Episode 168: Exercise Over Opioids


Greg: 00:00:02 – Welcome everyone to Two-Brain Radio. It is our mission at Two-Brain to provide 1 million entrepreneurs the freedom to live the life that they choose. Join us every week as we discover the very best practices to achieve Perfect Day and move you closer to wealth.

Chris: 00:00:26 – One of my favorite finds has been foreverfierce.com. I linked up with Matt several months ago at Forever Fierce and he had some fantastic ideas, and so he and I have put together a couple of packages that we think are really going to help CrossFit affiliates everywhere. Two-Brain mentoring clients use Matt almost exclusively. He’s got fantastic designs and he takes all the work out of it. All that time that you spend searching the internet and Pinterest and junk like that for great CrossFit T-shirts? You don’t have to do that anymore. Matt has designs for you. You can put your logo on one of his templates, which are fantastic, and your clients will never know the difference. It saves you so much time that you could be using on other things like real marketing. He’ll also go so far as to remind you when it’s time to reorder. He’ll give you suggested order sizes, he’ll help you set up pre-orders so you’re not even fronting the cash for the inventory. It’s all amazing stuff built to help affiliates and that’s why I love this guy and this company, foreverfierce.com; they do all the Catalyst shirts, all the Two-Brain shirts, all the Ignite gym shirts. They do everything for every business that I own.

Chris: 00:01:31 – On the journey to change health care, there are many possible starting points. One of those might be the gut, one of those might be the brain and one of those is certainly the lower back. This podcast was recorded live at the Two-Brain workshop with Andre Riopel. A local physiotherapist who recently turned 60, he’s also an entrepreneur and he’s just been named as a sort of Tsar for Ontario health care. Now in Ontario, Canada, our health care is mostly funded, but that funding model changes all the time and so Andre is providing some feedback on what should be funded, how should we determine what lower-back pain gets funded, who decides what lower-back pain even gets funded? How do we test for lower-back pain? Do we use imaging? Do we use functional-movement tests? Do we use something else? And what can we do as gym owners to help people avoid or alleviate low-back pain. A lot of the stuff that Andre says here is crazy, crazy interesting, but it all points to prevention. We can do a lot more in a gym than many physicians can do and it’s because we have a different skill set. At Two-Brain, I want to help you develop that skill set even more, so this year the coaching side at the summit will be bigger than ever. On June 8th and ninth in Chicago, Josh Martin will lead the coaches’ side at our annual summit and we’ll be working on different tools. We’ll be talking about different diagnostic procedures and what you can do to actually help people. Back pain is a complex topic. It’s a mystery. You’re tied into opioid addiction, you’re tied into bad screening techniques. You’re tied into immobility and people actually prescribing the exact wrong thing. But it’s a good place to start because it’s a spotlight on the complex web of health care, our perceptions, how we talk to clients and what we can actually do to help. Enjoy.

Chris: 00:03:30 – OK. Andre, welcome to the podcast.

Andre: 00:03:32 – Hi Chris. Nice to be here.

Chris: 00:03:35 – Yeah. So for the people who are listening at home, what’s your story? What led you into physical therapy and you know, paint us that picture.

Andre: 00:03:44 – OK. Well, first I’m an old man. I’m 60 years old, but I guess I consider myself very physically active, I’m a passionate advocate for physical activity. I’ve been involved in this field for a long time. I’m a passionate cyclist, I believe. My mantra is something my father told me when I was 15 years old. You know, I was on a wrestling team in high school. I was always a bit of strong for my weight, gymnast, gymnastics, this sort of thing. And I’d go out riding to train for my wrestling team. My father was shoveling the driveway and I come back sweating and he looked at me and he’s says, “You know, if you got that much energy, why don’t you do something useful?” And it kind of like hit a chord with me because I thought about it after. And I’m always—I’m a big believer of purposeful activity and purposeful fitness. And in that category comes active transportation. So I find this irony in people who drive to the gym and then ride a stationary bike, you know, and it’s a beautiful day outside. So that’s kind of like my bias. I wanted to be a phys-ed teacher when I was in high school and then I took kinesiology, I didn’t even know what a physiotherapist was. And then, in kinesiology they talked to us the first class and they said, you know, where do our graduates go?

Andre: 00:05:22 – And then they gave us a clue and then they talked about physiotherapy. I thought, oh that’s an interesting profession. You should go into that. The job opportunities are way better. So I applied and I got into physiotherapy and then that was in London, Ontario. And I came to Sault St. Marie because there was a job here in a sports clinic. So I was quite interested in working with sports teams. And I worked with the Greyhounds, which is hockey, it’s a big thing here. And also I was involved in a local cycling club and I was a competitive cyclist too at the time. And I was also an official in wrestling. I injured myself in an accident when I was in my twenties. I broke my pelvis. Anyways, so I became an official in wrestling and stayed involved in that.

Andre: 00:06:12 – And came to the Sault, started a family and I had an opportunity to work with the national cycling team. I traveled with the cycling team in Europe for two years. So I worked with national-caliber athletes. That was really an eye-opener for me on many levels. At the time, cycling, in this country, we had an ace. Steve Bauer was one, you know, actually wore the yellow jersey in The Tour de France, won a silver medal in the Olympics in 1984. So I knew Steve well, I got to know him and work as a therapist, massage therapist. So I developed my sense of feel. So anyway, that’s a bit of my background. Locally, I’m very involved with a cycling club. This year they gave me an award for being a champion of, a public-health champion.

Andre: 00:07:04 So that was a big honor for me because I am very passionate about public health and physical activity. And I’m a real proactive transportation advocate. And also recently I just got a new job. I have a private clinic. We have five physiotherapists, we’re the biggest private clinic in Sault St. Marie. We have two massage therapists. We work outside of the gym, GoodLife Fitness. And last week I got a job—I specialize in assessing people with acute low-back pain. So the province of Ontario is developing a program, they feel that physiotherapists are the best people to assess people with acute low-back pain to direct them whether they need to see a neurosurgeon or whether they need that. Because we have an opioid crisis. And medical practitioners have a fairly narrow scope when it comes to low-back pain.

Andre: 00:07:58 – So somebody comes in and my back is sore, so they get an X-ray and you get pain pills and/or muscle relaxants to use. And then sometimes you go to the chiro or go to the physio. But most of the time that’s pretty standard. And we have a big problem now with an opioid epidemic and a lot of that started with people who came in and developed chronicity and low-back pain. So that’s part of the job is trying to reduce that. So that’s a little bit in a nutshell of where I’m coming from at this.

Chris: 00:08:26 – We’re definitely going to talk more about the lower-back pain thing, but what tools are physicians using now to determine if somebody even has low-back pain?

Andre: 00:08:40 – Well, I mean the first thing people complain of is their back being sore. Typically a physician would do— physicians are trying to look for is what I refer to as red flags. So we talk about mechanical low-back pain, which is 98% of all back pain. By mechanical I mean issues with muscles, discs, joints, ligaments, what have you. OK. People talk about, you know, my sacroiliac. Or “I have a disc bulge.” These would all fall under the category of mechanical back pain as opposed to what we call dangerous things like a tumor or a fracture or some kind of an inflammatory disease, ankylosing spondylitis, these sorts of things. Those are what we refer to as the red flags. But the majority of people who have—and back pain is basically very common. 80% of people will experience an acute episode of back pain at least once in their life where they’re unable to work. So it’s the rule. It’s not the exception.

Andre: 00:09:50 – So back pain is very common. But I mean, every profession has what I refer to as a tool box. So typically when you have a sore back, people think, OK, I got to go find out what’s wrong. Right? And ironically, the care or the treatment that you’re going to get depends not on what’s wrong with you, rather what the person that you see, what’s in their toolbox, right? So if you see a guy and he’s got a hammer, well, you know what you’re going to get. If you’ve got a screwdriver, you know what you’re going to get, right? So in the toolbox of a physician, they have access to diagnostic imaging, right? So they can order things like X rays and MRIs and CAT scans and what have you. And then basically they also have access to drugs, right?

Andre: 00:10:44 – And so that’s in their toolbox, right? So when you do an assessment, they quickly look at what we call tests for the red flags. The neurological things, so they’ll check your reflexes, they’ll check sensation, they might palpate your spine a bit, but they don’t really do what we call a biomechanical analysis of your spine. They don’t really look at the way it moves. They don’t actually look for patterns of pain. And this is where the physiotherapists, we are drugless practitioners, because we don’t have that tool. And then in the profession—and the same with chiropractors, too, they fall into that category. They’re drugless practitioners. So both of these professions are people who do a mechanical assessment. OK. And then in that field of people who do mechanical assessment, there’s a huge, different types of subtypes and stuff like that. And then of course the people in the fitness industry, they tend to be more on the mechanical side of the things. And they are interested in prevention. They are all interested in working with people or working with athletes who try to not get hurt or people who are hurting and try to get them get better too. So it’s part of our background. So that’s what my interest is in this conversation is to talk a little bit about what you should look for, these kinds of things. So that’s where it came from.

Chris: 00:12:06 – Before we talk about red flags and yellow flags, what are the problems with diagnostic imaging?

Andre: 00:12:13 – So one of the things that— the conversation now at this time—before I even talk about that, I have to go back to the 1980s and tell you about common paradigms of looking at what causes low-back pain in the first place.

Andre: 00:12:34 – Because it is a common problem and very disabling. Like it’s a huge, huge cost to the system. A lot of people are off work and the cost to the system is basically loss of productivity. So when you’re off work because your back is sore—and that’s probably the number-one cause of people who don’t go to work is their back is sore. So we have to be very careful of—like that’s why we want to prevent disability, like being off work and unable to work. So 1980s, there was a physician in Montreal, his name was Farfan. And when I went to school, his paradigm was that back pain was caused by the facet joints in the back of arthritis. Cause when you—so this will bring us to that conversation about diagnostic imaging. So you basically treat what you see.

Andre: 00:13:25 – So when you look at an X-ray and if you take an X-ray of a 50-year-old person, you will see things. OK. And then there’s a language to X rays, right? So you see things on an X-ray and the common terms that we use are problematic because they use, if you read a report from an X-ray right now, you’re going to see things like moderate degenerative changes. And the word degenerative is a negative word. And that conjures things in my head. Oh, I’m degenerating. You know, there’s something worn out, you know, or spurs and they talk about that. And then they’ll talk about things like bulging of thecal sac or impingement on the spinal cord. That’s what they see. So at the time they thought that the majority of people with back pain, you push on the back and it’s sore.

Andre: 00:14:21 – And so the idea was that, if we separate the facet joints from each other, take the pressure off that joint because on X ray, that’s what you saw. That should solve a lot of back pain. So people were prescribed with strengthening abdominal muscles and pelvic tilting and all that stuff. And then in the early eighties, somebody came on board—actually was before that, there’s a guy named James Syriac who’s a British orthopedic surgeon who basically did the complete opposite of what Farfan was doing. So he started bending people backwards, which is actually doing exactly what Farfan said you never ever do that. And I was graduating from school at the time. And I’m going, wait a minute, this is kind of crazy. This is like we’re learning one thing and then they’re telling us to do completely the opposite.

Andre: 00:15:07 – So what’s going on here? So this just goes to show, like be very careful about what the truth is now. Because you know one thing for sure it won’t be true tomorrow. So don’t get all hung up and say this is the way things are. Because the way things are is one thing is constant, Is that it’s not going to be constant. So that’s why. So it’s really good to keep an open mind about things. But there are certain truths that always will remain. It’s what the person is feeling and what they’re telling you. That’s real. Right? So people say, oh my sacroiliac joint’s out of place. I said, no, that’s not—my back hurts on the right in the lower side. Oh, OK. That’s the truth. So anyways, so Robin Mckenzie revolutionized the management of low-back pain because he started to bend people backwards a lot.

Andre: 00:15:53 – And then he developed this, what we call a mechanical diagnosis. And I want to talk a little bit about this methodology because it still rings true today. And because he was not looking at looking at structure, so let’s go back to diagnostic imaging. The problem with diagnostic imaging in today’s world is that you’re taking a picture of a structure but the problem is motion, but there’s a loss of motion or there’s a disruption in normal motion. So somebody can’t bend forward or can’t bend backwards, bend sideways, etc. So here’s a mechanical problem and then you’re looking at a static picture, right? So if I want to know about—I can’t open my mouth. OK, well let’s take a picture of your face and that will tell us what’s wrong with you.

Andre: 00:16:42 – But you don’t know that. So really in a perfect world, if the diagnostic imaging technology for me would be an MRI that I could do a movie. Bend down, straighten out, what happens when you bend, which joint is not moving properly or what direction is not moving. So an X-ray or MRI does not tell you the story about what goes on when you bend forward. And the other thing about back pain, it’s not always there. It’s the level of pain. So you can have moments you’re completely pain free and then moments where you’re hurting. If I take an MRI or a CAT scan or an X-ray and at that particular time, my back feels good right now. So the anatomy changes based on your movement. So you take a static picture. So that’s the first problem.

Andre: 00:17:24 – So you’re not really getting the information you’re looking for. So you’re getting—and what happens is that you can get what we call false positive and false negatives. So you take a picture of something, and let’s say because of the way you’re lying down or whatever it is, the disc and the tissues are in position, they’re not interfering with the nervous system. So everything looks good. Yeah. So you’re told nothing’s wrong with you. So that’s first of all a problem, that’s what I call a false negative. A false positive is the opposite. So basically there is some degenerative changes in your back. So you know, you’re moving along, you’re 55 years old and all of a sudden boom, oh God, my back hurts. You get up in the morning, you have acute back pain and you’re really concerned.

Andre: 00:18:10 – We’ll go take an X-ray. Your X-ray comes back, you have severe degenerative changes at L4, L5, S1—oh, I’m wearing out. That’s it. Well that’s wrong because you know, before your pain was there, that degenerative change was there, too. So it has nothing to do with what’s going on right now. So right away, you think enflamed, old age. You get an anti-inflammatory. Well maybe the problem is not inflammation. Maybe the problem is not muscle spasm. So there the problem is that with diagnostic imaging it gives you a wrong diagnosis most of the time because it’s not really identifying the problem. And then the other thing that happens with diagnostic imaging is the language of a report. So there’s so much false, what we refer to as a false negative.

Andre: 00:18:58 – So in other words, the X-ray language or the MRI language, will talk about moderate herniation of L5, postural lateral impinging on that, and there’s a doctor that’s telling a patient basically your desk is ruptured. And then you tell somebody that you have severe degeneration. Now what happens to that person and the way that makes them feel, because that’s the conversation that we’re having today is basically we scare the shit out of people because of the words we say to them about what’s wrong with them. And I have people that come in my office and basically they’re terrified. And what we are learning today about pain and chronic pain and chronicity of pain. So that other doctor, he’s afraid cause he’s reading these words. Oh you poor guy, you must be an agony. I got to prescribe you some strong medication here.

Andre: 00:19:49 – You’re hurting, buddy. Like take it easy, don’t move, lie down. Here’s a rest position. Here’s morphine or a Percocet or oxycodone. Like you name it. And then if it doesn’t work, you go back later, cause now he told you to take it easy, which is the worst thing you can do for a sore back. Then you hurt more, well increase the dosage because the drug companies are telling us that we solved the problem of pain because we are able to manipulate the dosages so you don’t get addicted, which is a big lie and Big Pharma is paying that right now. This is a lie that they propagated for the last 20 years and now we have an epidemic because it’s not true. So basically the whole paradigm of mechanical back pain has been twisted from the start because the physician and diagnostic imaging are looking at the wrong thing.

Andre: 00:20:45 – And this is where movement assessment specialists come in. One of the thing about language and ideas, OK, so pain is not something that you feel in your back. Pain is something you feel in your brain. So the brain is the big filter. So we use the term nociception. So take a hammer, hit your hand, you know, the sensation travels to your brain and your brain decides what to do about it. Is this something that I should be afraid of? It is something I should react to. You put your hand on a stove. And it’s very helpful to us. It preserves us from dying or run away. I mean that’s why we have a pain system. But in chronic pain, what happens is that this filter—so in the brain we have the amygdala, which is basically the core of your brain, which that’s the part where it looks at your experiences in the past, it looks at your emotional state and basically directly links to the motor cortex and also the sensory cortex. And will decide whether to amplify or minimize things basically on how you feel. And it’s a huge filter, a huge, huge filter. So, and I see different people, I see people who are what I call the stoics. And I see the people who are the paranoid and fear. So we look at two emotions that are really common in back pain is fear and anxiety, right? So fear and anxiety are multipliers of the pain experience, so anything that actually increases fear or anxiety to a condition, when you have pain, will actually multiply it. And then of course you take a pain medication. And this is a big issue with pain and I can talk a little bit about that too, because what happens with especially opioids, your brain has capacity, we have what we call opioid receptors, right? So they’re basically part of the linkage system to how we feel the pain experience, as I call it, because pain is a brain experience. Pain is an expression. Pain is an emotion, if you want to call it like in that way. So those opioid receptors are usually fed in our, what we call feel-good system. So, you know, when you work out—so there’s three or four things that—and endorphins, right? Endorphins, adrenaline. So they basically feed the opioid receptors, they go to the part of our brain where we feel good, we feel happy, we’re content. So the opposite of that is of course, fear, anxiety, and what we call the emergency system, where your adrenaline comes in. You’ve got to run away from harm or you got to deal with an issue.

Andre: 00:23:25 – So stress, you know, your stomach activity changes, your heart, your blood pressure goes up. So that’s called the emergency system. OK. So this whole pain endorphin system is when you take an opioid, right? So it binds to those opioid receptors. And basically stops the pain signals, which kind of makes you in kind of like—you still feel the pain but you don’t care. People will tell you that take who opioids, like I feel the pain, but it’s like it’s not an emergency anymore. Right? It kind of calms you down, sort of thing. So you care less but the pain’s still there. Still there. Now the problem with the system is the moment the brain has a reduction in the sensory input from the opiate receptor, it starts to grow new ones very quickly within two or three weeks.

Chris: 00:24:19 – Wow.

Andre: 00:24:20 – So now what happens is that because the opioid receptors says I’m looking for those endorphins, where are they? Right? So it starts to grow new receptors. So then of course your pain level comes back. So you go to the doctor who says well, we gotta increase your dosage, which creates this vicious addiction cycle. So in chronic pain when you’ve been taking—now we know with chronic pain is that there is undisputed evidence that opioids don’t work for chronic pain. They actually are the problem. But you can’t just simply stop taking opioids when you’ve had chronic pain because you’ve got all these receptors screaming, so that’s the pain that you feel is not necessarily the pain that you have, but the pain of withdrawal. So you have to sort of de-prescribe opioids.

Andre: 00:25:10 – There’s a system, because your system will react. It’s an emergency. There’s something missing in my system. You will do anything to try to stop that. So it’s a really, really complex system and we are just trying to get our heads around that and how to deal with with—and then, so that’s the opioid. And then we have issues with anti-inflammatories, too, and muscle relaxants. Because in the prescription of medication for back pain, those are the three big ones, right? So we have an anti-inflammatory, we have a muscle relaxant, and we have an opioid pain medication, Tylenol 3s, codeine, all that stuff, right? So here we go. Anti-inflammatories: The assumption is that there is inflammation. So anti-inflammatory works with your auto-immune system and they will reduce the inflammatory reaction, but inflammation is a healing response.

Andre: 00:26:04 – So there’s an excessive amount of inflammation. So the assumption is that you can control the inflammation. You’ve got to think about inflammation as a healing response to change your view of it. So it’s a repair process. It’s just when it’s excessive, and then of course you continue to hurt yourself, you continue inflammation, of course, that’s a problem. So there certainly is a place for judicious use of anti-inflammatories, but in the big picture anti-inflammatories, they basically stagnate, perhaps, the repair process. So you have to be very careful. And also that’s the one issue with anti-inflammatory, the secondary issue, of course, they’re hard on your belly, they irritate your bowel lining and they’re also hard on your kidneys and your liver, right? So those are the big issues. And you take people who take anti-inflammatories for long periods of time for years and years and years.

Andre: 00:26:54 – They basically rot their insides because they thin out the lining of the stomach and all these things they need to, to recover and repair it. But the anti-inflammatories sort of create problems, and they’re corrosive to the system, so you cause problems. And also the thing is that the assumption is that your pain is caused by inflammation, your back pain. And I can tell you for a fact, because we’re drugless practitioners, we think differently. Maybe your pain is caused because the joint or the motion segment is stuck a little bit. It’s tight. And that’s what happens with the back. And I can talk a little bit about that and mechanical diagnosis in a minute. So I’m just trying to cover the facts about medication.

Andre: 00:27:37 – And the last one too is the muscle relaxant category of medication. The problem with that is then you assume that your pain is caused by muscle spasm. Right? Cause you look at somebody with a sore back and you feel their back and it’s really tight, so you feel well that’s the spasm that’s causing the problem. Well the spasm is a protective mechanism to try to brace the area that is sore, to prevent from further harm perhaps. But there are side effects of back pain medicine, it makes you lethargic and one of the things with back pain is that you don’t want to be lethargic, you want to be moving. So we don’t want to be laying in bed all day. Right. Back in the days in the 80s they used to put people in the hospital in traction for weeks at a time and then when we started to really looking at the outcomes of those people, take two people with the same problem.

Andre: 00:28:24 – You put one in traction for a week in the hospital, full-blown disc, like nerve pain, everything. And you put the other guy, you tell him to just go home and move as much as you can. The guy that moves gets way better than the guy that stayed in bed in traction. We were hurting people, we we’re putting them in the hospital, we’re filling them full of drugs and we actually hurt them for a week. And then eventually he gave, he said I’m not getting better, I might as well go home. And then they got better. But anyways, so that’s sort of my thing with diagnostic imaging, the problems with that about what it does to the fear cycle and increases anxiety and not really helpful in diagnosing the mechanical back pain and then use of medication. So there’s two big challenges there.

Andre: 00:29:05 – And I’m not suggesting here that we have all the answers as therapists, but we’re getting there, we’re certainly better. So I’m gonna talk a little bit about that aspect now. So, back pain, right. We have different, separated into what we call tissue diagnosis. And versus a mechanical type one. So you have two categories. People say to me, when I come into my clinic, they say, Oh, I have a—my L4, L5 disc is pinching my nerve, whatever. Or they say my sacroiliac joint has slipped. My piriformis muscle is tight. And I go, well, I don’t know about you, but I can’t feel my piriformis. My sacroiliac joint, I mean I can squeeze my baby finger and I know I’m squeezing my baby finger, but to say that I feel my disc, you don’t feel a disc, you feel pain.

Andre: 00:29:54 – You feel tingling. This is what you feel. Don’t tell me—when I ask what’s wrong with you, tell me what you’re experiencing. In hurts where when you do what, this is the sort of thing that I’m interested in because one of the things about this tissue thinking is they did a really clever research, and this has been done a few times since, so they were trying to look at our brain—when you look at your homunculus. So the part of the brain that actually feels different parts of the body, and if you look at the hand has a high representation in your brain. The lips, the genitals, but the low back is very poorly represented. So our ability to sort of identify what’s wrong with us, like from a tissue perspective or even a localization perspective or where your hurt is.

Andre: 00:30:40 – That’s really related to what’s wrong too. So they did this study where they would inject a radiologist under X-ray with specifically in inject different tissues, a sugar solution. He injected the disc, injected the muscles, injected the ligament of the sacroiliac joint, injected the ligaments that support the spine. And the person would describe the pain that they felt with that. So they had pain patterns with different tissue. And guess what? It was totally inaccurate. You could inject muscles and you felt pain down the leg or in the back. So that idea that where you feel pain tells you where the tissue—so you push the sacroiliac joint, I call it the soft kiss of Venus in your spine. That little indentation there and say that’s right where—but that indentation is basically, there’s ligaments that cross there.

Andre: 00:31:33 – There’s sacroiliac joint, there’s L5 S1. Because you press there, that tells me what the problem is. So what, so you call it, give it a name. People want to be reassured, oh, this guy knows what’s wrong with me. So that’s a positive thing. OK. Because people say I’m hurting. It hurts like hell and oh, somebody knows what’s wrong and gave me a name to give to it. So now I feel better because somebody actually knows that I’m not—that there’s something real happening to me. So that’s part of the thing., But unfortunately to help make that person better, it’s not helpful. So this is where—when we’re looking at what we call a mechanical assessment, and is this is where your people in the gym and the fitness, what I’m saying to people who work in the fitness industry, be very careful not to come up and give people tissues about what your piriformis is like.

Andre: 00:32:22 – I know people who do like, it’s interesting because I have a person who did a few courses on myofascial stretching, right?

Chris: 00:32:30 – That’s their hammer.

Andre: 00:32:32 – Sure. But it’s OK, but the problem now you’ve gotta be very careful what you say to people, too, because you say, well, you know, your such and such a thing as tight and we stretch it and it feels better. Well that’s stretching. So you get all your myofascial—of course, the myofascial system, we understand that. But remember that the body is not very good at identifying or localizing pain just because you pressed it. So palpation is the least accurate way to find out what the problem is. So this is why we want to try to shift the thinking from tissue diagnosis or basically diagnostic imaging diagnosis and using medication when you have a mechanical problem.

Andre: 00:33:17 – So I want to talk about mechanical assessment. Mechanical diagnoses. So, when you look at a mechanical assessment, your patient comes in or the, your client is—OK. What’s the problem? My back hurts. Fair enough. Where does it hurt? Around down here and it goes down my leg or doesn’t go down my leg. So location is important, but the other part to this equation is does it hurt all the time? When does it hurt? Does it hurt when you’re walking? No, it feels better. The more I move, the better I feel. That’s important. Does it hurt when you sit? If I drive my car for two hours, my back is really sore. Does it hurt when you lie down? So now you’re starting to think mechanical diagnosis and you’re also getting a sense of the behavior of the pain under different mechanical stresses, right?

Andre: 00:34:18 – Because sitting, lying down, walking, lifting things, bending forward, those are mechanical situations that either will irritate the tissues at fault or actually correct the problem, right? So that’s an important—so we need to know what makes them hurt, what doesn’t make them hurt, this sort of thing. So that’s the first thing you want to know. When people say my back hurts and I say, where does it hurt—and the problem is the moment you start talking about pain and say, well, how much does it hurt? The moment you think about how much it hurts, it hurts more, right? Because you’re thinking about hurt, because your brain pays attention to hurt or doesn’t pay attention to hurt because you’re making a person anxious. Hurts a lot, doesn’t it? Like, and I’m listening to people who question people about back pain.

Andre: 00:35:04 – You want to talk about back pain but not really talk about it. So I focus on what doesn’t hurt. When does your back feel good? Right? I want to know does the back feel good when they’re active and moving versus staying still. Right. So Robin Mckenzie came up with three different types of pain patterns on a mechanical diagnosis. So we talked about categories. So the first is what we call a postural syndrome. Postural syndrome is basically—best way to describe that is if you take your finger right, just grab your finger right now and just bend it backwards. You know, you feel a bit of a stretch, right? So that’s a posture. You’re sitting on the end of your ligaments, you know, and that’s fine. It’s a little bit uncomfortable.

Andre: 00:35:51 – But keep your fingers stretched for, you know, two minutes, five minutes, an hour, you know, after a while it starts to hurt. So what do you do to take the pain away? Take the pressure off and move it a little bit and it goes away. So a postural syndrome is basically a load on your tissues at end range, typically, for a sustained period of time that goes with away quickly when you get out of that position. So what’s the solution to that? Move. Don’t sit too long or change your posture. And your posture, it gets a little more complicated, but a lot of the pain that we see is postural and every one of us feels that. We sit at our front of our computers for hours on end. And guess what? After a while you got to get up and stretch right.

Andre: 00:36:40 – And the pain goes away quickly. Postural pain usually doesn’t hurt at night when you’re laying down because you tend to be—postural pain is usually associated with sitting or standing. And it’s usually relieved quickly by moving. So people with postural pain have no contraindication to exercise. As a matter of fact, the more exercise, the better they are. So that’s the most common one. And then you have that pattern. So people come. So that’s your postural syndrome. Then we have what we call, there’s two other categories. The other one that we see is what we refer to as a derangement. A derangement means that something is stuck or something is not moving in a way that it’s meant to be able to move and it happens fairly quickly. It can happen. You know, I bent over and I felt something go in my back and then I couldn’t move in a particular direction. It’s very different flavor than a postural syndrome.

Andre: 00:37:37 – Although don’t forget, they can mix together a little bit. So this is the classic if you want to talk anatomical, which I don’t want to do here, but you know, a disc herniation with would be a classic derangement. So something is out of position the way it normally should be. That pain can be constant or can be relatively—they’re all aggravated by certain postures. That pain can have what we call a referral pattern that you can feel pain that radiates down the leg. You could have what we call neurological symptoms. And then we’re getting into our red flags. So neurological symptoms include, you know, numbness, especially in the foot and tingling. So tingling and numbness are indication of nerve pressure, right? So we all experience numbness; you cross your legs a certain way, you know, your foot goes numb, right?

Andre: 00:38:31 – Because you’re putting pressure on your side, the nerve in your foot goes numb and then you uncross your leg and it tingles. So tingling is considered what we call a release phenomena. So it’s not necessarily a bad thing. So, but if numbness is constant and your foot is numb and it wasn’t numb before. And then the pattern of numbness is important because nerve roots supply different parts of the foot, for example. So we want to know where is it numb and then we do an assessment. It’s actually numb when you stick a pin in a spot, I can’t feel that. Or I feel less of it. You know, that’s not a good thing. Right. And then the other thing that is also a red flag is what we call weakness. And I’m not talking weakness—there’s types of weakness that we call weakness caused by pain.

Andre: 00:39:13 – So if you have something that hurts, every time you contract it, it hurts, so you can’t contract hard, that’s pain four weakness. But pain three weaknesses, is just the tissue is weak and in low-back pain, there are two most common presentation is in the ankle. So we call a foot drop. So that’s L5. So what happens, a person will walk and their foot slaps or they can’t walk on their heels. So the L5 nerve supplies, the tibialis anterior, the extensor longus is lifting your foot. So a person can’t walk on their heel, but it’s not because it hurts, it’s because they just don’t have strength. And if you test it and if you measure it, so that’s a red flag, that means there’s a nerve compress. And usually people are not happy when that’s happening.

Andre: 00:40:00 – OK. And the other one is S1, which is the walking on your tippy toes. Right? So these people will say, my leg feels wonky and I can’t push off or walking up hill. But you’re walking on your tiptoes and one side you can’t, but not because it hurts, but because it is just weak. And that’s another red flag. So we call that. And then if you do reflexes, deep tendon reflexes, we can check the reflexes and what you see is there’s a loss of reflexes, a loss of sensation and the loss of muscle power. You’re pretty damn sure you’re talking about a compression. Having said that, that weakness can be reversible, the numbness can be reversible. So you want to know is it constant or reversible? And this is where your mechanical diagnosis comes about.

Andre: 00:40:46 – So the objective of a mechanical assessment or mechanical therapist who’s going to look at that is trying to reduce that neurological finding sign. We call that a sign, right? Cause it’s not pain. Pain is really not really helpful. It’s not accurate, but it can be. So the objective is can you make that numbness—go on.

Chris: 00:41:10 – Yeah, just to back up. There are three categories, right?

Andre: 00:41:14 – So the second one is derangement. I’m talking about derangement right now. OK. I’ll talk about the third one after I’m done with derangement because it  leads to that. So a derangement is something out of place or something stuck. A disc herniation is considered a derangement. You know, even after that spiel about anatomical diagnosis or tissue diagnosis, it forms a paradigm for you to visualize what’s actually happening in the body. It’s kind of helpful. But I think you’ve gotta be very careful of not hanging your hat on that too much because in 10 years from now, we may prove that has nothing to do with it. But what’s real is that the person can live their foot or they have numbness. That’s real. That’s a sign, right? You can’t argue about that. So anyway, the second part now, if a person typically that has that sign, we look at, we call it motion disorders. So basically I can’t bend forward. I could bend forward two days ago. I could touch my toes and now every time I been forward I get this excruciating pain that shoots down my leg. Or I can’t seem to be able to bend backwards as I used to be able to do. And when I bend backwards I feel stuck.

Andre: 00:42:30 – So then you want to know, OK, so one causes the pain maybe and one actually is limited. So then you do what we call repeated position or sustained position. So if you keep bending forward 10 times, does that pain get more and more and more so you have an increase, so that’s an increase in the pain, or does it get less and less and less? So we call it a directional preference. If it hurts, don’t do it. But if goes further than that. f you keep doing it, does it hurt less and less? I mean people who train know about that. You do 10 push-ups today it hurts like hell. But if I keep doing it, after a while, doesn’t hurt as much. I have to do 20 to get the same feeling. That’s a different kind of hurt and that’s a good hurt, right?

Andre: 00:43:11 – Yeah. So we just that—the repetition. So it’s not, if it hurts, don’t do it. If the more you do it, the more it hurts. Don’t do it. But that’s common sense. Like banging your head against the wall. You know what? It hurts a bit. But if I keep doing it, it doesn’t hurt less. I don’t get used to that. So stop banging your head against the wall. But having said that, and you can use that as a positive too, because what you are trying to do as a mechanical assessment is you’re trying to figure out if a direction and you keep pushing in that direction whether or not it will hurt less. And there’s another important thing that we use, another phenomena. So repetitive movement about increasing or decreasing the pain. But the other one, it’s a phenomena called centralization of pain.

Andre: 00:43:54 – So by centralization, I mean—the opposite of centralization would be peripheralization. So in your back, for example, the further down the leg your pain travels. Usually, typically that means an increase in the severity of the problem. OK? So if you’ve got pain in your back but doesn’t go any further. That’s considered less seriously than pain in your back that travels down the back of your leg, but not below the knee. But then that’s the second category. Or if a pain in your back that travels down your leg goes below the knee, goes into your foot and you start to feel neurological symptom. That’s worse, that’s an increasing severity problem. So your objective is to try to reverse that, centralize the pain. So say for example, somebody comes in with a sore back and you make him do a floppy push-up, a cobra extension exercise and aw man, I can’t do that. It hurts. OK, just stay in that position for a little bit. It hurts my back but my foot doesn’t hurt. It hurts less than when I started doing it, so the light goes on. So you have a directional preference to extension. So you see the language now of your diagnosis, how it changes and how you think differently. Who cares what tissue it is, it feels better and it’s reducing the leg pain so you’re going in the right direction, continue going in that direction. So that’s how we—push on here. Push on there. So we tend to—you have to get your patient paying attention to this too, because are with their bodies 24 hours a day so they can actually control those postures and position and try to keep the pain out of their leg by watching what they do and what they don’t do.

Andre: 00:45:37 – And then once that’s happening, then you know you’re getting better. You’re healing. So this is what we call a mechanical assessment and diagnosis. And that’s a common presentation for most people. They tend to, what we call, use the word extension principle versus flexion. So we bend them back and the more they back in and the more they bend back in different ways, the better it feels. So we talk about lordosis versus, you know, back in the days of Farfan and you want to do that and we made people worse, but we don’t want to go back there. So that’s sort of the idea of mechanical. So my third category, so the derangement part, something’s out of place. I just want to say one more thing about derangement and about joints because a derangement does not usually happen in the back but any joint in the body where something is—and all our joints, especially when you age and stuff, and this is where manipulation comes in and where we manipulate—you can self-manipulate and the word manipulation means different things to different people.

Andre: 00:46:36 – Manipulate really comes from mano, hand, hands on, pushing on you. So when you manipulate tissue people associate manipulation with what we call a philosophy thrust, which is creating a noise so you crack, you know, and there’s been a lot of work done on what exactly happens when you hear that noise and how useful that is or not useful in the management of mechanical back pain. And I think that it’s way oversold. It’s the relationship. So we can crack your knuckles, you know, there’s different joint sounds the body makes, and people will have different, how do you feel about cracking? It feels good when I crack or oh, I don’t like that sound, you know? So there’s an emotional component, but we use the term cavitation. So you have a capsule around the joint and then when you create a pressure on that capsule, you create a vacuum or negative pressure.

Andre: 00:47:37 – So all of a sudden there, that quick exchange of nitrogen gas goes into the joint quickly and makes a sound. OK. So it indicates that you moved the joint and it doesn’t really indicate what joint you moved or the area, but you have a sense of where it happens under your hand and stuff like that. And there seems to be like back in the days where the chiropractic profession, evolved, there was this paradigm that, you know, you have to realign the spine, you know. Like what we know today, it was so wrong from the get-go. So like if you pushing on nerves— \so they would take an X-ray, which is totally useless, and they would diagnose subluxations and then they push on there, you get annoyed and say if you come every month and we keep you in line, you’ll be fine.

Andre: 00:48:20 – So they got basically funded by the provincial government so you get 12 sessions a year funded by the government to prevent disease. Right? Once a month, like it was perfect, like it was such a load of garbage, like it was just total nonsense. But I think the profession has evolved and I think that the people who still hang on to that ideology are like dinosaurs, right? But we still hear about it. So that’s the joint. But what I’m getting at with joints is that surface of joints glide on each other. And we have—so the use of the word subluxation in my expertise, or in my profession, sometimes we have what we call a resting or a neutral position of the joint. So your shoulder for example, you know, when it’s sitting in a spot, it’s kind of sitting where the tissues are kind of relaxed and everything’s in quote in the right place. But joints can move within that. Joints have to have a certain degree of movement, mobility, and you know, they’re slippery surface.

Andre: 00:49:22 – There’s fluids in there. There’s different ligaments and cartilages that kind of keep the orientation or the alignment of these joints in a particular position. And sometimes when you move a certain way, especially with a little bit of aging and the surface is a little rough and you don’t move a lot, then muscles are tight and stuff like that, the joint tends to not be perhaps in what we call the perfect place, or the nice place. And also we talk about every joint in the body. If you look at the biomechanics of we call the instantaneous access of rotation, right? So basically there’s a slipping and rolling action that happens and the shoulder, you lift your arm up, see, and then the pivot point is moving around a little bit. So it’s not like a pure hinge joint, but each joint has a certain path that is considered normal.

Andre: 00:50:10 – So for example, the knee joint. Let’s say your cruciate ligament, the anterior cruciate ligament is gone. When you do certain movements, the knee will tend to shift a bit. It won’t be quite where it should be. So the two partners, the two bones won’t be where they need to be. So like a drawer, you know, if your drawer, you open and close a drawer and it’s perfectly aligned and glides really good and then out. But let’s say a couple of screws are loose or the thing’s a little worn out. Then if you push on one corner, gets stuck, then you lift that corner a little bit and all of a sudden it gets unstuck. And this is the magic of manual therapy, right? So what happens over time, there’s different people who came up with the ability to feel joints and where they were not sliding.

Andre: 00:50:55 – And then slowly with a variety of techniques and ways kind of guide them or glide them or move them in a better place. And then the movement came back very quickly. And we do those miracles every day in our job. And I mean we call them miracles because it’s pretty impressive and people are pretty impressed by that. And physiotherapists and chiropractors they tend to get good at it. And they call them different words how to do it. Then there’s different people who have different techniques, spinal fascial, what have you, but at the end of the day that’s what we conceptualize is happening. And we have a lot of evidence for that. But those are your sort of slam dunks and you can kind of—and in the spine, the same thing can happen, you know, and which joint is not perhaps moving properly, whether—people talk about discs and facet joints and muscles and this and that, but really what it is is a motion segment, all those things work together.

Andre: 00:51:43 – And then we talk about how everything is lined up and everything is connected, absolutely. And that’s something that you tend to have to look at the big picture. So that’s our dysfunction, our derangement category. We have the postural category, we have the derangement category. And then the last one is what I call dysfunction. Dysfunction is something that most people will see in their—like athletes come in and especially older athletes. Dysfunction is basically a shortening of tissue after injury. So basically now there’s a disruption of the anatomy. The healing is done, but now the tissue is tight, right? So dysfunction gets better with actually stretching the tissues that are tight. And I think a lot of people in the fitness business, that’s what they conceptualize every body that’s sore as dysfunction. They look at somebody’s posture and say, oh this muscle group’s too tight or this and that, and then you stretch and you align yourself better, et cetera.

Andre: 00:52:54 – So that’s, you’re thinking the word that is used by the Mckenzie classification as dysfunction, but there’s many people who call that thing a by different word, but it’s the same thing. You just call it a different word. It doesn’t make it new. Right. Oh, invented a new technique. I’ve been around the block and I’ve done every course out there and I’m going like, this is the same as what this guy does. I’s just a different use of words that are definitely, but we use that term. But one thing that is at the end of the day is don’t put words in people’s mouth, don’t invent things. The real thing is whether it feels good and doesn’t feel good. Whether it helps or doesn’t help. Without putting words in people’s mouth.

Andre: 00:53:39 – So we have to be very careful what we say to people. And sometimes it’s better not to say anything. And I think what I find as a therapist, because the reason that I say, be careful what you say because what you say now will be proven untrue in a week or a year or in five years from now. So don’t be so dogmatic about what you think is right and wrong, right? Because the only reality is what the person’s experiencing. But even that’s not real because it’s influenced by what they think and what they think is influenced by what you say to them, so be very careful of that conversation and be very aware that people’s emotions have a big influence. And this is where the current research is going in chronic pain is how the brain is involved in all this stuff and how the brain—not only is the brain, the amygdala is involved, but also there’s a part of your brain, when we look at the brain, the majority of the cells in your brain are the glial cells and the glial cells is the majority of the gray matter. Before they thought they were supportive self, they provided, you know, nutrition and stuff to the neurons and in all these—but what they’ve discovered is that those glial cells are very connected to the autoimmune system.

Andre: 00:54:54 – So it’s very interesting. And then they connect to the different—there’s an influence from the amygdala, there’s an influence towards your cortex or your consciousness. And so for example, we were thinking of inflammation, right? As a healing protective mechanism. So you bang your hand and it gets inflamed. It hurts like hell. But there’s such a thing as your brain can actually cause inflammation too. The glial cells are the cells that are responsible for what we call centrally mediated inflammation. So, you know, you get these people who have fibromyalgia or different aches and pain in their body and you actually look at it and it’s inflamed. And we are like in the process of thinking that maybe that’s basically mediated by the brain and by emotions. So the fact that people have chronic pain or fibromyalgia and hurt everywhere and then we start to look at how they think or how they’re programmed and you know, as a child, you know, I look at parents and children, right?

Andre: 00:56:02 – And you see the projection of the parents’ sort of reality about anxiety, fear, and it’s projected to those child. The child falls down and he hurts his knee and then the child looks up and look to see if mother’s looking. If Mom’s looking, he starts crying. And then Mum comes over there, it’s all you poor thing. Let me look at that. And then they rub it and then so he gets attention. So, you know, I mean it’s OK to pay attention, but if you look at health, if you look at an ambulance attendant right? When he comes to an emergency, they don’t panic. No matter what’s going on because they don’t want to portray anxiety because that doesn’t help the situation. And people—you see that as a movies, you know, the guy is shot, his leg’s cut off, and they calm him down.

Andre: 00:56:48 – They know the guy’s gonna die, but they don’t say, oh, you’re going to die. You know, you can’t even feel the leg’s gone, they say, oh, you’re looking good. You’ll be fine, calm down, because that really excites the nervous system in a negative way. It’s not productive. So their job is to calm people down. People in emergency, I mean they go fast and stuff like that. So be very careful that you don’t portray your own anxieties on to somebody else. And then that goes for your children or for your clients, for that matter. You’re a little bit concerned because you’re the kind of person who likes to think. You’re very obsessed about what you feel all the time. And you visualize all of these things that I’m going like, well, the glial cells are going, hey, we’ve got to send some inflammation there.

Andre: 00:57:32 – We have a mirror pain, right? So somebody has a tennis elbow on the right arm and you know, you pay attention to that arm and then all of a sudden it develops on the other side, then we see signs of inflammation. Well that’s what we’ll call a mirror pain. So we actually prove that now through what we call functional MRI. So this is all happening right now and this is all research that’s ongoing. So it’s very exciting in a way. But right now the last frontier is the human brain. So this is sort of kind of the view of looking at back pain, which is basically a simple topic, but it’s not that simple and it’s quite intriguing. And how, you know, the role of people who work in gyms and thinking about not being, so—you know, it’s kind of fun to throw big words around. It makes you look good.

Andre: 00:58:20 – You know, like this guy knows words that I’ve never heard before, he must be smart, right? But really who you are you deluding, yourself, right? Because it’s not a healthy conversation because are you—just think about the effect of the words that you say and use make people feel. OK, sure. Are you pleasing your own ego here or you’re trying to help that person? Because I know that health care providers have to be aware of that. And I think that we talk about, you know, your job is not to be the hero in the story, the hero and the story is your client.

Andre: 00:58:56 – Right. And we talk about that and that’s a dynamic that is not really well taught at school. You know, we spend our time learning the nervous system and the name of every muscle and the direction that they move and stuff like that.

Andre: 00:59:11 – But we really don’t spend any time about how we feel and what the words we use and hospitality and how you make people feel, and really in any business this is the number one thing is how do you make people feel? You know, and that’s what you show. And then in medicine it’s huge. But that’s kind of like a big picture of sort of my take on back pain.

Chris: 00:59:39 – Yeah. That’s great. Very in depth. So we’ve got a few minutes left, and you once told me years ago that every human should be able to do a squat, lift their arms above their head. And there was one other thing, I thought it was—

Andre: 00:59:51 – A handstand against the wall, which is basically lifting your hands up over your head with your body weight on it. That’s a favorite conversation. When we look at postural syndrome, going back to our conversation and what a lot of people in the fitness industry talk about muscle balance, right?

Andre: 01:00:14 – And talk about, and what do you mean by muscle balance? Are you talking to right to left balance, front to back balance are you talking about tightness, are you talking about weakness, you know, whatever. You make it up. So we have these ideas or these concepts that we can balance things, or whatever. I am a physical therapist. I think of balance as the ability to stand on one foot with your eyes closed for 30 seconds. Right? So that’s a different kind of balance, right. Anyway. So when we look at dysfunction, postures, OK, and we look at culture, different cultures. So North Americans, we spent a lot of times sitting down, right? So basically your body adapts to the environment you put it in over time. So if you never lift your arms over your head, sooner or later, you won’t be able to, right?

Andre: 01:01:06 – If you never squat down, I’m talking squat with your feet flat on the floor and bend your knees fully and your hips fully, eventually you gradually slowly lose the ability to do that, right? So, that’s what it does. It does cause shortening of tissue. We can talk muscle, ligaments, capsule, whatever you want. But also there’s a thing too that happens is you actually, the bones change, right? So if you look at a 60-year-old knee, and you look at the size of—if you take a serial X-ray every 10 years of a person’s knee, and you ask a lay person to arrange the order by age, anybody can do it because it looks different as it ages and one of the features is that the joints actually get a little bit bigger. The bones get a little bit bigger.

Andre: 01:02:00 – So that’s why you see an old lady that has joints and you see that bigger knees and knuckles and stuff like that. So my sense is that perhaps what happens in the arthritic process is that we use the term calcification. OK. So, and it was interesting cause I was talking to an orthopedic surgeon because we see calcification in the shoulder, it’s a common thing. So calcific tendinitis is a common diagnosis and basically’s another one of those radiological diagnoses, right? So basically you take an X-ray of a shoulder or an ultrasound or an MRI or what have you, and it will show that the suprasinitus tendon is calcified. So when I say calcification, people visualize a bone, hard right? And the surgeon told me, he said, you know, I operate shoulders. He says, we see the pictures.

Andre: 01:02:53 – But when you actually touch it, it’s more like toothpaste. It’s actually soft. But it’s calcified in a sense that it’s dense. But there is more calcium in the tissue, that’s what makes it more dense and then it starts to gradually get hard. But it’s a relatively slow process. So that bone is bigger, but that the new bone, if you want to call it, is softer than your normal bone. So if you take your joints and you take it to end range, normal healthy end range on a regular basis, you’re pushing the edges. You’re preventing this rust from building up, for lack of a better word. But I like the analogy of rust because people understand, you know, don’t use it, it rusts, right? So when you look at the propensity of let’s say things like knee osteoarthritis or hip, which is basically an epidemic in North America.

Andre: 01:03:48 – And there is some evidence now to looking at countries like in Southeast Asia perhaps and in many places in Africa. And so, and we look at 60-year-olds and the prominence of osteoarthritis, for example. It appears that there’s less of it. There’s some suggestion that there’s less. But I mean there’s a lot of factors involved here, but one of the factors, when we talk about different cultures, there’s different postural habits in a culture. North Americans, and one of them is the use of toilets. They squat because they don’t have toilets. They squat, they have a pit. I was in Malaysia and that was about 15 years ago and had a bit of an epiphany there because I had a sore stomach on the plane and I had a bit of bowel issues. So the first thing I wanted to do when I landed at the airport in Kuala Lumpur, was head to the head, right?

Andre: 01:04:43 – And I opened the door of the first thing and I thought, oh, something’s wrong with this one, they took it out, it’s broken, there’s just a a hole there. And I went to the next one and I realized that’s what they were. And I go, OK, when in Rome. So you squat and then that was just my introduction to Malaysia. And then I started visiting and stuff. And what you’ll notice is that people are squatting on the sidewalk, the shoe cobbler is repairing shoes in a full squat position. A lady dressed in a nice long dress was waiting for the bus. She was squatting on the sidewalk, in a resting position. When I went into people’s homes, they were sitting on the floors with their legs crossed on a little table. You know why that was not easy for me to do that cause I didn’t do it all the time.

Andre: 01:05:28 – Right. And so their level of flexibility as a therapist, I’m thinking like my therapist mind, when you look at the mobility of the joints, and that’s the first thing I do when I see somebody that has pain in the hip and we suspect osteoarthritis is starting, I always look at the mobility of that joint. And invariably one of the first symptoms or signs that you see with somebody who’s developing an osteoarthritic process is stiffness. You lose the mobility of the joint. So thinking around, if you move that joint every day to its full range of motion, not because you exercise, it’s just basically what you have to do based on your normal daily activity. In our house we squat because we don’t have a toilet. So you squat every day, you don’t think about it.

Andre: 01:06:12 – And you’re always able to do it right. And over here we do the opposite. So you have difficulty squatting down. Well let’s raise the toilet a little. You understand? So we can’t squat. So squatting is a normal and quite healthy stretch, if you want to use the fitness term. Actually does a lot of good to your hips, your knees, your pelvis. And also there is a lot of evidence that it helps your bowel movements too. It helps the elimination process because what it does to your pelvic floor, et cetera. So there’s a lot of good to do that. So maybe if you go online and you look at Lillipad, yeah, basically squatting platform, so I did that at my house. I built one, and my wife kind of looked at me funny, but anyways, but squatting is actually quite healthy to do.

Andre: 01:07:07 – So that’s why people who do fitness a lot of things that they do is that. So that covers the lower part of the body. So basically the squatting will basically keep your lower extremities and your pelvis and your hips and your lumbar spine a good balance if you want to use that term. And now, the shoulder, the neck, when we see people lifting your arms over your head. Lifting your arms over your head may sound simple enough. But one of the tests that I do with people is I measure what I call forward backward reach. You basically lift your arms both hands on the wall as high as you can and make a mark. And then turn around, put your back to the wall, your heels on the wall and your hips on the wall and then touch your fingertips to the wall and see how high you can go.

Andre: 01:07:55 – So that’s lifting your arms over your head. I call that forward to backward ratio, right? So if you’ve got your back to the wall and you can’t even reach the wall, that’s a reflection of your shoulder mobility and your thoracic spine mobility, right? So we tend to have round shoulders. So the muscle of the pectorals, the muscles of the shoulder blade and the thoracic spine get stuck in fluxion. And the other thing that happens is we’re talking about shoulder impingement issues, right? When you lift your arms over your head and you stretch up there, you actually stretch the tissues and structures that help improve the subacromial space. So impingement is caused because there’s too much tightness in the subacromial area. And one of the best strategies to improve that is actually stretching your arms overhead, hanging, right? So hanging is proven to be one of the most effective ways to maintain the mobility, not only of your thoracic spine, but your shoulder blades, your scapula, when it actually interacts with your thoracic spine and you lift up.

Andre: 01:08:57 – So think about the handstand against the wall. That’s an advanced way of lifting your hands over your head. Or under your head I guess if you’re upside down, but you get the point. But the thing that it does is if you’re able to do that and you did that every day for 30 seconds, say, it improves the strength of keeping you in that position. Right? Then it’s good. So think about a shoulder press, the shoulder press is basically take a two-pound weight, lift it as high as you can as a stretch and then hold it there and walk with them. Because when you walk then you start to involve the long chains of your body and you get like what I call—the thing about stretching, we’re not specific. I think that the best stretches are what we call chain stretches.

Andre: 01:09:49 – Think of the downward-facing dog, you’re stretching all the posterior chain or I think of a layout on a ball where you’re stretching back or cobra or lifting your arms over your head. You’re stretching your hip flexors. Right. If you keep your pelvis forward. So those are really healthy stretches to do. And I think in our society, if we had two or three activities that you did that every day, then we would help prevent a lot of musculoskeletal issues or things called pinch points or dysfunction from happening. You know, or postural syndrome because we are improving alignment and mobility of these things. So that’s my thing on lifting your arms and squatting.

Chris: 01:10:26 – That’s awesome. So we’re going to have to do this again another time because there’s a lot more we can do there, but we’re out of time. So, really helpful stuff, Andre, and I think people are going to ask you questions.

Andre: 01:10:36 – I love to have questions.

Chris: 01:10:36 – But you’re a Luddite, you told me; how can people reach you?

Chris: 01:10:45 – Well, I mean, I do have an email.

Chris: 01:10:48 – OK, let’s write that down.

Andre: 01:10:51 – Yeah, andreriopel@shaw.ca. So I’m more than happy to respond to email. I do look at Facebook and these kinds of things. Starting to, you know.

Chris: 01:11:01 – Oh, good for you.

Andre: 01:11:02 – I don’t want to spend too much time looking at a screen though. I think I screen time is a very counter to my belief systems. We definitely spend too much time on screen time and I think there’s a direct relationship between health and the amount of time you look at a screen, mental health, too. Thank you.

Chris: 01:11:24 Hey everyone. Chris Cooper here; I’m really thrilled to see you this year in June in Chicago at the 2019 Two-Brain Summit. Every year we have two separate speaking tracks. There’s one for you, the business owner and there’s one for coaches that will help them make better, longer, more meaningful careers under the umbrella of your business. This year we’ve got some pretty amazing topics like the client success manager, how to change your life, organizational culture or the business owner’s life cycle, how to have breaks, how to have vacations, how to help your marriage survive, owning a business, motivation and leadership, how to convert more clients, how to create a GM position that runs your gym for you and leaves you free to grow your business, how to start a business owners group in your community and more. Point here is to do the right thing that will help gym owners create better businesses that will last them for the long term, get them to Tinker Phase, help them be more successful, create meaningful careers with their coaches and give their clients a meaningful path to long-term health. We only do one big seminar every year and that’s the Two-Brain Summit and the reason that we do that is because a big part of the benefit is getting the Two-Brain community together and welcoming strangers into our midst and showing them how amazing gym ownership really can be. We’ll have a link to the Two-Brain Summit, including a full list of all speakers and topics on both the owners and the coaches side in the show notes. I really hope to see you there.

Chris: 01:13:17 See you guys later.

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