The FARM Cast

In this engaging conversation, Dr. Beau is joined by Dr. Audra Lance and Dr. Brett Winchester to discuss the evolution of clinical practice over two decades, emphasizing the importance of patient management, communication, and the integration of functional medicine. They explore the significance of confidence in patient care, the evolution of DNS, and the role of mentorship in healthcare education. The discussion highlights the need for enjoyment in work and the excitement surrounding upcoming educational events.

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Summary

Dr. Beau interviews Keith Baar, a muscle and tendon expert, about his research and findings. They discuss the practicality of research and the challenges of sifting through vast amounts of information. Keith Baar shares his background in kinesiology and how he transitioned to studying tendons. They delve into the importance of tendon as a master mechanical tissue and the implications for tendon injuries and rehabilitation. They also touch on the use of vitamin C and gelatin in enhancing tendon health and the importance of timing and targeting in collagen synthesis. The conversation explores the use of blends of proteins, such as whey protein and hydrolyzed collagen, along with vitamin C, to benefit the musculoskeletal system. The combination of these components can increase connective tissue protein synthesis and muscle adaptation. The importance of vitamin C in collagen utilization is highlighted, as it is essential for collagen secretion from cells. Fasted training can enhance adaptation by increasing metabolic stress and activating specific molecular signals. The timing of nutrient intake, particularly protein, is crucial for optimal muscle and immune system function. The concurrent training effect, where strength and endurance training are combined, may be influenced by protein intake and metabolic demands. The benefits of fasted workouts and the time dependency of glycogen depletion are discussed, with a focus on mitochondrial adaptation and connective tissue response. Splitting training sessions into multiple bouts can provide more stimuli to connective tissues while still achieving the same adaptive signal for the heart and skeletal muscle. Low glycogen training can be achieved by having a low carbohydrate dinner the night before a session, resulting in a fasted state without negative effects on the body. Multiple smaller sessions of rehab exercises throughout the day may be more effective than one longer session for tendon healing. The donut hole theory of tendon healing suggests that offloading a tendon can lead to scar-like changes, while loading the tendon can promote healing. The relationship between muscle mass and strength is not linear, and strength gains can be achieved without significant muscle growth. There may be a nutrition molecular pathway that can increase tendon lengthening, which could have implications for athletic performance and injury prevention.

In this conversation, Dr. Beau and Greg Rose discuss various topics related to movement and injury. They touch on the alternating joint hypothesis, the three pathways of injury (trauma, insidious onset pain, and altered motor control), and the importance of hands-on palpation and manual therapy in treatment. They also discuss the potential for a TPI-like model for screening and coaching runners. Overall, they emphasize the importance of understanding movement and addressing both mobility and stability issues in order to prevent and treat injuries. Running as a sport requires highly trained skills, just like pitching in baseball. Any movement can be turned into a sports skill with the right boundaries, technique, and rules. Running can be a skill, especially in sprinting and distance running, where training plays a significant role. However, the challenge lies in maintaining proper form and technique over long distances. Shoe fitting is crucial in running, as it should match an individual's physical abilities and needs. Force plates have revolutionized training by allowing coaches to understand and evaluate athletes' movements and exercises. Guidance devices, like RNT, can be helpful in teaching proper movement patterns, but it's essential to transition to performing without the device to ensure transferability. Motor learning drills should be practiced with variety, high conscious level participation, and sufficient time to strengthen tissues and make individuals more resilient. The decision to transition from motor learning to strengthening is a coaching decision based on trust and proficiency in performing the desired movement pattern. In this part of the conversation, Greg Rose and Dr. Beau discuss the concept of advantageous asymmetries in sports. They talk about how certain asymmetries can be beneficial for athletes in specific sports, such as golf and baseball. They also touch on the topic of normal movement patterns and how they can differ among athletes. Additionally, they discuss the importance of force production and how it affects performance. They mention the idea of the 'big brake theory,' which suggests that an athlete's ability to decelerate is crucial for acceleration. Finally, they mention ongoing research and development in the field of movement analysis, including the exploration of top-tier movements for assessing wrist and foot mechanics.

In this conversation, Dr. Beau and Mike Stella discuss the role of manual therapy in rehabilitation and performance enhancement. Mike shares his origin story as an athletic trainer and how his injuries led him to explore different approaches to recovery. They discuss the importance of manual therapy in pain modulation and creating movement opportunities. They also address the criticism of manual therapy and the need for transparency and education. The conversation highlights the value of manual therapy in the context of individualized care and the unique needs of elite athletes. In this part of the conversation, Dr. Beau and Mike Stella discuss the challenges of providing individualized care in a healthcare system that often prioritizes volume and efficiency. They explore the complexity of movement and how it can vary from person to person, making it difficult to define optimal movement strategies. They also touch on the relationship between movement dysfunction, pain, and injury, highlighting the need for a personalized approach. Mike shares his experience in building a sustainable private practice that offers high-quality care and discusses the importance of patient education and communication. They also discuss the role of social media in marketing and building a brand. In this final part of the conversation, Mike Stella discusses how he gained a following on social media and the importance of providing valuable content. He emphasizes the need for competence in one's field and the ability to display that competence in a consumable way. Mike also shares his journey of building his business and the lessons he learned. He highlights the importance of authenticity and the power of the relationship between clinician and patient. Mike concludes by discussing the qualities he looks for in his staff and the importance of overcoming adversity.

Dr. E was heavily involved in the early days of blogging and podcasting in the physical therapy field. He developed an ISTM course and brought his own tools to market. He initially resisted the evidence-based movement but eventually embraced it and changed his approach. Dr. E's parents are both physicians, which influenced his decision to pursue a career in healthcare. He leaned heavily on manual therapy techniques early in his career but has since shifted towards a more eclectic approach. He emphasizes the importance of being open-minded and not being 100% certain about anything in healthcare. Dr. E has gone through different phases of practice and has learned to critically evaluate different treatment approaches. Dr. E emphasizes the importance of McKenzie principles in his practice, as they modulate pain and improve function. He appreciates that McKenzie's techniques work, even if the theories behind them have been disproven. Dr. E believes in empowering patients with loading strategies and modulating pain before introducing strengthening exercises. He emphasizes the importance of dosage and patient compliance in achieving successful outcomes. Dr. E also discusses the need to refer patients when necessary and the challenges of integrating different treatment approaches. Dr. E discusses the importance of balancing work and family life, and not being solely defined by one's career. He shares his own experience of achieving his goals and finding a balance between work and personal life. Dr. Beau agrees and emphasizes the importance of finding a balance and being passionate about what you do. They also discuss the impact of being a role model for their children and the importance of enjoying what you do.

Severs' disease, also known as calcaneal apophysitis, is a condition that affects children between the ages of 8 and 14 who are going through a growth spurt. It is characterized by pain and inflammation in the heel, particularly in the back of the calcaneus. The condition is caused by the growth of bones outpacing the growth of soft tissues, such as tendons and ligaments. Factors that contribute to the development of Sievers' disease include playing sports during the growth spurt, wearing restrictive footwear, and lack of attention to growth spurts in sports physicals. Treatment options include rest, immobilization, isometric exercises, motor control training, and dry needling. It is important to accurately diagnose the condition and tailor the treatment to the individual.

In this episode, Dr. Beau and his team discuss the importance of triage in musculoskeletal care and the decision-making process when determining whether a patient needs to see a specialist or undergo surgery. They share several case examples, including a high-level runner with a foot injury and a patient with a chronic shoulder dislocation. The team emphasizes the need for individualized care and the importance of considering the long-term implications for young athletes. They also highlight the role of primary care providers in ordering imaging and making treatment decisions. In this conversation, Dr. Beau discusses two patient cases. The first case is a 36-year-old male with chronic low back pain and disc bulges. Dr. Beau focuses on addressing the patient's pain and improving his movement patterns. The second case is a 47-year-old male who experienced increased headache and neck pain after receiving a Y-strap adjustment. Dr. Beau emphasizes the importance of a thorough examination and appropriate treatment.

The conversation discusses a case of a 34-year-old female with hip pain and a history of low back pain. The patient is active in CrossFit and has been experiencing right anterior hip pain associated with squatting, running, and jumping. The pain started several months ago and has worsened recently. The chiropractors suspect an internal hip issue and work on stabilizing her back while calming down the hip. However, further examination reveals that the patient has a history of ovarian cysts and potential endometriosis. The chiropractors recommend that she see an OB/GYN and consider functional medicine to address the hormonal dysregulation.

In this conversation, Dr. Beau and Dr. Phillip discuss the neurocentric approach and the importance of diagnostic specificity and determining the appropriate intervention points and treatment modalities. They also touch on topics such as staying up to date with research, using AI in healthcare, and balancing creativity in practice. The neurocentric approach focuses on the role of neurology in physical medicine and integrates various treatment modalities to address neurologic dysfunction. It emphasizes the importance of assessing neural contributions to musculoskeletal issues and tailoring interventions accordingly. Dr. Phillip Snell and Dr. Beau Beard discuss the importance of having an organizational heuristic to guide clinical practice. They emphasize the need to identify the tissue that is causing pain, develop a narrative about why it is irritated, educate the patient, and provide a symptom modification procedure. They also highlight the significance of addressing systemic factors such as stress, poor sleep, lifestyle choices, and diet, which can contribute to increased systemic inflammation. Dr. Snell shares his method of staying up-to-date with research by using spiders on PubMed and reading abstracts that catch his attention. He also discusses the potential of AI and Web 3.0 in healthcare. In this final part of the conversation, Phillip discusses how he utilizes GPT-4 in his creative process. He takes GPT-4 with him on runs and asks for feedback on his ideas. He envisions a future social app where people can seek medical advice from multiple sources. Dr. Beau shares his struggle with integrating his creative self into his profession. They discuss the importance of balance and collaboration in pursuing creative projects.