Debunking Rehab Myths w/ The Combat Therapist (SSOF Ep. #11)

James de Lacey2:45

Awesome. I want to dive into a little bit then, what made your rehab stint so poor then from soccer that essentially, I guess, changed the trajectory of your whole life to go down this path?

The Combat Therapist2:45

Yeah, so I had a partial dislocation within my shoulder, did a bunch of, I followed the rehab protocol to an absolute tee. I did absolutely everything I needed to do to the point where I thought, is it just me? I can't get better.

But long story short, first instance I had three, four months of consistent rehab stuff. I was going into the clinic every week, every two weeks, getting doing the progressions. It was mainly just light dumbbell stuff and theraband stuff, which is still the common theme within a clinical setting. But after that they decided, okay, well maybe we should get some imaging done. Had one MRI done, nothing came back on the result. Then I continued to go through that rehab process because I was like, oh, there's nothing on MRI, so we keep going through it. That was another three or four months.

Then I decided to get a second opinion from a sports doc. He immediately saw on the initial MRI that I did that there was some discrepancy within the labrum. So then they're like, well, you need to get another MRI, this time with a dye injection. Came up, had a third of my labrum torn.

So it was just a massive waste of time where I was trying to fix something that, in my opinion as well, the rehab that I was doing was not conducive to me getting back to elite sports. It was conducive to me if I was a geriatric 60-year-old that wanted to play lawn bowls again, but not if I was wanting to, because I was playing fullback as well, I was throwing the ball in, all of these sports demands, but I was doing just, I wasn't doing anything over a one or two kilogram dumbbell.

I had no strength conditioning, had none of that robustness built into my programming. So yeah, that's it. It was just a massively delayed process. I wasn't working towards any adaptation that was susceptible to any change. But knowing what I know now, I probably didn't even need the surgery because I had to get surgery as well. So then not only did I waste 6 to 10 months prior to the surgery, I wasn't even stronger before the surgery itself, but then I had to go through almost double the rehab process because I had to labral repair, and then I had to start from square one going through all the rehab.

James de Lacey4:55

Oh, so what I guess, what would you have done then instead of the theraband, dumbbell work to get yourself back?

The Combat Therapist4:55

Yeah, good question. So if I was in the exact same position I was in now and me trying to take a conservative approach, what I'd be doing is, because I was quite young at the time, so I don't remember the exact presentation in terms of my aggravating factors, pain and things like that. It was more of a stability issue.

So first and foremost, I'd be looking at things such as, depending on whether I was still on the pro scene or not, I'd be looking at BPC-157. I know, a friend of mine mentioned that I think two or three weeks ago. I swear I've heard BPC-157 literally every day since.

Yeah, it's banned, right, for, I think so. But if you're a recreational athlete, I think it's fair game. It is a peptide, but the thing is it's found in your gastric system, so most of the side effects for that have been studied, mainly just gastric upsets, because it's already found in your gastric system.

So yeah, probably if I wasn't playing professional sports, I'd be utilizing that. I'd be working on, because this is sort of the approach that I take with any rehab protocol as well, applying the most amount of load and most amount of adaptation, whether that's strength, hypertrophy, whatever the case is, based on my aggravating factors. So I'd be working into pain-free ranges or slight discomfort ranges within external rotation, internal rotation, working on the, because if we look at the labrum as a construct of the shoulder joint, all it does is deepens the socket slightly.

If it's the hip, different story, but the shoulder, you've got so many surrounding structures. You've got the rotator cuff, delts, lats, pec, all of these structures attached to the shoulder. So if you get those strong, you can help stabilize the shoulder, and that's what I missed completely.

I'm never going to get any adaptation through any horizontal pulling, vertical pulling, horizontal pushing, horizontal pulling if I'm doing one kilo, a pink dumbbell at rehab. So yeah, a ton of different stuff I'd be doing. I'd even start, because the biggest thing that I had an issue with was overhead throws, so I'd even be doing that at a super lightweight, starting to build that stability. If you don't train the mechanisms in which you're having issues, you're not going to be able to rehab it.

It's just, most of the time, everything I do with every single client is just super logical. It's not a crazy out-there approach to things. It's just I've created good systems to help reverse engineer specific injuries.

James de Lacey7:42

I know Bill Knowles in the States, the ACL guy. A presentation of his, he kind of looks through a similar lens, and he had, I think it was a top skier doing ACL, and they got back on the skis, I think it was two months after surgery. And he was saying things like, that's where they're most comfortable, why wouldn't we go back to that and try start strengthening it through those movements? You know, it's similar philosophy.

The Combat Therapist8:10

Yeah, and I can appreciate timelines and things like that. It gives, because the thing is, the biggest question that people have is, how long is this going to take? Obviously it's very hard, but I'd much rather work with the philosophy of I want to give you the highest probability of getting you back to doing what you want to do as quickly as possible.

These timelines that you get from your orthopedic surgeon and things of that nature, that's just a rough guide. But if you're willing to put in more work, and you look at elite athletes as well, they get back to X, Y, and Z so much faster because they're obviously doing a ton more than—

Somebody that can only... and I understand people have different priorities. Some people, that's not their number one priority, getting back to doing a certain sport or things like that. It might be the slower approach to healing might be best for their lifestyle. But I'd much rather, and much prefer working with people that are really adamant on getting back to doing things.

James de Lacey8:56

For sure, for sure. And I guess that way as well with your philosophy on it is it bridges that gap between the rehab you're doing and then the activity of sport that you're doing. Because often, as you mentioned, the bands and pink dumbbells, and they go, "Oh okay, it's better now, you can go straight back to whatever you're doing," but you haven't trained anything in between.

The Combat Therapist9:21

No, and I think within the physiotherapy context as well, I think that's a really big gaping hole within the industry. It's like we've got strength conditioning coaches who are really good at building high performance. I think for the most part, if you're a good S&C coach, you can probably do a better job at rehabbing somebody back to their sport versus a run-of-the-mill physio within a clinical setting.

Physios are really good diagnosing, but we've gotten to the point now where for the most part, if you really need a clear diagnosis, you can just get imaging done. So obviously all the assessment tools that you have at your disposal, they're important, but who gives a [expletive] what the diagnosis is if you can't get somebody—if you don't have the skills to get somebody back to what they want to do?

That's the biggest issue that I had, and I was like, as soon as I started my career, I'm like, "I pretty much need to be an S&C coach as well if I want to actually be good at what I'm doing."

James de Lacey10:14

And rest can't be a prescription for these injuries.

The Combat Therapist10:14

No. Neither can, like ibuprofen or the common... that was what I was taught. You need to take—just get them at the acute stage of their pain, get them to take Nurofen for the first week. And it's just such a... with bed rest. It's such a recipe-based approach that just there's no creativity there either.

James de Lacey10:35

And then you also got to add ice to the injury too every day.

The Combat Therapist10:35

Exactly. Even though the doctor that advocated for that has gone against it. It's just like, that's the thing.

James de Lacey11:01

Yeah, and that's the thing as well. If you are young—this is just something for any young, could be coach, physio, anyone in the rehab space—if you learn off the right people, you can fast track your progress beyond what people... There's people that have had 10, 15, 20 years in the industry, but they're not willing to learn more because they're still following the same recipe that they did once they graduated.

The Combat Therapist11:29

And that's the thing as well, it's all about the results you get for people. If you've got a year in the field, if you've got 10 years in the field, it does not matter. It's purely based on the results you're getting for people, in my opinion anyway.

James de Lacey11:29

For sure. Actually, because most of the listeners on here, I guess you could say amateur athletes, amateur fighters, people who maybe don't compete or just can't compete locally or even some professional level, touching on that idea of icing injuries—you mentioned obviously that the person who came up with that idea has kind of backtracked on it. Do you have any more information on that for the listeners? Ice injuries, don't ice injuries, anything like that?

The Combat Therapist11:56

First 24 hours, ice it. But beyond that, you're much better off mobilizing the area as much as possible. If we look at the—let's use the classic ankle sprain as an example—if we look at the swelling around the area, if we utilize venous return and the muscle calf muscle pump that we have available to us, that's going to give us further benefit of lymphatic drainage versus just icing the area.

It can actually make the joint feel stiffer if we keep icing it, and people don't realize that for you to actually ice the area correctly, you need to get your skin temperature down to 13 degrees Celsius. So for you to be able to do that, you need to pretty much put the ice directly on the skin, and you can't do that for a long period of time to where you get—because you're going to get just ice burns and [expletive] like that.

So the opportunity cost as well, it's like if your goals are getting back into moving, you need to start integrating that as much as possible. If I was to get an ankle sprain today, what I'd be doing—first 24 hours I'd be icing it. Compression is obviously a good thing as well. Same thing, it helps drain the fluid back up towards the heart so that it can just help with circulation.

But I'd genuinely be doing thousands and thousands of repetitions in dorsiflexion, plantarflexion, eversion, inversion, and just getting as much movement through that area. The biggest thing that people don't realize with pain is it doesn't equal actual tissue damage. It's perceived threat.

So if you can—what's the best way to remove a perceived threat? It's by moving the area more. The more you move the area, the body realizes, "Okay, it's actually safe for me to start dorsiflexing and plantarflexing the ankle. I'm not going to create further tissue damage and I'm not going to injure myself further if I do these things." And then that helps more than anything else to bring that pain response down.

So that's if I was—and that's free. Moving the ankle is a free thing. You don't need all these ultrasound therapies and things like that that have been disproven as well. So does that answer your question?

James de Lacey14:07

Yeah, definitely. And for anyone listening who's maybe hearing the terms plantarflexion, dorsiflexion, just move your foot up and down, side to side, move it in circles and like that's...

The Combat Therapist14:07

Yeah. And then you just slowly integrate a calf raise as comfortably as you can. Start with two legs first, because two legs is easier than one leg. Once you can do two legs, progress onto one leg, and then just work through the sequences that you need depending on your sport as well.

We want to restore range first. The best way to do that is to do that without having any weight on the area first. Then you start weight-bearing it and you just progress it along accordingly.

James de Lacey14:59

You mentioned about the ultrasound thing. Obviously physio clinics love having it because it's, I guess, fancy tech. Don't do much. And as you mentioned, it's been disproven. Do you want to maybe jump a little bit into that? Because I've had plenty of ultrasound in the past and I've sat there thinking, "What the [expletive] is this going to do?" And it's done nothing.

The Combat Therapist14:59

All it does, it heats up the area. Even when I was studying as well, they started—they're like, "Yes, clinics have this, but it does sweet nothing."

So yeah, if... and that's the thing as well, I think the most important thing to note—and I think it's where people go too far down the evidence-based route as well—is if there's something that the client feels helps them and you do it and they feel better from it, then it works. It doesn't need to be over... a big systematic review that says, "Oh, it's been..."

If somebody feels like, as an example, someone thinks massage is going to cure whatever injury they have, you'd be stupid not, as a therapist, you'd be stupid not to use that and have that in your back pocket. Because perception of things that help—just as important as the evidence as well—it's using your clinical experience combined with the latest evidence. That's a good practitioner, not actually creating the plan based on the person in front of you. That makes sense?

James de Lacey16:15

I want to throw a bunch of topics at you and you can just pick whatever and go with it. I know you're active on Twitter about some of these topics as well, and obviously some of them, I guess, are just things that are repeated day-to-day within sport.

So things like foam rolling for recovery and, I guess, flexibility, static stretching for flexibility and recovery. I've got a couple more. I've got tight muscles and pain. I've got Functional Patterns, or I like to call them Fictional Patterns, and GOATA. There's five random topics. If there's anyone that interests you, jump in and you can start riffing on it.

The Combat Therapist16:43

Well, let's go down the line because I think—because I wanted to share this on Twitter as well because a lot of the—I think we can cover a lot of things and a lot of myths within the health industry within just this one podcast.

So if we start with foam rollers as an example. I prefer to use foam rollers for certain exercises, so co-contraction stuff, getting your hamstrings, calves, glutes to fire at the same time. I think it's a much better tool for that versus people say like, "Oh..." I think the big precipice around foam rolling initially was it breaks down scar...

Tissue and things like that, there is no way in hell that foam rolling a muscle is going to break down any sort of adhesions. So it's akin to just pretty much putting a rolling pin up and down your leg. But I want to put this as a caveat with everything that we discuss: each of these treatment tools, whether that be massage gun, foam roller, whatever the case is, if you use it and you feel better as a result of using it, then who am I to tell you that it's a device? If you get benefit out of it, utilize it, but just know that there's other things out there that can also help as well.

So that's my opinion on foam rolling. It can be a good way to sort of warm up the muscle as well by rolling over it. You can work on trigger points as well to get some neuromuscular changes as well, so you're not actually changing the muscle structure. You're more so changing the nervous system's response by pretty much overstimulating it, by either trigger point release with a lacrosse ball, massage gun stuff, and foam roller stuff.

Those trigger points that you're going through, if you work—and the thing is, you can use a lacrosse ball for like 30 seconds max, doing two sets of 30 seconds on an area and that's enough. You don't need to spend—if you are spending 20, 30 minutes on a warm-up routine before you're working out, before you're in the gym, then your programming is just piss poor. It's simple as that.

You should not need—all of my clients do a warm-up of at least two to five minutes tops, and most of that's just getting some movement patterns reintegrated back in. So I think having to warm up and use all of these devices is very overrated in my opinion.

James de Lacey19:01

So the Donnie Thompson body tempering, if you're aware of that, the one where they have the big 40 kilo metal roller that they just lie on their hamstrings—I'm assuming that's a similar mechanism then, it's just kind of downregulating the nervous system a lot of—

The Combat Therapist19:28

Yeah, a lot of quick instantaneous changes occur within the nervous system structure, so yeah, similar concept as well. But yeah, that's the thing—all of these tools have pros and cons, and if you understand how each thing works, then you can choose whether you want to utilize them or not.

I'd much prefer to warm up with specific movement patterns, so being able to be in a good squat position, being able to move through various ranges that I want to target. That's more important to me as more so movement preparation for what I'm going to do when I start adding resistance and load. So yeah, that's foam roller.

James de Lacey19:53

What was the other? Static stretching.

The Combat Therapist19:53

Static stretching. I think has had a lot of hate unnecessarily, because I think if you don't have passive range—somebody two, three months ago, if you asked me this question, I would have said yeah, static stretching is pointless. But I do think it has its place, because what it does is if you can't hit a position statically, you can't expect to hit it actively. So it's one of those things that you can utilize in your toolbox.

I think it's had a lot of poor reflection on that modality because there was a study that was like they did static stretching and then they did a sprint after it. Well, no [expletive], your power output's going to be reduced. How many people are static stretching before they do it? And I think it was a 10-minute stretch and then having to jump or sprint with nothing in between. So it's like, anybody that does—regardless if you're static stretching or not—you're going to feel [expletive] going straight into a sprint like that.

So I think static stretching is good to get into certain positions you otherwise can't get into actively. But I much prefer the way that I program as well, is integrating almost like resisted stretching with the things that I do. Use it as an example: standing calf raise machine. If you work through full range, you can get a really good eccentric dorsiflexion, so toes up stretch when you're doing that.

So instead of you having to do that statically, why not do that under actual resistance? Change the sarcomere length, make all of these adaptations that will be long lasting, because yeah, once again, static stretching is more so a neuromuscular adaptation. So I'd much rather get a neuromuscular adaptation as well as a change in true muscle length if possible.

James de Lacey21:34

I do the same thing as well. I got almost loaded stretches for almost every joint in the body. And I mean, as you mentioned, static stretching can be good, help you relax at night as well, but you don't get the structural changes. If you were doing a standing calf raise and holding that bottom position loaded, you're getting structural change too, plus you're getting a little strength at that length and a whole bunch of other things.

The Combat Therapist22:04

And when it comes to training, we want to be as efficient as possible. If we can hit multiple parameters within one exercise, why would we not do that? So yeah, and it all depends on your time availability as well. But yeah, that's the approach that I take to stretching: is how can I mobilize, giving somebody as little as possible, and then you just build layers on top of that, depending on what their needs are. Obviously some people need certain accessories more than others, and yeah, it goes down that positioning.

James de Lacey22:27

Nice. Should we touch on what was—muscle tightness and causing pain? So obviously the typical is your lower back's sore because your hamstrings are tight or your hip flexors are tight or whatever it is.

The Combat Therapist22:58

Yeah. I think that's absolute [expletive] and it's been dispelled a lot. I think the best way to cover this particular component is—I think everyone that's listening, number one, your posture doesn't cause pain. Really important to note. Number two, one specific structure in your body, one specific muscle in your body, is not going to cause things further up and down the chain. It's a lot more complex than that.

We even look at, as an example, say yeah, tight hamstrings—I stretch my hamstrings, that's going to help my low back pain. What about the other factors, like how you're sleeping, what your dietary measures are, what your body is like as an inflammatory environment as well? Because that's going to help and create a more hypersensitive environment conducive to pain. What are your stress levels like at the moment? Are you sleeping eight hours a night? These are all factors.

These are factors beyond just a hamstring stretch. So for people to just say, "Oh yep, you've got a tight hammy, that's why you've had low back pain for the past 10 years" is just a very, very small lens and microscopic approach to the big picture. Yes, it can potentially contribute, but there's so many more factors when it comes to pain.

There's even—I think the biggest breakthrough that I've personally had with clients that I work with is them actually understanding how pain works and understanding their injury. Once they have those two things, it helps de-threaten the injury response as well, because if you know that you're not going to get worse by starting to load things up, because you've been educated as to how things work, then that in itself helps massively. So there's a huge psychological component to injuries as well.

So yeah, having tight hamstrings biomechanically might be putting more pressure on the low back, but it's not the only thing that you need to look at in isolation. So the way that I like—my philosophy of rehab—there's a lot of pain science people and there's a lot of purely biomechanics. I like combining the two. I think you need to understand one to understand the other as well.

Biomechanics—yes, can we offload some of that pressure through the low back by lengthening structures through hamstrings and dispersing load more evenly? Yes. But that's only one part of the picture. There's also the pain science side of things that needs to be addressed as well.

James de Lacey25:14

Do you want to dive a little bit into that pain science? That's something that I've been meaning to read. There was a recommended—I can't remember what the book was called, Explain Pain or something?

The Combat Therapist25:14

Yeah, something like that. I don't know if you got it already yet, but you want to maybe just dive in a little bit on that?

So this is essentially—I've learned through a lot of—Greg Lehman's a really good resource for pain as well. He's got a lot of really good views regarding pain science. I think it's really important that—I don't like when people educate people about pain saying, "Yeah, it's all in your head" and things like that. But I think even understanding how pain works can have a massive influence on your rehab time frames as well.

Because I think the most important thing—if I was to give somebody one piece of advice to make it just as simplistic as possible so they didn't have to go and do further readings and stuff like that—is that pain is a perception of threat. It isn't necessarily when you have pain—you're not causing more, you're not necessarily causing more damage to the area. I think—

That's a really important thing to note, especially for individuals who've had chronic issues. So if you've had a chronic injury, then it's less likely that when you do have pain when you're doing an activity that you're actually causing further tissue damage. What happens is when you get injured, the area of injury becomes more sensitive to the same stimulus. So it's almost like if you're—so the body can't dissociate, say for example you've got an alarm system at your home, it can't dissociate whether there's a cat that set off the alarm or if it was an actual burglar.

So it's the same signal, but the threat is completely different. If you've got a cat in your house versus having a burglar in your house, it's going to be a lot different. So I think the biggest thing from a pain standpoint is learning that it is a perceived threat, and it's something that if you've had chronic issues you might have to work through slight bits of discomfort.

But a really good metric that I utilize with a lot of people that I work with is you get the 24-hour pattern, in particular how does it—it might be a little bit uncomfortable during the actual session itself, but how's it pulling up the next day? If there's a slight bit of discomfort, that's fine. Obviously if it's more intense than it was as you were exercising, that's a different story. And I think it's an area within rehab that needs to be further consolidated.

Pain's a very hard thing to educate and explain, especially when you have got a 20-minute consult, which I used to have when I was working in a clinic. I found it really hard to get the message across without it sounding like, oh, it's all in your head. So yeah, it's a really hard topic to discuss, but I think there's yeah, there's becoming more and more available resources to learn. Greg Lehman's a really good resource. Jared Powell, who's the shoulder physio, talks a lot about pain as well.

So yeah, there's so many things. People think, oh, if you've got scapula winging, that causes pain—that's been disproven as well. Another thing I tweeted about yesterday was subacromial impingement doesn't exist anymore. People with shoulder pain that have those impingement symptoms actually have larger subacromial spaces. So it's like, well, if it's impinging but the space is bigger, how does that work?

James de Lacey28:43

So what's the pain then if it's not an impingement?

The Combat Therapist28:43

Well, it's obviously the stuff that I was just describing before, the sensitivity stuff. But it's more so just if you get the shoulder stronger globally in general, then you're going to have better outcomes than focusing on specific scapular mechanics and things like that.

So when it comes to exercising any injured area, a lot of it has to do with just being able to give yourself more movement variability and variety, as well as getting the area stronger. If you can do both of those things, then it's going to help. It's pretty much the way that I explain it is you have to prove to your body that it's safe to do something. Until you do that, you're still going to have remnants of pain.

James de Lacey29:09

So if I sum it up briefly, it's almost pain does not always equal structural damage. You can have pain without structural damage, and that's just a perception of threat that you just have to work through, correct?

The Combat Therapist29:38

Yeah, that's I think that's the biggest thing to note. Is you might have pain in an area, but if you think about it—and if you're hyperfocusing on anything, this can be injury-related or not—but if you're hyperfocusing and worrying about, oh, I've got pain in this area, I've got pain in this area, if you constantly rewire your thought process into that, of course the area is going to be more sensitive.

And most of the time, and this usually happens near the back end of the phase when I'm working with someone, is they end up completely forgetting about the fact that they had the injury. Because that's the way I structure things. First, the first time we talk, we discuss your injury. After that, I'm never asking them, are you in pain, are you in pain? Because it's just focusing on the wrong things.

I'd rather focus on what the individual can do versus what they can't do. And I think rehab itself is a really shitty term because I think rehab, I think drug and alcohol addictions. So it's already framing everything in a negative fashion to where you're broken, where you're not. It's just there's a few things you can't do. If you train intelligently, you can definitely get back to doing them in most cases, unless there's something significant going on.

James de Lacey30:54

That reminds me of—I think it's a Frans Bosch philosophy. I don't know, it definitely didn't come from him, but I think it was mentioned in something he did. But for example, in rugby, maybe a player has ACL injury and they're maybe doing some single leg balance or whatever it is. By having them pass the ball back and forth while doing it, now you can't concentrate on the knee or the leg. Now it's on the ball, so then you can do these tasks and kind of forget about that perceived, I guess, threat of something happening.

The Combat Therapist30:54

Yeah, yeah. And the more an injury influences your life, the harder it is to rehab. So I've worked with people, for example, it's affected their work, ability to earn income. It's affected their relationships as well because they're stressed out because they can't earn income. So it's not just the injury, it's the emotions associated with the injury that causes further issues.

If you look at a lot of chronic injuries and you speak to these people, it's more so their injury has had a massive effect on their life. So I think we always go down the lens of thinking, oh yep, this structure is causing X, Y, and Z. But it's so much more than that. Even just looking at the psychological components of how much an injury affects somebody can make a massive impact on their rehab timelines as well.

James de Lacey32:09

Those are all good points. We've got a couple more—well, probably have more as well after these anyway—but I guess we could lump them in the same category. Could we? Functional Patterns and GOATA. Yeah, so let's start off, because I know a lot of people just go straight to the negatives about these movement patterns. Let's start off by just discussing some pros of the movements.

The Combat Therapist32:09

And for the reason that they're in this industry, people are getting results from it. But I think you need to dissociate why that might be the case. So if we start with GOATA, we're loading the knee. Say for example, I've heard a lot of people that get improved knee symptoms using GOATA patterns. But if we look at the exercise mechanics in itself, a lot of it is working through—they avoid a lot of pronation-based positions. So you're just going to be loading up, let's use the knee for example, you'll be loading up the knee in a different variation.

So when it comes to injuries and pain, movement variability is a really important thing, so it taps into that. Number two, it's almost like a deload because you're never going to be able to maximally barbell back squat or even goblet squat in a GOATA-based pattern. If you're primarily in that outside arch position, it's almost like a mini deload. You've got movement variability.

On top of movement variability as well, they have a play around with crawl patterns. I think especially for grapplers in particular, being proficient and being able to move your body through certain crawl patterns can be beneficial as well.

The thing I don't like about both Functional Patterns and GOATA is the fact that they—it's a fearmongering tactic to get people into their training protocol. It's like, this is the only way to train. If you don't train like this, you're going to end up injured, you're going to [expletive] your [expletive] up. Which I just can't stand. Any movement philosophy—AthleanX does this, MoveU does this, all of these really big rehab conglomerates, they all do this.

They're like, if you train in this way, you're going to be in pain. But look, we have the magic philosophy and cult that will be fixing your orthopedic injuries until you're 100 years old, and the course is $1,000.

James de Lacey33:59

And then you can get certified too.

The Combat Therapist33:59

Yeah, so it's a perfect pyramid scheme. But with Functional Patterns as an example, the best thing that I would take away out of that is train some rotational characteristics. That's all you need. You don't need to—you don't need to pretend and simulate striking with the cable.

James de Lacey34:24

Yeah, whenever there's exercises that are—especially if they're geared around a certain sport, because I think Functional Patterns leans a little bit into combat sports in terms of their philosophies and stuff.

The Combat Therapist34:49

Yeah, so anything where it looks like it's almost the sport—just [expletive] play your sport. It's that simple. You should be getting qualities—especially as a combat sports athlete, you're training a [expletive] ton in the first place. The things you should be doing in the gym are number one, they should be keeping you in the ring or on the mats.

Map for longer, and number two, you should be getting things out of it that you can't otherwise get out of your training. That is the purpose of it, especially if you're taking combat sport seriously. So it's like half of the functional patterns movements, you're wasting a lot of time when you could otherwise be spending that getting better at the skills required for your sport, especially from a combat sports lens.

James de Lacey35:38

Definitely. I mean, always preaching that on the podcast and the blog, you know, sports always number one. Your training in the gym should complement that. And as you mentioned, if you're doing functional patterns movements, you're severely underloading essentially every movement pattern, and then you just, I can't even make sense of half the stuff they're doing. It's just like a dance.

The Combat Therapist35:38

That's the thing. These systems just give people other ideas that there's other ways to train, and I think that's a net positive. But saying that if you're not doing those movement philosophies is a detriment to your health is not a great, I would never in my wildest dreams ever create a system that discusses those things whatsoever. Because people are in pain, you can't, taking advantage of that and saying that your system's going to help that is just, especially if you're in healthcare.

The reason most, the should be the reason anyway, that most people are in this field is to help people with their health. So you can make, you can, if you're saying oh, all the training you've done in the past has caused all of these imbalances, which what the [expletive] does that even mean?

I've had consults with people where they are just listing off grocery lists of all of these deficiencies, misalignments, asymmetries that they've been told from therapists, which it is completely normal to have asymmetry in the body. That's the most important thing that you need to know. And having that asymmetry may not be even causing your pain in the first place.

So should we really be worrying about focusing on getting both of your scapular mechanics the exact same? Or should we just find a training style for you that you can tolerate, you can progressively overload in? That's my focus whenever I work with someone. Not, oh yeah, your scapula is winging by three degrees, we need to address that, that's causing your pain.

James de Lacey37:28

Not everything has to be perfectly balanced, eh?

The Combat Therapist37:28

Not at all. It's almost something that you can easily tell someone, I guess. Oh, you know, these things aren't balanced, that's the reason for XYZ. And it becomes an easier, easy thing to kind of measure and try correct. And essentially it's a losing battle because you'll never ever get there. That's why you have a dominant hand and a dominant foot.

And you want to be, you obviously want to be as objective as possible. But at the same time, is that objectivity leading them down the right path? Because I think some therapists do it as sort of an ego thing. They do the assessment and they're like, oh yeah, look at you, you can't do this, you can't do this. And first, the first relationship you create with the person's like, you've just told me how [expletive] I am at moving. How's that conducive to them getting back to doing things?

James de Lacey38:14

Exactly. We actually have a question from the Twitter from the one, well I retweeted your tweet anyway. But someone asking, it's a bit of a loaded question really, what exercises do you recommend for huge scoliosis?

The Combat Therapist38:14

Yeah. So I get DMs all the time asking what exercise for X, Y, and Z. It's an impossible question to answer. And if it was that easy, I would just create a product for knees, ankles, shoulders, low back, and be like, do this stuff and the job's done, and I'd be out of a job in a week.

So to break this, let's break this down more of as a principle-based thing. Scoliosis number one is, you've probably had it for years and years. So if it's starting to cause your pain now, structurally nothing drastically has changed over the, over say you've had, say last week you started having an onset of pain, we can attribute that to not to the structure of your spine. Because you had, say for example, if it's a developmental issue, you might have had that for twenty, thirty years, and what, now magically it's an issue, you know what I mean?

So with scoliosis, it's like, well let's look at how the spine's positioned. Obviously there's some form of curvature there. So what I'd be doing is potentially working more so, anything that's actually loaded. So like barbell back squats, things of that nature where we're getting that downward compression, I might be preferentially using unilateral exercises instead, just to offset and not have a downwards force when our spine doesn't accommodate. That's one that we might potentially. Another thing is just trying to get expansion through the more compressed side.

Say we're bent to one side, then we might do like, as an example, like dumbbell lateral dumbbell side bends the other way, adding some sort of inhalation component as well to help expand that area. And that might help disperse load through that compressed side of the spine as well. So for anyone with scoliosis, would be finding somebody who is intelligently trained, intelligently can create a training program based on what your needs analysis is.

It doesn't matter what the presentation is. You got to find what's aggravating, what are things that help alleviate symptoms as well. Do more of the stuff that alleviates, and then tweak the things that aggravate symptoms. So yeah, that's how I'd address that sort of presentation. And it's pretty logical in nature, but obviously the skill set comes with, how can you turn a principle into a specific set of exercises where I think a lot of people struggle with.

James de Lacey40:40

Yeah. What's your take on means of artificial recovery for combat sports, and I guess tips or advice for recovery for combat athletes?

The Combat Therapist40:40

So are you talking when you say artificial recovery, saying all the side stuff and ice baths, sauna, cryo, whatever you name it? All right, so if we look at whenever it comes to any system in general, I like to move the big rocks first. So I think you're better off investing time into getting adequate amount of, getting an adequate amount of sleep. That's a natural steroid. Why would you not put a lot of attention into improving that system as much as possible? That's number one, what's your sleep like.

Making sure that your dietary intake is optimal as well. So obviously if you're weight cutting, different story. But making sure you're in a slight surplus and enough protein intake, all of these basic things that people just overlook dramatically because they'd rather some of the sexier stuff, like ice bath, infrared therapy, all of these other things as well. So it's like, before, if you're not doing these two things first, you shouldn't even be worrying about the additional things on top of that.

And then when it comes to specific other metrics, you got to look at the cost of doing certain things as well. So sauna, as an example, you're going to be exhausting the system, and there might be better ways to utilize that sort of central fatigue into your training instead. But at the same time, if it helps you feel really well rested, then it's like, who am I to say that utilizing the sauna is a bad thing?

So when it comes to all of those additional accessory-based recovery metrics, it's like, well, if there's something that really helps you feel better, and even the research behind ice bath and stuff like that, from a recovery standpoint, it's a little bit up in arms as well. But I've taken them in the past and I feel like the perceived lactate flush that I get after doing some of that contrast therapy, it feels unreal.

So if you're in the same boat, who am I, or who are the people that are running studies, to tell you that doing a certain rehab metric is a waste of time if you feel genuinely so much better from doing something? Then you definitely should do it, because it's that power of that placebo as well.

James de Lacey43:06

For sure. Other than I guess the typical sleep, nutrition in terms of recovery, is there anything else, maybe advice, tips you'll give to a fighter to help them with their recovery? I guess from training to training, week to week.

The Combat Therapist43:35

I think it mainly comes down to how things are programmed as well. So I see a lot of MMA fighters in particular, because they need to meet the demands of striking, grappling, there's so much training they need to do. But I don't see a lot of people that have really intelligent programming on top of, because yeah, they're doing grappling, striking, strength and conditioning. That's a ton of total loading throughout the week.

So yeah, I think the biggest takeaway I would give to somebody who's an amateur fighter that can't outsource these things themselves is looking to do some form of high-low periodization. So having a more intense day where you're doing, might be the gym session and the harder day of training, whether that's sparring hard, grappling.

Things like that, and then coupling that with a low day, which is like doing just drilling. It might be drilling positions on the floor, it might be just working on certain combinations with your striking patterns. That's a much better way to look at, because the way that I look at recovery should be complementary of what you're doing from a training standpoint as well. So if you really have to emphasize on doing absolutely everything necessary to recover, then maybe we need to second-guess: are we training intelligently enough based on what we can currently tolerate?

So sort of looking at things the other way around, I think. And it's the same process as what I said: if you've got a 30-minute warm-up, your programming and the way that things are structured probably isn't an intelligent way for you. And it's the same process with training as well, because we know skill acquisition—we get better skill acquisition when we are more fresh.

So if we can integrate that into our training on a low day, then we're still getting multiple benefits. It's not just pushing yourself as hard as humanly possible. You look at Firas Zahabi—he says most of his training is at that sub-maximum intensity, around 70% most of the time, and then they dial things up as they're preparing for a camp.

And you look at, especially sports that you need to peak for, it's all about consistency. The longer you can stay training without getting an injury because you've just fogged yourself trying to do two-a-days, trying to just absolutely smash yourself, you've got to look at the bigger picture as well.

Obviously there's less time if you're near the back end of your career and things like that, but you've got to factor all these things in whenever you're structuring the way that you want to train.

James de Lacey45:43

Oh, for sure. I've got—if anyone's interested in that model, if you just search "How to schedule your MMA training" on Google, you'll find an article that explains it too. And as you mentioned with the training, I mean, the number one rule is: don't train so hard that you can't recover. It's just about, again, planning it correctly, not staying in this middle intensity zone where you're doing strength training or strength conditioning, pads, grappling, or at that middle intensity, just absolutely drilling you day to day to day to day. Something will break eventually.

The Combat Therapist46:05

Exactly. It's just that the barbell strategy of investment—the same thing should be integrated into any athletic training pursuit as well. It's like that middle area: you're getting a little bit of something, a little bit of nothing at the same time. So you've got to work at either end of the spectrum to just squeeze as many results as possible whilst minimizing injury risk as well.

James de Lacey46:34

Perfect. Is there anything else that we missed covering here?

The Combat Therapist46:34

No, I think we've covered a lot of misconceptions within the industry in such a short span of time. I think if anyone wants, from a rehab standpoint, the biggest thing that I want to just hone in is: there's a lot of things within the industry that look really glossy and sexy on paper, but I think things are transitioning in the right direction in the sense that people are starting to call out things that might not be the truth.

So if you're seeing a therapist now, they tell you your hips are out of alignment and they haven't done an x-ray—that's [expletive]. If they're saying that an asymmetry is causing your pain unless it's a true asymmetry, that's probably [expletive] as well. Your posture doesn't cause pain. Your shoulder blades winging out a little bit doesn't cause pain. All of these things that are typically—even some people feel worse when they're in that sort of military posture, more upright. Some people feel better when they slouch because it's more of an expanded position through the back of the spine.

So I think, and that's what I'll be constantly reiterating when I tweet and talk about these things as well, is just teaching people that it's safe to flex through the spine. It doesn't need to stay neutral the whole time. There's so many different things and misconceptions that have just—I don't know, they're slowly heading in the right direction. But yeah, there's a lot of things that I think people think to be the truth, but it's just not the case anymore.

James de Lacey47:51

You reminded me of one thing before I get you to plug your Twitter. Chiropractor, in terms of joint or spinal manipulation or joint manipulation: what is actually happening there? And can you actually manipulate a joint, I guess? When someone says you're out of alignment, can you actually manipulate something back into alignment?

The Combat Therapist48:17

I don't think so, no.

James de Lacey48:17

Did I trigger you?

The Combat Therapist48:17

No, I don't think you can. Because even if you look at the force production to truly manipulate a joint—the spine can handle up to 2,000 pounds of force, which is just an insane amount of load. And I think that's a really encouraging thing as well, because when you tell somebody that who's got back pain and they're scared to bend down and pick up a piece of paper—you are very, very... your spine is a very sturdy structure.

What I think's happening when the adjustment process is occurring is: you hear the crack, which is just a release of an air pocket through the spinal area as well. Obviously they are shifting the spine slightly when they're doing that as well. But from an alignment standpoint, it's not—one crack session is not going to realign anything. Especially you look at scoliosis people: they have to spend, I think you can, with a smart training system as well, you can help mitigate the effects of scoliosis, but this is over years and years of time. It's a lot of time invested.

So someone says to you, "Oh yeah, we just need to crack you," and we look at the chiropractic profession to begin with—I have no... There's really good chiros out there, there's really bad chiros out there. There's good physios out there, there's [expletive] physios out there. So it's not like there's good things from each and every profession. If I wanted a spinal manipulation because that makes me feel better through the spine, I'd much rather get that done by a chiro who's done it thousands of times versus a physio that maybe does it once or twice a week.

So in terms of the whole alignment thing, it's like, well, they're not getting the—chiros in general, that first started as a marketing—it's a very marketing-influenced profession. Because from the start, there's Dan Kennedy, who's one of the best marketing experts of all time, consulted with a lot of chiropractors, which have that—and that's now the model that still exists. It's the classic: "You've got—we've got to work together for the next X amount of time.

You need to get cracks twice a week, once a week," and it's a three, four grand package. And they rely on that adjustment because they've been educated to say, "Yeah, if you don't keep coming back each and every week, then you're going to go out of alignment slightly, and we need to keep that alignment in place," which is complete [expletive].

So anyone that's being told that from any health professional—it could even be a physio saying, "Oh yeah, you need dry needling once a week, you need massage once a week to make sure that the muscle stays loose"—that's [expletive] as well. So I think that's the biggest takeaway, and what I don't want people to go through is being—and the thing is, some therapists just don't actually... they're not up to date with the research, so they might not be saying things from an unethical standpoint, but they're still spreading misinformation about the service that they provide.

So the biggest takeaway in terms of what I try and advocate and try and tweet about is just giving you the no-[expletive] truth on absolutely every aspect of the rehab experience.

James de Lacey51:48

You triggered a few chiropractors listening.

The Combat Therapist51:48

Well, I've—the best I've seen, there's a chiropractor on TikTok who doesn't crack anybody's backs, and he shits on the profession himself. I have nothing against chiropractors, but if you're just using spinal manipulation as your only skill set and you're not providing people with a well-regimented program and all of these other things as well, then you're not doing a good job.

And I don't care if you're—it's the same thing with a physio. If you're giving people one or two shitty band exercises and saying, "Yeah, this is all you need to do to get you back to high-level football, rugby, whatever the case is," then you're doing a [expletive] job as well.

I don't even want to pigeonhole myself as a physio, because there's a lot of things within the physio context that I disagree with as well.

James de Lacey52:39

So you mentioned about where maybe a physio, someone saying you need to massage or dry needle to keep your muscles loose. A lot of combat athletes, I guess, blame lifting weights or whatever it is, that they start to feel tight or they lose flexibility. So from, I guess, your experience, your opinion...

So you mentioned about where maybe if a physio, someone saying you need to massage or dry needle to keep your muscles loose. A lot of combat athletes I guess blame lifting weights or whatever it is that they start to feel tight or they lose flexibility. So from your experience, your opinion, then what is it that I guess fighters can do to maintain that feeling of looseness or not losing I guess that range of motion?

The Combat Therapist53:07

So I think when it comes to range of motion lifting, I think it can definitely stiffen you up in general, but we also need to look at why that might be the case. You see a lot of people, especially let's use the bodybuilders as an example, especially as they pack on a lot of mass as well, they start becoming more and more immobile. But I think it also has to do with an ego thing as well, like people start reducing their range of motion within a squatting context.

If you reduce that range of motion, then of course you're going to be stiffer because you're not working—if you work through less range of motion, you're not going to have more range of motion available to you. So it's a matter of having programmed heavy stuff where you're just trying to move as much weight as possible, but also what's fine to squat full depth at a sub-maximum weight and use that as an induced mobility sequence in and of itself.

So I don't think weight training should help improve your range of motion if it's not. You're not doing a very good program in my opinion, and that might mean doing things that are a little bit unconventional and different to what you're used to. But 100%, there's definitely ways to get strong but maintain mobility.

So it's a hard—I know what specific advice do I have for them, but it's just make sure that you're utilizing a smart training protocol where you are getting into joint positions that mimic your sport. If you're doing knee slices, guard passing positions like that, you need to be able to get that knee over the toe. It doesn't necessarily need to be under load, but these are the sort of positions that you need to get into.

You need to be able to endure lumbar flexion under load if you're trying to retain guard and things of that nature as well. So it's like these are other things that you need to make sure that the gym stuff that you're doing, you're not restricting your range of motion by trying to just pack on as much weight as humanly possible to where you're just doing half-rep, quarter-rep stuff. It's got to be—it has its place depending on what our needs analysis is, but you need to pretty much work through the ranges that are required for that sport.

James de Lacey55:13

You nailed it there, pretty much strength training is mobility training when you're doing it through the full range. Anyway, potentially you're going to maintain or even get more flexible. For example, I guess the most common example would be a Romanian deadlift, right, for the hamstring. So if you do that properly and you get in good range, you're probably going to become more flexible over time.

The Combat Therapist55:37

I think it just comes down to intelligent training. This could be for rehab—is just training at the end of the day, depending on where people are within their spectrum. All it is is what training can we currently do to help stimulate and create adaptation that isn't causing further tissue damage or aggravating things from a pain standpoint? Where do we want to be and how can we bridge those two relationships together? That's essentially my job in a nutshell. That's what I do.

James de Lacey56:03

Oh no, this was a great chat, Mr. Combat Therapist, since I can't say your name until the reveal. But where can they find you on Twitter? And I'll check in the description too.

The Combat Therapist56:03

So it's just the Combat Therapist on Twitter. I may be looking to branch out onto other platforms in the future, but yeah, essentially what I—I don't just speak about combat sports. A lot of it is the stuff that we have discussed within this talk here as well.

So essentially what I want to do is teach as many people as possible. So a lot of—I've seen a lot of physios and health professionals mainly target their information at other health professionals. I think it's much more beneficial to teach the general population. So regardless of if you've had any injury, if you've had any rehab process that you haven't enjoyed and you want to learn about—pretty much the way that I create tweets and information is like a complete no [expletive] approach.

So giving you the good things about a certain—this might be a training philosophy, a treatment modality like foam rolling, massage, massage guns, things like that. It's just giving you the no [expletive] approach to it, and that's obviously based on my experience as well. I don't have all the answers, but I'm trying to get as honest and as ethical of an approach to rehab with everyone I work with.

James de Lacey57:18

Awesome, well go give them a follow. But thank you for coming on, I really appreciate it.

The Combat Therapist57:18

Appreciate it mate, it's good to talk to you. Cheers.