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FC2O Episode 7 - Dale Walker
26 Plays5 years ago
Join me with Dale Walker - soldier, nutritionist, physical training instructor, CrossFit enthusiast, university lecturer and physiotherapist - chatting through nutrition, barefoot training, functional exercise and much more. For many years, Dale was entrenched with some of the world’s most elite fighting forces, including 2 tours of Afghanistan. Dale incorporates a holistic, patient-centred approach to Rehabilitation and is a champion for using movement as medicine.
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Transcript
Dale Walker's Introduction and Background
00:00:00
Speaker
Yeah, that's the first time I saw you in action and it was particularly good as well. I was a physio student at the time so I was the knowledge sponge and I was hungry for information and the information you were giving me was very different from the education that I was getting at the medical school I was at in London and it was kind of more
00:00:25
Speaker
in tune with what I was thinking. I'd already had a degree in exercise physiology and nutrition. I've been an army physical training instructor. So I trained, I was a fitness instructor, I trained lots of people. And then I was venturing as a PT venturing into, into healthcare. And coming across things like the Czech Institute, your work in particular, Grakovetski, did I say that right?
00:00:50
Speaker
Yeah, Grakovec's spinal injury theory, all of a sudden, how can the healthcare system and education process that I'm going through at the moment not know about this? FC2O, from chaos to order, from chaos to order.
00:01:34
Speaker
Welcome to FC2O. Today we have Dale Walker joining us, a soldier, nutritionist, physical training instructor, CrossFit enthusiast, university lecturer and physiotherapist. For many years, Dale was entrenched with some of the world's most elite fighting forces, including two tours of Afghanistan. As a speaker, teacher, clinician and mentor, Dale incorporates a holistic patient-centered approach to rehabilitation and is a champion for using movement as medicine.
00:02:01
Speaker
The key goal for Dale is to work with health promotion and injury prevention so that we can change our behaviour as healthcare professionals from reactive to proactive. In this episode we dive into Dale's work with the armed forces, key influences on his learning and practice and how Dale has applied these learnings in the military, in the world of CrossFit and in his role as a university lecturer. We dive into nutrition, barefoot training, functional exercise and much more. Some of what you hear may surprise you. Enjoy the show, here we go.
00:02:39
Speaker
Well, welcome to FC2.0 with me, Matt Wolden, and my guest today, Dale Walker. Dale, welcome. Good morning, Matt. Thanks for having me on the podcast. Yeah, that's a pleasure. Thanks for coming on. So, Dale, well, I should just do a little introduction. Of course, you have a physiotherapy background and you've been in the forces for how many years have you been? Regular and reserved probably about 22, 23 years. I'm getting on now.
00:03:05
Speaker
Yeah, very old, very old and wise. So when did you originally qualify as a physiotherapist? Was that pre-forces or was that during your time in the forces? So yeah, I left the Royal Marines to become a physiotherapist. I started my Physio qualification in 2002, graduated in 2005.
00:03:26
Speaker
worked in the NHS for a year before going to Sandhurst and becoming a British army officer, physiotherapy officer and then Headley Court and all around the bazaars.
Transition from Headley Court to Stanford Hall
00:03:41
Speaker
Yeah right, that's near me. What's happened to Headley Court these days? Well unfortunately Headley Court has shut down so all that history is gone but things move on, things evolve and
00:03:56
Speaker
It's Stanford Hall now, which is sort of Loughborough way, which is a purpose built building. It's meant to be fantastic. They've got things like the Karen system there, which sort of... What's that? It's like a kind of virtual reality walking space. So you can get gate analysis in this kind of space age platform when you've got the VR helmet on and all that good stuff. We've got one here, a basic in Manchester.
00:04:22
Speaker
at Salford University? No, it's outside Salford University. It's the brain and spinal cord injury research centre, which is just outside Salford Royal. So that's the only other current system I know. And they've got all this
00:04:39
Speaker
I think they're building the skill set that they had at Headley Court. I don't think you can ever replace that skill set. It was at Headley Court because so many great minds were there. That's where I cut my teeth. That's where all my mentors were when I was a young physio. And I was just very pleased to be part of that era. But like you said, things evolve, things move on. Stanford Hall, Loughborough, I'm sure it's, I will take a trip down there at some point, but I hear very good things about it.
Spinal Engine Theory and Movement Understanding
00:05:07
Speaker
Excellent. Yeah, I can imagine. I can imagine, right? Well, so, you know, just to give people a bit of an outline for today, we're going to talk through a number of different areas where Dale and my careers have crossed over the last, well, it's getting on for 20 years. It's probably, yeah, 17 years, I imagine now, because I think our paths first cross.
00:05:25
Speaker
in 2003. Now, I put on an event in 2003 with Serge Krakowski, the guy who wrote the Spinal Engine textbook, who is an incredible wizard of a man, a nuclear physicist who got back pain and then ended up
00:05:44
Speaker
Thinking that he'd need surgery but getting advice from some of his medical friends to say I'd avoid surgery if you can and so he went into trying to solve this for himself and He ended up coming up with this amazing theory, which as far as I know still has not been refuted and this came out in 1988 which is called the spinal engine and the whole notion that the
00:06:07
Speaker
the legs really move from their amplifications of spinal movement. So that's quite an interesting thing which maybe we can dig into potentially as part of our discussions. But so you came to that event, didn't you? Is that right? Yeah, that's the first time I saw you in action.
00:06:26
Speaker
and it was particularly good as well and I was a physio student at the time so I was the knowledge sponge and I was hungry for information and the information you were giving me was very different from the education that I was getting at the medical school I was at in London and it was kind of more
00:06:48
Speaker
in tune with what I was thinking. I'd already had a degree in exercise physiology and nutrition. I've been an army physical training instructor. So I trained, I was a fitness instructor, I trained lots of people. And then I was venturing as a PT, venturing into, into healthcare. And coming across things like the Czech Institute, your work in particular, Grakovecki, did I say that right? Yeah, it is. Yeah, Grakovecki's Spinal Engine Theory, all of a sudden, I'm like, you know,
00:07:18
Speaker
How can the healthcare system and education process that I'm going through at the moment, not know about this? And there was a guy called Steve Hines, who's a Czech practitioner, and he was on the course with me. And he was the best at Moscow's Kalito. I was good.
00:07:40
Speaker
but i wanted to be steve because he was better than me and i was like where where did you get all this knowledge from how do you know these things and he was like what you know have you heard of this guy called pool check i was like yeah yeah you know i met pool back in 2001 you know i've been following his work for a long while i asked when when when did you first see pool's work was that online or did you get a video or something or what was it
00:08:01
Speaker
It was the video, the spinal stabilization or I can't remember what it's called, scientific back training. VHS videos, I was working at BAE Systems and I was one of the trainers there and then we went to FitPro, we saw him in 2001 and then if we fast forward to 2003 when it was purely through Steve that I came to your
00:08:30
Speaker
to your conference and my god did I get some knowledge bombs that day and it really started my journey to be in line with what you were doing already. Yeah, fantastic. And how did it compare? Because I'm quite interested to hear it from your perspective because obviously my background was I had done an osteopathic degree before I saw the Czech system and you were in the midst of your physiotherapy but also had all of your
00:08:58
Speaker
physical training backgrounds. So when you saw the Czech information, did it, because for me it seemed not only what was missing from my osteopathic training, but it also seemed to have gathered, you know, the very best of what I had been able to put my hands on as a researcher doing my Bachelor of Science thesis and then my Master of Science thesis.
Holistic Physio Practices and Educational Simplification
00:09:25
Speaker
And so, you know, I was
00:09:27
Speaker
fairly well versed in some of the very best rehab people on the planet at the time. And then I found Paul's work and it was just he had taken that information and applied it to another level. And so that was what kind of inspired me to go into the system. But how did it compare with what you had seen through your sort of path?
00:09:48
Speaker
Yeah, so I think when you obviously I'm an academic now myself, ironically, but really, it was about implementation.
00:09:58
Speaker
And it was about joining the dots. So when, you know, my students now, the best thing I can do as a kind of a coach or a mentor or as an educator is help them learn by joining the dots. Can you see that this is connected to this, which is connected to this, which is connected to this? And because I did exercise physiology and nutrition,
00:10:23
Speaker
It was obvious to me that we need to be eating well and moving well at the same time. Those two were synonymous for me from that first degree. But when I was doing my physiotherapy training, it was all about movement, exercise. It was very biomedical. But then,
00:10:44
Speaker
we were lucky because we were in London at St George's as well so we had two Australians that were there, one Kiwi and one South African and they brought with that kind of rich mix that you only really truly getting London and it was Lester Jones who changed my mindset. I just come from the Royal Marines, I had a very kind of military mindset if we're talking about
00:11:07
Speaker
you know spiral dynamics i was very blue and i was moving into orange and he helped me transition from blue to orange to green by teaching me the biopsychosocial method and i can remember these series of books in the old school libraries remember books matt
00:11:28
Speaker
Yeah, I do, yeah. Yeah, called topical issues in pain. And, you know, my, you know, my, my brother had a disease called neurofibromatosis. So, you know, he'd had chronic pain his entire life. I was very interested in his journey and helping his journey. And pain was something that was really quite personal to me. But also, you know,
00:11:52
Speaker
you know, it's important to everyone. So the fact that there was not just this biomedical model, that there was a psycho model, that there was a social model, and we might even move on to the biopsychosocial spiritual model that you and I both champion as well. And that was the difference is that rather than this, we were being taught reductionism, when we really wanted the holistic method. Yeah.
00:12:19
Speaker
But by the same rationale, it's difficult to teach the holistic method because you've got to know lots and lots. So if we reduce it to for this problem, we do a joint mobilization. Yeah. For example, and that, you know, using the the Cyriax method or the Mulligan method or or any other method that begins with M that's anti-median. Yes, exactly. I think this is a really interesting thing in education, though, is a really interesting challenge because
00:12:47
Speaker
What I've seen many times now is that you get true masters of a craft, true masters of a given field. And what they do is they obviously try and simplify things down so that it's understandable, so it's easier to teach. And quite often that involves putting things in boxes or in categories.
00:13:04
Speaker
And then of course people start to learn that and they get excited about it because it's the next thing and and You know, you might get people really into let's say muscle imbalance or really into core stability or really into the bio-socio social model or whatever But because it's simplified down I think then sometimes the students looking at it start to almost see the categories that have been simplified as as
00:13:31
Speaker
the truth, as it were. And so to give you an example of this, you know, tonic and phasic muscles, it was obviously something that yonder talks about a lot. Yeah. But but, you know, I'm 99% sure that yonder knew full well, there's no such thing as a tonic muscle, and that all muscles have both tonic and phasic function, tonic and phasic fibers and tonic and phasic motor neurons.
00:13:54
Speaker
but that they have a dominance one way or the other. And so I think he categorized it to simplify it so people could understand. And then the next thing is what I've seen in the last 10, 15 years, people saying, oh, yonder, all that muscle and balance stuff is wrong. It doesn't work because there's no such thing as a tonic muscle. Oh, no such thing as a phasic muscle.
00:14:14
Speaker
I'm sure he just simplified it down so people could understand it. And it wasn't that he was saying there is such thing as just a purely tonic or a purely basic muscle. But we have that challenge, I think, in all walks of education.
00:14:30
Speaker
this sort of simplifying to dumb it down, essentially. But if it's taken too literally, then, of course, people say, well, it's wrong, which is which is true. And it is dumbed down. It's not as accurate as it could be. I think you've hit the nail on the head in terms of this kind of sound bite therapy advice. And, you know, social media can be, you know, it's a double edged sword, isn't it?
00:14:54
Speaker
Yeah so you've got a lot of physiotherapists out there that are busy attacking each other rather than you know focus or attacking other professions for reasons unknown when you know we're all healthcare professionals we care
00:15:12
Speaker
about health and the patient. And I think it can be very damaging when professionals are attacking each other for no other reason than one upmanship. I'm presenting at Therapy Expo again for this year in November. And I see myself as a therapist rather than a physiotherapist.
00:15:37
Speaker
So working with sports rehab, working with massage therapy, working with sports therapy, working with physiotherapy, osteopathy, chiropractic, those into functional medicine. And let's be part of a bigger tribe rather than petty infighting. Let's raise our game rather than be reduced to the level of petty bickering. Yeah, absolutely.
00:16:01
Speaker
and so one of the other sound bites that you hear and my students come to me with this kind of sound bite mentality and it will say all passive treatments are wrong by Peter O'Sullivan who you know is a you know I'm a big fan of Peter O'Sullivan I think he's doing some fantastic work you know with his you know cognitive functional therapies and and stuff like that and and what I like about
00:16:32
Speaker
his work is it, it's the complete polar opposite of kind of what a lot of people have been teaching verbatim. And it really challenges the belief system around that. What I don't like is the fact that he's doing his own research, proving that his method works, ironically, there's no unconscious bias in that research, I'm sure.
Manual Therapy and Patient Empowerment
00:16:52
Speaker
But they, you know, they come to me with this example of
00:16:56
Speaker
Peter O'Sullivan, highly respected physio, someone that I'm a big fan of. I love his work. And they say, get rid of all passive treatments. I'm sure he's been quoted out of context on that one. And I would never. So the great thing about what I do is rather than just as an academic, we also run a student-led physiotherapy clinic, the Manchester Institute of Health and Performance. And here the students can see
00:17:21
Speaker
me in action as a clinician, advising them. And they said to me, I can't believe the amount of hands on manual therapy and passive treatments that you do. I thought you were the exercise exercise guy. And I was like, well,
00:17:35
Speaker
you've got to do this in order for them to be able to move or in order for them to be able to do the exercise. You can't just do the exercise. What are your experiences of working with students and doing that sort of thing, Matt? Yeah, well, you know, very similar. One of the things that I, I guess when I first was heavily into corrective exercise and, you know, rehabilitation conditioning and so on, I perhaps did lean towards the idea that
00:18:04
Speaker
treatment was certainly overrated and perhaps in many instances unnecessary and I wouldn't say that that's
00:18:13
Speaker
far from where I'm at now. But I remember one of the things that struck me at one point was that, you know, if you treat someone, if you think of how we talk about, you know, if you're going to treat a patient, that's one way of saying treat, but also you say, I'm going to take my kids for a treat. I'm going to treat my wife to a meal out or whatever. So if we treat people, then we essentially, we're spoiling them. We're spoiling them. And if you spoil someone, then you ruin them.
00:18:38
Speaker
right and I know that it's playing with English language but at the same time what it's creating is it's creating a potential dependency on you and so the beauty of the exercise approach is that of course you're giving them tools to get themselves better and so you're empowering them with the right tools and it's something they can do in their own time you know so
00:19:00
Speaker
I think L. Edelman in one of his papers, which obviously he's one of the more critical people of manual therapy in particular. And he says that, of course, most people would only go to have a treatment maybe once or twice a week for 30 minutes or so. So when there's 168 hours in the week,
00:19:20
Speaker
well that means you know you've got 167 that you're not getting that influence and so i totally agree with him on that and that's where exercise and self-stretching and self-mobilization can be beneficial but the flip side to that is that you know we are a very social species and we are evolved from chimpanzees who actually touch each other uh you know if you look at bonobos and there's some serious touching going on there but it's a means of
00:19:46
Speaker
pacifying ourselves, calming ourselves, but the sense of touch. And I think, again, sometimes I can be a bit hands off and then maybe I go for a treatment myself, maybe get a massage or something. And you're laying on the table and you're thinking, oh my God, this is so potent and so powerful, so relaxing. I can't believe that I haven't been doing more of this work with my patients. I've been giving them all these exercise programs and lifestyle programs and nutrition. I need to get them on the treatment table more.
00:20:14
Speaker
You know, I would say over the last few years, I've increasingly moved back to ensuring that I get at least some hands on time with the client. As you say, it may be for a very objective reason that they've got restriction in a certain part of the body and we can mobilize that out effectively using manual techniques or at least set them off on the right track.
00:20:33
Speaker
But I think one of the key things in terms of manual therapy and where manual therapists traditionally have been very, very helpful to people, of course, is in relieving pain. And a lot of that may be through their reassurance, through their manner, through touching the patient, letting the patient relax, explaining a story as to why the pain may be there. It might not be the right story, but it's still giving them something to hang their pain on.
00:21:01
Speaker
And so, you know, when you look at the model that Punjabi came up with back in the 90s, which is his model of joint stability, I think it's a really profound model because what he's got, he's got neurology, it's a triangle, he's got neurology at the top.
00:21:16
Speaker
he's got the active system at the bottom right corner and the passive system, the bottom left corner. And so what he's talking about in the joint is he's talking about, of course, you've got nerves, you've got you've got the muscles that control the joint and all the passive structures that hold the joint together. So they're the what he calls the subsystems. And so, you know, when we're when we're giving exercise, of course,
00:21:37
Speaker
we're dealing primarily with the active systems of the muscles, which are controlled by the neural system. So that's kind of where we are a little more focused on those two corners of the triangle. But the interesting thing that we've known for quite a long time, since at least the mid 90s, is that the active system can be divided further into the tonic component of the system, which is more the deeper muscles, the deeper fibers, which are more involved in stabilization and fine motor control.
00:22:06
Speaker
And then the phasic fibers, which are more superficial, are more involved in moving you and generating power and talk around a joint. But the pain inhibits the tonic fibers. So where manual therapy, I think, can have a huge effect in terms of rehabilitating someone is in helping to reduce the pain. So the pain is a neural factor in their experience. And so what we want to do is we want to
00:22:34
Speaker
work with the patient to reassure them to put their hands on, to mobilize, to improve fluid dynamics, improve joint mobility, whatever it might be. And we can do that really effectively with our hands and without clinical interaction. And then by decreasing the pain, now the rehab exercise is going to be more effective. And now the lifestyle change is going to be easier because the patient actually has the space and the energy and the focus to be able to make those changes.
00:23:01
Speaker
Yeah, that's a really nice way of putting
Military Rehabilitation Approach
00:23:04
Speaker
it. I'll give you an example of, so back to my Headly Court days, which is when we were very lucky to be in a military system, it's a tertiary rehabilitation centre. So the soldiers are getting
00:23:21
Speaker
exercise throughout the day, hydrotherapy, balance and proprioception, endurance, cardiovascular conditioning. So they're basically exercising. And then parts of the day they come and see me and we do some physiotherapy treatments. And we basically probably over treated a lot of people, some might say that
00:23:40
Speaker
we did too much of what we did. And I can remember having, you know, I just done my acupuncture course. So, of course, all my patients got acupuncture. You know, I just done my joint mobilization course. So, you know, I was spinal-manipping everyone, you know. And then, so we basically did our kind of our own audit. And so I'd spend a day acupuncturing people or a day doing joint mobilization. But the day that I did massages was on everyone.
00:24:10
Speaker
was the day that everyone got better regardless right right which is you know which is counterintuitive for a hands-off technique yeah definitely definitely yeah very interesting isn't it yeah so I mean what I was gonna
Barefoot Running and Biomechanics
00:24:26
Speaker
sort of dip back into is that, of course, so we had this kind of initial crossing of our pilots in 2003, with Grakovetski there. And, you know, his whole thing, obviously, was this spinal engine concept. And, you know, to link in with Paul Chek's work as well, one of the things that I remember hearing Paul talk about was that
00:24:44
Speaker
When you run, let's say in a standard running shoe on the road or something, he was saying, and this was in 2001 when I first heard him speak in the UK, he was saying, as you strike the ground, of course, all the proprioceptors in the foot and throughout the lower limb are sending information back up into the spine and, of course, ultimately into the cortex.
00:25:15
Speaker
You know, what Grakovetsky has shown mathematically is that the spine will spin.
00:25:20
Speaker
based on the ground reaction forces coming up through the leg. And he said, the moment you start playing around with the joint reaction forces by, for example, putting a cushion shoe between you and the ground. Well, the amount of mathematical computation that the nervous system has to do to adjust to that is just phenomenal. And the speed with which it has to do it. So he was kind of making the point. So no wonder low back pain is a lot of, or is a very common injury amongst runners.
00:25:46
Speaker
And I feel that's kind of an interesting way to look at it, and I was aware of Grakowiecki's work at the time. But you know, one of the things that happened between 2003 and when you and I next met, which I think was around 2010, 2011, is that I ended up becoming the distributor of Thebram Five Fingers, the sort of barefoot minimalist shoes that look like gloves for feet.
00:26:09
Speaker
in 2007 to the UK market so that kind of was set up as a parallel business to my clinical business and so of course I dived right into all of the research around Barefoot and so on and you know ended up speaking at various running stores and to various groups so I had to really develop my thinking around it and one of the things that that actually struck me was that
00:26:33
Speaker
you know, when you when you run on a firm surface, like like a road or, you know, like a firm playing field or running track, then you get a certain amount of ground reaction force. And that, of course, comes up through the leg into the spine, spins the spine, and it takes you through into the next step, which is which is Grakovecki's whole theory that you're actually using the spine as a kind of
00:26:56
Speaker
energy storer and generator. So essentially all of the viscoelastic structures of the spine whether it be the discs that are rotating as the shoulder girdle and the pelvic girdle are counter-rotating during during gates. So you're getting slight torsion and twists through all of the discs
00:27:15
Speaker
which means you're getting slight compression of all the facet joints on one side. And so as you compress the facet joint, the cartilage within the joint is getting compressed, and then it will recoil back out. And those discs with their oblique fibers, they will get torsioned, and then the oblique fiber that's on stretch will recoil back. And so he's saying, essentially, you know, the kinetic energy is hitting the spine, being stored as potential energy, and then being unwound as kinetic energy. So you take the next step forwards. And that's his kind of spinal engine model.
00:27:43
Speaker
Now, the interesting thing is that then if you...
00:27:46
Speaker
If you get someone to then go and run on sand, for example, like soft sand, then of course it's very fatiguing, first of all. But also, where it's fatiguing and where it stresses the most is the abs and in particular the obliques. So around this same time, I was working with an elite sprinter who was training with Linford Christie's group and they used to go down to Wales every couple of weeks to train in the sand dunes and they called it their core session.
00:28:16
Speaker
And the reason it's called session is because if you're running in sand, well, you don't get the ground reaction force. So because you're not getting this ground reaction impulse, the only way you can spin your body around for the next step is to use your obliques.
00:28:33
Speaker
Right. So, so if you're not using this passive system, essentially of, of harnessing gravity within the spine, then you have to use an active system, which is your muscular system. And then particularly in this case, the, the obliques. So I just thought that was kind of very interesting because, um, you know, what you see with barefoot running is that people will tend to forfeit strike, which attenuates some of the shock and, uh, presumably tunes the right level of shock going into up the leg and into the spine.
00:29:03
Speaker
But then if you put them on a soft surface, like sand or like potentially even grass, then you might find, or you do find that they're much less likely to forfeit strike and they may heel strike. So it's like the nervous system is adapting the amount of force coming through the leg in order to get the optimal amount of spin through the spine and not to overstress the spine. And that's how we move naturally in nature, depending on the substrate we're running over.
00:29:32
Speaker
But the moment you put a running shoe on, then of course you're always on a soft substrate, which means that practically everyone, somewhere between 80 and 90% of people, will heel strike when they're in a cushioned running shoe. Which means now you're only really using kind of one of those systems instead of sharing load between forefoot strike, heel strike, maybe even midfoot strike.
00:29:52
Speaker
as you're changing on different terrains. Well, now you're constantly on a soft terrain, so you're just repetitively hitting that same way of running, which again, probably leads to increased propensity to injury due to just cumulative overload of that pattern. So I thought I'd just share that as a kind of link into, the next time we met was in Hereford, and you're obviously working in the forces still with some of the military's elite there.
00:30:23
Speaker
What had you picked up in the interim? Because obviously our paths are kind of separated. I've been involved with the Five Fingers. And the reason I was coming down to Hereford was with the Five Fingers as the UK distributor.
00:30:35
Speaker
Yeah, and thank you. I still have the Vibrams that you gave me. I still wear them. Wow. And they've been to Afghanistan with me twice. Wow. And yeah, I use them for deadlifting, which is when I need that flat surface. But yeah, so when I was working with the military's elite, you were good enough to distribute some of the Vibrams to the guys.
00:31:03
Speaker
And I always think of soldiers as accidental athletes. So they do all this athletic activity, but they don't really think of themselves as an athlete in the same way. They won't sleep enough because the job dictates that you have to do too much. They probably don't look after their nutrition as well. They rely a lot on protein powders because you might not be able to access
00:31:31
Speaker
good quality organic food where you are. I was going to ask, how does that tend to work in the forces? Assuming you're not serving, if you're in the UK, are you being fed specific food by the forces or how much of it is self-contained and how much of it is dictated by the forces themselves? Well, it's all been contracted out to various companies who will go for the cheapest nutrition because of the volume of people they've got to feed.
00:31:58
Speaker
And a lot of the guys that are into eating clean and healthy, and you've got to get there fast as well because military guys like to eat. So if you get there at the end of the lunch hour rather than the beginning, you're having salad.
00:32:17
Speaker
again. So yeah, that's a that's a whole separate subject about the the nutrition side of things in the military. But going back to the original stuff, which is about the the vibrams. Like I said, they're these accidental athletes. So you give them something like a vibram five finger, and then they need someone like me, you know, physiotherapist to tell them no, no, you need to adapt to barefoot running, you can't just you there's a the transistor
00:32:45
Speaker
transitionary period of probably three months minimum before you can go out, you know, and go out and run any distance in these. And the guys literally the next day, Oh, yeah, I did a 10 miler with kit on in the vibrance. And I was like, you are just a lunatic. You know, what did I say? I said, you got to build up to these.
00:33:09
Speaker
Yeah, yeah, yeah. So when you say with Kiton, what could that mean in terms of, you know, to the layperson? Is that, is that, you know, a few pages or a lot? Yeah, they go 20 kilo rucksack on. Right, right. Wow. And they'd be up over the hills with it as well. I'm just doing insane stuff. And these guys are all in great shape. They're all the military's elite. They're highly conditioned. But they don't look after themselves in the same way. They just go, well, you know, I'm, I'm an elite soldier. Therefore, I can
00:33:37
Speaker
I can do this the normal rules of adaptation don't apply to me and we had to you know we had to have some education and some conversations around that just to keep the guys safe from themselves but the other thing so there was this the fact that they didn't want to spend the time transitioning which was the whole the whole thing with the barefoot running when i went through the barefoot running process you know it took me six months to a year to transition
00:34:04
Speaker
And I did it in a graded, careful, monitored way with a little diary recording how I felt and which muscles I felt sore and all that sort of stuff. But that was because of the geeky nature of being a physio. Whereas when we were doing things like speed and agility and jumping and plyometric stuff, those guys wearing the Vibrams, as opposed to those guys wearing normal training shoes, they were quicker, they were faster, they could jump higher.
00:34:32
Speaker
All anecdotal evidence, I can only tell you what I saw in this very small cohort, but it was clear that those that had what my ex-girlfriend, who was a professional dancer, would say, a better relationship with the floor. She used to say, what's your relationship like with the floor? If you've got all this big padding in between you,
00:35:02
Speaker
uh on the floor your relationship is not very good yeah yeah definitely definitely very very interesting very interesting um so uh i mean just just to sort of elaborate on a couple of your points there of course because i was involved in selling the five fingers from 2007 to 2017
Barefoot Training Benefits
00:35:19
Speaker
I was keeping up to speed with all of the research that was coming out and most of it was very beneficial in terms of supporting our whole discussion because of course being barefoot ties in with evolution and how we've adapted to our environments to arrive at this point in time.
00:35:41
Speaker
One of the studies that I recall seeing was looking at well there's a couple of studies which relate the first one was about lifting and what they found that when you lift in in vibrant five fingers compared to in a standard lifting shoe you could lift more in the lifting shoe assuming you're doing a static lift so if you're doing a squat for example so in others your feet are static
00:36:05
Speaker
then what they found was the group could lift more, and I forget exactly how much more, but it was statistically significant in their lifting shoe compared to in a Vibram five-finger. But the moment you start to add movement into it, you start doing things like jump squats or depth squats,
00:36:23
Speaker
then it switched. And so essentially, the moment the proprioception becomes more primary, let's say, or more important to avoid injury, then the guys in the five fingers, or in the five, you know, they're all the same guys, but when in the five finger condition,
00:36:40
Speaker
then they could lift heavier. So that's really interesting, isn't it? Because essentially, the lifting shoe compromises proprioception. The five-finger doesn't. But the lifting shoe also gives you support, stability, it gives you a heel. And so the point is, okay, A, it's changing the biomechanics a little bit, and the kinematics as a result of that.
00:37:00
Speaker
But also, if you imagine that the nervous system can only generate, let's say, 100 units of neural drive at any one moment in time, well, if you have to stabilize your feet and your back and carry this bar in the squat pattern, then you have to dissipate that 100 units of neural drive across the entire system.
00:37:28
Speaker
So that would be in the five fingers. But if you've got your feet stabilized within a supportive weight shoe, well, now you don't have to send so much neural drive to the feet. So you can lift heavier. You can send more neural drive to your prime movers, like your hip extensors and your lumbar erectors and so on. So that was really fascinating and kind of ties in with what you saw. But there are a couple of other studies. One was a jump study, just looking at a vertical jump. And again, the guys that were barefoot or in a pair of minimal issues jumped higher than the guys that were in a tennis shoe.
00:37:57
Speaker
And again, this kind of comes back to what we were just talking about with the sand or with any kind of surface that's squawgy or that gives when you push down on it. Of course, it dissipates energy, right? So then you can't get the recoil back up into the vertical jump.
00:38:14
Speaker
But if you're pushing down against the floor, either barefoot or in a pair of minimalist shoes, well, then you're not losing any of that energy into the structures of the shoe. And so therefore you can jump higher. And that's exactly what this this study shows. But there were also other studies, you know, in particular, there's one with netballers which showed and these were elite netballers and they got them to
00:38:36
Speaker
half of the group to go in standard netball shoes and the others to go bare for a proportion of their training. And they essentially measured acceleration, they measured short sprints, I think it was 30 meters, agility, so they had an agility course, and they measured ankle stability and balance.
00:38:54
Speaker
And basically, in all measures across eight weeks, the guys that were barefoot improved statistically significantly more than the group in shoes. So it just shows, when the foot's allowed to do what it's evolved to do, assuming you do it sensibly, which is a big proviso and a big assumption, then it will start to function better and start to function more intelligently and more efficiently and so on.
00:39:23
Speaker
kind of backs up what you were saying.
00:39:25
Speaker
Yeah, no, I'm delving into the squat movement pattern at Therapy Expo. I'm presenting Bulletproof Your Squats, which is potentially dangerous for a physio to go into the world of squats and talk about injury prevention. But one of the things is that on a lot of people, they do need a heel raise in order to make the squat pattern
00:39:56
Speaker
just more efficient and making sure they're not going into spinal flexion and all sorts of compensatory mechanisms as well. But the other thing that a lot of them forget is that the coaching will generally be about weight back on your heels, weight back on your heels, keep your weight on the heels. Whereas you're not creating the arch in the foot when you're doing that.
00:40:18
Speaker
So, you know, we get them to dry down through their great toe and then obviously kind of push out to create that arch as the foundation of the squat. So the foot is the, the podiatrist will love this. The foot is the foundation of the squat movement and everything begins with that proprioception from the foot that then goes up the kinetic chain. And if you're coaching,
00:40:46
Speaker
weight back on your heels in a in a an elliptic limping shoe or any shoe with a big heel raise then you can forget about the foot and I deal with some pretty high level crossfitters who squat on a regular basis you know they've got some good numbers up but their foot position when you get them barefoot
00:41:06
Speaker
is rubbish. You can almost lift their toes up. So they're leaking power by not creating this stable base. And that's where things like wearing the Vibrams or barefoot training would benefit them massively in terms of proprioception. And that's what they don't see. They just see the load.
Military Nutrition and Eating Habits
00:41:25
Speaker
Yeah. Yeah. So, you know, one thing that I was going to ask you about is you mentioned nutrition and I find it kind of interesting that
00:41:35
Speaker
You know, a lot of some of the really cracking nutritional studies of the last century or so have come from the military because, of course, my understanding at least is that, you know, when your soldiers are out at war, one of the things that's most likely to win that war for you, one of the key things
00:41:53
Speaker
is if your soldiers are well fed and if they're actually able to perform. And so there was, I'm sure you've heard Paul Czech speak before about Major General Robert McGarrison and his various studies. I think he did a lot of it on rats to be fair, but it was also based on his observations on his travels and so on. But he was looking to find
00:42:15
Speaker
how different foodstuffs influence behavior, influence performance and so on and so forth. And, you know, that's a, that was a, obviously, he was working for the British Army at the time, and it was all about optimizing the kind of functional capacity of the soldiers. So it's interesting that we've
00:42:34
Speaker
It almost feels like we've got to a point where we kind of got a school canteen mentality with the army. But I guess that's always going to be the nature of feeding a huge group of people. Well, the flip side of that is the ration packs. So when you're out on exercise or in a remote location somewhere,
00:42:56
Speaker
The ration packs in the last 20 years have improved phenomenally. And a lot of the time it's just being embarrassed in front of the Americans. So the Americans 20 years ago would come over and they're like, what is this rubbish you are trying to make me eat? Apart from this is trash, they wouldn't say rubbish. This trash, this poison, like cans of spam.
00:43:21
Speaker
um uh corned beef hash uh biscuits brown and all these kind of old school things that we we just kind of got on with it and it would it wasn't very healthy it and the studies were done purely on calories assuming that all calories whether they come from whatever macronutrient are the same yeah and and we know that that's probably inaccurate um but
00:43:46
Speaker
So we've gone from this and the Americans have these meals ready to eat, the MREs, which were much nicer and much tastier. So the new ration packs that we have are phenomenal now. Obviously we cater for vegetarian and vegans.
00:44:04
Speaker
There's all sorts of things on the menu now. It's absolutely delicious. I would happily eat a ration pack now because they are phenomenal. So in terms of the man out on the ground, the ration packs are better.
00:44:23
Speaker
good quality food in the officer's mess if you're lucky to be an officer, but in the normal dining halls as well, the food quality is still cheap and cheerful simply because of the volume of people they've got to feed.
00:44:36
Speaker
Yeah, I mean, you wonder, because obviously in the schooling system, certainly here in the UK, partly off the back of Jamie Oliver's attempts and various other sort of media pressure, it does seem like there's an increasing push towards higher quality foods. Obviously, it's still being done on a budget as best it can. But I know a lot of the the sort of state schools now have organic foods within their menu. Obviously, it's not all organic. But it does seem like there's a little bit of a
00:45:03
Speaker
a change in the way things are being seen. So I wonder if that will happen in the forces as well. Well, I'd certainly like to see that as well. But the other thing is that what steets in tradition is the dessert, or we used to call it duff.
00:45:18
Speaker
So you'd have like apple crumble custard or something like that. And it would not be unusual for people to double-duff, which is have two desserts. And particularly when I was in the Marines, we'd eat four times a day. They'd have something called nine o'clockers, where we'd eat our fourth meal of the day at nine o'clock.
00:45:41
Speaker
we were just trying to get in as many calories as we could you know i went down to something like probably about eleven and a half stone on comfortably at fourteen stone i was just sort of skin and bone to send you a muscle tissue ironically probably stronger and fitter than i've ever been.
00:46:01
Speaker
Right. But it was interesting. So the Royal Marines pioneered this kind of eating four times a day, and that significantly avoided injury. I know the Navy SEALs have a system where they're allowed to eat as much as they like through training the same with, I think, our Special Forces selection. They, you know, they have these fantastic feasts, because they know that you're just burning so many calories, you need that good quality nutrition. So I think in some places in the military,
00:46:29
Speaker
you'll get higher quality nutrition than others but there's also a big push towards things like protein powders because after you've done your physical training you probably haven't got the opportunity to eat you've got to go to work or you've got to do another task so you can probably get away with a protein shake rather than an actual meal because there's no way for you to cook there's no kitchenette or anything like that
00:46:54
Speaker
Yeah, yeah. Well, tying in with that, because you mentioned earlier, vegetarians and vegans and catering for them, what's your experience been with people that are putting their bodies through that much stress and eating a vegetarian or vegan diet? Do you think that's sustainable in most cases or did you see challenges with keeping up with the, for example, the body being able to repair and get anabolic again on these diets?
00:47:19
Speaker
Yeah, you know, I've got some bias in the sense of that, you know, a very good friend of mine is a vegan. So he educates me a lot about being vegan and training and how he needs to be cautious with what he's eating, making sure he's getting higher protein and good quality nutrition. So in a place like the military where you eat as much as you can,
00:47:48
Speaker
because you never know where your next meal is coming from. It would be much harder to be vegan, probably fairly easy to be vegetarian. I know quite a few vegetarians in the military now. And the old vegetarian rat packs as well that the gherkas used to have, they would taste the best anyway.
00:48:09
Speaker
So, as far as, what happens is you kind of get this group mentality where the energy of the group keeps everyone going. Regardless, as long as they've got enough calories in, they will continue with everyone else. Because the group mentality, the strength of the group brings them along.
00:48:30
Speaker
Mm-hmm. Excellent. Okay. Okay. Yeah, Paul Chek and I have just done a podcast, which isn't out yet, but we've done it on, we call it The Honest Vegetarian. And so we were looking into a lot of the challenges of vegetarianism and things like obviously fat-soluble vitamins, which are very difficult to get hold of if you're not eating meats and animal products.
00:48:52
Speaker
Yeah, you know, some of the common myths around vegetarianism and veganism, but also meat eating as well. We weren't trying to be anti-vegetarian. We were just trying to put up as much sort of objective evidence as we could, as well as looking at it from multiple angles, because quite often the rationale for why people choose to eat that way may be
00:49:14
Speaker
either misguided or misunderstood or whatever so so we we dig quite deep into that and i was just wondering uh you know whether you had seen anything in terms of you know deficiencies or difficulties repairing but it sounds like not particularly is that has that been your experience well it's really just you know your body's breaking down when you're in the field so um making sure you you know you've got enough multivitamins like the effervescent multivits
00:49:39
Speaker
would be, you know, I used to consume those daily. I used to supplement as well with, you know, cod liver oil, glucosamine sulfate back in the day, whether it worked or not. You know, I felt better for taking it placebo, you can look at it like that. But I think the main problem
00:49:57
Speaker
is that we have got a sugar addiction in the military. And indeed, you know, society, the military reflects society, society, the military. And no matter, you know, matter if you're vegan, vegetarian, pescatarian, or a carnivore, we've all got an issue with sugar. Yeah, yeah, yeah, very nice. Particularly sugar and, you know, things like tendinopathy.
00:50:21
Speaker
And then there's some new, some interesting stuff coming through about things like gelatin and gelatin flakes for tendinopathy and supplementing that.
Collagen and Connective Tissue Health
00:50:31
Speaker
Yeah. Well, we just, we just wrote a paper on that, actually, Mark Sisson and myself. So Mark, I'm sure you're familiar with, but he's one of the sort of leading lights in the paleo world. And we co-wrote an editorial and a practical paper for the Journal of Body Work and Movement Therapy. So that's in the current edition.
00:50:49
Speaker
And yeah, unfortunately, it's behind a paywall. So if anyone's listening to this and wants a copy, they'll have to email me direct. But I'll leave details in the show notes so you can access them. But yeah, I can certainly send them out if people are interested. But you're absolutely right. There's a lot of evidence that shows that when you eat collagen, which is somewhat rare these days in the sort of modern diets,
00:51:13
Speaker
that it gets absorbed, first of all, and second of all, it turns up in the places where you need it, like in your skin, in your tendons, and so on and so forth, in your cartilage. So it does seem that our diet has become somewhat devoid of collagen because we tend to go for the prime cuts of meats. We tend not to use stewed meats and slow-cooked meats and bone broths and things like that so much anymore.
00:51:40
Speaker
And actually also a lot of gelatin is even being removed from desserts where it used to be used and being removed from sweets and stuff. So people could get gelatin through jelly type sweets and jelly type desserts. But even that's starting to be removed in favor of vegetarian style products. And so, you know, we have a real
00:52:03
Speaker
collagen deficiency in terms of what we're actually taking on board. So when you're stressing your connective tissues, which of course is one of the key things that linking back to the barefoot running, that's when we were telling people about transitioning to barefoot running, as you alluded to with the soldiers. If you do it too quick, you get injured because as much as there's a strong evolutionary story for going barefoot,
00:52:28
Speaker
our individual evolution as individuals, how we've grown up and what we've done with our feet throughout our lives is going to dictate how effectively and how quickly we can adapt to that. And of course, the slowest adapting tissues are the connective tissues. So we always used to recommend actually that it would be somewhere probably between six and 18 months for people to fully transition into a barefoot or minimalist style of running.
00:52:59
Speaker
And what we're seeing now is this kind of, the reverse now, the maximal, some of my students have got so much cushioning between them and the ground, it's almost laughable. Yes, yes. And the whole barefoot movement was about minimalists for a reason. So you had this better relationship with the floor. Now with all these maximalist shoes, how can you feel anything? What are your views on that quickly?
00:53:27
Speaker
Yeah, yeah. Well, I've mentioned it on a couple of the other podcasts as well, but, you know, to just reiterate, well, first of all, what the maximum issue idea was, was that we're going to take kind of the best parts of being barefoot, which they see as
00:53:45
Speaker
essentially having a zero drop in the shoe. So one of the things that the whole barefoot and minimalist footwear movement spawned was the idea that pretty much every shoe that we wear, whether it be a dress shoe or obviously for women,
00:54:01
Speaker
more high-heeled shoes, well, not necessarily women, but there are more high-heeled shoes, whoever wants to wear them. And then, but also running shoes have what's called a heel drop. So essentially the heel is higher than the forefoot. And in most running shoes, that's about a centimeter in most cases. So it's quite significant.
00:54:18
Speaker
um and of course what that does is it almost forces the heel strike that we were talking about earlier um and in normal standing of course it pushes your weight towards your toes towards the forefoot so it means that you've become a little more quad dominant in the way you activate your muscles which inhibits the glutes of course if you're quad dominant so there's various sort of
00:54:37
Speaker
rationale where you look at a standard running shoe or training shoe and you think that's not really a very good idea to have that heel drop. So what the maximalist guys do because they said so we're going to take that concept we're going to make our shoes completely flat.
00:54:50
Speaker
But what we're going to do is we're going to add cushioning and we're going to double up the cushioning. So it's like one of the one of the sort of strap lines was it's like running on clouds kind of thing, you know. But but the problem with that is that the human nervous system is designed to tell you where you're at in space. And so if it can't feel where it's at in space, then it will hit the ground.
00:55:09
Speaker
harder in this instance to try to find where the solidity is. And we've known about that since 1984. Nike knew about that since 1984. They published papers from their research department showing exactly that. The more cushioning you have between you and the ground, the harder you hit the ground.
00:55:26
Speaker
Um, so when we, you know, when we look at it in those terms of the nervous system, it makes perfect sense. Um, but yeah, there was, there was a research paper that came out maybe, uh, maybe three or four years ago now when the maximalism thing was just really taking off, um, by Irene Davies and she, she basically showed that
00:55:44
Speaker
When you're barefoot, you have the lowest loading rate through the leg as you run. Put on a running shoe, it's somewhere between doubles and triples the loading rates. And then you put on a maximalist shoe and the loading rate went so high, they couldn't measure it on their accelerometers. It actually kind of broke the system. So it just goes to show, you know,
00:56:04
Speaker
The more you play around with human biomechanics and how it's evolved to function, the more likely you are to get off track. I think that's exactly what happened in that situation. Interesting.
00:56:17
Speaker
Yeah, yeah, yeah. So, and we actually, I think the next time we met after Hereford was in London, and I don't think we realized that either of us were there at this conference. I forget what it was called now, but Daniel Lieberman was there and Ben O'Nick and some real big names in the world of sort of, I guess, gate biomechanics and foot biomechanics and so on.
00:56:42
Speaker
And as we were leaving, we bumped into each other on the tube train, didn't we? Do you remember that? It was a bit of serendipity, a bit of synchronicity.
00:56:52
Speaker
Yeah, yeah, yeah. And so you were then at that point able to sort of give me a bit of feedback on what had been going on with the shoes, with the soldiers you've been working with. And yeah, it was just a nice, like you say, serendipitous catch up on the train. But off the back of that, I think we started to stay in touch a little bit more and somewhere around 2016.
00:57:16
Speaker
We met up in Manchester because with the shoe business, what we had decided was important for the Five Fingers was to try to get more involved with the whole CrossFit scene. And I was aware that you had become involved in the CrossFit scene. So can you tell me a little bit more about how you got involved with CrossFit and where you're at now with it? Yeah, obviously.
00:57:41
Speaker
I'll have a love affair with CrossFit. I really enjoy it. So it was back in Afghanistan in 2010, when I was treating all these US Marines, they were coming in with shoulder problems.
CrossFit Introduction and Challenges
00:57:53
Speaker
And I was like, where are you getting these shoulder? But they were coming in on a daily basis. Where are you getting these shoulder problems? And they said, oh, we're doing CrossFit. I was like, okay, you're doing some sort of cross training. And you go, no, no, no, we're doing CrossFit.
00:58:06
Speaker
Okay, so they eventually took me down to their gym. And there's a particular workout called Fran, which is about keeping pull ups and thrusters. Okay. So
00:58:20
Speaker
Obviously, I didn't know where kipping pull up was apart from my gymnastic day, so I did a kind of modified version of these. So I did that. It was incredibly difficult. I took much longer. They kind of laughed at me. And then probably for the next five days, I had significant delayed onset muscle soreness. I was unable to move my arms above my head. I had trouble washing my hair.
00:58:45
Speaker
I couldn't believe that such a short amount of intensity had created so much catabolic muscle damage. After that, I was just hooked. But I didn't start CrossFit proper until about 2012. I just got into the whole thing. Again, in the army, we were seeing lots of shoulder and low back injuries.
00:59:09
Speaker
I began to understand it. I did my level one qualification and then got the opportunity to work for CrossFit in Berlin as the physio for the Invitational, so working with all the high-level guys, Rich Froney and Sam Briggs, Camille LeBlanc-Bazinet. And then I started doing loads of competitions, so where I was the physio at this competition. And then I went to CrossFit Regionals and I must have worked probably two, three hundred
00:59:37
Speaker
different competitions and what i did because i'm a bit of a geek is i gathered all my data together from every event and i did like a post event analysis where were people getting injured and that was very much depending on the on the ward to work out of the day.
00:59:55
Speaker
Then I went on to do my master's project on functional movement screening. And CrossFit, could we predict who was going to get injured in CrossFit from the functional movement screen? Unfortunately, we couldn't. But what it did highlight is so I followed 100 recreational CrossFit athletes for six months. What it did highlight is the shoulder and the lower back were vulnerable. And then my audit
01:00:21
Speaker
from these 300 competitions showed that the shoulder and the lower back were vulnerable and then the literature also mirrors that. So I had three pieces of evidence and now I run courses, bulletproof shoulder, bulletproof back for just dealing with these particular issues.
01:00:42
Speaker
And really I'm there as an advisor to stop people getting injured in the first place. In many ways, the same sort of advisor you were for barefoot transitioning. Yes, yes, right, right. I don't know whether you have any advice for me about what worked well for you in helping people adhere to your ideals about the health of the transition.
01:01:07
Speaker
Yeah. Okay. So whether they actually followed what we were revising or do you actually sort of give? Yeah. Yeah. Yeah. Yeah. Well, I guess.
01:01:16
Speaker
I suppose it's difficult to know unless you're auditing it, which I wasn't. Because I was involved in distribution, I guess what it was was primarily my role was going out and speaking at a running store that had just got the shoes on board or even run and become in central London. I think I did 30 or more presentations for them across several years.
01:01:40
Speaker
So the point is you're going and speaking to a group and they're probably not going to see them again. So I did get some obviously, again, over the years, many lovely emails from people saying how, you know, their back pain had gone or their knee pain had gone or the advice was useful. So anecdotally, there was there was at least some benefit to people. But I think
01:01:59
Speaker
you know, certainly there were a lot of stories of people jumping into quick, you know, ending up putting additional stress into because you know, what happens when you're barefoot run is that because you tend to forefoot strike, so most people will tend to switch straight to a forefoot strike.
01:02:15
Speaker
Which if you already forefoot strike, because some people just do that naturally, but only quite a small percentage would do that naturally at, let's say, a moderate pace. When you start to sprint, everyone tends to forefoot strike. But really, at a moderate running pace, it's like I said, about 80, 90% of people will heel strike in a running shoot.
01:02:35
Speaker
But so the point is if you switching from heel strike to forefoot strike, then what you're loading a lot more is first of all The second met head. Okay, so you're putting a lot more load through the metatarsal heads You're putting a lot more load through the plantar fascia
01:02:51
Speaker
and you're putting a lot more load through the Achilles tendon. But reciprocally, that means that you're relatively unloading the knee, unloading the hip and unloading the low back. So quite a lot of the time people with knee, hip and low back issues because of running, they start
01:03:06
Speaker
barefoot running, it seems to improve their issues. And probably because they're in injured, they're not going to push themselves too hard either. But if you're relatively fit and healthy, and you just jump into a pair of five fingers or go out barefoot running,
01:03:21
Speaker
Well, in fact, it's more so if you get into a minimalist shoe. And I'll explain why in a moment, what people tended to do was to go, oh, wow, this feels really nice. It feels really efficient. I feel more springy because I'm forefoot striking. And so then instead of following the advice you recommended,
01:03:37
Speaker
they tend to go, and as you said, do 5K or 10K with this forefoot strike, which they've never really used before. And so the upshot is they end up with sore achilles, maybe sore calves, sometimes sore plantar fascia, certainly sore second med heads is very common as well. So those are the kinds of injuries that people would pick up. And I mentioned just a second ago, that tends to happen more in minimal issues than it does if you're actually barefoot.
01:04:04
Speaker
And the reason that's the case is that if you're actually barefoot, then the thing that tends to limit your run in terms of the actual total distance you'll cover.
01:04:14
Speaker
is not your Achilles tendon or your plantar fascia, but it's the skin on the sole of the foot. So the skin tends to be your rate limiting factor
Running Shoes and Biomechanics
01:04:23
Speaker
if you like. So if you imagine most people in this day and age, if they were to take their shoes off and go out for a run, they're not going to get that far before the sole of their foot starts to feel a bit blistery, a bit uncomfortable, and they're probably going to stop at that point and either walk back or maybe they're carrying their shoes in the backpack or whatever, and they'll stick them on their feet at that point.
01:04:42
Speaker
But so if you're thinking of transitioning to barefoot, it is a better idea, if you can, to actually go purely barefoot as opposed to going in a minimalist shoe, I would say. But yes, back to the original question, I would say that it was probably taking a complete guess. I would say it's probably less than 50% of people that would actually follow the advice fully in terms of making that transition.
01:05:10
Speaker
Yeah, that's that's pretty similar to what I've got. What I did was what I always do is I divide sort of my athletes into four categories.
01:05:20
Speaker
So you've got the beginner, someone that's new to barefoot running or someone that's new to CrossFit. And they're vulnerable. They're vulnerable to injury because they haven't got the motor skills, they haven't got the physiological adaptations. And then after they've been doing that six months a year, whether it's CrossFit or barefoot running, they're kind of recreational. They have adapted to the load. And as long as they stay at that load, in actual fact, they're relatively risk free. And then the next
01:05:50
Speaker
level of vulnerability is when they when they want to do a race they've got a 5k race or 10k race coming up or a crossfit competition and they up that training load again and that what makes them more vulnerable and then finally that there's the elite category who uh you know the genetic freaks um they're symmetrical they're
01:06:10
Speaker
that they've been adapted to the task for a long period of time and they can run 5k, 10k barefoot every day. They can cross for every day and it doesn't really seem to make any difference. Have you found something similar with your guys? Yeah, I would say that that's certainly been the case. I mean, we had a guy who is an elite runner. He was a, what's it called? Trying to think of the Hawaii Ironman.
01:06:38
Speaker
come to me in a moment, but it's where they do the world championships in Hawaii every year. And so this guy was in the category, it's called Kona, isn't it? K-O-N. Yeah, that's right. And so he had qualified for Kona a few years in a row in his standard running shoes, but he'd ended up getting an issue with one of his flex antennas in his foot. And so he'd had to have surgery on it. And
01:07:04
Speaker
The surgeon, of course, himself had taken various MRI scans before doing the surgery and so on. And then this guy basically said, whilst he was rehabilitating, he was looking at the fact he had qualified again. This was probably around 2010, 2011, but Kona was only three months away. And he was thinking, can I get myself back up to the fitness level to compete in the World Championships?
01:07:33
Speaker
you know, given the fact I've just had surgery. And so because he couldn't train, he was reading around and he found all this information about barefoot running. So he approached us to see if he could get a pair of five fingers. And we said, yeah, you know, he sent him a pair and, you know, explained the transition and he transitioned.
01:07:50
Speaker
like I say, in three months. So he ran, I mean, of course, he was a super elite athlete prior to his surgery. So he obviously had a tremendous base. But he went straight into wearing the five fingers. And three months later, he's competing at the World Championships. And he got through the whole thing, no problems. And from that point on, he was sold, he basically wore the five fingers every year from there on in.
01:08:13
Speaker
Wow. But the interesting thing with him was that I got to meet with his surgeon probably four or five years down the line because this surgeon is one of the few foot surgeons in London who is very pro barefoot. He said most of his colleagues are still very much on the orthotics
01:08:29
Speaker
bandwagon, as it were. And not to be negative about orthotics, but he had kind of, in his words, kind of seen the light that if you support something, it gets weaker. And if you allow it to work or encourage it to work, it gets stronger. And so he was now using this approach with most of his surgical patients in their rehabilitation. And he said, and the amazing thing with Steve, this athlete, was that he said, I've got the MRIs from before I operated on him.
01:08:59
Speaker
And I've got the MRIs from him now. And he said, it's like a different person because it's the foot's about twice the size because of the hypertrophy in the, so not twice the size, of course, in terms of length, it widened quite a lot, but it's the thickness of it. And so all those intrinsic muscles, even the extrinsic tendons coming into the foot, everything had thickened right up. The skin had thickened up the fascia, the fat pads. He said, it's about twice the thickness of what it was before.
01:09:30
Speaker
So I never actually got to see it, which is a shame. But so that's an example of an elite guy. We had another elite coach who worked with, again, with a lot of international athletes. And he did exactly the same. He recognized the benefits of forefoot striking in terms of minimizing impact, optimizing energy capture and return in the gate cycle. And that this tends to happen when you forefoot strike.
01:09:58
Speaker
And so what he said, sorry, that tends to happen when you wear minimalist shoes or go barefoot. So I don't know if you recall them, but there was a footwear brand called Newton's and they got fairly big for a period of time. And their whole concept was that they had shaped the sole, so it really encouraged a forefoot strike when you run.
01:10:22
Speaker
So this guy had initially got all of his athletes to wear newtons and so he'd been doing that and of course they were all experiencing quite a lot of doms in their cars as a result of wearing the newtons. So then the next thing was was that he contacted us and said look I want to transition my athletes into five fingers could you come down do some kind of deal for us.
01:10:42
Speaker
So we did, we did a presentation, they gave them a deal with about, I think it was about 30 of them got five fingers, and they wore them again. And what they all said is that they got a kind of second round of doms, because whilst the Newtons had been encouraging them towards a forefoot strike,
01:10:58
Speaker
it wasn't nearly as acute as wearing a pair of five fingers where they really went into a forefoot strike. And then even a couple of them went beyond the five fingers and went to barefoot running. And they said, and with that, they got doms again because your forefoot striking even more. So you're pointing your toe even more. So really kind of fascinating that, you know, first of all, yes, elite athletes can adapt very well to these things, but also that at each stage of the progression, they were getting doms because it's just that little bit more
01:11:27
Speaker
I guess, kind of required by the nervous system to point that toe, the less you've got between you and the ground. That's fascinating. Yeah, yeah. So, you know, just stick with the CrossFit. You know, one of the things I remember you saying when I met you that time in Manchester was that
01:11:46
Speaker
one of your observations with CrossFit at that point was that it was fairly heavy on the sagittal plane loading and not so strong in particular in transverse plane but I think also frontal plane loading to some degree as well. Has that changed at all or is that still an observation that you would make?
Thoracic Spine Flexibility in CrossFit
01:12:04
Speaker
CrossFit is constantly evolving but it is very much sagittal plane based. I mean they've done a lot of the games as well because
01:12:14
Speaker
they do lots of different things as well. So it's much better. But the basic foundation movements as well is is they're still lacking twists. So with the exception of the Turkish get up, for example, which is a really nice movement as well. But just so the first thing I do, you know, part of your functional movements, your first functional movement, your first primal pattern is is the twist pattern, isn't it? Being able to just just roll and you're probably twisting in the womb.
01:12:42
Speaker
So what I do is I just get them to get a medicine ball and they just throw it against the wall, just throw and catch, throw and catch. So we're working plyometrically, we're working rotationally, we've got a motor skill of throwing and catching and that appears to be enough just to get those systems working because one of the contributing factors to their lower back pain and most crossfitters will experience low back pain
01:13:09
Speaker
particularly as they begin to ramp up the loads, is that their thoracic spine is so stiff because they don't do any rotation and they don't do any thoracic extension.
01:13:18
Speaker
And they won't, you know, they're good at mobilising and foam rolling and things like that, but they're just so stiff from all the sagittal plane stuff. Just getting them to do some simple throw and catch rotation is a game changer for many of them. Well, of course, I guess that ties in with the shoulder issues as well, doesn't it? Because to get the arms above the heads, you do need thoracic extension and thoracic mobility. And so
01:13:45
Speaker
So I say you do need it. It certainly helps to minimize stress in the glenohumeral joint and minimize risk of impingement. So it could be, like you say, quite a key thing in injury prevention as well as conditioning. Yeah, that's a really good point, actually. But my observation from the shoulder is they spend so much time doing Olympic lifting, this kind of jump shrug movement.
01:14:11
Speaker
What they've done is they've developed a motor pattern where the, you know, the upper trapezius
01:14:19
Speaker
works faster and is more neutrally switched on than the lower trapezius. So as that proximal force couple, upper traps, lower traps, serratus anterior work, because they haven't trained serratus like we would in gymnastics, because they haven't trained lower traps, because apart from on the rings, you're not really doing a lot of isometric lower traps work.
01:14:42
Speaker
you end up with these huge dominant upper traps that just, they're the initial movement of any glenohumeral joint and it's effectively creating dysfunction through repetition.
01:14:55
Speaker
Yeah, yeah, makes sense, makes sense. Okay, one other thing I was going to ask about in terms of the CrossFit is that I suppose an observation from my end, some of the early CrossFit I thought was, it concerned me because it didn't look very well controlled and there was lots of terrible form issues and so on, but I think they've really got on top of that now, haven't they? I think form is actually, there's always limitations in a group environment, of course, but
01:15:24
Speaker
it does seem like form is very carefully focused upon these days. Is that is that true to say or would you say? Yeah, well, the quality of the there's a big thing about the because to become a level one trainer is like a three day course. And the exams quite tough. So you know, you can be you can just come off the street or three day qualification and open up a gym. Right. But you know, what they don't see is that anyone that did that, you know, you've got to be a player in the game to open a crossfit gym.
01:15:55
Speaker
You've got to have had a background. Loads of people have got really good backgrounds in strength and conditioning, and the industry kind of polices itself. So the level of coaching that I see anywhere that I've been to a CrossFit gym is actually really high. It's probably the best I've ever seen anywhere. What, and I said this on Paul Chex's podcast as well, is that there's this kind of in-between space from we want them to have the best form.
01:16:24
Speaker
Perfect form, but we're taking something like Olympic lifting and then we're adding the components of endurance to something that was never designed for endurance. Yes. So what happens is that if they're not scaling the weight or changing the weight as they fatigue,
01:16:43
Speaker
then they're going to compensate with an adaptive movement due to fatigue or maybe pain. And that's where the danger comes in, in the sense of they're doing a compensatory movement just to get the weight up. They're chasing the reps rather than focusing on form. That will still be evident in any workout. So I'm quite consistent. So I will have a series of plates there. If the weight gets too heavy for me, then I'll just deload.
01:17:12
Speaker
you know, if the movement gets too much for me and I can't maintain form, then I'll go to the next regression of the movement. And what I see happening is that people go, no, no, I've started with this exercise, I must finish with this exercise, regardless of this is going to cause me a mischief, or it's going to overload my tissues, because most of the people get away with CrossFit because they're under the age of 35, they're fit and healthy.
01:17:39
Speaker
Yeah. But if you're over the age of 35, maybe struggling to recover, that's when I see the spike of injuries in that over 35 is far more common than the under 35s. Yeah, of course, of course. I think, you know, part of the success, but also part of the danger of CrossFit is the fact it's a group environment. And I think, you know, one of the things I love about it is that they're trying to create this sense of tribe and, you know, there's a lot of kind of
01:18:06
Speaker
certainly from my experience the idea that you leave your ego at the door and it's a team environment you're encouraging people and so the guys that finish first will stop and support the rest of the group and so on but I suppose the challenge with that is that and again having experienced it but by doing quite a few sessions I'm certainly not an expert but I've been to the local box
01:18:31
Speaker
a few times and each time the workout is phenomenal in terms of how hard you push yourself.
01:18:38
Speaker
As you begin to fatigue, it's very difficult to not keep pushing because everyone's watching, cheering you on. Of course, there's people there that are fitter than you. For guys that feel like they should be doing better than the girls, but the girls are beating them, that's an issue. Or for the young people that feel they should be doing well, but there's older people there that are beating them. It kind of creates this sense of drive in the individual that's training.
01:19:04
Speaker
which may lead into, like you say, loss of form and potential injury.
CrossFit Group Dynamics: Benefits and Risks
01:19:11
Speaker
I don't know how you get around that, but it's, like I say, it's a strength because you push yourself and because there's this team sense, but it's also a potential weakness as well from an injury risk perspective, I'd say. I don't know if there's any solutions to that, but I imagine it is what it is.
01:19:30
Speaker
Yeah, the community needs to take responsibility and identify themselves at these different levels because people are focusing, they're very task orientated. I'm here to do this workout. This is a piece of work. When I finish that work is when I am done.
01:19:52
Speaker
And that's great because it creates intensity. We've got people working together and you always work better and you'll push yourself harder if you're competing against someone. But that's the double-edged sword, isn't it? And what I see is, I see a lot of people with effectively niggles,
01:20:11
Speaker
I've had Achilles tendinopathy for, I don't know, six months to a year. I've had this kind of shoulder rotator cuff related pain for about a year. And then they're accumulating these injuries without actually really stopping, being educated about it, or doing the corrective exercise around it. I think we've got this thing at Bulletproof Bodies where we call it the compensation wad. It's all the stuff that you're not doing in CrossFit that will make you a better CrossFitter.
01:20:41
Speaker
Oh, nice. That sounds like a great concept. And that's really through my gymnastic background because it's all the stuff that we used to do a lot of isometric shoulder work. Because all these people are doing this high level gymnastic things like bar muscle ups, ring muscle ups without the necessary conditioning for the lower trapezius and the serratus anterior. Whenever you're dealing with a hybrid sport,
01:21:11
Speaker
You've got people coming in from Olympic lifting, gymnastics, rugby, football, hockey, whatever. They are individuals coming to a particular activity where
01:21:25
Speaker
it's a kind of one size fits all and that doesn't really work. So we've got to be mindful of how that individual moves. And the assessment that we do is, you know, what are their movement patterns like? Have they got a long torso and short legs? Short torso, long legs? You know, what's their squat pattern like? What's their hip hinge pattern like? And analysing and assessing these things
01:21:49
Speaker
before they begin any sort of workout, a kind of pre-participation screening. Obviously with the functional movement screen we know that the literature is quite clear and from my study as well we can't predict injury but we can have a good look at how someone's moving and kind of tidy up the movement
01:22:12
Speaker
So something I notice in people with lower back pain is that when you get into hip hinge, they tend to spinal flex first rather than hip hinge first. So kind of a default. I don't know whether you've experienced that. Yeah, of course. Yeah. I mean, I think that's a very common finding in clinical practice. And, you know, if you just take it back to the standard sort of lumbar pelvic rhythm type view of it, then
01:22:39
Speaker
it's all about load sharing isn't it? Load sharing between when you bend forwards in the lumbar pelvic rhythm you're looking for load sharing between the hip and the spine and hopefully that movement is shared nicely between the two areas, between lumbar flexion and hip flexion. But when you're not using your hips so much and you're moving more through the spine then of course across a period of time you're creating more wear and tear potentially or more
01:23:08
Speaker
fatigue in that area, potentially creating segmental instability if you're overusing that area. And so you're not sharing well between the hips and the spine. So then of course, when you end up with pain, to start using the hips, when you've not been used to using the hips, it's a motor pattern you haven't yet formed is something that obviously feels foreign to that individual.
01:23:31
Speaker
So yeah, I've seen that a lot, which is obviously, you know, well, you know, it's part of why I think hit-back dissociation and finding a neutral spine is an important component of the rehabilitation process because really it's teaching a new motor strategy, it's teaching proprioception, so the person actually knows what's going on in their spine rather than just going to a default pattern that has obviously irritated them.
01:23:59
Speaker
really important proviso there is that you want to move beyond the neutral spine in the longer term or the hip hinge or whatever you want to call it. Part of the reason I'm just going into this is that of course there's been
01:24:14
Speaker
quite a lot of criticism of posture, of biomechanics, of neutral spine, this kind of thing as being related to pain and essentially people saying that it's over focused upon. And there may be some truth to that, but I think it's important not to completely throw it out as well because there's good rationale for adopting a neutral spine, for example, such as
01:24:37
Speaker
you know, the transversus abdominis and the stabiliser musculature switches on better in a neutral spine than it does when you flex because the moment you flex or the moment you extend
01:24:47
Speaker
the ligamentor system or the passive system is taking more of the loads and the spine is more stable in that position because essentially you're doing what any manual therapist would do if they're trying to manipulate the joint. Generally, a joint manipulation, what you're trying to do is to take the joint to a position where it's got no more range of motion. So in the neck, for example, you would flex, side bend, right, let's say rotate left. And by adding those vectors in, you're limiting the range of motion in the joint.
Spine Flexibility and Core Stability Misconceptions
01:25:17
Speaker
And so then what that means is that then it only takes a small thrust and the joint will pop. So if you think of that in a more functional environment, if the spine's in neutral, then it's got its most number of options in terms of which way it can go. As soon as you start to add flexion into the spine or flexion and side bending, flexion rotation, a combination of all of those things, then the spine starts to lock down. And that means you have
01:25:40
Speaker
less range of motion before you hit the barrier, before in other words, before you start to stress the passive subsystem. And so the analogy I like to use when I'm talking about this is just like playing tennis, you know, so if you were to be flexed in the spine, well, that's like playing tennis all from the front of the court. And sooner or later, your opponent is going to suss it out and lob you, right? If you're extended in the spine, it's like playing tennis from the back of the court. And sooner or later, you're going to get a drop shot hit on you.
01:26:08
Speaker
Um, or, you know, out to the right, it will be on the right side of the court, out to the left, left side of the court, or right rotated might be, you can only do forehand. So no matter where the ball comes on the court, you've got to try and rotate right so that you can use your forehand. Right. So, so the analogy is, you know, is relates to the spine is that if you want to play the game well, if you want to be able to perform optimally and minimize risk of losing or injury could be another way to put that then to get back to the center of the court and make it at your default position.
01:26:38
Speaker
is probably your best strategy. I love that. Can I have that? You can, you can. That is a great analogy. But yeah, I wanted to touch on this as well. Obviously, you know, I'm a yoga teacher for the specialising back pain of a Pilates instructor. And, you know, I've been working with core stability for a long while. And I think it is kind of misunderstood in the sense of
01:27:07
Speaker
of what that means and you've got people like back to Peter O'Sullivan where he's come across individuals who have become hypervigilant because before you move you've got to switch your core and well-meaning therapists have iatrogenically created an issue.
01:27:28
Speaker
and he's got this big piece around look what core stability did and look at the damage it's done and he's got some really good case studies around that which I think is great. However,
01:27:41
Speaker
That isn't what my community is about. My extreme sports community need their core stability. So if I'm, you know, I was at Ninja Warrior the other day, doing some slacklining, you know, I need to be switching on my core, otherwise I'm going to fall off the obstacle. Otherwise I'm going to fall off the slackline. Yeah. Yeah. If I'm kayaking, I need to be switching on my core so that, you know, I can drive that core to extremity.
01:28:05
Speaker
when I'm paddling and if I'm lifting heavy I need to recruit everything and I need to be taught how to do that so you know while you know your average Joe we're in danger of creating hypervigilance
01:28:23
Speaker
if you're dealing with extreme conditioning or extreme athletes, they need every bit of help they can get. And so, you know, it's horses for courses, isn't it? I don't know what you think about that. Yeah, well, you know, I think one of the issues with the observations that Peter Sullivan's made is not that they're wrong, but that they have probably come about
01:28:44
Speaker
Partly because of this whole thing of trends that occur in rehabilitation or in manual therapies or whatever. So when costability is a big thing, people jump and say, oh, you've got to pre-contract and you've got to activate and you've got to squeeze and draw the navel in.
01:28:59
Speaker
And if you don't keep up to speed with the new developments that are occurring the whole time, then, you know, like, certainly I went on a course with Diane Lee in 2003. So that's quite a long time back. And she was saying, no, we must not be teaching people to draw in. What we need to do is we need to encourage them to use a feeling command or you as a therapist use a feeling command rather than a doing
01:29:21
Speaker
Because if you use a failing command, like for example, imagine there's a string between your tummy button and your spine and someone's gently tugging on that.
01:29:30
Speaker
So that's a very different command to saying, draw your navel to your spine. Okay, so the former is a feeling command, and the latter is a doing command. And she's she was making the point essentially in another way of saying it is that when you when you give a doing commands, what it means is that you activate your phasic system, because the phasic system is about moving you is about doing stuff.
01:29:52
Speaker
But when you give a feeling command, it's much more subtle and it activates more the tonic system. So you get this subtle drawing in of the transversus abdominis as a result of that feeling command. And so that's the kind of level of activation that we want and minimizes this kind of over bracing, overprotective behavior that Peter O'Sullivan's observed, which, you know, and absolutely, I'm not saying he's wrong. I'm just saying if people had done it the way Diane describes it,
01:30:22
Speaker
probably would have had less issues. Now that's
Rehabilitation Competence and Holistic Approach
01:30:24
Speaker
one aspects, but there's many other aspects as well, such as, you know, this whole notion that what you want to do with any client, with any, with any person that's rehabilitating or learning a new lift, let's say, is that you start out with them. Imagine you're teaching someone in CrossFit to do a power clean, they've never lifted before. That's quite a complex movement pattern under loads. And so they're going to start out as what will be
01:30:49
Speaker
termed an unconscious incompetent so they don't even know what a power clean is but you essentially say to them okay this is how you do it this is the technique etc etc give them all the the breakdown and the tips and so now they become a conscious incompetent so they know how to do it but they still haven't done it and they haven't mastered it so they've got from unconscious incompetent to conscious incompetent
01:31:12
Speaker
next thing is they give it a go. And, you know, with various feedback, they, you know, hopefully, let's say they get to a point quite quickly, if they if they're coordinated, and, you know, have a bit of a bit of lifting experience, they're going to get to a point where they are consciously competent, where so long as they're concentrating, and they're thinking through all the keys and key kind of cues that have been given to them, they can do a reasonably good power clean. So they're consciously competent.
01:31:39
Speaker
But you need to get to the point where you're unconsciously competent to be really effective in your power clean. And that's the same, that same process works with anything from learning to play tennis, learning to swing a golf club, or indeed learning to reactivate your transversus abdominis or your multifidus or whatever it might be. It has to start out with, first of all, the client doesn't know why they're in pain.
01:32:02
Speaker
the practitioner identifies, ah, well, look, your transversus isn't firing. It seems to be inhibited in some way. Okay. So that the unconscious incompetence of the patient now becomes conscious and competent that they are now aware why they're in pain. So the next thing is, this is how you activate the transversus abdominis. So you activate it using a feeling command or doing commands. So now they can do it whenever they
01:32:25
Speaker
consciously think about that feeling command, they can activate the transverse abdominis. Fantastic. But you still haven't finished rehabilitating them yet because they need to get to the point where they are unconsciously competent.
01:32:36
Speaker
And the issue with that is that A, it takes a lot of repetition to achieve that. So, you know, if you've got a dedicated client or patient, then they're likely to achieve that. But there's several other things that can inhibit that possibility. One is that they may have viscerosomatic reflexes going on. You know, that's a very common one that if you've got an inflamed gut of some sort or an inflamed uterus or an inflamed prostate or a bladder issue, then all of those things, all of those viscera
01:33:06
Speaker
reflects back to the spinal cord. What we know a viscerosomatic reflex will do is it will inhibit the tonic motor neurons at the cord level, which will then go back and affect the motor. Well, because they're the tonic neurons, the tonic motor neurons, they're affecting the tonic fibers of the segments that have been affected. Okay, so quite often that will be from those organs I just mentioned, it will be the lower abdominal wall, the key part to stabilize the pelvis and low back.
01:33:36
Speaker
So the point is that the person can't ever make that leap from being a conscious competent to being an unconscious competent unless the physical therapist is working with visceral health and visceral function which means with nutrition and with lifestyle and so on and unfortunately in the manual medicines
01:33:56
Speaker
musculoskeletal medicine, let's say, that's exactly what it has been. It's been musculoskeletal without looking at visceral health and hormonal health and psychological health. So the skill set and the assessments and the tools that we use are all targeted towards musculoskeletal nuts and bolts of the body and not looking at the visrosomatic reflexes and so on and so forth.
01:34:19
Speaker
So that's I think a huge reason why people like Peter O'Sullivan are finding those kinds of results because we're not dealing with the whole organism.
01:34:30
Speaker
Yeah, I mean, we talk about this quite often, actually, you know, we tend to be reductionists. If we we take something down to the minutiae, fix the minutiae, then build them back up again, they should be fine. But if you look at, you know, pull checks for doctors model, if we're looking at if if you and I are looking at doctor movement exclusively, we can only ever get someone the 25% better. And that's all we that's all we can do, because we haven't addressed
01:35:00
Speaker
how they're sleeping, how they're recovering or what they're eating or what their goals are, what they need to get back to and you know a lot more about this than I do but you know the holistic message and this is what I try and get through to my students is that as a physical therapist you know rather than the title anyone doing stuff to you physically
01:35:26
Speaker
I can only get you a quarter of the way there and then you potentially need to see other people or you need that physical therapist to also be skilled in nutrition.
01:35:38
Speaker
And that's where osteopathy is so much better than physiotherapy because physiotherapy, we already have dieticians who would say, oh no, that's our role within this kind of NHS setting. Why would the physio possibly want to do that? But if you have a qualification in nutrition, obviously nutrition was my first qualification,
01:36:02
Speaker
particularly sports nutrition, then I would always give some sort of nutritional support along with what I'm doing. I'm not a skilled counsellor, although I'm sure most therapists do counselling as well. And then I'm not a sleep hygienist, but I know enough about sleep
01:36:23
Speaker
and with all the techno apps that we can use, we can monitor those things. How much of that kind of model do you use with your patients? Well, that is the model really. The interesting thing is I think the more you study these different fields, the more you see they overlap and they interreact. So for example, the examples you just gave there,
01:36:47
Speaker
You know, if someone's got sleep issues, then there's a few obvious reasons why they may be getting them. You know, one is stress management. So you need to be able to counsel them, give them various self-help tools, exercises such as zone exercises or Tai Chi or meditation, mindfulness, those kinds of things. So you need to have a little bit of awareness of that. Now,
01:37:11
Speaker
Other reasons why someone might not sleep is that they're eating the wrong kind of macronutrient ratios for their physiology or for the demands on their system, which means that a classic one is that people tend to over consume carbohydrates, particularly in the evenings. It's where we tend to go for our treat or for our pint of beer or whatever it is to relax in the evening, the chocolate, the dessert, et cetera, et cetera.
01:37:38
Speaker
The challenge there is that if you've already had a meal that's relatively high carb, like most vegetarian meals or pasta-based meals or whatever, then the blood sugar will go right up after the meal, which is very normal after a high carb meal. And then you'll get a strong insulin release, which will make you feel sleepy because your blood sugar will drop back down. So now your energy drops down. You feel ready for bed, which is great. So you go off to bed.
01:38:06
Speaker
but the problem is that as you're going off to sleep in this kind of double down state because of the the insulin being high and the blood sugar therefore being low what happens is if that blood sugar drops below what's called the functional physiological range then it triggers you to release cortisol so then your cortisol
01:38:25
Speaker
is the only thing you know unless you were to eat some sugar in the middle of the night you know your blood sugar is not going to come up again unless you release cortisol and cortisol is what mobilizes the stored sugar the glycogen from our liver from our muscles to bring the blood sugar levels back up again the problem with that is that
01:38:44
Speaker
cortisol is antagonistic to melatonin, which is your primary sleep hormone. So essentially you end up having a broken night's sleep or an agitated night's sleep, or indeed you have insomnia. So you've got the nutrition, you've got the kind of doctor happiness if you like, and finding time to have self-time and introspection. Then of course another reason people don't sleep is because they've been relatively inactive all day. They've been sat at a desk all day.
01:39:13
Speaker
they haven't actually expended any great energy. So one of the tricks to improving insomnia is to exercise more. But to exercise, ideally, earlier in the day, ideally outside, so you're getting sunlight on the skin, that helps to reset your circadian rhythm and so on and so forth. But I suppose back to your point is that
01:39:35
Speaker
you know which part of that is just sleep hygiene and which part of it is nutrition and which part of it is counseling and which part of it is exercise professional you know it's like this unless you've got an overview of how it all integrates then and you know we have a nice image of that in our Ghost in the Machine paper actually that Paul Czech and I wrote last year and it's just kind of showing the four doctors and showing how you know if you
01:40:04
Speaker
then it really impacts on all of the other systems. So you can't, it's what would be termed an irreducible system. The moment you remove one of them, let's say you take Dr. Kyle out of the equation. Well, now that's going to impact on your sleep, it's going to impact on your energy levels to move, it's going to impact on your happiness, because we know that what foods we eat can dramatically affect our mood. And we know that if we aren't eating well, it'll dramatically affect our sleep. And then our sleep will also affect our moods.
01:40:31
Speaker
and similarly if we're not eating well it will affect our desire to exercise and if we don't exercise that also affects our mood so you know it's like you can't take one of them away and still be effective you've got to be working with all of them either as a group of clinicians working together in a nice tight-knit way or as an individual holistic clinician
01:40:54
Speaker
That's
CrossFit Injury Rates and Stress Management
01:40:55
Speaker
the revolutionary healthcare figure five is that the wheel. Yes So the we yeah the wheel is that's actually from our most recent paper The one I was thinking of was actually last year from the ghost in the machine paper Or was it the working with the ghost machine paper? I'll look it up while we're while we're talking but I tell you one thing I was gonna mention which
01:41:20
Speaker
still relating to CrossFit was, you know, one of the sort of criticisms, as you've alluded to, is the injury rate in CrossFit. And I seem to remember we talked about this, but I actually found a paper which was in the Journal of Sport Rehabilitation by Ashbeck, Brooke and Durell. And it was called, are injuries more common with CrossFit training than other forms of exercise?
01:41:49
Speaker
And essentially they were comparing CrossFit to weightlifting, distance running, track and field, rugby, football, ice hockey, soccer, so football being American football, soccer or gymnastics. And what they actually found was that there was very little difference in injury between all of those sports. And so what they were saying was that
01:42:14
Speaker
you know, CrossFit isn't any more injurious than taking up one of those other sports. So those that are kind of a bit negative about CrossFit, you know, if you look at the stats, then it doesn't really stack up that there's more injuries. I suppose from my perspective, and this is where I'm interested, you know, for your point of view, is
01:42:37
Speaker
I guess people often don't see CrossFit as a sport, they see it as kind of like going to the gym and so the gym is in inverted commas a bit safer than going out on a competitive field of play where there's a lot more randomness and you know multiple factors that have to be controlled for. So you would think in a gym environment that you'd be safer
01:43:00
Speaker
So the kind of flip side to looking at this is that yet you're still getting injured as much in CrossFit as you are, say, in a rugby match or in a soccer match or whatever. So what's your take on that? And I'm sure you've seen a lot more studies than I have.
01:43:18
Speaker
Yeah, well, you know, I've got a particular interest in injury rates across, but my interest is in extreme sports as well. Rather, you know, there's so many rugby, football, hockey, netball physios out there. My interest is more in the extreme. But if we look at basketball, for example, so injury rates are measured, like
01:43:41
Speaker
per thousand hours as well so you do a thousand hours of this particular activity and these are the the the injury rates that are common so basketball so a study by pakari um so roughly you'll get nine injuries per thousand at nine point one per thousand hours of training um if we look at running
01:44:01
Speaker
Again, the PCARI study is the one I'm going to use. 3.6 per thousand hours of training. But CrossFit, coming in between 2.4, which is the Weissenthal study or the Giordano study,
01:44:19
Speaker
or the HACS study which is 3.1. So it's actually much lower than we think. So if we look at elite sort of weightlifting and gymnastics, that's roughly the same rate that the gymnasts are getting injured. We look at triathletes
01:44:38
Speaker
4.6 per thousand hours of training that's from the burn study tennis 4.7 so because and really it's the classification of that you know are we talking about CrossFit the sport or are we talking about CrossFit the training methodology and maybe we need to dissociate the two there and I've got data from all the CrossFit competitions and I've also got data from
01:45:04
Speaker
from CrossFit, I ran a CrossFit clinic for a long while and I still see a lot of CrossFit athletes, but if we look at the injuries that occur, they're all the same, shoulder and lower back. And obviously wrist and knee and all that sort of stuff, but in terms of injury rates, you're far more likely to get injured playing rugby or football or basketball than you are doing
01:45:30
Speaker
you know crossfit yeah yeah that makes sense and i suppose one one last thing on on the crossfit tack is is that um one of the things that concern me a little bit knowing a bit about what we've just been discussing which is essentially you know the four doctors and the idea that there could be stress on all of the systems and that therefore we need to manage all of those systems many people that are
01:45:52
Speaker
let's say a little bit out of shape or they want to lose weight, they are in that state because there's a lot of stress on their systems, because they're not sleeping so well, because they're not eating so well, because they're not moving so well and so on. So then they may think, okay, I'm going to go to CrossFit and hopefully that will, you know, with a kind of burn, burn calories mentality or with the, you know, the vision that they've seen online of all these ripped CrossFit athletes. So they kind of go down to the local box, but
01:46:20
Speaker
You know, my experience and having seen, you know, various people involved in CrossFit over the last decade or so, it seems like there's obviously not a lot of screening for what we were calling the check system physiological load. So in other words, the level of stress that the system is under. And yet CrossFit is quite a strong stress stimulus, let's say, because, you know, it's
01:46:46
Speaker
working out typically for an hour at a time. And obviously, people get encouraged to go as regularly as they can, which is great. But what's your experience of seeing people essentially burn out or to get on well or to get to a point where there's so many injuries, they can't seem to get back into the box or into the swing of things? Yeah, we talked about this before about like,
01:47:11
Speaker
The thing about CrossFit is a victim of its own success. You know, these people want to go every day. Yeah. And they also want to bang the drum every day. Yeah. And try and get a new record at this or a new record of that and try and, you know, they think that every day is going to be their best day. Yeah. And there's a big education process of what it's the invincibility fable of youth is yeah, you know, I'm young, I'm fit. Therefore, I think the normal
01:47:39
Speaker
The principles of exercise don't apply to me so there's some naivety around that and there's some ego around that and I've definitely battles against some of that I can tell you. I think the whole process needs to be a bit more where I come in.
01:47:58
Speaker
is that we're doing more sort of pre-participation screening effectively after the horse is already bolted, you know, they're already doing CrossFit and then we've got to address, you know, how many times a week are they training? So we've got some interesting stuff about if you train less than three times a week in CrossFit, you are actually more likely to get injured. Okay, interesting.
01:48:23
Speaker
So there's like a level of physical adaptation. So by training three times a week, that's the sweet spot. If you train less than three times a week, you're not doing enough physiological load to get the driver that could be protective. Yes, yes. Things like plyometrics will be, low level plyometrics can be protective as we know. Whereas if you're training every day and even on your rest days, you're still doing stuff,
01:48:51
Speaker
that is creating huge amounts of stressors and you don't understand about, you know, catabolism and that anabolic effect that we need that rest and recovery. Then yeah, you see a lot of people burn out or the classic tired all the time, but they don't want to give up because they're addicted to
01:49:16
Speaker
to the environment and they're addicted to this feeling. All of a sudden their self-worth is attached to the workout of that day. And then we're into a whole dangerous place of being somewhere we shouldn't. What are your views on that?
01:49:32
Speaker
Yeah, so I think the challenge is that with these groups is that they obviously are coming, as we said, already from a position where they already have quite a high level of physiological loads. And so what we talk about in the check system is that quite frequently
01:49:49
Speaker
Well the model is what we call the 1, 2, 3, 4 model and 1 stands for finding the dream or the goal or the sort of one love, the legacy, maybe even your life's purpose. So that's kind of the one. It was your overarching dream, the focus for why you're there rather than it being a short term goal. I want to lose weight or I want to get abs so I can see in the mirror or whatever.
01:50:12
Speaker
it's like well how does that fit into a bigger lifestyle or bigger vision for your life but then it's the two forces so one two three four so the two is the two forces and so what we're looking at there is how yin are they versus how yang are they and essentially yin is the feminine principle it's about darkness and rest and sleep and nutrition and hydration yang is about brightness and activity and movement and inflammation and breaking things down
01:50:41
Speaker
destruction etc etc now most people's lifestyles when you look at it in that kind of um metaphorical context um their lives are too yang they're not getting enough exposure to the dark they're getting overexposure to the light they're busy busy go go go um they're often eating pro-inflammatory diets and pro-inflammatory foods and drinks uh the coffee culture is just one big yang hit right so so the thing is then
01:51:08
Speaker
Perhaps as a result of that, they start to get fatigued or put on weight or whatever it is, they decide they need to get down to CrossFit. And then we add more yang to the yang. And the problem is that we really need to first unload them. We need to make them more yin before we start building up the yang again. So my view is that in an ideal world, when people approach a CrossFit box,
01:51:36
Speaker
do really well to initiate is essentially an unloading phase. You don't start with base conditioning. You start with an unloading phase. So let's teach them to stretch. Let's teach them to do Tai Chi. Let's teach them to do Qi Gong. Let's teach them how to eat. Let's teach them how to sleep. Let's teach them how to be hydrated. That's the first eight weeks of the program. And see how you feel with that, because you actually get strong. If you stretch effectively,
01:52:02
Speaker
In other words, if you have someone that can assess your muscle imbalance profile quite quickly, which should be quite doable to a skilled practitioner, you actually get stronger by stretching because you stretch the muscles that are facilitated and over-utilizing neural drive. So a classic one is that pec minor is often facilitated. And what it's doing is it's stealing neural drive from the serratus anterior.
01:52:28
Speaker
and the rhomboids and perhaps middle trapezius. So you could go working that rhomboid middle trapezius serratus anterior to try and make it work. But if the neural drive's going to the pec minor because it's facilitated, you're going to have no or minimal effect. But if you can de-facilitate, in other words, to inhibit the pec minor, then just immediately as a result of inhibiting it, which is what stretching does, it inhibits muscles.
01:52:55
Speaker
then instantaneously you get greater drives to serratus and to lower trapezius, middle trapezius, et cetera. And so then you've actually gained strength by stretching. So it's like a no strengthening.
01:53:10
Speaker
strength program, if you like, or there's no effort strength program, let's put it that way, because you're just stretching. So I would say that
Functional Fitness in Military Training
01:53:18
Speaker
that would be a kind of optimal way to do it if you could make it juicy enough that people would actually, you know, stick to it. And
01:53:29
Speaker
Just on that point, that's why you start out with the one love and with the legacy and the purpose and so on, because what you're trying to do is create a bigger picture, a more long-term picture for what the person's trying to achieve.
01:53:43
Speaker
Of course, that's their life's purpose, but you could bring it down. This is what we teach in the check system is if you could do a macro periodization, which is great for business, of course. As a business model to do a macro periodization for someone, it essentially means doing a periodization for a season, for a year. If you did a one-year periodization as the first thing you did in CrossFit and said,
01:54:04
Speaker
So here's your next year's plan. The first eight weeks, we're going to unload you. The next eight weeks, we're going to put you through base conditioning. The next eight weeks, we're going to go into whatever, strength, endurance, performance, conditioning, et cetera. That's the way we do it in the check system. So you're unloading the system, decreasing the yang, making them more yin. So essentially they're more balanced. And then because they're balanced and because you've built a foundation for them, now they can grow their building taller without any risk of it toppling.
01:54:33
Speaker
Yeah, that's a great analogy. I know the Czech Institute does a great job on that. So really what we're doing is we're adding fitness to a movement problem, which we have to be very, very cautious of doing. So, you know, promoting dysfunctional movement.
01:54:55
Speaker
over just getting them to move right in the first place. So a lot of my work is trying to undo the bad habits that people have learned because I'm not in the advantageous position to get them in that first position and that's why I'm going into the young military officer cadets and showing them
01:55:17
Speaker
the very beginning of their career how to move well and how to make sure that the movement patterns that they have are correct before you start adding load, speed or fatigue to them. That's a great way of doing stuff because we don't want to be trying to solve
01:55:38
Speaker
a movement problem with a fitness solution. Absolutely, absolutely. And of course that leads beautifully into talking about the current sort of project with the military, because you're still serving in the military, aren't you? As a reservist, yes, yes. And so I know that you've had Gavin Jennings from Czech Europe come in to do a presentation on the primal patterns and so on, and you've got this system, is it the THOR, T-H-O-R?
01:56:08
Speaker
Yeah, so that's trading for human optimization and readiness. Okay, so can you tell us a little bit about that and how they interface?
01:56:20
Speaker
What's happened is the British military is changing more in the last two to three years than it has in the last two to three hundred. So we've got multiple things going on. We've got a new system, so the Virtus system, which is a new sort of webbing system that's state of the art.
01:56:39
Speaker
It's got a weight distribution device that allows you to effectively customize the load that you could have on your back. We've got women going into the infantry for the first time. And we've also just changed the way that we're training people physically so that everything used to be around
01:57:02
Speaker
the two minutes of press-ups, two minutes of sit-ups and a mile and a half run, best effort time. That was basically our fitness test. It was very much in the dark ages. That's now been brought forward with our new physical employment standards. They're still teasing them out at the moment as well, but they'll be effectively marching with load and running, this time only 2K, but they'll be done
01:57:28
Speaker
in a specific way. It's been educationally informed I think from the University of Chichester and lots of stuff from St Mary's in Twickenham just down the road from you in terms of strength and conditioning. So we're now doing a standing broad jump, an L-sit med-ball power throw effectively, pull-ups are back in,
01:57:55
Speaker
deadlifting is back in and there's a lot and obviously sprints as well so they've gone down the functional route and when we went to the presentation that we're talking about
01:58:08
Speaker
you know, seven primal patterns. And I was like, well, you know, seven functional movements. So I was like, well, this looks very similar to pull checks primal patterns that he did all the way back in the 90s. You haven't just you haven't just liberated that have you? Well, yeah, you haven't just set it free. And he goes, Oh, no, this is all come from the the George Herbert stuff, and move now and, and all that sort of thing. And I was like,
01:58:34
Speaker
I'm not so, you are aware that lots of people from the PT Corps went and came and did the pool check course. So there might be a little disclosure there. Anyway, so by the by, that's come into that. So there's lots of stuff going on with the regular soldiers.
01:58:52
Speaker
But the military is relying more heavily on its reserve forces than ever before. So there's a missing piece of the puzzle there. So what I'm doing is I'm trying to serve that military community by making sure that we do lots of injury prevention stuff. So in my unit, 207 Field Hospital, we've been doing functional movement screening for the last nearly five years. So we have a look at how someone's moving.
01:59:16
Speaker
and assess their movement before I give them a program to load them up, before they can then go into these new physical tests. Because, you know, if you've got someone that's never deadlifted before, and now they're going for a one repetition max, you know, that's potentially hazardous. So we've got to be, there's an education piece around that. If you've got someone that's sprinting, which is our highest level gait skill, and they haven't done any sprinting for a long period of time,
01:59:44
Speaker
they're gonna be causing themselves all sorts of mischief. So Gavin and I are hopefully putting stuff together that would be using the Czech principles to inform their version of functional movement. There will be the people that can do because they're young, they're fit, they're determined and they don't have any health issues. But it's the other people that maybe drive a desk
02:00:08
Speaker
or they're coming back into physical activity after doing a staff role or they've been out on a language course and then for two years and then they're coming back into the system. These are the people that will need to be just adequately assessed and adequately reconditioned. It's great that the military has changed it into
02:00:31
Speaker
into these functional movements but you know realistically although we see a lot of girls doing pull-ups in CrossFit you know how many girls can knock out 10 pull-ups that are coming straight off the street without the time to do all that conditioning around it I'm you know we've got most guys can barely do five pull-ups yeah yeah absolutely and their weight distribution is in their shoulders rather than ladies it tends to be in their pelvis yeah yeah so you know there's there's big educational pieces around that and obviously
02:01:01
Speaker
Nobody thinks about injury prevention. Nobody thinks about, you know, prehabilitation. Nobody thinks about getting the physios and the healthcare professionals involved before the process starts. And that's probably being bugbear.
02:01:16
Speaker
Yeah, I was going to ask about that because that was part of what I think you've been liaising on with Gavin was this idea of using some of the Czech materials or integrating them at least into a kind of prehabilitation type of approach. And so is that something that is just a plan at the moment or is there there's actually steps being taken in that direction?
02:01:41
Speaker
Well, here I have to hold my hands up and say I'm guilty of being too busy at the moment. That was my bag. That's something in the pipeline. Gavin left that firmly with me and I've been finding excuses not to do it. I'm busy doing podcasts and things like that. Yeah, I know. What a slacker. Exactly. So it's something we're definitely going to get into. Excellent.
02:02:06
Speaker
And there's opportunities there because also people are hungry for that knowledge as well. I kind of feel that people are given a half truth these days. And particularly, I use the Czech Institute as my kind of secret weapon, if you like.
02:02:21
Speaker
because I know how everything relates to everything else, as do you. And that may be missing in some of my fellow clinicians. The other thing is that I'm authentic in the sense that I do crossfit, I do barefoot running, I eat clean, I sleep well, you know, I make sure I get regular exercise. So I need to use all the same products.
02:02:44
Speaker
for my own fitness as well. So, you know, I foam roll or using a pulse roll, vibrational foam roller, I use complex as part of my competition recovery. I make sure I'm doing yoga every day. And that way, you know, the athletes that come to me, they know I'm authentic. And there's a big piece around, you've got to be, you know, careful that you're not just talking a good game, but you're actually, and it comes back to that analogy, you know,
02:03:10
Speaker
Do you even lift? Yes, exactly. Yeah. Yeah. Yeah. Very good. Very good. Excellent. Well, you know, I think that's probably covered most of the questions that I had. One thing, because I know that functional exercise has obviously been your thing for many years now, but when did you see that starting to, you know, I guess
02:03:33
Speaker
influence or filter into the forces and in particular when you're working with the elite forces were they doing functional exercise before you got there or was that something you helped to instigate or what was the sort of pattern that you saw there?
02:03:47
Speaker
Well, that's a great question. So basically, coming from the army, so I was army first, you know, it was press ups, sit ups, mile and a half run, and then tabbing, which is, you know, effectively moving from point A to point B with a pack on as fast as you can up hills. But it wasn't until I got to the Marines, the Royal Marines, the Royal Marines were doing functional training. And their methodology for training people, it was progressive. And when was this?
02:04:18
Speaker
So this is back at I joined the Marines back in 99. Okay. So yeah, it's quite a long while and this functional training
02:04:26
Speaker
was very consistent, particularly when I met Paul Czech in 2001. I'd just been going through this functional training with the Marines, things like, you know, fireman's carries, and it was more kind of be fit to be useful. What can be more useful than a fireman's carry? And rope climbing. And yeah, we did weights, but we didn't do a huge amount of weights. It was all body weight. And we do some deadlifts and some squats, but the majority of it was kind of calisthenic fitness.
02:04:56
Speaker
And then Iraq and Afghanistan kicked off, and you got this kind of merging of troops. So probably about 2009, 2010, when Afghanistan was in its full flow, you've got American forces, Canadian, you've got the Brits, you've got Australia, New Zealand, then you've got other countries like Denmark, Romania. So basically, you put all these alpha people together, all these alpha males together,
02:05:24
Speaker
you get them in a gym. So what do you think they're going to do? They're going to do stuff that's showy. And then all of a sudden people come and say, Oh, what are you doing there? What are you doing here? This is where basically everyone discovered sort of cross training as opposed to cross fit was there, but people were doing other types of training. Yeah.
02:05:43
Speaker
And it was a great learning environment. And that's where everyone switched and then the whole barefoot movement kicked off and the functional movement kicked off. Because before that was just you were either a runner or you were a bodybuilder. And that didn't really fit with what I was when I was a Royal Marine. I was a functionally fit person. And I wasn't a bodybuilder, I wasn't a runner, I was kind of both. And then the CrossFit model
02:06:10
Speaker
was the one that competed to be, I don't know, king of the castle in a sense. Whereas because it was everything, you know, it was a bit of bodybuilding, it was a bit of cardio, it was everything. And people were put, all these soldiers were pushing each other to be fitter. Like who was the fittest? Who was the strongest? Who was this? Who was that?
02:06:30
Speaker
And then we got this kind of fusion of all these different trainings. And it was a really great place to be around. You know, the gym was always fun, people was doing crazy stuff. And that for me, is where sort of functional movement kicked off. And we changed the way that we trained forever. You know, once you've done a CrossFit workout, you're not going to go back and start bodybuilding again, you might do a little bit of that. But because you've experienced the gains of function,
02:07:00
Speaker
and fitness together. You're incorporating a gymnastic movement, an Olympic lifting movement, a power lifting movement, and a metabolic conditioning workout in one. It's the best of all worlds. Excellent. Great stuff. Great stuff. Well, look, Dale, we've spent a long time on the call, so I think we should wrap it up there. Obviously, you mentioned the
Contacting Dale for More Information
02:07:21
Speaker
image from... Well, we were talking about an image from one of the papers. It's actually figure three
02:07:27
Speaker
in working with the ghost of the machine which i will i'll post that image on on the show notes on my website matt warden.com under the podcast tab so if you want to see that image i'll pop that up there but thanks so much for your time and for sharing all of that real wealth of expertise and experience it's been been fantastic to to chat through it all with you and we could have gone on for a lot longer i think
02:07:53
Speaker
Yeah, the trouble when we meet up, Matt, it's normally, you know, a couple of coffees later, and we're still going, we haven't even scratched the surface. That's it, that's it. Yeah, yeah. But maybe we'll do another one down the line. But thanks so much for today. And if people want to learn more about your work, you know, and because I know you've got a book you've been working on, and obviously, you're still working clinically. So what details can you share with them as to how they can get hold of you?
02:08:20
Speaker
Yeah, really on my blog site, on Blogger, which is don't get cross, get fit, bulletproofbodies.blogspot.co.uk, that's where I'm posting most of my new stuff. You can find me on Facebook at bulletprooffizz0 with a zero.
02:08:42
Speaker
You can find me on most of the socials as well bulletproof buddies one on insta I always respond back to you. I've got loads of people that I do programming for like internet conversations sort of telehealth And they normally coming to me. I've got this injury. I've seen lots of people. No one's managed to get rid of it What do you think it is? and then you know a couple of
02:09:07
Speaker
a couple of well-designed tests and a bit of experience and you can get to the bottom of things as well. But if you go onto my blog site, don't get cross, get fit, there's a free ebook that myself, my business partner Uzo Ekiogh have done.
02:09:23
Speaker
and we're working on the the actual book don't get cross get fit at the moment so that should be available christmas time fantastic fantastic that's excellent well like i say thanks again and i will post all of those details so that you've got the links available on the the podcast tab on matt warden.com so just remains for me to say thanks again dale and look forward to next time
02:09:50
Speaker
Absolute pleasure. You're very welcome, Matt. Thanks. Bye bye. Cheers now. Thank you for joining us again on FC2O. I hope Dale's insights and experience have inspired you in giving you some new perspectives. Please feel free to share this or any of the other episodes of the podcast with those you think would benefit and or enjoy it.
02:10:12
Speaker
Dale is contactable via bulletproofbodiessffit.com and he's also available at bulletproofbodies.blogspot.co.uk and on that blogspot you'll find access to a free ebook that he wrote with his business partner Uzo Ehiog called Don't Get Cross, Get Fit.
02:10:38
Speaker
Dale's also available on Bulletproof Physio on Facebook, and that's spelt Bulletproof, and then F-I-Z-Z-Y, and zero, so Physi-O on Facebook, and then Bulletproof Bodies One on Insta. Thanks for joining us on FC2-O. You can ensure you catch all future episodes by subscribing at Apple Podcasts or following us on Spotify or Stitcher.
02:11:03
Speaker
Please join us next time where we'll be interviewing Phil Austin, osteopath and PhD researcher into persistent pain. See you at the next show.