Chest Training After surgery with Dr. Shannon Ritchey

Welcome to the show, everybody. Today I have Dr. Shannon Ritchie, who I met at a dinner recently, and she is a doctor of physical therapy and founder of Evlo Fitness. Her method, Gentle Consistency, focuses on building muscle without breaking down the body or causing chronic inflammation. And it was from our dinner discussion that I wanted to have her on the show because we have so many questions about how to exercise after surgery. And we talked a little bit. I'm a big protein kind of person, both before and after surgery. And so we talked about those things at dinner, but having her on the show to explain all the different things that she has in her practice and what she can offer is what intrigued me.

I'm happy to be here. Thanks for inviting me.

Yes. The, the whole thing about exercise after surgery, like, I don't know how much you run into this. Certainly for me because I do a lot of chest wall surgery and I have to repair the pec major all the time. So everybody listening, I try to, I try to say it this way, right? So we have the World Cup coming. For those who don't know, largest, most important soccer tournament in the world is being held in the United States this summer. And anybody who tears their hamstring around the time of this recording is not going to be in the World Cup. Because it's going to be a 2 to 3 month recovery depending on the severity of the tear.

Yeah, that's a good point. I mean, yeah.

So when I operate on people, I try to tell them like, yeah, you're not going to go in the World Cup, you're not going to be in the NFL, you're not going to be on the tennis tour or the golf tour. You just have to recover and then go back to whatever activity you have to do that Dr. Richie will let you do in the due course. But so they, they constantly pressure me to tell them like, when are they going to be able to do X, whatever X is. And if they say CrossFit, I'm like, never, because I find it to be a stupid type of activity that tears your shoulders up and your chest wall and everything else. So I just tell them like, that's not a good idea.

Yeah, why? I'm so interested to hear why you— because as a physical therapist, I treated CrossFit patients all the time, but I'm curious on your thoughts.

I think it's a terrible thing, uh, to me personally. Like, I see all that jerky stuff they do and I'm like, That's just— I'm old now, and I don't, I don't think any of that looks good to do. And I just want people to be able to do like, uh, resistance training with weights and walking. And if they want to do Pilates or yoga, all that sounds great over time when it's healed. But I, I operate on folks, and their pec has been in an abnormal position for a long period of time, so they're Their origin's intact from the shoulder, but their insertions are all FUBAR.

Really?

So it depends on who did the initial surgery. So for everybody listening or watching, we'll do the, my hand's a big fan from my shoulder down to the bottom of my pec. And so when they release the pec, it window shades up, and then they put a device in. And so it lives there like that for much time as they have the device until someone like me or another person takes it out and then you got to figure out how to get that back down. Now, depending on the size of the device, the atrophy of the muscle, where they disinserted it depends on where you can get it back.

Do they not reinsert it at the bottom of the sternum when they do the surgical repair, or—

Depends on the size of the implant. Oh, so you have a tiny frame person and bigger implant. They're releasing it more and more and more, and they really shouldn't do that. You should just respect the the width of the patient's just natural breast width. We'll say like, yeah, 12 centimeters is kind of an average size.

Yeah.

For a small person. And then, you know, you try to pick something that fits that frame versus a tiny gal who just came to my office recently and she's so small and has 475 cc implants and part of the implants really in her armpit because her chest wall is not big enough to accommodate the width of that. Device. So like just trying to fix somebody after that is, it's not great.

Yeah, yeah, yeah. I mean, I imagine that I'm thinking of it as if we're training a movement like a chest press or we are training those muscles, how that will, how that will impact the ability to get stronger in something like a chest press. So that's what I'm kind of thinking about, especially if you're, if the origin insertion is now, or if the insertion is now changed, it might change the angle of your arm that like is more comfortable. I wonder how much extra compensation you're going to get from surrounding structures. So that's kind of like my—

what I'm always trying to get the insertion back to where it should be.

Yeah, love that.

Is my goal.

Got it. Okay.

Laterally, it actually— it's more common to get like a U-shaped configuration where the lateral border will go back and you can get the origin back, but the middle won't go back. Because it's window shaded up a lot.

Oh, interesting.

And the pecs— pecs a big fan anyway. So a lot of times you can release it and get it to come down. But, you know, I want everybody to have the best chest wall reconstruction I can do for them.

Yeah.

At that time. And I don't know until we're doing it, you know, how well we can do.

Sure.

But we're trying to get that so that when you or another therapist or they follow a protocol, they can get a level of strength back and certainly want mobility to be, you know, absolutely as normal as possible. Yeah, that's why the whole like CrossFit thing— I've had people with torn, uh, labrums and rotator cuffs and all this stuff after, you know, those, uh, those workouts and just doing that. Um, so I'm like, I'm like against all that stuff.

Yeah, well, I think it's like I think it— people want to strength train.

Yeah.

Like, and they want a program to follow. And CrossFit is super popular. I mean, it's—

Yeah.

It's something that people think about when they're like, I want to get into lifting weights. And so they're like, let me go try a CrossFit class. But what I like to educate people is that there are so many different ways you can lift weights and it doesn't have to be one specific way. And what we care about is there are boundaries that we care about as far as like building muscle and building strength. And we can go through all of those, but it doesn't need to look like, you know, heavy barbell lifts, Olympic lifts, these things that a lot of people kind of picture. And I think it intimidates people or it makes people feel like that's what they have to do. And if they can't do that, then they're not going to do anything at all. So I like to kind of meet people in the middle and be like, "Oh no, there's so many different ways we can do this." So, and I try to talk to patients a lot about overtraining. Yeah. Yes.

So I think, you know, obviously I take predominantly female clients, you know, 99% of the clients are female. And I have to have all these talks about like caloric intake, particularly protein amounts and calories and calorie deficits and training and overtraining, because I have a lot of people who come to me just for a specific operation where I take implants out and I do a simultaneous fat transfer. And of course Everybody wants me to get obviously the best possible results at one time. And if they start feeling better, it's very easy to create a calorie deficit by overtraining. I think women overtrain, obviously, you know, tell me how bad the overtraining epidemic is in women.

Totally. Um, I have my own personal history of overtraining and It's because we are marketed to think that that's what we need to do to be as small as possible. Um, we need to burn off what we ate, or we need to earn our food, or, oh, I had dessert and a glass of wine at dinner last night, so I need to like go extra hard today to burn that off. And not only is this actually not very effective because your body adapts when you give it, just like medicine, You want to give your body the right medicine, the right drug in the right amounts to limit side effects and to maximize its potential outcome. The same goes with exercise. We want to give our bodies the right amount of exercise in the right doses with the right amounts of recovery. And that's how we see the best outcomes. When that scale is tipped, when we give our body too much exercise stress stimulus, we see symptoms like joint pain, hormonal dysfunction, reproductive issues, um, all low energy, anxiety, all sorts of things. And this is because our body is trying to protect us. So your body, when it senses an energy deficit in the way of lots of exercise and potentially underfueling, goes into savior mode of let's reserve as much energy as possible. And so things in your body stop functioning the way they should. And not only do you not feel great, but it's actually not necessary at all to achieve body composition results if that's if that's your goal, because that's often why people are doing this, is because they want a certain body composition, right? Um, which is like, okay, is that worth it for the cost that you're doing to your body? Um, not only that, it, it might not be necessary. When we give our body— when we fuel appropriately and not underfueling, um, fueling appropriately and exercising appropriately, you can change and improve your body composition and increase muscle and decrease fat without those negative side effects. And so I think the problem is people are not educated on how to do that because we're just taught that no pain, no gain, more is better, no recovery days, slam your body into the ground and that's what will work. Um, when we see that the biggest levers we have to pull are kind of threefold. So I think of it as muscle building muscle and building muscle comes from training your muscles close to failure, training each muscle group 2-ish times per week on non-consecutive days, allowing for enough recovery. Um, it also comes from proper diet if fat loss is a goal of yours. And even if fat loss isn't a goal of yours, proper diet is important for all of us, and eating enough protein to supplement your strength training. Uh, and then I see it as recovery as well. Uh, so making sure that you are taking days off from stressful exercise so your body has time to heal and repair. Um, cardio is in there as well. Cardio is— gets demonized, I think, sometimes in the strength training world, but it is super important. And we see that You're not going to get the same cardiovascular benefits from strength training alone. You do need cardio in addition. 150 minutes of light to moderate intensity cardio with little sprinkles of like high intensity stuff here and there is great and very doable for so many people. So if you have that framework and you give yourself enough time, you will start to see your body change without all of those negative side effects.

I think the patients that I see have so many problems with chronic inflammation. So they retain a bunch of fluid and certainly they have have, you know, a lot of sympathetic response. They have more cortisol, and they, they have this constant problem with weight gain. But they're, they're misinterpreting the weight gain because fluid retention is not putting on extra fat or anything like that. And they, they fast more, they train more, and it just makes everything worse.

Yeah.

So then they get, you know, more fatigued. Yeah, it's just a really— I—

then the story is cycle, really.

And they're very consistent stories.

Yeah.

When you have chronic inflammation.

I saw this in my practice as a PT all the time. I saw it with myself. And I think, again, we have to go back to what are the ingredients in your routine currently? So how are you exercising? That's important. It's not just if you're exercising, but how you're exercising. So If we focus on building muscle, not only will you not feel like you're working out as quote unquote hard, like strength training, strength training typically doesn't feel like you got hit by a truck. At least good strength training shouldn't, because if you feel so sore and so exhausted from your strength training routine, it's gonna be hard to show up the next day or, uh, you know, and the day after next to train with enough intensity. And that frequency is important. So, It proper strength training won't make you feel smashed. And so it's easy to stay consistent with, and it also doesn't cause an overstress on your body, which triggers that inflammation response. A lot of people overstress their body day in, day out, and they never have time to repair and heal. So not only are they accumulating inflammation, but they're not giving their body the right stimulus because they never get back to recovery baseline to where they can give their body a high-level stimulus to be able to adapt and change and add new muscle. So, It's kind of this vicious cycle. So I personally think that if someone is dealing with a lot of chronic inflammation, peel back and kind of start fresh. And start by making strength training the cornerstone of your routine and train each muscle close to failure. Lifting weights does not necessarily guarantee muscle growth. You have to train close to failure.

Okay.

And training close to failure in each muscle group of your body 2-ish times per week, taking recovery days. From there, I would consider adding, uh, well, fueling, all, always, always fueling properly, and then consider adding some cardio on top of that. But I like to kind of peel back the cardio first, get the strength training down. People will find after just a few weeks they already feel so much better. Yeah. Their body might feel like it calms down a little bit. They feel more recovered. They might feel like that less kind of puffy or swollen or inflamed feel, and then they can start to layer on more intensity as they're healing.

I'm always, uh, like taken aback by how quickly people ask me about exercise right after surgery. Like, I do, you know, some, some things surgically that would make me think people just don't want to do stuff for a while, but it's so in their minds that they have to go back and, and, and do things. So I always release them to walk. Like, they're coming to the office the next day, and I tell them they can walk as much as they want. You know, the thing we're trying to avoid is bleeding in the post-operative period. We don't want to ever have to go back for that problem. So walking is a tremendous, like, tool for me. Like, it doesn't increase your heart rate, doesn't increase your blood pressure, and it's actually very good exercise.

Yeah.

When it's not 1,000 degrees outside in Austin.

Oh my gosh. I know. Oh, it's been brutal.

We do.

We do it anyways, but we just are like sweating immediately.

Absolutely. So then moving into what you said about transitioning, like we transition them to do more lower body. Sooner because we're doing chest wall surgery. If we're doing things to areas like areas where I take fat from, then they're definitely going to have more swelling in those areas as they return back to, to, to doing activities and more aggressive activity, of course. But can you, um, and I talked to this about my patients because I'm 56, I've had, uh, 5 knee surgeries, I've torn my Achilles and my knees are not great. Wow.

Yeah.

So I've had them both microfractured when that was a thing. Just doesn't work. But, um, you know, I'll walk, I'll weight train, I'll do a stationary bike. Uh, I don't do any of the Olympic lifts anymore. I try to like be very mindful of stuff now. I'll lunge with like my weight or kettlebell weight, but not like super aggressive or anything like that, trying to maintain, you know, thigh strength and have really good balance so I don't fall as I get older.

Love it.

What are the, you know, like, how do you think about low impact versus joint-friendly exercises with someone who's a delicate flower like me?

Yes, well, it's a good question because low impact does not necessarily guarantee low joint stress, and high impact does not necessarily guarantee high joint stress. Now, we see that if you are putting your joints in a position that violates your own anatomical structure— as you know, everyone's bones are shaped differently, everyone's structures are slightly different— and so if you put yourself into a position that violates your— the structure of your tissues in your hip or in your knee, even if it's low impact and you're not jumping off the floor, that might not be an exercise that's conducive for your joint health. That might not be low joint strain for you. And that's a— I know this sounds really simple, but you shouldn't be moving through pain. If you have pain in a movement, it could mean modifying the movement, changing the path of motion, changing the weight, changing the movement altogether to find an exercise that feels comfortable for you. I think that's one thing that we're not okay with or we're not used to hearing people say when it— in regards to exercise, exercises should not feel uncomfortable in the sense you feel pinchy or pain or just this general level of like unease. It should feel smooth. It should feel coordinated. It should feel like I am stopping this exercise because of my muscle. I'm not stopping this exercise because my knee kind of hurts and like I think I need to stop.

So the joint stuff.

The joint stuff. I'm not stopping because of joint discomfort. I'm stopping because of muscle fatigue. And so I think that that's a really important distinction to make is that every exercise in your routine should respect your anatomy. And again, it sounds simple, but it's like, just, you don't have to know, you don't have to have an X-ray to know your anatomy perfectly, but your body will tell you, your body will start to tell you if a range of motion is, if you're not ready for a certain range of motion, if it's painful, if it's pinchy. So you may be able to, maybe you, for your knee stuff, for example, maybe side lunges or curtsy lunges or forward stepping lunges don't feel the best on your knees, but maybe a step-up or a hip thrust or a Bulgarian feels— but I'm just using examples— do feel better on your knees, then we can train those movements instead of the movements that don't feel good. Also, you might feel like a jump squat that's high impact actually doesn't feel bad on my knees at all. And we see that a little bit of impact can be beneficial for joints because it's a very good load for the bone. Now people take that and they do way too much and they overdo it, they overdose it, and then that backfires because you place a stress on your body that your body's not ready for, and then you get symptoms. So that's kind of how I like to see the whole impact, low impact discussion.

So going back to the patients, that's why we let them do more lower body earlier, and we just give that, you know, I, I try to give everybody this kind of 6 to 12 week healing for the chest wall because it's, you know, if everything was done and the muscle was not in play, it would be a lot simpler.

Yeah.

Deal for us. But because of that, I've had people do too much because they feel better. And once their, their level of energy is returned, they don't like actually they either don't ask or have loaded too heavily too quickly and they just tear their pack.

Yeah.

And so then that creates a situation where you have to either let them sit with a hematoma in their pack or you have to reoperate on them.

Oh yeah.

And none of those are great. So what we've tried to do now is be very mindful of that and give it adequate time to heal and then have a more you know, graduated load building, you know, program after that. And so that all obviously makes sense.

Love that.

Um, the— and the biomechanics are different because we already changed, you know, from the initial operation that was done, it changed their biomechanics, right? And then we tried to— I just had this discussion about an hour ago. I was like, now I'm gonna try to get this muscle back where it came from.

Yeah.

And then everybody looks at me like, well, why can't you do that?

Yeah.

Like, well, not Harry Potter. And the thing is, the fan shape of the muscle over time, depending on the year-over-year atrophy of the muscle in that position, changes its ability for me or anybody to go and bring it back down and put it where it actually was released from. Sometimes, like, if they left it basically intact between, you know, 6 and 9 on a clock face, It's not a big deal.

Yeah.

But it never is.

Right, right, right, right, right, right, right.

If it was, my job would be super simple all the time. So—

and you're right, they're probably not loading those muscles regularly. And that's, that's what's so fascinating about— this is a great example, but you in this, in your specific case, but I think that this can be seen globally across our body. There is structural change to the muscles when you're not loading them frequently. As you age and as you get older. And this is a big problem for every muscle in our body, but especially when you're trying to reconstruct something and get it back to maybe its original function. It's like, well, the tissue isn't the same as it was, which is just— I think it's a good comparison, a strong comparison for people to kind of think about when they're thinking about their quads or their back or their shoulders or anything. All of it is atrophying. Atrophying as we age and the structure, the physical structure is changing and infiltrating with fat and all of that.

And you know this too, is when you operate on someone's chest wall is their pec minor shortens because they rotate their shoulder internally. And then because it's sore, they're just trying to guard or whatever.

Yeah.

And I have patients ping us, you know, on our messaging portal and they'll say, oh, you know, hurts, you know, my shoulder hurts. Like, well, here's what you're doing. So you need to like get your shoulder blades and roll them back like I showed you. I show people in the office, but it's like natural guarding, protective, to internally rotate, and that just shortens your pec minor, and then that just makes everything worse. I've already like put the pec back, and you can't have them do exercises right now to unload.

Yeah.

Anything, because you'll just tear a repair if you do that. If you try to stretch their pec minor with elbow in the doorway, hand behind your head.

Yeah.

Going to tear what I did in the OR. So it's just one of these recent things that happened and it was, it was from a chiropractor and they're like, I went to the ER and I was like, oh no, the ER is not going to help you.

Yeah. Oh no, no.

I mean, I'll get you a muscle relaxant and you got to get your posture sorted out. Those are the things that, you know, as we try to get the, the, um, biomechanics of the chest wall restored and try to get you healed up enough so then you can go back to safely loading the muscle and doing things. That's—

yeah, of course. Yeah, there's a, there's a lot to consider. Um, I think one thing that, that is maybe when, when your patients are ready to start loading again, loading their upper body again. Strength training is incredibly powerful for posture because there's actually a lot of research coming out to say that strength training through a full range of motion increases flexibility just as much as stretching does. So what's really great is that—

I hate stretching.

Yeah. So what's really great is you can kind of kill two birds with one stone. You can get stronger, three, four, five, so many birds with one stone. Like you don't have to— and this isn't to say that there isn't a time and place for stretching. I'm not saying that, but I am saying that if you strength train, you— everything else kind of falls into place. But of course, you can't just like pick and choose the areas of your body that you want to strength train. It's posture. All of our muscles are there for a specific purpose and to hold our skeleton in a specific place. And so we want all of them to be strong, which means we need to be loading the front side of our body, the back side of our body, our shoulders, our hips. Everything. Our feet, our feet play a role in posture, believe it or not. The neck, everything. So I think that if someone is overwhelmed with like, I have all of these things that I have to do, I've got to stretch, I got to do mobility, I got to do balance training, I got to strength training, just start with strength training and strength training will check so many of your boxes and then you can kind of fill in the holes from there.

So, and then for those of you who strength train and have phone neck, that means you're on your phone while you're training, you're defeating the purpose. Right? You're ruining your posture with phone neck. Uh, the number of like, uh, what is it, the whoever does, you know, spine, right? The, the ortho or the neuro who does like cervical spine, like their business is protected forever based on phones.

I know, right?

You have a whole— oh, when did the iPhone come out? In early 2000s?

Yeah, 2008 maybe.

So that's what I'm like, everything just got Ridiculous.

I know, I know. And I always say like posture is a function of your environment. So unfortunately, if you're not changing the environment, your posture might not ever change. You could do all the scap squeezes in the world, but your body's not going to stay like that if you're going right back to 9 hours a day staring at a screen that's 8 inches from your face.

Oh yeah.

And it's a reality for a lot of us, unfortunately. But that's why I always say like get up, move around, move your body around, move your head around, look out into the distance. Because posture isn't just about musculoskeletal, it's also about the inputs coming in through your eyes. It's about, you know, lots of different things. Neck position, obviously. So, yeah, I like to say just try to not stay in a posture for a long period of time if you can.

Well, yeah, the post-op period is difficult. So we have those discussions and, you know, we try to get them And I was— so everybody understands this, um, there are going to be good days and they're going to be challenging days when you're in recovery from any procedure. It doesn't matter. And, you know, a procedure that does something to the chest wall, that's very challenging because it affects your shoulder and your arm. And, and people are very worried that they're gonna, you know, do something and then that creates more compensatory problems. So, you know, we try to get them quickly, you know, moving along and knowing that they're, you know, they're fine. They can have their arms out, they can do all this stuff. It's all fine. And keep your, your shoulders, your neck, all that in a better position so you don't have, you know, problems. And then of course, sleeping's an issue and trying to get comfortable and like all the things. Yeah. So, Dr. Richie, my patients, you know, many of them take this kind of 3-month to 6-month period, they get healed up, and they're really looking for a program to then help them strength train. So at that point, would Evolo be a nice transition for them to get back into training and building muscle?

Yes, I would say that as soon as you clear your people to start lifting with the— with enough intensity to like train near failure. Um, which— what would you say, that's like 6 months?

Yeah, you know, this is a good story. We'll do one story, which is my favorite thing. So when patients ask me like, when are they going to be able to do what they used to be able to do? Yeah, my first question is, what was it that you were able to do before that you want to be able to do? So I used to have a lot of folks come from the military, and they would pass a physical training test which they do annually in the military, and then they would come and have surgery. So they would have a whole calendar year to get their strength back to pass that test again.

Got it.

And so I remember this gal came back and she passed her test again, but her bench press was 5 pounds off of what the previous mark was the year before, and she was ticked off by that. And I was like, well, I mean, that's pretty good. I was going to say, yeah, like you had chest wall surgery, you rehabbed everything, and you can basically within 5 pounds to have the same bench press. Yeah, that's really effective. So I know she didn't really look at it that way, but that to me is a huge win in terms of her ability to recover. And, you know, We don't spend too much time patting ourselves back on the backs about, you know, technical execution in the operating room. But being able to reconstruct someone's chest wall and get them to bench again like that.

Yeah, it's awesome.

Yeah. So that took a whole year though.

A year. Yeah.

And but she started loading, you know, probably in the 3 to 6 month window. But by 12 months, she's basically able to go and pass a test for the military.

Yeah.

And have the same, I mean, within 5 pounds of bench press. I mean, that's—

yeah, yeah, that's really not— and think about the trajectory that that then puts you on going forward. What are you going to do in 1 year from now? Like, dang, you're going to be for sure surpassing what you were doing before.

We're all a little impatient though, Dr. Guttmacher.

I know, I know. And that's, and that's really the biggest thing that I think is our issue, is that we want the results immediately. But I'm here to tell you that it just doesn't— our bodies just unfortunately don't like fast change. They just don't. And our remodeling takes a long time. And, but when you are patient with it, your body gives you so much more back. And then you start to, and then you never look back. You're like, oh, I can continue to load my body and get stronger. Like I'm stronger now at 34 than I was than I've ever been in my life. And I've had 2 babies back to back and I'm still stronger than I ever have been in my life. And so to me it's like there is no, I mean, there's obviously a ceiling, but it, it's really exciting when you give your body the space to actually recover. So, What I like to say is if someone's, if someone's cleared to exercise and they can exercise in any way they want, they can exercise with, they can load their pecs and their chest muscles with full intensity. Um, we want to start looking at training near failure, like I've been alluding to a lot. So I want to kind of take a moment to describe what that means. So training near failure, failure-based training means you're physically unable to complete another rep. So let's say you're doing a bicep curl, you physically cannot curl the weight again. That's how you know you've reached true muscular failure. Studies show that you don't have to get all the way to failure, but you do need to get close, maybe 1 to 3 reps shy of true failure. And what that looks like is you really slow down, your pace and velocity really slows down. So, you know, you're a couple reps shy if you're like, ah, I don't know if I could do this, but you can. So that's how you know you're close to failure. And that's what the end of every set should look like.

Okay.

Now, this can be with relatively light weights. This can be with relatively heavy weights. As long as your final few reps feel heavy, that's what's really important. So I think people get caught up with, I got to do heavy barbells, I've got to do, you know, I've got to do pull-ups, I've got to do all these really heavy lifts. And the research shows that you just don't have to. You can lift relatively light, which is a lot more approachable for many people because they're like, this weight just feels like something that I can manage and that I feel comfortable doing. And as long as you take that lift near failure, it can be equally as effective as the heavier dumbbell. So we do that and then we train the whole body. So you want to train each major muscle group 2-ish times per week on non-consecutive days. So let's say, just staying with the chest example, so let's say you're training your chest on Monday, train your chest again on Wednesday, Thursday, or Friday, and then be done with chest.

Um, for the week.

For the week. And, uh, and we do that for every muscle in our body. I like to recommend 3 to 5 strength training sessions per week. 5, your strength training sessions could be a little shorter, which I personally like because I feel like I can get higher intensity in shorter, um, time periods. Uh, the longer workouts just kind of feel more brutal, and I feel like towards the end of my workouts, I just— I'm getting less high-quality stimulus because I'm tired. Um, so I tend to like the shorter, but if you like longer workouts for less days of the week, that's great too. You can kind of slice and dice it however you want. And then making sure that you're, like we said, eating enough protein. Protein is crucial for muscle development and growth. And choosing exercises that actually honor your anatomy. If something feels pinchy or uncomfortable, like, don't just keep pushing through. Like, let's find you a different exercise. There are a wide range of exercises that you can do to load muscles appropriately.

Yeah, I, I'm glad that you reiterated protein. I find that to be the most redundant conversation I have to have with people. Yeah, it never stops. And people will come here and they— so people usually will come and spend a week with us in Austin. So most of my patients are out of state and when they're out of the country, I have them stay at least 2 weeks just because of the flights and everything. And they're really obviously good about it when they're here. My office staff are incredible. Big shout out to all my staff. They have, um, this, um, they're very willing and understanding of what's going on with the patient. So the patient's had surgery, they're in town, they're not in their environment, so they really go out of the way in the office to make sure that like We have hydrogen water in the office and they'll mix up amino acids. You know, uh, the— we have amino acid powder. They'll make them a protein shake or they'll try to do everything they can in the time that we have them. As we have them doing treatment modalities, like we have this great thing called the Human Regenerator, which really gets you into more of a parasympathetic state after surgery. And we have lymphatic massage and simultaneous NaNoVi therapy, and we have hyperbaric chamber and red light therapy. We have all this stuff going on, and I'm constantly talking to them about sleep hygiene, protein intake, and, you know, the exercises, walking, and trying to stay on track with your supplement. And, you know, it's like this never-ending conversation about diet. Yeah, I know, I know, because people just fall out of that quickest, especially when they go back home.

Yes. And I think that any habit comes by changing a little bit at a time and kind of meeting it where you're at. I know for me, when I first started eating higher protein, I relied a lot on protein bars and protein shakes. And what— is it the best? Probably not. You probably want to get your, you know, protein from whole foods if you can. But sometimes you know, you're not there yet. And so for me, at least, that's, that's what allowed me to kind of start building muscle in the beginning. And so if that's somebody's, like, I don't know, I, I know there's different opinions on— and I'm not nutrition trained, I'm not formally trained in nutrition, so I'd like to leave that to the nutrition experts. But that's just my personal opinion, is like, meet yourself where you're at, and it's okay to supplement sometimes if you, if you—

it's a big challenge too, because they're, you know, we talk to them about food quality a lot.

Yeah, because food quality, yeah, it's a huge deal. Yeah, it is.

And, you know, I found that lately, uh, there are a lot of vendors of protein, and I don't know that the label is exactly what's inside.

I know, I know.

There's a lot of fillers and stuff, and yeah, people stay swollen longer, and I get suspicious about the, the source of the protein. And, you know, for everybody listening, we don't use collagen around the time of surgery. It's not really got a great protein squirt's not a good source of what we need around the time of surgery. So we kind of— I have a ton of trouble with my folks who are vegan or vegetarian. They just don't get a lot of protein.

Yeah, yeah.

So we use a, a pea protein specifically so that nobody really can complain, and it's more uniform. And, and we have a grass-fed, you know, protein as well. But we have to supplement with some, you know, other source outside of meals because people have a tough time. Like, yeah, well, meal, you know, if you ask them to get 100 grams of protein in a day, it was like, oh my God, I know. Am I supposed to do that?

I know.

Like, well, I eat about 200 today normally, but that's just— I'm used to it.

When you get used to it, it becomes a lifestyle eventually, and then you don't even have to think about it.

Yet. I don't.

But it is hard. It is hard because you just start to reach for the things that are higher protein. Like, I reach for, you know, Greek yogurt, cottage cheese. I do a lot of sardines. I do a lot of, um, we, you know, ground turkey, ground beef, like chicken. Like, you—

it's easy at the store too. Like, if you, if you go to the store and shop, it's not actually that hard if you're like that.

Yeah, yeah.

It's a little bit different. Like, I'll work I'll have a project to do and I'll just go to the store and get a, um, a whole chicken, you know, like a rotisserie chicken. And yeah, and you know, a bag of apples or something. And you know, that sounds kind of boring. I'll get some pumpkin seeds or something. Yeah, I'll have— I'll be fine because that's a really actually well-balanced—

yes, yeah, that is actually— yeah, I know. And it, it's funny because like I I've become a little bit of like a garbage disposal. Like I'm like, I just don't care as much about— I have the days where I'm like, like last night we went to Odd Duck, which I don't know if you've ever been, but it's one of my favorite restaurants and ordered basically everything on the menu, including 3 desserts. And like, it was so good. But typically, like on my day to day, I'm just kind of eating as a way to fuel me. I'm not really looking for it to be like the best meal of my life all the time. And that's been really helpful for me because It's just kind of like, get it done, and it doesn't need to be— and I know that's a hot take. There's some people that are like, "No, I need every single meal to be delicious and amazing." And I'm like, "I get it, I get it." But for me, it's just been like, it's okay for it to be a little boring. It's all right.

Yeah, yeah, definitely. So I'm not a sponsor, but I send all my patrons to The Well. And, um, because there's a gluten-free, dairy-free, seed oil-free, uh, restaurant. And most people don't know that that's actually a way you can eat. So like, and you come from different parts of the country, people are kind of fascinated by that. Yeah, being an option.

Totally.

Because they don't have that, and then they eat there and they're like, wow, it was really good.

Yeah.

And so like, you can't eat that way, you have to make a pretty conscious effort to eat that way. Yes. But if you have gluten sensitivity you just kind of have to. I have that. So, you know, we have to eat that way. But you can get enough protein, you can strength train properly, as Dr. Richie has told us. And those are all things you can do habitually.

Totally, totally. And it— I— we call it gentle consistency. So it's just like doing the things, not making things so extreme is my personal motto, because if it's extreme, I just won't stick with it. Like, that's just just how I am. I think that's how a lot of people are too. Um, so if you just kind of make things, um, feel more gentle and approachable, you're more likely to stay consistent. And then as you go along with that consistency, you'll start to see results. And as you see results, then you can start to do some of the fine-tuning stuff, um, as you go along. But I personally believe that if we all stopped expecting our routines to be so aggressive right out of the gate we would be so much better off.

Awesome. I think that's a great place to stop. If, if they want to learn more about Evlo or dental consistency, where can they find you?

Yeah, evlofitness.com is our strength training— it's a strength training app. All the classes are taught by physical therapists, um, follow-along classes that you can do from home. So if you like to like do a class with an instructor, um, we help you do that. We help you build muscle from home. You can follow me on Instagram, Dr. Shannon DPT. I also have a podcast called The Dr. Shannon Show. I think that's it.

Thanks for coming on.

Thanks for having me. This is fun.