Barbell Shrugged - Why $4,000 of Physical Therapy Didn't Work and How Active Life 1 on 1 Did w/ Dr. Ray Gorman- Active Life Radio #4

Episode Date: August 2, 2019

Have you spent thousands of dollars trying to get yourself out of pain, only to find yourself  more frustrated and less jacked than ever? That’s what was going on for the client we discuss on this episode of Active Life Radio. In this episode you’re going to learn all about what went wrong in physical therapy, how our one on one coaches are able to spot it, and of course, how our client got back to full blown competitive exercise without having to get surgery, drugs, or boring rehab.   Guest Bio: Dr. Ray is the director of staff at Active Life. He works with one on one clients and is responsible for coaching the staff. If you have heard of the Active Life Immersion program, Dr. Ray runs that too. The dude is a stud!   Minute Breakdown:   0-10 - How to decide if surgery is really necessary. 11-20 - When is it outside the scope of physical therapy? 21-30 - How to transition from hanging from the bar to doing pull-ups. 31-40 - The difference between a labrum tear and a frayed labrum. 41-50 - What’s the difference between the needs of a high level athlete and you? 51-60 - Your coach is your guide, not your master.  Work with an Active Life Coach like Ray at activeliferx.com/shrugged Find Larry at @RayGormanDPT   ------------------------------------------------------------------------------ Show notes: http://www.shruggedcollective.com/alr-gorman2 ------------------------------------------------------------------------------ ► Subscribe to Shrugged Collective's Channel Here http://bit.ly/BarbellShruggedSubscribe 📲 🎧 Listen to the audio version on the Apple Podcast App or Stitcher for Android Here- http://bit.ly/BarbellShruggedApple http://bit.ly/BarbellShruggedStitcher Shrugged Collective is a network of fitness, health and performance shows that help people achieve their physical and mental health goals.  Usually in the gym, but outside as well. In 2012 they posted their first Barbell Shrugged podcast and have been putting out weekly free videos and podcasts ever since. Along the way we've created successful online coaching programs including The Shrugged Strength Challenge, The Muscle Gain Challenge, FLIGHT, Barbell Shredded, and Barbell Bikini. We're also dedicated to helping affiliate gym owners grow their businesses and better serve their members by providing owners tools and resources like the Barbell Business Podcast. Find Shrugged Collective and their flagship show Barbell Shrugged here: SUBSCRIBE ON ITUNES ► http://bit.ly/ShruggedCollectiveiTunes WEBSITE ► https://www.ShruggedCollective.com INSTAGRAM ► https://instagram.com/shruggedcollective FACEBOOK ► https://facebook.com/barbellshruggedpodcast TWITTER ► http://twitter.com/barbellshrugged

What's up, everybody? Welcome back to Active Life Radio on the Shrugged Collective Network. I'm Dr. Sean Pastuch. I'm your host, and we're joined again by Dr. Ray Gorman, the Director of Staff at Active Life. Today, we're going to talk about one of our clients. Her name was Amanda, and we're going to talk about what the reasons that one-on-one work for Amanda went to physical therapy and over $4,000 in medical bills prior to signing up with us did not.

Remember, we're not a medical service. We're not going to replace surgery that somebody needs. We're not going to be able to help somebody with instability. We're not going to be able to help people who need to be in doctor's offices. And when I say doctors, I mean, physical therapists, chiropractors, anybody who is managing these acute cases. We are, however, going to be able to, through this conversation where we talk about Amanda, we're going to be able to talk about where the humanity of taking care of a client comes in, where diagnosis can lead somebody down the path to the wrong intervention, and how that path of the wrong intervention can beat somebody up mentally, emotionally, physically,

financially, to the point that they're not even sure if there's an out for them. We're going to cover all that kind of stuff on this episode. I'm excited to get you to it. Remember, if you love this podcast, stop for a moment and head to wherever you're listening to podcasts. Leave us a five-star rating because you love it and a review. Say something nice about us. Mention us by name if you would. We want the guy that shrugged to keep liking us. And lastly, if you're interested in getting information about how you can become a client of ours or how you can become a coach who helps clients the way that we do, head to ActiveLifeRx.com slash shrugged.

On to the show. What's up, Dr. Ray? Dr. Sean, how are you doing? I'm doing great. Awesome. It's good to be back. It is good to the show. day and Ray and I were both just doing an immersion course at the same time. So two different groups, we run an immersion course about every month where we teach coaches how to do what we do for our clients. And Ray had one today at 2.30 PM and so did I. And my daughter's home, my wife was on a call in the office and the nanny's here and the people were here cleaning the house. So I went outside to the front for one hour and sweat through my shirt. It was disgusting.

Yeah, it's warm. Yeah. So on to the stuff that the people care about. They don't care about the weather. This is a meteorologist enthusiasm. Enthusiasts. What a great job, by the way. You think so?

You always get to be wrong and nobody cares. Yeah. Yeah. Amazing. And if you just predict it's going to be sunny, you're probably right like 70, by the way. You think so? You always get to be wrong and nobody cares. Yeah. Yeah. Amazing. And if you just predict it's going to be sunny, you're probably right like 70% of the time. True. What school don't you graduate with that rate? It's amazing.

All right. So let's talk about your client, Amanda, who I think is a phenomenal case study for the reason that we started this company. And not even for the way that she was managed as a client, but for the reasons that she signed up, the mistakes that were being made before she came on, and the fact that if we weren't around, she might still be dealing with this stuff. And I don't think that that's too big of a pat on her own back to make. Right. So give them a little bit of background on Amandaanda and then we'll get into some more depth perfect so amanda had amanda had come to us um like you

said after extensive you know mri injections multiple orthopedic visits um kind of last option was surgery on the table and it was recommended surgery. Yeah, I believe so. Yeah. I believe that, that it was on the table. Um, it was kind of one of those, like we, we can do this and this is your outcome variability. Do you want to? And for me, whenever that client tries to have that conversation, I want to exhaust every single conservative option that we can before we go through with that. So what you mean is that when they told her we could do surgery, the surgery was like, look, we're going to do it. And these are the outcomes that might occur. Yeah.

And your philosophy is, look, if you're at that point now and you're ready to do it, we might as well do this and see if we can avoid it. Yeah, what's the difference of now and six months? Right. Well, in some cases there is a difference, but in this case it might not have been. It depends on the situation. I think the thing that people get caught up in is that I'm going to have surgery, and that's not to say that there isn't a time and a place for it. It's just the perception of what they're viewing surgery as. They're viewing surgery as a fix. And from a biomechanical perspective, that's absolutely what it is. Surgeons are fantastic

at fixing things biomechanically. From an outcome perspective, it's not always the case. So somebody who has, let's say a torn labrum that shows up on an MRI might go in and have surgery. And if the issue wasn't actually the torn labrum, that surgery might not have been what that person needed. Yeah. So this is an interesting thing. I just watched a documentary on Netflix called Heal. I know you haven't watched it because I told you to watch it on your flight from from new york to reno um what they talk about on the on that documentary was the idea that um people in the medical world western medicine look at the human body as a series of machines and that something goes wrong, it means that part of the machine is broken. So we just go ahead and service that part of the machine.

And then the entire machine will work again. When in reality, the body is a series of intertwined machines with a level of intelligence to each that will get thrown off when one breaks down and is just fixed in a very isolating way. Right. It's the thought process of hardware versus software and not the thought process of the hardware interacting with the software that is the human body. That was good. You like that analogy? I like that. I need to write these things down. During the immersion course today, I was talking to the group and I was like, you need to communicate in a way that will resonate.

I'm like, fuck, I got to write that down before I forget it. Instagram post, then it's always there. Yeah, totally. Yeah. Well, I got to remember to put it on Instagram post. So if you listen to this podcast and you haven't seen a post from Active Life RX or Active Life Professional or Sean Pastuch that says you need to communicate in a way that will resonate, ping me.

Yeah, remind us. So, okay. So she had been recommended that surgery was an option for her because, I mean, I remember her telling me she had spent over $4,000 on physical therapy and orthopedics. And that's memorialized on our website. She's the testimonial that we have up. Right. And one thing too is, I know in the intro, you had alluded to things that we can help

with and things that we can't help with. And I want to make sure that we define for the listeners, what is the kind of instability that we don't do well helping? And what is the kind of perceived instability that we do well helping. That's a great point. For example, somebody might feel like their shoulder is unstable because it's painful, right? That would be a perception of instability versus somebody who literally sneezes and their shoulder dislocates. Now that's a literal case, a literal case. Yes. I've, I've known a few people who that actually happened to. Um, now there are cases of people

who sneeze and their shoulder dislocates. And I still know people who do muscle ups and push jerks and things like that. Uh, they just have to be very cognizant of their fatigue levels. So it really depends on what's the goal you're trying to match. But in the case of somebody who has a perceived instability, which is often one of the presenting factors with a labral tear, that's something that we can help with. And often it's calming the shoulder down, getting the brain to make the body feel safe in that position, and then reinstalling these dynamic factors, these strength patterns that are going to resist the feeling of the shoulder being unstable. Yeah. I used to own an event company called

Flex Events. If any of you guys have ever been to flex on the mall, flex on the beach, flex in the city, that was my company. And, um, we were at an event on the mall one year and I remember walking, you know, I'm just walking around and seeing how people are doing, looking for smiles,

looking for frowns, turn them upside down. And I see this girl crying and this guy behind her holding her like, like he's hugging her. I'm like, it's fucking weird. So I walk over and like, is everything okay her like he's hugging her. I'm like, it's fucking weird. So I walk over. I'm like, is everything okay?

And he's like, she went to do a clean, and both of her shoulders came out of the socket. And I'm like, oh, is she okay? And he's like, no, they're still out. And I looked at her. I'm like, oh, yeah, they are. Now, I had to go over and grab the person who was on the ambulance. That's the protocol. And they were like, yeah, we got to take you to the hospital the hospital we don't do this and i was like um are you sure and she was like uh the girl like the girl was like i don't want to go to the hospital like this has happened

before it just really hurts and i was like look if you want you know give me permission in front of like 10 of these people right and i'll try to pop that back in for you because I've done that multiple times. So I popped both of her shoulders back into the socket, and clearly she didn't work out the rest of the day. But that's the kind of person that you're talking about where she doesn't need surgical intervention for that instability because it's happened before. She wasn't unaware of why it happened. It's like, okay, well how do we build artificial stiffness in the muscles that surround that

joint to make that less likely to happen? Well, that's a good case for saying that, look, if you want that to stop happening, you probably need surgery. If you want that to stop happening, if you're willing to train with the associated risks and other things that can come with it, you can probably get by without it.

Right. But you're making a choice there and reduce the incidence. something going on with their connective tissue and they go in and have surgery. And after rehab, everything has gone well. They go to do a muscle up and something happens. So that's a good example of the outcome that you think is going to happen. Doesn't match up with the actual outcome. Yeah. So, okay. We went down a rabbit hole of instability. We did tell the fun story, but that's cool. It was good. I think i think it was valuable dude i was fucking flabbergasted when i got there and shit and i was like whoa that's crazy your shoulders are literally down by the bottom of your pecs yeah that is not where they're supposed to be yeah and i'd seen that once once before the competition also someone went to catch a snatch and they dumped it behind them the wrong way externally rotated her left

arm popped their shoulder forward and came out and she was like my left shoulder really hurts i can't tell if it's serious and i don't want to look at it yeah i looked at it and i was like we can uh let's go talk in private and we put the back in don't recommend popping people's shoulders back in you can hurt them really bad, but let's move on from, from that. Absolutely. Yeah. So essentially with her, it was, it was really the, the fact that I kind of thought she had this perception of instability, probably being a higher level athlete, um, probably a little bit of laboral degeneration, which is very common. Um, it is, it is essentially part of the process. When you say a high level athlete, she was like 40.

Yeah. And she was, uh, you know, qualifying for the, um, age group qualifiers. So she was like top 200 in her age group in the world and CrossFit. Yes. Okay. Yeah. And you know, part of it is just re recalibrating to healthy training habits, right? One of the thing that I, one of the byproducts of what happens when you get injured is you end up reassessing what you're doing. And so it's, it's no longer saying like, oh my gosh, I need all of this volume. It's taking the step back and saying, wow, over the last six months that I've been feeling better, I've been doing less and actually gaining more because my recovery has been through the roof. Yeah, you know, the scary part of that for people is not once they're in it, it's making the decision that I'm going to take a chance that doing less is what I need because they associate, um, doing more with the reason why they perform well. Yeah. And that's the, that's the scary part is like deloading that volume for the purpose of gains.

But they're like, uh, I don't know. I work really hard all the time. And that's what seems to have got me where I am. Right. It was actually funny. Uh, one of the posts that I made one time was, um, your old volume is like an ex. You just need to move on like an ex-boyfriend or ex-girlfriend. And she sent it to me and said, I've never had a post that was so relatable. I thought that was always a great, uh, like, it's just amazing when it's like, you see the light and you know that like, that is no longer what you need and your clarity becomes i can do so much better yeah i'm gonna steal that tonight put it on active life rx and i will credit you for as long as you credit me i'll definitely credit you so so what was she

like when she came to you what was her situation um all in i mean it, it was, it really, you know, we talk a lot about having to sell athletes on ideas. She was kind of at her, her last wit with this stuff. So it was also at the same time where she had had surgery on her hip. So in a mental state, I think she was in a good, a good place to say, look, I've got, I can't really do much for my hip anyways. Um, I might as how recent was the hip surgery? Her hip, when we started, I think she was about 10 weeks out. I think she just had a hip scope. Yeah. Fucked up. Yeah. But it was perfect. It actually worked out really well because it forced our hand into very low volume, very dedicated work. And then also I was able to help her at the same time with her

shoulder. Once it was appropriate for us, I was able to help her with her hip. Okay. So really what was going on with the shoulder was it kind of presented like this labral degeneration. Um, there was really no significant locking of the joint. There was no crazy, what I call gross instability where that joint is kind of essentially hanging on by, you know, the muscles and things like that. There was still ligamentous stability there. And my go-to with stuff like It was let's heavy, slow resistance. You see what happens. See if we can make a change to the perception of that joint and then start reintroducing things that were priorly aggravating. So you said she was all in and that's cool. But how do you think that she got to a place where it was like, yeah, you know what? $4,000 of physical therapy and orthopedic care hasn't helped me.

I'm all in on this. This is going to work. Did you ever talk to her about that? No, you know, that's a good question. I never did have that conversation of saying, why this? She probably would have said she talked to this phenomenal voice through the phone that just exuded confidence for her and made her feel great about things.

That would have been me. But I'm curious. That's a question we should ask her. Yeah, we should. We should. Yeah, it's interesting because she was right away all in. So she's all in. She starts doing what you're asking her to do.

And what was the conversation like early on? What were you guys talking about? We've done enough episodes right now where we talked about exactly what we did to help people get out of pain. We can discuss that a little bit. But what I'm more interested on this episode is, you know, what were you guys talking about? Like, how are you keeping this interesting for somebody who now has a hip they can't use fully and a shoulder they can't use fully? And we're now going through a linear progression where nothing is constantly varied. Right.

How do you keep it interesting? What do you talk about? You know, the unfortunate part about keeping it interesting is that oftentimes that can be part of the problem. So it's really sticking to a program and setting expectations of, hey, look, I've got 12 weeks of work that I would like to put in before we start to make this interesting. Can you buy into that with the outcome being X, Y, and Z? You want to get back to pull-ups?

We can get you back to pull-ups. These are the steps I need you to take before we get there. Can you describe the steps? Because I think that one of the problems that people run into when they work with a physical therapist who's not familiar with what it is that they want to do. You know, this is not a knock on physical therapists. There are phenomenal physical therapists who do work well with CrossFit athletes and field athletes.

There are also phenomenal physical therapists who don't. What ends up happening is when you need the physical therapist who's right for you and you end up in the wrong office, you get the wrong treatment. And so I think that what happens oftentimes

for people, especially CrossFitters, is they're so used to knowing their weights. They're so used to knowing their times. It's a very measured kind of sport, which takes a very specific kind of personality. When I say sport, I even mean training methodology. But so now you go to the physical therapy office and they have you working with bands and you can't track how much resistance is on the band. Am I improving or not?

The weights that they're using are in exercises that don't look anything like what they do in the gym and are not anywhere near the weights that they're used to using in the gym. So even if the structures improve, the confidence to use the structures in a different environment under different loads isn't there. Right. It's drastically underdosing the client. Right. And so physically and mentally mentally, physically and mentally. Yeah, absolutely. I mean, we, you know, when I, when I work in the clinic, um, I like to make rehab look like training. And that's one of the reasons why I think when you trans, when you get somebody online in strength and conditioning realm and you say, look, this training, this is, this is

training, right? We're just training at a lower capacity than you're used to. We're training at a lower intensity than you're used to. But we're still trying to overload the tissues appropriately and adequately. So taking somebody through a progression might look like if your range of motion is painful, let's say shoulder flexion, we want you to be able to get your index finger to the floor when you're laying on your back with your elbow fully extended, relatively passive, right? We don't want you reaching back for it. If you can't get to that position pain

free, then for me to load you in a position past that painful point might not be what you need. Now, there's another end of the spectrum that says it might be. So you really have to have somebody in your corner who understands the difference of when you shouldn't load that person and when you should, and realizing that the movement screen is one piece of the puzzle. So for example, I don't want you to hang from a bar until you can get your arm over your head pain-free. That might be a goal, a marker that we use to getting to the next step. Right. And then it's okay.

Now we want you to hang from a bar for 10 seconds pain-free before we're going to let you hang from a bar for 10 seconds, right? Pain-free before we're going to let you hang from a bar for 20 seconds, right? 20 seconds before 30 seconds, 30 seconds before three kips. Yep. And people are always like, well, how do you get this time? And it's, well, how long would it take you to do a set of 15 pull-ups? Right. So if you can't hang there statically, what makes you think that you've earned the right to hang there and move dynamically? Right. And my friend Tim Szymanski, you guys might know him as WadDoc, did an experiment.

I want to say like two and a half, maybe three years ago at the CrossFit Games. I think it was three years ago. pull-up bar that allowed for forces to be measured where when you kipped it told you how much of your body weight was on the bar at the maximum force yeah and it's like it went from like an average of 1.8 times body weight to i think 2.4 times body weight on the bar now it's like okay well you're going to do that 15 times and hang from a bar for 35 seconds while you do it. For five rounds. Right.

So you obviously need to be able to at least static hang for 35 seconds. Absolutely. Okay. So moving on. Yeah. So really with her, it was symptom management. Like, let's get you calmed down. Let's start a loading progression. Um, and we got to about

week six. Um, and it's, it was, Hey, are you ready to start doing some things that I think you're ready for? And she was like, well, what do you, what do you mean by that? I was like, how about we try reintroducing some movements that look like CrossFit? How about we program kipping pull-ups and some handstand pushups into your vacuum? Now, if somebody wasn't a competitive CrossFitter, would you give them those things that early? Um, it would depend on what their skill level was and what their goals were. Right. So, so like for me as a client, if I was a client, for example, I don't care if I ever walk on my hands because right now my feet are working

and I don't ever care to do a handstand pushup because, uh, I just, I just don't find them worth what the risks are. So would you have me doing those things if they weren't in my goal set? uh no so i had another client who um she was also post-op and i was post-op and post-rehab yes post-op and post-rehab yeah she actually had a partial total shoulder okay meaning that one of the the um the portion of your arm that attaches to your shoulder was a prosthetic it was it was uh made of plastic and titanium. Under the skin. Under the skin, yeah. So with her, it was, look,

I think we can get you back to doing pull-ups. And it was like, okay. But that was my goal for her. And then it got to a point where I was like, do you want to do a pull-up again? She was like, no, I don't really care. I'm totally fine doing ring rows. Cool. Then let's stop. Like that's my bad for miscommunicating with you. Or I shouldn't say miscommunicating for doing a poor job of relating your goals to my ideas.

Right. And so then it became, let's take these out and let's actually do stuff that you care about. Because for her, it was my goal is to be able to train from a fitness perspective. From a fitness perspective, a kipping pull-up and a ring row, there's no difference from kind of the cardiovascular stimulus you're going to get from that. Right. And very little difference from the muscular endurance that you're going to get. Pulling pattern direction. Sure.

But for somebody who's not looking to hang from a pull-up bar. They don't need to hang from a pull-up bar. They don't need to hang from a pull-up bar. And for those of you guys out there who are like, but pull-ups are functional. Do me a favor. Stop. Stop. They're functional if you need them.

The odds of her running up to a fence, jumping, and having to pull herself over the fence is low. The odds of her hanging off the ledge of a building and having to pull herself up onto the top of the building again is low. She doesn't need to do pull-ups if she doesn't want to do pull-ups. Yeah, and on that same kind of tangent, if we want to train a lat pull-down, we can just use a band and do a lat pull-down. We can rig up a kettlebell and do a lat pull-down. Or we can put her on a lat pull-down cable.

We absolutely can. There's nothing wrong with it. Yeah. The reason I gave those options is gyms typically don't have those for our clientele. So let's take a break right here so that we can tell the audience how awesome we are and give them an opportunity to reach out to us. And we'll be right back. What's up, Shrug Nation?

Are you enjoying this episode? I bet you are. I'm going to keep this brief. We'll get you right back to the show in a moment. In the meantime, if you're interested in anything that we're doing at Active Life, make sure that you head to ActiveLifeRx.com slash shrug. You want to be a better coach. You want to help your clients better. You want to get out of pain, but you don't want to go to the doctor or miss the gym active life rx.com slash shrugged that's where you need to be we'll see you when you get there turn pro here we go

back to the episode okay so outside of ordering a lat pull down machine for the gym, getting on it and using it, what other kinds of things are we talking about for this client, Amanda, that you started to reintroduce that might be relevant for other people who are dealing with the same kind of shoulder issues that she is? And now we're kind of in that place where they feel like they can do more, but they're not being freed to. Yeah. So I think the, the big thing comes down to, um, your clients are going to be told that X exercise. So remember we're talking to the client, right? But I'm saying in general, you as a, as a consumer of medical advice, let's say, are typically going to be told, whatever movement your doctor associates with dangerous,

don't do it. So the problem with that is it's not about never doing that movement. It's about figuring out a way that you can responsibly reintroduce those movements into somebody's gym routine, exercise routine. The reason why your doctor tells you that is out of safety for you. It is in that moment, the amount of time that they're able to spend

with you and the demands that your sport has. oftentimes they might not have that time to know about every single sport out there and every single demand and every single intricacy of training. This is why when we talk about getting the right kind of help, it's, are you able to do this from a biomechanical perspective? Do you have the tendons, ligaments, muscles attached that allow you to do this movement? If the answer is yes, then it becomes an adequate loading and rest schedule. Because for somebody who walks too much, walking is the problem. If you go into the doctor and they just say, well, just stop walking. We're not going to make that jump. Right. But taking the emotional health of the client and what they perceive, why that movement is important to them is really

important to, to bring that back into training and be able to reintroduce kipping pull-ups, kipping handstand pushups, snatches, uh, jer jerks things that are more dynamic and strength to somebody's repertoire yeah okay so these things start getting reintroduced for amanda and she's like not quite as bad as i thought this would be right does that mean that everybody at home should just start reintroducing those things not at all um no. Because like we said, there's a pathway to getting back to them, right? So we want to see somebody have static tissue tolerance where you're able to hang on the bar. We then want to know, can you control the kip? Do you have adequate strength through your shoulders to control that range of motion. If you just took a,

if you took a bowling ball and put it on a string and just kept dropping it, that string would eventually start to lose integrity. Provided that you can hold the string. Right. But imagine now somebody who doesn't have the capacity to do strict pull-ups doing kipping pull-ups. When you hit the bottom of that rep, you're that bowling ball recoiling every single time. Dude, we got to figure out how to make a video out of this. That's a good video, right? Yeah. You got to think about how to do it so that I don't have to go buy a bowling ball.

That's true. We'll figure something out. Yeah. But that's what's happening from a microtrauma perspective. And so getting clients to buy in and saying, you need to earn certain mile markers before we start doing something that you're not ready to do, it's different, right? There's a reason why we want strict strength before kipping strength. I mean, it's the same thing when somebody goes to do a heavy push jerk and they don't have the overhead capacity, but they have the hip strength. I mean, it's the same thing when somebody goes to do a heavy push jerk and they don't have the overhead capacity, but they have the hip strength. You know, that hip drive is what

gets the load up there, but then they're the person that either collapses under the bar, has soft elbows and loses the weight. Well, this is like that American champion or world champion weightlifter that you worked with who couldn't sit and press weight over her head that was like eight pounds. Yeah, that was wild, right? I mean, it was like eight pounds. We had all of the strength in the world. So this, this, just so you all understand, this woman was snatching what? 225 cleaning jerking, like 260. Yep. And Ray sat her down and said, let me see you press this weight. And she couldn't press an eight pound weight. Yeah. And so like you want to talk about.

And what Olympic weightlifting coach is looking for that? None. Right. Right. Because it's not their, it's not their scope to look for. Because we're well, and also like it's very outcome driven. So the issue being that, well, yeah, but you can still snatch 225, you know? But if you watch the lifts, you're like, man, that is

a struggle to control it. That is somebody using their head as a counterbalance to where the weight is. And that weight better be perfectly over their center of gravity. Otherwise we're going to have no shit moment. Right. You know? Um, now can you get through training like that and get lucky and not have anything happen? Absolutely. Do I want to run that risk of somebody that I'm working with? Probably not. Right. Okay. So what was it about the things that Amanda did before she started working with you that made it where the four thousand dollars plus that she spent were were misguided i think it's kind of a combination of of what we said before you know the um the solution has to meet the problem but what was what was the problem

they were telling her she had the problem was the problem that they were telling her that she had was this labral issue, right? A labral tear. Just so people understand, the labrum is – I know the word gets thrown around a lot. One of the things that we aim to do on this show is take those big words that are medically used and are expected that you're going to understand and break them down for you. So the labrum is essentially a soft tissue structure, which means it's not a bone. It's a soft tissue structure that is around the joint. It's around the shoulder joint in this case. And it lines the inside of the joint and comes out of it almost like a cuff.

So picture like a turtleneck coming out the collar of a t-shirt is that a decent explanation yeah it increases the surface area of the joint so now when the shoulder bone sits inside the shoulder joint the labrum essentially makes the shoulder joint more flexible deeper and larger overall so there's more contact with the shoulder bone makes it way more stable correct now they said she had fraying on it which essentially means if you picture taking a rope and like rubbing it over a step the rope starting to unwind it's that it's it's pieces of it kind, starting to shred off of it, if you will. Right.

And I'm sorry, which sounds really bad, but in reality is far less significant than a longitudinal tear, which is a, you know, a straight line tear of the structure. Right. And the other thing too, is that if we were to get an image of her other shoulder, it likely would look the same. Right. And they, and very, very, very rarely does somebody who has an issue in one shoulder, one hip get an image of the other one.

Right. For basis of comparison. Yeah. Why would you waste the money? Would it though? Um, yeah, I mean, in this case it would be, you know what, you also have that on the other side though. So maybe it's not this that's causing it.

Well, but we don't need an MRI of the other side to, to kind of know what the research tells us that it looks like right which is why we have that if people you know they've taken plenty of shoulders that are asymptomatic and they show quote-unquote pathological findings or abnormal findings oh dude i worked with an athlete one time whose name i won't name because i didn't ask him if we could and he's very well known and when he finally got in my shoulder they were like i don't understand how your arm is still attached yeah and he's like yeah it feels fine i've been at the games three years in a row right big deal right everybody interprets pain differently everybody relates pain differently he didn't have any that right i'm just and that's what i mean three of the four rotator cuff muscles the glenohumeral ligament and the labrum were all torn that's

that's wild dude crazy wild but so anyway so she had labrum flare what you're saying if i understand you correctly is that the onus is not on the patient the onus is on the health care practitioner to say yeah you have a tear but that might not be the reason why you're symptomatic let's do a little bit more investigation here. Right. And I, and I think part of it too, is, you know, when you go to your traditional physical therapy clinic, um, I don't know many that have a rig set up with a pull-up bar, right? I don't know many that have, huh?

Pure physio. Pure physio does. Yeah, absolutely. But I don't know many that have that right so again it comes down to getting the right kind of help so with her it was anytime her shoulder started to feel better she was kind of on her own in the gym right because the the the rehab setting and the gym did not mimic each other right so to meet the demands of your athlete when you don't have the equipment to meet the demands becomes a really big issue.

Now, I want to throw in right now, I have to do this because I feel compelled. If what you just heard feels like what you're going through, activeliferx.com slash shrugged. We want to work with you. Hit up the one-on-one, contact us, apply now, rx.com slash shrugged. We want to work with you, hit up the one-on-one contact us, apply now, whatever it says, and let's talk. Yeah. And the other thing too, is look, this is not a knock to traditional physical therapy clinics. Um, they absolutely are necessary and serve a purpose for the community. Um, it's a self-awareness campaign that when a client comes in and you don't have the equipment needed to service them, um, your best customer service option for that client is to get them to somebody who can, right. And, and, or to get them as far

as you can, right. prior to them needing other equipment. Absolutely. I've, I've got that all the time. Um, you know, I run a small cash pay clinic in, in Reno and I don't do post-op care in my clinic. Um, it's not what I'm set up to do. I don't have biohazardous waste stuff. I don't have the things needed for that, but I work with other clinicians in the area who say, look, when I get this athlete to a certain point, you sent them to me initially. I know sending them to you, they're in good hands. And I remember doing this as a novice clinician.

I would see neuro clients all the time that I was like, man, I have no clue what I'm doing here, right? I've just been told that this is kind of what I need to do. And now I kind of burned through this client's insurance money. And now I got to tell them, oh, we're kind of where we are. Like, is that my fault? It sucks. Yeah.

You know, you're making do with what you have and there's, there's a better way for it. All right. So get around. So then, you know know what you go ahead i for those you guys who are listening ray was about to take a sip of a beautiful la croix i was gonna quench my thirst yeah with what do they call that grapefruit pamplemousse take a sip i got you don't just don't take a sip into the microphone can't hear that i don't know if maybe they did maybe they didn't but go ahead now you're back with, uh, with Amanda, the big problem that she was having was how she was being returned

to sport. And the way that I like to look at this is essentially, if you look at, if you look at phases, I first want to know, like we said, can you do something statically? Can you do something dynamically? Can you do something dynamically? Can you do something slow? Can you do that same thing that you now have the control to do slow fast? So if I understand you correctly, what you're saying, what you're actually saying is the physical therapist did a great job of creating stability and safety in the shoulder for everyday life right it was now okay everyday life for me amanda is not the same as everyday life for you you know sarah whoever right exactly who doesn't come to the gym so exactly so the responsibility now is on that physical therapist to be able to

return her systematically to sport which frankly in most cases falls outside the scope of physical therapy. Yeah. And that's where we fucking rake. Right. And I've never seen in a physical therapy note, you know, the first workout Amanda did back to kind of intensity. I've never seen in somebody's therapeutic exercise log, three rounds for time, 200 meter

run, 10 pull-ups, 200 meter run, 10 power snatch. Now were those strict pull-ups or kipping pull-ups? Kipping pull-ups. So you had already put her through dead hang, kips without pull-ups, strict pull-ups without kipping, single pull-ups, double pull-ups. Yeah. So I essentially need to make sure that in a vacuum, my clients can handle that intensity. Each part of it by itself. Right. So we had been conditioning pull-ups. And when I say conditioning, I mean we had been accumulating capacity, accumulating volume.

So she had been doing three sets of 10, then three sets of six butterfly. So I know that I've got, let's look at it again. I like to use the bank, right? But let's look at it like your bank account. If I've got, what is that, 42 reps in the bank of capacity, I feel pretty comfortable programming 30 reps in a workout. And then I can start to use that as my new bank of now me training under intensity.

Now, are there guidelines? So are there bumpers on the on the workout so if you feel this i want you to stop like for example i have a client named jason who was also i mean i don't want to give you guys the um the the false picture that everyone we work with is a elite athlete right most of the people we work with are everyday people it just happens that this example is also a master's age athlete who made it to the crossfit games on one shoulder and um he had surgery after the games were over and now we're like 20 weeks post-op something like that and um everything i give him

that is return to sport look alike is or like progressing to return to sport says zero pain allowed if zero pain experience prior to workout. Right. So no increase in the pain. Yeah, it's going to definitely depend on the client. With her, I wasn't too worried about it actually. I kind of – I didn't want to put that there to put that thought in her head. Um, the other really cool thing that I want to bring up about this before I forget, because you said like, you know, we're, we're typically talking about elite athletes, not typically, but in this case, we're talking about higher level athletes. Um, I mean, Amanda's still

your everyday person, right? As far as her tasks of what she does. She's a mom of two. And the really cool thing that happened when we were done working out is we changed her training habits. And what that resulted in was allowing her to spend more time with her family, right? Cause she didn't need to train as much. She didn't need to train as much. And when she saw that she could do more with less and she was only doing more because everybody else was doing more like that was, that is the biggest win that as a coach I can ever have because I've now shown my client the light of what can be and what doesn't need to be. Yeah. And when we first started this company, those were the things that like that. And they still do. But those were the things that fired me up to be like, we have to grow this thing.

We have to grow this thing. Because it was it was all these people who were like, I'm hopeless. I'm shot. I got to find other things to do with my life. And then, you know, a few months later they were like, yeah, I'm doing everything again. It's fucking great. I was like, Oh my God. Like what that means to them, what they tell us that means to them is so much more than just their shoulder feels better. It's I wake up in the morning and I'm more confident because I know I'm going to be able to go to the gym and I feel fit and feeling fit makes me confident. It's, I'm able to RX workouts that I haven't been able to RX in two years.

And that gives me the confidence, the little bit of ego that maybe I need to get through my day. It's the, I feel like I had a puzzle that wasn't getting solved. And I felt like I was incomplete and broken and that being fixed and solved like that. When I started hearing those stories early on in the company, I was like, we have to grow this thing to where we can handle thousands upon thousands upon thousands of people. Yeah, absolutely. Absolutely. So now she's working out less, I mean, and getting better results. This is a person who stayed with us, with you, for 18 months. Yep. She bought six months when she started because I told her that this is not going to happen to anything less than six months. And in six months, she'll know if she likes this or not.

And she'll know it worked. And I think like three or four months in, she was feeling way better. So why did she stay? Because after six months and she was feeling way better yeah so why did she stay because after six months she bought six months more and she was like oh i think that'll probably be good then after that she bought six months more was it a state of do you think that she was in a little bit of dependency or was it that was it something else um i think it was maybe a little bit of fear of regression um of, of going back to old habits. Um, I think with her, it was also the combination of, well, if we got my shoulder feeling this good, maybe we can get

my hip feeling this good. Um, and we were able to do that. And then I think it became a, I enjoy your coaching and the bond that we've created as an athlete and, um, athlete and client that if I'm paying somebody to write my one-on-one program, how is that any more dependent than I'm paying somebody to write my don't get injured again program? Yeah. So I asked you that question because I was interested in what you thought the answer would be. I had this conversation with her on multiple occasions.

And what she told me was after six months she was feeling great and she wanted to see if she could get even better. So she stayed on for six more. After that, at the end of the year, she was like, I know I'm good. Like I know I don't need to work with Ray anymore. I want to work with Ray because I'm enjoying the way that my workouts are going. I feel so good. And I'm even like, she started posting things where her son was working out with her.

And she was like, you know, it's just cool because I don't have to think anymore. And that's why she stayed on for six more months. And then after that, it was just one of those situations where she was with us for 18 months. She felt like she could handle it herself and she wanted to try to handle it herself. Yeah. And the cool part about it is, I mean, we still keep in touch, you know, and she was, she was one of my earlier clients probably within my first six, six months of working with you guys.

Maybe. Um, and no, it was longer than that. Maybe a year. Yeah. Yeah. Maybe about a year. Um, and it was really cool to just, to be connected to somebody like that, you know, in a way that like, and again, it's somebody that you've never met, but you've helped kind of shape the period of their life that they're in from changing their training habits. Like that is a really cool, a really powerful thing

that I don't know if coaches revel in enough. Now, speaking of that, we've discussed before where the line goes between physical therapy and what we do. And we talked about that on this show. We've talked about it on other shows too. Where does the line between what we do and her coach is? So what I mean by that is let's say that she wants to do 21-59.

Let's go after it. Where does the line for her coach become they should really be working with us? And where does the line become they should really be working with somebody else from us meaning not us but their coach instead so you're essentially saying where does kind of the prevention and performance line start yeah and i don't want to look at his prevention blur they do blur and and and there are people who work with both a coach who writes their performance programming and us to make sure that their body can handle their performance programming. Right.

What I'm asking is if someone needs to choose, the money is just too tight, they can't do both, totally respect that. At what point should they be working with us? And at what point should they no longer be working with us based on that assessment? Right. So if you're having to significantly change or have your coach modify things that you should be able to do or were able to do in the past, that's a sign that you're likely not attacking the correct problem. I love that. I need to fucking write that down. Again, write it down. You know what's nice is it's recorded. You can go back and listen to it again. So how about the other way?

Uh, and then it becomes, can we get you back into the things that you were doing? And does your training from, from your performance, from your active life coach start to look like the kind of training that you would be doing from a quote unquote, you know, performance or GPP coach, then we can start shifting you back to that. And it, it never really becomes a, um, a one or the other. We can work really well in adjunct, but when somebody is trying to make that jump from, you know what, I'm ready to break the wheels off this thing, there are definitely coaches who are better at that than we are. Now, I don't know if you could hear that, but we were laughing a little bit because I sat up fast and my headphones came unplugged. And then I was trying to plug my headphones back in without, uh, without you guys hearing

it and ruining the sound. And Ray, I think you did a pretty good job handling the moment, but, uh, yeah, a little bit of back head stuff. So, so I'm glad that you touched on where the performance starts and where the, uh, durability, if you will. Yeah, absolutely. where the performance starts and where the uh durability if you will yeah absolutely so in conclusion you know this is a this is a story of a client of ours who could do everything on her own decided to stick around for six more months, the 13th, 14th, 15th, 16th, 17th, and 18 months of her program.

Has she talked to you at all about the kind of impact that she's been able to have on other people because of the change that she had? I don't know specifically about other people. I think, you know, I kind of mentioned the way that her lifestyle changed because of it, which I think, you know, anybody who has kids, I think they can appreciate when they can free up time to spend more time with your kids and actually be present in that moment because you're not thinking about going to the gym or thinking about what you could be doing and knowing that, you know, the balance of what is programmed for me is actually what I need and what's going to solve my problem. I think that has an impact to almost everybody that, that you relate to.

Yeah, I agree. And, and I forgot that we talked about that time. Cause that's what I was leaning to. I knew that she discussed that with you and I was looking to pull it out of you but i forgot that you had already said it all good it's that freaking headphones coming undone okay so what can people take home from this what should they have learned they just listened to us for 50 minutes what should they have learned so that tomorrow they are a different person the the take-home from this is that it's it's not just about getting help it's about getting the right help um when you think you're close to returning to sport if the things that you did didn't look like returning to sport and when i say sport in this case crossfit you know methodology, that kind of training

is the sport, right? So return to training, return to sport. If you're not doing those things, you need to have somebody who is capable of programming and, and able to maintain that balance for you. Um, the other big takeaway is that your coach is your guide. They're not your master. So you are ultimately in control. And a good example that I like to tell people is oftentimes what you need is not work from me. It's advice. What's the difference? So the difference being that we're often seen as writing programming,

a company that writes programming for the athlete who has too much volume on their plate. It would be an irresponsible role for me to come in and say, I can make you durable with more when really what I need you to do is less before I can make you more durable. That's another example of getting that right help of somebody who's going to set you straight in the expectations of what you're looking for. I'm ending it there. Turn pro. That's going to be a wrap for this episode of Active Life Radio on the Shrugged Collective

Network. I hope you enjoyed it. If you did, please head to wherever you listen to podcasts and leave us a five-star rating as well as a great review. If you really love this episode, make sure you're sharing it with the people who need to hear it. Value unshared is value wasted. And of course, if you're looking to get more from us, whether it's coaching courses, one-on-one coaching from one of our staff members to help you get out of pain without going to the doctor or missing the gym, head to ActiveLifeRx.com slash shrugged. We'll see you then. Term Pro.