Movement Analysis and Breathing Strategies for Pain Relief and Improved Performance [transcript]

Written by Christopher Kelly

July 20, 2019

[0:00:00]

Christopher:    I first became aware of your work when I was in Costa Rica with Tommy and Megan and the rest of the crew. We were interviewing Ben House, so I know you know. Ben said there is a physical therapist that can do better work than most regular physical therapists remotely via video conference. And I thought, “Wow, no way. That can't be bright. I have to look into this guy.” And so I did and I found you. And I did a video consult with you. In fact, I did a couple. Oh, look at that, a couple, I just mentioned it.  

Zac:    I see what you did there. I get it. 

Christopher:    See why I did that? Crack to funny without you even noticing. And sure enough, you were fantastic. I don't really know that much about physical therapy. In fact, I know almost nothing. So I'm hoping you're going to tell us a little bit about what you did for me because that was highly beneficial. But before we go there, can you tell us about how you became first interested in physical therapy? What was going on at that time? 

Zac:    The reason why I got into physical therapy is because I was a mediocre athlete who wanted to be better than mediocre. I used to run Cross Country and Track. And I did it collegiately at the DIII level, so nothing sexy. I was maxing out on my running. I mean I was up to 70, 80 miles a week at one point. And I'm like, “Man, I need to find something else to get better.” And that's when I found the weight room. I really started to enjoy that process of lifting weights, improving my movement more so than I did the running component. 

    My coach in high school was a chiropractor. I'm like, “Oh, maybe I can be a chiro and I can help people that way from a movement perspective as well as manual therapy.” Then I worked for him. And I ended up hating it, just absolutely hating it.

Christopher:    Oh.

Zac:    Yeah. And I'm like, “Man, I can't do this.”

Christopher:    Why do you hate it? 

Zac:    Well, first off, when I first saw the manipulations or the adjustments as the chiro calls it, I was scared shitless. I can swear on this, right? 

Christopher:    Yes, absolutely. You can swear on this. I must admit I had the same response. I know nothing about chiropracticy, but I've read Ben Goldacre’s book where he talks about these adjustments of the cervical spine and some case of some baby that died or something, which I'm sure every chiropractor listening to this will go, “You're an idiot.” And I probably am. But yeah, I must admit. I do find that quite frightening too. 

Zac:    And I think what also turned me off was – now, this is not representative of all chiros, but the guy who I worked with, he did a lot of modalities, which as I learned is kind of BS. It was very supplement heavy, which I'm all about supplements, but it was just like, “I'd give you the supplements and not do anything for your diet.” And I think just the combination of all those factors didn't jive with me. So I was at a loss. I'm like, “Well, what do I do now?” 

    Then I went and started working at a PT clinic in town where I grew up. And I absolutely fell in love with it. It was way more exercise focused, which was my bag. And I'm like, “Yeah, I'm definitely going to go do this.” Then I went to PT school, made it through PT school. And what really led me down the path I am now is a clinical affiliation that I did while I was in PT school. So once you do all the didactic work, you go out and work at a clinic and learn under someone to pick up all their tricks of the trade, so to speak. 

    And the person who taught me, much of what I know is Bill Hartman. He is by far the best physical therapist that I know. He just opened my mind to just many different thought processes, techniques and a way to treat PT that we didn't necessarily learn in school, but that got me really juiced up to be in this profession. And once I had that clinical, that set me down the path that I am now, which is a mix of doing in-person work, doing some online work, not just from a PT aspect, but also doing training, mentoring, teaching, all of that. And I haven't looked back since. 

Christopher:    That's awesome. What was it that was special about Bill? Was he still around? Is he still practicing? 

Zac:    He is. Yeah. To this day, he's become more of a friend and a mentor. We got a father-son relationship kind of thing going on. I aspire to be like him next year because this man has been practicing for a very long time. And he still has the drive to get better. He's still progressing his model. He's still teaching. He's still making other people better. And just to see the leaps and bounds that he's improved just in the last two years, I mean -- I feel like he’s more than many clinicians improve in a lifetime. And these, a guy who definitely keeps a fire lit under me, keeps me striving to get better. He's a great man. 

Christopher:    What's the metric? How'd you know he got better? What is it you're seeing him do now that he wasn't doing two years ago that makes you think that he's that much better? 

Zac:    I think the model he uses, which is mostly what I adopt as well, is simpler. Yet the results have been unchanged. 

Christopher:    Oh, okay.

Zac:    When we worked together, Chris, I was able to give you just a couple of simple moves. 

Christopher:    Oh yeah. It was ridiculous. I thought it was like a party trick. I thought you're making fun out of me. 

Zac:    Yeah. Yeah. You really do have. Hey, just kidding. No. Yeah. With a few simple tests and if I looked back to how both he and I practiced two years ago, it was way more in depth, way more nuanced in terms of the techniques that we would have to use. The coaching was much more challenging. I've just noticed that things have gotten way simpler. 

    And I think that's what we need to strive in all professions. Nutrition is a prime example of that. 

[0:05:26]

Christopher:    Oh yeah, great. Yeah.

Zac:    I'm not a nutrition expert by any means, but you look at all of the different diets that people are advocating for. And they often war against one another. And let's not even get in the supplement industry. But we can all agree that vegetables are important. We can all agree that you need --

Christopher:    Actually, we can’t. I just touched on Baker on the podcast. 

Zac:    Oh really? So maybe not. Okay. 

Christopher:    That’s literally nothing. The only thing I think we could agree on is that whole food is a good idea, right? So if you're going to do carnivore, you eat the whole animal. And if you're going to eat plants, then you eat most of the plants rather than just processed stuff that comes out of crinkly packets. I think that's what everyone agrees on. 

Zac:    So nutrition is just a lost cause. Maybe I'll just stick with movement. 

Christopher:    That is awful. Yeah.

Zac:    Yeah. But there needs to be simpler heuristics. I think that many people can follow. What I've seen him do from a movement standpoint is find simpler heuristics for us to follow to maximize client results. 

Christopher:    Tell us about what you learned working with basketball players. Am I right in thinking that you used to be on a team working with NBA players and then later on -- I think they call it the D-League. I don't know anything about basketball, so excuse my ignorance. 

Zac:    Yeah. I was in that professional basketball for about a year and a half. I did a half season with the Memphis Grizzlies. I was brought in mid-season with them, worked the summer with them. Then I spent a year in the NBA D-League with the now defunct Iowa Energy. I think they're the Iowa Wolves now. 

    I learned a lot. That was actually the -- especially when I got to the D-League, I was more than just a PT. I was the PT. I was the strength coach. I was the nutrition guy. I was the sleep guy. And I would also have to do -- yeah, I mean everything. And I would also have to do load management with the coaching staff. So determining, “Hey, should we practice today? Should we not? How much should we do? How hard should we go?” 

    And it was at that place that I really began to appreciate just how limited scope movement is alone, but also how many different things we can work on with people to maximize performance in their case. If we do really good things movement wise, but then we have three hard practices in a row and we have a game the next day, that's not going to be beneficial for them because their workload is too high. And they don't have the ample time to recover, thus, performance suffers.

    And I started applying a similar thought process to the people I work with now in the clinic. I was finding that I could do great things with movement. But a lot of these people would also have other comorbidities or other factors that were going on in their lives that were influencing their outcome. I couldn't tell you how many people who I saw had this particular pain syndrome, but then they also had three autoimmune diseases. Or where I work at now, -- because I work in a more underserved population -- I can't tell you how many times I've worked with people who have specific pain that was either from a domestic violence case or they just have a poor relationship with their spouse. 

    Working in the NBA and in Pro Sports really led me to appreciate just how multifactorial people's complaints and conditions are and thus requiring a multifactorial and multimodal approach and oftentimes a multi practitioner approach, which is why I really appreciate what you're doing because I know that you are gathering together a bunch of practitioners to help people meet their goals. And I think that's ultimately what most people are going to need because the conditions getting any easier to treat. 

Christopher:    And how do you manage that? We might call it systems thinking in physical therapy. How do you manage all that in your head when you have a patient walk into your office? How do you manage the complexity? 

Zac:    What I do is I work with -- when someone comes to see me, they expect a movement fix. So that's what I give them. And I try to maximize what I can movement-wise for as long as I possibly can. So if we address all their movement and things are going well, then that's all we need. If I hit a brick wall or if I am not getting this person better, then that's when I have to start thinking what else could this individual need to take themselves to the next level. And maybe for them, that's working on their sleep hygiene. Maybe for another person, it's a psych referral. And I would really have to have a specific patient, I think, to know where that person needs to go because everyone is maximizing those qualities differently. 

    So yeah, I think to me, if I had to prioritize things, I think either going the sleep route or possibly going the psych route are usually the first two areas that I'm considering. Because if someone's not sleeping, it’s going to be very challenging for them to follow through any habit change, whether it's nutrition or anything like that. Just because your ability to have good habits is effective because you can't make good decisions if you're not sleeping well. 

[0:10:16]

    I also think -- especially after hearing Bryan Walsh talk when I went to his seminar, how much he discusses purpose as being incredibly important in someone and in yourselves. Well, what if the person you're working with doesn't have purpose? Or maybe their story is inaccurate and that's the rate limiting step that's leading to them having issues? And that's probably a psych referral. And you probably need to focus on that as well. 

    So if those two things are in line, then it's a matter of just trial and error of what's going to be the next thing that makes this person better. Is it they need more fitness oriented stuff and I need to refer them to a trainer or I need to do training with them? Is it that their nutrition is a joke and I need to start that process?

Christopher:    How do you assess that? You said that nobody knows what a healthy diet is, but you obviously know what a joke is. 

Zac:    Yes. Well, I think a joke would be -- so with the people who I work with, if they're eating out multiple times for a week, eating fast food, I think that's a low hanging fruit, no pun intended, to go after. If there's someone who is eating whole foods, that's probably a little bit more sophisticated and nuanced. And that's probably outside of my current skillset. I would probably need to refer to that person. 

Christopher:    It's very interesting to hear you say that sleep is the keystone behavior that leads to all the others. You're not the first person to say that on the podcast. Ashley Mason is a clinical psychologist. And much of her recent academic work has been around mindfulness eating interventions and low carbohydrate diets. She does 20% of her time in a sleep clinic doing CBT for insomnia. And that's why she's doing it, right? Good luck trying to have someone do a mindfulness eating intervention if they're tired as hell. It's the keystone behavior that everything else rests on. 

Zac:    Yeah. It's funny you mentioned that because I usually – before, I didn't really appreciate sleep to the extent that I do now until I was in the D-League. And I want to just give you an example of a typical travel schedule that we had. We would fly. I lived in Iowa. We'd fly to Reno, Nevada to our time zone change, early morning flight 6:00 a.m. because those were the cheapest flights. 

Christopher:    I hate those. I hate those flights.

Zac:    Oh, man.  Red eyes, early mornings, I will avoid them at all costs. And I will pay the premium so I don't have to do those. So we'd have to do a 6:00 a.m. flight, play the next day, off of a two-hour time zone change. We played that night. You get home to the hotel probably like 11:12. Next day, 6:00 a.m. flight to San Jose, 35 minute drive to Santa Cruz, which is where the next game was, day off, play the next day, night game, then fly that morning. After a 35-minute drive back to San Jose, fly from San Jose to Salt Lake, play that night and another 6:00 a.m. flight. 

    And needless to say, our guys were sleep deprived as all hell. And we were doing early morning practices at the time. And it was just a recipe for disaster. We got a new coach midway through the season. And we went to dinner. I was telling him some of these problems. I was accruing data at the time as well to show that our guys weren't sleeping and thus, performance was impacted because we were on like a 16-game losing streak. 

    And by simply changing our practice time alone, we saw a complete 180 shift, not just in our performance but the mood of our players, the wins. I mean it was pretty dramatic. I have a post. I can send you the post.

Christopher:    I'll link to it in the show next.

Zac:    Yeah. We’ll outline all of that. Yeah. It was a remarkable change. And just that change alone, without changing anything else, led me to realize just how important sleep is. And I spent a lot of time while I was in the D-League just learning about sleep and trying to see how I can maximize my sleep and the sleep of my clients. 

Christopher:    It sounds like the perfect setup to teach somebody to hate the sport that they grew up loving. I can imagine it like loving something your whole life and then you get to do it as a professional. Then suddenly, it's the worst thing in the world you just can't wait to get out. [0:14:15] [Indiscernible]. 

Zac:    Yeah. Well, it's not really swanky until you get to the NBA. I mean --

Christopher:    Right. So everybody's hoping they're going to make the moonshot. 

Zac:    Well, I mean the amount of money that you make is dramatically different. Well, the travel schedule is still absolutely brutal. There is no circadian rhythm. If you work in Pro Sports. You're staying in nice hotels at least. I slept really well because you're staying in some of the best hotels in the world despite having the sleep deprivation, despite the 4:00 a.m. returns at home, all of that. 

Christopher:    Right. Was it a differentiator though when all the team’s sleep deprived? I imagine this comedy sketch where you've got basketball players trying to dribble the ball. And the ball just flies off to one side. Then they fall forward and buttheads and then fall fast asleep on the court. Is it not like that? Is it not every team sleep deprived? 

[0:15:01]

Zac:    Probably to an extent. But what I did notice was when I spoke to some other teams or based on their location, not everyone did the early morning flights all the time. Not everyone did the early morning practices. It's more, in Pro Sports, about damage control. So what's the least amount of sleep deprivation that I can induce to maximize performance? 

    And that's why a lot of teams are -- you read about this more in the NBA than you do in the D-League, but they're plotting out what towns they’re going to stay in overnight and then fly out the next day. If there's a game, what towns they're going to fly that night and then just sleep in. I think it's way more nuanced than it used to be. And even though it's not a perfect situation where you're getting the consistent sleep schedule, anything you can do to maximize sleep is critical. 

Christopher:    Talk about the types of pain that you see in your practice. We did a survey of our audience. And we've had 10,000 people, more than 10,000 people now, complete this seven-minute analysis that's linked on the front page of our website. And there's one open-ended question at the end. It says, “When it comes to health and fitness, what's the number one thing you've been struggling with?” 

    And when I looked through the answers, the word pain appears in all -- like every other row, right? And there's no body part that people aren't struggling with like, “My back hurts. My neck hurts. My shoulder hurts. My knee hurts.” You name it. It hurts. I thought about using some of the words that people were using when they answered that question. Then I realized that there's probably not enough context there for you to say anything interesting about that person specifically.

     So perhaps it would be better to talk about some of the people that you see in your practice, the types of pain that they're suffering from. Because talking about that keystone behavior sleep, like if you're in pain, then obviously that's going to affect your sleep. So talk about the types of pain that people are suffering from when they come to you. 

Zac:    It really runs the gamut for me. I see acute injuries. I see people who've had surgeries, whether it's a rotator cuff repair or whether it's an Achilles rupture in there. They're getting that. And I see a lot of people with persistent pain where they've had longstanding pain for several years. And lately too, I've been seeing -- I'd never seen this before until recently, but I'm also getting a lot of people who just don't feel right. They feel twisted internally or they feel as though that there's just tension in specific areas. Or I have people who are so hyper aware of their bodies where they feel their anterior pelvic tilt. It's like, “How do you even know what an anterior pelvic tilt is?” 

Christopher:    Yeah.

Zac:    I mean you'll be amazed, Chris, how often I get those conditions. So it really runs the gamut. But what if I told you, Chris, that regardless of where you're hurting, it's not necessarily going to change my decision making in terms of what I'm going to do with you. 

Christopher:    Yeah, that's interesting. Yeah, we've seen that before, right? Like we don't really know how the symptoms are going to play out, but the underlying process that led to those symptoms might have a lot in common. 

Zac:    Yes, because I think from a -- if you're a physical therapist, the first thing you have to do is rule out the big bad stuff. So if you've got someone who has, say, acute disc bulge and they have leg weakness, they have loss of sensation in the genital region, changes in bowel, bladder function, nothing I'm going to do about that. That requires an immediate referral, even though there's pain. 

    So once you've done your due diligence at ruling out potential red flags, what you're going to be addressing is the movement system. Does this person have the ability to move at all of their joints? If I've lost movement in any given joint, that's going to change how we move. That’s going to put stress on the body differently than if we had someone who had all of their movement capabilities. 

    It's like this. You've been in a long car ride before, Chris, right? 

Christopher:    Yeah, of course. It's terrible. 

Zac:    Absolutely terrible. You're in the car ride for two hours, three hours. You're getting sore and stiff somewhere. Usually, what you do is you'll pullover and you'll get out and walk. Then things usually get better. Then you go on terrorizing yourself on the remainder of the drive. 

    Well, let's say I took away your ability to get out and take a break from driving. Well, then the stiffness or your symptoms of whatever you're experiencing are going to continue to increase and get worse. Maybe you start getting stiff in other areas as well. The movement system in your joints operate in a similar fashion. 

    Suppose that I have an inability to straighten out my elbow for whatever reason. That's going to change the mechanics within the joint. That's going to put more stress maybe on the bicep because it's overly contracted or maybe it's going to stress some of the tissues on the backside of your elbow because they're constantly unstretched and tight. That's going to change how blood flow goes to all of these things. And that could potentially be a contributing factor to the pain people are experiencing. 

    So what I do is I give people that ability to get out of the car. If we can restore your joint range of motion in all directions, that allows you to even out that workload distribution throughout your body. That way, it ensures that the tissues aren't getting too overloaded. You're evenly distributing the pressure of gravity across the entire joint surface. And more often than not, by addressing that, people's pain gets better. Then we just have to teach them to be able to sustain those joint options or all of that joint range of motion when they're exposed to greater forces or for longer periods of time. And that's where a fitness program comes into play. 

    Now, if I've done my due diligence with that and we've addressed those areas and there's still issues, then we might have to refer to one of those other areas, whether that's psych, whether that's nutrition, because obviously, those can also lead to pain or whether it's sleep, which increases your inflammatory process if you are not getting enough of it. 

[0:20:49]

Christopher:    How'd you go about assessing movement in a client, especially remotely via video conference? That seems incredibly challenging to me. 

Zac:    It's probably easier if I tell you what I do in person first. Then I'll go into the online side. So if I'm seeing you in person, what I do is I get you on the table. I do some of the standing tests that we've done. I get you on the table as well to see what range of motion you have available at all your joints. 

    When I'm measuring these ranges of motion, I have a bias as to the range of motion that we see either at your shoulders or your hips. It's probably influenced to some degree by the orientation that your ventral cavity is in. What the ventral cavity is is your thorax, so your torso, your abdomen and your pelvic region. That's where a lot of these movement limitations start. 

    If you look at the research on movement variability, which variability is essentially repetition without repetition? If I do ten squats right in front of you and I have good variability, even if those squats look the same to the naked eye, there's going to be subtle differences that occur with each squat. And the research has been shown that if someone possesses those subtle differences with each movement they do, that has been associated with increased health and performance. 

Christopher:    Oh really? So greater variability is better. 

Zac:    Yes, assuming you reach the same endpoint at each time. 

Christopher:    Okay.

Zac:    There's another study they did with elite javelin throwers. And they measured their ability to throw the javelin. The elite javelin thrower could not reproduce the same throw twice in a row. There's always changes that are occurring at each of the joints. And this makes sense because if I'm making just subtle changes with each movement, I can fine-tune the execution even better. 

Christopher:    Oh, I see, I see. Yeah. 

Zac:    Yeah. So in elite athletes, we see that there's those fine-tune adjustments that can be made over a period of time. When you're a beginner, you're not always hitting that same endpoint each time you perform a task. Bike riding is a great example of that, right? If I’m going to bike -- 

Christopher:    Yeah. That's exactly what I was just thinking about. When I corner a mountain bike, then maybe I hit a rock that I didn't really see when I was -- so that changed the position of the bike. So then I changed my body position to compensate. I got to the same place at the end of the corner, but I did it in a different way than I did the last time I wrote this trial. 

Zac:    Yes. Now, let's take you first learning how to ride a bike and put you on the same course. You're probably not going to make it through the course. You're probably going to fall, get bruises, cry for your parents, all the things that we do when we were first learning a bike or learning how to ride a bike. 

    So we want to be able to have that adaptability when we're moving. In people who are experiencing pain or have an injury or have a history of a previous injury, that exploration, that variability in the actual skeleton, so in the spinal region, is reduced. And that's pretty consistent. It's not as consistent in the extremities. 

    Some of the research that’s been done at least in lower extremity has shown that variability can either be excessive or it can be reduced. Do you have either of those options available? But it appears as though the ventral cavity, thorax, abdomen and pelvis, that's pretty consistently reduced in cases of pain or injury or history of injury. 

    If I have a loss of motion in that region and since our extremities, our appendages, our arms and our legs, have attachments to our core, their movement is going to likely be influenced based on the lack of movement in that region of the ventral cavity. So by me assessing how your arms and your legs move on the table, I can get a sense for what you might need at the ventral cavity. 

    When I do that online, all I'm doing is I'm finding surrogate measures or things that give me an appreciation for what I would normally see on the table, but in standing. For example, there's certain measures that I might do on the table that will also give me an idea of how that person is going to squat because there's certain things your body has to do to be able to drop into a full squat. And that's really the only difference. 

    Then now, instead of using table tests as my comparator, so when we do an activity or an exercise, I go and recheck that to make sure we got a change. I'm now using a standing activity or something more active or more gross to determine the course of action and the success of an intervention. 

[0:25:14]

Christopher:    Do you have any idea of how much of a disability is to be not having the person in front of you in real life? 

Zac:    As I've gotten better, it's not as much as I would've thought. And what's interesting too is I've had some people who I've seen online first. Then I've treated them in person. And my decision making or what my findings and thoughts would've been were still pretty accurate. So yeah, the better I've gotten at coaching, the better I've gotten at doing some of these movement consultations that I do online and just the more reps and the more fine tuning that I've done with my testing, the easier it's been. 

    Now, I think there's some people -- if I have someone who's not really good with technology, then it can be a really big problem. And that's the one time that I will say it's not as good of a way of working with someone as it would be in person. I remember I worked with this one woman. Her audio was just awful. 

Christopher:    It’s just too bad.

Zac:    Yeah. I couldn't hear what she was saying. I don't think she could hear me. She was using her phone and didn't have a stand or anything like that. And in those cases, it's more of a lost cause. But most of the people who gravitate towards me are pretty good with tech because that's just how people are growing up now. 

Christopher:    Exactly. And that's how they get in your content. You run a -- host a fantastic podcast and create a lot of online content. So I'm sure those people are used to using technology in order to get access to that content. So it's not that much of a stretch to use video conference. 

Zac:    Yeah, absolutely. If someone's good with tech, I can usually do pretty well with them. And also I think, too, the market that gravitate towards me is either in the fitness or health and wellness field or there's someone who's really interested in that. And more often, they're not -- they have at least some degree of body awareness as well, which is also very helpful. Whereas if I had someone who was older, not good with tech or maybe not really body aware, then it would be much tougher to do an online consultation. 

Christopher:    I've got a great question here from our mutual friend, Zach Moore.

Zac:    My man, my man.

Christopher:    Your man. Yeah. 

Zac:    I love that guy.

Christopher:    Zach is great. We love Zach. He's done some excellent work for us. And Zach asks, “How'd you go about talking to somebody if they're in pain doing a movement? You don't want to scare him or her, right? A lot of clinicians, coaches heighten the pain response with the way that they communicate.” 

Zac:    Yeah. Well, a lot of the -- in the manner that I talk to someone regarding pain, the biggest misconception that many people have is they think that if they experience pain, that means they're hurting themselves or they're damaging their tissues. Which if you are versed in modern pain, neurobiology and pain science, that's wholly inaccurate. 

    And there are several instances in which you can have pain but not necessarily have tissue damage. If you've been drinking, you've been out all night and you wake up with a headache the next day, well, the reason why you had a headache is not because you did some damage to your head or you hit yourself in the head, unless that, of course, happened when you were drunk, right? There's other factors at play. Or say you've recently undergone a break up with your significant other. That can lead to physical pain or emotional pain, I should say. What was injured there? You didn't actually have a heart injury, but we have pain occurring. 

    So a lot of what I do in the beginning when working with someone is setup that thought process that, “Hey, just because you're hurting, it doesn't mean that you're injuring yourself. Pain is a protective mechanism that's ensuring you don't do whatever you did again. And experiencing a little bit of that is okay. It's not going to damage anything.” 

    Now, that being said, that doesn't give us free reign to push through pain and move and just be like, “Oh, I don't care. I'm hurting, but I'm going to push through this,” because guess what? Pain is there to protect you. But if you go too long while experiencing pain, that could potentially lead to reinjury or tissue damage of some other kind. So we also want to be mindful of that as well. 

    So what I usually coach my people on is I let them know, “Hey, it's okay if you experience pain. But I don't necessarily want you to do that while you're performing a given fitness exercise because you're probably not working the areas that I need you to work as effectively as you could.” So if they're experiencing pain, it's not like, “Whoa, whoa, whoa, we’ve got to stop doing this.” It might just be simply changing the movement just a little bit. So they're moving differently, maybe making the technique a little bit more refined. And more often than not, that changes how the movement feels and can help someone with pain. 

    So it's not about trying to scare that person that they're hurting. It's about getting their bodies to move in a manner that passes the eye test for us as fitness professionals, but also feels good and is meeting the goals that are desired by both yourself and the client. 

[0:30:00]

Christopher:    Yeah. Zac has been really helpful to me in the past. Actually, I’ve just been -- you're just reminding me. “My back exploded.” You hear these sorts. Of course, it's nonsense, but that's what people say. And for me, it happens after a series of stressful events, racing Cyclocross, splitting some wood with probably terrible form. Then I did some dead lifting and then had this excruciating low back pain early one more. It was so bad I couldn't get off the floor. It was like take-your-breath-away back pain of course. 

    So the first thing I did was busted out my Stuart McGill book, the Back Mechanic, like, “What have I been doing wrong all these years?” Of course, what did that do? It just made it worse. Then I had a pet talk with Zac. And he talked about catastrophizing and awfulizing and all this stuff. Sure enough, I was okay the next day. 

    And he pointed me at -- I forget. I think it's the Barbell Medicine guys. And I've watched a couple of their videos. I got back into deadlifting much sooner than I would’ve done otherwise, just with a lightweight. And I was really surprised I actually felt better after lifting some weight than I did before [0:30:56] [Indiscernible], which is the exact opposite of what you'd expect to happen. 

Zac:    Yeah. I just read a thing, Harvard Medicine, recently where they were saying that inactivity is probably the worst thing you can do for back pain because it leads to increased chronicity. And the same thing too with catastrophization and fear-avoidance behavior where, “Uh-oh, my back hurts, so I'm not going to do anything.” 

    Both of those things have been associated with having pain for longer periods of time because pain is going to be produced if your body and your brain perceive that there's some type of physical threat or some type of threat that's about to occur. Your thoughts can contribute to that threat. So if you can do things to eliminate the threat, whether that's teaching the body to move safely in a manner that's not experiencing pain, whether that's educating you on why catastrophization is not a desirable thing. And the way I would do that would be giving you some facts about pain or educating you about the way pain works. All of that can be incredibly useful. 

    Usually, my process when I'm educating someone on pain is if you have this belief, then I'm going to give you things to go against that belief. So for example, if I have someone who is seeing me for the first time and they have back pain and their doctor sent them to an MRI right away and they're like, “Huh. Well, it's bad. I got degenerative disc disease. And I've got a bulging disc at 0.4, 0.5 and whatever,” but they have no leg symptoms and they just have a localized back pain, well, there's a lot of simple things you can do by arming them with accurate information. 

    And we can give them stuff like, “Well, did you know that depending on what study you read, 30 to 80% of individuals who are asymptomatic have those exact same findings that are on your MRI. We can also go with the degenerative disc disease starts around age 20 if you're looking at the research, but that doesn't mean that all 20 year olds have back pain. So saying things like that should give the client hope that, “Look, because you have pain now and even though you have these findings, it doesn't mean that you can't go to the other side and be someone who has the findings but is asymptomatic.” 

    So you just have to know what the facts are and be able to explain them to someone who's hurting in a manner that doesn't degrade their experience, that doesn't provide too much cognitive dissonance that they don't want to believe you. But also, I guess –

Christopher:    Right. I get what you’re trying to say. 

Zac:    Yeah.

Christopher:    Yeah, yeah. So you're not sort of belittling them or just being dismissive. It's somewhere in between. 

Zac:    Yeah. Well, because when you get too far into educating someone on pain science, you run the risk of having them think that this is all in their head. 

Christopher:    My head, yeah. 

Zac:    And we want people to understand that, “No, what you're experiencing is a real phenomenon, but it's probably not an accurate representation of what's going on in the body.” Just like there's times where you'll feel a vibration in your pocket and you think it's your phone, but then you look and you have absolutely no notifications. This is a common phenomenon. But we don't always go to Verizon or the AT&T store to fix our phone because we had a vibration that we didn't have a notification. Yet the unfortunate thing is we absolutely do that with our bodies knowing that the information that we're experiencing is not always accurate with what's going on internally. 

Christopher:    Is it useful to talk about -- so when I saw you as a client, it was not because I'd thrown out my back or my back had exploded or anything like that. It was more of a chronic niggling thing. Is it useful to talk about what you did for me? Is that typical, what you saw especially in endurance athletes, like runners and people who are cycling or maybe swimming? Is it common? Was I a special snowflake and by talking about what you did for me, it's not really going to help anyone listening?

Zac:    What I would say is I think what's becoming more common than not is people have pain for extended periods of time. And I think even though you're an endurance athlete and you've probably have your bumps and bruises along the way that have been egging you on because you are still an active individual, I don't think that that's entirely unique. There are some people who are super active who have these pains, but there's also people who are inactive that also have those same pains. But we can most --

[0:35:10]

Christopher:    Yeah. I’ve seen that my problem was partially caused by too much sitting because I know that makes it worse. And that's what I do, right? I spend all day sitting at a computer. Then I get into a mountain bike and do some more sitting. The thing that was paradoxical to me was standing wasn't necessarily any better. Like if I spent all day standing outside, then I get the same God damn pain. The only thing that seemed to work reliably was lots and lots of walking. 

    So that's typical then? So regardless of whether you were an endurance or not, that kind of niggling, sort of asymmetric low back pain is something that you see a lot of? 

Zac:    Yeah, absolutely. I think when anyone experiences pain, we don't necessarily know what the cause is because there is no one cause unless it's you jumped and you landed this way and you tore your ACL. 

Christopher:    Right. Yes, definitely nothing like that. I would say that I was experiencing a low grade chronic pain that if I was to scale it on one to ten, it was never more than a three. It's like just a minor irritation, but an irritation nonetheless. I think it was enough to persuade me to part with money to talk to you on Zoom anyway. 

    And the thing that really, really surprised me was like -- so by the time I talked to you on Zoom, I tried a lot of shit that didn't work, right? I tried foam rolling and stretching and like, “Oh let's just go for a walk and see if that gets rid of the pain.” And nine times out of ten, it would do absolutely nothing. 

    So I was pretty confident that you'd be able to fix my problem. But I didn't think you'd be able to do it [0:36:30] [Indiscernible] too. I didn't think it was going to happen right there and then with a few breathing exercises. So can you talk about how you went about assessing the problem -- I guess you already have to a certain extent -- and then the remediation that you did? 

Zac:    Well, let's go more in depth than what I did before because I think I kept it pretty superficial. Basically, what I did with you, Chris, was I looked at what movements you can and cannot do. So what are your movement capabilities? And I have certain standards that I would like my people to be able to do. 

    For example, if you can't touch your toes or you can't achieve a full squat, there's probably some movement limitations somewhere on the backside of you, just somewhere. I don't know where that is but somewhere. Because in order for you to fully touch your toes, everything along the back side of your body has to relax and so, too, with the squat. Then I do something to appreciate the front side of you, which would be the arms overhead backwards then. If you can't do that fully, then there's probably something on the front side that is creating a movement limitation.

    Then there's a few other things that I look at. And based off of that information, that lets me know what type of intervention I need to give you to be able to restore those movement limitations. So if you can't bend forward and touch your toes, I know I need to do something that places your body into a position that allows that stuff on the back side of you to be able to relax or to be able to fully go through the movement that it’s currently not doing. 

    Pretty much what I do in a nutshell is find what you can't do and give you things so you can do that stuff. Then I retest the activity to make sure that we're heading in the right direction. Then I also get feedback from yourself in terms of how you feel. And that's why I was really excited when you're saying, “Oh, I don't feel that hip stuff that I normally feel.” 

Christopher:    It was that kind of pain where you knew it was -- I don't know what it was. I knew it was possible for it to go away. And come on, instantly, it's almost like you could turn it on and off like a switch, which like -- that kind of suggested me that there's not any tissue damage, right? 

Zac:    Yeah. It’s the car analogy that I went with before. It's like you were driving. You were sitting for an extended period of time, but you can never get out and go for a walk. So I just gave you that ability at rest, so to speak, to go for a walk because we were able to place your body in a position that allowed you to restore range of motion at your joints that you likely didn't have for whatever reason. What that reason is, I don't know. 

Christopher:    So where does the anal sphincter fit into all this? I feel like most of your practice is centered around the anal sphincter, right? 

Zac:    There's so many jokes in there that I just -- I'm going to keep it professional. 

Christopher:    It's a gift. 

Zac:    It's like instead of the softball being lobbed, it's like I have the tee-ball right here. But you know what? I'm going to step off the plate for right now. 

    So I would say that most of my work -- I'll go into the anal sphincter of course, just for you, Chris -- but most of my work involves getting someone to be able to stack atop their thoracic diaphragm and their pelvic diaphragm, which is where your anal sphincter would come into play. So every time you take a breath of air in and a breath of air out, your whole body, during the inhalation, ought to be able to expand in all directions and then during the exhalation, ought to be able to compress in all directions. 

    This is how the concept of intra-abdominal pressure occurs, which is a common term that we hear in our industry, which, “Can you generate enough pressure within the abdomen and pelvic region to be able to perform a given movement task?” What I find is if someone has a movement limitation developed for whatever reason, their ability to generate both intra-abdominal pressure and intra-thoracic pressure is altered based on the position someone's in. 

[0:40:21]

    For example, if I have a scenario where those diaphragms aren't stacked, but instead, I'm more contracted on the back side of my body and more stretched, so to speak, on the front side of my body, well then I have a scenario where those diaphragms are in a more of a scissor based position or they're angled away from one another as opposed to being atop one another. 

Christopher:    I see.

Zac:    That's going to change how you move. That's going to change how you manage pressure within your body. So we worked on with you and what I work on with most of my people is getting that person to stack their thoracic in their pelvic diaphragm atop one another, so then we get a balance between their ability to generate pressure in the abdomen and in the thoracic region. 

    Now, where the anal sphincter comes into play or as I -- did we go chipotle squeeze with you since you --

Christopher:    Wait, chipotle squeeze, yeah. That didn't resonate with me terribly well because --

Zac:    You don’t need chipotle.

Christopher:    -- I'm not really a chipotle sort of guy. I'm like, “What the fuck is he talking about this chipotle thing? Can you show me on the anatomical chart where the chipotle is because I really don't know?” My wife said, “No, I don't think that's what he means. He means like a burrito.” I'm like, “Oh. Yeah, I've seen one of those things before.” 

Zac:    Yes, yes, yes. Well, some food that makes you gassy. So in order for you to get the pelvic diaphragm in an orientation that is able to be stacked over the thoracic diaphragm, you have to be able to tilt your pelvis underneath you. Most individuals who have movement limitations have an anterior or a front sided or a forward tilting pelvis. This is useful because most of us, if we're going to fall, are going to fall forwards. So that helps mitigate us from falling forwards. 

    So if I can coach you to be able to get your pelvis underneath you, which involves certain things happening at your sacrum and as well as your [0:42:09] [Indiscernible], the pelvic bones, that would be useful because that's going to open up some movement options. 

    Where contracting your anal sphincter comes into play is it allows for that tilting mechanism to occur more effectively. The reason why is because your external anal sphincter attaches to your coccyx, which is the little tail that you have at the end of your sacrum. If I contract that muscle, it pulls the coccyx and thus the sacrum into a position that corresponds with that tilting of the pelvis posteriorly or backward. 

    When that tilt happens, there's also other things that happen up the spine. So as the pelvis posteriorly tilts, the lumbar curve, which is like more lordotic or more -- if we're using my backside as a reference, is more C-shaped, it reduces that C-shape. It allows for your upper back to expand more effectively because all the curves go together. And the combination of all of those things might help you touch your toes or might help you squat because your spine has to be able to get into that position in order to do that. 

    So it's using simply just one aspect or tugging on one part of the skeleton to be able to move the rest of the skeleton. It’s why I coached you in that manner. 

Christopher:    Can you describe the exercises that you had me do? There was a kind of breathing component to it. That's what I thought was a party trick. And in fact I met Lance and Alison who you may also know. 

Zac:    Yes, great people. 

Christopher:    Yeah, great people, personal trainers. I met them at Bryan's event last weekend. They were asking me whether you gave me the balloon to breathe into. And it's like, “Oh no. I didn't get the balloon.” You're going to have to tell us about this breathing exercise and where the balloon fits in. 

Zac:    Yeah, no party stuff for you. 

Christopher:    I'm really sad. 

Zac:    I don't really use the balloon much anymore. And the reason why I don't is because I was using it a lot. It's really complicated to teach. And for the return on investment given the complexity of the movement, I didn't think it was necessarily -- I was able to get similar outcomes without using something like that. 

    But where the breathing comes in is once I can get your thoracic and your pelvic diaphragm stacked to top one another, which we use various exercise positions to be able to do that. And I can give you -- I'll send you some links of some stuff for people to watch some of this stuff in the show notes because it's a little bit harder to --

Christopher:    Yeah. That’s generous of you. Thank you. 

Zac:    Yeah, it's a little bit harder to visualize. But what the breathing does is once we have that stackability of those two diaphragms is we allow for that multi-directional expansion to occur in the torso as well as in the pelvis. Because under normal conditions, -- and I use scare quotes for that -- you should see multi-directional expansion of that entire body cavity. And that's really all that the breathing serves to do. It allows for those areas to stretch and expand, which can be useful in restoring range of motion. 

Christopher:    That's exactly what it felt like actually. It was like a stretch that you just didn't know how to do before. So it was surprising that inhalation and expansion was leading to what felt like a stretch. And you wouldn't have thought -- I never would have thought to do a stretch that way. 

[0:45:12]

Zac:    Yeah, absolutely. Then you can -- based on what someone's moving limitations are, you can bias more air being pushed into specific areas versus not. For example, for you, we did a lot of activities that biased pushing the air into your upper back. For some people, I have to bias people pushing air into their chest wall or the bias may change. Maybe we have to do a specific move that gets their pelvic floor to relax or be able to assent. That's where the individualization comes into play. But it's still restoring the same mechanism to be able to influence range of motion everywhere within the body. 

Christopher:    Talk about how you go about changing somebody's behavior. Your exercises were an interesting example for me. Like, “Okay, so you've got something that's pointy enough to make you part with a bunch of money to talk to a physical therapist. And he's given you some exercises that instantly fixed the problem. Yet still, you can't get these exercises done.” A day would go past. I'm like, “Oh wow, I didn't do that thing that I paid a load of money for Zac to tell me to do.” 

    And when I carefully examine, “Why is it that I'm not doing this,” it's like even the tiniest amount of friction would stop me from doing it. And I'm sure this is very common in all humans. For example, for these exercises I'd have to get down onto all fours and put my face near our disgusting carpet that has about 300 pounds of dog hair and dust in it. And the moment I did that, my nose would stuff up, so I wouldn't be able to breathe through my nose. It took a while to realize --

Zac:    I dint know all this. I dint know all this.

Christopher:    Yeah, sorry. I should’ve probably said just to give you some feedback. But yeah, I've got pretty junky sinuses. I had a deviated septum that had surgery on about ten years ago. It was brilliant. After the surgery, it was amazing. Then it just went right back to where it was within about a year, which is pretty bad. I quite often can't breathe through my nose. 

    Then I seem to be super sensitive to any kind of allergens. So stuffing my face in our carpet will definitely set me off. But there's really nowhere else. I live in the countryside. I've got this really rough deck that's going to hurt my knees if I'd get down on all fours like that. Or then you go off the deck and it's just like everything has thorns basically. 

    It sounds stupid, but just that tiny amount of friction was enough to stop me from doing these exercises. So I wonder. Is this a problem that you see when working with clients? And how do you overcome these behavioral change problems? 

Zac:    Yeah, that's an amazing question. It is a problem that I sometimes see. I see it less online than I do in person. And I think because people are -- more often, they’re not parting with cash. They tend to take --

Christopher:    Yeah, skin in the game.

Zac:    Yeah, exactly. 

Christopher:    Skin in the game or maybe sunk cost is another way of saying that. 

Zac:    Absolutely. So if someone's gotten to that point, they're usually pretty serious about what they have to do. But I've also had a lot of people, especially within my in-person practice where I'm at, who won't get things done. So my process usually is finding the minimal effective dose for someone to be successful first and foremost, which I'd say over the course of my career because I've been able to give fewer moves to get the same outcome, that's been incredibly useful at increasing adherence to the program. 

    When I was first out of school and earlier in my career, -- and this is true for a lot of PTs now -- I see a lot of people giving five or six moves to be able to do at home. Then your program takes 30 to 45 minutes. For most people, that's incredibly unreasonable to ask that time demand, especially if they're in pain. So their ability to do behavior change to begin with is probably reduced. Then all these other life stressors are likely going on in that person's life. 

    So being able to pare down the exercise program has really helped me. So most people, at the most I would ever give someone is three activities. But more often than not, if it's someone in person, I usually give them one activity to work on which would take five, ten minutes of their time or if it's online, it's usually two or three. 

    I also -- let's say that I've given someone these activities. And they still aren't executing in the manner that I need them to. Well, first off, I will recheck testing and see if they've gotten changes. Maybe the amount that they did is enough. Then I'm like, “Cool. Well, just stick with that. You seem to be getting improvements.” 

    If it's not, then I have to have a question of, “What is the rate limiting step? Is it there is a physical barrier,” which was the case for you, Chris, “where the exercise just wasn't logistically feasible to do?” The good news is I'm not married to anyone exercise. I'm a total exercise player, Chris. So if that one doesn't work for you, I can most certainly find another activity that goes after the same goals that is more likely for you to execute. 

    Then it's a question of me saying, “Look, Chris, here's what I'm thinking. But you know you better than I know you. Do you think you could get this done? Then if you give me the green light, then cool. I'm going to give you this move. Then we reconvene and we see if that one's more executable.” Now, let's --

[0:50:24]

Christopher:    Well, of course, I'm going to say that I can get it done, right? I'll lie. Every time you ask someone about what they are going to do or what they did do, they lie, right? 

Zac:    Yes. Well, movement don't lie though. 

Christopher:    That's true. 

Zac:    I know very well if someone didn't get their stuff done. So it behooves most people to just be honest with me. And more often than not, I've had people who are honest. Because then, I usually will say like, “Well, okay. I've given you these moves. And we didn't get the changes I was looking for. How often did you really get them done?” If they're consistent, well then that leads me to, “I’ve got to pick something different to be able to help this person.” 

    But let's say after all of that said and done, I still don't have the adherence that I want. Maybe I'm at the bare minimum of activities I need to get there better, then what I typically do is go through a motivational interviewing type process to see if we can get this person to adhere to some type of schedule that's reasonable for them. 

    I did this with a woman who I worked with recently who had a rotator cuff surgery. I let her go on her own for about two or three weeks. And she came back to me and said, “Zac, I didn't get any of my stuff done.” So I said -- we basically just had a conversation of, “Well, what is reasonable for you to get done?” Then I didn't throw any options at her. I had her talk through that process of being able to perform her exercises. And she told me what days she could get them done and if there are any barriers on those days. 

    For example, -- it's so funny. I’ve got to tell you this. She's like, “Well, I could totally do my exercises in the morning. But my husband, every morning, will make me coffee while I'm still sleeping in bed. And he'll rub me and say, ‘Here's your coffee princess.’ He's been doing this for 30 years.” And I said, “Look, you might think that that's silly. Of course, you'll be able to stop doing that and do these exercises instead. But I know it's going to be really tough to break a 30-year-old habit.” 

Christopher:    Oh [0:52:20] [Indiscernible] you.

Zac:    No. Yeah. And that's the last thing I want to do. It's like that's a meaningful thing she has with her husband even though she even says it's silly, but it's probably important. Otherwise, she wouldn't bring that up. 

    So we picked the two days that her husband wouldn't do that for her to get her exercise program in. I printed out a calendar. And I had her write down those days and what the exercises were. I said, “You’ve got to meet me in three or four weeks with checkboxes on those days to let me know that you did the program.” She came back yesterday. And sure enough, that was the first time she was consistent. 

    So it's about letting the person who you're working with design a program for themselves that they know they can execute and giving them some ownership in terms of their plan. It was really cool to see that because that was the first time I was really successful with her in particular at getting her to adhere to the plan. 

Christopher:    That's brilliant. Congratulations. Not easy to achieve at all.

Zac:    It's all her. 

Christopher:    Yeah, yeah. It is. But you're definitely facilitating. This might be a stupid question, but you talked about the minimal effective dose there. Would you ever use those words with a client? I'm guessing not because you probably get lots of idiots like me that “go all-in.” They use this “all or nothing” thinking. 

    So Zac going to go, “Well, here's the gold star program. For this one, you get a silver. And this is a bronze. Just see what you can do. See if you can get a gold star.” Of course, people like me will say, “Well, if I can't get the gold star, I'm not going to do it at all.” So that's probably what will end up happening all the time. It’s nothing at all. It’s the “all or nothing” thinking. So do you ever say to clients, “Oh, this is the minimal effective dose or words to that effect? 

Zac:    Well, I knew with you that you don't like Tim Ferriss. So I knew that saying minimal effective dose wasn't going to be useful. 

Christopher:    Why’d you bring that? Why’d you bring I don’t like Tim Ferris?

Zac:    Because you gave me hell about my email responder that I had with --

Christopher:    Oh, that's right. Yeah. 

Zac:    I totally [0:54:09] [Indiscernible].

Christopher:    I’ve got to tell people the whole story now. Yeah, the email auto responder that says, “Oh, I only check my email three times per year. Don't expect a response sooner than that.” Then I always think about what if everybody on the Internet did that, that I had this stupid autoresponder that you reply to the response and you get another autoresponder message. It's like, “Ugh.”

Zac:    An autoresponder to your autoresponder. That's very inception-like. It’s what that is. 

Christopher:    I'm not sure this would generalize to everything that Tim says. I'm not even sure that he would use an autoresponder like that anymore. I think you've got a lot of flack for that. He was a lot younger when he wrote -- is that from The 4-Hour Workweek?

Zac:    Yes, absolutely.

Christopher:    I've heard Tim talk about how he would completely redo that book if he was to do it now. He was a very different person back then. 

Zac:    Yeah. Fortunately, I have no ego and I took your advice. I've actually gotten a lot of positive feedback getting rid of the autoresponder. 

Christopher:    Oh really?

Zac:    So thank you for that. 

[0:55:01]

Christopher:    It's my pleasure. 

Zac:    What was the question again? 

Christopher:    So my question was would you ever used those words, minimal effective dose, with a client?

Zac:    That’s right. Typically, I don't know because I've also -- and I probably should've mentioned this, but one of my best buy-in tricks is showing one person, one move. And if they get a profound result from that, it's like, “Oh, well this is easy. I can probably do this.” So now, I let them know that there are other things they could do. 

    Now sometimes, this is less common, but I'll have someone who is not just seeing me but is seeing many other people. And they want to do everything to get themselves better. But you either run into one or two problems with that. One, if someone's seeing multiple practitioners, you've got the “too many cooks in the kitchen” issue. And you don't know what's helping and what's not. And the other thing then is they're really good for maybe a few days, but then because they're trying to change too many things at once, the execution of all these new habits is too overwhelming and then they fail. 

    So that person has to know that the best program in the world is not the best program if you can't execute it consistently. So I really try to preach consistency with this stuff both after I've shown them the result that something small can do and that, “Look, I need you to be able to get really good at this activity because that's going to allow me to take you to the next step. And I won't be able to take you to the next step unless you get good at this concept first.” 

Christopher:    I have one final question for you. I want to be very respectful of your time. And we've already gone over. I'm sorry. But the question is, is there a way -- so the exercises that you gave me, the breathing exercises, is there a way that they could generalize into any body positions? I sometimes find myself wishing that I could do that exercise whilst I'm riding my mountain bike. For some reason, the combination of dead lifting and then riding my bike, that kind of like switches that pain on. 

    And Lesley Patterson, I was coaching with Lesley Paterson over at Braveheart recently. And one of her favorite tricks -- or at least to me, it was. I wouldn't say this is her favorite trick. But her favorite trick for me was deadlifting, like fatiguing the muscles and then going out on the bike and doing some sprints, right? So you're starting already in a depleted state. Then you're trying to sprint to your maximal extent in that depleted state. And that would be like a really good thing to switch on that low back pain. And it would suck. Like you're thinking about the low back pain and not about getting shit done. 

    So I wish there was a way to do that whilst I was on the bike. Like I'm probably not -- maybe I've just been stupid and I just need to stop riding my bike for a second and do this at the side of the trail and hope that nobody comes by and thinks, “What the fuck is this guy doing?” 

Zac:    Yeah. Well, the exercises that I gave you are really just regressions of more intense movements and positions. So the Rock Back exercise that I gave you, if I took your body while you were in that position and I tilt you just so you’re rough right, well, that's the bottom of your squat. You could argue some of the exercises that I give people are a deadlift. You could argue that biking is very squat-like in the sense that your spine has to be in a very similar position to what it is when you’re doing a squat. 

    Depending on your seat height, you can either bias it so it's more quadriceps dominant or more hamstrings dominant. That was one thing that I had learned when I went and observed the people at ALTIS. I don’t know if you’ve heard of ALTIS. They’re like a track club. Dan Pfaff is the coach, not Stu McMillan. His name is escaping me right now. Stu is there. Dan and Stu, they're really good coaches. 

    But if you wanted to bias the acceleration phases of sprinting and you were injured, doing a low seated bike would work the same musculature. And if you wanted to work on top end speed, you would do high seated bike. Well, it's like all of this stuff is the same. The concepts are the same. The positions your body has to get into is the same. And it's just a matter of picking a spot where you're at that continuum where you can place your body into a position that we deem useful or that we deem as good for you and then helping you be able to demonstrate those same things along the way. 

    For example, if you can't get your body into a position like on the Rock Back and biking -- say you could do a Rock Back but you couldn't achieve that same position in biking, we need to find some type of intermediary in between those two things to be able to get you to do that. And maybe that's going through a squat progression or something. I don't know what that is with you. But also too, you're biking fast, I wouldn't expect you to be able to do the slow paced breathing that we worked on just based on the energy system demands. 

Christopher:    Right. But if you're doing high intensity interval training, then there's rest periods in between. 

Zac:    Yeah. And a lot of times if you're doing HIT and you're not doing an active recovery where you're continuing to bike, I will have a lot of people get into a squat position. There was a study that was done -- I forget what year it is, but I'll send it to you -- where they compared two recovery postures. They compared hands overhead like so, the classic one that we had all our coaches tell us to do. So you open up your chest and your diaphragm --

[1:00:05]

Christopher:    I see.

Zac:    -- or someone who's folded over at the waist. And they measured heart rate recovery. And you get a significantly faster drop in resting heart rate or in your heart rate if you're in the folded over position as opposed to --

Christopher:    No. I never would’ve guessed that. 

Zac:    Try it. And if you can get into a full squat -- I mean I've had people’s heart rate drop like 30, 40 beats in under a minute just due to the body position itself. 

Christopher:    Oh, I see. So there's like a greater resistance of blood, right, that you have to pump against more gravity when you're --

Zac:    I think it makes gas exchange more effective when you -- because when you're folded over, your diaphragm is able to dome more effectively so you can get respiration to occur more effectively, which would -- if your tissues are getting more oxygen, then there's less of a need for the heart to pump blood fast. Because that's why the heart rate increases and why your stroke volume increases. It’s so your tissues can get oxygen. 

    Well, if I improve how I'm taking oxygen in and expelling carbon dioxide by folding over, which would allow the diaphragm to dome more effectively, then there's less of a need for increased stroke volume and increase heart rate. Heart rate drops really fast. 

Christopher:    That's very interesting. I will link to that study in the show notes for this episode that you can find over at nourishbalancethrive.com/podcast. Elaine does a fantastic job of gathering up all of the resources that we mentioned in every episode and linking them. If you poke around inside of your podcast app, you'll find these show notes. And Zac, you can link some of the video exercises that I did. Is that okay? Is that all behind the paywall? Can you do that? 

Zac:    Certainly. All this is free, man. 

Christopher:    Goofy. Well, that's pretty amazing. And what about your practice? Do you have room for clients at the moment? Can people consult with you online? 

Zac:    Yeah, absolutely. And I can send you some of that information. But if you go to my website, zaccupples.com, there's a Services link at the top of the page. And I have offered training, offer movement consultations, which is what we did. And I offer mentoring if you want to learn how to do some of this stuff with your people 

Christopher:    And tell us about -- haven't you got a seminar coming up, the Human Matrix seminar? 

Zac:    Human Matrix as I do on my website, yes. Yeah. So what I've tried to do is I've taken a lot of continued education over the years more than I can count. And what I found is it can be very complex to try to apply all of this stuff or try to meld it into a one simple, easy to use model. Things can get confusing. And yeah, it’d just be hard to implement. 

    So what I've tried to do is I tried to simplify the movement model by figuring out what is movement. And if we understand what that is, we can build a frame workout that not only helps people in pain, such as yourself, by restoring a movement baseline or a movement foundation, but then also knowing how to apply some of those concepts to the training floor. 

    For example, if you're a trainer and you can't get someone to squat to full depth despite your best coaching efforts, maybe there's a movement limitation that they have that is impairing their ability to squat that deep. Or if you're a clinician, you’ve got someone who hurts three different areas and you're unsure where to start, I'll show you where to start. And that's what Human Matrix serves to do. 

    Yeah, I have several seminars coming up this year. In August, on the 3rd and 4th, I'm in Cincinnati. And I'm in Vancouver, I think, the 24th, 25th. Raleigh, North Carolina, September. 

Christopher:    Wow.

Zac:    Yeah. It was all over. Boston, --

Christopher:    Back to the daily schedule.

Zac:    Seriously, man. Yeah. Boston in October, New York in November and then Florida in December, man. Then I've got some 2020 stuff coming up too. So it's all over. My last seminar in June was the first one to sell out. 

Christopher    Oh wow. Congratulations. 

Zac:    Yeah, man.

Christopher:    Just to be clear, these are for practitioners. These are for physical therapists, trainers, anybody that's in working with clients rather than direct to consumer. 

Zac:    Well, I've had some direct consumer come and they've loved it. There's this one guy. 

Christopher:    Oh okay. Interesting.

Zac:    Yeah. I've had a client of mine come to this. And he absolutely loved the seminar. And I've also had someone who's -- he's like in business, but he goes to movement seminars for fun. Well, it's helpful if you have an anatomy background of any kind. 

Christopher:    That's what I like.

Zac:    Yeah. I also have some pretty good pre-reading material to help prep you for some of the concepts as well. So there's a lot of videos, a lot of things to read, all of that, so you just get an understanding of what it is. Because I also try not to get too in depth with the anatomy and all that because I don't think it's necessary to get the outcomes. I don't think you have to know all of the muscles. You just have to know what body position this person has gone into and what we need to do to get them to the exact opposite so that way they have the full repertoire restored. 

Christopher:    Okay. And will you teach me to find the chipotle muscle? 

Zac:    I absolutely will. 

Christopher:    Excellent. That's an offer I can't refuse.

Zac:    And if you can't pay extra – no, man, I'm kidding. 

Christopher:    Well, this has been fantastic, Zac. I very much appreciate you. And I especially appreciate you fixing my chronic pain, so thank you for that. And I will of course link to your website zaccupples.com in the show notes for this episode. Is there anyone else? Are you a social media person? Can people find you on social? 

[1:05:13]

Zac:    Yeah. I'm trying to be on it less because I find that I'm less happy when I'm on it. But if you want to find me on social, I'm on Facebook. I'm on Twitter. And I'm on that Instagram baby. 

Christopher:    Oh shit.

Zac:    Yes, sir. 

Christopher:    I don't want to get off track here. 

Zac:    No, please do.

Christopher:    But it's really interesting for me to connect the dots here. You’re saying something and I'm thinking about Ashley Mason. Then you're talking about the behavioral science. I'm thinking about what Simon has said. And I've just interviewed Cal Newport about his new book, Digital Minimalism. And I'm thinking about what he said about social media. 

    And now I cringe every time I ask people like, “Are you on social media? Are you draining all your activation entity and not getting any meaningful work done by spending all of your time on Twitter?” It’s what is the question that I should be asking guests. But you've already figured it out. You've already figured all of it out, Zac. 

Zac:    Yes. Well, so here's my thought process too. So you've heard -- they talk about this mostly in finance. If everyone is onto something, you should be going the exact opposite somewhere. Well, it’s really easy to set up a Facebook, Twitter and Instagram account because I think the content on there is -- it doesn't take any time. But then you have way too much noise and not enough signal. 

    Whereas I would rather do, I'm a big fan of the long form content. I'm a big fan of doing things like a podcast such as this where it's in depth. We take a lot of time. And it's harder to do because I think there's less people doing that, even though a lot of people have podcasts. I still think it's a less utilized medium compared to social media because everyone is now an Instagram influencer. I would rather --

Christopher:    Every account I look at, everybody's got 50,000 followers on Instagram. How did that happen? Then you spend time with some of these people in person. And you realize how it's happening. They are documenting every last aspect of their life. And quite often, they're taking photos and then using that as a bait and switch thing like, “Oh, look at this picture.” And then underneath, there’s some narrative where they're trying to teach you something about something completely unrelated to the picture, which I really don't enjoy at all. 

    But that's how they got 50,000 followers, right? It’s by documenting every last moment of their life. You see them in the back of a taxi and they're like -- just taking that, even that just tiny moment to be on Instagram rather than alone with their own thoughts, which is somewhat terrifying when you think about it. 

Zac:    Yes, I agree. I would rather be alone with my thoughts and present in the moment. And that's something that's been really hard for me to do. But I think decreasing the amount of time that I've been on social has been incredibly helpful in that regard. 

Christopher:    That's good to hear. Well, thank you so much, Zac. I very much appreciate you. 

Zac:    Thank you, Chris.

Christopher:    And I think I'm going to have to do another follow-up consultation with you where maybe I get a bike somehow in the video shot. I think I could figure out how to do that. Put the bike in a stand. Then you can show me ways in which I can try and do some of your exercises whilst on a bike. How about that? 

Zac:    We'll see what we can do, my man. It sounds good though. 

Christopher:    Okay. Thank you. See you, Zac.

Zac:    Adios. 

[1:08:01]    End of Audio

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