Nick Sanders 0:00
All right. Hello, everybody. Today I am with Jason raqa. And we're going to talk about some dry needling things. We're gonna talk about some physical therapy. And what's most interesting to me is Jason does a lot of visceral manipulation. So obviously super fascinated and interested about how the gut and inflammation neurology affects pain, chronic pain, movement, dysfunction, all those things. It's definitely an interest of mine. And so Jason and I met at a dry needling course. What's been a week, last week, we can have something like that. We could go and we chatted a little bit. But of course, you never have enough time that to talk. So he was nice enough to join us on a podcast so we could really sit down and chat about it. So Jason, thanks for thanks for joining me.
Unknown Speaker 0:46
Yeah, absolutely. Glad to do it.
Nick Sanders 0:49
Can you just quickly introduce kind of yourself your practice and what you do down there in Texas?
Unknown Speaker 0:54
Yeah. So Jason Rocca physical therapist, I started a cash based practice in the Fort Worth area, February of 2020. And then March of 2020 happened and everybody knows what happened then. And so I just kind of kept it kept going to low level I had started off mobile doing mobile visits anyway. So my overhead was really low. So like one to two a month. And then a few months into 2020, it started to build a little bit. Once it once we got into 2021. And it looked like we were going to not be shut down anymore. Then I ran into space. So I'm doing that part time as it's building, and then still part time in another clinic as well.
Nick Sanders 1:42
Gotcha. So it was COVID. Like, on your radar when you decided to do this?
Unknown Speaker 1:47
No, no. So I had actually, I've been I've been talking about doing this for years. And actually the other company that I've been with that was part of what they were doing was mentoring me to do my own thing. So I had been with that other company about 10 years, had been doing meetings with the owners over the years. And so when I decided to do it, it was January of 2020, I filed for my PLLC because I had the flu one week, you know, stuck in a room and I was like, I'm just gonna go ahead and get this done. And started seeing patients in February and then no clue that that was coming. And then even in March, right, like, in Texas, we didn't we didn't really ramp up and start shutting down right away. So it was it was like, Well, what's going to happen with this?
Nick Sanders 2:34
Yeah, I distinctly remember, One patient in particular, were like, maybe COVID is gonna be a thing. I don't know what COVID is. And then it was like, the next weekend I was was the world shutdown. So I can't imagine, you know, we were in it at that point, but I can't imagine starting and then, you know, days later,
Unknown Speaker 2:53
yeah, gosh, so I know this only because it'll be two years. This weekend that everything shut down like the world shut down, because it shut down my my birthday weekend. And that's coming up next week. And so it was like, happy birthday, the world shut down.
Nick Sanders 3:11
Your party is canceled. Yeah. Oh, that's fantastic. So anyway, I just, it's just been such a crazy ride. And I think we're still I feel like we're on the other end of it now. But seems like it seems like we're getting close. But man, two years, and it's still so props to you for growing your practice in that that period. That's, that's no small feat to grow a cash practice. And then to try to grow it through COVID is, man, that's crazy.
Unknown Speaker 3:40
Yes, yeah.
Nick Sanders 3:41
So it sounds you know, I was talking to Matt, who hosted us down there at Fort Worth physical therapy. And he was telling me a little bit about what you do from the visceral standpoint. It sounds like that's a pretty big part of your practice, correct?
Unknown Speaker 3:58
Yeah, it's, it's become a big part of it, for sure.
Nick Sanders 4:01
So, so tell us a little bit. What is visceral manipulation? Who are the clients you see? Like, what is that niche?
Unknown Speaker 4:08
Yeah, so So viscera, for those that wouldn't know exists or just basically refers to our organs? This room manipulation refers to mobilizing those organs. So the way I usually explain it, like to a new client, I usually say You know, one of the things that I do is visceral manipulation. You know, this refers to our organs and our organs have this type of tissue that surrounds them called fashion, we have fascia throughout the whole body, and then I'll use like an like an orange analogy, I'll tell them, you know, it's like when you peel an orange, you know that you peel the orange peel off and you've got that white layer around the orange is like the thin layer of fascia underneath our skin. And then you start to separate the origin you got those divisions that make it into slices and that's like the deeper layers of fashion that go into the different muscles and muscle fibers around the nerves and then all Going around the viscera, so around the organs, and those create ligaments and those ligaments attach them to other structures. Sometimes it's other organs, sometimes it's muscle, sometimes it's bone. And our body is, is designed in kind of this hierarchy, where it's going to protect what's most important. So, you know, organs more important than muscle, and bone nerves more important than most my bones. And so, you know, when those structures get tight, so, you know, common example I'll use is, if the small intestines gets tight, and I go to bend forward, you know, normally, those would fold move, get on the way, if they get tight, and they can get tight for various reasons. And we can get into all of that here a little bit. But if they get tight, then my body's gonna say, Hey, I don't want to move that way that's going to put pressure or compress the small intestine, so maybe I'm gonna bend a little bit differently. So then you start getting stress and strain to a lot of the musculoskeletal structures that we find people come into the clinic with, you know, disc herniations, muscle spasms, low back pain, hip pain, things like that. So this role manipulation would then go in and use manual techniques, and they're very gentle, to help restore that mobility to help the the tissue start to slide and glide a lot better.
Nick Sanders 6:22
Yeah. So I'm trying to think of where we start this to, so that it makes sense for everybody. I know where I want to go. Yeah. Why do you think that those adhesions happen? If, like, why does that visceral mobility decrease?
Unknown Speaker 6:37
Yeah. So a number of factors, right. Because we're talking viscera would include the intestines, large and small, deliver the stomach, but it would also include things like the heart, the lungs, the thyroid, the you can include maybe even the brain and that so. So it depends on the region. But you know, big ones, that people I think, really would understand pretty clearly as surgeries. Anytime you have, say, an abdominal surgery, that's gonna go in, and that's gonna leave scar tissue. That's an easy one to grass. Trauma, direct trauma to an area. So a lot of times, I'll tell people, like, if we're talking abdomen, we're talking things like car accidents, and the seatbelt went across you are the seat belt across the chest, and dealing with the heart and the lung mobility or, you know, falls on the tailbone is a big one, that concussion wave that would go through you as you as you hit the ground, not to mention what it does to some of the pelvic structures. So those are the so those are the big ones that are easier to grasp. Other things that I get into with with clients, when I start expanding is anything that would cause inflammation in your body. So now we get into autoimmune issues. Anything that causes gut inflammation, so food sensitivities, things like irritable bowel syndrome. We know that there's this gut brain connection, and largely through the vagus nerve. So now that opens up this, this whole other world of anything that potentially causes brain inflammation can cause gut inflammation. So you might have some, some adhesion issues because of that, and vice versa. So it can be a number of things for sure.
Nick Sanders 8:20
Yeah, that I think the surgery one is is apparent, right, you have a scar, you have lesions, your body's going to heal that. And depending on how that immune response goes, you get different results. When the client asks, and this is my, this is my kind of current interest is Why do you think gut inflammatory problems? Call it? Let's call it leaky gut? Why do you think they cause some of those visual adhesions? Or why are you seeing some of those mobility issues? Because that That, to me, is is a fascinating concept, right? Because if you have inflammation, now you start to see abdominal garden, you start to see tenderness in the abdomen, the visceral things that you're working on. And now that changes everything, right changes, core muscle activation, changing posture, spine, run it down. Right, right. What do you think that mechanism is? Or why do you think that happens?
Unknown Speaker 9:14
Yeah, I mean, I think I think you've touched on a big one right? There is, you know, when you start having the inflammation, I will just keep kind of talking, say the abdomen because that's an easy place to kind of conceptualize it. But you know, if you get inflammation, we know that inflammation will cause scar tissue inflammation in the muscles going to, it's like your body splinting that area and that lack of movements can cause adhesion. We know that same thing with the Oregon so if you have inflammation, your body is going to do something to change the way that you move is going to like you said the tone may increase and the muscles around the tone in the actual structure will increase. I mean, they're surrounded by fascia. We know that fascia contracts. There was a pretty important study. I think it was 2013 where they talked about how fascia can tracks in a smooth muscle like way. And so we know that when, when an organ has an issue, whether it's a pathological issue, whether it's a mobility issue that fascia around, it will hug it. So if you can see my shirt, if I start to bind that area, like it's like it's fascia around the organ, it creates these lines of tension. And so when that happens, that changes the way we move. And so when when we start changing the way we move, then we start putting the more stress and strain on the muscles, the joints done in a way that they maybe weren't designed. And so then you start looking at it was this more of a repetitive issue, you know, I've been sitting a different way. And so I've got more strain on me, because I've been kind of offloading to avoid putting stress through something, or I'm bending a different way. Now over and over again, when I reached for the phone on my desk, you know, whatever the case may be, I think largely it comes back to, you know, we start seeing the pain and the and the stress on these structures, because of how our body's responding to protect itself from something deeper, something else. Yeah,
Nick Sanders 11:13
that motor control motor planning side of the altered movement pattern as a result of, and I think we overlooked that I think we talked about it in like sports, you know, you have a hip mobility restriction. So now you're throwing motions off because you can't rotate through the opposite hip. But I don't know that we talked about it in this scenario is maybe as much as we should wear. Hey, because you're having these abdominal restrictions and guarding now you're avoiding that position, which is causing you to move this certain way. And I think and this is kind of a manual therapy interest of mine, the conversation of is it the structure of the fascia, that's the problem? Or is it the neural input that's altering that motor pattern? And I don't know, I don't know that you can separate those. But I think there's probably a spectrum of it starts as some kind of fascial weird thing that turns into a motor programming motor patterning issue. is kind of my theory, like something had to have started it, you know, like, what started the change? What are your thoughts on that? That kind of? Is it the fascia? Is it neural? How do you separate those?
Unknown Speaker 12:24
You know, early on in, in my career, so, yeah, not a second point is that chicken or the egg right? Early, early on in my career, so I've been, I mean, my 16th year now. So early on, I was very much more biomechanics focused, I think, like a lot of outpatient orthopedic type, therapists would be there. Even if they got into manual therapy. Like that's, that's largely the direction a lot of manual therapy programs go. And so that was my focus. So I would have said, it's the, it's the structure of the fascia. The longer I do this, the more I realized that a lot of what we do, no matter what kind of manual therapy, we're practicing, no matter what, however, passing, we're largely affecting the brain and the nervous system. So you know, fascia has McCanna receptors, those are neural structures. And so something affects those Makenna receptors, that's going to send information up to the brain, the brain is going to say, we got to do something with that, and maybe we tighten up, maybe we guard so. So I think I think the neuro components probably, in my opinion, the neuro components, probably the bigger of the two, but but then you get into, you know, direct trauma surgeries, how much of that? Was the fascia getting injured? Or do you say that, you know, because that fascia got injured? It's those neural structures that cause you know, so I don't be I agree with you, I don't think you can separate them. But I think all of what we do really is more Racine effects we see because of how it's affecting the neural structures would be my my opinion on
Nick Sanders 13:53
that. I'm 100%. On board with you there. I begin, I do think there's something that triggered like there's that initial input, right, the fascia is highly, the sensory integration of the fascia is huge. So when you have a surgery, have a trauma, you have inflammation like that input through the nervous system has to be doing something. Right. But then ultimately, it's the neural changes that I think we can have an effect on. And, and I think that kind of leads into this idea of visceral manipulation. It's not something I've been formally trained in, I kind of assess it, I kind of mess with it a little bit. But most of the techniques are super general, that I've seen. Could you describe like, from a manual therapy standpoint, when you put your hands on somebody and you're trying to do this or manipulation? What are you looking for? What do you think you're accomplishing with that?
Unknown Speaker 14:45
Yeah. So I've learned this from manipulations through two different approaches. And they're a little bit different. And so it depends on the approach I'm taking with that particular patient but in general You know, sometimes my, my approach with a patient, especially if they came specifically for visceral manipulation, and they go more than pure Thrall Institute, visceral manipulation or out where they do osteopathic assessments and so there's an osteopathic technique called listening, where essentially you're loading the fascia with a very light pressure. And then you're feeling for as the as the faster response to that load, you can pick up on the lines of pull. So, you know, it sounds odd, and it would probably look odd to a lot of people that don't know what's going on. But one of the ways, the main ways to kind of get a general idea of where to go is you put a light pressure on their head, and then just load it, and then you come off and then you're you're able to it's like you just like you wake up that fascia, and then you pick up on these, those lines of pull that we're talking about. So you know, I might do that. And it might feel like, okay, that pulled down to the left side of the abdomen. And all that tells me is there's something on that left side of the abdomen, abdomen, that the body is saying, hey, I need help here. It doesn't tell me what structure it just says it's something and it may not be visceral, it may be that it's the psoas muscle or it may be a U joint, but it tells me I need to go look more there. So, so in those scenarios, then I would go and look where that pool was. So let's say left side of the abdomen, then I do the same thing. But I'm more local. So I'm using, you know, other pressures around the area trying to pick up on those lines of pool until you kind of pinpoint, okay, that pool was coming from that structure. Okay, that was the sigmoid colon. So the last, you know, the lower part of the large intestines. So then you start feeling around and you can feel mobility, you know, all tissues, all joints, you know, in our world, we talked about infill, right, but in a in a client's mind, they don't know what that means. So I just telling you, all tissue needs to have movement, right. And when it doesn't move, well, it's got a harder feel to it. When it moves, well, it's got this, this give to this springy feel to it. And so even the viscera are the same. So you can move those structures. And if, if there's a hardness to it, or you feel like you run into a barrier, that's dysfunction. And so a lot of times, that's, that's the route, I'll go with it. I'll also use just a lot of your standard range of motion functional movements, tests as well. And so, you know, I might do like a rotation, you know, they might be standing and I'll rotate them one way and then the other and just feel them for okay, what's, what's stopping that? Where am I feeling that stop it and go look at those different structures. And then, you know, anatomy comes into play at that point, okay. It felt like it was getting stuck down here at the left side, but what's at that left side? And that start thinking, you know, what, what visceral structures, what joint structures, What nerve structures, what muscles, you know, and you kind of start considering what what feels like it's going on.
Nick Sanders 17:56
It's so kind of off topic, but you get to talk, I get to talk to people that are manual therapists. And we're talking about viscera. But I've talked about everything, it's, it's so interesting to hear the similarities of it is a little feel like it's touch, you know, you kind of feel that tone. And I actually purchased the book from brawl. I haven't read it as much as I probably should have. I've been through it. When you say you're pushing it, like you're literally you got hand on stomach somewhere. And then you're literally pushing head to see if it changes tone in the abdomen, or
Unknown Speaker 18:31
region. No. So for the assessment, it surely is literally just handling the head,
Nick Sanders 18:36
and then follow it is not like depression test for radiculopathy. Or
Unknown Speaker 18:40
oh, no, yeah, it's really designed on him, like five grams of pressure, like pretty light, right? Enough to stimulate McCanna receptors. Now, not every client do I do that with like, you have to read the room, right? Like the first visit, if somebody comes in and they don't know what I do, if they're just coming to me for back pain, and I start putting my hand on their head. They're not coming back. Well, they might. But they're probably not. Right. So yeah, so usually, I'll help go the other route with the movement test, Mike Allen, did you feel that that's kind of stuck here, the first visit, I may not even work on that, I might kind of ease them into that. And so that's where the other approach that that I tend to go to goes comes into play because it's, it's, it's still gentle, but it's a little bit more hands on making a lot of people just like to feel like you're doing something and so if it's appropriate, then I'll I'll be a little bit more I want to say heavy handed but I'll just be a little bit more direct with the treatments to it. Whereas where there are times that is so subtle and indirect of a treatment that the patient's like, Did you do anything? So
Nick Sanders 19:44
So I tend to be more direct with like if I'm gonna do like I'm literally looking for tone kind of the what you're describing, and if I find tone, I kind of lean into it a little bit. Right? You have to push it on people for a bunch of years. It almost feels like your hands take you there. Like I don't know that I have a strap had a G, but it just kind of like, close up, there's some tension, right? And you kind of right kind of move towards it. What makes you decide whether you're going to use a lighter technique versus a heavier technique?
Unknown Speaker 20:14
Yeah. This would get into similarities about how the needling course right how you guys teach, how do you dose the needles? Right? Yeah. So it's going to depend on the patient, the different factors they've had in their history. If I've got somebody that's coming in that, that are given me a lot more indication that they're, they're more inflamed, they've got a higher they're, they're more sensitive to touch or treatments, like they, you know, they're just, they can't tolerate as much like they're telling me, you know, I, I had this treatment, it made me really sore, you know, like in the needling course, we talked about the Gosh, I'm gonna butcher it isn't the QI QA s? USD? USD. Okay, so, yeah. So, you know, you test those points, and you kind of get this this range. And you decide, okay, to a higher range, that person's may be more sensitive, I'm gonna go lower dose, kind of similar, you're gonna you're just looking at their history. And I'm kind of gauging that as I'm doing a history with them. And, and as I feel them, and just kind of feel how they're responding to my touch. You know, there, there was a patient by saw just last week, for the first time that I chose just to do, I think two things. Were there. Because of that reason, it was, you know, this has been going on for a long time, this is a chronic issue. You're constantly in pain, I'm going to do less, but then, you know, I'll get maybe an athlete that they're in pain, but they're still trucking along. Right. And so they don't, I might might push a little bit more. So, you know, that clinical reasoning comes into play for, for a lot of that. Yeah.
Nick Sanders 21:59
So it's I mean, to me, that sounds like it's a very patient directed approach, like, Absolutely, absolutely. Yeah, that's, that's how we've designed we have that our neuro release treatment course with with IDN, where it's cupping, and scraping and more the tissue kind of work. And that's how we that's how we push it or portray it, right? Like, soft heart all everything works, right. It's just a matter what the patient needs in that moment and have an idea and it sounds like you're going the same way. Absolutely. I feel like I was on clinicals early in my career where I was kind of like push through everything. And they just never made a lot of sense to me like, yeah, as a therapist, how do I know that it's safe to push through something like that patients given me feedback, something in their systems off, whether that's emotional or pain related, or, or whatever. And I think early in my career, I probably did push, push through stuff too much. Like, I just doesn't, I don't know what but I don't know how that makes sense. Like, if it's enough to stimulate a response in their nervous system, if it's enough to create a mechanical input, it's probably enough to create some kind of change. Right? It's yeah, better place to start. So interesting to hear even that you're going that same route with it.
Unknown Speaker 23:11
Yeah. You know, one of the things you know, if you ever take the broad courses, a lot of times what they'll do is so don't quote, you know, John P overall, who, who created that specific approach? And, and one of the things they say is, and they'll do the French accent, I can't do a French accent. It'll sound Jamaican, so I'm not even gonna try.
Nick Sanders 23:29
Are you from Texas? No.
Unknown Speaker 23:33
I was born in South Louisiana. Okay, so like Cajun country,
Nick Sanders 23:38
a these a i know a lot of people from Louisiana that are really good manual therapists. Is that a thing there?
Unknown Speaker 23:43
I have a hard time finding them. Like I have. I have family in Louisiana that I've searched many times for them. And there are manual therapists there. And I think over the years, there have been become more but yeah, but 510 years ago, I had a hard time finding anybody over there. Really? At least least in the parts that I have family.
Nick Sanders 24:00
Chris, Chris Davis, Katie, Louisiana. Okay, that's
Unknown Speaker 24:05
yeah, that would be exactly where my dad's in the Lafayette area. So that Acadian Area
Nick Sanders 24:09
Connection, Mike. I'm gonna butcher Mike's last name. But there's another guy in the same similar area. But yeah, Chris is fantastic. They got a clinic there. They're awesome. We've done a bunch of dealing courses. Anyway. That's interesting. I mean, I just didn't like because, right in the PT world, there's people that just don't want
Unknown Speaker 24:27
to talk about manual therapy anymore. So interesting to hear is true, man. That's like a whole nother podcast. I
Nick Sanders 24:32
don't want I don't want to go. Anyway,
Unknown Speaker 24:35
we'll see. Yeah, jumping over all what you get back to what you were saying, you know, he'll say you provide a little, little something. And then you let the body do the rest. And so it's like, you give this little input, and then you let the body take over and do what it's going to do. And so, somewhere along the way, somewhere along the way, in my you know, probably in the first five years of my career, I remember or, at the very beginning, I was all about, I have to fix you, if you don't get healed, it's, it's, I take it personally, like, I didn't do something, right. And then somewhere along the way, I've started to shift to be more, I'm in a partnership with you and your body, we work together, I'm not responsible for fixing you. But, um, I'm going to do everything I can to help your body to do what it can do best. And, and that kind of goes back to what you were saying, like, you know, like, I now I don't tend to push and force through a whole lot. The body's guarding that for a reason. So I think, Okay, what's another way to go about it? And can it go somehow into a backdoor, you know, go around that barrier and and still affect the nervous system, but get it to let that go. And so yeah, I agree with yet. I see that still a lot in the PT world, but I've largely moved away from that.
Nick Sanders 25:55
I love I love that explanation. Yeah, that's perfect. In the NRT course, again, like we do all their three different tools, we do cups, we do scraping, and we do percussion. And the idea is if if somebody doesn't like one of the tools, it's not that that one tool is magic, like, use it if they don't like compression, switch to distraction and use use cups. If they don't like that do shit, right? You can switch and you can, you can kind of, but I think I'm still in this phase of I am like, I take it personal if I don't fix them. Yeah. But I know that it's not my responsibility. Like, I'm smart enough to know that I can't enforce a change just because I wanted to write, I need to create a stimulus that I want your immune system to fix. But I still, I still don't personal
Unknown Speaker 26:40
don't get me wrong. Yeah, I if they don't get better, I feel that frustration. I'm taking it like, like, oh, I say 80% The error only 80%. Like, get back on the table. We got to figure this out. You know, so a that's still me. Don't get me wrong. But
Nick Sanders 26:56
I've also learned that if it's 80% better, just let it ride for a couple of days. Because yeah, maybe maybe that last 20 just disappears on its own. Yes, true. That's true. Because I've gotten myself in trouble with that exact Oh, get back on the table,
Unknown Speaker 27:10
overdoing it. Yeah, over treat them. You overcook it
Nick Sanders 27:13
their immune system. Yes. Yeah. But that, yeah. It's interesting to see again, when, you know, coming at it from a visceral side of things, but the approach sounds so so similar of, let's provide the input, let's not over treat, let's see, kind of see how it shakes? What, how did you get to? Well, you know, before we go down that rabbit hole, what's the other you mentioned that there was another side to the visceral? What is what's the what's the kind of alternate to that?
Unknown Speaker 27:44
So, so it's where I started, actually. So I started with a group called the Institute of physical art. And that's, that's where I've gone through their programs certified, but that's where I was actually, and this will get us into the question you're gonna ask, that's, that's where I got introduced to this real world. Okay. And so, you know, their, their approach is very eclectic. You know, it's a manual therapy approach, it's, it's very much, you know, mechanics, bone and joint, some are very heavy and soft tissue that I found, the Institute of physical art, they got a good balance between addressing the joint for soft tissues, addressing the nerve mobility that are the neurodynamics. And when I was when I was coming out of school, and, and getting in with them, like they were starting, they were just kind of starting into working with the viscera. And considering the viscera, overall, was already doing his thing. But I Pei was starting to work it into their curriculum, and so did their fellowship. I didn't do their fellowship, I applied to it. And we were all we were all set to basically go ahead with it. And then we had a surprise, pregnancy, which was great. We had gone through infertility treatments for our first and we thought, well, you know, we don't want to go through that. Again. We're good with one. And so I had submitted my application, like, talk to them to like, yeah, you're strong candidate. And then, boom. I don't know if we can afford this then. Because, you know, we're going to move to Steamboat Springs, Colorado. I was looking at like, it was going to be like an extra $40,000 to take on for the year. And I was like, I just don't know if we can justify that. And so I'll pull up my application. And you know, I mean, I wouldn't go back and change anything about it. Because we've since had another I've been told they're bonus babies. That's what we should say not not surprised. We've We've since had a third bonus or a second bonus, maybe so maybe we have three now,
Nick Sanders 29:44
but when we hear we like three seems like a big number.
Unknown Speaker 29:47
I mean, you get one or two or two. I keep bugging Matt and I'm telling he's that too as well. I'm like, Dude, you just need to third it makes you feel younger. He's gonna I hope he listens to this Here's,
Nick Sanders 30:02
yeah, he and I had that conversation over dinner while we were down there. And yeah, you know, we're in the, our youngest is four months old and our oldest got two and a half. So we're kind of in the like, the heat of it right now. The idea of, you know, three is threes big.
Unknown Speaker 30:20
Yeah, we are, we had a pretty good gap. So that helped, like our oldest is nine and a half our, our middle is six and a half. And then we have a nine month old. So, you know, the nine and the six year old, they're really good about helping out where they can. We don't quite have babysitters yet, but we can at least leave the room and feel comfortable for a little bit. So yeah. Yeah.
Nick Sanders 30:42
Anyway, so you've done a lot of their coursework, then like you've kind of gone through their program.
Unknown Speaker 30:47
Yeah. So yeah, they do a certification program. And so I went through their certification. And then, and then I was gonna go to the fellowship. But yeah, I stopped stopped short of that.
Nick Sanders 30:59
Interesting, interesting. And so, like, I'm assuming then just because of the visceral work, you do kind of that eclectic approach. That's what kind of takes you into private practice and seeing some of those clients, right? Like, it's just gonna feed us. Right.
Unknown Speaker 31:13
Right, right, absolutely. There's just, you know, there's a lot of potential that I knew it was a lot of it came down to, because of what I saw, I did a clinical rotation up in Steamboat Springs, at their main clinic at the time, and you know, just seeing some of the stuff that they treated. I was like, I didn't know that PTS could treat that I didn't know that could be treated, in general. And so just to see that I was like, that just opened up the possibilities and just the potential of what we can offer, as as a PT, but also, you know, as a manual therapist in general. I mean, it was, like mind blowing. And so then, then what are some of those examples? Yeah. So the very first one, I remember seeing, you know, Greg is, Greg Johnson, he, he and his wife, Vicki, are are the creators of the Institute of fiscal art. So I was watching Greg treat with one of his fellows, and it was a lady. And she was having lower, lower lumbar pain, maybe SI joint pain, I can't remember. And, you know, and, and these, you know, all of the fellows that are getting trained, like, they've all gone through the certification program already. So like, they're not chumps, right? Like, they're great therapists. And so if they're, if they're struggling, you know, there's typically something going on there. But he comes in, and, you know, they kind of go through a quick like, subjective just because so he can kind of catch catch up to speed. And then he goes and treats her uterus. And, you know, just do the abdomen, just so we're clear. For everybody that is looking for this row therapist, it's all a lot of this can be done externally and is done externally. So. So he goes to the lower abdomen, he treats the uterus, she is up no pain. And so I remember asking them, I said, Greg, what, what made you think the first time you treated yours, I'm gonna go treat that lady's uterus. And he said, Well, I had a lady that, you know, I was treating her for low back pain, chronic low back pain, and it just wasn't getting better, like I had expected. So I said, So he goes, don't let me go. Let me go study some anatomy. And then let's get back together. So he goes and studies he looks what's in that area. And he goes, Well, this, this has got to play a role. And it's got a ligament that attaches from the back of the uterus to the sacrum, and you get these ligaments that come out to the side to towards the inside of the pelvis. He said this, this would make sense, goes and treats it. And it solves her her back pain issue. You know, so that was that was one of them. And then probably the other, there's, there's plenty of stories, but the other probably, like mind blowing, when at the time was when he started treating heart mobility. And, and, you know, it's, it's a, it's a fine line to walk right, like so when I when I treat this kind of stuff now, like it's a fine line as a PT to walk, knowing what my scope of practice is. So I try to tie all these visceral things to something musculoskeletal, right? So that way I'm treating you for mobility because of this, but like he would treat stuff and we'd start to see things change that, you know, weren't musculoskeletal like blood pressure decrease anxiety decrease, and you know, he wasn't treating them for the blood pressure. He wasn't treating them for the anxiety because you know, Pts we don't do that right. But But he he was treating knowing that these things could potentially be affected but this person was having some other musculoskeletal issues or mechanical restrictions that led him to consider that. So yeah, those those were kind of the two I opening mind blowing ones that I remember.
Nick Sanders 35:03
That's an interesting one. That's something that I like the visceral stuff makes a lot of sense. I've had a few of those highs myself. And heart mobility. I mean, we talked about vagus nerve, right, like, yeah, pretty interesting as far as autonomic change. And absolutely, absolutely, that's, that's kind of interesting.
Unknown Speaker 35:21
So, I don't know, I don't want to touch that one.
Nick Sanders 35:24
I don't know. I don't know where we go with it. But if we were if we were in person, I'd be like, show me something. Yeah. I mean, I just love the you know, exercise is obviously vitally important. And from a treatment standpoint, you need it. But anybody that's done manual therapy for a while, those are Ha's are like, you're not going to, what are you going to do to exercise that out? Right? Like, yeah, you put some input, you let the person's nervous and immune system kind of do the thing, and then all of a sudden, the pins just disappears. Right and right and put right time. It's, it's, I mean, it is crazy stuff.
Unknown Speaker 36:00
Absolutely. And that's it. And I think you would, you would probably agree with this. I'm like, It's not to negate that the exercise is still very important. You know? Yeah, absolutely. You talked about motor programming, early motor learning, right? Like, you need to retrain, retrain that, but you're right. Like, it just made perfect sense to me early on, and like, why wouldn't I try to correct something that's not moving? Well, that's affecting how well you can even do these exercises. You know, I mean, how many times do we have people that come in? They're like, yeah, I tried physical therapy didn't work. What did that look like for you? Yeah, you know, they gave me a bunch of exercises. And you know, it just didn't help. Well, let's take a look what's missing, and then you start digging a little bit deeper, and you find, hey, this is restricted. And that's going to affect like you talked about earlier, right? Like, we know, inflammation, we know, alignment issues, we know that, you know, a lack of movement can affect how well the neuromuscular components of the system function. And so maybe those muscles aren't firing well, because of this restriction and free this restriction up now those exercises might work a little better for you. So definitely not, you know, and I try to tell people that like, when, when we talk manual therapy, like when I have a student or something like our goal is to get them to the point where they can do stuff like that. But you're right, like those aha moments, like just it just like, why wouldn't you do that? Why wouldn't you consider that?
Nick Sanders 37:25
Especially? Yeah, I mean, and like, you're exactly what you're saying, you're gonna move around and inhibited or guarded muscle because the pain you're gonna move around it, like, how are you supposed to activate it? And if your body's guarding it that hard? Why would you activate it? Right? Like, let's take away the let's take away the garden and then see what let's see what shakes. I don't make sense. To me. That's kind of my bias, my background, but it's so painful when you hear people say manual therapy is garbage. And you're just like, come on.
Unknown Speaker 37:53
I know you've kind of alluded your some of your manual therapy background being Mulligan's. You're gonna mean like, that's great stuff. I got. I was taught some of that early on to and I was like, this makes perfect sense. And it works.
Nick Sanders 38:05
It's all aha was like it all match. Yes. Like, yeah, you put this little bit of pressure on their neck, and then they're like, my neck pain is gone. What do you do?
Unknown Speaker 38:13
What does it loons nags? And snags? Right? Yeah.
Nick Sanders 38:17
Yeah, I'm the VMs. And my first year as a PT, like, I was fresh out of school. And somebody brought me a magic hat as a gift. And they're discharged. Like, like, that person was happy, right? Like it was just a stupid Mulligan. thing that works so well. And then, obviously, the needling side. And before we run out of time here, I at least want to hint at the needling How did you end up because that's the needling is another thing where you get some aha was how did you end up at a needling course, like what got you there?
Unknown Speaker 38:53
I knew I was gonna do needling. I've known I've noticed him do it for a while, like I knew. It's a good complement to what I do. I purposely was holding off. Because at the time in the clinic I was in nobody was doing it at that point. But you still were talking five to eight years ago. And so and it was a busy clinic. And I knew whoever did it first was going to get pulled into every patient that needed to be needled. And I am very protective of what I do. And I like to spend that time with the patient. And you know, and I would still get called into rooms like, Hey, can you come and check this out? Like I do. I do a lot of pelvic work. And so I would, I joked, if it was the right patient, I joked, you know, I would get called into the room to check your tailbone. I'm like, Hey, I'm Jason and the guy that comes in looks at your button and like because I was constantly getting pulled into the room for that. So like that was already happening. Like I can't add in something else that's going to pull me away from the patients that are coming to see me so I purposely didn't do it. But then we started having more therapists go through it and different different needling programs, right, like, honestly, integrative was not even No, my radar didn't know it was out there. I was, I was looking at it like, Oh, I'll probably do this one. And then a colleague of mine, who was a former student of mine, did integrative and she's like, Hey, this fits our model and our mindset really well, I think you need to consider doing this one. And so, and then one of those therapists was started to try needle up at four with PT, and she started drawing my patients, and I was like, this is making a difference. And I need to learn this now. So, you know, I was planning on traveling for it. And then Matt was like, why don't we just try to host it? Like, why don't we still work? It worked out? Well,
Nick Sanders 40:43
that's pretty cool. That that's how that's how you got connected? Yeah, I mean, talking to you, I could tell like I, you know, again, I know our course. And, like, it matches your philosophy. It matches your philosophy very closely. Yeah. As far as neural input, and how it affects the system. And then those kinds of things. So before we hopped on, you said you had started needling a little bit? How's it going? What kind of stuff? Are you noticing?
Unknown Speaker 41:08
Yeah, it's been good. You know, I, I tend to have this method, when I take like, a course, that's a new approach where, you know, the first week or so it's really just like, going through the different techniques, like I'm breaking it down and just do I need to remember the techniques, how to do it, where to do it, you know, things like that. And so, you know, this last week, week and a half, that's largely been it was, you know, trying to Okay, as I'm treating patients, I'm thinking, okay, I can put a new layer because of this, or this, maybe put them here. And so then I just start, you know, the patients that are appropriate and are okay with it. That's what I've started doing. So you know, some lower body stuff. So I actually already had a lady let me needle her face. She was like, I've got this weird ear stuff that's been going on, like, treated the cranium last time, and it kind of helped, but it's still going on and, like, learn some stuff. So she was good with it. And then you know, and as that as that gets more comfortable, then I'll start, you know, kind of integrate, okay, like, okay, there's this whole approach that I have to now integrate it in cells to kind of start thinking about it more as Okay, needling here, but I'm also gonna need all these other places because of how this affects the nerve or the nervous system. And, and then and then after that is really in the Okay, now, how do I fully integrate this into what I'm already doing? And not just be like, Hey, this is the side deal, but now it becomes a part of the whole approach.
Nick Sanders 42:33
Yeah, I'd be interested to have this conversation again with you in a couple of months. Begin. You're cool. You're cool. Yeah, we should your quote, from Brawl about apply a stimulus and then let the body like, I feel like in a way, that's exactly what we're saying with needling, right? Yeah, we get we get heat all the time. Because we want to know, well, if I put the needle in, does it activate the muscle or deactivate? The muscle does it like, it does what it does, like the immune system is gonna react, right? The person's body is going to react and, you know, wherever their body takes it, that's what's gonna, you know, you're just creating a stimulus, right? So I feel like that quote, in matches kind of exactly what what our model kind of entertains. And as you get more comfortable, I have to imagine that it just like the blend, I'm really curious to see how you, you know, we call it that fourth generation where you got you kind of integrated into your own stuff. I can't wait to see what your what your model looks like. We also
Unknown Speaker 43:34
got to say we should we should definitely do this. This podcast that you're doing, I kind of had started one like like this. Last year, I just kind of didn't have the time to keep it up. But I'll resurrect it at some point. And we'll do this and we'll talk needling a little bit more than Yeah, that'd be good.
Nick Sanders 43:50
Yeah, I don't have time to do it. Either. It gets all kind of crazy. But it is fun, just to like, especially, you know, as you get into, like having your own private practice, like, there's only so many people to talk to, you know, like, as far as like just talking shop and hearing what other people are doing, you kind of get into your own. You get into your own rhythm and you know what works for you. But I, so the one of the bigger fascial or visceral ones that I've had, I had a younger kid in high school age, had his appendix removed. And then after his appendix removed, every time he went to the bathroom, every time he peed, he would get like, penile pain. He'd get painted and like, like, what happened? Did they Nick anything? No, nerves work, everything's fine. All right. Why is this like, what is this pain? You know? And Mark Hernandez who teaches our pelvic floor course I emailed him I'm like, What am I missing here? And the oh, what's the ligament comes out of the belly button, the developmental ligament.
Unknown Speaker 44:47
So the IDM and the look umbilical cord or the umbilical like it's, it's one
Nick Sanders 44:51
of the umbilical ligaments. It has a fancy name, your caucus? Maybe? Maybe it attaches to the bladder? Yes, your bladder Yeah. Yeah, so Mark's, like, throw a cup on his belly button. So we put a cup on his belly button, we mobilize it. Yeah, ping Gong never comes. Like, oh, that's so cool. Like that stuff is just so wild to me. And it's just the more you learn about how all the neurology connects, and then that fascial piece, and the developmental ligaments, there's, there's a part of like that, that's it's a it's a piece, right? And how does it like you're saying, how does it all fit into the treatment perspective is, I think it's an evolving concept. But pretty cool.
Unknown Speaker 45:36
So something as a side note, but something I think you'll find cool. You mentioned the developmental ligaments and the structures that are there. So one of the ways that you can also assess the health or the vitality ethic they say an organ is, so there's this inherent movement that happens, it's it's a subtle movement, like, if you were to put a live MRI on like, it's, it's not anything that you would see, but it's a very subtle movement towards midline and away from midline. And so what it is, is, you know, when we were developing, we were very much in line, right. And so then as we, as we grow, and develop, and we became more, we kind of opened up. And so all these structures that started more midline, now, they start to move away from midline. And it's like this, like the body has this memory of where we came from, and where we went. And so a healthy, vibrant organ is going to have good movement. So and this is different from a cranial sacral rhythm, but it's kind of a similar concept, right? There's a subtle rhythm that you're filling in. So you can assess like, if I, if I took, we'll take the liver, because it's, it's a big structure like so it would move up and out and down and in. And if, let's say that, let's say I had an abdominal surgery, and there's a scar that's holding that liver, I'm going to feel that movement not come up and out as much because it's being held here, even though I'm not physically taking delivery, moving it. So it's like, it's like our body has these memories of where we came from, which is to me like the more I learn about anatomy, and the more that I learn about, you know, embryo logical development and how that affects us later on. Like, it's just amazing. It's like the body is, it's very well designed, right? It's amazing design.
Nick Sanders 47:30
Yep. And I think in an effort to simplify it, we mess it up sometimes. Right? Like, sure, like, we got to identify the pathology. And once we have that pathology, we know everything. But yeah, the consequences of that pathology are complicated, like, there's layers to it, like you're saying, there's primitive reflexes, those embryonic reflexes, when things get really stressed, like, where do you go, you know, the autonomic nervous system side of posturing and tension. It's just how does that all fit into, and then, you know, take it next level of central sensitization and effects on the brain in the spinal cord with with systemic the chemical side of the hole, right, the chemical inflammatory side of this whole equation. You know, how does that fit into the autonomics? And some of those, you know, they're curious, how many of those people where you're seeing some of those primitive guarding kind of patterns of the viscera also have systemic inflammatory problems, autoimmune conditions? That kind of stuff? I wonder if it goes together?
Unknown Speaker 48:28
Yeah, I think it does. I mean, at this point, that's largely what I see. When I when I started out. Treating the viscera, like I was seeing, like a general orthopedic population, like I would see high school athletes or, you know, weekend warriors, or, you know, just like younger population to old population. And so even like, one I remember, it was a high school cross country player, like he had he was he was an inmate he stepped in the pothole kind of did one of these and kept going, had this side pain. And I think, I think it was the right side pain. And, you know, he continued, he was like, 13 something, but you know, he just had this nagging pain when he would run like he would get to a certain level of intensity and he was starting to have this pain again. It turns out his ascending colon was what had tightened up on him when he had that jolt into that pothole. So like the visceral work works for even like a more acute injury somebody that's young and healthy, because that's where I started right like I started looking at it as Hey, that hip pains not getting better it's been there for a while there might be you know, something that's tight this really and then as I started to develop a little bit more than it was more like okay, now these chronic issues where there's inflammation involved autoimmune can conditions that are involved that that there's this constant inflammatory process going on. Yeah, like those things are, are starting to be affected. I mean, we know 70 70% of the immune system is found in the gut. And so if you think I've got an auto immune system, the immune systems dysfunctional at that point, it would make sense for things to tighten up through there. So I find that all the time. One of my one of my biggest referrals, right, referral sources right now is from a naturopath of the group that that's a lot of what what she's getting my way is when when people come in, and she does her tests, specifically, there's a stool test that she does when it shows up with certain things like, she's like, let's go see Jason see if there's a mechanical restriction. And then, over the last probably few years, where I started really kind of getting into it is emotional trauma and how that manifests physically in our organs. And so I've been seeing more of that. And so like it started off, like, Let me treat this because you're young and healthy, and it didn't get better. And and now it's evolved for me into, you've got a lot going on, and we need to consider all of these layers that affect it. But it works across the spectrum for sure.
Nick Sanders 51:14
That's yeah, the the young case, the first thing that pops into my head is how many times does that kid end up having some surgery? Like, doesn't get better with conservative PT, they go in, they do an image of his hip. He's got a labral tear, because everybody's got labral tears. And then it's a labor repair. Sure, you don't I mean, like, yeah, how often or spine right? Like, oh, look, we found a disc bulge? Well, yeah, okay. Right. And you know, when you talk about people asking, Don't you just love your job? And when people get better, like, Yeah, but the ones I remember are the ones where you go, what if I miss something, right? Yes, yes. If I miss the way, you know, not that that's the norm. But what if I missed a weird visceral thing? Or weird systemic inflammatory referral? Or? That's a tricky one. Are you seeing? So this, this is what drove me into the looking at this row was the autoimmune stuff, because the basic stuff gets better, right? Like, somebody comes in with normal back pain, kind of the common causes, you know, at this point, I expect them to get better pretty quick. Or I'm missing something, right. And so that's kind of where I went got into the like, looking at the visceral stuff. How effective are you seeing like people with just like chronic belly pain, and they have, you know, they have digestive issues called gluten sensitivity, allergy, whatever, you know, leaky gut stuff, but then like, their stomach always hurts, you know, they can't put pants on, they can't, you know, they're wearing loose fitting shirts. Are you seeing changes in digestive habits? And then I mean, I would assume if that gets better than the belly tenderness goes away. But are you saying?
Unknown Speaker 53:00
Yes. So I see, I see it go a couple of ways. Probably the majority of people are on the constipated side, right? Or maybe they're bloated, maybe they get bloating after they eat certain foods. So, like, for the constipation issue, I'm seeing, you know, when we treat this stuff, it at the very least temporarily changes the bowel function to where the stools are maybe a little bit softer, the frequency maybe increases a little bit more the volume of the bowel movements increase. So at the very least, to see that now, where it gets tricky for me is there's so many factors at play, and a lot of these people have other factors that are playing into it, that just kind of brings that right back. And so, you know, I very much emphasize the team approach to treatment with those kinds of patients. And, you know, you know, I can address this aspect of it, but you're gonna need Somebody to address that aspect of it, you know, the dietary aspect of it or, you know, the prescribe you some supplements or you know, something that's going to help you get the leaky gut conditions off. So, but in general, yes. And then, like the visceral work will affect constipation. I've seen it go the other way around to where like one lady I had she, she didn't tell me this house trainer for hip pain, chronic hip pain, but part of treating her was treating through the viscera. And she was like, you know, I've noticed that. For years, my stools have been loose, like almost to the point of diarrhea she has, they're solid again. And like, you didn't tell me that. So I've seen it go both ways. And the bloating, same thing like bloating a lot of times the small intestines can be a huge part of that with all the vessels and lymphatics and all that that goes with that. So, I am seeing that. But, you know, for some people, it's for some people it does resolve for other people. It's a I think you kind of made Shouldn't you had a case with a needling lady like she just kind of comes in like every six to eight weeks at this point? I think it was your, your dystonia lady, I think is what you were talking about. You know, I've got people like that. And then for other people, it really it becomes part of how they choose to manage what's going on, because for some people, you know, like, we can't reverse everything, right. And so for some people, it's, my goal is to avoid surgery. My goal is to feel at my best, and this is part of it. And so I might see them, you know, once every couple of weeks to once a month or something like that, to just loosen things up like that.
Nick Sanders 55:35
To the obsessions. chin ups. Yeah. Juno's body tuneups, I think, yes, yeah, yeah, I'm becoming a bigger. You know, in conventional insurance based pizza, you don't get to do tuneups, because insurance doesn't allow it. Now that we've been cat, I mean, we're going on five years now. So what you want but the value of the tuneups like people like them, because they feel good, and they're no medications? And, you know, and it just kind of keeps them moving while so. Yeah, definitely. It opens up a lot of interesting aspects. And I think you're gonna see, I think that's why you're seeing the popularity of in the PT world of going cash, because we have such a skill set as a profession that we're just kind of held back on a little bit when you want to get three visits, and it's all post surgical care and that kind of stuff. So it's it's, yeah, again, that's a topic for a whole nother podcast. Yeah, absolutely. The whole health of the profession, right, like, that's right. Anyway, Hey, man, this was fun. I really enjoyed kind of talking shop. My poor clients that are about to get their release, pushing on a lot more again.
Unknown Speaker 56:39
Just just know what's underneath what you're pushing on. Right? That's, that's what I tell people like, you just got to consider what's underneath. That's yeah.
Nick Sanders 56:45
Well, I have a client you the so right. Have you seen this thing? Yeah. Yeah. It's like, what do you think about this? I was like, I think it's gonna mobilize your colon.
Unknown Speaker 56:55
Yeah, yeah. Absolutely.
Nick Sanders 56:58
But people love it. Right? It does. Good stuff. Yeah, so no, and we do some abdominal needling and some different things that are pretty, like, from the neural side, the input side, that's fast. So there's so many layers, I also want you at some point to want to connect you maybe we can do a big podcast with Mark Hernandez, because he has a lot of, I'm gonna take his course, at some point, you're gonna like that course. I just know you will. And it'd be it'd be really interesting to kind of get a conversation with a bunch of different, like, almost like a, get a bunch of manual therapists and just kind of talk about all the nuances. It'd be real fun. We'll figure out a way to do that. Yeah. So I'd like to wrap up all the podcasts with what do you think you're going to be most interested in next year, or things you want to learn or dive into? What do you think your head?
Unknown Speaker 57:50
I want to take the advanced course for sure. So I've already started looking at that. But, you know, prior to getting into the needling a week ago, I was actually looking at a couple things. For years, I've wanted to go through the certification process for the visceral work. The thing I've been held back on the most is, you know, not the practical side of it, it's you have to write up 10 case studies. And so I just, I have not had the time to do that. And if I'm being honest, I still don't have the time to do it. But I'm gonna try to make that happen. So that'd be one. But then I had also started looking into functional medicine certification. Okay, functional medicine practitioner certification, you know, more at this stage for the knowledge of it, but I might, I might go that route with it just to just to keep learning.
Nick Sanders 58:43
Yeah, I did a podcast with a naturopathic doctor out of Canada. And it is interesting, just to hear the little nuances difference in their training and some of the stuff that I don't know that it opens up any awkward, like, I hate that we can't order x rays, and it doesn't really open those doors for you. But the knowledge I think of kind of understanding some of the, you know, herbal stuff and some other things might be might be interesting. That's really cool. I'm glad you enjoyed the needling course, obviously. Yeah. I would love to see again, let's have this conversation a couple of months, a few months, for sure. Let you talk a little bit about what you're finding and how it's, you know, kind of getting into your system. I think it'd be fun. Yeah, that'd be interesting. All right, Jason, where can people find out more about you?
Unknown Speaker 59:29
Yeah, so my practice website is the name of the company is our three physio, the letter R and the number three, so WWW dot our three physio.com and then Instagram and Facebook. I'm not. I'm not a huge social media fan, but I do my best to keep up with it. Mostly on Instagram Stories, probably. So at our three physio for those
Nick Sanders 59:55
through all of us PTS, we're all trying. We're all trying to learn social media. Yeah. Alright this was fun thank you thanks again absolutely thanks for watching and supporting the channel we hope you enjoyed this week's episode let us know in the comments below what you liked what you disliked what you'd like to hear more of and any questions we can help answer we appreciate your support and we look forward to seeing you on the next one
Transcribed by https://otter.ai
