Muscle for Life with Mike Matthews - Dr. Matt Fontaine on the Easiest Ways to Prevent Injury & Optimize Performance

Episode Date: August 12, 2016

In this podcast I interview Dr. Matt Fontaine, who’s a fantastic sports doctor in the Washington DC area that I’ve been seeing for a lingering bit of biceps tendonitis that has been getting in the way of my pressing. Matt has been practicing sports medicine for nearly 15 years and has worked with everyone ranging from professional baseball players and triathletes to weekend runners and Crossfit warriors, and has helped people through some pretty gnarly injuries and setbacks. In my case, he has been using a technique called ART (which you’ll learn about in the interview), and it has really helped loosen up the muscles in my shoulder and arm that were aggravating my biceps tendon. I wish I had known about this months ago. In addition to simply getting results, Matt also really impressed me with the breadth and depth of his expertise and experience. He really knows his shit, which is why I wanted to pick his brain on things like finding and fixing muscle imbalances, predictors of injury, the nature of soft tissue injuries, simple preventative measures you can take at home, and more. As I get more heavy weightlifting under my belt, I’ve come to appreciate stretching and mobility work even more for the purpose of preventing injury and maintaining optimal performance, and this is one of Matt’s real specialties. I think you’re going to find the interview really enlightening and helpful, so here it is. 10:08 - Dr. Matt Fontaine's take on Crossfit, how to do it right starting out and the #1 predictor of injury. 19:28 - Tests you can do to find muscle imbalances and improve your performance. 27:49 - The second most common predcitor of injury and why using pain as an indicator of injury is too late. 30:40 - What a repetitive motion injury causes and why soft tissue injuries should not be overlooked. 36:26 - Easy and preventative measures you can take for recovery and when you should see a Doctor. 42:29 - How to find a good Doctor for injuries. ARTICLES RELATED TO THIS PODCAST: 5 Foam Roller Exercises That Improve Performance: http://www.muscleforlife.com/foam-roller-exercises/ The Definitive Guide to Mobility Exercises: Improve Flexibility, Function, and Strength: http://www.muscleforlife.com/mobility-exercises/ 3 Ways to Use Myofascial Release to Reduce Pain and Improve Performance: http://www.muscleforlife.com/myofascial-release/ Want to get my best advice on how to gain muscle and strength and lose fat faster? Sign up for my free newsletter! Click here: https://www.muscleforlife.com/signup/

Hey, it's Mike, and I just want to say thanks for checking out my podcast. I hope you like what I have to say. And if you do like what I have to say in the podcast, then I guarantee you're going to like my books. Now, I have several books, but the place to start is Bigger Leaner Stronger If You're a Guy and Thinner Leaner Stronger If You're a Girl. I mean, these books, they're basically going to teach you everything you need to know about dieting, training, and supplementation to build muscle, lose fat, and look and feel great without having to give up all the foods you love or live

in the gym grinding through workouts that you hate. Now you can find these books everywhere. You can buy them online, you know, Amazon, Audible, iBooks, Google Play, Barnes & Noble, Kobo, and so forth. And if you're into audio books like me, you can actually get one of them for free with a 30-day free trial of Audible. To do that, go to www.muscleforlife.com forward slash audio books and you can see how to do that there. I make my living primarily as a writer, so as you can imagine, every book sold helps. So please do check out my books if you haven't already. Now also, if you like my work in general, then I think you're going to really like what I'm doing with my supplement company, Legion. As you may know, I'm really not a fan of the supplement industry. I've wasted who knows how much money over the

years on worthless junk supplements and have always had trouble finding products that I actually liked and felt were worth buying. And that's why I finally decided to just make my own. Now, a few of the things that make my supplements unique are, one, they're 100% naturally sweetened and flavored. Two, all ingredients are backed by peer-reviewed scientific research that you can verify for yourself because we explain why we've chosen each ingredient and we cite all supporting studies on our website,

which means you can dive in and go validate everything that we say. Three, all ingredients are also included at clinically effective dosages, which are the exact dosages used in the studies proving their effectiveness. And four, there are no proprietary blends, which means that you know exactly what you're buying. Our formulations are 100% transparent. So if that sounds interesting to you, then head over to legionathletics.com. That's L-E-G-I-O-N athletics.com. And you can learn a bit more about the supplements that I have as well as my mission

for the company, because I want to accomplish more than just sell supplements. I really want to try to make a change for the better in the supplement industry because I think it's long overdue. And ultimately, if you like what you see and you want to buy something, then you can use the coupon code podcast, P-O-D-C-A-S-T, and you'll save 10% on your first order. So thanks again for taking the time to listen to my podcast, and let's get to the show. Muscle to the World And I've been seeing him for, let's see, I've probably done six or seven treatments now, uh, for a lingering bit of biceps tendonitis that, uh, has just been getting in the way of my pressing. It started with heavy incline bench pressing several months ago, which actually started with

my neck just being tight. And I kind of just ignored it. So I was like, yeah, whatever tight muscles it happens. Uh, but then it was just not going away. So I backed off the, the, the heavy incline bench barbell pressing and went to flat. And then from there, eventually my biceps tendon started to get aggravated. And, uh, I tried, you know, the, the various things that you can do at home there. It's, it's a tough thing to treat because a lot ties in there in that bicipital groove and what is actually causing the friction on the tendon is hard to isolate. So I found Matt who has been practicing sports medicine for about 15 years now and he has worked with everyone ranging from professional baseball players and triathletes to weekend runners and CrossFit warriors. And he has helped

people through some pretty gnarly injuries and setbacks way worse than what I'm running into. And in my case, he has been using a technique called ART, which you will learn about in this interview. And it has really helped loosen up the muscles in my shoulder and arm that were aggravating my biceps tendon. I wish I knew about this months ago because I had tried all kinds of things with lacrosse balls and foam rolling and stretching. And you just can't get the results that you can get with ART. It's pretty cool. In addition to just simply getting results with me, Matt also really impressed me with the breadth and the depth of his expertise

and experience. I mean, he really knows his shit, which you'll quickly see as we get into the interview. And I wanted to pick his brain on various things like finding and fixing muscle imbalances, predictors of injury, the nature of soft tissue injuries, simple preventative measures that you can take at home and more. And I'm really happy with how it came out because I think he shares some really great insights and some real practical tips. And, you know, just as a side note, as I get more and more heavy weightlifting under my belt, I've really come to appreciate stretching and mobility work more for the purpose of

preventing injury and just also maintaining optimal performance. Because as Matt talks about in the interview, pain really is a lagging indicator. And once you're feeling pain, you're further down the road of dysfunction than you probably think. So this whole area of, you call it prehab and just stretching and mobility and maintaining healthy soft tissues is really one of Matt's specialties. So I think you're going to find the interview very enlightening and helpful. And here it is. Matt, thanks for coming on the podcast. I'm excited to have you because my arm finally feels really good again. Awesome, man. Well, thanks for having me. I'm excited. It should be fun.

Yeah, yeah. So let's start with just a brief introduction of who you are, what you do, kind of what your background is, some of the feathers in your cap and so forth, so everyone listening can get a sense of how you approach things. Sure. Well, I'll give you the cliff notes. My credentials basically, I'm a doctor of chiropractic. I have a clinical doctor in chiropractic. I've been in practice for going on 16 years now. Primarily, the majority of that has been in sports medicine. So doing a lot with athletes. And did my residency at Texas Back Institute, which is in Plano, Texas.

Basically, what they do down there is they spine surgical center. And they do have a pretty good conservative management team as well. Everything from pain management to spine surgery, they do a lot of level one research there, chiropractic physical therapy. So as far as complex spinal cases, I've pretty much seen what's out there and I've seen it in a collaborative sense through all different specialties in medicine, including chiropractic. And let's see, I practiced in Florida for about a little over a decade. And during that time, I had the privilege to work with a couple of Major League Baseball teams that made their spring training headquarters down there.

And I've also, over the last 10 years plus, been an active release technique provider and started doing that in 2005, 2006. And through that, I was able to work at quite a few Ironman events as part of the ART Ironman medical team where basically we put ART docs up at Ironman events treating athletes so uh did Ironman Florida did Clearwater 70.3 world championships and also St. Anthony's down in St. Pete, which is part of Ironman 5150 Olympic Series. Yeah, yeah. And just to interject on that, that's one of the reasons why just everybody listening. One, we're going to talk about ART a little bit later in the podcast, and Matt will explain what it is, how it works.

And it has helped me a lot, because if you've been following me in my work at all, you know, that over the last several months, I've kind of had this on again, off again, shoulder bicep tendon, wasn't exactly sure what it was. It would just bother me when I would be pressing and I would, you know, I could do additional warmups and kind of just work around it. But, uh, I had done kind of exhausted what I, the self-treatment options that I knew about, um, with myofascial release and, you know, foam rolling and just mobility stuff. And yeah, it sure helped a little bit, but it didn't, it didn't fix it. So then I went looking for like, okay, I gotta, I just gotta

find someone that this is what they do. So I went, my criterion, my number one criterion was I want to find someone that works with professional athletes. Cause I figured these, if you know, these guys, their livelihood depends on how well their limbs are functioning. So if someone can keep those people as clients, they must know how to get results. And so that's why I originally found Matt via a friend of his and somebody he worked with in Clearwater. And so just to kind of throw that out there, and I know we're going to talk a bit about, Matt, like how do you find a good sports doctor

and when does it make sense to go find a sports doctor? But that's just something that I think is – because I think I've been to quite a few chiropractors over the years just for maintenance stuff. And, and, um, it's kind of hit and miss. I would see that found that some of them were very much into just like coming, okay, just come every week and I'll just, uh, you know, adjust your neck, adjust your back and kind of just forever type of thing. And then others will be very into, oh, well, let me muscle test you on like 42 different standard process supplements and you need to be taking, you know, and it just becomes where I couldn't say I noticed much of a difference one way or another. So also the fact that you are

multidisciplinary, I think that's another thing that drew me to you. So that's your background. Now let's get into kind of the meat of the podcast. And let's start with, so you've worked obviously for many years with a lot of high level athletes, a lot of endurance athletes, and now these days, CrossFitters, right? Like people that are, I mean, well, they're into weightlifting, but you see a lot of CrossFit people as well, right? We do. CrossFit makes up a pretty big chunk of our patient base. I've heard from quite a few PTs. They're like, CrossFit has been a boon to my business.

Yeah. I mean, I work out with one of the bigger gyms here in the Mid-Atlantic, and so I find that that helps actually getting into the community and kind of finding out what it's all about. It definitely gets a bad rap in circles that maybe don't know enough about it. There's two kinds of, you know, thought processes. And there's certainly a lot of people, you know, kind of crossing over from bodybuilding into CrossFit.

You get a lot of endurance athletes that are kind of finding CrossFit either as a way to cross train and then everything all the way up to people who are, you know, trying to get into the CrossFit game. So, you know, I think it's, it's a fad that's here to stay for a while. And, uh, there's a lot of, uh, there's a lot of benefits to it. Certainly does come with its risk of injuries. And, you know, that's kind of what we see in the office and, you know, we do our best to, uh, try to keep them in the gym, keep them CrossFitting and, uh, maybe do a little bit safer.

And, you know, so what would be some of your what would be like some of your tips for people that are considering CrossFit or that are new to CrossFit? Because I've written about it. And, you know, I think I think it is great that it's introducing a lot of people to barbell training and to weightlifting and resistance training. I think that there's a lot of crazy programming out there and a lot of crazy programming out there and a lot of bad coaches, but if you have good coaches and good programming, it makes sense. So if you have somebody, what would you say to people that are new or considering CrossFit and how can they reduce the risk of injury and stay healthy as long as possible?

Yeah, I think you hit the nail on the head right off the bat. I mean, coaching and programming make all the world of difference, right? So I always nail on the head right off the bat. I mean, coaching and programming make all the world of difference, right? So, I always go on the mode of, you know, the devil's in the details. And so, even in clinic when we're doing rehab, I don't contraindicate exercises as much as I contraindicate individuals. So, you know, take a deadlift or a squat, for instance, you know, really good exercise, depending on where you're at with injury or movement might not be something you want to start out with. So what I've seen from my CrossFit gym and some of the other CrossFit gyms in the area, the guys that are doing it well, they have a really good baseline intro. They'll have what they consider a three months or less.

So they take the time to scale workouts. They don't just throw everybody into the fire. Usually they try to incorporate some type of a movement screen. That's one of the things that we've done at our gym because at the end of the day... And just to define that so people know what that is. Yeah. So technically the movement screen was developed by a physical therapist, great cook. A lot of research went into it. And essentially it boils down to seven prime movements that the body does, starting from overhead squat, straight leg raise, testing out your hamstring flexibility. It looks at core stability, shoulder function. So it really kind of hits on these seven basic movements that

every human structure should be able to execute. And so what it allows us to do is to predict injury and also to basically diagnose in real time muscle imbalance. So the number one predictor of injury is previous injury. The next number one predictor beyond that is muscle imbalance, right? So that's one of the biggest patterns of movement dysfunction that we see in clinic. And I say we, and that's across the board. You're an orthopedic surgeon, physical therapist, sports chiropractor, even just, you know, your standard chiropractic office will see this. And specifically in runners and just athletes in general is poor movement, right? Where people lack... Like what are the most common ones that you run into? Most common, you know,

just issues that people have with inability to move properly. Yeah. So it's really funded on, you know, there's kind of areas of the body that tend to have to be more stable and areas of the body that tend to have to be more mobile. And so one of the things we see in a lot of people that move poorly, which in today's day and age is most of us, right? Because we're not designed to sit at a desk. So if we just start from the ground up and we kind of hit the ankle, foot and ankle joint, you know, we need a good amount of mobility there. And we tend to see a lot of people have stiff, restricted ankle movements, uh, also stiff and tight in the hip. And what that ends up creating is a lot of issue in the knee because the knee is just a hinge joint. And if you're

bleeding motion from above and below the knee, then the house to compensate and the leg can kind of rotate inward or outward. It puts a lot of torque forces onto the knee. has to compensate and the leg can kind of rotate inward or outward it puts a lot of torque forces onto the knee so uh moving up from the hip uh you need a good stable core basically that kind of midsection area up into the middle back you need to have good flexibility of your upper back in between the shoulders ability to rotate the bend backwards you think about most people tend to be locked in a forward position, kind of that computer posture. Move it up into the shoulder.

Again, it's a very mobile joint. Needs to have full range of motion, but also needs to be able to, the body needs to be able to create stability around that highly movable joint. So those are kind of the things that we see go awry. Those areas of stability are lacking, and the areas that we see go awry. Those areas of stability are lacking. And the areas that we tend to need mobility, particularly the hips, the ankle, and the upper back, we tend to see people very restricted and locked up. Yeah. And so how does that play out in the gym then?

Because, you know, because you'll hear if you just Google around a bit and read about, oh, well, some people will say the deadlift is just a terrible exercise. It's just going to destroy your back and other people. And some people say the same thing about the bench press. And no matter how you do it, it's terrible for your shoulders. And I mean, as a general rule, when you run into binary black and white thinking like that, usually like for me in anything, red flags kind of go up because rarely anything in life is that cut and dried.

But outside of death and taxes and like a lot of physics, I mean, black and white thinking in a clinical setting really needs to be kind of scrutinized because it is a case by case basis. So what you look at is a lot of people tend to go into the gym with some of these movement dysfunctions at play and oftentimes multiple regions, right? And so they try to execute a deadlift on a body frame that isn't stable where it needs to be and isn't mobile where it needs to be. So if we take the hips, if you don't have the flexibility to get into the hips and get down deep, what will happen is you'll end up rounding your lower back. And if you try to pick up something heavy enough off the floor with a rounded lower back, that's a recipe for disc herniation, sprain injury, and so forth. Same thing goes with a bench press. If I have a forward protracted shoulder position, if you just think about kind of that rounded shoulder,

I'm already starting that movement in a dysfunctional position. The shoulder is not in a stable position and I'm going to execute a pressing movement, which is going to, you know, put the rotator cuff at a disadvantage mechanically. And it just sets you up for a whole slew of issues from biceps tendonitis to shoulder impingement. And that can progress all the way to more significant things like rotator cuff tear, labral tears, commonly known as slap lesions, and a whole slew of issues. So the biggest thing for somebody trying to get into, you know, like lesions, and a whole slew of issues. So the biggest thing for somebody trying to get into, you know, like I said, whether it be CrossFit or any sport really is to start with a good movement screen. And, you know, we could talk more about that later,

but that's definitely something that, you know, a good clinical physical therapist, sports chiropractor should be able to take care of. Yeah. Yeah. And, and people, you can learn about it. Like Matt said, Gray Cook is, I mean, I've seen his work, seen him just kind of credited as the real progenitor of mobility. I mean, obviously, Starrett is known as he has made it a bit more mainstream than Cook, but Cook's stuff came first. bit more mainstream than, than Cook, but you know, Cook's stuff came first. Absolutely. And so if you look at, you know, the top strength coaches, if we just go from the professional level on down, I don't care if it's major league baseball, NFL, NHL, the NBA, these strength coaches are, they're movement screening, they're, they're athletes coming into camp every year. They're looking for where are the areas that

we're bleeding movement and power and strength that set us up for injury. I mean, just like you said earlier, when you're investing multi, multi millions of dollars into these guys, that's their livelihood. It behooves us to be able to diagnose an injury before it happens and get to it. So yeah, Kelly's done a lot of really great work with his MWOD stuff. We use a lot of his stuff in the office. I've personally met him twice at our gym. He's come down to mobility clinics, done a really good job of kind of getting that mindset out into the CrossFit community, which, you know, like we talked about earlier is reaching a lot of people. You have a lot of people, you know, into CrossFit these days. And so it's at least creating an awareness.

Yeah. And it's making, it's making working out popular, which is cool. Exactly. Exactly. We're getting people off the couch. Exactly. So then, okay. So let's say you have somebody here and they're just new to just weightlifting in general. What are some, like, I mean, obviously getting a full movement screen is great and definitely be recommended if they have somebody that they can go see and that works for them financially and so forth. But what are a few simple things that, you know, they could test at home to know if they are, should they clearly be like, are they ready to really start doing a proper strength training program, for example, which is going to involve heavy bench press, heavy overhead press, heavy squat, and heavy deadlift. Like what are a few

things, like if you can't touch your toes, then blah, or if you can't, you know, do this with your shoulder or do that, or if you can't do this with your back. Sure. I mean, you know, if we just take a couple of things, I mean, if you have an ability to execute a fairly decent squat position, and I'm not going to get too technical with that, but most people can kind of tell whether, can you just squat down and drop your butt between your knees without having to come up on your toes? Yeah, break parallel and be stable. Exactly. You know, if you just think about, you know, just a simple box or a chair, can you squat back into that chair without having to make some kind of grossly complicated movement, you know? I think the toe touch is slightly misleading because most people kind of think that, hey, I've never been able to touch my toes. I'm not very flexible and I have just tight hamstrings. And that actually is not true for most people. Because of all the sitting we do, the sciatic nerve lends

itself to being entrapped by the tightness that occurs in the muscle of the hip. So as I go to execute a forward bend and try to touch my toes, what happens is there's tension along those muscles and that can grab onto that nerve right in the hip where you sit and not allow that nerve to slide as you make that movement. And what will happen is it'll shut the movement down and it creates a lot of tension down the back of the leg. It's basically neural tension from the nerve being stretched. And a lot of people will misinterpret that as tight hamstring. And so we'll find in clinic after we've done some active release to the hip, and we can talk about that a little bit more, but some soft tissue release work to the hip, we find that that frees up that motion and we can improve their range without even doing anything to the hamstring.

So, you know, there's some telltale things. I think, you know, for most people, it depends a lot too on your background. You know, were you an athlete growing up? Did you play sports? Do you have some experience in the weight room? Those kinds of things, you know, for a lot of people jumping in to doing a lot of these lifts, the answer is no to that, right? So if I've come from a background of playing football and I've done some basic movements in the gym, squat, deadlift, I've got some experience to draw on from that, you know? One of the things we kind of look at in the gym is, you know, the litmus test of does that movement look athletic, right? If it looks athletic, odds are, there's a lot of things working correctly. And if it looked horrible,

you know, you kind of glean it from there. So no, that's good because people can always, and I've recommended this to many people that have reached out to me and I've actually asked them to send me videos, but, uh, just like with any sport, if you want to get good at, you know, like I spent a few hundred hours working on my golf swing on camera, which is the only way to build a golf swing efficiently. But similarly, if you want to really see if you're, if you're executing a weightlifting movement properly, video yourself, uh, get a friend and they're, you know, yeah, who cares what people think everybody's taking selfies and trying to show off. So in this case, you're doing it for a useful purpose

and get it, get a video of your squat from, you know, the side and from the back and the same thing with deadlift and saying, you know, all of your big lifts. And that's a, I like that tip is just like, does that look graceful at all? Does it look fluid? Does it look right? Go compare it to you. You can find plenty of good models online with, again, with good strength coaches on this is what a squat should look like. Does yours look like that? No? Well, what are the big differences and how do we fix those? How do you get it more toward ideal? Exactly. We've done a lot of work with golf pros over the years. And Titleist Performance Institute has done a really good job of bringing together some of the top minds in physical medicine, whether that be strength and conditioning, physical therapists, chiropractors, golf professionals,

with the underlying premise of healthy golfers golf more, right? And there's a lot of really good research that's come out. And they've done a lot with just that, you know, looking at swing faults are not always a technical issue. 100%. Somebody could have a swing fault that's related to a biomechanical issue where they lack normal structure and function of a joint. And unless you have that looked at by a professional who's able to actually fix that, you could be spinning your wheels with all kinds of, you know, coaching cues and techniques. So it's the same thing.

And I think looking at stuff on video, you know, in the gym, we usually will look at people and kind of evaluate their squat. Can they do an overhead squat? We can glean a lot of information from that. We do the same thing with runners, get them to shoot some running video

and you can really glean a lot, especially in running, as in with golf, you can slow that video down. Were you really able to pick up a lot of distortions that you miss with the naked eye? So, you know, there's definitely a value for starting with, hey, does that movement look remotely athletic? And if not, then maybe it warrants, you know, a further look. Right. And so on the upper body, what would you say is like,

if you can't do this, you shouldn't be, you know, going heavy on your bench pressing, you should be addressing mobility or your overhead pressing, for example. Yeah. So two simple things are, you know, one, can you, you know, make a fit and kind of reach one arm up over your head to try to bring your hand between the shoulder blades, like if you were going to scratch your back and can you bring your other arm behind the back, and how close can you get those two? In a normal healthy shoulder, left and right. So like locking hands is the idea. Yeah, if you can lock hands, great. Now reverse the position where you switch the arms,

the opposite arm reaching behind the back, and the other one behind the head. If you're about even with both of those and you're within, you know, you can kind of touch your fingers or you're at least within a hand's width, probably you have some decent shoulder mobility. But what we find in most people is that you'll see there's a huge difference left to right when you switch those arms around. And the reason for that is a lot of people lose what's called internal rotation. around. So, and the reason for that is a lot of people lose what's called internal rotation. So basically that ability to reach behind your back and kind of bring your hand up the spine and how high up can you reach without doing a lot of compensated, you know, bending and twisting.

The other one you can do is do basically what we do in a clinical setting is an exercise. It's called a wall slide. And you basically stand with your back to the wall. Can you keep your head flat and your chin kind of pulled in slightly and bring your arms up to 90 degrees? And can you reach the back of your hand and forearm to the wall? Most people that are really tight in front, they'll find that they have difficulty doing that. If you can't get your hand all the way flat to the wall, you're probably going to have issues somewhere down the road with heavy pressing, whether it be shoulder pressing, bench press, those kinds of things. That's a good point. And also something that like I this is me kind of learning this lesson in that what I have run into, I'm sure would have been caught earlier when I was I first started manifest as, as just neck tightness when I would bench press, no pain, just that my neck would just be tight.

Like if I tried to turn to the right and I just was like, in the beginning, I was like, yeah, whatever neck tightness. I mean, it happens sometimes your muscles get tight, but then it would progressively get a little bit worse when the next time. And I kept on going heavy and eventually I was like, all right, I need to back off that, which I did. And then was getting it massaged and that was better. But I'm sure that I was missing, my shoulder then are being stuck and they're not sliding and moving the way that they should. Friction, friction, friction. Eventually, uh, it's just

the repetitive use, uh, element of it. It doesn't, it doesn't matter your form. And this is the important point is that your form can be great. You know, if you would have seen me bench pressing, you would have said, Hey, that he's doing a good job. There's, it would be hard to, you'd be hard pressed to find something particularly out with the way I was doing it. But what you can't see is what was going on on the inside. Exactly. Great point. Great point. So, you know, certainly if we know there's these restricted movements, you're more at risk. Like I said earlier, the number one predictor of injury is previous injury.

The second most common predictor is the muscle imbalance that we see. So, you know, it's true that even with perfect technique, the basic rule you can go by is that all musculoskeletal tissues will fail at a certain percentage of load or a certain number of repetition. Now, that failure rate is different. It's on a scale. You know, it can be everything from a mild sprain strain to a really significant tear. So, you know, and it goes back to one of the things that people tend to be misled by is, hey, you know, I don't really have any pain. I just have a lot of tightness. So the important thing is that pain is a lagging indicator. By the time you have pain, you have incurred tissue injury.

The human brain is a very adaptive system. It's one of the things that makes elite-level athletes so elite is their compensatory mechanisms far surpass that of the average Joe. They're able to compensate for muscle imbalance to where it's almost not even noticeable to the naked eye. for muscle imbalance to where it's almost not even noticeable to the naked eye. But when they do break down and have injury, they usually do so on a much more dramatic note. If you look at a few years ago, you had, I'll never forget this, a good friend of mine, he's another chiropractor,

Jason Sehorne was a big quarterback for the New York Giants. He had a knee injury. They had to do ACL reconstruction. Now, here's a guy, top NFL player, has access to some of the best doctors going, right? Comes back out, first or second game following season, and tears his hamstring. How does that

happen? I mean, at some point, right, it's a buildup of scar tissue that, you know, they obviously didn't address, but, you know, here's a guy who has access to, like I said, some of the best training out there. And that's just one example we see we see all the time. So, you know, the true reality for most of us is that, you know, by the time you reach the 30s and 40s, right, the compounded effects resulting from decades of basically repetitive motion, what we call hard miles and duty cycles,

starts to basically show up in the form of pain. The tissues become less elastic. And so a lot of the injuries that we tend to see from tendonitis to shin splints, you know, plantar fasciitis in the foot with runners, runner's knee, IC band syndrome, you name it, even dismal injuries in the spot tend to really have been an injury that comes on that looks acute, but it's been in the making for 5, 10, 15, 20 years even. And that's one of the biggest things that's misleading to people is they'll come in and say,

you know, I don't understand. I've been doing this, you know, whatever their sport is for X amount of years and I've never had a problem. And I always kind of look at them and say, well, the unfortunate thing is when someone goes to the hospital, to the ER, they're having a massive heart attack. They don't get to tell the doctor, oh, what the hell? I've never had any chest pain. Those issues have been developing over time and so we kind of take that for things like cancer and diabetes and heart disease and kind of know that those are chronic that take a

long time to kind of show their head it's really no different than soft tissue it's due to repetitive motion you can have great form but if you run enough miles sooner or later you're going to have some soft tissue injury and then you can get caught up in this cycle um you know we can kind of talk a little

bit more about what actually happened with the repetitive motion injury it's uh it's actually pretty simple to understand but most people haven't really had anybody explain it yeah yeah yeah yeah let's let's just right now because, I mean, it's something that if you lift weights over a long period of time, you're going to run into it to one degree or another. It's just inevitable. That's right. And so, you know, part of it is soft tissue has always been kind of downplayed. I mean, if you look at the kind of injuries we see in orthopedics, I mean, you know, if you fractural or dislocated bone, that tends to be a little bit further on the hierarchy scale than, let's say, a soft tissue injury.

Until we really look at the long-term sequela of those soft tissue injuries, I mean, for years, those injuries were kind of like, you know, put down by the wayside, like, hey, everything looks good on the x-ray. It's just a soft tissue injury. Yeah. And if it's like not a real injury it's just kind of a thing yeah like hey no big deal i mean yeah certainly you know uh compared to a lot of the other acute if you take out all the acute sports trauma acute sports betting injuries you know acl

tears concussion broken bones those kinds of things What we're left with is the bread and butter of orthopedic sports medicine. And those are soft tissue injuries and joint dysfunction, right? So basically over time and enough repetitive motion, the tissues will start to get tight. I don't think anybody who's done anything surprisingly understands what that feels like. And so as the tissues get tight, now they start to rub and there's more friction, right? So as that friction builds, we get caught in the cycle where the tissues are tight, they're starting to rub more, but we're continuing to do the repetition. And it can be small amount of workload. Think of like hours and hours at a computer, or it can be things like

running, cycling, working out in the gym. And as the tissues get tighter and tighter, they start to create basically a tourniquet effect. You're not getting enough blood flow deep into the tissue. And what we know in proven physiology is that decreased oxygen to the tissue, what we would call hypoxia, actually stimulates the body's repair mechanism. And so the default for soft tissue is to lay down fibrous scar tissue. Same concept occurs in the blood vessels. If you have high blood pressure and a lot of inflammation,

the body tends to heal that with cholesterol plaquing. So most people can kind of grasp what goes on with that. In the soft tissues, the body responds the same way to an acute trauma as it does to a repetitive motion, meaning it starts to lay down this fibrous tissue, which is very inelastic. And now you have tissues that are less elastic. And as you continue to use them, their threshold for injury starts to drop. And you start seeing things like being able to lift less weight in the gym. Movements that were non-painful are now becoming painful

i can't run as far the list goes on and on and then so from there um like for instance if we just kind of use my what i was running what i'm running into for example so then uh where does that come in in terms of inflammation and then pain and then twofold so most of the repetitive motion injuries do create some degree of inflammation, but it's kind of under the radar. It's kind of a low-grade inflammation. It's there all the time. Take kind of the two extremes, you know,

you sprain an ankle, it swells up real good, or you break a bone. There's a lot of bleeding, a lot of swelling. It really stimulates the body's alarm system. With these repetitive motion injuries, the irritation and the inflammation, particularly in the beginning, but over time, are kind of on a lower level. They're there, but not really enough to just cause the body to go into this alert load, right? So,

most people continue to, you know, exercise, workout, play sport. Maybe they have some tightness, maybe they're a little bit more sore after a run, but you know, again, it's not really preventing them from doing what they're doing. And it kind of goes on, you know, under the radar and it's basically just a matter of time. Yeah. And that's what I ran into. So then I guess, I mean, when we look at it as a whole, this is kind of inevitable. It's just a consequence of using our bodies. If it starts with muscle tightness, anyone who does anything remotely physical regularly has run into that. So what would you say is, like if we look at it in terms of, okay, so there are some to prolong the health of our tissues and prevent injury. And then so like it could start there with some self-treatment stuff.

And then at what point would you say does it make sense where somebody should go find someone like you and they're just ultimately going to, you know, that's what it's going to take for them to be healthy again. Yeah. So, you know, if we look at kind of like, you know, the body is a very adaptive machine, right? So, you know, over time, tissues that are kind of stressed optimally, good technique, given plenty of recovery time, the adaptation will be positive in the long run, right? You get bigger, stronger, able to run faster. The big thing that a lot of people don't recognize

is that they're not really respecting the low recovery curve. And basically all that means is I go in the gym, I do a workout, all right? And am I fully recovered by the time I go in the gym and do that workout again? Whether it's a long run, a ride, you know, if you're a triathlete, you know, a swim, bike, run, you're in the gym, it's workout, workout, trauma and repetitive motion are cumulative. So if we respect the load recovery cycle, things like sleep and nutrition come into play. I mean, that's a whole separate podcast, but don't think that there's too many people out there that haven't, at least if you're really athletic and active, I've heard that, you know, Hey,

it's important to get, you know, really good quality sleep because that's when you do most of your recovery. So, you know, over time, that's one way to help prevent this is to kind of have a good game plan. You know, a lot of people just don't really have a good game plan. If maybe they're working with a trainer, and again, it comes back to programming, if they have a good programming structure with enough rest built into the program, you know, if you look at how professional athletes strength train, right, everything is periodization. So they're having all these macro cycles broken down into smaller mesocycles

and they kind of target specific things. But at the end of each of these cycles is a built-in deload, whether that be for a week. You know, most pro athletes, when they come off their season, they're up to a month where they're really not doing anything in terms of heavy strength training heavy workouts you'll find that you'll find that in powerlifting as well where you'll have guys olympic lifting and stuff where after uh after a a meet or after a particular after you like they're peaking in in their training if when it's real real heavy real strenuous i mean

some famous guys would not then touch a weight for a month yeah it's all about letting the body get back to neutral and uh you know they're doing other things they're doing things for recovery and you know uh things like getting massaged getting in the tea you know uh their clinician uh getting some body work done and there's all kinds of things, you know, with regard to that. Nutrition, obviously, what you're fueling the body comes into play, you know, but as far as like getting into things that people can start doing from a preventative standpoint, foam rollers, lacrosse balls, they're pretty popular now. We do still see people that have kind of heard of it, but aren't really using it. And then there's certainly people that just don't really know what they're for, haven't been exposed to it. So, um, those are real simple things to

use. And, you know, again, I think that, you know, even in the CrossFit community, they've done a really good job of, of making active recovery, uh, kind of in the mainstream. People are realizing, Hey, you know what? I just did a heavy squat workout. Maybe I should get on a foam roller and like roll out my legs. Maybe they'll be better recovered for the next workout. So on that end, what we tend to see is that problems that really require in-clinic treatment, you ask, you know, how does somebody know? Like, hey, you know, when should I go see somebody? So you're starting to have an issue. Things are a little tight. Notice, hey, when should I go see somebody? So you're starting to have an issue, things are a little tight, notice, hey, I'm just not moving that well. And you're devoting some time to getting on the foam roller and trying to do some stretching. And a couple of weeks goes by,

it's not getting any better. That's an indication that you need to get in and have somebody take a closer look at it. Because tightness in the tissue will respond favorably to a foam roller. We can loosen up the tissue, but if it's an actual area of scar tissue where the body has laid down this fibrous tissue and glued muscles together, and we probably have some nerve entrapments through there, that's when you really need to get in and have some clinical treatment, get some active release done, maybe have a little bit more instructional on how best to use these foam rollers

and lacrosse balls. Because again, the devil's in the details. So there are tweaks that we can do to make those have more of a maximum benefit. So those are just a couple of ideas to think of. Yeah. And if anyone listening, if you're not familiar with the mobility foam roller lacrosse ball stuff at all, if you go to Mcle for Life and search for mobility, you'll see a few articles I put together on to give you some simple routines that you can do for your upper body and lower body. Because if you're to go pick up Starrett's

book, which is great, Becoming a Supple Leopard, you'll be quickly overwhelmed because it's very encyclopedic. So you're going to look through it and you're just going to wonder, you're going to say, okay, this all looks cool, but what do I do? Like, all I know is my, the neck, the right side of my neck is tight, or all I know is, you know, my shoulders are tight and I can't, I can't do the simple stretch that, that, that Matt was talking about. So again, if you want to get a little crash course in it, just head over to my site. And then from there, of course, there's a lot more you can learn, but at least, at least there's a starting point of saying, hey, do these, start with these basic and that'll cover your big muscle groups and it'll at least improve things in terms of range of motion. And so then Matt, go ahead. Yeah, I was just going to reiterate, I mean,

I think the big thing is, you know, getting a sense of awareness that, hey, there are things that we can do and, you know, kind of recognizing that, hey, I have this restrictive limitation. And, you know, I'm going to talk about earlier, I think Kelly's done a really good job and great cook. And, you know, the issue for a lot of people is the books tend to be kind of more textbook like. So a lot of people find themselves in a position where they're like, hey, I see these movements. I'm not really sure how to execute them. And that's when you should be taking that to your coach down at your gym or if they're not familiar with it, getting in and getting in to see a physical therapist or a chiropractor who's into doing a lot of this physical medicine. You want somebody who's focusing on know, focusing on sports injuries.

Yeah, yeah. Let's now just segue into how to find a good doctor. Yeah. So, you know, the number one thing that's most salient here is really these injuries need to be treated with a tri-prong approach. And what I mean by that is you need to have somebody looking at joint issues, restricted joint movement, response to manipulation. You also need to be looking at soft tissue. That encompasses everything from the muscle, the fascia, nerve entrapment. Nerve entrapments probably are responsible for about 80% of the symptoms that we

see in clinic. Numbness and tingling, pain, restricted movement. And the third component to that is the corrective exercise. So if we look at traditional therapy that people have gone to, tends to be very pop-heavy on exercise. And within exercise, there's a whole slew of how best to approach it. It should always be done in a progression, starting with, are we addressing mobility issues before we're addressing stability issues, meaning improving range of motion, which brings us back to the joint and the soft tissue issue. So from a clinical standpoint, most people need to be having some clinical manual therapy. And if you're not getting somebody to put their hands on you and actually fix these problems with your structure,

all the stepping and activation and strengthening exercises in the world are going to be short-sighted. They're just not going to have the effect. I mean, I always tell people, if you're baking a cake and you leave eggs, flour, butter, you leave one or two of those out, that cake's not coming out right. And it's the same thing in physical medicine. So the basic paradigm of how do we treat these things needs to be that tri-pronged approach. You know, certainly nutrition comes into play as well. But now we're talking about really optimizing recovery and things like that.

Right. You know, I think one of the best things that people can do is to go on to ActiveRelease.com and you can click on the find a provider link, plug in your zip code, and you can search for providers that way. Yeah, yeah. And if you want to take a minute here just to talk about ART and just because it has,

I've noticed improvements in my problem after, I mean, I've seen you five times now, is it five or six times? Yeah, somewhere in there. Yeah, and after each one, it's noticeably better. And after each treatment, it's the best that it has been, you know, since it started bothering me months ago, where I can actually see like there's light at the end of this tunnel or such. I'm not just going to have a permanently aggravated biceps tendon.

Sure. So it's been pretty cool. I can attest to it personally. Yeah, so I mean, the basic principle with ART, it's been pretty cool i can attest to it personally yeah so i mean the basic principle with with art it's been around for over three decades like i said we're sponsored with ironman medical so you know again these people are investing the better part of a year to train for a race you know at the pro level for sure and definitely at the elite and uh and amateur level so you know the the treatment is highly effective when it comes to manual therapy treatment.

I mean, really, ART is the gold standard. There really is no substitute. It treats nerve entrapment. Essentially, what it does is it restores sliding to the tissues. We talked about how the body gets glued down. You know, if you think about what really happens when I get on a foam roller, I mean, I'm really compressing the tissue, but I'm not able to create the sliding. And so that occurs during the AR treatment where, you know, the active release doc is actually, he or she is putting their hands on the tissue, creating some tension where the two muscles are good together.

And then through a process of active motion, we're able to create a lengthening. So if that's directly in an area where the nerve is entrapped, we can create some movement of that nerve so that it frees up motion. So from a soft tissue standpoint, that really is your go-to. There's other treatments out there. Grafton is very effective where they use these stainless steel instruments. And there's other companies that have come out with other materials to basically create this kind of scraping tool. There are a lot of areas in the body that works really well. Again, I would always default to, am I going to see an ART provider?

Because they're going to have kind of the most well-rounded toolbox, in my opinion, for taking care of these soft tissue injuries. And from there, obviously, manipulation is a big thing. And so most of your acid release docs that are full body certified, they've probably put in two to three years minimum of postgraduate training, right? They tend to have most of their practice focused on heavily in sports medicine, because again, it's just in keeping with the kind of injuries that we see. and so that being said most of these people are going to have a pretty active functional exercise component to their practice meaning they can teach you proper mobility exercises how to use a foam roller

everything from activating and strengthening exercises to you know a seamless transition and getting back in the gym and actually coaching up some, you know, strength and conditioning exercises, i.e. squatting, deadlifting, things like that. Yeah. No, that's good. So that's like everyone listening, you can kind of go back over that and make a list of questions that you'd want to ask any potential doctor you were thinking of seeing just to get a better idea of what are they trained in? How do they go about treating things?

How comprehensive, you know comprehensive is their treatment? I also personally, I mean, I don't know if it'd be a thing for you, Matt, but I think it's good to see if they work with any sort of professional athletes or high level elite athletes. I mean, I always, I was initially, I was just like, I'm going to start there. I'm going to find someone that like, what do the, what do the pro athletes, who are the type of people they see? And I'm just going to go see one of those guys. I mean, you know, in all fairness, I've seen that work on both ends. I've had the privilege to know a lot of really great docs over the last 16 years. Yes. Some of them have been at that high level. And so, you know, if you're at that high level, it really speaks to, you know, a high level skillset because they just don't keep guys around very long unless

you're getting results. On the flip side, there is a certain amount of being in the right place at the right time. I was pretty lucky being down in Florida, had some good opportunity. That doesn't necessarily happen for everybody. There are a ton of highly qualified docs out there that are just happy running, you know, their practice. Maybe are training a ton of highly qualified docs out there that are just happy running you know their practice are treating a lot of athletes but you know maybe it's at the collegiate high school and under and then just you know active individuals so believe me there are plenty of docs that i know personally that haven't really had the opportunity to work with some of these pro level teams that are every bit as good as a lot of the docs that are working with them. So there is some political stuff.

Yeah, I mean, that goes without saying, for sure. But certainly somebody who's really been down that walk, fairly sure that's a pretty good vetting process to know that they have a pretty high skill set. So, you know, those are kind of the big things that I would call up. I mean, if you find somebody on an ART website, you know, their craft and then you know you call the office you can just ask them you know hey uh you do do manipulation is there a chiropractor i'll tell you yes they do and then ask them a little bit about do you incorporate physical therapy into and then you can just ask what kind of patients they can see

and don't be afraid to ask specifically for your injury. You know, Hey, do you treat runner's knee or plantar fasciitis? Um, you know, sometimes you can get a lot of information off of their website, but not everybody has a very comprehensive website. So, um, I would say, uh, be weary of going to a website that doesn't have a lot of information. If, uh, you look good on the surface, you found them on the ART website. It's worth a call to the office. Talk to the staff.

Usually staff is very knowledgeable about what the docs treat and it could go from there. So now what about you specifically? So if we have any listeners that are in the greater Virginia, DC, you know, this whole area, where can people find you?

You know, what's your website? I know you mentioned that you are going to be working on like a big upgrade in terms of content and stuff. Yeah. So, um, we, uh, we're located in Alexandria, Virginia, just outside of DC, Northern Virginia, Washington, DC Metro. So our website is potomacphysicalmedicine.com. Um, that's going to be the same URL. We are in transition right now to, uh to we're getting a new web layout. We have a blog site currently. It's Prehab for Performance. Prehab, the number four,

performance dot com. That's going to be phased out and we're going to actually have that just all encompassed with the Potomac Physical Medicine dot com website. So that's really the best place to look at stuff. There's a bunch of good content on there. And I would say within the next month or two, the blog content will be on there as well. Cool. I mean, I think that covers everything. That was great. That was very comprehensive. A lot of practical information. It's good because it addresses just questions that I'll get via email and I'll answer privately. So a lot of those types of discussions make for good public discussions as well. So now, you know, there's people, hey, here, here's the answer.

Check this out. So I'm sure that it's going to be well received and you may be hearing from people. Yeah, absolutely. I'll just throw my email out there. Anybody wants to contact me directly, they can reach me at drmattfontaine at gmail, drmattfontaine at gmail.com. Okay, cool. And Fontaine is F-O-N-T-A-I-N-E, right? That's correct. Okay, awesome. Well, that was great, Matt.

Thanks for taking the time. I really appreciate it. And I appreciate you fixing my arm and my shoulder. Anytime, man. I'm glad we were getting it done. Yeah, thank you. Really appreciate you having me on. It's been fun. My pleasure. Hey, it's Mike again. Hope you liked

the podcast. If you did, go ahead and subscribe. I put out new episodes every week or two where I talk about all kinds of things related to health and fitness and general wellness. Also, head over to my website at www.muscleforlife.com where you'll find not only past episodes of the podcast, but you'll also find a bunch of different articles that I've written.

I release a new one almost every day, actually. I release kind of like four to six new articles a week. And you can also find my books and everything else that I'm involved in over at muscleforlife.com. All right. Thanks again. Bye.