Rehab Science: Overcome Pain and Heal From Injury | Dr. Tom Walters

June 5, 2024

Natalie, Derek, and Tom discussed the importance of understanding the root cause of injuries and using evidence-based exercises to prevent future injuries. Tom emphasized the complexity of chronic pain and its relationship with the sympathetic nervous system. Derek highlighted the benefits of mobility practices, such as those found on social media, in preventing injuries. Tom & Derek discussed the growing popularity of peptide therapy, with Tom emphasizing the need for proper regulation. Overall, the conversation emphasized the importance of a multifaceted approach to managing pain and injuries, including self-care, education, and evidence-based exercises.

Natalie 0:00
Hi, and welcome to the Invigor medical podcast, where we’re going to walk with you on your journey toward optimal health, performance and well being. My name is Natalie.

Derek 0:09
And I’m Derek.

Natalie 0:09
And we’re going to be your hosts on this journey. In each episode we share insights from top professionals and physical, mental and emotional health. With that said, let’s dive into today’s podcast.

Okay, today we are thrilled to welcome Dr. Tom Walters who is a renowned physical therapist and strength conditioning specialist. Welcome to our podcast today, Tom. With Tom, he has extensive experience in orthopedics and movement disorders. And he’s here to share invaluable insights into injury prevention and to discuss his book, Rehab Science: How To Overcome Pain and Heal From Injury. We’re so excited to have you. Welcome to our podcast!

Tom Walters 0:45
Thank you for having me on. You guys always excited to talk about pain and injury. It’s so cool, what you guys are doing with this podcast and just helping educate people out there on these topics. So thank you.

Natalie 0:55
Oh gosh, that means so much. I’m mostly on here because I love hearing myself talk. But I know that Derek is uh, loves sharing, loving sharing the good work. [giggling]

Derek 1:03
I’m very excited.

Natalie 1:04
Very excited. We actually, this is awesome. You’re the first guest and author, we’ve had the actually sent ahead a copy of the book, which is super fun. We’ve always like done some research on our own. But it was awesome to have a physical copy of the book. If you’re watching on YouTube, you can see how monstrous this thing is, which is super exciting. I mean, when I flipped through it, it felt to me a bit like an encyclopedia on taking care of your body and helping with healing and injuries. And I know I’m really excited for this because I think a lot of our listeners are people who are in exercise and who want to be healthy and live long, healthy lives. And for a lot of people injury is just so debilitating and feels like it’s the end and like what are you going to do? I know I sprained my ankle two, three summers ago. First kind of like real injury I’ve had in my life, which is crazy, because I was 36 at the time.

Derek 1:55
Wow.

Natalie 1:56
Yeah, I know wild, right. I’ve been I played soccer growing up, you know, through high school, and I started wearing stilettos when I was 13. So you’d think, you would think…

Derek 2:04
You had lots of good training!

Tom Walters 2:05
You would have had lots of ankle sprains.

Natalie 2:06
Right. Yeah, you think that like I would have had some kind of ankle injury. I played basketball too. So there’s lots of pivoting and power. But no, it wasn’t until I was 36 year old doing something stupid that I totally like I remember the doctor was like this would have healed faster if you’d broken it. And I’m like, that’s great. But it was debilitating, right. And I didn’t I didn’t go to P.T. And I wish I’d had access to something like this. Because the recovery it did take time. And there was a lot of exercises that I wanted to do that I couldn’t do because it’s in my ankle. And even now it’s like not quite the same size as the other one, but I don’t have pain in it. So anyway, really excited to dive into all of this information. But let’s start a little bit with just you. It’s kind of nice to get a picture of how you got here and why you wrote this book in the first place. So, go.

Tom Walters 2:52
Yeah! Alright. Well, you know, I like you, I grew up as an athlete. So I was in martial arts and gymnastics. Those were kind of my sports in high school and I ended up having knee surgery I think when I was a sophomore in high school and you know, it was back in the day where we were mobilized people for a lot longer. So I was in the straight knee brace for six weeks, I just atrophied.

Natalie 3:12
Yeah.

Tom Walters 3:12
I ended up developing a contracture in my knee joint, I couldn’t bend it past 90 degrees. And so all that I ended up being sent to physical therapy, and it was my first exposure to this field. And prior to that, I was just obsessed with exercise for performance reasons. You know, I was, I was like, a teenage boy, so I was reading Muscle and Fitness, I was trying to make my muscles bigger, Derek’s

Natalie 3:30
Derek’s like “Can relate.”

Tom Walters 3:34
So, you know, it’s like my first experience with oh, you can use exercise to, you know, rehabilitate yourself like this. I just never had hadn’t really an injury and or had pain at that point. You just heel so well when you’re that age.

Natalie 3:48
Right. Oh the good ole days.

Tom Walters 3:48
So I kind of, I was just, I was already interested in exercise. So I went and did an exercise science degree, that was my undergraduate degree. And then I looked at a lot of different things. But ultimately came back to physical therapy for a lot of reasons. It was just, I wasn’t going to be in school until I was out of my 20s like medical school, I just wanted to get out and have a life like I knew that wasn’t going to be the sole focus of my life. I wanted to experience my 20s I was interested in exercise and injury and physical therapy was just a good fit on a lot of levels. And you can go different directions in physical therapy. So I was always interested in orthopedics, which is- it’s just more mechanical, like you’re thinking about joints, their architecture, how joints move, it was more exercise related, like it was more, it was more similar to the exercises I used as an athlete, like, going to the gym. It was it, you know, it’s like it’s more sports medicine. It’s like orthopedic, physical therapy. It’s very similar to sports medicine, and you can go into pediatrics, neurological care, geriatric. There’s all these specialties within PT, but I just kind of knew orthopedics and sports medicine was the direction I was going to go. And so I went out and started doing that. And I’ve been a PT for 17 years. It’s taken a lot of twists and turns, I get bored really quickly. So Um, I’m just a very impulsive person, which I’m trying to get better being so impulsive.

Natalie 4:02
[Laughing] I can totally relate to that.

Derek 4:49
We can both relate to that.

Tom Walters 4:50
I just, I just, I need a lot of stimulation. I can’t – I would never – I lasted in a normal PT job for two years. And then I quit and just knew that I had to…I don’t I think like a lot of us like there’s a lot of these conversations nowadays on people want freedom, and being an employee for someone is not ideal. So I just knew that kind of the entrepreneurial direction. I didn’t really know that at the time, but I just knew I had to do something different. And so I got into teaching, which was-I taught for 10 years at a college here. And that was a lot better. Because you know, like, the academic schedule is way looser upper chapters have like, you can get just a lot of free time during the day.

Natalie 5:42
Yeah.

Tom Walters 5:43
So that was awesome. And then, while I was at that job teaching, I started an Instagram account. I just was frustrated with things. Patients would come in and tell me just things that were harmful to them. And unfortunately, a lot of times the other practitioners would tell them to kind of keep them dependent on care.

Natalie 6:00
Mmm. I’ve heard that before too.

Tom Walters 6:01
Oh, so frustrating. And it happens in every profession. Some are worse than others. But,um that. I started posting that was kind of that was December 2016 on Instagram. I think at that time, I was probably the only, there were only handful of physical therapists on Instagram posting physical therapy content and I just kept doing that. And the social media stuff grew so much. I didn’t have any idea. I had no strategy, I was just posting.

Natalie 6:26
Right. You were just posting and sharing.

Derek 6:27
Well, and sharing valuable content.

Tom Walters 6:29
Yes, just authentically sharing content about questions the patient’s had, like just trying to be helpful. And it just grew and kind of ended up where I’m at now with these big social media accounts and a business that revolves around it and a book.

Derek 6:44
Yeah!

Tom Walters 6:44
And it’s been an amazing journey. But I would have never thought this is what I’d be doing.

Derek 6:48
Well, that’s amazing. You know, to touch on the book – so like Natalie said, this is the first time we’ve actually received anything. I can’t tell you, when it landed on my desk, I was so excited. Like, I was so excited. And I read the intro. And like, it resonated with me on a very deep level, having worked in a physical therapy clinic as an aide, I saw a lot of the similar things that you were just talking about how like, there would be times where like, not not necessarily intentionally, but where the system itself is kind of built to like you only have 30 minutes with a patient 20 of that maybe even 25 minutes of that is like spent with an aide with an untrained person, because like I was spending more time with the patients than the physical therapist was. And I would see what the physical therapist would do. And like, you know, it’s like, okay, well, great, here’s a couple of exercises and then sent them on their way. And so when I read, when I read this, the intro of your book, I’m just like, this is a guy who understands that equipping the patient with the tools that they need to take care of themselves is paramount. Like that is the most important thing. And like I absolutely love that. I don’t know if you can if you can touch a little bit more about your philosophy of giving these tools to patients.

Tom Walters 7:57
Yeah, well, it’s, you know, I think physical therapy, when you look at it, there are there’s so many problems. And this is when people have a bad experience in physical therapy. Nowadays, I think a lot of it is driven driven by insurance and reimbursement, you know, when people go in, physical therapists are getting a lot of the same training. There’s different approaches and things but every physical therapist would like to spend more time with people and give better quality care. And I think, unfortunately, that’s just not possible. The business, this is why working for someone sucks in a lot of cases, because they are, of course, it’s the business, they’re focused on productivity and getting more-being able to bill more units. And as insurance companies reimburse less and less, that means you’ve got to see more patients. Each PT has to see more patients in the day, which usually means that they’re spending less time with a physical therapist, and then going immediately to the aid. And I just think, you know, when you look at my, my training, I had done a residency in manual therapy. So I did a lot of hands on work with people. And I think there’s a lot of good evidence out there in the short term for manual therapy, that’d be like you go in and somebody does massage on you or an adjustment or mobilizes your joints. But the thing that has the really long term evidence for keeping you better is movement exercise. And so much of that stuff, if you’re self motivated, and you have a good guide, you don’t need someone to sit there and babysit you doing that.

Derek 9:13
Yeah.

Natalie 9:14
Yeah.

Tom Walters 9:14
You know, you can literally just have a book with pictures. And if you’re finding the program then symptoms, the findings of the program that when you look at the condition that matches your symptoms, if you know if you if you have that right information, you can do a pretty good job of figuring out Okay, does this sound like maybe I have a rotator cuff problem? Maybe I’ve got frozen shoulder, you can read that you can read about it because people do this all the time. Right? They’re going on WebMD Yeah. And they’re reading about what they-their symptoms and trying to figure out what they have. And so the book is essentially the next step of okay, well, you figured out what you have, here’s the program that an exercise that you’d be prescribed in physical therapy. If you’re motivated, just go do that yourself.

Derek 9:51
Yeah, yeah. You know, before seeing your book, that’s something that I kind of like thought of myself and like if I if I was ever to get injured, I know that there’s a series of exercises that are specifically tailored to like these these specific injuries. And so I’d know like, go on to Google and search, okay. neck injury, physical therapy exercises, and there would probably be something from some university that would pop up with diagrams and but like, it wasn’t always a guarantee, and it wasn’t always-it wasn’t always a university that this resource came from. It would come from all kinds of different places that you that I wasn’t able to personally verify like, Yeah, this is this is a good vetted source of information for me to do this. And so that’s, that’s what I absolutely love about about your book. And I don’t know, maybe we can actually just like, open this up and show people like the fact that it’s like, you know, I love the way you structure it of like, okay, you do it by by category of like, their, you know, body part. And then let’s talk about the specific conditions that these body parts can actually be affected. And then, you know, talking about specifically like, Okay, if this is the body part that’s being affected, these are the exercises you wanted, like, just the whole layout is just absolutely brilliant. Like, I just want to tell you that personally, I absolutely

Natalie 11:02
I only see him this animated when he’s talking about Huberman. I just want you.

Tom Walters 11:05
Well, if I can be anywhere in the same realm, that’s pretty amazing. Well, it’s exactly like you said, I think, you know, I’ve been a PT for 17 years, and after enough time of humans coming in with pain and injuries, you can really, most humans get kind of the same 15 to 20 problems. Yeah, you know, the book covers 50. I – there were some in there that, you know, are maybe a little less common, but it’s like, these are the 50 most common conditions I’ve seen in my years as a PT, and the ones that, and the nice thing is that most of those are responsive to kind of a graded exercise and movement plan. So it really is just trying to give people those tools so that they can – and we say a lot in the book, you know, obviously, if you don’t get better, or you’ve got something, you’ve had a really traumatic injury, or you have some other kind of red flag type symptoms, then you want to go see like someone, a local provider and make sure there’s not something more sinister going on. But most things can be managed on your own. And at the end of the day, even when somebody comes in to in person physical therapy, the goal is to equip them with those tools and empower them and build their self efficacy so they can learn to manage on their own. It’s just like, if you want to see a psychologist, you won’t want to go to a psychologist, it’s like you will only get better when you come back to see me each visit. And I do these interventions with you. Like their goal is to teach you, give you tools to cope on your own. And that’s really what the best evidence based physical therapy should revolve around. And the book, you know, I agree with you, it can be hard to know, are you finding a source out there that’s credible? And I think, what I really tried to do in the book, there’s almost 500 research citations was, this, obviously a component of this is my clinical experience, but a big part of it is what’s in the research.

Derek 12:44
Yeah.

Tom Walters 12:44
So it’s not just me making stuff up.

Natalie 12:46
I think it’s really interesting. And I wonder if you can touch on this, you know, looking through the book, I noticed, and I’m guessing it’s important that the very first thing you start with is pain. How pain works.

Tom Walters 12:57
That’s intentional.

Natalie 12:58
Yeah, yeah. So unpack that for us. Why when you’re like going through, like, this is how you fix everything. Why is the pain where you started?

Tom Walters 13:04
Yeah. pPin is the number one symptom people seek care for? You know, so I think a lot of people have questions around pain, but most people don’t understand how pain works. You know? So there’s a lot of misconceptions around pain. Most people think that pain always means they have an injury. So people are always hunting for what can I identify in my body that’s causing this pain? Can I get an MRI or get an x ray and figure out what’s going on here. And we just know, pain is so much more complex. And I think there’s a lot of factors that go into pain, that a lot of people come into the clinic, especially when you start getting into chronic pain states, they have other factors that aren’t just purely musculoskeletal, whether it’s mental health factors, stress, lack of sleep…this is gonna sound like Huberman. excelpt the nutrition factors. Like all of these other things that play into the pain experience. So I think it’s so important from the beginning. I know so many people who get this book just jump to the rehab programs, but my hope is that they’ll always, that they’ll go back to the beginning. And understand those first five chapters on what is pain? How does the pain system work? What are the factors that influence pain? And then after that comes injury, and kind of just helping people figure out what is the difference between a tissue injury and this experience of pain?

Natalie 14:17
Yeah, cuz that’s kind of what I’m thinking is like, why is it important in the rehabilitation process, to understand what is pain and how it’s operating in the body?

Tom Walters 14:26
Yep. And I probably didn’t even answer that very well, but it kind of gives you a roadmap, I think. It helps you navigate it, because pain creates a lot of fear for people and there’s a lot of that talk and the research if something is really painfu-most people their natural response is to be kind of fearful and anxious about it and then to move less. And so then they-and then you know, sometimes there is a place for contemporary rest, but sometimes that – if it lasts too long, that can lead to all kinds of other issues deconditioning, stiffness in the region, weakness, you know, loss of muscle mass, and so I think for me, being in this field, I always feel sort of grateful that having this background in pain, I think I don’t get as scared of it when I have it. And so that was a, that was kind of a big part of those chapters was trying to provide that pain education to people so that they feel kind of better equipped if they do, because we’re all inevitably going to have some pain or injury, at some point, most likely in our lives. So just feeling like, you know, you don’t freak out if that does happen.

Natalie 15:30
Well, is it and correct me if I’m wrong, pain in the body is meant to like, it’s your body’s way of like protection, right? Like when you put your hand close to fire, you feel pain, because your brains like that could melt our hand off, that’s not safe, right? And so the pain comes as like protection. Is that the way it’s also happening in injuries in our body. It’s like a noticing something’s off and so it’s like saying Be careful. Let’s protect this area.

Tom Walters 15:54
Yep, totally.

Natalie 15:56
Yep.

Tom Walters 15:56
It’s, yeah, pain. You know, if you look at the definition of it, it’s a both an emotional and a sensory experience. And they say it’s associated with actual or potential tissue damage. And so actual tissue damage makes sense. Like you sprained your ankle, most people are gonna have payment that like you stretch those ligaments in your ankle, maybe you tear them, that’s probably going to create pain. The interesting thing about pain is that you can also have it when there’s potential tissue damage. So there’s lots of cool studies really just make people believe something’s gonna hurt and they’ll experience pain even though nothing’s being done.

Natalie 16:25
[giggling] Right.

Tom Walters 16:25
So, but yeah, at the end of the day, it’s a survival mechanism. It’s meant like you need pain, it’s so – we, we kind of think of pain negatively, but there are people who are born without the ability to feel pain, and they usually die really young. So, you know, if you fracture something or have a cut, and it gets infected, you can’t feel pain. Well, that that’s bad. Probably. Yeah, it’s bad. So you know, pain is really a normal thing. What’s abnormal is one pain lasts too long, you know. So pain, we see these situations where pain lasts longer after the point of the tissue healing. And so you can get in sometimes people develop these chronic or persistent pain states where their pain systems sort of off It’s like a, it’s a, it’s like, your nervous system becomes too sensitive, almost like if the alarms in your car went off just when the wind blew or something.

Derek 17:08
So does that tie to like the sympathetic nervous system, just being too tightly wired and just like firing off all the time?

Tom Walters 17:15
Yeah. That’s a big, a big part of it. There’s a lot of focus now actually, that’s why you hear a lot about breathing with pain is trying to kind of get some parasympathetic, trying to kind of wind – switch from that sympathetic fight or flight nervous system into kind of a relax and digest kind of state. But that is a – for a lot of people. And that’s where it’s so multifactorial. I mean, that is one part of it. Some people have a lot of sympathetic activity, kind of that fight or flight. And they’re so like, tense and just on edge all the time. And that can feed into basically your nervous system. It’s like you’re telling your nervous system, you’re threatened.

Derek 17:50
Yeah. All the time.

Tom Walters 17:51
You know, and so it – pain is all about threat. So you’re really with people who’ve had people who have especially that chronic pain states, you’re trying to convince their nervous system that there’s not as much threat as it thinks there is. And then that will kind of reduce sensitivity over time.

Natalie 18:05
And that makes sense why, like, when you’ve been in pain, like you’re exhausted.

Derek 18:09
Yeah.

Natalie 18:10
Right? Like, I was just talking with a client on the phone the other day, and she’d let me know that she’d broken her ankle. And she sounded so tired. And that makes sense. Like, it’s like if you just injured yourself, and you’re feeling that like nervousness around movement, and like pain could come at any time plus the pain itself. Like, it makes sense what you just said about the sympathetic nervous system, just being like in high alert, and like, That’s exhausting. You’re not meant to live that way.

Derek 18:30
And I think I think it goes the other direction, too. When you’re exhausted, I feel like you’re more prone to feel pain as well. I got to tell this dumb joke, because it’s in my head. And I just got to tell it, I went to the doctor the other day, he asked me on a scale of one to 10 Where’s your pain that I said, Oh, pie, you know, 3.14? And he’s like, Oh, why is that? And I’m like, because it’s low level, but it’s never ending.

Tom Walters 18:51
That’s good. I like that.

Natalie 18:52
HAha. [laughing] What a nerdy joke.

Derek 18:54
Sorry, I just had to get that out there.

Natalie 18:54
No! Dont apologize. I love nerdy Dad jokes. They’re the best.

Derek 18:58
So with that being said, so pain and exhaustion and just like this, all these chronic conditions, what’s your general approach for addressing the kind of the root of all those?

Tom Walters 19:13
I mean, it’s so individual to each person. And this is where, you know, this is where it can get a little tricky. This is why the information upfront of select the programs and the book is so important, because people really have to take time to kind of sit and be aware of their situation. And try to kind of peel back these layers and figure out what factors, what seems to be going on in my life that’s associated with when my symptoms are activated? You know, so when I have a pain flare up, what was going on in life at that time? You know what I mean? Because, again, most people are just gonna think, if my back started hurting, they’re gonna think well, did I like pick something up? What did I do with my back? It’s going to be very mechanical in their mind. That’s just where most people go with pain in their physical body. But when pains been around longer, you’ve really got a, you really have to on an individual basis try to be aware of all of these different factors, whether it’s stress, you know, was I, was there something stressful that happened at work, maybe I don’t, maybe it’s a relationship with my boss, maybe it’s a relationship with my partner, maybe I didn’t sleep as well. Inflammation’s talked a lot about with pain that persists. And so maybe there’s something from that standpoint of it, maybe it’s a nutrition type factor, that’s there’s some sort of pro inflammatory thing that you need to be paying attention to in your diet that’s there, maybe there’s some pattern happening there. Sometimes it’s just a lack of movement. You know, there’s all these specific kind of therapeutic exercises that are prescribed in physical therapy. And those tend to be more useful with people that have the more mechanical pains where the pain kind of fits with a recent injury or something. And like an ankle sprain is a really good example. Like, there’s gonna be really specific therapeutic exercises for stability, motor control, you know, strength, that are specific to the ankle, and maybe up that kinetic chain. But if you have chronic pain, a lot of the research is just focused on more on just general movement, just like getting people to go for walks like just Pilates, yoga, like whatever, just find something you have joined us move more. I was just looking at some interesting studies the other day, where they found that people who are more sedentary, they had more inflammatory cytokines in their blood, which of these immune system molecules, so more inflammatory ones, and less anti inflammatory cytokines, and people who are more active have the exact opposite. So they have less pro inflammatory cytokines and more anti inflammatory. So…

Derek 21:39
Why is that? Is it because because like, I know that when you exercise, like there’s an inflammation response, and so is it just that your body’s better at like taking care of those cytokines and saying, like, okay, yeah, this is just, you know, this is just like everyday procedure, like, we just sweep these out. Whereas people that don’t move, like their body’s not used to that and so the cytokines just kind of hang out more. And, and uh…

Tom Walters 22:00
That’s a great question. I haven’t really heard a physiological reason for why that is. But I would imagine, it probably does have a lot to do with what you’re talking about just like the vascularity, just like blood moving, because aerobic exercise is the one that’s talked about most with chronic pain, as being so powerful. And some of it’s this kind of neurogenesis idea of just like when you exercise, with aerobic exercise, you get more blood to certain regions of your brain.

Natalie 22:23
Mm hmm.

Derek 22:23
Yeah.

Tom Walters 22:23
And that can, we know, pain is an output of the brain, so there’s some thought that maybe increase blood flow to the brain helps change the pain experience, but I also think, in the body, there’s so much reason, you know, if you increase blood flow, you increase oxygen and nutrient delivery to those tissues. So I think there’s probably a lot going on, and I would imagine with the immune system it probably is related some to just kind of clearing some of those inflammatory cytokines and, and then maybe the exercise itself itself, then you release more of the anti inflammatory, but I, you know, I don’t know the exact physiology of that, what happens.

Natalie 22:54
It’s just so cool. Just like, you know, like, how much we know and how much we don’t know, it’s just wild to me. And you were, you basically just were going to, just answered the question I was going to ask, like, how much of a role does like immobility play in pain and injuries? Right, but you kind of just said that a little bit. Like, if it’s like chronic pain, like, get out and move, but maybe you want to dive into that a little bit more? What kind of role do you see immobility playing in the patients that you see?

Derek 23:18
Can I tack on that?

Natalie 23:19
No. Go ahead.

Natalie 23:20
I’m just kidding.

Derek 23:22
I’m just kind of with that. So move with mobility. There’s also like, you look on like Instagram and all these social media platforms, people that have specific mobility practices, and you know, a lot of people do it, like as a pre workout, or they just have it as an independent practice. Maybe we can kind of lump that in. Hopefully, that’s not too much.

Natalie 23:38
Sure. No, no I love it, because I have somebody I follow on Instagram, and she has all that she’s got all these mobility flows. Yeah, she’s a lifter, but most of what she posts are these beautiful mobility flows, which I just watch. They look cool, but I’m also like, her body, her physical intelligence, and the way she’s moving is just so tight, and I’m like, I wanna be like that.

Tom Walters 23:58
Her motor control and awareness. It’s fun to watch people who are really good move.

Natalie 24:01
Yeah!

Tom Walters 24:01
It’s almost like art.

Natalie 24:02
And I can’t help but think she’s gonna be 95 and moving like that. Like, that’s what it looks like when you look at her. Yeah.

Tom Walters 24:08
Totally. Yeah, mobility is an interesting one. It’s become such a popular, there’s so many people kind of creating programs and things related to mobility. And I mean, mobility in the physical therapy kind of rehab space is just one of the kind of components where somebody could have impairments. So like in physical therapy, somebody comes in and we’re looking we’re doing assessments looking for impairments in their musculoskeletal system. So mobility is one of those, you know, basically how far can your joints move? Can they move through their full range of motion? Whereas flexibility is usually looking at how the extensibility of your muscle tendon unit, so like think about like a sit and reach hamstring test, like we all had to do as kids like, that’s a hamstring flexibility, you’re looking at how far can a muscle stretch so in those other impairments, like balance coordination, motor control, strength is an impairment you know, so you’re kind of going through and looking at where are the deficits in this person’s system and mobility has just become really popular. I think because on visual apps, visual platforms, it’s easy to see. So, but it’s really important. And I think there’s a lot of people doing good things. There’s kind of different branches of it. There’s passive mobility, which would be kind of more like a passive stretch where you’re… well, you

Derek 25:19
You just got balloons.

Natalie 25:20
You just got balloons!

Tom Walters 25:20
What is that?

Natalie 25:21
Okay, so there’s been some kind of update not to get off topic, if you’re not watching on YouTube, balloons just went over Toms screen. I-this just happened when I was on a Team’s call the other day, and they’re like, can you hear me? And I was like, yep. And then like a thumbs up bubble when I was like…

Tom Walters 25:35
Yes!

Natalie 25:36
Then I started trying, and I went hearts and hearts came up and like, and we’d spent 10 minutes meeting just seeing what all we could do.

Tom Walters 25:44
So what triggered balloons?

Natalie 25:45
I didn’t even know that was a thing. I have no idea.

Derek 25:46
Congratulations?

Natalie 25:47
Try to do it again.

Tom Walters 25:48
Mobility? I was just gonna try to ignore it. I was like, I have no idea what’s happening right now.

Natalie 25:55
There were so many balloons!

Tom Walters 25:59
Awesome. Yeah, so no, I think in the mobility space, yeah, there’s like passive mobility, which is kind of like, it’s like, they’re like joint stretches, it’d be like, if you we do these a lot of people who have joint contractures or stiffness.

Derek 26:10
Its like a chest stretch in a door. Like you, where you do like a chest stretch, you put your arms in the door and you like…yeah.

Tom Walters 26:14
That would probably be more likely that would fall this is where things get like you get into semantics like that will probably be more of a flexibility things, it’s a muscle stretch. Like a joint mobility one would be like, one we do a lot of like ankle dorsiflexion. Like say somebody has limited ankle dorsiflexion. Like they can’t push the kind of good knees over toes, like the knees over toes position, they can’t do that with their ankle. This happens a lot after ankle sprains, they lose ankle joint dorsiflexion. So it’s kind of like you’re putting someone in a position where there’s no muscle stretch, or very little, and it’s putting all the force into their joint tissues. So what’s another good one, I’ll say like, another one that happens like with knee surgeries, sometimes people lose the ability to straighten their knee all the way. Okay, and so just straightening your knee joint, there’s a little bit of a stretch on your hamstrings, but it’s mostly in those people that their joint tissues get tight. You know, so that would be like passive mobility. We do a lot of those things early on in rehab, but a lot of things you see on Instagram are more like active mobility. So the person, they’re kind of cool because they require coordination and strength and good mobility. And ultimately, that’s what you want. That’s what would happen towards the end of the rehab process is you want somebody to have good control over their body, and have the strength to move against gravity through full range of motion. So like a pistol squats, a good example, you know, pistol squats, like so pistol squats, you have to have really good joint mobility for one in your hip, knee and ankle. And you have to give strength and motor control to be able to actually go down and successfully get through full range of motion and back up. Not a lot of people can do a good pistol pistol squat.

Natalie 27:41
I can’t.

Derek 27:42
I can’t either.

Natalie 27:43
Not even close. It’s one of my goals. I’d love to be able to get there but it’s a when you don’t really you’re like oh yeah, let me try that. And then you like start you’re like, nope, well, like, there’s just so much happening there.

Derek 27:54
I’m gonna say this. Natalie, your your Instagram handle is that tall girl? That’s true. How tall are you?

Natalie 28:01
I’m six foot.

Derek 28:01
So I’m six foot three. So like maybe it’s just like, there’s just so much farther to go.

Tom Walters 28:07
Those are long levers. It is, it’s true. I mean, biomechanically, those are longer levers. I’m only five nine. So I think, you know, being a gymnast in martial arts, there is something to be said for that. Look at all the Olympic gymnasts. They’re short levers. You know? So it is harder. I think as you get taller to have long femur, long tibia, like you just have a lot-your muscles are moving way longer levers to do something like that.

Natalie 28:28
All right, cool. I’m glad we have an excuse. Yeah. But no, still, it’s like you don’t really like even just lifting up the non standing leg and flexing your quad to try to get it straight and hold that while simultaneously engaging everything else and keeping your balance. And it’s wild how much I’m gonna want to be able to do it because it’d be cool. Do it. But there’s so much going on there. You’re totally right.

Hey, I hope you’re enjoying today’s podcast. I just wanted to take a quick break. Because if you’re listening, you probably know what we do here at a bigger medical podcast, but maybe not what we do and Invigormedical.com. So let me introduce us at Invigor. We provide prescription strength treatments and peptides for weight loss, sexual health and lifestyle optimization. Every treatment plan is carefully prescribed by licensed doctors and sourced from legitimate pharmacies. You don’t ever need to buy questionable research chemicals again. And bonus as a podcast listener. You get a 10% discount on your first treatment plan with code PODCAST10 at Invigormedical.com. Now let’s get back to today’s episode.

Tom Walters 29:32
Yep, yeah, it’s a complicated Yeah, you look at those movements that people who are good at ’em, make them look so simple. And then when you go to do it. You’re right. It’s like if you-your nervous system will tell you right like, Nope, this isn’t happening.

Natalie 29:42
Absolutely not. Yeah, it’s almost like that first time you go for a box jump. Hey, you’re like…

Derek 29:46
Oh boy.

Natalie 29:47
24 inches like this is, but like you just have to really talk yourself into it because your brains like Danger, danger. Yeah. And then one day you prove yourself right that it is dangerous when you finally knock when you-Oh.

Derek 29:57
And then you see Dr. Tom Walters.

Tom Walters 29:59
Yeah. Exactly! Keep me in business. You might get a book. Buy the book.

Derek 30:03
That’s right. So, so talking about mobility practices, it’s kind of just like a good practice. Like, I guess what I’m trying to see is like, is it overhyped? Is it too much? Or is it something that actually does have a lot of good solid basis behind it?

Tom Walters 30:19
Yeah. I think sometimes it gets a little overhyped, like foam rolling was for a while, you know, like, it’s not like you need to go, I think what you want to do, it’s good to warm up. And especially as you get older, like I didn’t warm up at all, when I was in my teens and 20s. I’d just go sprint and do weightlift. But I think now that I’m 42, like I have to if I don’t warm up, I tend to tweak things easier, more easily. So I think-when you think about mobility, I think the easiest thing for people to think about is whatever movements you’re planning to do in your workout, have a warm up, that kind of takes you through those movements at a lower intensity.

Derek 30:50
Yeah.

Tom Walters 30:50
Like don’t make it overcomplicated. Like, you don’t need to spend 20 minutes like foam rolling every muscle in your body. Or if you’re going to do squats, you probably don’t need to do a bunch of shoulder mobility rises, you just need to do the-you need to go-You might just do squats, but just bodyweight. Just don’t make it over complicated.

Derek 31:09
Brilliant. Very cool. I guess part of the reason I asked that is one of the people that I follow in the space Peter Attia, you know, he’s very outspoken about a lot of things. But one of the things he’s very outspoken about is what he calls stability training, which I don’t think it’s beyond mobility. And I think is because his whole focus is like longevity and health span and then increasing that as much as possible. And so I think this type of exercise that he does are much more practical and much more kind of like activity of daily living on a kind of on steroids more or less. What is your take on things like along those lines?

Tom Walters 31:44
Yeah. No, I see a lot of the stuff he posts, I appreciate that he’s very, like a proponent of kind of the musculoskeletal system and strength, because we do have a lot of evidence on that related to longevity, things like grip strength and quad strength and those being predictors of how long you live. And I think that the whole kind of usually stability exercises are ones where you’re using your neuromuscular system to really improve the control of kind of your joints and your kinetic chain. So it could be something like, like, sometimes we’ll do ones where we do like a lateral step down. We’ll have somebody stand on a step, they have to reach down.

Derek 32:20
Yeah, those are the worst. I had a knee injury in middle school. And yeah, those are the worst.

Tom Walters 32:27
Yeah, totally. They’re like, they’re, you know, there’s exercises like that, where they’re, of course, gonna build strength, but more of the focus on them, they’re just with body weight, they’re more trying to help kind of build that brain body connection. You know, it’s that neuromuscular control because your muscles are innervated by nerves that come from your spinal cord, which are connected to the motor cortex in your brain. So when you try to move and learn to control something, you’re sending a message or an output from the motor cortex of your brain, it descends down your spinal cord, and then it goes out the motor neurons to the most relevant muscles. Yeah, and the more you practice that the more refined it becomes just like learning to shoot a basketball or something like you’re just you’re, you’re developing a motor program. And so a lot of stability training is that like, an ankle sprain is another good example. Because ankle sprains, because you’re damaging ligaments. The primary impairment is a loss of stability in the joints. So if you damage a ligament, which is a tissue, you don’t have voluntary control over, it’s a passive tissue, it’s ligaments, we don’t have nerves that connect them. You can’t contract your ACL, like it’s just in there and holds it together. So if you tear a ligament, like with an ankle sprain, then you’re going to focus primarily on teaching your neuromuscular system to make up for that loss of stability because of the damaged ligaments. So you’ll use your perennial muscles and your tibialis, posterior tibialis anterior in your calf muscles, you’ll perform exercises where you’re kind of, you’re improving the efficiency of your nervous system to control that joint to make up for the loss of stability due to the ligament damage.

Natalie 33:58
Gotcha.

Tom Walters 33:59
So when Peter Attia, like I think when these people are talking about I agree, when you’re looking at longevity, you want to have strength for sure. Like you need to have strength because we lose muscle mass. Ope!

Natalie 34:08
See? There’s the thumbs up!

Tom Walters 34:11
You need to have strength because we lose muscle mass as we age. It’s the whole sarcopenia thing. But I think before we can think of it like a pyramid strength to me comes kind of after movement quality, you should learn how to move well first, which is like where, you know, me growing up in martial arts, I took it for granted. When I was a kid, I just learned to move well, in gymnastics I was always barefoot and I was always standing on one leg doing things. So, you know, I think there’s a lot of value in just first learning to how to control your body become aware of your body and control it through movement with just bodyweight and then after that, putting load on it and getting stronger.

Natalie 34:46
That is, ties in perfectly because my next question was going to be how important is the strength and conditioning regimen when contributing to injury prevention and overall health which I was going to caveat with also, so many people that lift, or do intense exercise regimens cause injury through it. And I feel like you just kind of like reverse engineered that a little bit.

Derek 35:07
Touched right on it.

Natalie 35:08
Right.

Derek 35:08
And one thing I’m interested in is the pyramid like so he said, we were talking about just overall good movement of the bottom strength trainings, probably somewhere above that, I’d be interested to see what the other levels are if I don’t know if that’s a thought that you’ve like, solidified.

Tom Walters 35:20
Yeah, yeah, it’s not one I’ve like fully built out. But it’s, um, it’s, it would be interesting to put that-kind of structure all those things, because and I think it depends on what your goal is. At the end of the day, if you are thinking about something like longevity and kind of healthspan. I think, when it comes to the musculoskeletal system, if your concern is longevity and health span, the thing you want to avoid are injuries. Yeah. Right. So like, because if you have a musculoskeletal injury, that leads to some major impairments, and that limits you from participating in things in life, and then maybe that ultimately takes you down the road of being more sedentary and less active. That’s what’s gonna take you towards death basically fastest.

The quality of life just like precipitously drop. Yeah.

Totally. Like, you know, I mean, one of the tests that you hear about all the time is basically just Can you get up and down from the ground without touching the ground, right? Without touching with your hand.

Derek 36:17
We’re going to be doing that after this, by the way. [laughing]

Tom Walters 36:21
But you know, what tests like that is a really good indicator, like they’ve done that, and they score it on 11 point scale. And every point you lose, they followed people. The people who lost more and more points died sooner. So it’s not like not being able to get up down from the ground causes you to die. It’s just that it’s associated with a lack of strength and mobility. And I think, you know, maybe a pyramid is not a great way of thinking about it, because I wouldn’t necessarily say it’s like, you’ve got mobility kind of components, you’ve got motor control, and you’ve got strength, and you kind of-maybe a circle or like a pie-chart is better?

Derek 36:52
Well and there’s like cardiovascular aspects of that as well, cardiovascular health. So it’s a very complicated web for sure.

Tom Walters 36:54
Yeah, totally. I’m sure VO2 Max all that stuff. I think if you’re looking at just the musculoskeletal system, it might be better to have kind of like a pie chart or something, I would almost think, kind of active mobility, motor control and strength all kind of share equal portions of that. Because if you think about getting up down from the ground, you need good hip and knee and ankle mobility, you need the strength, kind of like that pistol squat that get up and down.

Natalie 37:20
You may not be able to do that first, but if you do some strengthening exercises to get yourself to the point that you can, right?

Tom Walters 37:27
Yes. Exactly. And strength training. If you look at injury prevention, resistance training has the best evidence. So every physical therapy rehab program, all the phase three, phase three of every program, my book is resistance training.

Natalie 37:39
Yeah.

Tom Walters 37:40
You know, which has a motor control aspect to it. You have to learn to control your body through those movements. But ultimately, you want to be able to, it’s that idea of progressive overload, like as you put stress on your musculoskeletal system, the tissues become more resilient, become stronger, and if your tissues are more resilient, they’re less likely to fail mechanically.

Natalie 38:01
Right.

Tom Walters 38:02
You know, like if your Achilles tendon for example, like, that’s a worry for a lot of people don’t want to rupture my Achilles tendon? Well, if your calf muscles and your Achilles tendon are stronger through doing calf raises and jump rope and different things, you’re less likely to tear that tissue because it just it’s just stronger mechanically.

Natalie 38:18
Yeah, that makes sense. Okay, so I’m curious, because we also talk a lot about food and the impact it has on overall health. So are there foods that contribute to healing after injury or that might be a roadblock to injury?

Tom Walters 38:34
Yeah, I think nutrition is a huge factor to consider. I mean, those are the building blocks of your tissues. So I think after injury, probably one of the most important things to think about is protein intake. And, you know, we hear a lot about this on in nutrition talks. Right now, Peter Attia like different podcasts out there, but you’ll hear if you’re involved in strength training, or healing, the number you hear a lot is one gram per pound of body weight for protein. I think that’s a good kind of easy one to remember. Sometimes you hear 1.2 to 1.6 grams per kilogram.

Natalie 39:10
I’ve heard take your body weight, multiply it by point seven. And I’ve heard that too. So like anywhere from point seven to like one gram per pound of body weight.

Derek 39:19
Another one I heard is take your height convert it to centimeters, and then that’s fairly good?

Natalie 39:25
There’s so- I love all the different things, right?

Derek 39:27
Yeah. People are coming up with all kinds of stuff.

Natalie 39:28
Get a lot of protein, right? Especially if you’re lifting that’s like my focus in my nutrition is like, not necessarily keto, or paleo or whatever. I’m like, most of what I’m getting is high quality protein, everything else is bonus.

Tom Walters 39:39
Totally, it’s so important for healing those tissues. And I think that if you focus on your protein first, you’re less likely to eat a bunch of junk stuff that you know, you’re just getting all these empty calories from everything.

Natalie 39:49
Yeah. It’s satiating, that much protein in a meal. And you try to eat 45 grams of chicken breast or beef and like you don’t have a lot of room left or anything else.

Tom Walters 39:59
Yeah. You’ll tap out, you’re not going to keep-uh, that’s part of the problem that you hear with Western diet is this that everything tastes so good. You could actually be fooled. But when there’s all these sweet and salty things, you can keep eating them.

Natalie 40:10
Yeah.

Tom Walters 40:11
That’s a whole tangent, but I think, yeah, for injury, I think proteins really big. Some orthopedic surgeons will actually even prescribe protein drinks after surgery for people just to make sure they’re getting enough, you know, obviously getting enough calories because if you’re hypo caloric and not getting enough, it’s going to be hard to rebuild tissue. And then I think, you know, when you start, do you guys know this site examine.com?

Derek 40:32
Oh I love it. I’ve been getting ads. In fact, they just ran a recent ad. That’s like $500 for lifetime membership. I’m like, $500 is a lot, but it’s like for the entire life, like Oh my gosh! So I’m on the precipice. But yeah, anyways.

Natalie 40:49
I’m not, so explain.

Tom Walters 40:50
I’ve been using it for probably 10 years. And they it’s a website that is run. It’s all evidence based nutrition. So they look at every supplement and every health condition. So you can search by health condition, or by supplement, and it will give you a breakdown of the evidence, how strong is the evidence for whatever thing you’re looking at. It’s all non biased. It’s just literally teams of PhD researchers. It’s amazing.

Derek 41:14
That’s cool. The user interface is so just like clean and amazing.

Natalie 41:20
And now our podcast has become an advertisement for examine.com

Derek 41:22
Well, and guess who else uses exam?

Natalie 41:24
Oh, dear Lord.

Derek 41:25
Mr. Huberman.

Natalie 41:26
And there it is.

Derek 41:26
Dr. Huberman. Yeah, so he talks about it alot.

Natalie 41:28
Hey, but this time I mentioned Huberman first.

Derek 41:30
You did! You did. You did.

Natalie 41:31
That’s two episodes in a row. We have a running thing, like how long will it take Derek to mention Huberman? But I did it first last time and again, but in reference to your use-reference to your love, but it’s still, it still counts.

Speaker 1 41:41
So it’s a good site. I think that because there are a lot of I mean, I think in the day when it comes to pain, you could kind of go different if your focus is mostly pain than I think you and especially chronic pain, then you might look at ways to to reduce inflammation in your body. And then you hear things like curcumin, tumeric, things like, there are some out there fish oil, things that can help reduce inflammation. But I think to me, those are, you would only think about those after getting everything else dialed in with your mental health, your stress, your sleep, your movement.

Natalie 42:11
Yeah.

Tom Walters 42:12
And then on the injury side, if you’ve had surgery, or you’ve had an injury, whether it’s the actual tissue injury, then you would really first from a nutrition standpoint, be thinking about protein and calories.

Natalie 42:21
I gotcha. And inversely, do you see more injuries in patients who have not good diets? Like that are-I mean, I’m just curious if that plays a role, too. If you like consistently have a bad diet, you’re not getting good nutrients? Are you more prone to injury in general?

Tom Walters 42:39
Yeah, I definitely think it’s hard to track. But I think the where the area you hear about this a lot is people who are extremely hypocaloric with like eating disorders, and just thinking about stress fractures, and just the body breaking down because of that. It’s hard to know, you know, it’s hard to get patients. I don’t think people are always aware, and are they going to be honest about? Yeah, it’d be really interesting to track.

Natalie 43:01
Well and when you think about sugar too, like you mentioned inflammation multiple times. And sugar is like the biggest proponent of inflammation in the body, right. And then if you don’t know how your gut microbiome is working, or if it’s imbalanced, or if you have sensitivities to food, like just you know, it could be gluten is causing inflammation in your body or other things, and so may make you more prone to injury because of what’s going on.

Tom Walters 43:03
Yeah.

Natalie 43:04
Or make the injuries more prone to pain, you know, things along those lines.

Tom Walters 43:25
Yes. That’s the thing to like, because a lot of the lot of people who have chronic pain will have started with kind of a normal, acute injury, you know, but then it turns into something. I have one actually in my back that I’ve had for six years, I have kind of a spot about the size of a quarter kind of in my right, like, lower thoracic spine that started in jujitsu. It was a rib injury in jujitsu. And then I was in a stressful job, I was in that teaching job. And there were certain stresses associated that my kids were young, there’s just a lot of life stress. And I think that I there’s all these, there’s this thing I hear a lot that nerves that fire together wire together. And so it’s this is true for mental health disorders, too, like panic attacks and things that you get kind of a pattern of neurons that fire together and the more you keep firing them, the easier it is to fire those in chronic pain is like that to where your nervous system gets better at firing that pattern. So it takes a weaker and weaker stimulus to fire that pain pattern or that panic attack or whatever it is.

Natalie 44:23
That makes so much sense.

Derek 44:24
Unless you do something to counteract that.

Tom Walters 44:27
Yeah, so it’s like it’s a lot of it is graded exposure where you don’t run from it, you kind of try to face it in small baby steps, then get your system to desensitize. And I had to kind of do this, my back. It’s not and I think this is a good thing for people to know that if you have a pain thing that’s been around for a long time, it’s not always realistic that it will completely 100% go away. Sometimes it’s just more about management. You just figure out strategies to kind of keep it at bay so you can keep doing the things you’d like to do and maybe have to modify some things in life but some pains don’t. It’s not realistic that they totally go away. If that were the case we’d have a solution for chronic pain and chronic pain is only getting worse and worse. So I think you have to look at all these different factors and just know going into it that you probably can help knock it down, but it might not ever fully go away. And that’s the case for my spot. I have this spot that starts hurting mostly from psychological stress, even if it’s good, like, even if I’m about to go on vacation the night before it’ll start hurting, so…

Natalie 45:23
I’m familiar with that, yeah.

Derek 45:24
Interesting.

Tom Walters 45:25
Yeah, it’s not even like mechanical anymore. It’s something else or my physiology.

Natalie 45:30
Okay, so now that we’re talking about chronic pain, this is not on here at all. And it’s something that just popped into my mind because it’s something that I’ve been learning a lot about the last last year or so. And I’m curious your thoughts on CBD, the endocannabinoid system as it relates to pain, because I know I’ve read so much research about people with chronic pain who on a really good high quality CBD supplement to like, have it nearly eradicated, you know? And so I’m curious, have you done any have learned that kind of learning on your own and how it applies?

Tom Walters 45:58
I need to go dig back into that research a little more, because there’s so much out there and I and when I was writing the book that we do have a whole chapter on complementary and alternative medicine kind of practices. And I know with like, I have seen research, supporting you know, THC and strategies that target that system for things like chronic pain, chronic cancer pain, it’s like you hear this in cancer, you hear this in certain pains, I need to go back and look. CBD is tricky, because the CBD kind of creams-I think there just needs to be more research on it. When I looked the last time there weren’t a lot of good-you need these sham studies where you have a fake cream versus the actual CBD cream, because what ends up happening on a lot of those studies, a lot of the things we think really are have high efficacy and really work, when they do it against a sham, a lot of times it’s no different. So it points to like how powerful people’s beliefs are. Not to say that CBD may totally have a mechanism that’s there. I just, I haven’t dug into that research recently. And I haven’t seen it shared.

Natalie 47:06
Yeah. I would say dig into it again because it-there’s been a lot more in recent years, that’s coming out and even aside from creams, just internally daily doses of CBD and CBD being one comp, one cannabinoid of 1000s, they’re discovering within the hemp plant, like literally 1000s. And they’re starting to figure out what each of these do. I mean, the most commonly known ones are THC and CBD, obviously, but those are just two cannabinoids. Yeah,

Tom Walters 47:30
Yeah, I believe it.

Natalie 47:31
It’s wild.

Tom Walters 47:32
Huberman-talking about Huberman again…

Natalie 47:34
Here we go!

Tom Walters 47:35
Yeah, he had Dr. Sean Mackey on who’s the I think he’s the director of the pain medicine center at Stanford.

Derek 47:41
Yeah.

Tom Walters 47:43
And that was a great podcast. And he really dug into a lot of those pathways. And I think he did talk about some of that stuff in there. And I need to go back and look at it because the number of CBD companies that reach out to me about it, and I usually just kind of blow it off. And I’m so focused on movement and exercise and education around pain. But I think if you get all those things dialed in, I’m totally open to people adding those, to me, they’re complementary things like, it’s like sauna, and cold therapy. Like all this other stuff you can do, it’s like, that wouldn’t be your primary intervention, I don’t think but it would be like a complementary thing that can really help there’s some PRP and stem cell are like that, too. Like, if you want to add those in and just see if they help?

Derek 48:24
One thing that I wanted to actually ask a question about, did you talk about in all these alternative therapies that you talked about specifically as peptides? Right. So, so peptides, it’s a very interesting field to be in, right. So at Invigor Medical, we offer prescriptions for peptides that, you know, and, you know, there’s a lot of really popular peptides nowadays, like semaglutide. You know, wegovy, ozempic, those are both peptides. You know, insulin is a peptide that’s used for treatment, and it’s been used for treatment of diabetes for decades now. And so, you know, there are some cases for peptides. But one of the things that you talked about in your book is you have to be really careful where you source these peptides from, because they can be like, just like, really patent? Yeah. I don’t know if you want to touch on that just a little bit.

Tom Walters 49:09
Yeah, I do. I mean, I think that’s one of those areas. That just we didn’t go into extreme depth on that topic. Obviously, I’m not an expert in it, I think there’s just, you know, there needs to be a lot more research done on it. But I just think that’s one of those areas where there really could be, there could be some things that come out of that, that really change the way we think about the treatment of pain and but I think people just have to go into it, knowing that it’s kind of in the early stages of research and development. And I think you know, the protocols of these different things where the source you’re getting it from, you just have to be as think you have to be pretty skeptical and really do your homework going into something like that.

Derek 49:51
For sure.

Tom Walters 49:51
I mean, that’s true for a lot of these other interventions that we talk about a lot. PRP and stem cell are like that. It’s you can find studies that support it, you can find studies that don’t support it. And I think it’s just most of the people I talk to in these areas just basically say there isn’t enough research, where the protocols for how it’s developed have been and studied enough to determine this is exactly like the formula that we should use for this thing. And I think, so maybe they work, maybe they don’t. But I think the first place that sounds like talking to people who are in those spaces is that we have to figure out what the formula is that’s has the highest efficacy first,

Derek 50:29
And go from there. You know, and to touch on that as well. So part of the reason I bring this up, is you go and you look up peptide sources online. And, like, there are literally people who are purchasing peptides from websites from-they are called research chemicals, and on them say, Do not inject this into your body, it is a research chemical, and they are buying it and say like- I’ve seen Facebook threads that are just like make me speechless, where it’s just like, My subject is doing XY and Z. And it’s like, they’re referring to themselves injecting this research chemical into their bodies, and it’s just like, absolutely mind blowing to me.

Tom Walters 51:03
That’s pretty freaky.

Derek 51:03
Well and it like-there are you know, it is an expanding field. And so people just don’t know where to look. But there are places like Invigor medical, where like, you can get a legitimate prescription, you can actually like talk to a doctor and say, okay, yeah, this you can do. These are approved for these uses and like, actually walk you through the process. So.

Tom Walters 51:23
Yeah. What do you guys prescribe it for? Is it for pain and injury? Is it lots of different…

Derek 51:29
So we don’t actually prescribe for pain and injury, but I mean, the-what are the peptides we carry? We carry quite a few. So PT-141 is actually namebrand Vyleesi, but it’s bremelanotide. It’s for postmenopausal women that have lower libido. So it’s something that increases libido, we have Semorelin, which helps, it’s a secretagogue which induces natural production of HGH in the body. And, you know, obviously HGH is illegal. But there’s a host of benefits that came from that. And so there’s a lot of different peptides and then semaglutide is a GLP1 glucagon like peptide that helps people lose weight.

Tom Walters 51:29
Yeah.

Derek 51:29
So, you know, there’s a lot of peptides that do have a lot of evidence behind them. And then there’s other ones that that don’t have as much and so you know, you have ones like BPC-157, that the FDA has actually come out against and said like, Hey, don’t carry this. And then you see these places that are like selling it, and are like having a front and center. And it’s just yeah, it’s absolutely crazy.

Tom Walters 52:31
Yeah, that chapter, you know, actually, that chapter in the book. I think when we do future editions, it’s the one that will change the most, because it’s all these alternative kind of interventions, and a lot of them are newer, and I just think there’s going to be so much more evidence. A lot of the pain and injury stuff around education on pain and Exercise and Movement and sleep, a lot of these things are more established. I think that chapter, every time we do a new edition is where I’m at to spend most of the time it’s where I-it’s really probably where the most surprises came as I was going through the research just because things are changing there all the time for sure. Yeah, even listening to you talk about peptides. I’m like, wow, I need to go learn more about peptides.

Natalie 53:08
Yeah right! And CBD. Add CBD and peptides to the list.

Natalie 53:12
Oh, my gosh, we could go on and on, we literally will have to have you back on the podcast. This has been such a fun conversation and so illuminating. And I feel really confident that our listeners are going to latch on to all of the content here. There’s just so much to learn. And definitely recommend picking up if you’re physically active at all, or you let me get it in the camera frame or you have injury or you just want to know how to take better care of your body and to heal and overcome pain and injury. This is like it feels like the encyclopedia and there’s just so much incredible information here. And by the way, thank you for writing this book because lots of people don’t have access to PTs or they live in pain and and fear and like going and figuring it out is actually something that they resist because they’re afraid it’s going to be bad news. And I believe that knowledge is power and you writing this book is an incredible step in people taking control over their own health and well being. So thank you for that. Thank you for taking the time to talk with us. And where can people find you and your book?

Tom Walters 54:07
Well, thank you for saying all that. Thank you for having me on so much of the mission with the book and all the social media stuff was to because you’re right there are so many people out there who can’t afford care don’t have access. Even if you live in an area with good care centers. There’s right now eight week to 12 week weights and there’s just so much people can do on their own. So yeah, I mean, if people are looking for more of this type of content, I’m just @rehabscience on YouTube and Instagram. And the book is called Rehab Science: How to Overcome Pain and Heal From Injury. So pretty much rehab science everywhere people. I try to respond to comments on YouTube and DMS on Instagram. So if people have questions, they listen to this and they’re looking for a link or something they can always DM me, so.

Natalie 54:46
We’re just so excited that you took the time to be with us today. I’m really excited for our listeners to gobble up this content. Anything you want to add here, Derek?

Derek 54:52
No, I mean, obviously I was gushing at the beginning. I’m gushing at the end. I’m absolutely a huge fan of the work that you’ve done.

Tom Walters 54:58
Thank you.

Derek 54:59
And I think you’re very honored that you joined us. And I had the opportunity to, that we had the opportunity to talk with you. So thank you so much for joing us.

Tom Walters 55:04
Thank you guys. Thanks so much. I appreciate you guys. Thanks for letting me come on and talk about this and about the book. I really am so passionate about helping people understand pain and injury. There’s so much we can do to navigate these things on our own. And so I just, thanks for the opportunity to talk about it.

Natalie 55:19
Yeah. Absolutely. Thanks so much.

Derek 55:21
Thanks for tuning in to the Invigor Medical Podcast.

Natalie 55:24
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Derek 55:27
Your feedback matters. So feel free to share questions for future episode ideas in the comment section.

Natalie 55:32
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Podcast Guests

Dr. Tom Walters
DPT, OCS

Podcast Guests

Derek Berkey
Host
Natalie Garland
Host
5226 Outlet Dr, Paso, WA 99301
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