NeuroCentric Approach Zoom Case Study-Hip Pain in Masters PowerlifterOctober 30, 2023
NeuroCentric Approach Zoom Case Study-Lumbar InstabilityNovember 4, 2023
Members of the NeuroCentric Approach Online Academy meet regularly on Zoom for an informal, online coffee chat and case study.
Below you can find transcripts of this meeting and watch the video from YouTube if desired. To learn more about becoming a member, click below.
The 4 Nerves of Shoulder Pain
Transcripts from the video above are below...
Able to join us live today. Let's see how this goes.
Alright, got some people coming on here.
Good morning Sean.
And I'm here on the link as well. So I'm on a Peloton bike that I picked up this past week.
Reason being, this is the, the hazards of getting old.
About two months ago now, I was in the dog park with my brother-in-law.
He was his 60 pound doberman puppy. Not really a puppy but I don't know, she's a year old I think.
And my little fife dog, rough girl, 20 pound mini Ozzy Shepherd, that the two dogs are quite competitive with each other. And I flung the ball for my doggy. She brought it back and I was bending down, foolishly pivoting on one leg right about the time that my brother-in-law decided to fling his dog's ball directly over my head.
And his dog spun around and decided the quickest route to his ball was right through my lateral knee.
So net result of that was a grade two sprain of the M C L and a horizontal, well at least on the M R I, it showed a horizontal tear of the medial meniscus on that side joint space well-preserved, which is good given that I've had pretty substantial knee issues. Orthopedically going back to sporting days and things of that sort.
But my running is on hold right now 'cause the knee doesn't tolerate it so much and I gotta get my cardio on a little more consistently. And I also want to be able to get my hit training on and this is a good way to do it without too much bang banging on the knee.
So meat problems do happen. N C A team who've thought.
Nice thing is, I like how quiet this is so we can have a back and forth forth like this perhaps.
And I can get a little zone two going on. Lemme get my data going
we can chat a little bit about Yeah, dog trauma. Jerome, you're right. Yeah that is, I think it's a sure sign of getting old.
Yeah, this wasn't a, a twisting injury in some exotic sporting event.
60 year old male presents with injury in a dog park. How demoralizing.
Yeah, about as demoralizing as the fiber supplement I put in with my water along with the creatine and the collagen and all that stuff.
Folks are still joining in here. Here's Mark Heller coming on. Good morning Mark. Nice to see you here.
Mark and I have been back and forth this morning a few times. Mark, do you mind if I read a little bit of your email that you were kind enough to send?
You're on, you're on mute.
Mark, do you mind if I read some of that email?
I That that would be fine.
It'd be great.
So Mark was kind enough this morning to provide a little feedback about his experience with the N C A online Academy.
For those of you that know, know Mark, gosh our, you know, our relationship really kinda started I think Mark with the very first continuing education program that I ever did, which was with George Roth 10 EG therapy.
I was in like second, second quarter I think at Western States at that time. And you and I wound up showing up at the same presentation for 10 EG therapy. So yeah, we've been circling each other for a good long time. Mark, how long you been in practice mate?
33 years in
practice. Oh 40, 43. 43.
43 years in practice.
And Mark is a columnist, regular columnist for DC online.
He's been very kind to Justin and myself over the years with his vocalizing about the effects that he's had on his on using at that point. YAP and D T M primarily. So this N C A thing, however, is kind of coming up underneath all of that and providing a little more of, of a rationale and a premise behind why you do a technique like D T M.
So Mark most recently was on the N C A online academy, which you can be too if you want to.
It is a member program. You can go over to the neuro centrical approach online website and find links to it.
But Mark took the shoulder course on there first. He's completed that and he sends me this very nice email. It says, first I worked on two people close to me yesterday after watching the shoulder videos. Both had quite chronic problems. One was a frozen shoulder,
let's see, had not so bad pain but still lacked abduction over a hundred degrees.
Did the manual therapy portion for the frozen shoulder that was demonstrated on that with closed pack positioning and mobilizations for in external and internal rotation and immediately had a 20 degree change in abduction range of motion. That's nice. There is still room for manual therapy in this program guys. I do it all the time with every single patient.
And the second person had severe left shoulder arthritis and Marxist was feeling hopeless about her left shoulder. The index movement was abduction, which was limited to 70 degrees and the primary thing that he did was cross fiber over the suprascapular nerve at the top of the shoulder and also followed the radial nerve down with radial nerve restriction work.
And this person feeling hopeless about her left shoulder had immediate changes in abduction from 70 degrees to 120 and better the next day. So the better the next day is the fun part in this as well.
There are those out there in the, the twitterverse and whatever else that will say that these kinds of quick changes that we can see from manipulating nerves that are in trouble.
Well I'll take that last part away. The, the quick changes that we see in these kinds of patient interventions is a parlor trick and it's schmaltzy, it's overly promotional and that it short-lived that the only way we can get long-term benefit is with long steady state work.
And I would suggest that it all depends on the tissue that you're playing with. If you're playing with a nerve that's unhappy and you make it less unhappy and it still responsive because it still has good metabolic health, it's not been overly compressed for too long of a period of time to the point that you've got some sort of long-term permanent damage to that nerve, then that person will have quick benefit if you bother to actually tell them what the hell's going on and you reorganize their home care to focus on simple things that they can do for that, those benefits will be very long lasting.
I see it, have seen it now for 15 years consistently. It's not always the issue. I'm not suggesting that every single thing that those of us playing in physical medicine seeing is a nerve problem.
It's not, my left knee is not a nerve problem. Well possibly you think I might be investigating the possibility of a saphenous nerve getting tangled up in that repair process? Yeah, I am but I had a dog problem with my left knee. It wasn't a nerve problem.
So yeah, the idea is to make sure you're looking for neurology that is getting in the way of the function of that particular patient and conceptualizing why it might be happening and to
Appropriately. Yes sir. What you got, mark?
Well, I'm trying to understand when I put a suction cup over the tip of the shoulder and then have the person raise their arm, is that supraclavicular nerve or suprascapular nerve? And I'm al I'm also trying to understand the anatomy of where we're working on the suprascapular nerve. I know it's underneath the upper trapezius. I know there's a place that that nerve dives down there. Okay, you wanna elicit it a little more?
Sure, yeah. 'cause suprascapular nerve in my experience is a pretty common one here.
Especially if we evaluate in that shoulder pain patient what the status of their lower cervical spine might be like, such that there might be things there that are contributing to this.
If the person has some irritation, call it a joint derangement pattern per McKenzie at C five six, C six seven, then we're likely to have four nerves in a shoulder pain patient that start to show symptoms. One would be the dorsal scapular nerve exiting the right through the middle scaling, turning backwards and going under the upper trapezius to provide motor to the rhomboid muscles. And there is a lot of that pain that we see in patients when they tilt their head back. That radiates down to the medial border of the scapula.
The other two of the other nerves that we'll commonly see, and these would be in in your shoulder pain patients if you've got a neck issue going on a joint derangement pattern would be patients with pain on the posterior your shoulder.
And that is most, in my experience, most commonly the radial nerve and the triangular interval there.
And I think a lot of what we have historically been treating as a subscapularis trigger point in the patients, a armpit with that presentation is probably radial nerve in that interface. The other's, the axillary nerve and the quadrangular interval there. Now to answer your question, the suprascapular nerve after it comes off up here, as you mentioned, goes deep to the upper trapezius. The way that I get to it, mark, as I'm demonstrating right now, you take fingers and I would typically do this from behind and hook and pull the upper trapezius a little bit outta the way. Now I'll drop down right in that supraclavicular fossa.
So I'm I'm in front of the upper trapezius, correct?
Correct. Okay. And then, and then you're gonna move laterally and you're roughly in the area at that point O of where the suprascapular nerve interacts with the belly of the supraspinatus. And then the nerve will continue to a pretty common interface point where we'll have an interface issue right underneath the scapular spine underneath that little restraining ligament right there where it sends a shoot off to the superspinatus and another shoot that goes to the infraspinatus. And you can, what I think we're doing with our cups, primarily when you put a cup on a superior shoulder, you're probably modulating that interface right there.
You can get in with your fingers and be a little more specific as well.
The one that I find the most benefit with is right there in a supraclavicular fossa. And it's easy to do with the patient as well because in your seated portion of your exam as they typically with that shoulder pain patient reporting that elevation either in abduction or flexion is the painful range of motion. As they do that, you can very quickly, just as we demonstrated in that video mark on the course, you can sit behind them or stand behind them and lift on their neck and provide traction and see if their range of motion changes. And that would implicate something as that is narrowing the neural foramen and the, and the neck is as being contributory to the presentation.
And then you can get in on the suprascapular nerve right there. And I generally, my, my objective as I get on it with that hook position from behind is I, I think I'm trying to get on the front side, the anterior aspect of that nerve's travel and I'll palpate through there and see if I can hallucinate the nerve and then pull on that while they, and create a, which would create a bit of a different interface all down that neuropath and have the patient re repeat their index and we see if they've got any improvement there. And if they do, then I'm gonna spend a little bit more time on that and I'll commonly treat that in supine as well, seated at the head of the table and working in with transverse nerve mobilization while the patient works their arm around. Which brings up a, a bit of a important point on the,
the, the way that we apply the, the neuro centric approach stuff. We're looking to not only do to change that interface with our manual contact, we also want to include some kind of improvement by using patient movement ideally.
So that gives us a little bit of that flossing stuff that we'll commonly have.
You know, to go back, I think we've talked about this on some of these other ones, but I see it so commonly and I see it as a, a lovely way of highlighting sort of the, the integration of multiple neurally focused components that we're trying to do with N C A.
Is that patient with neck pain, possibly shoulder pain, but the pain radiating down the middle towards the medial border or the scapula.
And that patient I've found often will report that their symptoms tend to get worse when they're stressed out.
And in addition to the effects of cortisol and the other catecholamine hormones on neurology and reducing the action potential and those kinds of sensory nerves, the, the effects there will, can be heightened if you increase the mechanical pressure on the nerve right there at the middle. Scaling, how does a stressed out person breathe high, shallow rapid apical breathing pattern.
So when that person gets stressed out, you got potentially one more thing right here. Most of us these days, we are often, a lot of the sources of our stress tend to be anchored around devices like what I'm playing with right here. We have a, you know, a job or some sort of thing that we're doing or you're trying to meet a deadline or you're trying to go through some kind of stupid effing battle on social media and that kind of stuff can get you breathing wrong. You get all up here and then we've got the potential for one more little interface problem with that, that piece of neurology in that area. And commonly I'll see that patient as well has a medial winging of the scapula on that side.
If the motor function of that rhomboid is somewhat compromised because of chronic compression of that suprascapular nerve. Why I'm bringing this up is it gives us a nice inroad. Now in a patient that presents with neck pain,
it gives us a nice inroad to talk a bit about,
a more holistic approach to addressing the things that they're doing. You know, patients come to us in pain commonly doing the kind of work that we do and their stated goal for the visit is to reduce their pain. But really what they want is improve function. They want to get their life back. You gotta love hearing that one all the time.
So if you push them a little bit more, you can have a bigger impact on their life with this kind of approach. I think certainly been what I've seen over the years in practice.
And you know, it doesn't mean that you have to be the one to weigh in on all of that stress stuff. Just know how to refer appropriately, make sure you've got some psychologists, some therapists in your referral Rolodex for those of you to know what the hell that is and, and get in touch with, get in touch with those folks. At least the very least get the patient aware of that relationship.
I see that one as well.
Many years ago, Lauren Moseley did a video D v D set, he described some of the research on the way that nociceptive neurons, particularly c fiber ent, can get primed to pinging in the presence of catecholamine hormones. And the story is one that we commonly see with patients that have been in a rear impact motor vehicle accident.
So you guys are aware of the, the sheer forces in the lower cervical spine and the, the closing and possible facet implication at the upper cervical spine in that mechanism of injury.
And commonly people that have been through that kind of thing, they feel a sense of victimization, right?
They're like, you know, I was doing everything right.
I was stopped at the light, I was paying attention to the road. I wasn't playing with my phone or whatever, and somebody, you know, slammed into me from behind and now I've got all these doctor visits I gotta go do. I've got all this stress associated with the, the dealing with the insurance company and all of that.
And in those cases, one of the key things I ask in history with what their life was like from a stress perspective when all of that occurred because Mosley in the way that he brought, brought that up, those sensory nerves around the injured spinal tissues are nociceptive neurons. And you guys remember that nociceptive neurons respond to intense pressure, intense heat and chemical changes in the tissues. They cause that nerve to report upstream to the spinal cord and then onto the brain that something's going on in those particular tissues.
And when that occurs in the presence of catecholamine hormones, 'cause the patient was going through quite a bit of stress at that particular time when they were, when they suffered the injury, then those nociceptive neurons will become primed to chemically respond to the presence of catecholamine hormones.
Now I do not know the half-life there and how long that's going to stay, but I set the patient up for the possibility that this, that at least a portion of the symptoms they are feeling in their neck might be just because they're stressed out because the release of the, the catecholamine hormones will cause the nociceptor to fire and the brain has to figure out what the hell's going on.
And the common presentation I might see down the road months after is the patient's doing great, their range of motion is great, their function is restored, their N D I score is beautiful. And then they come in to a, to an appointment and they're like, and I ask 'em how they're doing. I'm like, when is this thing gonna be done?
Why am I still injured?
Because their tissues from all of the other metrics that you've been using, range of motion palpation function have healed and yet periodically bam they can get intense pain in their neck.
And I think part of it is that those catecholamine hormones get released, the patient has a firing of that nociceptive neuron, the brain from on high looks down the tunnel and says, okay, who's talking down there and why?
And based on collected experience in your hippocampus and amygdala that brain says, oh, looks like it must be that that injury is still causing some issues there.
So if you drop that info on the patient as a possibility in visit number one with that M V A, now you have an off ramp in that patient if that comes up down the way to get off of their hysterics potentially and hyper vigilance treatment seeking and all the other fun things. So just some thoughts. I amusing there.
Justin, you're on this morning.
See you on there. You want to come in and talk a little bit?
Dean’s Iphone (2)
Hmm. Good morning everyone. How are you?
Dean’s Iphone (2)
Peach. So I came in a little late 'cause I I had a business call this morning. Was there a a case that I should chime in on or just in general additions?
Dean’s Iphone (2)
we were, let me
mute you there for a sec. We were talking, mark and I, about some shoulder issues and talking specifically about location path and function of the suprascapular nerve in shoulder presentations.
And so yeah, if you've got some recent cases in regards to that you want to chat about, go with it.
Dean’s Iphone (2)
Yeah, absolutely. So one of the things I've been working on recently that I have not had a chance to share with you is the capsular mo mobilizations for the, the neurology around the glenohumeral capsule. As far as I've had some very interesting, I would call it freezing shoulders in the freezing face, being able to like clear it up quite quickly by, by working that super scapular nerve and as well as primarily the nerve to subscapularis. Like making sure that those as those articular branches enter the glenohumeral capsule, making sure that those guys are moving as just as great good as possible.
And I'm sorry if I'm seeming a little groggy, I'm still waiting for that old coffee to kick in, but I, oh gosh, I'm looking forward to sharing this information. 'cause it's this, it's the same concept as the hip where it's, you are aligning tenson to the capsular orientation of the tissue in contrast to the nerve insertion point to create a sheer force between the two.
that's good stuff. I look forward to seeing what you've got there as well. That hip info, Justin, that you put together for the lower quarter course,
that hip info that you put together with the opterator nerve and its spray patterns of innervation of the hip capsule and then subsequently theorizing according to the various ways that the hip capsule fiber orientation can be adding manual therapy techniques to theoretically try to get in and work that interface between the operator nerve and the the hip capsule itself. And I find that that is a really delightful way to play that. It it, it's like putting a cherry on top of the rest of the work that I'm doing on that particular hip. I've got one of those cases to talk a little bit about too that I'll flesh out over coming weeks as we get more detail.
But first I'd like to say hello to my old classmate, Alan j Alan. Good morning, are you in? Good morning
Good morning. Are you in Kelowna today?
No, I'm down in Vancouver.
Ah, all right. Say hello to my son. He's a brand new Canadian citizen.
I sent my best, the best work I've ever done. I sent to Canada and you guys didn't give him back.
That's good. We we need him up here.
Yeah, yeah, no doubt. He just got full on citizenship last week.
And Now I gotta learn how to sing old Canada So.
Well you don't, he does.
Well, you know, I want to join in. Maybe I
maybe I can hit a harmony somewhere in there.
Yeah. All right. Yeah, that's good. Yeah, we could use that too.
Alright, so back to the hip stuff.
And for, for you guys that are wondering what I'm talking about, the courses and the hip firing pattern, all that stuff, that is material that we have available in the onli, excuse me, the in-person course for the lower quarter. We've got an upper quarter and a lower quarter each 12 hour courses, we're starting to book in-person coursework now, but the work that we have online on the online academy is a good place to get your feet wet or if you've been to those courses already, it's a good way to review some of that. And members, lifetime members to the site will get a hundred bucks off of those person courses when we launch those.
Now a case that Justin, I'd be interested in your input here as well.
But, and this individual has given me license to talk about his his case and this kind of an environment. But many of you know that I've got an office at Kabuki Strength Lab and that one of the founders of Kabuki Strength Lab is Rudy Calab.
And Rudy is,
for the last 10 years or so, he's been the age and, and, and his age and weight class has been the world record holder in all three lifts and cumulative totals in the sport of power lifting.
He's an incredible individual, one of the most delightful, gentle, wonderful and giving human beings you're gonna run into.
And Rudy has really not had all that much coaching from the coaches at Kabuki because he's very self-sufficient and you know, it's one of those things where if you're functioning at that high a level, why mess with it? You know? And he's been doing so well for so long that he's mostly just him and his training partners showing up in the gym. And every now and then we'll have a little bit of a, a tweak as happens in this population and they're their training blocks as they're preparing for competition. And Rudy is getting ready for world's, another world's event in November, I believe it is.
And Rudy's weird because he's at an age where we are supposed to be getting weaker. He's 75.
Research would suggest that I think it's after your forties every decade we lose about 10% of strength.
Rudy has improved in strength on all three of his lifts for five years running.
I will show at some point 'cause he's gotten a, he developed a habit on his birthday of attempting a PR on a deadlift. And he did that in the gym this year.
And not only did he increase his PR by one or two pounds just on a lark, he pulled it for two ruts.
He's incredible. But the last two times that I've seen him over the last year and a half or so and his training blocks for little tweaks that he had, I've noticed kind of disturbingly that this area in here was getting moving off, shall we say, off pieced. And from a d n s perspective, he was starting to exhibit some classical problems in here showing a really pronounced rectus diastasis.
And on recent presentation we had, you know, with some groin pain that he had, I was working the stuff that Justin was talking about a moment ago regarding the hip joint and the operator nerve. And I was able to help him dramatically very quickly by working a putative operator interface issue between the adductor longest and adductor
two of the adductors.
And in that, that was lovely to see, but he still had some issues and his, his exam also showed some potential meat-based involvement at the hip joint itself, which I would completely expect in a 75 year old athlete like that.
So just the other day we were working on this again 'cause I'd make it feel better with the ator nerve stuff, show him stuff that he could do and then he would come back and we doubled down on, on the rectus diastasis and the issues here in his middle.
And he would try a wide stance, like a sumo style deadlift with no weight and squat down. And that was his index movement and he could consistently make it worse by moving into something that looked like a cossack squat moving out to the side.
So he did that and without doing anything else, I just got him to start working on a position change. What you see in a lot of power lifters like this is as soon as you start playing with these area and you mention anything about bracing, they go full tilt boogie. So they're, I'm like, okay, now show me a squat pattern. He's like, and squats and comes back up. I'm like, no man, just squat to the chair, squat to the toilet, show me something and it is very low threshold and give me good position there. And we worked on a position, worked on the four quadrants of stay of breathing and bracing here that they talk about the principles of loaded movement work at Kabuki.
And he dropped down in that position for the index movement and that sumo style wide leg squat.
And he's concentrating very hard on that neural ingram that he's got to make it different than what he's used to.
And he drops down into that, looking down at the floor, moves to the side in his little sack movement and looks up at me. He says, you fucker,
he is like, it really is that simple, isn't it? I'm like, you know, just because you're a world record holder doesn't mean you're immune to these developmental principles that we've been using in this facility for the last 15 years.
And I said, it's time to put a new kitchen in to your wonderful house. We need to pull some things down to the studs. And even though right now he is still rocking his progressions on his, on his training program and we'll go set more world records. I mean, there's a point when you reach 75, you just outlive a lot of your competition on the platform, but he's gonna go set world records now in addition to making him our resident science experiment for longevity and strength training,
we, and setting records, we want to keep his hips healthy. So we're in the process of working on that and I'll let you guys know how that progresses over the coming weeks.
Anybody have any questions here?
I, I do. Just insights on that. I, I'd like to get your thought on this, what I, what I've noticed over the last 10 years with hips or, I mean, it's just more of an idea or an observation that potentially there's in, in relation to this diastasis in the abdominal wall that maybe there's like a, an underlying like inguinal hernia type thing that's progressing and just the way that you were describing that, like I, I'd I'd love to get your, your insights on this idea that just by tweaking the basics there, like I wonder how much that's just reducing potential Yeah. Abdominal pressure there that might be reducing what otherwise would eventually become some sort of like full blown hernia.
I agree with that and see it pretty commonly, Alan, and I'm not sure, I think we're probably working a chicken and egg scenario with that.
You know, the thing that when I try to make a narrative in my own mind that makes sense with that the intermuscular septum between the rectus and the external oblique right here, common spot where we'll have these kinds of sports hernias that will tend to be potentially drawn onto a lot of tension.
If that person has that open scissors presentation and they're kind of spilling out of the front right there, then the anterior cutaneous nerves right there that come out of that SEPTA will get presumably some pretty significant mechanical forces placed on them.
So if we improve that to get hoop stress improvements, like Stu talks about by getting better firing patterns in the transverses and in the obliques, then we should be able to reduce or at least change the putative mechanics at that interface point with that, that neurology.
I have seen that work a lot and I have, I had a runner recently that was D one runner that both Justin and I have seen over the years that was having this and put my finger right on the pain and make the pain happen. And he went in to see his primary care and his primary care is like, you've got a full on inguinal hernia, that's what's going on here.
And he sent him out for ultrasound and then ultrasound was read as negative and his primary was really doubling down on this and sent him out for m r i, he did not have an inguinal hernia and we just needed to do some more of the long game work on improving his stabilization pattern there by shifting him from a high threshold to a low threshold stabilization strategy and getting him functioning a little bit better. And we have, and he's running painlessly now. It just takes a little longer when you're doing, doing it through that function lens exclusively.
Justin, you got any input there?
Dean’s Iphone (2)
Yeah, yeah. As a person who has diastasis recti and has for many years and gone through the process of, of quote unquote fixing it and then neglecting it and then needing to fix it again.
I, yeah, so some, actually some of the things that I've been playing with recently is actually starting to focus in on the, still doing all the functional interventions, still doing everything that we talked about, but that we would typically talk about you and I like, you know, like scissor positions.
But one of the things that I've been doing recently on my patients and that has helped me, my myself, is actually working on the, on the large rigid structural ligaments in the front and the back of the pelvis such as the, such as the ileal lumbar ligaments and the spic pubic ligaments in the front. So both from a innervation standpoint and from a
mobility because those get, because those, those ligaments are quite rigid.
Dean’s Iphone (2)
I, this is venturing a little bit outside of, well, what we're typically teaching at N C A, but it's worth noting that when I, I've been treating that stuff from an osteopathic perspective and it has helped get patients out of that anterior pelvic tilt. That's, this is just a huge side note. I'm also looking at it this, I'm looking at it from also a transverse nerve gly of, of the insertion of the innervating neurology of the area as they innervate those ligaments, but as well as increasing the pliability of those ligaments, just ati tiny, tiny bit, most likely from a neurologic perspective to get 'em out of that huge anterior pelvic tilt. So I'm just gonna plant that seeds for, for people to think about. I can't demonstrate how I would do such right now, but it is something that I've been playing with quite a bit and, and it, it does seem to speed along the process, but obviously the functional interventions are primary.
Justin, your timing here is uncanny and I know I, I'm hoping Mark was around his computer right then when that, when you were talking about that.
Mark and I have a candid enough relationship that we will each call each other out on our bullshit. And so Mark was also another email this morning said something I think you're missing are low force osteopathic techniques in this. And my comeback was, I don't know that we're missing that We can use whatever manual therapy technique works for you.
I just want you to make sure that you are incorporating the best current evidence on mechanical sensitivity of neurology, the best evidence on pain neuroscience, the best evidence on systemic issues and metabolic issues that can push sensitivity of neurology and incorporating that in an elegant way.
Whatever manual therapy manipulation or exercise interventions you wanna do, that's great. We have a strong bias towards D N SS procedures.
I admittedly do not have the same skillset anywhere near approaching what Justin and his geekiness has acquired over the past 10 years of working with osteopaths to put together these kinds of
low force mobilization things and such.
But we do go through those in the, the in-person courses to at least familiarize yourself with them and at least to give you direction to where you can deepen that investigation if you want to, the, I think the,
I do have a placeholder on the online academy for a couple of courses like this one on transverse nerve mobilizations, which was Justin's baby and the, these kinds of an introduction to these kinds of osteopathic movements. So hopefully Justin will be able to have some, some opportunity to put something like that together and that'll be available on the site and another course in the not too distant future.
The next course that will be available will probably be this evening, although I will say I'm looking outside a gorgeous northwest fall day and I'm presented with the opportunity cost of sitting at a computer and finishing the edit and upload of that course versus going out and seeing if I can gather some CRE mushrooms with my doggy. So you might have to wait an extra day. But the sports hernia, athletic pube alga of course will be dropping in the next one to two days and then the one after that will be one on tendinopathy where I'll be just fleshing out what I think the N C A brings to the table that adds to the current theories about tendinopathy and expands on Jill Cook's work, Rio Bon's work, car Silber Nigel's work, Paul Ackerman's work, and Brian, if that Brian that I'm seeing on here is a name is Brian Dinger that will address some of the things that we've gone back and forth in the community at the N C A Online academy and also in direct emails about that kind of stuff.
I did appeal to Paul Ackerman to come on here and talk about this, but he, his speaking fees were richer than what we have coffers to, to be able to manage.
So at least for right now. So I'll continue to explore that relationship. You'll, we'll see what we can get on here for visitors at some point when you're tired of talking to me and Justin,
mark and others have mentioned that we want to try to these meetings to an hour or less.
I think that's a good strategy because you know, you got families, places to go, things to do and you wanna try to maybe think about this as a weekly meeting for right now with friends.
So we're gonna try to do that. I've got some highfalutin ideas to possibly even go back and explore some of the things that we saw historically with the Rose City rehabbed performance, a rehab performance microbiology group back in the day where we would meet in a pub every two weeks and talk shop.
And I'm thinking of relaunching something like that and periodically we'll have a similar kind of meeting like this, but we'll do it at a different time and with different mood alters.
And I could envision that being a hell of a lot of fun too, if we have live streams with other similar groups in other towns. I know down and Van Tony McDougall put together the Rain City Club, I think it is, it's called. And those guys were going strong for a period of time, but I'd like to see something like that where one group on a live stream is showing up from a pub somewhere and another group is in another location and we switch back and forth and just basically develop a community to have fun. And I'm, I'm looking quite honestly to try to get the hell off of social media, but I just feel like it's toxic in so many ways.
So I'm looking for a way to keep my geek community somewhat close and playful and inquisitive and let's see what we can do to try to change the face of our professions and to help people better on my, this is probably a co topic for conversation at some point with Mark, but when I am
considering what the hell it is we're doing with all of this and thinking about the trajectory of, of the chiropractic profession over the years too, I find it fascinating sometimes that it's almost like this n c a perspective almost seems to be a bit of an updating perhaps of some of the classical ideas about what the hell it is chiros are doing when they're moving joints.
That will be ironic as hell for me, but I do think it's fascinating to consider.
I thoughts anyone before we sew this up, we got about four minutes to go.
Donna j Crow. Hello.
Good to see you dca, nice to see you here as well.
I hope all of you guys are well and enjoying your weekend. Thanks for putting up with me while I'm trying to get a little workout in here and if I don't have any questions or considerations here, then I will hopefully see some of you guys next week. Julio.
Take care gang.
Dean’s Iphone (2)
Phillip, I was wondering why you were breathing hard. I missed that you were exercising.
I was Literally like, are you, I was like, I was gonna ask if you were okay 'cause he sounded short of breath.
Dean’s Iphone (2)
a little bit
like, like those old videos we do with Chris Din. We were just walking across the gym floor. He'd be Getting Cardio. Yeah, right. He, I gotta use Peloton last week and I retrofitted it, took the computer off and put a stand on the front that I'm mounted my laptop to.
Dean’s Iphone (2)
yeah, I've got a grade two M C L on the left knee and a medial meniscus tear from an encounter with a dog and a dog part. And I'm trying to figure out ways to keep my zone two and my hit training going so I can outlive all of you motherfuckers.
All right, I'm gonna, since this is recording, I'm gonna go ahead and turn that recorder off.
Hang on one second.
I wouldn't let me do that.
Are you doing okay bubba?
Dean’s Iphone (2)
Me? I'm doing well. Are we still recording?
Yeah, we are. Unfortunately. I'm trying to,
Dean’s Iphone (2)
all's it's not recording. There we go.
Dean’s Iphone (2)
That's okay. I got a little,
Dean’s Iphone (2)
A little, a little nerdy addition for those that are still here as we were. This is kind of, we'll, we'll call this the, the advance.