Position, Breath and Gait with Dr. Keaton Worland

You're listening to the PT Profit podcast, episode number 64. Today I'm sitting down with Dr. Keaton Worland and we're talking all about position, breath and gait.

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Let's get started. Hi, I'm Beverly Simpson, former fitness manager turned online personal training business owner. And this podcast is where smart fitness professionals, including trainers and clinicians, discover how to increase client performance and movement, package and position their products and services and get out of their own way so that they can increase their revenue to live a life that they love without sleazy sales. Welcome to the PT Profit Podcast. What's up, coach? Thank you so much for pressing play.

On the podcast today.

If you're new around here, I'm your host, Beverly Simpson. And today I am super pumped to bring to you a very Special guest today, Dr. Keaton Worland, who is a doctor of physical therapy in St. Louis, Missouri. But he's more than just a therapist, which you are about to discover when you listen to this episode. While he works as a therapist, he's a performance coach and a clinical mentor. He wears various hats inside of his practice and really helps people go from rehab to performance, which we actually talk a lot about inside of this episode. He has a unique perspective and a consistent desire to learn more for his patients. Not only has he been in the shoes of his patients, he understands the process and he can recognize the difference between conditioning and reconditioning processes and works to consistently navigate these waters, which we actually do talk about inside of this episode. He's been able to create and develop his own principles with the patient's needs at the forefront of his decision making process, which has allowed him to get his clients out of pain and allow them to live their lives in the way that they want and deserve. He shares with us some incredible insight inside of this podcast which I'm super excited to bring to you today. So without further ado, let's go ahead and roll that interview.

What's up, Keaton? Thank you so much for joining me on the show today. How are you doing?

I'm doing great. Thank you so much for having me. It's a, it's an honor to be, to be on here.

Oh, that's so kind. Honestly, I'm so excited to have you because I just keep seeing your work pop up over and over and over again. So I know that you are going to share some incredible insight to the community today. So thank you so much.

Absolutely, absolutely. We will see what we can do.

Yeah, it is going to be fun. All right, so let's just go ahead and dive right on in. Can you just share with my people who might not know who you are, a little bit about who you are, how you got started, why you do what you do and who you serve?

Yeah. So I am a physical therapist and a strength coach. I've been a PT for almost six years now and a strength coach for almost nine. So really, just like most people that are into the field, I was a high school athlete, got interested in sports medicine and just the fitness world in general to kind of facilitate like performance enhancement and whatnot. But in college, when I play, I was playing college basketball, I actually had a injury while back squatting that kind of changed the trajectory of my career. And so I actually ended up rupturing two discs in my back and fracturing my back. And I was told that the only way that I would ever be able to lift again or move again without pain was to have surgery. I knew that wasn't an option, though. That wasn't something in my head that made sense. And I knew there was a better way. And we had a trainer and physical therapist at my college that showed me that he cared and that he had a better way to rehab the situation. And so through a lengthy process of reconditioning and relaying the foundation, I can say 13 years later that I'm pain free. I still have to manage things, but it was through that process that I actually was turned to the power of physical therapy and performance coaching. And so that's really what changed my trajectory because I was going into orthopedic medicine, I was an MCAT away is all I had to take and then apply. So it was a late change in the game, but that's kind of how I got into physical therapy. And now I'm serving basically the general population. I don't work with a ton of high level athletes or anything like that. It's not where my passion lies. My passion lies with general people that want to enhance their life and move better and learn how to take control back control of their life when they're overcoming pain.

That's amazing. And I had no idea. Now, can you just really quickly take me back to that moment of, you know, when you were doing the back squat. Now, would you say that it was like a compilation of things that led up to that moment, or was it the back squat specifically that caused it? And if so, you know, were you just doing this yourself or was this under supervision? How did you get there?

Right, yeah. So really, if we, if we. If we go back to it, it's really a pride issue. So I've never been the tallest, I've never been the most athletic, but I be dang sure that I'm going to outwork anybody that I can. And so they. We were supposed to be doing sets of five on our back squat. I said, forget it, I'll do seven. Just because I needed to show that I can work harder than the other people as a freshman. And what I didn't realize, though, was that leading up into that, I had always used a weight belt to support myself. Right. And to help kind of create that intra abdominal pressure, whatever. At our institution, we weren't allowed to use the belt. And so I didn't realize how much that was actually playing a role for me. And so it left me susceptible at this point. And so not understanding the role of the equipment constraints that I'd been using mixed with my pride landed me in a pretty nasty position on that final rep. So not a. Not a fun time. Yeah.

No, but also, it changed your life for the good, so.

Absolutely, absolutely. I wouldn't change that experience for anything because of the lesson learned there and the perspective I gained from rehabilitation. So I wouldn't change a thing.

Yeah. All right, so now do you find that, you know, with the general population and the people that you work with, do you find that you attract, you know, the same type of people, the people that are super active and want to go hard, you know, how do you combat those feelings with your clients?

Yeah, I absolutely do. It's an interesting conversation to be had with those patients of teaching people the concept of restraint and modification and being able to pump the brakes a little bit as we restore their movement health first. Because what we have to talk about is when somebody comes in, they're in a pain state, and then it's up to our conversation to guide whether they're trying to go back to just health or if they're trying to go back to performance. So those are kind of like the three realms that I believe in. And so it's where they're trying to go, where it kind of dictates that conversation, and then gradually exposing them to the stressors to get them back to whatever level they're seeking.

Can you expand a little bit more on your three performance, your pillars or your thing?

Yeah, the pain state, I mean, that's pretty much. That's where I. Almost everybody that I see starts. Right. They're coming to physical therapy for some reason or another, and so they're almost always in that realm. And so in that realm we see reductions in their movement profiles. Right. So they may have a loss of range of motion, they might have a reduction in force production or coordination. And it's, we identify how those, those kind of, those components might be contributing to their, to their symptoms. And so each of those components are always going to be filtered through their, their pain or their sensitivity aspect to get a deeper understanding of what's going on. When we go into the, the health realm, that's where we're looking at things that are much more specific or about variability and having more options and more movement opportunities to perform a said task. It's not necessarily about having the highest level of force production, but being able to complete and have the resources available to them to meet the demands of a task. Whereas the performance is actually going to be probably closer to your pain state than your health state. And what I mean by that is that pain is chaos and it has this level of uncertainty going on. But when we look at performance and we've moved through this competency component and we're unconscious and competent, we leave ourselves susceptible to what we don't know. And so there's that opportunity for chaos to ensue and we have to navigate that and have those conversations and making sure people understand that performance enhancement is, it's something where we're trying to push the needle, but there's always a secondary cost there. And so we have to just be mindful of that and tread the waters carefully and gradually build them up rather than just jumping right into it.

Do you feel like most people jump right into it? Is that one of the things that you think set your, your practice apart?

Yeah, a lot of people definitely try to, try to go right, right to it. Right. But it's, it's important to, to realize that jumping right into it when a tissue may not have a threshold that is prepared is going to end yourself in a not such good situation. It's like if you, if you look at some of Tim Gabbitt's work and he shows that like that acute to chronic ratio, like there's a sweet spot there. And if I am, if I'm injured or over trained or any of those situations, I'm going to be closer to that injury point. Whereas if I can back off a little bit and show a little restraint and slow down for a minute, I might be able to recapture that proper work ratio and then I'll then be able to progress from beyond there. And so it really comes down to just having a situation where you can have a conversation with the patient about what their goals are and what I think they need will facilitate that.

So you say what you think they need. Right. I'm curious, you know, how. How often, you know, how. What does the conversation look like versus, you know, what you think they need versus what they think they need. How often do you have to mitigate those types of.

Yeah, it's a, that's a. That's a constant battle. Right. Everybody know. Everybody knows what's best for themselves. And often that's actually. Right. Like if you ask enough questions that patient or client, they're going to tell you what they need. But I don't think they necessarily realize they're telling you that. And so you have to help them see that they're answering the question for you. But it's the interventions that we're selecting that will lead them down their path.

That is interesting and profound. And I think that's actually really hard for people to under. To take on that. I think that there. With trainers. Trainers specifically, because I'm not a physical therapist, so I'll speak to it. The training side. There, there comes. There comes this belief of like, I know better because I've been in the field. And I think that people often discredit that the client knows their body.

Right, right.

The how. But they do know their body.

Absolutely. And so I think it's also interesting because I didn't mention it earlier, it's like I see the transformation of how people are perceiving their body because I actually work from. I run a. The personal training component of our company. And so I'm literally taking people all the way through that spectrum. And so to see their evolution of like, they know what's best for them to. I think this is what's best to me to, you know, I had an idea of what I should try is that. Okay. And just like their, Their awareness of their situation evolves, and that's where I think they truly gain some autonomy and control of their situation is through that entire journey. And so it's been pretty. It's a pretty cool experience to see people regain that confidence in their lives.

That's awesome. How do you carry them through that process?

What do you mean?

Like, how do you. How do you get them to, you know, break down those guards, those walls? Because I'm also assuming. Assuming that people are coming to you. You know, perhaps they've tried physical therapy in the past or they've tried other things and it's to no avail. Right. How do you Meet them where they're at and carry them along for the journey.

So I think it starts on day one when they come in firing. I've tried this, I've tried that. Nobody's listening to me. And then stopping and saying, you know what? I don't care about what we get done today, but we're gonna have a conversation. You're gonna tell me what you think you need and I'm gonna hear you. And so when they see that I care is what it comes down to, then I get, I get some trust from them. Then we can do a couple random interventions that might make them feel a little bit better, but they now have confidence in me. And so that, and so when they have that confidence, then they're much more likely to respond to the situation, to something I ask them to do, or to eliminate something that I think may be contributing to their symptoms or to start the process of behavior change. Those things start to become reality and a possibility for them. But it doesn't mean that the struggle goes away. They still have their tendencies, right? I mean, they still want to do, they still want to go on their five mile walk, even though that they have a crazy injury that permits that. Right. And so you guys say, hey, take a two mile walk twice a day. You see how that feels? And then, so they see that they can do that. And then you just kind of build them up. And when they find success in what we're saying and what they're doing, then they tend to stop asking questions that make you think that they don't trust you or they don't know what you're doing or something like that. So does that make sense?

Yeah, yeah, it does for sure. You know, there is something too, that I'm curious about your perspective on in terms of like, within. For the general population specifically, not your active athletes or your, you know, coaches. Right. Is that, you know, how, how, how are you navigating, you know, when people should be pushing the limits or working hard versus when they need to be backing off? Because I feel like there is a, you know, people like to live in extremes. They're either around on the floor and being like, I'm rehabbing, or, you know, doing their five mile runs or, you know, trying to get back to a marathon with them again.

Right, right, right, right.

So how do you navigate that?

Yeah, so I fundamentally believe that we should always try to stay training. It's kind of like a mantra that I try to instill with people and we look for ways that we can keep them moving at all costs. But if we're dealing with somebody, say, that's surgical from a rehab perspective or, or coming off of a surgery in a general population, we might have to bias other body regions more intently to allow them to keep moving. Right. So we have to look at things like the different biomotor attributes, like your flexibilities, your powers, your strengths, the different bioenergetics. So you start getting into energy system development and how we can implement that to actually promote healing or to promote the resource availability for those, for their goals. And then we start talking about more of their coordinative aspects and maybe some soft tissue work that they can roll around on the floor with for, at the end of a session, if that's something they truly feel like they need. It's not something that I'm keen on, but. And you know, if they like it, I'm not going to take it away from them. Whatever, do your thing. But so I think it comes down to that, you know, we have to, they have to understand I'm never going to try to take things away from them, but I have to just modify the process unless I have to. Right. So.

Yeah, okay, so you keep people training. So can you just talk me through a little bit of like your, you know, assessment and your beginnings, like, how do you begin with a patient?

So if we look at it from a patient or a client, it doesn't matter. My assessment looks the same. Okay, so it's the exact same. We start, we start on the table and we're going to look at some just global. I want to get a global idea of where their body is. And I, and I take things like heart rate and things and watch their respiratory rate to see if they're in distress when they come in. And so I just like to get an idea, you know, are they nervous, are they, are they in pain? You know, what's going on and how's that influencing their autonomics just on a basic, basic level. Then we'll look at the range of motion, the joint stuff, you know, shoulders, hips. We look at the rib cage position. For me, that's something that is like everybody seems like in the world right now that's a hot topic. But that is something that weighs heavily in my decision making. And so I'll assess that their respiratory mechanism pretty thoroughly. And from there, then we get them up and we look at their basic patterns, like a squat, hinge, pull, push, horizontal, vertical, you know, kind of all the, all the basics. And then I'm going to look at if they have an activity intolerance, as if they're in the patient sector or even if they're just coming to me to train and they have things that are wrong with them that they want to work on because that happens too, you know, then we look specifically at that so that I'm adding value to what they are there for. They, if they want to get down on the ground and play with their grandkids, well, we best look at how they're getting on and off the ground to see if they can do that or if they have the strength to do that repeatedly, or if they want to run around in the backyard with them, you know, can they, what's their running pattern look like, what's their gait look like? And so we can, we can start to make it more specific to them at that point. So I get my global, my global needs out of the way, then I get their needs met as well. And that looks different from everybody because everybody's needs are different.

Yeah. So you brought up gait. And I do want to bring this up only specifically because I've just seen a lot of your work around, you know, the idea and the concepts of gait. And I'm just going to tell you as a trainer, right? Little me, long time ago, this was never, ever brought up. And I think, I mean, I'm a mom, I've seen musical, I've seen lots of physical therapists. Right. So no one's ever talked to me about gait. And so I'm just curious about, you know, how, you know, why, why and when would you look at that and how important is that to be looked at?

Yeah. So I think to me it's, it's essential to always look at, no matter. It doesn't matter who it is, we all are ambulating or have some form of locomotion because I don't want to, I don't want to exclude anybody here. You know, there's some people that cannot walk, but they still have a mode of locomotion. And so we still look at that. And so we look at whatever their mode is. And so when, when the why we would look at that is because that's how we interact with our environment and how we navigate spatially our environment. And so if we can't efficiently walk across the ground and manage gravity and displace ourselves, then we're going to leave ourselves susceptible to injury, we're going to leave ourselves susceptible to poor performance because we're not managing the basics. And so it comes down to that it's just a basic, fundamental big rock of life. I need to be able to locomote.

How often would you say people look at that or think to look at that, and do your general population come in and go, hey, you know, can you look at my gate?

So I think very. I mean, so more often it's becoming more prevalent. I think people are becoming more aware of the importance of how they move. I think especially over this past, whatever you want to call this span of pandemic, because they've been outside walking, they've been doing those kind of movements more. And so they're like, something just doesn't feel right when I walk now. Or the amount of different Achilles injuries and aches and pains associated with walking that have come in since this whole ordeal is incredible. And I think it's because their awareness is being raised on that moving and walking matters. But before that, it was really rare, but they would all come in and say that I walk pretty good. I don't know why you want to watch me walk. I know I have bad posture, but I can walk. All right. Okay.

Hey, interesting. Okay, so can you just share, too, a little bit about what it is specifically that you're looking for when you're watching someone walk? What are you measuring?

So I'm looking for any sort of asymmetry side to side that that might be presenting itself. And I always look at them without their shoes because I think you have to see what the foot is doing and how it's interacting with the ground, because our eyes and our feet are how we literally interact and engage with. With the environment itself. So if I can't see how the foot is managing the ground reaction force back into the ground, then I'm missing a component of how they move. So I always start by having. Watching their foot and seeing what their heel is doing, because that heel is going to actually be kind of like the rudder of the foot. And so what it does, it's going to dictate what the rest of the foot does down the. Down the stream there. And so we look at that, and then we'll consider the hips and how that's moving. You know, do they stay on one leg longer than the other? Do they have a weird arm swing where one arm doesn't move at all and the other arm swinging like a bat out of hell, so. Or. Oh, all the time. All the time. They'll see. You'll see somebody that's, say, pitched over to the right. Their right arm will just be locked down onto their Side. And they're swinging their left arm like no other nobody's business. And so that's constantly turning them one way. Right. And so they have these repetitive stressors now that are coming through their. Through their system. And if you tell somebody, hey, I just want you to snap your fingers at the top of your arm swing, they'll realize it right away. They're like. They're like, oh, holy crap, I'm not moving my arm. You should try that.

I got to try that. I mean, I'm not. I'm sitting now that as soon as we end this call, you know, I'm going to. I'm going to be like, wait, am I moving? Because that's kind of something, too, that I was going to ask you is that I feel like things specifically, like breathing and, and walking, these are things that we learn how to. We are unconsciously competent. And I'm saying competent in quotations because it's just something that we do naturally. People don't need to think, okay, here's what. I'm going to breathe. I'm going to breathe now. I'm going to breathe now. I'm going to breathe now. They're. They're just doing so. Yeah. And I feel like walking is one of those things, too. So. So, you know, if you ask me, do I walk, do I swing my arms? I'd be like, yeah, of course I do. Everyone does.

Yeah. It's interesting because, you know, like, breathing and gait, there's. They're actually, they're coupled. And so you see a respiratory pattern reflects somebody's gait pattern. And so when I'm taking an inhale, you know, I'm going to be in a specific stance versus when I'm exhaling and moving through that gait pattern. And so that's been something really interesting over the last couple of years to really dive into, because I've always been. I've always had a bias towards breathing, but to connect it with the gait component has been really cool. And then people just think, I've lost my mind. But that's okay.

That's okay. But you're starting to notice that they. They were. They're related.

Absolutely. Absolutely. And there's research out there that supports it. I just. Nobody's. Nobody's reading it or nobody's circulating it. Yeah, it's definitely there. So it's. It's interesting. It's an interesting aspect of walking that nobody cares about. Because if you think about, like, our pelvic diaphragm and our thoracic diaphragm. They have to change shapes with every step, and that is our respiratory mechanism up to the glottis. And so if I'm. If I'm not managing that pressure well, then, I mean, I'm not walking well. I have to compensate.

Okay. So now this just gets my mind going like this, only because, you know, I come from a postpartum background, and I'm going to just go ahead and be transparent. Is that, you know, I heard you say earlier, y' all feels like everyone's talking about it, but I'm going to tell you right now, it's like the top 1% of human beings are really talk about breathing and gait and all these things that we're talking about. Right. Because for me, I had. I did not get introduced to the power of breathing until I had a baby, until my body, I had babies. Like, you want to talk about how things are going to be changing with how you walk and how you breathe? I mean, it's a whole, like, you're. You're like a different human. So, you know, I was. I'm just curious, like, do you have a lot of moms in your world that have to deal with these types of, like, serious body transformations?

So if I'm being completely honest, I don't have a lot of recently had recent or new mothers, so I don't deal with a ton of that population. Just never have. But I work with a lot of females who have had children, or I've worked with other ones that are actually. They have pelvic floor dysfunction and are afraid to have babies, but are also not good managers of pressure. And so that's what we're working on. We're working on trying to create a system that she feels confident in being able to procreate. Right. And so it's like, that's where these types of. These experiences that we have as fitness and health professionals are super rewarding when you allow them to start to achieve their goal of, in this case, literally.

A human creating a human. I know, it's insane. Yeah, that's. That's pretty amazing. And I guess just for me, too, is that, you know, I think about how my walking. I would. I would have to go back and look at old videos that I feel like my walking completely changed when I was pregnant before I was pregnant and then to now.

Yeah. So when you have a baby, I mean, you have this large displacement of mass forward, which is already going to change the shape of the pelvis and how your center of gravity is in general. And so that's why you see these sways, right? Yeah, I represent it well. I know, but like that is just our way of how we can start to manage pressure better and redirect ourselves forward and displace ourselves in our environment if we don't, if we didn't go side to side, we would not be able to move very well at all when somebody is pregnant. That has become our tendency and our bias post baby. And now here we are trying to relearn how to walk, but we still had the physical disruption of the abdominal cavity that has to be recaptured first. And so if I don't reinstill the pressure system, then I don't reinstill the gait mechanics.

Okay. So first you start with pressure system, then you start with gait mechanics. But they're related. So you're essentially assessing both at all times.

Right, right. Every movement that we do. So breathing is movement, movement is breathing, breathing is gait, gait is breathing.

Okay, got it. So, so now when you're. Now we're talking about like very, you know, just out of cure, you know, we're talking about things that like really breaking it down, like nitty gritty or breaking down stuff. Right. But, but you're also not just teaching people how to walk. Right. You have to run that risk essentially of maybe going, you know, how do you navigate that? Or you push them like where it's not going to be perfect. Like do you make sure that every movement pattern that they do is perfect? Like what becomes more important?

What's perfect movement? Repetition without repetition. Right. I mean there is no perfect movement. The movement is, did you complete the task? And so that's a good movement. Did it hurt? And so, you know, a perfect strategy doesn't exist for any movement. I think we over constrained, we try to shape movement too much in the world of fitness and health that we're trying to create this absolute just optimal movement strategy that doesn't really exist. People say, I want normal mechanics. What are normal mechanics? As soon as I stand up against gravity, it's gone. Like I'm compensating immediately. So to tell me that you have normal mechanics is just, it's crap. And so I don't care if you have wiggles in your movement a little bit or your knee collapses in a little bit. And it's probably not. As long as it's not habitual and it's not leaving you at risk, it doesn't matter. And so last thing I want to do is somebody that might be lacking a Little bit of confidence is to say, hey, you're moving wrong still, like, get it together. Like, I want to build them up, not break them down.

Yeah. Do you feel like you have people that are, you know, do work primarily people that are scared to move or nervous to move.

So the niche that I'm in. Yeah. Because I'm taking them from their pain state where they failed in a lot of other physical therapies, settings, and they don't think they're ever going to get better. And so I would say I'm on the more chronic side of things if I had to. It's not the only people I work with, but I see a fair share of them. And so it's not a fast process. We don't achieve our goal in six months. We achieve it in maybe three years. But we grind it out and we work. And so we don't have endpoints like we. We are. From the table to. Till you feel confident, like, I don't have an endpoint.

And it takes sometimes three years.

It might. I've had people that I've worked with PT through their performance enhancement section. Right. Of the, of the training component to where they got to where they really wanted to be, where they felt confident in themselves. Yeah. It's been, it's been a couple years. And then they just stick around. Right. And it's. Then it's just like, I want to. I want to keep getting better for sure.

But how do you navigate that conversation? Because, you know, listen, that's. No one wants to hear, like, okay, great. It's going to take five years, right?

Yeah. So it's not. So it's not like they're in pain for five years.

Yeah.

So they're out of pain at whatever rate that. That happens. But then it's. It's just, it's about them knowing that they can achieve what they want to do and that their bodies are adaptable, they're strong, and they, they are. They are. They can be independent and autonomous in their lives. They have control. And just sometimes people aren't ready to take back control. Sometimes they still need somebody. And that's okay, you know?

Yeah, for sure. Okay. Now I feel like I want to circle back because I want to make sure that I hit it all. Because you really, like, blew my mind a little bit when you were talking about the, like, swinging of the arms. And I was like, wait a second, do I swing my arms? When you were, you were telling me the, the points of, like, what you're looking at specifically when you are looking at gay. And you were talking about arm swinging, you were talking about hip shift. Do you care about like where the foot is hitting?

Yeah, I care where. Yeah, I definitely care where the foot's hitting because that's our first, first opportunity to manage the force from the ground up. And so, so I absolutely care about that. And I think that there is, you know, we'll watch like when does the pronation of the foot occur? Um, and to make sure that, that, that's not poorly timed because pronation isn't bad. It's just usually poorly timed. And so you have to. And what I mean by that is that somebody that comes in with a flat foot just has a foot that's trying to push down really hard and manage gravity. And so we need to slow them down and bring them and bring them back a little bit into their. Into the gait cycle, the earth earlier phases of the gait cycle. And we can train there. And so what that looks like is things like where we're putting the heel up or the foot up on a front foot elevated split squat, for instance. And so we're doing activities like that are just going to slow down the translation of their tibia forward and allow them to spend a little bit more time in the earlier phase of the gait cycle where they shouldn't be pronating yet. And so then they get competent and good there. Then you start to allow them to shift the shin past the foot where they're going to have that more pronation based dorsiflex position.

Okay. And so that's really what you're looking at.

Yeah.

Okay, so just out of curiosity, because, you know, it's my podcast, I get to ask you. I had a, I had a client that never would step on his heel like he always would. Just like his heel was always, never touching the ground on your tippy toes.

Yeah, So I mean, that's a, that's a thing. That's a, that's a medical. Could be, I mean, I think could be a medical thing where they're called, we call them toe walkers. And so it's just where they don't trust putting the heel down because of one, one reason or another. Whether it's tone in the back of the calf or it's a literal physical length deficit in the tissue are typically the reasons why. But then sometimes that might be a cue into. He might have heel pain. And so I'm not putting my foot down because my body's avoiding pain.

Or.

Something else in the system. I mean, it could be. It could be anything there. But those are typically that one of the three options that it's going to be.

So, you know, and you. Because it's interesting because he's a friend of mine and I've worked with him for a long time and he. When we would talk about it, because I noticed it, like it's something that you notice all. You know, it's not one of those, like, it was just obvious. And I asked, I said, do you ever put your foot down? And I remember him saying, this is like, hey, this is like back when I had no idea that this was even a thing. Okay. And he said, no, I always have walked like that. Like from the moment he was like, can. He can remember that. He said he, he would say I was born like this.

Yeah. So that's, that's where we're getting into physical, like body archetypes and their. Their physical structure. Because you see people that like, bounce around, right. They just kind of look like they're just bouncy. If you look at them, they typically don't put their heel down him.

Exactly. Yeah.

So that, that's. That's coming back to a bar body archetype situation. That his system is just very springy and probably nothing that you're going to really do to change that. You can just help to slow it down a little bit. And if that was the goal. But if he's not in pain with it, don't change it.

Got it. It just was. It's just, you know, once you start seeing things, you know, you can't unsee them.

Oh, absolutely. Yeah. It's always there. Always.

No, and I just, you know. So for you, right, too, like just go out into the world and just see how people move. Like, is that all you just see, like everything.

Favorite thing in life is go to the mall and just people watch. People watch. Yeah, absolutely. They're in their natural habitat. Watch them move. It's shocking.

Is it? Oh, yeah. Tell me, what are some of the things that you see? Surprising.

So, I mean, you'll see. Oh, my gosh. I don't even know how to describe it in words because it's just like a straight visual that you need. It's bad. Like people, People do all sorts of things with their bodies to try to manage gravity. And that's really what it is. And that's why I think it's so. It's so interesting is we got. Their body thinks that that's efficient.

Yeah.

Why? Like, why. And I'm gonna. I'm gonna keep watching. That makes me sound like a terrible human. But it's just like, I want to know why. Why people behave in that capacity. What is going on in their body that makes them have to. We've been talking about arm swinging. Like, throw their arms around weird or not rotate their ribcage or teeter totter side to side. Why the heck does that person look like they're walking sideways? Like, it's just interesting.

Yeah. Honestly, it's fascinating me too now, because it's also kind of the stuff that nobody's pays attention to. Right. Our brain can only take in so much data at one time. It pays attention to. We just think. We just. We're not thinking about it. We're doing it unconsciously. And so now it's like, it must be so. It must look so. You know, because when you look out into a sea of people that looks like they're doing the same thing now to you, it must look like they all are. Complete chaos, almost.

Yeah. I love playing the game of, like, this person walks with a limp and being like that hurts. This.

Your. Your.

Their left foot hurts. And then. Then I don't really have boundaries, so sometimes I'll go up and ask them. So there's. I want to know if I'm right. Right. It's like, it's nothing other than that.

Think you're a magician. They're like, how did you know that?

Sometimes, I mean, sometimes you're wrong. Right. It's. But it's just like, you start seeing these patterns show up in people, and you can start to see why they're moving the way they are. And that's. I mean, that's incredibly powerful for improving your decision making, whether you're a coach or a clinician. It can be really, really powerful to understand these patterns. So.

Okay. Yeah. I mean, I feel like when I was training, I would always hear all the time, you know, oh, that my hip hurts. Like, that my hip always hurts. I. I can't squat. I can't deadlift because my hip hurts. And I feel like it never is. The hip never.

Oh, not never. Sometimes, but.

But. But not as often as you would think. Or people.

No, that's just where they're. That's just there. We output at our weakest point. Right. And so maybe that's a weak spot for him. That. That's taking the brunt of everything. But that's not usually the driver. Very rarely.

Causation. That's not the causation. Okay. That's. That's. That's amazing. Now I totally feel inspired. I want to be like, okay, what is this person? How's this person moving? I want to go look and see where they're moving. But on also just out of curiosity, you know, you've got people that have, that do have structural differences, you know, are structural. They are, their bone structure is different. That, that's got to have an impact in how they move.

Absolutely, absolutely. So I mean when you're dealing with somebody with like a bony abnormality or a joint replacement, the rules change, right? I mean, so we have to respect that. And so we can't continue to say your squat's going to look very, is going to look squatty because it might, it's not reality. If they necessarily have a fused ankle, might not ever be able to squat the full depth. But that doesn't mean they can't, they can't squat. You teach them how to modify their range, let them have a sub optimal squat pattern. Because squatting, they're still moving, they're still getting fitness or they're moon proving their, their health, whatever your goals are. But the, the structural constraints are, they're just that they're constraints that you have to work around. It's just like we make them work around external constraints to shape their movement. That, that's their constraint towards us that we have to manage.

How do you determine, you know, from someone who's, you know, a lame, I guess, or you know, someone who doesn't have such a trained eye, but the difference between, you know, what is a structural, what is a structural constraint versus a pattern that needs to be learned. How do you determine that?

Yeah, so honestly that's, that should be taken care of in most intake forms, the intake process, you should gain that information of what's going on in their body if they have these, these artificial joints or a injury history and then if you don't, or if you, if you struggle to piece that together, asking and having your network available to you where you can reach out to somebody and say, hey, does this sound like this might be limiting them? Like, so as a fitness professional reaching out to a physio or a chiropractor or somebody to say, hey, is this seem like this is going to mess us up? Like nobody, I mean wearing both hats, like we're not offended, like we're not offended by that, but nobody I can call, I can tell you on one hand how many people or trainers have called me and asked me something about their client and it just doesn't happen. And I don't know why. I think there's this dichotomy of people. Like, we think we're always, like, fighting each other. And like, every therapist wants to be a coach. Every coach wants to be a therapist or, like, manage breathing and rolling and all these other, like, it's. It's just we're managing movement. The context that's different is, is where they came to see you. And so. And, like, is insurance paying for it? But.

Yeah, well, yeah, that too. But, you know, it's. It's a couple of things. And honestly, I've talked about this a lot in my, you know, in my, in the podcast and also just, you know, from my own experience, I'm prideful. I'm not too prideful to share, but I think what happens a lot to trainers specifically, and I'm sure this happens for physical therapists, too, but I think there's this component of. Of righteousness that they want to be right and this fear of losing authority when they reach for help, but they miss this. They miss. The most important thing is that nobody expects you to know everything and be perfect and that asking for help actually makes you more authority, drive, that sense of authority and trust. Because now the patient, the client knows that you know your limitation. And not only do you know your limitation, but you have a network of people that are going to ultimately get them to the goal. So what ends up doing is deepening that sense of trust more than breaking it.

Yeah, I 100% agree with you.

It's a hard. It comes down to pride, honestly. And, you know, it comes down to pride because people want to be like, no, I'm the go to. I can do everything. And not recognizing that you become more powerful when you. And you're like, I don't know, but I know someone who does.

Right, Exactly. And like, given that I wear both hats, that doesn't mean I keep everybody. I refer to other trainers all the time. Like, if I'm not a good fit for you, I'm not going to hang on to you because I don't want to be the roadblock or the stumbling block for you. It's like, pain. Here's my buddy. Go check. Go check them out. We're good to go. And you know, and it's like, about having that then having communication and relaying what I saw, you know, clinically and letting them and answering any questions that he may or she may have. But I'm interested. Not to, not to flip the script, but, like, do you. Do you. Do you have therapists like, that reach out to you at all? You mean we struggle asking and reaching out to therapists about shared clients as well? I think it goes both ways.

I do think that it does go both ways. It does. And I think that, you know, for me, when I was training moms, because I'm not, I'm not working, I trained my mom from my membership. But back in back, right. I will say that I have not had physical therapists reach out to me specifically unless they've been in a course. Like I would took a pregnancy postpartum course and we had trainers and we had physical therapists and there was a lot of relationship building there.

You know.

With, with pts, reaching out to trainers. And I think that comes, you know, and it does go both ways because what I have seen is that just like for pts and you can play both hats is that, you know, not all trainers are equal and neither are pts. Very nervous to recommend trainers that are maybe not qualified to be working with this patient.

Right.

Well, I think that there. And, and it's. And it's. Right. It's totally fair. Just as there are trainers that are scared to recommend PTs because they'll work. Like I, when I had a client that was in California and I was like, listen, you need to go to a pelvic floor physical therapist. And when she found one, she was like, the PT told me that I should not be assessed until, you know, six months after my giving birth. And I was like, what are you talking about? No. So you know, these that are like, oh, you can never, you know, you're not going to be able. You live in San Francisco and you can't walk to work anymore because of the hills. And tell a mom who just gave birth to a ten pound baby that she can't pick up more than three pounds. Get out of here.

Right, right.

That's never gonna happen.

Unrealistic.

Just unrealistic. I mean, I'm not, I'm not gonna lie to you. The hardest part, one of the hardest moments I had with giving birth to my children is I had a cesarean from both my kids. And the second one, I wasn't allowed to pick up my toddler for six weeks. And that was excruciating.

Oh my gosh. Yeah, I can't imagine.

I mean that's both of us. We were like, it was terrible. Terrible.

That's, that's tough. That's real tough.

Okay, so I definitely want to be mindful of your time, talk about it, but I'll. I do want you to share a little Bit like right before we hit record, you were starting to talk a little bit about your mentorship. So I am curious because I can hear the passion that you have for, you know, serving general population. And I think too this is something that a lot of coaches and a lot of pts miss is that we forget that we're gen pop too.

Yeah, absolutely.

We're gen pop too. And the last thing that we need to be looking at on ourselves. I know, you know, you said a lot of people work for me, you know, from they were athletes, but for me, I came from me search.

Yeah, okay.

I was looking for like I came to fitness because I was in musical theater. So it was different. Right. I am curious, can you share a little bit about your mentorship? Like what is it that you're working on now?

Yeah. So Dr. Jason St. Clair and myself over last number of months have been meeting and discussing regularly the N equals one or N one mentorship. And so basically this is something that we have, we've seen a need within the physical therapy specifically realm, but it extends to coaches, it extends to the chiropractor, extends across the health professionals. Right. But it is geared at improving decision making, which is something that nobody wants to ever tackle. We want to always talk about how we can improve movement strategies and how we can, you know, integrate the most up to date technique. But nobody wants to talk about how do we get there and how do we come to those decisions. And so it's all about reasoning. And then we have a model of reasoning that we try to bring to life. We try to bring it to life with different assessment pieces and interventions and showing you that there are specific buckets of how we can categorize and prioritize the information that we are bringing in and make better decisions. We bring in thousands of pieces of data in every patient encounter, you know, what's useful and what's not. Like that. That's a hard thing to decipher. And especially for a young clinician who I think would thrive in a situation like this. You know, we have to, we have to have a process in play to consolidate the information, allow ourselves to judge it, process it and eventually reflect on it in a bigger, grander scheme for our, not only our sessions, but also for our clinical approach in general. And we have right now where we are just going live with our beta version. We actually recorded a module this morning and then the first week with the participants is actually next week. And so we're actually getting underway here. Super excited. We got 10 people in it. It's a great group. We're excited to see what comes of it and the feedback so we can continue to grow it. But it's something that I think is going to be a great opportunity for people to grow and myself included. You know, I can't imagine how I'm going to grow personally from it. And it's a little bit of a selfish motive because I want to get better, too.

So I love that. And I think that you bring up a really amazing component because I think we, we, we often hear all the time, you know, information is not the same with implementation. And that's true. I am a firm believer of that. I say that all the time, but then no one talks about. Okay, so now you've implemented. Now what? Like, we don't talk about the, like the assessing. For me, from a marketing perspective, I always say guest test and assess. Yeah, yeah, we miss that. You know, there's a component that most people are asking, not realizing that they're asked, because how many times have we been like, okay, the book says we do this, so I did it. And that didn't happen.

Right, exactly, exactly.

The book said this is going to happen, and that's not what happened.

Yeah, exactly. Working off of principles. And why are so many results different? Like, it just doesn't make sense. Right.

Yeah. So, sure. And then, you know, where do you go? Where do you navigate that? So that's, I think that's going to. That's really powerful. So, okay, so for all of you who want to learn more about Dr. Keaton, where can I send them?

So my most prevalent aspect that I, that I have is Instagram, which is just Keaton Worland, dpt or my, my website, which has kind of went by the wayside the last little bit as I've been working on the mentorship. But we're bringing it back to life. But that is Keaton Worland performance dot com. And so I'll be. I'll be updating the blogs much more regularly here. And now I have to, because I'm going to hold myself accountable for saying here. But so those are the two main spots to find me.

Okay, cool. And we'll link that up in the show notes. Where are you based?

So I didn't even say it. So I'm in St. Louis, Missouri.

No, go to high school.

That's the question that everybody freaking asks. So I'm not from Missouri. And so everybody that asked me that question, I'm like, why the frick do you care? I'm from Indiana.

My husband is. My husband is from St. Louis, and we've been. We've been together now 13 years. And.

I don't get it. I don't understand. It doesn't make any sense. I'm like, whatever. Usually at this point, I'm just. I pick a different high school in the area. Every time. Just say one. I'm like, yeah, why not? Reactions that you get when you say, say different, different ones. It's. It's hilarious. I'm like, why does that matter? Like, why did that matter?

They have made a judgment call based on, like, who you are, where you're from. Really?

It's so funny.

Like, that's so bizarre. Oh, yeah, it is. It's so funny, you know? So I'll tell you off the camera, but anyway, thank you. Really appreciate your time.

Absolutely. It's been a pleasure. Thank you so much.

Yeah, sure.

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