Phillip Snell
Good morning over here to all of my Zoom neuro centric approach Online Academy folk.

We'll let folks come on here in the next few minutes and welcome over here on Facebook to you guys. We want to make sure that you have access to some cool links. Hopefully you can see those now on your screen to be able to learn more about what we're doing here at Neuro Centric approach.

This is the online academy over here. That is where we house, where I house the online educational courses for neuro centric approach. All of the courses there and all of the in-person courses that I teach are available for continuing education credits via pace for chiropractors. You gotta check with your own state to see whether they, whether or not they take pace, which is the largest accreditation body or chiropractors in the us. If your state doesn't lobby your board, talk to 'em.

We, I also teach the continuing education courses in person. We just had one this past weekend, which is why I did not show up here online or on Zoom.

'cause we were teaching a course for the upper quarter.

And at Evolution Healthcare and Fitness here in Portland course came off great. I felt good feedback from folks there. It was exciting because I was able to see for the first time, now I guess the, how the process is, is growing in the field.

We had a couple of doctors that showed up, Dr. Brandon Fromm and Dr. DJ Goldstein that were among the earliest people to take the coursework and it was really exciting to see how they had taken it and integrated it into their own clinical model and then grown it using their own tools. So with that, I would like for you guys to make sure that you understand that this is not, although we do teach some techniques like dermal traction method, like transverse nerve mobilization and like some functional exercise corrections in the, in the coursework.

The way that I would prefer that it be understood by those of you out there is that it is a principles based system that rides over the top of all of those, those named silos of information that you and I have accumulated over time.

So that, that looks like, you know, at the functional medicine or the functional movement bedrock.

I am highly biased by the dynamic neuromuscular stabilization system or DNS training from Prague, from the Prague School of Physical Medicine. That's Pablo Collage and his work and his incredible teachers. I've hosted those teachers here in Portland for a number of years and I've gotten to know them a bit and I use their work every single day. In clinic. I would suggest that you could probably just play a DNS card on just about every physical medicine presentation. It shows up in your clinic and you will get that patient better.

I would also say that often too long, too often, just relying on that takes too long and our medical model in the US and most of the west doesn't really lend itself in our short, relatively short visit times to using that exclusively. So I like to incorporate other models that I've learned like to excellent work of Stuart McGill, which is incorporated into this Sue's work indeed is also integrative and derivative, not only of his own research, but also the research and learning of other people like, like Vladimir from, you know, one of the early Prague school teachers.

So we incorporate McGill's work, incorporate the Neurodynamics research probably first and foremost in that where I, I believe the cutting edge on that type of research is Michael Schack lock's work with neurodynamics systems.

You should do their coursework too to learn that directly.

There's also good representative work out of the Neuro Orthopedic Institute, NOI, that's David Butler and Lorimer Mosley's work.

We also incorporate the pain neuroscience science with an understanding that the process of central sensitization often occurs and continues to be maintained because of under explored susceptive pinging in the periphery.

And it's our job in physical medicine to find that and put that fire out and then to guide the patient on reducing those elements of central sensitization from the primary ENT to the secondary afferent to the tertiary afferent to the brain. And that's the kind of stuff that we cover here. Now, your inputs, we are agnostic about in neuro centric approach. Your inputs, what I'm referring to there in this systems-based analogy, your inputs are what you do after your assessment to try to help that patient feel better. Your inputs could be manually based, they could be exercise based or a combinations of all of the above.

They could be educational based for your manual inputs. Perhaps you've learned, you know, perhaps you're in a rothi provider and you've learned fascial distortion method. Perhaps you are a Mike Leahy adherent and you've learned a RT, perhaps you've, you've been fascinated by the stecco work and I've learned fascial manipulation from Antonio Stecco and, and Warren Hammer and those guys. And those are wonderful, wonderful inputs. They are all techniques and our techniques are gathered under the umbrella of neuro centric approach. And we're agnostic about your technique.

Just use the program, the neuro centric program to identify under explored neural tissue that is driving a motor program that in turn is altering joint arthrokinematics, which can result in arthralgia both of those things which can reduce performance and increase the likelihood of pain.

So your other inputs from exercise, perhaps you are an adherent of Ben Patrick's work at knees over toes guy or a TG, perhaps you are an FMS and SFMA doc and you are using SFMA and FMS and Gray Cooks's, excellent work and Greg Rose's excellent work.

Your inputs and exercise could be DNS or PRI. We don't care. We are agnos agnostic to the, the techniques that you're using. And I'm trying to encourage all of us in physical medicine to take a step back from our technique oriented livelihoods where many of us tend, tend to just get somewhat like crows attracted to shiny things. And we go and gather techniques and we throw all our techniques in a relatively cluttered bend, so to speak, in our, in our treatment rooms.

And then with the patient when they're in front of us, we kind of reach for whatever bend item in the bend seems to be on the top.

And often that results in very good results because many of those techniques are formidable and incredibly helpful for our patients.

But the how the well you learn in the technique trainings, how to use those techniques, but often the when to use them in and the why to use them is missing. And that's the material that we're trying to lean into on doing this particular kind of work this week.

One of the case or the case study this week that I wanted to highlight was actually just an encounter with another one that we, an email encounter with someone that we talked about a while back. Some of you and, and for those of you that are unaware of this, these dialogues that I do here are recorded and they reside on the blog at neuro centric approach. You go to neuro centric approach.com and there's a tab at the top for blog and you can find each of these, these meetings recorded and put out there for your perusal if you like.

But one of those several weeks back was a patient with central sensitization after an anterior cervical disc fusion. And so the anterior of course means that they came in off of the front side to fuse that disc. Mind you, she did not have radicular symptoms. She had unremitting pain of moderately high to severe intensity and that was what pushed the A CDF decision by her and her surgeon that helped with the pain that she had been having in her neck before. But she started developing a new type of pain on the back sides of her neck on both sides.

And that new type of pain was of different qua quality, different character. She had a burning hot pain in those areas that made it even uncomfortable to have a collar on on her shirt.

And that puzzled her surgeon. She saw her surgeon for this pain and they kind of threw their hands up and they said, well how's your pain from the, that we went after for the, with the surgery?

And the patient said, well, I'm better. And they say, great, we did our job.

And they, they said, I don't know why you've got the pain back here, why don't we send you to physical therapy? So they sent her to physical therapy and physical therapist worked on her and did some basic neck, neck exercises, did Gwen Joel's work, did isometrics in four quadrants.

And when the patient asked, well why do I have this burning pain back here, that doesn't seem to get better. And they said they didn't know. So they did not provide any kind of narrative for this person whose brain is searching for some reason for that ongoing symptom back here that's puzzling her surgeon and puzzling her physical therapist.

And she wound up in my office in our world working with neuro centric approach. I'm, you know, I see some folks that are on here right now, Brandon Fromm, who's been one of those docs that I mentioned earlier that has been leveraging this system for a while. And here a patient complaining of hot burning, superficial pain right back in this area.

We know in the NCA that that's gonna be a limited number of neural structures that can be causing that one. We know it's gonna be neuro because of its hot burning, super visual nature.

And we know that there are a limited number of neural structures that can be involved with that.

And in this particular patient it looked like these were a combo platter probably of posterior rami coming off of the dorsal primary rami coming off of the spine, innervating the skin over that area, but likely also some elements of the supraclavicular nerve.

And my suspicion was that that area took a little bit of impact from the anterior cervical disc process, surgical process, which involves making that incision and then putting retractors in at the SCM and pulling that SCM back. And just under that mid belly of the SCM at these cervical plexus is where the four nerves that come out of herbs point right behind the mid belly of the SCM that we are fond of going after in one of the techniques in NCA that we talk about, which is dermal traction method.

One of those four nerves, and I'll just name the four nerves while we're here, the transverse cervical nerve comes across here in this area. And that could have been impacted by that retraction process and the surgery process, but unlikely to cause the pain that she's having in the distribution that she's having.

The greater auricular nerve running up into the pena of the ear and just anterior to the, the pena, the lesser occipital nerve going up across the backside of the skull.

A little bit lateral to the greater occipital, which, which many of us are a little better, better aware of because of its involvement in greater occipital neuralgia, which we covered in depth in the the upper quarter course.

And then we've got the, the nerve of interest that I'm talking about here, which would be the supraclavicular nerve, which drapes kind of like a shawl over the top of the shoulder and innervates the superficial structures here, the skin over the AC joint, not the AC joint. The AC joint gets its innervation and the surrounding ligaments and the GH capsule from lateral pectoral nerve, the axillary nerve and the suprascapular nerve.

But that I felt was the primary nerve with consideration in this particular patient.

And our inputs for that looked like I trialed manual therapy and I trialed manual therapy moving as we teach in the coursework from outside in from the least amount of effort in to deeper therapy. And my first input was actually at the furthest distance breathing because the patient was highly upregulated, very type a personality and such. So I did, as many of us are trained in our DNS systems work, I did an IAP assessment, saw that she wasn't doing too well in that and I coached her into breathing exercises, some breath work, and I was, I got a, a pain, an oral pain severity score from her before we did that.

And then I took it after and after just doing some breath work and theoretically downregulating her sympathetic nervous system a bit, getting some autonomic balance, she reported a one point drop in her, in her pain. So there, right out of the gate, we've got a way, a place to get a lever under in this patient to motivate them to consider stress as a possible ongoing continuation of this. Okay? Now that did not get rid of all of her pain. And in the NCA system, we like to stack cumulative benefit from our inputs and our areas that we're assessing now. Then I went to this area and I just stroked the area where she hurts.

I was able to reproduce the pain. So the idea then is we have the observed tissue that is unhappy, but we don't know exactly why. Now, one of the more common reasons is neural entrapment. I don't have a, a strong compelling argument to make in this particular patient that there is an entrapment etiology possibly because of scarring from the surgery, but probably not based on her presentation with me. But one of the more common reasons, entrapment right behind the SCM owing to a motor imbalance of the deep neck flexors primary flexors versus the upregulated and hypertonic SCM secondary flexor, which commonly will get involved there.

And that's kind of the bedrock when Joel's work in this particular domain.

So I decided to try a relatively non impactful, very soft skin rolling dermal traction method over the area of her symptoms.

And I did it and she initially said, that feels important and I think feels better. And I only did it for about a minute. And then she, she very quickly said, that's getting worse. That's getting worse, okay.

I'm like, all right, my model then suggests that we're looking at a central sensitization cause of that particular issue. And the way that I'm going to attempt to address that is at the level of that nociceptive involvement, that dis or poorly regulated sensitivity of that primary afferent, okay? The first order afferent in the, in the periphery right there. And one of the ways that we can do that is by using an a TRP V one agonist capsaicin over that area. And we did, the patient was coached into that. We talked about some non-threatening reintroduction to movement and how do you think the patient felt after I was able to provide her with a relatively detailed explanation of what tissues were likely to be talking in this area and why.

Lo and behold, she has a narrative, and I've said it many times that the probably the most important thing we can do in a clinical encounter is to provide a compelling believable narrative.

It's great if it's right, but even if it's wrong, it still helps. And at the very least, if it's wrong and you are humble and you are willing to work with the patient over successive visits, if it's wrong and you've prepared the patient for an exploratory collaborative process, then you can move to the next item on the differential list and work from there.

But not having a narrative to my mind is unacceptable in the patient encounter and share that narrative with them and get, get that buy-in and compliance with them so that they will do their homework as well.

So in this particular individual, their type A had gotten ahold of them, they wanted to go back to running very badly because that was part of the way that they dropped their, their sympathetic nervous system upregulation and running was what was their first love. But when they would go out running, they would run like our co-founder Justin Dean used to refer to as T-Rex. So the shoulders up here like this and the arms kind of clawing at the air and, and the DNS perspective, they would show up with that open scissors position with the chest proud and an anterior pelvic tilt.

And she sent, so she sends me video of her running. She's like, while I was running it felt great and then later it felt really bad and I was sore for two days. And is that bad? Is it wrong? What do you think of by form? I gave her some very minimal cues on the form. Mostly external queuing strategies. You got a basket of apples on your head, your pelvis is a basket of apples, they're heaping full. Don't spill any apples, run quietly, you know, try to reduce the ground reaction forces there by running quietly, running with spaghetti arms. Let your arms just kind of, you know, wiggle and such so that she's not getting up in here.

Fill the picture with your breath as you're running the picture here being your torso, top of the picture here, bottom of the picture where the seated patient is when we're coaching them into this so that they're bringing their breath, they're using their diaphragm to bring their breath down lower and at a zone two level and they're run less likely to be using the scales at this point in the game and getting everything interested in that. You know, superior migration, the shoulders, she went out and ran like that for a week and got back in touch with them via email. And that didn't seem to be striking a chord with this patient.

They were still frustrated, but in their email they reported that the burning pain in this area gone.

Now she's got pain back at the original area of the surgery. Does that mean that the surgery was wrong? It was off or whatever? No, let's think about our first order, second order, third order ens there. Let's think about the first order primaries and how that central sensitization process goes. Those first order primaries are mostly the C fiber afferent, right? And you know that we've got three times the number of C fiber afferent out there in the periphery that we then we do those other sometimes referred to as silent nociceptors, the A delta poly modal neurons that are primarily mechanoreceptors. Now, if those C fiber ens continue to ping over time because of something going on out there in periphery that's under explored or because of top-down processes that are driving them to continue to ping, then those a delta poly modal neurons will move from their somewhat, from their primary mechano receptive role.

They then can move because of an input of in increased number of calcium channel ions, particularly TRP V ones, also PIO ones and PIO twos on those particular neurons, they will become nociceptive drivers.

And what that looks like in our patients is movement is perceived by the brain as being threatening.

Now in the early stages of an injury, that's relatively helpful and normal, right? If it, it hurts to move into that direction of the original injury, the body in its wisdom says, why don't we lay off of that for a period of time? But then if that just keeps running, if that program keeps running for a period of time, that stays in place. So my thinking with this particular patient, we've used a TRP V one receptor agonist, the capsaicin cream over a period of time to downregulate that sensitivity of the C fiber reference. But now we've still got the mechanoreceptors, the a, the a delta poly modal neurons that are kicking in.

So you guys, I'm talking about this at this level of complexity because most of you have had some exposure to central sensitization and what's going on there.

And you've had some training, so we can talk a little more geeky level, right?

But who was it? Napoleon Hill that said, when you explain something to your potential buyer that your marketing to explain it in a fourth grade level. So we also have to have different ways or different vernaculars explaining this material to our patients. Here's the analogy I came up with on the fly, I liked it. Feel free to rip it off and use it with your patients if you do. So this particular patient is a mother, a couple of kids. So I said, let's imagine you've got two kids.

You got a, your youngest is little boy that tends to be very mischievous. He's three, four years old, he's got a big sister. And the big sister is six, seven years old and big sister wants to make sure that little brother is behaving appropriately. Big sister in this analogy is an a delta poly modal neuron little brother in this analogy is a c fiber ent. So when that c fiber afferent and, and in the, to continue the analogy, mom is the brain.

So in this particular analogy, the little brother has found is out in the yard and he's found something that he's playing with. And let's say that what he's playing with is the dog's toys and he's throwing the toys over the fence and the dog's getting wound up and, you know, unhappy about that process.

So the little girl sees all this going on and she's like, mom, mom, Johnny's throwing Fido's toys over the fence.

So in this case, little sister has only gotten interested, wants the behavior of little brother started to exceed something that she felt was normal.

Copy that. Then she comes, I'm talking about all of that. And then my dog literally just came up here and is nudging me. She's gonna start playing with a squeaky any moment here.

But come on up.

So Fife will join our discussion.

So the, in this particular case, the C fiber afferent little Johnny throwing in this case, Fife's toys over the fence.

Is he behaving inappropriately? Does mom need to come out and put a smack down on Johnny? Does mom need to come out and put Johnny in a timeout? Does mom now let, we could even take a side branch right there. Mom might put Johnny in time out. Why? Because mom's flustered. She's busy, she's cooking dinner, she just got home from work, she's had a really stressful day at work. She's about to lose her job. She's a single mom, she's trying to raise these kids. She doesn't have any bandwidth to deal with this complaining that's going on in her backyard from her kids. She doesn't have any bandwidth. The brain doesn't have the bandwidth to deal with the complaining from the C fiber afferent and the va, a delta poly modal neurons.

Does that make sense? Have I lost anybody here? Anybody have any questions?

Hello, Charlie Paxton. Schofield. It's been a minute. Thanks for coming back. It's good to see you again, Charles.

Alright, so in this particular case, if mom has the capacity maybe through in this analogy, deep breathing to center herself and go back out or go out into the yard to examine the situation, then she can see that Johnny throwing the toys over the fence and seeing the reaction of of the dog is kind of funny. She might take a video of it and put it on TikTok and now she's making money for her family. I don't know, whatever. But maybe mom can look at what Johnny is doing and can coach Johnny into turning around and throwing the same toys in a different direction and then finding that it is perhaps even more fun to see Fido fife go out and grab the toy and bring it back and then the game continues, right?

So this is graded exposure to feared stimulus and done in a way that is constructive and changes the perception and the behavior of Johnny and Mom goes to Susie in this case, the a delta poly modal neuron who is overreacting because of Johnny's behavior and says, Susie, thanks dear, I appreciate you for, for doing that and for letting me know, but based on what I'm seeing, Johnny's behavior is just fine. We just need to coax him a little bit, help teach him to do this movement a little bit better. And in the meantime, honey, you don't need to tattle on everything that Johnny is doing.

Now I gotta be candid with you.

I think that little narrative that I provided, I was pretty damn pleased in it. I, it came, it just, I just kinda like opened up my mind on the keyboard and it just spilled out. It was cool, very cool. But I am welcoming your feedback on that and any potential similar kinds of things that you want to share as well.

Let's see. Hello, Aubrey. Lawrence, welcome in over there on Facebook. I hope Alaska is treating you well, my friend. I've enjoyed your videos that you've been sharing from up there.

Brandon, you're on here, here, you wanna chat? Tell everybody what you, what you took away from our visit last week. Brandon from is on here. Let me ask you to unmute.

Brandon Fromm
Hey, can you hear me? I sure can. Brandon Brandon's was with us last week for the upper quarter course here in Portland. That's a 12 hour course and our next one's gonna be, that's an in-person course. Our next one's gonna be in St. Louis with Dr. Scott Grogan and his crew in July. You can find that at Eurocentric centric approach events on the events tab. Brandon, you've had a another week to play with things after we talked and workshopped together, what did what you gotta report, brother?

Actually I took this whole week off, so I've just been farting around at my house. But your question, are you talking about with central sensitization and explaining this to patients or

Phillip Snell
I, I am asking you to offer up some first person understanding of what the hell it is we're doing here with neuro centric approach and how you've incorporated it in practice for better or for worse.

Brandon Fromm
Yeah, so, you know, I've used it, there's lots of benefits I've had from it, but as far as, you know, creating a narrative for patients, I think that's one thing that even at that seminar has, it really stood out to me when you talked about that. 'cause it, it was something that I, I I think I, I understand the importance of it, but I was kind of failing to see how significant in the NCA approach it, is it how helpful it is at helping to explain things to patients in a way that make a lot of sense.

For example, I get a lot of patients that come in with, you know, let's say shoulder pain. And it seems like, and it may just be at the clinic that I have and the types of patients I see, but it seems like no matter what their shoulder pain is, it's always diagnosed as bursitis or arthritis. And that's pretty much all they're told. And people are sometimes under the impression with like, they're not ex, nothing's explained to them. So they think, oh, I've got arthritis. Well it's gonna just spread throughout my whole body. Or I've got bursitis. Well this is, this is when I start going downhill. I'm old enough and it's, you know, I'm just getting old.

And, and that's kind of what they're told by, by their doctors. And so by explaining and showing the patient like, Hey, watch if we do this, we can modify your pain right now. This is something you can do for it to help you in between visits. And just help them kind of understand how, how they got there in the first place and give them tools to help themselves. And this is how I'm gonna help you go forward. And the whole problem solving thing, like you talked about where, you know, we're gonna try things and if we're not seeing the results we're looking for, we're gonna gonna, we're gonna change it, look at it from a different perspective, a different level here and try to try to get to the bottom of this as quick as we can.

And it, it's really, you know, from a practitioner perspective, I love that I can get, I'm confident I can get somebody results say, I mean that day, you know, it's very rare with MCA that I cannot give somebody something to run with or some improvement that day.

But it also kinda just gives them some answers finally. 'cause a lot of times people are confused about what the heck's going on? How did I get here? How can I prevent it? And that kind of thing. So for me it's been incredibly, it's, it's really changed the direct, the trajectory of my entire career I think. And it makes me very excited, especially about difficult cases and, and patients where surgery has failed and PTs failing and you know, nothing's working. And you know, I, I don't, I don't wanna say like I want those desperate patients, but I come almost like when the, when people have somewhat just given up and they're like, you know, I I think it's just gonna be this way.

And that's fine. And I, I really, I enjoy a lot telling them like, don't give up. You know, let's set some crazy goals for you and let's see if we can make 'em happen. And, and I really love that.

Phillip Snell
Yeah. Yeah. I I what I, what I consistently see in my own practice is it, as you just finished with right there, we all know that our patients most commonly come to us to get out of pain, but at their gut level, the reasons why they come to us is because the pain is taking them away from doing se things that are meaningful to them that provide value to them. It could be how they earn a living. It could be how they recreate it could be, you know, how they socialize with friends or family or whatever. But the, the process allows us, if we open the door to it, to move beyond a pain centric practice to one that really focuses on improving function in that individual.

And that that's a de I mean, I don't want to demean it or besmirch it by talking about money, but that's a good economic model.

It's that is, is you can get somebody out of pain, say using a McKinsey model very quickly, but then you've, you know, basically thrown them into a McKinsey purgatory and all they're doing is chasing their pain all the time instead of trying to improve function if you don't teach them anything else.

Yep. Brandon, how long have you been in practice now, bud?

Brandon Fromm
Let's see, just, I'm on my eighth year, so it'll be eight years in July.

Phillip Snell
Now I'm gonna put you on the spot just a touch because you said some things at other times with me that I think are poignant and that I think are pertinent. And this day and age as the economics of running a practice and such push us towards economic models, a variety of different kinds of economic models that sometimes take joy and curiosity out of the practice.

And you were candid enough to share with me how you felt when you first came into your first neuro centric approach course and you were also willing to share how you felt after and some of the things that we were able to do directly for you that kind of turned your head.

Would you care to share some of that for anybody that might be listening and wondering whether or not they wanna come play with us?

Brandon Fromm
Yeah, so prior to coming to the, my first NCA seminar, so I'll back up a little bit, right outta school, I ended up, I bought a practice that had been in business for 45 years. And the guy that ran it, you know, he had a pretty old school type of, you know, approach to chiropractic care, which is, it's understandable.

And he had a, he had an okay patient base, but it was a lot of, a lot of people that at, you know, at that point he was doing mostly instrument adjusting. And it was a lot of people that were kind of fit into that type of approach, I guess.

So when I took over, I quickly transitioned it more to man some manual hands-on adjusting and some things like that. And over time I just found, I found myself wondering many days I'd be working on a patient when they're on their, you know, face down and I'm, I find myself spacing out almost thinking to myself, am I really helping this person? You know, what did, what am, you know, for me, I get what I get out of what I do is not the money. It, for me, it's like making a difference in someone's life. And I want to, I want to be confident when they leave that I've made a difference and, and not just, you know, heard people through like a assembly line type of thing.

So I would find myself thinking that a lot and it, it really, my, my mind kind of got the best of me and I got to where I was just like, I'm ready to quit. And I had, I had actually written a letter to my, all my patients that just kind of like a, a draft basically saying I was quitting and this, you know, I, I got into the practice for these reasons and I'm not able to achieve it the way I thought. And so, you know, I need to, I need to do something different. And after that, I, I carried that letter around with me every day for a while, just in my pocket. But anyways, my friend dj, he convinced me to, to go to one of these seminars and I did.

And you know, it, it really changed my perspective on patient care because I got into chiropractic school and they, you know, they, you know, they teach us all the fundamentals, you know, get a good framework and I, I, you know, the whole thing about the nervous system controlling everything, like I, I genuinely believe that and I, I think there's a lot of evidence supporting that, but I also have trouble with people that claim the spine is the only problem or the only thing that causes problems with the nervous system. And it was, it was very hard for me to try to tell a patient, you know, 'cause I think, and I'm making assumptions here, I gotta say, but in, in practice, if I tell a patient, you know, you're not getting better, well, I need you to come in a little bit more often, or I need you to come in two or three times a week.

Right? You know, I was at a point where I was so busy, I could, I had no room in my schedule to tell people to come back three times a week. I still don't. And so my standard is I actually see people once a week. And with NCAI can easily do that and get great results. But anyways, I was at a point, I was burned out. I just, I needed something different. And it, it, it was like, I went to this first NCA seminar and we were throwing things at, at you and you know, as you guys were, you were presenting this and almost I threw it at you. Like, I do a lot of things where I'm like, I'm gonna prove that this doesn't work.

And so I started throwing random shit at you guys. And the last thing that I threw at you thinking it was just a tangent off of what I read in the, that course, the, the prerequisite material for the course was how muscle tension and tone was influenced by, by a mechanism was like guarding a nerve, a nervous, like a nerve or something. So you might have tight hamstrings, but maybe it's protecting your sciatic nerve. And it's, it is not a hamstring issue, it's a nerve issue. I've never considered that in my life, but I'd also struggled with tight calves my entire life. I've never been able to squat without my heels coming up off the ground.

It's not a painful thing. It's not, I don't have ankle pain, I don't have calf pain unless you touch my calves. But I, it just, it had never occurred to me that this was a neurologic issue. So I, I just randomly threw it out there at the seminar and I, after about 15 minutes of the most painful soft tissue work I've ever had in my life on my legs, I was, I remember I was able to squat down comfortably. And even though I don't, I don't regularly stretch my calves and or anything anymore, but I still maintain a huge improvement. And that was over two years ago. I still have a huge improvement as, or my baseline's way better than it was prior to that, even without constant work on it.

So that actually to me, I went off on a tangent with NCA and I still practice this way where I actually, I look at, I'm not looking at necessarily just common neurologic symptoms like you talk about, but I'm looking for really subtle cues. And I look at the way people move and their, their chronic muscle tension. I particularly pay attention to the patients that say, I always hold my stress in my neck and shoulders. And I say to them, maybe that's not your stress. Maybe maybe that's your nervous system trying to guard you a bit. And so we'll go through different things and I, I actually do get a lot of, I have a lot of success with patients who tend to, you know, hold their stress in their neck and shoulders by treating several, like the supraclavicular suprascapular, those types of nerves.

I, I actually have great success giving them months of relief from it just by treating those and showing them, here's some things you can do to also work on these and breathing strategies and stuff. So, I don't know, for me it's take, it's made it so that I could, I feel like I feel very comfortable taking any case on.

I I, I just feel very con it's taken me from being, I'm this entry level, you know, chiropractor, fresh outta school where I still think I know a lot, but I don't know shit. And then now I, ironically now it's like the Dunning Kruger effect NCA taught me, I don't know shit at all. And, but I actually, my confidence, and I know this, I'm kind of using the analogy backwards, but I feel so much more confident because even if I don't know the answer, I take this approach in with any patient and I I'm gonna figure it out right there with them and I take 'em through the process and I never have to feel like I'm, I just have to know the answer, right that second, this is a process where I can I take the patient with me, I show them, this is how we figure it out, here's some stuff to empower you, and this is the course we're gonna go at first.

And if we're not seeing results, this is what we're gonna do next. And that, that, so that for me is what has done

Phillip Snell
One of the things that was absolutely inspiring to me and beautiful. 'cause you know, as a, as a teacher and, and putting together a model here that's somewhat, somewhat new and integrative, you know, I, my, my bias and my ego gets challenged on a regular basis. Am I wrong? Am I putting, you know, something of worth and merit out there?

You know, part of how we learn from that is to do research. We need myself and others to actually generate some legitimate research in that way. But at the first order way of determining that is, is the process reproducible? Can you teach it to someone else? And can they then in turn use it effectively to, to provide the results that you, you know, in this case me are seeing in practice. And it was fascinating and gratifying to see that over a two year period in, in, in direct contrast to what we talked about in the course of how many of us go take a technique based seminar. And then we have this two week phenomena that occurs where everything that we see from that point on is for about a two week period of time, is that system, that silo of information.

And then slowly it kind of, you know, you don't use that technique quite as much. And then it goes into that aforementioned Ben in your office, that cluttered Ben of techniques.

And the, i I think that the, the, what you showed me and what DJ has shown me is two years of consistent diligent practice.

And where you slightly tilted it was to take your own training, your own bandwidth. Your, the place that you feel most drawn to based on your own experience and your own experience with patients was to evaluate for motor hypertonicity and functional movement. And then you use that as your inroad into investigation of the, of the nervous system and how it might be contributing to that observed phenomenology. And i, I absolutely adore that you took where you felt strong and you were able to find an inroad using the neuro centric approach to be able to leverage in a way that makes you feel comfortable, that makes you feel strong, that makes, that allows you to be able to talk easily with your patients about it and to demonstrate compelling results very quickly.

Kudos to you. I can't tell you how as an instructor, a teacher, how gratifying it is to do that. Because candidly, sometimes, you know, I'm showing up, I'm doing this kind of stuff on a, on a Saturday morning, you know, when I've got other things to do and you know, I sometimes wonder if I'm just shouting into a big old hole out there.

Thanks for shouting back brother, here's one to you.

Brandon Fromm
Yeah, you bet. By the way, I have found DJ and I both have found several studies that kind of support how, you know, the, a nervous like peripheral nervous system under threat is going to change or causes changes in, in people's movement patterns and postures and things like that. And even their, their strength in different ranges of motion to cause as little of a threat as possible in the nervous system. It, it'll actually change the way we move and the way we can move to protect itself, which is really interesting. That's kind of what I look at a lot when I'm dealing with patients.

'cause I, I deal mostly with like very chronic type problems with people. Like I have a several month waiting list for new patients right now, but it's the patients that I see, it's usually they're already seeing another chiropractor or they have for 20 years. And the stuff I'm seeing when they come in is they're like, I've been seeing my chiropractor for 20 years. They tell me my right leg is short every visit, you know, once a week, every time, every week for the last 20 years. And it's always that way. And their only answer is, well, you just need to come in for the rest of your life. Or once a week is what they tell 'em, I think.

And, and you know, we'll just correct it. And you know what, then the harm's, there's no harm there. And the way I look at it at now, like I'll see someone like that and I I pose the question every time is, is this, you know, a pi ileum on the right for example, is this, is this because of the way they sit on their wallet or is this because somehow this is, that position puts a a lot, puts less threat on a nerve like the sciatic nerve for example. Is this a position, a compensating pattern to, to alleviate that stress in the nervous system? And by treating it that way, I've actually, I've had a lot of success where we get rid of that leg length inequality for months and months by just treating sciatic nerve or similar structure and

Phillip Snell
Or upstream. The way that I will commonly see that is that repetitive si presentation, it is all I commonly see to be a lateral disc herniation that is not severe enough to be causing the lateral presentation posture lateral antalgia that we commonly will see with people walking around like John Wayne when they've got a lateral disc. But if you keep that in mind and go upstream and evaluate their, their pain by using a McKinsey model, the lateral glides and look for a directional preference, and oftentimes you'll find it. And then in addition to that directional preference, you'll usually find the QL on that involved side that's pushing that antalgic posture is hypertonic, as you noted to pull them up.

So rather than just pulling them up to unload that sciatic nerve in that position, it's also pulling them away from the involved nerve root and that's upstream from the sciatic nerve. So screening that, putting your interventions on at the nerve root and IVF is a good model too. So that's a probably a good spot to stop. We're coming up at the, the end of our hour.

It's so lovely to see some of my old guard out there with Aubrey and Charles showing up. I Charles, I saw in your, your info recently as we put the, I put the locator page together on the neuro centric approach and you can find your details out on the site now and others in the general public as they, we start to develop a name for this particular process and people start searching for it and looking for a provider locally.

They can find you guys and each of you with your level of experience within the program is listed on there. So yes, everybody check your details on there@neurocentricapproach.com slash find a provider. It's find a provider tab at the top and I'm happy to, if you provide me with a, a different or better headshot or, you know, altered nu information about contact there to make changes on your behalf there on that.

So that's what I got. We got a cloudy day in Portland, but the rain scrubbed all of the alder pollen out of the air so I could breathe again. That's kind of nice. And I'm gonna take my little thigh nudging doggy out for, for a good run and walk.

In the meantime till we meet again next weekend at 9:00 AM Pacific time. You guys stay curious, stay compassionate and take what you've learned and go help some people.

I thank you for your attention. Be well.