#22 - Integrating Gait Training and Positional Breathing for Fitness and Therapy, Part 1

FAKTR, 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 consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thank you for listening. Today we kick off a new training titled Integrating Gait Training and Positional Breathing into Fitness Now, breathing has become a very popular topic in recent years in both fitness and rehab, but how do you even begin to retrain a process that happens in our body constantly and without a lot of conscious thought? Beyond that, how do you convince your clients and patients that correcting dysfunctional breathing is a crucial first step to helping them achieve their fitness and performance goals? The position of the axial skeleton and its ability to change shape as we inhale and exhale greatly influence the way our body moves. This influences the body's center of gravity and the way distal extremities manage stress, which is where gait comes into this equation. In this 2-episode presentation, we cover positional breathing concepts and drills that you can use to restore optimal positioning of these structures as a foundational step before fitness training and therapy. By doing this, we ensure our client or patient can dynamically control the rib cage and pelvis to drive stress to the right areas, which helps them better manage gravity and improve weight-shifting capabilities. Our presenter today is Christopher Kelly. Chris is a certified strength and conditioning specialist, performance enhancement specialist, and certified exercise specialist. He's also the owner of Fitness Rehab, a company that specializes in post-rehabilitation fitness and movement training. Over the past 14 years, Chris has worked with clients ranging from those attempting to avoid or recover from back, neck, and shoulder surgeries, All the way to professional golfers, soccer players, and even opera singers and performers. He has educated hundreds of physical therapists, massage therapists, as well as fitness professionals in this approach to training, as well as on topics such as movement screening, rehabilitative core training, exercise prescription modification, and much more. So with all of that being said, let's go ahead and dive in into today's training. Let's cue the music and get started.

All right, Jessica, thank you so much. Truly a pleasure to be presenting to all of you that are watching this webinar and those that will be joining us on the recording, just people all over the world. This is a topic that I'm really passionate about, and I really hope you guys get some great takeaways. But I'm going to just go ahead. The learning objectives of our webinar are we're going to discuss the role of posture in relation to the way we move. Okay? Posture is something that is thrown around a lot. Some people think it matters, some people think it doesn't. And what I hope to do is give you a practical understanding of posture as in the way that I see it as a movement therapist, all right, the way that I use it, and the way that it applies to the way that we move on earth. We're going to talk about the concept of shape change. Okay, that's a term that we'll become a little bit more familiar with as we go throughout this webinar, and how it drives all movements. Okay, and how that's going to impact maybe some things that you see in your clinics, maybe some things that you see when your clients put their feet on the floor. And then we'll get into how breathing and gait relate to everything that we do. All right. And this is a topic that I'm particularly passionate about because it is something that has greatly impacted my life. So just a little bit about me. I am a movement nerd. I love everything biomechanics and movements. I have been a— I'm the owner of Fitness Rehab. We are a multidisciplinary health practice in Lakeland, Florida. I'm in practice with a physical therapist, a chiropractor, medical massage therapist, and I myself am a strength and conditioning coach as well as a movement therapist. And really, the way that I got turned on to this stuff was through A really bad injury. Okay. I was a college soccer player and my entire life had led up to playing in college. I'd worked my entire life and that was my passion. And I played at a pretty good Division 1 level. And we were playing in the preseason of my sophomore year. We were in the final preseason game. We were in the 89th minute of our last preseason game before we started. And I was vying for a starting position. I'm a fullback by trade, but for any of my football fans in the house here, but I was going to cross in stoppage time. And I tore my ACL. Okay? I had a non-contact ACL tear. It was a full tear. I missed the ball and I just planted wrong and just things went. And as a result, I almost immediately had surgery and I spent some time just basically inactive. I couldn't do anything. And I was just hopeless because everything seemed to hurt and I was just lost for a while. And I had the pleasure of working with a physical therapist and an athletic trainer who taught me a lot of these concepts and at the same time took me under their wing. And helped me to understand my body in a way that I didn't before. And going beyond just the therapy itself, they gave me better self-awareness. And I think that that was the most powerful thing that I could have had because it helped me to make changes for my own body. And as a result, I ended up walking back onto my team early. And I remember after playing again for 90 minutes and just feeling the confidence that I lacked before in my own body, I cried just because I'd been given back something that I thought that I would never have again. So this is why I do what I do now and something that I I hope to give to everyone that I work with. And a lot of those concepts I've continued to learn and study and go forward. And this is what I do today with athletes in my practice, as well as clients that are hoping to avoid surgery or recover from surgery. These are the concepts we use in conjunction with our therapists, with our massage therapists, our physical therapist, and our chiropractor. We work in conjunction in kind of the same language. So today we're just going to kind of go through some of the way that we utilize this system and some practical takeaways. So the big picture, the 2 central pieces of what I'm going to talk about today are breathing and walking. And the reason that I feel that those are so important, just independent of anything else, is that they represent the things that we do most in life. All right. They say that we breathe an average of 20,000 times a day. For a hyperventilator, that's far more. And when we talk about walking or gait, that's standing. Okay. That's weight shifting. That's even sitting because we're never fully still in one place. We're always shifting our weight, whether we know it or not. And so by working on these things and working on the better control of these things, we teach our clients how to manage gravity and how to more importantly manage the forces that are acting upon their bodies. And I think independent of any type of an injury, I work with fitness clients as well as people that are chronically injured, and improving these qualities in everybody improves the quality of life, improves the quality of treatments. It gives you a lot of different tools to act as an adjunct to manual therapy. So I really believe strongly in this stuff. And regardless of whether we're dealing with somebody that can barely do anything Or we're dealing with a high-level athlete, there's something that everyone can take from this, and that's why I like it so much. So when we talk about breathing, the question I begin with is, why is breathing important? All right, and one of the key things that we're going to talk about here is that really what we're doing when we breathe is influencing the position of the axial skeleton. So the alignment of our pelvis, of our rib cage, of our cranial bone, and even of our feet. And every time we take a breath in and we exhale, whether or not we know it, We are influencing our center of gravity. So when we have certain compressions, certain breathing limitations, an inability to expand certain parts of our rib cage, those are also going to impact the way that we move. And as a result, it's also going to impact the way that our central nervous system senses that area. It's going to impact the way that we can shift weight into or push out of that area. And I think that on a neurological level, breathing is also a tool that we can use as a conscious input into the nervous system, and that's why it's so powerful. And exhalation and restoring an exhalation is one of the most powerful things that we can do to dampen sympathetic tone that you might see in somebody that comes in after an acute injury or somebody that is chronically stressed or has chronic anxiety. So that alone is a very powerful reason why breathing is important, but pressure management is also a very, very big factor here. And when we talk about why do the feet matter in particular, I mean, there are many reasons why the feet matter and the hands matter, and one of them being is that the feet and My hands have more sensory receptors than any other part of the body. And so anytime that I impact my workstation with my hands or the floor with my feet, okay, I'm influencing everything else up the chain. So the foot tripod, the heel, the pinky toe, and the big toe, the control of the foot tripod, the ability to balance atop the foot tripod is one of our goals for every client that we work with because it acts as a rudder to direct gravity, whether it be forward or backwards. And as a result, that's going to cause consequences up the chain. And what I mean by this is Let's say we have a client that is zone 3 dominant. Okay? They stand in their toes. So more weight shifts into their toes all the time. They're used to standing this way. And so when they walk and when their foot hits the ground, their center of gravity actually lands forward. When they stand, rather than contacting as much pressure into their heel, they're going to shift that forward. As a result, that might cause them to arch their back in order to stand a little bit more upright because the righting mechanism of The body is going to attempt to hold ourselves up by arching the back in order to keep us straighter. And again, there are other consequences that we'll talk about with this, but if we're dealing with an athlete and we need to teach them to change levels or change directions, the ability to shift from the heel to the pinky to the big toe, the ability to push off when I jump through the big toe, incredibly important. And this is something that the management of gravity and the ability to teach somebody to move across their foot is something that I believe is one of the most undervalued qualities in sports, Or in therapy or anything else because, again, whether we're dealing with a high-level athlete or somebody that's been impacted by a traumatic injury, giving them back heel strike, for example, teaching them to shift their weight back is going to reduce a lot of the extensor tone along the entire backside of the body. It's— as a therapist, it's going to give you more access to the posterior hip capsule and the ability to create external rotation in the rest of the body. And it's going to give the person, again, a lot of sympathetic release as opposed to shifting the weight forward. So— These are all reasons why the foot is important and all things that we'll get into. So our goal with this stuff, when we talk about— we're going from like big picture to small picture, but our goal is to establish the ability to stack these structures of the axial skeleton, the ability to stack the thorax atop the pelvis, atop the malleolus of the foot. All right. And this is what I would consider to be heel strike, an early stance of gait. This is also what you might consider to be neutral. In therapy, they talk a lot about neutral spine, but what I want to emphasize Here is that this is just a starting place. I don't want someone to walk around like this. The goal is not to have somebody to maintain this posture always. It's the ability to start from this posture so we can move forward. It's almost like an airplane taking off on a runway. I want to start them on the backside of the runway so it has more room to take off, as opposed to starting forward on the runway because we simply don't have as much room. The other thing that this does is that this stacked posture. is going to give us the opportunity to take a full breath in and a full breath out. It's going to give us the ability to externally rotate and open the ribs with an inhalation, as well as the ability to close it with an exhalation. And when we're talking about training or resistance training, if I'm progressing a client to a gym setting, training in this position is going to help me to load gravity through the body versus around it. Whereas if my center of gravity is a bit forward, the axis of rotation is going to be different. I might be loading— if I'm doing a back squat, for example, I might be loading gravity through the lumbar spine a little bit more than I would want to, as opposed to the legs and the thorax. So this is just the most efficient way to do that as well. So there are all reasons why. And again, I want to teach my client to reestablish this frequently as they move throughout their activity.

If you liked what you heard in today's episode, then you're in for a real treat because today's episode is sponsored by the Breathing Assessment and Biomechanics course taught by Christopher Kelly. In this dynamic 7.5-hour online course, you'll learn a comprehensive approach to assessing the biomechanics of breathing. You'll also be taught a step-by-step method for breath coaching to improve flexibility, mobility, and posture. To learn more about this course and specific state CE approvals for chiropractors, physical therapists, and PTAs, as well as massage therapists, visit the link in the show notes. Or search our course library at online.sports-seminars.com.

A good reference that I can utilize to describe the importance of this is the idea of a pendulum. If we look at a pendulum, we think of our stacked posture as the middle of the pendulum. In the middle of the pendulum, I have the ability to demonstrate full variability of movement in one direction and full variability of movement in the other. And if I can start from a good position, then I can potentially move in any direction that I choose. Whereas if I already start in a poor alignment, if I start, for example, with let's say an anterior pelvic tilt or center of gravity that's shifted forward, that's like starting my pendulum slightly off to the left or slightly off to the right. That difference in movement is going to influence the way the compensatory mechanisms in the rest of the body, and it's going to change the way that I move. It's not going to allow me to get as far to the other side. And if we're talking about somebody that has let's say lower back pain and is Shoved into extension and is unable to flex as well, this creates repetitive stresses that could potentially create pain just because that area becomes a focal point. So again, teaching our clients to reestablish this through some of the ways that I'm going to show you are a great way to begin a treatment. They're also a great way to progress someone from, let's say, a table or the floor into more gravity-intensive positions in which gravitational forces are acting on the body. Giving a client an understanding of this concept as well, I work with professional singers and professional athletes a lot.

Mm-hmm.

Professional singers are— the breathing for them is extremely important, and they're very aware of when they are compressed. And teaching them these concepts gives them a much better way to self-adjust throughout their performance. Or if we're dealing with somebody in pain, giving them this knowledge teaches them to self-adjust throughout the day, which is also very beneficial. And what I want to emphasize with this is I found this picture of a singer of optimal singing posture, and this picture is wrong. In order to fully produce a sound, the singer's gonna have to contort their body and going to have to use an arch in their back or a rounding or a compression of one area to get an expansion in the other to fully produce force. If I took a balloon that was full of air on all sides and I squeezed part of it, more air would go into one place, and so we would get more projection of air in one direction. When somebody is singing, that's exactly what happens, is a singer is going to contort their body in order to produce a change in tone, or higher sounds or to belt, for example, where they go into like a crazy range. And they simply wouldn't be able to do that if they didn't use momentum as an athlete would when they were sprinting or cutting. And this very talented singer is actually my girlfriend. She's a professional opera singer. And you can see here that this posture where she is intentionally arching her back is something that singers assume all the time when they're belting and they're trying to produce emotional high notes. And the reason that is, is because it gives them access to more force. She's compressing the backside of her body in order to propel And this is exactly what happens in sport as well. So if I'm looking at these traditional representations of bad posture, we have a lumbar lordosis or a thoracic kyphosis or a forward head. I could look at this and I could say, these are bad postures, or I could look at them and say, these are simply a moment in time. In order to take a step forward, as I shift my weight over my foot and I push off, my back is going to have to arch as I create terminal hip extension and terminal extension. That is something that is going to need to happen. Naturally occur. It's a cycle. But by the same token, I just want to be able to reciprocate out of that. I want to be able to flex my spine after that. And where we get into trouble is when we get stuck in these shapes in any particular position. So with that in mind, you could say that posture then is just a representation of how the body has most mechanically self-organized itself to keep the eyes on the horizon and stay upright. And often where clients will experience pain is where these compressions occur, where they cannot get out of these compressions, where they can't shape change. And this is what I mean by the idea of shape changes that we want to be able to access one shape, a lumbar lordosis, for example, as I'm pushing off, but we also want to be able to access a subsequent lumbar flexion as my leg is swinging through into the next step. All right? So it's the concept of, can you compress and can you expand? Because as I inhale, the diaphragm is going to descend. The lungs are going to fill with air. The rib cage is going to externally rotate and raise. Whereas as I exhale, the rib cage is going to compress. The air is going to be pushed out of the lungs. And as well at the pelvis, as I inhale, the pelvic inlet is going to open to accept the pelvic floor as well as the guts being pushed down by the diaphragm. As I exhale, the opposite is going to happen. Those things are going to be pushed up. So the body has to be able to go through compression and expansion. And so if I look at the ribs as my balloon, if I squeeze one side of that balloon, more air is going to go into one place and that's going to create consequences. So again, going back to the client, That might have a lumbar lordosis. We're getting less air on the backside of the rib cage and maybe more air in the belly. Maybe this person has been told to belly breathe or coached that way. Maybe this is just something that they developed as a result of habit. What will happen? They will tend to be pulled forward. They will tend to be compressed from the backside and pushed and pulled forward from the front. And as a result, that area that is being compressed continuously might start to develop a repetitive stress. So again, and this goes for— and every time we inhale, The same thing is going to happen. We want to be able to fill the balloon. Every time we exhale, we want to be able to compress the balloon. By the same token, just as breathing is a rhythm, we want our lungs to be able to open and compress, and we want to be able to move across our foot in a similar fashion. And so, the ability to access the heel, in my mind, is also the ability to feel the backside of the rib cage because they are both very posteriorly oriented. A very early stance or a heel strike stance is the ability to sit back into our heel, the ability to scan the Basically starting at the top of the runway. As the foot impacts the ground and we advance forward, pressure and air and all of that stuff is also going to go forward. As I move into max pronation, and my foot is going to go from a supination to a pronation to a point where we're in a position of maximal compression, where this is exhalation, where I have to start to push back off. Just as my diaphragm ascends, I have to be able to push off and push through my big toe and and come into toe-off as I propel my body forward. And this is a cycle that we go through to some degree whether we're compensating or not. But what I want to be able to do is give my clients or give my subject access to all of these motions to, to better allow them the ability to expand and compress, to produce force, to restore the rhythm of the ability to flex and extend spine, to open the ribs and to close the ribs, and to also direct pressures in a certain way. The question then is, does your trampoline work? Because when we talk about movements, we have 3 phases for everything that we do. And this is why the foot and breathing are intimately linked. We have falling to earth. We have this— I'm doing a squat. I have descending into a squat. I'm moving from a position of, we could say, external rotation or moving back or sort of backwards movement towards a position of internal rotation, which is folding forward. That's a position where— My foot hit the ground in heel strike and starts to flatten and come into pronation. And then, we have the bouncing back up where my heel clears the ground, I push off, and this process repeats again. And so, for every action that we undertake in life, every movement that occurs, every breathing cycle that occurs, the same thing happens. My foot lands on the ground, my foot flattens, I push back off. I do a squat, I descend, I have to have the capability to produce the pressure to push back up. I inhale, My diaphragm descends, my pelvic floor is pushed down. I have to have the strength and the pressure of the ability to create the compression and the strength of the pelvic floor necessary to create the ascension of the diaphragm so it domes against the ribs. And then, if we start to extrapolate out, then we start to look at the tone of the body. Do I have limitations in certain movements? If I lack the ability to externally rotate, for example, in my hips, chances are I have Somewhat pushed forward already, so I land early in this internally rotated position. So we put more pressure on certain structures. Do I have— or if I'm excessively externally rotated, I lack the ability to create internal rotation to create push off the trampoline. I may lack the ability to push back up. And so in this case, you might have a client that is hypermobile or has pain as a result of weakness. All of these things are the way that I look at the body in terms of, does the person have the ability to get into a position? Do they have the strength to get out of a position, and do they have the ability to do it repeatedly? Everything that we do— breathing, movements of any kind— represents this. And it is something that when we freeze this as a moment in time, we can kind of view a client this way: what qualities in this individual are we trying to restore? And so if we look at whether we're looking at a singer or an athlete, you could look at this athlete, you could look at that large anterior pelvic tilt, and you could say like this person has poor posture. But in reality, Naturally, they're creating all of this compression and arching their back and kind of shoving everything forward in order to create more force. And so when they hit the ground, they can spring off the ground more quickly and more powerfully, just in the same way as Steph here is arching her back and using her arms as rudders to create more compression and more push forward. All right, it's, it's something that they learn to do naturally in order to be more efficient and to use the ground like a trampoline. And again, Again, these are good things. They need these in order to produce athletic capabilities. When you look at extremely athletic people and what they do in their sport, they're going to have exaggerated features such as this. The problem though comes in when we can't get out of these positions. And so what I want you to realize and what I want my clients to realize as well is that I want my client to be able to arch their back. I want them to be able to access all ranges of motion, to be able to access all motions equally. Anterior pelvic tilt, lumbar lordosis. Any posture is not necessarily bad as long as it's variable. We should be able to access this position. We should be able to get out of it. Spending time in certain repetitive postures is going to almost freeze us in these postures. It's going to make it harder to get out of those positions. And so part of our work with these breathing drills is to give clients back what they don't have. For, for an athlete like this, for a lot of my sprinters that I work with and a lot of my singers that I work with, we do a lot of work in terms of some of the drills that I'll demonstrate today in terms of teaching them to shift their center of gravity back again and find hamstrings and posteriorly tilt the pelvis as a cooldown from things like this so they can start the recovery process. And that's the point is that if they can start from a good position, they can recover from a good position, they're going to be a better performer and arguably have a greater potential to avoid a lot of the overuse injuries that go along with extreme sport. And so then what is bad posture? And oftentimes when we have postures or we have clients that are going to present with Unresolved pain that is repetitive in nature, that is not acute, that they know a client that continues to come in with a back pain or a knee pain or any kind of thing. Oftentimes, this is just the focal point for compression. For example, if I lack hip internal rotation, but I can't create extension of the pelvis, then I'm simply going to do it at the lumbar spine instead. So a lot of the same compensations that clients will manifest in static or in low force situations are the same things that our athletes will manifest in higher They just happen earlier and more frequently. So again, I mean, that's not always the case, but this is what I found to often be the case. All right. And if this does present, if we have a client that presents with a glaring lumbar lordosis or a glaring thoracic kyphosis, that's going to change the way that the shoulders move. That's going to change the behavior of the hip sockets. The pelvis is not going to move as well or have as much variability as a result. So resolving this first has a lot of value. Because then it's like taking a garden hose and squeezing it in the middle. If I have a situation where a client is excessively compressed, you're going to have pressure that's going to build up in one place and it's going to cause stress. So if I can start to alleviate this and I can start to address this upstream first, then a lot of the things that we're going to see downstream are going to be better off as a result. So this is why I always like to start our sessions with breathing drills and why I like to use positional work where I'm teaching my client to find their heels or I'm teaching my client to find their midfoot and to direct pressure in a certain way that they lack, just to give them a little bit more variability of movement, to give that back. And then, as well, with our manual therapists, they'll oftentimes do this type of thing before they do manual therapy because a lot of the sympathetic tone that would otherwise develop there will clear up as a result. So again, just because we align things and we talk to the client to breathe again. So again, it's the idea of getting stuck on a trampoline. If I have a client that— whose center of gravity is positioned too far forward, Or might be shifted into one side more than the other, or whatever it may be. They don't have the ability to get out of that position just due to whether it be the inability to create the force necessary to do it or just landing in a bad position every time they take a step. In high-level sport, that could manifest as an ACL tear or as a hamstring strain. Whereas in lower-level situations, this is oftentimes going to manifest itself as repetitive stress. So it behooves us to kind of look at it in this way from the perspective of, are we seeing these compensations throughout the body? This is something that I get into a lot more in my courses, but we're going to see a lot of correlation between what the pelvis is doing and what the rib cage is doing. If I look at a hip flexion measure, I should see a similar result in a shoulder flexion measure just because those 2 structures are so intimately linked. That gives me a tell for, okay, maybe this person's center of gravity is pushed forward. Maybe what I'm seeing on the table is something that I'm also going to see in standing. And it's oftentimes going to be quite clear. But often, if I can teach this person to shift their weight back a little bit, if I can give them hamstrings, if I can give them a pelvic tuck, and I can get 15 to 20 more degrees of hip flexion, if I can increase their shoulder flexion through one move, then that makes a lot of sense for me. And it's almost as if I've restored just a little bit of rhythm in their body just to teach them to relax a little bit and assume a better position before I work on my other interventions.

Okay, guys, that's it for today's episode. Be sure to tune in for episode 23, where we continue discussing this important topic with Christopher Kelly. In episode 23, we will introduce simple assessments to determine positional limitations of the pelvis and rib cage. We'll talk about positional breathing drills that you can incorporate into training and therapy, as well as exercise modifications to immediately improve control of the pelvis, rib cage, and foot. You won't want to miss it. Episode 23 drops in 2 weeks, or 1 week for our Patreon subscribers. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in today's episode. We'll see you next time. 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.