Dr. Jonathan Sanburg: The Cutting Edge Of Sports Performance Physical Therapy

In this episode, I sit down with my go-to expert for all things sports performance and injury recovery—Dr. Jonathan Sanburg, a highly respected physical therapist who’s changing the game when it comes to getting people back to peak performance.

We dive into what’s truly cutting-edge in the industry right now: treating injuries from a fitness and athletic performance lens, instead of the outdated “rest, meds, surgery” approach most of us have been conditioned to follow. Dr. Jonathan breaks down how and why this mindset shift is essential—not just for athletes, but for anyone who wants to move and live pain-free.

I also share my personal journey: how I narrowly avoided an unnecessary exploratory knee surgery (yes, really!) thanks to a referral to Dr. Jonathan and his dream team at PT Revolution in Tahoe. Turns out, all I had were some deeply knotted muscles causing inflammation near my joint. Since then, I’ve been working with Dr. Jonathan for over 2.5 years, learning firsthand that the real path out of injury isn’t rest—it’s doing the work. He even shares his tip at the end on how to find a great sports performance physical therapist, as well as how to spot the approaches that just waste your time.

Dr. Jonathan Sanburg is a Sports Physical Therapist and Performance Coach with a Doctorate in Physical Therapy from Creighton University, where he focused on return-to-play for athletes. A Sacramento native and former elite-level soccer player, he competed at Gonzaga University, earning a Bachelor of Science in Human Physiology. He has trained at the world-renowned EXOS and Champion Physical Therapy and Performance, where he worked with NFL, MLB, MLS athletes, and members of the U.S. military’s most elite units. Dr. Jonathan specializes in guiding youth and professional athletes from injury recovery to peak performance.

TIMESTAMPS:

Dr. Sanburg has changed the way Brad looks at physical therapy. His emphasis is on “return to play” athletes. [02:16]

Kime is a physical center where the focus is on sports performance and injury rehab rather than treat and go home and rest protocol. [06:48]

At Kime they work closely with physicians, many times including post surgery treatment. [10:04]

Do people go to physical therapy for injuries or are they seeking advice on performance? [14:34]

Jonathan had studied strength and conditioning to add to the PT training. [16:01]

Where does rest come in these days? [19:35]

How does one work around the pain without doing more damage? [21:45]

Is there a difference between treatments for an acute injury vs. overuse injury? [26:40]

Resistance training is probably most important if you were going for longevity. [29:27]

You should move a lot throughout the day for cardio respiratory fitness. [31:04]

A good PT provides the value that the patient expects for their particular performance or body . It is not necessarily pain related. [35:30]

We need to strike a balance between like muscle strength and tendon rigidity or stiffness. [37:42]

How does one get bone spurs? [40:21]

Is there a difference between pain and soreness? How does the brain determine? [44:50]

Do we always honor the aches and pains? Check with your body after 48 hours. [52:54]

Are athletes’ performances getting better in the modern days? [01:01:18]

Jonathan is a competitive racer besides serving as physical therapist. [01:04:13]

How can a person be sure they are finding the best in physical therapy care? [01:07:53]

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TRANSCRIPT:

Brad (00:00:00):
Welcome to the B.rad podcast – where we explore ways to pursue peak performance with passion throughout life. I’m Brad Kearns, NY Times bestselling author, world #1 ranked masters age 60-plus high jumper, and former #3 world ranked professional triathlete. You’ll learn how to stay fit, strong and powerful as you age; transform your diet to lose body fat and increase energy; sort through hype and misinformation to make simple, sustainable lifestyle changes; and broaden your perspective beyond a fit body to experience healthy relationships, nonstop personal growth, and ultimately a happy, healthy, long life. Let’s explore beyond shortcuts, hacks, and crushing competition to laugh, have fun, appreciate the journey, and not take ourselves too seriously. It’s time to B.rad!

Jonathan (00:00:51):
This is where I make my money right here, Kime Performance Center, like, so it’s, it’s not easy.

Brad (00:00:54):
Pay attention, people. Start taking notes right now.

Jonathan (00:00:56):
Yeah. Is not as easy as like,

Brad (00:00:59):
Please welcome Dr. Jonathan Sandburg to the show. My main man in Sacramento, California, who has guided me through a very enlightening and successful journey, healing from my sprinting injuries, notably my achilles tendon surgery that I had in 2022. They sent me, Hey, time to go to physical therapy. And as soon as I walked in and saw this guy, he put me to work and it transformed my mindset about what’s going on, on the cutting edge of sports performance, physical therapy, prehab, rehab healing. And boy has it been a recalibration because, uh, a lot of us have been socialized to think, well, when you get injured, you go see the doctor, typically, they’ll send you to the orthopedist, they’ll do x-rays, they’ll propose surgery or medication to treat the swelling or the pain. And this is now been just tossed outta the water in favor of a very cutting edge approach that is centered on sports performance and fitness, and working hard to heal the functional weaknesses in your body that represented the cause of the injury or the dysfunction in the first place.

Brad (00:02:16):
So Jonathan’s gonna talk you through what is happening on the cutting edge of physical therapy, sports performance, strength and conditioning, which he has experienced in all these things. Oh my gosh, it’s just been really cool to be immersed into this community. <laugh>, thanks to my little nicks and aches and pains that I get, but it really is something that I think will be beneficial show to all of you who have wondered what to do when you get banged up and how to get better. A lot of times we sit around and rest and cross our fingers and wait for the injury to heal, but oh, no, no, no. The first day I walked into his clinic, I was doing my little wissy boy commentary, like, yeah. So the surgery was two weeks ago, and it’s still kind of burning, especially in the morning.

Brad (00:03:06):
It’s kind of tight right here, and it’s a little tight over here sometimes, but not all the time. And he says, go over there. Grab a 45 pound kettlebell, sit on the bench, put it on top of your knee. I want you to do 20 single leg raises on the slant board, and boom, boom, boom, off to the next thing. So you’re gonna get a kick out of this guy. He’s officially called a sports physical therapist and performance coach. He earned his doctorate in physical therapy from Creighton University with an emphasis on return to play for athletes. He is a real competitor in his own right, which I really respect in practitioners because they’re there, they emphasize, they know what’s going on and they’re out there kicking butt. He likes to race mountain bikes and Enduro bike racing, which we’ll hear about a little bit.

Brad (00:03:48):
But he’s had great experience working with some of the most elite athletes in the world, including NFL, combine participants, players in major league baseball, major league soccer, and also some of the top track and field athletes in the world, including Olympic gold medalist Andre Degrass down in Arizona at this very famous Altus Performance Institute. And he’s gonna give you a quick tip near the end of how to determine whether you are in good hands with a cutting-edge physical therapist that’s gonna help you, or whether you might wanna look elsewhere if you’re immersed in kind of the rest and gentle therapy approach that still prevails in a lot of the physical therapy world. Dr. Jonathan Sandburg from Kime Performance Physical Therapy in Sacramento, California.

Brad (00:04:38):
Dr. Jonathan Sandburg. Hello. We’re here this time. I’m not on the table, we’re in chairs, but you’re my guy and I’ve been coming to you for almost three years now. Yeah. To the KIME Performance Physical Therapy Center here at Uriah Faber’s Ultimate Fitness Gym in Sacramento, a Sacramento landmark. And I thought, Hey, you know, we should get on the podcast sometime and talk about this wonderful world of, you’ll probably define it better than I, but I I think it’s like, you know, sports-minded, performance-minded physical therapy. Yeah. As opposed to maybe the compare and contrast to the old school getting hurt, resting, coming back. Yeah, yeah, yeah. Taping it up, whatever. So let’s, let’s get into it, man. Tell me about your, your career path too, which is really interesting and what we’re doing here at the, at the Kime center.

Jonathan (00:05:27):
Yeah. Well, one, thanks for having me, Brad. I’m super excited to be here. So yeah, my career path, like most sports, physical therapists or physical therapists get in, I would say sports performance, that side sports medicine. You’re an athlete and you get hurt. So I tore my ACL as a kid. Oh. Um, so I ended up going to physical therapy, and my physical therapy therapist then, um, is now, uh, the CEO of this company, which I work for Kime. And so through that process I was like, oh, this is kind of fun. You know, I was getting towards the end of my A-C-L-C-L rehab and I was asking my PT. I was like, oh, hey, to, like, can I intern? And I was a high school at the time. He was like, yeah, sure. We can figure something out.

Jonathan (00:06:04):
So I started interning as like a, as a junior in high school, I think sophomore, maybe, something like that. And I was like, man, this is, this is cool. Like, this is really fun. I could see myself like, uh, doing this one day. I, um, not someone who wants to sit still all day and be at a desk behind a computer. And so, you know, from there, uh, decided I would go to physical therapy school, went to undergrad, and kind of chose my undergrad degree. And, where I went based off, you know, the hopes of getting to PT school. Yeah. Uh,

Brad (00:06:29):
it’s pretty competitive nowadays.

Jonathan (00:06:31):
Hmm. and then through that, uh, through that journey I had, I did a lot of strength and conditioning and learning, you know, the weight room, doing strength conditioning, internships. I had the opportunity to work at EXOS as a strength coach intern. Uh, I had the opportunity to go to EXOS during PT school. Uh, tell

Brad (00:06:48):
About EXOS. Yeah. Yeah.

Jonathan (00:06:49):
So EXOS is a, EXOS is, um, a physical therapy performance training facility. You hear, you’ll hear their name a lot in circles in terms of like the NFL combine. So there’s roughly, you know, guys that are trying to go from college football to the NFL. There’s like, uh, I think roughly 300 they get invited in NFL combine, you know, they do the 40 Yeah. The high jump, the broad jump, and then some, and then some skill drills and speed drills. Yeah. And, uh, they train, like, I wanna say it’s like half of ’em, or roughly half the guys across their different facilities. Wow. Um, they provide sports performance training, not just the professional athletes, um, in the off season, but also physical therapy and then training to youth athletes. Even the everyday person, uh, can go in there in terms of, uh, like the locations I was at, I got to intern in Arizona and, and Florida, which are two larger locations, and everything’s kind of in-house there. So they have nutritionists, massage therapists, physical therapists, the strength coaches. It’s all kind of like a one stop shop.

Brad (00:07:45):
So when they invite these combine guys over, are they like, uh, you know, gonna bill ’em later when they sign their contract or something? I mean’s gotta be. So

Jonathan (00:07:52):
They’re not, they’re not billing them, they’re billing their agent,

Brad (00:07:56):
So right right

Jonathan (00:07:56):
It’s really the agents and the agencies that these athletes sign with, they really determine, um, where they go. For example, um, I worked with a combine athlete from Sac State. He was a, he was a lineman, and so the agency he signed with the guy was like, Hey, you’re gonna go to EXOS, you’re gonna go to Arizona for your eight weeks for combine training. And so he had tweaked his knee before going to exos, so I was helping him through his MA rehab. And so I was telling him all about it. It was kind of fun because I had already lived it and done it. And so his agent put him there, they put him up in an apartment, you know, they front the load the bill. Yeah. It’s not cheaper. Yeah. Um, and then once you sign your signing bonus, I think that’s subtracted out of your signing bonus.

Brad (00:08:34):
I mean, hopefully they get drafted, otherwise, possibly it’s an investment in, uh, a bust. Some costs. Some costs for sure. Yeah. Yeah. Sure. So, yeah, so, um, places like that and places like Kime here where we’re inside this amazing sports training facility that Uriah Faber built for the, for the fighters are especially nice to watch when I’m getting treated on the table and looking over. And some of these world level guys Yeah. Are, are going through their, their sparring and stuff. But it seems so different from my previous experience of going to sort of looks like a, a doctor’s office or a medical office. Yeah. And your physical therapy consists of rubbing the wand with warmth on your injured knee, and then you go home and rest for two more weeks. Yeah. So how did this thing blow up into the cutting edge of sports performance and injury rehab kind of blended together?

Jonathan (00:09:23):
Uh, had a kind blow up? Or just the profession

Brad (00:09:25):
Itself? Just the whole industry. Just the

Jonathan (00:09:26):
Industry. Yeah. So, well, one, um, it’s, that’s like a, the image I think still think it’s not just you, but many people still have about physical therapy. When people are like, oh, what are you doing? I’m, and I tell ’em, my physical therapist, like, oh yeah. So like, they have this image, right? And that’s the image. You go into this business district, right. And you go into a building and they’ve got some PT tables, they maybe have a stationary bike, a treadmill, and they don’t have a weight over 10, 20 pounds, 20 if you’re lucky. Right? Yeah. And that’s it. It’s carpeted. There’s no weight rack, there’s no dumbbells, there’s no kettlebells, there’s no trap bars, there’s nothing. Right. Yeah. And so that is, I think, you know, sports medicine, I think probably started more so highly in pro sports, right? And then it kinda got filtered down, right?

Jonathan (00:10:04):
Yeah. Where the, the physical therapists are coming outta school, they’re like very sports minded, but maybe couldn’t get jobs in pro sports or college sports. Like, oh man, I wanna treat athletes. I wanna help these people. I wanna help everyday active individuals like yourself. Those that run marathons, those that are cyclists, those are track and field masters athletes, masters swimming athletes. So it’s kind of, I think becoming an extension where, you know, you come into a place like hopefully us, like Kime and you get this, what we would say is, you know, hopefully a world class, you know, professional sports experience where you were treated no differently than them. Mm-hmm <affirmative>. The exercise, the progressions and the load you’re put under is no different than them. It’s obviously catered specific to you. And then with our network being the network of surgeons that we have in our area that we, we coordinate with that our specialists, whether it’s in the Tommy John of the elbow for like our baseball pitchers. Mm-hmm. Whether it’s the ACL friend of your, your field sports, field sports athletes, um, we kind of know who in the area and who is elite in the best of what they do. Yeah. There’s a Dr. Sean Robinson out of Elk Grove moving to Folsom who, uh, he’s one of the a surgeons, uh, Dr. Hunter Green is also an, an a surgeon outta Citrus Heights Rancho here. Yeah. So like, these are, these are world class surgeons right here in the Sacramento area that we, uh, that we have a strong relationship with that we can, you know, send, you know, Johnny or Tommy to get his, to get his Tommy John. Tommy John done by. Yeah. Which is pretty cool. And then, um, you know, we’ve, we have reached within just your sports, me, GP doctors, your, all these other, you know, medical professions that when you come see us, you hopefully get a world class professional experience where it’s not just the physical therapy, but if we need to, you know, divert you somewhere else because you can just need, we need another look or eyes on something else we

Brad (00:11:44):
Can Yeah. So I guess you got people coming in off the street injured or perhaps coming in after their surgery or whatever, and found you like I did, I was going to physical therapy. This was up in Tahoe at PT Revolution. Yeah, yeah, yeah. Very similar to here, where Yeah, very in a gym with exercises and equipment everywhere. And finally they said, Brad, you, you quit coming here. You need to go get this Achilles worked on because this giant bone spurring going away. Yeah. Yeah. Then come back. And, uh, that’s when I got set up with you was after the surgery. So I guess, is that happening on, on both sides where you’re coming in post medical and then pre-medical hopefully with the decision of, do I really need surgery or can I get this right without it? Yeah,

Jonathan (00:12:28):
Absolutely. It is spot on. It’s a combination of both. It’s the youth athlete gets hurt on the weekend, or doll gets hurt on the weekend, mom or dad or someone tells ’em, oh, go to time. So then, you know, they, they schedule, they walk in the door and then, you know, we kind of assess and go from there. And then it’s obviously the opposite, the relationships with the surgeons. The osteopathic doctors, the pain med and rehabilitation doctors are like, okay, you have Achilles tendinitis, or you got hip replaced where you have knee STA surgery, here’s where you’re gonna go to physical therapy. And then, so yeah, it is both,

Brad (00:12:56):
It seems like still a remaining problem is that the first step we generally take in the general public is we go see the doctor. Yeah. Like the orthopedic surgeon. And that’s what happened when my, when my knee was hurting. Yeah. I went, I was directed to go straight into the orthopedic surgeon and I didn’t need any of that. I needed a sports-minded physical therapist. So can someone like call up and make an appointment and come in here and get insurance coverage or whatever to get assessed before they see a doctor? And is that like something that you’d recommend or is becoming a new standard as opposed to the old standard?

Jonathan (00:13:33):
Absolutely. So, I, God, I don’t know how recently, but within the last five or 10 years, physical therapy has become like direct access. So yes, you do not necessarily need to write away, go get a referral or a prescription, let’s say from a surgeon, a doctor, a GP to come to physical therapy. You can call us, walk right in the doors and we’ll take care of you. And then within a certain amount of time, according to like state laws and stuff, we do then have to like, uh, send our note, our medical note out to just continue care. Yeah. Need be kind of thing. So, yeah. Absolutely. And I recommend too that like wherever you are in the world, in the US, if you have a strong physical therapy, uh, sports medicine clinic, you’re here, go, go seek them out. Because we view ourselves much of the time as like, we’re kind of your quarterback. Right. Like I said, people come to us and let’s say they haven’t seen any other medical provider. Yeah. And we start to work with them, we’re like, oh, okay. Like, we’ve definitely taken this far, but there’s something just kinda like, not right quite yet, or like, we need to maybe go see a surgeon, or we may maybe need to go see a pm and r doctor about like an injection, A PRP or cortisone or something. Yeah. Yeah. Uh, to maybe bring down some payment a different way. Yeah.

Brad (00:14:34):
Mm. Well I wonder like is there a certain percentage of your clientele that are coming in just to get better or is pretty much everyone injured or complaining <laugh>?

Jonathan (00:14:46):
Yeah, so it probably depends on, I would say your, uh, your experience with us. Like I have some patients that have, I have treated for injuries and that they come back to see me and they’re on more of, let’s say like a performance, you know, basis where they’re asking for advice on training, on performance, on how do I set a PR at my marathon? Hey, how do I get stronger for this? Or, Hey, I’m a college soccer player, I’m gonna be home for winter break. Can you kind of help me with my off season training? And, and I want to improve in, in scenarios X, Y, and Z. So it’s both, right? It’s that they’ve had previous experience with me or with someone in our company. They come back for more help. Mm. Because of the value they see, we provide them. And then it’s, you know, other people that see me ’cause they broke something, they have something torn and then it kinda like turns into like end up pseudo performance training.

Jonathan (00:15:30):
Um, because like, oh my God, you’ve helped me so much. I wanna continue working with you. I trust you. Uh, like I have an older lady, she had a discectomy and we got done with her rehab. I was like, I was like, you’re good to go my friend. Like, I deem you healthy or fit. You don’t need me. She’s like, no, I don’t wanna stop. Yeah. She’s like, but Jonathan, I want to, I I trust you. Yeah. You know what I’ve been through and I don’t know if I trust someone else to like program the weight room for me because they don’t know my history. And so, yeah. She continues to see me from a performance perspective and I, you know, continue to provide her what she wants in her life, what she needs.

Brad (00:16:01):
So you mentioned that you were also studying strength and conditioning. Was that like personal interest that helped you with, you know, your resume or getting accepted into PT school?. That you, you brought that other other thing in and, and do a lot of PTs do that?

Jonathan (00:16:17):
That’s a great question. So I think it started as personal interest and then it became the realization of Oh wow. Like, you know, you kind of mentioned earlier in the conversation like, you know, how did sports medicine come about? And you know, you’d only ever been in physical therapy facilities where like, you know, not looking like ours a big weight room kind of thing. Yeah. Well I started to realize and learn at a young age, man, like load in load meaning the weight is what moves the needle, right? That’s what causes the adaptation, the stress. Right. You talk about like sauna, as you talk about cold therapy, you talk about fasting, right. Those are all stressors on the body in some way, shape, or form that acutely have a really positive impact on the body for like health lifelong jelly. Yeah. Just like weightlifting does.

Jonathan (00:16:58):
Mm. Right. So it became a pa it was kind of the interest of first, oh I want to, you know, I want to get stronger. I wanna have bigger biceps, you know, bigger chest, or I wanna be able to, you know, run faster down the soccer field. And then it was, it turned into a realization, oh wow. Like this is really what sports medicine is to a large degree is manipulating load, applying load at certain times and certain amounts in certain ways to then hopefully facilitate the recovery or the increased performance of our patients or athletes.

Brad (00:17:23):
Speaking of load, man, when I came in here, I think it was did they send me two weeks after surgery? I think there was some time it was really short. Maybe it was one week. Yeah. And I came in and I’m like, already trying to get the award for the most woosey client that you’ve ever had. ’cause I was like, so anyway, Jonathan, it still feels a little hot around here in the morning. And then sometimes it changes up to here and you’re like, go get a 45 pound kettlebell, go sit on the thing. I want you to put the kettlebell here. <laugh>, I want you to do two sets of 20. And so I do like one set. I remember after surgery my first thing and I’m doing the set and then I come back and go, yeah, well it is kind of feeling a shooting little, it’s maybe dull and maybe shooting.

Brad (00:18:03):
Like I just was so worried that I was messing myself up because we’ve been so programmed over time. Yeah. To be like, well I had a little procedure, now I’m gonna rest six weeks and cross my fingers and hope when I come back and starting with my sport that everything’s gonna be fine. Which is now we can realize what a ridiculous notion that it is. Mm-hmm <affirmative>. But it’s still a lot of people think that way. I finally got my buddy Dr. Steven in to Kime. I’m like, call up Kime. Call up Kime. ’cause he had a hot side of his foot. Oh yeah. It was so bad that he couldn’t run for months and he got a MRI and everything was fine. Yeah. And so it’s like, well, what’s going on this hotspot you could actually see, but there was nothing to do. And he was waiting, waiting, waiting, hanging out.

Brad (00:18:43):
Then he finally came in and had an assessment like, oh, by the way, your ankle mobility sucks and you need to do this, this, and this. So it was amazing awakening for me that like, here’s a surgically repaired Achilles tendon, which is so delicate and sensitive. Anyway, and I’m coming in here and I’m, I’m getting to work every time. This guy had no emotion, no like, you know, no empathy from my little complaints. And then the next week I’d come back with a slightly varied complaint and he’s like, alright, kettlebell on the knee, two more sets, then we’re going to the pogo pops and all the other stuff. Yeah. Yeah. So it, it’s, it’s pretty wild how this has changed. And I dunno, gimme like the, the scoop in major sports as well as everyday clientele. How, how things are different now and how it’s all about load and strengthening your way to

Jonathan (00:19:30):
Yeah. So, um, different. So like from you’re asking like, how do, how

Brad (00:19:35):
Do we, I mean, where does rest come in now? And deactivity Yeah. Yeah. Versus is there a way for almost everything to come in here and do something about it For sure. Instead of sit and wait?

Jonathan (00:19:44):
Well, I would say like, the short answer can always be, there’s always something you can do in some way, shape or form to probably move the needle forward. And so, um, like a good example I would say is right now, like, uh, I have a youth athlete who, who had an injury of the hip and then there was a healing time where they weren’t allowed to do anything ’cause a tissue is mm-hmm <affirmative>. You know, had to, had to heal their safety precautions around it sometimes. Right? Like with, let’s say some of our shoulder surgeries, our Achilles operations and our big surgeries, there is a time where okay, like doing nothing on that joint specifically is needed. Protect the, protect the graft, protect the joint a little bit. But that doesn’t mean like, you know, you couldn’t, let’s say if you had an Achilles operation, you couldn’t get on the skier.

Jonathan (00:20:20):
Right. And like mm-hmm <affirmative>. Get the heart rate up. Right. I always find it so interesting one that like, when you think about the body, you think about what drives healing. Right. Well, blood, right blood is what carries most of those healing factors. And anytime we exercise, we increase blood. Right. It’s something like, I think 85 to 90% of your blood volume is driven to your muscles and your, and your heart. And while you’re doing intense exercise and the rest is kind of just going to the, you know, the vital, vital organs, the kidney, the liver, the intestines, just to kind of keep it alive, but Right. A majority of your blood goes to your body with heavy, intense exercise. Mm-hmm. So if as we exercise more intensely and as we exercise, more blood gets to our muscle or to our joint area at least, and we need blood for healing mm-hmm.

Jonathan (00:21:01):
Right. To repair said things that have been either hurt on our own or via the surgery. Well man, you kinda like think about those two just simple things. Right? Well, like there’s always something to do then, right? Right. If that’s, like, you know, at the, at the end of the day Right. Blood and then moving blood to a certain area is what helps us heal. Like we can always do something. Right. So circling back, my girl that’s had this hip issue, um, she can’t really do a lot on it right now, but being a soccer player, knowing she wants to get back to something that’s very cardiovascularly taxing. Yeah. Like, we’re still doing, you know, skier stuff, you know, intervals Yeah. Trying to keep, get her heart rate up. Hopefully that, so she, which we can do more stuff and she gets back to running, playing soccer. She’s not as, let’s say, deconditioning as as she as she previously was. Yeah. Yeah.

Brad (00:21:45):
Are there some easy rules of thumb? Like I think you told me once, work around the pain. Yeah. So like don’t introduce additional pain to the area, but do stuff that’s somewhat tolerable, even though I can still complain about something, but it’s not making it worse. But I’m, I’m getting all this, uh, load and things that are gonna eventually help.

Jonathan (00:22:04):
Yeah. So pain, pain, this is where, this is where I make my money right here in center. Like, so it’s, it’s not

Brad (00:22:10):
Easy pay attention. People start taking notes right now.

Jonathan (00:22:12):
<laugh>. Yeah. It is not as easy as like, uh, ’cause it’s a case by case thing sometimes with pain. So first I would say that pain is not synonymous with damage first off. Right. And just like an easy analogy I always tell patients is when you were a kid, sometimes you fell, you scraped elbow up. Yeah. It looked really, really bad. Yeah. But it does wasn’t necessarily all that painful. Yeah. Versus if you get a paper cut that doesn’t look so bad, but you’re like, oh wow, that really stings and that is very uncomfortable kind of thing. Yeah. Right. And so that’s like a simple analogy I use for patients. And so if we know pain is not synonymous with causing damage, right? In your case it was Achilles base. Well, data research tells us, you know, that loading it to a certain amount and keeping pain below a three is actually potentially gonna be better because we’re making a change in the tissue, we’re getting it to adapt and we know we’re not causing damage.

Jonathan (00:22:59):
Yeah. It’s that you have to, I don’t know about sell it, but communicate it in the way to the patient where you can hopefully strike a belief system or, uh, a trust and understand that they will trust you to do that with them. Right. Yeah. When you came in that first day and I told you, okay, we’re gonna load this thing, we’re gonna put load on it, your eyes are like, whoa, <laugh> like load. Like, are I gonna rip my achilles or rip this? I’m like, no, it’s okay. Let me kind of talk you through it.

Brad (00:23:23):
And you know, everything that I complained about was three or below the whole time. Mm-hmm <affirmative>. Okay. Maybe I backslide a couple times where, you know, like this week you had me doing the calf rehab and Yeah, now they’re sore. So I know I’m gonna back off from the protocol, but like, um, if you stay in that three or below, it’s such a great, uh, general insight for, for anything that is in the ache and pain category. Yeah. You know, like my mom’s 88. Yeah. She’s in great shape. She walks, she’s active and she has low back pain a lot. So she can do her, uh, uh, medicine ball, exercise ball stretches and this that might not feel super comfortable, but there are 3, 2, 3, 3, 3, 4, whoops, two, three. And um, then you’re kind of doing yourself a solid rather than sitting around looking at your watch. When the hell am I gonna feel a hundred percent better? Which is in my age group. I can promise you people never, you know, it’s never gonna be like, I’m never gonna be perfect, but I am can always cover my weaknesses and, you know, try to get, try to get more functional in certain ways that I’m lacking.

Jonathan (00:24:30):
Yeah. No, like I would say as like a, just a, a general, like if you can continue to do things on an injury and the pain is below a three, you’re probably okay. Right. Or you just work around it. Right. There’s always something you can do. You know, if you hurt your right knee, well, we can still work the left leg, right? Yeah. That extra blood flow, lower body is still gonna help us. Yeah. And we know sometimes that work in the opposite unaffected side is actually gonna help the affected side. So yes, there’s always something you can do. The problem becomes is, is right. You, you get injured and then you get pain and then, and and naturally everyone goes, okay, I’m gonna rest. They rest 2, 3, 4 weeks, pain comes down like, oh, no pain anymore, I’m gonna go back to my activity. Yeah. And so let’s just say their activity was running and they normally run three miles. Yeah. Well the only thing that happened from the rest and then pain coming down Yeah. Was that your pain came down. Yeah. But as far as your tissue tolerance, let’s say your strength, your connective tissue tolerance, your spring, all that has now come from here to here. Right. So

Brad (00:25:24):
Do we think we’re detrained

Jonathan (00:25:25):
Exactly. Just detrained, right? Yeah. Like I think there’s like the amount of muscle mass you lose. I think if you look at like studies of people that are sitting in hospital beds because of injuries there just don’t move. Yeah. It is a substantial amount very fast. How about

Brad (00:25:37):
The tour guys? Have you seen that?

Jonathan (00:25:38):
Oh yeah. Like I think right, they like the guys that go space, the tour guys, you know, that much bone muscle or mineral density lo loss that they have just from being on the bike, not loading. Yeah.

Brad (00:25:47):
I mean this is frightening.The research I’m talking about is this, the tours three weeks. Yeah. And when these guys are racing and, and giving it their all Yeah. They’re pretty much sitting on a bike Yeah. Or sitting on a bus seat or laying in bed and so they’re actually not doing much walking around or anything. Yeah. That’s weight bearing. Yeah. And at the end of the tour, their, their bone density has dropped significant.

Jonathan (00:26:09):
Do

Brad (00:26:09):
You know what, it’s some shocking thing. Like how could that happen three weeks? It’s crazy.

Jonathan (00:26:13):
It is. It’s kinda like I use the analogy of school, right? It’s, it’s really easy to like, let’s say have an A in a class and get a D on a test. Your A goes from A, you know, A to a C minus right away, but to get from that C minus back to that A over the course of the semester or the, the class period, like that’s a lot of effort consistently week after week after week after week. So it’s, it is the body detrained super fast. Mm-hmm. And then it’s, you know, consistency all the time that bring it back to a level which you can perform what you wanna do.

Brad (00:26:40):
So someone who does have like an overuse injury as an endurance athlete or maybe an acute, you know, playing, playing your pickup basketball and you whack something, um, first thing they should probably do is come see an expert that’s sports minded. But yeah. Beyond that, so that, are there some guidelines to follow for the, the amateur enthusiast that wants to do right by their body and not, not get things worse, but how, how do you process through these things?

Jonathan (00:27:07):
Yeah. So, um, so there’s two questions kinda you asked about acute I think was one. And what and what was the other,

Brad (00:27:12):
You know, like an overuse injury? Oh yeah. Okay.

Jonathan (00:27:14):
Yeah. Right. So like if, let’s say, if it’s, if it’s acute, right? Again, pain is your guide kind of early on, right? Most people are looking at pain so we can go back, right? If it’s, you know, if it’s pain that’s less than less than a three. Yeah. You know, easy stationary bike is usually like one of my go-tos, right? Mm-hmm <affirmative>. Whether it’s the knee, the hip, the ankle. If we have swelling in any of those joints or we have some amount of pain, what we know, just gentle motion generally helps pain, right? And while we’re doing that gentle motion, whether it’s, you know, mobility drills or stretching or easy cycling on a stationary bike, as long as pain doesn’t go above a three, you’re probably not doing yourself too much harm, I think is like a general rule of thumb in terms of the overuse things.

Jonathan (00:27:52):
That’s one where it’s like, okay, like why did you get to this overuse, you know, issue. Was it, you know, you, you upped your train volume too fast too soon? Did you change your mechanics and maybe how you run or your position on the bike that led to forces being stressed a little differently across the joints? And so it’s, it’s not quite as simple as the overuse things because there’s a symptom, but below that symptom, there’s potentially all these kind of causes that can be, you know, sometimes very quick fixes for what you, what you’re now dealing with and what you see as pain at the moment.

Brad (00:28:22):
Yeah. Yeah. I assume that one of the major causes would be just poor overall functional fitness where you ask some cyclist to go down and hold a deep squat and they fall back on their butt or, or things like that.

Jonathan (00:28:38):
Yeah. So it can be many things. It, it again depends on the sport, right? Mm-hmm. Like, you know, I think we talk about longevity, right? We there, we know there’s like probably three physical, you know, attributes that people live a long time that have, right? Big cardio respiratory system, big VO2 max strong, lower legs, big lower leg mass, and then big grip strength, right? Mm-hmm <affirmative>. So whatever sport ath athletics you could participate in recreationally, you probably have one to two of the three, right? So like, you know, the guys that are, you know, let’s say bodybuilders or power lifters really strong, right? Lift a lot of weight, pound for pound and probably pretty good grip strength, cardio respiratory system, probably not the strongest mm-hmm <affirmative>. Right? Our cyclists are endurance athletes, our runners really good. The O2 max for respiratory system. Um, maybe not the greatest weight to body ratio strength in terms of let’s say a deadlift, a trap bar split squat, that kind of thing. Yeah.

Brad (00:29:27):
Yeah. So if you were, if you were going purely for a longevity top score, what kind of things do you think are the most important?

Jonathan (00:29:36):
Ooh, that is, that’s a good question. So, you know, cover the buckets, you know, do something that fits all that fits all three, so Right. Your esistance training is probably number one, right? We just know across all literature, it’s kind of like if someone could, I always tell people someone could bottle resistance training up in a pill, you’d be a trillionaire, right? We could all take every day. Right. And you would be done working immediately. Yeah. Like that would change world forever. So resistance training, right? It just has so many positive effects on the entire body. And so when we think about the big three, right? Big, strong lower legs, VO 2 max and, and grip strength, it covers two of the three mm-hmm <affirmative>. Covers the, you know, the helping build big, strong lower legs, and it helps the grip strength. And then, you know, so if you do some type of resistance training and heavy again, is is relative, right?

Jonathan (00:30:16):
I have 80 year olds that I treat all the time. You know, they squat 20 pound med balls for them. That’s really heavy Yeah. For you and I Right? That’s like, ah, you know, I could probably do a hundred of those, right? Yeah. And then on the other side of the spectrum, right, is your cardio respiratory fitness. So probably something really, really fast sprinting, right? Sprinting, we know that as you age. Yeah. Type two muscle fibers, your power goes really fast. Yeah. So if people trip and fall, they can’t catch themselves. Yeah. So something that’s, you know, sprinting or something plyometric right. Where you’re um, you’re trying to create force, uh, really quickly within the body. Yeah. Yeah. So I would say those are right. You know, your, your buckets do something heavy, slow in the weight room, do something really fast, whether it’s in the weight room or sprinting. And then, you know, probably everyone’s like this zone two kind of thing. You know, something long and slow. Right? Where your heartbeat fills all the way contracts all the way. Yeah. I

Brad (00:31:04):
Appreciate how you mentioned sprinting right at the top there because cardio respiratory fitness is not only developed with steady state long distance endurance training. And I think with all this hype around zone two Yeah. And people putting these checkpoints up, like for longevity, you need this, this, and this. I think we’ve kind of lost sight of the fact that if you do a resistance training session where you’re going in and doing the seven machines, you know, with a couple sets and then, and going out, you’re getting a cardiovascular workout during the whole thing. You’re building your cardio respiratory fitness with any activity that you do. So, as a longtime endurance athlete talking to another, we’re gonna talk about that shortly. But that’s great that we have the capability for these competitive circumstances where you’re going and, and pegging your heart rate up high and, and giving them the most up, you know, trying to get a VO two max type of effort.

Brad (00:31:57):
Yeah. But for a lot of people, you know, you, you play, you play basketball for an hour, you stand around a lot, you sit on the bench, you come back, you’re still getting an excellent cardiovascular training session mm-hmm <affirmative>. For the entire experience. Yep. It does not necessarily have to be steady state. Now I also think that we don’t move enough in general everyday life. So a huge void is not necessarily the number of hours that you’re pegging at zone two on your stationary bike, but the fact that you’re sitting on your butt all the time working on your computer and not even taking two to five minute walks on the hour, which would greatly improve your health, longevity and everything else.

Jonathan (00:32:39):
Yeah. Yeah. I, I mean, I I totally agree, right? Yeah. It’s, you know, the analogy I always tell people is that whenever I see endurance athletes in the clinic, it’s kinda like they don’t have a trainer. They’re generally not doing enough stuff that’s really fast and hard and they’re not going slow enough. Everyone kinda lives right in the middle where they’re like they go hard, but the, and they think that’s what drives it forward, but it’s not hard enough to make an adaptation. Yeah. Right. And then they also don’t go slow enough to make that adaptation. Like the extremes seem to be where the, where everything that raises the ceiling as opposed if you just always live in the middle. Right. If we always just do, if we always just do three sets of 10 in the weight room Yeah. We plateau at some point.

Jonathan (00:33:19):
Yeah. If you always go for your, you know, your run and let’s say, you know, you do a seven 30 pace or an eight minute pace, you know, for a lot of people that’s kinda like not super, super fast. Yeah. But that’s relatively fast for them. Yeah. Well that’s not really gonna help you run that six minute mile consistently. Yeah. Right. Um, you know, three, just like three sets of 10 isn’t gonna help you, you know, deadlift more weights, you plateau. Right. You gotta, yeah. You gotta do something more intense. Right? Right. So do some sprints, uh, lift heavier weight for less reps, you know, four sets of five. Yeah. You know, three sets of five.

Brad (00:33:49):
So when you were at AOS around these very top level athletes, and I also want you to talk about your experience with the Olympic track and field athletes including gold medal as Andre Degra from Canada. Yeah. Who was training down at the same facility as you, uh, or that was Altus, that was a different place. Same place. Okay. Ti

Jonathan (00:34:05):
Sous kinda was in using the EXOS.

Brad (00:34:08):
So, so tell me about these facilities that are now kind of the ultimate cutting edge and then also, uh, what the athletes are like and what’s their, you know, overall training pattern and lifestyle that you see attributes.

Jonathan (00:34:22):
So, so cutting edge, I guess like we define cutting edge. So like, like you don’t actually need a lot of fancy equipment. Now, the facilities I got to, I had the pleasure of like being able that work in and, and be around, like they did have some really cool fancy equipment, but it wasn’t necessarily like, you know, it looks really clean. It’s really kept really well kept all the time. So that makes it look like, oh my God, this is a great gym ever. But I think what makes the facility like the minds in that, in that facility, like who the coaches, who the PTs who, who are the people running you and then the culture. Yeah. Right. So it’s in, in the culture usually in the greatest facilities is, you know, a culture of excellence. Does everyone walk in the door?

Jonathan (00:34:59):
Does the entire team, the physical therapist, nutritionists the, uh, the strength staff, uh, they all walk in and do they want excellence outta themselves or they want excellence for their athletes, right? Yeah. So for me, that’s what’s, that’s what makes, that’s what makes a facility world class. It doesn’t necessarily have to be like the prettiest gym. The biggest gym, as long as you have the enough of the right things. Yeah. And you have minds that strive for excellence, that want the best, you have athletes that also want that excellence. Yeah. Now you’ve got a recipe for like, you know, gold medals. Yeah.

Brad (00:35:30):
That’s cool. Instead of the sizzle. Yeah. You’re going for the heart of it, like the, uh, uh, you know, crunk gym in Detroit Yeah. Where Thomas Hearns and many other fighters came out of. It was, it was a, it was a shit hole. Yeah. But it was a place to get to work and, and build the greatest fighters in the world and, and make ’em tough. Absolutely. Now we have a little bit of a balance of a cooler environment to train in that’s amenable and clean and all that. That’s great. But I appreciate you putting that at the top. And so for you, like when, when you come to work, I see your level of focus and also perhaps, you know, tending to more than one person over the, over the long timeframe. Like we have our individual engagement and hands on and then I’m sent off to the kettlebells to go do my reps and come back and complain. But you got a lot going on all day in both a hands-on mode and also in your head when you’re looking up to show me what that pizan pain and all that. Yeah. So like what does it mean to you to come and bring your a game every day? Oh,

Jonathan (00:36:30):
That’s a good question. Bring, what does it come to mean? Bring day game every day? Um, hopefully providing value that the patient expects mm-hmm <affirmative>. Right? And, and if I can provide value that the patient expects, and hopefully that value is, you know, usually most people that come to physical therapy, it’s usually pain related, right? So it’s, it’s bringing pain down. But, you know, so first off, it would be like, do I provide value that the patient expects and can I exceed it too? Right? And so exceeding it for me would be, I help them in a performance way, in some way, shape or form, right? Yeah. You came to me, you know, a couple weeks ago, like, Jonathan, this attorney, I was like, okay, cool, well, let’s deal with it, but I’m hoping that the things I actually give you, not just help with your pain, but we talked about you, right?

Jonathan (00:37:09):
The events you do, you’re a high jumper, and then you run like the four, the 400. Those are, you know, to an extent very different events. You know, high jump is very explosive. And the 400 is more like, you know, I’d say cardio respiratory base, right? Yeah. But the, the need to be, I would say, you know, have a strong musculo tendons unit together and be, and be stiff, um, is beneficial for both, right? So it’s, I can use exercise and I hopefully provided value that you expected getting you outta pain, but then hopefully the exercise I use to get you outta pain also increased your performance on the backend.

Brad (00:37:42):
So you mentioned stiff and you wanna see those tendon stiff and able to handle a, a lot of load. Um, can you, can you tell us about those discussions we’ve had where Yeah, I think you described it like, the reason I came in here beat up with, with a pretty serious injury was like my muscles were too strong for my tendons, which weren’t stiff and and rigid enough yet because my training for my whole life has been endurance and nothing with heavy load. And so we need to strike this balance between like muscle strength and tendon rigidity or stiffness. Yeah.

Jonathan (00:38:16):
Yeah. So there seems to be potentially like a bit of a balance between, you know, muscle strength and how much force the muscle can produce and it can handle and, and the type of stiffness that the tendon has, right? So, you know, let’s just say, let’s just say, right, we’re a cyclist and, and, and all we do is, you know, it’s a very cyclical action, right? And so they typically don’t do a lot of weight training, but you know, I don’t know anyone that’s seen a cyclist that doesn’t have pretty robust thighs, right? Yeah. So a common thing you see in cycling is right, you get that that tendonitis or the quad tendon. The patella tendon, right? And so they haven’t done a lot of heavy and slow, heavy and slow in the weight training, right? So the heavy and slow is essentially what is gonna make the tendon stiffer.

Jonathan (00:38:55):
You know, if we wanna get in the cellular part of it, it’s, there are these, these crosslinks within a tendon fiber that when you do heavy and slow resistance training, that puts down more clock crosslinks. So right at a, at a physiologic cellular level, that is what makes a tendon stiffer like it’s self, right? Mm-hmm <affirmative>. And so if you have a muscle that’s really strong, always pulling on a tendon that doesn’t have, let’s say at a cellular level, a lot of cross links, a lot of stiffness to it. Yeah. Right? You can get this overuse, tendonitis, inflammatory issue, and then it could be, you know, chronic tendinosis where you get like degeneration of tendon. Mm-hmm. Um, and so again, right, there’s this balance, they have big strong muscles that hand that can create decent amount of force and then tendons that haven’t been loaded in a way that puts down more cross links.

Jonathan (00:39:37):
Yeah. And, and less and less so. And then on the flip side, right, we’ve got like, let’s say, you know, our basketball players maybe jumping up and down all the time, our track athletes, you know, on this hard surface, you know, whether you’re asking your tendon to create a lot of force and get stiff Yeah. Really quickly. Yeah. Right. Well, they don’t do enough strength training for their muscle to handle the jerk that the tendon gives back on the muscle to an extent. Yeah. Right? You get these muscle pulls, these calf pulls, these, these hand string strains, right? So there does seem to be a bit of like, you know, give and take in terms of how strong the muscle is and how much force it can handle back from the tendon, and then how stiff the tendon is and how much jerk or pull it can handle from the muscle over and over.

Brad (00:40:21):
That’s really cool to look at it that way. And so I guess you’re looking at your weakest link when you come up lame with a hammy, or in my case, my calf muscles and hamstring felt great. Yeah. And then I was growing this bone spur on my heel, which didn’t seem, seem right. Talk about how, how the bone spurs developed in the body.

Jonathan (00:40:42):
Oh, that is, that is super nuance. So I never know if I’m the best person to ask, but like, so right in, in kids it’s called like seavers ORs severs, and then, and then in adults they just kind of call like, right, it’s a haglins deformity is like the, the, the fancy name for it. And then just most people, the lay person knows it as, right. It’s a bone spurs it, it’s extra bone calcification. Hmm. So I think the, the easiest way to boil it down is that there’s a law called Wolf’s Law, and it’s really interesting and the fact that everything that we all do in our daily life affects our body physically. So let’s just say cyclists is an easy example, right? There’s on the bike all the time. So they’re not putting a lot of load stress through their hips, through their low back, um, in any way, shape or form. So if you look at the bone density of a cyclist, their femoral neck bone density and their lower back bone density, it’s quite low compared to the average person. Right. There’s no stress going through the bone. Yeah. So the, so the body doesn’t thinks and doesn’t tell it to basically put more bone in that area. Right. So if you look at, let’s say, you know,

Brad (00:41:50):
So Wolf Law is like the bone needs to be stimulated in order to get stronger.

Jonathan (00:41:54):
Exactly. Right? Yeah. And so like, and a good example is let’s say in hockey and soccer players, they develop some hip issues where they get extra bone growth or bone spurs as we call it, right? Yeah. And it’s called FAI, and that is potentially, you know, an overuse, but an adaptive thing because they’re putting so much stress as, and force through, through the, the pelvis, the acetabular, the femoral neck, that extra bone gets laid down because the brain and the body like, oh wow, we’re putting a lot of force there all the time. Yeah. We need to like maybe like protect this area and create more support here. So it’s laying bone down. So it’s kind of like an adaptation for the sport, but in the long run in the health of the joint, it can have negative implications just like cycling, you know, the body not putting bone down there is, it thinks it doesn’t need to, but for longevity and health of that joint, that’s not a very good thing either. Yeah. Yeah. So circling back to kind of you, yeah. So these, these bone, this extra bone in these areas is probably just due to stress, extra load, right? Yeah. You know, you giving what you do, you put a lot of stress through your achilles and your ankles based off the sports you participate in. And so, um, it’s mostly probably due to that essentially just stress

Brad (00:43:01):
Concentrated in the area. Yeah. I mean was it was like if you’re watching, maybe you can see my, my heel actually it looks pretty good now, but I, I guess you told me like the, the tendons kept pulling away and then the bone fills in the gap where, I’m not, you know, I’m not strong and rigid enough to handle that pulling on when I jump in, jump in the air or something. Yeah. Right. And so it’s like filling, you have that it’s not supposed to as opposed to getting strong bone density when you’re doing nice controlled strength training or appropriate physical loading where you’re getting a nice strong femur, whatever inside your body. Yeah,

Jonathan (00:43:36):
Yeah. No, you, you hit it dead on. It’s, it’s again, a balance of, you know, the tendon connects to the bone and there’s this blending of collagen and periosteum. Yeah. And you can get avulsions right, where the, the tendon or the muscle pulls off of the bone and pulls a little bit of bone with it. Right. That would tell you that the bone couldn’t handle the force of the tendon and the muscles force that pulled on it. Yeah.

Brad (00:43:57):
You’re talking about over time too. Yeah. This is not like an acute injury where you get whacked in a car wreck, but like the avulsion is coming from day after day after day, beating yourself up feeling those, those pain warnings. Yep. And then, you know, in my case, warming up and feeling better, thinking I was fine. Yeah. But then over the next 24, 48, 72 hours, I’m like filling in bone where it’s not supposed to go. I suppose it’s happening.

Jonathan (00:44:20):
Yeah.But to potentially Right. We, can really go down the weeds, but you know, very simply Yeah. It’s, it’s potentially an overuse thing where, you know, bone or muscle and tendon pull on the bone over and over and over and over. And for some reason that bone is not able to handle that load, that stress Yeah. Of the force on that. Yeah. And so it, it pops right, you, you feel it pop or you get like a, what’s called a stress reaction, which is what would be prior to an avulsion and, you know, you get pain there and it’s kind of like a hot spot on like an MRI or an x-ray.

Brad (00:44:50):
Let’s talk about pain for a moment. I think I was listening to a recent podcast where the conversation was like, you know, pain’s entirely in the brain and your muscle doesn’t really hurt. It’s only that your brain sending a pain signal. Something like that. Yeah. It’s kind of a thoughtful way to, to look at it. Obviously, everything’s happening in the brain, but maybe you can give your, uh, take on, because earlier you said pain doesn’t necessarily mean injury. Yeah. Or something like that.

Brad (00:45:24):
What’s going on when we have our aches and pains every day?

Jonathan (00:45:26):
Oh, that’s such a, that’s a big question. Ah, yeah. Yeah. I am, I am.

Brad (00:45:30):
It’s it’s pain 101 college class. Yeah. Yeah.

Jonathan (00:45:33):
I’m no by no means the expert in this whatsoever. So pain can be, can come from many, many ways.

Brad (00:45:41):
When people say that this is what I want to call you out on, when they say they’re not an expert, they have vast knowledge of the subject and they know so much that a lot of times you’re calling yourself not an expert ’cause you’ve had so much exposure to it, as opposed to, I think we need to do a little commercial here for like a social media education awareness, public service announcement. ’cause when you hear people spouting on 17 different subjects and they’re very emphatic and like precise with like, this is the deal with diet. What you gotta do is you have to start with an oatmeal bowl, uh, with 17 grams of protein every day because your body needs 17 to 27 grams. It’s like, really? Dude, you’re full of shit. You don’t know much, but you’re really precise and focused and you sound convincing.

Brad (00:46:24):
But the smart people I talk to, they always couch stuff with like, well, I’m not an expert. Or like, Dom dagostino, one of the world’s leading experts on the ketogenic diet. He said, I don’t know. So many times in our interview I said, dude, it sounds like, you know, you said this so many times. Like, what’s up with that? I finally, and he goes, be very careful with people in the scientific community who speak in absolutes. Because the more you learn, the more you understand how, how much you, you don’t know. So now we, we teed him up as the non-expert in pain and we’ll get some insights.

Jonathan (00:47:00):
So in terms of like sports orthopedic pain, right? It’s um, it, yeah, it can be, oh, I got distracted. What, what was the original question around pain? Yeah.

Brad (00:47:09):
Like what is, what is what is really happening when you have these signals and aches and pains happening that the brain is, uh, you know, sending a message to Yeah. I guess protect you or, and that sort of thing. Yes. That’s what we hear a

Jonathan (00:47:22):
Lot. Yeah. So, um, right. There are many reasons people could have pain, right? If you break a leg, that’s obviously, we know why we had pain, right? There’s a physical structure that has been compromised in some way, shape, or form, or like a tear ligament, right? So I think those are fairly obvious, right? Yeah. So it’s, it’s really you’re gonna wanna understand what the mechanism was and maybe why you had pain, right? So let’s just say, you know, for example, uh, people that, let’s say, let’s see, you haven’t done anything in a long time. They’re like, I want to be a runner. Okay, love that. Let’s, let’s go get active. Let’s go exercise. Right? They go run. They say, I’m gonna do three miles. I don’t know why three miles, three miles is like in running. You ever notice, like that’s like the distance every casual runner person getting into running. I was like, I’m gonna run three miles. I ran three miles today. I’m gonna run three miles tomorrow, kind of thing.

Brad (00:48:10):
That’s probably the most I should ever recommend anybody run, by the way. Anyway, go ahead. Yeah, <laugh>. So,

Jonathan (00:48:15):
So let’s say they decided to become a runner and they go for a run, right? And they’ve never run, you know, three miles in their life. And so then, you know, the next day they’re like, oh my gosh, I’m sore. But like for the new person that knew to exercise or some form of exercise, they might say, that is painful. Yeah. I’m like, okay, well, like, is that muscle soreness pain, right? Like, ’cause soreness, soreness, soreness, pain is like, that’s significant soreness. And, you know, we can get into some of the, like, the details around that. Yeah. In terms of like, soreness we think is, you know, actually a very cellular thing. Actually, not so much a damaged thing from a healthy perspective. Maybe that’s a way to frame it. So if you were to go, let’s say lift heavier, I were to weight train and maybe I have a weight train in a month, and I’m like, I’m gonna do split squats and a bunch of lower body stuff, and I wake up the next day, I’m like, oh my god, my hamstrings, my butt.

Jonathan (00:49:03):
Yeah. I, I can’t walk. Right? Yeah. Like, I don’t say that’s pain. I’m like, okay, that’s soreness uhhuh <affirmative>. But that soreness isn’t because I’ve now shredded my muscles. There’s, there’s, you know, it’s not exactly, it’s not as simple as saying, my muscles have been damaged, now I gotta eat protein. It’s, well, there’s a lot of cellular reactions that go on in this process. And because of the ions and things that are required for these cellular reactions, those have a lingering effect on the body 24 or 48 hours later Yeah. That we perceive as pain. Yeah. Or, or, or soreness. Yeah. Versus, you know, someone that, you know, broke a leg.

Brad (00:49:39):
So is it like inflammation and, uh, fatigue from the actual muscle fibers that’s making you feel super sore and stiff the next day

Jonathan (00:49:50):
In terms of like, so you’re asking in terms of someone who’s healthy when they feel sore down Yeah. Did you

Brad (00:49:54):
Down split squats and you weren’t used to it? Yeah.

Jonathan (00:49:55):
So in, in terms of someone healthy, you’re asking the next day, okay, what does their soreness due to here? What does that like perceived pain due to? Yeah. Right. It’s, it’s, well, I would say simply one, it’s you just ask yourself, your body was not prepared to do that exercise for that amount of time, for that many reps, for that much load, for that cadence, for that speed, that intensity, right. It just was not prepared mm-hmm <affirmative>. And we know it’s not prepared because you feel soreness maybe for three, four days. Yeah. Right? And, and so then right, you’re asking, okay, what does the soreness cause? What is the cause of soreness? Is I think what we’re getting down to,

Brad (00:50:27):
Or it was what represent too. Yeah.

Jonathan (00:50:29):
Well, it represents some amount of physiologic, uh, fatigue. Yeah. Right. And that, okay, your body was stress, a good stress acute, a good stress acutely. We now need to recover and, and listen to our body, you know, before we’re ready to, you know, do something again or do something intensely again.

Brad (00:50:46):
Yeah. Um, is it true like when you have like extreme tightness and soreness, that if you were put under anesthesia, you would actually be super flexible? Like you heard that one too,

Jonathan (00:50:58):
That Yeah, that is,

Brad (00:50:58):
So that’s, it’s not really a tight muscle. It’s the brain saying, I’m tightening your muscle up, fool. ’cause you, I don’t want you to Yeah. Rip it apart.

Jonathan (00:51:06):
So that is such a good question. So it’s so interesting. So I found it like, as I’ve practiced as a clinician more and more, um, I think a back is a good example. So right in our low back, we have these vertebrae, we have nerves that come out either side. Well, those, those nerves and those nerve roots, they control how, um, our lower body muscles feel and then actually control our lower body muscles, contractions. So I see people in here that I’ve been working with for a long time, and let’s say they lay on their back on the table and they bring their leg up to 90 degrees. Yeah. Perfectly. Like you’re a perfect example. Mm-hmm <affirmative>. Perfect 90 degrees, and then they go off, they’re doing their exercises and you know, a couple weeks later they’re like, oh, Jonathan, I hurt my back. Right. I’m like, okay, well let’s evaluate it.

Jonathan (00:51:42):
If I ask them to do a straight leg raise, and I know healthy them gets to 90 degrees and they stop at 55 uhhuh and they’re like, oh, that’s really tight uhhuh. Or like, that’s painful. Yeah. Well, is it because they don’t have the actual physiologic length or tissue mobility to get to 90 degrees? Or is it that they’re getting a signal from their brain that’s from their back that is now saying, Hey, don’t move this far because we could cause damage or because that hurts, or Yeah. We have so much fatigue and perceptions and feelings of tightness Yeah. That you no longer can move. Yeah. You know, in the original range of motion you had.

Brad (00:52:23):
Right. So the answer is they, they, they have the 90 and then they are

Jonathan (00:52:29):
Stressed

Brad (00:52:29):
Getting limited Yeah. By the brain. Yeah,

Jonathan (00:52:32):
I guess. Yeah. And they’re getting limited by the brain and, you know, that’d be maybe centrally and then peripherally it would be due to the stress or the pain of a local area. Yeah. Whether it was the pain of the local back or you sprinted, you know, you did, you did, you know, repeat, repeat VO2 max stuff the day before. Yeah. And you, you know, you came in, you’re like, your hamstrings were shot, right? Yeah. But before the workout, you’re totally fine.

Brad (00:52:54):
Okay. So now what do we do with the information? Like, do we always honor these aches and pains and soreness and stiffness and adjust workout and strive to never feel that way? ’cause I’m like, I’m still struggling with this every day. Like, what is the best decision to make for my workout decision? And when my back was stiff for 12 weeks from I guess that acute injury of dead lifting without warming up. Yeah. I’m like, dang, what do I do? Like, um, do you, um, because it feels like if you warm up and get in the flow and get warm Yeah. Um, sometimes the pain and the stiffness gets put on the sideline so you can go crush it and then seemingly dig yourself a deeper hole. Like how do we navigate that

Jonathan (00:53:36):
As a That’s a really good question. So I would say two things. One, you can look at it peripherally. Mm-hmm. So like how your muscles feel just from a sorens perspective. Yeah. One, and then you can look at it centrally. Um, and so what I would say centrally is, right, everyone’s heard about heart rate reserve. Mm. Super fancy. I’m not saying go and look at heart rate reserve and use that as your metro, but maybe just look at your resting heart rate in the morning when you wake up, say you use the restroom, you know, sit down for a sec, put your, put your watch on your heart rate monitor and see where your resting heart rate is that morning. Mm. If your resting heart rate is, you know, let’s say within three to five beats of what it normally is mm-hmm <affirmative>. Okay. You’ve probably recovered maybe from a central perspective Yeah.

Jonathan (00:54:14):
At least cardiovascularly Yeah. That you’re ready to do something again now peripherally Right. That’s we talk about that could be perception. Yeah. Right. Or it can actually be, you know, fatigue early and, and at the muscle. So for that, I tell people, Hey look, if you do a workout and you do let’s say like a lower body day and you’re asking yourself when you want to do another lower body day. Yeah. Well, obviously there’s at least one day rest, right? Yeah. Let’s say you get to the second day and you’re still pretty sore, you still feel that tightness. Yeah. Right. Maybe wait one more day. Mm-hmm. Right? So I kind of just generally say, look, you should be able to do a, a good workout and if you recover within one, you should recover within one to two days from that. Yeah. So 48 hours. Yeah. And you’re probably ready to hit it pretty hard again. And if you get to the third day when you’re like, okay, I’m ready to hit it, and you’re still like walking around, you’re like, oh man, I feel really sore still. Yeah. At least peripherally within your legs. It might be best just to wait one more day. Yeah.

Brad (00:55:13):
Yeah. Here’s the thing I’m noticing, like, I bottom out not an hour after the hard sprint workout. Yeah. But it’s more like somewhere around 48 hour mark is where I really make my checkpoint to see what that workout did to me. Especially with regard to managing the injuries. In other words, like, my foot does not feel hot at the end of the workout because I warmed up and I pushed it and it’s inflamed. It feels fine. But then two days later, how am I feeling? I, I feel like I’m onto something good as far as managing, because I screwed up before. Yeah. Going out to the track, getting excited, ready to kick some butt, warming up, bringing the blood flow. And then that ache and pain, that stiffness that I woke up with is completely gone. And that tricked me every time. ’cause I’m like, well, I feel fine right now, and yes, I can do two more reps, <laugh>. So how does the athlete manage that? Because otherwise they’re coming in to see you and telling you the stories about that stuff.

Jonathan (00:56:07):
Yeah. So for like the common everyday athlete, right? It would, it would say, right. Just assume that if you do something really intense, whether it’s, you know, intervals running or, or on a bike, um, or it’s a heavy lower body day. Yeah. Right. There is, probably just four to eight hours that you’re gonna need to probably not do that same stimulus, the same exact stimulus again. Mm-hmm <affirmative>. I think as a general rule of thumb, forty eight hours Right. Is check back in with your body after two days to see how we feel. All

Brad (00:56:38):
Right.

Jonathan (00:56:39):
All right. As let’s say our resting heart rate in the morning come back to normal. Um, do we have that lack of soreness? Uhhuh <affirmative>, right. Has that kind of dissipated, not that soreness itself is like the, the best marker, but for the average person that doesn’t have maybe access to all this tech. Right? I mean, without looking at your whoop. Right. Again, again, whoop is, whoop is central. Right. It looks at you like your sleep, right. Your, your heart rate, your heart rate reserve, your heart rate recovery, those kind of things. So that’s very much central, but peripherally, you know how you feel. I think people are generally pretty good judges of when they don’t feel good and when they feel bad. Yeah. So for the average athlete and average person, if you do a big workout, whatever it is, check in with your body after 48 hours, if you feel like, okay, that soreness, that issue is dissipated mm-hmm <affirmative>. And your heart resting heart rate in the morning is kind of back to where it should be. Yeah. You’re probably good to go.

Brad (00:57:24):
I like how you split it up between central and peripheral ’cause like as endurance athlete. And then we’re gonna kind of, before we wrap up, I wanna ask you a little bit about your cycling endeavors now. But like now I’m realizing like as an endurance athlete, it’s almost all central. I didn’t have, you know, injuries and, and knickknacks. It was just, is my heart rate low enough and do I feel the energy to go slam again because it’s swimming, biking and running the load is dispersed anyway. I almost had zero injuries through my entire triathlon career. If I had a hot shoulder for three days, I’d just pedal my butt off. Yeah. And everything was fine, but it was a constant struggle to get that central recovery going. And now I feel like the opposite where, look, if you tell me to go and do two track workouts a day, I could carve the time in my busy schedule to do it, but my body would disintegrate. You know what I mean? It’s totally different. Yeah.

Jonathan (00:58:17):
Yeah. So the central versus the, the peripheral. Right. And like, and you could say within central, like I used heart rate as like the the

Brad (00:58:27):
Metric, right? Yeah. Many other things. Yeah.

Jonathan (00:58:28):
Right. We could say the nervous system too, you know? Yeah. Within, within fancy sports, professional sports. Right. They use like force plates and they have the athletes jump Oh, right. And do some types of jumps. And there’s certain metrics that they look at that they find this is a decent barometer of them measuring your central nervous system.

Brad (00:58:46):
That’s a great idea. I love that’s fatigue, right? Yeah. Um,

Jonathan (00:58:49):
And so have you seen

Brad (00:58:50):
The, the app, the tap test on your phone? <laugh>, my, my friend showed me this. It’s called the CNS tap test. Okay. And you, you download this thing and it says, ready go. And you tap as fast as you can for like 10 seconds. And if

Jonathan (00:59:02):
You don’t give them,

Brad (00:59:03):
And you know, you’re, you, you know, my record’s 82 or something. And so I can get from 78 to 82 if I’m really sharp. And it’s, it’s really tough. ’cause you, you gotta like stay in the rhythm and supposedly if you’re a little central nervous system fatigue, you’ll have a lower score. Kinda cute. That’s too

Jonathan (00:59:19):
Cool.

Brad (00:59:19):
Yeah. Yeah. No, we’re trying different ways to like, but I, that force plate thing is awesome. That’s, you know,

Jonathan (00:59:24):
It’s, it’s funny that, that you brought that up because right with the force plates, there is a jump that they do where they’ll basically kind of do these pogo in a row. Yeah. And they’ll look at kind of, um, basically how much time they spent on the plate and how, and how high they jumped in.

Brad (00:59:36):
And then you, that test. I was a little disappointed on some of my scores. Some of them were okay. Some of them were pathetic. So there’s always something new to, there’s

Jonathan (00:59:44):
Always something to work on though. Yeah. Yeah. But it’s, it’s funny the tap test, right? It’s again, what you’re saying is it’s speed. Yeah. Why you asked somebody do something really fast. Right. And so if someone has to do something really fast, that demands a lot from the nervous system in terms of how the, the nervous system, the muscles work together. Yeah. And so it’s the same thing when pro sports with the, with the force plates, they’re asking ’em to do something really fast. Yeah. Really hard. Just once or twice maybe. And then they can get like a litany of data on just one athlete and they’ll do it for everyone on the team. And if you’re outside of certain, let’s say standard deviation, what your normal spread is, you know, with kind of like yellow flag to red flag, Hey, look, we might want to back off training for this person there or give them a break.

Jonathan (01:00:22):
But obviously the lay person, you know, that does, doesn’t have access stuff daily. At least at the moment. I do think in years time we will. But like if I could give, you know, just your audience just one quick thing. If they wanted to experiment, how fun. There’s an app called My Jump too. And you can use the app to look at your vertical jump. Wow. But there’s something on there called rebound, A Rebound Jump or RSI Reactive or Reactive Strength Index. And so it’s these POGOs and so if they wanted to, they could do this every day, right? Mm-hmm <affirmative>. And just take the app and, and the camera uses as watches them and it gives them their number. Wow. And then they could just, you know, track these on an Excel doc, just remember it too. And if they’re, you know, so far away from so many standard deviations away from the number they normally get Yeah. They would know pretty quickly. Yeah. Oh

Brad (01:01:04):
Wow.

Jonathan (01:01:04):
Love it. My muscles and nervous system are like, probably not great today. Yeah. But in general, if they don’t feel, if the muscles don’t feel great,

Brad (01:01:11):
Pretty simple, it still sluggish.

Jonathan (01:01:12):
They’re pretty simple. Like Yeah. You know, if at 48 hours you’re still pretty sluggish still, maybe wait another 12.

Brad (01:01:18):
Yeah. I talk about warmup a lot and how I feel Yeah. With my dynamic stretches, my drills and my wind sprints. And if they feel off, obviously it’s not time for, you know, yeah. The proper high intensity sessions. Same with I think endurance. You step out, you’re pedaling for 20 minutes, and then you kind of know where you’re at, whether you should turn around, which happened to me a lot, or whether you should continue for five hours. Yeah. It’s pretty cool to be intuitive, but also take advantage of all the tech. And so maybe that leads up to a question. When you’re around those, those top athletes and, and the greatest Olympic track and field athletes and the NFL guys, do you see a future breakthrough and more things coming in? Are they at a really high level right now? Are there some envisioned optimizations coming that will even make these guys stronger, more resilient? Me, injurious, whatever? Oh,

Jonathan (01:02:09):
That’s, that’s a good question. I think recently people were talking about like, they don’t think that like athletes have gotten that much better. I, you know, we, we could talk about track, right. Jesse Owens versus like you

Brad (01:02:23):
And then difference in time Yeah. With all the conversions.

Jonathan (01:02:25):
Yeah. Right. People do these conversions, the math and stuff. I’m like, oh, if Jesse had these shoes, if he had this kind of training Yeah. Could he have done what you’ve seen has done, or, or Andre Grass, some of these, these world class elite runners. Yeah. But in terms of like, what I see is the, is is the future and like maybe where the next boundary’s gonna be made or in terms of it’s like probably recovery. Right. Right. Like I, I think if you think about like the tour to France Yeah. And, and you know, like all these guys are going faster and faster and the climbs are, are better and better and better. Yeah. The times are jam, you know, it probably comes down to recovery. You know, like, you know, every little, you know, the, the food that they eat when they eat, how much they, when they drink, how much they drink. Yeah. What are they drinking, what do you know, what are they doing in their spare time to just optimize? So it’s probably not one thing Yeah. But like what they’re doing outside of their performance Yeah. In terms of their recovery.

Brad (01:03:18):
One of the things I’m thinking of these days is like all these athletes are now on social media all the time. Yeah. And engaged in the digital world like the rest of us. Yeah. But Hicham El Guerrouj the greatest middle distance runner of all time. He lived in a dormitory in a training camp high in the Atlas Mountains for nine months a year. And like his hobbies were reading magazines at night and praying to Allah and that was all he did was train, eat and sleep. And it’s like, I think we’ve passed that point where the most dedicated athlete on earth, like El Guerrouj Yeah. Now you, you can’t match that because now you’re obligated to sponsors and appearances and all this crazy stuff. That definitely affects recovery. I think

Jonathan (01:03:58):
That’s a That’s amazing. It’d be, as opposed to adding something more to optimize, it’d be taking things away. Yeah. Right. You know,

Brad (01:04:03):
Simplifying one’s life as an elite athlete.

Jonathan (01:04:05):
Yeah. Yeah. No, I definitely could see that. Right. Like all this stimulation we get from social media and the phones and all that. Yeah. A absolutely.

Brad (01:04:13):
So you’re also a competitive racer, so I don’t

Jonathan (01:04:16):
Know, I’m competitive, but let’s

Brad (01:04:17):
Try, but let’s wrap up with, talk about your passion and kind of how it, how it blends into your practice and makes you a better, better practitioner. ’cause you’re, you’re, I mean, I, I have great respect for someone who’s out there slamming while they’re taking care of people and dispensing information. So, yeah. You’re out there doing competitive is it cyclecross and

Jonathan (01:04:36):
Yeah, I love bikes. Yeah. Yeah. Yeah. Uh, I love, I love racing mountain bikes and doing what’s called Enduro racing. Uh, I think that’s, that is so fun to me. The adrenaline rush. Uh, I love the combination, the strength you need and the

Brad (01:04:49):
Racing. What do they do on Enduro racing?

Jonathan (01:04:51):
Uh, so Enduro racing is where you ride your mountain bike down the hills fast as you can. Yeah. And they time that the distance or they time, uh, how, how fast you went the, that distance. And then you have to then ride your bike to another stage. So there’s like four to six stages. So four to six times you go down the hill as fast as you can. Yeah. So they time all that time. So it’s the adrenaline rush and the skill of riding your bike down the hill as fast as you can. Yeah. But it’s also the cardio respiratory fitness of you have to go from the bottom of one stage to the top of the next stage, which could be a thousand foot climb. You know, and you, and that takes you, you know, in a certain amount of time. Yeah. Right. And so you get this accumulated fatigue across the

Brad (01:05:28):
Dead. Are you timed on the climb or

Jonathan (01:05:30):
It’s only not timed on the

Brad (01:05:30):
Climb. So if you, if you take a lot of time, you’re still out there in the hot sun climbing a thousand foot climb, you still gotta get up to the top. Yeah.

Jonathan (01:05:37):
Right.

Brad (01:05:37):
Oh, wow.

Jonathan (01:05:38):
Yeah. So you’re, you’re not, I shouldn’t say you’re not timed. You do have a certain window you have to make it in though, right? Yeah. And it’s usually a window that is big enough where you don’t, it’s not a rush. Yeah. You can kind of leisurely Yeah. Moderately pedal a we’ll call it a zone toothpaste kind of thing. Yeah. And you’ll make it there with plenty of time to kind of like rest, get some food, drink some water. But yeah, it’s, you’re still out there six hours kind of doing

Brad (01:05:57):
Your thing. And what about the descent? Is it, um, all technical or are you pedaling too and, and generating watts to improve your time?

Jonathan (01:06:06):
Both. Right. Yeah. It could be very, very technical. Um, and then, you know, you could come down a technical area into a corner that’s, uh, 90 degrees the other way, but you kind of almost come to a stop. So then it’s like a whole lot of watts for 10, 15 seconds to like get up to speed again before you go down another technical section. Then you might have to come to like a slight stop or slow down a lot, and then you’re up to speed. So it’s, it’s this very stochastic Wow. Kind of riding on this wild.

Brad (01:06:30):
All right man. Keep doing what you’re doing. Thank you. Dr. JonathanSandburg here at Kind Performance Physical Therapy at Ultimate Fitness Gym, Sacramento, California. There’s a bunch of locations in the Sacramento area. Yeah. But you guys also have a cool website and of course we gotta plug the, the Kime cast. Yeah. Yeah. If Tony Niles, the founder, I just appeared on that recently and it’s really cool. He talked to me sort of about the background of the podcast and why they’re going to this great effort to do these nice productions. And one of the things he mentioned, which was super interesting, was like, um, the recruiting aspect. Yeah. So knowing this operation is so dedicated to sports performance and dispensing education and information brings the top level talent to, uh, to a track, which I believe is a difficult thing these days, is to find the very best of the breed when you’re hiring new people.

Jonathan (01:07:18):
Yeah. It’s, yeah, I mean, Tony’s, you know, he, he’s the CEO, he is the commander in chief. He oversees all, everything for us. And he’s I, and Russ Dunning is his co-business owner and partner. Um, I can’t say enough good things about them, but yeah, it is, it is hard, uh, to hire people that have this try, like we said, for excellence, that they want to come in every day and, and be excellent themselves. And, you know, hopefully we get athletes and people like yourself that they want to be excellent themselves, that we can collaborate together and, you know, and improve the world, uh, to have a health healthier, happier people.

Brad (01:07:53):
So if someone’s listening, watching and they’re not in the Sacramento area. Yeah. Maybe they’re international or Yeah. Anywhere across. How would you scrutinize or navigate to a really top quality performance minded boom, cutting edge physical therapy support practitioner? Easy,

Jonathan (01:08:11):
Easy, easy answer. Oh, okay. So this is, so if it says

Brad (01:08:14):
Sports call and how many watts can you, you put out for an hour? An anaerobic threshold per kilogram of body weight? No, no, no. I’m about 5.2. I’m going for 5.3. No,

Jonathan (01:08:21):
No, no. So it would be if it says sports performance on their website or their building says sports performance. Yeah. Look at photos of the place. If they have weight racks, you know, dumbbells, trap bars. If they have weights five to a hundred pounds, yeah. You’re probably in a pretty good place.

Brad (01:08:35):
They’re probably not BSing either. They’re probably not just sitting there. Now if you do go in and see everything clean and pristine and all the fives are in the slot and the tens are there, I want stuff messed up and dirty and the kettlebells over in the corner. Yeah. That’s our kind of place where people are doing work, man. Yeah.

Jonathan (01:08:50):
So if,

Brad (01:08:51):
Okay, so that’s number one is, uh, a, um, a fitness related environment. Yeah.

Jonathan (01:08:56):
So that’s number one. If it’s, if it, if it says sports performance and they don’t have the weight racks, the weights <laugh>, they’re just, they’re faking it. I’m sorry. You’re faking it. And then two would be, you know, maybe look at some of the, the degrees of the people where they’ve worked right. On kinds website, we all have our bios and you know, the environments we’ve all been in. So if they, let’s say have, you know, if they have A-C-S-C-S, which is like a strength condit coach certification. Mm-hmm <affirmative>. That’s what you would wanna see. So like your Doctor of physical therapy or master of physical therapy, and then your strength fishing coach, CSCS, I would say those two basic letters. Yeah. Right. It would be like that with the weight room, you’re probably in pretty good hands and you’ve got someone who is, who’s like-minded like myself in Sports Med and, and, and is gonna do the right thing.

Brad (01:09:36):
Love it. All right. Thank you for watching and listening everybody. Thank you, Jonathan. Keep up the good work. Thank you.

Brad (01:09:41):
Thank you so much for listening to the B.rad Podcast. We appreciate all feedback and suggestions. Email, podcast@bradventures.com and visit brad kearns.com to download five free eBooks and learn some great long cuts to a longer life. How to optimize testosterone naturally, become a dark chocolate connoisseur and transition to a barefoot and minimalist shoe lifestyle.

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