The Intelligence of the Body
The Intelligence of the Body is for therapists ready to move beyond techniques and truly understand how the body works as an integrated system. Through clear, practical teaching, each episode helps you refine your thinking and deliver results that last.
The Intelligence of the Body
EP 3 | What If the Pain You’re Treating Isn’t the Real Problem? with Bruce Baltz
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What if the pain you feel isn’t actually where the problem begins? Paula Nutting sits down with Bruce Baltz to explore why lasting pain relief requires looking beyond symptoms and understanding the body as an interconnected system.
They discuss compensation patterns, movement dysfunction, clinical reasoning, and why treating only the painful area can limit results. Bruce also shares insights on movement assessment, therapist intuition, and long-term recovery strategies.
Timeline Highlights
00:30 – Meet Bruce Baltz
02:10 – Pain vs. root cause
05:00 – Compensation patterns
08:15 – Movement assessments
12:40 – Whole-body treatment
16:05 – Treating beyond the hotspot
20:20 – Long-term recovery examples
25:10 – Client education and awareness
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Disclaimer:
The following program is for informational and educational purposes only. The content discussed regarding musculoskeletal health, injury recovery, and physical therapy techniques is not a substitute for professional medical advice, diagnosis, or treatment.
Listening to this podcast does not establish a therapist-patient relationship between you and Paula or her guest presenter. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition or physical injury.
If you think you may have a medical emergency, call your doctor or emergency services immediately. Reliance on any information provided in this podcast is solely at your own risk.
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Hey guys, it's Paula Nutting, your musculoskeletal specialist, and this is our monthly spot on Ask Me Anything. And this month I'm super excited and proud to invite Bruce Boltz uh along to talk on all things that are Bruce related, and for me, that is everything that's about stretching, active isolated stretching and fitness. So I'm so excited because I I was just asking before we started up here. I know it's been a long time that he's been doing the stretching, and he was talking it's like 15, close to 20 years. So, Bruce, I'd really love to have you jump on board with me and let's unpack everything that stretching is or maybe isn't and how therapists can apply it in their clinic.
SPEAKER_02Hi, Paulo. Thanks for inviting me to be with you tonight.
SPEAKER_01Thank you.
SPEAKER_02Well, it's morning there, night here.
SPEAKER_01Yeah, morning here. And I'm just going to give a little bit of a shout out for everyone who's watching and listening. A couple of things, you can get into the chat box and type away, and we'll see it. We've got a little ticket tape that you can probably see underneath there. It just talks uh about your questions. Hey Tammy. Oh, hey Tammy, it's good to see you. So Tammy McCugh is one of uh Eric Dalton's gorgeous, gorgeous practitioners who works with him. So she's jumped on board to have a bit of a listen. She's a bit of a Bruce fan as well, I think, quietly. The other thing that I've got to explain everyone is that when we are looking, if I'm looking at Bruce, I'm actually looking this way, but in actual fact it turns us because these are mirrored. So occasionally, if you see the two of us looking away from each other, we're actually looking at each other, but we've forgotten that there's no mirroring on the uh the live stream yard event. So that's housekeeping. Bruce, talk to me, give me your background. Where are you from, and how long have you been involved in the massage industry? How long have you been involved in stretching and in the fitness game?
SPEAKER_02Well, that's kind of a I don't know, a question that has a longer story to it, but I'm from New York City originally, and I started as a personal trainer in 1979 and did that for about 15 years, and then decided to go to massage school. And the reason I went to massage school was so that I could learn better uh the anatomy of the body to be a better personal trainer, and the best personal trainers I knew uh were were massage therapists because they had a better education at that time. Uh, personal training worlds changed an awful lot, but that's how I got started. And uh after going to massage school, I was doing both massage and personal training, and then there was probably a 15-year span there where it was all massage, and I started off with teaching a deep tissue stone classes through a company called Lestone Therapy and moved to Florida and got very involved with the whole Florida massage um organizations and education, and and that's where I met Aaron Mattis. And Aaron Mattis was the gentleman that I trained with and still communicate with on a fairly regular basis about stretching, and so I've been doing primarily the stretching for about the past 20 years, so about 45 years in the industry, but the past 20 years has been very much focused on active isolated stretching.
SPEAKER_01Yeah, wow, and you know, you're absolutely 100% on the bull. When you get a massage therapist and a personal trainer and you mix them together, it's a gorgeous combination because the anatomy in physiology is so on point from learning your origins, exertions, etc., in in the massage realm, and then you can apply it beautifully for um for health and wellness. But you were saying before that you can't prescribe exercises in massage. Is that that that's always been the case in America?
SPEAKER_02I America, you'd have to look at individual states on what their regulations are, yeah. And many of them uh don't uh don't allow massage therapists to be personal trainers, it's kind of uh beyond the scope of practice of their license.
SPEAKER_00Yeah.
SPEAKER_02So you'd also have to have some sort of certificate in personal training to be able to incorporate that and not have any conflict of interest with your licensure.
SPEAKER_01Yeah, okay. Which I suppose makes sense. We've got the similar kind of things. We've got uh uh uh association guidelines and our uh we get probably governed by our insurance companies what you can and can't provide in an insurance, which is safety, and and I get that that's important. So, did you design the active isolated stretching, or did that come from Aaron and you've adapted, or we we've had this conversation once before, and all I can do is Aaron Mattis' work, that's what I do, and I do it to the best of my ability in the format and the way that he designed the program.
SPEAKER_02But that being said, I can't do Aaron's work like Aaron does Aaron's work, and nobody else can, but nobody can work like you or work like me or anybody else, so it's our own personal interpretation of that work. So I interpret Aaron's work to the best of my ability the way that he does it, but it has to be, but it's just an interpretation, yeah. You know, so I've studied it this long simply because I want to emulate as best I can the work that he does.
SPEAKER_01Yeah, incredible and beautiful work. So if you had a patient that came in, or a client that came into your clinic, you talk me through where where the the stretching component fits into that.
SPEAKER_02Well, 95% of the clients that I see, all I do is stretching with them. So massage therapy isn't part of that protocol. Now, that doesn't mean that I won't incorporate some if I feel it's necessary, but for the most part, I work um primarily with a lot of golf clubs, you know, throughout Florida. And so with their population, you know, we design programs that are geared toward their sporting activities.
SPEAKER_00Yeah.
SPEAKER_02And and so then you got to take into consideration their age, their flexibility, their injuries. And so you have to have sort of an understanding of the mechanics of the sport as well as any conditions they're bringing to the table as far as their underlying conditions are concerned.
SPEAKER_01Yeah, yeah, because a lot of a lot of golfers are 65 and up. So the flexibility and thoracic rotation and stability, yeah, yeah. You're talking to a golfer, I guess.
SPEAKER_02Yeah, well, you know what? We're made to wear out. The question is how fast do you want to do it?
SPEAKER_01Yeah, that's a great line.
SPEAKER_02Well, it's true, it's true. We're our design is to wear out, and so when we overuse our joints and our muscles and our sore tissue, they start to wear out. And and if you have bad mechanics on top of that, or injuries, hip replacements, uh herniated discs, whatever it is, that that's all going to impact you know your ability to function.
SPEAKER_01The comment I heard, and I'm trying to struggle to drag through my brain where it, but it was last week, was they'll say the days of saying wear and tear, it should be replaced with wear and repair, because moving through a joint, actually mobilizing a joint, being strong, is much more efficient to articular surfaces than to go, well, I've got an injury, I've got, oh my god, I've got a knee problem, I'm gonna rest it. Rest is actually the enemy of uh a healing strong joint. What do you think about that?
SPEAKER_02The the advantage of stretching compared to what people would be doing, say, in active movement with weight-bearing activity, is that there's no weight bearing on the table when I'm working with somebody. So we can get full range of motion with no impact, you know, with no downward load on the joint. And so we're able to move joints pain-free, where if they're walking on it, they're gonna be hurting it. Yeah, so it allows them to build confidence and movement. The main thing that I have to do is when you work with somebody who's in pain, you have to let them understand that their movement patterns when they're walking are gonna hurt, but you have to build their trust when they're on the table because they associate it with pain.
SPEAKER_00Yeah.
SPEAKER_02So you have tight hamstrings, say, for instance, and they're fearful of being stretched that way. You know, you just have to take it to them gradually so they can build trust in the movement. And I always start start with if it's the right leg that hurts, I start on the left. You know, because I want them to understand the way it should feel. And we when you when they understand the way that it feels, then they start to build trust on the side that might be more affected from the injury.
SPEAKER_01Okay. So for people who don't know what active isolated stretching is, can you give a the reader's digest? Well, you don't have to give it the reader's digest version, you can give it a really lovely expansive version of what the heck it actually is. Well, people go static.
SPEAKER_02A lot of people just go, oh well, and and and you know what? And I'm when every time that I teach, I don't tell people what they're doing is wrong. I just say this is a different approach. And so if we can support what we do um for clinically based massage therapy in science, then I think it's just a difference of opinion, which is fine. Because at the end of the day, the client has to believe in the treatment that they're receiving and the practitioner that's providing it. And if they believe in those two things, they're gonna get good results. It could be a totally different approach, though. So with AIS or active isolated stretching, we hold stretches for a very short period of time because we want as much blood and oxygen exchange as possible, but you have to affect it just long enough so the body realizes it's gonna be going into a plane of movement that might be challenging. If we don't challenge the body at all in stretching and just go up to where the barrier is, then they don't get any better. They might stay the same, they might not get worse, but they're not going to improve because we're not asking it to improve, we're asking it to stay the same. So we have to encourage change. The body only changes by an influence that changes the norm. Right? So, I mean, the easiest example is that we're just talking about the hamstring. If you can only raise it to 35 degrees, then maybe I might take it to 37 degrees, the first stretch, just so they feel it. And I say we hold stretches for about two seconds. That allows the body to experience the movement, but without resisting the movement.
SPEAKER_00Okay.
SPEAKER_02And so every time we stretch a tissue, if we're talking about hamstrings, the can the quadriceps contract to make that movement happen, then our brain automatically sends a signal to the hamstrings to let go through reciprocal inhibition. So now, so now that leg's being lifted and the body saying, Okay, Bruce wants to lift his leg, now we got to let the hamstrings and glutes go so we can lift it. If I just move them passively, that signal's not sense. Yeah, now there's benefits of doing it passive, also. So, but it but as far as and and if the practitioners and the client like passive movements, then they should be doing passive movements. That works for them. For me, I've seen the results, and so I use the skills that I have that I think are more effective for my approach. You go by what what what your good read you get your results from, I think. Yeah, yeah, right? Completely so this and this is the picture of that right now that you're showing. You know, that that lower picture is one of stretching the hamstrings. We do stabilize the body, and so it can't compensate.
SPEAKER_01So that's what those those uh the the straps are, they're just to keep the pelvis and the and the ilium, I guess, in a nice neutral plane while you're going through that pose.
SPEAKER_02Right, because we everybody has compensation patterns, and so our body wants to take the path of least resistance. Yeah, I don't want it to take the path of least resistance, I want it to take the path of what should be its normal pathway.
SPEAKER_01Yeah.
SPEAKER_02You know, keeping joints lined up, keeping things stacked the way they should be stacked for functional movement.
SPEAKER_01Yeah, I'm hoping that we might be able to get back to that other slide again so we can have a talk on both of them. So I'm just sending a little message to like my mate say previous slide, please. Uh, because I think that it's yeah, there it is. So I that looks fantastic. And the thing that I like about that actual image is that this woman on the lower one, she's got a chin tucked, so you know that she's actually got herself into a into a good spinal alignment even before you're going any further on that. So are you taking her into range and this just backing it off a tiny bit so it's uh into say if if that's if that's 80, she's good got good range to 90, you're going 90 to 95, back off, 95, back off, and you're just going from 95 to 90, 95 to 50.
SPEAKER_02No, so what this so what happens with this is that we also know when we contract a muscle or stretch a muscle, we push the blood out of it. The benefit of stretching or massage therapy or most body work, as far as I know, is in the recovery stage. So we want the blood and oxygen to get back. So after I do that stretch with the hamstring on that lower photo, we let the leg back down to the table again because that's when both the quadriceps and hamstrings are in a neutral position. So the new blood and oxygen comes in, and then we repeat it because it's about blood and oxygen exchange. Right now it's being pushed out. The body already has a lack of blood flow in that area that we're treating, and so what we want to do is increase the blood flow. So it's through that repetition and that relaxation recovery stage that we get the benefit of the stretch gradually. I'm not trying to take too much at once, we're trying to take a few degrees at a time, but over 10 or say 10 repetitions, eight to 10 repetitions, you've probably moved that person maybe 15 to 20 degrees. Um, and it holds, but they're gonna go back and do their normal life, and it's gonna fall right back into that pattern until they figure out what patterns they have to change in their own mechanics.
SPEAKER_01Yeah, all right. And uh uh Hans has just said PF is how he learned it. But for me, PF stretching, you didn't take it back to neutral, you just took it to end range where the actual contraction is felt by the patient. Um, we do a lot of MET in in in my camp, right? So at point of bind, so it's completely different again.
SPEAKER_02But it's also something that you can support with physiology on why it's beneficial. And so all I can say is that I didn't have the same success with providing the treatments that you do as I do with the AIS work.
SPEAKER_00Yeah, yeah.
SPEAKER_02You know, and so I just went with what I liked and what made sense to me. And uh for me, it was more about more consistent oxygen exchange instead of durations of tilting stretches for a longer period of time. I understand why it's beneficial, but it's just not what active isolated stretching is about.
SPEAKER_01It don't float your boat, honey, and that's all that matters. And you know, the the thing with that is that is that we have patients and clients that go, I'm gonna see Bruce, and they wake up in the morning and they go, it actually doesn't feel too bad because I know I'm coming to see you. So that there's placebo is not a dirty word, it but it's the start of how the body is staying to already pre-engage in in uh better movement patterns because it's it's at a neurological level knows that your techniques align with their their health journey. So for you.
SPEAKER_02It's what they're it's what they're willing to receive.
SPEAKER_01Yeah.
SPEAKER_02And so, but uh, but I also believe that if I'm providing this, any whether it's active isolated stretching, P and F stretching, deep tissue massage, stone massage, it doesn't matter, body work in general, we get to a plateau where the client kind of hangs out at this level where they're not improving anymore. It's because the stimulus that I'm providing or we're providing is not the same and they've gotten used to it. Yeah, so they need something to change it up so their nervous system has something new to respond to. And if they have something new to respond to, then they might get to a different level of healing that I couldn't provide them because they've been doing AIS for the past 10 years and uh they're AIS'd out. You know, there's time for them to find another modality to challenge their system with, and it could be cranial sagral, it doesn't have to be, you know, um more uh physically related body work, it could be something gentler.
SPEAKER_01Yeah, in actual fact, quite often it is, isn't it? It's the it's if you do something that's quite deep and then you put in something that's light, it tends to make the nervous system that upregulatory uh process go, oh hang on, this is different. It's it's right, it's like the gym. If you do three sets of ten of the same weight forever, you're never going to change. You plateau really quickly.
SPEAKER_00Right.
SPEAKER_01That specification of treatment and in the cardiovascular world and in the in the resistance world. Do you um do you think it affects the joint capsules with in this work as well? Like we are we looking at a joint capsule um stretch in this space, or is it really more soft tissue?
SPEAKER_02Well, the way that I look at it, I can't really stretch a muscle without affecting a joint someplace. I mean, a muscle crosses a joint, and so but this type of joint might be different, you know. So, for instance, we do a lot of work with the hips, and I know we can affect the joint capsule of the hip. Now, does the shoulder have a joint capsule? Yeah, but it's all muscular, primarily a muscular capsule. So we do movements to move the head of the humerus around so we can see the range of motion in that joint and where there might be impingements because you have to look at the structure around any joint, and the shoulders are really complicated joint as far as the structure is concerned with the muscles that cross that region.
SPEAKER_01Yeah, it's a high joint, like it's it's real whoever designed it, they they should get a fail, like a C minus, who have actually designed that to be hanging with just a little bit of tape slash cord ligaments.
SPEAKER_02Terrible, yeah. But you know, but you wouldn't be reaching to get your coat out of the backseat of a car if you didn't have it. So I mean it's a double-edged sword. You know, you we have great range of motion for sports or for whatever else we want to do, but at the same time, it's also the most unstable joint in the body, yeah. And so, and being that the acromium process is produced by the clavicle and the scapula coming to that point, there's a structure there that um, you know, with supersprinate is coming underneath the acromium process, it makes it less than a perfect design. Yeah, yeah, because it gets impinged, and then you have a lot of problems, and we know it because we work with people every day that have shoulders issues, you know, either from a skiing accident and they broke their collarbone or horseback riding or whatever it is, and now the whole joint is thrown off, and so it's out of balance.
SPEAKER_01I don't know about you, but I I occasionally will get a patient who'll come to see me with terrible shoulder issues, and they'll have a history of a fractured clavicle decades ago. And um, one of them said to me, Oh, look, and like that is they fractured and and progressed to a point like that. So there's this massive lump there. And the surgeon said, Well, you're not going into any beauty competitions, are you? You don't really want that set back to a like so it's straight again, do you? And she was like, Well, I suppose not. But then, you know, two years, five years, ten years, twenty years, she's got chronic, chronic neck and back pain issues.
SPEAKER_02No, and it happens, and it's just from a little bit of misalignment.
SPEAKER_00Yeah.
SPEAKER_02You know, it starts from the ground up with most people, but there are obviously impact injuries that can be very localized, but then affect a whole bunch of other complexes when. Gets injured because we go away from pain.
SPEAKER_01Yeah.
SPEAKER_02Nobody says pain, I want more, you know.
SPEAKER_01No, no, exactly. Yeah, give it brilliant.
SPEAKER_02Well, some people do, but yeah, well, that's not I don't work in those places. Exactly.
SPEAKER_01Really interesting comment you just said, it generally uh the problem normally comes from the down up, the from the ground up. Do you want to unpack that more? And you're saying, like, if if the legs haven't got the alignment or if there's immobility in the in the lower half, then it's reproducing up.
SPEAKER_02Well, yeah, I mean, it's our foundation, and we never take care of our feet. I do a lot of work in my private practice with people with feet, ankle and foot weakness. And when we can start to develop that foundation and make it stronger, it makes the knees, etc., hip, and the whole line up makes it better. Um, I've had a client that had a uh you know, one leg longer than the other, they put a heat and their shoulder was hurting, they put a lift in their shoe and their pain in their shoulder went away. Because you know, if you're a sixteenth of an inch down off at your foot strike on one side, by the time it gets up to your neck, it could be two inches off, you know, or off in a much greater margin than it is when you're when it was down at your feet, and so and the head always wants to write itself to be straight. So if you have a scoliosis and you're coming this way, then your head's gonna come the other way, and so and that creates a lot of different issues, yes, and so it could be something as simple as that, but that's a little bit more based on uh you know it's a science that I'm not as well versed in, you know, when it comes down to all of the on how muscles stack and and and how it refers up the bot up the body. That's a little bit um a different type of science, you know, that's beyond my ability, but I do understand the concept of it, and I do know if I make the feet stronger, the knees can feel better and the hips can feel better.
SPEAKER_01Have you got like can you give a couple of little tips for therapists out there for if they to get an understanding of whether they've got weakness in their feet or ankles, and if there's a little trick you can show them that there's no really little trick to it, but if you've never done anything to strengthen your ankles except doing gastrocs that's gonna come up on the balls of your feet, you're stretching one muscle in the back of your leg.
SPEAKER_02You have tibialis anterior, you have the peronials, and you have tibialis posterior. Those would be you know, and then you have your extensors and your flexors of your toes. So if all of those, if you've never trained those specifically, I can tell you they're weak. If you wear shoes, they're weak. So, you know, and on everybody now, the amount of weakness is gonna just depend, you know, depending on their own structure, if their arches collapsed or if they have valgus knees or whatever. It it's there's just a whole bunch of things that we could talk about that throw off that whole foot strike posture thing, yeah. And and it takes time to work on it, and it's not easy because then you still have to look at the movement pattern and try to correct it. None of this works. I don't believe any of our work works optimally without strengthening the body because we're gonna go back and do the same thing, so we're temporarily taking people out of pain. We hope that we are, but it will only be temporary if we don't look at what structures are failing and how they're not working. Yeah, you know, the training that I do with people is all on the most, I would say 85% of it is on the massage table.
SPEAKER_01Okay, so you're actually giving them, you're doing some flexibility, so stretching range, and then getting them to do a strengthening.
SPEAKER_02I do a lot of isometrics where I apply the weight, you know, through resistance. Yeah, and but we're looking at getting muscles that are the smaller supporting muscles to fire that don't fire because quads, hamstrings, and glutes, say, for instance, take over. In the shoulder, you're gonna have pecs taking over and biceps taking over and deltoid, but not the rotator cuff muscles, they're smaller, they don't have to do anything if the bigger muscles just want to take over, but then you don't have stability if the smaller muscles don't take play their role.
SPEAKER_01Yeah, that's right. They are your stabilizers versus the the mobilizers, right?
SPEAKER_02So, but but if you're not stable, especially in the shoulder, then you're not going to be very mobile. Yeah, you can't have both, you can't just have it one way.
SPEAKER_01Yeah, stability and mobility have to be a job lot. Uh I was reading a book by Joanne Averson, which is about fascia and um and yoga and movement and anatomy, and she was getting there's an exercise, but just having your feet down, like a foot down, and lifting the the big toe and the little toe up, and then trying to lift all of them up and just dropping the big toe and the little toe down, and then trying to take one toe down. I go tell you, that's that's a whole new level of what the heck, because I can't, I can I can lift them up, but I can get the big toe and the little toe down. But to get the others down, unbelievable how weak we are just in in single movement patterns and and we have the ability to do that, it's just that we never have trained ourselves to do it, yeah.
SPEAKER_02And so, yeah, it's definitely a problem and definitely something that I think that is underlooked.
SPEAKER_01Gate and the elderly is is where she was coming from. If you've if if you have problems with gait and the elderly and you want to make sure that you feel balanced, that's where we've got to come in. That we've got to actually work those those digits independently.
SPEAKER_02But it's harder as we get older to be able to do that, though. Yeah, yeah, because it's here, you know. No, I don't think it's as much psychological. I mean, we put we have there's a lot of water under the bridge, so to speak, right? I mean, we've had injuries, you might have arthritis now. You have weaknesses that um are long-term, and so there's a lot more compensation, and you could have hammer toes and you know, bunions, etc. All of these compromise the ability for those muscles to work in your feet.
SPEAKER_01So it's not just a failing neural pathway.
SPEAKER_02I don't think so. I mean, I know I know when you have hammer toes, say for instance, that it generally comes along with tight calves. So, but if you have tight calves, you're gonna have tight hamstrings, you know, because they can't really work independently well of each other, you know. Maybe if they're not weight-bearing, but definitely if they're weight-bearing, they're gonna be tight. And and there's a big difference. I mean, you were mentioning yoga a little bit ago. There's a big difference, I believe, in body movement and in stretching. You know, I there's a lot of body movements that that are yoga postures that I think are absolutely amazing. But I would question whether they all are stretching. Yeah, you know, there's a big difference between body movement and stretching. And what we do with active isolated stretching is we take gravity out of the way of being the mover.
SPEAKER_00Yeah.
SPEAKER_02So if you're standing up and you're reaching down toward your toes, I don't believe that's the best movement to try to stretch your hamstrings because it's a gravity move, it's a gravity movement. Now, it doesn't mean that it's not a it's not a bad movement to do, it's just I don't think it stretches well. When you're laying on your back and you lift your leg up, you're not worried about falling, and and and there's a positive movement to influence a stretch of the opposing muscle. You don't have that when you're leaning forward, and so we try to take that out of the way. We try to take that out of the way, and when I first learned AIS, and it was confusing to me, and it was confusing to me probably for about the first four years that I was practicing it. But what confused me was Aaron didn't really speak about the muscles that are being stretched, he was talking about the muscles that were contracting to initiate this that that muscle to be stretched. So it made me look at anatomy differently. I always looked at it as if what we were stretching, but then I he was telling me, look at what's contracting, because you want the client to be active, and the better you know your anatomy, the more workarounds you have to help somebody. Because we have a lot of muscles that have similar functions, and so and so if you have if you're if you have pain in one plane of movement, then we might be able to work around that to then come back to it later after we get more oxygen and blood into that area where that initial injury was.
SPEAKER_01So so, Bruce, if I was going to say um the sartorius, the uh tensor fasciolata, and the rectus femoris, they kind of all flex the hip in certain certain pathways. Right. Is there is there one that you would you go, oh well, that's the bad boy more than that one, or we'd have to be working on these two?
SPEAKER_02All of them. You know, it's you can't because I one thing I'm pretty sure about, at least what I've been taught in my education, is that when one muscle stops functioning well, many of the other muscles in that area are going to also splinter contract to protect that area that's hurt. So now maybe you had something that was rectus femoris related, but now so as in iliacus are getting tight along with your adductors to prevent movement to stabilize you so you don't move. And it's as we discussed, the worst thing for you when you're having those problems is not moving, because not moving only produces more not moving, yeah, and it gets worse. So, but at the same time, you have to know what these muscles do. So if I if I have a problem with paraformis, and before I really want to stay focused on paraformis, I want to make sure that the glutes and hamstrings are open because if I can open the glutes and the hamstrings, I brought more oxygen and blood into that hip area. So now let me go after the ones that are more affected, understanding that they're still going to be tight and they're still gonna be it's still gonna be uncomfortable for that client to have this worked on, but they've also built confidence with the other movements. So if I build confidence with the other movements, now when you go after something that's a little bit more sensitive, they say, okay, well, I trust this now because it didn't hurt me before, or I wasn't hurt to get to this point, so they'll relax more, but you got to talk them through that experience, and you happen to have enough sensitivity in your hands to feel it.
SPEAKER_00Yeah, okay.
SPEAKER_02Because when we started, when I started it with massage therapy, it was probably over about a five-year period of time that I felt my hands were getting smarter, yeah. That I sort of sensed more what was going on underneath the skin. Same process, same process with stretching, feel that end range of motion. Where is it? Because it's gonna be different on almost everybody, but 95% of the stretches that I do, I do on everybody, it's just a different intensity, and the range of motions will vary. Okay, but because the muscles only do certain things, you know. I can't make them do something they're not gonna do, you know. Go ahead.
SPEAKER_01No, no, uh, I was yeah, no, no, I was just uh I was waiting to see if that was a pause or we're gonna keep going through. Um, what I was gonna ask next is uh we get people that come to see us that are hypermobile. What do you do with them?
SPEAKER_02They can have as much pain as the people who are overcontracted and tight.
SPEAKER_01Yeah, more so quite often.
SPEAKER_02Yeah, because you know, if if you stretch a muscle or you stretch a nerve, which would be a muscle as well, because they pass through it, but if you stretch that nerve, it's gonna fire pain because it's active. If you squeeze it tight between a joint or muscle, it's gonna fire pain because it's being compressed. Yeah, pain, same pain that you feel for two separate reasons. So yet you have to. If somebody's hypermobile, I'm still gonna do some stretching with them just to get additional blood and oxygen into the joint, but then it's gonna be primarily strengthening because that's what they need. They need to support the mobility that they currently have. I don't need to make something more unstable, it's already unstable. So we want to strengthen those areas, and we spend a lot of time doing that. Had a woman that came in today that I've been working with some and and has had parathyroid problems, etc., etc. So that affects the bone density, and so we're trying to make her street feet stronger. She has an Achilles tendon problem now. I probably spent 45 minutes working that one leg, but I did start in the hip, even though she has good range of motion. I want that blood and oxygen to be closer to the site where I need to work, where it's more apparently where the problem is.
SPEAKER_00Yeah.
SPEAKER_02But if I don't open up the hips, the quads, the hamstrings, and gastrox and soleus, etc., if I don't open those muscles up and I'm working on the foot, it's gonna be harder for me to get the effect that I want in the foot.
SPEAKER_01So you're removing the splinting behavior of larger, larger muscles, so that then they go, okay, I can I'm gonna back off because I trust that the at this the muscle talking, I trust that you're gonna come in and and support the area that we have been trying to support. So that's how you get the go the larger and then come into the target muscle.
SPEAKER_02Right, and that's and that's done also with stretching, but also with the best way to bring blood down into the leg or any place is by using the muscle to ask it to bring it there.
SPEAKER_00Yeah.
SPEAKER_02So we do a lot of stuff with soleus when it's a lower leg because that's a much denser muscle and it carries more blood flow to the feet. So we want gastrox, yes, but I want soleus to really start to pump and bring the blood down to toward the foot.
unknownOkay.
SPEAKER_02Then when I'm working on the foot and some of the intrinsic muscles, it's going to be much more likely to have a positive effect.
SPEAKER_01Yeah. And that makes sense. Um, Tammy's asked with hippocitis, do you do you in your expertise go after certain muscle? Because we, a lot of patients coming with hippocitis. Do you like kind of kind of is there a hippocytis can quite often be related to the obturators or uh piriformis or like dot dot dot fill in this space?
SPEAKER_02Yes. I mean no, well, bursitis. Which one? Well, I guess it kind of depends on which which which bursers are affected. Well, say the greatest because it's not just one, but you know, I will open up rectus femoris because it crosses the hip. I'll open up the glutes just because they're the glutes, and it so, and then I listen to my client. I'll palpite also to see if there is a hot spot. And I think tensor fasciolata is also something that has to be open, you know. So, and the adductor, so but it's the whole complex. It I don't ever treat anybody with one muscle. Now, if somebody comes in and says to me, Look, I only have a half hour, can can you help me? Yeah, you know, then I will target that area a little bit more intently where the pain is, but often it's not the pain's not where they're where they feel the pain, it's not not where it's at. Yeah, you know, so I might be doing work on say quadratus and they have hip pain, you know, because I know that's what's hiking their hip up and what's you know producing that discomfort or assume it is, and glut minimus and media also, and they and their pain could be from weakness. So what we found is that if I strengthen these areas and bring blood and oxygen into them, often it supports the problem as much as the stretching does.
SPEAKER_01Okay, you gotta make it strong.
SPEAKER_02You have you there's an imbalance, and so we have to look at all the imbalances, whether it's flexibility or whether it's strength.
SPEAKER_01So do you go stretch, strength, stretch, strength, or you go strength, stretch, strength, stretch, or is it a depends?
SPEAKER_02I usually do stretch first, but if I don't have much time, and it also depends upon what am I is it is a treatment for are we treating something or are we asking somebody to be active to go out and do something?
SPEAKER_00Yeah.
SPEAKER_02So if it's more active, then I want to do more muscle activation to make that area warmed up so it can function better immediately. We work too long on something, we sedate the muscle, so that's not gonna make it better for performance. It's probably gonna help more long term to try to correct a problem. So it kind of depends upon what when the client comes in and what their activity is gonna be afterwards. If I'm doing stuff that's more structurally related, I don't really like them to go out and play something right afterwards.
SPEAKER_01So you yeah, okay, so that's that's a good point. You've got um um 65-year-old fellow, or no, say 45-year-old guy who's playing on the tour, he's he wants to get in a good good uh round at golf. So he's gonna come in to see you to get a little bit of mobility, but a lot of functional action, like turning obliques on, whatever, whatever's gonna give you that that glutes to drive and rotation, but you wouldn't be stretching him doing long stretches before he goes out onto the course. Is that how I'm reading it?
SPEAKER_02Yes, that well, that's true, but I mean, but it's also a little bit more uh it's a when you when you have an athlete of a high level of a high caliber, you can probably work with them a little bit harder than I would with somebody else because there's bodies are used to the intensity. Um but what I wouldn't want to do for anybody at any athletic level is give them more rotation or flexibility than they're accustomed to because they're not gonna be stable. So what at whatever they're you know, whomever they are. Now we have a lot of young guys that are on the tour that have a rotation in their lumbar spine that's not human. And and eventually that type of rotation is gonna catch up with you. So for people like that, I want to try to bring some stability into that area, not more flexibility. But if you have your average person that's going out to play, or your, you know, it could even be just it could be a professional golfer, but what you don't want to do is let them have five more degrees of rotation that they're not accustomed to because now they're not going to be stable. So if they have a pre-existing condition, you know, in their back, say for instance, or in their shoulder, then you're giving them more range of motion, but they're going beyond where they're stable. Yeah, so now they're not in stability anymore, and they can get up aggravating the condition, a pre-existing condition. Yeah, you know, and and hurting themselves. So we want to try to prevent that, you know, as best we can with with the information that we receive as you know, therapists.
SPEAKER_01Yeah. So you general Joe General Jane, who is um comes in to see you with with lower back and neck pain, uh, because that's what everybody has on the planet right now. Um, and you'll do some stretching. Look, yeah, I I a lot of people say, Can I go out tomorrow and do my Pilates? Or can I go out tomorrow and swim, or can I go out tomorrow and go for my normal jog? Do we back that off as well if we're doing a lot of um AIS?
SPEAKER_02I think it kind of depends upon the person that I'm working with, as I said before. I mean, we have a lot of people that come that come in and see us that are very avid athletes, and they might be you know in their 60s, but still compete and still want to compete. So, but if they're used, and I've worked with them for a while, I have a few people that I work with that it almost doesn't matter how hard I stretch them, and they'll I know they're stable and they're gonna be fine. Yeah, but that's not the norm. If we really go after something that's more detailed and a little bit more intense, then I tell them not a good idea to play today, you know, and so but then we plan around that type of schedule. Uh but most of them can do something, you know, it because they might be using muscle muscle groups in a different way. I can stretch somebody pretty vigorously and say three or four hours later they want to go swimming, they won't have a problem.
SPEAKER_01Yeah, yeah. I suppose what they do then is working out what their movement patterns how are they are they cheating? And recognizing that.
SPEAKER_02Yeah. No, I have many people that have just have a hard time. I'll have them stand up against the wall and get their heels up against the wall, and I want them to be flat up against the wall with their head back. And most of them are looking up here. You know, it's like they their shoulders are so far rounded and their hip flexors are so tight that they can't get themselves up. And they'll get against the wall, but their heels have to be away from the wall, or they feel like they're going to fall forward. You know, and so we work with things like that, trying to get their shoulders back, trying to get their head back without looking up at the ceiling and being flatter. Because they walk like this. And when you walk like this, you're not going to be able to stand up straight, or at least hold the position and feel balanced.
SPEAKER_01Yeah, we're so we're so flexion-driven, aren't we? Our our society is just the just getting more and more and more flexed versus uh we've got these horrible devices that um everyone spends their entire life down like that when they're walking. Like the normal speed of traffic was 60, then they brought it down to 50. This is kilometres, they brought it down to 40 kilometers an hour because people were not watching the roads when they were walking on their device. They've now talked about putting the stop or give way or whatever on the ground versus up like a traffic sign up here because no one is is looking that way anymore. So, like I say, Darwin theory, bring it back up to 60 or 75, and anyone who's stupid enough to be walking with one of these um, yeah, the Darwin theory works for me every day.
SPEAKER_02We're gonna have all sorts of interesting conditions that we're gonna deal with as a society that we don't even have the effects of them yet.
SPEAKER_01Yeah. So stretch picks, how do you what's you have them strapped to the table and you're doing with the tubing?
SPEAKER_02No, well, I can. I can I can do it on the table, it would probably be in a side-lying position, though, or I'll do that in this in a seated in a chair. You know, Aaron, a number of years ago, had a a chair design that has a narrower back on it, and it has a very low center of gravity. And so if I want to take arms back into extension, you can without hitting the back of the chair. And so it's it's designed for that type of work. And so I'll do a lot of shoulder work seated just because I have I can work in many different more planes without having the client have to move from one side to the other or back on their side again and back to their side, etc. So they're in a they're in one position, and I'm able to go through you know uh most of the series of the shoulder without having them having it in a more comfortable position.
SPEAKER_01Okay, yeah. And people don't like flipping and rolling and flipping and rolling and up and down. So that is actually quite a smart thing to do. Um, there was you had the two images like that we had on that previous slide. I'm just seeing if if I can get them to bring that back up again. One was stretching the hamstring, and I'd really like to know what are you doing on the top left one?
SPEAKER_02It's that's for glute max. Now, I with this one, I didn't have the strap on the client, so I wanted to just show a body position that if you were gonna be more in a traditional massage setting, how some of these techniques can be incorporated into that, you know, and I there's not too many people that are gonna study one modality for 15 years. Um, so people take what they want out of what they've learned and then they incorporate it into what they do, and me recognize from coming from a traditional massage therapy background that you know, strapping down somebody to a table that's in a spa might not be an appropriate technique. And so then how could we use some of this information to help our clients if we feel we want to use that? And I would say 90% of the people that I work with are in that category that you know that I train that are students that are in the category of I'm just gonna I like this one, I'm gonna use that one. This one was too hard or I don't understand it, so I'm not gonna use that one. And and that's fine, you know, that's what it's about. You can you can pick and choose what makes sense to you, and but there's not one stretch ever to do to correct one problem.
SPEAKER_01No, they it I completely agree. It's such an interesting um uh looking at the body's movement patterns, the concept of how a joint cap for me. I find that that I need to try to specialize on either the muscle belly tendon try or work on the joint capsule. So a lot of a lot of stretching might be get into there, feel feel the muscle, now kind of just get a little bit move a little bit more into see if you can get it at a deeper level. So moving off the hamstring if if we have to um unsplint that, yeah, and then come in to really get into the the deeper rotator muscles because I find that that a lot of people have restrictions in either internal or external rotations, they don't they don't map nicely.
SPEAKER_02Like, do you like that's when angles become really important because if we're not and we could be off by five degrees and we're on a different muscle, it doesn't mean that it's not a good stretch, but it could mean that you're not stretching what you think you're stretching, yeah. You know, and and a simple example would be stretching the adductors. If I'm moving somebody's leg away from the midline of their body, but if I let them externally rotate, we're back on their hamstrings. So we have to keep that those toes facing up toward the ceiling or slightly internally rotated when they're going into abduction, and and it's nothing wrong with the other movement, it's just like you're not going to be stretching what you think you're stretching, and so and then and especially when you talk about the deep six rotators, there's different angles for each one of those. And if you're off, then you're not on it, yeah. And I use those same techniques in the reverse to strengthen, so it allows me to look at the smaller muscle groups and try to strengthen them the same way that I stretch them.
SPEAKER_01So you take them into the stretch and then you get them to contract.
SPEAKER_02Yes, yes, yeah, then that's most of the training that I do with my clients. Some of it's off the table, you know, to get proper gait and to see what their compensation patterns are. But then we go back to the table to strengthen the muscles that are weak that are allowing them to hold themselves in a proper position.
SPEAKER_01Yeah, yeah. It's so interesting how the body, the body just is continuously adapting. But if we can't get strength and stretch at the same time, um rather, I think if we can do strength and stretch at the same time, we're really actually doing a much better treatment. And and I know that that many massage therapists will go, well, we're not actually allowed to do um some of this work. But and if you're instrument, I see if you're instructed in an isometric situation and you say, I just want you to push into me, then someone might call it an MET, someone might call it a PNF, but we're actually getting to contract. So they are actually doing, and I think that we are still within our scope.
SPEAKER_02I believe we're still with a negative, we can gain seven 80% of our strength. So if I'm working with somebody that just had a knee replacement, say for instance, and their quads are really weak, you know, I'm not asking them to, I might ask them to hold that extension against some resistance, but then come down slowly in a negative format. Um, so I don't do as much as say isometric type work. Yeah, I might if I'm trying to have somebody have the power to stand up, you know. I don't want them to have to stand up hard, you know, they can't say stand up from a chair yet. So you put cushions underneath them so they don't have to, they maybe they're starting at say a 45-degree angle, and then I'll have them drive into something and I'll tell them to relax and drive and relax, and then to try to build up that strength to be able to stand, yeah. So so it it it varies a little bit, you know, depending upon the lack of function that somebody might have, the type of strengthening that you might want to do.
SPEAKER_01No, I agree. E-centric and concentric are absolutely especially eccentric, that's the ball. Like, yeah, get someone to like you passively bring their their knee into into that ex like full range, so we're able to extension or slightly you know well, it should be at 90 degrees, so it should be full extension of the knee joint, and then just getting them to drop down into flexion off the table. It might only be just 15 degrees or 20 degrees, exactly.
SPEAKER_02But we'll take what we get, you know. And if something's supposed to be 90 degrees, I don't expect to get 90 degrees, I might be getting 30 degrees, yeah. But it might but because you don't force anything.
SPEAKER_01No, and you're working with their functionality, aren't you? And you're also working with safety, so you're actually trying to make them feel safe with you in and in your clinical space.
SPEAKER_02Yeah, exactly. I mean, it's it it doesn't, you know, it's the same here on this side of the world or on your side of the world. I mean, the bodies work the same way, it just we're governed by different regulations that we have to you know adhere to. We don't take that much insurance here for massage therapists. Okay, you can, but it's a lot of work to process paperwork and all the other stuff. So I don't take insurance. And we're not really set up for insurance, you know, here in this country. Um, I know in Canada they do and other places where they're more part of the traditional Western medical group, you know, um, but it's still a battle, and uh so I choose not to fight that one. It's just it's it's way too much work.
SPEAKER_01I'm with you on that. We have work cover, uh, where the therapists will be uh will be attacked by the work. So if someone has an injury, they go in to see the physiotherapist or they go to the surgeon, they get the re uh the surgery, they then go into rehab, and they might come in to see you for 10 sessions, and that's covered off with work cover, which is an insurance-based thing. But we have every every person who completes their diploma in remedial or my therapy or whatever it is, has then got to register with a training organization, which a lot of you guys have to be registered, and within that registration, they need to have their first aid annually, they need to have insurance so that they actually are insured by by some form of insurance company, AION's preferred provider here, uh, and that they have to have an ongoing level of education points. So part of these are all about adding CECs or CPEs or whatever you want to call it. Um, the associations match with the insurance companies and say these are the 20 modalities that we will accept, and that's the Aon, like the health providers, the insurance companies will go, you can provide any of these.
SPEAKER_02Right.
SPEAKER_01As long as we fit in that list with I can treat if I'm if I'm my insurance provider is ABC, they let allow me to do AIS and they allow me to do resistance training. So I actually covered off. That's that's how the process kind of works over here.
SPEAKER_02Well, I wish uh ours had I wish ours worked that way. It's not that straightforward for us.
SPEAKER_01Yeah, you've got your chapters that are all kind of individually um set by different regulatory models from what I last.
SPEAKER_02Yeah, well, you know, there's licenses almost in every state, and most of the states have their own requirements. So what's done in Georgia and done in Florida, what the requirements are for continuing education hours, or maybe base education could be different.
unknownYeah.
SPEAKER_02New York State has its own thing. California, you know, they're not they're not licensed, they're a certified state. So there's all sorts of a blend of stuff that goes on in the US that makes it a little bit complicated and definitely makes it not a portable, you know.
SPEAKER_01Yeah, I was gonna say it doesn't let doesn't land portability, does it?
SPEAKER_02No, it doesn't, unfortunately.
SPEAKER_01So Bruce, we're almost cracking out of time here, but is are you uh presenting in any workshops anywhere, any conferences for anyone this year or next year?
SPEAKER_02Yeah, I I primarily we talked about this a little bit earlier. I I primarily do educational events through associations, whether it's the AMTA, which is the American Massage Therapy Association, or the FSMTA, which is the Florida State Massage Therapy Association. Um, and there's a few others, or I go to school. So, but and I'm prefacing that by I because I don't have the time to market the way that many educators put the time and energy into marketing of individual classes. So I would rather just have another establishment or organization decide they're gonna send something out, they would like me to come in and teach AIS, I'm happy to come and teach. And but they already have the mailing list and the room available, and so in those are the environments I attend teaching in, or I get invited to sports facilities such as golf clubs to come and train their therapists. Okay, and so it's it's stuff that's a little bit more just put into place. All I have to do is show up with the materials, yeah. And those are the classes that I do now.
SPEAKER_01So if anybody is listening to this recording and they're interested in getting Bruce to be doing some stuff, and you happen to be a member of um AMTA or the Florida chapter, then send them an email and say, hey, we really want Bruce to come out, we really want to see some presentation work from him because um the only way you're gonna get him out out of the clinic is to actually ask for him. So I think that that's one of those really important things that if if if you want great therapists to be teaching and there's there's some amazing practitioners out there with a wealth of knowledge, then you have to be a little bit proactive and get on the keyboard and ask to get them in there. So that's hopefully you'll get more just a few more gigs to help therapists out there, and that's kind of part of what we do through this space here in the Ask Me Anything's is to get people aware that what you do, what different people offer, and how um they might get a little bit more.
SPEAKER_02Well, I mean, I I love our profession, and so and I really have a passion for the work that I provide, you know, for my clients. And so it's more about sharing it, and it's it's a nice place to be in because I don't do it, I don't do the education to make my living. I do the education because I want to do the education, yeah. And so I make my living by doing treatments and doing some other things involved. I mean, actually outside of our own b world of practice, but you know, and so it's nice to be able to sort of pick and choose and to uh you know, I I might do eight workshops a year, yeah, you know, and that's that's pretty much you know what I look to do.
SPEAKER_01But your passion is the in the clinic, so that's where your best laid.
SPEAKER_02Well, I I guess. I mean, I'm I'm enjoying helping people because there was a time there where I was doing nothing but teaching, and and that was hard, just running around living out of a suitcase. And so I got it it wore me down, it wore me out, and now it's just like now when I get the opportunity to teach, it's fresh, it's new, and uh you know, and I'm excited to do it, and you know, but I also like staying home now, and so being able to stay at home and uh you know and help clients at a on a level where it can be consistent is um I'm enjoying that part of it now.
SPEAKER_01Yeah, yeah, there's something horrif horrifying about that. I I probably do the same a little bit less than eight to ten, but like and a lot of virtual stuff now, which is kind of what you know when we live in Australia, it's a bit hard to travel. Um just prohibitive, and we don't have the numbers of therapists around here that support you coming around and teaching in different colleges, etc. But you know, people like James Wozowski, who travels, you know, was doing 48 out of 52 weeks a year, yeah. Traveling around, like that's his passion.
SPEAKER_02That that's just where he's really good at it and uh is a great educator, and uh and he loves sharing, you know, and that's what it comes down to that we really love sharing what we do, but he's taken it to a level of where being on the road is what he loves, and uh traveling and sharing his work. And I think that's great. Everybody kind of finds the place where they fit, yeah, you know, in this industry.
SPEAKER_01And thank you so much for for coming in and and and passionately offering your information to everyone who is listening. We've had some good responses. It's been awesome to hear from from Tammy and from Hans and from some of the other other guys that have been uh actually making comments and asking questions. So it's been an absolute pleasure, and I'm so happy to have finally met you in virtual person, Bruce.
SPEAKER_02Well, this is great, and uh I still find it very interesting that I can look at you and not see you now.
SPEAKER_01I know I've just been doing I'm look I'm at the pole, nowhere near Bruce, but everyone thinks I'm yeah, exactly.
SPEAKER_02All right, well, thanks very much. I've really enjoyed it.
SPEAKER_01Yeah, thanks, and thank you everybody for coming in next month. I'm hoping that we've got well, we do, we've got Chris Reed, who is a uh Bowen therapist. So if you uh don't know anything about Bowen uh therapy, then you want to jump in, and that is on the 8th of April Brisbane time, which means 7th of April um for the rest of the Northern Hemisphere. May is Diane Matowski, date to be advised. And then in June we've got Gil Hedley talking on Fasha. So I'm very excited. That's the 9th of June for you guys, and the 10th for us in Australia. So, Bruce, thank you so much. It's been an absolute cracker, and I'll let you go and do whatever you gotta do because it's easy for you.
SPEAKER_02It is, and you gotta get to work now.
SPEAKER_01Yeah, yeah, make myself a coffee and get some lunch.
SPEAKER_02Anyway, it was great. Thank you very much. And uh keep on doing what you're doing, it's great for the whole community.
SPEAKER_01Thank you, thank you. That's a lot of you. All right, thanks everybody. See ya.
SPEAKER_02Or good morning, good day.
SPEAKER_01Bye.