Chronic Pain: Femoral Anteversion & Retroversion : Rick Olderman
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Guest: Rick Olderman
Release Date: 5/15/2023
Welcome to Trulyfit the online fitness marketplace connecting pros and clients through unique fitness business software.
Steve Washuta: Is chronic pain, purely structural or other other facets? Should our squat positioning be based on biomechanics? Or should we all have the same squat positioning? How do we know if it’s the knee causing the foot issue or the foot causing the knee issue? And does it really matter? We discuss all this and more in the upcoming episode.
Welcome to Trulyfit. Welcome to the Trulyfit podcast where we interview experts in fitness and health to expand our wisdom and wealth. I’m your host, Steve Washuta, co-founder of Trulyfit and author of Fitness Business 101.. On today’s episode, I speak with a physical therapist, Rick Olderman, you can find everything about him that Rick Oh, l d e r ma n.com.
He is a physical therapist with 20-plus years of experience. And today the conversation is going to surround chronic pain. Rick has an outside-of-the-box approach to how he deals with chronic pain, it’s sort of a three-pronged approach is going to talk about but in addition to that, we go into biomechanics.
And what some people in our industry are missing out on specifically, which I thought was really interesting. And I’ve talked about this with my wife before who’s a sports medicine doctor is femoral anteversion and retroversion. How where that femur is placed in your leg or how it inserts in the hip. How that could change, squat positioning and things of this nature. It was a fantastic conversation.
And I’m sure we’ll have Rick on again in the near future to discuss one particular ailment or diagnosis. So if you have something that you want us to talk about, it’s something that you maybe deal with differently than someone else, or clients who come up with the same element or issue over and over, feel free to write in email@example.com.
And I’ll reach out to Rick and we’ll have a conversation about it. No further ado, here’s Rick Olbermann. And I, Rick, thank you so much for joining the Trulyfit podcast, why don’t you give my audience listeners a little background on who it is that you are and what you do in the health and fitness industry?
Rick Olderman: Hi, Steve. Well, thanks for having me on, truly, and I am a physical therapist for about going on to 30 years now. I specialize in helping people with chronic pain issues, not because I’m particularly interested in chronic pain, but because that’s what fills my schedule so much all these years. And so I think we’ve got a big problem about how to solve chronic pain. And that’s what I ended up focusing on.
Steve Washuta: Do you have a definition of chronic pain? It doesn’t need to be, let’s say, in the literature and Rick Oldermen’s definition of chronic pain.
Rick Olderman: Yeah, well, you know, in the literature. Chronic pain is defined as pain that lasts longer than three months. So I don’t know who came up with that. But, you know. I kind of think of it as any kind of pain that seems to rear its ugly head, you know. Once or twice a year or daily, you know, for a long period of time, is, is chronic pain, you know, if it’s something that you have to keep trying to manage, that’s considered chronic pain, as far as I’m concerned.
Steve Washuta: Is the reason and I’m sure we’re gonna get into your ideology behind all of this. But do you consider the reason for chronic pain to be multifaceted meaning is it not just a structural issue, but it’s also maybe a psychological issue and a cultural issue and a sort of a day-to-day issue of on people’s lifestyles and things of this nature?
Rick Olderman: Yeah, well, gosh, you’re heading right into, you know, what am I overall writing theories about why we have chronic pain? I’ve developed this three pillars theory. So everyone has a threshold above which they have pain, I don’t care whether yours is up here, down here, it doesn’t really matter. above this threshold, do you have pain, and I find that there are three things that are pushing us towards that threshold.
Rick Olderman: One is musculoskeletal issues. One is psychological, emotional, or spiritual issues. And then the third is, are things that we ingest, diet issues, allergens, molds, things like that, it can, your pain can be a result of all three of those or just one of those or any combination of those.
Steve Washuta: And it’s difficult to diagnose because of that reason, I’m not speaking for you, I’m speaking for myself, you can disagree, because what can happen sometimes is a patient can go get, let’s say, imaging, and we can see something that is obviously telling of maybe some potential pain, but there could be more to the story.
And we associate that let’s say, some lumbar issue with the specific pain, but it could be deeper than that, right? It could be because of their lifestyle, or because of some issue that they’re dealing with psychologically, meaning I could look at 10 Different X-rays, and they could all have the same lumbar issue, but maybe only two of the clients are in pain. And that is sort of telling that the pain is way deeper than just what we’re seeing on imaging.
Rick Olderman: It can be and this is the beauty of what I’ve been kind of digging into for these past two and a half or so decades, is understanding the musculoskeletal component of things. I’ve become very confident that if someone isn’t responding to my treatment, it’s because they either have some structural issue like a tear or something that hasn’t been identified yet.
Rick Olderman: Or there’s an emotional or not dietary issue going on. So the results that I get are so consistent. That consistency helps me arrive at those conclusions much more rapidly and confidently when they do occur.
Steve Washuta: Walk me through a patient experience in normal circumstances compared to yours, meaning if I go to a regular physical therapist, as opposed to Rick, what may you be doing differently than the average physical therapist?
Rick Olderman: Yeah, well, it may kind of look the same. But initially, basically, what I do is, if let’s say you’re, you’re coming with back pain. So if you come in with back pain, back pain is part of a larger system that I call the lower body system. And so I’m not sure if is this going to be a video? Video, okay.
Rick Olderman: So if we look at the skeleton, what we look at it, for anyone who comes in with any kind of it doesn’t, you get the same exam, if you have foot pain, knee pain, hip pain, or back pain, it doesn’t matter, because it all belongs in the same system of problems.
Rick Olderman: So we evaluate you from the ribcage all the way down to the foot. Regardless of what kind of pain you have, I don’t believe that many practitioners do that. And there are certain things that we look at in that exam.
Rick Olderman: That are I feel key to understanding the source of chronic pain. One of those is perhaps femoral anteversion, or retroversion, which we can look at, if you want to and talk about, but we’re looking for patterns of issues that are occurring, and then physiological reasons for those patterns of issues.
Rick Olderman: And I know that sounds kind of complicated, but really, it’s it’s much simpler to look at things from a system standpoint, than the component that training that we’ve received in school to try and identify unhealed pain.
Steve Washuta: Well, I don’t envy you, because what I find difficult, is you’ll see some practitioners say it’s the, let’s say, the knee issue causing the foot issue. And you’ll see others who say it’s the foot issue causing the knee issue, right. So when there are multiple issues, you know, let’s say knee, hip ankle, which there usually is, right, because there are some compensation patterns and some synergistic dominance.
How did you really pinpoint? Which is which? And do you think it’s that there are practitioners who just say, Hey, I’m the knee, guys, I’m gonna, I’m gonna say this is knee related, and that everything else is coming from the knee? Do you think that you need to be targeted like you’re saying. And really just dig down and say, what is causing all of these other issues?
Rick Olderman: Yeah. So certainly there are people who just will be called the knee guy. But, you know, understanding the source of the pain, it could be all at the same time. So understanding exactly which one came first is sometimes important. But often, because it’s affecting the whole system when you fix the whole system, it doesn’t really matter which one is coming first.
Rick Olderman: So what often happens is, when you fix the whole system, the one that is the hardest to fix ends up being where the source is. And so and then that’s when I usually get because during my exam, you know, I asked people, hey, you’ve got back pain? Do you have any other older injuries in your feet, knees, hips, or things like that? And invariably, people will say no, right? And then once we start solving problems, and we run into cash, what’s going on with this ankle, though? It’s restricted. And there seems to be a problem down here.
Rick Olderman: Oh, gosh, now you think about it, you know, and then they remember some old injury. So the problem is. Is that we were not trained to think of our old history as the cause of our current pain. And that’s where the disconnect is happening for a lot of people understanding what’s going on.
Steve Washuta: Yeah, Rick. I am so glad you said that. I had this conversation a lot with some young personal trainers that I mentor, that when you fill out, let’s say a health history form or your client does rather or what we call a por que a physical activity readiness questionnaire, you can’t just get that form and call it a day, you have to sit down with them go over the form, and do it.
My wife is a physician, she calls it the what else you just keep asking what else? What else? What else? Because inevitably, there are things that they’re not going to mention for me specifically, I just had surgery on my hand. it is called a central slip injury. And when I went into the surgery, they asked, Have you had any other surgeries? And I had said, No, I had two other surgeries. I just forgot them.
Right now you have this, like natural amnesia, where you want to forget that you’ve been through these like medical, you know, problems in the past, but I think we really have to make sure that because everything matters, right? Like you said, if that person did, let’s say break their ankle 10 years ago, they didn’t think it was a big deal.
They’re healed quickly. And they were younger, what had happened. That doesn’t mean there are not, you know, reverberations down the road and compensation patterns from that initial injury.
Rick Olderman: Absolutely. In fact, I just had an appointment with a guy who is having chronic Achilles tendinitis. Now tendinosis is looking at almost rupturing his Achilles tendon because it’s so damaged. He had an appointment with me. He says, What is going on here? And of course, he denied having any other injuries. And then once I tested them, we found a significant problem with his eye opposite leg.
Rick Olderman: And I said, Why is this happening? He said I have no idea. I said, Are you telling me there’s no you? And he was an athlete? And I said, Are you telling me you’ve had no injuries to this other leg? He says, I mean, okay, I broke that ankle when I was playing high school baseball. But that hasn’t hurt since I said, that’s the source of the problem, right.
Rick Olderman: And we’re trained to believe that because something doesn’t hurt anymore, that it’s not a problem anymore. But what we don’t understand is that our brain creates compensation patterns to allow us to go around these little obstacles that are happening in our lives. Because our focus in life is to get from A to B. And our brain doesn’t, you’re saying the brain get me from A to B.
Rick Olderman: And your brain says, Okay, I’ll get you there. But I’m going to do these little maneuvers to help you get there. So this mental jujitsu is happening under the radar. And then only when we start to have chronic pain, do we start start to realize, oh, what your brain has been doing all of these years.
Steve Washuta: Yeah. And also to someone like you, it’s not complex, because you know, the body so well, but to the average person, they can’t put two and two together right now, me I’m a corrective exercise specialist doesn’t mean much. But it took me a while through my injuries to sort of relocate what exactly happened, I had a labrum tear in my hip. I elected not to get surgery.
But in you know, I sort of rehab myself. But what I did in there, as I call it, was some compensation patterns where my adductors on that side became very weak because I couldn’t engage them. And then I ended up having to get a double and greenall hernia surgery, which was most likely because of the fact that my adductors were so weak on one side, so like, you know, we can put the pieces together, right, I
call it being an anatomical sleuth, but the average person can and that’s why they need to go to people like Rick when they have pain because it is I know to you, it’s not complex, but to them, it’s usually a layer to deeper and they’re not going to figure it out themselves.
Rick Olderman: Correct. And frankly, Steve, I’m the last person that these people come to, you know, they’ve been to tons of other people, their personal trainers, yoga instructors, Pilates instructors. So I don’t believe that this is just in my wheelhouse. I believe everyone who works with the human body, and helps with movement in some way, or improving the human body needs to understand really how the human body works.
Rick Olderman: And I think I would love nothing more than to be put out of business. And never see your chronic pain patient again, and have you guys take them all because you’re the people that they’re coming to first. So you should have this knowledge, I feel you know, and you can’t have it, it’s not that hard.
Rick Olderman: It really isn’t as one of my therapists, because when I owned my own orthopedic clinic here in Denver, I trained all of my therapists, I wouldn’t let anyone work at my clinic who I didn’t train. And so invariably. The response I got from my therapist is. This is so much more comprehensive, yet so much simpler than what we were taught in school. And that’s the way it is when you understand things from a system standpoint.
Steve Washuta: What do you think about common therapies like soft tissue work, let’s say, AR T and M T, sort of chiropractic methods, things of this nature? Acupuncture is something that you are working with, in your practice, do you think they’re all sort of somewhat beneficial? And somewhat not? What is your take on those?
Rick Olderman: Yeah, I think all of those things can be very beneficial. So there wouldn’t be around if there weren’t. So what I think is missing. Though, is an understanding of why all of these conditions are happening that these people are treating, and even if they’re treating them successfully, and making the pain go away, if things aren’t looked at from a system standpoint, it’s likely that that pain will come back, maybe not at that exact same vertebral level,
Rick Olderman: Or that same joint, but maybe in adjacent joint or tissue or something like that, it will come back if you’re not solving the system’s problem. Because ultimately, how you’re using your body is the reason all of these problems are occurring. If that isn’t being addressed as a system. then that’s it’s a it’s a patch.
Steve Washuta: I imagine dealing with and you can tell me that I’m wrong dealing with, let’s say a weekend warrior. And maybe a real athlete. Like a collegiate athlete, and then just someone else who doesn’t even work out at all and come to you with chronic pain could be different given their lifestyles, do you treat them differently? Or do you not see that as a big difference? Pain is pain.
Rick Olderman: You know, it’s funny, I received a phone call from a professional athlete a little while ago. And and they said, Yeah, and I talked to them, and they said, Well, you know, my body is different because I’m a professional athlete.
Rick Olderman: And I said I don’t think so. I said the person who’s working in an office is using their body just as much as you’re using yours. It’s just in a different way. So they’re a professional athlete. For the office. You’re a professional athlete for a sport. So the body is not any different. So I look at everyone exactly the same.
Steve Washuta: Okay, but other particular Exercises may be that you see with, let’s say, athletes or again, the weekend warriors that could be causing some issues, let’s say, right, so someone goes, Hey, listen, I’m involved in CrossFit on a regular basis. And these are the exercises I’m doing as opposed to someone who’s just in the office, do you feel like you have to maybe say, Hey, listen, not only to we’re treating the pain, but you might have to back off of certain things that you’re doing in order for the body to heal.
Rick Olderman: Yeah, I’ll only talk about that kind of stuff after I know that they understand why they’re having pain. So I’ll go through my exam, explain and show them exactly. And we do tests and retest. So let’s say it hurts for you to you know, maybe bend over. Alright, oh, that causes my back or sciatic pain every time I do that, okay, now we’re going to do this exercise.
Rick Olderman: And we’re going to do that again. And lo and behold, it’s, it’s resolved now. Alright, so now they understand, they can link, you know, that exercise with their pain. So at that point, they understand what’s going on with their pain. And and then we can talk about, okay, so let’s look at your exercise program. How is that addressing this thing that we found is solving your pain?
Rick Olderman: And if it’s not addressing it, or if it’s working against it, then I don’t have to tell them don’t do that. They come to their own conclusions. And I’d rather the patient come to that conclusion because it’s their body. And it’s, it’s their goals. You’re right, I can lead them there. And I can, you know, usually most people figure it out once I show them what’s going on.
Steve Washuta: Yeah, a lot of it’s just the sort of Socratic method, you just keep asking the questions, and then they say it out loud. And they recognize themselves and what they’re doing when I have clients who are a little bit older, who, let’s say, play pickleball. And for some odd reason, it’s something they’ve been pushing toward the older seniors.
And I disagree that that’s not a great sport for some of these seniors who have very quick Twitch lateral movements, for people who are in their 60s and 70s. It just doesn’t always go well.
So anyhow, they come into me with injuries all the time and say, What would you do the last week? And I said I played pickleball. I said, I want you to play pickleball Tuesdays at once your ankles start hurting a Wednesday, I said, Oh, okay, you know, and they start to put two and two together.
Yeah. But it is, it is a big part of being a health professional that you want them to pick up that on their own, and you have to kind of force feed them the information because they’re not going to make the proper changes unless they feel like they came up with the idea in the first place,
Rick Olderman: it’s a much more permanent idea when they come up with it themselves. I mean, let’s face it, a lot of times, I have to actually tell people what to do. All right. And I’ll do that if I have to. But I just feel it’s it’s, you know, it’s absorbed internally much better if they can come to those conclusions.
Steve Washuta: There seems to be a big mobility craze now. And I’m certainly someone who is all for mobility. When I work out, let’s say for me, it’s the most important thing to do is to move all of my joints and every range of motion possible before I work out. Now, now that I’m older, I’m 38, I have to do a better 15 20-minute warmup before I do anything before any exercise. It’s a really long dynamic warmup.
So I’m all for mobility. But from a corrective exercise standpoint, I believe. And you could disagree that a lot of this is strengthening that needs to happen. Let’s say when someone comes in with like a lower back issue, it’s because there’s a lot of weakness in certain areas, and they’re not stable enough. It’s not that they’re not mobile enough. Do you disagree? or agree with that? What do you think about the whole mobility craze? In general? Well,
Rick Olderman: you know, not all mobility is created equal, some mobility is excessive, and some is not. So this, I kind of mentioned for more retroversion. So let me kind of explain more about retroversion and anteversion in regards to mobility, and how this might affect how you warm up. All right. So if we have a skeleton, and we have a thigh bone, all right, now, the shape of the thigh bone is not the same in all people.
Rick Olderman: Some people’s thigh bones are twisted inward. This is called femoral anteversion. And some people’s thigh bones are twisted outward. And this is called for more retroversion. So there are a lot of implications to understanding whether this is happening or not. Those people and females tend to be more towards for more anteversion with a bigger Q angle.
Rick Olderman: Pardon me
Steve Washuta: with a bigger Q angle, correct?
Rick Olderman: Well, that’s one of the things that contribute the cue angle is the internal rotation of the thigh bone. So and then men tend to be more retroverted or externally rotated with their thigh bones. So when this is happening, in general, the hip joint, the knee joint, and the foot joint, don’t like internal rotation, because that increases compression. All right.
Rick Olderman: But when you have a thigh bone that’s already built for internal rotation. That means that you have to control that internal rotation even more than most people who don’t have a thigh bone built like this. All right. So and the thing that will control that thigh bone the most is the butt muscles. All right, so you have to make sure that your butt muscles turn on correctly at the right time during your gait pattern.
Rick Olderman: That’s the most common activity that we’re doing with our butt muscles. So that’s the most critical one. So anyway, regarding this, so if your warm-up routine is taking you into internal rotation a lot, you’re gonna say, Oh, this is a piece of cake, I can do this all day long because you’ve already built bias to that.
Rick Olderman: And if your routine is then trying to take you into external rotation of the hip joint, and you don’t have that motion, you might think, Oh, I’m too tight, I can’t, I’ve got to work that external rotation to get more external rotation of the hip joint.
Rick Olderman: Well, it’s not a function of soft tissue, it’s a function of the shape of your thigh bone. So all you’re doing is more damage, trying to get more external rotation, when you don’t, physically physiologically have it. With a retroverted, femur, if you’re try again, external rotation, oh, I can do this all day long. This is why guys sit with their knees apart. They call it manspreading.
Rick Olderman: Right. And women typically sit with their knees together, because they have this anteversion and retroversion idea of the shapes of their thigh bones. But if that same person, the guy with the external wrote that with it for more retroversion tries to get an internal rotation of the hip joint, and thinks it’s a soft tissue restriction,
Rick Olderman: well, then they’re only going to be damaging the tissues, in their hip joint. Because even when the knee is in a neutral position, that could be all the available internal rotation that the hip joint has, because of the shape of the thigh bone.
Rick Olderman: And this is often where labral, tears, excessive arthritic changes, bursitis, and all sorts of groin issues occur because of a lack of knowledge of femoral anteversion, or retroversion. So from this standpoint, and so if you do try to get an make that hip go into internal rotation, it’s not only going to be expressed at the hip joint, the next joint is the SI joint. So that’s going to go into compensate for the lack of hip joint mobility.
Rick Olderman: And if the SI joint is not moving, then the next joints are going to be the spine joints. And so now you’re creating all of this compensation occurring through other joints, because of your idea that you need all of this mobility in your hip joint so that you can have whatever some book has said, we should have this much internal rotation and this much external rotation. So this is generally how mobility works all through the body.
Steve Washuta: Could you walk me through how femoral retroversion or introversion, and a squat could hypothetically be affected by that meaning? You know, if I’m retroverted, how that would change, maybe the positioning of my squat?
Rick Olderman: Absolutely. So this is really important. In fact, I worked with an NFL player just recently, and he came in for let’s see, what was it, it was ankle pain, but he also had hip pain and knee pain that he didn’t think was as significant as his ankle pain. And this only started when he started working out when he went to his, you know, Division One school for, for football.
Rick Olderman: And they, what they did is they put all these guys in that say, Oh, your alignment, these are the exercises you’re going to do. And this is exactly how you’re going to be doing it. No idea of for more retroversion or anteversion. And this is when all of his lower body pain happened. Right? Once I told him about this concept, the pain of nine years, while he’s playing NFL football, went away in three days.
Rick Olderman: Because it was a biomechanical issue, not a structural issue. It was becoming a structural issue because of the biomechanics. But it wasn’t to that point yet. So to answer your question about four retroversions, and let’s say squatting, we all have this idea in our brain, that when we stand, our feet should be pointed forward. But if you have a retroverted femur,, what that means is, is that you are now internally rotating that hip joint, to get your feet to point straight forward.
Rick Olderman: And so now you’re walking around with excessive internal rotation all the time. And guess what, what are the muscles that are contributing to that the inner thigh muscles, so then you start to get tight inner thigh muscles that start to constrict the hip joint, because of this idea of I’ve got to pull my feet forward. So when we’re squatting, and now we’re under load, we have to make sure that the feet are pointed in the direction that the thigh bone is rotated.
Rick Olderman: And so if you have recovered femurs, the feet have to be pointed out in order to align it with the shape of the thigh bone, in order that the knee and the hip joints can move correctly and with a full range of motion in their sockets. If that foot is pointed forward, you have and now you’re standing in relative internal rotation, your hip joint will be restricted.
Rick Olderman: And so then when you go into that squat, again, the SI joint, the knee joint, the ankle joint, the back joints will all start to accommodate or compensate for that lack of mobility in the hip joint. It’ll be subtle, but when you have 600 pounds on your shoulders, and you’re doing squats for days and days and years and months and whatever, that really adds up.
Steve Washuta: What is the argument if any, with people in your industry doing the same thing as you, if you might present this to them? What would they say? Do they have the most people agree with you? Do they disagree with you? Is this something that you sort of learned over time through your 30 years, as opposed to what was presented to you sort of academically?
Rick Olderman: This is what I’ve learned over my 30 years. So most people in my industry, don’t even look at femoral anteversion, or retroversion, don’t even know how to measure it. So and if they do, they don’t know how to use that in terms of biomechanics, in sports that I’ve found, you know, of all the therapists I’ve been trained in at my clinic and all of the therapists that I meet, this is new information for them. Because they were not I wasn’t certainly wasn’t taught this in school.
Steve Washuta: I can tell you that, to me. Like one of the people that you were teaching said, although it is somewhat complex, it actually makes things more simple, right? And in a way, so when I work with people,
I never fight to get them in a particular squat position in which I believe biomechanically they’re not meant to be and right, it’s very obvious to me to tell if this squat is, you know, forcing somebody to be uncomfortable to the point where the biomechanics, first of all, look wrong, right?
We haven’t had a sense as fitness and health professionals, I’ve watched, literally 10s of 1000s of squats at this point from different people, that this doesn’t look right, right, this person’s feet need to be a little bit wider than mine, that’s fine.
This person’s toes need to be slightly pointed out. That’s, that’s okay. And I think, understanding that all of our bodies were built a little bit differently, especially like you said, with where the femur inserts, makes perfect sense to me.
And it’s not woowoo nonsense, it can be seen on an x ray, or you can lay anybody down, show an x ray and see exactly where their femur inserts. And so why would one person assume that if the femurs are in different locations, then the knee and ankle and foot position should also then not follow suit and be in a different location? It all, it all makes perfect sense to me. Why, though, do you think that some people have not either caught on to this?
Do you think that or do you think that there’s just there’s such a, let’s say, like, the the ideas that are in the industry take a long time to sort of change over if that makes sense, right? The books have been written, and sometimes it takes 1015 20 years for things to be turned over? Is that the reason why this isn’t like, updated information, so to speak?
Rick Olderman: I have no idea. But I would guess that you’re right, that, you know, I think, you know, I think what it is, is that there is a critical mass of poor information out on the internet. And what I have found is that a lot of this information just continues to be recycled, and said maybe in different ways, or whatever, over decades, I’m still getting people who say I have neck pain, because of a forward head, you know, that it has nothing to do with your forward head.
Rick Olderman: And so, you know, it’s just that, you know, or I have back pain, because I have a weak core, I have never strengthened core muscles to solve back pain ever. And I and I don’t give core strengthen your muscles. Because if you’re using your body correctly, they will be strong naturally. And so these kinds of ideas, I think, are just circulating, because that’s what’s out there. And so someone like me, who sees things a little differently. You know, I’m just a small voice in a large sea of voices. And so people want
Steve Washuta: Well, usually what I’ve seen, and I’ve had a lot of people on my podcast Rikku, who think like, you want to think like me a little bit outside the box.
And almost always, there are people who are looking at the full body. Right? It’s, it’s so many specialists nowadays because that’s just the way people went everyone hyper-specialized into certain areas. And I think we lost something when that happened.
Because people will, because you’re hyper-specialized in the area, you assume that every issue has to do with the thing you know, the most, rather than taking a step back and saying, You know what, I don’t know, I’m not,
I’m not telling you that I know where this comes from. I’m just telling you that my job is to fix this. And I’m going to look at it from a more of a global, let’s say perspective. And I think that’s great that you do that.
And I think a lot of people who I’ve talked to who are dealing with pain. All have that same ideology where they say it’s a little bit complex, It’s psychological, it’s physiological. And we’re not going to just look at one area, we’re going to think outside the box. And I’m glad that there are people like you who are going, you know, above and beyond, and even maybe, let’s, let’s call it is what it is.
It’s a little risky to do that. Because there’s going to be somebody in your industry who goes. What is this guy doing? I didn’t I didn’t learn anything that this guy is doing.
But you’re willing to do that because you know. That you’ve helped people before and it’s worth it to you to continue to help people even if you’re risking going, quote-unquote, outside the mainstream?
Rick Olderman: Yeah, well, for me, you know, what helps is that my focus has been on solving pain. My focus isn’t on helping people understand that I’m smart. Or all the facts that I know, or that, you know, whatever. So if something wasn’t solving a patient’s pain, then I wouldn’t use it. And I would figure out how to solve that.
Rick Olderman: And now that I’ve been doing that for 30 years, almost, I feel like, you know, while my name may not be out there, among all the Giants, I feel that what I’ve figured out is true. And that’s the thing that has guided me rather than my ego is that. If it’s true, it will solve the pain in all cases. And what I know does, unless there’s a structural issue going on, like a tear or something,
Steve Washuta: Are there techniques or toys that you use that other people don’t? Or maybe you use them in ways that other people don’t?
Rick Olderman: I don’t use many toys. Once you understand how the body works as a system, you know, you won’t need that. But I one of the techniques, though, that I have learned is Hana semantics techniques. This has been hugely powerful. Because it is about knocking down neurologically based tension patterns. that are running through our bodies.
Rick Olderman: So if you have read any Anatomy Trains by Thomas Myers, if not, okay, so, Thomas Myers is a researcher and fascia. And he and fascia is a connective tissue in the body. And it turns out that he identified superhighways of fascia that connect the head to the foot. These are these occur in the back of the body. And the front of the body decides to spiral directions. There are upper body fascial superhighways, too.
Rick Olderman: And so what that is telling us is that these fascial superhighways are connecting, you know, pieces of the body that are far away from each other. And what the hand of semantics does. is, it turns out that they are the neurological tension patterns that are locking people in. In chronic pain patterns of dysfunction are typically along these fascial superhighways. And there is also a neurological component to this.
Rick Olderman: Because these also happen to be hardwired reflex patterns that are hardwired into our bodies that we’re born with. As we grow, we override these reflex patterns. Because we can’t reflexively respond to our environment, you know, 24/7 for the rest of our lives. So our cortex overrides these. So that we can just go about our day for the most part, but we never lose that hard wiring.
Rick Olderman: And it turns out that, that hard wiring is responsible for the tension generation along these huge superhighways of patterns of fascia throughout the bodies. So I use these techniques to solve difficult pain,. Because usually it is a difficult pain is due to a pattern of chronic tension and contraction, rather than tightness or weakness.
Steve Washuta: From a lifestyle perspective, do you give clients advice?Saying simple things like hey, you need to sit less, or you need to be worried about let’s say, your posture when you’re standing in place things of this nature? Or is this not something that you’re concerned with?
Rick Olderman: Oh, yeah, it’s definitely a part of it. So posture is a big deal. In fact, posture strategies are really important when it comes to neck pain and headaches. And we can go into what that is, if you want to. But you know, what I’ve learned is I need to meet people where they are.
Rick Olderman: And if you’re sitting for eight or 10 hours in a day in the office, then we need to teach you how to sit better and, you know, situate this office setup better, these ergonomics better to suit your body. And my clinic, I once had a woman who came to me with, you know, chronic neck pain, back pain. And so she said, I can’t work at my office anymore, because it’s just so painful. So we spent 15 minutes working on her ergonomics.
Rick Olderman: And literally she started crying. Because she didn’t understand that she could she never thought that she could sit again without pain. It was just a simple meeting of her body and understanding what ergonomic changes needed to be made. To support her body in a better way. And she was pain free after that. It was like she felt like she was sitting in a cocoon. She was so comfortable.
Steve Washuta: For some of the listeners who know the body a little bit better. And I have a lot of personal trainers and people who are your fitness professionals. what are maybe some specific exercises you would give to say let’s wake up some of the glute muscles for people who are maybe in their 50s or 60s or 70s. And do work eight hours a day and happen to be set. going down in a chair.
Rick Olderman: Yeah. So the gluteal muscles, their primary function is to stabilize the hip joint and the pelvis during gait. So this is where the problem usually happens. So instead of I mean. I’ll give a glute strengthening exercise if someone. Are you familiar with the with anterior frontal glide syndrome?
Rick Olderman: Yeah. Okay. So if someone has anterior femoral glide syndrome. And most people with chronic hip or SI joint issues, and so forth. They have an anterior from the localized syndrome, the gluteal dysfunction is the source of the problem of that. And so I’ll give them a specific exercise to turn on the glutes and get them to wait neurologically. Wake up and become strong again.
Rick Olderman: However, if we don’t fix the gait pattern, all the strengthening in the world is not going to solve anything, because you’re not using the muscles in the way that you’re designed to use them. So what needs to happen during gait is at foots trike. The gluteal need to be turning on naturally. Usually about maybe 10% or 20% of their maximum contraction.
Rick Olderman: And once we get that happening, low Behold, most pain starts to dissipate, because now the femur head is tracking correctly in the hip socket, and the pelvis is being controlled correctly.
Rick Olderman: And the rotation of the femur is being controlled correctly. And so all of a sudden, all of these pain complaints start to melt away. So we can do squats and lunges and things like that to strengthen the glutes. And certainly those will target the glutes, but they’re not targeting them. That doesn’t carry over into function. Because our knees are only bent, maybe 10 to 20 degrees when we’re walking.
Rick Olderman: If your glutes it will only turn on when you’re bending your knees 90 degrees when you’re squatting, it’s not going to translate to that 10 or 20 degrees when walking again. So that’s what I found. All of those exercises are great. But you can have the strongest glutes in the world and they’ll still turn off when you’re walking. I see that all the time in athletes.
Steve Washuta: Very interesting. Makes perfect sense. If you think about it. You know the functionality of you know having to do let’s say whatever even even a more targeted exercise. Like let’s say a clam shell like a bandit clamshell or something.
But you’re still you’re in that severe knee bend, right? And you’re forcibly pushing your leg not in the same way that you would be using it when you’re walking, right.
So it’s a completely different direction and use of the leg and the functionality. So if the ultimate goal is to work on that gait. Those other exercises, although they can help. Let’s say Wake the muscle up and help support No, they’re still not doing what they’re supposed to do. So that does make sense.
Rick Olderman: Ultimately, you have to get back to the function. How is this person using their body? How can we get them to use it better to turn on these muscles naturally? And by the way, it’s not only that muscles need to turn on, some muscles need to turn off too.
Rick Olderman: And so if you if we look at this is why I was interested in your adductor strain experience is that what I have found is that when the gluteal muscles do not turn on, right, and they are if we look at the hip joint, the gluteal muscles are a primary stabilizer of that hip joint.
Rick Olderman: And so if we have anterior frontal glide syndrome, then the thigh bone in the in the socket starts to move, like carrying around and that hips join kind of like a washing machine that’s out of balance, it’s just going to start bumping off and tearing things and disrupting things, right. So but what I found is that the less that the glute muscle is activated. The more the inner thigh muscles become activated.
Rick Olderman: Because this is a cross bracing system. I’m gonna hold that up with my head. This is a cross bracing system for the hip joint is the adductors on one side. And the gluteal is on the other. And so if the gluteals aren’t working, well, how are we going to stabilize this hip joint? Well, the adductors are called on to do more work then. And they become chronically tight and disruptive as well. Yeah.
Steve Washuta: That makes perfect sense to make what are maybe. And you know, we talked a lot about the lower chain. As you called it, where maybe some more upper chain related exercises. Excuse me, issues and problems that you see that you deal with differently than the average physical therapist. Oh, sure.
Rick Olderman: So let’s talk about chronic neck pain and headaches for one thing. All right. So if we look at the skeleton. We’ll see that the skeleton is comprised of all these long bones. Right, all these long bones here, and there’s only two areas where there aren’t long bones. One is the pelvis. We all know that the pelvis is the center of function for the low back and the lower body system. The other area is the scapula.
Rick Olderman: And the scapula is the center of function for the upper body system, neck, and head. So what’s happening is that there are significant muscular attachments. Running from the scapula to the neck bones and the base of the skull. So when the scapula is not working correctly, stress is transmitted via these muscles to the neck bones. Causing cervical compression. Side bending and rotation in the circle joint, especially when there’s asymmetry and the upper body system, right.
Rick Olderman: So solving, but this, no practitioner ever looks at the shoulder blade system as the source of chronic neck pain and headaches. And in my recent book. The Solving the pain puzzle. The one that I just published here. I mean, I have three stories of people who we saw their migraines and other headaches and neck pain.
Rick Olderman: And it turns out that they had structural problems in their shoulder joint once those were fixed. All this melted away. Interesting that and this goes back to our original conversation about old injuries.
Rick Olderman: One of them was an ER nurse who, you know, you know, said I have never had any problems. And then once she ended up having two full-thickness rotator cuff tears in both of her shoulders. unknowns to her, and at once I forced her to go get MRIs because something was going on with her shoulders that we couldn’t identify.
Rick Olderman: And I said I thought you’d never had any injuries before. And she said, you know, now that you mentioned it. I mean, 15 years ago my shoulders hurt for a few weeks. But then it went away. And that must have been when she tore her rotator cuff muscles.
Steve Washuta: Very interesting. And your thing just because let’s say I know there’s like. Like C six C seven like innervates down near the scapula. Like the rhomboids and stuff, so you can feel pain sort of reverberate around. You’re not saying like compression in that area is going to cause scab like a scapular pain. You’re saying actual scapular and shoulder dysfunction is the root. It cause that causes all of the rest of everything else sort of up? Correct?
Rick Olderman: Yeah, in fact, I just saw another patient with radicular symptoms, neural symptoms down into his hands, you know, he had a herniated disc in his neck. Right? We saw that in about two weeks. And what it was was a shoulder blade. So the shoulder blade is what is likely causing all the structural problems in the neck like that herniated disc. That then causes the ridiculous symptoms down the leg down the arm.
Rick Olderman: So in medicine, we see these nerve roots coming out of the neck and say, Oh, it’s gotta be a problem with the neck. True, it is a problem with the neck. But why is it a problem with a neck. It’s a problem with the neck because of the shoulder blade system is operating on it.
Rick Olderman: And you know, the three patients that I mentioned with neck pain in the book I they ask there’s orthopedic surgeons, and neurosurgeons if the shoulder has anything to do with any of these ridiculous symptoms and headaches, all of them to a person said, No, impossible.
Rick Olderman: There’s no research to support this. There is research to support it. But they’re not looking at that research. They’re looking at their own research to support their own belief systems.
Steve Washuta: Yeah, and maybe I shouldn’t be saying this on camera. But I can tell you this just happened this morning. My wife had a patient, she’s a pediatric sports medicine doctor who had fractured his scapula. She has never dealt with it before.
Her two pediatric orthopedic surgeons had never dealt with a fractured scapula before. They called the trauma surgeon who had who never dealt with the fracture scapula before. So they had no they had nobody to hand this kid off to. Right. because it’s just, it’s just not something that they deal with on a regular basis.
And if you take that down the chain. If that’s not something they deal with on a regular basis. Then all of the other things that potentially come from the root cause of this issue. They are just they’re not used to it. So it does make sense.
And like we just discussed, most people, including myself, always thought. Okay, this was a secondary issue coming from somewhere else, right? This is a neck issue causing the scapular pain or the scapular shoulder issue where. Whereas in when you look at it from your perspective, it does kind of make sense.
I think, again, I don’t envy you playing anatomical sleuth is really difficult to do, right? It’s easy to ask someone where all their pain is. It’s easy to maybe even diagnose and look at what’s going on is dysfunctional. But it’s hard to say. What is causing what but I like how you think outside of the box and say. Well, you know if maybe the reason why there is so much chronic pain is because we’ve been sort of miss diagnosing the root causes of a lot of this.
Rick Olderman: Absolutely. And Steve, I mean, I say this, you know. In all honesty, there’s no reason you can’t know this information to. It doesn’t require someone like me, only to know that I’ve trained all of my therapists to know this. I’ve traded on the personal trainers to know this.
Rick Olderman: Anyone can be trained by Yoga and Pilates instructors. They can be trained to know this. You just have to have the desire really. And so, the sleuthing. It’s funny that you mentioned that you’ve said that twice in the introduction to my new book. Sherlock Holmes is one of my heroes, right? And the introduction is about Sherlock Holmes and how he is a great Sleuth. And so that’s how I use these codes.
Rick Olderman: And one of the reasons he’s a great sleuth, is because he realizes that everything matters. Every little detail matters. The problem is we have not been trained to understand how those details matter. And that’s what I’ve been figuring out for these last two, two plus decades now.
Rick Olderman: It and the more I understand it, the simpler it all becomes. And so that’s why when, you know. People look at me like, you know, oh gosh, you know, this guy knows, I know, it’s so simple.
Rick Olderman: I don’t know everything. But I know enough to help a lot of people with chronic pain. And so it’s not impossible to learn this and understand it, it’s so much simpler. And that’s it invariably, from the patients whose chronic pain we solve at my clinic. They’re all just like, I can’t believe it’s that easy. Why isn’t everyone else doing this? And that’s like, that’s the recurring theme. Because it is so easy.
Steve Washuta: Well, aacomas Razor, as they say, sometimes the simplest answer is the best answer. Rick, this was super lightning and fun. I hope maybe we can do it again down the road talking about some other topic. Maybe even honing in on one particular let’s say issue or elderly and go down the anatomic side of it.
But why don’t you give my listeners some insights into where they can find you. Let’s say personal trainers or people in the health and fitness realm. And they want to learn more about what you do or if there may be general population and have problems.
Rick Olderman: Yeah, I think just go to my website, rickolderman.com And that’s older man opposite of a younger woman. And just go to rickolderman.com You’ll see all my products. I have some free stuff on there. But you know, that’s where you’ll find everything. That’s the easiest way to dive in.
Steve Washuta: I will put all the links in the description. My guest today has been Rick Olderman. Thank you for joining the show for podcasts that you’ve seen.
Steve Washuta: Thanks for joining us on the Trulyfit podcast. Please subscribe, rate, and review on your listening platform. Feel free to email us as we’d love to hear from you.
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