Written by Christopher Kelly
Dec. 25, 2014
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Christopher: Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and I'm joined today by Dr. Seth Oberst. Seth is a physical therapist and strength and conditioning coach. Hi, Seth.
Seth: Hey! How are you?
Christopher: Good. Thank you. So tell me, what's your background?
Seth: Yeah. Well, as you stated so eloquently, I am a physical therapist as well as a certified strength and conditioning coach. I grew up actually on a farm in Ohio and I've kind of always had an interest in movement and so I went through an undergrad degree in Exercise Science and I went on to physical therapy school because I thought that was the best way that I could kind of interact with people on a holistic level. I'm a proud graduate of Ohio University with a doctorate in physical therapy. After physical therapy school, I went on to do a sports residency which is just further training and kind of advanced skills in specifically treating athletes. I finished that up last year and so now I'm kind of a practicing therapist and coach.
Christopher: Cool. So tell me, what sets you apart? What makes you different from most other physical therapists?
Seth: Yeah. Well, boy, I don't know. I like to think that one of the things that I really stress in the way that I look at things is, one, is looking at a holistic approach and looking at the body as a system of systems rather than kind of parsing out individual – you know, if it's a knee problem, let's only look at your knee being a knee guy.
It's not really kind of how I look at things and I think certainly a big slant that I take and that I have found as super beneficial has been kind of the neural mechanisms and addressing the person as a functioning nervous system and as a functioning neuromusculoskeletal system, something I think certainly I'm not the only one to do but I think it is kind of lost in some of the general physical therapy population.
Christopher: Okay. So is it possible for you to explain simply what that system is and why it's important?
Seth: Sure. Well, when I say the nervous system and the neuromusculoskeletal system, I think what we need to appreciate is the way that the nervous system interacts. Motor control is kind of like -- the example I use is motor control is essentially the ability of the nervous system to activate specific muscles at specific times for specific tasks. I think we under-appreciate how vast that network and that system is because we do so much of it unconsciously.
I liken the body to kind of like a puppet in that we've got all these strings hanging and the brain and the nervous system are able to pull on which strings are necessary to activate the arm or the leg in a kind of a symphony of activation rather than just these random rigid, uncoordinated movements. And so I think taking that appreciation and applying it to movement and how to interact with those different bottlenecks in order to kind of up- or down-regulate that system based on the person's needs.
Christopher: Okay. I get it. So maybe tying into this, you talked to me earlier about patterns of dysfunctional breathing. Is that related to these same systems or is it something completely different?
Seth: Oh, no. It absolutely is. I think the ability to breathe, especially to breathe appropriately using the diaphragm, getting rib expansion rather than I think we see so many of these people who are stressed out, busy, not mindful, that we get this chest or upper chest breathing or apical breathing as it's called and it just adds so much stress to the system.
We found that if you're breathing mostly up in your chest that your heart rate elevates, that your normal heart rate variability decreases and so it adds increased muscle tone. These people become very hyper and inflated or unable to get air out. I think most people get air in very easily but the problem is getting air out and so I think that that absolutely correlates to this.
The diaphragm, which is this flat, dome-shaped muscle that essentially covers the entire base of the rib cage, attaches to your lumbar spine. It is incredibly important for postural control, certainly for performance in up-regulating VO2 max and all these things and so absolutely that's a crucial way into the nervous system because it has such innate relationship to the nervous system.
Christopher: So you're telling me – I'm sure because whenever I read about one of these things everybody is doing wrong, I'm always affected, like it's always me.
[0:05:07]
Seth: You're that guy.
Christopher: Yeah, I'm that guy that's got all of these things fall in our chairs when these all caved in, all of that good stuff. So how do I know whether my breathing is dysfunctional?
Seth: Well, that's a good question. One, I think if you can be able to first -- well, one, not even loaded, meaning just sitting or standing or laying on your back. If you take a breath in through your nose, you should be able to see your belly expand in 360 degrees and then as you exhale that should sink down and your ribcage should be aligned over your pelvis.
You will see this in that if you were to take your – so if you lay in your back and you were to put one hand on your chest and one hand on your belly, when you take a breath in, two-thirds of that or about two-thirds of that breath should come from your belly and then your chest should move perhaps the last third, if at all, under normal resting conditions.
What I see so much of is people take a breath in and it's all in their chest and they have no diaphragmatic contribution to that breathing. It really stresses out the nervous system and can really wreak havoc especially when we are – you know, people are under a lot of load, whether that's emotional load, physical load, do the training or all these things.
Christopher: So why would you do this then? If it's dysfunctional and it's not optimal, then what causes it?
Seth: Sure. Yeah. Well, I think, man, I think a lot of it has to do with the way that our – we sit a lot. When you're sitting, your abdominal cavity is pressed up into your diaphragm, reducing its ability to descend during inhalation. Part of that is when we're in this constant stressed out state – lack of sleep, lack of hydration, all of these things – what happens then is we start to breathe more and more and kick on that sympathetic state or the fight-or-flight response.
A fight-or-flight response, well, say a lion comes crashing into the room, I would want to get the hell out of that room and I need to be able to get as much air in as possible as soon as possible. However, that's counterproductive when I am trying to walk down the street or go up and down the stairs and so we see this whole kind of – it gets flipped up on its head and so the stressed out state becomes the norm and so we've got to be able to kind of vacillate and the body kind of creates that balance and we need to restore that balance.
Christopher: Oh, yeah. I have not thought of that at all. Yeah, you're right. I see what you're saying now. So like the kind of that 20-second sprint power just to get yourself out of harm's way would not really rely on breathing that much, right?
Seth: Sure, because we're just trying to get out of – and that's an evolutionary process that's very effective short term but long term we see these people that never get out of that state and so if you never get out of that state then you adopt this dysfunctional pattern as the normal pattern. It's almost like your thermostat is reset.
Christopher: Interesting. So what does it mean then to have a difficult time accessing your nervous system?
Seth: Well, let me be clear. I think everyone has access to their nervous system. What I mean by that is I think people have unable to kind of down-regulate and turn things down and so the access to that more calm parasympathetic state or that rest and relax state and so I think a lot of the interventions that I'll do depending on the individual or the athlete and what they need will be more towards that down-regulation because most people can get up when they need to get up but they can't get down when they need to get down.
Christopher: Right.
Seth: Much as it sounds like a song lyric or something but… So to answer your question, to get into the – when I say access the nervous system, I think we do that through breathing, some developmental patterns that we used as infants doing different contact points but also just as simple as getting enough sleep, getting enough hydration, and turning on muscles that need to be turned on and turning crap off that doesn't need to be on.
Christopher: Right. I see. Yeah, so it's kind of more about balance like most people –
Seth: I think that that is the biggest thing I have found is that, dude, we just need more balance in all our – and I think the best athletes in the world, if you look at them, they are so well-balanced, they are so efficient and I think that's what's lacking. So when you get out of balance then it's a castle built on sand and it's eventually going to crumble because we are just so tipped towards one side that that last penny makes the balance completely fall off the scales.
Christopher: So what techniques do you recommend then to access that kind of rest and relax and sort of the nice, calming, soothing side of the nervous system?
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Seth: Sure, sure. And I don't think – I think, one, is being able to diaphragmatic breathe. A lot of people -- as the example I gave earlier, just laying on your back and being able to breathe into your diaphragm and exhale fully, getting air out of the system I think is one avenue I think. Certainly, getting enough sleep and there's tons of sleep experts out there on that. But I think putting into some of these developmental patterns, I'm not opposed to having people crawl a little bit because as infants that's how we developed and sometimes we lose this kind of state.
It's interesting, you know how people kind of crawl actually is a warm up or a cool down part from an activity. I coach at a local CrossFit gym and so that's part of our program is to get muscles firing in a correct pattern. We'll do a lot of forward and backward bear crawls and different things.
It's interesting. Looking at people who – some infants skip crawling in their developmental phase. They go right to cruising on furniture from the ground. It's interesting that people who do that we'll ask, "Hey, ask your mom next time you see her did you crawl as a baby?" And some of them will have skipped it and those people typically – I'm not making any outlandish statements here but typically don't move as well. So I think accessing some of those developmental, those primal patterns certainly are beneficial for people who need it.
Christopher: That's interesting you should say that. I met Darryl Edwards at the Ancestral Health Symposium a couple of months ago and we were doing some of his Primal Play outdoors which was really interesting. I've got a one-year-old daughter and it was really fun because we were just like copying the things that – she was at that age right then when she was mostly crawling. I don't think she had taken any steps at that point.
Seth: Uh-hmm.
Christopher: So, yeah, it was really fun to kind of try and access those movements by copying her that you wouldn't normally do but that's interesting that you can use that as a way to solve this problem.
Seth: Sure. Absolutely. What I found is that when doing some of these patterns, the realization, the actual realization of efficiency and motor control goes through the roof. I mean, people who are struggling with their – because ultimately I want people to go train and so it's like we've got to get rid of the bottlenecks and the right limiters and so putting people in these positions and then having them go whether that's a press or a pull pattern or having to do a push press right after some of this reverse crawling, it's amazing how much better they can force couple and balance the system.
Christopher: Interesting. I'll remember that. So I think as you know I'm a mountain biker and the medical doctor that I'm partnered with is also a mountain biker and so we have a lot of mountain bikers that we work with. I know that too much sitting is definitely a bad thing and I'm sure that most of the people that we work with do too much of that just because of the type of sport that we do. A lot of people, they spend a ton of time at a desk and then a ton of time on a bike and –
Seth: Sure.
Christopher: I know that's not a recipe for success so what would your advice be to cyclists? What kind of activity should they be doing other than sitting?
Seth: Sure. Well, I think the easy answer would be stand more.
Christopher: Right. That seems to be not great either. I've got a standing desk and initially I just stood for eight hours and that created as many problems as the sitting did.
Seth: Right. No. Absolutely. Kelly Starrett, I'm a big fan of his and he has done a lot with getting people towards those standing desks. I think one thing that he mentions that I have found beneficial for some of my clients is having them put a little stool or a bar underneath their foot so they can prop up because what I see is typically we go from a lot of sitting which just seems to be more spinal flexion based to standing which I typically see people fall into more spinal extension and we've got to find a mid-range in between there, that neutral spine position and so being able to take some load off, put your foot up on a stool, that can normalize some of that. But also I've had success with people who are standing, having them do some breathing activities that take them into – if they're standing a lot, take them into some spinal flexion with some facilitated breathing patterns and that seems to kind of unload that.
But to your point I think, as far as – a lot of standing doesn't feel great and a lot of sitting doesn't feel great. I think that's where it comes back to this balance and having people have some movement variability. One of the things that I see with a lot of bikers and all endurance athletes is that we kind of like to bike our way through things. You can be a better biker and not always have to be on your bike to be a better biker.
Christopher: Right.
Seth: So I think some of the time, sometimes we have to get the athlete to understand that, look, I'm not trying to take you away from your skill. Your skill is your skill, whether that's biking, running, swimming, pitching. But there're other things that we can do that put you in different positions to offer more balance to that position.
[0:15:16]
It's just like Greg Cook. He always says that you need full spinal motion in order to squat. That doesn't mean that I use all of my spine motion during a squat. In fact, I would ideally want you to keep that in a neutral spine position when you squat. But in order to appreciate balance, we have to be able to appreciate both ends of that spectrum.
So I think that's the same with biking. We need to sit; we need to stand. We need to be able to feel what it feels like under some load in a squat. We've got to be able to have a variable system. That's what decreases that nervous system stress and ultimately tissue stress.
Christopher: Okay. So what role do you think that strength conditioning plays for endurance athletes? I know it's kind of – I'm not sure. I'm not sure that the kind of [0:16:03] [Indiscernible]. I don't know. What do you think?
Seth: Oh, well, I think it certainly plays a strong role. I mean, I think for a long time, endurance athletes have typically been only endurance athletes. Look, I'm going to run to get in shape and I think we're finding more and more that you need to be in shape to go run. You don't bike to get in shape. You can; that's part of it but I think you need to be in shape to go bike because these are skills in and of themselves.
Part of that skill is being able to reproduce some of those movement patterns in the gym in some powerful positions. I think a lot of times endurance athletes are worried about too much muscle hypertrophy or too much bulk and I think we can still push power and strength and still be able to have some of these high power-to-weight ratios.
There's been some evidence to support the fact that aerobic athletes, their performance in aerobic activities increases with anaerobic or power training interventions and so I think it's a huge part, and we could continue to miss it. It's like people think they can just run to get into running shape and that's just not really necessarily realistic. We need to run some; don't get me wrong but we've got to have you in the gym. You need to be able to feel what these different positions feel like so that you have a better appreciation and your nervous system has a better appreciation for what it feels like to be under load.
It's four to five times body weight when you are running and you're landing on one leg. The power output of a single leg downstroke in a pedal is huge and so it's like we've got to be able to reproduce that and power through that with some exercises in the training room.
Christopher: So what do you recommend then? I'll tell you what I've been doing over the last few years. It seems to have worked quite well for me but that's not to say that there couldn't be something else that would work even better and that's just really body weight stuff so things like TRX and maybe some kettlebells but they are not really heavy in the way that you would think heavy.
Seth: Sure.
Christopher: Do you think that's useful at all or is that enough or should I be doing something else?
Seth: Well, I think it's certainly useful. I mean, I think one of the things that I typically see is that people pursue capacity before competency. I just wrote a piece on this on my website. I'm certainly not the first to talk about this but you need to start with body weight and so I think that is good. But like I said, if you're landing, that's multiple times body weight on that single leg during a running, even jogging.
So body weight exercises may not be enough. They're a good start and you need to be able to move well with your own body weight before adding external load to that movement pattern. But I have found that some of the best runners, bikers are people who are quite powerful athletes and can generate quite a bit of force very quickly.
I think kettlebells are great. Kettlebells get a lot of work done with less system load but I think doing some more single leg things, some pistols, squats – I think a front squat position certainly for a biker is awesome because of that position that you're in. Essentially, when you're in that lower position, you're essentially in that front rack position of the front squat and so being able to challenge your spinal control and your lower extremity control under some external load is important because that is what we see in that actual sport.
So, yeah, man. I mean, I think pistols, I think front squats, single leg squats into a pistol, front squats, I think some of those, and the individual coach can determine what's necessary, maybe even powering into some triple extension whether or not that's a clean or some variation of that, whether that's some jumping and plyometrics. I think the individual exercises, while important, are not as important as having a good appreciation for the goal of what am I trying to do? If I'm trying to increase power, then I need to train like I'm going to increase power. And that requires some load.
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Christopher: Yeah. When Ivy was first born, my daughter, I used to be able to like hold her and then get into a pistol squat position and then squat back out of it on one leg. And now I can't even get close. I can't even do it with my body weight and that's just from – I tend to stop strength training when I start racing and after the end of the season I have become quite weak. I wonder whether that's a mistake too then, whether I should continue to strength train even when I'm racing because a lot of people, they are frightened that the strength training is going to subtract from their performance in a race.
Seth: No, no. I think for the majority of people, I think it actually augments it. Now, you know, certainly, total volume and total system stress is important during a race season so maybe the goal is not to hit the weight room four or five times a week but certainly to augment those things because you're right, we see this all the time with endurance athletes in the off season when they are training, getting ready for training. I mean, they look great, their system is robust, and then middle of the season they look like these gaunt, wasted away like skeletors and it's like what happened to you, man? You used to look like a human and now you're like some sort of twisted zombie. And so it's like we've got to be able to balance that.
Christopher: So you think it's no good then. I should continue to strength train. Okay.
Seth: I think so. Yeah. Depending on your mileage and what your goals are, you absolutely should I think maintain some basis of that. I think people are going in pre-season and post-season and are significantly weaker post-season. I don't know. I don't know if that's a good thing. I think that that indicates to me that something's been lost along the way. If the goal is to get you strong or powerful for the actual training, then why are we losing it during the season?
Christopher: Right. Yeah, that's a good point. And do you think that I can work on this stuff by myself or do you think that I need someone to help me to see that I have good form. You were talking about adding, making sure that the performance is perfect before you add any sort of weight. Do you think I can do that by myself?
Seth: Well, I think having a mindfulness for that movement, that ideal expression of movement is important. The biggest thing I try to coach people on is that, look, you need to be mindful when you're doing this. Now, that doesn't necessarily mean obsessively hyper-aware where you can't even train because you are so worried about form. But you need to have a basis as athletes and even just humans that are trying to function normally. We've got to have a mindfulness for that movement. How am I moving? Why do I feel this way? Being aware of what's -- kind of a self-actualization of how do I feel and why am I moving this way.
But ultimately I think everyone needs a coach because I think -- you don't know what you don't know. I think even coaches need coaching because there's only so much that you can make yourself aware of, whether that's videotaping yourself moving or using some mirrors and feedback and different things like that. They are important but I do think that ultimately you don't know what you don't know, man, and I think someone else watching you at least on occasion for some check-ups and tune-ups is a beneficial thing.
Christopher: So how do I choose that person? How do I know? I just walk into the local CrossFit box. How do I know that that guy – I mean, I've got less of a clue than he has, right? So how do I know that he's good?
Seth: Right. Well, I think someone – what I have always told people is that what makes a good coach or a good therapist or really anybody is that someone who's willing and able to adapt to your needs and wants. Because if we just pigeonholed people into these different things of, "This is what we do here so this is what you're going to do," I think that leaves a lot on the table. I think the best clinicians and the best coaches rise or lower themselves – and I don't mean necessarily lower like because this guy sucks, I'm going to suck, meaning like raise or lower themselves to meet where that person is in their continuum. So if this person's amped up, I need to match that to a certain extent. If this is kind of a low mellow guy, then I think I need to match that to a certain extent but then know when to push those buttons.
So what I want to say is look. When you go into these places and you interact with these people, do they seem like, look, this is someone who's going to be willing to adapt and work with me or is this a rigid, "This is what I do here so this is what you're going to do"? That's the coach I'd probably I think that – that's the luck of the draw. If you match what they're doing, great, but I think that's just a flip of the coin.
Christopher: And do you think that would be a good proxy then for like being technically competent then knowing exactly what good form would look like?
[0:25:06]
Seth: Sure. I think it's a good start. I mean, look, I could be a really cool guy and tell you exactly what you want to hear and then have no idea what the hell I'm teaching you in a box squat. So I think you need to work with them a little bit and have an idea of kind of what their philosophies are. I think people who are engaged and passionate and willing to learn are people who are going to be good coaches for you. I think the people who just kind of go through the motions and aren't really coaching you one on one and giving you kind of cues and good coaching cues, probably not. So, yeah, you have to work with them a little bit but I think you can get a pretty good appreciation for people's capability pretty quickly in my opinion.
Christopher: Okay. I wanted to ask you about what it means to chase symptoms in physical therapy because I know what it means to chase symptoms in other areas of health. To give you a really good example, a few years ago, I was a real wreck of a human being that was eating a terrible diet. I was becoming anemic through poor digestive health. One of the reasons I was anemic was through an iron deficiency. My primary care physician just chased the symptoms and sent me into the hospital to hook me up to an IV to just replace that iron which of course may or may not have been of importance at the time.
Seth: Yeah.
Christopher: But it didn't really do much to address the underlying root causes of the deficiency. You shouldn't really ever get iron deficient if you're a man especially but so what does that mean in physical therapy? Does the same sort of thing happen?
Seth: Oh, my goodness, Chris. I mean, I'll tell you. I think it's a big problem. People do chase the symptoms and I think it starts – because that's what the patient is expecting and it's like –
Christopher: Exactly. What are you doing for my knee?
Seth: Why aren't you looking at my knee? And it's like, well, I am looking at your knee but I think you need to appreciate the fact that the way that you're landing when you're jumping, your spinal position is a major problem here, bud. And we've got to fix that so that we can address your knee or your foot or however that is. So you're right. It's a huge problem certainly in the physical therapy profession.
What we're finding more and more is that symptoms don't indicate necessarily tissue damage or tissue status. If I were to take an MRI of 100 random people off the street, a lot of them are going to have herniated disks and, oh my gosh, how are you even walking around type readings from the radiologist yet they come in and they feel great. They have no pain at all and I am just picking that out and so it's like we are chasing that pathology and it's just – the correlation there is so weak.
So we've got to kind of rework that into – we've got to fix the mechanical problems. We've got to down-regulate or up-regulate your nervous system depending on where its status is and then we can address any sort of tissue stress that's resulting from poor movement patterns. It's like we almost – we go the opposite. It's like, oh, let's work on your knee and maybe if we have time we'll fix the way that you're landing when you're walking up and down the stairs or landing from your jump. It's like no, no, let's fix all that and then your knee is going to get better.
Christopher: Right. So how hard is it to find someone that understands what you've just said? Am I going to be able to do this? If I just walk into any physical therapist office in Santa Cruz, say, would I find someone right away or are they quite elusive?
Seth: Well, I wouldn't say that they're all quite elusive. I think we are getting more and more of an understanding as more evidence is coming out to support this although I think the best clinicians have been doing this for centuries honestly. I mean, you know –
Christopher: Do you have a word for it? So in health, kind of the help I am used to is called functional medicine. It's like kind of this idea – it's a label really. Is there one for physical therapy or no?
Seth: Well, that's a good question. I think someone who is not pathoanatomical-driven.
Christopher: Right.
Seth: Someone that you want to look for. I would say a movement-based approach is appropriate or certainly a holistic approach to movement and performance would be something that I would kind of look for. Some of the literature and more PT nerd stuff talks about looking at impairments and treating impairments, meaning like loss of motion or inability to control the spine, all these things versus knee pain, knee swelling, some of those more symptom-driven things. So certainly someone who is movement-based and movement-driven is something you should probably look for.
It's tough. Like anything, I mean there's good and bad in all professions but I think having an interaction with the therapist is certainly an important one. Something I'll tell my clients is, "I anticipate you feeling better and moving better in two to four visits."
[0:30:15]
Christopher: Oh, really?
Seth: That's not to say that you're going to be resolved but I think that you will feel better ASAP. I mean, look, my goal is just nobody leaves -- whether it's training with me, treating with me, people aren't leaving in a worse state than when they're coming in. They are feeling better when they leave because we are restoring that balance in that stuff.
These clowns that say, "Well, it's going to take 12 weeks for you to feel better," I mean I can't think of anything that would take 12 weeks to feel better unless there is some sort of ongoing weird pathology, some sort of systemic type diseases process. But, you know, I think people putting the therapist being strong in what their capabilities are and being able to make themselves accountable is huge too.
Christopher: Okay. I was wondering what category orthotics fit into this. One of the other not so great experiences I had was I walked into a sense of a sports medicine in quite an affluent part of California and I thought this place looks kind of shiny and nice and I'm sure they can help me with my ankle that's quite sore right now.
I think the underlying root cause was the fact that I hadn't really walked anywhere for about two years, like I literally rode my bike to the toilet almost, like everywhere I went on my bike. My ankles were not used to bearing weight anymore and so they started to hurt when I did anything other than riding.
I went in there and they suggested that I should just put something inside my shoe and that was going to fix it. Now, is that treating symptoms?
Seth: Oh, yeah. Absolutely. It's like putting a bandage on your cut. Well, eventually, your cut will start to go away so we can take the bandage off type deal. I mean, it's absolutely treating symptoms.
Kelly Starrett talks about this in his Ready to Run and I certainly have read -- really appreciate some of the work of Daniel Lieberman in Story of the Human Body. He talks about, look, the human foot is made to bear weight to be flat and to – it is the ultimate expression of mechanics and physics. It's an unbelievable structure to support our weight. Why would we need all of these external things to put in our shoe in order for us to be able to walk to the toilet so that we don't need to pop a wheelie in order to pee on your bike?
Yeah, so it is a way to treat symptoms and not understanding the root cause. I mean, luckily for you, your orthotics probably paid for that shiny building there. But I think ultimately we've got to be able to address the underlying cause, whatever that may be. Sometimes orthotics are indicated for a short term to get people out of pain if it's that broken down and bad that we can't even walk without them. Yeah, maybe we get them in short term but I think that the problem I see is that that's all we ever do and it's just constant triage.
Christopher: Right.
Seth: It's like: is your foot going to fall off? Yes or no? Okay. Here's an orthotic. See you later. That's not fixing anything. That's just kicking the can down the road.
Christopher: Right. Yeah, of course. What ended up happening was that the foot inserts, they felt good and so I wore them, right? I bought 17 pairs of them so that everything – and I put them in my cycling shoes. A year later, I'm still looking for deals on Amazon on where I can get these inserts and of course I'm no longer talking to the sports medicine place at all. So I'm just wondering whether they should ever introduce them at all or – I don't know.
Seth: It's almost like a drug dealer. They got you hooked. They gave you the stuff and now you're jonesing for more. It's funny how that stuff works.
Christopher: Yeah, so I wanted to ask you. I'm going to do some strength training and I'm also going to be doing some endurance stuff on the bike which is kind of a necessary evil for the pursuit of victory if you like. I want to be the fastest man to bike race so I can and I know that I need to do some long endurance sort of more catabolic stuff in order to get there. Now, do you have any thoughts on protocols that are going to allow me to recover faster?
Seth: Well, I think certainly taking care to – I guess in what regard? Do you mean like as in –
Christopher: Anything. Like literally anything from diet through rest to exercise, stress reduction supplements – any of that stuff.
Seth: Sure. Well, I think the biggest thing that we need to do when you're training for this and you're doing multimodal exercises, meaning you're doing biking, you're doing some strength training, perhaps you're running or swimming or something to kind of hit all these different areas, is that we have to have an appreciation for the overall stress to the system whether or not that's kind of making a log book or having an idea of, look, just measure your weight every morning or your heart rate. I mean, there are some easy apps on the iPhone that I'll just measure my heart rate first thing in the morning and just see where I'm at. You can track that over time.
[0:35:19]
If your heart rate is going up and up, that's probably meaning that there's too much stress to that system. There are some central nervous system tap test things that look at reaction ability and that looks at kind of your status of your nervous system. What we see is that people who are in this kind of overall overstressed state due to whether that's overtraining or under-recovery is that they'll have a slowing down of that nervous system and reaction times become slower.
I think the biggest thing is is being appreciative and mindful of how your body feels. I mean, that's why movement practice is so different than an exercise. Movement addresses system stress. It addresses skill acquisition, all these things. That's what a movement practice does. Exercise is just doing crap because it's supposed to help me.
So being mindful of: how am I feeling? I think the way to look at it would be: your nervous system and your brain is kind of like an overprotective mother and I think – Todd Hargrove who wrote A Guide to Better Movement, he kind of uses this example I think either in his book or one of his podcasts that I thought was really great is that it's kind of like an overprotective mother in that it wants you to stop getting hurt. It doesn't want you to get hurt. It stops you from getting hurt. But it doesn't really let you go play and so we have to be like, "Look, mom. Everything's okay" or you need to listen to your mom when things are out of whack. And so having some of those basic metrics certainly help, whether that's, like I said, heart rate, central nervous system, how you're feeling.
Are you getting incredibly stiff and sore and you can't recover from some of those things? Then we need to maybe down-regulate, use some more soft tissue work, use some more joint mobilization type work, breathing strategies to kind of balance some of that volume out.
Christopher: And then what have you found to be best in terms of diet? Do you ever say to a client, "Look, I can't really help you until you stop eating that crap"? And what is that crap when that happens?
Seth: Oh, yeah. Well, I certainly address diet. For the hard core diet stuff, I will send them to some nutritionist that I have respect for. But certainly more of the inflammatory foods just wreak havoc on people. I mean, as you well know, with the work that you are doing, certainly the gluten, tons of these simple carbohydrates, simple sugars, I mean these things are wreaking havoc on people.
It's interesting. I think the other thing that I'll see sometimes with people, believe it or not, is smoking still. I mean, my God. It's the 21st century and people are still smoking. Those are the people I say, "Look, I can't help you until you get rid of this crap."
But your glutens, your simple sugars, low-fat diets, I mean, I've seen more people respond positively to higher fat diets, lower carb diets than anything. So certainly it becomes an issue and it's kind of like, if you imagine like all these different – if you think about a bucket and that bucket is performance and we have all these different pipes draining into it -- one is mobility, one is a movement practice, one is diet, one is sleep. If one of those pipes gets backed up, it starts to overflow into the other thing. So you could be great at moving but if you eat like crap it's going to show up in your movement eventually.
Christopher: Okay. What sort of macronutrients have you seen work best? I know for me as an endurance athlete, the high fat approach has been phenomenal. But I know that's not necessarily optimal for strength-based stuff just because, you know, just glycolytic so much more of the time. So what have you seen work best? Is everyone individual?
Seth: I think that everyone is individual and I think it's based on kind of how they respond to different macros. I mean, certainly high protein base is going to be beneficial for people who are under the bar a lot and training a lot. I think people who vacillate back and forth -- I really struggle with people who are vegan from the standpoint of getting enough fats, getting enough proteins into their diet and enough to be balanced. Not that it can't be done as an endurance or a power athlete but certainly it makes it much more difficult.
But I have seen – certainly, their protein intake needs to be high and nutrient timing in that getting carbs at appropriate times so that kind of golden window 15 to 60 minutes after a bout of exercise, particularly strength is that kind of golden window to get nutrients into the system and kind of normalize that insulin, free blood glucose levels.
[0:40:16]
Christopher: Yeah, I see. I understand. Do you recommend supplements? Do you say to your clients, "Look, you should be taking this whey protein powder" or anything like that or do you think that it's possible to achieve everything with whole food?
Seth: That's a good question. I will use some supplementation for protein, particularly in that golden window post-workout.
Christopher: What type of protein do you like?
Seth: I typically will have people use and myself will use kind of a mix of whey, sometimes casein although sometimes I try to – I don't know. I go back and forth because of some of the dairy type stuff with that. So I've kind of gone back and forth. Personally, I do think most people can get better with a whole foods diet but I think it depends on the individual's needs and some of their kind of own regulatory abilities.
Christopher: I wanted to ask you about there's this sort of condition that's not really a disease called adrenal fatigue but it's a useful label because everybody knows what you're talking about when you say it. Over the last – I don't know – eight months or so, we've run hundreds of these saliva cortisol panels and nearly every single one of them has come back with really low cortisol and that correlates really closely with people feeling like crap, that is really tired is the main thing, and they are no longer seeing any kind of gains from strength and conditioning work.
I'm not suggesting that everybody has adrenal fatigue. I'm just suggesting that by the time that you're feeling kind of tired and mildly depressed that you are probably affected by this sort of thing. I was wondering: is it something that you see often in the CrossFit world or have I really got a really polarized view of the universe?
Seth: Well, certainly, I do see a lot of that adrenal fatigue which as you know can also result from high levels of chronic stress to the system. That comes back to my point earlier about the ability to down-regulate some of this stuff and balance some of these stresses.
I think the interesting thing about the CrossFit community specifically is that the one thing they are really becoming better and better at – now, you certainly hear stories but as someone who coaches CrossFit and does participate and certainly does a lot of that stuff, they are really mindful. So I think that that's a great thing. It's a movement practice and the people who – they are hard core but they understand their limits and they understand when it's time versus when it's not time to rest.
I see it more in people who are kind of these executive athletes who are piling on kind of this heavy workload. They are trying to get in shape of I just sat for eight hours and they're running all this kind of chronic stress and they never turn down. Certainly, we see that in kind of that realm of people, especially people who just can't breathe correctly, have no access to their parasympathetic state and it's just this constant amped up state all the time. These are people who are getting five hours of sleep at night. It's like, look, your brain is telling you to go to sleep; you should probably go to sleep.
Christopher: Uh-hmm. Is that a real problem that you see a lot then in people wearing the sleep deprivation as a badge of honor?
Seth: Oh, yeah. I mean, I can remember when I was in school. I mean, it was a badge of honor. Oh, I've got exams. I'm going to get five hours of sleep for the next four days or a week. It sounds cool at the time but then it's like, you know, you can't function this way. There's a reason that we have – this activating system makes you tired for a reason and so I think we need to listen to that rather than just powering through.
The unfortunate thing is we've got all these supplements and things that we can do to kind of correct for this and kind of basically drown it out. It's similar to kind of like getting an orthotic in your shoe rather than fixing the problem. I'm super tired; I guess that must mean I need more caffeine. Let me start drinking three cups of coffee after 12:00. Then your sleep patterns are disrupted and that stress is never abated.
Christopher: Absolutely. Finally, I just had one last question for you which was I've talked about myself, an endurance athlete, and then maybe you know the CrossFit community better than I do and we talked about those people but who else is strength and conditioning for? Do you think I should be recommending to absolutely everybody that comes to us not feeling great and that does some lab test that showed problems? Should everybody be doing some sort of strength and conditioning work?
[0:45:05]
Seth: I think almost absolutely people need to be certainly more confident in movement. Now, I think some of the best athletes I see – this isn't an example you're asking but I'll get to that in a second. The best athletes I see are already quite strong and they just need to move more efficiently. On the flip side, I think we see other people that are just so fragile and so de-conditioned that they're like a time bomb and it's like, look, as soon as one wrong – they're like a China doll. As soon as they take one wrong step, they are broken.
There are so many studies to suggest that strength is a positive predictor for decreased mortality and morbidity. Even looking at something as simple as grip strength or ability to get up from the floor is a predictor of mortality in huge studies. So that’s a measure of strength; that's a measure of mobility. Certainly, imbalance, getting up off the floor but grip strength I think –
People who are stronger are typically a little bit more useful and are a little bit more resilient and adaptable and that's what we are really going for is efficiency, resiliency, and being able to adapt to various situations. People who are stronger and have a strong movement practice typically do better. Certainly, they are able to – their blood sugar levels are more closely regulated with strength training and all those more physiologic things but I think even from a movement standpoint and a quality of life standpoint it's crucial.
Christopher: Would you ever send someone away though? Say they were pretty sort of sickly and not feeling great, would you ever say to someone that now is not the time for CrossFit or now is not the time for any sort of strength-based work; you just need to concentrate on the other factors and get healthier and then we'll talk about lifting some heavy weights?
Seth: Sure. And, look, make no mistake, if someone is – everything that we do should be scalable so not everyone necessarily needs to be putting a bar on their back. Maybe that squat that looks awesome for a 20-something or a 30-something guy who wants to get jacked up looks a little bit different for someone who is 85 and just got over a bout of osteoporosis or something. Maybe that looks like standing up from a chair and walking and coming back down and doing some of that.
Strength training should be scalable. Not everyone needs to have external resistance and so I think that's a huge part of it. I think part of the way that I've been trained is to be able to find people who aren't appropriate for some of these higher level things but still can benefit from movement and some strength things and some of the basics, kind of a regression.
I never turn anybody away from strength training. I will say that sometimes people are – it's not the biggest thing on their to-do list right now. Certainly, if there's a deterioration and some sort of medical problem, look, we're going to need to address this first but the end goal in mind is you need to be more resilient and adaptable and some of the best ways to do that is some basic training methods. Whether that's external resistance or just moving their body through space, that's to be determined based on the individual.
Christopher: Awesome. Well, thank you so much, Seth. This has been a very enlightening conversation. I know that the best place to find you is sethoberst.com. You blog there regularly. You talked about it in one of your posts which was excellent. I read it this morning. It's really enjoyable. Is there anywhere else that people can find you? I need to be in South Carolina in order to work with you in person, right?
Seth: That's correct. Yes.
Christopher: [0:48:51] [Indiscernible] the kind of strength guys like us. It's a real bummer that you can't do any like video consulting or anything like that.
Seth: Well, I do do some video consulting through my website so that is a possibility for people. Like you said, it's sethoberst.com. Another way to reach me would be on Twitter at @SethOberstDPT. Certainly, I'm happy to talk with anybody but those are my two main ones. I'm not on Facebook currently but I do have a website and certainly I'm always happy to talk to people through Twitter as well.
Christopher: Excellent. Well, thank you so much for your time. It's very generous of you. Thank you.
Seth: Thank you. I appreciate it. I'm a big fan of what you guys are doing.
[0:49:33] End of Audio
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