7 Cutting-Edge Physical Therapy & Recovery Techniques You Can Use To Heal Your Body Fast.

Hey, what's up? It's Ben Greenfield. I feel like crap. I feel like complete crap right now because I lied to you. No, I didn't. I didn't lie to you. I just. I made an error last week when I was talking about electrical muscle stimulation, and an astute listener wrote in and informed me that I was in error. And it turns out I was. I was talking about an electrical stimulation device called a Mark Pro, and I said it had a square waveform that was really good for healing tissue, but it's actually not the square waveform. The square waveform is the one that all the other electrical muscle stimulation units have. The Mark Pro is what's called a dynamic decaying waveform, not a square waveform. There. I can sleep at night now, and so can you. I know you were laying awake at night wondering about that. In this episode of the Ben Greenfield Fitness Show.

You know, the occlusion effect of musculature and training under the occlusion effect is pretty powerful, and it's getting some more good press in the physical therapy realm right now. The thing about scraping, like you said, I hate the term scraping, because you think as a patient that you're going to go in there and you're going to get skinned with this metal tool. And the more and more that I've used this tool, the less and less pressure I think you have to actually use through it to get through some good results for alleviating pain and increasing some functional range of motion.

He's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield.

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Hey, what's up, folks? It's Ben Greenfield, and my podcast guest today has a lot of Alphabet letters after his name. His name is Dr. John Rusen and PT, DPT, CSCS, ART, FMS 1, 2. Not kidding. YBT, SFMA, FDN. You almost sound like a robot, dude.

Appreciate that, man.

It's a lot of letters, and I know that you as a physical therapist, which I am guessing is the PT part of those Alphabet letters, you delve into a lot of therapy and recovery techniques. And I've actually been to your website and seen some of your writings. And you actually, you talk about a lot of stuff like functional dry needling and soft tissue mobilization and blood flow restriction training and even that cupping thing that we see that the swim team recently did in the Olympics. So I know that you're kind of on the cutting edge of all sorts of different modalities one could use to heal their bodies that potentially go above and beyond the foam roller. So I'm excited to get into that stuff with you today. And for those of you listening in, John works with some of the world's best power athletes. The NFL, Major League Baseball, the Olympians, competitive powerlifters, bodybuilders. He's got a sports performance of physical therapy practice in Madison, Wisconsin. He owns John Rusin Fitness Systems, which is like an online fitness platform in which he helps people around the world. And so he's definitely got a lot out there. And his website is drjohnruzin.com and I'll link to that as well because he has a lot of cool programs, including what's called a functional hypertrophy program, which I want to actually ask you about at some point during our discussion, John. But first of all, welcome to the show, Ben.

It is great to be on. Long overdue. Like, we were talking off air.

Yeah, had to reschedule a billion times.

But that's what happens with busy people.

Glad we made it happen. We're actually recording for those of you who want to. The kimono opened. We're recording on Labor Day, which is what we do instead of going hiking and barbecuing and getting drunk on boats, I podcast. So, John, I notice on your website you say you're not the run of the mill physical therapist. So considering that came from your mouth, why do you say that?

It's funny because people view physical therapy or really any profession, and they try to stereotype it. So when I get introduced as a physical therapist, I almost cringe now because a lot of what I do, I'd say like 90% of what I do professionally is more along the lines of human performance. But I happen to have a couple of those letters at the end of my name, like you mentioned. So people automatically think like, oh, a physical therapist. I know what that is. I know the systems that you run. I know what you're able to do for me, But I don't run those systems. And I try to provide something a little bit different than the status quo right now in our industry.

So what do you mean when you say something that's beyond the status quo. I mean. And I guess what I'm guessing you mean is when I go into physical therapists, which I've been into a handful of times over the past decade, there's always just a series of elastic band exercises that you go through. Usually you spend a little bit of time on the recumbent bike. Sometimes you stand on one of those balance pillows, and then you fill out copious amounts of paperwork.

Dude, that's exactly what I'm talking about. And that is the traditional physical therapy model. You know, that's the model that insurance pays for right now. And, you know, nothing wrong with that model. It will work for a couple, you know, a vast majority of people. But for those people that have goals and aspirations in athletic endeavors, physical endeavors, I truly believe that you almost have to be a hybrid practitioner. You have to know a little bit about everything so you can offer your client or patient what exactly they need. And for many people coming through my doors, they need more foundational movement, they need more muscle, they need to lose body fat, and then, you know, they have to get out of pain like everybody else as well. But, you know, it's all layered into some of the programs that we run.

Okay, let's jump into brass tacks here. Let's say I'm doing a body scan right now to identify a body part that I would potentially be in physical therapy for. I'm not. I'm not too bad right now, but like two weeks ago, for example, I sprained my left ankle. If I were to walk into your clinic with a sprained left ankle, what would you be doing that's different than what, what, like, a normal physical therapist would be doing?

See, that's. That's a good question, because, you know, one thing that we do is try to separate traumatic injuries. Like, you know, a sprained ankle, you did it, you know, running, whatever, you twisted your ankle, and there was mechanism of an injury there. But a lot of people come in with chronic natured pain and dysfunction, and that's really where I specialize in, is trying to get the origins of why you're having these problems, what's holding back your performances or what's keeping you in pain. So, you know, we do the coolest things in the industry. Like you mentioned in the intro, we're dry needling people. We're putting people through functional movement capacity screens, we're doing soft tissue work, advanced things that most other practitioners aren't quite doing in your manual therapies. But, you know, it really depends. And I think that you know, putting, you know, trying to force squares into a round peg hole is not the system for athletes. We need to have more diagnostic tools, more movement screening tools. We have to appreciate people's goals above and beyond what they're coming in for and what they think they're going to get from us. So trying to, to over deliver on some of that, I mean, I get it all the time because people come in and see me and after a two hour evaluation they'll be like, whoa, this isn't physical therapy. What is this? And that's like, I love when I hear that because everyone who usually comes into me, they've been through the system before. They've been into traditional chiropractic, they've been in traditional pt, they've worked with personal trainers and all of that. And those systems have failed them so many times, we're people's last hope to try to either enhance their performance or get out of pain.

Got it. Okay, so you mentioned functional dry needling, so why don't we jump in right there. What is functional dry needling? Why is that something you would do?

Well, it's a technique that's pissing a lot of people off in America and North America specifically the last couple years. But functional dry needling, the dry needle, is a tool itself. So don't get it confused with the technique of acupuncture. It's essentially the same tool, but dry needling itself is like the big umbrella. So functional dry needling is just a type of method that you use this tool, the dry needle with acupuncture is another method. And there's actually seven or eight different methods under the acupuncture umbrella as well. So you can see there's a bunch of different theory behind it. But basically what I use it for in my practice is not only treating myofascial trigger points in soft tissues, so mostly muscle, tendon and even some joint space, but also for regenerative purposes as well. So there's some spotty research on it right now, which kind of holds it back from being more mainstreamed. But right now, a majority of states in America, it's in the practice act for physical therapists. And many of the states that it's not, it's kind of a gray area right now, but it's one of the most exciting emerging practices for manual therapy in the rehabilitation setting.

So how does it work, man?

You get a needle, you glove up your alcohol, swab, whatever region that you're going to go through, and these little monofilament Needles. These things are about a tenth of the size, diameter of like pencil lead. So these things are tiny. They have a little cone shaped edge on them, a beveled edge. You tap them into the tissue. And you know, it should be said that the people that are practicing functional dry needling, they're already movement specialists. They're people that know anatomy, biomechanics, neuroanatomy like the back of their hand. So, you know, there's a palpatory process, there's a movement screening process that goes in. But like any other modality that you use, whether it's your hands, whether it's a foam roller, whether it's a dry needle, we're trying to just clean up some weak links in that kinetic chain. So pretty much we target a couple key players in that kinetic chain and we treat them with the dry needles and then we look for test retest to make sure that we're actually either relaxing some of the tissue, getting some more functional length, transferring back into some foundational movement patterns like the squats or the hinge, just to see what that novel stimulus that we just added to the system can cause. And from there it looks very traditional. You have to follow it up by something. This isn't just goofy guru science where you throw needles and everything's okay, really. We're just using those to open up our capacity to move a little bit better, remediate movement, and then go and use it and train.

So when I have a massage therapist working on me and they're finding like trigger points in tissue areas that, that are like tight knotted areas, you're doing something similar, but you're doing it with needles rather than say like knuckles or fingers or elbows or knees or something like that.

Well, think about this for a second. I mean, if you have like a manual therapy. So like massage is one of those. I also practice a technique, art active release techniques, which is a really notable technique. But you have to push through so much to get down to some of these deeper layer musculature. I mean, you look at just the dense fascia that encapsulates the muscles, and then you go above that more superficially to the skin. You have these dermal layers that are pretty freaking thick. And I mean, you're just kind of playing with yourself. If you think that, you know, you can get deep onto something like a piriformis that's under these gluteal muscles that are the thickest muscles in the body. Like, oh, yeah, I got my lacrosse ball in my piriformis I'm doing well here, or somebody's elbow. In your piriformis, you can't drop that deep. And the transference is pretty tough too, because you're not actually making physical contact. You're just kind of putting pressure points through the dermal layers, through the adjacent musculature, and just kind of hoping, poking and guessing and trying to get some sort of novel stimulus into those, those deeper tissues. But with dry needling, man, you can essentially throw the needle right into contact with some of those deeper layer musculature. I mean, we're doing it on some of the deep layers, the multifidus, the rotatories of the spinal column. We're going deep into like the deep six rotational group at the hip. You know, some. I mean, I've gone through my career having difficulty treating certain spots because we can't access them very well. And in the process, you end up beating up your patient. You know, if you've had some deep soft tissue, man, that hurts and it bruises and you just feel like you just got beat up on the table instead of having a regenerative effect. So, you know, it's just another tool in the toolbox for some practitioners that are licensed in their state to use. But it's something that's opened up some of my results for not only getting people out of pain, but actually the recovery process as well.

Cool. I like it. Is there much research behind it?

So there's new research. You know, majority of the research has been done through acupuncture. And this is where people get off, because right now we're button heads, physical therapists versus acupuncturists in kind of this rehabilitation setting in America. Because everyone wants to use this tool, but they want to have exclusive access only to use this tool and not have their competition using it. But essentially we have kind of spotty research. There's research saying that, yeah, it works in some cases, it doesn't work in other cases. You know, it's old. But there's more emerging research coming out now because our practice act has been opened up. So with more people practicing functional dry needling and dry needling in America, we have more studies that are looking at this. And you know, if you go and just like type it into Google Scholar right now, you can look at the last couple months, there's been like 300, 400 plus new studies on this modality. And you look at the years before, it's probably like 300 total. There's emerging evidence coming out. But again, I'm not going to sit here and say that it is definitively going to help you no matter what. But you also have to take into account that it doesn't matter what the research says. Sometimes it matters if you personally, as an athlete, as a patient, get a positive response from it. And hey, if you do, then that's a technique that you can utilize when you need to.

Yeah. Interesting. It's like me in structured water, right? People ask me why I drink structured water, and I'm like, there's not a lot of research behind it, aside from in test tubes, but I just feel better when I drink it. So I drink it. But I did notice that there's actually a few good systematic reviews and meta analyses. I just checked it out on the effectiveness of dry needling for at least myofascial pain. It looks like one study here looked at several dozen different studies on dry needling and found it to be pretty efficacious for pain and range of motion as well. So interesting. And it's a little bit different than acupuncture.

You know, the tool's not different. Just to be clear on that. The application is the reason why you would be doing it.

Okay, gotcha.

For functional transference into movement.

Gotcha. Okay, let's jump into another one instrument, Assisted soft tissue mobilization, or iastm. I noticed this is something else that you've talked about. What is that and how does that work?

So basically this is a tooled assist soft tissue work. So if you've ever seen somebody kind of like scraping away at the skin and you can see it's kind of like a beveled edge.

Like Graston.

Exactly. So that would be one of the most popular ISTMs. But, you know, there's a bunch of different tools out there, and they all stem from something in Eastern medicine called the guasha rock. And I actually had some experience when I was working for the Chinese Olympic Committee a couple of years ago, prepping for the Olympics. I had all of these Eastern techniques done on me because they wanted to show the Western consultant what they were all about in the Eastern medicine. So this was my first experience with the Gua Sha rock, which is all this stuff. That's where it stemmed from. Basically you get down an ancient Chinese remedy and they scrape until they bruise the tissues. So they get over and they just want an inflammatory process through the tissues. I mean, you turn purple after just a couple minutes on this thing. Excruciating pain feels like you're being skinned. So obviously that technique is not going over well in America. So I think people wanted to use. You know, it was getting decent results for thousands of years over in China. So when it came to America, but we just marketed it a little bit differently. We changed the application, and all of a sudden we have, like, these stainless steel and these titanium tools with beveled edges on them, and they're smooth on the skin.

And they're all very expensive, too. Like, like hundreds of dollars for these devices that are designed to, like, hit specific body parts. They look like butter knives, man.

I mean, hundreds. If you look at Graston, thousands. Thousands of dollars. I know practitioners that take out loans to buy these things, but in the last couple years, there's been some. There's like a tool specifically that I use as the edge tool. It's only a couple hundred bucks in comparison, but it's all getting at the same thing. So we're all targeting the same kind of effects that you'd be targeting with dry needling. It's just a different modality that you're trying to get at. So we're all trying to decrease pain, increase range of motion, increase functionality and transference into whatever your sport or your physical activity is. It's just a less invasive way to get at some of these tissues.

I've done some of this scraping before. One of my buddies had these things made by a company called Hawk Tools, which I guess the way that I understand it is Graston, in the US or in at least westernized countries, was the original scraping tool. And they lost their patent or something like that. So now other companies are popping up, creating these. These type of tools for, like, scraping across certain areas. And so these were. These are ones called Hawk Tools that he used. And I had some elbow pain and scraped both elbows, and the pain was gone within. Messing around with that thing for about, like, 10 to 15 minutes. But it left exactly what you were talking about, like these big, like, scraping, almost like burns on the skin, like, like, and. And actually pretty painful after a while. Almost like a carpet burn kind of. When you're doing your type of scraping, what'd you say the tool is that you use the edge tool?

I use the edge tool. It's something. I just like the feel of it. I know some of the practitioners that originated it with some of their techniques. But the thing about scraping, like you said, I hate the term scraping because you think as a patient that you're going to go in there and you're going to get skinned with this metal tool. And the more and more that I've used this tool. The less and less pressure I think you have to actually use through it to get through some good results for alleviating pain and increasing some functional range of motion. I mean, again, talking about the dermal layer, essentially, we're just using this as a neural kinetic enhancement tool. So we're just trying to stimulate some of those nociceptors on the skin surface, and we're trying to relax the underlying musculature that are linked to that skin surface. So the dermatomal and myotomal linkages, that's all we're doing. So we're just adding a novel stimulus to whatever area that you're trying to treat. And, you know, the transference back into the central nervous system is really what we're getting at. And a big misconception is that, you know, when you. When you get scraped, you could kind of visualize like, yeah, there's some scar tissue getting broken up there. There's no scar tissue getting broken up, like, 100%. 99.9% of the benefits that come from any of these techniques, they're all neurological based. There might be a tiny bit of mechanical breakdown. I mean, if you absolutely went after it, but there's very minimal.

And when you say they're neurological based, you're not saying they're placebo. You're saying they're not working on the musculoskeletal system. They're more working on actual nerve and endings.

Well, I would say they're working on the neuromusculoskeletal system. And, hey, man, placebo is out there. Placebo is pretty powerful. And it's very hard to differentiate on some of these very subjective techniques. But as long as people are seeing benefit from them and not being scraped raw, I'm all for that.

Yeah. Yeah. Interesting. Yeah. And I'll link to the Guasha Chinese traditional Chinese medical practice in the show notes for this episode, because there's some pretty disturbing pictures there, what they call skin blemishing. If you want to see what it actually looks like, go to BenGreenfieldFitness.com PT that's just BenGreenfieldFitness.com the letter P and the letter T. And I'll have that in the show notes. But then this edge tool that you use, John, can any. Like, could I go buy that and just use it on myself?

Yeah, definitely. It's over on themanualtherapist.com in the shop there. A couple cool rehab tools over in that shop.

Okay, cool. There's a whole bunch on Amazon. Like there, there's a whole bunch of different, like they, like gua sha scraping, massage tools and tools with like different, you know, in different shapes. And you know, it's kind of interesting because I even had a massage therapist who had me buy a bunch of these rocks. Like, like rocks that you would use for. What do they call the, the type of massage therapy where, where you get rocks placed on different parts of your body. Some are cold, some are hot. It's like, I don't know, hot rock massage, something like that. You can tell I don't get any massage anyways. There are a bunch of like river rocks and you can use them for scraping because they're in all sorts of different sizes. So I've been taking those to some mussels now and again as well. They're just on. And that's all they are. They're just like smooth river rocks. But they seem to work pretty well, at least better than a butter knife. But I may have to get this, this edge tool now that you're talking about because it looks, looks pretty cool. So we've got functional dry needling as one method that you use. Sounds like you also are a fan of this instrument. Assisted soft tissue mobilization. Much sexier title than scraping, by the way. How about another one I've seen you talk about? That's pelvic floor postural re education. Pelvic floor postural re education. What is that, man?

It's just what it sounds like. It's the pelvic floor. For many people, especially females, it goes through dysfunction and definitely trauma through many different things, but most mainly the birthing process. So I think that's an underserved area of physical therapy that really doesn't get much love from the general public. And it affects high end athletes more than you'd know.

You mean like basically peeing while you're running? What do they call that? The.

Yeah, the workout. Pees.

No, they're not the workout. Well, incontinence, that's on the top.

Urinary incontinence.

Yeah, urinary incontinence. Is that what you do?

Floor dysfunction for sure.

Okay, so what exactly does pelvic floor re education involve?

It's putting back everything, getting functionally strong in the intrinsic muscles of the pelvic floor, but also incorporating, you know, just functional movement capacity back into your physical practices after you had something, you know, like a pretty tough trauma and the birthing process or really any type of injury. It affects a ton of women I originally got pretty interested in it because when my wife had our most recent child, our youngest child, Cam, you know, she went through something where she was doing interval sprints on the treadmill about six months. She was at about six months. And she ended up severing her pubic symphysis. So we had to alter her training, we had to alter everything. She's a, a, she's a high end athlete as well. And you know, after she gave birth, man, she's tiny, she's five feet tall, 100 pounds, and she gave birth to this like nine plus pound behemoth, man. And you know, stuff was just like, not where it should have been. So, you know, after doing a ton of research, you know, this is definitely a specialty in the, in the, in the profession of physical therapy. I took what I knew, which is sports performance regenerative rehab, and then just in training and I started to look at how we could kind of integrate this stuff together. You know, things like making sure you put an emphasis on the posterior chain of the lower body, especially the glute hamstring group, to realign the pelvis so it integrates well with the lumbar spine so we can actually get some activation through the pelvic floor. Simple stuff. Planking progressions, contraindications for people coming off of pregnancy. It was an eye opener for me because coming from the strength and conditioning world, getting into women's health, that's like polar opposite type stuff. But really, the more I delved into it, it's kind of all the same. Everything is kind of looking at foundational movement, trying to build strength, capacity and trying to transfer it back into whatever your goal is with a tiny bit of niche therapy and niche training.

What about, and this is something that we talk about always on the show when we have a chance is poop. We've talked about things like herbs that you can take and we've talked about everything from doing colonic massage where you massage across your large intestine from left to right and across in the mornings, or even using in some situations like, you know, vibrating foam roller or like, you know, deep tissue massage on the abdomen in terms of pelvic floor, re education for things like constipation or improvements in bowel movement. Would that include some of the things I've seen folks doing, you know, like on, on YouTube videos? I know, you know, Kelly Starrett and Jill Miller, who does like the yoga tune up balls, like they have one full episode devoted to just doing like lower glute work on the underside of your butt to help you, you poop better. I mean, is that included in pelvic floor re education or is that a totally different beast?

No, no, they're on point there because it's like I said, it's kind of all the same. Getting your postural alignment in check, making sure that some of the strength curves of some of those major muscles, but also the intrinsic muscles and getting them not only, dare I say like supple, like Kelly would say, and functional again, especially after they've gone through a bout of dysfunctional dysfunction. I think that's big because it can play a huge role in everything. If you look at the pelvic floor, just the physical location, the anatomical location, and you look at the lower aspect of the GI system, I mean those things are almost adjacent to one another. And neurologically they have a lot of, of overlying neurovasculature as well. So there's definitely a linkage there.

Yeah, that's really interesting. And I think a lot of people neglect deep tissue work in that area because if you're getting a massage, it can be an awkward place for a massage therapist to work. And I think if you're doing your own, whatever foam rolling, some of us just forget about taking like a tennis ball or a golf ball size object and just like working it into our, our butt and hip area, you know, just because it's kind of a difficult, awkward area to get at, but it's really interesting. So you call that pelvic floor postural re education.

You know, on the point of, you know, doing some of the ball work and some of the soft tissue work on yourself, especially through some of those like really deep muscles, like the iliopsoas group and even like the deep hairiform and the deep six rotators, you know, on the backside of your butt. It does, we have to say that you have to kind of know what you're doing when you're going through some of the stuff. So I think like Jill Miller's ball is great because it's a soft ball. You lay on top of the ball so you can actually like figure out how much weight you want to put into, you know, that surface area of the ball coming in contact with your abdomen. Whereas like I've seen some bad in my day, like people smashing 150 pound kettlebells into their stomach. We do have to remember we have vital organs in there. And if you're putting hard sharp objects into that surface, that could be said for the butt too. You're kind of playing a Russian roulette game, because you could flare up, obviously, the musculature, the neuromusculature, but also you have things that you rely on to survive in there. You kind of got to be careful. So, you know, grading it with the softer ball like Jill's doing, or even using a different size or shaped ball, you know, on the backside of that piriformis group can be advantageous because I just wrote an article about this, I was on T nation a couple weeks ago about people sticking the lacrosse ball in their butt as soon as they have any symptoms of lower back pain. And I've seen it time and time again that people end up flaring themselves up chronically from just flaring up the sciatic nerve by putting that ball essentially right next to the sciatic nerve. Because most people with lower back pain, their glutes aren't strong, they're not thick, they're not big. So essentially you have like this paper thin glute and you're throwing a lacrosse ball and it's not protective by any means, and you're hitting some of these big bundled nerves. Nerves, and it's just flaring up the entire system. I mean, people go for months thinking that they're doing well trying to treat some of this stuff, and they're just shooting themselves in the foot. So, you know, education's a big thing on that.

Those bundles of nerves are important. I think that some people who do a lot of, like, teeth gritting, deep tissue work a lot, you know, like Kelly Starrett's Becoming a supple leopard book, which is great, do need to realize that you can't just mash a bundle of nerves, like up and say like the, the. The brachial plexus of the shoulder or something like that. Right. Without. Without potentially doing damage.

Yeah, I mean, there's, there's always a cost benefit of everything that you're going to do, whether it be training, whether it be rehab. But people don't necessarily think that, like, soft tissue work can harm you. Yeah, sometimes it can. If you're like. If you have no idea what you're target certain structures and you're overly aggressive to the point of like, excruciating pain in the wrong spots. And when I say pain, I mean like kind of like that nerve pain. That's not what we're going at. So, you know, differentiating those two things is big.

Yeah. Buy yourself a good copy of like Grey's Anatomy or go dissect a cat. So you start to figure out where things, where things are before you shove sharp objects or pointy objects or hard objects into, into said anatomical areas, especially the area we were talking about, your, your crotch and, and region where there are important, important sphincters and nerve bundles. Be careful, kids. Okay, so let's turn to a sexy topic of late. In light of the recent Rio Olympics. Cupping. What's your opinion on cupping?

You know, cupping's a technique that's been around forever. Again, it's an Eastern Chinese medical technique, you know, thousands of years in the practice. But I'll preface all of this by saying that I do not practice cupping. I usually don't recommend cupping for any of my clients that are remote. But that being said, I know that they've had their bout of publicity after Michael Phelps climbed out of the pool with these red dots all over him. So it's an interesting technique. And again, I had the opportunity to be over in China working with these guys, working with their best medical practitioners over there. They don't use cupping for neuromusculoskeletal issues. They don't. What they use it for is systemic health benefit. And that's something totally polar opposite of what everyone was talking about after the Rio Olympics.

So what is cupping exactly? Can you explain how it's actually theorized to work?

That's a good question. If somebody had the answer to that question, man, all this conversation would stop. But basically there's different forms of cupping. So there's heat based cupping and there's also decompression based. So it uses air. So the heat based cupping. So essentially you have a cup and they put heat to the, they put it on the skin, you know, targeting a certain area and the heat is put on the top of the cup. And because the heat is put on the cup itself, it takes some of the air out of the cup and it actually decompresses the tissues. It draws the tissues up into the cup itself. So that's the old school technique. You know, in America you're probably not going to be seeing and fire on people's backs, you know, in the rehab clinic. But you know, again, Americana, we, we changed it just a little bit to make it more mainstream. So I mean, decades ago now they came up with myofascial decompression, which is essentially like, you ever see Austin Powers where he has the Swedish made penis enlarger machine.

You mean the pump?

Yeah, the pump.

I think I do remember that. Yeah.

So I mean these things essentially look like the pumpkin. So you put it on a tissue and you literally, like, pump it up and you take the air out of that cup and it draws the skin and the dermal layers up into the cup itself. And because it's almost like a bruising, if you were to, like, bite yourself, it's like that kind of. Or suck on your arm and really, like, draw the skin up into your mouth, it's that similar feeling because the skin itself goes into, like, an inflammatory process, drives blood into the most superficial areas of the dermal tissue and essentially bruises on spot. So it's a technique, again, that's used to theoretically reduce pain. Functional trigger points. It's supposed to enhance movement. But again, if I said that there wasn't really good research on functional dry needling, there's really no good research on.

Cupping, aside from some of the research that's been done on actual pain management. Right?

Yeah, yeah, but with a grain of salt. I mean, Michael Phelps wasn't dealing with pain management.

What they were doing was a lot of people think because the Olympians were using it, it must be good for just pure sports performance. But again, all I've ever seen is that it can assist with chronic pain in a specific area.

It can, and that's chronic pain. There is some efficacy to it. But everyone got hyped up about the performance enhancement stuff. And if you look deeply at the Olympians this year, who were the ones with the cupping marks on them, they weren't the Chinese. They weren't anyone from any other country but America. Which begs the question, why are the Americans the only one using this technique? It's interesting because back in the day, when I was first out of DPT school, I went through a training course at the Olympic Center's in Southern California on myofascial decompression. So they were actually doing the education on this technique. So I think they were a little bit more vested in some of these techniques. It might be a placebo effect, it might have had a positive response, it might have no response, might have a negative response. But I think that's the reason why it was so polarized in the American athletes.

Yeah, yeah. And then there's also. I mean, I think everything that you were just talking about is considered to be what's called dry cupping. Right, right, exactly. But then they've got wet cupping too, which is where you're actually. And there are some nasty photos of this. I've never had this done. I've had friends who've had it done send me text messages like, check out this amazing procedure. I'm Having done. And that's where you do the cupping. But then I believe when you have the suction in there, you're actually like making a scalpel incision and drawing out blood. Have you seen this?

Yes. Yeah. Any opinions on it? It's not a very mainstream practice in America, I think for good reason. Yeah, it's almost like old school bloodletting.

It's very similar to bloodletting. It looks a lot like it and apparently it's supposed to move key or energy in and out of areas or be good for. I guess they would use something like that for infections or something along those lines to draw out. I've heard talk about drawing out parasites and all sorts of weird things, but yeah, if you want to see some nasty photos and scraping wasn't enough for you, go. Go do a Google image search for wet cupping because that's some nasty stuff.

We actually featured a picture of that on a review that I did on my website and people are just bitching and moaning about how gruesome that picture was. We kept it up, but I was actually contemplating taking it down.

Yeah, it's nasty. So, speaking of blood though, I want to talk about something else regarding blood and something that I've done, actually. Me and Aubrey Marcus, who owns this company called Onit down in Texas, did a few months ago this workout called a Katsu workout, where he has this device. It's like a little handheld monitor that will put a specific millimeters of mercury of pressure around specific limbs, like your leg limbs or your arm limbs. You'd put it around your biceps, for example, and do curls and it restricts blood flow to an area. It's also known as Kaatsu training. K A A T S U KA Tsu Blood flow restriction training. Using almost like tourniquets around the muscle and in this case using a fancy device that adjusts the actual pressure in those little rubber tourniquets that you're wrapping around the muscle. What's your opinion on blood flow restriction therapy for either rehab or performance or any or all of the above?

It's funny because all these topics, they all come from the eastern countries and they're all very, very hot topics in physical therapy right now. But blood flow restriction training, people laughed at it in America 20 years ago when the bodybuilders were using it, they were getting their knee wraps, they were wrapping their upper arms and they were going to town on high volume training for. For the biceps and triceps.

Yeah. And by the way, I should mention that in addition to Using that more advanced device I mentioned. I was a bodybuilder 10 years ago. I used to weigh 45 pounds more than I do now at 3% body fat, and would just train my butt off for three to four hours a day in the gym. And I remember wrapping these tourniquets around my muscles to get that pump, to get that lactic acid, to get the vascularity. Supposedly there's an increase in growth hormone release from the buildup of lactic acid, et cetera. But yes, I remember when this was something that people would laugh at you for doing in the gym because you would just like literally old school, be wrapping rags around muscle parts.

It sounds ridiculous. And even now, you know, like 20 years later, if you do that in a commercial setting, you know, at least two people will come up to you and go, bro, what are you doing? You know, like, because it's just so bizarre. But the occlusion effect of musculature and training under the occlusion effect is pretty powerful. And it's getting some more good press in the physical therapy realm right now because they're looking at the Kaatsu training, they're looking at old school bodybuilding, occlusion style training. And they're like, well, what does this do to us? So at a 70 to 80% occlusion of a limb and then training under that, we're able to actually stimulate, you know, like a training far less external load. So like less weight in your hands, if you're doing a bicep curl and you're able to execute more reps, to really get into this metabolic pump effect of the tissues and just drive increased blood flow in there and then keep the blood flow in there to get the metabolites, rush nutrition to the tissue. And it's one of these things that has been moving into physical therapy because if you look at people, you know, with gross atrophy of some of their musculature after surgery or an injury, you know, we want to keep the loads like somewhat low for most traditional based physical therapy clinics because the people are inherently weak at that point. So this is a safe and effective way to get a training effect by minimizing the load, minimizing the joint stress, and like getting the pump of your life and actually building some tissue.

So you actually, do you utilize this in your physical therapy office or in your, in your sports performance practice in training?

I do many of my training programs, sports performance, hypertrophy based programs utilize blood flow restriction. I do mostly for the arms. I try to be Very, very efficient with direct arm training. So it kind of gets you, it gets you a huge training effect very, very quickly. So that's where I utilize it for my athletes that, you know, everyone likes to do a couple bicep curls and tricep push downs. This is a way to get a quicker pump from that. But I've been layering it into my physical therapy. But then again, I don't see a whole lot of traditional based physical therapy clients that are coming in with a leg half the size of the other one. More sports performance high end people that are dealing with usually movement capacity based issues.

Yeah, I mean if you were gonna do a training session anyways, especially I would say like, like a single joint training session where you're working on a bunch of machines. I recently did the Don Wildman workout, which is this. He's like an 83 year old guy, lives down in Malibu. He used to own Bali's Fitness and he's just got a bunch of machines in his basement now all lined up in a row and you just go from machine to machine to machine. He's got this three days a week for the past 20 years or whatever. This is all he's done to stay fit from riding his mountain bike. And you do 30 reps, 20 reps and then 10 reps, like descending in reps and increasing in weight on each machine as you go through. And I was mentioning to the guys I was doing that workout with last week, it'd be interesting to do it with an elevation training mask on to increase diaphragmatic strain and inspiratory and expiratory muscle work. But this would also be something you'd probably use one of these occlusion training bands or cats who train equipment on to perhaps increase the amount of lactic acid. Walk in there like Robocop with your, with your bands and your, and your mask. But yeah, for sure.

I mean it works very well for increased like almost muscular endurance or metabolic stress based set in rep schemes. So this isn't something that you're gonna throw a couple cuffs on and then like hit like a 3rm like bicep curl. Yeah, that's not the style of training here. Yeah, you know, using about, about 35 to 40% of your max load and doing like 15 to 20 reps and keeping the rest period short, keeping the cumulative stress in the tissues high. It's something that is very, very effective, especially on tail ends of workouts. Regenerative purposes. If you want to keep the external stress low on your system and your joints. It's been a cool tool to see, not only for my body bodybuilders, but some of my sports performance guys that, you know, they're already pretty banged up. You know, looking at some of the triathletes that I'm working with, they're banged up from the road work, man. So like when they get in the gym, we need to keep joint stress on the minimum. And this is a technique that we layer in pretty nicely.

Nice, I like it. Now, you mentioned hypertrophy. You have like a. What do you call it? A functional hypertrophy training program.

Exactly. FHT.

What is that?

FHT is, you know, my last 10 years or so, all the methods that I've used from being a strength coach, being a physio, working with amazing people, working with average joes, and we kind of put one system together, 12 week training program that utilizes the best of methods that I've written about over the last three or four years and that I've been using for a decade.

Nice. Cool. So, so it's like a, like a program that you would follow primarily for muscle gain.

You know what, there's multifacetets to it. It is functional hypertrophy training. It sounds kind of cool, but essentially what we're trying to do is maintain and maximize musculature, cut fat, but also still be an athlete. This isn't a bodybuilding program. It's a mesh between aesthetics training. So it has different techniques from a bunch of different trains of thought in the fitness and sports performance injury industries.

Gotcha. Okay, interesting. And I'll put a link to that one in the show notes too. For those of you who want to check out this functional hypertrophy training program, you're giving us a discount on that one, right?

Absolutely.

Okay, cool. So we'll put a discount. I'll keep it secret, but you got to go to the show notes over@BenGreenfieldFitness.com PT and you can check out Dr. Rusen's program if you want to try out some of his muscle building stuff. I want to ask you about a few other things though. Rhythmic and reactionary, dynamic stability, strength and stabilization. That's a mouthful. I've seen you write about that a little bit. Is that more than just like standing on a balance disc like I do when I go into physical therapy?

Oh yeah, it's way more than that. And you know there's a difference between open and close chain, rhythmic stability. Everyone's seen the Bosu ball, everyone's hated on the Bosu ball. I'll use it here and there for certain clients and patients. But it has this polarizing effect that people think that because the ground is now dynamic and you have to balance that, you're getting this increased training effect from it. And that's pretty much been debunked. But on the contrary, if you have rhythmic stabilization, something that we do is a manual therapy, say, for the rotator cuff complex. The rotator cuff is a region. It's a complex of four little tendons coming off the musculature in the shoulder to try to centrate the shoulder joint, the ball and socket joint, to keep it in a good position. So are we going to strengthen the rotator cuff? Like, probably not. These things are like the size of your pinky finger, even at the muscle bellies. So, like, what, are you going to hypertrophy, you know, your supraspinatus? Probably not. But what we want to do is have, you know, the fork, the four tendons of that cuff working synergistically together. And the best way to do that is by putting it into a position that you're currently lagging in, you know, you know, broken link in the kinetic chain, so to say, and trying to challenge it from multidirectional instability training. So, you know, something along the lines of everyone seeing the shoulder blade, right? That's kind of what they were getting at with the shoulder blade, where you go back and forth and you kind of like, you get some vibration coming through the arm. We do it manually. But another cool technique that we're doing, especially with the upper body, is a hanging band technique. It's kind of the same mechanism of neuromuscular retraining, of having instability on a barbell, on a kettlebell, something up over your head in a bench press position, whatever it may be, just so your neuromuscular system becomes more involved in stabilizing in an open kinetic chain.

So this would be, for example, if you're using a barbell, attaching elastic bands to either end of the barbell to introduce more dynamic movement of the barbell, both up and down, but also maybe a little bit of like, side to side shaky motion.

Exactly. So, I mean, you hang, say, two kettlebells off of bands from each side of a barbell, and you go to bench press, you're going to be far more like, holy, like, what direction is this thing going? Because the bands are bouncing, the kettlebells are swinging, and you really have to work hard to stabilize through ranges of motion at that point, I think, like, Two years ago or so, there's like, this video that went viral on YouTube after James Harrison, you know, the linebacker for the Steelers, he was training with this thing called the Tsunami bar. So the Tsunami Bar is like bamboo, and it literally has bend to it. So he is bench pressing, like, three plates on the side with a Tsunami bar. This thing's like bouncing all over the place, and he's just going to town. People are like, holy. And ever since then, I think people have opened up their minds to, like, high performance athletes, you know, strength athletes that are truly, you know, outliers on the functional curve. And seeing how this may be applicable to some of this style of training.

I'm looking at this online right now. The Tsunami is like the Shake Weight on steroids.

Oh, dude, this is really cool. Bar is unbelievable. It's not something that I use a whole lot of.

You have one at your facility.

I do, but again, we use it if the goal is like a deload or something like that, where we want to take the external load down again, decrease the joint stress. It's a common thing in many of our training programs, and we want to increase the neuromuscular capacity to a movement. This is a great way to do it.

It looks like Rogue fitness has them too. They call them band bell bars. Interesting oscillate. It's like a Shake Weight on steroids. That's crazy. That's really cool. I'll have to link to this in the show notes. If you guys are listening in, I'll definitely put a link to these things. They got a bamboo bar, an earthquake bar, and a tsunami bar. But you could also just take a regular barbell and attach elastic bands to it. Huh?

Yeah. With most of this stuff, you know, the blood flow restriction training, you know, get a knee wrap and do it. You don't need the $200 pneumatic pump. That's gonna, you know, grade your blood pressure. You know, that's not feasible for most people. You know, tie bands. Do a cuff with this. You know, just get two bands and hang some weights. You can hang a dumbbell. You can hang a plate. You can hang a kettlebell. That's true.

You could just. You could hang a dumbbell using an elastic band from the end of. From either end of a barbell and create a similar effect.

Yeah, or plate would probably be recommended. The dumbbells really tough.

I like it. That's really cool. I hadn't thought about doing that before, but that's really interesting. Rhythmic and reactionary dynamic stability, strength and stabilization. Cool. I like it. I'll put some links in the show notes to you guys and Those are at BenGreenfieldFitness.com PT John, are there other unconventional or little known healing methods or training methods that you think are efficacious or that you use but they get underplayed, not taught, talked about enough things that people might not know about. Anything else that you want to kind of bring up or point out that you think folks would find interesting?

It's funny because I spend a lot of time trying to increase the recovery of my athletes because many times the guys and gals that we're working with, their big limiting factor is how much can they train without digging themselves into a hole. So usually the stuff that people think is too simple to work works really, really well. So things along the lines of walking, low intensity, steady state cardio, you know, at like a zone one heart rate, that's amazing, not only for systemic regeneration, but just for orthopedic health and wellness. I mean that's something that we use with even our high end athletes. Like we have them walking, like go walk your dog for 30 to 45 minutes and then do the secondary recovery session off that. So things along those lines shouldn't be overlooked. Another thing that gets no credit, just like walking, is controlling your breath and really just working on diaphragmatic breathing skills, especially after workouts and on secondary days like before you go to bed, taking down your central nervous system after a heavy bout of training or competition. It's one of the quickest, most effective ways that we could possibly do to start sparking the recovery process instantly. Now everyone thinks that they got it down like this $30 protein shake with all this in it after, you know, a second after they get off of their last rep of the bench press. But you know, take 15 minutes, go do some systemic foam rolling, hit the big tissues, go and do some dynamic or biphasic stretching and then lay on your back, elevate your hands, your arms, your legs and deep breathe. And that's going to do more for you to spark recovery than a lot of fancy stuff out there. So I mean, even some of the high end athletes I'm working with that make millions of dollars a year, they're not doing some of this stuff. And when they implement it in, it's a game changer because then all of a sudden the fancy stuff works even better when you have a better base to go from on that recovery side of things.

I don't know, man, breathing and walking, that sounds pretty boring to me.

It is boring. That's why it gets no credit. Just laying down the foundations and just doing the easy stuff. It makes the fancy stuff, things like post workout systemic dry needling, so much better. So, I mean, it's all about encompassing every single thing that you can do to get better. But if you're trying to major in the minors, it's never going to work, especially when you're trying to expedite the recovery process.

Yeah, well, this is all really interesting stuff. And from the Chinese method of Gua Sha rock scraping to the edge tool that we talked about to the Kaatsu band, the special bars that shake some of John's articles like his T Nation article on the best and worst physical therapy methods and John's functional hypertrophy training program with the special coupon code he's going to give to us. I'll link to all of this if you go to the show notes, which you can find over@BenGreenfieldFitness.com PT. So John, thanks for coming on the show today, man.

No, I appreciate it. Great time.

All right, folks. Well, this is Ben Greenfield and Dr. John Rusin, the man with many Alphabet letters after his name, signing out from BenGreenfieldFitness.com have a healthy week.

You've been listening to the Ben Greenfield Fitness podcast cast. Go to BenGreenfield Fitness.com for even more cutting edge fitness and performance advice.

Sam.