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The Bill Hartman Podcast for The 16% Season 3 Number 6 Podcast
Bill:
Bill Hartman 0:00–2:59
Good morning. Happy Monday. I have neuro coffee in hand and it is perfect. The sun is up. It is a beautiful day. It is Monday. I'm talking with Eric Cressey tonight. This is exciting. I haven't talked to Eric in a long time, at least not directly. We've emailed and such. So I'm looking forward to that. I got a pretty good question that came through askbillhartman@gmail.com and then I had literally the exact same question come through on Instagram over the weekend so I thought I got to answer this one because obviously people have a curiosity. And it's also one of my favorite topics to talk about because it makes people really uncomfortable because it kind of bucks the status quo a little bit. But I think that once I get through with the explanation, you'll understand why I have an opinion of such and then hopefully it will be useful for you as far as your thought process and make your life just a little bit simpler. So the question that came through asked Bill Hartman at Gmail is from Alex and Alex says I watched your upload of the 6 a.m. Coach's conference call from this morning It was the first time I personally heard you discuss in depth the concept of there's no such thing as sagittal plane. Playing with regards to the example we were talking about calcaneus and talus and tibial relationships and how they cancel out rotations to produce this forward apparently imaginary sagittal motion. I'm unsure as to whether you went into more depth with the call itself, but I'd be incredibly interested in whether you could address this fully in a Q&A, aha, today, and how it applies to perceived motion in both the sagittal and the frontal planes. Alex, thank you for the question. Thank you for this opportunity to explain this. Typically, the way I would do this would be to whiteboard it. So I don't have the whiteboard in the home office as I do today. So I'm going to use a visual aid. I made this just for you. Not very skilled in that manner, but it'll work. I also brought in a skeleton to give you a nice visual representation. First thing I want to talk about is a little bit of geometry. So the Cartesian plane concept of the X, Y, and Z axis still applies. We visually, we perceive this three-dimensional, actually four-dimensional. I like that there's space time in there. but this three-dimensional world of the x, y, and z axes. And so that's what we see. And so when we started talking about anatomy, they decided that, okay, we move in three planes, therefore there must be three planes. And I would offer that visually, we see the representation in space of this three planes, but we don't actually produce movement in three planes. What we do is we cancel out rotations to create direction. And so let's talk about that.
anatomical planesbiomechanicsmovement mechanics
Bill Hartman 2:59–5:54
So if we look at things from a geometric standpoint, we have this point in space. And if I put enough points together, I can make a line. And if I have enough lines together, I can make a plane. And if I put enough planes together, I can make a shape. And so the shape that we're going to worry about is this cylinder. So this is a stack of transverse planes, if you will. And so if I put this over the skeleton, this is what our representation looks like. And so I have a three-dimensional representation now of the transverse plane. And what you'll notice is that if I draw a line across any two points in this cylinder that crosses through the midline of the cylinder, I can make a plane in any direction. And so what I want you to recognize is that if I'm looking down this cylinder, the sagittal plane and the frontal planes actually fall within this transverse plane. And so there's nothing unique or special about the sagittal planes. They're just part of this three-dimensional transverse plane representation. And so if I go three degrees off the sagittal plane, what do we call that plane? It doesn't get a special name because it shouldn't be special. Neither should sagittal nor frontal. It's just a three-dimensional representation to help us have a conversation and nothing more. But it's not how we produce movement. We produce movement in rotations. So let me give you a, for instance, so when you were developing in your mother's belly and you were a flat plate of the embryo, and this embryo folds itself over like a burrito—thinking about Thursday chips and salsa already. So your burrito is actually a tube just like my cylinder, which means that you are all transverse plane. Every joint in your body moves on a helically oriented direction. So they move in helical movements, which are rotational movements. All the relative motions that we talk about between body segments are rotations that cancel each other out to produce motion in any direction, not just straight ahead, not just sideways. So again, we can eliminate those as being special planes. There's nothing special about them. Every movement is a cancellation of rotations. Your infraternal angle is representative of the helical angles of your axial skeleton. Therefore, it tells us what you're good at. How great are you going to be at rotation is going to be determined by your infraternal angle. When we talk about high force production like bench presses and squats and deadlifts and especially with these tremendous weights, what you have are human beings that are incredibly capable of canceling out rotations and directing it in one direction, which allows them to lift these gigantic heavy weights. So if we want to talk about sagittal and frontal planes, I'm okay with that. I really am. When we talk about directions and points in space and things, but when we talk about how we produce movement, we only do things in rotations, and if we can start to see that, our problem solving becomes spectacularly easy relative to trying to think in all of these multiple directions that just create confusion. Again, I encourage you to think this through a little bit. I know it's confusing because I just took away two things that have been ingrained in your brain as far as how we do move. There's nothing special about those planes. They don't really exist. They are a resultant of the cancellation of rotation.
sagittal planefrontal planetransverse planehelical movementinfraternal angle
Bill Hartman 5:54–8:46
When we talk about directions and points in space and things, but when we talk about how we produce movement, we only do things in rotations. If we can start to see that, our problem solving becomes spectacularly easy relative to trying to think in all of these multiple directions that just create confusion. Again, I encourage you to think this through a little bit. I know it's confusing because I just took away two things that have been ingrained in your brain as far as how we do move. There's nothing special about those planes; they don't really exist. They are a resultant of the cancellation of rotation. So again, hopefully this is helpful. Alex, if you have any further clarification questions on this one, please ask away at billharmonthegmail.com. If you're angry with me, please send your hate mail directly to me. You can DM me on Instagram or throw this up and be angry on YouTube if you like. I'm totally cool with that because I know it's uncomfortable to think this way. But if we're going to solve problems and if we're going to get better, we've got to start looking at things differently. So think differently. Have a great Monday. I hope you all have a fabulous week to get it rolling. I'll see you tomorrow.
movement planesrotational mechanicsbiomechanicssagittal planefrontal plane
Bill Hartman 8:46–11:39
I talk about experience a lot because I think it's very valuable, but we always have to understand that it's not just one individual's experience that we can utilize to determine whether something is useful or effective because of the way that the outliers impact things. So if I have an extreme capability that I'm able to demonstrate because of my physical structure or some genetic capability, it's fascinating to look at. It's interesting. It actually may be useful in guiding us in a direction, but because it is based on the individual himself and their unique capabilities, we cannot use that as a standard of anything. Like I said, it might provide us with some information that might be useful at some point in time, but we can't rely on it as an absolute. Everything that we talk about from a health perspective, so we're talking about like healthy knees, healthy ankles, etc., this is all multifactorial. There are so many potential influences. And a lot of times these things are presented as this is the one thing that you need, and it is rarely one thing, because we have this massive interaction. I'm always talking about like even during treatment. I really don't know why people get better, but what I am capable of doing is narrowing probabilities to determine what might be the best intervention under these circumstances for this individual in this context. So we have to narrow these things down in that way. But again, we can't say that, oh, it's this one thing that's going to make this massive amount of difference. It is possible that it is. It's just really, really rare. So again, this is one of those filters that we have to run things through. When you're looking at some of these extremes, so I actually looked some of this stuff up and I actually looked at it so I would be able to speak minimally intelligently about this. If you look at the way some of these people are accessing these end ranges of motion, this is about as idiosyncratic as it gets. So I was looking at one gentleman who has this extreme amount of knee flexion. He has a very, very deep squat, but the way that he accesses his deep squat under most circumstances would be considered a compensatory strategy. But if you look at the way that he does it, he also has two things that are very unique to him. So he has an anteverted hip and he has a twist in his femur. And this is actually one of the ways that he is actually capable of accessing these extreme ranges of motion. So if you are one of those people that actually have these same capabilities, you might be able to do what he does and you might actually find it beneficial under some circumstance. But for the people that don't have these little idiosyncratic elements in their anatomy, they will merely be frustrated in their inability to actually access these movements or positions. So again, we have to consider how this works. It's always going to be an n equals one scenario. That's why we work off of principles and we apply these principles to the individual and we work through progression to determine what would be best for this person in these circumstances. So again, we can't apply one person's capabilities broad stroke. So what you actually need to find out through experimentation, very careful experimentation, always safe to fail experiments under the guidance of someone with a broad scope of knowledge, understanding and experience would be the best way to do it. You have to find out what is normal for you and what is best for you under the circumstances within a specific context. So Rachel, I hope that answers your question in regards to that. Now, when we look at the extreme end ranges that these people are demonstrating, it would be rare that we ever be exposed to these ranges of motion except under these exercise circumstances. So when we talk about the extreme ankle range of motion, you're actually beyond what would be typical end range propulsive strategies. So some people may find that useful. Some people may not. Again, their ability to access these extreme ankle ranges of motion. If you look at some populations that were squatting as part of their culture, they actually have changes in the ankle bones themselves. So the end of the tibia has an extra facet on it that makes it easier to deep squat at an extreme angle of dorsiflexion. The talus is also shaped differently, which allows some of these extremes. But again, we're not really accessing these during normal activities, during normal performance. So again, the question that becomes, is this beneficial on any level at all? So always a question mark. But the thing that you want to do with these types of things, especially when we look at the extremes is we want to try to filter this information as much as possible through as many lenses as we can to determine what can we take away from this that may apply to a much broader audience or a broader population.
extreme range of motioncompensatory strategiesindividual variabilitypropulsive strategiesmultifactorial influences
Bill Hartman 11:40–14:47
But for the people that don't have these little idiosyncratic elements in their anatomy, they will merely be frustrated in their inability to actually access these movements or positions. So again, we have to consider how this works. It's always going to be an N equals one scenario. That's why we work off of principles and we apply these principles to the individual and we work through progression to determine what would be best for this person in these circumstances. So again, we can't apply one person's capabilities broad stroke. So what you actually need to find out through experimentation, very careful experimentation, always safe to fail experiments under the guidance of someone with a broad scope of knowledge, understanding and experience would be the best way to do it. You have to find out what is normal for you and what is best for you under the circumstances within a specific context.
individual variationmovement experimentationanatomical idiosyncrasiesN equals one scenarioprinciples-based application
Bill Hartman 14:48–17:27
So I do recommend that. Mike Robertson is on today for IFASTU for the Q&A call there. So if you're a member of IFASTU, be ready for that. That should be really fun and interesting as well. Okay. And I have a pretty cool question for today. A little off the beaten path, not really going to be like one of those typical, oh, do this and then this kind of a kind of a questions. So it's a little bit more of a reasoning type of question, but it's still very, very useful and very, very interesting. And this comes from Marcel. Marcel says, I've been implementing your model with some good success, but there seems to be a variation in how much of the changes we get to stick. Some clients, things change very, very nicely and stay that way. And others seem like an ongoing battle to maintain good movement variability. Can you talk about what factors influence things not sticking? and how are we going about working out what the client needs if it is hard to maintain changes? Well, Marcel, welcome to my world, okay? So this is not weird, it's not unusual. There are always people that change very readily and you may never see them again after that first visit because they do so well and then there's the people that are much more challenging. And that's just the broad scope variation of how humans have so many potential influences. So let's look at this from a broad perspective for a second. So there are always things that we can know and there's things that we don't know. When we talk about things being multifactorial, we don't even know how many things potentially influence, but let's look at the human as a broad system that's made up of subsystems and let's say that you have 12 subsystems in your body and one of those lacks sufficient adaptability and then promotes a deficit in movement which can ultimately result in pain and they come to see guys like you and me and let's say that we do an intervention and that intervention addresses that subsystem that is the limiting factor and then they have a great outcome and everything goes really really well they learn how to maintain their adaptability and they feel great. But now let's say that there's multiple subsystems that could be involved. So let's say that we've got two or three out of these 12. And let's say that our intervention covers eight of those. But unfortunately, the two or three that are low in adaptability are not affected at all. Now we don't make the change. And so those are the things that we have to understand is that this is why we never really know why people get better or why they don't get better. Because there's so many potential influences. And so what we're trying to do is we're trying to influence as many of those subsystems as possible with treatment and training to produce the desired outcome. So there's always that factor in play. The adaptations that we often utilize on the rehab end of things, before we get to sort of like the fitness and the conditioning and reconditioning elements, they tend to be learning based adaptations. So some people learn faster than others. Some people have more perceptual capabilities. Some people have a broader experience to draw on. So they do adapt faster. Some people are better trained. So again, we have these genetic influences. We have these cognitive influences. We have psychological influences that all determine what type of progress we're going to make with people. And so again, we have to take all of those things into consideration when it comes to things like training, personal behaviors, habits, et cetera. So now we have potential interference problems. So if I am training to produce high force, high strength, hypertrophy, et cetera, and I have these really strong concentric orientation, elements that influence the way that I move or can't move. Then we have actually an interference with training. So sometimes you got to take certain things away from people for a while so they can become more adaptable. Some people have unknown stressors or they don't perceive them as stress. So maybe this is a job, maybe it's a lack of sleep, maybe it's a relationship. All of those things can potentially influence our outcomes because it does influence the system at some level. And then that produces what you and I would measure on the table. So thankfully, we've got a really good proxy measure for the fact that there is some sort of influence that is affecting our patient or our client. We also have to consider structural adaptations and sensory adaptations that become influential. So if I have somebody that has a true structural change, many times we can overcome those. If they're small, and they don't influence our ability to shift volumes and pressures. But if we have something like, say, a shoulder labrum or a hip labrum injury that's extensive enough, we no longer have that intact mechanism of a synovial joint. And then we got to send it back to the doc and say, look, well, we gave this a shot. It didn't go well. Here's what I think. And then we get help from that perspective as well. When we talk about the sensory influences, all of your sensory systems have adaptability built into them. And so if I have a lens in an eye that can't change shape enough, then I have potential visual problems. If I have perceptual problems that are associated with vision, that needs to be addressed as well. So now we look to our behavioral optometrist for some help there. If we have a sensory issue in our mouths or a physical deficit, so we have people with a really small narrow palate, a narrow airway, all of those things influence our ability to breathe and move and be comfortable. And again, managing the way that we perceive that from a stress-related standpoint, all become these influences. So there's a lot of stuff here that we have to take into consideration. It makes it very, very difficult. Because again, a lot of these things are just unknowns, and we're doing this by processes of elimination. It's like, okay, so it appears this, it appears this, it appears this, and we start to take things away, or we say, look, at some point in time, we have to recognize that it is not within our scope to help this person. We may be able to identify that there is a problem, but it is beyond our scope, and so then we need to refer them to someone else that may be able to help. That might be their primary care physician, to become the case manager to start to manage this thing, or if we can identify a specific deficit because of our training, then we can refer them to the appropriate professionals. So there's a lot of things that are potential influences. The first goal I would say is to try to eliminate any interferences that are obvious. Again, this could be a training related thing or just a personal behavior thing that we think is an influence that we can usually manage those rather readily. But there's always going to be those unknowns. So that's what makes this a little more difficult than we would like. Sometimes it'd be great if everybody came in and made those changes on the first day. But sometimes it is a struggle. There are many influences, my friend. Hang in there. Hopefully this was helpful just to stimulate some thought process for you. Have a great Wednesday. Chips and salsa tomorrow. Coffee and Coaches call in the morning at 6 a.m. and I will see you guys later. It is Thursday. Coffee and Coaches Conference call. I have neuro coffee in hand and Dr. Mike, it is perfect. I am killing it on the neuro. I'm telling you, I believe it.
motor learningneuro-developmentalmovement variabilityadaptabilityrehabilitation principles
Bill Hartman 17:27–20:28
And so what we're trying to do is we're trying to influence as many of those subsystems as possible with treatment and training to produce the desired outcome. So there's always that factor in play. The adaptations that we often utilize on the rehab end of things, before we get to sort of like the fitness and the conditioning and reconditioning elements, tend to be learning based adaptations. So some people learn faster than others. Some people have more perceptual capabilities. Some people have a broader experience to draw on. So they do adapt faster. Some people are better trained. So again, we have these genetic influences. We have these cognitive influences. We have psychological influences that all determine what type of progress we're going to make with people. And so again, we have to take all of those things into consideration when it comes to things like training, personal behaviors, habits, et cetera. So now we have potential interference problems. So if I am training to produce high force, high strength, hypertrophy, et cetera, and I have these really strong concentric orientation elements that influence the way that I move or can't move, then we have actually an interference with training. So sometimes you got to take certain things away from people for a while so they can become more adaptable. Some people have unknown stressors or they don't perceive them as stress. So maybe this is a job, maybe it's a lack of sleep, maybe it's a relationship. All of those things can potentially influence our outcomes because it does influence the system at some level. And then that produces what you and I would measure on the table. So thankfully, we've got a really good proxy measure for the fact that there is some sort of influence that is affecting our patient or our client. We also have to consider structural adaptations and sensory adaptations that become influential. So if I have somebody that has a true structural change, many times we can overcome those. If they're small, and they don't influence our ability to shift volumes and pressures. But if we have something like, say, a shoulder labrum or a hip labrum injury that's extensive enough, we no longer have that intact mechanism of a snowy joint. And then we got to send it back to the doc and say, look, well, we gave this a shot. It didn't go well. Here's what I think. And then we get help from that perspective as well. When we talk about the sensory influences, all of your sensory systems have adaptability built into them. And so if I have a lens in an eye that can't change shape enough, then I have potential visual problems. If I have perceptual problems that are associated with vision, that needs to be addressed as well. So now we look to our behavioral optometrist for some help there. If we have a sensory issue in our mouths or a physical deficit, so we have people with a really small narrow palette, a narrow airway, all of those things influence our ability to breathe and move and be comfortable. And again, managing the way that we perceive that from a stress-related standpoint, all become these influences.
subsystem adaptationlearning based adaptationssensory influencesstructural adaptationstraining interference
Bill Hartman 20:29–22:43
If we have a sensory issue in our mouths or a physical deficit, so we have people with a really small narrow palate, a narrow airway, all of those things influence our ability to breathe and move and be comfortable. And again, managing the way that we perceive that from a stress-related standpoint, all become these influences. So there's a lot of stuff here that we have to take into consideration. It makes it very, very difficult because again, a lot of these things are just unknowns, and we're doing this by processes of elimination. It's like, okay, so it appears this, it appears this, it appears this, and we start to take things away, or we say, look, at some point in time, we have to recognize that it is not within our scope to help this person. We may be able to identify that there is a problem, but it is beyond our scope, and so then we need to refer them to someone else that may be able to help. That might be their primary care physician to become the case manager to start to manage this thing, or if we can identify a specific deficit because of our training, then we can refer them to the appropriate professionals. So there's a lot of things that are potential influences. The first goal I would say is to try to eliminate any interferences that are obvious. Again, this could be a training related thing or just a personal behavior thing that we think is an influence that we can usually manage those rather readily. But there's always going to be those unknowns. So that's what makes this a little more difficult than we would like. Sometimes it'd be great if everybody came in and made those changes on the first day. But sometimes it is a struggle. There are many influences, my friend. Hang in there. Hopefully this was helpful just to stimulate some thought process for you. Have a great Wednesday.
sensory integrationrespiration mechanicsclinical decision-makingprofessional scopereferral pathways
SPEAKER_00 22:43–22:50
There's nothing I think. I think the internet is killing it on your impersonations of you killing it with your coffee.
Bill Hartman 22:50–22:51
Have you seen some of those?
SPEAKER_00 22:52–22:53
I love it.
Bill Hartman 22:56–23:15
I will stop socializing, and well, actually we can continue to socialize as much as we want because we can do anything we want on this call. So if you got any questions, comments, gripes, complaints, fire away. Anything that you want to talk about, Nikki? I saw you were checking your notes.
client relationshipspain personificationpatient communication
SPEAKER_02 23:16–23:24
I was. I've been listening to your podcast with you online with three other people.
Bill Hartman 23:24–23:25
That's awesome. Thank you.
SPEAKER_02 23:25–23:53
You're welcome. It's very helpful, very insightful. So I'm doing a lot more traveling and I picked up on your podcast and I was listening to, I think it was episode 10 when you were talking about client relationships and you mentioned something about making the, like not personifying the pain in somebody when you're dealing with them. Can you expand on that a little bit more and like how you avoid that?
client relationshipspain managementtherapeutic communication
Bill Hartman 23:54–26:51
Well, the number one mistake that a lot of therapists make is they make the situation and the interaction about pain. I can do absolutely nothing about it. Literally, I can do nothing about it. Now, my intent would be to help them alleviate it. But it's not my decision. And in fact, it's their decision. I don't talk about it too much. Campo is on the call and he was a patient at one point in time. And so he knows what I say to people when they walk in the door. And I always say things like, 'What's your status?' I never say, 'How is your pain?' Because the minute you give them that, that becomes the point of importance. And if I can't impact that, I just made it the most important thing. And now I'm already behind the eight ball. I put myself in a bad position because now, if we don't alleviate it, I'm the bad guy or I'm the guy that can't help them. So my goal when they come in is to focus on the things that I know that they have control over. So it's like, 'Hey, how did you do with your homework?' So I give them exercises to do at home. We call it homework. And they say, 'How'd you do with your homework?' So now the focus is on execution. So these are the things that you can do. These are the things that you can control. And so that becomes all of the focus. Because like I said, Nikki, you do not control your health. People like to think that they do because we do things that we do that make us feel good or we think that contribute to our health. And there are many things that we do know that do contribute to our health. But ultimately we never do, because there are so many factors involved in what we would consider health. Again, my goal with all of that with that concept is to take that off the table as a useful measure of the interaction. Of course, I want them to feel good. Of course, I don't want them to be in pain. But if I make that any measure of focus, you have immediately failed because now that is the one thing that they will be focused on. Then they start to blame themselves or they'll blame me or if it's a situation with you they'll blame you. We don't want to put ourselves in that situation because it's so difficult to be successful under those circumstances because if they don't walk out without pain then you fail.
pain sciencetherapeutic communicationpatient focusbehavior change
SPEAKER_02 26:52–27:07
Yeah that makes sense. How does your tactic change with somebody who has already identified themselves with pain through multiple doctors or physical therapists? They come to you and they're already there. Does your tactic change?
pain managementclient communicationbehavioral focus
Bill Hartman 27:08–30:03
I don't, I'm not the first guy ever. I'm the last guy, hopefully, you know, like five or six down the line. Does it change? Um, no. It's harder sometimes because you have to pull their focus away from it, because everybody else has done that to them. The doctors, unfortunately, spend a lot of time talking about it. And then they ask questions like, how is your pain? They just gave them ownership of it. Right now it's my responsibility to alleviate my pain and I don't know what to do or I can't do it. So again, you've created this situation that is almost unwinnable. If you take that off the table. So it's nobody walks. They never walk in the door and they go, hey, how's your happiness. Nobody ever asks you that, right? But it's the same thing. Happiness is an output. It's a decision that is made based on the environment and the context, et cetera. Pain is the same thing. The only reason that pain gets all the attention is just because it's unpleasant. It's kind of like that relative you have to see once a year that you have to spend time with. It's just unpleasant. But that's why it gets attention. It's like, because again, where they talk about pain science, which is kind of silly, you know. If you've ever heard N'val Ravikant talk, he says, if you have to add the word science to something, it's probably not as real science. But nobody talks about the happiness science. Like they talk about pain science, because again, pain is this uncomfortable, undesirable feeling. We don't have the same approach to good things. So again, I just try to get people away from it as quickly as possible and get them to focus on those things. The same thing happens in weight loss. You get people focused on their weight. And while we do obviously need markers, but if it becomes the weight and not the behaviors, then you start to fail. There's a lead measure and a lag measure. And so weight is a lag measure. The weight is the outcome of the behaviors that came before that. And so the thing that we need to focus on in that situation is, okay, did you prepare your meals as you were supposed to? Check that one off the list, okay? Did you eat them when you were supposed to? Did you get your workouts in like you were supposed to? Did you get your sleep? Are you drinking your water and your green tea, et cetera, et cetera. So we always focus on behaviors with those people. We don't really talk too much about the numbers because the numbers take care of themselves. If you execute all the behaviors, then everything takes care of itself. So pain's no different for me than the weight loss concept is like, I'm just not going to talk about that. I'm going to talk about the stuff that matters that you do have control over. So that's how I look at that, if that is my expansion on that.
pain sciencebehavioral focushealth psychologylead and lag measuresclient communication
Bill Hartman 30:04–30:19
So pain's no different for me than the weight loss concept is like, I'm just not going to talk about that. I'm going to talk about the stuff that matters that you do have control over. So that's how I look at that, if that is my expansion on that.
pain managementbehavioral focusweight losscontroloutcome measurement
SPEAKER_02 30:20–30:24
No, that does help. I made that mistake this year. I know how to.
Bill Hartman 30:24–31:04
We all do. And I'm not perfect. I screw up sometimes too. But the thing about it is, regardless of the situation, no matter what we're talking about, the focus needs to be on the things that you do have a measure of control over. And it should be, we never really have to talk about the other stuff. It's a byproduct. It's like a goal. It's like, okay, a goal is an end. If you want to lose weight quickly, cut off a limb, okay? And the people go, well, that'd be crazy. Yeah, it is crazy, but it does work, right? So that's not the goal. The goal is the behaviors, right? The intent should be to focus on the behaviors. So that's what I try to do in the clinic.
behavioral focusgoal settingpatient psychology
SPEAKER_02 31:04–31:08
I like that. Okay.
Bill Hartman 31:09–31:17
And if you get them to do something that they're already habitual, right, Dr. Mike? And then you just replace it with something good.
behavior changehabit formationpain management
SPEAKER_00 31:17–31:19
The secrets off. I never thought of that with pain before. So basically, like we were talking with weight loss, I talked about it as action goals versus outcome goals. But I never thought about it from a pain perspective, which is really clever.
pain managementgoal settingbehavior change
Bill Hartman 31:19–31:20
There you go.
SPEAKER_00 31:21–31:34
I never thought of that with pain before. So basically, like we were talking with weight loss, I talked about it as action goals versus outcome goals. But I never thought about it from a pain perspective, which is really clever.
pain managementgoal settingbehavior change
Bill Hartman 31:34–32:03
Well, for me, it's like they're all the same. Pain is just an output, a choice the body makes based on all the experiences, all the context, and all the internal information that has to be processed. It makes a decision and that is the output. Again, I literally think about all the potential influences that are inside of you every moment of every day. You're not controlling that; you might think you do.
pain sciencebiopsychosocial modelpain as output
SPEAKER_00 32:04–32:31
I think the conversation that I will always have with clients is when they'll say like, how much weight can I lose? I have no idea. Here's XYZ principles that we know work. Let's see how your body responds to it because you don't really know the backlog of metabolic distress or over color. You don't know all the other things that are in the background that you're dealing with.
weight lossclient communicationmetabolic healthbody response
Bill Hartman 32:31–34:33
Well, there are unknowns in every situation, right? Yeah, yeah. And all we have to do is respect that. It doesn't mean that we're not going to make progress. It doesn't mean that we can't be successful. It just means that there's stuff that we're just not going to know. But that's why it's a process and that's why we follow things over time. And people ask me, it's like, how long do you think it's going to take me to get rid of this? It's like, I have no idea. I said, if you broke a bone, it would be six to eight weeks. We kind of know that one through experience over time that most people will heal a bone in six to eight weeks. But I'm making a point. It's like, okay, so if this is a learning-based adaptation that I have to teach you, how fast is it going to take you to learn how to do this and make it unconscious? I don't know how long that takes. What is the effort that you're willing to put forth? How many things are you doing that interfere with what we're trying to accomplish? So it's the runner that comes in with plantar fasciitis and then they say, okay, how long is this going to take? And it's like, how long are you willing to stop running? And they go, well, okay, I usually do 120 miles a week or whatever. I don't know how the marathon runner runs these days. They go, what if I only do six? It's like they don't, they don't quite get it. They keep doing things that interfere with their behaviors. And so those are the things that, that have to slowly be taken away because again, they're habitual just like everybody else is, or they don't want to pick things up. So you got, you've got some positional stuff and then you've got some, some muscle activity stuff that limits the great toe. So, so you're going to have to look at Um, so, okay. So here you go. When you have, when you have an actively, um, uh, planar flexed first rat. Okay. When it's actively planar flexed, you have a pelvis problem in the, in the, the posterior aspect of the hip that is exactly the same as what's going on in the foot. Is it a right side or left side bilateral? Oh, okay. So then you must have a really big orientation to have a straight leg raise on that side then.
unknowns in treatmentplantar fasciitislearning-based adaptationhabitual behaviorspositional dysfunction
SPEAKER_00 34:35–34:39
I'll take a video if you don't mind and send it to you.
assessmentcommunication