#12 - Where Does Rehab End and Fitness Begin? Q&A with Drs. Riddle and Teter

Factor, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents, serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, and welcome. We have this special Q&A episode where we're going to be asking some questions today of 2 of our Factor fans. Family of instructors. We have Dr. Todd Riddle, our director of education, on today, as well as Dr. Tom Teeter, who is the developer of the Rehab to Fitness course curriculum. So, as many of you know, with our Factor podcast, each episode features a webinar training provided by one of our instructors, and the first two trainings that we featured were by Dr. Riddle, which was our importance of developing systems in your rehab. podcast episodes and webinar training. And then Dr. Teeter was featured in our podcast and webinar training discussing how to integrate fitness into your clinical practice. So 2 giant topics. We had a ton of people who really responded well to these podcasts and these webinars, and they've written in with questions. So today's an opportunity for us to ask those questions of both of our instructors. and dive a little bit deeper into both of these topics. So first of all, thank you both for joining us today. I really appreciate you taking the time out to kind of dive in a little bit deeper in these 2 mega topics with fitness and rehab. So to kind of get started off, I know that when our webinar series was launched, when our podcast series began, we were kind of in the midst of just the beginnings of COVID and this pandemic that has just rocked the globe. Your episodes and your webinars were recorded back in March and April of 2020, respectively. So at that time, we were still in that place where we didn't quite know what we didn't know yet, so to speak. So I'd love to hear a little bit about you guys. And if you could each answer this individually, how things have shifted in the past year for you. Now here we are coming up on the end of 2021. Obviously, we know a lot more about how COVID has impacted practices and your individual practices at this point. But I'd love to hear from each of you how things have kind of shifted for you in practice and in how you're implementing the things that you taught day to day. Dr. Riddle, we can start with you first.

Obviously, our situation was a bit unique in that we had made a transition back from Georgia to Texas. So I basically shifted my practice from there to here. I think the The biggest difference I found when it came to practice was obviously the safety protocols, trying to ensure the safety of my patients as they were coming through the office. So making sure that we had our masks on, making sure that we were cleaning appropriately, making sure that we were trying to keep the distance between— the stuff that we normally saw and have been all accustomed to over the past year and a half or so. I'll tell you what, the big thing I found myself trying to do was work around the people that experienced COVID themselves, actually having contracted COVID, and then trying to program their rehabilitation or even their fitness around that deficiency that was caused. So what I've been calling COVID injuries— people that were forced to stay inside, forced to quarantine, and lost access to gyms, lost access to their ability to exercise, and therefore became deconditioned. And when it became time to safely transition, if you will, back into public, a lot of folks picked up where they left off but didn't realize that they had lost a lot of capability and therefore were becoming injured when they were reinvesting back into their fitness programs. And then on the flip side, you had a lot of people that just remained sedentary the entire time and started to develop problems from sitting for too long— low back pain, neck pain. A ton of people working from home from their couches and as opposed to setting up proper workstations. So I've kind of seen the gamut applying rehabilitation to having to rehabilitate people out of injuries that were caused vicariously from quarantine and from the pandemic. So it's certainly been a transition that even as of today, still kind of reconciling and still kind of working through. But hindsight's 20/20, there are probably a lot of other things I would have done differently. But I would say the number one thing I have focused on is trying to reinstitute rehabilitation and fitness programs back into my patients' and clients' lives.

Absolutely. Dr. Teeter, would you say you've kind of experienced the same thing in your practice?

Yeah, I would say it's very similar to what Dr. Riddle suggested. I think the one thing that the pandemic has really forced me to do and think about is the idea of kind of being agile. When the pandemic hit, I was kind of forced out of the office space I was in, and I was unable to practice for about a month and a half to 2 months because I couldn't get into my office space. So I had to change locations at the very beginning of the pandemic, and then when we were Starting to see patients again, when some of the lockdowns loosened up, you had to be very concerned about like protecting yourselves and making sure everyone's wearing masks and you're cleaning every surface, wearing gloves between, with every patient, making sure you keep distance not only between yourself and the patient, but between patients and making sure that you're staggering people in a way that they feel comfortable coming in and out of the facility. And because of COVID I was in a similar situation to Todd where I was trying to regrow my practice after coming out of teaching. It was a much steeper slope to get back to a more normal schedule. And one of the things that I really had to focus on was ways that I could implement these same strategies with my patients, even if we couldn't be in person. So one of the things that with some of my clients and patients we started doing was this concept of virtual training and virtual rehab, where a lot of my patients had the— I forget exactly what it's called, but it's like a Google box. It's like a picture frame and you can connect to it. It's basically like being on FaceTime. And for almost a year with 2 or 3 of my training clients, we trained through the box before there was a vaccine and everyone felt comfortable getting back in person. So it was a very steep curve, but I agree with Dr. Riddle. I think the number one thing I've seen as far as injuries is people because of COVID were forced to, even athletic people were forced to stop working out or stop training. And there was a significant amount of time off from sport. And then the next thing you know, they're allowed, restrictions are loosened up. They're allowed to go back to activity. And then they just jump right back into the load and volume of activity that they were doing. And you just saw a lot of overuse injuries. So it was really trying to keep people reminded that you've had some significant time off. We need to slowly and steadily progress you through load until you're back to normal. And that could take a significant amount of time.

Absolutely. And I can see how that would be very stressful for patients and then especially athletic populations. Another question for both of you that a lot of people have asked questions regarding their athlete population that they're treating in practice or the teams that they're working with. I know both of I know both of you work with youth athletes from time to time who are looking to prepare for a season ahead. Obviously, with the lockdowns and quarantine, a lot of these young athletes were not able to have a regular practice schedule like they used to, probably weren't able to get into the weight room at school for strength and conditioning as normally they would have. How were you guys able to still assist these young athletes in getting back in preparation for the seasons when things eventually opened back up while they were still in a place where they had been sedentary for a while? Dr. Riddle?

Yeah, it was entirely individualized. Some of the athletes had better access, meaning they maybe they had a home gym or some other place that they could exercise. It was very interesting. Some of the high schools here, in order to try to maintain some semblance of a strength program, had to move much of their weight room out into their gymnasium space in order to create enough distance. To be able to work out. And as Dr. Teeter mentioned there a minute ago, be able to stagger the workouts enough where the athletes really weren't coming into contact with each other. But that dramatically changes how you can perform exercises. So if you're accustomed to having a spotter, or if you're accustomed to doing drop sets or negatives, that changes the workouts in and of itself. That's best case scenario, because these were athletes that were still actually able to get into a weight room and perform some semblance of a controlled strength program. On the flip side of things, you had a lot of athletes that didn't have access to that, perhaps didn't have the finances or the resources to purchase equipment. And we all know that if you tried to go find any kind of exercise, home exercise equipment during the pandemic, it was entirely unavailable. So if they had the resourcefulness enough, meaning they had things laying around the house that they could adapt, they tried to use those. So I oftentimes had folks trying to use rubber bands or PVC pipes, anything that we could get creative with resistance that was safe. And have them use common household items. I would oftentimes tell them to fill old milk jugs full of water or for sand as resistance, and we could develop a program based upon that. So it was, it was kind of like Rocky IV where Rocky was going to Russia and had to work out in a barn for whatever period of time he was there. We kind of went Rocky IV on some of these workouts. Fortunately, if they were coming to see me at the office, I had the things there. I had the strength rigs, I had the barbells and whatnot. But if They couldn't get in to see me, then we had to adapt with whatever they had at home. So again, it was very, very individualized. Sometimes it didn't work. Sometimes the athletes didn't want to do the work. There was a loss of motivation and they ended up with some kind of overuse injury because they just didn't acclimatize back like they were supposed to. So it's still very much a steep learning curve and we're still working it out, but it was definitely very different then.

So Dr. Teeter, I know in your Rehab to Fitness course, you teach healthcare practitioners a lot about how to properly assist patients with developing fitness programs for them, helping them adapt to different stressors or prepare for different events. How would you say that you would recommend for a lot of those healthcare practitioners that are out there now who still may be dealing with patients that are just coming out of lockdown, just coming out of quarantine and getting back into sport, how would you suggest that they help their young athletes in this same way when they've gone from being sedentary to all of a sudden, hey, it's 2-a-days and it's time for football again?

That's a pretty loaded question, but I can give, like, 2 simple rules that I've been using. I think they've worked really well. Number one is keep it simple. Keep it as simple as possible. When we're talking about the pandemic, I'm with Todd. I had patients who had almost nothing at home, and I had people who were very affluent and had fully functioning home gyms. And then I even in my office, because I do offer some of those services and I needed equipment myself when I moved, I just started snatching up everything I could off of Facebook Marketplace. And I have a pretty functional strength training apparatus in my clinic. So it was kind of all over the board and whatever we could come up with, whatever you had, we had to come up with some type of plan. I even went very old school, like Todd was saying. And one of the most effective things I found with a lot of my clients was just simple things like isometrics, which is a very lost and forgotten intervention that we can use to maintain strength with some of our clientele. And so I would find ways to get people to find immovable objects and use different forms of isometrics. And we had great success with a lot of clients who didn't have a lot of equipment at home. They weren't making a lot of gains in strength, but our goals with a lot of those people was just to make sure that they weren't losing a lot of strength. And that was— if we could have someone come out of the pandemic at the same level or very similar to the same level in strength that they left, Then that was a win. Like, we weren't looking to make progress, we were just looking to decelerate the rate at which they lost their strength. So we did a lot of old school stuff like isometrics, and it worked really well. So just try to keep it as simple as possible. And then the second thing is really make sure you're considering the smallest meaningful change you can make, meaning, you know, what's the next thing I can do that's just a little bit harder that's going to continue to create adaptation? A lot of times people are looking for equipment-based loading. And they're trying to find the hardest thing that they can possibly do with their client when really they may just need a very low threshold stimuli to continue to get adaptation or to continue to not lose adaptation. So what's the smallest meaningful change you can make? And then just do that consistently. Like I said, I had 3 clients that I trained through the Google box is what we called it for a year. And both of, all 3 of them are over the age of 60. Some, one of them's over the age of 70. And they were at the same strength level when they came back into the office to be able to do strength stuff than when they left. So it wasn't like we made a ton of progress, but we definitely slowed the rate at which they lost their fitness adaptations.

Absolutely. And I feel like that's a really great principle anyway. Like, all too often people just become overwhelmed when they— especially in the situation that we all have found ourselves in in the past few years, where if there's so too many possibilities in front of you, It just becomes overwhelming. And I feel like sometimes, at least from what we've heard from practitioners, that is a bit of a barrier for them to figuring out how to assist their patients in this way is just all of the possibilities, like all of the overwhelming doors that they could choose to go down. Along those same veins, I know that within the past 2 years across the board, statistics are showing that as a society, we've experienced an increase in stress, Anxiety, depression. How have you guys seen that manifest in your patient population? Are you seeing more patients now dealing with kind of more of the biopsychosocial aspects of pain versus just the physical aspects? Dr. Riddle?

I certainly saw an uptick in it. It's interesting, and it's changed because when we first started to feel the effects of the pandemic, Both physically but psychologically, it was because we really didn't understand what was going on. And now that we have a better grasp of it, but now we're kind of working through the different variants of the disease, if you will. I've seen a shift in how people are handling it, and it's multifactorial. So yes, I've absolutely seen a change for the worse, if you will, in the psychology or the psychosocial aspect of a patient. A lot of anxiety, a lot of depression, mostly because there's just a misunderstanding and a fear for the future, not really understanding or knowing what's going on. From a world standpoint, but then also how that's going to affect their own everyday life. So not only am I seeing the physical ramifications of it when they come in in pain, but I'm very often finding that there's this very significant groundswell of fear and anxiety that is a significant driver of their pain as well. So I'm finding myself having to adapt my programming and my patient care So there's, it's been a challenge, but it's also been a very significant, as far as I'm concerned, a win because it's made me kind of open up my eyes to other resources that patients can use both from the comfort of their own home, but also don't actually require a great deal of money. So it's forced me to kind of reconsider how I provided patient care. As Dr. Teeter mentioned there, he was doing a lot of telehealth and home healthcare via video. I didn't get into that nearly as much. However, when I was still seeing patients, I was still seeing patients coming in with things that I had not seen that much of in the past. And it forced me to kind of open up and recognize other drivers of pain and find other resources specifically because everything was so overwhelmed. Supply chain was overwhelmed. People's time, other healthcare providers' time was overwhelmed. Going to the hospital for an emergency room visit was almost out of the question unless you were on death's doorstep. So overall, I definitely saw a change in the way that I was having to provide practice. Now, clearly, it's settling down to some extent. I'm feeling a bit of a return to normalcy. I don't want to make it entirely about how COVID has changed my practice. It definitely has, but I'm starting to see a return to normalcy. But I'm keeping in place a lot of the things that I saw, or the changes I had to create as I move forward, because I think overall it is actually going to help to positively affect my patient care.

Dr. Teeter, would you say you've kind of seen the same thing in your patient population, or how have you addressed the biopsychosocial components?

I don't want to say I've seen it to the same level of what Dr. Riddle described, but what I've just kind of witnessed is just a generalized tension, whether that's from fear, anxiety of the unknown, like all the things that he suggested. But people are just generally more like tense and fearful because like you said, we just don't know when this is going to end, how long it's going to take, how it's going to affect people, and we're kind of learning on the fly and learning new information day by day. I think I've had several patients or even athletes that I work with that are, that are pretty mobile people. And when you, you could just tell by speaking with them or just watching the way that they're moving that there's just a generalized level of tension. So I've just had to be more aware of that. And one of the simplest things I started having a lot of people do, and I've had patients that come in the office that you can just see it in their demeanor that they're normally happy And fun people to be around, and they're just kind of cranky and frustrated. So I started getting a lot of people into just simple breathing exercises, and even one of the things that we started suggesting is using the app Mindspace, and people seem to like it, and it was just a way for them to focus intentionally on breathing and calming themselves down and helping returning themselves to a more parasympathetic state so that they're not generally in this state of tension. So I agree with everything Dr. Riddle said; we just have to be more mindful of it, and particularly now since we don't know how much longer this is going to last. I'd like to say that we feel like we're coming towards the end, but we just don't know. And this could be something we deal with for the next 18 to 24 months even. So we just have to acknowledge that people's fear and anxiety is definitely going to change our perception of pain. And then when we feel that that's the case, come up with appropriate interventions to help bring them back down to normal.

Exactly.

Absolutely. And I think it's important to address that with your patient population. Obviously, we're addressing it today on this podcast episode because We listened to those trainings back from March and April, not having known at the time what we were facing and what we were getting into. I just think it was important to kind of address that now. And I know a lot of our listeners had questions just about how that changed things. Moving along, I wanted to kind of go through, not necessarily like rapid fire, but I wanted to be sure to go ahead and send out some of these questions to you guys that we've received from our listeners and our subscribers. Some of them have to do obviously with your respective courses. Some of them have to do with fitness and rehab in general. And then some of them may even be seen as a little bit controversial. But I thought you two were the perfect guys to kind of hit those controversial topics head on. The first question here is for you, Dr. Teeter. Your Rehab to Fitness course introduces fitness programming into healthcare practice and builds that bridge between where rehab ends and fitness begins. This is a 2-part question. So the first piece is, why did you feel that this information is crucial for healthcare providers and fitness professionals to understand?

I think the biggest thing is just because it's not something we learn. I can only speak from the perspective of being a clinician and licensed as a chiropractor, but we didn't learn this stuff in school. And what people like myself and Dr. Riddle have had to find out just through experience and amassing knowledge over the years is that Load and putting people under stress is something that is a necessity if we're going to create long-term change in people's biology. And so when I started thinking about the course, the primary reason why I wanted to do it was because it's all the information that I had to dig up to learn to do what I do and people like us, what they do. And I think this is one of the biggest challenges in chiropractic education is we like to bucket ourselves in this little pocket of the world where all we do is manipulation. Which is a fantastic tool, and I use it quite regularly. But we don't ever think about the what's next and how to continue to progress someone. Dr. Riddle and I had a really extensive conversation just yesterday about the idea of just the general adaptations and how I think a lot of times even us as clinicians don't fully understand the depth of what it's for and why it's important. And if clinicians and students would learn this stuff in school, it would be a much easier transition to take people from low threshold stimuli and rehab into. loaded exercise, and, and there wouldn't be a need to have this idea of bridging the gap. It would just be all part of one load continuum. So that's the main reason why I thought it was important, because it's not stuff that we typically learn.

The second part of that question, and you addressed this somewhat, is where do you feel are the biggest gaps right now in what is currently being taught? Because I know you have the unique perspective both of having taught at the collegiate level in a fitness program for fitness professionals But then also being a chiropractor, you have the experience of having gone through chiropractic school as well. Where do you feel like the big gaps are on both sides of that coin?

Systems. I think in both chiropractic college and let's just call it undergraduate where I taught for people who are trying to be strength coaches, what we're taught is a lot of science and a lot of principles, but they never really teach the application piece very well in most environments. And they really don't give you a systematic approach to evaluating decision-making. And so you're left with all of this information about science, but no way to apply that practically. And I think all of practical application is just having a systematic approach of checks and balances for your work, whether that's chiropractic care or fitness application. We need a systems approach, and they never give that to us. It's stuff that we have to come up with on our own by taking continuing education courses. And so that's why I wanted to include that, that the whole entire First three hours of our course is all about laying a foundation and creating a system. And the other thing about a systematic approach is we have to realize too, if we're working with athletic populations particularly, that we can't be everything to everybody. And so you have to have a system where you can communicate and collaborate with other professionals when it's necessary and when it's important for each individual patient. So it is a systems approach. I think is the biggest flaw that we have in the application of this model for both populations and chiropractic.

Absolutely. And I know that's something that we teach in the FACTOR course is a system. Obviously, Rehab to Fitness is also based upon kind of systematizing how you put things together and how you create those programs for patients and clients. Dr. Riddle, the next question here for you is related. What is the biggest mistake that you see clinicians making in regards to rehab?

I'm going to echo everything that Dr. Teeter just talked about there in a lack of system, and he'd mentioned the term a couple of times, was continuum. I don't see a significant effort in trying to progress a patient from not only just back to normal, but better than normal, to actually improve performance. Again, something that Tom and I have talked about at great length for years now. So I think the biggest delay, gap, whatever you want to call it, the biggest The biggest problem I'm seeing is once someone is out of pain, that's generally where care stops, whether it's a chiropractor, athletic trainer, physical therapist. We have equated pain with dysfunction when that's only a small facet of it. We're not actually ensuring that we've made them more resilient to their activities of daily living, to their lives, to ensure that, or at least to help ensure that they don't see this injury again. To kind of summate there, I just don't see enough of a continuum. I don't see from start to finish enough substance in between in the decision-making and then the actual action plan to make sure that a patient is more resilient.

And that is a great segue, actually. You guys both have mentioned this word continuum, and one of our questions here kind of hit upon that from, I think, one of the webinars, Dr. Teeter, that you recently did, which was on the rehab continuum. This person asked, where do personal trainers and strength coaches fit into the patient care and rehab continuum? Where do they fall in that spectrum?

So if you use the logic that Dr. Riddle and I have worked on, then there are basically 6 stages of care. And that starts on the left of a spectrum where you have 3 buckets that are strictly considered what we would probably say rehabilitation. But the other thing we have to consider too with all of this is there's so many areas that blend together that it's not like everything is segmented into its own individual category. So on the left, we have acute management, we have foundational kinematics, and we have motor control. These are all things we typically do in rehab. Now, if you have the right side of the spectrum, we have 3 buckets where we have functional integration, which is introducing Body relative strength. You have progressive kinetics, which is power. And then you have fundamental capacity, which is just working on work, like doing work. And so a strength coach would traditionally do those last 3 buckets. But if you have a really good strength coach, you can have that person work also in the motor control bucket, because in order to actually apply motor learning to the motor system, you have to have some semblance of motor control. So what we tried to come up with is a continuum of these 6 buckets. And say a strength coach can fit in either at functional integration where we're starting to actually apply external load to the body for body relative strength, or even in the motor control bucket if that person's trained well enough. And one of the things that I experimented with right before COVID hit, and I was really disappointed because it kind of threw a wrench in everything, but I had an intern who Dr. Riddle has met, Dr. Harrison Vauter. He is graduated now, but when he interned with me, we kind of experimented with this a little bit where Because he was the intern, I would do acute management and kinematics, which is basically all the things that you teach in the Factor course and all the things we learned in chiropractic school. And then he would do the motor control and integration piece, acting as if he was a strength coach. And actually what it did was it freed up my time to do other things with other patients while he was still providing fantastic care under the continuum that we discussed. So this works really well if you have the ability to have a strength coach as part of your team, but they fit. They're literally 50% of the rehab continuum. And one of the things I want— I just thought about while Dr. Riddle was talking, and I'd like to touch on it if you don't mind, is he was talking about bringing people back to normal. But we have to also think about what is normal for each individual person is going to be different. What's normal for an office worker might be stopping after motor control. It might be. But if you have a soccer player or a tennis player who is actually playing in tournaments, a normal for them would be, are you playing a full match under normal speeds and normal amount of time? So we have to take them further down this continuum than we would if it was just a sedentary person. So we also have to think about the idea of normality in reference to each individual's activity levels. And then we can come up with a plan along that spectrum to return them back to whatever activity they were at. Fitness professionals are a huge part of the system of rehab if they're trained appropriately, which is another reason why we wanted to come up with our class.

Absolutely. And that kind of begs the question, what types of, I guess, skill set or what type of education would you look for if you are a clinician looking to bring on someone to handle the strength and conditioning aspect or the fitness aspect of what you're offering your patients? What type of things do you look for?

So first, I think, and this is probably not a very popular answer, I think, but everyone wants to look at education. The first thing I look for is personality. I want to know that this person has enough of a personality that they can connect with people on a very personal level. And then because they're able to connect with people, they can communicate. I've seen lots of strength coaches or lots of clinicians that are brilliant academically, but can't relate to people. And so people don't always follow through with the things that they suggest because they don't feel like the clinician or the trainer is invested in their care. So the first thing I always look for is personality. Can I— is this someone I want to work with, first of all? And then secondly, what I look for is an understanding of a logical thought process based on science, meaning does this person have a firm grasp of anatomy and physics? Because everything we do when it comes to the application of load is about anatomy and physics. We're literally applying physics to the human anatomy. After that, I can teach you everything you need to know to work in a setting under our system. But I need to know that you can relate to people and communicate and that you have a pretty decent understanding of anatomy and physics. I can teach you everything else.

Absolutely. And I feel like soft skills are something that's so important regardless of what type of role you're looking to fill in your practice. Like, you want to make sure that somebody has the right cultural fit, the right, and by that meaning your company culture, like someone that gets along with other people, somebody that has a personality that jives with your patient base. All of those things are things that can't be taught necessarily, whereas like you mentioned, the skills and the knowledge about how to apply the system can be taught, but some of those foundational pieces kind of have to be inherent to that person.

Yep.

The next question here, we were talking a little bit about this rehab continuum and how you have healthcare providers on kind of the left side in terms of what they perform. The right side would be more of your fitness professionals and coaches. Dr. Riddle, where do you draw the line with fitness coaches who attempt to perform rehab, that kind of step over a little too far down the left side of the continuum there? What is acceptable and what's considered inappropriate for a fitness coach to perform?

Well, I think we need to more clearly define the terms of where that line is, which As far as I'm concerned, that line is pain. If you are dealing with an athlete that is in pain, that falls more on the clinical side. If you are dealing with an athlete that is beyond pain and is now working on recovery, revitalization, on performance enhancement, I think that falls over onto the more fitness side of things, clearly understanding that there is going to be some overlap between the clinical and the fitness side, there actually kind of has to be. And I will go back to my own experience as an athlete, but also my experience as a clinician who works with athletes. There were times when I was still providing a rehabilitation or a hardening program that needed to be taken over by the strength coach because they were the ones with the athlete more than I was. So I could provide recommendations as to what exercises I needed to see done and at what intensity levels, and then it could be monitored by the strength coach. So there was an overlap, if you will, of where I needed to do work, but I also needed the cooperation of the strength coach or just the coach on how that hardening program needed to be implied. But however, the line for me— it's a very hard line— is pain. So whenever an athlete is experiencing pain, they ought to be— we keep using athletes as our demonstration here. It could be everyday person that's working with a personal trainer At a gym. I have an office in a gym, and we have conversations on a regular basis about their clients that are in pain. They don't want to deal with the client's pain. They want to deal with the client. They just don't want to deal with the client's pain. So where we have struck a very unique relationship is I help deal with the pain, but I also help keep that client with the trainer so that there's, as Tom put it a minute ago, a deceleration of loss. So we can keep that person in the gym. We can keep them functionally moving forward. But that also has financial ramifications for the trainer that they're able to still maintain their living because now that person doesn't have to take time off. So I can manage the pain side. We can have conversations about how exercise needs to be changed, progressed or regressed based upon how that person is presenting to that trainer or to me. So there's a very delicate balance there. Pain tends to be the scale for me, but that does not mean that someone in the strength and conditioning or the fitness world is not going to be dealing with pain. There just needs to be a collaborative conversation with the clinical side.

Absolutely. Dr. Teeter, one of our listeners was asking, and this kind of goes along with what Dr. Riddle was saying in regards to, you know, we don't only treat athletes. Clearly, many practitioners who treat athletes and active individuals also see everyday individuals that might need to just prepare better for whatever daily work they do. So the question was, does progressive loading apply to everyday patients that are also athletes? So for example, like a construction worker that doesn't necessarily do extra fitness training, but he or she needs to be prepared to do their activities of their work every day.

Absolutely, 100%, end of conversation. Yes, there's Basically, 2 to 3 principles that apply regardless of your orientation, meaning whether you're a clinician or a strength coach. You have to consider the body's a biological organism, and we, when we encounter stress, we respond to stress in a very particular way. General adaptation syndrome. You have to consider that if you're looking to get some type of very specific adaptation, you have to apply a specific stimulus, specific adaptation to imposed demands. And that if you want to continue To see adaptation, you have to progressively continually add load, which is progressive overload. So regardless of whether you're a construction worker or an athletic population, everyone has to have a tolerance to load. And what we know is that the more load you can tolerate, the more resilient you are. The more resilient you are, the less likely you are to get injured and or sick. And so the application of load to the biological Awesome.

I love that. I love that you have kind of principles that apply there. And speaking of principles, Dr. Riddle, someone had asked, what are your views when you design your rehab programs?

Much along the same lines of what Dr. Teeter was talking about there. So fundamentally, whether I'm putting together a rehab or a fitness program, those programs are all built upon the foundation of understanding the human body. of specificity. So what does that person specifically need to get through their everyday, whether they're an athlete, whether they're a stay-at-home parent, a civil servant, whoever the case may be? We all still— we have to adhere to that principle of specificity. Individuality— what is that one particular person— what are their goals? I'm not going to have someone who has zero interest in going into a gym getting a gym membership and trying to move weights in a gym. I'm going to try to find other ways to impart exercise in their life that don't have them doing things they don't want to do. And this goes back to the old cliché, hey, Dr. Riddle, what's the best exercise for low back pain? And the truth is it's the exercise or activity that the patient's willing to do. Individuality is a huge one. And then finally, it's progressive overload. And this kind of seems to be the theme through this entire conversation here is making sure that wherever they start, that it's harder and safer at the finish. So we've got to take them from A all the way to Z, or whatever our stopping point is, whatever we've determined for that person, to make sure that we have safely progressed them all the way along. So specificity, individuality, and then overload. I love it.

And I think too that that was a really good point that you made. Oftentimes we've heard it, we've seen it in memes, we've heard it in jokes— what's the best exercise to prescribe your patients? And it's the one that I'll actually do. That being said, Dr. Teeter, one of the questions that came through for you was how would you suggest, or how do you recommend, or what advice would you give to especially new practitioners who are really having a hard time figuring out how to encourage their patients to start with fitness? If they're someone that typically is rather sedentary, like how do you help encourage that patient who's never, never really moved very much? Yeah. That movements and fitness in general is a really important part of having a great quality of life?

I think a lot of it just comes through conversation. I try to work that conversation into all— it's intertwined in almost every aspect of what I do with my patients. So it's not the end of their care. It's not the first time they've heard any of this stuff. A lot of it also has to do with just teaching people. People are so fearful That they're going to that they're they're fragile and they're going to break, and teaching them that they're resilient. And the stronger something is, the more something bends, the less likely it is to break. And so how we accumulate that bendiness, if that's the word I'm going to use, is through resilience, and that's by adding tolerance to tissues. The stronger you are, the more tolerance your tissues have to stress, and the more, as Dr. Ruble and I were talking about yesterday, the more. Stress your body and your tissues can encounter. It kind of— fitness is a way that we can shift the needle in allowing you to encounter more stress before you break, but also to be able to allow you to adapt more efficiently to the stressors that you're encountering. So fitness has to be a part of the conversation. And look, we're living in a society where close to 50% of the people are somewhat obese, and getting people to move is sometimes a hard thing to do. But I have recently started working— I have a lot of elderly clients that are over the age of 60 that want to maintain their independence into their old age. My grandfather just passed away a couple weeks ago, but he was 92 years old, and up until his early 90s, he was a very fit, mobile, active guy because he was always working around the farm and moving around and taking care of his body. And so it's not so much At that point about aesthetics, it's just getting people to understand like, hey, you really have to change some of the ways that you're behaving because if you want to continue to be as active as you are or if you want to live a long life, it's not about aesthetics. It's about being able to move your joints in a meaningful way, placing your body under load in a way that's going to force it to adapt positively.

If I could jump in there for a sec, I really want to reemphasize a point he made there that I think is very important is that conversation starts Early. It starts early in the care plan. For me, that conversation actually starts day one. That is, we're going through and reviewing the complaints of the patient. My solution is making sure they understand they're going to play the most significant part in this, meaning they're going to have to maintain an exercise program of some sort, that our plan is not going to be solely based upon them laying on a table and having me provide care for them. So day 1, we're already working on a thought process of if we're going to improve, if you're going to improve, the impetus of that's going to be on you. I'm going to walk with you in that journey, but you're going to have to do the work. So that conversation starts day 1.

Which is also why if you look at our— for anyone who's taken our courses, if you look at our continuum that we've come up with, and if you look at the way that our interventions are laid out, the very first thing that you come across is patient education. We're having these conversations the very first day. The reason probably why you got to where you are is because your tissues were underprepared and they were overloaded. Well, if we can't change the load, then we have to change the preparation. And the only way we can do that is by the application of load to the biological organism, i.e., fitness. So these conversations have to start on the very first visit.

Pardon the interruption. These Q&A episodes are so full of great content that I hate to hit the pause button on the discussion, but I would be remiss if I didn't take this opportunity to tell you about some of our upcoming in-person courses. October 23rd and 24th in Houston, Texas, we'll be hosting the FACTOR Rehab System 16-hour hands-on course. On November 6th and 7th, the Rehab to Fitness course will be in Orlando, Florida for its last live course date of 2021. And then on December 4th and 5th, for the very first time, we're hosting a DNS course in our hometown of Houston, Texas. Now DNS stands for Dynamic Neuromuscular Stabilization, and the course we are hosting is a DNS Exercise 1 course, which is open to both healthcare providers and fitness professionals. To learn more about these and all of our upcoming course dates, You can check out the links in the show notes or click on the live events tab on our website at factor-store.com to view our full event calendar. You also have the option of subscribing so that each time we add a new course to our calendar, you'll be notified. Just click the subscribe button. Now let's get back to the show. I love that. And I think all too often we hear from in our courses and throughout even interacting with people online around the globe. We've heard from both students, new practitioners, and seasoned practitioners about situations where they're just having a really hard time getting that patient buy-in piece. They start out in practice and they're excited to share what they know and they're excited to help people. And especially new docs can really kind of get beaten down in that first year, especially when you end up wanting that patient to get better a little bit more than it seems like they do. And, and you're more invested in their healing than it seems like they do at times. I know earlier in our conversation, we were talking a little bit about the BPS model and how some of those biopsychosocial aspects really can affect the condition that they come into your office with. Dr. Riddle, one of the questions we received for you was, how do you address those psychosocial components through physical activity? And this is a great question, I think, for both of you. Dr. Riddle, if you wanted to go first here. But how can movement and how can getting them engaged in some type of fitness that they enjoy doing, how can that help combat some of that BPS?

Yeah, that's, that's a great question. And it's actually just an extension of the conversation we've continued to have is exercise has been found to be one of the strongest prescriptions, if you will, to combat mental health. I just recently read an article and posted about how yoga Even something like yoga has significant power in combating mental health disorders, depression, anxiety. From a physiological standpoint, there's a lot of positive effects. We see the flooding of hormones, the endorphins, the feeling that we get when we exercise, that feeling of achievement, which kind of speaks to the psychological aspect of it too. So I think exercise is a great way to address mental health because one, generally it just gets us up and moving, get the blood flow going. I mean, that's about as simple as it gets. But most recently, a lot of us had to do that exercise outdoor, which we all know has significant benefits— being out in the sun, breathing fresh air, being in nature. Those all have very positive effects on our mental health. And I think though the biggest aspect of it is that sense of achievement, that sense of self-efficacy, knowing that they can do for themselves is the most significant contributor to battling mental health, mental health disorders, or improving mental health. Because we know through the research that one of the greatest predictors of chronicity of pain is a lack of self-efficacy. So if we can improve their self-efficacy, improve their feeling of self, their sense of self, and that they can actually provide and do for themselves, then we definitely will see a change in their overall mental health status. So that's why, again, day one, I always have the conversation about, hey, you're feeling some kind of way about your pain. And it's in their feels, literally in their feels, you can see the anxiety, it comes through in the way they talk about it. And I've mentioned this before in other podcasts, I actually screen for that before they ever get into the office using the yellow flag questionnaire. I want to see what kind of mental health we're dealing with before they ever get into my office so that I can customize the conversation for them about my recommendations of where we need to go. And it will almost always include some sort of physical activity very early on, if not on that same day. So I'm looking at it from a variety of different aspects. Yeah, obviously I'm looking at the biological causes of what's going on with them, but I've much more recently taken a very significant interest— and I think again it's mostly because of COVID— in how people are responding to their ability to get back out and kind of get into the gym and take control of their health. I just saw a patient today that he had kind of laid off of doing exercise that he loves to do. He's part of a high-intensity gym, and he had to take some time off of it because of his shoulder. And he said that it really started to play with his mental health. He started to really get anxious. He had an anxiety attack over it. There was some depression. And that was a very significant part of why he came in to see me, was I had to try to help straighten out the biological part, which there certainly was. But layered on top of that was the depression, the anxiety, and his feeling that he wasn't going to be able to use, in this instance, his shoulder as well any longer. So if we are disregarding the psychological or the psychosocial part of this, we're leaving a lot of patient care on the table and almost ensuring that your care plan is going to fail.

Absolutely. Dr. Teeter, would you kind of echo those same sentiments, or how are you seeing physical activity in terms of benefiting some of your patients when it comes to their mental health and the biopsychosocial social aspects of their conditions?

I would agree with most everything you just said. I don't agree with— disagree with anything you said. I think we know is movement inhibits pain and it makes you feel good. That's not something that's new, and that research is pretty steep, and you can find a ton of information about different ways which movement can make you feel better. What's interesting, and Dr. Riddle touched on the idea of just simply being outside. And I remember not too long ago during COVID I read an article of some research that was done where they took, I think it was Japanese businessmen, and they made them go outside twice a week, just go for a 30, 45-minute walk in the woods. And they not only reported higher happiness or rates of wellbeing, but the longitudinal study, if I remember it correctly, some of these people lived 7 years longer than their peers if they were just outside twice a week. And so we know that Just moving our bodies is good for us. I think another aspect of this that we kind of leave out is not only just the psychological part, but some of the research that's coming out about how the brain and the chemistry of the brain with exercise— for instance, particularly talking about the endocannabinoid system— when we exercise, there's always been this idea of having a feeling of euphoria. Some people call it exercise or runner's high. And a lot of times people have suggested that that's been linked with endorphins and and Keflins. But, what they're finding is that's not actually the case is that each of our brains are hardwired with endocannabinoid receptors and that our brain actually produces trace amounts of endocannabinoids or trace amounts of cannabis, which has a very calming effect on the system.

Yeah.

So, yes, exercise can be a great drug and it can make you feel awesome because of not only the mental and the Psychological benefits that it has. If you look better, you feel better, but also just the chemistry of now all of these things that we're learning about the brain and the endocannabinoid system. So movement has to be a part of what we're talking about. Otherwise, if we just provide passive care, we're kind of setting people up for failure in the future.

I think in order to kind of wrap things up here, I know we're running a bit long with this episode, I'd like to ask a question to each of you Because a lot of our listeners wrote in with this question in particular, and I think it would be just great to kind of hear your insight. Dr. Riddle, I can kick it to you first. What is the one piece of advice that you would give your younger self when you first started practice?

Oh man, that's a deep one. Da da da. Yeah, I've actually got. I have answers for it. It's it could go in a variety of different directions, so I'll try to kind of keep it. reeled back in. The first piece of advice would be to know my limits. Very, very early on in my career, whether it was as a kinesiotherapist or as a chiropractor, we get this self-sense, this sense of entitlement with our abilities and that we can fix everyone. And I would tell my earlier self that I can't fix everyone, and neither is it my job to fix everyone. I've learned as time's gone on here that my job is to guide. My job is not to be the fixer. So that would certainly be one of the very first things, is to not be so hard on myself and to realize that as much as I want to, I can't save everyone. Another thing would be to really get back to my roots as far as exercise goes. It gets very simple to get caught up. A lot of the new equipment, the, the high-tech stuff, if you will. And again, not that I think there's any problem with it. If you look in our rehab continuum, we talk a lot about some high-tech stuff. There's lasers and there's acoustic wave therapy, and there's a lot of really neat, very valuable stuff in there. But sometimes, especially as a young practitioner, it's hard to afford those things. So you're forced to rely on your mental abilities, your skills with your hands and with brain in order to sort someone out. And one of the best ways to do that, and we've been talking about this the entire time, is through exercise. You can have a very significant and positive effect that doesn't cost a great deal of money through fitness and through exercise. So again, my advice to my younger self would be don't be so hard on yourself and get back to your roots and stick to your roots.

Dr. Teeter, same question for you.

I would say some very similar things. Like, I think Early on in practice, you have a desire to try to help every single person or be everything to everyone and always have the answers. And I'll say the same thing Dr. Riddle said: you can't help everyone, and it's okay to not know the answer. A lot of I think some of the best relationship forming that you have with someone to gain their trust is to say, "I don't know," but I can help you find out. Like we can figure this out. I'll have to look into that. I'd rather be honest and say I don't know than lie and give someone an incorrect. So you can't help everyone, and it's okay not to know everything. I think the other thing is be really good at forming relationships, not only with your patients but also people outside of the office, meaning other clinicians. I refer in my town to other chiropractors that have a different skill set at times, and it's because I've formed solid relationships and we trust each other. I think keeping it simple is always some of the best advice. Like, we tend to overcomplicate things. Try to use the logical approach. And then I think the best advice I would give myself is try not to continue to confirm your own biases. Learn as much as you can from people outside of your field. Seems like a lot of the students I see coming out of school right now— and Dr. Riddle might have a very close appreciation of this now that he's back in the classroom— but I think a lot of students only want to learn things that they're biased towards or from clinicians within their own field. athletic trainers, physical therapists, massage therapists, and even strength coaches, which are people that are not in the chiropractic clinic. So I would tell people, don't just learn and read things that confirm your own bias. Go learn as much as you can from others outside your field because it'll make you a more well-rounded practitioner.

Absolutely. And obviously, with us being an education company, both of you are in education, we realize the value of continuing to progress your learning after graduating and after getting out of school. With that being said, what are you two learning right now? What are your classes? Are you guys excited about learning in the coming year ahead? What courses are you diving into right now to enhance your learning?

So that's actually pretty funny. I'm reinvesting some time back into actually Dr. Teeter's class. I know this sounds like a setup, but I'm reinvesting a lot of time back into Dr. Teeter's class as he continues to change his information Right now, I'll be honest with you, I'm taking a clinical turn more towards mindfulness and breathing and mental health for my patients. It's not that I don't feel like there's still tons to learn out there in rehabilitation and in exercise. I will most certainly get to those. There's a lot of really valuable courses out there, but my focus for the time being, and I think this is a perfect time to talk about it, will be to pay more attention to the mental health of my patients. and have better resources to help them adapt to that. So I've got a couple of courses and a couple of resources, books and otherwise, that I'll be focusing some of my time on to learn more about mindfulness training for my patients, breathing techniques, and things of that nature. So that's kind of the direction I'm going now for the foreseeable future.

And Dr. Teeter, for you, what are you learning right now? What are you diving into?

There's tons of awesome courses in the marketplace I would love to take, but because of travel restrictions and COVID. I'm kind of trying to do some similar things to Dr. Riddle and just kind of circle back and reinvest in some very simple subjects. I'm— after talking to Dr. Riddle yesterday, I really am going to take a really deep dive into physiology and homeostasis and try to reinvest in learning as much as I can about that because that's such a huge part of what we do in the clinic is tapping into people's physiology. I want want to have a better understanding of that. And then the other thing I'm really toying with right now, and I'm trying to read as much as I can, is about kind of like motor programming and motor control and how those 2 things fit together, if they fit together. There's a lot of really interesting coursework out there about loading tissue. I'm really fascinated right now with some of the work of Dr. Andrew Ospina and functional range conditioning. They're putting out some really solid information regarding motor unit activation and loading different lines of tension for different muscle groups. So I want to reinvest in the idea of looking at motor programming and motor control. And I think if I can understand how to load the body through physiology and how the brain organizes movement better, I think that'll make my rehab and fitness interventions a little more successful.

I would 100% agree with that. I felt kind of— I don't know, I felt kind of lost, or come back— I didn't know what to say about what am I looking There's just so many different things that I'm interested in, and I 100% agree with what Dr. Teeter was saying there about the motor control side. I'm absolutely fascinated by the neuro aspect of rehabilitation. A couple of years back, I'd started into a course called Functional Neuroorthopedic Rehabilitation, FNOR. It's since shortened the name to NOR, Neurorehabilitation. But that course and courses like it, where it investigates and really dives deep into the evidence and the impact of neurology on how we impart ortho and rehabilit— orthopedic rehabilitation. So that's another fascinating and I think a very fruitful place to spend some time. I'm definitely going to be looking at that as well.

And along those lines, as we're speaking about courses and education, I know that both of you are working on some exciting updates and things coming down the pike, both with the fact rehab curriculum as well as the rehab to fitness curriculum. So would you guys mind sharing a little bit of insight with our audiences into what they can expect in 2022?

Oh man, I feel like Dr. Teeter and I are like the Wonder Twins and we're trying to activate our powers. Obviously—

Can I be the Pink Ranger?

What we're trying to do is, is take the components of his course and the components of what we've developed with and expand upon this continuum we've been talking about where FACTOR fits in, in the beginning of the rehabilitative process and then transitioning a patient all the way through the performance side, should that be what a clinician is interested in. And obviously being evidence-based courses, we're constantly trying to keep up with the evidence and how it changes. And I loved when Dr. Steed was talking about biases, how we change our biases. There are certain things that I did earlier that I probably would not really consider doing nowadays because my thought process about that has changed as the evidence has evolved. So from my side of things on the factor side, we're updating, we're talking about new interventions, we're certainly deep diving into more exercise and how to be more specific with the way that we provide exercise. I think one of the biggest gaps since we were talking about that in rehabilitation is Providing stupid, illogical exercise programs, providing cookie-cutter programs that really don't benefit the patient. They're really meant to benefit the doctor so that they could bill for it. So I'm all about trying to provide patient-centric services. So we're taking a very significant deep dive in how to provide patient-centered services that also provide value to the practitioner. So lots of stuff coming up. Lots of research changes, tons of new exercises, new treatment interventions on the factor side. But that's going to become our hallmark, is making sure we're staying up to date, providing value. Come to a class on Saturday, Sunday, apply it on Monday.

Absolutely. Dr. Teeter, what's going on on your side of that continuum right now?

Oh boy, Rehab to Fitness is about ready to drop a nuke and explode come the first of the year. You know, I've always felt like the material that we present has has been really solid and has been very helpful to the people that have taken the class. As COVID threw a wrench in things and we were not able to do a lot of in-person classes, and so we shifted Southeast Sports Seminars and Rehab to Fitness, and we put the Rehab to Fitness course online. And one of the things I've just noticed is it's just to do this well and to understand it well enough to do it, it's just a lot of time. And so our 16-hour classes weren't just, were not enough time to go through all the material in an in-depth way to make people proficient at trying to add this into their practices. So starting the first of the year, we are starting a 16-week online cohort model where you sign up for a semester. It's 16 weeks. It's either going to be spring, summer, or fall. We're gonna do this 3 times a year. And for 16 weeks, every week you're getting material. Where you'll watch an online lecture, you'll have some assigned reading, and at the end of every week we're going to be able to communicate through a Zoom conversation, whether it's with myself answering any questions you have, or my hope is to bring out other practitioners in different areas of the subject matter and have them answer questions for you of how they're doing it in real time. So it's a very interactive way to learn the material. It allows me more time per subject matter. And it walks you through start to finish how to lay the foundation, how to create a system, establishing a baseline, building a plan. And we're adding a lot of new modules. One of the things we haven't been able to talk about because of time constraints is power training and capacity training. And because now I have this new format that allows me and offers me a lot more time, we're adding in power modules of sprinting, jumping, and throwing. We're adding more in-depth information on our conditioning and work capacity chapter. And then at the end, we're doing case studies. At the very last week, we're doing practical applications and case studies of how to step by step with real patients and real athletes, how we take them from start to finish from rehab into fitness or developing a fitness program. So I think it's going to be huge. It's a lot of information. It's a lot. It's a commitment for people to go through it. But I also think, as Dr. Riddle would say, anything worth doing well is worth doing, and we're going to do it correctly. I don't want to just be another one of these courses where people zoom through it over the course of a weekend, really don't understand all of it, then try to apply the material and say, well, this is what I learned in Rehab to Fitness. We really want to make sure that people have a firm grasp on how to apply this information. And, and the one thing I'll also just kind of suggest with this is a lot of times when people take a course, they have this idea that it helps them become experts in certain areas or certain subject matters. Look, exercise is about 8 different subject matters. You have physiology, exercise physiology, endocrinology, orthopedics, biomechanics, neurology. Like, there's all these different specialties that make up what we call exercise. It would take someone a lifetime to become an expert in one of those areas, let alone all of them. So, we're not trying to make experts in the application of exercise. We're trying to make people understand it well enough that they can take the information back back to their office, apply, create a system from what they're doing with their clients and athletes, and then apply this practically into their office setting or in, in a gym setting. So we've got— I think we've got some really cool things on the horizon. And as Dr. Riddle said, as we continue to develop more information, the deeper we dive into some of these subject matters, the class continues to change. I can promise people that the first class they took in October of 2018, what they're seeing right is entirely different. So we're just trying to stay abreast of the information and provide our users with the best experience possible of how to take this information and apply it practically.

I love it. And I think that's an important point to emphasize for anyone that's listening, is that as a company, as an education company, Factor continues to evolve the curriculum. So the course that you may take one year is not going to be the same even the next year. And obviously that's been the same for the Rehab to Fitness course. That's been the same for the Factor Rehab course. Factor started back in 2010, and the way that that course has evolved and that curriculum has continued to evolve over the course of the past 11 years has been tremendous. Another thing too that I want to make sure our listeners are aware of is that we are, as Southeast Sports Seminars, in the process of undergoing a rebrand. So essentially, we're going to be the same team that you're familiar with offering the same world-class education that we have been, but we're changing our name to Southeast Professional Education Group. And the main purpose for that was to be more inclusive and more reflective of and to better represent all of the different types of courses that we offer. When we first started this company back in 2013, our primary focus and goal was to offer courses for sports healthcare practitioners. And healthcare practitioners that treat athletes and active individuals. And while that still is a huge component of the different coursework that we offer, we've expanded beyond that. We have courses now in neurology and concussion management. We have other courses that deal with assessment. We have others in pelvic floor health and women's health. So we wanted to be sure that we had a new name and a new brand that was reflective of, again, the full breadth of all of the different course offerings that we have available. So needless to say, all of us have been very busy during the past 2 years. COVID was definitely a step back for, I know, many of our listeners in terms of their practices. Maybe their day-to-day volume with their patients was not as busy, but I know many of you that are listening, you really took that opportunity to do some really cool innovative things in your practice, whether it was reaching patients in a different way through telehealth or updating some of your systems and processes in your practice and in your business. And we've done the same thing here at Southeast Sports Seminars, soon to be Southeast Professional Education Group, and obviously with our Factor coursework, with our Rehab to Fitness coursework as well. So all of that being said, thank you both so much for taking the time to do this special Q&A podcast episode for our listeners. I think we have covered the majority of the questions that have been submitted. But again, for those of you that are listening, maybe this is the first podcast that you've tuned in for. If so, welcome. We appreciate you tuning in and listening today. Obviously, you probably heard a ton of great information and insight from these 2 content experts that we have in the areas of rehab and fitness. If you have not had an opportunity to go back and listen to episodes 1, 2, 3, and 4, certainly I recommend you doing so. Episodes 1 And 2 were our first, obviously first and second episodes of The Factor Podcast, where Dr. Riddle did a training on the importance of implementing systems in your rehab. Then in episode 3 and 4, Dr. Teeter conducted a training where he talked about the importance of integrating fitness into your clinical practice. So if you haven't had a chance to listen to those, definitely I recommend after you've heard our episode here today, Certainly go back and listen to those episodes so you have a better idea of some of the content that we were speaking about in today's episode. So again, thank you both so much for being on. Any last parting words or any information you want our listeners to know about anything that's kind of weighing on your mind or pieces of advice you wanted to leave us with today?

2 things. I wanted to thank Dr. Teeter for coming on and behaving himself. And then secondly, obviously we're both available via social media. media. You can find me on Instagram and on Facebook, Dr. Todd Riddle, DCCSCS. I post a lot of relevant information there. So if you're ever looking for extra information, feel free to find us, find me at least on the socials.

Yeah, same for me. I'm happy to answer any questions. I love conversations around these subject areas. So you can find me on any of the social medias at Tom Teeter DC or on Rehab to Fitness on Facebook and Instagram.

Awesome, guys. And again, for our listeners, those are the main places where you'll also find out about all of these different updates that both Dr. Riddle and Dr. Teeter have been working on with their respective courses. Obviously, you can follow Factor on Instagram, Facebook, and obviously LinkedIn as well. And then the same for Rehab to Fitness, we're on Instagram, Facebook, and of course our website factor-store.com has all of the information and links to get you all the details you need about both of these courses as well as our full Factor family of course offerings. Again, thank you guys so much. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on FACTOR Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.