Once you get past that initial, which we refer to as the health and therapy phase, we really try to manage the acute injury, whatever tissue was affected. If it's an ankle sprain, you're trying to manage that acute swelling, that acute pain. We use biological timelines as a reference source, but then we also use a criterion model relative to basic strength and range of motion. And once you get through that phase, like to Bill's point, it's just training and understanding where you're at and what you have to get to. You also look at a lot of literature from Issyrin and some of the Russian literature as far as the rate of decay of athletic qualities. For example, you tend to see a quicker drop-off in high-intensity efforts, like sprinting and jump output in basketball. Because those are more CNS-like, short-lived outputs, maximal outputs, whereas true aerobic fitness that is more structural-based, more like mitochondrial and cardiac changes, takes longer because they are true structural changes. So what you're trying to understand is how long you were unable to load or challenge those systems. And then those are probably the first ones you want to hit. And if it's more of a longer-term one, maybe you try to go the aerobic route too. But once you get past that pain and health phase, it really is training at that point. There's a phrase out there: 'training equals rehab.' I agree and disagree. It is valuable in that context, but it's not the same thing early on. So they are different, but they do get to a point where, as our strength and conditioning coach says, your rehab should look like training because ultimately you have to get back to doing the things you need to get back to.

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.

Yeah.

Okay. So here's what I would do. This is just to see; I have no idea what the outcome is going to be. Don't change a thing. Monitor her heart rate and see what she's performing at to understand where she is starting. Then I would start to manipulate that. I would also consider the duration. I don't know if 30 minutes is long enough to even create an adaptation. If it was me, I would probably be trying to follow the same suit that you are in regards to what you're chasing, but I think I would get a heart rate monitor because if you follow some of the standard recommendations, like in Beeru's book on training, where they established the cardiac output development level at 120 to 150 beats per minute, that might even be too hot, especially from an intensity standpoint that she would be able to maintain at whatever level of oxygenation that she has available to her. Again, my question is to find out where she is and then start to manipulate that and see if you can change it. I would also start extending the durations as much as you can because to make some of the changes that are promoted, I think you would need to do that. I don't think 30 minutes is going to cut it. It doesn't matter so much what activity you're using, but involve as much muscle mass as you can. The bike might not be enough muscle mass. Are you doing anything else to promote the reduction in her vigilance, like meditation and things like that?

Which is like, how many people do you know that have a blood pressure of a hundred? Like my mother. And she's always been told she's hypotensive and has been too. And so I don't, you know, I think that if you look at then all these, so for me, it was just a couple of interesting questions. Like my blood pressure is like, my systolic blood pressure is like 110, 114, which I would generally have to consider good. And now I'm like, I mean, it's not so good. And so then I'm thinking all the levers that you can pull to lower blood pressure. Exercise being one of them from an ability to the not Bill Hartman version, pump blood, more blood per stroke, right? So create more elastic vasculature would be kind of the other piece. And, you know, then they're kind of some nutrition, some different nutrition things. But, you know, I think that, unfortunately, exercise is like complicated to study because you start dealing with population, intensity, duration, mode, you know, all those different variables, then all of a sudden it's like how could you even figure something out to say, here's a good prescriptive approach?

They'll go off this foot conversation and you're talking about the people that are making course corrections. I'm almost thinking of like a classic waddling gait. That would that be along the lines because that would almost be more of like an open chain pronated position where they're very just getting pushed from side to side.

You can look at it in isolation, right? So if you take somebody to 90 degrees of knee flexion, right? So that's where your constraints are lessened. So like you do your anterior drawers and all that kind of stuff in that position because the constraints are lessened in that position. And that's looking at it in isolation. Michelle, what I would say is that the most important thing is that you have the full excursion of knee range of motion. So you think about this. So as I flex the knee, the tibia internally rotates on the femur. And then as I extend the knee, it externally rotates. So if you have normal knee extension, you can make an assumption that you've got enough tibial external rotation. If you've got normal knee flexion without resistance, then you can make an assumption that you've got enough tibial internal rotation. It'll be like if you get down on like in tall kneeling and then sit down on your heels. Okay, you would want to me that could do that right and that is that is a passive that like that's at the passive constraints.

Don't ever give me that kind of credit. I'm an idiot like everyone else.

So Terry was doing a lot of PNF diagonals and things like that. And literally I just turned him into dynamic activity. So he's now, you know, D2s, he's doing a bilateral. One of the two extensions and stuff like that. So like I said, just took everything that we've done statically, positionally, and then superimposed the breathing on top of that. So exhale on exertions, inhale on recoveries. And again, it's not about anything special per se. It's just doing the right thing at the right time versus making these blind assumptions that everybody's going to have the same needs. And like I said, Terry being so compliant, he's like the dream client that anything you ask him to do, he'll do.

Apple.

Yeah. We really missed out. We didn't take advantage of him while he was around, I think. So think about this for just a second. It's like, what question do you not get answered when you type it into Google? I mean, it's that simple. But you have to ask a really good question to get really good answers back. So it's the quality of the questions. It's the intention of the questions that matters now. It's not about information. And Steve Bond, we always talk about education when you're on for some reason, because I think you're my connection to that. It's like, it's the questions that matter. Answers are easy. Kids, if a kid's got one of them, he's the smartest kid in the room, when it comes to an answer, but if he's not asking good questions, he's lost, right? Yes, sir. Yeah, it always comes down to the questions. That's where people are lacking now, right? The quantity of information is not a problem at all, at all. People should not be buying information. It's free. Okay, you ever get a pump? Like the yoke pump, Yeah, like, I'm not talking about the pomp. He's the happiest guy in the world, right? Remember that one? Sorry, Washington. If you don't know what I'm talking about, if you don't know about that movie scene from Pumping Iron, you really shouldn't be on this call. Good morning. Happy Friday. I have neuro coffee in hand and It is perfect. Wow, Dr. Mike, well done. Wow, great fight. It's been a great week. The clinic was busy this week, so a lot of fun there. And then got a lot done, talked to a lot of good people. So I'm having a blast. I'm taking this opportunity with the weird schedules and stuff to actually stay in touch with a lot of good people, a lot of smart people too. So I'm having fun. Today's Q&A's a little bit different. So I'm gonna start here, we're gonna do a little intro thingy that I'm doing right now. And I need a better representative model so I gotta run over to the purple room and shoot the rest of this. The thing that we're gonna talk about today is respecting the initial conditions of how someone presents in regards to table tests because I had a bunch of questions that came through in regards to interpretation of table tests. We had a thing that happened in the intensive group That was a question came up where we had a symmetrical measure that was not symmetrical. And so we're going to talk about that today, which is actually kind of a cool thing to understand because I think a lot of people misinterpret some tests. When they see equivalent measures on both sides of the body, they're making an assumption that the same thing is happening and it's not. So with that in mind, I'm gonna cut away.

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.

This is a phrase we use incessantly: meeting them at their story. So, you never negate what their belief system is because the minute you do that, you've hit a barrier. Right? Now your ability to establish rapport and communicate with this person has been negatively affected because you basically told them that anything they believe is invalid.

But looking at this from an opportunistic standpoint I think is really powerful.

Yep, yeah. So we went through four sets after four breaths and then we carried it on to a TRX lat hang with a hip lift. So we had her on the ground grabbing a TRX strap, same thing with her heels on a 12 inch box, bridging up to get her hips as high as she could. Then making sure she's kind of rolling up for us to kind of get a good zone of opposition and help to get her ribs a little more dynamic and get the exhale to bring her ribs down into position. And then we cued letting her bra strap kind of fall between her shoulder blades to get scapular upward rotation. I like that sometimes just because gravity helps pull them into position if they're able to let go without using these high tension superficial strategies.

Yes.

So here's my thing with that. My brain goes to the fact that everything feels so much better now than it did a year ago. I don't feel like I'm giving up anything because everything feels better. Even my squat pattern feels good. Other than when I tried to safety bar squat with a ramp, that still doesn't feel good. Kettlebell loading, bear hug, tempo type squats—that feels good. With my heels elevated, I can get into a deep position and expand and breathe, and it feels amazing. I don't know if I have enough perspective or context yet to evaluate things. Even before hip surgery, I could touch my toes. Now I can touch my toes, and it feels like how a toe touch should feel.

Yeah, exactly.

Yeah.

No.

You have to appreciate the orientation of the pelvis when they make that first move of the center of gravity.

Right.

What is the obvious solution here, Annette? To create a real IR. And that's it. That's the solution, right? Now, when I say that, it's not looking to split that easy, obviously. But you know what you have to acquire. So what measures would you have to have intact to push into the ground.

Their perception is whatever. They've been doing probably.

Yeah, that's, but see, that's why you have to find a rhythm that's comfortable for them because it's the recoil that creates the expanded representation on your side. Remember, you can only create the compressive strategy. See it? Yeah. So, you kick a wave away from you and the wave kicks back. Okay. Yeah. Um, have you ever seen Olympic swimmers? Like in the Olympics. So they get up on the box and they're shaking and trying to swing up. Why do you think they do that?

Okay.

So when you did the hook lying activity, you had her feet like really, really far apart on the table.

Okay. So we're on a sideline for a while rolling, trying to get more AP expansion. Once we've got that, when I get him back on his feet, can you give me an exercise or something? What does that look like as far as trying to?

No, he hasn't thrown. He's now starting to get his arm warmed up into throwing. As he's getting into it, he's starting to touch his elbow a lot. We went over what's happening. He says he still feels a little bit, still feels a little bit, still feels a little bit. So this is recurring. We've tried breathing exercises to gain some range of motion and we've tried training stuff like kettlebell carries, but it's been really hard to gain him any type of range of motion and to get away from that tweak he's getting. I just wanted to know your view on Tommy John recurring and the arm bend. Maybe I'm missing a lot of pieces here.

Yeah.