#23 - Integrating Gait Training and Positional Breathing for Fitness and Therapy, Part 2

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 continue our presentation of gait training and positional breathing for fitness and therapy with Christopher Kelly. If you haven't taken the opportunity to visit the link in our show notes and learn more about Chris's full 7.5-hour online course on breathing assessment and biomechanics, I highly suggest that you do that today. Now, in episode 22, we discussed the importance of breathing biomechanics and how they can affect our center of gravity and posture. In today's episode, we will introduce simple assessments to determine positional limitations of the pelvis and rib cage, positional breathing drills to incorporate into training and therapy, and exercise modifications that can immediately improve control of the pelvis, rib cage, and foot. Be sure to stick around for the live Q&A segment at the end of today's episode, where Chris goes on to answer some great questions from our live webinar audience. Without further ado, let's cue the intro music and get started.

So what I want to emphasize, I want to make very clear what we're trying to do with breathing drills, because I think that this is something that has been made popular in our industry, like breathing has become much more popular in recent years. And I think that that's great. But without context, it makes no sense at all. And so what I want you to realize is that when we're talking about breathing, we're working on restoring the motion of the axial skeleton. And when we talk about the rib cage, that's the ability to produce the bucket handle motion of the ribs, which is lateral expansion, and then the pump handle motion of the ribs, which is anterior to posterior expansion. Every time I take a deep breath in, my lateral ribs should be able to externally rotate. My sternum should also be able to raise. As I exhale, they should be able to drop. There are certain measures and evaluations that we could do to see if this is the case. We can look at the infrasternal angle to see, does it expand and compress as I inhale, exhale? And using these things as a guide for what I'm doing tells me whether or not what I'm doing is working. And those are things that kind of go beyond the scope of this webinar, but what I want to make very clear is that it's our priority to restore the dynamic motion of these structures so we can also, by extension, restore the dynamic motion of the hips and shoulder sockets. In a similar fashion, as I inhale, I want my pelvic inlet, which is the top of my pelvis, to open to accept the pressure and sort of the pelvic floor being pushed down. The pelvis opens like a bowl. As I exhale, the opposite happens. My sacrum nutates, my pelvic bowl closes, my pelvic outlet, which is the bottom, opens as my pelvic floor and my guts ascends and my diaphragm ascends back up. I want to make sure that I have full variability of movement in these motions as well. And again, if I can restore this, I can also improve the motion of my innominate, the motion of my femurs, and And you might say— and we're talking about micro movements. Very little motion occurs at the sacrum. Very little motion occurs at the ilium. But the direction of pressure absolutely occurs. And so restoring these micro movements and the capacity of this structure to accept and to propel pressure away is vitally important and something that I do believe influences the rest of the body very much. And so the question then becomes, can we change shape? It's a little bit hard to tell in this picture, but we have somebody that on the right Right. As Nate is inhaling, you can see that his center of gravity is a little bit further back. You can see he has a little bit of a reduced lordosis, whereas as he exhales, we have a little bit more of lordosis. So this is what happens. As I inhale, I'm going to counternutate the sacrum. I'm going to flex the lumbar spine and fill the backside of the rib cage. Whereas as I exhale, my diaphragm ascends. The opposite is going to happen. I'm going to nutate my sacrum. I'm going to create a bit of lordosis in this area. This is a rhythm that occurs with each breath. And when we get stuck in one of these shapes, We could say that the person is potentially pushed forward or pushed backwards in a sense. So when we talk about rib cage presentations, we have a situation where you could look at the left and you could say this is an anterior pelvic tilt or a lumbar lordosis. What I see from a breathing perspective though is we have somebody that is compressed from behind and expanded in the front. So the behavior then that this is going to encourage is belly breathing, is an inability to utilize the abdominals eccentrically to close the rib cage. The opportunity to potentially overuse the rectus abdominis, potential to also overuse our hip flexors, overuse our back extensors because we stay in this position to some degree all the time. Whereas on the opposite side, I have somebody who is in this sort of swayback posture, who is maybe overusing their rectus and overusing their abs, and as a result is sort of being pushed backwards. In either case, there are consequences that go along with this. In either situation, it's suboptimal because we want the person to be able to move forward, but we also want the person to be able to move back. And this is something This is something that I'm going to confirm with measures that I utilize as part of an evaluation, but knowing this is powerful because when I put this person's feet on the ground and I'm working with them in a movement context, I know I need to teach this person to move forward and utilize their foot over the ground, or for the person with an anterior expansion, I need to teach them to move backwards and better control heel strike before I start to move them forward again. So if we talk about the person with their back arched, if we're looking at the rib cage and we have these 4 quadrants, you could say that we're expanding in the front and compressing in the back. So we're looking sort of a shove from behind. Whereas if we have somebody whose back is rounded, they're overusing their abdominals and compressing in the front, we're not able to get as much air there. And so you could say that we're being propelled or pushed backwards in a sense. So when we're talking about breathing drill consideration, then in either case, what we're looking for is competence in stacking. This is The ability to align the cranium with the pelvis and find the appropriate muscles is my primary concern. We always want to start in gravity-reduced or ground-paced positions, as you can see as I'm lying on my back here, and transition into things like half and tall kneeling into eventual standing. And the reason that is, is because we're reducing the effect of gravity on the body. I want to start in more simple positions in which I can use references like the block between my knees to teach the client to feel what I want them to feel, and then move them to more unsupported positions where they're having to stabilize and control gravity. In terms of the learning process, I want to give them conscious competence and understanding over what they're doing in a very isolated environment, and then move them into more of an integrated environment before I return them to movement or sport. And so our goal with all of this stuff is to establish stacking. Here's a drill that I oftentimes use for a lot of my clients that are shoved forward. Going to press their back into a wall, I'm going to have them push their feet into the ground and dig back in order to feel heels. I'm going to cue them to feel hamstrings, and using the wall as a reference, I'm going to cue them to tuck their pelvis slightly off the wall. What this is going to do is this is going to push them backwards. I can also reach forward with my arms in order to create a little bit more abdominal activity. And if I'm looking at my arms and my knees as rudders, and I'm kind of sticking them out, both of those things are pushing my center of gravity backwards so I can stack my thorax atop my pelvis. The key in this position Is that my subject is able to demonstrate both motor and sensory competence. And we talk about motor competence, what I mean is that it looks good. Like it looks stacked. It doesn't look ugly where even in this drill, you can see like my head is a little bit forward of the wall. If I'm being a real stickler about that, I might put like a block behind my head in order to line everything up here. And also they feel the right stuff. And a good tell for whether or not we are in heel strike is I cue the client, okay, this looks apparently good. But I say, okay, I want you to dig your heels back. Tell me what you feel. If they feel hamstrings, we're go because I know I know that hamstrings are one of the muscles that are going to pull me through the gait cycle. Those are the things that are associated with my foot landing and controlling heel strike in order to transition my body forward. Whereas, if they tell me, oh, I feel a lot of quad, that tells me that their center of gravity is probably a little bit further forward. Their knees might be coming forward as well. And as a result, their weight is a little bit more in the front of their foot. So based upon that, I might regress them into a supine position where I have them put their back on the ground and their feet on the wall, because that's just going to give them a much more supportive environment. And it's going to use gravity in the favor of heel strike. Gravity is going to help me drive back towards my heels. So another example, using supported positions. If I'm teaching my clients to close their rib cage, this is just me like using a sink here. All right. A seated position is something that I also really like to use because again, this is in my mind just another version of the thing on the wall or the thing on the floor. In the same position, I'm digging my heels back. I'm trying to find hamstrings. I'm reaching with my arms, trying to find obliques, and I'm cueing my client to look forward and stack their body. Once the client can demonstrate competence in this movement, I move them to standing and they can do the same thing. Then I can start to teach them the level change. I can start to teach them to squat in this position. I can start to teach different movements in this position. And again, I don't expect them to go out and play their sport this way, but by reestablishing this in a conscious warmup, we're kind of upregulating the unconscious competence For them to go do their thing. And so when we talk about static breathing drills, the idea is that we're compressing one area in order to expand another. For my wide clients, for my individuals that are going to be pushed forward, this is one of my favorite exercises. It's just called toe touch breathing. We literally have our clients shift their weight back into their heels, reach down and touch their toes. In this position, he's compressed in the front, he's open in the back. The goal would be— the thing that I would teach him to do would just be to inhale and think about driving air into your lower and your middle back. As you exhale, just hold the position. And if you do that for 5 breaths, it's crazy how much more you're going to drop down just because we relax and we eccentrically oriented the stuff on the back a little bit more. Whereas with a dynamic drill, if we've envisioned static breathing drills as almost stretching from the inside out, in which we compress one area to expand another, dynamic breathing drills are ones in which we're going to use the weight of the axial skeleton, of the pelvis, and of the thorax in order to move in a position. And so this is an example that I created, or a drill that I created for clients whose pelvis is more forward on the left versus the right. So for them, I'm encouraging heel strike in this drill by putting a reference under their heel, coaching them to dig their heel back to find their hamstring. And once they do that, I will have them just take a deep breath in, and then on the exhale, drive their body weight into this position. So I'm having them reach down and touch their toes. And what that's doing is that's pushing my hip back, that's encouraging my center of gravity to go backwards. That's also encouraging my body to push into my hip capsule and everything related to my center of gravity to push backwards. Once the client can demonstrate an eccentrically oriented area, once I can kind of fill that area with air or relax the area that is my target, then I'm going to teach the client to move into that area and to rotate into that area. And if we're dealing with an individual who is maybe oriented to one side or has a pelvic or a thorax torsion, this type of thing is quite useful. Even if we're talking about somebody that is just— has an arch in their back, having them reach forward with their arms and perform a squat by pushing their knees forward is also going to push their center of gravity backwards and is going to give us a similar effect. And so if we're looking at a case study, just very quickly, like let's say this is a low back pain client who comes in with quite a pronounced lordosis and feet that are externally rotated. In my mind, when I look at— and again, this is something that we cover ad nauseam in my course— but if we look at their knees, we have a tibial tuberosity and a femur that are both externally rotated. And this is what happens when we get into toe-off. Both our tibia is going to have to externally rotate, which is going to be followed by our femur in order to to push off as we push through the big toe. If I see somebody with knees that present in this way, that's a tell for the fact that their center of gravity is already extremely forward. So if I'm trying to do a squat with them, for example, or if I'm trying to have them deadlift, what I'm really going to do is I'm going to start with their center of gravity pushed forward as opposed to being able to shift back. So this might be somebody that I ask to do a squat and almost comes up onto their toes almost immediately. You can also see from their back here that they're shoved They have an arch in their back and potentially low back pain. And so for somebody like this who may complain about always feeling tight, this might manifest as a knee issue or a low back issue, or maybe they feel it on one side more versus the other. First thing that I want to do with this person, just from a gravity management standpoint, is give them more access to their heel, give them the ability to fully stack and gain a more upright posture. The subsequent effects that is going to have in the rest of the system is going to truly show me what is limited and allow me to make more targeted interventions. But by taking that step alone, restoring the capacity to stack, I'm going to give them more access to the ability to move well, and I'm also going to potentially alleviate pain because I gave them the opposite position. So in terms of interventions for this person, for me as a training strategy, my goal— and again, I'm speaking both a movement and a training context— is to push their center of gravity backwards. If this is an individual who is shoved forward, so I want to give them abs and hamstrings in order to create a posterior pelvic tilt and give them back the ability to flex their spine and get into an an earlier phase of gait. For them as well, I want to concentrate on lighter or gravity-reduced loads. You could also say that somebody that just shoved forward is probably going to be a really good deadlifter, but not as good of a squatter, because deadlifting involves creating a lot of compression and picking heavy things up from the ground. And that's essentially what a person, by shifting forward, is already doing all the time, because they live in this compressed position where their back is constantly arched, their center of gravity is constantly forward. So by using movements that are lighter and gravity reduced, I'm teaching this person to better self-organize and better use their heels, better perform a squat, better perform movements even where we're doing gait drills. And the other thing that I can do with this individual in particular is prioritize aerobic endurance and volume versus load in order to improve the ability to expand. If I improve capillarization, if I improve aerobic endurance, that's going to improve overall systemic recovery. It's going to give the person the ability to relax tissue, to breathe better, and everything But some drills I might give this person would be something like this. If I'm creating just 3 things that I give them to go home with, I might give them something like hook-lying hamstring breathing. In this position, I would have them lie on their back, push their feet into the ground, dig their heels back, and just subtly posteriorly tuck their pelvis. The goal here would be for them to feel hamstrings as well as just a little bit of abs. What I'm looking for is the ability to demonstrate competence in this movement. I don't want them arching their back, and the ability to feel what I want to feel for typically 5 5 to 10 breaths at a time. I'm using a block between their knees. You can barely see that because this person may lack a little bit of hip internal rotation if they're shoved forward. I might have them squeeze a block between their knees because that's going to encourage activation of that musculature. But if we look at another really great drill that I like in order to shift back, we would have a dynamic rock back. So by starting on all fours like this, I cue my client to inhale, to sit their butt back to their heels, and as a result, to get get flexion of the lumbar spine. In this drill, I can have them push their feet into the wall and dig up so they're feeling hamstrings, but our focus here would be just a little bit more of a posterior weight shift. So I'm using my hands again as rudders to teach the client to push back and to inhale. Once the client can kind of gain confidence here, I could even teach them to shift their weight a little bit more to the outside of their hands, which is going to encourage a little bit more external rotation as they rock back and inhale. And so in this position, I would teach them to rock back and inhale to get air in, just as we would as we breathe in. And then just rock forward and exhale. So it's, it's almost as if I'm teaching them to propel into and out of a squat. The progression here would be to teach them to propel in and out of a squat. I could stand them up and I could teach the same thing just based upon their ability to demonstrate competence in this drill. So last but not least, again, one of my favorite warm-ups for my compressed clients is heel elevated squat. Again, the goal here is to put everything together. You can barely see it here, but I have my heels elevated on a bolster. And that's going to bring me into a little bit more plantar flexion. That's going to encourage heel strike. I'm using a TRX here to sort of deload me a little bit. And I'm encouraging the client to just squat down in a stacked position, to inhale as they lower, and to exhale as they stand. And this is a very sensory-heavy movement in that I would be very much coaching them to feel hamstrings as they went through this movement versus quad, because I know that they're able to shift back in that position. But again, once they can do that with the TRX, then I would remove the TRX. And then as we get into the normal workout or the normal stuff that they're doing during the day, I would train them just as I would anyone else. When we talk about a warm-up, or I call it their daily warm-up, it's very sensory and motor heavy. I really want to work on quality there because I feel that it is going to translate to the rest of their day or the rest of their life. And what we frequently do with our clients is we'll send them home with a sequence like this in order to encourage the orthopedic outcome or the gait outcome that we're looking for And then we'll retest some measures when they come back. We'll have them squat. We'll see, does the squat look better? Can this person touch their toes better? Again, those are things that I get into more in my courses. But one of the cool things with breathing drills as well is if you do it right and you do make a change, you're going to be able to see that change immediately. Choosing a KPI of some kind, such as the toe touch, if I can improve posterior expansion of somebody's thorax, they're going to be able to get down much farther in their toe touch. And that shows both me and the clients that they are on the right track.

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.

So with that, thank you so much, guys, for listening to this talk and listening to me utter on about gait for an hour. If you're still following this webinar, I know that you guys are really interested in this stuff, and I appreciate you seeing value in it. This is something that I have seen work, make major, major changes for people that have been really difficult, but also improve the quality of my own life and the quality of lives of the people that I care about. So these concepts are things that, again, I get more into in my courses. But with that, I'd love to open this up to questions. And that's it.

Thank you so much, Chris. Regarding breathing drills and yoga, obviously breathing such as like pranayama and even the bee breathing where there's an audible sound is very popular in Do you have any clients that have incorporated kind of meditation and breathing to help with some of the breathing dysfunction they might have?

Most definitely. I absolutely have. When we talk about breathing, we have the biomechanical aspect of it that I talked about a lot, but we also have the biochemical aspect of it. One of my favorite books is a book called Breathe by James Nestor, and it talks about breathing techniques from pranayama and from Buteyko breathing and other disciplines, and the way that we can manipulate the way that we breathe in order to influence the nervous system. And one of One of the things that I do with all of our breathing drills, especially for my older clients, and I've learned this through messing up actually, is that I will have them do it in a meditative style in which I say, you're going to do this for 3 minutes as opposed to X number of breaths, and I want you to focus only on this muscle. Gives them a target, and I think that it helps somebody who has been in a really probably going throughout their day and a lot of stuff to think about, a clear focus. But meditation is something that I personally do and that I encourage all my clients to do. And really, I encourage them to meditate in position. that allow for these changes that we talk about, such as lying in a Lewitt position with their back on the floor and their feet up on a chair. So I absolutely do, and I think yoga is a wonderful adjunct to this type of training.

Wonderful. Absolutely. Another thing that kind of comes to mind is in our FACTOR trainings, a lot of times we may encourage or talk to practitioners about using some type of external cues. So such as like a metronome or something to that effect when it comes to going through rehab or going through exercises. Have you ever utilized any kind of external cues to help with timing of breathing so that those that have an irregular rhythm start to have a little bit of that brain feedback on getting a regular rhythm, or even the breathing in and then holding, pausing, and then exhaling?

Yeah, that's a great question. And that's one of the things that we want to encourage with clients when we talk about breathing is the ability to demonstrate a full inhale, a full exhale, and a Pause. Oftentimes, one of the things that you're going to see, especially with clients that are sympathetically dominant or what is called hyperinflated, where they have a hard time getting air out, is very shallow breathing, which they have no concept of that. We absolutely do. I have used a metronome, but just manually. Typically, what I will do when I'm when I'm coaching this is that I will encourage a four to five second inhale, a one second pause, and then really the longest exhale that they can take, followed by a one to two second pause. And I want my client to demonstrate that in order to. Demonstrate competence in a movement. And I think another thing that I should mention is really with any movement, if we have somebody that was able to breathe through a movement, like let's say they're doing a squat, for example, and they're able to squat deep, take a deep breath in with that movement, and then stand up, but then I put a weight in their hand and their breathing becomes more shallow, that's an indication that their sympathetic nervous system is becoming more dominant and the capacity for motor learning is going down. So oftentimes what I'll do, I mean, once we kind of encourage the client to breathe themselves and we teach them this cadence that we're looking for, which is typically a 3 to 5 second inhale and a longer exhale, I will just have them do that in dynamic movements such as a supported squat, such as a rock back, such as even things like walking backwards in order to get that same sort of cadence with what they're doing and kind of move more into those dynamic breathing drills I talked about. Does that make sense?

Yes, absolutely. In terms of kind of the current climate, obviously, we are 1 year into COVID now. We're seeing more and more that not only are people suffering from having difficulty breathing while they're sick, but then we're seeing long-term effects in breathing or long-term effects in capacity for activity and being able to breathe well. Have you seen any of that in your practice with your clients? And how are you addressing kind of this new normal in terms of what we might be seeing from a breathing standpoint?

Yeah, that's a great question. And like, I've been on the breathing train for a long time because I think that it's sort of the beginning of all movement. But what I've seen in my work is that clients that I've trained for years as well as new clients will come in and say, I think there's a problem with my breathing. I think that overall what it's doing is bringing awareness to this, bringing awareness that breathing might be a more important part of the equation than people think. And as far as what we're doing, I mean, what's really interesting and something that everybody can incorporate with their clients is that one of the things that we do with all of our clients is something called a BOLT test. And that's a blood oxygen level test, and it's a breath hold. And so all it is is I take a deep breath I exhale, and then I plug my nose, and I start to inhale when I feel the need to breathe in. I don't hold my breath as long as I can, but what that indicates is the body's ability to tolerate CO2, but also the body's ability to utilize the oxygen in our blood. That's a great indication overall of how healthy somebody's breathing is. And that's something that we kind of use as a marker for health in that sense. And so, what we've been doing as far as training goes is kind of using that as a KPI for our clients. And then encouraging our clients to nasal breathe with their tongue at the roof of their mouth. Mouth breathing is something that I believe has caused a lot of this breathing dysfunction that we talk about, and that could be due to a number of factors. But one of the things that I love for all of my clients is just having them go out for a walk while breathing through their nose and trying to keep their tongue at the roof of their mouth. And the way that they know if they've gone anaerobic or fight or flight is when they need to take a breath in through their mouth. It's a great regulatory mechanism for athletes, but it's also a really cool thing clients can do just to go and feel better.

Yeah.

I encourage anybody to go out and try this. I mean, literally just go out for a walk or walk around during the day and just put the tongue at the roof of your mouth and just breathe through your nose as much as you can. That alone will restore a great amount of capacity. And then once their BOLT score has improved to some degree, and typically I'm looking for about a 40 BOLT score, once they've gone above maybe 15, then I can start to incorporate some more aerobically based methods like nasal breathing during exercise because we're generating more carbon, so it's going to be harder. I can even do things like limited Breath holds, which are techniques that divers use in order to increase their breathing capacity. So there's a lot of that, but the number one thing that I do with all my clients is that I encourage them to read the book Breathe by James Nestor because it is such an eye-opening window into the things that breathing does for better and worse.

Absolutely. In terms of the different athletes that you work with, do you find that or have you seen trends amongst certain types of athletes? Do your swimmers tend to have a much more well-versed mechanism for breathing well as opposed to maybe some of your power athletes or even different bodybuilders and things of that nature?

Yeah, that's a great question. And again, it's specific adaption to imposed demand. I think that typically the breathing strategy is going to mimic the way that they train or the way that they perform. I do work with some bodybuilders, but trying to think of the most anaerobic athlete that I work with some strongman competitors that everything that they do is completely alactic and anaerobic. There's very little aerobic component to that. They are very, very compressed all the time because they never do anything to encourage expansion. They are probably the worst that I've seen just because they're always just lifting heavy stuff and just squeezing the crap out of their tissues. They have a hard time breathing. Typically, they occlude faster. So anything that they do, they want to go to level 10 and Whereas with like my soccer players, for example, because I work with a lot of them, soccer is a more aerobic sport. Soccer is probably 10% sprinting and everything else is basically aerobic recovery. They're better breathers as a result. They have much more aerobic endurance. They move a little bit better. They change a little bit better as well. So even if they are compressed, doing this stuff yields a much faster change. And swimmers are some of the best and the worst that I've seen. There's a lot more that goes into it than sport as well though. It's also mindset. Type A's are oftentimes very compressed. People that tend to be in extremely stressful situations in which they might be in a bad life situation, they also tend to be extremely compressed just because both of those things are going to impose more overall stress on the body and just create stiffness as a protective mechanism. But I would say my more aerobic athletes and my more aerobically fit people are those that breathe better. My more alactic anaerobic athletes like my strongman competitors or just your typical person that is obese that sits on a couch and because they have to manage so much weight, everything is anaerobic, are going to be far worse. Does that make sense?

Absolutely. In terms of the clients that you've worked with and after you've been doing some breathwork with them, their breathing improves, have you tracked any of the metrics in terms of how their sleep improves? I know there's a lot of correlations between the two.

Yes, absolutely. So we have certain health KPIs that we use, like in my, I guess in our practice, that we want clients to Okay. And sleep is one of them. For us, tracking sleep has been problematic in that you could use monitoring systems like the Whoop or iWatch that's kind of tracking movements, but we just use questionnaires as far as the overall quality of sleep. But what we will do is every 4 weeks, if I'm working with somebody over a long period of time, I'm going to ask them about their sleep. I'm going to ask them about their overall level of activity. But when we talk about more acute KPIs, what we typically do is we're going to use things like the BOLT score, which is a breath-hold test that tells me about sort of the client's ability to utilize oxygen. I'm also going to use certain measures like a toe touch and a squat for my healthy clients. So if a client can touch their toes, if a client can demonstrate a full squat, chances are they have a lot of variability in their movement. For my clients that have greater trouble moving, I might use something like supine hip flexion because that's like a squat, that basically the same information, or supine straight leg raise. But in overall terms, yes, we definitely track sleep. We make our clients aware of those things, and we have that as kind of a pillar of things that they should see as far as improvement goes.

I think that's wonderful, and that's huge in kind of addressing the whole client and the whole patient. Someone was asking here if you have utilized the RPG method, and that is part of the Global Postural Reeducation by Sauchard.

I have not.

Another question here was in regards to what you were You were saying about soccer players and how they oftentimes are very adaptable and they have some of the better breathing mechanics that you've seen. Is that also applicable to mountain bikers? Have you seen cyclists falling into that same category?

Honestly, cyclists are tough because you have to think about— when we talk about the ability to shape-change somebody and the ability to modify somebody's position or to improve the way that they breathe, really what I've found is one of the determining factors is their access to variability. And the things that they do. So the game of soccer, I mean, you're moving laterally, you're moving forward, you're moving back. There's just a ton of variability in soccer. And so they're dosed with that all the time. Whereas with cyclists, they spend a lot of time in one position. Yes, they are moving. Yes, they are moving in different directions. And certainly mountain biking in particular is going to be less so than road cycling, but they are always fixed to a bike. And as a result, they're always fixed into a certain position. So yes, I think that they are— I would say that if I were to compare Comparing the two, the soccer player would be a little bit easier to change just because the soccer player is moving around more. The soccer player is not stuck in a position quite as much. And so one of the go-to strategies for anybody that I'm working with, I'm just working with the general population clients, is to encourage them to go out and find some activity that they enjoy that involves a lot of different movement because we're going to dose their body with a lot of things that it currently lacks, whereas repetitive postures are the opposite of that. So I just think of it in those terms. And I haven't worked with a ton of mountain bikers. I have worked with road cyclists. And with them, a lot of the things that we're going to be dealing with, exaggerated thoracic kyphosis because they are over a bike a lot. And to some degree, they're going to also be in hip flexion a lot. So countering those things by teaching them to utilize their hamstrings and to up-pump handle the sternum are 2 KPIs for that particular athlete, I would say.

Thank you so much, Chris. This is incredibly informative. And it's certainly something that I know is a huge topic that a lot of healthcare practitioners and fitness practitioners as well are really putting some attention to these days for sure. So, and again, Chris, thank you so much for your presentation today.

Thanks so much, everyone.

That's it for today's episode. Be sure to tune in for episode 24 where we launch a new training with Dr. Ross Keys titled Shoulder Injuries and the Throwing Athlete. In this 2-part training, we will dive into the sport-specific demands of throwing athletes, including specific focuses on baseball, football, boxing, MMA, volleyball, and tennis. You won't want to miss it. Episode 24 drops in 2 weeks, or 1 week for our Patreon subscribers. In the near future, we are also planning a few special Q&A episodes with our past instructors. So please be sure to click on the Q&A link in our show notes and ask any burning questions you may have. 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 helps. 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 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.

Thanks, Jessica.

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