transcript

Speaker 1:
[00:00] What is the one body part most women neglect in their training?

Speaker 2:
[00:03] Glutes.

Speaker 1:
[00:04] That's right!

Speaker 2:
[00:05] They think they're working their glutes, and they want to work their glutes, but a lot of them haven't quite figured out how to do it.

Speaker 1:
[00:09] Heat or ice for acute injury?

Speaker 2:
[00:12] Neither. What?

Speaker 1:
[00:13] Talk to me about that. This week on The Dr Vonda Show, I have Dr Dan Ginader, who is a doctor of physical therapy. When people feel a pain, their first in clinician is to sit down and rest, to which I say to my patients, listen, if you have a pain in one arm, you've got two legs, another arm, and a core that can still function.

Speaker 2:
[00:34] When people hear pelvic floor, they think, oh, I've just got to do my Kegels. And if you ask every pelvic floor physical therapist, they'll tell you that Kegels are the devil. I've had so many patients that when they learn how to relax the pelvic floor, all of a sudden everything else just becomes unblocked.

Speaker 1:
[00:47] What is the basics we have to do in your experience?

Speaker 2:
[00:50] First of all, everybody should be exercising, period.

Speaker 1:
[00:53] You haven't gotten the message at 30. You haven't gotten it at 40. You find yourself, it's usually at 70. They're like, oh my God, I'm just hearing this. Is it too late for me? What is your thoughts on that?

Speaker 2:
[01:03] There's no such thing as it being too late.

Speaker 1:
[01:08] All right, my friends. So this week on The Dr Vonda Show, I have a new guest that I just cold DMed, because sometimes I do that when I see experts out there that align or not align, but I think will add a lot of value to what you're thinking. And Dr. Dan Ginader, who is a doctor of physical therapy with a physical therapy studio in Manhattan at 27th and 6th, in case I have a lot of Manhattanites who listen to this. If you need things, he has developed the Mims Method of Physical Therapy and has a book called The Pain-Free Body, Simple Stretches and Exercises for Common Aches and Pains. And I am excited to have you on today because I want you, first of all, to help me set the record straight on when people feel a pain, their first in clinician is to sit down and rest, to which I say to my patients, listen, if you have a pain in one arm, you've got two legs, another arm and a core that can still function to help you. So from the perspective of an expert in physical therapy, what is your perspective between just stop and rest and wait three weeks to atrophy versus find out why it hurts, get to the root cause, not all knee pain comes from the knee?

Speaker 2:
[02:36] Well, first of all, thanks for having me. I am in fact in Manhattan and I am the Clinic Director of Mims Method Physical Therapy. I am not the creator of Mims Method. Brittany Mims, the owner of the clinic, is the creator of Mims Method, but I am more than happy to be her right-hand person and Clinic Director of the Clinic. But to get to your question, I do think that a lot of people do think that, oh, I got hurt while I was doing something active. So clearly being active is the root of the problem. So to help, I have to become unactive again. When in reality, you got hurt while doing something active, but you were hurt because you were probably doing something your body wasn't quite prepared to do. And the reason it wasn't quite prepared to do that is probably because you're already spending quite a bit of time either resting or at the very least not focusing on the areas where you need strength and mobility. And so when you do get hurt, instead of taking a rest, which sometimes is warranted, and oftentimes you do have to at the very least take a break from the movement that caused the injury, instead of just jumping straight into the rest though, you should maybe ask yourself why you got hurt in the first place and then begin taking steps to address that so that ideally it never happens in the future.

Speaker 1:
[03:46] Sometimes people take the rest option because they're afraid of getting re-injured. You must hear this all the time. I hear this every day, you know, people, listen, if they're not living under a rock, they know that mobility is medicine. They know anti-inflammatory foods is good for muscle bones, tendons, ligaments, but they don't activate because of a fear of injury. How do you help people when they're sent to you work around that fear? Because often it's a mental game, even to get started when you're trying to rehab them from an injury.

Speaker 2:
[04:22] It's 100% a mental game. And in that mental game, a lot of times the first thing that we try to do is just find the proper re-entry point for activity. Because as you outlined, the classic presentation is somebody got hurt doing something and then they rested. And then ideally, they know they don't want to rest for the rest of their lives. So after maybe a few weeks or even a few months of resting, they get back into doing something that they think they could do or they could at least do before they took that rest, only to realize that they've atrophied and gotten weaker and gotten stiffer in certain spots. And then that can lead to a new injury. And that new injury kind of reactivates that same fear and reactivates the same rest. And a lot of times, by the time I see someone, I've seen them after going through that cycle two, three times, and they've really built up that apprehension to activity. And so, when I see someone for the first time, first of all, I make sure I take the time to truly listen to their story. Because if I can show that I'm invested in their story, and I can show that I'm listening to where they've been before they got to me, then I know that I can start to build that trust. And then once I have that trust, I can reintroduce some things that maybe they do have some fear around. And then once we can introduce even one or two movements, even if they're very simple, even if they're very gentle, but if they can do them, then they start to build that confidence. And then if they can do them, as long as I've given them proper things to do, then they can feel themselves activating something that they intuitively know, oh, this should have been stronger. Or they can feel themselves loosening up into a range of motion they maybe didn't have before. And then we can kind of start to build from there. But yeah, it's definitely a mental game that first time I meet them.

Speaker 1:
[06:00] You know, and in my practice, in my orthopedic practice, when someone has had this cycle that you keep talking about, and I do spend the time to sit down and talk about, often the problem is weakness, not actual, you feel pain because you're weak, not just because you're damaging tissue. To build the confidence, instead of just telling them to go back to the gym and blah, blah, blah, I send them to a skilled physical therapist. Because you guys get to spend a lot of one-on-one time. Great physical therapy houses are not one clinician to five, six, seven people. It is one-to-one, one-to-two. So you get to spend a lot of time rebuilding that mental confidence in a body. And part of the conversation I'd love to hear your perspective on is a question I get asked a lot. How do I know what I'm feeling is okay? How do I differentiate actual pain of injury from sometimes workouts just hurt?

Speaker 2:
[06:59] So that can be surrounded by a ton of gray area, obviously. But the first thing that I'll tell people is to trust your intuition. Our bodies are pretty in tune with what is dangerous and what isn't. And so I tell people, if you feel something that feels like pain and your body is shouting at you that it's a warning signal, just back off because chances are it's not going to be worth pushing through. And then once I've gotten the chance to know them for a little bit and understand what their signs are and also understand what their activity level is like, then a lot of times it turns more into if you feel a discomfort with the first rep or two of like a squat or a lunge, I'll tell people to A, think about the things that we've talked about activating. If you're seeing me because you have pain with a lunge, because you're feeling pain in the front of your knee, then likely you're overactive in the quads and we're trying to get you to activate the glutes, something like that's a simple example. And so the first step is, are you feeling your glutes? Are you activating the things that we're trying to activate? And if you are, then try to do that. And then do three or four more. And if you start to feel those symptoms shift towards, oh, things are loosening up or things aren't quite as stiff as maybe they were in that first couple, then you know it's safe to continue. But if you feel like those symptoms are only continuing, maybe do more than you do, maybe never do more than like eight or so, then that's a good sign to step off and recalibrate. And again, it's not jumping straight back into the rest. Maybe you just need to go through a smaller range of motion. Or maybe there's a regression of exercise that we can introduce you to. But I normally do like to have people just go through a few and just see what direction those symptoms start to move before they decide ultimately if it's a true warning signal or not.

Speaker 1:
[08:44] And in doing so in a calibrated measure like you're talking about, people will understand how to listen to their body so that every signal does not become an alarm. It's, oh, that's how that feels, right? Because the reality is, I've been a sports surgeon at elite levels my whole career. You were a Division I athlete. You've worked with elite athletes. Sometimes we're just in pain all the time.

Speaker 2:
[09:09] Of course. Yes.

Speaker 1:
[09:09] Right? But understanding the vocabulary of your body's pain is what you're helping mere mortals. Now, I'm a mere mortal athlete. Mere mortal athletes do, right?

Speaker 2:
[09:21] Right. And for people that have not had that athletic background, it can be a really tough thing to navigate. I've told people in the past that I would much rather have a 20-year-old athlete dealing with something, not because they're an athlete or because they're young, but because even in those 20 years, they've already become acquainted with what it feels like to be hurt and what it feels like to be sore and what it feels. They know how to differentiate those things, and so it becomes a lot easier to deal with and work around. The toughest patient that I'll ever work with is a 50- to 6-year-old person who has never really been hurt in their life, but maybe two years ago started to feel some symptoms of knee arthritis, and then they went in for a total knee replacement. And it's not only the first surgery they've ever been to, but it's the first injury they've ever dealt with. And so after five or six decades of life, to now finally be introduced to what these warning signals feel like and what this pain feels like, and what it feels like to go through something hard will always be tougher than somebody who's kind of been through the wringer already and has a really good process for understanding what their body's trying to tell them.

Speaker 1:
[10:30] I am laughing, Dan, because it is exactly what I say to my own Director of Physical Therapy, that the hardest people to get to trust their bodies or even understand what their bodies are saying, or even knowing where their knees are, frankly, or their hips are, people are confused. Because of course they are, they don't know the inside anatomy, and so it's our job to educate them. The hardest is the person who has never been hurt before, and then their 40s, 50s, 60s. Because, to your point, if you've been an athlete, and you had your first ankle sprain at 14, and you know what real pain feels like. So it's really about education, because what I find is, when people don't understand the signals of their body, they just stop. And one by one, we give up mobility, and we find ourselves confined to, I had once someone tell me, you know, Vonda, I don't walk. And she was serious. She got out of the car, went to her desk, got back in her car. So when we give up the primary skill of our bodies, which is mobility, right, toddlers move, it's just interesting to me that you said that without prompting. And I'm like, yes, exactly what I experienced. So you know, a lot of people who listen to me at this point, and especially on this podcast, are women 35 to 65. And early in that process, 35 to about 50, they're going through perimenopause, which is estrogen walking out the door. And we wrote this paper called The Musculoskeletal Syndrome of Menopause last year, talking about all the changes that go on in a woman's musculoskeletal system when she no longer has the benefit of estrogen. Do you see in your clinic dramatic changes in the musculoskeletal system across the lifespan of women? You're like, a 40-something-year-old woman is going to experience this. Do you see those patterns?

Speaker 2:
[12:32] Yeah, of course. So, Mims Method Physical Therapy, our niche is working on Broadway. We currently provide the in-house physical therapy for both Wicked and Chicago on Broadway. We also work with a lot of dance schools around New York City. And because that is our niche, I am the only male that works here. A lot of our other PTs are former ballerinas, dancers, and have more of an inclination to want to join that niche. And because of that, we see a lot of women here at Mims Method. And I definitely see those changes. And it reminds me, I just had a patient last week send me the results of her DEXA scan and just say how terrified she was that they found osteoporosis and multiple bones. And I kind of had to sit her down and say, hey, this is scary. And I acknowledge that. But also, you're not alone. You are, if anything, indicative of a lot of people in your demographic. And there are things we can do. And there's things we can work on. And you can talk to other physicians to make sure that you're getting the calcium intake and other things that you need to show. So, yeah, I mean, that lifespan is real and it's seen. But I will say, it is far less exaggerated in especially active individuals and especially the individuals that are already focusing on strength training.

Speaker 1:
[13:56] So, phrased another way, you're saying, based in your experience in physical therapy and with high-level dancers and athletes, dance athletes, the better shape you stay in going into this period really matters.

Speaker 2:
[14:13] Thousand percent.

Speaker 1:
[14:14] Yeah. I would agree with that and the data bears that out. What we also observe is that even athletes, when we go through this and estrogen walks out the door, what worked for them before doesn't work quite as well or at all now. Do you observe that? The recovery periods become differently and you're dancers who are 35 and I was the doctor for the Pittsburgh Ballet and the Atlanta Ballet for a lot of years and I could squeeze dance out of hips until about 42. That's the oldest I retired a dancer at 42. But there comes a time when what worked just doesn't work. Do you observe that?

Speaker 2:
[14:56] Hundred percent, especially the members of the ensemble, the more dance heavy roles on Broadway. Once they get to, once they hit 35 at the very least, it's just those day-to-day aches, they just don't go away the way they used to. The warm-ups get longer, the cool-downs get longer, they start going to more massages and more things like that. I'd say the number or at least the age that I see is 32 to 35. If you are regularly dancing and very active, that's when things really start to shift and it just becomes harder and harder to manage.

Speaker 1:
[15:33] Well, and unless people know that every single tissue in the musculoskeletal hierarchy, everything coming from a mesenchymal stem cell, so for those of you out there, not in our field, muscle, tendon, bone, ligament, fat, annulus of the back, cartilage, has estrogen receptors, and estrogen is not sitting in those receptors, no wonder the whole system starts to break down. So, how do you modify the care you give for the midlife woman, knowing that this is happening? And then I want to talk about frozen shoulder.

Speaker 2:
[16:10] Okay. Well, if they were a former dancer, a lot of the education becomes showing them and teaching them how to slow down a little bit. Because we talked about the response and the inclination to when you get hurt to rest. In a lot of these dancers, the inclination is exactly the opposite. First of all, they've had the fear of God drilled into them that they can never be hurt. Because if they're hurt, then their track gets taken and everything, their life will never be the same. And so, they're so used to hiding these injuries and pushing through these injuries, that when they feel an injury, they want to push forward and they want to move forward and they want to just get through it. And when you do become a little older, and again, you've lost that estrogen, you don't have the healing power that you used to and those structures are changing, the conversation now becomes maybe you do need a little bit of rest. Maybe you do need to slow down a little bit. Maybe we do need to take this train that's hurtling down the tracks and just kind of ease back off a little bit. Because if we can't get your body to fall back into a state where it doesn't feel constantly threatened, we can't move forward anyway because you've developed so many compensation patterns and you're feeling tightness in so many places that we just can't override that unless you can finally convince yourself or convince your body that things are going to be okay and you can get that to kind of turn down a little bit. So that's a lot of it. And then for the other side of the spectrum, the women who maybe were not in great shape before they hit this period, but then they saw their doctor and their doctor said how important it was to start resistance training. They don't have any idea what resistance training means. I have so many people that come and see me and say, well, my doctor said I need to start resistance training. What is that? I was like, well, and we start from the bare bones. We start with a lot of bodyweight exercises. So on that side of things, it's teaching people how to gain confidence in their body again, because the woman you mentioned who just doesn't walk anymore, that is actually very common, where you start making these modifications of, oh, I don't take the stairs anymore because they hurt, or oh, I don't wear these shoes anymore because they hurt. Then before you know it, you're confined to slippers in your house because it's the last thing that doesn't hurt. So starting slowly, starting with a lot of education, and again, it goes back to that first evaluation confidence building, where you just try to start with three or four movements that they can do, that they can feel confident in, and then once you get that going for you, then you can build over time.

Speaker 1:
[18:40] Absolutely. I like what you said because I think when I tell people all the time, we need to start lifting weights. But I also say what you just said, it may take you six months or nine months to get the mobility in your body to be able to lift significantly, right? And so sometimes that starts when I prescribe exercise, I prescribe it according to a little acronym that I've used for 20 years called FACE. So flexibility and joint range of motion, aerobic, carry a load, which is weightlifting, and then balance and equilibrium. How much time when you start out with people, do you spend going through flexibility and joint range of motion?

Speaker 2:
[19:25] So because I deal with a lot of dancers and former dancers, that is generally something we can kind of just move past.

Speaker 1:
[19:31] But for the mere mortals, the wandering...

Speaker 2:
[19:33] For the mere mortals, yeah. For the mere mortals, that's where it starts. Because as you mentioned, you can't do a strengthening movement if you can't get in that movement in the first place. And so one thing that I really took home from my Division I athlete days is that so many kids, at least when I was going through, it's a little different now. So many kids in high school were not given any access to proper strength training. And so it was very popular for the... at the Division I level to take in these freshmen and not have them touch a weight for six months and just build these mobility basics, build the flexibility basics and only start introducing true resistance, true weights when they can show that they can get in those positions. And so that's kind of something that I've taken to just apply to the older population because it really is no different. And that I will not put a... even though I know it's important to do, you know, the more resistance, the better, I will not put a weight in their hands until they show that they can accomplish these very basic movement patterns. Because then I know that I can safely load them. And the load will be tolerated and it will go well. Versus, I think another reason a lot of people have a poor experience with the resistance training side of things is because they had somebody add a whole lot of resistance before they were even ready to do something bodyweight. And so I really take the time with the mobility side of things for sure. There is no such thing as it being too late, but it's always better to start as early as possible. And it's important to recognize that if you are starting late, that the difficulty level will be increased. Because you don't have that same base of having worked out a little earlier, you haven't built those movement patterns, you haven't built up that muscle tissue, it will be harder and it will be slower and it will require more consistency. But you can still always do it. There's no such thing as it being too late.

Speaker 1:
[21:24] You may think your bones are fine, silent. But if you're a woman over 40, your bones are talking to you. And unbreakable bone is how you answer back. During perimenopause and menopause, your bone loss can triple without us even knowing it. That is why I created my eight shield, Building Better Bone Program, including Unbreakable Bone Nutrition Augment. Built on clinically studied collagen, microcrystalline hydroxyapatite, and the essential micronutrients your skeleton needs. It's the only formula designed by an orthopedic surgeon who spent 25 years rebuilding bone, muscle, and movement. Stronger bones are the foundation of a longer, more powerful life. Start building your unbreakable era today at shop.drvondaright.com. Well, and that's why for certain people, I love to send them for a short course of physical therapy with an expert, before I even progress them to the gym. The place I practice by design as a sports surgeon has physical therapy, but we're inside a performance center. So there's this gradual progression of people moving through the system. But I won't send them out onto the gym floor, just where they're going to try out a bunch of machines, which I don't really love machines. But because they need exactly what you're talking about is the body knowledge, the body mechanics, the knowledge that you guys can impart. But before we leave midlife women, nothing screws up a dance routine more than a frozen shoulder. Or it's the number one thing. If I go in my clinic and I see a 46-year-old with shoulder pain, before I jump to, oh my God, she's got any kind of pathology, I jump to she's lost her estrogen and she's got a frozen shoulder. Anybody watching, I'm showing you how the people present with less than 90 degrees of moving their arm forward. So what is your approach to this two-year-long or what can be a two-year-long process in some people?

Speaker 2:
[23:43] Well, I think there are two approaches. There's the approach where you're so early in the process, you just have to kind of surrender. And there's the approach where you can start to see the light at the end of the tunnel. And then you almost treat it as if there's somebody that got a rotator cuff repair and never really did the physical therapy afterwards. Where you're still the very building blocks of building mobility and strength back, and you're moving slowly so you don't overload the tissue, but you can start to move forward. And for the most part, it's hard to, especially in the cases that aren't super exaggerated, it could be hard to tell exactly where you are in that phase, especially if they aren't very active. Because if they're not very active, they likely may not have noticed that loss of range of motion or even that loss of strength, because they're very rarely getting into positions where they would notice that. A lot of times people don't notice it until they can't wash their hair. That's right. But you can still wash your hair with a bent elbow at less than 90 degrees of shoulder flexion. That's right. You can make it pretty far. And so when I have someone that's been sent to me diagnosed with frozen shoulder, I will give it a good go for two to three weeks. And if over the course of those two to three weeks, I'm making week over week improvement, then I give them the side of the education of, hey, we might be in the thawing stage of this. We might be able to kind of move through things. And if they don't make that progress in those two to three weeks, and things are exactly the same as where we left them, then it's more of the education of, hey, listen, we might just need to wait this thing out. Because if we start to force this and we start to move past it, we're likely only going to irritate that inflammation cycle and, and prolong the already really terrible journey you're already on.

Speaker 1:
[25:29] Well, and, you know, from the medical side, that's when I, I mean, I start talking, I don't give steroid injections in general, but for this, so that you can do what you need to do, I sometimes do. Or, and definitely everybody has to make a hormone optimization decision in my hands. But from a therapy side, because I have so many people, because of my practice that come in, we've discovered the, our Chief of Physical Therapy, and that long, slow stretches are the most effective. Not anything ballistic, we're not putting weights in people's hands, but just manual therapy, long, slow, manual therapy helps us. I always say to my patients, if you get three degrees a day, you're going to make progress, right? Doesn't have to go from here to here in no time, right? That is so hard for people. But you know what else is hard for people? Besides frozen shoulder, I get DMs every single day about the itises, the especially glute tendonitis. I'm pointing to my own glutes here. Glute tendonitis, which is different than bursitis, right? It's a very specific. Then I'm a big fan of getting to the root cause, so I stand people on one leg and make them show me whether they have a Trendelenberg sign or not, which for those of you listening, hip drop, knee falling in. Because I think a lot of these itises, tell me your perspective, are not only loss of estrogen, but glutes that don't fire.

Speaker 2:
[27:06] 100%. So I think a lot of people are intimidated by the itises, which is why they're so dead set on telling you that they have them and why it sticks in their brain. I think the Latin influence in medication and medicine in general has just made a lot of things sound way more intimidating than they probably are, where itis just means inflammation and then if it's your glute, that just means your butt wasn't strong enough to the point to where it got overloaded enough, to where the tightness was enough, to where it was pulling at the bone at enough of a level to cause a little inflammation. And as you showed, when you get them in that one-legged position and all of a sudden everything just caves in on them, then you can say, see, your glute doesn't work. And so it's overloaded and then it gets tight and then it pulls and that's why it hurts. But if we can work on the strength and we can get that glute firing the way that it should, then all of a sudden it's going to be able to handle the things that you're doing with it. And then that itis will go away because there's no more pulling, no more inflammation, no more reason for it to be tight and angry with you. So I think the education side of things first and foremost is the most important bit.

Speaker 1:
[28:15] And you know what, I go so far, I march people over to the PT gym, which is connected to my office. There's a big mirror on one of the walls. I have people do it in front of the mirror because for me to describe for them that their glutes are too weak and they'll say things like, but what do you mean I do a leg press all day? They're really trying hard. But what people don't do is single leg work. And what they don't realize is that you can still press a leg press without your glutes firing very much at all, or you can be the world's best runner. And so this whole education showing you the deficit, but it also is why I'm not an orth pod who just sticks steroids in every itis, because we're not getting at the root cause, right?

Speaker 2:
[28:59] Right. So the steroid will take, and that's another conversation I have with patients, especially if they tell me that they're considering a cortisone injection, just kind of ask what it means. I say, well, the cortisone is going to hit the reset button on your itis. It's going to get in there. It's going to flush out the inflammation for sure. But if you don't understand where that inflammation is coming from, and you don't take steps to reduce the risk of the inflammation coming back, then you can hit the reset button. And then in two to three weeks, it will be just the same as it was, because you've given it no reason to not come back. And so that's a big conversation. And also, like you said, a lot of people are doing bilateral movements. They're doing squats or deadlifts or leg presses with both legs at the same time. And they have no idea how much weaker one side is compared to the other, because they never test it. And another thing that I've learned working with dancers is you can use all kinds of muscles to get your body in all kinds of positions. That doesn't necessarily make sense. You can't take someone's word for it just because they tell you that they're doing these movements. And then I get someone on the ground and I say, okay, I'm going to have you do ten bridges. But what I'm going to have you do is you're going to push only through your heels and you're going to try to squeeze your glutes together with such force that you feel like the only reason your hips are coming off the table is because of how hard you're squeezing your glutes together. And we're going to see how you feel after ten bridges. And then all of a sudden after doing ten bridges, which to them seems like a simple exercise, after seven, eight or nine, they're like, oh my goodness, like I have nothing left in my glutes. They're like, well, because you've never really learned how to use your glutes before. And so I am a firm believer in just showing people with their own body versus just to try to talk it out, yeah.

Speaker 1:
[30:46] Yeah, I love that you do that even with your pro dancers because having been in dance along, you may be able to do a lot of moves, but it doesn't mean that your glutes are doing it, for instance. Or I have this, the biggest people I have, bless their hearts, I love them so much, are the runners. You may be able to run a marathon and it may have very little to do with your glutes. And then you get back pain and then you get itises and then your gait becomes all wonky and it just begets the kinetic chain malfunctioning that happens. So you had talked a few minutes ago about when we're doing the heavy lifts, which I like people to do actually. I like to teach people to progress to power lifting with squats, deadlifts, which is all dependent on technique, hip hinging technique, and being well stacked for your squats. Because frankly, it's really important for bone density, which as a bone doctor is critical. But the reality is that form is so important that without good form, a lot of people will get low back pain, right? I like to say if you don't have the mobility in one joint that's supposed to be primary, your body will steal it from somewhere else. So do you experience that? I guess I'm leading you to answer the way I want you to. But I think a lot of SI joint dysfunction and low back pain has to do with the kinetic chain, mal firing of tissue, of muscle. What do you think?

Speaker 2:
[32:19] I very much agree. I think very few people have a true structural issue in their pelvis and SI. Yeah. I have a lot of people that tell me they have a structural issue in their pelvis and SI. I will say that I have had some hypermobile dancers who are a mother of two or three to where I know their pelvis is moving. I can feel their pelvis moving, but they're the very rare case when in reality, 80 percent of the people that are feeling some sort of, and I just do that number out there, but it's the overwhelming majority. It's a movement coordination issue. You're overloading one side more than the other, probably because that's just where you're comfortable getting that muscular contraction from. But I do agree that most of that pelvic girdle discomfort is coming from a movement firing sequencing form issue in one way or another.

Speaker 1:
[33:13] How important do you think the pelvic floor is in overall exercise?

Speaker 2:
[33:20] I think the pelvic floor is very important. Here at Mims Method, we have two certified pelvic floor PT's. And I've just seen it make such a difference, especially, not limited to, but especially in the pre and postnatal side of things, where there are so many women who I think that, so first of all, I think that having a baby is so common. All of us were one-time babies, all of us have mothers, that there are a lot of OBGYNs that are a little jaded in terms of the women's experience when giving birth. And a lot of times, I have women, I've had women tell me that they have incontinence issues or they have a lot of these other things that they've been told by their doctor is normal when it doesn't have to be.

Speaker 1:
[34:13] Well, it's common, but is it normal? I mean, 80% of women become incontinent, so it's common, but assigning, you're right, doctors do say that. People say, oh, it's normal, get over it. It's common, but why should it be an expectation, right?

Speaker 2:
[34:31] Right. And so in pelvic floor PT, you can regain a lot of those skills again, and you can become acquainted with what it's like to work your pelvic floor, because I've also seen a lot of patients where I've tried all kinds of things to get them to fire their core, fire their TA, become acquainted with what it's like to kind of use that coarsening kind of musculature, and they can't do it. And it turns out the main issue was that they were so hypertonic in their pelvic floor that they didn't have the ability to fire any other muscles in the area because everything was just being taken over by the pelvic floor. And with just two to three weeks with pelvic floor physical therapy, they can learn how to turn off those muscles, which oftentimes is the answer. I think another thing when people hear pelvic floor, they think, oh, I've just got to do my Kegels. And then if you ask every pelvic floor physical therapist, they'll tell you that Kegels are the devil. Everything's more active probably than it has to be. If anything, you're hypertonic and you need to learn how to relax the pelvic floor. But I've had so many patients that when they learn how to relax the pelvic floor, all of a sudden everything else just becomes unlocked. They have an easier time activating their glutes, they have an easier time activating their core, and all of a sudden, all those sequencing movement issues that may have been leading to a pseudo SI discomfort or a pelvic discomfort are now completely taken care of all because they've learned how to relax their pelvic floor.

Speaker 1:
[35:50] Yeah. And so, the contraction of Kegels done poorly just perpetuates, right, versus a functioning pelvic floor. So you and I have spent a lot of time now talking about muscles below the belly button and the kinetic chain going up the leg, but something else I see a lot and correct constantly in my office, but is obnoxiously bad upper body posture. You know, we're at phones all day. We're rounded shoulders. Even men I see are developing kyphotic, which is mean that hump at the top of your spine. And as a result, not only bad posture, lots of unnecessary shoulder pain. Now some of the biggest offenders, bless their hearts, I love dancers so much, but how can you be so pulled up on stage and so hunched over in the wings? So talk to me about your experience with upper back posture and what the, not just your dancers, but everybody can do to correct in a meaningful way.

Speaker 2:
[36:56] So fixing your posture is, I would say, a half hour by half hour activity. A lot of people think that, oh, if I need good posture, I need to stay in that good posture all day long. When in reality, if you stay in a good posture all day long, it's probably doing you about as good as staying in a poor posture all day long because either way, you're staying in the same position all day long. So a lot of times, I'll tell people every 20 to 30 minutes, have a little alarm go off in your head, and if you've fallen into that rounded posture, just get back out of it. When you get back out of it, move around a little bit and give that feeling back. Then sure, over the course of those next 20 to 30 minutes, you might fall back into it. But if you correct and you come back out of it, then you're always constantly thinking about it and you're working those muscles and you're going to build strength over time. And probably over the course of the next few weeks, if you're really diligent about it, over those 20 to 30 minutes, you're falling less and less and less into that position because you've gotten used to coming back out of it so much. And so I think a lot of people are maybe hesitant to fix their posture because they think that they're going to have to stay in it all day long, and that's not comfortable and I don't want to do that. But if you just have a little alarm go off in your head, I think that's a lot more doable. And then in terms of how that can lead to shoulder discomfort, I've had some people that come to me with shoulder pain, and they're sitting with the most rounded upper back that you've ever seen in your life. And in their natural posture, I don't cue them, I don't anything, I have them go through a shoulder range of motion. I see, let's see how far you can move your shoulder. And then I correct their posture, I have them come up, I have them drop their shoulders a little bit, and I have them move their shoulder again, and they look at me with these wide eyes, like they're shocked, like, oh my good, I can't believe how easy it is to move my shoulders. Well, that's just the difference between you getting just the tiniest little bit of thoracic extension versus your resting posture. And if we can work on that extension and add some shoulder strengthening and things like that, you're going to be a brand new person in no time flat.

Speaker 1:
[38:54] Oh, I love that approach. I'm going to start doing that posture trick with range of motion for my people. I mean, maybe that's why I'm going to try that on myself because, you know, I'm an arthroscopist, a sports surgeon. So my surgery has done me holding two devices, shoulders in this position, right? And so I've noticed decreased range of motion over the last 30 years. So I'm going to try that trick you just did. So listen, you wrote a book called Pain-Free Body, Simple Stretches and Exercises for Common Aches and Pains. Why don't you think people spend enough time on this, the stretching and exercising to prevent? And then what are a couple of the, if we could do two or three things every day, because everybody out there is like, oh my God, he's going to tell us to stretch for 50 minutes a day. How am I going to? What are the, what is the basics we have to do in your experience?

Speaker 2:
[39:48] Well, first of all, I think the reason people don't want to do it is because we as humans just, we love a quick fix. I think that's why medication has gotten so, maybe you can call it out of hand. I think that's why people love the idea of an injection because, oh, it's just a simple shot and all of a sudden my pain's gone and I don't have to do anything else. Like that's of course enticing. And I also think it can be intimidating to take onus over the fact that you kind of do have the power within you already to change the way that you're feeling. And I think that can feel like a lot of responsibility. And taking onus of that, I think, can be a little intimidating. So I think it's those two things, the quick fix and also just recognizing the responsibility that make it tough. And then in terms of things that you can do on a daily basis, first of all, everybody should be exercising, period. It doesn't have to be anything fancy. I too come from a powerlifting background. So like those powerlifting principles and strength and resistance strengthening are kind of where I stand. But if you are a Pilates person, I think Pilates is great. If you're a yoga person, I think yoga is great. If you're doing something that doesn't involve any resistance training at all, you should probably find a way to do some level of resistance training at least once a week. But if you're doing other things, you've got to remember that your body weight is resistance as well. And so there are a lot of other things you can do, which is by manipulating your body weight. So exercising all the time is important. But outside of that, the daily things, I think it's just important to recognize where you spend most of your day. So you mentioned that you do a lot of surgeries where you're rounded and you're forward. So you should probably be doing something every day that kind of reverses that trend. My girlfriend is a dentist. I go over that with her all the time. So for her, it's a lot of getting the head back, it's a lot of opening up the shoulders, and it's a lot of just getting back into that even lower back extension. Those are her daily movements. If you're a corporate worker and you spend all day sitting at a computer, they're probably not too dissimilar where you spend most of your day with the forward head, the rounded shoulders, the rounded back and sitting. So your two to three things probably involve standing, pulling the shoulders back, getting the neck back, and just general moving because you spent most of your day sedentary. And so I think you just kind of got to be honest with yourself on what you're doing for most of the day and pick two or three things that are the opposite of that. And chances are you'll feel a lot better for it.

Speaker 1:
[42:02] Yeah, agreed. I even went so far as to go to Home Depot and buy myself a piece of PVC pipe that I put here just to get my shoulders really back and help with that motion that you just described. So I have one more question and then some myth-busting I want you to do before we sign off. And I want to know in your experience if there's ever a time when it's too late. Like you haven't gotten the message at 30, you haven't gotten it at 40, you find yourself at 65. I got a lot of emails about this. Actually, it's usually at 70. They're like, oh my God, I'm just hearing this. Is it too late for me? What is your thoughts on that?

Speaker 2:
[42:45] There is no such thing as it being too late, but it's always better to start as early as possible. It's important to recognize that if you are starting late, that the difficulty level will be increased. Because you don't have that same base of having worked out a little earlier, you haven't built those movement patterns, you haven't built up that muscle tissue, it will be harder and it will be slower, and it will require more consistency, but you can still always do it. There's no such thing as it being too late.

Speaker 1:
[43:13] That's right. I agree with that. It will take longer, but your body will respond. Your body is meant for response. Okay. So let's do some expert PT myth busting, or I don't know how you're going to answer these things, so we'll see.

Speaker 2:
[43:30] Well, I don't either. Let's see how this goes.

Speaker 1:
[43:33] Is foam rolling legitimate or overrated?

Speaker 2:
[43:38] Foam rolling is legitimate if you feel better afterwards. There are a lot of people that try foam rolling and say, I just don't feel a difference. I say, well, then you probably shouldn't be foam rolling. But I have some people that foam roll and they say, oh, it's the only thing that gets my hip to loosen up. Well, then there's probably something to that. And so I think a lot of it is placebo, and placebo is a wildly important and valuable thing, and powerful thing. And so I think it's legitimate if you feel like it works. That's my answer.

Speaker 1:
[44:05] Stretching before lifting? Yes, no.

Speaker 2:
[44:09] You can stretch before lifting or exercise as long as you do a dynamic warm-up.

Speaker 1:
[44:12] Yes, that's right. Dynamically stretching, right?

Speaker 2:
[44:15] Right. So there are a lot of people that really love that static stretching, and I think that's great. Do the static stretching, especially if it makes you feel better. But before you do something like a heavier lift or a besor, before you do something explosive, you need to be doing that dynamic warm-up first so that you can get out of that static kind of relaxed positioning before doing it.

Speaker 1:
[44:38] But the static lifting can be done after your heavy activity. You can dynamically warm up, do your activity, and then spend the time that you need just on muscle group stretching, right? You can do it that way.

Speaker 2:
[44:51] Correct. Yeah. In a perfect world, it's dynamic workout static. But for the people that really want to do static first, you can just follow it with a dynamic warm-up.

Speaker 1:
[45:00] Got it. I understand what you're saying. All right. What is the one body part most women neglect in their training?

Speaker 2:
[45:08] Glutes.

Speaker 1:
[45:08] That's right.

Speaker 2:
[45:11] They think they're working their glutes and they want to work their glutes, but a lot of them haven't quite figured out how to do it.

Speaker 1:
[45:17] Heat or ice for acute injury?

Speaker 2:
[45:22] Neither. What?

Speaker 1:
[45:26] Talk to me about that.

Speaker 2:
[45:28] I am of the school of thought that especially in that first 24 to 48 hours, you probably don't want to really limit your body's ability to get whatever healing markers to the injury as possible. I know that the research isn't super strong, but I do think that if you can stay away from ice unless you're starting to blow up like a balloon. Yeah, for smaller. Right. And let the body kind of like do its thing, then I think that's ideal. And then I also don't like putting heat over an acute injury unless... I mean, yeah, there's really no good reason for it. So for the most part, I am neither. I am team compression. I am team elevation. I am team monitor. I am team do whatever you can that does not increase symptoms. But oftentimes, I tell people, especially in the early stages of an acute injury, no heat or ice.

Speaker 1:
[46:26] Are you a... even if you have to not weight bear, are you an early non-weight-bearing motion person?

Speaker 2:
[46:35] I am team early motion. Early motion with no increase in symptoms. You should be constantly moving as much as possible in a way that does not irritate symptoms.

Speaker 1:
[46:43] Okay, final question. Women are out there doing their best. They're training hard. They're sore as heck. Two days later, I just did a heavy deadlift and I'm going to be really sore today. It was two days ago. What is your go-to recovery tool when we're working out really hard?

Speaker 2:
[47:04] The go-to recovery tool, especially two days after a heavy deadlift, is some sort of either steady state cardio paired with some flexibility work. But it's the time that when you're really sore, that you just want to encourage as much blood flow as possible, and you want to make sure that you're moving in a way that encourages that flexibility to return. Because I've seen a lot of people, the weekend warriors especially, they'll do the heavy deadlift and the heavy squat all on a Saturday, and then they're so tight until Wednesday, Thursday that they have not moved basically at all. Then they basically only have Friday and Saturday to get back to doing that again. But when I meet them for the first time, they can barely move because they never take the time to reintroduce that blood flow and reintroduce that mobility. So I think steady state cardio and some sort of flexibility work in the time when you're the most sore is the best kind of recovery process.

Speaker 1:
[48:04] Perfect. That'll be my plan today, my steady state cardio and a full flexibility. So Dan, thank you so much for spending the time. I know that the people listening are going to get so many answers because the majority of the questions I get are the, I hear you, but how do I recover? So this is going to be so valuable. Thank you for spending time with us today.

Speaker 2:
[48:29] Yeah. Thanks so much for having me. This is a great conversation.

Speaker 1:
[48:31] Wonderful. Thanks.