Tom Walters
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Kelly: [0:00:04] Hey everyone, I’m Dr. Kelly Starrett.

Juliet: [0:00:06] And I’m Juliet Starrett.

Kelly: [0:00:08] And you’re listening to The Ready State Podcast.

[music]

Juliet: [00:00:16] This episode of The Ready State Podcast is brought to you by our friends at LMNT.

Kelly: [00:00:20] You know that I begged for a grapefruit flavored salt.

Juliet: [00:00:24] Oh my God, you were obsessed with the grapefruit salt.

Kelly: [00:00:26] I love grapefruit flavored things. I don’t know what it is.

Juliet: [00:00:27] Yeah, it’s true.

Kelly: [00:00:27] I don’t think I’ve eaten maybe two grapefruits in my life.

Juliet: [00:00:30] It’s sweet and a sour combination that gets you.

Kelly: [00:00:31] It is. I don’t know what it is but the grapefruit LMNT is fantastic. In fact, as we move into this sort of-

Juliet: [00:00:38] Winter season.

Kelly: [00:00:39] Yeah, shoulder season, I have been making a big flask of hot LMNT-

Juliet: [00:00:44] Hot grapefruit.

Kelly: [00:00:44] Hot grapefruit. And I sip on it all day long. I feel so sophisticated. I’m drinking it in a little cup.

Juliet: [00:00:49] So what’s awesome is that grapefruit used to be a seasonal flavor and people like you liked it so much that now it’s available year round.

Kelly: [00:00:57] I may or may not have hoarded it.

Juliet: [00:01:00] We have lots of it at our house.

Kelly: [00:01:00] Like a Girl Scout cookie you just drag through the whole year. So look, one of the things that I’m realizing and continuing to realize is that if I’m getting enough sodium, lo and behold, enough electrolytes, I feel better, especially on low carb days.

Juliet: [00:01:15] True fact. And again, huge fans of grapefruit LMNT. If you order through our link, you get a free sample pack with all of LMNT’s flavors. Go to drink lmnt.com/trs.

Kelly: [00:01:27] #weliterallydrinkiteveryday

Juliet: [00:01:30] This episode of The Ready State Podcast is brought to you by Vitruvian.

Kelly: [00:01:33] One of the reasons I think a Vitruvian is a great choice for a home, especially if you’re getting kids under basic loads or you’re working with beginners, is that you don’t need lots and lots of different equipment. And one of the reasons that’s salient is we know that probably the best way to progress people is something called a basic linear progression, originally put out by Mark Rippetoe. But we have used it as our rehab model. Basically, you’re going to do a little bit of work and we’re going to add one or two pounds or five pounds the next time you do it. And we can make massive amounts of progress. The problem is, as you know, people don’t have all those weights or all those dumbbells. Are you going to have a 23-pound dumbbell and a 24-pound dumbbell and a 25-pound dumbbell? It doesn’t work.

Juliet: [00:02:15] No, people just don’t have the space for it. And they also don’t know what to get. I mean we get so many calls and requests and texts asking us, okay, I want to have a home gym, but what two things do I need? And turns out it’s hard to be super effective with just two things.

Kelly: [00:02:28] Yeah, I think as you and I have spent more and more time working on—we have all these tools—how to reduce the barriers to adherence. And if you can go out to your garage quickly and just do a few sets-

Juliet: [00:02:40] Or even your living room, realistically.

Kelly: [00:02:40] Yeah. Three sets of five very quickly and then tomorrow do three sets of five, you can work that into a busy schedule. And for children particularly and youth athletes, teenagers is who I’m thinking about, it’s very simple to get set up quickly, under the front squat, and go for it.

Juliet: [00:02:54] Yeah, and more and more people are talking about the importance of strength training these days. It seems to be like a theme on the internet. And so I think a lot more people are interested in it but often it’s overwhelming to figure out where to begin and this is one of the places to do it.

Kelly: [00:03:07] Yeah. And the device is fabulous. It does a lot of things but that basic linear progression function, gold. If you want to learn more about Vitruvian, go to thereadystate.com/Vitruvian.

Juliet: [00:03:19] We are excited to welcome Dr. Tom Walters to the podcast today. Tom is a board certified orthopedic physical therapist that specializes in the treatment of pain and movement disorders. He’s the founder of Rehab Science and dedicates his time to teaching people about movement, pain, and how to most effectively recover from injury. Besides running his clinical practice, Tom served as a fulltime undergraduate kinesiology professor for eight years where he taught human biomechanics, therapeutic exercise, and pain science.

Kelly: [00:03:48] This conversation with Tom is great. I’ve known Tom for a long time. One of the things we’re here to talk about is his work and what I think is pretty subversive. He’s moving out a lot of very low level, cookie cutter rehab. You might go in to see a physical therapist for acute things, and putting it in the book and saying this belongs in your home.

Juliet: [00:04:07] Yeah, he’s just saying, hey, a lot of the stuff that you might think you need to go see a professional for or a practitioner for, you can actually really take care of on your own at home or with a coach or at your gym.

Kelly: [00:04:17] This book is great. Cowritten by a good friend, Glen Cordoza. But one of the things I love about it is you ask this kind of question: Do I need a professional person to prescribe me clam shells? Do I need some really low-level therapeutic exercise? And we find in our experience of this exercise is safe and it’s really hard to mess yourself up doing this. And yet, if you engage with some of these principals, you’ll have a better understanding of how your body works and you’ll be able to take a first crack at seeing if these things help your symptoms before you have to initiate the MS system.

Juliet: [00:04:55] Yeah. And I think we learned a ton of actual things from Tom and I have no doubt you will all enjoy this conversation. Tom, welcome to The Ready State Podcast.

Tom Walters [00:05:05] Thank you so much for having me, guys, this is awesome. Thank you.

Juliet: [00:05:07] And I’m sure Kelly’s going to want to tee up a question.

Kelly: [00:05:10] No.

Juliet: [00:05:10] But before he does-

Kelly: [00:05:11] Hey, hey, two of us are physical therapists here. We have a lot to talk about.

Juliet: [00:05:14] Yeah. Oh my God. Okay. I’ll be here to bring it down to reality. Anyway, what I wanted to start by saying is congratulations on your book.

Kelly: [00:05:20] Massive.

Juliet: [00:05:20] It’s called Rehab Science. Here it is for those on video. Man, I mean this thing probably weighs like 40 pounds. It reminds me a lot of Supple Leopard in its size and girth. And I just want to say congratulations because there was a massive amount of work put into this thing and it looks beautiful and I just want to give you a quick shoutout on getting it done because I know it was not easy.

Tom Walters [00:05:44] Yeah, I was going to say, you guys know firsthand how this all goes. And congrats on your book that I mean I should be having you back on. Maybe we do a live or something at some point to talk about your book. But yeah, I mean such a journey. You guys totally know from all of the books you have done already. And I’ve been following your podcast tour and trying to be as cool. No, it’s been a fun journey. Glen’s awesome. It’s awesome to work with him. He’s such a good, just his wealth of experience creating books of this size and magnitude just making it engaging. You imagine a textbook size book like this could be daunting and boring and intimidating to someone, but he’s so good at helping to organize stuff and put it together. 

Kelly: [00:06:27] He’s a ninja.

Juliet: [00:06:27] Yeah, he really is a master at that skill. It’s amazing.

Kelly: [00:06:28] Okay. So for those people who aren’t, you kind of let out of the bag, you have many hats: professor, physical therapist, dare is say Instagram darling. But tell us what this book is about and why you felt compelled to undergo this Herculean task of writing this book.

Tom Walters [00:06:49] Yeah. So the book really, the motivation came from all this time on social media, especially on Instagram. My posts over the years were very focused, they had a science kind of side to them looking at pain and injury science from obviously the PT background but from obviously the years of teaching kinesiology. So it’s bringing those things together. And then a lot of the posts, probably every third post, would be this carousel kind of post that would cover a condition, almost be like a mini protocol for a condition. My account didn’t start that way, it just kind of evolved over time. And somehow, I got into just, I would use an anatomy image, talk about, okay, today’s post is on patellar tendinopathy, here’s four or five exercises you could try implementing. And those turned out to be really popular. And it was so cool to see people over the years who didn’t have access to good care. I mean they might be in spots in the world where it was too expensive or they couldn’t access it. I mean just regular individuals too in the U.S. and all over that would see those posts and do the exercises and really benefit from them. But the hangup was they’re not comprehensive, it’s not a full program. And I didn’t want people to think this is all physical therapy is. Also, people just wouldn’t be able to find things. It’s hard to search on social media and find… I get so many messages, “Hey, do you have a hip impingement post? Do you have a plantar fasciitis post?” And just constantly going back through my own page-

Kelly: [00:08:15] You’re like I have 300 of those.

Tom Walters [00:08:17] Yeah, exactly. I’ve covered that about 80 times.

Juliet: [00:08:19] Yeah, you’re like I know I posted one, who knows where? Yeah, hopefully I tagged it correctly so I can find it again. Yeah.

Tom Walters [00:08:25] Exactly. So it was all of that. I would have to go find stuff and send it to people. So a lot of the motivation of the book was to take all of that writing over I guess six years now and just put it into one resource and to have in a lot of ways like Supple Leopard, have these applied things you could start implementing right away so it wasn’t just a book of information but you also had all the programs and protocols you could use to basically self manage your own issues.

Juliet: [00:08:50] So we’re going to get into talking a bit more about the book, in fact, a lot more about the book. But before we do that, I’d love to just hear a little bit about your physical therapy journey. I know that you worked as a traditional physical therapist. My understanding is it wasn’t totally for you, which I’ll let you explain why, and sort of the different path that you’ve taken with your own career as a physical therapist, and obviously, now an author. But just tell us a little bit about that professional trajectory you’ve been on.

Tom Walters [00:09:17] Yeah. I mean you’re exactly right. I came out of PT school knowing I was most interested in orthopedics and sports medicine. So I had planned on starting there. It was the closest thing to exercise science, which was my original passion before. That was my undergrad degree, was exercise science, and grew up as an athlete. So I wanted to be in that realm in orthopedics, in sports medicine. As you can imagine, all the different facets of PT was the closest one to exercise physiology, exercise science. And I was in an outpatient clinic. It really was in the first year I realized this isn’t going to work for me long term. It’s so monotonous.

Kelly: [00:09:53] You can’t hear the grin on my face.

Tom Walters [00:09:57] It’s so monotonous, you’re just dying slowly. It’s just sad. And there’s a lot of PTs who are really dissatisfied and depressed in that setting.

Kelly: [00:10:07] Really hampered by the system, that’s right.

Tom Walters [00:10:08] Big time. I mean, yeah, the system just really, I mean we talk about this in the intro of the book quite a bit. As a PT even if you love the information, love treating patients and helping them, the system is set up that you just can’t really provide quality care. I knew I wasn’t going to last in that for a long period of time. And so I also knew that I loved education. So I had this goal of I wanted to try… My first thought was I want to have a change and I need to move towards education. And so Kirsten, my wife’s a PT as well, and we went and did traveling PT. What actually happened is we went on a vacation to the Galapagos Islands and realized we could never go back to our jobs. We were like we have to quit. We went back, put in our notice. And so I only ended up being in a traditional clinic for two years. And then left, we went and did travel PT for a year. I worked for Cirque du Soleil for a little while. I was bouncing around a little bit trying to find things that had an education portion to it but were also just stimulating because the clinic was just so boring to me. I tell people all the time, I love talking about physical therapy, I don’t actually like practicing that much. You know what I mean? The first appointment of people is fun but after that I don’t want to do much anymore.

Kelly: [00:11:21] As an aside, as a young therapist, you see evaluations booked on your schedule and you’re just terrified. They take so much time. But then once you’re sort of in the system, you’re like-

Juliet: [00:11:33] All you want is evals?

Kelly: [00:11:33] Thank goodness for these evals. All I want to do is evals and hand them over. Because that’s really the interesting, hypothesis driving, getting to understand someone, the complexity is really rich in that first meeting.

Juliet: [00:11:46] And I don’t want to put words in your mouth, but my guess is some of the things that were difficult for you in the system we know about because we’ve obviously been around physical therapy for so long, but it’s short visits, not enough visits, not enough resources to do things with patients that actually make change and make a difference for them. And I think a lot of that is very similar to what many physicians complain about.

Kelly: [00:12:07] Even the expectations of the person coming, they’re just I don’t know what I’m doing here, right? I expect you to fix me very quickly. I’m not very invested in understanding the bigger project. And it puts everyone at a disadvantage.

Juliet: [00:12:21] Yeah. And I mean is that what you experienced? Were those things what killed your joy in terms of being a practitioner of physical therapy?

Tom Walters [00:12:30] No, it’s everything you guys are talking about. I mean I think the educator in me was really excited about those evals and then I would be really bored in the follow up sessions and really not want to do them. You’re seeing 15 people a day. It was too many people. You’re just rushing from one to the next. There’s all the paperwork. You’re stressed out. You don’t feel like the way the system is set up with those short visits, you don’t feel like you’re really making that big of a difference. Sometimes I feel like I need to talk to people for that whole time before I can even start doing anything.

Kelly: [00:13:00] And you do.

Tom Walters [00:13:01] You do.

Kelly: [00:13:02] That’s appropriate.

Tom Walters [00:13:02] Totally. I mean in pain and that relationship, people need to be able to tell their story. I still to this day, I still see a few patients here and there because I think it helps keep me in the game a little bit, it keeps me fresh on questions and common problems. But I see everyone for an hour now. It’s all self pay. And I think like you were talking about, Kelly, when it’s self pay, there’s a different… It’s like they come into it with the mindset of I need to take some responsibility for my own health and I’m going to do whatever they tell me I need to do because this is a sacrifice to pay cash to come to this appointment versus use my health insurance. I think in the normal health insurance model, the PT’s often checked out because they’re like, whatever, I’m just going to get patients, I don’t even have to market, people, there’s a line for eight weeks.

Juliet: [00:13:44] And there’s no connection to your performance and their outcomes as patients. You can work on someone for six weeks and make literally zero change and you’re going to get paid the same amount from the insurance company, right?

Tom Walters [00:13:55] It’s so true. The people are just going to keep coming. You just could ultrasound everyone’s back no matter what they have and you’d still get paid the same and people would still keep coming.

Kelly: [00:14:02] Genius. Whoa, let’s start a business together. The Counter Clockwise Ultrasound Bros. 

Tom Walters [00:14:08] Exactly I love it. I’m in.

Kelly: [00:14:09] You special in clockwise. I’ll specialize in counter clockwise.

Juliet: [00:14:12] I’ll just say that one thing that I’m sure resonated significantly with Kelly was—and it’s interesting how similar your journeys are, right? Kelly I think worked at a traditional physical therapy clinic for a little less than two years.

Kelly: [00:14:22] Eighteen months.

Juliet: [00:14:23] Yeah. But he made it almost as long as you did. But yeah, I mean he had all of those challenges and issues, and I think maybe chief among them might have been the paperwork. I think his skillset was talking to people and connecting and understanding their problems and doing the manual therapy and coaching. And his skillset didn’t necessarily or at least his excitement level did not include sitting down for hours and hours and hours at night after seeing 15 patients writing notes that seemed pointless.

Kelly: [00:14:54] And the note, just so everyone understands, it’s important to document your thinking, particularly if someone else is coming along or you need to know what worked and didn’t work so you can have a trail. So that’s not what we’re saying. And whether you keep SOAP notes or not, the documentation exists currently not for communication but for validation for the insurance company. And I think that’s really what people understand.

Juliet: [00:15:16] It has nothing to do with the patient care.

Kelly: [00:15:17] That’s right. And really ends up feeling like I don’t know that this is serving the patient, serving the physio, serving the process. But it is certainly serving that I’ve proven that I got another five degrees, you know what I mean? It’s really separate from the system. It’s a weird third-party validation model.

Tom Walters [00:15:35] If the note were purely just to document what you did with the patient so you know at that next session this is what I did last time, this is where we’re at-

Kelly: [00:15:43] That’s what we do with coaching, we write what we did and what happened. I mean that’s a coaching model. That should be a step for anyone.

Tom Walters [00:15:50] Yeah, that makes a lot of sense. But when it feels like you’re just doing notes to try and get reimbursed and jump over all these hurdles for the insurance company, I agree, it’s not what I had planned on doing as a physical therapist. Now you see all these memes, like this is what I thought I was doing and this is what I actually do and it’s just paperwork all day.

Kelly: [00:16:05] The drowning hand and then insurance company comes and high fives the hand.

Juliet: [00:16:12] Yeah, I mean I think that that’s professionally very common. Before I went into the health and fitness space, I was an attorney. I mean not a single law student… Every law student goes to school thinking they’re going to be at trial and in the courtroom and wearing their suit and making arguments and doing all these things that you see on TV. And then it’s the same. You become an attorney-

Kelly: [00:16:27] That’s marriage.

Juliet: [00:16:28] You’re locked in an office reviewing documents and reading… I mean it’s so similar, I think. So in a way I think those posts are helpful to at least help the young. Question for you before Kelly asks his: Do you think there’s anything any of us, how do we change this model? I mean it’s such a behemoth. I mean we have some people out there like Danny Matta and his team who are doing amazing work at PT Mastermind teaching physical therapists how to run cash-based clinics. So I think that that’s one way to do it, is to work outside the system. But man, I mean the system’s there and for many people, that’s all they can afford.

Kelly: [00:17:00] And it can be appropriate sometimes. If you’re in a hospital, that care can make total sense. It’s almost like we need a divergent system where in this very acute physical care, we’re looking at wounds and managing and looking at fevers and other things, and then there’s like oh, you need performance guidance now.

Juliet: [00:17:18] Yeah, and people need to be helped getting out of bed after surgery. I mean there’s some really critical things. And there’s also that immediate post-surgical window, the six weeks when people are acutely post-surgical is super helpful. But yeah, I mean so anyway, I don’t know, I wonder if you have any thoughts about the system writ large.

P: [00:17:37] I mean it’s such a complex beast, I don’t know. I mean I just honestly try not to look at it anymore. Just denial. I mean I think you’re right. I think most of my focus has been on just trying that cash pay, self-pay, what can I do to separate myself from this because to me, it just seems like I don’t know how you get past… I mean of course you could say, well, let’s have some evidence and research and show the insurance companies this is the way we should do things. I just don’t think you’re going to sway them. I think at the end of the day, that system is going to follow the money and be incentivized. I don’t know how you change it. To me, it feels like a very intimidating task. And I always feel like maybe the APTA and some of these organizations, hopefully they have teams that are working. I think I’ve listened to you guys talk a little bit. I think you have better insights into it than I do. I honestly left and didn’t look back.

Kelly: [00:18:35] Well, you didn’t look back, but you didn’t leave. Let me just set that up for everyone. This book is really important. And look, I may or may not have been the black sheep of my physical therapy school, for sure. Day one I was asking really difficult questions. I opened a gym. I suddenly was like, hey, I think there’s something else here. But one of the things I loved about this book and why this book is so important is that it actually gets us to skilled care. So what I feel like is that the system is set up when you go already it’s a strange issue. No one just blindly chooses a dentist they’ve never met before. You get referrals. Would you let a total stranger cut your hair, Lisa? Yes. I’m just going to show up and be like, hey, I’m at Supercuts, cut my hair. That works for a child. Does not work for an adult. And that is our current model. And so the issue is that there’s so much gap between understanding someone’s experience, understanding their history, understanding their motivation, and, hey, I’ve got three visits to fix this problem because that’s all the insurance is going to pay for, you’re incentivized, et cetera. But what this book does is it gets people the first shot that if you went to a traditional physical therapist, 100 percent of this book are the photocopies, hopefully not the photocopies, they’re the exercises you would get, plus the explanation you would get.

Juliet: [00:19:59] What are you talking about? They’re dittos.

Kelly: [00:20:00] Mimeographs. You could sniff them. But this is what you would be getting before you even have your first appointment. And I think that’s what’s really remarkable about this because if I come in and I’m like, hey, my knee’s been hurting and it’s obviously been hurting so bad that I can no longer occupy my role in society, I can’t do my job, it’s interrupting my relationship and my family, now I’m going to go see my doctor, now I’m going to get a referral, there was a lot of steps in there and a lot of time that gets missed. This isn’t like, hey, my knee hurts and I run and I go see Tom that afternoon. That’s the model we’d love to have but that’s not how the model works. And what you’ve done here, just for everyone, wow, this is so important, is that this is a simple, at home, subversive blueprint, of sound thinking, movement theory, and exercises to solve very common musculoskeletal problems. And if you do these things, chances are you’re going to feel better because these things work very well, they’re well validated, well clinically reasoned. And then if you don’t get success, you go see a pro. And what I feel like is that your approach to this has really given you enough advantage to say, hey, look, let’s go ahead and take up all this low slack out of the system which should never have been there in the first place, which is what drove me crazy. I’m like you’re actually not delivering skilled care, you’re not having doctoral level conversations, you’re not even able to tap into all of the advanced clinical reasoning that we could potentially deliver to someone. I’m just giving you some low-level movements that you should know how to do because we have the internet. So let me say that you never left the profession, in fact, you’ve skipped us into actually being able to progress what we want to do.

Tom Walters [00:21:43] Well, thank you for saying that. I agree. I think when you look at the evidence and the research around musculoskeletal conditions, the things that have the strongest evidence are education and exercise/movement. And so I think I use a lot of manual therapy. My residency was in manual therapy after PT school and I still really value that in the beginning and working with patients for lots of different conditions. But I think with something like a book, you can learn about pain injury and you can learn the movements that tend to help that condition. And I think those things once upon a time when I was new as a PT, I would have thought each person really needs these highly tailored specific exercises. And I think the longer I’m in things, I realize… I saw this thing the other day, you know how I always say special tests aren’t that special? It’s like exercises aren’t that special either. I mean I think sometimes we just get people moving and it’s not threatening their pain system, you’re just moving in the region where their symptoms are and you give it some time, most people get better. And so I think something like a book, you can learn, well, what are some soft tissue mobilizations I can use to reduce pain, what are some stretches and mobility exercises I can use to start some low load movements to start introducing some challenges to the system. And then I can end with resistance training that helps build capacity in that area. And that’s all stuff I can look at pictures and video and learn how to do. And like you said, if I don’t improve or if I have some sort of red flag symptom that seems more serious, well, of course, it’s not meant to tell you not to go to PT, but now you at least have some information so you’re going into that situation better prepared.

Kelly: [00:23:24] And everyone, if you show up to your physio appointment and you’re like, “Here’s what I’ve been doing. I’ve read this thing on pain science, I understand, I’ve been working on my sleep and nutrition. Here are some mobilizations. I’ve been working on desensitizing and restoring motion. What do you think the problem is?” Their head is going to explode. You need to be a much better patient. And that’s what you’re actually empowering people to do, is be better patients. And what’s the old maxim? If you want good outcomes, choose great patients. I mean I think that’s a surgery.

Tom Walters [00:23:53] Sounds right.

Juliet: [00:23:54] This may be premature, but I’m going to go ahead and ask you the billion dollar question because if you have an answer to this, this is how we’re all going to pay our mortgages for the rest of our lives.

Kelly: [00:24:04] Oh dude, what is this? How come you didn’t tell me this question?

Tom Walters: [00:24:05] I’m getting intimidated.

Juliet: [00:24:06] We’ve been trying to answer this question since we began. How do you get people to care to do these things before they get to the point where they do need to wave the flag and actually go see a physician or PT or chiropractor and spend their money? Because I think for us that’s always the billion dollar question. We’ve been working for years trying to tell people,  hey, there’s a lot you can do on your living room floor, there’s resources like your book and our books and many other people out there that are doing good work in this way that are trying to empower people to make that connection that, man, you don’t have to live with nagging pain, you don’t have to wait until your calf’s injured. There’s a lot you can be doing now. And things like your range of motion-

Kelly: [00:24:49] Besides making this book naked and filling it with bourbon.

Juliet: [00:24:51] So it’s the billion dollar question. How do you get people to care? And this is a struggle for us and I assume for you. But what’s your take on that?

Tom Walters [00:25:00] Yeah, it is such a tricky thing. I mean I’m not immune to it either. I’m sure I will have something that’s bothering me and I’ll let it go for a long time. I mean I’m a freaking PT and I’m doing that. So I will eventually implement something when it’s been around long enough and becomes frustrating enough. I’ll finally modify what’s aggravating it. I think when people come in with pain and injuries, obviously by the time they come and seek care, they’re already pretty motivated. So it’s just the education of how and why and that helps people. Because as we know, adherence isn’t good even when people do come to PT and seek care. I think I’m in a little bit more of a unique model where as soon as people are in that self pay model, like I said, I think they want to take more… They’re already in the mindset of taking extra responsibility to their care. So I haven’t found adherence to be as much of an issue anymore. I think in those insurance models, that system that is, because the patient doesn’t care much, the PT doesn’t care much, nobody’s really taking responsibility for that situation. In those settings, even with good education, it’s still challenging. And those are people who have already started to seek care. So they’re already somewhat motivated. The person who’s at home who hasn’t started seeking care, I don’t know, outside of scaring them, I don’t know. Looking at Peter Attia’s stuff recently, I think sometimes we’ve all talked about this. The test from standing to the floor and back up, right? I think sometimes linking things to mortality and potential detriments in functional independence. It’s like if you lose a bunch of quad strength, well, this could affect you in these negative ways from a functional standpoint, longevity overall. I wonder sometimes if those types of pieces of information would help people versus just the… I think sometimes the normal PT educational information isn’t serious enough for people to get motivated. It’s like, ugh, well, I’ve got this nagging pain and maybe it could interfere with these couple of functional tasks, but it’s not strong enough to motivate them to make that change until it gets severe enough that it interferes with the things they really want to do. But it’s a good question. I don’t know that I have the perfect answer either besides maybe relating it to more serious things in life. I don’t know.

Kelly: [00:27:15] Dentists make the case that if you take better care of your teeth, you came in for regular checkups, we could prevent a whole lot of problems. I think people started to get that message. I think that was marketing.

Juliet: [00:27:24] Yeah. But do you think there’s any preventative care modeling for physical therapists? What if everybody went and saw a physical therapist twice a year as a matter of course?

Kelly: [00:27:32] It’d be a waste of time.

Juliet: [00:27:32] But what if they did some movement tests?

Kelly: [00:27:34] Yeah, sure.

Juliet: [00:27:35] And they also said, okay, you can’t get up off the ground so you need to do these things?

Kelly: [00:27:38] We just interviewed Dan Buettner, who popularized and really made this concept of Blue Zone sort of international. And one of the things that he spent a lot of his time doing, as he just reported, is he’s actually working with municipalities about reshaping the environment. And I suspect at one level, one of the problems the three of us are talking about is that our lives don’t actually require native range of motion, they don’t require physicality, and our bodies are so tolerant. You can ride this thing hard, put it away wet, eat little chocolates and donuts, have a cigarette, win a world championship. It’s an awesome machine. And then the world doesn’t require you to do anything. If you had to walk all the time-

Juliet: [00:28:23] You’d be good at walking.

Kelly: [00:28:23] Or if your environment was set up in a way that you couldn’t engage in your environment, suddenly you’d be like I’d better get on that. I can’t go up and down these stairs. But otherwise, I think the issue is that until the environment changes or people start realizing that I’m aging and I can’t do what I want to do when I’m 60. It’s going to take a while. I feel like the glacial pace is the breakneck pace. But I think you both bring up a really good point.

Tom Walters [00:28:51] Yeah, I know, I agree. I think like you said with the dentists, relating it to long-term detriments in health maybe. But it’s hard. It’s hard in our world. I think their research it’s easier to link it to some… Like you said, the musculoskeletal system is so resilient and adaptable, some people could avoid certain things with their system training wise or mobility work, and they end up being fine. And then other people, maybe they end up being more likely to develop certain issues. It’s hard to predict with certainty what’s going to happen. But I think even the book, we went back and forth on calling it Rehab Science because you don’t want people to get in this mindset of, oh, I only use this when I have pain or a problem because we know all those exercises, resistance training and mobility exercises, I’m using those all the time in my general workouts. They’re not only reserved for having pain or an injury. They help keep your musculoskeletal system health and I think the thing that I feel like especially with resistance training, I think sometimes it’s easier, I think more and more people are getting interested in strength training or resistance training, I think people can more easily visualize if I pick heavy things up and get stronger and my muscles and tendons and all these tissues become thicker and stronger, that is going to make these tissues more resilient and I’m less likely to be injured. I feel like people can see that line of logic. And that one’s been a little easier for me to kind of get people behind these rehab type interventions. But like you said too, Kelly, I’m sure a lot of us, I worry about what’s going to happen to us as humans because-

Kelly: [00:30:25] Oh, it’s WALL-E. It’s already happening. 

Tom Walters [00:30:27] It’s bad. We’re all so comfortable and life doesn’t demand much from us from a physical standpoint. I don’t know if you guys ever saw the movie, was it Idiocracy? The one where everyone is basically just becomes dumb and is completely sedentary. There’s one guy who has average intelligence but he’s viewed as a genius. I think I’m worried that’s where we’re heading. Yeah, I don’t know. I don’t know how you change it. You guys are talking a lot about this in the book. Things like getting enough steps per day and making sure you… And you see this everywhere now. It’s not often good enough to have your hour workout and then sit all day. You’ve got to be moving more than that.

Juliet: [00:31:09] Hey Ready State listeners, if you like what you’re hearing, please subscribe and leave a review on iTunes to help others find our show. 

Juliet: [00:31:15] This episode of The Ready State Podcast is brought to you by Momentous.

Kelly: [00:31:19] Look, I’ve got to cut in and point out something has changed with you.

Juliet: [00:31:24] Yeah, and the thing that’s changed is I’ve started drinking a scoop of Momentous Vital Aminos before I work out in the morning.

Kelly: [00:31:32] Tell me more because I have been on the vital aminos, essential aminos tip for a second. Tell me why you decided to come over to the cool kids’ side.

Juliet: [00:31:40] So you know when you’re a kid and your parents tell you, like you get in trouble with your parents and you don’t really listen to them? They kind of are like womp, womp, womp.

Kelly: [00:31:47] No.

Juliet: [00:31:47] Then when your friend’s dad gets mad at you, you remember that forever. Well, it’s kind of a similar situation here in that you for years have been suggesting maybe I should eat more than a cappuccino before I work out in the morning, but it wasn’t until my dear friend Kyla of Nutritional Revolution suggested that I might get more out of my workouts-

Kelly: [00:32:05] Expert is someone who lives a mile away. This is crap.

Juliet: [00:32:05] I might get more out of my workouts. And so I have been drinking a scoop of Vital Aminos before I work out in the morning along with my cappuccino. And I will say I feel good and I feel like my workouts are better.

Kelly: [00:32:18] Yeah, and the reason we’re trying to do that is making sure that we’re not accidentally spending muscle tissue to fuel, to start to repair, by having those essential aminos, you’re not having a lot. It’s easy. It’s not like you’re going out on a full stomach. But you’re covered the essential basics of making sure that you have all of those circulating aminos so that when you’re calling for them you’re not accidentally tearing down your muscle to exercise.

Juliet: [00:32:42] And one side benefit is that I used to just drink a cappuccino and have zero water when I worked out, so just having this one scoop of Vital Aminos and some water has also been great from a hydration standpoint.

Kelly: [00:32:52] But I don’t like to have a big meal in my stomach before I go train. This way at least I know I’m covered until I can get to that protein, carb afterwards.

Juliet: [00:33:01] Yeah and I think it really is making a big difference in how I’m feeling when I’m training.

Kelly: [00:33:04] You’re shredded and it’s sort of annoying. And you’re getting more shredded and more annoying.

Juliet: [00:33:09] Well, maybe it’s the Vital Aminos.

Kelly: [00:33:11] If you want to find out about Juliet’s amazing transformation of behavior, go to livemomentous.com/trs and use code TRS for 20 percent off your first purchase.

Juliet: [00:33:24] This episode of The Ready State Podcast is brought to you by YETI.

Kelly: [00:33:28] I was just traveling, teaching at a place called the FBI, and there was-

Juliet: [00:33:33] In a place called Quantico.

Kelly: [00:33:34] Quantico. And the physical therapist there had a Yonder. And I was like, oh, I know that bottle. Tell me why you switched from your-

Juliet: [00:33:44] Insulated bottle.

Kelly: [00:33:45] Insulated bomb proof bottle to a Yonder. And what she said was I really like being able to see how much water I’ve consumed in the day.

Juliet: [00:33:53] Who knew?

Kelly: [00:33:54] Who knew? And I tell you, sometimes you’re like, I don’t know. But I do think there’s a behavior piece there for people, if you’re struggling to drink water, being able to measure as you go, I think that’s really relevant.

Juliet: [00:34:05] Yeah, and the other thing I want to point out is they also have created this really cool new tether cap, which is my go-to cap on all of my Yonder bottles. And you could even clip it onto stuff with a carabiner if you want.

Kelly: [00:34:17] I’m sure people are literally like look at the tether cap on that girl.

Juliet: [00:34:21] It’s a really awesome new way to enjoy your Yonder Bottle.

Kelly: [00:34:24] And more importantly, the most leak proof of all time ever. Because when I slip this thing next to my computer, I think to myself, no problem.

Juliet: [00:34:31] No problem.

Kelly: [00:34:31] I’ll gamble this. That Yonder Bottle is the shiz. It’s what I travel with. And it was really fun to see it in the wild with someone who’s saying this is the reason, and it was one of the reasons we loved, when they were putting it out, we’re like we can see how much water we’re drinking.

Juliet: [00:34:44] True fact. 

Kelly: [00:34:45] Look, if you want to know more, go to thereadystate.com/yeti.

Kelly: [00:34:50] I just saw the definitive research that one hour work out intensely, eight hours of sitting, cancels it out. Because we got so much pushback from people being like it doesn’t matter, I’m elite, I can lay on the couch. And Juliet and I were like I don’t think so. That’s not how your physiology’s supposed to work.

Juliet: [00:35:04] I just want to echo what you said about the strength training, resistance training though. I do think, you know sometimes I can be really critical about the firehose of internet information and people are confused and that was one of the motivations in our case of writing Built to Move, was just –

Kelly: [00:35:20] Create vital signs.

Juliet: [00:35:20] Just create some simple vital signs and give people a resource that was easy and accessible. But I do think to give kudos to our industry, if I include physical therapy and health fitness generally, is I do think we’ve done a good job of changing people’s perception, especially women, of strength training and resistance training.

Kelly: [00:35:40] Yeah, that’s true.

Juliet: [00:35:42] And I just was on this industry panel earlier today, and the data’s actually supporting that, that more and more women are reporting that they want to and are doing resistance training and are signing up and paying for gyms in order to be able to do that. So I think that’s a really positive change. I just wanted to echo what you said. I do think that piece is starting to click through for people, that they are realizing if they want to be able to do the things that they want to do when they get older that resistance and strength training is going to need to be part of that picture. So kudos to the larger community for that. I think that’s really changing.

Tom Walters [00:36:16] It’s this whole continuum of movement. And I think ultimately if you get people motivated to exercise, I mean that’s a big part of physical therapy. It’s just physical therapy ends up being a little bit more specific therapy. I mean specific therapy, exercise, these other interventions. But so many people, I’m just trying to encourage them just to move more in general and just to exercise. I think when you see things like that where people are getting more excited about resistance training or different types of exercise, I mean I feel like there’s so much on the internet right now about health span and longevity and all this stuff. Dr. T has done an awesome job of promoting exercise. And to me, if something promotes exercise, that ultimately promotes what we’re doing in physical therapy I think in a lot of ways. So to me, that’s a positive and I think maybe sometimes it’s just that, maybe it’s tackling and targeting exercise versus these kind of what might come off as very specific rehab kind of physical therapy. It’s tricky though.

Kelly: [00:37:19] Let me ask you this: In writing this book and putting it together, what surprised you or what did you come about in your understanding?

Tom Walters [00:37:27] I think as I went through it, there are aspects of just the writing a book process that were surprising. I mean a lot on that side of things that I didn’t really anticipate. And Glen kept trying to warn me but I just was like, oh sure, I’ve got it, no big deal. But on the content side, the book, I think probably the most interesting part to me was chapter 13, that CAMs chapter, the complementary and alternative medicine section. Because I went back through all this research on all these different interventions that people ask about: acupuncture, cupping, stem cell, PRP. It was really interesting. Actually, for like a month, I just would wake up and go on PubMed and go through each one and try to find the most relevant current research related to these interventions. It didn’t really change my mindset of how I look at those things. To me, I always tell people as long as you are incorporating or making the exercise and movement, that stuff, your priority, if you want to try adding some of these things on top, I’m okay with that. If you want to add acupuncture to these types of interventions or add cupping or add something like that to these things, then that’s okay. So it didn’t really change my mindset there. But it was interesting to go back. That was probably where I had the most surprises going back through that research and just refreshing my knowledge on when did these things fit in. That was probably the biggest thing in terms of content. The rest of it, I mean writing the book was just really a good opportunity overall to go through the research again because it’s easy when you’re busy all the time. There’s so much research. Just sit down and have a dedicated window where you just look at all the current studies. That doesn’t happen for me very often.

Kelly: [00:39:05] No. In fact, I rely on my friends: flexibility research, Brent Brookbush, Biolayne, people who are really deep in there, I really heavily consume their information because they’re experts and they love to do this as part of their jobs so they do a lot of it for me, which I really appreciate. Let me ask you this: What has been or the reception of physical therapists, who are all very enlightened and very open and love to support each other. I only saw this book and cheered and I think I told you right away, I DM’d you and I was like thank you, I never want to write this book, I don’t want to touch this book, I’m so glad you did it. Did you have a similar experience as mine with other physios?

Tom Walters [00:39:50] I thought I would be attacked more, honestly. And I have had some of that. But I think because the book was so similar to what I was already doing online, all those attacks had already happened.

Kelly: [00:40:02] The skin was already thick.

Tom Walters [00:40:05] Because I do get a lot of, “You’re not evaluating the patient and you’re putting these exercises out there and it’s not specific to anyone, it’s not individualized.”

Kelly: [00:40:13] Clamshells can explode a pelvis.

Tom Walters [00:40:14] Exactly.

Kelly: [00:40:17] Clamshells by the way are my current thing to just rag on as an allegory for… It’s great. Clamshells are great. I’m just saying you’re so worried that people are so fragile they can’t do a clamshell but they’re getting out of their car. I’m like, hello, the clamshell.

Tom Walters [00:40:32] No, it’s true. Yeah. Most of these things are pretty low load. It’s like when you consider what someone else is doing in life, I think your risk of being injured in these, I think it’s pretty dang low. Yeah, I think sometimes the PTs, they aren’t saying as much. Most of the comments are from people who have the issues and are getting the book. So that’s been positive. I have had a few people who are like shouldn’t the person go see a PT and get specific program tailored to their issue?

Kelly: [00:41:02] Let me say that again. Nope. You should take a crack at it yourself in your own home before you activate the medical system.

Tom Walters [00:41:08] I agree. I mean this has really been a transition for me in probably the last six years because probably prior to being on social media, I would’ve said, oh yeah, you really need to go see someone and have a custom program created for your issues and your symptoms. But now as I’ve been on here longer, I really have seen how not special exercise is to some degree. Like I say, therapy can be really powerful. And if you’ve got a back pain issue, you can get some of these specific therapy exercises for the back region in general, it really can help people. But I think what I’ve seen on social media is you don’t always have to have that evaluation, if you rule out the serious stuff.

Kelly: [00:41:46] Yeah, the red flags. And you do a great job teaching people here is what we think immediately, it’s not even physical therapist, it’s physician related. You need to go to the ER.

Tom Walters [00:41:57] Exactly. Once you rule out those red flag medical conditions, then yeah, like you said, take a swing at it. Most things with time and movements that get you in the right area and challenge those tissues are going to get you better. There’s all this research on regression to the mean. People are just getting better over time with most musculoskeletal conditions without intervention. And the practitioner will usually take credit for it, this person’s getting better, and really it might just be time, but oh, it’s this intervention I’m doing is making it better. Who knows?

Kelly: [00:42:23] Jules laughed at me because-

Juliet: [00:42:25] I was laughing because last year for the first time in my life I went through this phase of having low back pain. And I’ve had some weird health issues and stuff but by and large, I haven’t really had that many musculoskeletal-

Kelly: [00:42:36] Juliet, everyone, is a musculoskeletal unicorn. She doesn’t feel pain, she can go hard, she can throw herself at walls, she’s a three-time world champion, she can deadlift every single day. And she’s just like, yeah, casual stuff.

Juliet: [00:42:48] But I will say I got this low back pain thing and it was persistent. And I started to get into that psychological spiral that so many people with any pain but I think probably particularly low back pain get into of like, oh my God, this is my future, this is my life, this is how I’m going to have to live, I’m going to never exercise-

Kelly: [00:43:03] Juillet had a low back ache from doing nothing except squatting, running, deadlifting, biking.

Juliet: [00:43:09] But Kelly said to me, this is important, I’d like to give you a compliment, baby. 

Kelly: [00:43:12] Thanks, babe.

Juliet: [00:43:14] He said most low back pain resolves on its on in six to eight weeks. And he just said that. And what was interesting was literally seven weeks to the day… I mean of course I did a bunch of stuff.

Kelly: [00:43:25] She was super stressed also.

Juliet: [00:43:27] I did some stuff associated with it. But literally at the seven week and one day mark to the day, I woke up and I’m like, oh, I’m fine. And so I’m just saying that I really relate to what you’re saying there. We can throw a lot of things at pain and I would like to talk with you actually more about this broader subject of pain, but we can throw a lot of things at it. But yeah, I mean human beings are pretty amazing and pretty hearty and able to heal themselves.

Kelly: [00:43:51] One of the shifts I think that’s been really great for everyone is we’ve been having a lot more nuanced conversations of pain and helping people. And we can talk about explain pain and the great work, Body Keeps the Score, all of the pain educators. My physio school talked a lot about pain science and everyone had come out of the fulsome Folsom course and really understood and talked differently about pain. One of the things that I really appreciate is that you really do a great job and I think have an entire section just helping people understand and reframe that. And I think the price of admission of that book is if everyone just read that chapter, we could expand this conversation of, hey, it’s going to be okay, this is a signal, you probably don’t have rabies. I just want to give you kudos for that.

Tom Walters [00:44:46] Well, thank you. Yeah.

Juliet: [00:44:48] Maybe you could just give us sort of a Reader’s Digest version of what your approach to rethinking pain is and I don’t want to use the other book title. But what is your thinking and your approach because I agree with Kelly, I think we’ve been going around saying pain is a request for change and trying in our own way to help people reframe what pain means. But would love to hear what your thinking and approach is.

Tom Walters [00:45:07] Yeah. No, I like what you guys have been saying. I think that request for a change is a good way to look at it. I think when somebody comes in, whether I’ve had pain or someone comes in here, into the pain and has pain, everybody varies. Your approach to pain education is totally different depending on the person and where they’re at and how they feel about pain. But you do get people who are worried and anxious about it and wondering what it’s going to mean long term for them. Are they going to be able to keep doing the things they like to do? It affects their mental health in a lot of cases. You see so many people that when they have pain they can’t exercise. That ends up causing some depression because they’re really bummed out not getting to do these things they like to do. And it’s interesting now, there is some newer research showing that pain education, there’s some studies showing that it hasn’t been that effective. So I think it really is person to person and it’s probably kind of hard to study. You get some people who come in and they have pain and they’re like I’ll just do whatever, I want to get over this. And it’s not stressing them out that much. And then you get some people who are really stressed out about, they’re hypervigilant, they can’t stop focusing on it. And I think those types of people, what I have found is that request change concept of trying to help people reframe this as a threat. Pain is related to threat and it’s ultimately this survival mechanism to keep you alive, basically. But sometimes that pain can be accurate, sometimes it can be inaccurate. And just basically trying to help people understand what is pain, how does that pain system work from a basic physiological level. But I think probably sometimes the thing I think is the most helpful with people is what we cover in chapter four, all the factors that influence pain because I think-

Kelly: [00:46:48] Yeah. It’s a great diagram.

Tom Walters [00:46:49] You know what I mean? I think a lot of people don’t fully appreciate how many things can influence their nervous system. They think if I have physical pain, if I have pain in my physical body, it’s just related to my posture, anatomy, biomechanics, all these things we used to talk about. When I came out of PT school, my program was definitely very heavy in posture, biomechanics. And those things are still really important. A lot of people’s pain is still very much related to their tissues and forces and all that stuff. But I think appreciating some of these other things like sleep and what’s your nutrition look like and how stressed are you, what kind of thoughts and beliefs do you have about pain, has somebody told you that this pain means such and such a thing that really freaks you out or it’s never going to go away or your dad had a bad back so that means you’re going to have a bad back. Just these thoughts and beliefs. Or I saw another practitioner and they told me all my pain is because my legs are unequal in length or my pelvis is off. Just people carry a lot of harmful beliefs around. And so those kind of beliefs and narratives and things were a big part of why I even got into pain science in the beginning, having patients come in and me feeling frustrated for what they had been told and how that was affecting them in a harmful ways.

Kelly: [00:48:04] Wait, are you saying that all of those factors can’t be addressed in a 30-minute visit?

Tom Walters [00:48:10] Yeah, exactly. Easy. No problem.

Kelly: [00:48:12] Nailed it. There’s a type one error in that whole system. I mean that’s really-

Juliet: [00:48:17] You just put your hands together-

Kelly: [00:48:18] That’s right.

Juliet: [00:48:18] Magic happens.

Kelly: [00:48:19] And they sleep and then they eat better and you un mess up their work schedules and then you spend 30 years talking about their family. I mean three seconds.

Tom Walters [00:48:28] Well, that’s the first five chapters of the book and then it goes into injury because injury and pain of course can be really similar and can share a lot of things. But they can be different. We know people who have a lot of injuries who have no pain. And have pain, you can’t identify an injury. I think most people are just excited about getting into the programs and having something they can do for whatever issue they have. But I keep hoping that people once they’re in there will say, huh, I wonder why this is working or why I’m doing this and then they’ll go back to the earlier chapters. Because I know for me and I’m sure you guys feel this way, having some education about pain and injury I think is protective in a way. It’s amazing to me that we don’t teach more kinesiology. My kids are 12 and 9 and we don’t teach kinesiology or much about anatomy or the body just generally in school.

Kelly: [00:49:14] It’s true.

Tom Walters [00:49:15] It’s this thing you’re carrying with you for your whole life and people understand hardly anything about it. So whenever I have a small symptom, my shoulder hurts, I did this thing yesterday, I probably just irritated whatever, I irritated my rotator cuff a little bit or something. I don’t worry about it. I’ve got a plan of attack for some principals to help guide me through managing that issue. And I think my hope is that the information will give people that same foundation with whatever comes up in life with whatever pain or injury I’ve got, I’ve got this mindset, this education that changed my mindset so I know how to work through it. 

Kelly: [00:49:50] And not panic. I just was talking with our friend Michael Easter and his book The Comfort Crisis is this really important idea, is that we actually haven’t been uncomfortable or suffered physically. I think a lot of people suffer emotionally but this physical threat of suffering, which is what pain really is, we don’t have a place to put it or a way to reference it or be in a relationship around it. I think people are understanding… I just saw some quote that was just like, “A few minutes of breathing and holding your breath deeply like Wim Hof produces more  norepinephrine that jumping off a bridge.” And so if you can elicit some of these fear responses, pain responses, I get hot, I get cold, I’m on the bike suffering, I think then when your knee hurts a little bit, you’re like, well, that’s not bad, it’s just my knee hurts a little bit. But if you have none of that as a reference and then something shows up, it really feels catastrophic because you’re blindsided by this new event and you have changed nothing in your life. What has happened? I’m doing the same terrible things that I’ve always done but now my knee hurts.

Tom Walters [00:50:57] Yeah, I totally agree. We talk about graded exposure when people have pain. You’re exposing them to something threatening in graded doses. We should be doing that in life when we’re not in pain. I mean I think those things are protective just like you talked about. Thermal stresses like sauna and ice bath. I think that’s probably one of the major influences of exercise is you are exposing your system to a stress. I mean I grew up doing martial arts. I think back, when I did judo in high school and we were throwing each other all the time, that really helped probably now I think back on it, desensitize my system. I always think I used to joke about this, we should take people’s chronic pain and put them in judo and we’ll slowly-

Kelly: [00:51:34] Oh, you think you’re in pain? I’ll give you something to be in pain about.

Tom Walters [00:51:36] We’ll have a judo pain program. 

Kelly: [00:51:38] Let me just double click on that because that is so important, what you’re saying.

Juliet: [00:51:42] I have a judo story.

Kelly: [00:51:43] I will. But these early exposures that you’re talking about I think are crucial. And what you really start to get into is what is the education around pain as an experience and where do we start that? I think that’s a really great combo.

Juliet: [00:51:56] So I have to tell you a quick story. I think it was when Kelly was actually in physical therapy school.

Kelly: [00:52:02] It was before that with judo.

Juliet: [00:52:03] Yeah. We became friends with some guys in the San Francisco Police Department and they were playing judo and so Kelly started going with them.

Kelly: [00:52:09] They may have been Olympians. 

Juliet: [00:52:11] I mean Kelly’s a big dude, but these were some big, strong dudes.

Tom Walters [00:52:14] Kelly probably held his own.

Juliet: [00:52:16] Kelly had a history of doing a little bit of martial arts as a kid and stuff. So he wasn’t a total new. But there was this morning he woke up and where he had been laying on the bed there were these 27 blood marks from all these injuries.

Kelly: [00:52:30] Who doesn’t stick to sheets?

Juliet: [00:52:31] His bed was just covered in all these blood marks. And I was just like for frame of reference, you’re going into a profession that really requires you to use your body. I’m a lawyer-

Kelly: [00:52:43] It’s the gentle way, J.

Juliet: [00:52:44] I’m a lawyer, I don’t need my body. You need your brain but not your body to be a lawyer. But I think Kelly was like, okay, I don’t think this is going to work out for me, playing judo and actually… So he had his moment.

Kelly: [00:52:54] But I do think we had another friend who recently, he was teaching some sambo at a local martial arts studio. Shoutout Lavin. And he’s like, come over. And I got thrown to the ground 50 times that night and literally I was crippled. I was in my 40s. And I was like dude, I don’t know if I can do this a lot. And I realized just how many times I, like you say, had been thrown to the ground in high school playing football or in the tackle we played in the grass with friends and just the exposure of wow, that’s really uncomfortable, I’m really stiff, it’s okay. And I even think about one of the first conversations I had in actual American football was our coach said, “Okay, you’re going to be hurting between now and the end of the season. Everything will hurt every single day. Let’s make an agreement that we’re all hurting. That’s okay and part of this game. And if you think you’re inured, let’s have a conversation.” But he set everyone’s expectations of oh yeah, you’re going to be tackled by flying around people wearing plastic helmets for the next 10 weeks. You should probably get used to it. And I think if we said that to people, “By the way, life is pain, highness.” Maybe that’s what The Princess Bride was trying to do. 

Tom Walters [00:54:02] Yeah. No, that expectation is huge. Setting that expectation, I agree, when you start talking to people, a lot of people have some pain thing that’s bothering them. We’re just not all talking about it. And if you actually took some data on that and shared it with people, it’d probably help set up their expectations a little bit. I was thinking about this pain sensitivity too. We have research looking at kids who have been in the NICU, kids who are exposed to needle pricks from a young age end up demonstrating more hypersensitivity as they age as compared to kids who weren’t exposed to those things. I think it can go that way and it can go the other way of exposing people at a young age to gradually increasing levels of stress to help desensitize their system. It’s one of those things, it seems like again, like what we were talking about earlier, it only comes up when the person has pain or an injury. But we should be thinking about exposing our system to stress in appropriate doses to make it more resilient. But getting people motivated to think about that… It’s kind of cool that the health information seems to be blowing up right now. People getting into sauna and ice baths and things like that. And people are doing that for a lot of different reasons. But the cool thing to me is it’s exposing them to these stresses and probably making them more resilient for things in this injury, pain, PT realm.

Kelly: [00:55:20] I think we’re going to see haves and have nots, people who are in communities that start to value this, walking more, walking dogs versus don’t. I think we’re going to see a dichotomy as… Maybe Ozempic will come in and save us all. But chances are, we really are at least beginning to see that the functional unit of change is in the household. Just to circle back around, Juliet and I really feel like we do work at these large-scale institutions, university levels, we work at corporations, we work with branches of the government. It’s very difficult to make systematic changes at the top and to fundamentally alter, and I think this is something we talked in the beginning how PT attached itself to this insurance model, this medical model, so it could become legitimate. It created a beast and it’s hard to back out of that. It’s hard to change these bureaucracies and these systems at that level. And I challenge anyone, come on in, go ahead. You can reach out to Justin Moore, you can reach out to the head of the APTA and be like, okay, I have the ultimate plan. But no one has. But simultaneously, what you’ve done has gone right into people’s homes and said, hey, here’s where we can really start to make this fundamental change with you and a family member, you and a household member, you can get some relief and start to manage this without having to activate that EMS system, which I just can’t give you kudos enough for. The household is the functioning unit of change.

Tom Walters [00:56:48] Well, thank you. That’s the ultimate goal, just empower people because at the end of the day, I think you can make this stuff really complicated and complex. But at the end of the day, if you just have some education and you start moving and you do it in kind of graded doses, your system improves. The system is amazingly adaptable and resilient. I just think if you get online, you can start to get yourself spun up because it can seem so complicated. I’ve got knee pain and all these people are saying all these different things, I don’t know what I should do. Really, you can break it down and it can be pretty simple. It doesn’t have to be that complicated. If you can get it moving, find some ways to reduce sensitivity, work on slowly improving mobility and then make it more resilient with resistance training, I think it doesn’t have to be that complicated and it’s something you can grab a book and start doing. And like I said before, it’s not to tell people never go to PT but definitely start on your own because most of these things get better with these simple things. And if it doesn’t get better, then go see someone, by all means. Or if you’ve had a surgery… We didn’t cover any post-surgical stuff; I think there’s a case to be made for a lot of those things. If you’ve had an ACL reconstruction, it’s probably good to have someone work with your surgeon and create a program that fits with your impairments and your healing process. But there’s so much you can do just with learning some movements for that area of your body.

Juliet: [00:58:12] So my question to you is, since we’re nearing the end, is what are you looking forward to, what are you excited about? And I want to ask that question with an appreciation that you just released a book, you’re going around the world talking about the book, you probably want to go into a dark room in the fetal position and rest. 

Kelly: [00:58:30] Nope. Don’t get to do that.

Juliet: [00:58:32] If my own experience is any example. But what are you looking forward to, what’s next, who are you talking to about this book? What’s looking forward for you, Tom?

Tom Walters [00:58:40] Yeah. No, I’m honestly loving this part. The getting towards the end of the writing part and the editing, that was not so fun. But I think being an educator at my roots, I love doing the podcasts. I could nerd out on this stuff and talk about it for hours. This part is so fun to me. And I’m looking forward, we’re going to basically after this book, take each of the body region chapters and make them their own book. So you guys have probably seen, you know there’s the Treat Your Back, Treat Your Shoulders. So it’ll be like that. But they’ll be more comprehensive books, I think updated beyond where those things were. But kind of like a rehab your back, rehab your neck. So I’m excited to create those because there’s still people who look at this book and they’re like it’s too expensive, it’s too big. It’s intimidating to them to have a textbook size book. To me, it’s like $46, it doesn’t seem that bad when I think about what I paid for textbooks when I was going to college, to have a resource you can access for your whole body. But I get it, some people want just, I just want something for my low back. So I think that’ll be the thing. And then eventually down the road I’d like to create courses where there’s video content and maybe have a Rehab Science certification or something like that that teaches therapeutic exercise to individuals of all rehab and fitness backgrounds. Because for six years I taught for a group named Redcord. I don’t know if you guys ever knew Redcord. It’s a suspension system from Norway. But you can test people. You test different positions. It’s all closed chain and then you prescribe exercise based on that. And the PTs always thought it was cool but because they had already had a good foundation and assessment access prescription, it wasn’t as novel to them as it was to the fitness professionals. Whenever I go teach Pilates groups or yoga instructors, they wanted to stay for hours afterwards because they always had all these exercise variations to use with people but they didn’t really know when to prescribe them. And so I think there’s a big opportunity out there to help some of the fitness professionals better manage people who have pain and injuries because I mean if we’re being honest-

Kelly: [01:00:43] They’re the point of contact.

Tom Walters [01:00:44] They’re the point of contact. There’s so many people seeing their fitness professional first with pain or injury. I remember early on, the PT I worked for in the beginning, it was all about protect your intellectual property and don’t share it with anyone. And that was the mindset that I was kind of raised in initially in the clinic. And I just have realized, luckily, I have a bunch of friends in the strength and conditioning world, so I had both sides influencing, but I think at the end of the day, the goal is to help people. And I think having courses that help get fitness professionals up to a level where they feel more confident helping people who have pain and injuries is the next step. I know there’s groups out there doing this but I feel fortunate to have this platform, to have Rehab Science where it’s at and to be able to just… That’s something I’m excited about, is that next step of creating more of this educational material for the practitioners. Because the book was kind of for both but really for the regular person who just wanted a resource to self manage things.

Kelly: [01:01:36] Are you kidding? This book, every physio student on the planet, hear me now, this is your cheat code. Memorize this, you’ll be able to handle, first day, anyone who ever comes into you.

Tom Walters [01:01:47] Yep. For sure. You think about it, there was not a good therapeutic exercise book when I was in school. It was like, oh, you learn these and your affiliations. I mean to have something like this where I could have been like, oh, I’ve got this person with tennis elbow, here’s what another PT would prescribe and it’s broken into phases. It’s a book I would have wanted when I got out of school. Yeah, that’s been really cool actually to see doctors and newer chiropractors get excited about it. That’s been pretty awesome. So anyways, I’m just loving it right now. I’m just going around and talking about it. I’m not in a clinic all day. This is unbelievable.

Kelly: [01:02:20] Does that feel like you are the primary PT in the family now?

Tom Walters [01:02:25] Totally. Yeah. Exactly. Kirsten’s still-

Kelly: [01:02:28] This is actually just about getting out of your wife’s shadow. It’s okay. I understand. Long way around the barn.

Juliet: [01:02:34] All right, so tell our listeners where they can find you. Obviously, I can tell them they can buy your book on Amazon or anywhere they get books. But what about learning more about what you’re doing on the socials and websites and so forth?

Tom Walters [01:02:47] Yeah. I’m pretty much @rehabscience everywhere, mostly Instagram. And I’ve been putting more time in the last couple years to YouTube. So it’s similar to the concept of Instagram but more detailed, me talking through exercises. So it’s a little bit more detail that way. But yeah, pretty much on Instagram, YouTube, and Facebook. But yeah, that’s where people find me, at rehabscience.com. And then the book is obviously just Rehab Science as well.

Kelly: [01:03:11] The Ready State has followed @rehabscience for six years.

Tom Walters [01:03:15] Kelly, I remember you mentioned, I had someone message me and they were listening to your podcast, and oh, Kelly said I should check out… I really appreciate that. It was years ago and you mentioned that and I have not forgotten it. It stuck with me. I really appreciate it. 

Kelly: [01:03:27] It’s easy to spot super stars.

Tom Walters [01:03:29] Thanks, brother.

Kelly: [01:03:30] My friend.

Juliet: [01:03:30] Thanks again, Tom, Thanks for being with us.

Kelly: [01:03:31] Thank you so much, Tom.

Tom Walters [01:03:32] Thanks, you guys.

[music]

Kelly: [01:03:38] Thank you for listening to The Ready State Podcast. If you like what you’re hearing, check out all our episodes here or at thereadystate.com. And be sure to subscribe or leave a review on iTunes to help others find our show. 

Juliet: [01:03:50] Check us out and follow us on Facebook, Instagram, and Twitter @thereadystate.

Kelly: [01:03:55] Until next time, cheers everyone. 

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