In this episode of the Flex Diet Podcast, I sit down with Dr. Doug Goldstein for a deep dive into biomechanics, performance, and recovery. We get into the weeds on muscle performance, body comp, and how to reduce injury risk—stuff that matters whether you're an elite athlete or just trying to move and feel better. We also explore some cutting-edge tools like Springbok Analytics and dive into how intramuscular dry needling can change muscle properties to enhance performance. Plus, we break down contralateral adaptations, mental performance strategies, and smart approaches to overload. Lots of real-world applications and case studies in this one — don’t miss it. Sponsors: Tecton Life Ketone drink! https://tectonlife.com/ DRMIKE to save 20% LMNT electrolyte drink mix: miketnelsonlmnt.com
In this episode of the Flex Diet Podcast, I sit down with Dr. Doug Goldstein for a deep dive into biomechanics, performance, and recovery. We get into the weeds on muscle performance, body comp, and how to reduce injury risk—stuff that matters whether you're an elite athlete or just trying to move and feel better.
We also explore some cutting-edge tools like Springbok Analytics and dive into how intramuscular dry needling can change muscle properties to enhance performance. Plus, we break down contralateral adaptations, mental performance strategies, and smart approaches to overload.
Lots of real-world applications and case studies in this one — don’t miss it.
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Speaker: [00:00:00] Welcome back to the Flex Diet Podcast. I'm your host, Dr. Mike T. Nelson. On this podcast, we talk about all things too. Increase performance, add more muscle, improve body composition. Do all of it in a flexible framework without destroying your health. Today on the podcast, we've got a journey down more in the land of biomechanics with my good buddy, Dr.
Doug Goldstein. So I got to meet Dr. Doug in person out at the Parker University conference earlier this year in March, out in Vegas. I was able to attend Dr. Andy Galpin and Dan Garner's talks on the hypertrophy and training, how to set up everything. I worked with all these guys over at Rapid Health, so I worked there part-time doing sleep and other analysis for them.
And I walked in to see Andy lying on the table, and Dr. Doug [00:01:00] had a needle in his side. I was like, Hey, this looks pretty cool. What are you doing? So we had a good conversation there as Andy had some fun, but Andy's movement was much better. So I was like, Hey, this is pretty interesting. And I wanted to have him on the podcast to talk about different types of analysis, some mechanics.
Something called springbok, which I will have him explain. So we talk about everything from contralateral muscle adaptations to mental signs and muscle overload, contralateral side and shock absorption, some really cool case studies. We did have more videos on this one. I know a lot of like our audience here, probably 95, 90 6% of it according to the stats is audio only.
We do have this uploaded on YouTube if you wanted to look at some of the videos we did review. I tried to explain them as best as I could for our audio only listeners. But we did do a fair amount of biomechanical [00:02:00] analysis if you can see that it is a little bit better. Talked also about intramuscular, dry needling and different ways you can change muscular output.
And then we even talked about risks of hamstring strains, muscle activation, a whole bunch more super geeky biomechanic stuff. So this is probably the first time in public in a while. I've actually talked about biomechanics. So my master's was in mechanical engineering. All the course work was technically in biomechanics, solid mechanics.
Although my research, as listeners know, is in more of the heat transfer area. So early on I did a lot of gait analysis. Still do some of that here. Do a lot of manual muscle testing, hands-on therapy via RPR be activated therapy, some stuff from Tom Myers and a bunch of other stuff. So, it was super fun to geek out about all this stuff.
With Dr. Doug, we'll put all of his links and all his info below, so make sure to check out all of that. And for sponsors, if you're looking for electrolytes, keep yourself hydrated. [00:03:00] Check out our friends over at LM and T. I'm drinking the grapefruit one here today, which is one of my favorites. And then if you're looking for something to help get through the day, help with performance and even cognition and under fatigue there was a new poster at ISSN that talked about this using ketone esters.
With ketone salts, you can get some benefit to them, but you're probably gonna need a ketone ester which is a higher amount of ketones that make it better through the bloodstream. So check out my friends over at Teton Ketone Esters below. I do some advisement for them and end ambassador for them in terms of full disclosure.
Also, if you like this information and you want more, I check out my daily newsletter. That's where probably 90% of my content goes. It's completely free to join. We'll give you a cool free gift there. Go to the link down below so you can sign up and get tons of free information delivered in a hopefully semi entertaining format directly to your inbox.[00:04:00]
Without further ado, enjoy this discussion all about biomechanics and reducing your risk of injury, muscle activation, and more. My good buddy, Dr. Doug, enjoy.
Dr Doug Goldstein: Great to have you here, doc. How are you doing? I'm doing well. Thank you for having me.
And I'm excited about this one. I think as we were just talking momentarily before this, we're gonna have an interesting conversation that may go a few different directions, but I'm sure it'll be insightful for at least us. Hopefully everybody else finds it somewhat interesting. Yeah, if people haven't figured out why I really like doing this podcast, as I get to sit down with super smart people like you and just ask 'em all the questions I wanna know, which to me is like fun and entertaining and I had this idea even years ago.
I remember going to, God, what was it, 2000? Four. I went to an A CSM conference in Seattle, and at the time I was like super interested in omega wave. Could not find anyone doing a mega wave. Everyone's like, what the hell are you talking about? [00:05:00] Finally found a dude, Landon Evans, who did it out in that area, drove like three hours to meet up with him.
He was super nice to gimme a bunch of his time. He is like, yeah, man, just buy me a fancy steak dinner. I'll answer any questions you have. So chatted with him for like three hours and even at that point I was like, oh man, this is just an awesome conversation. He took me back to his lab at like 10 30 at night and like hooked me up to all these like weird electrodes and shit, but I was like thinking.
I think this would be cool, like if I could eavesdrop on all these like, conversations that other people are having in private, just to be a fly on the wall to hear what they're talking about. Some of it might be interesting, some of it might not be interesting. Now, fast forward, we have, podcasts and just tons of information everywhere, which to me is still almost amazing.
'cause I feel like I'm old now and this is some new revolution I'm just getting into. Well, that's awesome. Well, I really enjoyed the time that we had to spend in Las Vegas. I think we've lightly [00:06:00] touched on some of the work that I'm working on and some of the Yeah. Things that I have. You mind if I just share a quick snippet?
'cause I think it could drive the early part of this conversation. Yes, please go. Yeah. So formal training in physical therapy graduated from the University of Colorado. Went down the pathway of credentialing. My entire mission was to be a clinic owner. But multiple clinic owner, like all people, that seemed like the best path to practice orthopedic medicine, but also, make a living for myself and love what I do.
It became pretty clear quickly that the insurance path was had some troubles. And when I Putting that lightly Yeah. I'm pausing. 'cause I think that the the world who's listening is probably understanding. One of the earlier findings that I encountered that became a big roadblock was the big toe of the left foot has the ability to impact the right hip.
And that's just a very matic clinical thing that I would say, oh yeah, but insurance doesn't [00:07:00] care. And what, oh no. They'll be like, you're a weirdo. Exactly. And they won't pay you. So a very good friend and a longtime client of mine was Demarius Toms Bronco's receiver for many years. And I feel like I can say his name now because he's, I.
He passed several years ago, but he's one of the most interesting cases that I learned a lot about this larger understanding of the human. He had an Achilles tear on his left side. I apologize, his right side. But when I met him, he was complaining of left anterior hip pain and he would take his fist and he would hit his left hip.
And I looked at him one day and just finally asked, what are you doing? Yeah, why? You look crazy, right? Yeah. Like, why are you hitting? He said, it's so tight. It doesn't feel good. It's so tight. Well, as we started digging through this and doing the right clinical work, which is hearing his history, it became very apparent that his contralateral ankle was still involved and his contralateral ankle didn't have the proper [00:08:00] movement, the proper mechanics, and that was causing a compensatory pattern on the other side.
It's such a simple thing to say, but I still don't believe insurance understands compensation and they don't care about compensation. That's extremely freak side of pain, man. What are you doing? You crazy person. Yeah, crazy person. So when we started working with the right ankle and or working with the right ankle to improve the mobility of the tail curl joint, I'll show some pictures in a second to make, maybe make that a little more real.
So, but as we improve the right ankle, left hip tightness got better as his left hipness tight, left hip tightness got better, his sprint speed went up, his deceleration capacity improved, his ability to cut, his general resilience went up. One of the most important stats of his career was that he started 125 straight games in the NFL.
That's bonkers. And that's back.
Right around some of the rural changes where you could argue it used to be way more violent than what it is and it's [00:09:00] already super violent. There was a stat that came out yesterday, and I'm actually gonna, I'm, this is me looking at the text that I had sent a friend, because I think that this is such an unbelievable stat and it's a credit to him.
And by no means am I saying that I'm the only reason he achieved this fee. I'm just a part of this team. That was a part of how he performed well, which is obviously something we should hit on as well, which is what does a good care team look like for a person who's in the pro leagues, the stat was that Demarius Thomas is still the fourth in receiving yards since 2000, since 2010, despite not playing five years.
Oh, that's so wild. So it's an incredible feat that he was able to accomplish because he was interested in taking care of his body. And so that's, I think, a really good starting point. There are. More than two kinds of people, but let's bucket them to very simple terms. There's those that are wildly interested in their resilience of their body because they know how important it is to being able to participate, [00:10:00] pay, play, and get paid.
And there's those that have just been athletic their entire life that have almost assumed that this athleticism is never gonna go away. Yep. Kobe Bryants, I've never met him, but I think we can all agree there are those people, LeBron James, that put in the work because they understood it was a requirement.
Yeah. Even Jordan, as he got older in his career, even Jordan, so with all of that stated what parts of their care team were most influential is not, it's not possible to say that this person was better and more impactful, but I think there's a way to talk about what we've, what we knew and what we now know and what we knew is strength training's important.
Right. I think early, Larry Bird Magic Johnson days, early Jordan days. Jordan might've been one of the first guys that was like, weight training is a big deal. And he wasn't a big weight trainer when he started. No. And he became one, and he lifted the four games, which is another conversation topic.
Should we lift before or should we lift after current NBA teams are actually doing their heavier lifts and their [00:11:00] heavier ballistic movements immediately following a game, because it's when the body's most appropriately primed and ready. But as we progress now, we've got tools like SPRINGBOX Analytics, which is a three dimensional post-processing turn your MRI into a digital twin, which again, I'll show you, that system is now a way to measure the volume of your muscle, measure the infiltration of fat, not in the mu, not on the muscle, but in the muscle.
So we've come a long way. PT is always a part of that. There's always gonna be a part that's chiropractic. There's always gonna be a part that's, I'll say body work. And that includes people like A-R-T-M-A-T, massage, deep Tissue, Swedish, all that stuff. But my real focus from my training in PT was how do I make the muscles in the most optimal state so that other people that are a part of this team can maximize their impact with strength training or running mechanics or recovery or lge, whatever that may be.
So with all [00:12:00] that being said I still think we're on the surface of what we're actually gonna know in the future. And I'm sure you've talked to many people that have ideas on what this looks like. Similar to your prior podcast, which was the Microdosing group. Yeah. What does that mean? What does the mental aspect of performance look like?
I think it's a big deal. We all know that, but it's not fully explored and not fully known. We just know that it makes a huge difference in the ability for the athlete to compete at the highest levels. Yeah. My quick example of the mental side is. In the NFL like kickers because it's a very thing you're doing just like one task.
It either goes through the uprights or it doesn't. Yes, there's different conditions, different distances, but you'll see it routinely. Kicker does really well. Doesn't miss all of a sudden misses a 23 yard field goal and then can hit the broad side of a barn. After that. It, that has to be all mental.
Like they didn't get injured, they didn't get hit. They're not even in [00:13:00] other plays for crying out loud. But it just, I think it shows how much the mind plays a role in performance that we're just, I think, barely trying to understand right now. Question for you based on that, because I agree, but I'm gonna, I'm gonna put in the mechanical component that I Yes, please.
The mechanical side. Yes. Do you believe there's a world where the muscles are not cooperative, which the brain perceives, and some of those, we'll call it the tin cup yips, where you're wearing all the gear because you gotta figure out what's going on by the finally tuned athlete on the verge of greatness, right?
Yep. What if the body is the restrictor? Is it, do you think it's plausible that the body's not doing the work and the brain becomes frustrated that the body's not listening? And if we improve the body, could the body then unlock the ability for the mind to have greater ease during the activity? To complete the activity?
Yeah I agree. And that's where it makes it really hard is. Probably the best line I ever heard from this was from Doug Keel, is that [00:14:00] the body is in the mind. The mind is in the body. Like it's a complicated coupled like two-way street where this gets really woo really fast. But if you play with manual muscle testing, right, and again, I don't have a $60,000 bio deck, someone's gonna wheel into my living room.
If you do, I would love to do this experiment on it, but just changing mental status of people, you will see changes acutely, at least on a table, in an isolated situation with what is perceived to be muscular output and vice versa. So I think I agree. I think it's much more complicated than what we think is maybe they're in a bad state and maybe that bad state is I.
Altering their mechanics enough where the thing they normally did is no longer that same thing anymore because of some altered mechanics. So I do think it is actually, I think it is both. What are your thoughts? A hundred percent. I think it's a loop and it can, that [00:15:00] loop can spin. Yep. Either direction.
It's a closed loop that has the ability to go back and forth. I, again my background is on the mechanical side. So if we term this mechanical medicine just for a placeholder of a name Yep. If that kicker sustained a big toe stub at home while playing with his kids and he felt a little discomfort in that great toe and he doesn't really feel like it impacted him, he was able to walk it off, no big deal.
But that changed the ability for his great toe to extend on the left side if he's a right footed kicker. And if he's not able to plant that left leg and extend through that foot with a rigid mechanism, he's gonna not transfer force through the contralateral kicking leg. I don't know if that necessarily shows up as loss of vol, leg velocity, exit velocity of the ball, or maybe that just shows up as it's a little off to the right and it's now getting in his head and he's now changing everything about what he thinks to achieve the goal.
And go back to the Tin Cup example. I'm sure there's plenty of golfer who's listening that has said, yeah, I've tried to change things on [00:16:00] the course. They
Dr Mike T Nelson: go, well.
Dr Doug Goldstein: So having things come as simple as to one thought, like on the golf course, having one thought tends to work well, having 15 thoughts never goes well.
No. No. And even a high level of performance. Right? So I always, another one I really liked I got from Dr. Kaba Z Health was do the drill. Forget the drill. Like do the things, make them conscious. Make sure you're consciously competent at doing whatever the thing is. But then long term you have to be, I.
Consciously, or I'm sorry, unconsciously competent. Right. So it's Maslow's four step model. Yeah. Which I still like, is like the best model because if you're an NFL wide receiver, like you're not thinking about running mechanics. When you're doing a route, you're thinking, okay, I need to get by this guy.
I'm gonna look off this way. I'm gonna go here. Okay, I need to be here. The second I turn this way, the ball's already in my face. Yep. Right. You're thinking about the execution at a high cognitive level. Part of that's probably even unconscious [00:17:00] too. You're not thinking, oh man, I really need to move my right arm a little bit more in front because my left leg isn't going that far into extension.
Like, if you're doing that, it's you're toast. You're done. You're toast. So I'm gonna share my screen. I think this if Yeah, gimme the request here. I'm gonna use DT as an example. I think it's pretty fun because this was we're talking back in 2000 and I'd have to go back and say 2000, call US 13.
Right. Let's just for the sake of, when was this image? When was the bottom image? The bottom two images? And you can explain for the audio people listening, just so we'll have both. Yeah, a hundred percent. Make sure we give the right. I've got a window of four images. These are both, are all still shots of Demarius running the historic video of Demarius catching the ball from Tebow to running the touchdown in the playoffs.
The first pass of the overtime game against the Steelers. The top image, Mike, you're looking at it and others who are watching can see it. Yep. If you're able to interpret that, you're gonna see a few things that don't [00:18:00] look great right now, but this is also right before I started working with him. So assume that these images are free left hip tightness, like I mentioned that left TFL being very disrupted involved and having that right Achilles not have that full comfort with push off dorsiflexion so forth Activation.
The bottom image. Well, and to the viewers who are listening, you're gonna see a runner that's more upright than he should be. He's not driving downhill in the best way. But when we look at the bottom images, this is after he caught a, I think a bubble screen, I believe, where he then took it to the house against the Baltimore Ravens.
And in these two images, he still wasn't fully optimized. But the bottom right image I know Mike, you can see this, you can see how there's drive. Now there's four, I think, how far his leg is behind his body. And he's still moving forward. Correct? Yeah. When we started improving the right ankle mobility, right ankle strength, all of that's interrelated to me.
We can dig into that as much as you want. He developed more force and [00:19:00] that rate of force development going up gave him more mental comfort. Yep. That mental comfort gave him the ability to feel like he wanted to mash on the gas pedal and go faster as he felt more comfortable mashing the gas pedal and going faster.
He got used to feeling comfortable driving at that speed. Once you get comfortable as an athlete doing anything they're phenomenal at repeating, but he wasn't thinking about running fast. He just ran faster. Yeah. I would encourage all people to go look back and look at Demarius. When he caught the Tebow Pass.
I always describe it because he had a, he has a hitch in his step. He ran with a little bit of a hitch. He never had this fluidity that you would see later on in 2015. This would've been the year when he was with Peyton. Wes Weer Decker. It had a phenomenal year. In fact, I think that was the record breaking year where Peyton threw for the most yards ever, the unbelievable receiving corps.
There was one time when he caught a pass on the left side of the field. And he was sprinting at full speed. And it was [00:20:00] such a beautiful I'm a sucker for a good form during running. Oh, yeah. But he exploded down the sideline. And Patrick Peterson took this angle that he thought was going to catch dt.
But if you watch the video, and I'm to the viewers listening, imagine DT accelerating. And that angle was off. He went behind dt, DT went to the end zone. This is such a, which means he misrepresented how fast he thought. He the guy with the ball was gonna run, right? Correct. You're gonna, I think you're gonna love this, Mike.
'cause this is I quote from to Marus, I got to the end zone, scored the touchdown. 'cause Peterson followed me all the way through the end zone. He got closer to me. I think they were the same draft class. And Peterson walked over, looked at him, didn't touch him, didn't tap him. He looked at him and goes, you've gotten faster.
But that's phenomenal because it's a really cool thing of oh, okay. So these guys are all calibrated. Yep. With the competition. DTS performance increased. Peterson didn't have the chance to recalibrate to the level [00:21:00] that he was at. He would've changed that angle had he known DT was running at a speed like that.
But this is the beginning of my mind blown, wow, we can change the human and it can change performance, it can change the perception of performance from others competing against them ultimately led to DT having a phenomenal career, starting 125 straight games. And if I'm off on 125, it's by one or two.
It's a, it is an incredible, yeah, a lot encourage everybody to go look it up. But, and it looks like on those top two images, especially the one in the upper right, maybe it's just the angle. Yeah. Does he have a lot more upper body torque because of that? I believe so. I don't have the data. I would say yes.
Okay. I don't have the data on that because now we look at, and now you've brought in this whole conversation about catapult and harnesses and motion capture and. I didn't have that data. All I had, ah, okay. All I had was table data. I had what do you look like on a table? How do your joints feel?
What is going on now? Now I was definitely a part of the strength side, but [00:22:00] ultimately his team, which included the Bronco staff, people outside, it is never one person who solves for anything. Anyone who sticks to solve is full of shit. There's my first curse word.
Dr Mike T Nelson: That's all right.
Dr Doug Goldstein: I was a part of a team that resulted in an awesome outcome.
That outcome being damari is playing at a high level for a very long time. But as we dig into what we had then, which was not much, it was subjective, clinical back and forth between patient and provider. And now we have something totally different. I'm gonna pull up for the first time to the viewers, the interactive viewer from Springbok Analytics.
So, quick side note, in 2013, I joined the team to help them. Combination of few things, but to help them help Springbok get their message to professional organizations in the performance space, as well as talk through what the implications of this data may be. And you're gonna hear a lot of vague terms when I say might be, could be.
This is potentially, there is no [00:23:00] definitive springbok data equals this. It's another data set that allows us to explore more information and make a more comprehensive understanding of what's going on in an athlete at a professional level or a executive at a, I want to just be able to run three miles every other day level.
So when I click on this individual to the viewer's, spring box analytics interactive viewers loading, there is a two dimensional map of MRI images. So think those black and whites you get from an MRI are converted into a three dimensional digital twin. We are not looking at demarius, we're actually looking at an individual who's just a recreational weightlifter.
This individual sustained a left ACL strain three years prior to this scan. We have the scans that are closer to the date of injury, but what you're gonna see is things like the right rectus femoris, which is the front quad muscle that's a hip flexor knee extender at a 7.3% volumetric difference. You're gonna see other things like the [00:24:00] VAs laterals at a 2.1% different deficit. We're gonna spin, we're gonna look at that left biceps femoral long head and an 18% deficit. Ah ha. So the first thing to understand is the size of the muscle has the ability to somewhat dictate the force that the muscle can produce because we know that cross-section area equals more sarcomeres.
More sarcomeres equal more force generating capacity. But the question that is still unknown, and I have. Plenty of personal opinions because I, as an advisor of Springbot, get to look at this and speak outside of the company in a positive way. Yeah. Yeah. Springbok is an objective data set that's FDA approved.
Anything that I say about Springbok is my clinical interpretation from usage from early days. I had the question early on, what if that rectus more is small and appropriately positioned to be a very effective muscle? Small doesn't necessarily mean weak. It just may mean that [00:25:00] it's maximally producing force for the current architecture that it's in.
Yep. So if we take away a few layers and we start digging into things like this, you're gonna see how this individual has one muscle group that's markedly asymmetrical, and that is that again, that biceps, fems, longhead. So, which for listeners is more on the outside lateral side of the back of your leg.
Correct. The action of that muscle is not singular. It doesn't just ex flex the knee. It's also acting at the hip because it inserts onto the isum. The ischial tuberosity, which is a part of the pelvic complex, its ability to impact the pelvis in the knee, means that it can do multiple things to multiple areas.
So then that's the first time I'll bring in this kinematic understanding, right? What do we know about that muscle's ability to kinematically change? Or what can we know about that muscle in its current 18% deficit [00:26:00] that may impact the kinematic sequencing? How can we use this data? Can we take this data and provide more insights?
I'm gonna add all the muscles back and then show one more layer because what I'm trying to do is paint a picture of early days subjective clinical table work, indicates maybe muscle tightness to your comment about muscle manual muscle testing. It tells a part of the story, but when you layer it with more data, you have a more comprehensive or potentially comprehensive understanding of where this athlete might be.
The other thing that Springbok does a really fine job of measuring is the amount of intramuscular fat.
So on that same to the viewers listening, that same biceps femoris, that outer posterior lateral hamstring that acts as a hip extender, as a knee flexor, probably has a lateral rotation component based on its position of the body.
It's 18% smaller, but it's equally infiltrated with fat. It's no different than it's contralateral side. [00:27:00] So what we know here is that muscle doesn't have as many sarcomeres based on size, but it also has a equal level of fat. I don't have the testing to say that means this muscle produces 12% less force or produces an equivalent level of force.
Or potentially, maybe it means. That muscle has less eccentric capacity and it's not gonna be seen in an isometric or concentric movement in the gym. It's only gonna be noticed in the terminal swing phase of sprinting. But these, I say all of this because those are all the questions that I think all of us, to you, me, Mike, I think nerds in this Yeah.
We all want to understand. Oh, totally. So I'm gonna pause there because real quick I use Springbox as just an example of the advancement in tech and I use it as a longitudinal step in the right direction from table based data where we had manual muscle testing and range of motion testing.
What are your thoughts about it, [00:28:00] that being also a potentially deceleration of the knee under shear stress. Yeah. I think you're you. I was hoping you would go there. So I'm, because I've manual muscle tested, God, I've lost track how many people post ACL and a lot of times they didn't even tell me they had their ACL replaced.
'cause it was like 10 years ago and they forgot about it in their history and stuff. And even just you, again, very crude manual muscle testing. Rarely would I ever find, even the hamstrings air quotes as a whole group were very good at all on that side. They were almost always shit. I think that's a phenomenal, and when you bring up the ACL, it makes me think about the hamstring auto graft.
Yes. That was my another question, like, okay, now how was it repaired? What part did they steal in order to fix the a. So I would encourage all listeners, and I don't have it easily available, but there was a presentation by Matt Jordan, Dr. Matt Jordan, a PhD from the University of Calgary. Oh yeah. He is done.
Great stuff. [00:29:00] He's great stuff. One of the things that he was giving a presentation on at the Vail Health Summit at Stateman Hawkins Oh, nice. Was stealing the semi tendinosis, likely the gracilis. 'cause when they do that graph, they need enough tissue to create a yeah. Drupal bundle. ACL showed significant reductions in peak force in knee flexion during the swing phase of running.
And I'm modifying, I don't mean to modify Matt's work. I think I would tell you that we know that generically, when you steal tissue that's otherwise healthy, you are going to see some downstream effect to most people who don't sprint past the age of 30. 'cause those stats are pretty wild. The actual number's low, maybe it never is noticed.
But when you have a reduction of knee flexion, torque in capacity. It's going to alter, it has to alter the mechanics. If it, yep. If they take apart the machine is no longer where it once was. So the thing that I have a real interest in outside of ACL [00:30:00] is, 'cause you bring that up is hamstring strains.
When we look at what Buck does a lot of work on one of our bigger partners as a group is the English Premier League soccer folks. They deal with hamstring strains on the regular. And the greatest issue with having a hamstring strain is that the secondary most common injury is a re hamstring strain.
Dr Mike T Nelson: Yeah.
Dr Doug Goldstein: And so ultimately there is a strong need to understand this kinematic sequence. There's a strong need to understand which tests are most appropriate to measure and monitor and is the next step. There's an important need to understand which exercises are most appropriate. We both we both had a chance to talk with Andy Galpin, who's a phenomenal Yeah.
Educator, researcher. His podcast with Brett Contreras. Several ago on perform, they did a very big deep dive into glute training, glute work, the history of glute training. Brett wrote a book called The Advanced Techniques of GLT Training where he took I think it was this thick. Yeah, it was [00:31:00] 675 page feedback.
It was great. It was the one of the best things that I've read because it was the first time I'd ever really seen anyone take a healthy individual to the gym and just say, what does a leg press do? Where does it work? What tend to activate more than other things, and there's really interesting nuances in every exercise, which Brett would highlight in doing an open chain donkey kickback for the glute is a great way to engage awareness of the glute, but it's not necessarily the best way to load the glute in a closed chain capacity, which would ultimately increase hypertrophy and then overall capacity post after you wanna apply it.
So what I'm gonna share. And Mike I'm okay sharing this 'cause I'm, this is the first time I've ever shared this. Oh, I'm excited. Yeah. I'm excited to share it. I'm saying that not because I'm worried about the date. It's more, let me share some interesting findings. If I stammer, please do bear with me.
But when it comes to hamstring strains, I've had a chance with Springbok to look [00:32:00] at about 13 total. I call them known side hamstring strains, where I can say, I know this athlete suffered this injury, and I have the muscle data from that individual. I don't have the exact time points if these were all done within two days, five days, one week.
But the point is, I have a glimpse into what's going on in individuals at a architectural level when they have sustained a hamstring. I also have a really interesting lone hamstring injury where there's a pre-data set and a post data set. So you have this, is there, are there any flags that were present?
Is there something. So the thing that I would say is none of this is conclusive. The cohort is small. There's some similar patterns that continue to show up and I'm wondering if there are any opportunities to take this knowledge and learn from it. So on it on, let's use the left side hamstring strain.
On the injured side, we're seeing [00:33:00] smaller cross-sectional area, but more intramuscular fat. And now I'm gonna put a big asterisk because on my document I have a huge asterisk that says this is a possible meaning. I'm not saying it's nothing here is definitive, right? It's associative potentially that reduces the tensile capacity, right?
So the muscle that is literally smaller and more fatty, it's probably gonna produce less force. That's a somewhat safe place to say that, but I think that's, and I'm pointing over here 'cause we know that from table based work we can see atrophy in a muscle. We can see that it produces less force during a manual muscle test.
We can sense that athlete doesn't want to use that muscle during its activity when it would most likely engage. But what I'm desperate to learn more about, and this is why I went through this deep dive, what else is present? If the symptom is the hamstring, what else is present that potentially led to the hamstring?
And that makes me go down this somewhat first principles thinking about what's the traditional view, but [00:34:00] how do we rebuild that view to make it a better understanding of where it needs to be. So if the traditional view is that a hamstring pain or having hamstring pain means treat the hamstring. So see nail, take, hammer, hit nail problem solved bill insurance problem solved.
If we loop back, I think we just based insurance based medicine really quickly. I think we all know, at least those viewers that are here probably understand that's not a comprehensive understanding and we all no more to it than that. If it were only so simple, only, so what we need to actually do then I think is take that and say, how do we rebuild that too simplistic of a thought to a more appropriate level thinking.
And I think we need to target treatment where the tissue has actually remodeled. Now that doesn't necessarily mean the tissue is remodeled in a negative way. It could be that the contralateral plantar flexors need to reduce their tone because they have been compensating for a while [00:35:00] for loss of hamstring length, strength, and function, which is an interesting finding on all of these 13 known side hamstrings.
I've seen an increase, a slightly larger, slightly leaner increase in the contralateral side plantar flexors.
And again, possible meaning here, maybe it's a push off compensation, right? It seems like the energy through the system is gonna go somewhere. It's just a matter of where and how do we optimize?
It's these middle three things that stand out to me the most, the ipsilateral tensor fascia. And I actually want to, I'm gonna modify this for the viewers because I know I'm saying the language of anatomy, but we're gonna use this app here in this case. Which app is this for people? Listen, this is Essential Anatomy five.
It's a phenomenal app to visualize muscles. It's a great app for learning. But when we look at this right here, most often the biceps, femoral semimembranosus, that proximal hamstring region is affected. So [00:36:00] to those viewing, I'm just doing an anatomy deep dive with pictures. Yep. They're looking at the back of the, basically kind of air quotes, lateral hamstring.
Correct. If that hamstring is torn here, sometimes it's torn in the muscle, sometimes it extends into the proximal tendon. When it goes into the proximal tendon, the outcomes are a little. I don't wanna say worse, but the rehab timeline goes up because the myo tendonous junction is impacted in addition to the muscle component.
Yeah. You've gotta worry about soft tissue healing, not just muscle healing. Correct. So if that's the injury, and we're saying that in this case those athletes that sustain this left-sided hamstring insult also generate increased or slightly larger, slightly leaner muscles in the contralateral plantar flexors, which obviously transmits all the way through the achilles, down to the calcaneus through the push-off.
But I'm gonna spin the body now we're looking at it more from the anterior lateral kind of front lateral view. On the same side hamstring. [00:37:00] What we're seeing is a few things pop up. Lateral line. I love that you said you're seeing the same side TFL, which is a hip. Yep. Your internal rotator stabilizer of the pelvis medias the vast medias, which is a shock absorber.
Right. A knee shock absorber. As well as the tibias anterior on the same side as a shock absorber. So to your comment, I'm, and I know I'm dancing. Yeah, you're good. But what if the athlete was extending because they overrode the mental signal from their body and said, no, I need to run faster. My mind tells me I need to do this, but the mind pushed the body, but the body exceeded its current threshold and then in that moment the body was overloaded.
And when we know a body gets overloaded, the only response for a muscle to really stop injury from happening further is tighten up and constrict. Yeah. Do nothing. Just hold on for dear life. Please stop any more injuries from happening. Yep. But lemme [00:38:00] get to that end range of motion that I can't support either.
If I'm wicked tight, you're not gonna get to end range. Again, you could argue we might be able to override it with some athletes, but in general, that's what it's trying to do. Exactly. So then when we. Take this and we zoom out a little bit. I think that's great. But my brain is not satisfied because it tells me nothing about the contralateral side.
So if the injury on the left occurred, and we know that when I say we know it, we've seen data that shows up. Yeah. The same side T ffl, same side VA medias same side tibias anterior are actually losing their shock absorption capacity as a potential understanding something has to happen on the contralateral side.
Yep. And that's where we're seeing this interesting uptick. A slight increase in a steady state in size is what I should say, but an increase in fat. So the muscle is now arguably less elastic less. And you're showing the right glute max muscle. Correct. I'm showing the right glute max [00:39:00] muscle. So I have a curiosity question here with no answer and I don't mean to play hypotheticals too much.
I. But had that tissue been treated on the right glute, would it have changed the pelvic anti-rotation braking capacity of the pelvis, which would have not made the left hamstring, which is eventually injured, more vulnerable? I, we don't know. I'm throwing up my shoulders. I'm making a silly face, but I would love to find out if in some world we could use ShearWave at elastography T-M-G-T-M-G would be my guess, TMG, we could do some measurements of pation, if possible, in muscles that have that ability to be measured.
Is there a reduction of elasticity that could have been treated prior, which would allow the right hip to have a greater range of motion? B, greater rate of force development, but ultimately better control of the pelvis that might have potentially not allowed that involved other side to get exposed and then ultimately [00:40:00] go into a, a stress strain curve moment where it was beyond the capacity of the tissue.
The other thing that's super interesting is, and the final thing that I was able to find here is on the same side, I flipped the body to the viewer, to the viewers listening. We are looking at the same side ias as being involved. So in this example, to tie everything back in, to go zoom out big level, an athlete shows up on the table, they have a restriction.
It's very noticeable. Mike you and I've muscle tested people for a long time. Yeah. And they seem sufficient, but that muscle testing is typically done in a position where the pelvis is stable, has some level of support to the body. It doesn't account for force transfer across the anterior or posterior oblique slings, but it looks good.
The hip's good. Right? They're fine. They feel no issues in these areas. Springbok data [00:41:00] is showing that there's some potential relationship to an increase in fat, an alteration in volume. And if you also paired that with running data that said, this athlete's no longer sprinting at the same speed, we're also doing some markerless motion capture data with a really high end technology from like SwRI for example.
They've released a new product that's really incredible for sprint mechanics. Nice. But if you start to take all of that and put it in the pot and you start to spin it up, right, and you start to go, what comes from this brewing of all of these mechanical factors? Well, it is not clear yet, but I think the goal that we all hope for is that we can eventually say, okay, this athlete is vulnerable because of multiple factors that are indicating their hip, despite testing well on the table, needs some intervention.
That intervention could be a couple things. And this is where I'm gonna go into a different, my research corridor. I think some of that is [00:42:00] actually needs to be more manual intervention to the muscle, and that manual intervention can help alter the pation angle, which can ultimately improve fascial length, improve elasticity.
Ultimately just give that muscle a opportunity to work in the way that it needs to. I pause because I just threw a lot at the audience and a lot at the table, but my goal is that this doesn't solve for anything. It just shows that there's a depth of thinking required to, to advance the field, to that we can start thinking about this in more layered ways.
Was there any upper body differences you could see, or is it because the. Musculature in the upper body is so much smaller, it might be below what we're seeing for volumetric adaptations, maybe even because the, in general, the muscles of the lower body are a little bit bigger, especially when you start talking about like the, the forearms and biceps in a relative comparison.
Yep. Great question. And the answer to that question is, and I'm [00:43:00] to the viewers listening, I'm on the spring buck platform. What I'm trying to do, which is not allowing me I'm trying to pull up a full body MRI they have the ability to image everything from head to toe. In the instances where I have known side hamstrings, I'm only having T 12 down, so I don't have access.
Ah, okay. I don't have the oblique data. I don't have the abdominal data. I don't have posterior oblique sling data completely with the, the latus Doci. Yep. That was what I was wondering. Yep. So there, there's a really interesting project that I Springbot is completing with Major League Baseball.
Major league baseball is trying to understand Tommy Johns and elbow injuries. Yep. And I think it's safe to say if the elbow is impacted, there's probably kinematic factors that have led to it being affected. Yeah. And I would bet a lot of it's lower body if you're looking at pitchers I completely agree with you because when you, everyone thinks I'm insane, I'm like, well, I don't really work with baseball.
I'm just saying watch some of these pitchers on film and you can see what's going on [00:44:00] with their opposite hip. It just looks weird. I know that's like not a technical term, but you compare it to even some pitchers pre and post-surgery. You're like, what the hell? Yeah. You're hitting the note that is near and dear to my heart, and this was in the early days of talking to Major League Baseball with the Springbok team.
It was an opportunity to really emphasize what you just said to the viewers. Listening to the viewers watching, I've pulled up a cartoon image of the phases of pitching, and if you look at the initial phases, they are all standing on the one leg. Preparing your body to go into the caulking mechanisms to go into acceleration, deceleration.
So I agree. I think that it's a setup issue. Yeah. If you don't have the stability on the leg, you don't have the ability to transfer force correctly. And that, as you said in the hip and so forth. But we, similar to the hamstring discussion, hopefully we'll learn more about the major league baseball and pitchers and what we understand there, the goal is to figure out with some [00:45:00] greater fidelity what other things are involved when an athlete suffers an injury.
So I, again, I repeat, I live in the very mechanical lane. So when I previously mentioned I would love to optimize the hip mobility, and when I say hip mobility, again, I'm referring to like this muscle, the ICUs, because I believe that if that muscle has better capacity to lengthen and contract, it's going to offload or allow for greater force transfer.
Which hopefully reduces the ability for a muscle to sustain an injury. I don't want to say that one muscle, like this is the sole reason a hamstring strain occurs. As you just heard me list off for the first time. There are several muscles that display an issue and I think if we take all those muscles and put 'em into a more cohesive thought, it's probably a loss of pelvic control during a high end event that if that [00:46:00] pelvis had more stability, it would probably be in a better place.
So to your earlier question about the core and this hamstring discussion, one of the things that's interesting is I am very intrigued about the potential for the ipsilateral to the injury side. So the same side as the injury for the internal oblique to control the pelvis as it's going through its cycle.
I'm really interested in how the TFL and how the vais medias might shift the pelvis into more of a, like a hemi pelvis drop along with a sagittal tilt in an anterior direction. Right. All of these phrases are known by people. Your pelvis is in the wrong position. I hear that. I just wanna know why. I wanna know what muscles can I, can we, as clinicians, can patients, athletes, what can we do to maximize or improve that potentially improper position?
Yeah. And from the data, when the first thought I had, when you see all those muscles in the front light up is [00:47:00] treadmill. Probably wouldn't pick it up, but if you have, I think Red Bull had these really fancy force plates embedded in like a hundred or 200 meter track or something like that with like the full motion capture along the side.
Like, would you see that left side is just a, like a heavy foot strike, right? You're just putting way more force into the front part of the body upon impact. And so all, like you said, those muscles are also primarily shock absorbers because your pelvis is air quotes in the wrong spot. So as you're coming down on that left leg, you're just super heavy in the front and so you're just overloading that tissue on the eccentric all the time.
Can't say it any better than that. That, that's a phenomenal summary is exactly what you just said. So I have done a ton of work and this is where I'm gonna deviate into my research if I'm allowed to permission to, yeah, go intramuscular. Dry needling is a technique that is often used by people.
It's currently done in [00:48:00] several different ways. One, there's needle placement with no electrical current. There's needle placement with electrical current. The parameters that should be delivered electrically are not specified. Right. We, it's still a little unknown. Exactly What is the right answer for how much we should deliver?
My research has been heavily based in trying to understand the correct wave form as well as the correct frequency. Because I, I do believe that different tissues, and I think we can all agree the research will support this. Different tissues are gonna respond to different frequencies. Yeah. So when I look at the needle, to me it solves for the depth.
If I need to access a muscle that a massage or a rag gun can achieve the needle, gives me the conduit to deliver the correct electrical frequency. Once I'm in the right depth, and I use phishing as an example, once I'm putting the bait in front of the fish at the depth the fish is at now, the bait has to be the correct bait for the fish to actually bite the hook.
Yeah, that's been the most fun thing for me. And it's the thing that I [00:49:00] lose, I probably lose sleep and ex and also get excited about losing sleep because I am insanely interested in understanding that at a greater level what I've landed on is a specific waveform and a specific frequency.
What I'm seeing when I deliver that is a massive acute change in the pation angle of the muscle. Really. So the acutely the, so for listeners, basically the angle or the orientation of the fibers changes, is that correct? That's exactly right. And I'm gonna pull up some actual true ultrasound videos to highlight this.
Huh. And I'm glad you make that noise because this is, to me, the uncharted territory of, we all know Ian angle in an altered state is gonna impact the muscle potentially negatively. And we know there's multiple innovations to the muscle, right? So for listeners, it's not just like, Hey, you've got this, big pectoralis muscle.
There's one nerve that comes in that fires all of it. It's like, no, every muscle has multiple nerves, which has multiple air quotes, [00:50:00] different areas that it could potentially contract. So it's not as simple as the original model I was taught of, one muscle, one contraction, origin insertion, boom, you're done.
Yeah. Well, what is your current, I say your current knowledge, like where, what is the history of this? Because I'm actually from your side of the table. Like how did they talk about pian angle in the early days and where do you, in your current research, where do people land on it?
I more than what you just said, I'd love to hear this. So my understanding, so what I was taught classically through anatomy and eventually I was a TA for anatomy later on, is that ian angle is different per muscle. Right? That makes sense. Your biceps a little different than your quad. Different parts of your quad look different.
But it's fixed, doesn't change. And it was taught as, the pectoralis has these different types of orientations. The rectus abdominis has these, it's static. It doesn't change. There's one nerve that comes in, it fires or it doesn't fire and you're done. And the thing that blew me away [00:51:00] later was some research from from bodybuilding was describing this and saying, well, even all the way back to Vince Durda, well if I want to target, the upper pectorals because of the angle and the mechanics, I'm gonna do more of a lowering the bar to the clavicle or up near the neck versus power lifting style.
And at first I was like, wait a minute. Okay, for mechanics wise, that makes sense. Like you're stretching and putting different stress on different fibers. Fibers are gonna respond to different local loading. And then later you saw there was a little bit of research showing that. You could emphasize certain particular portions of the muscle, and then later you realize, oops, there's not just one nerve that goes into it.
There's mul multiple motor points. So, I, I don't remember exactly, the Peck has nine or something like that. I can't remember the exact numbers. You probably know, but it wasn't one. Yeah. I'm like, okay. So if there's multiple nerve endings into it that are split, that means we can, in theory, fire different parts of one muscle.
It's not this simple origin [00:52:00] and insertion type thing. And then you get into all the, I worked with Tom Meyers and the fascial side, and you start doing fresh tissue dissection. And then first time I did that, my head literally exploded about 11 years ago and went, I don't know fucking shit anymore.
I know nothing. So yeah, that's where I'm at. I'm with you. I felt like I was like, holy, everything I once thought is no longer what I need to think. Holy shit. And I remember talking to Tom going, Hey man. Like this messed me up for a good couple years. Like I had to literally go back and reteach myself anatomy and physiology because I was so, origin and insertion.
You gotta make sure you get each one right. And I remember asking Tom about this and he was super cool and he is like, well that isn't okay model to teach students to start, but that's definitely, not the simplistic way, the body works. And I was asking him if he has a better model and he just looked at me and he is like, just have them do this.
And I was like, oh yeah. Okay. Good point. So I appreciate [00:53:00] what you said. 'cause I would say that anatomy at it, what it was to your origin insertion comment was entry level education, right? Oh yeah. But you had to unlearn it If you want to go, in my biased opinion to the highest level, I spent a lot of time having to unlearn a lot of that and look at it from a different lens.
And once I was able to, I. I went back and did the fresh tissue, weak dissection like three different times. And the second time I came in completely different. I'm like, okay, I'm just gonna pretend I've never looked at any of this stuff before. I don't give a crap about me trying to memorize muscles, mo, anything.
I just want the visual picture and the trace. Is this thing connected to that thing? Right? So starting the leg, okay, where does this go? Like, for a while I was obsessed with finding a connection between the jaw and, muscles in the eye because I kept seeing weird stuff with the eyes in the jaw.
And, but once you start looking at it from that lens and you get to see different bodies and different things and fresh tissue, I do think it does open you up to be like, oh, okay, it's the whole [00:54:00] body. It's these, even just on a physical connection thing, nevermind the nervous system interaction with it.
I love it. And then I was listening to you the whole time, the viewer's watching. I was looking, yeah. All good. I was trying to find images from my time with the University of Colorado Health Gate Analysis lab. Oh, sweet. High end. Three dimensional force plate labs. Yep. Movement. All the stuff.
So what I'm gonna show you really quickly is just a couple photos of, you're gonna see this image here where the director of the labs, a gentleman named Gary Gary's phenomenal. Gary was, well, let me backtrack to the viewer's watching. You're gonna see Gary Walk. I got
Dr Mike T Nelson: Gary Schneider, director.
Dr Doug Goldstein: Gary's walking barefoot on force plates. It's picking up things you'll see here on the photo. Nice. It's all the good stuff. Right. What you're gonna see here is that Gary, without intervention was getting stuck at his second and third metatarsal head where there's like a hotspot right there.
Didn't get full. No big toe. No big toe that windless mechanism non-existent, which we [00:55:00] arguably know is less terminal stance, less push off, right? This kind of all circles back to our conversation when we take that and you're gonna see here what needles look like inside tissue with electrical current being delivered to the tibias anterior only.
So to the viewers, that's your front hand muscle. That is the primary dorsi flexor inverter of your ankle, most mostly at your talo curl joint. When we do this intervention, which I'll show you the ultrasound changes, not of this one, but of a different one 'cause my learnings have been layered. I have picked up better understanding as I continue to ask more questions.
But what you're gonna see here within five minutes, he's got big toe crack, big toe. So that begs the question of, okay, what did the needles do to the tissue? Was it a psychological thing where Gary felt like he could push off? Or was the mechanical altered, allowing the mental push off, has nothing to do with mental, his body just now did this and here's the result.
But what Gary would tell you is, and I didn't know this pre-intervention or post [00:56:00] until shortly after he had right knee pain, ah, there's a probability that he didn't feel comfortable extending his leg because he had pain. He subconsciously avoided it, which allowed tissue to become d altered. I'll use the word altered.
Dr Mike T Nelson: Yeah.
Dr Doug Goldstein: Negative way. But right here he's officially getting, it's hard to deny with No, there was no, Hey, Gary, push through your big toe. This is just yeah. Here's what happens. So I'll hide that because what we're seeing at a, and I'll pull up a few images here. This is using a point of care ultrasound from the GE point of care.
Similar duration. What? Exact same intervention, similar duration. The acute changes are a reduction of pation angle, so the viewers listening, pre intervention, pre dry needling with specific electrical frequencies. He was at a 20.4 pation and there's a slight error in the manual here, but I think we're gonna get better dialing this in [00:57:00] post intervention within a five minute window, there's a immediate improvement in the pation angle.
When that angle is decreased, that fascicle is elongated. When that fascicle is elongated, there's greater range of motion. I'm gonna show you the next set of images that not also more direct force too, because your line of pull is basically more direct. It's not as oblique. Yeah. Thank you. This is also the thickness of the muscle.
So you're gonna see a reduction in the thickness of the muscle, huh? Because it gets more compact. 'cause of the angles changing. Yeah. The, but it's also thinning out, feeling more relaxed Right. Point of what it's happening. So the value in showing that is the range of motion also improves at that joint.
I did a in-person with Stedman Hawkins and some of their researchers at their their very high end lab. We got to use their very expensive canon ultrasound, which is Ooh, nice. What I'm using. I got a chance to test this against a, something more valid. I didn't do the measurements, I did the intervention, but the measurements were [00:58:00] actually more interesting to me.
We saw a 77% improvement in pation angle. A decrease 77%. 77%. That's wild. Wild. In addition to that improvement of pation, we saw a 22% improvement in ShearWave modulus. We also saw an increase in SMI, which is local blood flow to the tissue. That's arguably because the muscle was contracted by the needle delivering a current, that created contraction.
But that's also fascinating because we know blood is healing. Right. So what if it's the opportunity of helping blood come to the muscle so it can infiltrate and give the, the healing properties that blood provides. Do you think that's just 'cause it's not as air quote contracted as much, so it's not restricting local vasculature there.
That's exactly right. And if you look at some of the early theories on trigger points, that's why we have pain responses because those contractions are stopping blood flow. And that hypoxic moment creates this afferent Pro problem where information goes back to the brain and says, [00:59:00] we're not breathing well.
We're not breathing well. Yep. Help us breathe better. Or the body's response E is to shut off, don't use, not good. Turn off. Yep. Yep. Find a way around. Roadblock. Roadblock. There's so much more to that. The physiology is, there's so much, it'd be a fun conversation to have with somebody who's really into that world.
But we also saw significant ranges of motion improvements at the functional plane. So we have this data of people moving. We can see that they're not necessarily doing optimal movement based on a subjective. I see. You're not. We have data sets, like manual muscle test. We have things like TMG, we have all these things.
We all also have mo motion capture. I believe that there's an intervention that can modify all of those. And that's where my research is heavily invested, is trying to understand what the data says. Where do I intervene similar to that hamstring roadmap, if I could just intervene with those tissues prior mentioned, [01:00:00] do we see changes in all of those prior movements, patterns, capacities, TMG, so forth?
And then what does that look like from a functional perspective? Because that athlete now runs faster and has less pain. So I've thrown a, I've thrown a lot and I feel like I could go for hours with you 'cause this is fascinating. Yeah. No. Are you good for a few more minutes or No, I'm great for a few more minutes, but cool.
No, that's super interesting because one of my, it's not really my theory, but one of my pet principles is that the body and physiology is way more, I use the engineering term plastic, meaning moldable, changeable. Than what we realize and historically, almost every time we think it's not that plastic we're proven wrong.
Right. You can go all the way back to, Baki Rita stuff where that he actually showed like new neurons were changing. You could reprogram the brain. I think it was his, I remember the story, right? His father I think had what a massive stroke and he taught him how to ReWalk again by [01:01:00] taking him through all the patterns of cross crawling and everything else.
And this sounds like, okay, yeah, this kinda makes sense to us now. But back then everybody else thought they were completely bananas, like out of their tree. Like what are you doing? This is the stupidest thing ever. You can't change your brain. Like once you're an adult it doesn't change. Like you just lost neurons.
Like, and now we know the brain may be the most plastic organ of all the organs possibly. We know muscle is very plastic overall, but we tend to. I think of that more in, I think, chronic adaptations to exercise and hypertrophy and strength. I don't think we think of it on a short, acute timeframe per se.
I'm I'm, yes, I'm, I agree completely. I'm smiling though 'cause I'm laughing at your last podcast and 10% that we're maybe a little frustrated, but I'm like, oh yeah. The neuroplasticity associated with the hallucinogenic world that is now Yeah. I'm in dentist, so I think I'm at the capital of Hall Halluc.
Yeah. But I completely agree. I don't think the body is non malleable. I think there is [01:02:00] opportunity that we are just at the surface of trying to understand. I'm heavily invested in researching the mechanical lane and I'm using mechanical as a place marker for all of this architectural work. Sure.
There's so much work to be done and to partner and I think I'll, I've, I'll voice one of my frustrations, it's that everyone is almost so siloed in this space. Oh, so, so that's why I actually stopped. You're like probably the first person I've talked biomechanics with in probably like five years, like in public, just because it, and it was nothing against the field, or like the people I knew doing the research.
Like they, all the private conversations I had have been awesome. But it was what you said, everyone is so siloed and it's either, you're on the neurology side, you're on the mechanic side, and it's a neurobiological model, and the whole pain thing. And all the pain people drove me nuts because they wouldn't listen to anybody else, even though I think they're actually correct.
I don't disagree with 'em. And yeah, I thought nutrition was siloed and I think [01:03:00] mechanics was worse. Unfortunately. I agree. So, to anybody listening that has an interest in not feeling siloed and being siloed, let Mike and I know.
Dr Mike T Nelson: Yeah.
Dr Doug Goldstein: I, shameless plug, but I'm very serious. I, especially from the PT space.
It's a, there's a very territorial feeling when you go into places. 'cause you don't, you don't want to upset people that are in care of certain people and teams and players, so forth, whatever. Oh, for sure. But you also just want to have an honest conversation about the potential for an advancement on their current knowledge.
There's a opportunity to layer this with, and you may sift through and say, this is not valuable, but we're gonna learn more. And the only way we're gonna learn more is if we ask questions. And I just, I appreciate your inquisitiveness. I can say that very loudly. I really like people who reflect in our inquisitive because I don't know how to stop asking the why question.
Well, why did the hamstring, why did the TFL why did this muscle, what did that do? Like, I just, it's [01:04:00] never ending. Yeah. And those are all super hard questions too, that. I think there's this perception out there that we will, we'll pick on the NFL. That the NFL, they have lots of money, they have lots of researchers, they have dedicated teams to this stuff.
They must have all the answers. I remember hanging out with a physical therapist with the Vikings three years ago in their, brand new facility at the time, million dollar Force plates. And they were super cool. They're super open super wonderful people doing great work. And I started asking 'em, I said, Hey, like, how do you know, like someone blows their ACL.
Like, how do you know they're good enough to play? Like these athletes want to play. You can't necessarily rely and go, Hey bro, you good? Yeah man, I'm good. Right? You can't, that, that can't be your default answer. And they were super honest. They're like, Hey, we got a bunch of protocols, we found a bunch of stuff.
We think this works. At the end of the day, we're never a hundred percent sure because there's so many things we don't know. Everyone presents a little bit different. What do you use as an absolute marker? If you're a force transfer on one side is 87% and your cutoff is [01:05:00] 89%, is that good enough?
I don't know. Yeah. But but hitting those absolute markers I don't pretend to know exactly what those are new technologies coming out like spring buck the research that I'm showing with the alteration of muscles if we quit asking why and what test is best, we're gonna end up a little bit of where we are right now, which is some stagnant, un inability to answer.
Yep. But I also appreciate that some decisions have to be made and we cannot continue to be, paralysis by analysis. Yeah. At some point someone has to give them the yay or nay, exactly. So I I just hope my a I hope this was valuable. It is fun. It is. It's so much fun for me to do.
Is, thank you for letting me come on. I, this is Oh yeah. I just hope this, this message is, let's ask more questions. Let's partner with people that are asking questions and share the work, right? Share, share the wealth, share the knowledge. How can we get less siloed in this space?
How can people work together? And [01:06:00] last question. I get this from, Cal Dietz and some of the stuff from RPR reflexive performance Reset. So their theory, which I would tend to agree with, 'cause I've seen this pattern happen a lot, is it might be an overly simplistic model, but if you don't have any technology, their argument is you're at a higher risk of a hamstring strain.
If we look at the main muscles doing hip extension, right? So driving your leg behind you that the glute max should be first, the hamstrings should be second on the same leg. The QL on the opposite side should be third. And that sometimes this order gets reversed where athletes who are at a higher hamstring risk, they're using the hamstring first, the glute max second, and then the ql, the people who are at a higher risk of more back stuff, they're using the QL first and then one of those two other muscles later.
What are your thoughts about that? I'm not saying those are the wrong muscles because I can't say, and I can't say the muscles I listed earlier are the right muscles. Right. I can say to those listening [01:07:00] that have ever had a chance to be with a patient or suffered an ACL as an example, when you're trying to relearn to fire your quad, which you know obviously downregulates post ACL post-surgically, one of the largest compensations you'll see is exactly what you just described.
You're gonna see an overactivation of the glute max and you're gonna see an underperformance of the quad. The body is trying to complete the task in any way possible.
Dr Mike T Nelson: Yep.
Dr Doug Goldstein: What I would say is. I would love to redo that test. Are you timed correctly?
By altering a few muscles and seeing those architectural changes that I referenced as my research, because I think that the blockage in that timing is due to muscles just not being in an optimal state.
What's the technique available to change that length? Tension relationship? I've seen that with my own patients, my own clinic. When you change that, the timing starts to go back to where it's supposed to be. There's always qing required, there's always coaching required, but I believe that it's almost it's the restrictor on the system.
It's like the [01:08:00] governor on the go-kart. If if you
Governor off the go-kart. The go-kart has the same engine. It just goes faster. I think that there are opportunities to impact certain tissues, and in the case of the hamstring strain, in order to time the ql, the glute max, everything you said.
I'm wondering if, and I don't have the answer, but I have a strong opinion, if we could just work on the same side of the hamstring, T-F-L-V-M-O, tibialis anterior, and this was a nice tie in to all the Thomas Meyers work. Yeah. If those actual linkages are more receptive to force transfer, then the body can do the thing it already knows how to do.
'cause it's already been healthy at one point and you get the timing of the glute max with the contralateral ql, with the stability of the, I think then it allows all that to happen. Yeah, that's one thing I've noticed too. I mean I do the kind of the standard RPR stuff to change the pattern. So basically you're doing some more hands-on work.
You're not actually just, I've tried to queue it out of people and it's almost, [01:09:00] I don't wanna say impossible, but I'll say very difficult. I think you probably can, but the amount of reps you would need is a lot. If you have a more advanced athlete, it's probably faster. If you can add load, it's probably faster.
But I've done stuff like, play with just the foot and ankle complex, which I know Cal's talked a lot about that made a big difference. I've done stuff with vision and vestibular and all of a sudden that like changed the whole pattern. So I think it's, there's multiple ways you can change those patterns.
And like you said, it's not that they're trying to run that way on purpose. Like the question I always ask myself is, okay, why does their body think this is the most efficient and best path? Because it's literally trying to do the most efficient, the air quote, best thing that it can do. But it has to make a decision that's not the most optimal.
We'll use that word for some reason. And even like with breathing stuff, which could be a whole nother whole hour podcast or longer, the thing that changed my thought patterns the most on that [01:10:00] was, okay, why are they breathing this way? Their body has to believe that this is the most efficient pattern, even though we know from a pure physics standpoint, it's not.
But to their anatomy, their structure, their nervous system, their inputs, it thinks that it's the most efficient. And when you freed up restrictions, you do a bunch of other stuff and you can allow them access to a more efficient path. It's mind blowing to me that their body will still pick that path and it'll actually want to stay there.
Like if you get the right thing set up, it wants to be more efficient. It's just being blocked. It's like removing parking brakes all the time, not necessarily trying to step on the gas pedal per se, if I use that analogy. It's a great analogy. What I would add to that is when I say I'm trying to take away to your emergency break, take away restrictions, what I do with my intramuscular techniques is not a solution.
It is a opportunity to access new tissue, which [01:11:00] requires another implement in, in often terms. That's the strength. Yep. I. Take away a restriction from the TFL on the same side and the VMO on the same side of the ham injured hamstring. We absolutely have to train the endurance of the hamstrings and that can Oh, for sure.
In, we already know eccentric lengthening strengthening. I believe the literature from British Journal Medicine shows us within 10 days of having a hamstring strain, if you can start working on controlled lengthening within pain-free reduced ranges, you're gonna see an improvement in the time to recovery.
So that's where we do know that short-term and long-term outcomes are optimized if movement is initiated sooner. And that's why in pt, you're seeing people in the ICU getting up and walking because we know that the consequences of immobilization at that magnitude in an ICU or putting a boot on because you had a small ankle tweak.
Yep. There are consequences to doing those things. So I am [01:12:00] presenting an opportunity, or I'm presenting a technique that I think provides an opportunity to pair with again, to, okay, what is the next best set of exercises? How could their current plan be modified to Cal diets? I think the spring ankle complex is a remarkable piece of research.
Yeah. It's mind blowing to me that it's still not as known as it needs to be. But yeah, that kind of blows me away. Just like I just show p pictures of Barry Sanders running. I'm like, Hey, look at this. Do you think he is got strong feet and ankles? Like he is all the way offset with like, I would say yes.
I would agree with you. So, if you ask a foot surgeon what's the most important joint, I think we all know the answer. Yeah. That again, medicine is siloed. Foot guy, ankle guy, knee guy, psychiatry person. Right. I think that we need to appreciate that there is a chance to remove a restriction with the technique.
Access tissue that was otherwise not listening, provide that tissue now with a different [01:13:00] stimulus that allows for an optimal change in neural programming, neural drive. That neural drive is a larger kinematic discussion, but it still requires great coaching. It still requires great, but great queuing, but again, what it can't, what can't happen is what is currently happening, in my opinion, is everyone is siloed and there's no crosstalk between organizations.
Yeah, because I've, I don't wanna use the word fix, but I've helped some people with better movement and sent them back to their coach. I've even left crazy voice notes for their coach if they let me, who I don't know, to be like, Hey, when this person comes back, could you just do me a favor and just watch their movement and just don't use the same cues because I'm hoping we change some stuff for the better.
Because if you go back to that same environment, they use the exact same cues they were using before and the same methods, they're just gonna push them back to, where they were before. And some coaches have been super receptive. They're like, oh man, that's great. And they've even left me notes after like, oh, I don't [01:14:00] know whatever the hell you did.
This person's, back further on their deadlift, their shins are more vertical, whatever. And I've gotten some angry messages of, how dare you tell me how to coach people And oh, I, let's use a car there, for example. 'cause we've been talking gas pedals. Everyone has a natural alignment.
Like their current state of alignment is, let's just say the car is drifting a little to the right. Yeah. Your body's response is to pull the wheel back to the left if you have helped them understand and let their body get to a neutral alignment. But their brain thinks, pull. Right. Well, where do you think they're gonna go?
Yeah, they're gonna back. Right. So it's a combination of factors. That's the ultimate answer. My hope is. I get to share my message about a potential pathway to expedite this all and provide a faster response so that drift is more adjusted, that, that car alignment is more adjusted more quickly, which reduces mental roadblocks and there's good queuing, good coaching that follows.
So people can then reinforce and bolster those habits that are now created. [01:15:00] Yeah. And with the Springbok data, and then we'll wrap up with where people can find out more. There is something intrinsically cool about visual information that I think is highly underrated. Right, because it, the analogy I used, and I can't remember who I stole this from years ago, is if I were to ask you if you were not in your home, like how big are the windows in your living room?
Like, well, that's a stupid ass question, but if you were to try to answer it, you're not a computer. You don't have like that number stored away because some weirdo on a podcast is gonna ask you that. You would picture yourself standing in your living room. You're about, this tall windows are about, so you would estimate it based on a visual representation that our brain is storing all this visual information because it's probably the most efficient way to store information for how the brain is structured.
So I think there is something very cool about like the Springbok data and seeing the model in front of you and all like, oh, that's this person's anatomy, or this is my anatomy. And seeing and [01:16:00] having volumetric measurements and differences. And you can see different lines. You can see patterns that I just don't think it's hard to even use words to describe.
And sometimes when they see that, I would imagine they're more bought in of, oh, okay, I see it now. Ah, I see what you're seeing. That makes sense now. Ah, very cool. Well that's, there's a gentleman, I won't say his name and not for right or wrong, but his opinion on treating athletes and he worked at the highest levels was share less education.
He said it creates too much going, it doesn't give a good signal. I'm on the opposite side of that. Yeah. And I'm a education heavy person because I think it's hard to unhear something that is so logical if presented logically.
Dr Mike T Nelson: Yes.
Dr Doug Goldstein: That can only enhance whatever you're trying to work on. So I will always err on the side of telling you everything that I think, not that I think I'm right.
Yep. I'll everything. I think because my goal is more aligned with your goal, you wanna perform better. I need you to understand why you think, [01:17:00] why I think you're performing, not optimally. Here's my, here are my thoughts on how to do that. Do we work together or do we work against each other? Can't, hopefully the education is good enough and the thought, the thoughts and the logic on my side are appropriate.
But if that goes well and the athlete is more receptive to the car analogy, they are like, you're right, I do drift right. I gotta stop pulling. Right. Okay, cool. I'm gonna help your car not drift. Right. You are going to stop drifting right Then. The car goes fast and straight. Yeah, because athletes, they live in their body.
They have all the information, like no matter how thorough our little things we do, like, it's gonna be a very limited time sensitive snapshot of, you know what, they're living 24 7. So I'm with you. Like, the more I can empower them to give them at least what I think my framework is and what's going on, they can then interpret it and spin it through their experience and see if it holds up or not.
Great. This is awesome. Where can people find more about [01:18:00] Springbok? Is this available to anyone or how is it available? Or if there's clinics or researchers or people that Yeah. Are interested in it, like how does it all work? Yeah. Springbok is something that's it is available in certain markets.
We've partnered with MRI locations to make sure that they can get access. But if they were to just go to springbok analytics.com no dash is all one word. They can learn more about Springbok there. If from me to you, I think I can share any contact information I have that maybe listeners wanna chat, we can talk through that.
But I just really appreciate, this is a great conversation, Mike. This is a really great conversation with no territorial behaviors. There's, it's very collaborative and I just wanna say how much that's refreshing for me. Oh, it's nice. That's part of the reason why I still do my own business and kind of in air quotes, do my own thing because it's very easy to get held up within, I'll say I've been in certain organizations in the past where the presentation of new knowledge was I.[01:19:00]
Said that they want it, but when it was presented, their actions said otherwise. We'll say or other organizations like, I do teach for RPR on occasion, super open about it. It's like, hey man, like if you've got a better way or you got something else cool that's going on, like, great, let's test it.
Let's figure out if this is useful or not. So it's nice to have fun conversations and especially people like yourself who are, research minded, but also in the field doing it. Because I think there's too much of this research says this and evidence and field work says this. And the reality is, if you're working with humans you're somewhere in between.
So I get hate mail from both people now 'cause it's never researched enough for the research people and for the experienced people. I never have enough experience for them. And, but that's where all the cool stuff happens. So that's the, that's where the rubber meets the road. So I like it.
Dr Mike T Nelson: I would encourage you to keep on your path.
I appreciate you.
Dr Doug Goldstein: Awesome. Well, thank you so much for everything. I really appreciate it. This was great and have a good day. Bye.
[01:20:00]
Speaker 2: Huge thanks to Dr. Doug for being on the podcast here. It was super fun to chat about biomechanics, injury risk reduction, things you can do to change all of that, new methods such as spring B and everything else. So this was. Super fun. I may have been over in Europe helping with some biomechanics recently.
I can't say much about it other than that with a high level professional athlete, and it's always super fun when you get to do that. And always really interesting when I get to learn new stuff, especially from people like Doug who are very open-minded just trying to find a better solutions for everyone including athletes.
What's cool about biomechanics is, especially if you're working more on the nervous system, is you can see changes right away, which is super fun. So big thanks to him. Make sure to check out all the wonderful stuff he is got going on. [01:21:00] If you're looking for electrolytes, check out our friends at Element down below.
If you're looking for some ketone esters, check out our friends over at Teton. Use the code, Dr. Mike to save some janero. Tecton is something very cool coming out this fall, so stay tuned for that. If you want more information for me, be sure to hop onto the newsletter, which is completely free by 90% of my content goes out directly to the newsletter.
If you're looking to increase your performance, add more muscle, improve body comp, all the stuff we talk about on the podcast, and you'll definitely love the newsletter and it's completely free. So go on to the newsletter down below. Thank you so much for listening to the podcast. Really appreciate it.
If you have someone who might enjoy this episode, please forward it to them. If you tag us online, that'd be great. As a thank you, please share the podcast around like, download, subscribe, all that wonderful stuff. If you're watching this on [01:22:00] YouTube, if you could do us a huge favor and hit the subscribe button.
That makes a huge difference. I'm working probably later this year to try to promote more of the YouTube stuff I, which I haven't done. And getting over the thousand subscribers really makes a huge difference in YouTube land from, so I've been told for people that are actually doing more with it.
So if you do that'd be super, super helpful. It only takes a couple seconds. Thank you so much for listening. I really appreciate it, and we'll talk to all of you next week.
A great little actress. Yep. And getting smaller all the time.
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