. If you've got a surgical something replaced, whatever, don't come see me.

I do not want it. I'm not good at it. I don't live there at all. And, I mean, the PT, as far as schooling, it's so broad. And there's so many subspecialties. My wife's a pediatric physical therapist she doesn't want to see anybody who's you know has an orthopedic problem that's what i love you know she works with neurological cases cp and you know things like that okay she's great at it she's a pt and so she there's a lot of stuff that other pts do in the ortho world that she doesn't do

and um so there's a lot of variability in pt you know there's and so mostly when you think about pt people think about outpatient orthopedic post-surgical all that stuff's great and um there's a lot of really really good people out there in every field and so the pt education is pretty broad and you know with that being said after school as you specialize in other things uh you know that's where the you know you know that being said, after school, as you specialize in things, you know, that's where the, you know, that's really fine. Somebody's good. You want somebody who's up on the literature. And so when it comes to the athletic world, you know, look for a PT or DC who's up in the literature.

You asked about schooling. When it comes to chiropractic school, yeah, I mean, manipulation, you know, pushing on joints and making them click and pop, that's what DCs are known for. We put a lot of training into that, the joint manipulation. And there's just more training in the current curriculum for chiropractors when it comes to joint manipulation. The physical therapy world in schools has gone under a lot of evolution over the past couple of years.

Now the DCs, sorry, the P.T. is coming out. They're all DPT, doctor of physical therapy. There's a lot more diagnosis going on and analysis, which is an excellent thing because the primary care doc is writing the script for somebody with a shoulder issue to tell the P.T. what to do to how to treat it. Is this terrible? Because the primary care guys don't know, and the P.T.s know exactly what to do to how to treat it is just terrible because the primary care guys don't know, and the PTs know exactly what to do.

So I'm all for that open access for the PTs and for them to be able to analyze and treat and get patients excellent care. And so similar on the D.C. world, education is broad. There's some that specialize in nutrition, some more in pediat nutrition, some more in pediatrics, some more neurological cases, like at Cold Pain Therapy Group. My father practices with me. He specializes in neurological problems, chronic pain, those types of problems. And I've

got a master's in sports rehab. So after DC school, master's sports rehab, and also a CSCS, strength conditioning, which most of the athletic training world lives and breathes that stuff. And so that's my, you know, specialization. And so it kind of positions me better to treat that subpopulation of athletes and people with movement disorders, those functional movement disorders, not necessarily the pathological ones. What got you into chiropractic versus anything else? Yeah. PT.

Yeah. I mean, looking back into it, I liked what the PTs are doing as far as that. When it comes to access, a care chiropractic puts me at a physician status and so I have open access people can come to me directly direct access I can order MRIs and and all those order those diagnosed you know the diagnostics and so I can do more you get next rowing for my neck I I can x-ray your neck too. All right. We're going to talk this week. Is that going to be your new profile pic?

That's right. X-ray of my neck going totally sideways. Excellent. You jacked it up recently. Yeah, I've actually had a, not to turn this whole podcast on to me, but I've had a lot of neck pain the last couple of months. Oh, we can diagnose it right now. Tell me more. I've had trouble turning to the right, especially.

Chart pain's about right there. All the pain is on the left side, I'd say C4. Sure, sure. Maybe. Yeah. Ish. What you've described so far is a mechanical pain problem. It hurts worse when you rotate.

Mm-hmm. Yep. So that tells us a lot about what's going on the other day my girlfriend's DPT at chemical clinic also and really I don't ask her to work on me that much at all I probably should more often with the amount of pain that I'm getting but but she was she was palpating my spine as processes and it feels like one of those is like dramatically shifted to the left like sure a little bit out of place and then I got some x-rays from a different car a couple years ago and you can very very easily

see that it's quite crooked sure um but anyway we can talk about about me another day but i just wanted to see if you could do that while while you were talking about it yeah ball ping hammer that's right yeah yeah just knock it back in place you know what if if nothing else works she'll bring out the uh mini trampoline and the two pound hammer and make things happen. I don't know what that means, but I'm down. No concern. That's a joke. A minute ago, you were talking about doing the joint mobs or what did you call it? Manipulation. Yeah. Yeah. Yeah. So Mike was saying, you know, most people expect that when they go to the chiropractor, they expect to get cracked and popped and whatnot.

Can you dig into that a little bit and talk about why you're doing that and what is happening and when that happens and how that helps people? That's a great question. Joints get stuck like muscles get stiff, all right? You get a muscle that's tight, there's also joints that get stuck. Most people are familiar with muscles being tight. So let's just kind of flesh out that analogy there. If you've got a tight muscle, it needs to be stretched. As you go through a course of stretching, it improves the motion there.

Similar with a joint, because you talked about a joint in your neck being stuck and rotated out of place. A better description of most joint problems is just a motion restriction problem, as opposed to the bone being stuck out in left field. If that's the case, you might need to see an orthopedic surgeon instead to get that thing fused.

But instead, as opposed to the joint being dislocated, it's more stuck in its motion. And so just like muscles get tight, joints get stuck. And so what I do when I'm treating someone's joint restriction problem, joint imbalance, is assess the joint motion. So you talk about the C4, C5, and the neck area. So assess the motion of each joint and apply a controlled thrust manipulation to move that joint through its range in a quick and comfortable way. And it improves the range of motion, immediately suppresses some pain

because there's an endorphin kick. Most people are kind of familiar with that. They pop their own neck or back and say, oh, it feels good. What they're doing is they're popping loose joints, so it feels good for a couple, you know, 20 minutes. And they don't really resolve any motion imbalance. So when I do a motion assessment, I'm checking for the joints that are most stuck,

applying a corrective force or thrust to those joints, improving the motion. As we go through a course of manipulation, five, six, 20 times, whatever it is, for that type of a problem, it improves that motion and balances the motion out across the spine. So usually, if there's a joint that's stuck,

there's an adjacent joint that moves too much and becomes sore and painful too. So if, if someone's popping their, their own back, kind of what I got from what you said is that, um, the looser joints are going to take that path of least resistance more easily than the tight joints. And they're going to make their problem worse. Is that potentially the way that works? Certainly not helping themselves. You know, most people will have a stiff neck and they pop their back, uh, daily for, you know, five, 10, 15 years. Uh, if I did that, it'd be called malpractice, you know? So if a self care doesn't work, uh, early and, um, uh, if a self care doesn't work in a dependable way then it might not be appropriate self-care okay i remember uh before we brought you on a couple days ago doug and i were talking

yeah and he was talking about how uh you know if you're laying there and a chiropractor is trying to manipulate a joint and and you don't hear a big pop, you know, you might feel like, oh, well, it didn't work. Ah, the placebo effect. Well, I remember thinking that. Sorry, go ahead. Well, you were talking about it, so I'll let you say it. Yeah, I mean, people expect to get cracked and popped. And given that most people have absolutely no idea what you're really doing,

they just expect to get cracked and popped. Like, if you go to do a manipulation on somebody and you don't get a series of cracks and it just doesn't work at all like i remember being you know in my my late teens and having that happen and me being like this guy's full of shit he doesn't know what he's doing at all i didn't crack a bit it didn't crack at all i mean like yeah and what does that mean if you try manipulation and it doesn't work does that what what does that mean yeah i mean what i explain to most people that i'm that i'm working with is that the click of a joint is ancillary to treatment it's not the desired effect that we're looking for but it's actually ancillary to the joint motion i mean if if a lumbar facet is really swollen and i'm going to mobilize that facet it's not going to click it's

going to feel kind of boggy and squishy and it's not going to be clicking and popping. You know, if somebody has in our very arthritic neck, it's not going to move around too much, but they can get excellent benefit from mobilizing that retrain, the posture going through some corrective exercises, changing their nutrition and all of that, you know, in that comprehensive type of a way,

the comprehensive plan, that's the best way to do it. And so if a joint doesn't click uh i mean you know it may not be and you know significant at all so that's not the goal it's just a side effect precisely but it's a fun side effect too yeah it always feels good when it happens to me it certainly helps people feel like it's working for sure actually kind of on that note i read a cool article the other day about about toothpaste and they put they put the minty flavor in there and they put in that sodium lauryl sulfate or whatever that makes it bubble also because when stuff gets clean they expect

bubbles and none of that stuff does anything but people just expect it and makes it makes people feel like it's working and it just helps sales immensely yeah so kind of like that i don't want to use a toothpaste that doesn't bubble. Yeah. It's all about managing expectations. And sometimes those expectations aren't quite accurate. So that's where the education part comes in. And so, I mean, you guys are coaches. It's all about managing expectations and putting people on the right track.

I know my wife is seeing you right now for some of her problems. Yeah. You probably can't talk about that due to some kind of HIPAA rules or something like that. That's right. We'll call her Jane. Go ahead.

My wife, Jane. No, she was just talking about how she really appreciated how both of us have seen chiropractic before. She really appreciated how you explain things. She felt like she was learning while she was there with you. I think you were just talking about education and a lot of times if someone doesn't understand why, and you know, it just seems kind of hokey. Oh, exactly. Right. And I mean, what, what I do as a part of the, uh, the healthcare community here in town is what everyone else does. We just catch

each other's failures. All right. And so, I mean, honesty here on the Barbell Shrug podcast. I mean, I found out a long time ago that most people hacked off coming to me. They, you know, they went into somebody and they were given some recommendation. They were confused about it. And the guy said, well, if it doesn't work, you know, come back in two weeks. And I said, what'd you go back? She's like, no, I came here. And so, you know, so a patients don't really do what they're told, especially if you don't understand why. And so, um, I mean, that's what I really focus on. And that's the majority of, of what I do is to educate people. And because if they don't understand why I'm doing something and they don't buy into it and they're not active with the nutritional recommendations

and the self-care and the corrective exercises, then it's not really going to work. I put a lot of trust into them being active with it because it's not a passive treatment plan. People can't show up and just get worked on and all of a sudden magically improve. Sometimes that happens, but oftentimes I'm asking them to do a lot of stuff too. One thing I've learned over the years is that when I give someone a piece of advice, I always

say it to them with the expectation that they're doing this dozen other things correctly already and I don't have to say that stuff, but they don't know that stuff. Even though I used to expect them to know it, they don't have to say that stuff but they don't know that stuff even though i used to expect them to know it they don't know it and so the fact that you tend to i wouldn't say you over communicate but you tend to communicate everything very clearly uh here just hearing it from ashley or jane jane jane mike's wife um now ashley's gonna think i have another wife named jane that's right disclaimer disclaimer yeah i think that's a great thing because people walk out of there you know or lock out of other other settings and have no idea why they were

told what they were told exactly you gotta say it three times you gotta write it down hand it to them and then when they come back the next day you tell them three more times i mean because most people leave with a feeling i mean you know in a if i'm gonna assess somebody for 45 minutes talking to them throughout the assessment, educating them, we start some kind of a treatment and they leave and they have absolutely, I mean, they can't recall everything. And so there are significant others as to what he's saying. It's like, ah, you know, a lot of stuff.

I don't know. That's why I'm not allowed to go anymore. Too many questions. No, I'll actually talk to you and then you can't talk to her oh yeah yeah that is a downside i'll talk about stuff that doesn't have anything to do with her yeah i wound up shooting the breeze for a while and she's sitting there saying hey wait a second i'm uh here for a reason guys yeah that's right uh what are some of the most common uh injuries you see with crossfitters specifically because i mean how many how many do you treat in memphis

yeah we were talking about that. We were just kind of chatting about that before we started here. And I kind of glanced through the records before I came over here. And there's got to be at least 60 Crossfitters or people who've trained at CrossFit gyms. Mostly from other CrossFit gyms, not FACTS. No, I'm just kidding. We're not screwing anybody up. I've heard all the FACTS athletes got hurt outside of CrossFit.

Fixing their cars and playing with their kids, but not at our gym. We're not screwing anybody up. From all over. I heard all the Faxman athletes got hurt outside of CrossFit. Exactly. Fixing their cars and playing with their kids, but not at our gym. Failing to lift with their knees or something like that. Yeah, something like that. But, yeah. And so CrossFit athletes, like any other athlete, you know, the pros, they get treated daily, you know, for some reason or another. And so, I mean, you know, nobody's getting hurt from doing dumb stuff in the CrossFit gym. Uh, they're, they're,

they're training hard. Yeah. And so, um, you know, they need tune-ups and they need very different types of tune-ups than the usual, um, you know, self-directed training, hard athlete, uh, which is, which is pretty interesting because most folks, I mean, even if they've been at CrossFit for a week or two, they come in with a higher level of understanding about movement and movement quality and how that's imperative to move in a healthy and efficient way. If you're going to pick up something heavy, it needs to be efficient. If you're going to pick up a hamper full of clothes, it needs to be efficient. If you're going to pick up a pencil, it needs to be efficient.

And that efficiency is similar across the board. And so they already come in knowing the importance of the movement efficiency. And so, I mean, it just makes my job so much easier because we can just hone in on the small dysfunction that's causing the problem, and then they can get on. Whereas somebody who doesn't have that level of understanding, they haven't been properly coached, there's just so much I've got to fix. So much I've got to fix, and that's fine too.

I love helping athletes at all levels. I know with respect to movement efficiency, me and you have a similar philosophy as far as the different needs of the different joints. I've talked about this on the podcast many times as far as which joints need to be trained for more stability and which joints need to more than likely be trained for more mobility. I've explained it a couple of times,

but you probably explained it a little bit differently than I do. So can you kind of dig into that concept and explain kind of what good technique is and how people are supposed to move and what movement efficiency really is on a joint by joint basis? Yeah, I mean, it's really the joint by joint. I just could pull it down pretty quickly. I say, look, your ankles are tight.

Your knee is loose and injured. Your hips are tight. Your low back is loose and injured. Your T-spine is tight. Your shoulders are loose and injured. Your lower back, I'm sorry, your lower neck is loose and injured because your upper neck is tight. And then they say, okay, why is that? I say, well, because we all develop from an infant to adulthood in the same way. And that's just how we're, you know, that's just how we develop. And, you know, because you're human And that's just how we're, you know, that's just how we develop. And, you know, because you're human, that's just the way it is. And I said, oh, okay. And then it kind of makes sense from that point out. You don't really have to go into postural ontogenesis and all, you know, like neurodevelopmental theory. You say,

oh, that's just the way it is. And then you can boil it down to a muscle tightness too. An infant comes out and their shoulders are elevated, their biceps are up, their hips are flexed, their toes are up, and they have the muscles are tonic. The same muscles that are tonic in an infant are the ones that are tight as adults. And it takes four years of development for an infant to be able to to do certain maneuvers like uh like a basically looks like a thruster and overhead squat all right that's it takes four years of neurodevelopment to achieve that as a human and then throughout adolescence and adulthood

we fall out of that pattern and so when it comes comes to rehab, it's really simple. All I really do for, for most athletes, if they're, if they're normally developed neurologically is to try to groove them back to an overhead squat and, you know, whatever that would look like for that certain athlete, just try to get them back to that overhead squat pattern and um you know there's there's certain uh there's certain differences based on different injuries but that's really what i pull it down to you know you gotta work on and achieve and maintain overhead squat and that fixes all the problems okay i might have derailed mike's last question about the most common injuries for the crossfit athletes here in town can you true you dig back into Mike's last question about the most common injuries for the CrossFit athletes here in town.

Can you dig back into that question and talk about the stuff that you see from CrossFit athletes specifically? Yep. See, one of the most common things that I see would be lower neck problems. Sorry, Doug. Lower neck problems with losing cervical thoracic stability when you're overhead with weight. Okay. So when, when, when an athlete's overhead with weight, what'll happen if they lose that stability is they shoot their neck forward. All right. Their head comes forward. Even some coaches talk about, you know, a head through the window. All right.

What that does is it throws in lower cervical flexion all right and upper cervical extension all right head through the window and that that destabilizes that whole cervical thoracic junction whereas what we have to uh what i teach and you guys need to coach you guys do a great job is the neck neck packed position. All right. So this teach people how to pack the neck. If you can't pack the neck actively, if a patient can't do that on their own, there's some other limiting factor. And that's when, you know, if they're in my clinic, they usually need some type of a manual intervention,

some kind of manual support to achieve that neck packed position, to teach it so they're aware of it, and then give them the the tools to groove it and reinforce it so i was gonna say can i break that down for people have no idea what you're talking about oh yeah sorry so the original the original the original thing that you that you mentioned was what's he talking about if you can look at me from the side ctp is when people push their head through the window they're putting themselves into computer posture like this they're pushing their chin forward yep and they're rounding their lower neck forward like that

into flexion and then their upper neck is kind of hyper extended just just the top few segments exactly right yeah and then top segment and then packing the neck is the opposite that cervical retraction where you're pulling your chin back and you're you're making those two curves kind of go opposite of what they were when you're sticking your chin forward exactly right and so your your mid to lower cervical is now going from kind of loose and flex to a little more stable you've got and then your upper your upper cervical is going from hyper extended and tight to um less extended i wouldn't i wouldn't say flex necessarily, but is it flex? Yeah, there's flex, yeah.

Flex, okay. Upper cervical flexion, because they're actually trying to work on the deep cervical flexors. You can't see them. They're behind your esophagus. And those are the ones that are active. You can kind of help to facilitate that activity by pressing your tongue with the roof of your mouth. Everyone go ahead and do that right now.

I'm doing it right now. Excellent. Yeah. I can't do it while I talk, but so pressing tongue and the roof of the mouth. You can't see it, but I'm doing it right now excellent yeah i can't do it while i talk but so pressing tongue the roof of the mouth you can't see it but i'm doing it you can't see these muscles all right but they're behind the esophagus and uh achieving that type of neck pack with the tongue pressed to the roof of the mouth um it positions the neck in a much more stable way because when you're overhead the upper back needs extension right trying to extend the upper back right if you're trying to extend the upper back but you're also, the upper back needs extension, right? Trying to extend the upper back. If you're trying to extend the upper back, but you're also shooting your head forward,

then you're trying to extend and also flex your upper back. It doesn't work, and it causes the joints to overload and jam, and it hurts later on. So what I got out of this is people need to push their tongue to the roof of their mouth, and they go overhead. And neck pack. And neck pack. And neck pack. I forgot about that. The easy way that I've heard packing the neck explained is that you're

trying to make a double chin exactly like this yeah i don't really have a double chin i think but no the ladies are always very concerned about the neck pack position right so uh on that note too is when when i'm coaching i rarely tell people to push their head through i tell them to pull their hands back oh awesome instead instead for that exact reason. That's a great coaching cue. This is what's really unfortunate. If you go to a CrossFit competition, the judges a lot of times, what they're looking for is ears in front of the arms.

If you don't get ears in front of the arms, it doesn't work. If you're in the gym training, that's okay. But I've seen you know perfect overhead position by an athlete and they're getting no rep that competition and i don't know if you've ever been to a crossfit i love to is this an invitation yeah you should come to do it i don't know we'll go to one sometime very good but a lot of times there'll be a judge who's not the judges aren't always uh extremely experienced a lot of them aren't coaches a lot of them are just another athlete or someone who just likes crossfit sometimes judges get thrown in these not super high level competitions

and they've been crossfitting for two or three months that's like their level of experience yeah a lot of times they're just like we just we need judges and they just like anyone want to judge and they just like ask the audience and people are like i guess i'll do it yes that still happens yeah unfortunately yeah so they the the standard ends up being ears in front of the arms yeah and so i remember uh specifically this happened to caitlin i don't know if you know caitlin mills specifically this happened to Caitlin. I don't know if you know Caitlin Mills. Yeah. This happened to her a year and a half, a year and a half ago at regionals. She was getting no rep, no rep, no rep. And I'm over there screaming, you have to stick your head, stick your head through like over exaggerate, not safe, but absolutely necessary if she wanted to do well at the

competition. Yeah. Ugly. And, and the dirty little secret here too is that when it comes to spine stability and performance, I mean, somebody could do something poorly and pick up heavier weight because that's what they're more comfortable with.

And after they fix the movement, they could pick up more weight after they fix it. But if they're comfortable in the dysfunction, they can, they can, you know, pick up more weight that way. So, uh, you know, there's obviously a difference there between training and, uh, competition. Uh, and then when it comes to the standards too, and we could fix that. Can we fix that? Uh, I've tried to fix a lot of things and it seems that it's pretty difficult.

Yeah. uh i've tried to fix a lot of things and it seems that it's pretty difficult yeah uh crossfit is uh is pretty discombobulated as a whole as an organization yeah large and organic huh yeah what exactly so it's like you may be able to fix this over here but you can't fix this over here yeah or you know some people maybe at headquarters have an idea about what things should be. And, you know, that's just the way it's going to be. Sure, sure. No matter what. All right. So what other injuries do you see?

Yeah, I mean, when it comes down to the step-down test, I mean, because, Doug, you've got a lot of great information on your mobility, the posters and the seminars that you've got. And so I'm not sure you looked at it, but looking at ankle dorsiflexion movement and how it affects the knee, how it affects the hip, how it affects the whole overhead squat patterning. Ankle dorsiflexion is huge. You want to talk a little bit about that? Yeah, sure. About lack of ankle range of motion and how that makes you compensate as a result? Exactly right.

It's a lack of ankle range of motion. Most that makes you compensate as a result exactly right it's a lack of ankle range of motion most people think oh my ankles are too loose they're too loose because i keep spraining them to the side well there's a side motion that needs to be checked of course but it's that front on motion that the tightness that people feel when they're doing a deep squat at the ankle the inability to keep their ankle or their foot flat to the floor during a deep squat. Or, easy test, get a step, a regular standard step, most building codes is seven inches. And so one should be barefoot, standing on a step, and be able to step forward, tap their heel with comfort on the step below, and not raise up the heel. In fact, also have the foot going

straight forward. So the, so the, the angle of the bones of the second toe are pointing straight forward and you step down, you know, everyone should have that ankle range of motion of a standard step down test. And a lot of people come in with some certain movement, you know, movement dysfunction that resulted in pain at the knee, the hip, the shoulder, whatever, low back. Maybe they think that their shoulders are too tight because they just can't get that weight overhead, but it all comes down to sometimes, all the way down to the ground,

to the ankle range of motion. And so achieving the dorsiflexion is huge. What about shoulders? I see a lot of shoulder injuries injuries or at least a lot of it's injuries that athletes say like oh well it's not injured it's just achy like it just i mean doesn't it's not hurt it just doesn't feel normal well that's injured i see a lot of shoulder injuries in the crossfit world yeah not at our gym but at most crossfit gyms we do a lot of overhead everything lots of jerks lots of snatches lots of pull-ups lots of

vertical pushing and pulling and and that that beats up a lot of people especially when they are just starting crossfit and they go from not doing any of it to just jumping right into it yeah i joke with folks pretty regularly about their shoulder issues uh in regards to i say hey if you weren't doing crossfit and you'd never reach overhead until you're you know pulling your luggage out of the bin on the airplane. Because nobody ever reaches overhead, especially with the weight in their hand, unless you're at CrossFit. And it's a movement that most people have lost and haven't done or have never done.

And so, yeah, it's one of those movements that requires some good scapular stability. Shoulder blade has to be stable but also very dynamic it's going to move through like a pretty big range but still have stability and that's it's it's complicated it's hard to assess on your own it's hard to you know hard to check for it and if it's not working right it's going to cause some some shoulder problems mm-hmm uh you wrote an an article kind of recently. Yeah. Maybe a month or two ago. Yeah, that's about how far my blog's usually out.

Yeah, you had a rebuttal to K-Star's icing. He did a video on ice. Yeah. Do you watch K-Star all the time? No. Somebody just asked me out of the blue. I was like, hey, what do you think about this video?

I was like, that looks pretty cool. He's done a lot of really awesome stuff. Uh-huh. We love K-Star and we watch it all the time. Yeah, really cool stuff. Follow him quite closely. And then I actually didn't see the Ice thing. I saw yours.

Yeah. I saw your rebuttal before I saw his video. Yeah, an inspired clarification. So what? It was more of an inspired clarification. Yeah. And so I then went and watched his video. Yeah, an inspired clarification. So what? It was more of an inspired clarification. Yeah. And so I then went and watched the video. Sure.

But can you tell us a little bit about that article? That's the latest article that's on your blog right now. Yeah, sure. I think the real point of the article was not to overgeneralize any one treatment. And especially in the manual therapy world, the chiropractic, PT, athletic sports injury world, everybody's real treatment-focused, and it's easy to do. I love certain treatments. I get excited about certain treatments.

And it's kind of a disservice to anybody who's paying close attention to say that one treatment is going to be far superior over another one in general. Yeah. So KSTAR said to summarize and correct me if I'm wrong, that we don't need to ice down anymore after we work out, but instead use compression because compression superior, uh, because ice, what ice actually does is it causes vasoconstriction. It pushes the blood out of the area, but if something is inflamed, it needs more blood. It needs more inflammation to heal up. And so that's a very valid point theoretically, but it doesn't apply, uh, across the board to athletes or to, uh to people in pain.

So, I mean, if you've had an injury, ice is the obvious way to go. Precisely. If I get a bee sting, I'd rather put ice on it than heat. Yeah. Yeah, and most would. But on the flip side, like K-Star was also suggested that don't ice yourself down after every single training session just because it hurts. And I think that as coaches, you would certainly agree,

if somebody is in pain after every single training session, they're either overtraining or they're training poorly. And, you know, it's tearing stuff up. Pain is a symptom of something going wrong. And if you think you're fixing it with ice, it's a big mistake. Precisely. Pain is never there without inflammation. Inflammation is the only thing that causes pain in the body.

And ice can help reduce inflammation if applied appropriately. But inflammation is also there to heal the tissues. And so it's all a matter of what people need. And so that's what makes matter of what people need. And so, I mean, that's what, that's what makes this stuff, uh, uh, so fun and difficult. And, um, so different on a case by case basis, but in general, the tools are not as, um, you can't really generalize, say one tool is going to be great. You know, it's, it's new and it's now it's great for everything. Uh, but instead you've got to really structure got to really structure your training programming, your nutrition,

your self-care, and then have a good diagnosis for a pain problem and then figure out what tools would be best for that specific diagnosis for that specific case. Cool. All right, let's go ahead and take a break real quick. And y'all watch the Technique WOD video and we'll be back. Hey, thanks. Cool. All right. Let's go ahead and take a break real quick. And y'all watch the Technique WOD video. And we'll be back.

Hey, thanks. Cool. Welcome back to Barbell Shrugged. We're still here with Dr. Brad Cole. Even though we don't like him. No, we like him. Yeah, haven't watched yet. And Doug Larson's still here, too.

That's right. I didn't go anywhere. Amazingly. We were kind of talking about some of the misconceptions during the break. Yeah, exactly. And we want to dig into those a little bit. Take the gloves off, guys. And I'll say the first one that came up was,

if I go to a, what was it? What was I thinking? No, go ahead, Doug. I think I lost track. Your question, or the thing that you've heard from many people about going to a chiropractor, is that they expect to go one time, and then when it's not fixed in a single session,

they're upset about it. As if he had, maybe he does have magic hands, but as if he had magic hands and could just magically heal you with his powers. Like you have to let something heal over time, and one session is never going to cover it, right? So you have magic hands? No comments.

But yeah, I mean, a lot of it comes down to simply a managing expectation. one session is never going to cover it, right? So you have magic hands? No comments. But, yeah, I mean, a lot of it comes down to simply managing expectations. And so something, yeah, if you're going to go to the doctor, to the chiropractor one time and then have it all fixed up, it doesn't quite work that way because what I have offers information, education, but also usually, unless I send them somewhere else, a manual treatment or some type of treatment that we do there and it takes a course of treatment to have a good treatment effect just like if you go get a course of antibiotics you take the antibiotics to a day until they're run out you're going through a course of treatment with the chiropractor

or physical therapist you're going to go through a course of treatment to have that good training or that good treatment effect. And yeah, similarly, people also have concerns about if I go once, I'll have to go for the rest of my life. You know, there's kind of two sides to that. One is, yes, you will, you know, there is, you have to go through a course of treatment to have an excellent effect. Sometimes it's two. Sometimes it's 30. It really depends on a case-by-case basis. But I think what a lot of people find when they come see us is that we can help them out with more than they had expected originally.

So when somebody comes in with a low back issue or a hip issue, and we also talk about their chronic daily headaches, and if they start to develop an Advil deficiency, then they can pop some more Advil and address that chronic daily headache. And so sometimes we can help out with those issues too. And so sometimes people find that we can help them out with more than what they had originally anticipated. So for someone that's never studied anything in your field, how would being a movement coach influence getting headaches?

Coaching towards it? I mean, how would being a movement, how would coaching someone on movement efficiency and dealing with their joints and popping their spine and stuff influence chronic pain that I have in my head? Oh, gosh. Okay. How is that even in the same category? Great question. As far as what causes a headache, the majority of headaches aren't caused by something inside your head.

The brain tissue doesn't really have a lot of pain receptors to it actually, but the blood vessels do. The skin around the head does. The muscles all around the head and the neck, they do. And so the majority of head pain is actually from the muscle and joint system around the jaw and the neck. And that's around the head. It causes the head pain.

And so if there's a movement problem in the shoulder, it causes shoulder pain. There's movement problems around the neck and the jaw that cause the majority of headache pains. So if you have a headache, it could be due to a shoulder issue. It could be a shoulder problem. It could be a tumor. It needs to be accurately diagnosed. So with things like forward head posture, like we were talking about earlier, about kind of jutting your chin forward like this,

be one of the things that might influence something like that? All day long, all day long. And so, yeah, I mean, people come with a shoulder problem, and we assess them and work them up and put a little bit of pressure on those sensitive muscles right there at the base of your skull on the backside. And all of a sudden they say, oh, that's my headache. And they start wincing and closing that one eye. I say, well, has it hurt your eye?

Yeah, it hurts my eye. It's because the muscle is causing pain up to the head. And so it's wonderfully diagnostic. You don't see that on MRI, but when you put your thumb on, pressurize those suboccipital muscles right there at the base of the skull and reproduce the headache. It's a beautiful thing because we can actually address that and fix that. Is that something you deal with on a regular basis, MRIs? Yeah, we can, you know, the MRI is helpful for answering clinical questions.

And so a lot of people, you know, people come in and say, I think I need an MRI. And, you know, I don't usually say it in a crass way, but what I think is, well, why would you need an MRI? You know, if, if someone needs an MRI, I would, so-and-so, yeah, I would need an MRI to help diagnose somebody. You don't, I mean, what would you need an MRI for? It's just a picture of your neck. And so, yeah, I mean, MRIs, they're, they're, you know, people talk about how they're overused. They're just more misused than anything else. Because they're there to answer a clinical question. And it's usually whoever's trying to diagnose the problem who has the clinical questions. I know in the fitness world, you go to seminars and whatnot.

And inevitably, I see a presentation at least once every couple of months where they show three pictures of MRIs. And they say, this person on the MRI very obviously has something wrong and they're asymptomatic. And this other person very clearly has nothing that we can find and they're in chronic pain. And then they kind of throw their hands up and they say, you know, MRIs, they're useful, but they're not really that useful. And that's why you should buy my program. There's some truth to that, sure. If you look at that confusion between symptomatic and problematic

and asymptomatic and normal degenerative wear and tear, torn meniscus, arthritis, bulging disc on MRI, normal, non-painful. If you look at all that and then shrug your shoulders and it's going to walk away, I think that's kind of selling the whole diagnosis, the MRI short. But instead, it needs to fit into the overall analysis of what's going on. If someone has evidence of another process going on and it's best diagnosed with MRI, then MRI is a good thing to have the rule out problems or rule in problems, but you use it in the context of figuring out

what's going on, but with caution too. I want to get back to the headaches real quick. How, how frequent, so mostly women, I hear I get headaches all the time and, uh, say, well, all the women that you know well all the women you know all the women i know i get headaches it's crazy a couple hours with you oh my gosh my girlfriends don't get headaches it's weird my wife nor my girlfriends no the uh so how often is the headache uh something that you can you can help fix or is it is, how often is it a chiropractic issue versus say, you know, someone needs to take some medication or maybe a nutritional issue? Yeah. Oh yeah. Great question. Like if you're going to talk about, you know, how often the

headache is coming from a neck or a jaw dysfunction. The research says 9 out of 10 headaches. And so most headaches. And so then you're left with migraines. And you can have a neck jaw dysfunction that causes a terrible, terrible headache. And so migraine just doesn't mean a worse headache than usual. It's just a whole different type of a diagnosis or headache. The genesis of the headache is completely different. And without getting into that, so how often is it nutritional versus movement versus hormonal

versus emotional versus environmental perfumes and allergies? The answer is yes. All of the above and often multiple causes of headache. And so we kind of describe it as a glass. And let's take a glass here, probably. Take a glass, and we start filling up the glass and pretend that it's not going to be painful until it's overflowing. And so if we pour in some movement dysfunction, pour in some nutrition, pour in some emotion, and then all of a sudden hormonal issues and it's overflowing, that's the pain.

That would explain the woman thing. I'm not going to say that. But there's all these things that stack up to cause the triggering of the headache. And so if you address the movement issue, then you can have more room for error. If you address the movement and the nutritional issue, then you're really getting the headaches under control. And then you address the movement and the nutrition or the hormonal issues there too. Then you've got to have even a better handle on the headaches. And so it's all

about managing the triggers and the things that stack up. So yeah, I mean, headaches are really difficult to work with in that it's rarely one single thing that causes the headache. But most headaches do have a cervical or a neck, jaw, muscle joint component. That's one of the triggers. Yeah. I saw you have a little bit of a nutritional component on your website. Is that something that you guys do at your practice, or is that just some advice you thought on the website? And how much do you integrate that into your practice?

I mean, the extent that I know about nutrition just has to do with nutrition information. That applies across the board to everybody. So I can't get into, because I have no idea, about condition-specific nutrition. Leave that to the nutritionists. That's a full-time thing. Don't go to somebody who does that on the side.

But when it comes to everybody out there, if you eat, and if you have information, which is all of us, then there are certain nutritional recommendations, which is basically the paleo diet. The only caveat I throw into the paleo diet, because sometimes people forget that the meat source can be fatty, and the fatty nature of it is often inflammatory because our modern-day meat sources are feasting on corn chips.

So keep that in mind and put the bacon and the sausage down unless it's wild. That's why it's good to kill your meat or get it grass fed. You've got it right. From the farm. Exactly. And if it's not grass fed, then back off on the bacon and sausage. Actually, I want to take one more twist or turn here at the very end. It just popped in my head.

I want to get your thoughts on sleeping positions and how that might influence something like chronic neck pain or chronic back pain. Sure. Do you advise people on that? Yeah. How to sleep? I kind of boil it down to sleep comfortably and then don't do things stupid. And so I don't explain it that way.

That's kind of what's going through my head. I usually ask them, well, how do you sleep? And some people will say really weird things after that point. And I'll say, well, you've got to stop that. But, I mean, outside of that, people will just try to sleep comfortably. They just try to get to a comfortable position. I feel like we just missed out on a good story. Oh, yeah, like I don't sleep with a pillow.

Some people will say I don't sleep with a pillow. Some people say, I don't sleep with a pillow. I say, well, why not? Because I can't sleep otherwise. Well, there could be some other issues at hand there. Are pillows beneficial? Or is that just something we like because it's comfortable? Or is it because it's comfortable? It's comfortable because it's good for us.

Which one is it? Oh, yeah. Chicken and egg. Chicken and egg. Cart and horse. I'll get a philosophy on here. Actually, I don't sleep with a pillow. Go ahead and dig into that.

You don't sleep with a pillow? Okay. I mostly sleep flat on my back with no pillow. He's a weirdo. And that doesn't put your neck in more extension than you'd usually have if you're awake? Says the guy that has neck pain. Well, no. Actually, I stopped using a pillow because it hurts my neck.

The pillow hurts? Yeah. I don't know. Maybe it was the wrong size of pillow or something. But if I'm on my side, I'll put a pillow under my head. I feel like that helps keep me in alignment. Precisely. Otherwise, your head's like by your shoulder.

That's not good to have throughout the night. But when I'm on my back, it feels better just to lay flat. Yeah. I do have very flat military type posture though it could be more the neck's fault than the pillow's fault and so when it comes down to it you kind of dissect out which is comfortable

just like Mike was saying a minute ago is there something weird? somebody sleeps cross-legged with their head face down in the bed we've got to stop that people that's weird people say well yeah is that a problem yeah it's a problem i don't you know we're just gonna say yes i can't probably out there people listening going i'm such a weird oh crap yeah stop that too yeah no no more uh no more uh a fatty inflammatory sausage and no more sleeping cross-legged.

I do. My wife went out and just bought these without any prompt from me. I think she read it somewhere and ended up buying those pillows that have like the... Oh, the big curved thing to it? Yeah, they're like curved and your head sits in it and it's really comfortable actually. Like a memory foam pillow? Yeah, it's like memory foam, but it also has like like it like cups your head yeah right right right yeah that's why my that's why my recommendation when it comes to sleep posture is is uh you know find what's comfortable and realize that that

might change uh as you uh change the function of your neck so yeah when people come in their back's killing them they say i think i'm I'm going to buy a new mattress tomorrow. I say, well, let's fix your back first and then find what's comfortable. There you go. That's a great point, actually. I find that I sleep, what's comfortable is different depending on how much I had to drink. So if I go to bed completely sober, I'm just on my back. But if I've had a few, then end up like head at the other end you

know yeah so five nights a week you're all over the place and the other two nights of the week you're on your back that's right monday and wednesday i'm pretty good but tuesday thursday yeah that's one way to find one's comfort yeah we're joking it's like four days a week uh all right you also had a question you brought you you stole my question song it's still yours We're joking. It's like four days a week. All right. You also had a question. You stole my question, so I'm going to steal yours. Okay. Go for it.

Another misconception is that chiropractors get more sales coaching and training in chiropractic school than they do medical. Yeah. Yeah. Well, actually, I wish I had more business and marketing background. You do. Yeah. Yeah. Well, um, uh, I actually, I wish I had more business and marketing background, um, just because, yeah, because that's obviously important. No, I mean, I think that a lot of people's, uh, conception about chiropractic has to do with, you know, what they see in, in the, uh, the newspaper inserts on any Sunday morning, you know, what's on the giant billboards. And this realized that since chiropractors aren't completely invested

and fully participating members of the medical healthcare establishment, that a lot of them market heavily. And so unfortunately, most people's, um, expectations or, uh, perception of chiropractic is colored by what they see in the, uh, in the newspapers. And, uh, I mean, you won't see our stuff up there cause I think that we do a good job of taking care of patients and, uh, getting them fixed and getting them out the door so they can go sing our praises and, uh, tell us some other tell some other sick people and some people who have some movement problems about us. Whereas, you know, there's all kinds of different folks out there that may be marketing heavily, but that doesn't describe all of us.

You know, I've often heard that comment from doctors. In particular, I remember one time hearing it from the anesthesiologist and it's like, if you're, if you're in severe pain, you don't have to market anesthesia. Like if you have a big cut in your leg and they're going to do surgery on it, you don't, you don't have to market anything.

They are begging you to fix them. Oh, sure. Yeah. The extent of the anesthesiologist marketing has to do with, uh, you know, uh,

chatting up with the surgeons over coffee that morning. Yeah, I mean, if you need to go to the ER, it's not like you're driving down the street and you see a big billboard that says, now until November 1st, half off at the ER. They don't have to advertise. It's the ER. You're going to go there. Half off anesthesia for your next knee surgery. That's right. They could double it, and you'd still take it.

It doesn't matter. It doesn't matter what anesthesia costs. next knee surgery that's right like they could double it you'd still take it that's right it doesn't matter it doesn't matter what anesthesia costs that's i've thought about that before it's like man they could charge you anything exactly i've never i've never asked no i've never asked the doctor how much anesthesia was ever i'm like just i'm like sir just please put that in my arm you could just scratch that out of the package put that that back in place. I don't want to be awake for it. I did find out that they charge separately, though. Yeah, the last time I went to the ER, which was like two months ago,

I got like three different bills. That's right. Hospital, doctor, and anesthesiologist. That was my last surgery. Maybe a couple surgeries. I also got one from the radiological lab or whatever for the x-ray. I got you. We got to go see this guy

and quit getting hurt. Mine was definitely an ER visit. Sudden onset mechanical pain. It had nothing to do with mechanical pain. Uh-oh. My hip was out of socket. I was going. Actually, I didn't have a choice. The ambulance took me there. The ambulance wouldn't take you anywhere else. shirt never mind we won't talk about it on here my hip was out of socket i was going actually i

didn't have a choice the ambulance took me there the ambulance wouldn't take you anywhere else that's right i gotta go see a chiropractor i appreciate that all right you want you want you want to shut it down uh yeah closing thoughts let's shut it down real quick all right doug what do you you got anything you want to promote i do give you and give you a chance to think about what you want to promote i'm'm going to promote something. Yeah. Peace, love, and chiropractic treatments. Usually something that will make you money.

Oh, okay. Okay. Everything. There you go. You did good not putting me on the spot right away. Definitely go out and watch Maximum Mobility. It is the mobility seminar that I put on. I'll provide a comprehensive system to figure out exactly where you need range

of motion and which joints don't need range of motion that way you can get the most out of the stretching exercises that you're going to do and you can improve your movement efficiency so you can stay injury free longer and you can learn the more complex crossfit movements or the higher skill crossfit movements a little bit easier because you have the adequate or the necessary range of motion to do that so that's in the fitter shop click on seminars and click on maximum mobility and you can read more about that product red awesome yeah go check that out go prehab before you rehab guys and uh yeah maximum ability i love it some excellent stuff um yeah i, if anybody has any questions or anything, just contact me. I'm sure my contact points will be up somewhere.

I'm on Twitter, and we have our clinic on Facebook. And I've got a blog, too. You can click on the Contact Me button. What's your Twitter name, and what's your blog address? Yeah, the at DrBradCole, D-R Brad Cole Twitter. And the blog is DrBradCole.com, D-R Brad Cole.com. C-O-L-E? C-O-L-E.

That's correct. The English version. If you can't spell Brad, then he doesn't want to see you. Exactly. Just keep searching. Thanks a lot for letting me come and talk. If you're in Memphis, come see if you have any pain, right? Yeah.

Or if you're five states away, fly over. Anywhere. I'll take you from anywhere. That's right.. Or if you're five states away, fly over. Anywhere. I'll take you from anywhere. That's right. I'll fly from Dubai. I'll talk to you. Yeah, I'll talk to you. I'll look at you and hook you up with somebody to help you out.

And don't forget to go to fitter.tv. That's F-I-T-T-R dot TV and sign up for the newsletter. That way you can be up to date on all the new stuff that we're doing. See you guys next week. All right. Thank you. Cool. Thanks.