Uncovering Underlying Issues with Dr. Zac Cupples

You're listening to the PT Profit podcast, episode number 142. Today I'm sitting down with physical therapist Zach Couples, and we're talking all about uncovering underlying issues. Are you ready? 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 tuning in to another episode of the PT Profit Podcast. I'm your host, Beverly Simpson, and if this is your first time hanging out here today, thank you. Thank you so much for joining me. I am super pumped to bring to you Zach Couples. He is a physical therapist and performance coach, graduated from Ambrose University's Doctor of Physical therapy program in 2011 and orthopedic residency in 2013. He's worked in about every setting from workers compensation to pain management to NBA to cash pay. And his goal is to take all the information he's learned in this field, including the 80 plus continuing education courses he's been to and and teach the most simple and effective methods in the easiest way to understand possible. Currently, Zach runs ZachCouples.com which offers remote movement consultation, mentoring and training. He teaches the movement seminar, Human Matrix across the world and Just for Kicks. He's also the physical therapist and education director of Elevate Sports, Performance and Healthcare in Las Vegas, Nevada, working with everyday and professional athletes alike, including golf, baseball, football, and mixed martial arts. In today's episode, we talk a lot about root causes, underlying issues, identifying red flags in places we didn't even necessarily know that we had. And specifically in this episode, we talk about sleep. Zach in this episode shares his own personal experience with navigating signs that something might be off. And we talk a lot about how we can be the first line of defense for our clients in this episode, because most people walk around in the I'm fine coma, not realizing how much better it actually can and gets to be. So, without further ado, let's roll that interview. What's up, Zach? Thank you so much for joining me on the show today. How are you doing.

Bev? I am spectacular. The sun is shining out in Las Vegas. I think that where I'm at, the pigeons are chirping already.

Lucky.

Yeah. Yeah. So things are going pretty well. Yeah, can't complain.

I love to. I love to hear that we're here freezing our butts off in New York.

Yeah. Well, you got. Y' all been getting hammered with, like, have it been snowing and all that there.

Yeah, it has been. Yeah. Just like the Boston crew. All of us over here were snowed in. Right. If it's not one thing or another, I swear the kids are never in school. I'm like, no wonder you guys are in School till 4th of July. Keep canceling the days.

Right? Well, are they now? Did they get rid of snow days and basically make everything virtual?

Luckily, they did not. We still have snow days.

Oh, that's. That's good. Yeah. Because I had read that somewhere that they were, like, talked about. Oh, my gosh.

They talked about it. They said, oh, well, now that we have these remote options. But no, they. They did not do that. Thank goodness.

That is one thing. Yeah. As a kid, you treasure. So to take that away would be just devastating.

It'd be a bummer for sure. All right, so I'm super excited for today, so let's go ahead and just dive right in. Can you share a little bit about who you are, who you serve, and how you got there?

Yes. So, again, my name is Zach Couples. I'm a physical therapist strength coach, and I work. I wear a few different hats. So the main hat that I do is my website, ZachCouples.com and the people I serve there are basically movement, rehab, fitness, and professionals. I help them take their understanding and application of movement capabilities to the highest level possible. Because I think it's one thing to run people through various exercises, but what if you could get more out of those exercises? What if instead of feeling your back and your hip flexors on your squat, you can manipulate your ability to coach it in a manner that allows you to. To get what you want? I can help you with that. And. And so I help my. My clients be laser, like, with their exercise application and understanding of anatomy and biomechanics. And I also online, I. I end up getting a lot of movement professionals who tried training programs. Maybe they've been training for an extended period of time, They've gotten a little beat up. They still want to get after it in the gym. I help a lot of folks with that side of things. And I also, being a physical therapist, if people have any movement restrictions or deficits that are impacting their day to day, I do a lot of consultations to help them with that. And then I also work in person in Las Vegas at Wonderful. Elevate sports, performance and healthcare. Basically doing a lot of the same things. But I also work with a wide variety of people who might be in persistent pain or have any issues that way that are also impeding their ability to reach their fitness, movement performance goals. And so that's pretty much who I serve. And then I also just, I teach across the country with some of my modeling and things like that to just help people maximize the movement capabilities of the clients that we work with.

Love it. How'd you get into that? What brought you there?

Teaching. My friend asked me. He wanted to learn what I was doing. And so my friend Mike Lee in Seattle, he's like, I want to because I've, I've, I've been on the Internet blogging for a very long time. Like I did that fairly early out of physical therapy school as really it was just a way for me to learn how to. I, I was, you know, coming out, I, I didn't know much anything because I was just new and fresh. So I read a bunch of stuff and I would just blog about that and I would blog about the seminars that I was attending because I wanted to, to be good at this. And so that morphed over time into me developing a model that I operate from and, and teaching about that. It's basically trying to solve specific movement problems that people had. And then one of my longtime followers said, hey, I want to know what you're doing. Can you teach a seminar? And so I said, okay. So then Dr. Mike Lee in Seattle, he hosted me and the rest has been history since then. So it's kind of been like this reluctant, I guess I'll do this and. But it's worked out to being the thing that I end up loving the most.

I love it. I'm curious, you know, what caused you to be a physical therapist? Like, did you have a sports performance background or were you just. I love to move.

Yeah, I was a collegiate distance middle distance runner. I was pretty good in high school and then mediocre in college. One of my kind of double edged swords in my life is I don't like being bad at anything. And so then I obsess about things until I get good at it. And so that happened with me only.

Because I'm the same, I'm very, yeah, I have an obsessive nature. So. And you know, doesn't. And it's not just with vices, it's with whatever it is. Right. It could be like learning something. So I laugh only because I get It. I'm the same.

Absolutely. Yeah. So that translated into running. So I be like, pretty good high school runner, get into college. I'm terrible compared to everyone else. And so I tried to figure out every way that I possibly could to get better. And one of the things that I did was I started training a lot in the weight room, which is nothing, something I had never done before. And I ended up falling in love with that even more than the running aspect. And so my thought was, okay, I really enjoy this. How do I make a career or really dive into that? And I basically, I didn't know much about pt. I ended up shadowing, or not shadow, actually working at a physical therapy clinic back home in Illinois, where I'm from. And I ended up really enjoying it. Because I was a tech, I was able to help walk people through exercises. There was a really cool moment where I worked with this. Right. Helped helped out. One of our physical therapy assistants do pool therapy with someone who had a spinal cord injury, couldn't move, like, was wheelchair bound. But then you get them in the pool and it's like, holy crap, they can do all these things. And at that moment, I was sold. And I've kind of just dove down that path ever since. So part of it was like experiencing pt, seeing how cool it was, but also not being good at running to the level I liked, trying to find every way I could be better, and then just falling in love with the movement process.

I love that. And I love that you say that, because I'm just a firm believer and probably because I'm similar in this way, is that you have to love the process more than the outcome because you're going to spend more time in the process anyway. And as a high performer, whether you're, you know, an athlete or a strength and conditioning coach, once you hit those goals, it just means that the goalpost is going to keep moving and you'll just keep changing it, keep reaching it. So you have to love the process more than the outcome. So I love that, in my opinion. So I love that you said that. So I'm curious, you know, what are some of the common for. For a lot of the coaches, strength and conditioning coaches and clinicians that you work with, what are some of the common struggles, traps, things that you see people get into that you really help, you know, shift perspective to see and look at things a different way?

I think there's a few things. I think one of the biggest things that's missing is there's so much information on the Internet I mean it's, it's abundant and you often hear people say, well, information's free, it's all there. But what's challenging is knowing how to apply all of this information when you have someone in front of you. And so that's kind of one of the things that I try to. One of the problems I try to solve for people is helping walk them through the application process. And that could be like in a mentorship context, like, you know, right before I hopped on this call, I was working with one of my mentees who has this one client who's, he's working him through a post op quad tendon repair and so trying to apply some of the concepts that I discuss or other people discuss live. It could be something like that, or it could be like, okay, we have all of this biomechanical knowledge, but for some reason you're still struggling getting the most out of a deadlift. Well, here's how we can coach. Like that was one of my last poach was how to do a snatch grip RDL and understanding the why and all of that. So that's probably the biggest thing that I see. And I see that a lot with teaching too. Like with my seminar, I try to develop a common movement model that we can all operate and make decisions from. And then when I'm walking through people coaching wise, they might think that they're doing something in a way that maximizes the ROI on that specific exercise. And then I show them two or three different tweaks and it's completely different in terms of the, the outcome that they get. And I also see that with just, there's, there's a lot of people, I think because there's so much information out there, you get people in the general population who consume a bunch of this stuff, but they don't even know how to apply it within themselves. And so that's what I think something is that's sorely missing. And some of that's just not having experience, but also not having someone guide you along the way to be able to do that. I was very fortunate early in my career. My mentor, Bill Hartman was able to provide that for me. And I think that really helped skyrocket my ability to learn a lot of different concepts and apply it in my own domain. The unfortunate thing is that's a bit lacking. We don't have an ability to filter. And sometimes bringing someone from the outside who can see things from a different perspective helps with that filter.

You know, I'm also curious, you know, you bring Up. A good point, which is important, is that information, when it's so abundant and, you know, fairly accessible, depending on where people are, right. In terms of, of, you know, going to the library, there's just so much information out there. I'm curious how many people you've worked with that also feel a little bit, you know, analysis by paralysis. And one of the things too that you said, you said that, you know, people will have, you know, they think that they're getting an ROI on an exercise and don't realize that there could be just a few simple tweaks. So how were they measuring? How do you even know what an ROI is for your exercise selection?

Yeah, that's, that's a really good question because it also depends on how accurate or effective your measures are. And there's some people, like in a physical therapy context, and this maybe is one reason why I like physical therapy, is you can see the results of your work in a positive or negative light very quickly, assuming that you measure after everything. So, like, in my eyes, I'll do something with someone and then I'll recheck a range of motion that's meaningful to them and myself to see if it worked or not. And I know very quickly whether or not something's going to be effective. There's some people who, they don't do that. And they're like, well, I didn't have time to measure and things like that. And it's like, well, I think it was Peter Drucker, who's a business coach, I'm sure you've probably read him, who said, what doesn't get measured doesn't get managed. And I'm probably bastardized that quote a little bit. So I apologize, Pete. So you have to find some way to measure, and that's in anything, you know. And if you're a coach who's an expert at fat loss, well, you, you better be tracking weight, various anthropometric measures, et cetera, et cetera. If you're a business coach, you probably should be looking at the financials or your analytics of whatever medium you're using to acquire clients. So you have to measure things and you have to make sure that the measures that you're using are useful. There can be some things. And, you know, one thing I'll kind of poo poo in my domain that I don't really utilize a lot that I use more in the beginning was manual muscle testing. Like, to me, I don't find that as a reliable of a measure, as looking at joint range of motion. Now, obviously they're looking at two different things, but when you look at grading progress on that, something like a manual muscle test is much more subjective than measuring range of motion of a given joint. And, and so then it's about finding what measures are the most meaningful and relate to the, the intended outcome that you're going after. So, so being able to consistently measure progress is something that's, I, I think very sorely lacking. I think especially it's true in the case of, you know, some of the mediums that this information is disseminated from, like on Instagram. And I'm, and I'm guilty of this to some extent because of some of the content that I put out on that is you might have someone, hey, this is an exercise that I'm using with someone and I use it for this, this, and this. Well, a lot of times people just try that exercise, but they might not measure to see if it's effective or not. And so you have to measure things in order to see what works and what doesn't.

I love that because, I mean, you brought up so many good points. I mean, the first is that you have to acknowledge the duality in everything, right? You cannot have the light without the dark. It's same thing with social media. You're going to, you can't be, you can't be a pt, you're not going to go to PT school watching Instagram. But Instagram can be a very valuable tool. So there, you know, it's, it's both at the same time and the same thing with being data driven. It, the data itself is neutral. It's all the meaning that we associate behind it and, and the metrics that we pick and what we make it mean, whether we, you know, as we're assessing performance, like for my end. Right. Likes, comments and shares aren't always necessarily awesome indicators of whether or not your message is resonating. Right. So it's, it's just, it's just, and then, you know, people will compare things that are not necessarily performance indicators. So it's just getting really clear from my perspective on what those are. What exactly are you measuring? What causes people to not put these in place, in your opinion?

That's a good question. I think, I think there's a few different things. One, going back to a lot of people, if they didn't really have adequate mentorship and they're trying to figure this out on their own. That's tough. Like, that's really, really tough. So you don't, you don't have someone to put context into things. And as humans, that's really how we learn. Like, you know, when you're, when you grow up, you don't have to learn to invent the wheel every, every generation. Like, we relied on previous generations of humans to get to where we are today. And the same is true in fields such as physical therapy or strength conditioning, having some type of mentorship or even going through internships of any kind that helps jumpstart you. So you almost have a filter. Now, the filter is biased to whoever you're learning from. But it's better to have that as your starting point than starting with a complete clean slate, because having some type of mentorship process helps save you a lot of the mistakes that you might have otherwise made. So I think that that's one thing. I also think too, the, the other thing is just with the abundance of information, there's a lot of noise. So it can be, it can be hard to disseminate what's, what's meaningful versus not. And then also, what's meaningful is going to depend on who you're working with. So, you know, one set of measures might be very meaningful for this population, but if you just start a new job and you don't work with that population anymore, then that's going to influence what's, what's going to be relevant. So I think those are some of the big things. It's just we don't, we don't, we don't have adequate filtering processes in place. And again, I don't. It's not something that I, with all of this, like I say this, I don't blame anyone for that. It's just, I think because of the nature of the way things are right now that that makes it that way.

You know, I also, I also, you know, again, I'll always go back to duality. Right. In terms of wealth building, you need speed. And this is why mentorship can be so valuable, because you get to leverage your mentors and your community's experience. Experience. And you're leveraging speed in that way, in a way that's effective. But the reverse of that is like, you can't learn how to be a PT in two posts. Right. Or you can't, you know, you can't all of a sudden be, you know the best and know the best if you're not applying it, because no one learns how to swim by reading a book on swimming. You got to get in the water, you got to do the reps.

Absolutely.

You know, so I Am also, I'm also curious, what are, you know, for, for you and your experience, what are some of the cases that have come up in your clinical work where you, where that have caused you to, that have been hard challenges and what are some of the ways that you navigate it?

Oh yeah, there's a lot I, I think to. Over the years, I've gotten to a point where I get a lot of people who've failed other places and then they come to see me. And one thing that you have to learn with this, that makes working with, with people really tough is, you know, I can, I can look at someone's measures and know that they need this, this, this, this, and this. But you can't ignore the human component. And that's probably the hardest piece with all of this because not only do you have all of these movement things you need to address, and you might have the best plan in place to help someone with these specific movement needs, but that plan might not work if they're a single mom with three kids who's working two jobs to try and make ends meet, and they have literally five minutes that they could probably do things in a given day, and it might not be every day or, or, and this is even more challenging. You get someone and because there's so much information that's readily available on the Internet, they have a preconceived notion about what's going on that might not be fully accurate. But those beliefs have become so entrenched for whatever reason, and there's probably a lot of reasons, reasons that we can't know that it might be hard to attain, buy in from what you're doing, even if that could be the thing that might help nudge them in the right direction. So I think that also makes it really, really tough. Those are some of the hard things. And the other thing that I think is really difficult is trying to in a lot of cases, inspire people to fix themselves. Because that's ultimately what us as movement professionals is going to boil down to for long term success. That can be hard for a lot of people, I think, especially in this, in this day and age. I'm sounding like a crotchety old man, you know, and I do have the hair for it, but geez. But, but, but in this day and age, we expect a lot of quick fixes. We expect things to happen to us as opposed to us making things happen. And I think the path to true success in any domain, whether it's getting out of pain, whether it's having a successful business, whether it's performing at a high level. It has to come from within. And so you have to, you have to take ownership of your situation and really put in the work to, to do that. And so sometimes us as, as movement professionals, we have to, we have to inspire that in our clients or, or put them in positions where they can do that and be successful. And, and so really having a little bit of that negotiation back and forth with, with folks to see what's going to be possible versus not, that's probably one of the hardest things. I think I'm still learning things about the movement side of things, but the human components where the complexity really lies and figuring out how it works, how I can apply these concepts with this particular person given these set of circumstances that I think if you can, the sooner you can learn that and the sooner you can learn how to resonate with certain people who, who maybe others couldn't, that that's really what, what can be a huge difference maker in, in the clinic or in the gym.

I mean, behavior adherence and being able to inspire personal responsibility is my opinion, one of the hardest tasks that you will ever learn. But master that and you will, then you're in. Yeah, I think personally, I mean, your business will soar because that's where people struggle the most. And to your point too, when you were talking, and also to bring it back earlier, you're talking about people have these stories and core beliefs and reasons based on evidence, based on experience, based on their personal context for things that we can't know they have, they become part of their identity and who they are. And shifting those perspectives takes skill.

Yeah, it really does. And I also think it has to start with you because we have these same issues. Maybe it's not on the movement side of things, but maybe it's, it's a maladaptive belief that, well, I have to try to make everything perfect and if I, if anyone has a negative experience with me, it's because there's something inherently wrong with me. Or man, I can't pull myself to read 20 minutes of something work related before I go to bed. Or man, you know, I should probably get in a little bit better shape so I look the part. But I really like Twinkies, so a.

Lot of it I want to go to sleep earlier or, you know, or what I see a lot too is, you know, you get so inundated with doing so many other programs, doing other people's coach or other people's training programs that you're not doing your own or you're not working out yourself or, or you're not, you know, you want them to or you're in pain and you're pushing through pain. Yeah, right.

Yeah.

We're, we're all bring, we all call in what we are experiencing. It's just what our brain will do.

Yeah. And I think unconsciously a lot of your clients can pick up on that if you're not following through to that extent. Maybe not all of them, but I think the ones that are the hardest.

Do I think too that that part of, you know, a really good place, this is my opinion place to start too is just having a really high level of self integrity is going to be a game changer in your business. In your business and in your science and in anything you do, just commit to doing what you say you're going to do, period. Whether it's go to bed at 8pm, go to bed at night. It doesn't have to be these big epic life changing things. It can literally be as simple as I'm working out three times this week, period. And then do it.

Yeah. And then if you don't, then readjust, recalibrate and see if you can hit the next best thing. Just like we do with our, with our clients. It's the same process ad nauseam.

Yeah. Always, always, always, always. So, you know, and I don't know, at least it was for me a lot of time it was me search, you know, my, my business and my career started from like well, these. I went down this rabbit hole because this is what I was struggling with. So I was spending the most time with it until I figured it out. Does that happen to you?

Oh yeah, yeah. I think there's, there's some things that I've struggled with personally that lead me to learning about certain things and then I can help that with, with, with my clients. So like for example, I have braces now. Well, and I don't have them because I wanted my teeth to look extra pretty. I was having some difficulty sleeping, did some research on that front. One of my good friends, PT justice in la, he's really into sleep upper airway things. I went through a process to try to maximize my sleep by doing a bunch of stuff to my teeth, my tongue, my nose, et cetera, et cetera. But going through that process helped me learn of like, okay, if I have someone who's struggling with sleep now, I can kind of walk them through some options that they could go through if they want to help with that. Or like I had a couple clients who were having some visual based issues and I didn't know what that was like. So then I ended up doing vision therapy for myself to see what that's about. So then I can better help my clients learn things. So I think that that's. It is really important to go through that process or you know, to go back to like you had said, Bev, committing to exercise three times a week. Well, how, how do I do that given that I have this, this and this going on in my life? And so then you kind of figure out ways to help troubleshoot that. And I think it just makes you more relatable, especially if you have similar problems like Bev, I'm sure in your case, because I know you have a family that you have to take care of as well as a business. I have.

No, that's why I laugh when you talk about that single mom life. And I'm like, oh, that's real.

Yeah, but, but so I bet you have some clients who. That resonates with you or that resonate with you and you can help guide them through that because you've been through that.

Sure, sure, sure, sure. You know, it's an interesting point that you bring up because I also think too that it can. It, it doesn't even necessarily have to be. It's more about the, at least for my case, that the circumstance can have a similar problem versus like I don't have to just work with parents. Right. So for example, I've got people that aren't parents but they've got, you know, full time jobs or they're full time studying. And so they've got a level of respect, responsibility that is similar that I could relate to the struggle of not being able to have an infinite number abundant of time. You know what I mean?

Yeah.

So yes, I do know what. I do know what that means. And, and I will also to share the context of my life in terms of like my children, for example, because my clients have to know what they're in for. I can't tell you how many times I've gone live and then my kids like naked running down the stairs and I'm like, oh my gosh, it's the Internet. Go put your clothes on.

Yeah.

You know what I mean?

Yeah, absolutely, absolutely. Well, you know, it's, it's at least laughable that you have little kids doing that. If you had grown people running across naked, well, that might be a little bit of a different story.

Well, no, I mean, luckily I can cat. Luckily I stepped myself up so that my Kids are never exposed. But that's just an example. Like there was one time I was doing all. So my, one of my kids like climbed on the counter and I'm like, no, please stop. You know, so it's just, you know, context. They all have to know what they're getting into.

Yeah.

So I'm also curious, can you share a little bit in terms of your process specifically, since you brought up, you know, the braces and the sleep concerns, how did you decide or differentiate? Because kind of to your point, like clients, they come in and they'll say, oh, I've, I've googled this, I already know what this is. Or they have like, oh, I, I, it only hurts in the summer, or it only hurts when it's raining. Right. Whatever that is. How do you navigate between. Or what's the process for weight? It's not these circumstances that are typical. What caused you to go down that, that, that rabbit hole. Realize that.

Sure. So some of it is you have to learn clusters of what, what certain symptoms might point you in one direction versus the other, or having potential explanations for things like that. So you had mentioned it only hurts in the summer. Well, then you might pry a little. Or winter. Yeah. Or it hurts when I'm cold. Well, sometimes there's explanations for that. If we use the temperature example, your skin has various receptors and your nerves that respond to temperature changes also too. If there's alterations in barometric pressure that changes the viscoelastic properties of certain tissues, there might be more expansion of certain tissues based on the pressure changes. And sometimes what that can do is that can lead to increased nerve stimulation of things locally and that might lead to a pain experience. So some of it is just figuring out explanations that make sense that don't induce maladaptive beliefs. So there's a lot of that going on. And then also trying to support or find data to support or refute a given belief. So here's an example. Someone might come to me and they might say, hey, Zach, my knee popped when I squatted. I'm not sure if it's torn or not. Well, I can figure that out relatively quickly. One, it's listening to the story, asking a few other call up questions like, was there any swelling? Do you have any giving way, so on and so forth. And you know, if it's yes, then it's like, maybe you do we gotta push you this direction. Or if it's no, then it's doing various testing to, you know, assess the integrity of the ligaments and musculature so on and so forth. And so if I have all that information and it's like hey, based on this, this and this, it's low likely, it's not very likely that you have that going on. And then based on this information I think we could work on this and this to help you with that given problem. So it's about that. But then I think also asking more questions about things beyond the initial complaint is also very helpful. So in the last two years I've asked a lot more questions about sleep related issues or if someone has difficulty focusing and things like that. And I've actually based on knowing what to look for, recommended. A lot of people get sleep studies and there's been quite a few clients who have caught, who had undiagnosed sleep apnea. Not me, but we did a sleep study and then the sleep physician diagnosed on the sleep study that they had sleep apnea. And like if that's left untreated that can lead to several negative health complications. So you just have to know what questions to ask. And one, and then the second thing is knowing where to push someone if, if something is potentially negative health, health, health wise. And not only that, but in some cases like some people won't do anything about their sleep apnea even if you educate them that this is a big problem. And that's okay because you just, you just have to provide clients with, with options information and maybe it's not the right time right now to address that and maybe you just got to address the problem at hand. But I think just giving them awareness that hey, look, if you ever want to do something for this, there's options that can help you with that and I can help guide you along that way. I, I think that's also really common with various psychological problems. Whether someone's dealing with anxiety, depression, past traumas, etc. They might not be in, in a mind in a headspace to, to deal with that at that point in time, but you just gotta let them know that you care. There's options that, that can help with that. But it's you, you have to, you have to expand your knowledge base enough that you can provide answers for people or if you don't have an answer in that time frame, well then that's how you can direct your next area of focus. I work with a, there's a physician who I go to now that's part of a direct primary care and I've had some family history stuff that was a bit concerning and I asked my, my doctor, hey, should I get this looked at and she didn't have an answer immediately. But that same day she emailed me and said, hey Zach, this test has this degree of sensitivity, this degree of specificity. We could potentially go this route. And so it'd be okay not having the answer right away, but also maybe on the back end, you gotta look to see if you can find the answer for that person and just be. Just being an advocate overall for their health and wellbeing I think is really.

Critical and will also be a game changer in your business, that's for sure. So I have two questions. One's a little bit controversial, but also I'll start with the easier one. Number one is, you know, you did mention you talked about level of awareness. So I'm curious, for your clients, when you're asking the questions, how do you unpack? And what are some of the questions that you use to, to really expose things that they might not necessarily be aware of. So let me give you a tangible example. So when someone says, oh yeah, I have no injuries. And then all of a sudden you get into the session or whatever and they're like, oh, well that was five years ago. And I actually did have a blah, blah, blah, you know, so people forget things or they're not even necessarily aware of things that they know that they. Because people don't know what they don't know. So they might not even know to tell you that, to say that that's important. So what are some of the questions you use to really unpack that some.

Of it is during the assessment, if I see something that's a little, oh, that doesn't make sense. Hey, have you ever had any issues here? So I'll ask that. That oftentimes unpacks things. I ask about every part of the body a lot of times, you know, so I might be like, hey, ever had any, like, you know, let's say they're seeing me for knee pain. I might say, any. Have you read any issues back wise, tension, discomfort, neck, so on and so forth. Asking them, what kind of things in their daily life are they limited in doing? Because then, you know, for example, they might say, well, I've had a difficult time reaching up into a cupboard. Well, that could be a lot of reasons why. Maybe it hurts their neck to look up that way. And so it's like, well, maybe I'm neck wise. Things like that. Some of it's, you know, looking at the symptomology that they're experiencing and recognizing that there could be other areas at play. So for example, if someone's got an issue with their hand asking about everything along the nerve tracts that go into the hand, that's also a relevant question to ask. Really diving into medical history. And I also think too a just a catch all thing that can really expand what you may or may not know is it's just kind of feigning ignorance with things. Hey, you, you know, you mentioned that you, you're having some difficulty with bloating. Could you, could you tell me a little bit more about that? And then that might lead them into a full story and then you can pick points off of that and kind of go with the conversation along that way. So I think a lot of that is really helpful. I also think another thing is sometimes people might come, at least I see this in the PT sense a lot is, well, I have a bulging disc and asking them, tell me a little bit more about that, what do you mean by that? And sometimes hearing their explanations, they might have an idea of what that means and it could be completely inaccurate. And so I think it's really useful to see what their thought is with things. I think this is especially true with, if someone says they have arthritis or degenerative disease. A lot of times those findings per imaging are considered normal age related changes. And they might not know that because a lot of times there's, if you look at population studies with, with that in particular there, there, that can be a very common finding in asymptomatic subjects. You know, depending on the age range that we're looking at. I mean, if you look at research on back pain or back MRI findings in particular, if you look at people who have absolutely no back pain and you image them over the course of their lifespan, anywhere from 30 to 80% of those individuals who are asymptomatic could have abnormal findings on imaging. The older you are, the more likely you are to have abnormal findings. But interestingly enough, the less likely you are to experience back pain because that peaks around age 50. Um, so it's like, well, you know, how do we put everything together to, to make a story that will inspire this person to get something done? Like that's the only way you get that is by understanding where their frame of mind is and really asking in depth questions to try to make that happen.

Okay, I love that. So this is going to lead into my second kind of controversial question because I'm curious about your opinion in, in terms of the, in terms of our medical field or in terms of the medical industry right now. Do you find that when you're sending people to get things like imaging or get things like sleep apnea tests that people are quick to either, you know, quick to misdiagnose or to diagnose or to ignore or you know, not to be specialized enough to even know what to look for. Like how do you, how do you navigate all of those, for lack of a better word, but those struggles essentially with our medical system.

So in my mind none of the imaging is going to change specifically what I do because I can't and we as movement professionals can't impact the structure. So I can't, I can't change how you look on the inside. So anytime I'm going to send someone to get imaging of any kind, it's to either rule out serious pathology that needs a solution. That's not me. And, and that's, I always operate under that framework. Sometimes that could be someone has an acute injury and I have to rule that out, that there's something sinister going on that needs serious medical attention. And that doesn't mean like you need surgery right away. But hey, you know, you had this, I don't know, acute disc bulge or something and you're getting some weakness down your leg. Maybe we should get some imaging and maybe then you need an injection or some type of anti inflammatory or whatever stuff I can't do.

Got it.

So that's really the big thing that I think about and I try to only do that when there's a cluster of symptoms that would warrant me doing that. So if for example, let's say someone they suffered an ankle sprain playing basketball, they had an inability to weight bear and it's point tender over one of the ankle bones. Well, there's this thing in, in medicine called the Ottawa Ankle rules. There would be two signs right there that warrants, you should probably get imaging for this person to rule out a fracture. And so you, we learn in physical therapy about these various things. If it's the case of I need someone to get a sleep study, if there's someone who's telling me they have a history of snoring, they never feel rested when they wake up, their partner tells them that they gasp for air from time to time, they, these could be a cluster of things or they could happen isolation, they have to get up four times per night to go to the bathroom. They were bed wetters as a kid.

Wait, that's a sleep apnea?

Is, could be, it could be a sleep related disorder. If it's more than once or twice.

Oh, more than Once or twice. Okay. I thought it had to do too, with like, that's a, that's a sign marker for diabetes.

And, and, well, that, that could be too. Also, with sleep related disorders, it's not uncommon to have blood sugar impacted as well. If you have gone for longer periods of time of sleep deprivation, either in quantity or quality, that can impact your, your blood glucose levels. And, and we've seen that with a few different folks who I've worked with where they have abnormal blood sugar. And now you got to ask, like, is one causing one? Is one causing the other? Are both happening simultaneously? Well, you probably should do something to address both in those cases. So that's not uncommon. Or like, if someone wakes up and they have a very dry mouth, those would be things where it's like, based on these findings, I think we should look into this and we do that with anything. You know, even if we've talked a lot of medical today, Bev, But I'm sure there's in business clusters of things that you might see that maybe lead you to think, hey, based on you saying this, I think we should look at these analytics and then do this based on that. Or in fitness, you know, hey, I, I'm an athlete. I, I end up getting beat on defense every time when we go this way. And then maybe, you know, as movement professionals, we look at this, this, and this, and then we address those variables. So a lot of it is just, it comes back to asking good questions, knowing when to do something and when not to do something. And that's always going to change depending on the information that you learn and the information that your clients give you.

And also knowing, you know, which is why it goes back to mentorship. Mentorship is just such an important, integral part to your growth and your development and how you learn to get better. Because I would never know to ask someone, you know, what their sleep patterns are, because the truth is that the majority of people aren't living in an I'm fine coma.

Right?

We're all like, we just don't know. You know, we just. Some people don't even know how good it could be.

That's another thing too. Yeah. Especially with sleep people like, oh, I sleep fine. Well, I thought I slept pretty well too. And then I got all this crap done and it's like, oh, oh, that's what really good sleep is. You just don't know. Well, and I think it's like we talked about sleep, but even someone who's never exercised or maybe they don't eat well, like the transition you feel when you change your diet from mostly processed foods to more whole foods, just the way you feel different after that, it's like, oh, this is what I should feel like. Or when you go from not exercising to exercising now you have all this energy now it's like, oh, wow, that's really different. So yeah, it's, I think we just have this baseline of we're used to, to feeling a certain way and I think it's, that's normal. It's human to resist change to some extent. But then when you make the change and it's that initial discomfort and that can be in anything. But then you see what things are like now after making the change, it's always hard to go back. It's just getting that initial change.

Yes, yes, for sure. Okay, Zach, I want to be very mindful of your time. This has been amazing. Thank you for pouring into my community today. So for those of you who want to come and hang out with you, learn more about what it is that you do. What are some of the best places as I can send them?

The main hub is ZachCouples.com that's Z A C C U P P L E s dot com. That's where I put all of my content. So a lot of my posts, my YouTube videos, all of that houses there. Also if you search ZACH couples on YouTube you can find me there. I'm on Instagram as well at Zack Z A C couples C U P P L E S so those would be the big places. I would check me out. If you're interested in, you know, maybe increasing your movement capabilities or you're someone who's struggled finding a good program to get into the to the gym, I can help you with that on the website or if you need help mentoring because that's a struggle point that you have. You're having a hard time with that filter. I help a lot of people develop that filter. And then also too, if you want to sign up for my seminar, my movement seminar, Human Matrix, which basically if you're someone who you've taken a lot of courses, you're having a hard time putting things together with that seminar, I'm going to give you a basic movement model to operate from. You're going to learn how to coach a lot of the movements that we do on a day to day basis at the gym at a much higher level. And then if you have someone who's struggling with movement restrictions and you can't coach them to squat deeper or depress without it feeling wonky. I can help you with troubleshooting through problems along that way. You can sign up for that there. I have three this year, if you're listening in 2022, May 7th and 8th in Buffalo, New York May 28th, 29th Seattle, Washington and August 6th and 7th in Boston Common.

As of right now, you're coming east.

Yes, Coast Beast is in the East. Yeah, but those are the places you can find me.

So cool. Okay. And we'll for sure link all of that up in the show notes. Thank you Zach. Really appreciate it.

Bev, I appreciate you. Thanks for this chat. It was fun.

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