00:09

Alright guys, welcome back to another episode of the Live LOUD Life podcast, I am with Nicole Schremp. She is a pediatric physical therapist, we just wanted to have a conversation and chat around what really what, you know, pediatric PT could look like some of the common things to look for, that might indicate or warrant, you know, consults or a conversation with a pediatric physical therapist. She’s, she’s at Children’s Hospital here in Denver today, for those of you who are local, and want to have a conversation, but I’ll let you introduce yourself, talk a little bit about you know, your history, what you what drew you to Pediatric Physical Therapy, so on and so forth. Awesome.

00:55

Well, thank you so much for having me, it’s an honor. Um, so as we talked about, I am pediatric physical therapist. So I completed my doctorate physical therapy at the University of Colorado. And while I was there, I actually had my first clinical in pediatrics and really had no idea what this field was I came into school thinking I was going to go into sports. And during the first clinical, I literally fell in love with the population. I have always had this motherly instinct and loved like babysitting and being with kids. And then I went, I found out PT and I get to be with play with kids all day, I just, it was wonderful. I continued to explore different avenues throughout school. However, kind of circled back to my last clinical, I went down to Texas Children’s and was inpatient there. And it really just solidified that I wanted to work with pediatrics. Knowing that I also knew how much more there was to learn, I was like, we only got so much when we were in school. So I applied and was able to complete my pediatric residency after I graduated, so that just gave me so much more exposure and experience in all different settings. It was a 13 month program that just finished last July. So I feel so fortunate to have continued my learning and every day, I just have more more questions. And love, literally love what I do.

02:35

That’s amazing. So when now, at least for me, and I think for most people, when they hear physical therapists, they usually think about, well, a something hurts and or post surgical. Right. So like I had surgery. And so let’s go to a physical therapist. So how would this? How would this conversation differ? And obviously kids do get injured and unfortunately have to go through surgery and things where that would be applicable. But my understanding is your role is separate from those Correct?

03:06

Yeah, that is correct. So I do a lot more with the developmental side and children. As a pediatric physical therapist, just broadly, we work with children and families, we want to assist the child in reaching their maximum potential in whatever capacity is the goal is that they can be active participants like in their home, in their school and in their community. So we want to make those everyday activities easier for kids. This can range from a child who might not be hitting their milestones. As the CDC puts them out there, we know that all kids have different trajectories in development. But sometimes, some kids need a little bit more help to start rolling or walking along those lines. And that’s more of that early intervention through the hospital. Now I am in a more developmental role. So children that have longer term care in the hospital, they can’t leave for one reason or another. I am helping them with those opportunities, giving them more opportunities to work on their city and and they’re rolling and all of those foundational moments and movements that we need later in life.

04:25

So obviously, in a similar field and understanding this but for for listeners. And we had on I had a conversation via messenger with a pediatrician at one point when the CDC took out crawling as a necessary developmental milestone. We’re not gonna get into the details of what the conversation was. But why is why are rolling, crawling and these types of things foundational Are these importance for the listeners or parents, you know, people just like, Oh, it’s okay, they didn’t crawl, they’ll be okay.

05:06

Well, in a broad sense, we want kids to have opportunities, we want them to move and explore their environment. So whether it’s them developing strength or improving their range of motion, or crawling really helps develop those fine motor and all of those arches of the hands and helps open up our hands in preparation for different activities. So all of those different areas, I really want a child to develop that symmetrical strength and range of motion. And we also need to be able to weight shift our body when we’re little, which we don’t think about to move forward and back or side to side and be able to catch herself, which helps us start with that balance. It’s going to help develop core strength as we’re moving in and out of, you know, our bases support. So where do we feel really stable? But are we able to go out and go get something and then come back without falling? All of those different pieces are going to be really important to start developing for children. So that they can, when they’re older, be able to do what they want and move around? Well,

06:13

yeah, no, I think that’s such a good explanation of it. Because I mean, when you look at, and I’ve heard multiple people say this in a number of different ways, but but rehab, rehab, training, whatever that might be, is really just a an extension of training in general, because when you’re talking about adults, it’s really no different. The more exposure you have to certain things makes you well rounded and better able to handle situations.

06:39

Yeah, that’s it. That’s exactly it. It’s key after PTS that we play, we do so much play with children, we just are trying to give them opportunities to explore their environment that they might not be either getting because they have an injury or, or we have to teach families to help them really learn how they are involved in their child and how we can make these activities. Functional, and really fun. But parents are really the driving force behind who we collaborate with.

07:14

Oh, yeah, for sure. I mean, kids aren’t going to do it on their own right. So when, when you’re having let’s say, for instance, you’re you’re at a barbecue at a you’re at, you know, whatever else having a conversation with somebody, what are some of the things that you encourage people to to look out for that might indicate outside of a pediatrician saying, hey, it looks like we’re behind on certain things. Because with a lot of things, there’s silent or subtle markers or indications that something might be going on where obviously the better to intervene before it starts to develop into a obviously a poor pattern.

07:57

So that’s, you know, it’s a broad question, but also not so I think some different things, especially for thinking about a child and their development. So what does that zero to 12 months kind of look like when we’re supposed to be able to roll and be in our belly and lift your head and set all of those as kind of progressive to help us walk it and move. So some things that, you know, we’re looking for, we want a child to be when they’re on their back, like kicking their arms and legs against gravity, and like kicking them in a symmetrical pattern. So we have both arms and both legs are be able to move, they’re able to bend and straighten and bend and straighten. That’s not only showing, there’s the good range of motion, but it’s also showing they have some strength, they’re actually moving their body against gravity, which for them is a little bit heavier than it is, you know, for us. We’re also you know, thinking about if a child is standing, that they’re able to stand and kind of move their body side to side versus are they only standing on their left leg? Like, maybe they’re not strong enough to move back and forth? So some other pretty common ones that we’re hearing more about our children just do they only turn their head to one side? Is there a flatter spot on one side of their head? So that’s where you know, there’s some different indications of torticollis or plagiocephaly? Or, you know, those those more? I guess like, is a child just only looking one way? Or are we able to have full range of motion in our neck to look both ways? So I think those are some of the big things that we’re looking for. And some children just aren’t as motivated to move with others. So is that a child and if it is like that might be their personality, but how can we keep encouraging them to move and want to explore by giving them fun activities, or something that they really want to get to is a cause and effect toy really appropriate for them? So They hit something that lights up and they’re like, oh my gosh, I want to do that again.

10:04

Yeah, no, I mean, and that’s what’s so interesting too. I mean, part of a lot of this is just obviously general observation, right? Because a kid is not going to be able to dictate and tell you if something’s wrong, or if they feel unbalanced or pain outside of crying. But yet, I think just overall perception and awareness for our own bodies is something that a lot of us lack. So I think just paying attention is such a big important thing, not only to your own body, but also to the kids to see what, what seem what seems off, outside of, you know, more serious things. Why do some of these things occurred like, like a strengthen bounced, outside of like a, you know, a significant neural disorder, which would be obviously more prevalent, or I guess, more, more prominent? First, I want to see, how do these strength imbalances occur in kids, when you would think there’s like, well, they’re just a kid, shouldn’t they just be naturally doing these things?

11:05

Yeah, it can be a hard question. It can be some, you know, sometimes, kids, our families need them to maybe be in a carrier more, or they’re in their mercy more, or they’re not exploring as much, or sometimes they might just, we might always hand them something on their left side, not even thinking about it. But there were only handed on their left side, or sometimes, however, we lay them down, everything might always be on the right. So they might only be rolling to the right. So their strength in the, you know, some core muscles and our arms and neck muscles only in one direction. So sometimes it just might be things that we’re not even thinking about. But when it would, kind of back to what you were talking about, in terms of observation, so much of what I do my first session is just watching a child move. So the power of observation of seeing how, what are their movement patterns? How are they moving? Do they have a variety of movements, or some things that we run into in the hospital, we only walk in on one side of the room. So if a child’s head is always to one way, they might only be strengthening moving as they roll to the you know, left, because that’s where everyone is, that’s where action is. Which could be true at home with changing tables or crib, they might just environmentally get exposure more on one side than the other.

12:32

That’s a good point. Because as I’ve had this exact same conversation with individuals that have multiple monitors, that you know, it’s I have two monitors, but ones over here and they gotta catch in their neck because they’re doing they only look right, they never look left and or we just live in this world. We don’t look out and around to create more exposure. Do you? Now obviously, being a pediatric physical therapist, do you see any adults do you intervene with adults? And my my curiosity with that is and I’m not sure if you’ve heard I’m sure you have though, is DNS dynamic neuromuscular stabilization. A lot of that’s based on developmental patterns, where they use these principles to intervene even with adults and getting people back into developmental patterns to fix issues. Do you find benefit in what you’re doing with adults as well as exploring these developmental patterns?

13:26

That’s a great point. So I don’t I ever since graduation, I’ve really been focused on now are named pediatric. Yeah, I have heard of it. But I don’t feel like I can really speak to it right now. Because that’s not where gotcha I’d be shocked if I wouldn’t see. I wouldn’t find it valuable for them just because knowing what I know about kids. So that’s something that I yeah, I do really have my niche right now. Most of the time, sometimes there are more adults with congenital or more pediatric diagnosis that I see right throughout the hospital, but most of the time, I’m working with children more on that developmental side. So working on those, those early motor skills.

14:17

What’s the obviously there could be put with plagiocephaly separately in Georgia call us like a fairly early intervention. What’s kind of like the the, I guess, average range of kids ages that that you do see or is it is very broad and wide.

14:35

It’s very broad and wide. I think I most I guess if I had to pinpoint it would be like zero to probably five right now is most of what I’m seeing at the hospital. During my residency, I was I spent time outpatient and did do some sports, pediatrics. I also was in the school district at Cherry Creek, so I worked with first and second graders. I’m so I have had that early experience. So from that zero to three year old all the way up to you at 1920. Knowing that right now I’m back to the younger age group.

15:14

Now, for adults, when, interestingly enough, sometimes when we’re dealing with like a weakness issue, their body weight, as you had indicated for peds, which is different, obviously based based on the age, but their body weight is too much for them, is there a time where you’re, you’re using resistance training outside of their own bodyweight, ie, different modalities or bands or something like that?

15:42

When I was in the sports, kind of doing more ortho for one day a week, for those nine months, when I was in the residency, we definitely were using a lot of bands using different probably very similar modalities that you would use on the chiropractic front. But definitely ankle sprains or low back pain or rehab from a sports injury, all those things that I think when you think about physical therapy, and kind of where your mind tends to go

16:11

outside of that in your specialty of zero to five, it’s pretty much just exploration, crawling groundwork, so on and so forth.

16:18

Yeah, it’s a lot of like giving these children opportunities and making it fun and exciting. And like, it’s a lot of play, we want them to want to do the movements, like it’s, I will do some facilitation to help them get into certain positions. But we’ve found more and more research of just like that cause and effect of them doing it and we get really excited or like they roll up, we’re like, oh my gosh, that’s amazing. Or they roll and they get some reward on the other side, whether they see a book they see mom, or you know what that looks like. So a lot of it is just using the child and letting them explore their environment and that reward of clapping or you know, some of those things, so they get really excited. Do you

17:03

is there any? I’m sure there is benefits? I don’t know if it’s the questions asked correctly. But if you do intervene with it, but is there advantages to doing soft tissue work in any situation to help facilitate a you know, some massage or vibration to activate something

17:21

100% And I was just in a continuing education course over the weekend, looking at how breath really impacts the body’s movement and core and thinking about some of the children I work with have tricks and bent. So they’re the top of their breathing, you know, is impacted because they have that open hole. So what is what can you do for read mobilization or some soft tissue massage on the ribs to really help expand and improve breathing, which is also going to help in so many different ways?

17:56

That’s interesting. Yeah, that’s a really good point. What are what are a few things just, I mean, obviously, in our industry, there’s certain there’s certain things that we want people to, I guess Miss tuberous, if you will, but not even Mr. Buzz, just like what are a few things that you think you would you’re trying to get out that people that people should know, about Pediatric Physical Therapy?

18:24

Yeah, that’s a great question. I think the big thing that I want people to know is encourage your child to explore like, it’s okay to let them play on their own and be able to move around in their own environment. And it’s also okay, if you have some questions on things that might not seem right for your child to ask your pediatrician and really use them as partnership. If they’re, you know, think everything’s fine, and you just still have your like parent instinct that something’s going on, reach out to a PT or look into early intervention. If it’s if you’re zero to three years old, it’s something that would be a it’s really great service for children with any sort of delay to receive services in their home. So I would just, I would just say, if something doesn’t feel right at all, whether it’s, you know, your chiropractor or another PT or your pediatrician, and if you don’t get an answer, just continue to ask.

19:33

How might I mean, this is? This is such a funny question, I think, because we kind of get the same. For adults, it’s harder because creativity, especially in that type of setting is is harder to intentionally elicit. But But if play bass is so important, what things do you tell your parents Now granted, you’re seeing them in an intervention status, if you will? But what things do you encourage people to do? If clay base is so important? How do you encourage parents to help their kids play more at home?

20:09

Yeah, I so one thing is really just talking to parents, what is your routine at home? What is your day look like? And then how can we put little pieces into their day that you don’t really think about as therapy, but therapy, so say diaper changes is, is something that we’re really working on some for strings. So we want parents who After every diaper change to help the child bring their hands to their toes. So something you know, you’re already bringing your self, the child on their back. So we’re really working on touching our knees or our toes in that position, or did the child love bubbles, like, let’s play bubbles down the hall and see if we can encourage them to crawl to the bubbles or to stand up to pop the bubbles. Putting little squiggles on Windows to have them stay in there and just pull off the little swigs. It’s really a ton of core strength and balance and reaching. So there’s a lot of different play based activities that we can get really creative with, and really seen the big pieces like how does it fit into their life and their routine? I don’t want to give parents a laundry list of homework, I want to give them some things that they are like, oh, yeah, we basically do that. But I can tweak it this way. And that’s actually going to help their child their individualized program of whatever that child needs to get stronger, or more whatever, like developing those skills.

21:41

And I think that’s I think that’s such an important way of getting at it because we say something very similar, right is it’s like, oftentimes, what we’re doing is no different than what you’re already doing. But the intention of how you’re doing it just changes slightly. And that makes the world a difference.

22:00

Portal. That’s the I love that how you set that the intention? Yeah, that’s exactly it. We’re making it fun and enjoyable, but they’re just a little, there might be a little different tweak, to really help us get that result that we’re looking for, or the child is going to start doing something just a little bit different. And parents are like, Oh, my gosh, this is wonderful.

22:21

Yeah, yeah, that’s awesome. I think that I think, I think that’s all I think that’s amazing like to it, because obviously, there’s there’s extenuating circumstances of more serious conditions that require a lot more obviously, one on one, but for the general type of public of having these things, most kids are doing fine with it, because they have this natural exploration, but making it fun in in seeing the games can also highlight certain things. I mean, I know for our kids, we talk a lot about like, they naturally go, I’m gonna pretend like I’m a dog, and you’re seeing how they crawl or do all these other things. And you really start to see discrepancy, so on and so forth. So that’s, that’s a lot of great information. I honestly, I learned so much. I don’t have a lot of other follow up questions. I think this has been wonderful for me to share to give people an idea, especially not to, because I think there’s a number of great pediatricians out there. But I think a lot of times these in our world, these movement based things of what we find to be super important, sometimes just get swept under the rug, they’ll grow, they’ll grow out of it as what we commonly hear, right. But we, you know, my thought is, well, maybe, but we might as well optimize them so that they can be interactive with their peers at school at home.

23:46

Yeah, I think that’s the big piece, we just want the child to participate with their family, friends in school environments. And you’re right, they might grow out of, but they might not and why not get evaluated by, you know, whatever setting that is, if it’s, if it’s a PT like to have a PT just do an evaluation, see where they are some other ones that we hear a lot that they might grow out of is to walking. So definitely that’s one that I did bring up before but something to be on the lookout for. So anything a child does all the time that they their only way of moving W sitting into another one. So it’s okay if we’re you know, going in and out of it or using that to transition but if we can’t move outside of sitting, you know in a W position or we’re only looking into our head to one direction or only walking on those toes, it’s kind of when we get siloed that that might you know, something that we definitely want to look at it. We want just kids to move. We want that variety. We want them to just do different things in different ways.

24:55

That’s such a good that’s that’s a good point too, because I think I think it’s kind of hard to say They sometimes like, well, what’s normal is like, well, when you walk when you look at anybody walking, we all pretty much walk the same way. And when you see something else like, well, we kind of use general general common sense. Like that doesn’t seem natural to how everyone else moves or walks. Same with crawling or scooting. Yeah, they’re like, well, they get around fine. Well, yeah, cuz they can, like we’re the other example that we commonly use is like humans are very task oriented, goal driven, as you said, I want to do this because I get a reward. We’re no different. If the task is to run a mile, you’re going to figure out how to do it, regardless of its efficient or not,

25:42

right? Yep. And that’s it. Some kids, there’s so many different ways of crawling, if you like, look on the internet or research, there’s like, I mean, so many different ways, we would ideally like a child to hands and knees crawl, because they’re getting cemetry, they’re getting reciprocal movements, they’re strengthening both sides. Some of these other ways of crawling, the child is efficient, they’re getting around, but might only be strengthening one side, or they might be putting one side of their body in a less optimal position. So we want the reason they’re doing that as they figured out how to move and get that reward. But we want them to let them keep going. But we also want to strengthen and you know, work on whatever other piece there is to that?

26:25

Yeah. Well, I appreciate the time this has been this has been extremely helpful for me as well. And obviously good to always see like, what are what are certain things that are coming up that are like, hey, it’s always that’s a hard conversation to sometimes like, this doesn’t look normal. But it’s just it’s, it’s worth asking a few questions and knowing who to talk to. Is there. Is there anything else that you would like to leave people with that has come to mind that maybe I didn’t ask a question about,

26:55

you think that it, I really, just to circle back, let your child explore, be able to have fun and play inside outside all of those different areas. And just trust your instinct. If you feel like you want to ask them questions, please do?

27:12

How can how can people reach out to you? If they want to work with you or or anything like that?

27:19

Yeah, I would love to hear from you with questions or anything. So I have an email address that I’ll pass along that we’ll be putting this in the show notes. Nicole dot c that Trump dpt@gmail.com. It’s a little bit of a handful. So we’ll just put it in the show notes. Have it be there?

27:38

Well, perfect. I really want to appreciate you taking the time out of busy day and chatting with us and sharing your knowledge.

27:46

Awesome. Thank you so much. One last piece that I want to put in the show notes too. If you’re if you have questions on milestones, work, and the CDC has different avenues for milestone trackers and milestones. And then

28:02

for early intervention, because this does come up every now and then where would one reach out to or who should they who should they be researching or looking out to for those early intervention resources.

28:12

So early intervention is a federally mandated program. So it’s like support for an education for children, you know, developmental delays and their families. So it’s anyone from the zero to three, you can go on. And I think if you just type in early intervention, there’s different community center board. So you want to reach out to your community center board or ask your pediatrician for a referral.

28:39

That’s probably Yeah, so it’d be a pediatrician be a good resource early intervention. Yeah. That’ll come up. Yeah. Well, thank you so much. I really appreciate the time and chatting.

28:50

Thank you so much for having me.

Anthony Gurule  00:00

Hey what’s up guys, welcome back to another episode of the Live LOUD Life podcast. My name is Dr. Antonio, I’m your host of the Live LOUD Life podcast. My wife and I, we co-own Live LOUD Chiropractic and Coaching here in Lafayette, Colorado. We are just outside of Boulder, Colorado in Boulder County. And our mission is to help families. We want to help make families stronger, so that we can build a stronger community. We want to help guide you to the adventurous life that you and your family were meant for. And we do this through chiropractic and coaching. chiropractic, obviously being more of a hands on approach, more of a clinical conversation, clinical diagnostics, but the coaching aspect is really what we believe is, you know, the foundation of what our system methodology, whatever you want to call it is, because a lot of this comes around through just coaching suggestions and recommendations. also, you know, obviously within that comes into clinical prescriptions of certain things to eat or supplements, so on and so forth. But it’s coaching a lifestyle, it’s coaching, it’s coaching a philosophy and a foundation about how to live an active healthy life as an individual, and setting an example of a healthy active life for your family, for your immediate family, for your friends, and more importantly for your community. So stronger families to make a stronger community as a whole would be a win win, right? And that’s what we want to be able to do. we want to be able to help fill in the gaps in the holes that you’re maybe not getting from, from other roles and conditions.

Anthony Gurule  01:43

And today that’s in particular where we’re going to talk about. it’s going to be a little bit more of a shorter episode because this is more of a quote unquote, you know, just discussion around how to lay out a framework and a better understanding of how to work out or what exercises are safe or maybe not safe during pregnancy. This is a very, very common question that we get.

Anthony Gurule  02:12

My wife Nichelle has created a mini course that has some workout ideas, recommendations, and prescriptions than laid out into a workout. She guides and  educates other clinicians on how to broach this topic as a chiropractor, how to better serve prenatal patients through chiropractic care, but also exercise recommendations and prescriptions, having recommendations with other personal trainers within the community whether that’s CrossFit whether that’s Orange Theory, chatting with coaches and owners and saying hey, if you have prenatal patients and they’re having these types of symptoms, or this has happened, here’s some better recommendations, not modifications. We call them lateralizations–you’re just you know, you’re doing something something different or something else we you know, we borrow that term from Charlie Weingroff, who’s a physical therapist and strength conditioning coach. But it also and also doulas, right, doulas and midwives and OBs who are directly involved with the prenatal process from nearly conception all the way through, having this conversation. we know that exercise is important during pregnancy,

Anthony Gurule  03:19

There are so many different studies that talk about the benefits of exercising during pregnancy, not only for the mom, but also for baby, which is quite interesting. They’re seeing increased cognitive-what’s the word I’m looking for? Excuse me, their cognitive output as a as an as a child through as they age is actually better from moms that actually worked out during pregnancy.

Anthony Gurule  03:50

Now this is tough, right? How do you define working out or exercise? it’s different for everybody. But we want to, and we encourage that, and yet we’re sympathetic to the different stages of life, aches and pains, so on and so forth, which obviously would limit what you can do from an exercise perspective. So you know, it’s a bit of a gray area on determining what is working out? what is exercise? What are the physical guidelines or recommendations for pregnancy? And without getting into the like, nitty gritty detail of every single thing. And obviously, every potential situation, if you had this versus this, what could happen? we’re not gonna be able to do that. What we just want to lay out is what is what are we trying to accomplish here, and we want to encourage you to stay as physically active as possible.

Anthony Gurule  04:41

And one of the things that constantly comes up is, well, should you add something in that you have not already been doing? Let’s say for instance, someone just through the stages of life with work and kids or whatever that is, they were not able to work out as much before they got pregnant, but now that they’re pregnant, whether they have more time or they understand the importance of exercises during pregnancy, well, would we say, “Well, you haven’t been exercising, so you shouldn’t do too much.” No, that doesn’t, that doesn’t really make sense. Now, we would encourage not to do too much, there’s obviously, you know, a too far swinging the pendulum of the other way. But we wouldn’t say “no, don’t exercise because you weren’t doing something before,” we just have to find those first few stepping stones to help them start to gain some momentum. and help hold their hand, if you will, So that their technique and they feel confident about lifting, or how far they’re walking or whatever that is. And that’s an important topic, because a lot of times people want to add things in, but they weren’t quite ready or weren’t doing them before. And they then assume that they’re not able to do them at all. So you do have to take that in consideration, there is a ton that you can do, and that you can still add, even though you weren’t doing them prior to pregnancy.

Anthony Gurule  05:54

Now on the big questions is, is it safe? you know, outside to contact sports, or different things like that the majority of what you’re going to do is safe for pregnancy, right? Rock climbing, we have pregnant patients that have been rock climbing before, obviously, there’s a certain inherent risk with certain sports or activities. You know, you could fall off riding your bike, you could fall over running, right, so we’re not encouraging any of these by any means. We’re just kind of, you know, setting some suggestions, if you will. And you have to take into consideration.

Anthony Gurule  06:31

Now, there are certain things to consider when you’re talking about like weightlifting, and how heavy and the intensity that you’re doing. And if you’re doing Valsalva movements, which is essentially holding your breath to maintain a more rigid or stiff torso, as you’re seeing changes in blood volume and blood pressure, you know, you do have to take that in consideration. And that is again, of course a conversation with your provider that is managing your, your pregnancy, but we recommend Mama’s weight lift, or do resistance training. During pregnancy, again, we talked about about load management and the intensity and things like that, but you can still lift and do fairly intense things. And it’s a fairly as a you know, as a scale and a wide range during pregnancy and see a ton of benefit from that. Now, are we trying to hit one rep maxes and PRs during pregnancy, I mean, some would argue yes, but I would argue, why, that’s not really an accurate representation of what your strength is anyways. So you know, you do have to to kind of keep manipulating the numbers and the weights and the intensity and the sets and reps in order to do it. But weightlifting and resistance training is safe, and it is effective. Now, outside of that, there’s not a lot of unsafe things to do, again, outside of contact sports, or things that would elicit, you know, potential trauma to you or baby based on impact we’ve had, again, not our recommendations, but some have tried very just easy scheme, because they’re in the winter months, and they wanted to and they felt very confident about not falling. So you know, you have those types of things.

Anthony Gurule  08:16

Overall, again, we’re talking about movement. You need to move, and it’s good to get your heart rate up. And it’s good to breathe hard. So that doesn’t mean just because you’re pregnant, you can’t do HIIT training or circuit training or CrossFit or Orange Theory. But you do have to listen to your body and understand certain signs that would indicate that things might be too much, right? Now those are going to be different for everyone, but a lot of this comes down to you know, lightheadedness, you know, breathing too hard. Certain aches and pains within lower extremity, chest, abdomen, so on and so forth would be obviously like your more extreme ones. If you’re becoming pale or anything like that, I mean, again, these are the same criteria, though, that would be if someone else was working out or training too hard. So it’s realistically the same thing. It’s just that your threshold level for all those most likely have gone down. And depending on what type of an athlete you were before, you’re going to be maybe a little frustrated that you’re not able to do the things you were able to do previously, which makes sense. But if you’re someone who wasn’t exercising before, you’re probably going to be a little bit more hyper aware of that, of just feeling that shortness of breath or that uneasiness. So again, we’re not saying you have to push through that because we’re not trying to set yourself up for a strength and conditioning program to increase your metabolic capacity to increase your strength and conditioning during pregnancy. We’re trying to help you maintain a healthy active pregnancy.

Anthony Gurule  09:54

Now, walking. walking is great. but in general, we encourage you to do something above and beyond walking. Obviously, again, certain things would dictate that you would not be able to do so. And this is again, any exercise. Any exercise that you do during pregnancy needs to be consulted with and work through and have a conversation with the primary physician who is managing your pregnancy, whether that’s your nurse practitioner, your midwife or your OB or obstetrician, right. But we would encourage more than just walking. walking is fantastic, but that’s kind of like your baseline minimum, right? Just like our activities, or recommendation activity guidelines. We want a few days a week of where we’re kind of just doing this steady state getting our steps in, you know, kind of pushing ourselves, we’re huffing and puffing, but still just kind of at that conversational level, but you’re not really getting a lot of benefits outside of that.

Anthony Gurule  10:55

So if you’re just walking, high five. kudos. can you do something more? Can you do some bodyweight squats? Can you do some bodyweight, you know, good mornings? can you do some walking lunges? do you have a suspension training, we’re able to do some bodyweight rows? Do you have some bands that you can do some rows with? You know, there’s a lot that you can do that allows you to get a little bit more out of that. Now, again, this all comes back down to preferences of exercises that you like to do, because that’s gonna allow you to maintain the most consistency, but then also the intensity that you like to do. And we do encourage having an open mind and at least being willing to try some high intensity things that allow you to still get your heart rate up a little bit. And it’s okay to lift more than five or 10 pounds. And not saying that that is a bad thing. There’s programs out there where it’s all directed around that where it’s lighter weight, high rep, but I just don’t want individuals and mamas to feel like they’re not able to do more and or being ashamed because other people are just saying they should back off because they’re pregnant. “why would you need a lift that much?” It fits within your strength, and your comfort, and your wheelhouse, that is totally fine.

Anthony Gurule  12:05

Again, you if you’ve been doing that enough, you understand the risk reward ratio and having a conversation with your practitioner has driven us to kind of help navigate and guide as you start to get further through pregnancies, what things maybe we need to change or manipulate. But that’s totally fine. Now outside of that, the question around safe also comes up around core exercises. diastasis recti, pelvic floor strength, so on and so forth, we want to enhance the capability of understanding how to control tension within your abdominal wall and your pelvic floor through pregnancy, because the pressure is increasing due to baby taking up more space. But we’re not we’re not necessarily we’re not gaining more strength, right.

Anthony Gurule  12:45

And so what a lot of people assume it’s when we’ve seen this, is “I don’t want diastasis. So I’m doing more core work to prevent diastasis from happening.” diastasis recti will happen in 100% of moms, it’s estimated at the week 35 Everyone will have some form of it. Now it is technically not a quote unquote diagnosis, though, until 12 weeks postpartum, because it is a normal thing that everyone will get. So you can’t diagnose someone with something that everyone will get–doesn’t make sense, right? So after that, though, if you still have weakness or spacing issues, then we can have a you know, a stronger conversation about putting a diagnosis on that.

Anthony Gurule  13:26

But what we’re trying to enhance and help is what exercises are quote unquote, not safe versus unsafe, but adding too much pressure or tension into the abdominal wall or the pelvic floor and creating more laxity. again, as that pressure for as baby’s growing starts to put more pressure on the pelvic floor and the abdominal wall. If you’re doing more things that increases the pressure within the within the abdominal cavity that’s going to push on that separation even more and/or push on that pelvic floor even more, creating potential incontinence or prolapse issues and/or more bulging and doming within the abdominal wall stretching out that separation or that gap even further, potentially making the recovery process more challenging or slightly longer. I’m not saying that it will but potentially, so we do have to take that in consideration. So we go through activation exercise of the pelvic floor, of the abdominal wall so that you better understand how to control those pressure increases while you’re lifting or exercising so that you simply can stay at a management level.

Anthony Gurule  14:28

And that in turn, helps you get through pregnancy of understanding how to lift up your older kiddo, having to lift up dog food or anything like that. It’s just managing and controlling pressure. So there’s really not anything that I would say that safe or unsafe. Now, things that we would advise against for core exercises is sit ups or crunches. You know a lot of those things that create like hanging knee raises and different things like that during pregnancy. A lot of those things that create a lot of intra abdominal pressure and tension. and especially during a flex position, that tends to put a lot more pressure on the abdominal wall, the separation where diastasis will occur as well as the pelvic floor.

Anthony Gurule  15:09

So, you know, while we never say never, there’s definitely a category of things that we definitely urge against because the risk/reward benefit and again, risk not being “injured,” But risk of potentially putting more pressure and making the recovery process  on the other side harder, is not is not something that we find to be as advantageous. But you can still get the benefits of quote unquote, core exercises through full body movements such as goblet squats, such as deadlifts, you know, depending on the phase that you’re in, push ups, which are, you know, a dynamic plank. or being able to do a TRX row, which is a reverse plank as you’re just lifting yourself up. three point rows where you’re on, you know, two hands or doing like a row on a bench, where you’re in a tabletop position that’s adding anti rotation exercises. So there’s a ton that you can do that still highlights and isolates, the core isolates, sorry. that highlights and will emphasize core activation, but through a full body compound movement. And what’s great about that is during pregnancy, depending on your energy levels, it’s hard to do all the little isolated accessory and all these separate exercises as it is. So it’s kind of nice being able to combine everything, so you get more bang for your buck, especially if you’re a parent and you’re on and you’re on baby number two or three, right?

Anthony Gurule  16:31

So what exercises are safe for pregnant women to do? All are. reduce or eliminate for sure contact activities, different things like that. the increased risk activities of you know, trauma and things like that. Outside of that you’re managing pressure, I would definitely encourage reducing anything that’s heavy lifting, that’s, that’s requiring you to do Valsalva moves, you’re having to hold your breath for an extended period of time. that changes blood pressure, so on and so forth. But outside of that, Pregnancy is a completely safe time to do all exercises. we definitely as we highlighted, urge and encourage, you know, certain things over other ones just for you know, added bang for your buck or full body movements, so on and so forth. And that, but outside of that you are free to do what you want.

Anthony Gurule  17:19

If you want guidance, though, you know, there are there are trainers out there that work specifically with prenatal patients. we would love to be able to have that conversation with you if that’s something you want to bounce back or navigate. Because we do want to encourage as much as we can. A very, very active pregnancy through exercise working out or however you want to describe that. So if you found this beneficial, please like share, subscribe. if you’re pregnant, I hope you can utilize this and take some of the information for you and yourself. If you have anyone else you know… a relative a family member, a friend who is pregnant and they’re unsure they’ve been you know asking this question what things I don’t know what things I can do. I don’t know if it’s safe for baby share this video with them. We’d love to be able to provide a better frame of reference and or context to be able to ask better questions so that they can find the workout program  or the movements that work best for them during their pregnancy. Until next time guys live loud .if you’re currently pregnant, Congratulations, and we look forward to helping and serving in the future.

Anthony Gurule  00:09

Welcome back to The Live Love Life podcast. My name is Dr. Antonio, your host of The Live Loud Life podcast. And I’m just so grateful to have all these different mediums of sharing, you know, information and whatnot. I think today, our generation more than ever, it’s honestly, I was reflecting upon this the other day with, you know, a friend. And we were talking about how, you know, when we were in middle school, we used to get my mom used to give me 15 cents to call her on this on the payphone in the mall, when the movie was done. So she can come pick us up. And it’s just, it’s just, it’s so funny, because this is just, what 20 years ago, and what our parents have gone through and what that next generation is, and what generate like my grandma, you know, Nichelle’s grandma grandmother who just turned 90 is still around, it’s just, it’s just, it’s just mind boggling. The amount of information that’s being passed around how fast informations changing and updating for, for better or worse for, you know, we’re not getting into the debate of that, and in just in just how we can communicate and share your thoughts and how, more importantly, you as a, as a consumer, if you want to call it that, but more so you as someone who is curious, can can can google or youtube anything and find a resource that teaches you or explain something, from Khan Academy to Udemy to all these different things. It’s amazing. And, you know, I hope that we can, through our, through our somewhat specific knowledge, shed some light on some situations and some issues that are beneficial to you to family members to loved ones. And that this could, this could help you in some way.

Anthony Gurule  02:11

And that’s what I honestly my biggest struggle and getting hung up on is trying to not perfect this but like what do you want to know? What do you what do the listeners, are curious about? My curiosity? Obviously, you sheds in certain ways, and I think that, that peels off and is shared with other people. But you know, I do want to make this relevant. So if you have comments and suggestions and topics, we always love hearing those to better suit these conversations about certain topics.

Anthony Gurule  02:48

now, basically, so I obviously have expertise in certain areas and not other areas. And if it’s something I don’t know, hopefully I’ll bring it be able to bring on a guest and share their thoughts and their knowledge. But today, we’re going to, you know, not a lot of housekeeping. This is my new office, we’re pretty amped, don’t mind the mess on some of that stuff. We just moved into a new property, I was hoping to actually shoot this particular episode on my new deck with this view of the mountain range and whatnot.

Anthony Gurule  03:18

But we’re super blessed. With this new home having a little bit more space for our homeschooling opportunity, to take full force with our kids getting dirty in the mud and exploring with toads and worms and chickens and ducks, our neighbors have horses. So it’s a pretty wild opportunity. And we’re just obviously super fortunate and blessed to be able to, to embark on this new journey. So with that, I’m hoping we’re you know, obviously a lot of time and effort being put towards getting the house set up. But utilizing our garage space, which is not massive, but being able to create some more content in the garage gym, around certain things and helping people move better. helping people understand how to how to kind of manage pain, how to move better, while managing pain, you know, kind of blend those things at the same time. How to be more mobile, how to get stronger, and that’s what I feel I’m best at. I’m not the best with nutrition, I’m not the best with hormones, um, you know, those are, those are important topics. I’m not downplaying those. I just don’t enjoy working with that stuff as much and I have a number of colleagues who I refer to out for that stuff. So if you have some concerns about those things that happy to bring those people on, but if you’re, if you’re wanting to get stronger, move better and eliminate your pain, you’ve come to the right place.

Anthony Gurule  04:53

If you want to live an adventurous life and live loud and not feel limited by previous injuries. or hesitations or reservations, about being scared about, you know, your injuries or that maybe injuries your parents have might have had, and trying to build some confidence around that. I know we can help you out with that. And that’s an that’s an in, I intentionally kind of lead us use that to segue into our conversation today, which is how to create confidence. And this in particular cases is about lower back, but how to create confidence after an injury. And that is one of the more challenging tasks when we’re dealing with recovery, how do we get you to feel more confident in your, in your abilities in your strength, in your, in your balance, you know, whatever that might be following an injury and, and in particular, what we’re talking about here is lower back and, and you know, it’s one of those, it’s one of those things when it rains, it pours like, you know, like, every now I’ve seen a ton, I see I see a ton of low back cases. But it’s one of those things like when you when I started seeing, like I get a couple of severe or like acute things. And I see a couple more. And the the theme, this week that I came across was this massive hesitation and reservation of having a disc injury, or back pain. and the hesitation or reservation, rightfully so we’re not discounting, you know, or downplaying what their fears are. But one in particular individual was worried that they re herniated, or had another disc bulge or injury, they previously had a discectomy from a sequestration years ago. And now they’re having, you know, fairly substantial radicular pain, which is referred pain down the leg with numbness and tingling and some burning, all of which are typically associated with the pinched nerve root, which is usually usually a response to inflammation and possibly a disc bulge or disc herniation.

Anthony Gurule  07:12

So you know, rightfully so they had a long road to recovery with a substantial injury such as this, this previous disc injury, and then this other individual, not as severe, but it’s been this like, underlying chronic thing that has just really been not, not robbing them, like she’s able to run, not run sorry, ride her bike and swim and do a fair amount of exercise. But her big hesitation is, I don’t want back pain, because my mother has suffered with back pain for over 35 years. So she feels that if she was to have back pain, she would end up like her mother, which is basically, you know, I wouldn’t say disabled right now. But as she describes it, she’s not able to do really much of anything. And so we have these two, although similar, you have very different cases of individuals who are extremely fearful of the diagnosis and the prognosis as it pertains to lower back pain. Now, this is where, as a clinician, you need to be very careful about your words.

Anthony Gurule  08:23

And we’ve had, I’ve had specific conversations up with both of these individuals about what they have been told, because I want to set, I want, I want to set the framework, and I wanted to know, the lens that they’re looking through and the perspective that they have for what they were previously told. And I don’t think their conversations with the practitioners were wrong, per se. But there’s a certain bedside manner, as they call it, that is needed when approaching sensitive topics such as these. And this is this is very true, you know, for conversations with pregnant patients, such as diastasis recti. For infants with tether oral ties, but it is our role and responsibility as clinicians for us to tell the truth based on what we believe to be true based on and support and giving supporting evidence. That’s the biggest thing. Because I think there’s a lot of clinicians who believe something to be true, but don’t have necessarily concrete supporting evidence. And that is, again, a debate for another time which we will not get into. This is always that’s obviously more of a, quote unquote, clinical debate.

Anthony Gurule  09:41

but we, we did a few specific tests. After our history and examination after the history examination for both these individuals, I, I fairly definitively knew where the quote unquote The epicenter or started the pain was, you know, based on the questions we asked the symptoms are describing, so on and so forth. And then we do a few, we do a few tests, and the tests are provocative tests. And the whole point of provocation tests is to provoke is to manipulate and shape the individual and push in, in pride in compress and stretch to determine what the source of where the pain is coming from. Now, this is where things get confusing, because when you chase the sight of pain, that’s where things can be a little bit muddy, right?

Anthony Gurule  10:39

Obviously, this one individual has pain on their legs, so we’re not examining the leg, because it has a very clear, clear dermatomal ridicular pattern. And the other individual had what she described as hip pain as she points to her glute medius, inside hip butt area. And she describes it as hip pain. And everyone keeps saying, well, it’s not your hips, your hip’s, fine, but they didn’t give her an answer as to like, why it’s actually hurting. And we know we did a more extensive test. But what we what we started with was a simple compression and slump test. So we have her sit into a chair. So if you’re dealing with lower back man justice, you do suggest you do this as we describe it, because I don’t want you to flare something up. But you sit, you sit up nice and tall, kind of towards the front, you grab the bottom of the chair, and you pull yourself into the chair as you’re compressing your spine, right? And we do this in a nice upright posture. Where our, you know, the curve of our spine and everything is supporting us. No pain. And we simply asked her to slumped, massage into her lower back, so her lower back is now flexed forward, and she leans forward, and then she pulls down on the chair again, and lo and behold, what hurts,?not her back. Her hip!

Anthony Gurule  11:53

So we start to ask then, what, what was the only variable we manipulated the pelvis tucked under a little bit, not that much. And so realistically, the only variable that we manipulated was lumbar, flexion and compressing the lumbar spine under more flexion. And that created a referral pain down into the hip. So the hip where she is feeling all the symptoms is not actually the source of what’s actually wrong.

Anthony Gurule  12:23

And same goes through for the individual with the leg pain, we performed a very similar test, and we were able to provoke some of the symptoms and we we tread lightly when someone’s that acute with leg pain, because we don’t want to piss things off a lot, we have a pretty good amount of information, part of the diagnostic process for provocation test is also reduction of symptoms. So if I can do certain things that I know decom–, quote, unquote, decompress the spine or open something up and things get better, we’re like, Okay, well, it seems like this is probably the cause, because we were able to eliminate the pain. So both are true in both directions. And, and this is what’s important, because with both of these individuals, they never had an examination or an assessment like this. And the assessments were all tailored around where the site of the pain was. well, moreso for the hip individual, the previous individual with the leg pain, again, that’s pretty cut and dry thing as a clinician, you’re not missing that. The big fault. This is a side note, the big fault with his case previously, was the insurance model and how it screws over the patient.

Anthony Gurule  13:27

And I know insurance is great. And it helped cover a lot of obviously the big costs for these things. And I agree. I agree that a conservative bout of care needs to happen before you go through more extensive treatments such as MRIs and injections and things like that. But what I have learned over the years is having the ability to go outside the lines every now and then to give the patient what’s best for them. If a patient is dealing with severe burning pain that we assumed to be a result of a disc herniation and inflammation, they oftentimes are not able to get steroid injections and oral medication until they go through about a care. And I think that’s wonderful. I think that’s good. That’s what I do. Like I agree with that. But I have found in my years that if someone’s okay with doing a steroid, it might be the difference of them having a horrible life for weeks and months and door getting a little bit better and getting some momentum in the right direction.

Anthony Gurule  14:36

And so this individual was getting spotty injections because they weren’t able to get an MRI yet because it wasn’t authorized through insurance because they weren’t done with their 12 sessions a PT so you know it gets it’s it’s unfortunate that it goes that way.

Anthony Gurule  14:51

But bringing all this back so this individual, obviously having back pain before and now Dealing with something similar. He’s just like, what is what’s going to happen like, I do not want to I cannot do surgery again. So obviously has major reservations about it. then the other individual, whose mother has been suffering with back pain for 35 years, like, I can’t have back pain. My mom’s had back pain, like it’s genetic. It’s, it’s something that I know will haunt me for the rest of my life. And so we had, you know, after we did the provocation test and kind of determined severity, I immediately go into how can I help you make your pain better like this. And we have a handful of exercises, I’ve gone through these exercises multiple times in a number of different either videos or podcasts episodes, we have some YouTube videos that show how we treat low back pain and neck pain, this pain, we’re going to film those again, because those became I ramble on those became way longer than I wanted. So I’m going to condense those to make them better for you.

Anthony Gurule  15:50

And recently, we had a testimonial of a previous college athlete who had a failed microdiscectomy as well. And she’s back to deadlifting. But we start with, we start with a few different exercises to help you help you find ways to reduce your pain. Now, if I can teach you how to do that, in between our sessions, you can go home, and you have so much autonomy and power to be able to handle the pain that you’re experiencing, will it be will it will it go away, maybe maybe not. But if you’re going day in and day out, like sweating bullets, not knowing when the next time your back’s gonna lock up on you, that’s a shitty way to live. That’s very, it’s very, very challenging to go day in, especially if you’re a parent and you have kids, I can’t pick up my kid, I can’t do this, this and this, that’s tough. But when you have a few different things, and a few different tools, and you’re like, Well, you know what, I know it’s not gonna be perfect, but I got I have these things, and I feel good with them. Because they make me feel good. There’s power in that. And so we give the diagnosis we give our thoughts we support it with we give evidence support, or based on our examination, and we say Hey, this is what we think is going on this this why why bla bla bla, that disc this, it disc that the nerves, this the muscle spasms here. that we’re for pain, so on and so forth. But I’m going to show you how to handle that. And right away, we teach them those things. And like, wow, this actually feels great. This is the best I’ve felt in days, weeks, if you know, I feel like I can actually walk I feel like I have, you know, a little pep in my step. And, and so then we come right back is like, Hey, you remember that thing you were so scared about? How do you feel about that? Now, are you still as worried as you were before and 99% of the time, like, you know what? No, I feel better about it.  it’s not gone. But yet their worry And their fear associated with it has gone down because they have they have more control. It’s the unknown and the lack of control for the majority of us, that makes it so challenging. And whether it’s, you know, the lack of control, because you’re dealing with something that someone else has, and you’ve heard, or you’ve seen them gone through it, or you or yourself has gone through it. And you don’t want to go through that again. But you were never given the tools to get a grasp of this.

Anthony Gurule  18:10

Now this, again, is just the tip of the iceberg because we’re just trying to manage the immediate, and there’s yet still a rebuilding process of building confidence. And, and that’s the next phase through various forms of stability, mobility, and this is true for all regions of the body, not just lower back, I, you know, I wanted to state that. So it’s not unique to just lower back.

Anthony Gurule  18:37

But I just completely lost my train of thought, oh, confidence, but just like anything else. And, you know, I’m a big fan of Jordan Peterson, clinical psychologist in, in Canada, who describes when someone’s afraid of something, the worst thing that you can do is remove them from that situation. Right? We have so much fear around certain things that by taking yourself away from it is not the right thing to do. Now, throwing you down in deep end is also not right. But we call it exposure therapy.

Anthony Gurule  19:17

This is something that has been known for a very long time, right? And so, you know, I call it exposure therapy, I say dipping your toes in the water, you have to try the thing that you’re afraid of. And if you have the support of the clinician’s eye watching you, you feel better about doing it. And, you know, I’ll guide you, I’ll cue you, I’ll help you. And as you’re able to do the exercises, the movements or the things that you’re afraid of without pain and feeling better, This light bulb goes off in your head, and your body starts saying oh my gosh, this is great. It doesn’t hurt.

Anthony Gurule  19:57

And you have this kind of this aha moment and glimpse into the future of what’s actually possible. In an instant of time, we’re just like, wow, this is crazy, it doesn’t hurt and the thing that I love the most is when someone like does a rep and they’re like, ah, oh my gosh, this is horrible, it hurts. And then we kind of just help, you know guide position, whatever that is and they do it again, it’s like I don’t feel it at all, you’re just like you know and see, see what’s possible?

Anthony Gurule  20:26

And and then we have a conversation about the future about what we’re able to do what we want to be able to do so on and so forth. So I want to leave you with some encouraging guidance that there is, there is the possibility of being able to do more. I don’t know what you’re going through, I don’t know the injury, the aches and pains, the history of what might be going on. But if you feel like you’re at the bottom, I promise you, there’s only up to go. And what’s beautiful about that is you just need to find the right door.

Anthony Gurule  21:10

I might give a suggestion, and it doesn’t work. That doesn’t mean what we’re doing is wrong. It doesn’t mean what we’re trying to attempt is not the right thing. You just have to try another door. There’s many roads to Rome. And when you find the right path for you. Hopefully, it’s hopefully it’s an avenue that you enjoy. It’s not always that way. But I promise you that things will get better. It takes dedication, it takes patience, and it takes commitment, just like anything else. I’m guilty of it more than anybody else, the quick fix, the want this done now. But it’s the it’s the daily grind. And if anyone has, you know, the the perfect saying or way to bring this all together, I would love to hear it. But it is again, it’s the daily grind. No one wants to hear the journey is better than than the destination because everyone’s thinking about the destination. And I agree with you. It’s much better to think about the day where you feel amazing. But it’s the day and day and commitment of movement, mobility, stretching, stability, training, eating, right, sleeping, right, all of these things that create the more resilient body that will allow you to feel confident to overcome the current hurdle that you’re on, and any other hurdle that you might be coming across as a result of life.

Anthony Gurule  22:32

Here’s a newsflash for you, you’ll feel some pain in your life. This won’t be the last time. But if you got someone on your side, hopefully live out chiropractic and coaching can be that team for you, to workshop to navigate to be a sounding board for these things, that makes it a lot easier. Rather than waiting till it becomes like this chronic thing that’s been festering for five to 10 years, stomp on it. If you feel good about trying to explore your own body and figure it out all the power to you, that’s what we’re about.

Anthony Gurule  23:07

But if you have any sort of reservation just reach out to someone, it’s a lot easier to just say, Hey, I got this thing going on. I’m not quite sure what it is, you know, it’s new, it’s not horrible. But I don’t want it to get into something it’s a lot easier to deal with an issue before it becomes an issue. And when given the appropriate suggestions. more times than not you’ll just take care of it. So I hope that this has provided some of you some more confidence about what’s what could happen. What sorry, what’s what’s was waiting for you as far as the ability to move the ability to be stronger, the ability to be pain free. the ability to enjoy the things in your life, without the hesitations and reservations because you have confidence in your back and your ankles and your knees and your hips, whatever that might be. There are resources I guarantee even if you said you’ve tried PT chiropractic massage, orthopedics, MD whatever it is, I guarantee I guarantee that there are things that you have not tried and or it was not just the right time for you that will help you live a louder life. So until next time, folks, live loud.