The thing that I would offer you, Jake, is that normal breathing should just be basic, quiet, nasal breathing under most circumstances. I don't try to make people breathe any particular way other than during some form of rehabilitative situation, homework or training-based type breathing, where we're working on sequence and strategy and such. Breathing behaviors are learned behaviors. And so what we want to do is we have to do enough work to make the changes that are desired, but to become obsessive about trying to be breathing in a very specific way all the time is much like trying to capture whatever good posture may be because it's ill-defined. What we're actually trying to do is restore the adaptability. So I should be able to breathe in many different ways under many different circumstances. And in most cases, people are arrested in one direction or the other. So if we look at the representations of the two archetypes in the axial skeleton, so if I'm biased towards an exhalation strategy with a compensatory inhalation, or I'm biased towards an inhalation strategy with a compensatory exhalation, I'm just biased at one end of this breathing spectrum. If I can capture the opposing strategy, then I typically have everything that falls in between. And so that's ultimately the goal. And so we need to do enough work on a regular basis where we restore that capability of the full excursion of breathing. Beyond that, maybe an occasional reinforcement periodically, especially if you're one of those people that has to assume a static position all day. So if I'm a desk worker or if I had to stand in a certain position, then my movement is limited throughout the day. Or if I've superimposed compensatory strategies on there from a performance standpoint, and I'm trying to maintain some element of health, then maybe I need to reinforce it periodically. But in general, Jake, what you want to do is you want to do enough work that you get the outcome that you desire. And so again, we're in the gray with this answer. It's not an absolute thing, but typically, when you're at rest, it's just normal quiet nasal breathing. You should be able to access that without the compensatory strategies. If you have to, then that might be an answer as to why maybe you're having a performance related issue or dealing with some sort of movement limitation.

But in general, Jake, what you want to do is you want to do enough work that you get the outcome that you desire. And so again, we're in the gray with this answer. It's not an absolute thing, but typically, when you're at rest, it's just normal quiet nasal breathing. You should be able to access that without the compensatory strategies. If you have to, then that might be an answer as to why maybe you're having a performance related issue or dealing with some sort of movement limitation. So hopefully that answers that question for you, Jake.

I think in general, Jason, your, like I said, your final statement is correct. What we need to do is we need to look at this from the perspective of, hey, we can call a diagnosis anything that you want. We can say that there's pain in this area and never knowing why it would be painful per se. Maybe there's a structural issue that we can sort of narrow things down to where we have some sort of finding on a, on a radiograph or MRI or something like that, that leads us in a direction and maybe we can blame some things on that. But in general, if we don't have any structural abnormalities and people do have pain, we'll just never know why they have pain in the first place. So then the goal is to restore this full movement capability. So can I orient the pelvis? Can I restore the relative motion to the pelvis, which is this full excursion of breathing? And so then I get normal eccentric orientation and concentric orientation of the surrounding musculature in the hip and the groin area. So again, I think that your model might be just a little oversimplified but you've got the right concept in mind. And so again, it's just a matter of restoring this full excursion of breathing restoring the relative motion between the body segments, and that ultimately is the best shot you have at restoring health, comfort, and normal movement capabilities. So Jason, like I said, I think you're on it.

Okay John, so you've got an orientation problem here that you might not be able to identify or there's a little confounding factor in there that might make this a little bit confusing. So let's go through what the possibilities are and maybe some of this stuff will jive with you and you'll get your aha moment and then we'll have a solution for you, okay? Since I don't have all the chess board, I don't have all the information, I gotta make a couple educated guesses here. Let's just talk about dead guy anatomy for a second. Intensive fascialitis is kind of here-ish. It's on the front side. It's anterior to the trochanter. Again, in dead guy anatomy, they say it's a flexor abductor internal rotator. Right away we have a little bit of confusion because you have two opposing activities here that the muscle is going to produce. So if it's an internal rotator and an abductor, that means it internally rotates and it externally rotates, which means that the orientation of the pelvis is going to come into play here in probably a pretty major way. So think about an inhaled position of the pelvis right off the bat. So if I ER that ilium, I immediately pick up some concentric orientation. I'm bringing the two ends of the muscle close together so it can concentrically orient. But now I got to start playing with other angles. And I've got to start looking at where this pelvis is positioned in space. So if I'm more forward, if I'm more anteriorly oriented, that tensor fascia lab, because it does have concentric orientation, is going to pick up that IR position, so I'm going to lose extra rotation. So right away, if my ER measures are reduced, then I know I've got more anterior orientation to play with, and then that's going to influence my decision making as far as my intervention is concerned. If I'm just tilted more what you would consider laterally or abducted as that relative position, I get a tremendous amount of concentric orientation, again, of tensor fascia lata, but this time I pick up ER, lose IR. Under those circumstances, I have to look at the position of my initial tuberosity here because as it approximates to the femur, I'm already in what you would consider a hip-extended position. And then I'm going to pick up more concentric orientation posteriorly. So not only do I have TensorFlow Latin in a concentric orientation, but I can pick up concentric orientation posteriorly here. And that shoves me forward. anterior on the left. So what happens is I get a sacrum that is now right facing. So if you're trying to extend the hip, as you said, then I'm already in a relatively hip extended position. So that can't be the solution. But what I do have on the other side, because I've got the sacrum oriented to the right, I have an expansive strategy on the right side. So what I would be doing is I would be probably trying to drive a concentric orientation here on this side to get that sacrum to reorient and then I can actually recapture the exhaled position of this ilium and chances are your problem is solved. So again, you get to play with the orientation of the pelvis when you're dealing with a lot of this concentric orientation, especially of some muscles that, again, behave differently based on the orientation of the ilium and based on the orientation of the hip. So, John, I hope that helps you a little bit as far as coming up with a strategy.

Marcos had a question about one of the videos that I posted on Instagram which was an armbar video to restore hip external rotation. I think I made reference to the left hip under these circumstances and it is somewhat similar in regards to what we just talked about with some of the orientation issues. And so, Marcos says in the kettlebell arm bar video, you advised actually rotating the shoulder in the inhale, internally rotating the shoulder in the exhale. This makes sense because those shoulder positions align with the breathing cycle. Could you discuss why we want to sequence the breathing pattern this way instead of staying at an N-range shoulder, internal, external rotation and breathing while on a static hold? Well, first and foremost, Marko, great question. And you are correct that you actually could use a static hold under those circumstances, especially for people that have difficulty capturing a position in the first place, I'll use static activities all the time. Although I wanna try to get to the dynamics as quickly as possible because when we can reestablish the fluid flows, so the gradients of high pressure to low pressure, high volume to low volume, that's actually what restores range of motion much more effectively. But we're also playing with some iteration in that exercise. So we were dealing with a loss of hip ER. And so just like we were talking about John's question, I had an anterior orientation and I had most likely a compressor strategy on the left posterior side, which is going to turn the sacrum. So that means I got a spine that's actually facing the right. And so when we're in the supine arm bar position like we were in the video, you'll remember the cues of staying left side heavy throughout. And so what we're actually doing is we're using an iteration that's within the axial skeleton. So I'm using the shoulder girdle as an iteration of the pelvis to start to turn the spine from its right orientation to its left orientation. And so with every breathing cycle, what we're doing is we're slowly turning the spine from its right orientation to the left. So as I externally rotate and I breathe in, I turn the spine as I internally rotate and breathe out, I hold that position and create a yielding strategy on the left side because I'm staying left side heavy throughout that exercise. So basically we get this inching around to the left orientation of the spine. We recapture that and then that allows us to recapture the hip position that's going to help restore that external rotation. So we actually bring the pelvis back and then turn it back to the left, which gives us back our external rotation. So hopefully that Also answers your question, Marcos. I appreciate you guys so much for keeping the questions coming and have a happy Tuesday. I'm gonna finish my coffee, grab a quick workout and then it's off to the clinic. I'll see you guys later.

As I externally rotate and I breathe in, I turn the spine. As I internally rotate and breathe out, I hold that position and create a yielding strategy on the left side because I'm staying left side heavy throughout that exercise. So basically we get this inching around to the left orientation of the spine. We recapture that and then that allows us to recapture the hip position that's going to help restore that external rotation. So we actually bring the pelvis back and then turn it back to the left, which gives us back our external rotation. So hopefully that also answers your question, Marcos.

And so if I use dead guy anatomy, and I say that I'm doing cadaver dissection, I say these muscles are extra rotators, because when I pull on them, the hip does this. And so Rachel, in your model, you are absolutely correct. That's what would happen. But I don't think that's as close to reality as we can get. So I think we can have a little bit more of a refined model. So if we think about a posterior compression, so a posterior compression would be activity of the muscles that go across this upper portion of the posterior aspect of the pelvis that push forward. And what that actually does is it changes the direction of the acetabulum. So the socket actually changes its direction. And so if I change the direction, so if I compress here and I change the direction of the acetabulum, what happens is I pick up internal rotation and I lose external rotation. So that's what we're talking about when we're talking about these compressive strategies. So every compressive strategy either re-orient or change the shape or has some other influence that produces an outcome. And the more understanding we have in respect of how this thing actually can move, so we have to refine our model. We can't use the dead guy anatomy as our representation, like most books try to do. And then they try to resolve these things. And now we have this massively confusing model with multiple rules and no foundational principles. If we take the same concept up into the thorax, where I have the traditionally upward rotation of the scapula, that is a posterior compressive strategy in the thorax that reorients the glenoid and it produces an internal rotation element. So through that middle range of overhead reach, that's why that would become an internally rotated position that we would use as we talk about moving through inhalation to exhalation to inhalation. Again, we're talking about that posterior element. So I appreciate this question so much because I know there's a massive amount of confusion as to why these things exist. What it comes down to is evolving your model, adding detail, layers of detail. It doesn't matter where you start. You're not right and you're not wrong. All models have limitations, and that's the one thing that we need to understand. It's just how much detail can we superimpose onto what we already know? So Rachel, take what you're already thinking because you're not wrong under certain circumstances. But now you need to add to this model and say, OK, if I compress this now, what happens with an understanding a little bit more about what the options actually are within a little bit more of a realistic model? We're never going to see reality. We always have to use a model because this is a really, really complex concept. And when we talk about movement,

And so hopefully that answers a little bit of your question. I apologize I had to rush today, but I got a lot of stuff going on this morning. You guys have a great Wednesday. It is the gorgeous one's birthday today and one of the best things ever. She forgot it was her birthday today. So I love that. And that's one of the reasons why I married her. So you guys have a great Wednesday and I'll see you. Oh, coaches and coffee tomorrow morning, 6 a.m. I'll see you guys then. It is Thursday. I have neuro coffee in hand and Dr. Mike, it is perfect as usual. 57, 57 grams per pot makes perfect coffee every time.

I got my own hair. I cut my own hair. Oh yeah. Oh yeah. The problem was all right, but the backside was pretty ugly. It was pretty rough. It was a mess. What is your form, my friend? Oh, yeah. A little bit of innovation, a little bit of creativity goes a long way.

You cut your own hair.

Oh yeah. The problem was all right, but the backside was pretty ugly. It was pretty rough. It was a mess.

What is your form, my friend? A little bit of innovation and creativity goes a long way.

Bill, how are you doing physical therapy? Well, if you're in your office, so you can do it, you're not doing it virtually.

Well, I'm doing both. How do you do it without touching people? So I don't get people all that much anyway. So when we look at a hierarchy of treatment, like hands-on stuff is rarely the first intervention. I won't say it never happens, but it's rarely. My goal is to have everything that I perceive as the effect be a learning-based effect. Anything that the patient can produce themselves is ideal because then they are learning. They are promoting their own sensory input, they process it, and then they spit out the output. And that's what I measure. Did we get the effect and change that we intended based on that intervention? So most of what I do is I coach. If somebody would need another sensory input, position can do it. So a lot of times it's just a little bit of creativity with the position. But again, that just goes right back to where we started, which is just coaching people into positions. I coach people on an activity just like anything else. So I don't say that probably I do some manual stuff every day, but certainly not every patient.

My father's a tailor. So this isn't super random. We've been making masks for people. One of the things we use for filtration are certain vacuum bags. So there's a company called Festool that makes super fancy sanders where you can sand and there's no dust. The vacuum sucks up the dust. They have a really nice bag. And so we use those bags as liners for the masks because it filters out 93% of particles.

Has anyone had anybody get injuries over these seven weeks? I haven't had a thing, not a tweak, not a single report from anybody.

Yeah.

You think it has to do with the amount of stress? Because I know a lot of my people are not working. And they have actually lost weight and, you know, enjoying life a little bit and able to sleep.

That's a really good question. So there are certain stressors that are associated with this whole thing, right? We all get stretched in one way or another, but you've got a great point. It's like people are probably sleeping a lot more than they did before, either intentionally or unintentionally, because they have the capacity to now. I mean, think about that as an impact. That's brilliant to bring that up.

I have thought about that too. I have a client who travels all the time, usually internationally, and has not been doing any travel as a result lately.

Is it the person that I would know?

Yeah. OK. And so he generally has had some problems. We've run into some resistance getting results in certain areas.

Right.

And I've always said that the disruption of the circadian rhythms and the stress from travel is such a big issue. We can't.

Yeah. And so, so we haven't been doing any travel, but there's actually been some other really stressful things happening in his life currently, but the weight is like gone. And it was so interesting to see how there could be an intense life stressor, but not this physical travel stressor where there's like extreme time zone change on a consistent basis. Like how the body is responding to different kinds of stress. And, um, and it's been really interesting. So yeah, Nick, I think you're right. Like, people are experiencing, not that, you know, everybody's living a stress free life, but they're experiencing different kinds of stress, maybe. And, um, and it's interesting for me to see the kinds of stresses that are permissive for weight loss and not permissive for weight loss.

And so, we haven't been doing any travel, but there's actually been some other really stressful things happening in his life currently, but the weight is gone. It was interesting to see how there could be an intense life stressor, but not this physical travel stressor where there's extreme time zone change on a consistent basis—how the body is responding to different kinds of stress. It's been really interesting. So yeah, Nick, I think you're right. Like, people are experiencing, not that everybody's living a stress-free life, but they're experiencing different kinds of stress, maybe. And it's interesting for me to see the kinds of stresses that are permissive for weight loss and not permissive for weight loss.

I'll be interested to see kind of how this whole learning thing goes for the kids as far as. Steve, do you have any input on that? Because I would be curious to see if the kids are actually adapting to this style of education and then maybe flourishing a little bit because of it.

I think it's a mix. I think it has to go a lot with socioeconomic a little bit. We're seeing that within our school district where I think you have a group of kids that are starting to get outside. And I think, like you guys were all saying, there's a huge health benefit, I think, that's coming out of this. But I also think it's also very socioeconomic, where I think on the lower side of things, kids are really having issues adopting because they're taking care of siblings. There's a lot of other environmental factors that are coming into this. So I think we're seeing the good. But then I also think we're seeing some of the rough stuff as well in our school district. So I don't know. I think a lot of kids are thriving. It's kind of interesting. It's kind of like this almost 80, 20 split we've got going, but it's like 25, 30% are fully participating. And then it's like, we're trying to get this other 70, 75% to kind of buy in and get themselves into a routine.

Dr. Mike. How real is this carnivore diet? It's now trending. I'm seeing people post about it. Like how real is it? Like are people actually doing it and what are the macros to make you a carnivore?

I kind of did a full academic assessment because it's kind of lacking in the academic kind of things. You know, I just, I think in general it, I find it silly to exclude food groups for no reason. Right. Right. And so, you know, like when people say like, Oh, I like, I don't eat this. And you're like, Oh, why? And they're like, Oh, it's not good for you. And it's like, you know, but like for no given reason, they're just decided it was magically not good for them. So with the carnivore diet to say like, you just eat meat. And, you know, so what's the difference between a carnivore diet and a ketogenic diet. So if we added seven spears of asparagus each day, right, and three mushrooms, like all of a sudden you lose all these magical effects of said carnivore diet. So those kind of huge like chasms of logic when those are missing, I find it really difficult to have conversations about should or shouldn't you do that. There's no good There's no good biological mechanism really behind it. You know, I think really if we look at time, the closest thing you'd liken to would be a ketogenic diet. And if you look at the data behind ketogenic diet, which from a sports performance perspective is really lacking. I actually did a webinar yesterday on it. And I did a review last fall on it as well, like an academic review. And it just, there is a lot of good data on sports performance and ketogenic diet. And so at best, it's just as good as a regular dietary approach. potentially better at endurance, but likely insufficient at high intensities, right, even after keto adaptation. So if you kind of apply all those same things to the carnivore diet, I mean, you know, that's kind of what you're left with. I think there are a lot easier dietary patterns for people to follow. I mean, I love your advice. So it's like, I think that, you know, but I also think that when you start excluding whole food groups, you know, your personal biology and physiology doesn't change because you've decided to eat or not to eat certain things. So this is a conversation I always have with people if they follow a vegetarian diet, like that's fine. But like the biology of your protein metabolism is still the thing. Like your body still needs two to three grams of leucine at every eating occasion to maximize muscle protein synthesis. Just because you're choosing not to eat, foods that are high in these essential amino acids doesn't change your body's need for it. And so when you look at these other extreme dietary approaches, you're like, okay, that's fine, but what are we doing to account for now all the things that we're not getting that we generally would have otherwise that your body needs?