#4 - Integrating Fitness into Clinical Practice with Dr. Tom Teter, Part 2

Hi guys, really quickly before we get started with today's episode, we are excited to announce that finally, we have resumed live in-person courses in limited dates and locations. So in 2021, we are hosting 12 Factor Rehab System in-person courses in cities throughout the US. And we really hope to resume international course dates by the end of this year and starting into 2021. Also, the Rehab to Fitness course and the Factor Peripheral Nerve Entrapment courses are each being offered in a fully virtual format online, but we are excited to announce that we are planning for a few select in-person course dates later on in the year. So for more details, keep an eye on our event calendar at factor-store.com, or you can always check out the event calendar link in the show notes. 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 digest, with actionable information that you can implement into practice Right away. Let's get started. Hi guys, I am super excited to dive into today's training, and I know that you guys are too. So if this is your first time tuning in, welcome to the show. Here is a quick rundown of our format. So each podcast episode is comprised of the audio content taken from one of our live free webinars. Now, If you're confused about what I'm referring to when I talk about the free webinars, go back and listen to our preview episode where I gave some backstory behind our free webinar series, which actually gave birth to the Factor Podcast. So essentially each training is split into 2 podcast episodes. You'll often see either a part 1 or a part 2 in the episode title. At the end of each training or at the conclusion of the part 2 of that episode, you'll hear questions asked of our presenter by our live webinar And while you may have missed your chance to ask your questions during the live broadcast, we do always have a Q&A link in the show notes of each episode so that you can submit your questions for our presenter. These will be answered in a future special Q&A episode, so definitely stay tuned for more details on those episodes as they're released. Now, as you may have guessed, much like your favorite cliffhanger soap operas, it's best to listen to the trainings in order. Meaning you listen to part 1 before part 2, for example. Otherwise, you may pick up in the middle of a training and feel a bit lost. So I definitely recommend going back and listening to part 1 before part 2. Since today's episode is part 2 of our training on implementing fitness into clinical practice, I highly suggest that you hit the pause button on this episode and go back and listen to episode 3, which was part 1 of this training, first. If you haven't done so. Now, in our episode 3, or part 1, Dr. Teeter laid the foundation for implementing fitness as an important component of patient care. We discussed the differences and similarities between rehab and fitness, touched on the reasons why rehab programs fail, and the 6 stages of care. In today's episode, Dr. Teeter will be talking more about exercise selection and load progression, how to manage pain during exercise, the ABCs of motor pattern programming, and how to utilize fitness as maintenance care. Today's episode is full of great content. So without further ado, let's get started.

One of the other questions that I always get from students is, okay, that makes sense, but how do you actually apply this in a day-to-day setting with your practice or with patients or clients that come into your office. So we've come up with this algorithm to really describe the exact process which we use in order to work fitness into our puzzle. So if you look at the top, it says client. The very first thing I ask a client is, why are you here? And they'll either say, I want to run a marathon, which is task-specific, or my knee hurts and I want to play basketball and I So it has the first question that we relate to is, does this person have pain? Now the answer is either yes or no. It's not kind of, it's I have pain or I don't. If they do have pain, then you can see we take them to the right of this algorithm. And the first thing we do is start our examination process. So we're going to take a subjective health history where we ask them for activity intolerances, what are your goals, all the standard things that you are learning in chiropractic school. Now remember, with our history, the number one thing— it's not the most important, but for the purposes of integrating fitness, we have to know what is your activity intolerance. What do you want to be able to do but you can't because you're having pain? Then we progress forward into looking at our evaluation. So we're going to do orthopedic and neurological evaluations looking for mechanical sensitivities. We need some marker for structure to determine, hey, this is the structure that's painful and hurts. Now from that information, then we can look for red flags. These are looking for contraindications to care. If we If we have any specific red flags, then we keep going to the right of the diagram and we're going to potentially do special testing. Now, this could be anything from an MRI, an X-ray, CT scan, blood chemistry, whatever that specific contextual situation requires. And then once we get that information, if the findings are abnormal and it's outside our scope or something we think needs additional referral, obviously we have a team of people that we can refer to the medical providers for care. But if we don't see any red flags or they have normal findings on special testing, then obviously we're going to integrate— if you look at the middle column, we're going to determine that it's probably a functional problem, and we're going to do some form of assessment to determine dysfunction. What I typically do is look for painless dysfunction and then try to find some therapeutic intervention I can do to improve mobility and improve motor control. After that, we want to have some type of test to determine that function's been restored. So what we typically do is something like the Y-Balance test. And we're going to see if you have a standardized baseline of movement compared to yourself, which is a quantitative look at movement and how you compare against others that's your same age, height, and weight. If movement has been restored, so we reduce pain, pain's gone, and movement function is normal, then we come over to the left top part of the diagram and we're going to do a qualitative assessment of movement in the form of Functional Movement Screen. All that tells us is What patterns we can load through fitness. And then as long as we have green lights, now we're going to start to progressively add loads. So what we do is we will go through all of those progressions. We'll do pattern-assisted unloaded, then we'll go unloaded, then we'll go pattern-assisted loaded, then we'll go resisted, and then we'll go advanced loading. So then you can see how all of this kind of fits together in the realm of a clinical application. Now we also have people in our office that come in that don't have pain, and there's like, Yeah, I'm— I wanna run a marathon and I wanna become more fit, or I want to make sure I don't get hurt while preparing for this sport task. And then those people, we always shift to the left. We start with our movement screen and we start taking information and going down all of the things relative for loading through fitness. So the challenge for most clinicians is looking at how do we incorporate fitness into this broader model? And we've seemed to have done it relatively effectively using this algorithm. But more importantly, I think the most valuable thing to understand is that people typically get hurt from— the majority of injuries you're going to see are non-traumatic, and most non-traumatic injuries are either being underprepared. Now, that could be just unfit, poor lifestyle choices, abnormal postural patterns, whatever that may be. You're underprepared to tolerate load and you're overstimulated. And if we can use fitness as a vehicle to make them more tolerable to stress by increasing tissue resiliency, We're going to see these long-term adaptive changes that allow us to decrease the risk of injury, ultimately to improve their health and longevity. So fitness can be such a huge piece of your puzzle, and I would highly suggest that you consider utilizing it in a way where we can use advanced loading progressions to get people back to normal function.

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So at this point, I would like to possibly answer any questions that you may have relative to fitness. Jessica?

You have a patient that you've progressed through their rehab, and you've brought them to where they've been discharged from rehab. How do you then transition them into a fitness program?

That's a great question. So I'm going to answer this in a roundabout way. So in my practice, The idea of maintenance care doesn't exist. What I mean is maintenance care for us is fitness. Now I'll use an example. I have a patient named Aaron. I have worked with Aaron for 14 years. Aaron originally came to me with acute onset low back pain. And so we put out the fire, we got the joints and tissues moving, and we restored motor control. As part of that, we needed to increase his tolerance to stress. So we started going through progressions of loading for rehabilitation. And as we were Towards the end of care, I said, we really need to continue loading these patterns to continue to get adaptation so that you ultimately don't get hurt again. You told me that you want to become more fit for cycling, and the best way we can do that is through progressive loading. So since that point, Aaron has worked with me. I teach an adult fitness class twice a week as part of my practice, and Aaron has trained with me twice a week for the last 14 years. And for 14 years, I'm gonna knock on wood, I have never seen him back in my clinical practice because he's maintained normal function and And he has increased resiliency to stress. So the end goal for every patient that walks into my office— and if you look at the diagram on the screen, you can see that I want everyone to live on the left side of the page. Fitness is relatively easier. It's easier to load people and try to keep them healthy than it is to fix things once they're broke. And so I would much rather use fitness as my version of maintenance care. Now, I'm not going to say that there haven't been patients over the years that maybe haven't had a relapse or Another type of injury that we've had to deal with. But historically, I want every single patient in my office that I have patient contact with to progress to fitness. I would say my experience is probably different than most because my office is in a fitness setting. And so I would say about 65 to 70% of my patients in some way transition to fitness. And the other ones that don't are just looking for that short-term reduction of pain. That's okay. But really what we're trying to promote is improvements in health and longevity. And so we We use progressive loading through rehabilitation as a way to get them to fitness, and that is our long-term form of maintenance care.

Thank you so much for that. What advice would you give to a practitioner that has a patient that maybe has never been involved in fitness before? They're very hesitant or resistant to working out, maybe because they have pain or have had injury in the past. What advice would you give to a practitioner in dealing with that type of circumstance?

I think it's all in how you frame the conversation. And a lot of people who are underprepared or unfit are for some reason fearful. Either they've had a bad experience with fitness. And let me give you an example. A lot of the fitness industry, they're not very good. Some are, some are fantastic. But historically, when we looked at fitness, most people either think back to high school gym class from a psychological perspective of we're going to run across the basketball court until you can't do it anymore. Or they've been to fitness settings where people haven't used a progressive system of loading. And so they've done way too much. They either get sore, they get injured, or it's not fun. And so they have this abnormal experience with movement. And so what we try to do is use the time we spend with low threshold stimuli, meaning if I have someone in a sideline position and I have them doing isometric contractions, that's fitness. It's just a low threshold form of fitness. And when you start to frame the conversation with the patients around load, it's like, hey, we're going to use This really low threshold stimuli to get this tissue to do what I want it to. So then we can get you back into normal movement patterns that you're going to do in everyday life. And that's where the activity intolerance is so important, because if you can relate the things you're doing with rehab back to that activity that they can't do, it's like, hey, remember last week that you couldn't play basketball or jump because your knee hurt? But now we're doing this bodyweight movement pattern and it's not hurting you. They're starting to see progress. And so they're more apt to buy into continuing forward. And the other thing that I always suggest to people too is My goal is to make sure you don't get hurt again. The only way I know how to do that is to make your tissues more resilient to stress, and so we can slowly and systematically start to increase your threshold to load in order to make that terminal task of sport or activity more tolerable and make sure you don't get hurt in the future. So I think a lot of it's just how you frame the conversation. My experience has always been that most clinicians and most fitness professionals always jump to the hardest progression. If we go back to our squat example, Let's just use an example of a goblet squat. That may be where a lot of clinicians start rehab for the squat. That's the 4th progression of load. So what I find, as long as you systematically find what their threshold is and do just 10% more, and you slowly and progressively increase that over time, because if they're having a positive experience with movement, they're not having pain and they're seeing improvements in function, it's not always that hard to get them to continue forward. I'm not going to lie and say that a lot of people won't not do fitness. Some people just don't want to do it. But I say in my experience, the largest majority of people will continue forward as long as you contextually frame the conversation appropriately.

Wonderful. Would you use exercise to help with scoliosis? And if so, what type of exercise?

It's a loaded question, so I'm going to answer it as carefully as I can. I would use exercise for anything as long as it's not contraindicated. And then what type depends on the context of the— I can't answer that specifically because it's context-specific to each person. What I would do is find exercises that don't hurt and that we can progressively load systematically over time. I don't know from my experience what I know about the treatment of scoliosis. If you're looking for specific rehab exercises, it's contextual to each individual person. But as far as just general loading, find exercises that don't hurt and that they can maintain integrity, and then you can systematically increase loading over time. I'll use exercise for anything because ultimately what has the greatest effect on movement retention competency and long-term viability to health is exercise. Exercise is the best form of medicine. And so as long as we can find exercises that don't hurt, that they maintain integrity, and that we can progressively load, I'll use exercise for almost anything.

Wonderful. Do you typically teach the patient the exercises? And this sounds like it could be for rehab or for fitness, and they do it by themselves? Or is there a professional with the patient All the time that they're doing the extra— like, while they're doing the exercise, do you have a professional with them while they're going through those exercises?

So I'm going to answer this a couple different ways— how we do it now and how we plan on doing it in the future. Right now, I'm a solo practitioner. I like to spend a lot of time with my people because I ultimately— I want to be the one that's responsible for their results. I can't see as many people doing it that way, but my outcomes are a lot better. So right now, I demonstrate it to them, I watch them do it, we're doing it together, make sure it doesn't hurt and that they're maintaining integrity. Now, I will use Use that time that we're doing those things together to teach them how to do it for themselves. Usually what I'll do is I'll take their cell phone and take a video of them doing the exercise and me narrating the key points I want them to focus on. And then I'll send that home with them as homework. And then when they come back, we'll check and make sure they're doing it right. And we'll progress forward if that's appropriate. So right now I do it all myself. My intern and I have actually been working on a system where you can have other staff do it. And we've got it narrowed down really effectively where in an interaction, With a patient that typically would take 30 minutes that I do for myself right now, I as the clinician can do 10 minutes of work. And if you had someone who's either a chiropractic assistant that's trained in exercise, or typically what we're suggesting is an athletic trainer that you can use for that purpose, then the clinician can do the 10 minutes of intervention that involves manual therapy, either joint manipulation, tissue regulation, some type of soft tissue work, and then they can turn the motor control and exercise piece over to the athletic trainer if they're trained appropriately. And we've been experimenting with this Currently, and we've got it to where 10 minutes is done by the doctor and 20 minutes is done by the athletic trainer or the assistant. And that allows the clinician to actually see more people per hour. We've got it worked out now to where if one clinician had 2 assistants, they could see up to 4 people an hour and still apply fitness in this broader spectrum of care to every person that walks in the door. So it's kind of a loaded question because right now I do it all myself and I enjoy that. Ultimately, from a business perspective, you can actually increase your productivity and still apply a really solid business model if you have assistants that are appropriately trained in this loading progression.

Thank you. Do you have any specific page, book, or an exercise guide where you find the exercises for the patients? Do you recommend a specific book or guide so that the patients can see the exercises being done correctly? This may be a great kind of segue into chatting a bit about the Rehab to Fitness course and maybe what you offer there.

Yeah. So yes, the challenge is, this is one of the challenges that drove me to try to start teaching this course that we teach with Rehab to Fitness is there's a ton of really, really great information available. But the problem is there's not just one resource for, say, a book to go to for exercises. I think across the rehab and fitness industry, there's a lot of really great courses that teach certain aspects of each individual piece of this puzzle. One of the courses I like a lot, and I'm speaking outside of the Rehab to Fitness course, is the Certified Functional Strength Coach. I think it's a great course for strength coaches to just learn the basic ideas of load progression, but we took that information and applied that directly to rehabilitation and clinical practice. So we developed the Rehab to Fitness course to teach clinicians, particularly chiropractors, physical therapists, and athletic trainers, How to utilize load progressions from the table all the way to things that you're going to be doing in advanced loading to get people back to sport. We're working on having an exercise library of all the things that— all of the progressions and regressions that we would teach. And that's something now that we're going to be including with our course. We're working right now diligently to get it online within the next couple weeks so that someone could take this entire Rehab to Fitness course from the table to advanced loading, all online via computer. So I really like the Certified Functional Strength Coach. Mike Boyle, who's in charge of that course, has a book that's relatively good. It's called Advances in Functional Training. I think it's a great book. It's a great baseline starting point for people to learn progressions and regressions. And then just with rehab, there's such a ton of really great rehab courses. Not to shamelessly plug, but I actually got a lot out of the Factor course when I took it a couple years ago. There's a lot of other really good information. through things like dynamic neuromuscular stabilization. And one of the things that we do heavily in our fitness classes is functional range conditioning just to improve self-joint mobilization. So there's a lot of great information out there. The challenge is learning how to take all that information and apply it into one systematic model. And that's what we try to teach in our Rehab to Fitness course.

Wonderful. Thank you. In regards to the patients you have that might be powerlifters, bodybuilders, people that are very, very adept at fitness and usually push themselves to the max. How do you have those regression conversations with them when they're in a post-rehab state? How do you convince those people that are used to going really, really hard to kind of back it down a bit for the purposes of getting back to where they once were?

That's a really great question, and I'm not gonna lie and say that's easy, because one of the problems with really high-level athletes is they're used to all go all the time, and that's usually what got them hurt. And so there's 2 ways I approach this. Number one, the first thing we'll talk about is integrity. You've lost integrity of joint position, and then you overloaded those tissues, and that's probably why you became hurt. Because remember, most of the things you're going to see are non-contact. So for non-traumatic musculoskeletal things, they've lost integrity, they've lost resilience to stress, they've overstimulated. So I had a powerlifter that I worked with for a long time who could squat 880 pounds or Something like that, or something crazy. And he was having just massive amounts of low back pain. Well, it was because when he was squatting, he was dumping himself into lumbar extension, compressing the facet joints and causing pain. That is a loss of integrity. He was hyperlordotic during loading. Obviously, that's not going to end well. So when I would take him back to the baseline progression, we went through all of our standard stabilization exercises for the spine. And as we started loading him, I would put him in a pattern-assisted squat, and he actually started laughing at me. He was like, Like, this is stupid. I can squat 800 pounds. Why am I doing this with a TRX strap? And I was like, I'll tell you what, I'll let you get under the bar, but you have to demonstrate with 10 perfect reps that you can maintain this neutral position I'm putting you in, and then I'll let you go under the bar. But we're not going under the bar until that happens. And he was actually— when I put him in spine neutral, stack the joints, and had work on breathing, he was literally sweating. And I was like, see, this is your problem, is that you're going into these high threshold strategies with compensation. Compensation in your sport under high amounts of load equals structural joint damage and pain. So we need to progress backwards and maintain this neutral position because ultimately that's going to allow you to be more compressive to load. And secondly, that's going to allow you to stabilize better, which ultimately will allow you to lift more weights. Now, this person's a very good friend of mine, so it's a great example of powerlifting. Good friend of mine from college, and we spent about a month and a half working on load progressions and got him to where where he could stabilize under the bar. And ultimately, he went from about 870, 880 pounds to over 900 pounds of squatting because we went back and retrained him to maintain integrity. It's not easy to get people to slow down and focus on maintaining proper integrity. That's usually why they get hurt in the first place. But if you can show them, like, this is what neutral is, and then you need to be able to maintain this before you can do that without pain— and if they've had a substantial amount of pain They know what that feels like, and they don't want it to happen again. So at that point, not as hard to get them to buy into this whole load progression through rehab.

Do you use any technique for post-traumatic stress injury for the mind? And if you do, what results have you seen? I'm thinking that may have to— maybe they're specifically asking about post-traumatic stress from an injury of some sort, kind of that pain avoidance.

Yeah, so I'm gonna be honest with this one. I don't have a ton of people like that. I have had some people who've had PTSD for other reasons. And what I try to do is obviously just be empathetic and compassionate about it. But also, I'm very one that believes for myself and the way I practice that I have a very small scope of practice. I treat neuromusculoskeletal injuries, and I have formed an integrated team of support of other medical providers that co-manage conditions with me. So if I have someone that's suffering from PTSD for whatever reason, obviously I start with being compassionate and empathetic, and we want to give them a positive experience with movement. But then I'll also co-manage that condition with a psychologist or a psychiatrist that I have on my team, and I want to make sure they're getting all the care necessary to make sure that the things we're going to be doing from a musculoskeletal perspective are going to be effective.

Do you use specific soft tissue techniques, kinesio tape, or others similar to that with your rehab?

Yes. I remember someone said this to me a while back, like, if you can walk into someone's office and tell if they're a physical therapist, a chiropractor, or a strength coach They're doing it wrong. So what I've tried to do in my practice is obviously through chiropractic school, you get taught manipulation and you should be at least adept at that at some point when you graduate. But from a soft tissue perspective, I do instrumentation. So I do instrument-assisted soft tissue mobilization. I can be honest that I've taken probably almost every course that I think that's out there on the subject matter. I am very partial to FACTOR because I think it is probably the most comprehensive system that I've seen for teaching instrumentation and the appropriate way to apply that intervention. I really actually like doing a lot of manual therapy with my hands. I think some of the work being done by Stecco in Italy— their course is fantastic. And even if you can't take the course, I would highly recommend just purchasing their textbook. I think you can learn 70% of the information just by reading the book, and it's going to give you a distinct advantage on how you apply your hands to soft tissue therapy. There's lots of different therapies from a soft tissue perspective. There's things like Graston and different instrument courses. There's Active Release. I think just find something you can do with instruments and find something you can do with your hands. I'm not— outside of FACTOR and Stecco, I'm not going to necessarily promote any of the other courses. I don't think they're good or bad. I just don't have a lot of experience with specifics of those. As far as motor control, I'll tell you a couple of things that I find keep it simple. I like using isometrics as a low threshold stimuli for improving motor control. And then I've had some really good success with things like the dynamic neuromuscular stabilization or forms of DNS. And then just using logic, like find the easiest thing they do well and progress them under load. I'll be honest with you, there's an enormous amount of continuing education on the market. A lot of it's really good, Some of it's not so good. But I think as far as being a really good chiropractor, be good at joint manipulation, have something you can do for soft tissue, have a little bit you can do with rehab, and then learn how to progress them through load with fitness. If you can do that, you can probably handle 90% of the people that walk into your office. Now, there's obviously other things you can do. I have found and had pretty good luck with using some McKenzie methods for acute conditions, and then also some nerve mobilizations with neurodynamics. Those are fantastic courses for acute conditions. So like I said, there's a lot of stuff out there. It's really just choosing where you feel like you need the most work and finding a course that gives you that valuable information.

The specific name of Stecco's book, I looked it up, I believe it's the Fascial Manipulation Stecco Method.

I think, I think it is fascial manipulation. In my head right now, I can see it. There's a person on the COVID Looks like they're running, but it's like a muscle person on the COVID It's a blue book, I believe. It's a fantastic book. It's heavy. It's a read. But I really like about their method of manual therapy for soft tissue is it very much jives with the things that Factor is teaching with instrumentation. And at the end of the day, I've tried to put myself in a position where if I'm someplace and I don't have tools, I have my hands. I can probably make it more effective if I had tools, but it's not necessary. It's something that you can apply. And frankly, there are certain regions of the body where I much prefer using my hands than I do the instruments. But I think that's what makes people good clinicians is knowing when to apply what intervention with whom and why.

Also have— it looks like an ebook PDF that you can purchase, Functional Atlas of the Human—

That's a fantastic book also. That's a great book. And if anybody has any particular questions, I will answer every question that you send me. You can reach me personally on Facebook at Tom Teeter, or you can reach me on the Rehab to Fitness page as well. And then on Instagram, it's tom.teeter. So feel free to reach out to me with any questions. I will respond as quickly as I can, and hopefully you found this to be valuable information.

I have one more question about adaptive movement behaviors due to recurrent ankle sprains and fear of reinjury.

Trying to understand the question.

So How do you deal with those adaptive movement behaviors? If they've had ankle sprains, they're afraid of reinjury, how do you get them moving again without that fear?

If I understand your question right, anytime someone's had an extreme injury, there's going to be fear avoidance. And so what I always try to do is give them a positive experience with movement and then slowly progress. So for instance, we'll go back to my basketball player analogy because this fits perfectly. I have a basketball player, it's a friend of mine that I've been working with He has had numerous ankle sprains and injury to his left ankle. And because of that, he plays still at a high level, but he has movement compensation. I think that's what you're suggesting by adaptive movement behaviors. He's compensating, and that's just become his normal movement, and it's just normal for him to hurt. And so we did some really passive things on the table like joint manipulation, and we wanted to get a positive input. So after adjusting his ankle, I put him in a half kneeling position and start doing some guided mobilizations. I was like, hey man, see how this doesn't hurt? He's like, yeah, that feels better. So we got that accomplished a couple times, giving him a positive experience with pain-free movement. And then we started putting him under load. So we would start— again, I'm going back to the same analogy— we put him in the assisted TRX with his body weight so that the straps could take away 20%. So we manipulate him, immediately put him into half kneeling to mobilize, To reset and reinforce joint motion. And then we put him in the TRX and slowly and progressively over time, we got him to be more comfortable with movement to where he was back to jumping. That being said, I think a lot of it too is how you frame it. You have to tell people to— just because something hurts doesn't mean that there's harm or doesn't mean that there's damage. Pain lives in the brain. And so we have to also use that biopsychosocial model and say, look, there is biology to what you're dealing with, but the psychology is you're avoiding this movement because it hurts. And really, this pain is something that lives within your brain. And if we can give you a positive experience with movement, you're going to be less fearful of doing that activity. And ultimately, going back to the idea of fitness, is as they get these positive experiences and these little tiny wins with movement, it's like, see, that didn't hurt. That wasn't so bad. Then they can be more comfortable with doing higher threshold activities. I have a great example. 65-year-old woman that I work with. She's had some ongoing arthritic problems with her knees. And because of that, her doctor told her to never ever squat Or bend down to pick something up. So she had avoided squatting forever. And I finally had to explain to her, I was like, look, you squat every day when you sit on the toilet. Squatting is not something you need to avoid. There may be ways to squat that we may need to change, or there may be movement function we need to restore to get you to squat well. And we got her from the point to where she was so fearful of squatting that she wouldn't do anything, to now she's training twice a week. We're loading specific variations of a squat. And I think now we're at the point where she's doing goblet squats with reduced range of motion with pain. And she's like, wow, I can really do this. I don't know why I was so fearful of this. So it's really sometimes contextually how you frame the conversation. But ultimately, we want to give people positive experience with movement so that we can progressively load.

Would you use K-tape to reeducate the way they walk to change that? Or would you use some type of tape?

It's a loaded question. I'll be honest, I am not an extensive taper. But I do believe that there is some purpose of using tape to create a positive afferent input to the brain that allows for more efficient movement. Dr. Riddle, who teaches the Factor course, teaches a dynamic taping course that I've used a couple variations of that and had enormous success with. I do think there's value in it. It's just something I need to practice more and get more comfortable with to really feel like I'm making it effective. But I think ultimately, end of the day, if we look at this continuum of care, we need to do something to reset normal afferent input to the brain. We could use tape to help reinforce that through continual stimuli from a low threshold perspective to continue getting that afferent stimulus. And then ultimately, we want to reload the pattern under gravity with load progression. So tape can be a great way to bridge some of the passive things that we're doing to reset neurological input to maintaining stability while we're loading the pattern. So I think it's an effective way to do it, and I think there's a lot of great courses. I like how I've had a lot of luck with what I've learned with the variations of dynamic taping, and I— but there's lots of other methods of taping. I just think that's my preferred method.

Wonderful. Well, thank you so much, Dr. Teeter. We appreciate your presentation. Thank you so much, all of you that tuned in to join us today, and feel free to reach out to us with any questions. Thanks so much, everyone. Have a great day. That's it for today's episode. If you have a burning question that wasn't asked by our live audience, please click on the Q&A link in our show notes to submit your questions for Dr. Teeter. We'll be sure to cover those in one of our future Q&A episodes. Be sure to tune in for episodes 5 and 6, where we will be featuring another training with Dr. Melissa McDonald on 5 considerations to promote performance in the female athlete. Whether you're a healthcare practitioner that treats an athletic population A coach or a fitness trainer, this 2-part training will offer guidance, insight, and research into the 5 key areas where your treatments and training programs for female athletes may differ from those of their male counterparts. Topics discussed include nutrition, weight training, and injury patterns, along with monthly hormonal shifts that affect athletic performance, injury susceptibility, and endurance. You won't want to miss it. Episode 5 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. Give us a 5-star rating to help us grow the show. Every little bit helps. Be sure to also look for our Patreon link in the show notes to access additional bonus content, early release episodes, and an ad-free listening experience. We're constantly adding more benefits for our patrons. So get in early for maximum value. Also, remember to visit the show notes for a link to download the PDF of today's full presentation. We'll see you guys next time. Hey guys, if you like what you heard today, I encourage you to visit our website at faktor-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.