Month: April 2022

Prenatal Nutrition and Supplemental Support EP|62

Live LOUD Life Podcast
Lafayette Colorado

Episode 62

Prenatal Nutrition & Supplemental Support

With Katie Braswell

Episode Highlights

  • Katie’s take on prenatal nutrition – is a prenatal vitamin really necessary? 
  • MTHFR gene how it plays into nutrition and the body’s breakdown process
  • Magnesium, fish oil, Vitamin D, Vitamin A, copper, & probiotics as supplements
  • Beef liver as nature’s multivitamin
  • Where to seek prenatal help outside of your OB or practitioner
  • Listening to your body and what it needs
  • General diet recommendations for absorbing nutrients – spending time outside, eating whole foods
  • Vegetarian & vegan diet
  • The male’s diet’s effect on baby
  • Ensuring you’re not undernourished during pregnancy 

About Katie Braswell


  • Holistic nutritionist
  • Specialist in prenatal nutrition
  • Business owner of Live Wild Be Well
  • Mother
  • Yoga Instructor

Connect With Katie:

Instagram: @livewildbewell


Anthony Gurule  00:09

Welcome back to Live LOUDLife Podcast. Nichelle is cohosting with me today, which is great because I normally do these solos and it gets very boring just talking about myself. But we have a good friend Katie Braswell, here talking with us. And it’s going to be prenatal nutrition, specialty and all that stuff. So I will let you introduce yourself. spill all the credentials, everything you want. And in any social places where people can find you, websites, etc.

Katie Braswell  00:47

hello, thank you for having me. two of my favorite people, and chiropractors, and people I lean on for a lot of advice and insight here and there. But I’m Katie Braswell. I’m a holistic nutritionist by trade. So I got my master’s roughly like two and a half years ago in functional and holistic nutrition. And I’m board certified through the NAMP. So I work closely with clients. Now I see them one on one in group settings, also in group coaching platforms as well. Prior to working in the nutrition space, I actually worked in the sales field for natural food products. So I sold brands like Rebel, Justin’s, Kind Bar, and just kind of learned a lot about our food sourcing, where our food comes from USDA, FDA practices, everything that really embodies foods. So I really became passionate about nutrition at that point, and also just passionate about sustainability practices, regenerative agriculture, and just really knowing where our food comes from, and the corruption that’s really on the back end of our FDA USDA model. So my mom is a holistic nutritionist as well. so it kind of led me to this field and I’ve just become really passionate about working with women, specifically, my focus in school and in my clinical practice was predominately on gut health, which was a good place to start because gut health does lead to a lot of things, whether that’s infertility, you know, in women, postmenopausal issues, gut health, and you know, babies and moms, and the whole gambit autoimmune conditions as well. So with all of that it kind of led me into kind of my practice and seeing clients one on one, but then after the birth of our son, I really got excited about prenatal and postpartum care, really have to just experience that myself, we had a miscarriage, it took us a little bit longer to conceive. And just, I really felt like there was a true need for more information like this out there. So that kind of led me to this. And so now, it was funny, because when I was pregnant with my son, I saw Nichelle and we were kind of dreaming up this business at the time, I was knee deep and as a sales rep and an industry that I loved, but I traveled a lot and it just didn’t feel right long term. And so I attribute a lot of my success to this one right here. But as far as you know, I practice now like I mentioned, I see clients one on one. Also I have group coaching programs, and then I have a good blog, too that has a lot of info so you can find me at or on social media @livewildbewell. So it’s a good place to find it.

Nichelle Gurule  03:03

Definitely follow that because it’s a really great, it’s awesome information and share it with anybody who knows pregnant and postpartum all this stuff.

Katie Braswell  03:12

Thank you.

Anthony Gurule  03:12

And now you guys are gonna be doing some projects in the future, which we won’t get into right now. But that being said, one of the main things that we asked our pregnant patients, which you obviously helped me with. Supplements, right. So obviously we’re talking about trying to eat whole foods. Balanced diet. But when you’re pregnant, adding supplementation, is necessary. Needed. So what’s your take? We don’t have to get into like the full list of it. But what are the main things they need to know about need to look for?

Katie Braswell  03:46

Right? Well, and it’s a really interesting topic because and I would imagine a lot of people that are on social media and are looking around are pregnant, are looking for advice on supplements. There are some polarizing topics right now on supplementation in pregnancy. And I’m definitely a Whole Foods practitioner, I’m always gonna lean into foods more than supplements, because our bodies can only break down so much. And we do a lot better with bioavailable forms, and we do synthetic. So I have a lot recently, I think there’s a lot more happening in this there’s a lot of discussion around prenatal vitamins and like, is a prenatal multivitamin really necessary? If someone has a really diverse diet? Are they getting in the right you know, essential nutrients do we even need that? And it really begs the question because, you know, there’s certain clients I have that will bring that up and it’s just like a flat No, they’re just not really getting enough bioavailable nutrients. You know, it has to be someone that has a diet rich and like vitamin A retinol, they’re getting in a lot of iron, you know, choline, calcium, all the things. and with that comes a lot of like organ meat consumption because, like beef liver is like nature’s multivitamin. So someone that’s eating a lot of beef liver, which isn’t the most palatable or delicious thing out there. So not everyone is gonna want that. But that’s usually something you know that a lot of eggs, you know, and someone that’s really, I would say, maybe on the gluten free side as well, like, you know, Eating some raw dairy or grass fed dairy, you know, getting in a lot of nutrients like that, and wild caught fish sardines, kind of eating like our ancestors in a lot of ways, like we talked about, like our grandparents. So that’s kind of one side. And I bring that up, because I’m getting a lot more inquiries about that. There’s a couple of influencers, I think, on the social media side that are pushing that pretty heavily, because we’re just seeing that women like the rates of anemia up and like, it’s like, why is that? You know, and I have so many clients that come to me, and they’re like, “I’m on this iron supplement, and it’s not doing anything.” So then we look at like a hair tissue mineral analysis and see their copper levels are really low. So they’re not really absorbing iron appropriately. So they could be supplemented with all iron in the world, and never see their iron increase on paper. So it is pretty interesting when you start looking at from that perspective, but if a general client comes to me, and it’s just looking at supplements, you know, and they have, you know, a typical diet, they eat fairly well, you know, but they kind of want to stay on the prenatal routine, a prenatal is definitely essential. And that would be most of what I recommend to clients. it’s really important to find a prenatal that does have a methylated folate, because not to go down a rabbit hole, but there’s a lot of genetic variants that are population, like over 60% of the population has one strain of MTHFR, which affects how they’re going to process folic acid, how they’re really going to work through those nutrients. So we need to have a methylated form. I have clients who are like, well, do I need to be tested for MTHFR? Before I take this, you know, folate, or folic acid? And the reality of it is it’s better to take the folate, it’s more absorbable.

Nichelle Gurule  06:30

Assume you are and go that route.

Anthony Gurule  06:34

can you explain a little bit more what that is for? Because people I’ve had people say, “I’ve heard about this, I don’t know what that even means.”

Katie Braswell  06:41

Yeah, so MTHFR. So it’s basically a genetic variant. And it reflects how we process methylated vitamins and B in B vitamins specifically. So you have to have a methylated form so your body can actually adapt it and use it appropriately. If you like, let’s say I do have MTHFR. And I have a single strain. It’s like a $200 test. So like Nichelle saying, it’s better to just assume for a lot of people because it’s not going to hurt you. So with that, it’s all about the absorption and making sure that you can actually process it appropriately. Like if I was to take folic acid, it wouldn’t, I wouldn’t be able to adapt it because my body can’t process a non methylated form of folate or folic acid. So that’s kind of a breakdown, we have to look at B vitamins too, though, because B vitamins are also a piece of the puzzle as well. And we do see that sometimes like, you know, with clients that I work with, occasionally we’ll see maybe an overload of B vitamin intake. So I do look at labs a lot of times in conjunction with an MTHFR diagnosis just to see like, Okay, is there something else going on here? Do they have an overload of B vitamins is their body may be able to process them a little better than we thought. So it’s all kind of a big piece of the puzzle like with and that’s kind of the issue with a general prenatal is it’s not always it’s not just like a one size fits all for everyone, which makes it a little challenging.

Nichelle Gurule  07:51

Now so question I have for you is because so many people don’t eat well. They think they well too. So you know, it’s actually looking at what are you actually eating because people think they a lot better than they do until they read it on paper and they’re like, Oh crap, I’m really not eating that well. Plus adding in so most people don’t eat well in America, right adding in that when you’re pregnant. There’s things that you do not want to eat so I can make myself suffer through things I don’t like in the taste of right now and maybe give me the heebie jeebies. Just think about eating. I can make myself do it. When it comes down to it swallowing a really good supplement that maybe it’s eight capsules a day. Or swallowing liver, eating sardines is just not going to happen but eat pretty well in general. But it’d be like, I could do desiccated liver capsules, which is not going to be good as raw liver that’s been frozen and micros. But like, how do you bounce it out with somebody who’s like, “that looks great on paper, I get it.” But like swallowing the needed brand or a couple other brands that are more capsules..Like where’s that in between for those people who like they want to do well, right? Because you’re gonna have more of the population that is like actively seeking. Yeah, I want to do better with nutrition, right? And they’re naturally going to be more open to like, alright, I’ll take the liver. Sardines, I’ll do it right. But when you’re looking at kind of more of that average population, how do you how would you handle that?


Katie Braswell  09:10

that’s a good question. And the first trimester speaks to that in a lot of ways like I have some clients do beautifully after 18 weeks, you know, they can eat a really nutrient dense diet but up until then, it’s like we need that insurance policy of having the prenatal available. You know, so I just work with a client where they’re at. I mean, if it’s someone and I am pretty transparent like you know me anyway, I’m pretty much like just shoot it straight. Like if you’re gonna be able to do this let’s put you on this plan but if not, this is the route we’re gonna go. The neat thing is there’s a lot of really great brands with prenatals like I love seeking health Dr. Ben Lynch because he kind of prioritizes genetic variants and like MTHFR and in his formulations and a lot with like histamine like a lot of women really have a hard time processing histamine and then having histamine intolerance and so he works a lot with things like that, like needed is a good option as well but so you know, we’ll kind of work with like, I have one client like seeking health it’s eight capsules like use Just as needed, she just couldn’t do it. So fortunately Seeking Health has a chewable, that’s a two tablet deal that they can just pop and be done, you know, so I kind of just have to work and see where the client is capable of. On the flip side, I do have a lot of clients that come to me with good intentions, and then it just never comes to fruition. So then we just have to kind of back up and say, you know, and the neat thing is, we can certainly pull together like, I don’t rely on just the prenatal and in fact, I don’t really recommend that someone just takes a prenatal and that’s it. Because we need so much more. I mean, you know, DHA, you know, having a great source that have omegas that are triple tested for purity and non and toxic materials. So like, you know, I love Nordic Naturals and Rositas, you know, to have a really nice pure brand and pure blend. Magnesium is a really underrated you know, nutrient really for looking at like mineral status in pregnancy. I think you know, per like the birth center boulder or bch, they say no more than 400 milligrams of magnesium in pregnancy. But magnesium has such a broad spectrum, there’s so many different forms of magnesium that can be utilized. But oftentimes I have a client who comes in, they’re like, Oh, I was given magnesium citrate, and I’m like, well, citrate is more for like constipation, so it’s not really gonna help you that much in pregnancy with your aches and pains and sleep and joint disruption. And so it is really important to find those other things. And I guess kind of diving into the gambit, you know, those would be things I would definitely recommend. Vitamin D is something that’s also it’s becoming a little bit more controversial, I think, because it’s been over supplemented for so long. And there’s just there’s some more research coming out. PubMed just released a couple of neat articles about it. Because a lot of people are able to synthesize and absorb vitamin D properly from the sun and a lot of foods. But we’ve kind of been told for X amount of time to keep supplementing, but we’re finding that a lot of women specifically have enough vitamin D, and sometimes they’re over supplemented. So that’s one thing as a practitioner, I’ve kind of backed up from saying, just like everyone should take 5000 IUs. instead, I’m looking closer at labs first and saying, okay, you know, what you have, like, your levels are at 70. Like you’re good. from a functional perspective, we’d like to see 60 to 80. If someone’s able to do that on our own without supplementation, I’m not going to add any more in. so that’s just one thing I’ve kind of seen. There’s some conflicting advice right now and kind of research on vitamin D and too much that it could cause some like calcification of the bones long term and things like that. But I don’t know, I don’t think there’s enough research yet on that to really say one way or the other. So vitamin D is one that can also help with a lot of infertility. We look at vitamin D pretty closely. And then other supplement wise, what am I missing? And then some things that all add in like beef liver, like you talked about, if it’s a client that maybe isn’t able to get a lot of B vitamins, beef liver’s incredible because it has full weight, selenium, B vitamins, iron, and just a lot that we can’t just get from like an average diet and it’s also bioavailable, because it’s 100% Food base, so it’s not a synthetic form. And vitamin A that leads to a whole other discussion about beef liver, but and I could talk about beef liver for days, anyone that follows me I’m like, Oh, here she goes again. But beef liver like vitamin A, Well, I think we were talking about this actually the other day. But, you know, there’s been a lot of conversation about too much vitamin A in pregnancy. And a lot of women are scared now to eat beef liver, because they’re like, Oh, well, we were told from our practitioner or OB that we shouldn’t have beef liver because it’s high in vitamin A, which it is that’s not wrong. But in order to exceed the RDI for your vitamin A and take that day in in conjunction with your prenatal, you’d have to eat like two whole, you know, cow beef livers. I mean, it’s like it the the amount of the quantity and this is just far beyond what anyone would ever intake. So I do like to layer in beef liver, if I can, whether that’s a client that’s able to take it in from a food source, like, you know, raw or, you know, maybe not raw in pregnancy, depending on your comfort level. Or if you want to cook it, or saute it or have it some people will just even like grind it up and put it in like a smoothie.

Nichelle Gurule  13:51

Does the nutrient value change when it is cooked versus raw? has there been studies as to how much that changes?

Katie Braswell  13:59

Yeah, you know, so Paul Saladino we were talking when I first got here you know, he did the heart and soil supplements and he talks a lot about the dehydrated liver and kind of the change. I don’t think it’s insane I think they say it lessens by like 10 to 15% of what it actually would be but it’s the same thing if you were to like freeze beef liver technically and then like we talked about like pre-thaw you’re losing some nutrients anyway. So I say you know for me personally like we were just talking about and I have some clients that are perfectly capable and and are comfortable eating raw beef liver and pregnancy they freeze it and then just swallow you know, chunks here and there which, you know, kind of depends obviously, there is a risk for parasites and things of that nature in pregnancy but that is probably your best way to get it in. I mean because it is so nutrient dense in its raw pure state. But there’s a lot of great companies now like Heart and Soil, Ancestral supplements is really great, perfect supplements, Smidge they have some really nice beef liver products that are that are pretty good.

Nichelle Gurule  14:59

if you’re gonna do it right It is better to freeze a freeze that we know from experiencing. We won’t get into right now,

Anthony Gurule  15:06

I ate raw liver…it didn’t go well.

Nichelle Gurule  15:08

It was not frozen for weeks at a time. So reach out to Katie, if you decide to go that route, don’t just dive right into chopping it up.

Anthony Gurule  15:19

I was very ambitious because I knew all the benefits of liver and this was straight from the farm that like just packaged I was like, I mean, it’s fresh, right?

Nichelle Gurule  15:33

I have a question for you? Because, you know, most people are going to most people are going to have a midwife or an OB. And they don’t have very much nutrition experience really at all, they just say take a prenatal and then the prenatal what are commonly recommended are really just be better if they didn’t take them. Like when I look at them, I’m like ooof. Especially because they’re just not taking into account the genetic variations that can affect even vitamin A and not being able to convert yet a carotene which is the plant version of vitamin A. So we’re looking at most people that are pregnant, or not going to go the extra step and see somebody like yourself, right? Nor is there enough nutritionists right now that exist to do that to break down and get all the labs and go through hair samples and all the things. Even if that sounds great that that would happen. It’s just not going to unite anytime soon.  So with that being said, like what do you wish you could give as information to people who are not going to see a nutritionist like yourself, whose OB and midwife are not giving that information? Maybe their insurance won’t cover an extra vitamin D test. It’s not going to cover checking their Bs, right? Like, what information would you love to get that person who’s like, listen, I just don’t have the resources for that. What should I do? Could could they be honest, specific supplements? Would you recommend like this supplement DHA and this? Yeah, they’re like, “I don’t live anywhere near I can get a fresh liver” what should they do?

Katie Braswell  16:51

That’s a good question. Because that is a general, you know, portion of the population. First of all, having kids is expensive. So it’s hard to invest when you know, you’re gonna have medical bills coming out, Or if it’s someone who knows they’re gonna have a C section and maybe, you know, is kind of preparing for that it is expensive to seek nutritional advice. And there is a handful of, you know, lucky people out there that, you know, see a practitioner that is really mindful and does talk about nutrition a lot. But yeah, I would say it’s kind of like a general idea. I mean, first of all, there’s some great books, like we’ve talked about, like Lily Nichols wrote a really nice book, nutrition for pregnancy, which is a beautiful resource. And I just love that it’s in the hands of so many people now. So that can be really great. And she gives a lot of good options for people that may live in a rural setting and may not have access to you know, every you know, Vitamin Cottage or Natural Grocers right down the road. Outside of that, you know, the general kind of idea that I tell everyone is, yes, find a really great preprenatal and like we talked about, you know, falling into that methylated folate, because if you don’t have the option to get supplemented, definitely, you know, try to go that route. So something like Seeking Health, Needed. There’s another one that I really love that just kind of came on the market that’s really good.  Yes! Full Well. I just got samples of it. So I haven’t taken it, but I like the whole like composition of it. So that’s a good option too. So I would always say finding a good prenatal and then working with your practitioner on that. Another thing that’s kind of underrated are probiotics. I think a lot of times, that’s something that should be talked about a lot more because we’re seeing a lot in clinical trials of the importance of having probiotics for mom both in the preconception period through pregnancy, and it helping actually, with like GERD, acid reflux, you know, things kind of complicating the baby in you know, the first few weeks. so it is really helpful to kind of foster a strong microbiome for the mom to then pass it on to baby. Also, with Group B strep, it’s important to stay on a probiotic. So a couple of brands of that, that I really like is just Thrive and Seed. There’s also a megaspore biotic, that’s pretty, pretty digestible, as well. So things like that, that would definitely important. And then really, the fish oil, definitely magnesium, and then vitamin D, you know, and I always kind of tell my clients that don’t have the resources to test because testing isn’t cheap. And oftentimes, it’s not covered by insurance. It’s, you know, be be a proponent of intentional intuitive eating, and really listen to your body, you know, what does your body want, I mean, if we really back up and kind of look, you know, 3040 years ago without social media without you know, technology all the time without the TV on, I think we paid more attention to what we actually wanted. And sometimes when you sit with that, you know, I’ve noticed even on backpacking trips, unfortunately, usually what I want isn’t there, but I usually this is what my body needs, you know, and like so I think when we kind of stopped the noise we really can pay attention to what our bodies are telling us. So I’m really a proponent of that is like having people really step back in pregnancy and in preconception and say, you know, your body’s generally going to tell you like, are you feeling like some someone were just like, I crave a burger like every week and pregnancy I’m like, Okay, well, let’s, you know, let’s think about Yeah, it’s your blood volume, you know, you probably need more iron, you know, those things. So, that’s always what I would say and vitamin D is pretty polarizing. You know, a lot of times with vitamin D, we’ll see like, seasonal disorder, you know, people seemed to have a little bit more irritation around like time change and the light changing and then things like that sleep can also be affected, you know, mood swings, mood disorders, you know. So those are kind of things to kind of pay attention to. A fatigue. I mean, that’s one thing in pregnancy, you know, you, you are going to be tired. But extreme fatigue is something that I think if a lot of us paid more attention, you know, we could probably kind of fix that with some food groups and time outside too.

Nichelle Gurule  18:01

Is it Full Well? So if I’m craving a beach vacation, does that mean any vitamin D?

Anthony Gurule  20:32

mineral you see that?

Katie Braswell  20:37

She can do it right outside, no problem. Colorado sun, little wind.

Anthony Gurule  20:41

So one thing I’ve seen on a few labels of checking, which and you can weigh in on this, or I guess, just affirm what I’ve seen is supplement companies are now knowing that we need folates. Yeah. And are you seeing that sub text that says, XML from folic acid?


Katie Braswell  21:01

Yep, that’s definitely something you’re seeing more and more, because there is a lot more discussion on it. It’s interesting, though, because I had a friend that put this whole thing on Instagram, she made a real about folic acid, and folate and kind of everything we talked about. she was working with a client that had been told to take folic acid. So she kind of went on this rant and did her whole spiel about it. And there was so much pushback, and it actually went viral, because this was like this whole debate. And it’s it really amazed me because I think in my small circle, I feel like the it’s out, like the word’s out, you know? Like, it’s like methylated folate or like, That’s it, you know. but I realized after seeing her thing, first of all, how many practitioners are very passionate still about folic acid and are not seeing the research or they just maybe have done their own research. And it’s limited and they still feel like folic acid, is it? So I think yeah, it’s it’s really interesting to see how many people still, like I have clients still to come to me and say, “Oh, I’m on folic acid.”

Nichelle Gurule  21:57

but I mean, it does take an average of, what does the study say, of 17 years before research goes into practice? So I have a close family member who I got an argument with this exact topic about. And I felt very confident like the first topic I was like, I own this one, I know it, and we chatted about it, when it came down to was that practitioners are going based off of the research, right? The research commonly uses that they’re looking at folic acid. Why? Because it did show to decrease neural tube defects, right. But now you’re looking at well, why did they use folic acid and not folate? Did they just not know? Or was it just cheaper when you’re doing studies that are having 10, 20,000 People? And the answer is that folic acid is synthetic, and it’s super cheap. Yeah. Compared to it is MTHF. So, you know, it comes down to that. And so she’s like, “but it makes you it does reduce neural tube defects.” I go, “Sure, But could it make things better? And is it doing other things to that body? If they’re not having the MTHF?” And she’s like, “well, I don’t know.”

Katie Braswell  22:52

Yeah, there’s a couple brands who are doing like methal-free forms, too. I guess if someone is having like a, you know, maybe an abundance of, you know, absorption or something’s going on that we need to kind of look at. But yeah, that’s interesting.

Anthony Gurule  23:04

And I think this really just comes down to, because I had a very, very short, not wasting my time, internet debate with a pediatrician about milestones about crawling. Right. So it’s the same thing. I think it just really, I think the differentiation is, we just have a different opinion as to what may be healthy or optimal actually is, right? Where we see one side of the spectrum is very much about well, we’re gonna play the conservative role. And we take this because we don’t want certain things to happen. Right. Defense mode, right? Well, we’re thinking more offense mode, right. We want this to, like flourish and thrive as best as possible. So what’s gonna be the best option?

Katie Braswell  23:44

Yeah, exactly. Yeah, it’s interesting, I think, coming from an integrative perspective. I mean, I think we’re all kind of immersed in the research, you know, even something as simple as like, red raspberry leaf tea is something like I did a post on that today. And so many people are just so scared, you know, they’ve been told, if I take this before, 38 weeks, like, you know, I could, you know, have uterine contractions and baby could come and it’s like, you know, what, I really want to sit with people that are having that fear, and, you know, totally understand where that comes from, but at the same time, I do think we have to get back to this point of being fairly intuitive and, you know, trusting our bodies and knowing that these resources have been around for a long time. And you know, how do we utilize that. and you know, with new research always comes changes, but it is interesting, the folic acid thing is, it’s yeah, it’s definitely controversial, I would say, to say the least.

Anthony Gurule  24:31

So outside of folic acid and the supplements. So we’re talking about whole foods, liver being big. What are some of the other just general recommendations? So I guess one of the things would be, I mean, I think the hard part for some people is when you’re looking at supplements, one of the big worries is, am I absorbing it, first and foremost. That definitely helps. But when you’re talking about all the different symptoms for pregnancy with energy levels, so on and so forth, rather than go going down the rabbit hole of assuming that this will fix everything what are some of the other big either nutritional things or just general suggestions for pregnancy do you give?

Katie Braswell  25:09

So the first thing you know I always say is, first of all, we need to spend time outside. I’ll just kind of start with a lifestyle thing so you know to start. because I think sometimes in pregnancy you know, and I was guilty of this like up until 20 weeks I didn’t feel that great. So I really didn’t like leave the house much. I was pretty much you know, definitely dealing with some nausea and things and some of that’s genetic and there I have my own suspicions that I was low on popper and you know, maybe that was why I had those things and B6 but you know, I think first and foremost, it’s really helpful to get outside get natural sunlight every day…that’s really impactful. Next to that is you know, like we mentioned with food, you know, making sure you’re eating these forms of foods that are bioavailable, you know, I always kind of go back to my days is in the natural food space is like when you’re shopping always shopping like the external you know, the square of the grocery store so trying to avoid the internal aisles because you’re going to be getting those real whole foods You know. we start looking at a lot of processed foods in pregnancy you know, not to go down a rabbit hole of poo fuzz you know, seed oils, polyunsaturated fats, that can be hard on the body so you know when you’re eating things that we want to make sure they’re full fat, they’re good oil, so coconut oil, avocado oil, beef tallow, gee–things like that are really nourishing and nutritive. You know, as far as meats go, I mean obviously I’ve worked with a lot of vegans and vegetarians in the past I would say I definitely lean in more to the that’s just more my niche is I’m really a big proponent of kind of this you know, well rounded eating patterns and eating you know, meat sources. but you know if it is a vegetarian like leaning in, I just had a client you know that just had her little one and she had a beautiful pregnancy you know, 100% vegan and did just a great job, you know, really like landed it she just ate super well, did a great job. And we really relied a lot on nuts, like that was like her big source of omegas and you know, I guess the good polyunsaturated fats. and then also making sure she had plenty of good fat options in her system, she was getting a lot of protein. So it kind of depends. depending on the client. meat products, obviously beef liver we talked about. bone in meats are amazing, because bone and meats tend to when they’re stewed are cooked together they leach more vitamins and minerals into the meat product rather than something that’s not you know bone-in. so you know looking for like bone-in chicken thighs or short ribs and things like that. And then fish products– wild caught fish–so that’s a big topic too, just making sure you’re not really intaking a lot of fish that’s rich in toxins mercury, all of those things. So I typically recommend smaller fish like sardines are really great. Tuna can be had in moderation but really it’s pretty high in mercury so I would say to avoid that. And then you know obviously the sardines Those are great because they have really small bones so they’re high in calcium. And then salmon is starting to test a little bit higher for toxins. I  like arctic char if you can find that wild because it comes from colder waters. cod is really great. And then obviously just getting in a well rounded diet of leafy greens, vegetables, root vegetables are really great and pregnancy. cheeses you know I like to say if you can go raw, you know if you’re comfortable with raw dairy and raw cheese, if you have a local supplier, that’s great and you trust them. if not grass fed is great. And then a eggs. eggs are just like a superfood for pregnancy it’s full of choline, full of omega, full of copper. Copper is a big one. You know, when we look at fertility a lot of times especially  really in males, we see instances of low copper and and females too, but it’s really important. There’s not a lot of foods that are rich in copper. eggs are one of them, oysters are another. oysters are great to have too, like a smoked oyster or smoked muscle. You can get those in little, you know, cans, just making sure they’re BPA free and they’re also smoked in olive oil. I could go on about this for days. So those are some of my favorites.


Nichelle Gurule  28:41

Just to add on to this, because you brought up the male side of it. there’s a lot more studies that are coming out about the placental health, the umbilical cord, even mother having nausea versus not that it could actually be coming from the male side of things. So making sure that it’s not just the female that’s putting in the time and energy of course, it’s her body that’s nourishing it wants to conception happens, right? But as everything just starts unfolding, those cells start replicating things happen. What was the 50% coming from? Is it coming from a healthy male and so all the same things you said are still true? For the male, there’s gonna be things that you tweak. So is there anything with conception that you suggest for the male party on top of all you’ve ever said for females.

Katie Braswell  29:20

that’s a great point especially, you know, there’s a lot coming out to about miscarriage rates and really being more male factor than female factor. So a lot of that does come down to copper. That’s the really the biggest thing, so like shellfish is really wonderful like oysters mussels. Co Q 10 is really great. As far as a supplement source, it’s good for our cardiovascular health, but it’s also really great for fertility both in females and men. NAC is a really powerful supplement. it’s anacetylcysteine and it’s a bioflavonoid that can also help with you know, fertility needs. it’s also really great in men but also it helps sperm health and mobility, and also women, it helps kind of boost up ovulation in a way so it’s really helpful with PCOS and things like that. And then my husband always hates this one. Fenugreek is a really interesting herb. And so it can be taken in capsule form. And it helps for mobility. So a lot of times if we have someone that’s going through like an IUI trial or IVF, and they’re having like a sperm mobility issue, this is a really wonderful herb for that. It’s also just great for general male health when you’re coming to fertility and things like that. The only caveat is, I had my husband on it for a while and he was like, You know what, I think I started, I smell like maple. Do you smell it? he’s like, I have this new BO. And it’s like, it’s weird. It almost smells like a pancake.

Nichelle Gurule  30:32

sounds great. Sounds a lot better than other options.

Katie Braswell  30:35

And I was like, Oh, I don’t know what that could be. And then I started researching. And I was like, uh oh, because it does start to kind of leak out of your system. So that’s the only caveat, if you’re gonna have fenugreek, be ready for that. And then beef liver. You know, back to that, I think that’s a really good option. it’s funny, a lot of my clients, I’m like, have your husband eat the same way, like everything we’re kind of putting together is like, but we talked a lot about this. It’s kind of like eating like our grandparents and eating like our ancestors and looking back to like, okay, you know, even like my grandma, I remember she would make like a big chuck roast. And she would like take the fat off the top of the chuck roast when it was done and use that as her like, rendered fat for the week. because they didn’t have a lot of excess resources and money. So she was like, butter is expensive. I’m just gonna use this, like, lard or tallow for the rest of the week. so that would be kind of my recommendations for male and female fertility. One other thing, you know, it’s really important for conception, both for females and males is also blood sugar balance. You know, we’ve talked some about this as looking at, you know, as a society, we’re undernourished, and we’re not eating enough, you’re not taking enough calories, we’re not really paying attention to how we should eat. And it’s really important to really fine tune when you’re eating, you know, I always recommend eating within like 45 minutes to an hour of waking up. And every two to three hours after that, that’s great in pregnancy, it’s great for preconception, great in postpartum. It’s just going to help you kind of balance yourself overall. And that’s something I think, as a society, we just we don’t eat enough. You know, on on average, women are undernourished and not taking in the calories they need.


Nichelle Gurule  32:08

Oh, I wonder why…is there a message that’s been passed around. Special K commercials that go around.

Katie Braswell  32:13

Yeah, I know. It’s like, it’s so sad, you know, because I think it’s just we’ve gotten away from this, like, Okay, we want to feel like nourished and healthy. And, you know, and it’s, when I even I get a lot of comments, like when I do my birth center classes on prenatal nutrition, as because our, you know, caloric intake and our needs, you know, go throughout pregnancy. So you start at, like, 1800, roughly, I mean, that’s on average, first trimester then 2,0000 and then 2200. And a third, and I have so many clients that struggle with that they just have this, you know, these and sadly, these disordered eating patterns that we have to reframe, and kind of work with and a lot of that is just, you know, kind of going through the motions and you know, if it’s trauma based or whatever is going on, but really retraining our minds on like, “Okay, this is good for you, you know, you do need to nourish yourself and there’s this new life coming too.”

Nichelle Gurule  32:14

And that is something that has to be talked about is like your body’s gonna change. I talked about that a lot because I have a lot of very fit women coming in and it’s really disturbing to them that their body’s gonna change and just giving them the confidence that like things will, you’ll get you back, I promise. you’ll get back to your movements. But we see a lot from the movement like in like the bodywork perspective of gripping and holding on to the Abs because what are we taught from a young age like, Paulin, abs and like, you gotta be small. And so then they keep that pattern, right. And then we have positional issues, because baby doesn’t have space, like you should look pregnant when you’re like 35 weeks, if you don’t, you’re holding your abs too much. So it comes down to food and how they’re holding body that comes from just a whole other thing from earlier on for them that we have to focus on.

Katie Braswell  33:32

Yeah, and there was one other thing you know, in that same mindset is like, you know, in the traditional, if we look at just, you know, OBs and what they’re kind of recommending, they’re recommending, usually like 60 grams of protein. And really, we’re finding on average, women need anywhere from 100 to 130 grams of protein a day in pregnancy. So that’s one of the things I want to make sure I hit on because that’s something I drive home with a lot of my clients and we see just lessened, you know, propensity for nausea, you know, any kind of things coming up preterm labor, preeclampsia, when you do have a lot of protein in the system. It does help with your recovery and glycine and collagen repair and all of that, too. So that was one thing I’m wanting to fix.

Anthony Gurule  34:09

I don’t have any other questions. No other questions. Is there anything else you want to add before we wrap up?

Katie Braswell  34:14

No, I think that’s great. Thanks for having me on. This is a dream. I could sit here all day, whether the camera was on or not.

Anthony Gurule  34:22

2.0 coming. Well, thank you so much.

How To Heal A Bulging Disc

What They Told You About Arthritis & Tendonitis Is Wrong EP|61

Live LOUD Life Podcast
Lafayette Colorado

Episode 61

What They Told You About Arthritis & Tendonitis

With Dr. Antonio Gurule

Episode Highlights

  • Overview of upcoming prenatal courses
  • Defining arthritis and tendonitis –inflammation and aggravation typically associated with pain
  • The benefits of loading weight & moving the body
  • Avoiding arthritis and tendonitis with consistent daily movements
  • The role of synovial fluid in keeping the joints healthy

About Dr. Antonio Gurule



  • Father
  • Doctor of Chiropractic
  • Owner of Live LOUD
  • Personal Trainer & Health Coach

Anthony Gurule  00:00

Hey what’s up guys, welcome back to the Live Loud Life Podcast. My name is Dr. Antonio, your host of the Live Loud Life podcast. This show is brought to by Live Loud Chiropractic and Coaching. That is our practice in Lafayette, Colorado. My wife and I  own Live Loud Chiropractic and Coaching. We help families through a variety and wide range of issues really starting with prenatal, postnatal, and pediatric care, while also then supporting the rest of the family from birth up into grandparents, older age, whatever that is. And our big focus is really just helping making families stronger. So that we can make our community stronger as a whole. And that you can express this loud life that you want to be able to live and pass that on to others just by setting an example about what health, fitness, strength, whatever that is to you looks like. And being that prime example I don’t know if you can hear right now. But in the background here we got some little baby chickens and ducks that are currently, they are hatched, they are currently baking under a heat lamp, as we are planning on closing on a property soon, which is amazing for us and our family and we’re gonna have just a little bit more space and hope we’re going to be having some chicken and some duck eggs. So that is what you may or may not hear in the background, not sure if you can hear that in the post edit.


Anthony Gurule  01:44

With that, a couple couple things we have coming down the pipeline. Nichelle is working with one of her good friends on a postnatal course. And what this postnatal course is, essentially, here’s all the things that we wish we knew, after we had babies, we been shown her, her friend who are doing this project again, not me. But there is application obviously to partners and husbands within that as well. From nutrition, from postpartum rehab, to postpartum mental health, you know, whatever that is, that’s going to be such an amazing course. And the reason why, when you’re pregnant, when your family is pregnant, all of the time, energy and focus is on you, up until birth, and then baby comes along, obviously, we want to make sure mom and baby are healthy and doing well. But then the focus starts transitioning on to baby– making sure that they’re gaining weight, making sure that they have everything they need. And oftentimes outside of the six week checkup that moms get, there’s not a lot of love given to the postpartum mama. And so they want to be able to fix that. So if that’s you, if that’s a friend, you know, if that’s you coming up in the future, be sure to look out for that we’ll be posting that on our Live Loud page, on our Instagram accounts, Nichelle’s personal Instagram, as well. And we don’t want to share too much about it, because it still kind of in the developmental stages, but that will be coming down the pipeline this year. Aside from that, speaking of pregnancy and postpartum, I generated-created generated-whatever you wanna call it. A course, that’s how to not suck at giving your pregnant partner massage. Obviously, us being body workers that’s something that we’re doing on the daily basis, helping our prenatal mamas. But it’s something that we advocate for at home, because there’s a ton of benefit for reducing aches and pains, for your pregnant partner, for the birth and labor preparation process of reducing restrictions within the abdominal wall and the pelvis so on and so forth to help with baby positioning and labor. But also from a connection standpoint, there’s a lot of changes going on in pregnancy. Again, I don’t know what those are, because I haven’t lived it. But I know when I’ve seen it happen through and with my wife for all three of our kiddos. And it’s a very challenging time when especially when it comes to touch and intimacy and different things like that. And not that this is an intimacy course. But the whole touch aspect is your as your body changing, it just it just feels different for not only you but also the partner. And so we wanted to help provide you a little bit of guidance on how you can give your pregnant partner some basic massages from hands which helps with carpal tunnel symptoms, from rubbing feet which helps with swelling, from working on the hips or the lower back, which is one of the main achy points or pain points when being pregnant. So if you’re interested, if you are a partner listening to this, and you’re interested in being able to provide your pregnant partner a better massage experience or have that touching connection point with you, I think I think you’d find that very handy and helpful. We’ll link that in the show notes and we all So I have that listed within our linktree in our Instagram account.


Anthony Gurule  05:06

And if you’re pregnant, or you’re about to be pregnant, or you know someone who’s pregnant, and you think that they might benefit from that, that’s a great, not passive aggressive, but insinuating gift to give to someone who’s like, Hey, would you watch this so that you feel more comfortable about giving me a massage, talking from the brain or Mama’s perspective. So it’s, it’s very, it’s very easy. We give some anatomical landmarks, it’s not clinical by any means we help describe what parts of hands can be used to make it more comfortable. It’s a short, it’s a very, very short, like, four hour course but it’s extremely, it’s extremely, extremely handy and beneficial to build upon that.


Anthony Gurule  05:53

Now, enough of the introductions, what I wanted to talk about today was arthritis, and tendinitis. Itis being the key and some different ways that I want you to, to look at arthritis and tendinitis As it pertains to what’s actually going on. Now to better describe, itis simply means inflammation. And usually associated with pain, right? Inflammation, usually associated with pain. It’s not always the case but usually associated with pain. So example, we’ll just use a bicep tendonitis. Bicep tendonitis, there could be multiple reasons as to why the bicep tendonitis in there and that first and foremost, what we’re trying not mean, first and foremost, but within the process of diagnosing and treating injuries, understanding the potential why something happened is a critical component. And this This is slightly foreshadowing for our conversation here. But also just knowing which tendon is irritated or inflamed is highly important to for knowing how to load properly, so on and so forth. But it essentially means the tendon is inflamed and irritated. Could be micro damage could be more damage, but the bicep tendonitis, tendon pain irritated. Okay. And usually that’s due to what as if you were to type this in, over use injuries, or, or too much loading or something like that, right? Does that make sense? Like usually it’s it’s described as wear and tear, or overuse, so on and so forth. And I’m going to dive a little bit more into that, hopefully help describe what that means.


Anthony Gurule  07:53

Now, we also can look at arthritis. arthro, meaning joint we can have inflammation of the joint. And most people associate this with knees, hips, shoulders, like these big major joints. Now, again, assumed and described as an overuse type of injury. For instance, if you run too much, you’re gonna destroy your knees and create arthritis, because of the wear and tear and impact. Now, that is not to say that load and too much load will not cause arthritis. But what we also have to we also have to know, not assume, but know is that load and force is one of the things that actually makes things stronger. Our body has this amazing ability to adapt and respond to the forces opposed upon it. Pending It is done at a level enough to elicit adaptation, and not so much that we create detrimental or possibly damaging effects. Okay, so there is this sweet spot of adaptation of loading just enough, but not too much that we create an issue. And that’s really where the magic happens. Now, what is that load? Well, it’s different for everyone. It’s different on a number of different criterias from your experience with lifting or loading or doing anything else. Not only that is how long you’ve been doing it, so for weightlifting, they they oftentimes called like your ‘weightlifting age’ of like how long you’ve been doing this because that that essentially will help someone determined how much how much your tendons have been under load and how much response and density they’ve built up over time.


Anthony Gurule  09:58

There’s also a number of just metabolic factors and conditions that would more so be in response to how your body recovers. So for instance, someone who might have like certain autoimmune conditions or certain conditions that just makes it harder for them to recover, that’s obviously gonna  make your recovery from that adaptation more challenging. So there are, there are a number of things to consider. And we’re not going to dive into all those because that’s not what’s most important. What’s most important to understand, though, is that load is a good thing. But just like anything else, too much of a good thing could be a bad thing. But I think, more times than not, we’re erring, too far on the conservative side, assuming that too much load will create damage, and thus you will have more degeneration, or more arthritis or more tendinitis, thus leading to more damage, thus leading to more pain, thus leading to further intervention down the road, ie steroids, injections, MRIs, possible surgery. make sense? And the reason why we have to look at this is we have to have a conversation about how much you’re currently doing. And then we try to meet in that zone of adaptation.


Anthony Gurule  11:20

So for instance, right, in the the example of the bicep tendonitis, let’s say, for instance, hypothetically, that someone is working out, doing some form of HIIT training, which usually involves a lot of upper body stuff, five to six days a week, and they’ve only been doing this type of training for six months, okay, six months, relatively new. they’ve been lifting before, but it’s been mostly kind of like your basic bodybuilding. You know, less intense, less dynamic type of movements. Six months ago, they decide to start hitting trading, they start hitting it harder on they’re doing a lot of different things at speed and in a more dynamic fashion. So we can see that there is a direct change in the amount of load in which the shoulders were being exposed to, with possibly less recovery time and or not enough recovery time based on the new training methodology and style. So we can see a direct link and change to why an instance of a bicep tendon  might be hurting. And so the question would then be, well, what’s the best approach to deal with this? Now, outside of an MRI, we wouldn’t necessarily know the extent of the possible damage to the tendon. But even with the MRI, you’re not going to fully know that unless there’s gross major damage and changes, okay, which your function and limitations and ability would would most likely be down because of that. So with, you know, with this story and example, making that assumption is that it’s slowly and gradually kind of crept up on us over the last six months, or realistically, maybe over the last six or eight weeks, we can make an assumption that we are above that zone of adaptation and the load is too much. Now, that does not mean we have to cut out all load. There are other factors that would be leading into this. And part of this is the biomechanical approach of leverage. There are certain movements in which when we’re talking about upper body movements, we might be loading or leveraging the bicep tendon too much and not sharing and distributing the load across other joints, such as the elbows, or other muscles, such as the pecs, the triceps and to your delts, so on and so forth. And they’re all involved in some capacity, but we’re really just looking like do we are we are we leveraging well enough, so our bigger muscles such as pecs, and delts are not taking as much load restraint as the bicep tendon might be?


Anthony Gurule  14:08

that’s a factor, the other factor would be recovery. The other factor you know, recovery involves diet, sleep, so on and so forth. So we can see a clear indication representation of why the tendon irritation or tendinitis occurred. But we cannot say that it’s because sorry, we know that it’s too much we’re just just above that zone of adaptation, but we cannot just assume that like the movement is bad because it just might be too much loading or too much weight or not enough recovery, then that’s part of the covering the rehab process is finding out what what really works, right. So I would argue that the majority of shoulder movements shouldn’t would be okay, pending we’re not significantly increasing pain within the shoulder and in thus in turn decrease in its function range of motion, swelling, and so on and so forth. Right? So we’re trying to find a middle ground of saying, hey, yeah, we would love you to keep working out, we just need to be a little bit more careful about what those might be based on those loading principles, so on and so forth. Now, what I, the reason why I wanted to share that story first was to go to the complete opposite way and talk about something as simple as knee arthritis-different. Again, we’re under the same assumption that load is the predominant factor that’s irritating, that irritating a tendon, a joint, a muscle, so on and so forth, right. And that is then in turn creating, itis, inflammation and pain. And we could say if we wanted to keep this consistent, we could say patellar tendonitis within the knee. We’re just going to say knee arthritis, patellar, patellar tendonitis and same, same region, same conversation.


Anthony Gurule  15:54

But here, we’re looking at an individual who’s been told they have knee arthritis. And they’re, let’s say, for instance, this has been an ongoing thing for the last three or four years. And essentially, the conversation is, hey, you’re doing too much on your knee, you need to you need to cut back and reduce how much load you’re putting onto your knee. Well, then the patient asked, well, what would those things be? What are your activities? Well, you know, I pretty much just walk the dog and that’s about all the extent of my exercise to do, I don’t do any resistance training or the like that well, walking, walking must be the thing that’s too much for your body. So you need to wait, let it rest, let it rest. And then you can get back to it. So we wait, and we wait. And we wait. And sometimes weeks, months, sometimes even years later, we’re still waiting for the thing to heal. Now, if you look at any, any sort of textbook, any sort of physiology textbook that talks about healing timelines, especially when you’re not doing anything, 12, six 8, 12, maybe 16 weeks is a pretty consistent timeline for when healing should occur. Right? Meaning that if you’ve been waiting that long, whatever has been quote, unquote, damaged, is healed, and that there shouldn’t be any more pain. But this is tricky about about this is the tricky part about pain. And we’ve had other episodes about pain before. But this is where you’re, we’re seeing well, if load is causing arthritis, but yet this person, or tendinitis, but yet this person isn’t doing anything, why are they still having this knee arthritis, tendonitis diagnosis, when they haven’t done anything, there’s no load even involved, but yet they’re still getting labeled as the knee is the issue and there’s some sort of damage, and that damage is irreplaceable and that it cannot change. And that’s what’s so interesting to then, you know, kind of tie this all back. Remember, the conversation of load elicits an adaptation response of strength. If you’re not loading tendons, connective tissues, muscles and joints, they will actually, I’m going to say it, I don’t want to say it but start to degenerate and weaken, if you don’t use them. It is a use it or lose it principle, right? If I was to not exercise, my knees would start to regenerate faster than if I did exercise.


Anthony Gurule  18:37

Are you argumentatively some of the extreme case, extreme extreme extreme case of too much exercise might be leading to some more damage on certain things. But you have to consider those that are doing those,  they’re in tune with their programming, they’re in tune with their recovery, they’re in tune with their diet. Right. So the the likelihood of more inflammation and issues arising actually reduces. because in order to even do that much, you have to be dialed in. And outside of that, usually those individuals that have tendon issues or joint issues, they’re more accidental just based on sheer statistics of how many repetitions one might do and the likelihood of running into an issue of a bad rep or something happening. That’s the reason why not because they’re doing too much per se. And they’ve actually looked at this with marathon runners. marathon runners predominantly which are done on concrete and street running. They don’t have any more knee arthritis than a sedentary population that does not exercise and are in some would say an argumentavely based on the radiographs that they’re looking at that the sedentary population actually show more signs of degeneration than those who are running marathons and are more active. And they’re starting to dive into this more where when we look at the joint, the joint is essentially two bones that meet each other. Okay. And then within that we have a cartilage surface, which essentially is like a smooth surface, which allows for the two surfaces to rub together with less friction, okay, and they’re contoured based on the shape of the other one, so that you have this nice sliding and free free moving joint. Now that is controlled, and the amount of range of motion is controlled through the muscles, but also the ligaments. And then within that the majority of our joints are what we call a synovial joint. So there’s a capsule This is a fibrous capsule that holds synovial fluid within the joints. So if we look at, I’m going to describe this and also show up but if I have my two knuckles together as a joint, I have, per se a piece of saran wrap that attaches the two joints together. And then within that saran wrap, I have this like oil, this like lubricant and oil that helps keep the joint a little slippery and lubricated. Okay, it is a fluid. And that fluid has a number of different properties within it, which helps keep it healthy. But as with most fluids within our body, that fluid ebbs and flows and moves as a result of movement. So as an example, the majority of our venus return, while our heart is pumping, and we have blood pressure is pumping through the rest of our body. And that pressure helps return that fluid back to the heart, the majority of that is actually pumped back through our body through movements. So our veins don’t have any contractile or tensile properties like a capillary would or your arteries, right sorry, arteries, not capillaries, per se, arteries would. And so they’re basically just a hollow tube, but they have a one-way valve. So as I move my arm, my muscle actually contracts and that squeezes blood out of the system, it goes through the veins, and then that backflow valve prevents, prevents essentially blood from backing up.


Anthony Gurule  22:00

Okay, so the joints are, are very similar in the fact that you need to move the joint in order to move new synovial fluid in and out it. is constantly be an interchanged. That’s the recovery model that we’ve been talking about, right. Unlike your automobile, which does not auto generate that lubrication, you have to drain it and refill it, we’re able to constantly do that on a daily basis through movement. And you need to do that, because what they’re starting to see is that you’re actually starting to see degenerative excess growth and changes to the cartilaginous surfaces and bony surfaces as a result of not moving. Think of it almost like like, like a self smoothing piece of sandpaper where we have two joints that are moving together that keep each other nice and smooth, not so much that they’re grinding into each other, but just enough to just smooth it out. So we have this nice slick piece of ice that the two sides can can have a relationship with, which is fantastic, because that allows the joint to articulate. Now, the question that we commonly get when we’re talking about this stuff is like, Well, what about what about a crunchy joint? Does that mean there’s more crud or crap in there that’s causing that’s, that’s going to be chipping away and wearing and tearing at it? No, it doesn’t. Now there are instances of a loose body where you have a fragment for whatever reason that has come off. But the majority of this is again, we have two surfaces rubbing together, you’re bound to get a little friction, and you’re bound to get some crunchiness. But you also have ligaments that are rolling over bones, you also have muscles that are moving, there’s a number of different factors. So if you have if you have crunchy joints, which we’ll do another whole show on, this probably does not mean that you’re wearing down the joint, you just have two surfaces rubbing together. Now it wouldn’t be different is if you move the joint and you had a significant pop or sound and there is a pain that listed with it. That could be an indication of potentially something more but we’re not talking about that right now. Right? We’re talking about two joint surfaces that need that need to rub against each other to help auto regulate their their borders and their surface in addition to moving more as helping synovial fluid pump in and out which keeps your joints nice and lubricated. All of which keeps a nice healthy joint so that you can load it and then you need to load it enough and more so that you reach the zone of adaptation to elicit and keep this auto regulation or auto regenerative properties going on. That is the whole reason why movement and skeletal muscle density which then in turn leads to healthier joints is a huge proponent of longevity. The more the more mobile you are right, the more you’re able to move around on your own, the longer you are more likely to live. Those that are required to have more assistance for basic movements, their mortality rate goes up. So if anything if all you do to live longer, is keep your muscles in your joints healthy. That’s good. Now the same goes true. That’s just a side note, why there’s a lot of talk about brain health and brain activity in stimulating your brain. It’s our body regenerates based on external stimulus. So if you externally stimulate your brain, if you externally stimulate your muscles, your joints, your tendons, you will continue to make them stronger. Now what what commonly happens is we get tripped up in this. And I’m not saying this completely wrong, but we get tripped up in this model of lightweight and high repetitions, assuming that heavier weight is more damaging, again, more damaging to our joints and our tendons and ligaments. That is not the case. There are benefits to a lightweight high repetition methodology and programming. But that is not the sole focus, there is a ton of benefit with doing slightly heavier again, relative to you. Resistance training, to again, elicit proper muscle adaptation, growth, strength, neurological conditioning, as well as conditioning for your joints. Now, even more important than that is full range of motion. So I was having this conversation with someone else earlier this week who was complaining of neck pain. And I hadn’t seen her for a year and a half for a few different reasons. But we were talking about workstation, ergonomics, and posture, and I just did an Instagram video on this as well, where I don’t demonize posture, I simply have a conversation about how posture should be dynamic. And yet we run into static positions from time to time, like I’ve been sitting here with you guys for 27 minutes. Now, I am hunched and I’m over. if I was to be doing this for 56468 hours a day, that might start creating some issues within my back, because I’m simply not moving the joints of ligaments, the tendons. See where we’re going with this, right. But what we start to see is, we live in this world, I am framing the image of me right now on the camera, I’ve only been looking here, and the majority of us, we only look here throughout the whole day, maybe down a little bit to a phone or a book or a laptop. But when was the last time you’ve literally looked all the way up towards the sky, right, or keeping your shoulders square as far left as you can. And as far right as you can. when was the last time you turn all the way to the left, or all the way to the right. When was the last time you took all three of those planes of motion and combined them together. So for instance, I could tip my head back to the side and then rotate left or right. So it would look something like this if you’re watching. Right, so I’m carving out this this 3D representation of all of the possible range of motion and positions that my joints should be able to go into. Now I’m not saying you have to use every single joint through its full range of motion every single day. While that would be awesome and ideal, it’s usually not going to happen. But for shoulders, when was the last time you extended back as far as you can, thus creating a lot of tension in the front creating restrictions within the joint. For the spine, we flex a lot. But do we typically don’t go through like a lot of true good flexion and or extension, not to mention lateral flexion and rotation. So we see while we’re trying to do our best efforts of exercising even functional training, which is, you know, just plastered everywhere. We still miss out on so many opportunities to condition, the muscles, the tendons, the connective tissue and the joints by going through just proper range of motion. Now this is not stretching per se, This is a movement modality if you will, which is specifically intended to elicit using your joints through full ranges of motion, right?


Anthony Gurule  29:00

So how would that look, let’s just, we already gave the the example of the cervical spine or the neck. for your wrist, it might just be some wrist circles, right? We’re constantly in flexion. Very rarely, we might be going up and down, side to side or rotation or any combination of that. Right. the shoulder we already talked about, a flexion we do a lot of flexion. And you know kind of out to the side. But even just bringing our arms over the head, it is surprising actually some of my patients who have not lifted their head, their arms over their head and in a while. I’ll say that right? And it creates a lot of stiffness around the joints. you can get it back but it makes it a lot harder if you haven’t done it in a while. now on top of just the shoulder. The hip. while we sit it goes through some flexion we walk it goes through a little bit of extension, but we hardly challenge it into internal rotation, external rotation or a reduction or bringing it away like we would with our arm So what I want to challenge you guys to do, and I don’t have I had a previously done like mobility challenge, if you will not like a competition or anything like that, but just encouraging this principle of moving your joints throughout the day and, and this, this reminds me, I need to revamp that and update that. But I challenge you to take and think about all your joints. And think about different ways in which you can move that. now you don’t have to be, you don’t have to be a chiropractor or, or a personal trainer or movement coach to do this. Most people understand movement to a basic degree, right.


Anthony Gurule  30:45

So for instance, let’s start with some of the more simple ones, your toes. your toes are flat when you’re on the ground. And then when you walk, they go through extension, so they bend up, right to propel yourself going forward. without shoes, when was the last time you will curled your toes underneath and kind of got the tops of your toes on the ground and push down on them, creating toe flexion? I guarantee I guarantee the majority of you haven’t done that in the last day for sure. The last week, and I bet the majority of you have not done that last month. Now, why does that matter? What’s you know, I don’t have any toe issues or pain like I’m doing just fine. Yeah, true. I mean, but I’m coming at it from a different model, right? As we already indicated, the movement model for mortality is is directly correlated, right. And what’s one of the main things that you need to be able to do as an adult as you grow older to regain and have as much, you know, independence and control? walking. So, you know, I would hate for anybody to have such stiff feet and toes, that walking does become painful. And I’m not saying it well, this is not a this is not a scare tactic, saying if you don’t stretch your toes, you’re gonna die sooner. That is not what this is. So, you know, calm down, all y’all out there. But this is just a brief example to explore and see how to take the movement process of just simply moving aside from stretching aside from strength training, both of which are still important, and just trying to move the joints through all this range of motion to re-lubricate your synovial fluid, to smoothen out the surfaces that are gliding against each other, to strengthen the connective tissue that surrounds it to densify and make stronger the tendons and the ligaments that are also there. Right. But again, there’s a load principle, you cannot just  mobilize and stretch your way to stronger, healthier joints. there is an element of loading that has to happen. We’ve talked about that loading the adaptation zone. And not enough is not going to elicit what we want. But yet sometimes too much. Most people assume we’re in the too much when I actually think we’re actually in the not enough. But yet, then we want to make good changes. And then we see this spike, remember the story of the crossfader they were lifting before we know they had good strong joints, but yet they did or sorry, cross it or hit training. But yet over the last six months, they change what they are doing, we saw a significant spike in load of the bicep tendon based on the activities that they were doing over the last six months. And we can then make a pretty accurate prediction and assessment that that was probably the cause of it. So just because we’re down here, majority of time, we call this the weekend warrior right? Throughout the week, most of us aren’t doing enough, we’re more sedentary than not but that on the weekends, we want to go play and we want to go play hard. And so we do a 20 mile bike ride, or we do an eight mile trail run. your body’s not conditioned to do that–the tendons the muscles, the ligaments have not been conditioned and densified and strengthened enough to withstand that. And then you see this tendinitis or joint pain or arthritis response because of a peak in loading not because the consistent thing so that’s where working with a coach is so beneficial.  they’re more or less just there to help you manage load to reduce injuries to get you to do the most that you can by also reducing injuries by keeping you know kind of control and reins on how far and much you want to push. athlete dependent, person dependent, recovery dependent. Okay, but I hope I hope that this at least sparked some questions that you can ask your providers. I hope that it gave you a little bit more confidence in your joints condition that the majority of you most likely do not have this life altering joint arthritis that’s going to require a replacement– a quote unquote replacement down the road, or significant tendon damage that you’ve been told, Well, you know, just keep going until it gets really bad. And then we’ll just do surgery on it. No, there’s so much you can do, you just need to know and understand the appropriate amount of what to do. And if you don’t know, that’s why there’s professionals, skilled chiropractors that are good at rehab, skilled physical therapists, and honestly, really good personal trainers and rehab professionals, that know training and loading would be phenomenal.


Anthony Gurule  35:32

And sometimes it’s just a console, hey, this is what’s going on. What do you think, Oh, well, what are you doing? And we go through the conversation of figuring out how much you’re doing? Is it too much? Is it too little? could you supplement some additional prehab,rehab, or strength training movements to further strengthen the ligaments connective tissue, and joints so on and so forth. And and I think that would be highly beneficial.


Anthony Gurule  35:55

Now, as a caveat, because I have heard this said before, and I just don’t want people to get caught up in semantics. Someone was arguing essentially, like joints, you can’t strengthen joints, you know, indicating that strength training doesn’t strengthen the knee, you can strengthen the muscles around it. But when we’re talking about strength then, think of it as again, like craving more density, making it more resilient. So in my mind, you can strengthen a knee, you can strengthen the cartilage, you can strengthen the bone, you can strengthen the ligaments around it, all of which can be strengthened because of the load response, the impact that’s actually being absorbed into the body will then feel oh, I am getting more load into me, I need to thicken, I need to strengthen, I need to become stronger to withstand what’s being asked of me.


Anthony Gurule  36:51

So I have confidence in you, I hope you have confidence in yourself. If you don’t you need someone in your corner that can help you gain that confidence to create more positive experiences with movement. No one wants to feel limited by basic activities, right? You want to be able to do the things that you want to be able to do. Now, There are things that I was able to do when I was younger that I’m currently not able to do if I wanted to do those I could, but I don’t have the time, or the training plan to be able to accomplish those right now. So don’t just assume that “Oh, I used to be able to do those things I’ll never be able to,” it all comes back down to the proper training and loading to help squash arthritis to help eliminate tendinitis, whatever it is that you feel like you’re struggling with. I know this can help.


Anthony Gurule  37:45

Live LOUD Life podcasts. Thanks for tuning in. If you got a buddy who’s you know always like oh my tendinitis is flaring up or, you know, my arthritis is so bad. Share this with them. you know, it’s it’s extremely helpful conversation, if not at least provide some ammunition so that they can go to their order their PCP or whoever is harping on them about arthritis and tendonitis and start asking some better questions, helps them start Googling maybe some different providers in the area to help again, create that confidence in your body so that you can move your joints more, make them stronger and live longer and live a loud life. Thanks, guys. See you next time.

How Holistic Dentistry Can Help With Jaw Development & Breathing EP|60

Live LOUD Life Podcast
Lafayette Colorado

Episode 60

How Holistic Dentistry Can Help With Jaw Development & Breathing

With Dr. Liz Turner

Tongue ties, mouth breathing and open bites are some of the conditions we sometimes take for granted in oral health. In Episode 60 of the Live Loud Life podcast, Dr. Liz Turner joins Dr. Antonio to discuss how holistic dentistry helps patients smile confidently, breathe clearer, and live healthier lives.


Episode Highlights

  • The difference between general dentistry and holistic dentistry
  • Detecting and correcting abnormalities in the oral pathway
  • How changes in our diet could change our jaws
  • Why facial musculature affects breastfeeding mechanics
  • Symptoms of tethered oral tissue or a tongue tie
  • Just because a condition is common, it doesn’t mean it’s normal
  • How mouth breathing impacts babies

About Dr. Liz Turner


  • General dentist
  • tethered oral ties advocate
  • mother

Connect With Dr. Turner 


Dr. Antonio: Welcome back to Live Loud Life podcast. I’m your host, Dr. Antonio Gurule and today I’m joined by Dr. Liz Turner. Dr. Liz and I co-manage a lot of patients, especially those that have tethered oral ties or tongue ties as they’re most commonly known. Actually, I’m going to see her myself soon, hopefully. My kids see her for some orthotropics which is where we want this conversation to go, kind of above and beyond tongue ties. Welcome, Dr. Liz. Please introduce yourself, give your social plugs, your websites right off the bat so people know who you are.


Meet Dr. Liz Turner

Dr. Liz: Hi, I’m Liz Turner, I’m so excited to be here. I am a dentist in Lakewood, Colorado, so I’m not too far from these guys. We work with a lot of families in the metro and surrounding areas and I have a couple of practices in one location–Fox Point Dental and Bloom Center for Sleep and Airway Health. I’m a general dentist, so I don’t just see pediatrics but I do see the manifestations of some of the issues that we can touch in the pediatric population in the whole lifespan. And so it’s really fun to put all the pieces together and start to really look at the root cause of a lot of health issues and how we can treat them from a dental perspective.


Dr. Antonio: That’s awesome and I want to segue right off of that. Before I knew this other side of dentistry, I guarantee the majority of people when they hear dentist, it’s cleaning cavities, so on and so forth. How does what you do differ? I know that could be a very loaded question, but differ from like the traditional dentistry that we know of cleaning cavities, so on and so forth.


General Dentistry vs Holistic Dentistry

Dr. Liz: Yeah, that kind of hops into my story a little bit. I was a general dentist for seven years, having had my own dental trauma and spent a lot of time in the dental chair. I grew up in a community in Maine where we didn’t have fluoridated water. And as dentists we are like, oh, fluoride this and fluoride that, and you have to have that in the water to be preventing decay. And so I just looked at dentistry as fixing teeth because cavities develop, and how do we prevent cavities? It took seven years for me to really look at, oh, my gosh, there’s so much more. I just thought I was in the wrong field.


So from Maine originally and then practiced kind of all over the place from Albuquerque to Minneapolis. I had my son born with an oral restriction (a tongue tie is the common name) and didn’t really know anything about it, just thought babies cried a lot. We ended up having him treated because I was able to find a dentist who had a laser. I didn’t have a great team in place, I didn’t really know anything about having a team, and it sounds weird to have a team for a tongue tie but we’ll get to that in a couple of minutes.


Shortly after I had him treated, my father-in-law had a heart attack because of years of undiagnosed sleep apnea, he had some AFib that developed and he threw a clot. And I’m just the dentist but I was like there seems to be a little bit more going on here. Then we started to look at his oral cavity. He’d had a stutter since he was four years old, he’s got his own oral restriction, a narrow arch, a high vaulted palate, real tall and lean so you never would think he’s got sleep apnea. It took a long time to get that diagnosis and at the end of the day, I mean, how many years does a heart attack take off somebody’s life? He arrested in the doors of the emergency room and was in a medically induced coma for six days.


It just makes me nervous that we’re not looking at trying to prevent these incidents from happening, we’re just looking to treat them when they’re happening. I started to connect the dots and looked at my own family and recognized, oh my goodness, as a dentist, we can see a whole lot of this sleep stuff. And at the end of the day, we need oxygen more than anything else and so these little tiny events early in life and through the lifespan, in the middle of the night when we’re not oxygenating properly, are really impacting our overall health. That’s a long, long answer of what do we look at, but as a general dentist, we’re trained to just look at the teeth and really we should be looking at the whole oral cavity and the health of the person as a whole.


Airway Assessments and What They Reveal

Dr. Antonio: I think that’s amazing, though, because I think something important you just said is “not properly oxygenated.” And what is the one thing that we do throughout the day more than anything? Is breathe, and that can be greatly affected by these things. One of the things that you were able to do (I wasn’t there during the consultation but my wife raved about) in your consultation of looking at our littles, is the airway passage. Can you walk through a little bit about what your assessment kind of looks like and what you’re looking for as far as how these developmental things are going?


Dr. Liz: Yeah. James Nestor put out this really cool book called Breath.


Dr. Antonio: That’s an amazing book, by the way. Sorry to interrupt. For anyone who’s listening, it’s not a clinical book. It’s very much a layman book, and he just talks about his journey so everyone should check that out.


Dr. Liz: He’s really funny. He takes his own airway deficiencies and like makes a big joke out of them but then fixes them and he references a lot of really great articles and things and so I think he breaks it down. It’s one thing to hear like me lecture about people’s airways all day long but it’s another thing to hear a journalist go on his own journey of plugging his nose and seeing how his sleep quality and exercise quality deteriorates. Because that’s another thing. From an athlete perspective, nasal breathing is at the end of the day what we should be doing.


Starting from infancy, babies are obligate nasal breathers so we really start to look at what the nasal passage is doing in our assessment. People come in for assessments and the first thing that I do is I just observe the person. Like are they sitting there really hyperactive? Especially the little kids, are they all over the place? And then I’m looking at are they just sitting with their lips kind of parted the whole time? Are they fogging up my mirror when I’m looking at them? Because if I’m seeing just this pattern of obligate mouth breathing, then I know that there’s something wrong from the beginning. And then we start to look at the shape of the palate, the narrowness of the arches. Because behind our dental arches is our nasal passage and our oral airway passage and if the nasal passage isn’t working well, then the oral passage will collapse and will cause these events in the middle of the night. So there’s all sorts of things that we see in the teeth and in the mouth that give us these indicators that there’s something wrong with the whole system.


Dr. Antonio: This obviously is a kind of “it depends” question, I think. The earlier the better for anything, but how early do you start to see those nasal passage and oral pathways really start to collapse and change? Do you see them in toddlers or is it more like it takes years and you don’t see that until adulthood?


Dr. Liz: We start seeing this stuff at birth. A lot of the things that we look at from infants is we’ll ask the family if they’re congested and they’ll say, oh, yeah, in the middle of the night. They’re like, you know, we’ve got to clear those boogers every morning. That’s a sign to me that there could be some aspiration into the nasal cavity that’s going to make it difficult for nasal breathing and the baby’s going to become more of a mouth breather. And once they become more of a mouth breather then the turbinates get inflamed and a lot of times the palate is going to form really high and vaulted and that’s going to restrict the nasal cavity even further.


Abnormalities in the Oral Pathway Can Be Corrected

We’ve all heard of the movie Napoleon Dynamite or the cartoon Beavis and Butt-Head, but we start to make a joke out of people’s anatomy and we start to normalize some of the patterns that we see in these obligate mouth breathers. The face will start to elongate because if we think about that, form is going to follow function. If we’re breathing through our mouth and our tongue is resting low, then the mouth is going to open and the face is going to develop in more of an elongated fashion and that’s just going to narrow the passages even further. It’s just this like cyclical growth pattern that happens because most of the cranial facial growth or the jaw growth happens before the age of six. If we don’t catch this stuff early in little kids, then we have some correcting to do later on that’s a whole lot harder, but can be done.


Dr. Antonio: I’m just thinking about myself being obviously older than six. What is it, 25 years old is when adults are pretty much skeletally mature, you’re not really growing at all? Are you able to make substantial changes in adults that are having these things or is it really kind of like we can improve things but we’re not going to really be able to make like profound changes within the bony structure, if you will?


Dr. Liz: Well, we can make changes in the bony structure. It differs male versus female, age dependent, but the cranial sutures don’t really fuse until the seventh decade. We have a lot of different appliances that can be used. Some of those have a minor surgery that goes with them to make that true sutural change. Other times, we can just increase the oral volume with things like Invisalign or teeth-uprighters to just make more room for the tongue. Because if we think about what the tongue is doing, it’s got to have room to live. If it doesn’t have any room to live, it’s going to live back in the airway and it’s going to essentially choke us or we’re going to open up our bite because we have to swallow and push our tongue forward. We start looking at this stuff early so that we can correct the foundation, so that we can build the house of the teeth, so we can line the teeth up on the right foundation, if that makes sense.


Dr. Antonio: Yeah, one hundred percent and we’ll make this alive for anyone who’s watching. I know I have it, my teeth in the front don’t close. The thing that was always like a joke for me is I could never eat ham and turkey sandwiches when I was little because I would just grab the bread and slide it off. I could not use my incisors the way they should be used and my palate is very high. I’ve worked hard on trying to improve nasal breathing, but I definitely know I’m someone who, at rest, I’m commonly just jaw mouth open. Like it just drops and it opens. Fortunately, I don’t have a lot of allergies or other things like that but it’s what you didn’t know, you didn’t know. When we were younger, this was never a conversation of anything that was happening.


Dr. Liz: You live a healthy life so you probably have a lower inflammatory diet that you prescribe by so you’re lower in some of those inflammatory proteins. What’s normal for you may be really sick for somebody else, if that makes sense. At the end of the day, it’s all about inflammatory processes and oxygenation.


Here’s Why Our Jaws Are Shrinking

The things that we look at early and what’s causing all of this stuff. In 2016, a study came out of Stanford that showed us that our jaws are essentially shrinking. And there’s another great book out there that’s written by an orthodontist, it’s called Jaws. It talks about how our genetic profile is really for 32 teeth but over time we’ve needed our wisdom teeth out and then there was a push to take out premolar teeth because there just wasn’t enough room for them. The introduction of the Western diet where we aren’t hunter gatherers anymore (we’re not like out killing our food and then cooking it over a fire and eating it, masticating as much as we used to) means that we’re not stimulating the stem cells around our teeth and so our jaws aren’t growing to the size that they should. Okay, that’s fine. I wouldn’t really change the fact that I have the conveniences of modern life but I do think it’s important for us to be aware that a lot of our children and ourselves are going to have some things we have to make up for and so a lot of that is the orthotropic stuff.


Dr. Antonio: For anyone, there’s the book.


Dr. Liz: Oh yeah, you’ve got it. Sandra Kahn, that’s a really good one, too.


Dr. Antonio: What was interesting, because I just had this conversation with a mom who brought their baby in for a consult for oral ties, it’s the same conversation and James Nestor talks about this in his book as well. He goes across multiple different civilizations and cultures, talking about diet and how the diet has also changed, and how essentially from that hunter gatherer perspective, but also just more palliative foods, just softer foods. When I was talking about it I was like when you think about it, what’s baby food? It’s just mashed up stuff. Whereas if we just were breastfed until then most cultures were just going to have some form of baby led weaning–softer foods still because they don’t necessarily have teeth–but they’re working on harder foods to actually develop more strength within that. But it’s hard because nowadays everything is semi processed, most things are just softer.


Dr. Liz: Yeah. And if you look at a lot of the marketing out there for some of the foods, it’s like “oh, melt in your mouth.” We don’t really want stuff to melt in our mouth! I understand that we need to do the early solids safely and there are ways to do that. There’s a lot of great feeding therapists that have recommendations for that and I do think that the baby led weaning approach is a really appropriate way. I’m not super strict about it because I do understand that we don’t want to force kids to do things that they can’t. Especially when we start to talk about the tethered oral tissue stuff, a lot of times they can’t safely form a bolus and so these kids are pegged as like picky eaters or they’ll hold food in their cheeks, they can only tolerate certain textures. But I do think it’s super important for us to introduce things that they have to masticate so that we can get the jaws to grow. That’s one piece of the puzzle.


Some Effects of Abnormal Facial Musculature

Another piece is what are the mechanics of the face doing? It’s funny because we think about the rest of our body and everybody’s like, oh, you’ve got to work out, you’ve got to tone, you’ve got to do squats to increase your glute strength. But nobody ever talks about the musculature of the face. Swallowing, we have to use eight different muscles and our tongue is made up of four muscles. If we’re not using those muscles appropriately, then we’re not going to develop the way that we’re supposed to. The lips and the cheeks essentially are supposed to be passive, they’re supposed to be nature’s braces, and the tongue is the one that’s supposed to be nature’s expander. It’s supposed to drive up to the palate and be able to effectively and efficiently breastfeed.


When we talk about breastfeeding medicine, at the end of the day, I want what anybody wants for their breastfeeding journey and that could be to not do it at all. But at the same time, I also want to know what the breastfeeding mechanics are and that they’re working really well. Because that shows me that the swallow pattern is developing well so that we can have appropriate swallowing pattern and retention and size of our jaws early on, and keep that going through the rest of their life. Like you pointed out, you have that anterior open bite, so likely you have what’s called a reverse swallow or a tongue thrust. And that’s just a retained reflex from the early childhood, so the first six months of life, because they have this infantile swallow pattern and a lot of times it just doesn’t go away. That’s not to say like bottles are bad or pacifiers are bad. There’s a starting point and a stopping point and I have opinions on all those things, because I have strong opinions on all this stuff, but we just want to know that we can get that swallow pattern corrected so that you don’t end up with that anterior open bite.


You’re a man, so women have lower levels of testosterone. Women that have that reverse swallow pattern, we see a ton and I’m sure you guys see this all the time in your practice. We see so much head and neck tension, forward head posture, tight muscles. And women will report, oh, I just hold my tension there. It’s not necessarily they hold their tension there; their tension just can’t go away. Because when we swallow 2000 times a day and we’re putting constant forward pressure on our hyoid bone (which is where our tongue attaches) and our hyoid bone is attached to all our strap muscles, we’re going to have so much of this head-neck shoulder tension traps. We see tons of migraines.


And it’s cool, because when we do some of these releases in conjunction with bodywork and proper therapy beforehand, what we hear six months later is that the tension just kind of like melted away. We’ll hear people just say, oh, yeah, it just doesn’t sit in my shoulders anymore and my tongue just sits in a different spot. I look at this tongue tie stuff as just one piece of airway puzzle. It’s really important for us to have the proper mechanics and the proper position but if we don’t have the proper foundation, then we can sometimes have some things we have to correct, if that makes sense.


Dr. Antonio: Yeah, that’s amazing. Based on what we knew at the time when I was younger, I went through speech therapy to try to assess the tongue thrust, all sorts of expanders and tried the things that help. And it helped but then once everything was taken away, it just reverted back to what it was. Because of what I know and what Nichelle has looked at me on, there’s just tension there that can’t really go away until something is actually done about it.


For these littles, we’ve seen co-management notes and certain things like that. We obviously look at a lot of the same things, but walk us through a little bit about the questions that you ask parents that would indicate a possible tongue tie or tethered oral tissue.


Diagnosing a Tongue Tie

Dr. Liz: Looking at babies before they’re even born, we can look at the familial pattern. A lot of the individuals that we treat have some type of an MTHFR mutation. We do know that there’s some type of a correlation between the MTHFR pathways and the methylation pathways and folic acid. People say, oh well, should I take a folic acid supplement? The reason we started supplementing with folic acid was to prevent things like spina bifida. We’re looking at a lot of the midline defect stuff. When I’m starting to talk to families about this stuff, they’ll walk themselves through and they’ll say, oh yeah, I know I have that MTHFR mutation or I know I have a family history of tethered oral tissues or tongue tie. I do think a lot of these are undiagnosed and so I think a lot of people don’t realize that they have it and a lot of times once we start looking at the baby, we start to realize that a lot of the family members do.


When we talk about the way that the midline forms, the tongue forms at 12 weeks in utero. It starts forming earlier than that but these tissues, the collagen frena, that are oftentimes too tight in these individuals, it starts to separate at 12 weeks in utero. And when it doesn’t separate completely, it’s kind of like the webbing in our fingers and our toes. If it doesn’t separate completely, they’ll go in and they’ll surgically correct it. The problem is we’re not really looking at these in the proper ways to diagnose them to know what to correct, unless you’re working with somebody trained to do so. I think a lot of the individuals that are able to diagnose–pediatricians, ENTs–they unfortunately can diagnose but they don’t have the ability to do it well because they were never trained. They get like an hour on the mouth. And even ENTs, I find that they’re not properly elevating the tongue to really look for the restriction.


The things that we look at in babies is body tension. We’ll look to see if they have like really tight balled fists or their feet are just flexed really tightly. We’ll see a lot of patterns of like torticollis or we’ll see plagiocephaly (flat spots on the head) and that just shows us there’s a lot of body tension. That’s what I work with you guys in conjunction with. Because if there’s tension in the mouth, which is kind of where we form from in these branchial arches, and it goes down through the rest of the body, then we’re going to have retained tension. What that’s going to do is it’s just going to mean that we’re never going to be able to relax the rest of our body to swallow appropriately.


And then we’ll also see a lot of cranial nerve restrictions. There are some cranial nerves that come out of the base of the skull and when those come out of the base of the skull and we have some birth trauma (whether it be like a vacuum assist or a C-section or just birth in general because it’s pretty traumatic), we can have some compression of the cranial nerves that can lead to some motor issues with the mechanics of the tongue. That’s why we like working with you guys because you guys rule that stuff out so we can really look for the true restriction.


When somebody comes into our office, what we do is we talk about all those symptoms and things we’re looking at are like colic-like descriptors. Some babies will be diagnosed with colic–which isn’t really a diagnosis, it’s just a descriptor of crying. And we’ll look for reflux, so aspiration in the nasal cavity, congestion. We’ll look for hiccups. A lot of times these babies will have had hiccups even in utero, because when they start swallowing at 30 weeks, they’re still not swallowing well.


Dr. Antonio: That’s interesting.


We Often Normalize Common Abnormalities

Dr. Liz: Yeah. I always ask, whenever somebody checks hiccups on our intake form, I’ll ask if they had them in utero, and they say “oh yeah, like four or five times a day.” And I didn’t want to believe it till my own kids, but yeah, every time. We’ll look for a central lip blister, so like a little blister in the middle, and that shows us sometimes the lip isn’t flipping to more neutral. We’ll look for cobblestoning of the lips which looks like little blisters, and they’re friction blisters. There was a post recently somebody pretty well known put out saying that they’re normal and common isn’t necessarily normal. So they’re common but I wouldn’t consider them normal. I would consider them a compensation that the lips are working way too hard and the tongue can’t really function.


Antonio: I had that exact same conversation this week. Just because we see it a lot doesn’t mean it’s necessarily normal.


Dr. Liz: Yeah. And that’s the thing with mouth breathing too, like we see it so much. So many kids right now are just underdeveloped and can’t breathe. And I’m super worried about what our population is going to be like in 15 years. Like we think we’re seeing illness now, we’re going to see a lot of illness in the future. Some of the illnesses, they’re big and they’re hard to treat. Like anxiety, depression, Alzheimer’s, dementia, cardiac disease, diabetes, obesity, all this stuff is related to like cortisol production and lack of oxygenation. It’s not just a breastfeeding issue that we look at but it’s so much more than that. Plus the aesthetic profile, like that big broad smile and the ability to show your teeth and keep them clean. Because when we mouth breathe, we have a lot of bad breath, we have more cavities, we have yellow teeth, so it’s like an aesthetic and confidence thing too. There’s a reason that a healthy smile is looked at as like nice looking.


Difficulties with Breastfeeding

Dr. Antonio: Which is definitely a much harder conversation to have when, first and foremost, breastfeeding is what’s challenging and they’re kind of on the fence about it. I don’t use the word invasive per se, but I’m like it’s definitely a procedure that’s not taken lightly. But when you’re looking at checking all those boxes and, you know, looks like a duck, walks like a duck, it’s probably a duck. But let’s look at beyond, right. Like I know a lot of this is newer and you can’t imagine what your kid is going to be like in 15 or 20 years, but we want to set them up for the best success as possible. And having this small little blip in their journey, of doing a revision, could mean the world of difference for certain things.


Dr. Liz: What I tell families is when we start talking about it all, they’ll really start to see the pieces in themselves. And they’ll say, oh, yeah, I had that small jaw and I had to go to speech therapy and I sucked my thumb and I didn’t like a lot of textures. And they kind of relate it to themselves and they realize that those things made them unhappy. And I say I don’t have a crystal ball and I can’t control every factor, but this is one thing that we have control over, and that’s developing the function early so that we can try to at least mitigate and lessen the severity of some of this stuff. Like you needed three expanders, maybe your kid will only need one. You needed jaw surgery, maybe your kid won’t need it.


At least if anything happens… Even in like removing tonsils and adenoids, because when we look at tonsils and adenoids, it’s all from mouth breathing. The family will say, oh yeah, I had the tonsils out. I’ll say, oh, how did that feel? And they’re like it was awful! And they’ll remember that stuff. When we look at like tonsils and adenoids, that’s just a filter. These are a filter and our nose is supposed to be the filter and we’re all obligate nasal breathers from the beginning. The turbinates are enlarged and so, on first latch, it distracts the baby so that they actually begin to breathe through their nose. And if we’re not able to get that latch for whatever reason… and ties are a big one.


Also, I hate to say, like some hospital support is not doing the service for our families that we need. They just say, okay, here’s that bottle. And I know there’s been a big push in hospitals to really try to promote breastfeeding, which is good as it is a big, big health thing. But yeah, so tonsils and adenoids, if we don’t correct the pattern of mouth breathing in conjunction with tonsils and adenoids, we’re still going to see snoring and sleep disordered breathing 12 years later. So we have studies on that.


Dr. Antonio: Two questions. I don’t know enough about the actual curriculum of becoming an IBCLC, but one of the main things is hospitals definitely are promoting it. Like, hey, go see the lactation consultant. But from the consensus, they are not able to actually diagnose these things.


Dr. Liz: Yeah. And I think that’s unfortunate because I do think that the training, just like dental training and speech training and lactation training, it’s a little backwards. We’re not looking at the beginning to the end. We look at the end, like there’s the speech problem. There’s the dental cavity and grinding. There are lactation issues, just give them a bottle. We don’t look at the reason that these things are happening and we’re not trained to. So I can’t fault somebody for not recognizing this stuff but I do think that there should be a subset of IBCLCs, who have a particular skill set and ability to assess the function that should be able to be diagnosed.


It’s fine, I feel like I have a relationship with IBCLCs I work with where we can really talk about the nuances from the functional and the structural things that we see and we can like co-diagnose, if that makes sense. They’re really careful to never diagnose. They say ultimately you have to do that, but they’re really forward in telling me these are the issues that I’m seeing and these are how I think that it’s being affected. But I do tell people your hospital-based lactation is great for the first couple of days of life and then you’re dismissed. I think as a country, we should have access to and really be pushed towards getting additional lactation support. Because our pediatricians can’t offer that. They say they can but they’re not feeding therapists, so we kind of do our moms and our families a disservice by not really advocating for that.


Working as a Team to Provide Patient-Centered Care

Dr. Antonio: I agree. We obviously work with a lot of the same people and you know when they say certain things that you’re like, alright, they think that’s what it is. Which is great because the people that we co-manage with are so thorough with their examination and the notes that they share. It’s like, yeah, I pretty much almost know what’s going on based on what that other person saw. Which makes life easy for everyone because then you’re not having to like recreate the wheel of the diagnostic procedure and you’re just piggybacking off that other provider, if you will.


Dr. Liz: Yeah. And I think it gives families a bit of confidence in the team that they’re working with if they’re saying the same things just because it is a hard decision to make when it’s for your kid. You have a hard job of being the consenting adult for a little one that doesn’t really have a voice and you just want to know you’re making the best decision for your family and doing something that’s absolutely necessary. And I think all of us are really good at helping the family navigate the difficulties of it, even though it is challenging.


Antonio: Definitely. I did want to circle back there. You had mentioned thumb sucking. Do you find a higher prevalence with thumb sucking with those that have the tongue ties and/or prolonged pacifier use, so on and so forth?


Tongue Ties and the Thumb Sucking Habit

Dr. Liz: Definitely. I look a lot at what this does from a perspective of releasing oxytocin from the brain. The tongue is supposed to sit up against the spot behind the front teeth and there is oxytocin that gets released by stimulation of the palate. When the tongue sits low and we have to use something non-nutritive to soothe ourselves or make ourselves feel better, we’re going to see a higher incidence of the need to thumb suck, pacifier use, clothing sucking, hair chewing on, and ultimately like nail biting and oral fixation stuff. We even have some adults that come in and they report, you know what, sometimes I wake up and my thumb is in my mouth. Those are oftentimes the people that we find their tongue is resting low and not stimulating that spot to get that feel good hormone to be released in our brain. So yeah, we do really work hard to try to build the function of the tongue beforehand so that if we need to do any type of release, the tongue sits right in that spot and we can try to reduce those habits as quick as possible.


Dr. Antonio: We know with habitual training that things as far as oxytocin and all those things can be retrained. But something as far as like oxytocin which just has such a profound effect on how someone feels, just releasing that and doing some exercises afterwards, are you actually able to see those things mitigate and go away?


Dr. Liz: I look at the little kids for a lot of it. Because if we can just put something else in their mouth, whether it be their tongue or a different type of appliance, kind of like these little orthotropic growth appliances or a habit appliance called a Myo Munchee, we can oftentimes get kids to stop using a pacifier because we stimulate the tongue to sit where it’s supposed to. We get the tongue resting high instead of low. Just as an example of one of the appliances we use, but it’s got a little spot right at the top that the tongue is supposed to be stimulated to. And sometimes people will take little gelatin spots and put it up behind their front teeth to try to get the tongue to sit there. It’s really interesting how some people will remember their own history. They’re like, oh yeah, I had this thing that they put in my mouth, like a little ball that my tongue was supposed to sit against. So this stuff isn’t new, we’ve been doing it for a long time. We just haven’t been doing it as cohesively, I think, as we could be.


Antonio: That’s fascinating, that’s really fascinating stuff. This has been amazing I guess because we talked about the differences between our traditional dentists and obviously the dentistry you’re doing, and I know you explained it very thoroughly and well. We’re kind of different from the traditional chiropractic model so when we talk about chiropractic and how we practice, we always try to say “hey, this is kind of how we’re different,” outside of like the general big lecture series, if you will. What are some of the things you really like to try to educate people on in really kind of differentiating yourself from other dentists as far as this stuff?


Parting Shot from Dr. Liz

Dr. Liz: We look at ourselves as a functional dentistry. Basically, we’ll treat a problem when it’s there but we’re always going to try to look for the root cause of it to try to prevent it from happening again. When we look at the function of the system, a lot of it comes down to nutrition, breathing patterns and ultimately the stuff we just talked about. Where’s your tongue sitting in your mouth? What are your lips doing at rest? Because if we can control those things, we can control a lot of the dental stuff we deal with–clenching and grinding, broken teeth, cavities, gum disease.


All the stuff that people hate dealing with, we can control if we can get to the root cause. We’re really big in just trying to educate people on what their current health status is and also try to help them find answers. If it’s not something that we can help with, we can try to help find them the right person, whether that be an ENT or sleep physician, a nutritionist, naturopath, things like that. Because there are definitely things that I would love to learn more about in terms of the nutritional stuff and I’d love to be able to offer more of those services on my own, but I just know there are people with way better knowledge than me. I’m more than fine farming stuff out to other individuals who I know can help my patients.


Antonio: Well, that’s amazing. I know I was sold before wanting to come and see you but I know I definitely need to come in because there were so many things that you said where I was like, yes, that is literally me to a tee. I will make it very soon.


Dr. Liz: Oh, anytime. I’m excited.


Antonio: I am too. It’s actually quite profound like literally how many things you just said which I had come across before but never took that perspective, so that’s pretty cool.


Dr. Liz: And I promise it’s not just for my patients. Every member of my family is in some phase of airway development.


Dr. Antonio: That’s awesome.


Dr. Liz: Little and big, so it’s kind of fun.


Dr. Antonio: That’s perfect. Anything else you wanted to add before we sign off?


Dr. Liz: No, I just appreciate all you guys do. It’s so fun working with your patients and I just think you guys do a great job in really educating people and encouraging people, and it’s just awesome.


Dr. Antonio: We appreciate the same. It’s been awesome connecting with you over the last year, year and a half or so, and thank you for taking care of our littles.


Dr. Liz: Of course, oh my gosh, they’re so fun. We have the best time.


Dr. Antonio: They love coming in.


Dr. Liz: We’ll be in touch and let me know if there’s anything I can do for you. My Instagram, I’ve got like eight accounts right now but probably the one that has the most information on it is @DrLizzzT.


Antonio: I’ll put it in the show notes and everything and link it over. Hopefully that makes it easier for people to find you.


Dr. Liz: Awesome. I’m so excited.


Antonio: Well, thanks again. I really appreciate the time, and have yourself a great weekend.


Dr. Liz: You too, talk to you soon.

Putting the Cart Before the Horse

Should You Exercise If You Have Pain? EP|59 Live Loud Life

Live LOUD Life Podcast
Lafayette Colorado

Episode 59

Should You Exercise If You Have Pain?

Physical exercise has many benefits, but sometimes you experience pain as a result. Should you then stop training? Is it possible to prevent pain in the first place? In Episode 59 of the Live Loud Life podcast, Dr. Antonio answers these questions and more to help you exercise with confidence.


Episode Highlights

  • Understanding what pain means
  • Pain and the perception of pain
  • Different ways in which chronic pain presents
  • Should you rest and heal or keep training?
  • Pain can be a guide rail
  • What you should know about training in the presence of pain
  • Why you should audit mobility and strength capabilities
  • How Live Loud Chiropractic and Coaching can help

About Dr. Antonio Gurule DC



  • Father
  • Doctor of Chiropractic
  • Owner of Live LOUD
  • Personal Trainer & Health Coach

Our Mission

What’s up, guys! Welcome back to another episode of the Live Loud Life podcast. My name is Antonio, your host of the Live Loud Life podcast. My wife and I own Live Loud Chiropractic and Coaching here in Lafayette, Colorado. We are a family-based practice, we love working with the littlest of littles, all the way up into our generational health of grandparents and adults. Our big mission is we believe that families deserve more from their health care providers. We are trying to fill the gaps from the information that they’re maybe not getting from their OB, their PCP (primary care physician), but also the gaps from maybe their personal trainers or their coaches.


While we’re not saying we’re a jack of all trades, we really find that it’s important to connect all those dots and to help be that coach or liaison, if you will, to help our patients and our members really set themselves up and their families up for the best health possible. That’s really what our mission and our goals are. We love guiding you through the adventurous life you’re meant for and if we can do that in any possible way, shape or form, please do not hesitate to reach out and ask.


Overview of Today’s Topic

Today we’re going to be talking about pain. This is a topic that we’ve brought up in a number of different ways. I recently saw a post about this which coincides with the questions that we commonly get, so we just wanted to recirculate back around to this and have a discussion about it to see if it can help you with maybe some of the pain that you’re having. This is specifically towards pain when you are training.


Headline wise, clickbait wise, you see “do this so that you never have pain training ever again” or “if you have pain when training, do this and it’ll stop it.” And I’m not going to lie, I’ve been guilty. It’s what you’re trying to do. You’re trying to get someone engaged and curious about certain things because they obviously have pain. I just hope that I can have a better discussion around it rather than simply saying, “Hey, if you do this one small thing, it’ll eliminate pain.” Because we know that pain is much more complicated than just, “Oh, it hurts when I do this and thus if I just do this exercise or this stress, then it’s magically going to disappear.” That is not how it works. It’s obviously a lot more complicated, as we just stated.


But questions that we get are:


Hey, I’m having pain when I’m doing this exercise, what can I do so that I can continue doing this exercise? So obviously there’s a certain amount of discomfort or pain that’s making something not enjoyable for someone, that would normally be enjoyable.


Or vice versa: I’m having pain when I’m doing this exercise, is it going to get worse? That’s a loaded question that we oftentimes will get.


And/or: Hey, I’m doing this type of exercise, is there anything I should be worried about or mindful of so that I don’t get hurt?


There’s a lot of different ways in which training with pain comes into play. Based on the last question too, a lot of times people have a fear associated with a movement that they don’t even have pain for but they’re worried about it. Maybe because previously they’ve had pain or someone else that they know has had pain or gotten injured when doing it and so they’re going in with his hesitancy. Which is good, they’re being smart about it. Hey, what do I need to be mindful of or prepared about in case something does come up? We’re going to kind of just lay out in general how this conversation goes, and the background of this conversation always starts with a relatively simplistic breakdown of what pain actually is.


What Is Pain?

Pain is the perception of a stimulus within our body. For instance, let’s just use a pinprick or a thumbtack. If you hit that on your finger, your body’s going to feel that sharp point and that mechanical stimulation–mechanical meaning just like pressure, if you will but there’s obviously very pinpoint pressure. Your body will feel that and it’ll send a signal to your brain, and it’ll say pain and then you’ll get that reflex jerk. Depending on the type of pain, you might just do a short circuit where it goes through your spinal cord and comes back, so you have this jerk response of pulling away. The same thing happens when you touch something very hot, it’s just because it’s faster–we want to immediately move ourselves from that potentially harmful situation.


Now let’s say there’s something else that’s a little bit more slow burning, if you will. You’re running and your knee starts to hurt. Obviously, it’s not like a pinprick where you’re going to feel that pain immediately, but yet it starts to grow and fester and your body’s continuously processing like “hey, my knee is not feeling good, it’s starting to hurt, I’m running further and it’s starting to hurt more and more.” So you’re starting to process what the mechanical impact or stimulation upon your knee is actually occurring.


Perception of Pain Is Real Pain

That in a sense is how our body perceives pain, but again the perception of pain is what’s important. This is where things get complicated, right? Pain usually always starts when there’s some sort of a stimulant, meaning something elicits it. The pain can then linger. The reason why we say usually is, let’s take for instance phantom limb pain. Phantom limb pain, there’s obviously not a limb there but yet someone could still be having pain there. There’s a lot of research that goes on to like why that is and how to deal with it, but we also did see the initial insult was there’s a reason why the limb had to be removed. Or if it was abruptly removed like let’s say in an accident, muscles, bone, and nerves were all damaged in the process of that, so there was still an initial insult to the tissue. Insult meaning injury, if you will. And then we have the lingering pain afterwards because of that.


What’s really important to understand is that it’s the processing of that, so the brain plays a huge role into this. One thing that I definitely want to make clear is that pain is real. Pain is real and this is where it gets harder. Because of this whole pain science movement, a lot of times people have been pushing for pain is in your head and we can manipulate it and that’s an easier way to manage it. While it’s a perception of pain, yes, that’s our brain processing in our head, it is still real and it’s very real to the person.


Acute Pain vs Chronic Pain

This dives down a lot more into like when we start talking about chronic pain and different things like this. In the instance of training with and without pain, while chronic pain is definitely a scenario that we do deal with…. And I actually really enjoy dealing with chronic pain patients because there’s a certain element of confidence that we try to instill and push to help deal with that chronic pain. And so when we’re talking about training, that’s an important lesson, that’s usually where we start talking about is this acute or chronic? We have the conversation about how pain is perceived and what’s going on, but going through our normal diagnostic questionnaire:

  • Is this new?
  • Has it been going on for a while?
  • How long has it been going on?
  • Have you had recurrent injuries here before?
  • How many injuries have you had?
  • Have you had surgery, so on and so forth?

We really get an idea of what the tissue, what the body has gone through, to determine is this something where the tissue is actually damaged or is this something in which the tissue was previously damaged but yet our body is holding on to this lingering perception of pain? Because of a lack of confidence, because of a lack of preparation (meaning we didn’t rehab properly) or because of a lack of a strength (which kind of coincides with that rehab process). Those are all fundamental to understanding where the person is and what to do.


Identifying the Root Cause–Some Practical Examples

Let’s play out some hypothetical situations here. We’ll say someone comes into the office: My shoulder is hurting, it recently started within the last week or two and I’m getting a pinch whenever I do overhead lifting. Has this ever happened before? No. This is the first time, never happened before, I’m not sure what’s going on. Did I tear a rotator cuff? Very common question. What’s going on? Depending on the intensity of the pain, we will run through a range of motion, orthopedic tests, criteria, so on and so forth. But the question they have is, can I still train with this shoulder? The answer is yes, you can.


Now, is there going to be some quick and dirty things that eliminate the pain so that you can go back to doing the exact same thing that was causing you pain? There probably are a few little tricks that could help, but understanding the reason why is important in the first place. And the example we always use outside of trauma (meaning you physically hurt it with an accident or an incident.) In this case like for a shoulder, let’s say you were mountain biking and you fell two weeks ago and now lifting with your shoulder is hurting. Okay, we want to look at that fall. But if there wasn’t an accident, there wasn’t some sort of insult, then the likelihood of there being tissue damage goes down. Not eliminated, but goes down.


But there’s a reason why the shoulder started hurting with the lifting that you’ve been doing so then we go through and ask more questions:

  • Has your training volume gone up?
  • Have you increased weights?
  • Have you tried new movements?

So on and so forth, to kind of indicate to us maybe there’s something that we’re doing that caused that shift and that change. Which is, again, more likely the cause. And so this gives us a really good idea. Okay, now that we know how and why and what was happening previously, we can make a very good plan of attack so that you can keep training. So that we’re not losing, we’re not going backwards, if you will. We’ll allow you to train around the pain, multiple roads to Rome. We just have to understand, what are the things that are causing the pain? What are the movements that are causing pain and really making things worse? If we can’t modify, change those and work on technique, then we might have to eliminate them and do something else that replicates what you’re wanting to do but allows you to not keep picking at the painful tissue.


Two Ways of Dealing with Pain

This is important because I think people in this situation, they have very black and white viewpoints. Part of it is they just don’t know the modification process or how to kind of adapt. Which is completely fine and that’s what we’re here for, that’s what personal trainers and coaches are here for as well. But they either assume “it hurts and I just need to stop doing everything so that I don’t make it worse.” And that’ll help, but they didn’t deal with the issue on how it crept up in the first place. Or they have the “no pain, no gain” mentality and they think it’s just push through, push through, push through until it eventually just goes away. Can it work on both ways? Yes. One hundred percent, it can work on both ways. But is there a way to get us to where you want to be faster? I think so. And it’s just that whole method we laid out of understanding everything that kind of caused it in the first place right.


That is an acute onset type of thing, where we’re talking about something gradually coming up over the last two to three weeks. Usually these individuals are like, you know what, I can’t put a date on it. There was never a certain instance. I just know over the last few weeks it hasn’t been good and it’s not getting better because I’m still doing the thing, so on and so forth. That’s a very, very common situation. Plan wise, super easy. Just stop doing it, which is again what most medical providers will say. If you had the same conversation with the PCP or your primary care, they’ll just say stop lifting with your shoulders, let it heal. “Let it heal and it’ll get better.” Now, letting it heal puts us under the assumption that something was damaged or wrong in the first place, which is again very unlikely unless there was significant trauma.


That’s not to say that the tissue cannot be bruised or irritated. We use this concept of bruising very commonly because I can hit my leg on the corner of a desk or a table and have a bruise which would be micro trauma, if you will, but there’s no significant trauma to it. But yet I could be walking around with a limp for a little bit or it could be a little bit tight and sore (where I stretch and it hurts) and if I just let it rest, yes, it’ll be fine. But oftentimes, if you continue to move, it helps work through that bruising and helps keep the muscle from kind of binding up and spasming. And that’s really what I think is going on as opposed to this damage that needs time to rest and heal.


I think there’s a way for us to keep moving, which again, helps so many people just mentally. But not only that. Physically, where they feel so limited by having to constantly “heal” any little aches and pain that they feel, with the assumption that it’s always something that was damaged. I find that to be critical because if we always just say rest-heal, rest-heal, rest-heal, the first sign of pain or discomfort, we assume something is damaged, whether I tore a muscle or a ligament or something like that. Where it’s less likely that is the cause and there’s still more that we can do, and that’s super important. Specific example, though. Gradual onset over the last few weeks, could be last few months, depending on kind of what your load accumulation is, if you will.


Let’s use another example and we’ll just use the same thing–shoulder. My shoulders, I have been having this shoulder pain, it’s been going on for years. I hurt it a couple of years ago and I rehabbed it, I got it stronger, but it’s just never really been the same since. And once it kind of hit the status quo, it was basically like I’ve done everything I can do with it and I’ve given up on it. But yet, when you look at the things that aggravate it, the patterning of all the things that make it worse or hurt are almost the exact same. And this is very common for most injuries, just based on a mechanical loading pattern.


Pain Caused by Flexion Intolerance

For like lower back pain, the majority of people, at least that I see, are flexion intolerant. Meaning, when they bend forward is when it doesn’t feel as good and then they let it heal. A couple of weeks later, it’s good and then they do the same thing–back and forth, back and forth. How many times can you damage or injure it and then just let it heal back and forth? It seems a little weird, right? The shoulder is very similar. And we’re talking about a very specific population. We’re talking about training, we’re talking about lifting and training, not just an everyday person who’s not doing anything.


With shoulders, very commonly, we see pushing from a horizontal and a vertical perspective as being most aggravating for the front of the shoulder or the top of the shoulder. Yes, are there times when you’re pulling that can hurt? But I find that it’s probably more biased, that most of us are doing more pushing than we are pulling. And just the way that we’re loading the pushing as well is causing more load and aggravation to certain areas, such as the rotator cuff, bicep tendon, so on and so forth. Or training this “impingement” type of scenario where we’re constantly impinging it due to mobility restrictions. So injury previously caused some tightness, had some compensation patterns if you want to use that word. I like using just more altered movement patterns to achieve the task. It’s the same thing but it is what it is.


But what we see is now that we’ve rehabbed it, we’ve stretched, we’ve strengthened, we’ve done everything but yet we saw a pain, we never relearned or addressed how it happened in the first place. We commonly see this with pushing types of movements, whether that’s bench press, dumbbell press or even just your basic pushup. We see bicipital irritation and you can sustain a substantial flare up of tendonitis on this. And then you can rehab it, let it calm down, but you’re still doing the movement the same way. So oftentimes, we’re looking at this from a technique perspective of just understanding how mechanical load will stress you in areas, and what to do and how that can be the difference of training with and without pain.


It’s a trial and error. You have to understand that when you make cue and an adjustment, doesn’t improve it. Now, these are sometimes the tricks that we see, that if you have pain with the pushup, do this to eliminate it. Yeah, that can make a drastic difference and we see it time and time in our clinic care when someone’s having bicipital or front of the shoulder pain when they’re doing like pushups and we just cue how to tension better, how to draw back and support using the back. Oftentimes the pain immediately goes away, not because the bicep tendon is not still irritated or inflamed, but you’re not loading it heavier or putting more load to it, allowing it to actually calm down. That’s what you have to look at as far as being able to train in the presence of pain.


Pain Is Sometimes a Guide Rail

This is what I think is really important and this is off a case we had last week. This exact same situation. After we worked on the shoulder and addressed what we thought was to be the primary culprit of how she was basically dumping into the front of the shoulders because she’s hyper mobile in doing pushups. Can I still train even though it’s aggravated? Because her previous physical therapist was thinking it was a pec issue and an upper trap issue and told her to just let it calm down because they were really inflamed. Those weren’t the issue. The issue was the bicep tendon and the way she was doing pushups. I said yes, you need to train, I want you to train because the little bit of pain that you do have gives you a good rail guard of understanding how you’re loading. Whereas if you didn’t have any pain, it’s a lot more likely for you to just kind of fall into the same patterns.


So pain can actually be a very good guiding rail about how you’re moving and what ways we could potentially be moving more effectively and efficiently. Obviously, this is different than the no pain, no gain. If you’re training and your pain rails, your guide rails, you keep brushing up against them, you’re going to flare things up and make it worse. I’m not saying that you train in pain and you constantly are just bouncing around finding the edges until things get more flared up. You’re using it as a guide to make the appropriate adjustments so that you can continue training without significant pain. Because there is an element to training without pain but it’s not “no pain, no gain.”


It’s not uncommon and it is very common to have a little bit of aches and pains, to have a little bit of signaling. Pain is essentially your body’s way of signaling when things don’t feel right. It could just be tightness, it could be irritated tissue, it could be weakness. Weakness in the sense of like, hey, whatever you’re doing, your body might not be fully prepared to handle that load. And the muscles, tendons and everything are being maybe overloaded or overstretched. That’s going to send you a signal to say, hey, this is too much. Or slow down or de-load, if you will. These are all good signs to have if you have the understanding of what they might mean and how it is affecting the training that you’re doing.


Verbal Analog Scale of Pain

When it comes to rehab, getting back into training or doing something in the presence of pain or having pain, whether that’s newly acute or chronic, we use kind of like a green light system. And this is not something I created, multiple different providers talk about a similar system. But most people who are going to be training in the presence of pain, we’re looking at a pain scale of really no more than a 5. Like a 5 is fairly substantial. For those of you don’t know, I’m going to run down what’s called the verbal analog scale, it’s basically when someone asks you like rate your pain out of a 10. Sometimes they have like a smiley face, frown face, cry face, so on and so forth.


To give you a little bit better perspective of functionally what this means, if you have a 1, 2 or 3, you are kind of like I feel something but something is not right. If you have a 4, 5 or 6, it starts affecting your day. Example would be your lower back hurts, you’re having difficulty putting on your socks, your pants, your shoes, so on and so forth. If you have a shoulder, reaching up to the cabinets is kind of sore or reaching behind your car seat to reach for something can be sore. That’d be an idea of like a rough range of a 4 or 5 or 6.


A 7 or 8, you’re in tears. You come in and you say, yeah, it’s like a 7 or an 8 and you’re not like visibly uncomfortable, where you’re almost in tears. Just the smallest bits of movement or so are really kind of flaring you up and making you kind of like sweat or anxious or kind of tighten up–that’s a 7 or 8. And if you say a 9 or a 10, like you’re rolling around in pain. We’re going to call an ambulance, we’re going to get you to the hospital because we need to manage your pain with some medication or something like that. Like it’s that intense. That’s what we’re talking about. When someone comes in, they’re having a conversation with me and they say it’s a 9 out of 10, I know that’s not true. Whether you have a higher pain tolerance or not, when you’re in that much pain, you can visibly see it on the person’s face.


Training in the Presence of Pain

When we’re talking about training in the presence of pain, if you got a 4 or a 5, as we said, it’s already affecting your day. That’s going to make it a lot harder to train. Now, when we say train, there’s certain ways in which we can do it that are going to be helpful for the pain that you have. I’m not saying you just do whatever you were doing just lighter or slower (although that might be the case.) You might have to completely eliminate some things but we still want you training and moving and that’s the whole point.


If you’re at like a 1, 2 or 3, that’s a green light. You can still train. If the movements are starting to aggravate that pain, meaning that pain is starting to grow when you do it and/or if it’s worse after the day after, then you overcooked it and we know we need to modify and change things more. If you’re a 4, 5 or 6, that’s a yellow light, right? It’s like proceed with caution. Still okay but you’re going to be going a lot slower, you’re going to be going a lot lighter and we might be completely changing the movements that you’re doing to be more supportive with the pain that you’re feeling and where you’re at. Anything more than that, that’s a red light. Like if you’re in that much pain, yeah, training is probably not the best option for you.


But notice we did not say that at any point of feeling pain, it’s a no. So many times, we hear don’t train with pain. Don’t do anything if you’re having pain because you’re going to then create compensation patterns or you’re going to change how this is happening and this, and you’re going to create all these issues. And then it just turns into this cascading event of, well, a year ago you decided to train with pain and now you have this compensation pattern. No, it’s not. That’s way too complicated, way too involved. The movement process of training is what can actually be so therapeutic and beneficial for the majority of injuries or pain conditions that we’re talking about.


This is all predicated on the understanding that most of what we’re talking about are not significant injuries. You can have a full-blown rotator cuff tear and not a lot of pain. And so when we’re getting into these more complicated cases, that’s where you just need someone working one on one with you to really help you design in detail a plan. To just take this information and say, “Oh my pain is not that bad. Even though I know I have this, I got a free go to do whatever I want.” That’s not the case.


Now, it couldn’t be the case where it was a previous thing that has healed and everything’s good now, but it’s always good working with a sports chiropractor, a sports PT or a personal trainer who understands these things to help you design that best plan and course of action for you. But this is what I find to be critical when we’re having a conversation around pain because most people will come in to see us in pain and they want to keep moving. Let’s take for example the last situation where I want to avoid having pain when I work out or train. We have to define, what do you mean avoid pain? Because there’s certain amount of pain elicited based on micro trauma loading that you might feel–soreness, certain things like that. But yeah, we don’t want to necessarily just feel pain when we’re training.


Train According to Your Mobility and Strength Abilities

If that is the case, then it’s really going through a checklist or an audit process of ensuring that you have the proper mobility and strength and previous loading experience for you to be able to do the things that you want to do or that you’re getting into. Example, I had a new patient come in a couple of weeks ago. He’s a father, two young kids between the pandemic and everything else and COVID. Has been out of working out and training for two and a half, three years. Actually, three to four years because his kids were born. He did have his oldest before that and that’s when things kind of slowed down. And he wanted to get into CrossFit. Love it, man, great! Found a local gym nearby, we know the coaches there, we used to go to the gym ourselves, I find them to be phenomenal coaches.


But the downside of group training and having someone who’s never done CrossFit before, has not really trained or lifted in over four years, is not having the one on one coaching ability to really look at and understand what this individual needs. We’re taking that upon us here. It’s just like, hey man, great gym, I know they’re great coaches, they’ll give great cues, they’ll give great modifications if you need it. But we really need to put you under a microscope and look at the things that you want to do so that your concerns of not getting hurt doing CrossFit–because that was a concern of his based on other people that he knows and I think just kind of the general misconception that people get hurt doing CrossFit for reasons that are similar to this.


Okay, let’s look at those things. Works in IT, sits at a computer, lack of thoracic extension, poor shoulder mobility, really tight hips because he sits a lot. I’m like alright, here’s the breakdown. We see this going on with your body. Not a lot of pain right now but we see this stuff going on. Could you do CrossFit with all this going on and not get injured and be fine? Yes. Is it likely? Well, it depends on how hard you’re doing CrossFit and what movements you’re doing. Right off the bat, within the first few weeks, as a very common exercise you’ll see in CrossFit, they were doing overhead pressing.


Full shoulder range of motion is 180 degrees, meaning your arm is basically straight up overhead, bicep to ear. Obviously, you can’t see me from a side view or this sagittal plane. But where he was at, he was maybe 150 degrees. He’s lacking like 30 degrees of shoulder extension and he’s trying to then lift overhead. The likelihood of you not injuring something with that if you continue doing shoulder pressing, it goes down. It’s very probable that he’ll create some sort of a shoulder issue, whether that’s in impingement type of symptoms and/or overloading of the rotator cuff because he can’t stack his joints overhead and he’s having to go through that altered pattern. And so this is like, hey, if we can use this as our audit checkbox or the check points, we’re going to ensure that we have proper thoracic extension, proper overhead range of motion, proper scapular movement, while being able to still stack our core and being strong, then we’ll be able to do that.


Live Loud Chiropractic and Coaching Will Help You

Notice we didn’t say you cannot train, you cannot do these things because we didn’t get them all right, and that’s a very common misconception for a lot of sports chiropractors and sports PTs. It’s just like, hey, you don’t have the range of motion, you shouldn’t be doing any sort of training at all. We gave him the green light because he didn’t have pain but we set some parameters. And the parameters now, because he doesn’t have pain, it’s not a guide rail for pain as our parameters; it’s a guide rail based on function and ability. Your shoulders just don’t have the ability to do this so we have to do it in a different way that allows you to be able to have that full range of motion


And I think that’s so important because we’re trying to help them set guidelines based on function to help them reduce the chances of injuring something. We don’t know what that probability is. I can’t put a percentage and say you’re this likely to injure yourself if you don’t do it. No, but we want to set themselves up for success. If he’s just getting into CrossFit, why not help him and support him to our full capacity so that he reduces the chances of getting an injury, that makes it more likely that he’s going to stay at the gym, which makes it more likely that he’s going to be consistent with his training and get back to the health goals that he’s wanting to get. That’s a little bit of a different scenario when we’re talking about training with pain.


I hope this was beneficial. I know it’s a little bit more convoluted because everyone’s situation is a little different. But I want you to just kind of run through this:

  • If you’re worried about training with pain, is it acute, is it chronic?
  • What are the things that are aggravating it?
  • Can we find different ways to help you maintain a good training cycle in the presence of pain?


Also, if you’re worried about having pain, really having someone help you set up that plan and go through that audit checkbox system, if you will, to ensure that you have all the necessary range of motion and strength to do the activities that you want to do and reduce the risk of getting injured.


Thanks for tuning in, guys. This is the Live Loud Life podcast. If you know of someone who is in that cycle of training with pain and restÞ let it healÞ come backÞ get injuredÞ restÞ let it healÞ come backÞ get injured… Send this over to them, I think it would be beneficial.


And as always, that’s why we suggest working with someone like myself, sports chiropractor, a movement chiropractor, a PT, personal trainer, and a coach. Just getting some one on one time to really go under those microscopes and determine what are the things of why you’re going through this recurrent pattern, if you are in that situation. And getting more confidence in training in the presence of pain and knowing that it’s really not going to necessarily make things worse if you know what you’re addressing and how to address it properly.


Till next time, guys. Live loud!


3 Exercises to Loosen Up Your Stiff Mid Back | Live Loud Chiropractic

How to Loosen Up Your Stiff Mid Back

Today we’re going over three thoracic mobility drills that will help you loosen up your stiff mid back. Maybe you sit at a desk a lot, or you’re a parent, holding your baby, nursing, feeding, changing, etc.—they all put you in a rounded back position. These will help you remove the stagnation from your life. 

Oftentimes, posture gets demonized, but the lack of movement is the biggest issue. Too much standing, too much sitting, and too much inactivity are all not good. 

These mobility drills are specifically tailored for opening up your mid back–the mid scapular region, basically, from the base of your neck to your lower back. So check these out, share them with a friend, because I know these will be super helpful for you.

I’m Dr. Antonio with Live Loud Chiropractic and Coaching, we are based out of Lafayette, Colorado, which is in Boulder County.


1. The Modified Spinx

The modified sphinx is great because it locks out the lower back so that we can target all of that energy and focus on the mid back. It’s basically a spin-off of the traditional cat-cow. The only difference is that we position ourselves to lock out other areas so that the movement that we’re generating is more tailored to the mid back. 

The mid back is one of the major areas that will get tight because of what we do on a consistent basis, whether that’s inactivity, or being stuck in seated positions in our car, our couch, or work. But even standing too much can also be problematic, because when we’re standing, we usually don’t have the correct ergonomic setup and we’re falling forward. Essentially, our back is just in a hyperflex position or a relatively flexed position, and it rarely moved out of that position. So we’re trying to create more extension within that. 

The classic cat-cow, as you know, is on your hands and knees quadruped, where you draw yourself up towards the ceiling, then drop your belly and back towards the ground. In this position, we get a lot of flexion in our upper back and not a lot in our lower back. When we go down, we get a lot of extension in our lower back, but not a lot of extension in our mid back.

To do the modified sphinx, sit your butt back towards your heels. Your hands should be anywhere from where they initially were, or back closer to your knees. (When I sit my butt towards my heels, it’s called a lumbar lock. Putting my low back into a little bit of flexion locks it down so that  when I do the cat-cow position, I specifically target much more of the mid back.)

I like calling this an undulation. Think of it like a wave or a rope undulating. I want to try to maintain as much movement and fluidity as I can in order to loosen things up. So from here, try going back and forth into extension, flexion, extension, flexion. 

What’s also great about this position is that, because I’ve locked the lumbar out, I can go in other directions. So if I’m in extension, I can tip my shoulders side to side to work on lateral flexion. I can also go into forward flexion and shift side to side. And I can also do rotation. 

Oftentimes we look at range of motion in these specific planes of motion, but we never combine them. But all of these joints have coupled motion patterns that need to work together. 

So we need to be able to go into lateral flexion and rotation, or forward flexion and rotation, or extension, lateral flexion, and rotation. We’ll then be able to carve out and find all of the little sticky points within the joints that oftentimes get overlooked simply because we’re trying to stay in one plane of motion rather than tying them all together. 

2. Thread the Needle

Thread the needle is usually done as a quadruped position, where you take one hand behind your neck, then you bring your elbow down and through, and then you bring it up towards the ceiling. 

But as we have indicated with other movements, such as the Modified Sphinx, when we’re in a quadruped head position, we get a lot of extra rotation or movement, not only from the lower back but also from the hips, because I can shift hips and move everything with it. We’re not isolating the mid back as much as what we’re trying to indicate and trying to do. 

If you’re watching the video, I’m going to show you first from a side view. I like doing this in that Modified Sphinx position, where I sit my butt back to lock out the hips in the lower back so I can’t get as much shifting or extra movement outside of the hips in the lower back. 

So from here, I’ll take a hand behind the neck, I’ll dive it down through the other arm, and then I’ll lift it up towards the ceiling. Then push the bottom hand (on the ground) and your elbow away from each other. You will get five to 10 degrees more rotation just by simply being more active in your twisting. 

Repeat this motion by coming down and up, and creating a flow of undulations rather than a static holding and trying to force it. If you can get a centimeter or two more each time, you’ll improve your mobility. 

Thread the needle can also be done in a wide-leg, standing position, but you’re going to see a lot more rotation from the rest. So if we’re wanting to isolate rotation for the thoracic spine, I find that doing that lumbar lock, or that modified sphinx position helps hold us you can really isolate rotation. 

You will see variations in how much you can rotate, whether your back is in flexion or extension. So you simply play with that. Do I want to be more in flexion and rotate? Or do I want to be in more extension and rotate? 

Neither one is better or worse, we’re just trying to improve all ranges of motions around all of those so that we get the most out of our mid back or thoracic spine.

3. The Half-Kneeling Wall Rotation

When talking about mobility, it’s really important to be able to isolate the area that you’re trying to make move more, as opposed to having all the energy leak out into other areas. When we do the half-kneeling wall rotation, it helps us lock in the pelvis in the lower back so we get all of the rotation through the thoracic spine, which we’re focusing on. 

To start, the knee closest to the wall is up, and the knee further from the wall is down.  This will torque and lock my pelvis into place.

In the video, you can see there are two ways we’re going to swim our arms to increase thoracic rotation.

If I start with my palms together pointed forward, I do an open book, to where I’m trying to get my hand away to touch the wall behind me. But don’t force it. Just keep repeating that motion so that you can soften that direction and improve that mobility and range of motion.

When your arms are wide open, I want you to think about lengthening your wingspan. In doing so, you’re actually going to twist your mid back a little bit more to improve that range of motion. So rather than trying to pull your shoulder blades together, I actually want you to spread your fingertips and your wingspan apart.


The other direction is to then turn into the wall. So again, I’m going to start palm the palm, but this time, I’m going to take the arm that’s closest to the wall, do a nice big arc around the wall. I then will be facing the wall. Then I’ll come back to starting position. 

Because I’m facing the wall, I can push into it to help me turn a little bit more. 

So this is your half-kneeling, thoracic wall rotation. It’s a beautiful exercise for improving the thoracic rotation in your mid back and overall improving the mobility of our thoracic spine for everyone.

Keep up the great work and LIVE LOUD!