Physical Therapy Modalities with Nat Collins, DPT CSCS | Koopcast Episode 101

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i'm your humble host coach Jason Koop and this episode of the podcast is the third and final in a series of podcasts that i am doing that is all about how to find how to leverage how to take advantage of physical therapy which is one of the biggest tools i think an ultra runner can add into their arsenal on the podcast today is nat collins who's a doctor of physical therapy as well as a certified strength and conditioning specialist i have been on nat's table more than any other physical therapists that i've known in my coaching career but more importantly than that nat has always indulged my myriad of questions that i've had for him all about the physical therapy modalities that exists in the universe out there those of you that listen to the podcast with jessica layman and last week with john chow will come to appreciate how many different types of modalities and treatment options that physical therapists have and i wanted to bring a little bit of that out throughout this conversation with nat i think you will find that he pulls no punches he really offers an insightful view on all these modalities what you can use them for what the history of them are what you shouldn't be

using them for and quite frankly if they're junk or not and that's what we are all about trying to find out so with that as a little bit of a backdrop i'm going to step right out of the way here's my conversation with nat collins when i sent you the outline the first thing i could think about is like how many people are we going to piss off i don't know man probably you're not going to piss off somebody always you're going to piss off people by trying not to piss somebody off like well why didn't he he should have gone further there he should have said more things yeah come on what i would well i don't know maybe maybe i could take the statement back but what i would want to recreate is some of the conversations we've had when you're sticking needles in me yeah because those are actually pretty good because we're just trying to like pass the time on what inevitably is a little bit painful and you have to be super precise yes yes so so that's the interesting thing to me is uh that it's even a hot button issue at all like it should not be it's not in other countries at all seriously yeah like australia they don't do this they don't have these pillow fights about everything canada doesn't do this canada even use their their physios use the term acupuncture medical acupuncture for a long period of time and it wasn't an issue at all seriously but here it is and the places where you would feel like

uh medical management is the most progressive those are the places where it's not even legal like the west coast washington oregon california they can't do it legally you know it's funny so yesterday i'm recording this is probably going to be third in the whole series right okay yesterday i recorded with a really good friend of mine who i don't think you've you've met i've known him since junior high school and um he's a dpt and uh he has his own clinic out in santa monica super successful clinic called the matrix clinic and he and i were talking about this exact same thing like why is has this not crossed into like california's borders he's like it's just so litigious that they're afraid to take the leap because of the risk reward associated with correct that type of practice or that type of mode yeah and they've seen what's happened in washington where i don't know how long ago this happened but kinetocore who is one of the the leading educators for dry needling techniques and certifications in the u.s they've now partnered with another group i can't remember who evidence in motion they were teaching a class like a puget sound or something i'll get that wrong and so it was another group 15 minutes away but the acupuncturist saw what was happening there uh probably saw that it was getting pretty close to their turf worried about it financially and sued

them and i don't know how much money they bled out trying to fight that but they lost it and the same thing happened in washington with physical therapists there can't perform manipulations unless they are directly trained underneath a chiropractor yeah yeah so i i don't know it all seems like it's about money in california you would think that they are not that litigious about everything that they'd be a lot more open like colorado is most states have put this into their practice act by saying they're not going to put something specific into their practice act yeah yeah well i can remember when dry needling was first approved is that the right word even approved like approved for practice we'll go probably it's probably something we'll go with that it was first approved as a modality in in the state of colorado recognized recognized there we go and inevitably what happened is every clinic started the this rush to get somebody within their practice certified yes and it almost like it became the de facto thing like you would walk in and they just start throwing needles at you in fact here's a funny story and i think i've told you this before um there's a clinic right next to our office at the time yes i know this clinic that um was one of the they might have been the first in colorado or one of the very first and so they brought all of our all of our coaches in because there's a new

thing we wanted to do some continuing ed you know let's kind of like learn about it and things like that they brought all our coaches in and we were like you're gonna do what like you're gonna do like what huh like of course we don't know because we're not in the inside look we're gonna do what and so the the the practitioner there said okay i'll i'll show you guys how how this works do we have any volunteers and like everybody got alligator arms at that time right they just kind of like full yeah they just kind of pull it up so i was like okay i'll do it like i'll do it just like do you have any you know went through the stereotypical do you have any this do you have any that i was like whatever she was gonna do something on my calf or my gastroc or something like that yeah roughly and and and you know to set this up a little bit more they're just coming out of their training which is extensive we'll go through that with what that training is a little bit they'd just gone through that training but in terms of having like live bodies outside of training i was probably like one of the first and she's trying to demonstrate this to what was a group of about 25 people or so 25 like onlookers or something like that and so she's going through the whole thing and she's like okay i'm gonna do this here's this needle it's super little you know you look at it and it's not you know it's totally benign looking and i'm sitting there on the table and i don't know what happened from one minute to the next but i had this excruciating pain and literally jumped off of the table like that's how like that and it probably made it worse because i jerked up so much right and i just turned to her i was like what the f was like what the f was that she's like i did something wrong

well she shouldn't have probably started there first of all because you're an endurance athlete and all the vascularity she's going to hit something yeah and it's going to feel really sharp so that's probably what happened yeah i don't know i mean it but anyway i guess my point with that is is like i've seen dry needling as a physical therapy tool starting and you you've seen it obviously you know more abruptly than i have but on the patient side of things being i feel like i was patient zero on that one particular case i just feel like trying to sell it like we we just have not done a good job that's one example and i don't mean like you shouldn't have started there like that's a bad place to go because endurance athletes have problems in the lower extremity and you got a needle there sometimes but just to show people what it's like and that it's comfortable maybe you know go in the glute start with some butt stuff first uh but the the term dry needling is stupid just from like a branding stamp like it doesn't sound comfortable yeah right so where did it start though like what's the let's go back like what's the origin of this because ultimately it came into physical therapy but it it started obviously way before that right it's debatable when it actually started but i think in its you know kind of the modern form it was in the 40s uh this physician janet trevell who actually was the doc for jfk um she was involved with a lot of research in wet needling which is what we know now is like essentially pain management or injecting like a steroid or another

substance into an area for pain relief and to do those studies you have to have controls and the control is to stick an acupuncture needle in the same area and they found that so something with no juice behind it essentially there's no fluid right yeah dry yeah right they found that just sticking the dry needle in there gives pain relief sometimes in the same way that dropping a steroid is uh getting people a little bit of relief so that's where that started um and also it was involved with just kind of mapping the the areas of referred pain when you put a needle somewhere so there are extensive maps of if you drop a needle here here's where it causes pain elsewhere or here's where it relieves pain elsewhere that's kind of how it started and then it's evolved in different ways in different parts of the country in different parts of the world um it just depends on the kind of the the belief that you have about what you do with a needle i think it's probably the same thing with acupuncture i know there's different branches of it there but the way it's used primarily now uh i think in in the physical therapy community is to either treat a trigger point which is to go into an area that feels tight painful causes causes pain elsewhere causes pain locally or to help stimulate an area in a way that you can't with superficial neuromuscular stimulation and so if a physical therapist wants to bring this into their arsenal of things that they can use to treat people i know it looks different state to

state but can can you kind of like paint that picture because it's not as easy as i'm just going to buy some acupuncture needles and start you know studying anatomy there you have to go through you have to well maybe it is as simple as that no uh no and they would never say that oh my god uh that would ruffle a lot of feathers so that first of all they're not even going to say that they're acupuncture needles um so the the process is this you have to be certified and licensed as a physical therapist in your state in colorado you have to be out for i think at least a couple years so you have to be practicing for a couple years you have to yes okay yeah and the standard now pretty much is that you have to have a doctoral degree there's some people you know practice 30 years ago have a bachelor's degree but for the most part you've gone through undergrad you've gone through a doctoral program you've been out for a year or two depending on the state then you go in and you take your level one class and i think it's 30 hours in person plus some time outside of that environment you can start with low level treatments for a few hundred hours it's like glutes hamstrings things things that you're not going to get into too much trouble uh if you run into something that's out of the ordinary then you come back for second class then you do things that are a little bit more consequential uh such as needling around the rib cage so thoracic paraspinals are the muscles that around your rib cage or if you miss you can puncture a lung that's really rare but they make sure that

you are rock solid before they they certify you so doing things around the rib cage around the head and neck actually into the foot into the hand making sure that you know nerve and vascular maps really really well before they certify you and is it the same like uh certifying body or overall body as physical therapy or is it like a subset of it they're not a subset they're a different entity totally different entity so so to get it to get accepted into this entity you would preferably have a dpt be practicing for two years and then you can kind of like just stay in that channel essentially for the most part it these certifying organizations uh they're different from state boards what the state boards will do is take a look at what are the requirements of a different core of these specific courses and make sure that they line up with the scope of practice of physical therapy and for the one that i did it was under kinetocore i had to be there for two separate weekend classes that were i think about a year apart i had to needle i don't know how many hundred patients in between and then i had a formal practical test but i had i don't know how many hundred hours of practical three-dimensional uh topographic anatomy before i even took the class and that's the i think the beef a lot of acupuncturists have with physical therapists doing this is like well they just took a

weekend class and they can stick needles wherever they want to oh that's not that's not true uh there's a lot of intensive training um before you even start the the practice um yeah i i think that it's way overused well i mean i'll talk about yeah i know i know that we'll get into that but um yeah we can talk about that right now because uh whenever you invest when any practitioner invests in a new skill what happens in running it totally happens in running right you start running the incline right right behind my house all the time and then all of a sudden you get really good at it you're like shit i'm gonna do the incline because i'm really good at it right and it's i mean it's the same thing anywhere it's same thing with any practice and especially with something that i mean you get fairly direct feedback from this type of mode you're sticking your needle in and there's some sort of you know there's a release of hormones that go that happens almost immediately the patient can feel sore almost immediately they can feel good almost immediately or maybe even the next day as opposed to a lot of other modes that take that are like more chronic adaptations right as opposed to acute and so it becomes this like or i've felt that it becomes this kind of like chronic reinforcement loop where it's like yes this tool can do everything you know i can kind of like and so that kind of points to your overuse point you know right uh for every condition for everything it it has specific

applications uh whether it's a diagnostic tool like it elicits these types of symptoms or it improves these types of symptoms it's completely dependent on the athlete on the situation on their phase of healing on whatever it is but like it shouldn't be used with everybody it shouldn't be used for 20 times it shouldn't be something that somebody goes in for you know like regular maintenance with it so who are the good candidates for it it completely depends i don't think that you are one really yeah why is that your pain response oh really i think that some people their neurological systems are a little bit more wound up you're trying to say that i'm a wuss you're trying to say that i'm not at all you're tough you're you're way tougher than i am i'm hypersensitive to needles you're way tougher than i am i don't doubt that it's it's your it's your body's response to you know a 0.25 millimeter needle and i think it elicits more of a pain response than it it down regulates anything else so if people come in and they say i've had a friend that's had this it really helps with their like itb syndrome or their achilles tendinopathy or something and you look at them and they're white knuckling talking about the idea of a needle or they're sweating through the sheet look we are going to find something there's something else they can do just as good of a job it's in the research there are some people that do really really well for me for my rotator cuff or for an issue with my

hamstring needling is fantastic for me but for somebody else it's just not going to do well it's about their body's response to it so is it more individual versus specific injury or is it both it's both okay there are some things that we know that there's okay evidence for good evidence for and just terrible evidence for with needling just as a whole like you're not going to go into the plantar fascia with a needle to treat that that's just a terrible idea it's not going to help anything that's great f evidence that's in all the physical therapy journals you're not going to do that so no needling for plantar fasciitis into the plantar fasciitis so i'm not going to say that you're not going to do something supportive that creates a therapeutic window like treat the soleus or the posterior or something else while you address mechanics footwear all that other stuff i think uh that it just it depends on the situation there are some things that it's more of a slam dunk for than anything else like what's what's a prototypical slam dunk uh i think uh a lot of times we we over diagnose iliotibial band syndrome or patellofemoral pain syndrome as it's actually a muscular condition and it's not related to the joint or the tendon insertion it's it's more due to muscle overuse or like a really hard workout or somebody's over stressed and needling the glutes or the distal quad or um you know closer to soft tissues closer to the knee is is is helpful those are really useful and they're areas that they don't have a really rich

neurovascular bed like there's not a lot of nerves and big blood vessels there those work really really well they do the same kind of the dry knee or that's um foam rolling will do yeah but it's a lot more pointed yeah and you can run stimulation right to that area so i think those things work really really well what else so as an athlete kind of goes into a clinic right and how and a physical therapist has this as a tool yeah how can they help the physical therapist know if they would be a good candidate for this or not i think they just tell them what their symptoms are and then the physical therapist should be able to piece apart whether this is a good candidate it i think uh the acuity of the of an injury really matters uh the severity of that injury matters so if it's something like a mild strain it's helpful if it's something like a really nasty strain where there's local bleeding not so good like a high grade strain you're not going to needle that um because some athletes will have this the they'll they'll just have this impression oh my friend so and so had this injury they went in they got needled i'm gonna go in and ask for a request for that same yeah yeah that happens like yeah like a la carte treatment yeah right like people want that it just depends i think low grade strains uh things where there's mechanical overuse or people like the running pattern just kind of dictates that they'll get a little bit more worn out like in a calf or their glutes or they're a little

bit more quad dominant or something like that it can help with those things like gives people a nice therapeutic window and like you get some relief here you do some strengthening it'll help with those things but i i don't i don't know that there is i don't think that there's a flow chart for what makes somebody a good candidate for this i do know that somebody that is really hypersensitive they're a little bit wound up they don't do well with needles in the past they've like passed out when they've had a shot like you just take them off the table right away who also might not be a great candidate even though they can tolerate the treatment is somebody that just wants you to beat the hell out of them every time they come in like the people that want grassed in and they just want to get bruised they just want you to like inflict maximal pain all the time like they're they're gonna get something out of the treatment but i don't know that it changes what they need to have it change there has to be pain in order to get the gain that type of mindset right like why do we want to propagate that cycle exactly i don't want that weirdness in my clinic okay so i guess i guess the point is is for the people listening out there is an effective tool in some use cases you can rule yourself out if you're already adverse to needles or you have a high degree of pain at the area that you're going into for yeah if you're hypersensitive if you've had a bad experience with needles in the past you're you're probably out like repeatedly bad experiences with needles i did have one person a while ago that like a an acupuncturist and this is not to dump on acupuncturist but this one person

saw somebody with foot pain and they jammed a needle like right in their web space between their big toe and their second toe and it freaked her out for years like a decade it we kind of brought her back into the fold and she just had some achilles issues she got a lot lot lot better so i think there are things you can pull it off the table but if people do reasonably well needles they are okay with low grade pain uh they're willing to do a little bit of exercise right after and they're going to use it as something that provides a therapeutic window and they're going to take advantage of it with either exercise stretching modifying the running volume making other modifications yeah they do all right do you think that area of practice is going to like expand or contract or just kind of start to find a norm because i already went through the find a norm yeah it's it's it's hyperinflated it's it's like normatec boots or trigger point stuff or crossfit um my god uh all these things just blow up there's a meteoric rise and then they kind of level off i feel like it's really going to find its niche the research is weird right now but i think it'll it'll kind of level out and be where it should yeah in 2010 2012 ish it was way overused oh my gosh yeah uh it was like art yeah oh same thing right art it became so prevalent yeah everybody wanted it everybody manning yeah it's right rt yep yep oh my god i got it you know it's all it takes man some

money some yeah same thing same thing cupping had the advantage though of is that it was visual right so the olympic athletes had it yeah same thing yeah yeah there's like a seminal moment for those things exactly oh man we're going down too many rabbit holes you mentioned the next rabbit hole so we'll pivot over that was graston right so this is this is something that i feel that a lot of endurance athletes are drawn to because there is a pain response typically associated with it and they're like okay i can feel something happening versus you know the banded glute walks that they do that just feel so trivial right so let's kind of take the same pattern that we took with dry kneeling with graston okay where did it start who are the candidates for it and we can go from there grass and i honest to god i i can't make comments about graston in general because i don't i don't know that brand uh they're kind of a behemoth there's tens of thousands of people that are certified in use i think a lot of them are chiropractors uh initially but they are they are their own entity grassed in i think they have a trademark they have this you know arsenal of tools that are their own that are i think super expensive and essentially they're they use stainless steel tools where other people that use a similar treatment um you can just get these on amazon now they're like 15 bucks it all falls under underneath this umbrella of an instrument assisted soft tissue massage and the idea

is that you're going to compress vibrates rough up bruise the hell out of do something to cause a change in tissue quality local blood flow anything locally i don't know how that started i feel like there's been some version around it for a long time uh it has evolved to where it's pretty ubiquitous and i think like you said in the endurance command the endurance community people get rid of their feel bad feel bad stuff by doing more feel bad stuff i like that quote a lot of i'm gonna use that but it's controlled it's passive it's just like oh somebody else is doing this to me now i can pass the baton and there's visual evidence a lot of a lot of the time like people get bruised in the area and you do you get a response and it seems to last a little bit longer than you know like foam rolling or trigger point stuff i i think that that one will really calm down uh as far as uh like the excitement about like grass and in general or a stem depending on where you're at in the part of the country i think they're a little bit a stem is a little bit more famous like pacific northwest because now unlike needling needling you got to go see a practitioner you got to go see a pt chiro physician somebody else you can go on amazon buy one of those things for 15 bucks that's what i wanted to talk to you about so is that which is awesome is it awesome or is it dangerous no well it could be dangerous depending

on the person but i think that's going to be self-limiting i mean you can't screw yourself up too badly right oh yeah you can't leave it to a bunch of ultra runners man come on now i will i'll walk into the you know the local shoe store and there's always somebody just like hammering away on their achilles exactly and i'm like i mean that's cool like i don't know how long you want to do that um i don't know how dangerous it is i i love the stainless steel ones i think they're actually pretty useful they're probably not useful in the way that it's uh described like in in the literature from these official companies like that it vibrates more in an area that's more painful there's more of a problem you're using it diagnostically in that sense yeah yeah yeah i think that we have figured out that scraping an area whether you do that just kind of like dry or there's actually lotion or something underneath that you're running that tool against that area it changes some things neurologically it changes some things with blood flow it's probably pretty acute you're probably not causing like a permanent change there so it's gonna let you do something else so you're not worried about the people that are buying these tools for 15 on amazon and digging into their achilles tendon no unless they go on instagram and tell other people how to do that but people are doing that too that's the thing right god i don't know before grass and it was like spoons i saw people literally doing this with like a spoon so i i don't know it's kind of the next dumb thing i guess to do that

i'm not too worried about it i haven't seen anybody entirely screwed up with that the way you could potentially see somebody screwed up with like like a dry needle or doing blood flow restriction training the wrong way like that can cause some legit problems um most of these modalities and little things like you're not gonna you're not gonna eff yourself up too bad with that you're probably just not gonna help yourself yeah okay i think that's the more dangerous aspect okay so who same question as we went through with the dry kneeling who the good candidates for this i think pretty much anybody depending on uh where the injury is i think it's great for areas that are smaller that you can't foam roll or do like a trigger point on so like around your toes your ankle things that have less soft tissue underneath them so like kind of around like the plantar fascia where there's not much muscle there or if you've had an ankle sprain it gets sore and there's not much you can do besides like tape it just lay off i think it's great for that kind of stuff um the people is not good for people that are really prone to bruising maybe have some issues with like iron cycling um have some more chronic pain issues uh people that have sensitivity issues or or are hypermobile i don't know if it's good to go in and beat up an area if your joint already has like a ton of laxity there i can't put any research behind that but i just question the use there can you can you describe the state of the research on that

particular mode it's all over the map really yeah it's really so i think first off it's important it's important for everybody to understand i always have to remind myself of this with any of these modes it's very difficult to have a lot of high quality evidence and that's because yes what you're testing for is very problematic to have or you can't at all have a double blind placebo controlled trial for right and so when we're looking at things where that is either extremely problematic or doesn't exist in the first place you automatically have to like down regulate how you treat the rest of the literature right i think it's one of those things where you can you can use it more to rule out than you use it to rule in for us in the pt community it probably isn't going to do us any favors because it's going to say that these things are less useful than they probably actually are yeah so you're not going to get that reimbursement and that hurts patients that hurts athletes trying to access this stuff like in the hands of a professional but i think it's it's the research is probably going to do more good for ruling something out than it is to say like in this instance it's great i think in those cases you actually can go more by the anecdotal stuff if it's somebody you feel like you trust they're smart they do their research they've tried different things they use it appropriately and they're not just a junkie for it that well okay that's actually a big difference right if you if you're in the hands of a

practitioner that is that's using a variety of tools or using other practitioners within their you know kind of within their reach or within their practice to get the best treatment for a patient versus a practitioner where they kind of be like they're trying to like they're almost like a one trick pony yes and they're using all of the weak ass evidence to justify either it not being harmful or slightly helpful i think those are two completely different situations totally yeah it if you see somebody that does the same thing with everybody maybe even especially if they are one of the people that is an educator for it you should probably maybe like rethink your process right that's really interesting i'd never thought about it like i mean if you go in 5 10 15 20 times a year it's the same thing and they're doing the same damn thing to fix the problem but you still got the problem now it's kind of on you you see the same thing with manipulations like oh god and there's a reason for that jason and that's because a manipulation causes this really acute uh certainly evidence-based response that makes people feel better it's a central response and guess how long it lasts for about the amount of time it takes for you to walk out of the clinic drive home and feel a little bit better and then what do you do you go back again and again but at some point it's not just the feel good from the manipulation are you hyper mobilizing the area like is there more laxity but there's a reason that that works and it's the same thing with a lot of these treatments almost all of them uh needling in some cases grassden or this ia stem stuff in some

cases blood flow restriction anything where you compress or relieve a tissue there's a short-term evidence-based effect but it doesn't fix anything right gives you a short window where you feel better there's a reason people use it yeah why do a lot of physical therapists kind of fall into that single-use trap and i in in to before i piss everybody off physical therapy is one of the tools in fact it's probably the biggest tool that i lean on as coach yeah i'm always searching for good physical therapists in every area of the country that i can send my athletes to because running is just such an injurious sport as much as i try to you know load manage and you know all that kind of stuff it's just going to happen but i'm always on the i'm always on the lookout for good physical therapists that can diagnose what's going on fix what's going on versus doing the same thing over and over and over and i i personally get frustrated when i hear stories or reports from athletes who go to the office and they get the same treatment yeah every single time for 20 weeks yeah and i almost want to bang my head against the wall what why is that a distorted version in my head or does that actually happen a lot it happens why god damn it uh it's almost i mean there we do that in coaching too right you see coaches who just prescribe the same thing for every athlete so maybe i will defend clinicians of all types and i'll defend some coach some coaches first if you have a thing that works if you

have a trick that works even if it's for a short short period of time then i can see why people would continue to use it just from like a self-preservation standpoint if they've got a thing that makes people feel better or can help them i can see why they do it so there's that why they continue to do that even though there's so much evidence to the contrary like that you should be branching out not throwing the same thing and everything like you know not you can't look at all problems the same way it's on the clinician it's on the coach to try to find something that specifically helps that athlete over a period of time that includes more than just the next 30 minutes to 48 hours because then you're not helping anyone so maybe that's the key for athletes is to look beyond the hour after the fix yeah and i i don't know if that's not just a societal issue yeah who though is like a passive short-term thing i mean for god's sake we had who was it that was repping advil at the race series oh it was iron man yeah it was a leave actually a leave yeah yeah that's dangerous i wrote an article on that yeah in triathlete magazine yeah guest article yeah so i think part of it is just the mindset uh of the country like well it's just the people right you like you you want to feel better

and so you find a thing that makes it a little bit better um and so i can see why people do it it's just it's a little irresponsible not to say like this is part of a larger framework where i'm going to do the work now we're going to help you feel better enough to to get you going but then this is a collaborative effort that eventually i hand off to you but it takes active maintenance work it takes some actual thought about what's happening and it takes diagnostics on your part and thinking about what's happening happening throughout a training cycle throughout the next two five ten fifteen twenty years of your your life um or your training to to ensure that you're doing the right things to get better and to continue to feel better not get injured like the injuries are going to happen i mean what's the injury rate in runners right now uh 70 annually we're probably not going to get rid of that no we suck it not being injured like this is this is what continually frustrates i don't i don't and i'm not this is not a defensive posture on on my part as a physical therapist um i don't know that we're going to get rid of that maybe not i don't know i think it's just the nature of the sport i just keep how we manage i just keep looking at this is this is you'll find this really interesting i keep looking at all the whole recovery industry oh dude from the normatech boots to nutrition to everything all of the research that we've done on strength training all the research that your

colleagues have done in physical therapy and other modalities and in the endurance community we really haven't been able to move this injury needle all that much with all of this stuff coming up and so the only logical conclusion is conclusions are either a none of that stuff works or b we're not using it correctly or maybe there's some confluence of people are just doing it more like people are just training more and then the recovery modalities are keeping things par i mean i guess that's the third option but it's really hard it's once again it's really hard to look at the vast proliferation of all of these things that are supposed to help athletes stay out of an injury state and recover and we still have such high injury rates you can't look at that as as success is the rate going to stay the same but what's under that umbrella looks different i don't know like the severity of the injuries is different what we quantify as an injury is different here's what i would say if we could move it to half yeah i would say yeah success we've done a good job coming up with stuff education modes treatment options recovery this that or the other we could move it to half i'd do a backflip like when i so i track i told you this before i track the injury rates with my athletes and i try to stay under 33 percent a third so a given year i coach 40 athletes if i can get you know 12 of them or something like that if only 12 of them have an injury and i define that

as is they lose one day of training due to an injury if i can get that less than about 12 or 15 out of 50 i consider that super successful and i think that's wildly successful i've only been able to do that like half half the years that i've been coaching it's really hard what have you been able to get rid of like what things have you been able to kind of suppress from an injury standpoint um so one thing is the duration yeah so i've built out this is part of the the point of the series of this podcast is i've built out a professional network of orthopedic people physical therapists and things like that so that from the time something starts to pop up with an athlete i can start to deploy resources to get them into treatment quicker and so a two-week process then now becomes a one-week process or something like that yes yes so i think that's where all this goes is i don't know that the rate totally goes away if we get to 50 that's fantastic but if we give people enough of a knowledge base which is something these short-term like one trick things don't do they don't advance that if you give people enough knowledge to know like these kinds of things are going to happen can you manage it on the fly and it's less than a 24 to 72 hour window that it's really limiting thing and even with that there's still something else that you can do aerobically metabolically from a recovery standpoint from some other standpoint that you're still generally improving and like moving the needle the way you

need to if you can do that then i think we're successful i don't think we totally get rid of injuries but i think we can change the way they impact people and their severity and we keep people from getting to the point where they're not because they're not using these things because they're not just taking nsads or something else where they don't totally blow up yeah i don't think that we do that by chronically treating people with these short-term fixed things i think we actually make them worse because they take away the warning signal and that's one thing i think can be dangerous when you put them in the hands of either kind of an ignorant athlete or an ignorant clinician is when you take away somebody's symptoms but you don't give them any knowledge about how they're supposed to fix the problem you may make this a whole hell of a lot worse like you might ruin somebody's career yeah here's the thing though that gets really tricky with that is that sometimes you've got to get them to the start line and you deal with all that shit like i've done after that i've done that i've not and i'm not trying to encourage people to go like short-term thinking like just get to the start line but there are some situations and typically what happens this is this is actually what happens from a training standpoint right you're trying you're trying to confluence the highest training load somewhere near the end of the training process right somewhere near the taper and things like that and that's typically the the time frame that has the most risk associated with it yeah and consequently they're

going to get injured more often during that time frame and so when you've got four to six weeks that's not long-term thinking that's short-term thinking like what do i need to do to get on the start line and you've asked me this question when's your next race yeah right yeah do you tailor treatment towards that like when's your next race is it two years from now or two weeks from now and what's the priority yeah hell yeah i do i mean i never thought uh coming into my career which is you know a decade now that i would make some of the decisions that i make where i'm like god this person's really close to having a full-blown stress fracture or something else and i'm like how important is this to you and i'm not going to do anything that's irresponsible but it's not my body i'm making decisions to help somebody else do what they want or need to do sometimes this is a paycheck for them yeah like this is to help their kids and it's it's different when you're not fixing a problem that's chronic um potentially being irresponsible by just doing short-term fixes and trying to keep somebody duct tape together well enough that they can get there well duct tape is the literal word sometimes i mean seriously i mean everyone go read fix your feet now uh those things are different uh but i think a lot of times the athletes they'll and you have seen patients like this i know you have

athlete comes in four weeks out from a race nat fix me you go and it works right some some sometimes races have this miraculous way of either suppressing or fixing an injury i see this all the time with athletes it's really weird but but important to this conversation is is they're like ah whatever i did no right before but that's the psychology that happens right whatever i did beforehand that was the key so i just need to apply this short-term fix all the time and then it propagates itself yes this anecdotal study with one person one time is now the universal rule that's the most important it's the universal rule weird things happen with injuries like i remember even you in leadville in yeah 2019 like man the first 50 miles this thing would not go away and then it i just shook it yeah it's weird the first leadville i did i didn't know whether i was going to make it 10 feet 10 miles or 100 miles like literally i was on the start line i was like all right well we're gonna see how this i can't remember what it was but yeah it's weird nobody's been able to explain i will say this i think as long as people consider the short and long-term effect of the decisions they're making i'm okay with going anywhere for them as a clinician as long as i'm not doing something illegal

like i've done things like god i would never do this for myself i think you're an idiot but this is really important to you there's money on the line so we're we're gonna go with it well it goes back to the individual nature of the athlete right because a lot of times um athletes will look to every day what i'll call everyday athletes um will look to the elite and the professional athletes as some kind of guidepost for something whether that's training or this person is a sidekick influencer and now i'm going to use that and things like that and what they fail to realize is the risk-taking proposition is different when it when your job is on the line right you can't take a look at people that have to hit their absolute anatomical physiological mechanical limits as the standard i don't think you can do that elite professional athletes have to go there and they have to do it repeatedly in cycles progressively four years to make their money that's how they make their living and the mindset is different i can't remember i've heard this quoted so many times i don't know if this is real but i've heard there's a study out there somewhere where they pulled olympic athletes and asked them if i gave you a drug they would guarantee a gold medal but you'd die the next

day would you take it yeah that's a really famous study yeah that's real yeah okay so you can't you can't that can't be your mindset for the average person yeah no and this is no disrespect to the olympic athletes no it shows but and it's an old i will say it's an older study i think it was done in the early 2000s i'll have to look it up afterwards and i'll link it up on the show notes for anybody that uh uh that that that is that is interested but the the basis of it was trying to evaluate that risk taking proposition right if we could give you something that would guarantee i think the way the way to get the way they worded it was guarantee a medal and olympic medal and you knew that you and you knew that you would die within the next year or some sort of short-term time frame would you take it it's like 70 or 80 percent would say yes yeah and once again it kind of goes to the mindset and that's not to say that that's good or bad that's a different podcast for a different time but in terms of when we look at athletes that have had cupping that have had needling that have had you know joint manipulation kt tape you know whatever and they're kicking ass out in the olympics the winter olympics are going to come around you know very very soon this is going to be the case again we always have to realize that that's a really special group of people that are that are that have just a different risk-taking proposition and professional proposition as opposed to the vast majority of the listeners out here yeah and their biology is different than your biology and what your day looks like too very true they even you like you could do a workout that would have me on you know like i'd be

on the floor for a week right now like i am so deconditioned that as a new father right now like oh my god i can't even imagine you know doing the incline right now i was about to say you're gonna turn down my incline invite well bro dude so i i just did the virtual boston last saturday uh after i'm pretty sure i've been training like eight miles a week for a few months now and just got up and ran a marathon last week and the last 10k was so just not pretty it was uh there was a lot of cramping and uh not nice feelings we're the worst purveyors of our own advice right yeah don't listen to anything i say okay we thought we i set this up as we were going to talk about modalities because i love shooting the shit with you on this talked about dry kneeling talked about grassed in yes third one is nat's choice i want to talk about this because it's something i see all the time people ask me about it and i think it's the dumbest goddamn thing i've ever seen in my life uh thanks joe rogan uh the so right have you seen oh god yes so describe physically what it looks like first it is uh i would like to say if you if you cut an h in half and you made it out of foam and the flat part is down and the arms of it are up it's i think original use as the name implies so right spelled p-s-o uh is to put compression

into the psoas muscle muscle which is your hip flexor um am i describing this yeah according to how you think about it uh it's been on joe rogan it's all over instagram it's all over the socials i can't go a day without seeing it on instagram and uh i feel like it's the idea is that you'll lay on it face down face down well not necessarily now the uses i see now are that you know you you lay on it face up and it's a decompression tool it helps get into your glutes they've expanding the use case they've literally uh and you know they've done a 180 on it um the psoas muscle uh for anyone listening uh is a muscle that's so deep it's it's against your pelvis pretty much uh it's way back there it's behind very large blood vessels it's behind your intestines there's a lot of sensitive sensitive uh internal organs that are right there so the idea that you're going to lay on a piece of foam get past all of that and target one specific muscle is obnoxious for a lay person to do that that doesn't have any background in anatomy it doesn't have you know thousands of hours of training in three-dimensional anatomy even if you had that knowledge it's like the idea that i had a friend describe it this way it's like the idea that you

would fill up a thousand uh balloons with water put them in a bathtub press on the top one and think you're going to get the the this one balloon at the bottom of the tub that is a good analogy you're just going to move so many things around you're not going to compress the right thing huh uh you're going to catch all this other stuff and you're going to feel something hell yeah you're going to feel something yeah because you're you're compressing your internal organs yeah you're compressing your colon you know or your appendix so yeah there's going to be a response i just i see stuff like this and i'm like this is best used you know to burn it for warmth or something i i i if you work for this company i'm i accept your ire uh because i feel like you're wasting people's money they're not going to be called they're not going to be calling me anytime soon uh asking to sponsor the podcast no no no you uh you're sponsored by like the tiger claw or something so i don't know i don't have any sponsors man i you know what i intentionally when i started the podcast i i made a commitment that i wouldn't take on any sponsorships the objective so so i could do stuff like this so i could bring somebody on and they could say no this is bullshit because if you have sponsors what i think what people don't understand is when you have a show or a piece of media that is monetized through sponsorship and you're looking for sponsors those people will look at that content and say and and and try to create a case against

sponsoring you so for whatever reason i said something bad about carbohydrate supplementation or something like that a gel company would never come out and sponsor me right yeah so i just wanted freedom to say and my guests to say kind of whatever the hell they wanted to and the result of that is no sponsorships well you're a low carb training guy oh i can talk about that that's one of my most popular episodes by the way i told you this shout out to jeff browning i love you jeff he's a good guy we disagree but he's a good dude yes i the thing i'll say about any of these these things like so right or whatever else it's not that you can't get some effect and it might not be helpful for you but it's just going to be short term and you have to take it for what it is like it's a thing that might make you feel better for now and you can use it before or after a workout plug that into everything else and just understand what you're doing just if you can save more hours in your day more days in your year training by being just a little bit smarter and not using this stuff as a standby i i think that's the proper path i just won't be more judgmental than that i guess uh i i had a feeling that's what you were going to guess or that's what you're going to pick out yeah yeah i mean with this mustache uh i don't know what the you know promotional materials will will show but i have a bit of a ted lasso mustache right now so i'll just use a ted lasso quote and that's to be curious and not judgmental which i think is a misattributed walt whitman quote i don't know if he

ever said that i think i think in this case is be be curious and then you can be judgmental judge the shit out of people when they're wrong all right man we're gonna let you go that was fun uh appreciate you coming on i'll always appreciate you fixing me and you fixing the athletes i've sent to you over years yeah i always appreciate the opportunity i i understand what's on the line for other people uh because it is for me too i'm a very cranky person when i can't run as evidenced by the last several months in our house that's right how can people get a hold of you if you want them to get a hold of you you know i just stick down my website because i'm kind of doing a rebrand um but you can email me directly at natcollinspt at gmail.com or and i'm serious about this especially if you work with so right you can call my cell phone nice things or unhappy things 719-357-7875 i seriously would love to get voice messages very bold anything in the show i would i would love it that's the first that's the first for this podcast i read a book by an author that was one of the more inspirational books i think i've ever read about just being open and and being direct about life and i please educate me if there's something i need to know or if you're happy about something i said i would love to hear it directly i don't want to say something about somebody that's not in the room and they can't really defend themselves so call i have a feeling you're going

to get some so rights like sent to your house next week by somebody who's listening i hope they send a letter that says use this and see that you are so wrong ah there you go brilliant all right man thanks i'm gonna leave it at the pun all right folks there you have it there you go much thanks to nat for coming on the podcast today and indulging all the questions about these various modalities and the history of them as you guys can tell nat just tells it like it is and if that last little segment on the so right is of any indication i've always appreciated his pull no punches approach to things and speaking of pulling no punches this podcast has never had and will never have any types of sponsorships or advertisements on it and part of the reason is is so we can talk about things like so right just like that in this completely honest and unadulterated fashion so if you do like this podcast you can do one of two or maybe even both if you are so inclined things to help me out here and help this podcast out first off is go and leave a rating or review on apple podcasts that helps the podcast out a lot also means a lot to me personally and the second thing is is if coaching is an option for you for whatever your 2022 goals are hit me up on social media i would love to connect you with one of our cts coaches or if i'm the right coach for you i would love to work for you with you in 2022 and beyond

i always love making those connections and i know everybody out there is starting to get their calendars in line because lottery season is right around the corner you can also check all of our coaching packages out at www.trainright.com the link to that is in the show notes either one of those if you do either one of them it would mean a lot to me and it helps this show out tremendously all right that's it for today appreciate the heck out of everybody listening and as always we will see you out on the trails you