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Licensed psychologist Dr. Jen McWaters, and wellness coach Kaitlin Reed, join forces to help women create an abundant life through holistic wellness practices, mindset shifts, and fostering a healthy relationship with food and their bodies. Join us as we take a deep dive and uncover the raw truth about mental health, nutrition, fitness, and beyond, offering insights and strategies for transformative growth.
Dr. Jen McWaters is a licensed psychologist and a holistic wellness coach for women. She is a Certified Integrative Mental Health Professional and is passionate about helping high-achieving women overcome their mental blocks, find freedom from anxiety, and create an abundant life inside and out. Find out more about her work at: awakeningholistichealth.com
Kaitlin Reed is a fitness, nutrition, and mental wellness coach on a mission to help women build the body and life they deserve and desire. She has BAs in Health Promotion and Wellness & Fitness Management, MA in Performance Psychology, currently pursuing her Ph.D. in Health Psychology. Her goal is to help women finally understand the science and strategy of nutrition and exercise so they can achieve their goals and live an empowered life. Head over to kaitlinreedwellness.com to learn more.
DISCLAIMER: This podcast is for educational purposes only and is not intended as medical advice. Please consult with your personal physician if you have any personal medical questions.
Welcome to the Counter Culture Health podcast. I'm doctor Jen McWaters. And I'm coach Kaitlin Reed. We're here to help high achieving women overcome mental blocks, find freedom from anxiety, create an abundant life, and build the body and life that they deserve and desire. In this weekly podcast, we'll uncover the raw truth about mental health, nutrition, fitness, and beyond. Let's get to it.
Kaitlin:Happy Thursday. Thanks for joining us for another week on counterculture health. Today, we have a very special guest on, my brother, Jordan Reed, who is a licensed physical therapist.
Kaitlin:So a few weeks ago, I asked you guys if you had any questions regarding, your training, injuries, aches, pains, anything like that. And so today, we brought Jordan on to answer some of those questions for you guys. So, Jordan, thanks for joining us today, and, hopefully, we can have some answers and, resolve some of these issues for some of our listeners.
Jordan:Yeah. Thanks for having me. I'm I'm happy to be on, so this would be fun.
Kaitlin:Love it. So I'm going to read his bio, and then we will jump right into the questions that you guys had for us today. Jordan earned a bachelor's degree in exercise science and a doctorate of physical therapy. He worked 12 years as a clinical physical therapist across inpatient and outpatient settings with patients ranging from 3 to 102 years old with a variety of orthopedic and neurological conditions. He is currently working in health care administration, but is still passionate about movement, fitness, and optimizing physical function across the lifespan.
Kaitlin:So thanks again for joining us today, and let's jump right into those questions. So question number 1. How important are warm ups before lifting, and what type of warm ups should we be doing?
Jordan:Alright. Well, I'm gonna confess before we even, answer this question that I love a good warm up. So I'm probably a little biased when it when it comes to this question. But, yes, you should you should most definitely warm up before any type of exercise. And so there's a lot of reasons for this.
Jordan:I think everybody knows, you know, when you warm up for exercise, you get an increase in blood flow. You get a you get an increase in core temperature. That helps to reduce stiffness in muscles and tendons and ligaments, which just prepares all of those structures in the body to handle the mechanical loads of exercise. You know, I think too, you know, in in my clinical practice, you know, PTs that work in orthopedics and neuro, we deal a lot with joints. And so maybe that's something that a lot of people don't think of is when you warm up before exercise, you you have fluid in most of the joints in your body called synovial fluid.
Jordan:And so when you warm up and you move those joints, it helps distribute that fluid within the joint. So it just kind of helps to lubricate the joints and and helps them to move easier and better. So yes, you should warm up. Now I'm gonna nerd out just a little bit. So one of one of the coolest things I think about about muscles is there's a lot of, like mechanical properties that and material properties that relate to muscle.
Jordan:Muscle's just a really, really interesting tissue. And so one of my favorite concepts related to muscles and especially when it comes to warming up is a material property called thixotropy. So if you've ever heard of thixotropy but what thixotropy is is it's it's a property of a substance that allows it to become less viscous or more fluid when it's subject to mechanical stress. So that's kind of an abstract topic, but there's one thing that people can can relate to really well when it comes to thixotropic, and that's a bottle of ketchup. So if you've ever been to a restaurant, can they got that crusty bottle of ketchup, you know, that's sitting on the table?
Jordan:If you if you, you know, try to put that ketchup on your plate, it it doesn't go anywhere. Right? Like, it stays in the bottle. It's not moving. It doesn't matter how hard you pound it or how you tip it.
Jordan:It's not coming out. If you put the cap back on and you shake it vigorously for a couple of seconds, what that does is that essentially gets the molecules of that ketchup that ketchup matrix mixed up. It excites those molecules. It becomes less viscous, and it flows out of the bottle a lot easier. K?
Jordan:So your muscles are your muscles are the same way. Your muscles are viscoelastic, meaning, like, they have properties of both, like, an elastic solid and a fluid. And so when you start moving your body and you warm up, that matrix that surrounds all those muscle fibers starts to become less viscous. Those fibers move across each other a little bit easier, and that helps to improve performance. And it might even help, your muscles grow and respond to the stimulus of exercise through a property another property of muscle that's called mechanotransduction, which is another thing related to muscle physiology.
Jordan:Look it up. You know, that's probably a topic for another, podcast. But if you get nothing out of this, basically, your muscles are a bottle of ketchup. And so shaking them up before you exercise, really helps you, respond better, better to the exercise.
Jen:And that prevents injury as well. I would imagine then.
Jordan:For sure. Yeah. Yeah. I mean, you're you're going to improve your the muscle's ability to respond to mechanical stress, which is really what what exercise is. You know, it's it's inducing mechanical stress, you know, into into the muscle, into the joints, into the ligaments.
Jordan:And so, you know, you're you want your muscles prepared to accept the stress that you're going to put to put on it. Yep. You know, and another thing, especially with exercise physiology that that people forget about when it comes to a warm up is the cardiovascular response to exercise. So that doesn't get a lot of, attention, especially when it comes to, like, strength training. But one of the things about strength training is, because of the the contraction of the muscles, it puts pressure on the blood vessels.
Jordan:So that increases what we call peripheral resistance, which means your heart has to pump harder, you know, to get blood throughout your body because the muscles are contracting. So one of the things too a good warm up does is it increases your heart rate. It causes vasodilation, which essentially means, like, your blood vessels just expand so they can accept more volume of blood, and that helps to regulate blood pressure. So I'm sure everybody's seen those social media videos where, like, somebody passes out after doing a big lift. You know, really that that's what happens is their heart was pumping really, really hard, against a lot of external resistance caused by a lot of muscle contraction.
Jordan:And then when that lift is done and they drop the weight, all of a sudden that bottom drops out of that blood pressure. They lose all the blood flow to their head, and they pass out. So, a good warm up can actually help, improve blood blood pressure response, you know, when exercising. I'm in Iowa in the Midwest. And so, you know, that's one of the things that we always, see that first big snowfall, is people have heart attacks.
Jordan:So they go from sitting inside their house to going out and shoveling snow with no warm up. And what happens is they get a really sharp increase in blood pressure. And so if you if you have a blockage or, in a coronary artery or if, you know, you have an aneurysm somewhere, you know, we'll see cardiovascular events, you know, in response to to that. And really, I think, if you had a good warm up before you shoveled some snow, you know, it might help prevent some of that, you know. So, lots lots of good things that that come out of a a really good warm up.
Jordan:So, yes, definitely warm up, before you exercise.
Jen:Jordan, Matthew, what about a cool down and or, like, post exercise stretching? Is that also important or is that less important?
Jordan:You know, I I think, if you are somebody who, you know, needs to work on, some flexibility issues or some mobility issues, doing that post workout is a really good time to do that because you've got all those benefits from that warm up and from that workout. I definitely think, like, if you're an endurance athlete, if you're a runner, if you're a cyclist, if you're a swimmer, doing a cool down is also really important to help your cardiovascular system, you know, recover. You know, I don't see or at least in in my line of work, I haven't seen as much research talking about the benefits of cooling down as the benefits of warming up, especially when it comes to, you know, injury prevention and and prepping the body for movement. But I think, like, psychologically, having a cool down after an exercise session can be a good thing too. You know, it it kinda transitions you from that workout to, you know, doing what else, you know, what else you have to do.
Jordan:But I guess I always see a warm up as kinda necessary for, you know, moving your body, especially if it's gonna be strenuous. I I guess I haven't always, personally, I haven't always placed the same emphasis on a cool down for myself as I have for a good warm up. But
Kaitlin:Yeah. I would say a warm up is probably highly neglected by most people for a couple of reasons. Maybe 1, they have no idea what to do, and 2, time restraints.
Jordan:Yeah.
Kaitlin:So I don't have the time. I barely have time to work out. How am I gonna have time to incorporate this warm up? So what would you suggest to people, on what to do and how long it needs to be?
Jordan:Yeah. I mean, I think there's a, you know, there's a pretty good formula for a warm up. You know, number 1, you wanna start with something to kinda increase your heart rate and raise your core temperature. So, this can be a lot of things. I mean, that could be light cardio.
Jordan:I mean, it could be anything from, you know, briskly walking to working up to a jog to hitting an exercise bike or a row machine. Forever, I've done jumping jacks and jump rope. I mean, that's kind of my my favorite thing. And really that takes me about a minute. You know?
Jordan:So you're looking for something 1 to 2 minutes is all, you know, as far as getting that heart rate up. So I typically do, like, 20 jumping jacks and a 100 rope skips. That takes me less than a minute to do. Then after that, I think the next component of a good warm up is you want to look at some type of mobility exercise. Now this isn't necessarily static stretching, but it's just working your body through, the range of motion that you're going to need for that exercise or directed at maybe some mobility deficits that you have.
Jordan:So, when I do this, I typically look at the demands of the exercise that I'm doing. So for example, you know, this morning, I did some, incline bench and some single leg squats and some RDLs. You know? So what do I need for that? Well, I need, like, some thoracic extension, I need some shoulder range of motion, and I need some hip mobility.
Jordan:So, you know, I did my jumping jacks. I did my jump ropes. I hit some rollovers to v sits. I did some, cat camels. I did some, hip CARs.
Jordan:You know, I did some arm circles, and then I moved right into my, you know, right into some lighter sets before my working sets. So, you know, all of that probably took me, you know, 10 minutes, maybe not even that, 5 minutes. So and I really think that's all a good warm up needs to be for most people is is 5 to 10 minutes. So, you know, if you've got 45 minutes to an hour to work out, you know, you're looking at 5 to 10 minutes, you know, of that of that session, you know, for for a good warm up.
Kaitlin:Yeah. I think that's good to point out. So I think a lot of people think it has to be this long, extravagant Nope. Thing, this plan that they need to put together. So
Jordan:No. No. Increase your heart rate, you know, pick 2 to 3 mobility exercises to work your body through a range of motion, and then hit some lighter exercises or lighter sets before your working set. So body weight squats and push ups are always like a real good bet. You know, that works your upper body and your lower body through kind of a resisted range of motion, and then then you're ready to go.
Kaitlin:Perfect. Question number 2. Best exercises to combat cell phone neck.
Jordan:Alright. So cell phone neck, actually has a clinical term. And so it's it's called, or you'd hear you'd hear therapists refer to it as upper cross syndrome. And so really what that means is that kind of muscles on the anterior get short, tight, and weak, Muscles on the posterior get lengthened and weak, and then you end up with kind of these postural abnormalities of this like you get this really forward head position, the upper back gets rounded. And so really the end effect of this is that the human head gets cantilevered out over the cervical spine, your neck.
Jordan:And so you know, the human head on average weighs between, like, £911. And so for every inch that that neck gets out over the cervical spine, you're, like, doubling the amount of force through the neck. So, you know, if you see somebody that's got a really rounded upper back and it looks like their head's way out over their body, I mean, you're talking about like a chronic load of 60, 70, £80 maybe, you know, through the cervical spine. And so it's really easy to see how, you know, people start to develop issues, like headaches, neck pain. We've seen people that actually develop issues with their jaw and chewing.
Jordan:You can develop breathing difficulties, you know, relate related to this position. And I'm really you know, so I come from the perspective of physical therapists. So, like, we really don't see people in our practice that have, like, mild symptoms. You know, typically, by the time they get to us, you know, they're they have, like, a pretty significant case where, you know, they're having, like I said, the jaw pain. You know, it hurts for them to chew.
Jordan:You know, they're having, moderate to severe headaches, you know, 3 or more days a week, or all the time. They've got chronic neck pain, like those types of things. So I guess I probably speak of this probably from the people that I've seen clinically that have, like, a a pretty significant case of of cell phone neck or this upper cross syndrome versus maybe people that just have kind of the more mild symptoms. And so I think you would you would definitely handle those like differently. The people that we see in clinical practice, we're really doing a lot of manual therapy on them because they have symptoms that need to be managed.
Jordan:They have symptoms that are interfering with their function. They have it symptoms that are interfering with their ability to do their activities of daily living, like like that type of thing. So, you know, we're doing joint mobilizations and manipulations. We're doing soft tissue mobilization. We might do some dry needling, that type of thing.
Jordan:And then the exercise piece of that, you know, we're really working on a lot of, biofeedback and postural retraining with these people. So when you have kind of these big global muscles that are on the outside of the body that everybody sees, so you've got, like, you know, your your sternocleidomastoids on the outside of your neck, you know, you've got your pec muscles on the front. You've got your upper traps and your scalenes and your, you know, your rhomboids and your trapezius in the back. When you have these big global muscles that are involved, a lot of times what happens is those those deep kind of segmental stabilizing muscles, that your body really requires for kind of that joint on joint motion that are that are deep inside the body. They're next to they're actually on your spine is where their attachments are.
Jordan:So like your deep neck flexors, or your suboccipital muscles that are right behind your skull, those muscles get really weak, and they kind of get, like, what we call reflexively inhibited. They just get shut off. And so what happens is you've got all these big muscles that are fired up, and they're tense, and they're locking everything down, and people really lose this ability to kinda like finally control their head and their neck. And so we're really working on a lot of biofeedback with these people. We might use, like, some external sensors to tell people that their muscles are firing when they shouldn't be, or we use physical cues or, some other external cues to kinda help people queue in like, hey.
Jordan:How do I how do I retrain these deep muscles so that I can actually control my spine like segment on segment, or I control can control my head on my neck, because it's really kind of interesting how people with these chronic severe issues that PT see, like, they just lose that ability. So I would say, like, if you've got cell phone neck or you've got upper cross syndrome and it's it's that severe where you're it's interfering with your daily life, it's interfering with your daily function, you're having moderate to severe headaches more than 3 days a week, you're having jaw pain, you really need to get in to see, like, a a PT. You really need that manual therapy. You really need that biofeedback training to kinda get you, you know, where you need to be. So but, again, that's not most people.
Jordan:You know, most people are probably the people that are having those more those more mild symptoms. So I think if you're having more mild symptoms, so you're experiencing just some discomfort, you might have the occasional headache, then, you know, you really need to think about addressing the issue. And that's, you know, stretching and mobilizing what's tight and stiff and strengthening what is weak. So if you think about, you know, one of the things that you see with these people are most pronounced, you kind of see that back that starts to round over and hunch. So definitely want to work on some thoracic mobility.
Jordan:So if you just take that, a soft foam roll, you know, you you lay it horizontally across your back, you lay on top of it, you can do some rolling on top of that, that's great for that thoracic extension, thoracic mobility. If you've got a tennis ball or a lacrosse ball, working that on on your pecs to kind of help loosen up, you know, some of the the those pector muscles that get tight. And then following that up with a that doorway pec stretch, you know, where you're putting both arms on a doorway, you're stepping through, you're really opening that chest up. So that's going to help kind of take care of some of those things that are stiff and tight. And then we need to work on strengthening what's weak.
Jordan:So pinching your shoulder blades together. You know, I always tell patients, pretend like you got a pencil between your shoulder blades, and you're trying to squeeze that pencil and hold it with those shoulder blades. That's great for kind of working on some of that control. And then like any type of rowing motion that you can do is gonna help strengthen up those muscles on the back that get really lengthened and weak. So, I'm a big fan of, like, face pulls is great for for, like, mid traps.
Jordan:Any type of single arm row you can do. I like to do a single arm row, and then once you get that row all the way back, that thumb's underneath your armpit, turn towards that same side, and that kind of pulls in that thoracic rotation a bit, which is another thing that really gets lost, you know, when that upper back gets really gets really stiff. So, I guess, to kind of summarize, you know, if you're having a lot of symptoms, you're having headaches, pains interfering with your day your daily life, activities of daily living, you really need to get in to see a professional. If you're just kinda having more of those mild symptoms, which is most of us, you know, stretch and mobilize what's what's tight and stiff and then strengthen what's what's weak.
Kaitlin:How big of a problem is this today?
Jen:Or is this something
Kaitlin:you thought you would ever see or or deal with?
Jordan:Yeah. I mean, it's kind of always it's kind of always been around. So for a long time, you'd see people with upper cross syndrome that were like, well, actually a lot of like office office workers, you know. So even before we had screens, you know, or screens were everywhere, like, typewriters, that type of thing. But you also see it in some professions.
Jordan:So, like cosmetologists or or hairdressers are like notorious for upper cross syndrome because you think about what they do all day. You know, they're working with their hands at at shoulder or eye level, their heads out and over their bodies, you know, that type of thing. So you would see, a lot of, cosmetologists or aestheticians with upper crossed issues. Dentists and dental hygienists are another profession that's like notorious for kinda having these, head, neck, jaw issues. It's always interesting when you get a dentist with jaw pain and they can't figure it out.
Jordan:You know? But, a lot of their stuff doesn't go below the jaw, you know? So you have to kinda help them, you know, connect those dots. So so it's been around for a while, but but now I think that everybody has a cell phone. I mean, you definitely see it more.
Jordan:You know, my my wife, when we're out in public always tells me to, like, stop staring because one of the things you do as a PT is you're always, like, checking out people's posture and you're, like, checking out how they walk. And so, but but, yeah, I noticed it all the time. Like, you'll see somebody. I'm like, oh, man. Like, they really have a have bad upper cross syndrome or, you know, they've got a lot of thoracic kyphosis, which again is that, you know, that hump on the upper back.
Jordan:And, you know, that's something that, especially for women, you really wanna pay a lot of attention to. You know, if you develop a really stiff thoracic spine, you know, as women age, as they lose bone mass, if they get osteoporosis, if you've got a really curved thoracic spine I should probably explain what that is. So your thoracic spine is the segment of your spine between your neck and your low back. So it's 12 vertebrae between your neck and low back, and you'll see that kind of people will develop a hump. Well, as you lose bone mass, what happens is because that spine is curved, you get more pressure on the front of the vertebral body than the back, and you'll develop what's called a wedge fracture.
Jordan:So you get so much pressure on the front that the front of those vertebrae will actually collapse and fracture. It's very painful. And so, especially women wanna pay attention to that and make sure, like, hey. Like, I'm watching my posture. I'm doing thoracic mobility exercises.
Jordan:I'm making sure that, you know, my neck and my chest are stretched out, that my muscles, especially in my back, are really strong, you know, that type of thing. Taking breaks during the day, you know, stepping away from the screen to walk and and move around. You know, and that can be as simple as taking, like, a 5 minute break every hour. You know, this isn't anything that really has to interfere with your work, but step away from the screen, stand up straight, pinch those shoulders back, and then, you know, you can get back and and move on with your day. But, can be a can be a big help for people and help them to avoid a lot of issues in the future.
Kaitlin:Great answer. Question number 3.
Jordan:Alright.
Kaitlin:I'm hypermobile and my hips dislocate and misalign making working out really hard at times. What should I do?
Jordan:Yeah. This is a really good question. So, when it comes to, like, joint hypermobility, I guess like how we would think of that clinically is, a PT would think when somebody says hypermobile that that's just the joint's ability to move beyond its normal range of motion. So, that can just be like a characteristic of some people, like a stand alone trait. So, like, you know, you'll see people, like, they do the party trick.
Jordan:Like, hey. Look. I can bend my thumb back to my wrist or, you know, something like that. So so some people might have that just kind of at, like, one joint that's just kind of a characteristic that they have. You'll see some hypermobility too also as, like, an adaptation to to training.
Jordan:So, for example, you know, you look at gymnasts. I've had a few gymnasts as patients, and they they will and dancers for that fact too. They will actually spend hours, like, stretching their feet into what's called plantarflexions. Like, you think your toes down or standing on your toes. They'll spend hours stretching their feet into that position so they can get that perfect point during their routines, because they get they get points for that.
Jordan:They get scored on that. So, like, that would be an example of hypermobility that's a result of a training adaptation. Baseball pitchers are another great example. I've worked with a few baseball pitchers, and, man, if you see, like, a a semi professional or professional baseball player that pitches, it's not abnormal for them to have, like, a 120 degrees of shoulder external rotation, which is just like you put them on the table, and it's like crazy. Like, you it just is one of those things that's just like that's not natural.
Jordan:Like, you shouldn't move like that. But it's an adaptation to their training because they've done that so much. So so when I hear the word hypermobility, like, that's what I kind of think of. So it doesn't always necessarily mean it's a bad thing. But I think with respect to this question, the person might be using the term hypermobility and ligamentous laxity, like, interchangeably.
Jordan:And so when a PT hears ligamentous laxity, at that point, you know, like, we're kinda thinking of a a condition where the connective tissue for that person is is, comprised in some way. So so or compromised in some way. So, ligaments are connective tissues that connect bone to bone, and so your how much those ligaments stretch or how much they can move is actually genetically dependent. So, your genes that you have just kinda determine the the how your your connective tissue is compromised. And so some are comprised.
Jordan:So some people have a lot of ligamentous laxity just naturally. Some people have very little, and then that ligamentous laxity just kind of occurs on a spectrum. So, you know, you might see some people that can, like, touch their nose to their knees, you know, or put their feet behind their head or something like that. You know? And they're ligamentous ligamentously lax.
Jordan:And then you have that can extend, like, all the way up to people that have, like, a diagnosable condition, like Ehlers Danlos syndrome or Marfan syndrome where their their ligamentous laxity can actually be, like, pathologic in some case. Like, they will just randomly dislocate joints because their ligaments are so lax. So this person sounds to me like maybe they might have, like, ligamentous laxity versus just hypermobility, if that makes sense. And so when you have people that are ligamentously lax, you definitely need to have some considerations when it comes to, exercise, the type of exercise that you do. Kind of the first principle when somebody has was ligamentously lax is, you wanna develop proximal stability before distal mobility.
Jordan:So this is a real, kinda like prevalent theme in in physical therapy, and it comes out of, like, movement development. So if you think about a baby, when a baby starts to move, well, what are some things they do before they before they start walking? Will they they get on their belly? They're able to control their head. They can roll side to side.
Jordan:They can sit. They can get up on all fours. All of this requires proximal stability, so so stability around the the spine, stability around the shoulders, stability around the hips. You have to develop that stability before you can move your limbs. And so when somebody's ligamentously lax, the first thing that I would do is I would actually assess, like, their core strength and their ability to stabilize their shoulders and their hips.
Jordan:Because if you don't have that, then you probably should shouldn't be or should at least be extremely careful about exercise at other joints, because you have to have the you have to have the stability proximally before you can have strength and mobility distally. I always tell people it's like firing a cannon out of a canoe. You know, you can't shoot a cannon out of a canoe. It's it's just not gonna it's not gonna go anywhere. Like, you've gotta have a base, you know, for that before you can produce any external force.
Jordan:So that's probably the first thing is, like, assessing core strength, core stability, shoulder strength, hip stability. So I'll stop there before I ramble on more.
Kaitlin:Okay. Final question. I had meniscus surgery on both knees. I want to be able to squat, but my left knee always hurts. What should I do?
Jordan:Alright. So we could probably, like, do a whole podcast series on, like, exercise and training, post surgery, post injury. This is a, like, a really, really loaded topic. So, I think I'll start, like, they did not they just said meniscus surgery. And so this individual didn't tell me, like, what type of meniscus surgery they had.
Jordan:So there's, like, different types of meniscus surgeries. You can have, like, a debridement where an orthopedic surgeon would go in and they would just, like, clean up parts of the meniscus so it's not catching or locking or popping or being otherwise painful, all the way up to, like, a meniscus repair where they would actually sew the meniscus together, and it would have to heal. And that's a pretty big surgery because it it actually involves, like, prolonged non weight bearing so the meniscus can heal and that type of thing. So I'm gonna be pretty general with my response, here just because I don't know, like, what type of surgery the patient had, so it's really hard for me to give, like, a specific answer. I'm also, I guess, kind of operating under the assumption that, if they've had meniscus surgery and they're asking questions about wanting to squat, like, they've gone through appropriate course of recovery.
Jordan:They've worked with a PT. They've been cleared by their PT and their surgeon, you know, to resume exercise and normal activity. If this person has not done that, they absolutely need to get clearance before they return to activity. So, and and number 1, that comes down to the orthopedic surgeon. So they're they're the one that was in there.
Jordan:They're the one that did the surgery. They're the one that's gonna have the best idea, you know, about the tissue's ability to, you know, handle that stress. So if you've been cleared for activity, you can pay attention to what I'm going to say. If you haven't been cleared for activity, please don't pay attention to what I'm going to say after this because you really need to get clearance, and go through an appropriate course of recovery, before you've done this. Also, if you've had surgery and you haven't done PT, like, get yourself to a PT.
Jordan:Like surgery and the recovery process and pain like changes everything there is about movement, and I have never seen anybody with a good outcome that decided not to do PT. Like they always have some type of residual issue that keeps bothering them. So, if you haven't done PT, get to PT. Alright. So let's get to the question.
Jordan:So they have meniscus surgery. We don't know what kind. They wanna do a squat, but their left knee always hurts. So physical therapy is really goal driven. It's like all about, hey, what does the patient want to do?
Jordan:What do they need to be able to do? And how can we get them to do it? So, you know, I guess the first thing I would ask this patient is like, why do you wanna be able to squat? What do you mean by squat? Because there's lots of different types of of squatting, and why is it important that they return to this type of activity?
Jordan:So if this person, you know, just wants to be able to do a bodyweight squat for functional reasons, like, that's really important. Like, squatting is is perhaps, like, the most functional movement, that a human does. It's involved in almost every single type of movement activity. So if this person can't, like, bodyweight squat, like, that's definitely something that we wanna get them back to. If they're talking about squatting for exercise, then I think we need to talk about, like, assessing their movement and what modifications we might be able to do, to kinda get them back to some type of squatting for exercise.
Jordan:So, the assessment, you know, we really need to look at the joint mobility. Joint mobility, and strength and control that the person has. So people that go through, knee surgeries or have knee issues are typically very stiff at their ankle. So they lack a lot of what we call ankle dorsiflexion. So that just basically means your ability to, like, pull your toes up and be on your heel.
Jordan:And when you squat, if you don't have ankle dorsiflexion, what happens is you get a lot of anterior stress on the knee, which if you've had a meniscus surgery is just gonna compress wherever that surgery was done. So number 1, we're looking at mobility at the ankle, especially ankle dorsiflexion. Number 2, we're looking at mobility at the hip. So again, people that have had knee surgery typically have reduced mobility in the frontal and transverse planes of their hip. So they have trouble with movement where their hip has to go away from midline and back towards midline, and then they have trouble with rotation.
Jordan:So we need to assess, hip abduction, hip adduction. We need to assess hip external and internal rotation and see where there might be some deficits there. People with knee knee surgery and knee problems also typically have very poor, eccentric control of hip internal rotation. So I said a lot of physical therapy words there, but basically, people can't control their leg turning inward. So not only does this happen a lot after knee surgery, but it probably is a mechanism that contributed to their knee problems in the first place.
Jordan:So typically, they have very weak hip AB ductors and hip external rotators. So these are the groups of muscles that are like underneath your glute max, underneath your big butt muscle. You've got a bunch of muscles underneath there, that are actually really important and help control, not only hip motion, but like motion of the knee. So that whole rotation at the knee piece. So, we typically need to assess these muscles and make sure that they're strong and that they can control that hip motion because what happens when you squat so as you squat down, you actually get internal rotation of your hips, so your knees will turn inward.
Jordan:So if somebody has poor hip hip control and they can't control those legs turning in, that's when you see those knees collapse during a squat. So, again, that causes a lot of medial and anterior stress on the knee, which is probably right where that meniscus surgery was. So, like, those are the types of things that we're thinking about kind of from assessing the person, ankle dorsiflexion, hip mobility, especially in the frontal and transverse planes, and then those hip external rotators and abductors, we wanna make sure that they're that they're strong and that they're, working correctly. So that's probably the first thing. So looking at at some exercises to target that.
Jordan:And then secondarily well, actually along with that, we're probably looking at modifying the squat in some type of way. So I think to have, you know, bilateral knee surgery and then expect to like throw a bar back on my back and like be able to squat like before the surgery is probably not a realistic goal. So again, as a PT, we're working with people to establish, like, realistic goals related to their recovery and their functions. So, we really need to work at, like, building that squat back up from the beginning. So, again, we're breaking that movement down.
Jordan:What are the parts of the squat that we really need to work on? Well, the first thing you do when you squat is you hip hinge. You know, so those hips have to come back. You've got to brace those those core muscles and those muscles of the lower extremity before you can bend your knees and get down in a squat. So we're probably retraining a hip hinge with this person, and then we're probably moving into, like, some Romanian deadlift type of progressions too, so that we're really working on strengthening that pattern of of movement because that's how the movement starts.
Jordan:And if that movement's not strong, the rest of the movement, is not gonna be very good either. And then we really have to look at, like, progressing progressing the squat, which is really gonna be like a regression from where that person was. So, like, I'm talking like, hey. We're gonna start with a body weight box squat. You know?
Jordan:And then we're maybe gonna move into body weight squats. And then we can maybe move into, like, a goblet box squat, and then maybe a goblet squat. And then maybe we're working on a barbell backs box squat before we're even moving into a barbell squat. So there's like 6 different exercises or 6 different progressions that I would put a person through. And so if you're looking to get back into, like, full heavy barbell back squatting, you're looking at, okay.
Jordan:How long does it take to produce adaptations in each of those exercises? Well, probably 6 weeks. And I've got 6 different exercises. So now I'm 36 weeks, and now I'm 8 months. So somebody so somebody with bilateral, somebody with bilateral knee surgery, you know, so we're assessing those those limitations at the individual joints.
Jordan:We're building foundational movements, you know, to get back into that that movement that they wanna do, and then we're building a progression of that movement. So, really, you you know, your time of recovery here, we're looking at, like, 6 6 to 8 months to get back into, like, a full barbell back squat, which is what I kind of assume, like, this person is is asking about. You know what? Okay. I'll stop there.
Jordan:Any any questions on that piece?
Kaitlin:I don't think people wanna hear that.
Jordan:No. People people absolutely people absolutely don't wanna hear that, but but that's something that as PTs, we deal with all the time. You know? And so, you know, that's kind of a classic one from, like, parents that have kids that have, injuries. You know?
Jordan:So you've got the 17 year old football star that tears his ACL and let the parents like, oh, they're gonna be back for, track or they're gonna be back for baseball. And I'm like, that's 9 months. And they're like, well, so and so professional athlete did it. And I'm like, okay, time out. Like, number 1, they're a professional athlete, which means they have access to, you know, the best medical resources, the best recovery resources, the best nutrition, the best the best trainers in the world.
Jordan:So number 1. And number 2, like, they're a freaking professional athlete. So, like, professional athletes are professional athletes for reasons besides their athletic ability. Like, you know, they they made it that long because they're durable. So, you know, so, if a professional athlete, like, got there in 9 months, like, what makes you think, like, your kid's gonna get there in 9 months?
Jordan:And it's kind of the same thing, like, when we're dealing with other people. Like, I know you want that, like, immediate thing and you wanna be back right away, but, like, I can get you there, but, like, here like, here's what it has like, here's what it takes, and it's like a full time job to do that. So, like, if you're not committed to doing that, then it's gonna take you a little bit longer. And that's that's fine. And that's fine for most that's fine for most people.
Jordan:But again, you know, unless you're willing to commit 3 to 4 hours a day to to your recovery and getting back to what you wanna do, it's just gonna take you a little bit longer, than maybe what you saw a professional athlete or or somebody like that do. So just thing just things that you have to consider. Yeah. So for this person, you know, probably, you know, they have meniscus surgery. They've got some pain.
Jordan:You know, you're you're talking probably again in that 6 to 9 month window before you're feeling good enough to put a bar on your back and and get into some squatting. And then you have to ask, well, like, is that an appropriate thing for that person to do? You know, and that kinda gets back into that whole risk versus reward type of thing. So, one of my one of my little things is, like, especially if you're older than 35, like my number one rule of training is like don't get hurt. And so, you know, I always say that because, as you get older, like it's much more valuable to your health and your longevity to maintain your ability to keep training than it is to achieve some outcome on any particular session of exercise.
Jordan:Like, you're gonna get you're gonna get much more out of the cumulative effect of training than than you're gonna get from hitting 1 more rep or adding 10 more pounds for that one exercise. So for this person too, you know, I might ask him, I'm like, well, what's it worth it? What's it worth to you to keep back squatting? Like, is it worth knee pain? Like, is it worth, like, not being able to, you know, engage in moderately intense aerobic activity, which if you're a little older, from like a cardio respiratory health standpoint, you know, that's probably more valuable to you.
Jordan:I mean, 40% of the deaths in the United States are because of cardiovascular disease. You know? So, you know, it's it's much more important for you to maintain your ability to train than it is for, like I said, any one particular exercise or or one particular, you know, session. So you definitely wanna, for this person, they they probably wanna ask themselves, like, you know, could the goal that I have for myself be accomplished with something that's, like, repeatable, sustainable, and progressable? You know?
Jordan:So so maybe, you know, maintaining lower extremity strength can be done and maintaining lower extremity muscle mass can be done in a variety of ways, you know, that probably have a better a better chance of them exercising throughout their lifespan than, like, barbell back squats. So that's probably a conversation I'd have with this person too is, you know, say, like, hey, maybe we should maybe we should think about other alternatives for you that, you know, you could do safer for longer that would keep you healthier. So but I understand. I love to squat, so that that'd be hard for me to give up too. So
Kaitlin:Well, that was gonna be my comment. Some of it is like ego work, taking your ego out of it and Yep. Acknowledging the circumstances and and where you are and what's best for you.
Jordan:For sure. You know? But again, you know, you know, back back squatting is great, you know? But, if I've got, you know, knees that have, you know, had, you know, bilateral meniscus surgery already, like, how long how much longer can I do that before, you know, I'm looking at it impacting my ability to do other things? You know, I don't know.
Jordan:And and some people get back into it, and it's and it's just fine. And that's another thing that kinda comes back to this whole time frame thing. Like, if you wanna continue to back squat and do it for a long time without problems, like it would be in your best interest to do that the right way and do it over a prolonged period of time, kinda how I laid it out rather than get impatient with it and just say, I'm gonna, you know, I'm gonna do it no matter how I feel. You know, you might end up with some other issues.
Jen:I have, a bonus question if it's okay, Jordan, to throw this at you.
Jordan:So I
Jen:was thinking about it as you were talking. So in my work, I often come across folks who have pain, chronic pain oftentimes, or pain that manifests as a result of, for example, high anxiety of complaints who complain like back stuff where they have this back pain that's very mysterious, and they go to the doctor and nothing's wrong with them. Yep. And I think all of us would agree that there is this relationship between pain and our emotional world, our mental world, so the psychological components of pain. And even when I've worked with the p t PT myself in the past for an injury, we had this conversation and and he mentioned, yeah, sometimes people come into the office and I actually think it's more of a psychological thing that's manifesting as a physical pain rather than a biological cause.
Jen:So I'm wondering what just your thoughts on that. Like, have you come across that, and what do you recommend to those clients who you suspect might have this psychological component to their pain issue?
Jordan:Yeah. So, I actually have a colleague who is an expert in this area. So when things like this come up, I defer to her. And if you're looking for a really, really good podcast guest in the future on this topic, I'm sure she would be willing to talk to you. So so that's one thing.
Jordan:But yes. So pain is pain is really, really interesting. And I think I think people, tend to think of pain as kind of this, like, one response to something. But one of the interesting things about pain is, when you when you take somebody and you put them in like a functional MRI machine. So that's an MRI machine where it can look at, kind of live activity within the brain.
Jordan:So it's not an MRI where it's like taking a still picture essentially. A lot of times what people do is they'll get some type of, I don't know, sometimes it's like radioactive glucose or something like that that that people will take. So you can see, like, the uptake in the body at at in real time. But one of the interesting things that they do is they put people in a functional MRI, and then they give them a painful stimulus. So they look at an MRI of the brain, when a painful stimulus is applied.
Jordan:And one of the interesting things is, like, the entire brain lights up during a pain stimulus. So it's not just that kind of, like, somatosensory area in the brain that we typically think of. It's like you get, you get that area lighting up, but you also get, like, areas of the brain associated with memory lighting up. You get areas of the brain associated with oh, we froze up again. There, I think we froze up again.
Kaitlin:Yeah. You're good.
Jordan:You get that somatosensory area lighting up, but you also get, areas of the brain, you know, connected to emotion. You get areas of the brain connected to memory. You get areas of the brain, associated with executive function. You know, sometimes even areas of the brain related to sensory processing will light up. So it's like really it's just like really interesting.
Jordan:So pain is really I think it's evolved a lot as research on the brain has expanded and we've gone from thinking of it as kinda like this, you know, singular, stimulus response type of thing to really recognizing that it's a whole, kind of like psychosocial somatic experience. And you see some clinicians like like my colleague that's approaching it in that way. And you definitely start to see, like, some of the connections that you were talking about, Jen, where, you know, that that physical manifestation of that pain can certainly be related to, other, biopsychosocial issues, that are occurring. And that pain is not always correlated with, some type of, anatomical or physiological pathology. And so you see that a lot too.
Jordan:And, you know, one of the things that I always tell patients, like especially patients with back pain, you know, the vast majority of the population has, anatomical pathology in their spine. So, you know, if you if you took a cross section of the population and you put them through an MRI machine, you'd probably find something. You know, you'd find arthritis, you'd find stenosis, you'd find herniated disc, you'd find impinged nerves. But those findings don't always correlate with people that have low back pain. So you'll also find a bunch of people that have all that stuff going on, and they're like, oh, yes.
Jordan:News to me. I'm completely fine. I've never I've never had back back issues. And you'll also find people that have those same issues, but they have debilitating pain. And so that's kind of another thing, you know, that I always communicate with patients is, like, you know, pain doesn't always equal dysfunction and, like, dysfunction doesn't always equal pain.
Jordan:And so when you're having those types of issues, like, sitting down with somebody that understands them, sitting down, you know, with multiple professionals, you know, so sitting down with somebody, that can do, you know, behavioral or mental or emotional health counseling is really important, especially when you've been dealing with chronic pain. Working with a physical therapist on activity modification and lifestyle modification is an important thing. You know, nutrition is a large component for a lot of these people. Typically when you have, this population, you know, substance abuse can be very, very common. So, you know, and, you'll see, you know, not just drugs of abuse, but maybe abusing medications that have been prescribed by a physician.
Jordan:So, you know, it really is pain really is multidimensional, especially chronic pain, like, is multidimensional. And so it should be addressed in that way. And, again, you know, one thing I always tell patients too is, like, your pain is your pain. Like, you own that. So, you know, if you're working with somebody and they're dismissive of your pain, like, find somebody else to work with because you're never gonna get you're never gonna get anywhere.
Jordan:You're never gonna make any progress if you're working with somebody that doesn't believe what you're telling them. You know, and that always kinda blew my mind as a clinician is, like, how could you, you yeah, like, how could you kinda dismiss somebody else's, like, lived experience? Like, if they're in front of me and telling me they have pain like they have pain, you know, and it's it's not my job to to, you know, tell people that they aren't feeling the way the way that they are. It's my job to help them find a way, you know, to kinda manage through it and and to get better. So, again I
Jen:love that response because I think that's a more nuanced way to look at it because it is. Often, we're so siloed in the way we're trained as professionals. And so often, I'm sure it's it's hard to have that conversation, or even the patient says, like, no. I believe it's mechanical, anatomical, whatever, right, versus being open to the even the idea that maybe there's also an emotional component. Because I've read cases where people have had just immediate lift of their back pain after actually doing, like, trauma work and releasing something, and then the back pain's gone.
Jen:It's it's kind of wild. The the body is so interesting and complex. I think we just have to always have space for that, that we don't always actually know sometimes the root cause or it's something different than what we thought.
Jordan:Yep. Yeah. And, you know, chronic pain patients, almost I don't wanna say almost always, but but a lot of the time do have some, history of trauma in their lives. You know? And so that's kinda like another thing when you're working with chronic pain patients.
Jordan:Like, you have to understand that, you know, especially when it comes to, like, manual therapy. You know? So, like, I was I was trained as a manual therapist, but, you know, if I'm working with somebody with chronic pain, like, I need to ask permission to do manual therapy because I don't know, like, what type of you know, I always kinda keep that trauma experience in the back of my head, and I don't know what kind of experience that person had. And me putting my hands on them even though it might be in a very gentle way, a way that's designed to help them feel better, you know, might be making some of their pain worse. And so I think that's another thing.
Jordan:Like, if you're listening to this and you have chronic pain, if if a professional is is is working with you and out of the best intentions, they're doing something that's that's not helping you or making you feel worse, or is complicating your situation, like, let them know. Any professional that is serious about helping you is gonna wanna know those types of things. And so just be, just be upfront and honest with them and just say like, hey. Like, I, you know, I really know, like, what you're doing is trying to help me, but but it's not. So can we find something else, you know, that that works?
Jordan:Or is there another alternative or or something like that? So, but those are types of things that, you know, if if you're not informed on that, like, they they just might not know, you know, and they're just doing what their training has always told them to do.
Kaitlin:Are the other questions, Jen?
Jen:That no. That was great. Thank you for that. I know that was a random curveball there. So appreciate your your thoughts on that.
Kaitlin:Absolutely. Ton of great information today. I know I learned a lot as well, and I know our listeners, got answers to their questions. So now they can take this information and, go put it into practice and, take your advice on some of these things. I know I have some work to do on my warm ups.
Jen:Be guilty. I'm back here, like, pinching my shoulder blades together as we're talking, trying to stretch out.
Kaitlin:Thanks. So thanks again for coming and answering our audience's questions, sharing all of your knowledge, and taking the time out of your day today, to join us. We greatly appreciate that.
Jordan:That was fun. I appreciate you guys having me
Jen:on. Thanks, Jordan.
Kaitlin:Alright. We'll see you guys next week.
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Intro:You can find me, Jen, at awaken.holistic.healthandatawakeningholistichealth.com. And me, Caitlin, at Caitlin Reed Wellness and Caitlin Reed Wellness
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