1 00:00:00,000 --> 00:00:03,100 Hi, I'm hypermobile. And if you're listening to this, 2 00:00:03,100 --> 00:00:19,800 I'm guessing you might be too. Hello, my name is Alex and 3 00:00:19,800 --> 00:00:23,100 welcome to help Ryan. Hypermobile we're gonna have to 4 00:00:23,100 --> 00:00:27,500 sit for and today we're talking all about exercise, and I don't 5 00:00:27,500 --> 00:00:30,100 know if you can hear the enthusiasm in my voice but 6 00:00:30,100 --> 00:00:33,300 exercise is one of my favorite topics. 7 00:00:33,800 --> 00:00:38,200 It's one way which if it's safe for patients to to do exercise 8 00:00:38,600 --> 00:00:41,100 we can help support hypermobile people and having really 9 00:00:41,100 --> 00:00:44,900 profound jizz in their health. Now again I want to stress every 10 00:00:44,900 --> 00:00:46,700 hypermobile individual is different. 11 00:00:46,700 --> 00:00:49,600 It's not exercise is not possible or even safe for every 12 00:00:49,600 --> 00:00:52,100 hypermobile patient. And this is why I as always, 13 00:00:52,100 --> 00:00:55,100 it's so important that you speak with your qualified and trusted 14 00:00:55,100 --> 00:00:57,600 health care, provider to make sure that you are doing what is 15 00:00:57,600 --> 00:01:01,400 safe and correct for you. Now, before we get any go any 16 00:01:01,400 --> 00:01:05,900 further, I do want to give a little shout out to somebody 17 00:01:05,900 --> 00:01:07,600 took the time to send some feedback in. 18 00:01:07,600 --> 00:01:11,200 I actually received a lot of feedback from the first three 19 00:01:11,200 --> 00:01:13,800 episodes it was The response was overwhelming quite frankly. 20 00:01:14,100 --> 00:01:16,200 Thank you to everyone who's taking the time to subscribe. 21 00:01:16,200 --> 00:01:21,300 Download like share, follow or right in and Vicki. 22 00:01:21,600 --> 00:01:24,900 Thank you so much for taking the time to say to leave. 23 00:01:24,900 --> 00:01:27,900 This comment Vicki said, I'm leaving a 10 star review here 24 00:01:27,900 --> 00:01:29,600 because I couldn't find the review bit. 25 00:01:29,800 --> 00:01:32,700 I think we can only have five stars on Spotify but I'll take 26 00:01:32,700 --> 00:01:34,300 ten. Thank you so much Vicki. 27 00:01:34,700 --> 00:01:37,700 Brilliant information. I used this in a recent medical 28 00:01:37,700 --> 00:01:39,600 consultation and it couldn't have helped me more. 29 00:01:39,700 --> 00:01:42,700 Follow the advice Vicki I'm so So happy you found this 30 00:01:42,700 --> 00:01:44,200 information helpful except what I'm trying to do. 31 00:01:44,200 --> 00:01:47,200 I'm trying to make some or just provide everything I wish 32 00:01:47,200 --> 00:01:49,700 hypermobile people knew about a bunch of different topics. 33 00:01:49,700 --> 00:01:53,700 So I'm so happy that you actually found it useful. 34 00:01:53,800 --> 00:01:56,200 In today's episode, we're going to talk about a few different 35 00:01:56,200 --> 00:01:57,300 things when it comes to exercise. 36 00:01:57,300 --> 00:02:00,900 So firstly we're going to talk about exercise just in general 37 00:02:00,900 --> 00:02:02,600 why it's important. You already know it's important 38 00:02:02,600 --> 00:02:04,200 so we won't spend too much time on that. 39 00:02:04,300 --> 00:02:06,900 We're going to talk a little bit about my personal journey and 40 00:02:06,900 --> 00:02:10,800 the role that exercise has played in terms of my body and 41 00:02:10,800 --> 00:02:14,400 how I'm able to live my life. Then go on to talk about eight 42 00:02:14,500 --> 00:02:17,000 things that you need. Your healthcare provider to be 43 00:02:17,000 --> 00:02:19,300 thinking about when they're working with you, to help you 44 00:02:19,300 --> 00:02:22,600 develop an exercise strategy for your unique body. 45 00:02:22,600 --> 00:02:24,500 So these are 8 really, really key points. 46 00:02:24,500 --> 00:02:27,400 I can't wait to get into them and finally, we're going to be 47 00:02:27,408 --> 00:02:30,200 talking a little bit about how to tell the difference between 48 00:02:30,200 --> 00:02:34,400 the pain of re-injury and the pain. 49 00:02:34,400 --> 00:02:36,800 And I said that in quotation marks because it's not shouldn't 50 00:02:36,800 --> 00:02:39,900 really be pain of healthy muscular fatigue, and these are 51 00:02:39,900 --> 00:02:43,900 two entirely different things. And it took me decades to figure 52 00:02:43,900 --> 00:02:45,700 that out so I hope I can help you figure out. 53 00:02:45,700 --> 00:02:50,100 I figured out a bit faster than I did exercise is important. 54 00:02:50,200 --> 00:02:52,800 If exercise was a pill, everyone would take it. 55 00:02:52,800 --> 00:02:56,500 The benefits are undeniable. In fact, if you are in the 56 00:02:56,500 --> 00:02:59,600 strongest, third of the population at midlife, you are 57 00:02:59,600 --> 00:03:02,700 two and a half times more likely to live to 100. 58 00:03:03,100 --> 00:03:05,900 And I like this statistic and you can look in the show notes 59 00:03:05,900 --> 00:03:08,200 for all the research that I'll mention in today's episode. 60 00:03:08,700 --> 00:03:11,600 But I like the statistic because it highlights the fact that 61 00:03:11,600 --> 00:03:14,000 firstly Your size does good things for you, which we know it 62 00:03:14,000 --> 00:03:16,200 does. But secondly, you don't have to 63 00:03:16,200 --> 00:03:19,500 be that Olympic gold medalist. You don't need to be in the top 64 00:03:19,500 --> 00:03:22,200 1% of people to get the benefits of exercise. 65 00:03:22,600 --> 00:03:27,500 You just need to be in the top third and that's something which 66 00:03:27,500 --> 00:03:29,700 although, it's probably it's not going to be achievable for 67 00:03:29,700 --> 00:03:31,400 everyone. If it's achievable for you, 68 00:03:31,400 --> 00:03:33,800 that's a great goal to work toward okay. 69 00:03:34,600 --> 00:03:38,300 Now here, I'm referencing Professor, Keith bar, and he'll, 70 00:03:38,300 --> 00:03:40,300 he says, we do strength exercise. 71 00:03:40,300 --> 00:03:42,700 So we can have a long and happy. Happy life. 72 00:03:43,000 --> 00:03:45,600 And we do strength exercise in particular because it improves 73 00:03:45,600 --> 00:03:48,500 longevity and the ability to do things. 74 00:03:49,000 --> 00:03:52,100 So if you are strong, you are going to be able to go up and 75 00:03:52,100 --> 00:03:54,600 down stairs, you're going to be able to lift objects. 76 00:03:54,600 --> 00:03:57,200 And this is literally you interacting with the world 77 00:03:57,200 --> 00:04:00,900 around you physically. And for people who have never 78 00:04:00,900 --> 00:04:05,300 had issues doing this, you don't appreciate how amazing it is 79 00:04:05,300 --> 00:04:07,700 just to be able to interact with the world around you, until you 80 00:04:07,700 --> 00:04:10,500 lose that ability. It's something that I think so 81 00:04:10,500 --> 00:04:14,600 many people take for granted. And exercise is one way that you 82 00:04:14,600 --> 00:04:17,700 can try again, if it's possible for you to protect or even 83 00:04:17,700 --> 00:04:21,600 improve your ability to do that. Now Professor Keith Bar, goes on 84 00:04:21,600 --> 00:04:25,000 to say that we do endurance exercise because it feeds the 85 00:04:25,000 --> 00:04:28,200 brain and as someone who's talking from a hyper mobile 86 00:04:28,200 --> 00:04:30,100 perspective, I am hyper about myself. 87 00:04:30,100 --> 00:04:32,200 But also in the UK registered osteopath and I work with 88 00:04:32,200 --> 00:04:35,400 hypermobile patients, I want you to think of exercise is also 89 00:04:35,400 --> 00:04:38,400 feeding the body. So with conditions involving 90 00:04:38,400 --> 00:04:39,800 high permeability. For example, high quality 91 00:04:39,800 --> 00:04:41,800 Spectrum, Disorder or hypernova. At least I know syndrome. 92 00:04:42,000 --> 00:04:46,900 We see a lot of dysautonomia and this means altered function of 93 00:04:46,900 --> 00:04:50,400 something called the autonomic nervous system and the autonomic 94 00:04:50,400 --> 00:04:52,500 nervous system in really simple terms. 95 00:04:52,500 --> 00:04:55,900 You can think of it as the part of your nervous system that does 96 00:04:55,900 --> 00:04:57,500 all the stuff. You don't have to think about. 97 00:04:57,500 --> 00:05:00,100 So I'm breathing right now and I'm not having to think. 98 00:05:00,200 --> 00:05:04,100 Inhale exhale it's my body's just doing that thank goodness. 99 00:05:04,600 --> 00:05:07,600 And it does things like digest your food, for example. 100 00:05:08,300 --> 00:05:10,000 So autonomic nervous system does a lot of things. 101 00:05:10,300 --> 00:05:14,600 Autonomic nervous system also Is in charge of how your body gets 102 00:05:14,700 --> 00:05:18,300 in nutrition and oxygen and other things to the bits of 103 00:05:18,300 --> 00:05:21,800 tissue and you that require it. And one system that really 104 00:05:21,800 --> 00:05:26,500 requires a lot of oxygenated and nutrient-rich blood is your 105 00:05:26,500 --> 00:05:29,400 musculoskeletal system. And if you're hypermobile person 106 00:05:29,400 --> 00:05:32,700 a good example of dysautonomia might be that youth have really 107 00:05:32,700 --> 00:05:35,200 cold fingers and toes. Even when it doesn't make sense, 108 00:05:35,200 --> 00:05:37,400 that's your autonomic nervous system, likely being a little 109 00:05:37,400 --> 00:05:40,400 bit weird, as always, if you're concerned, go see your doctor 110 00:05:40,500 --> 00:05:44,300 but we see See that people who are hypermobile have altered 111 00:05:44,300 --> 00:05:49,500 delivery and altered like flow of nutrients of nutrition of 112 00:05:49,500 --> 00:05:50,700 blood. Sometimes a fun product food, 113 00:05:50,700 --> 00:05:54,900 Etc, around their body and exercise in particular endurance 114 00:05:54,900 --> 00:05:57,600 exercise or aerobic cardiovascular exercise. 115 00:05:57,600 --> 00:06:00,900 So that type of kind of lower intensity exercise done for a 116 00:06:00,900 --> 00:06:04,400 slightly longer period of time. That's a way that you can get 117 00:06:04,400 --> 00:06:07,400 your cardiovascular system working a little bit to try and 118 00:06:07,400 --> 00:06:09,300 deliver nutrition to those tissues. 119 00:06:09,800 --> 00:06:14,200 Now as we age and this is For everyone, it becomes harder to 120 00:06:14,200 --> 00:06:17,600 maintain muscle mass. So your musculoskeletal system 121 00:06:17,600 --> 00:06:21,500 is in some ways, a luxury, if my body's trying to protect me in 122 00:06:21,500 --> 00:06:23,200 the present moment and the analogy. 123 00:06:23,200 --> 00:06:26,000 I like to use here is thinking of the body as a bioeconomy. 124 00:06:26,000 --> 00:06:29,000 And if we're trying to protect Alex, we're going to prioritize 125 00:06:29,000 --> 00:06:31,400 my brain, my heart, and my respiratory system, because I 126 00:06:31,400 --> 00:06:33,600 will die very quickly. If those are not functioning 127 00:06:33,900 --> 00:06:36,500 things, like my hair, and my nails, and my muscles and 128 00:06:36,500 --> 00:06:39,500 Joints, those come a lot further down the list. 129 00:06:39,900 --> 00:06:43,100 So, as we age some of, Our processes, especially those 130 00:06:43,100 --> 00:06:46,300 involving metabolism, which is how we kind of, we get things 131 00:06:46,300 --> 00:06:49,600 actually into our body. Those processes become less 132 00:06:49,600 --> 00:06:53,500 efficient and they start to work differently or not work at all 133 00:06:53,500 --> 00:06:55,900 sometimes. And that's why we start to see a 134 00:06:55,900 --> 00:07:00,000 decline in tissue quality, in people's, for example, bones. 135 00:07:00,000 --> 00:07:02,300 You'll hear of a lot of people as age, starting to get 136 00:07:02,300 --> 00:07:04,900 osteoporotic or have osteopenia. They're having changes in the 137 00:07:04,900 --> 00:07:07,700 quality of their bones. We see the same thing and muscle 138 00:07:07,700 --> 00:07:11,600 and connective tissue. We see a decline in quality and 139 00:07:11,600 --> 00:07:15,200 one That we can try and counter that decline in quality. 140 00:07:15,200 --> 00:07:19,200 Is we can say that we can use movement to stress the tissues 141 00:07:19,200 --> 00:07:22,100 physically and support the idea that we need those tissues. 142 00:07:22,100 --> 00:07:25,500 When you're exercising, you're saying actually, I know I'm 80 143 00:07:25,500 --> 00:07:27,600 but I need to be able to go up and down stairs. 144 00:07:27,600 --> 00:07:30,900 All right, I know I'm 35, but I need to be able to pick my 145 00:07:30,900 --> 00:07:35,400 toddler up because they need me to help to raise lawmen to do 146 00:07:35,400 --> 00:07:38,100 things with them. So by using a stamp out, an 147 00:07:38,100 --> 00:07:41,500 appropriate stimulus of some kind, we can try and counteract 148 00:07:41,500 --> 00:07:45,100 this Decline. Now, people who have issues with 149 00:07:45,100 --> 00:07:47,800 collagen and other aspects of their connective tissue, there 150 00:07:47,800 --> 00:07:50,600 had a huge disadvantage here because from the moment, they 151 00:07:50,600 --> 00:07:53,100 were born. They've had issues with the 152 00:07:53,100 --> 00:07:56,000 function of that system. So at a disadvantage, however, 153 00:07:56,400 --> 00:08:00,600 in some cases and for some patients, we can use exercise to 154 00:08:00,600 --> 00:08:05,300 try and address some of those those changes there and to try 155 00:08:05,300 --> 00:08:07,300 and prevent these negative changes long-term. 156 00:08:08,000 --> 00:08:12,300 Additionally, for hypermobile patients, one big benefit It of 157 00:08:12,300 --> 00:08:15,600 doing strength training is that for some patients, they can 158 00:08:15,600 --> 00:08:18,400 actually in a way build their own braces if they get enough 159 00:08:18,400 --> 00:08:20,800 muscle mass. So, because I started my career 160 00:08:20,800 --> 00:08:23,100 working in sports and now I recommend me with hypermobile 161 00:08:23,100 --> 00:08:26,200 patients. We do see these, these muscley, 162 00:08:26,300 --> 00:08:29,600 hypermobile patients, and these are these will be people who 163 00:08:29,800 --> 00:08:31,500 generally just through sheer luck. 164 00:08:31,500 --> 00:08:34,299 Managed to find a way of exercising that works for them 165 00:08:34,299 --> 00:08:36,700 and they've been able to maintain some muscle mass and 166 00:08:36,700 --> 00:08:40,200 that muscle mass helps their joints to feel stable. 167 00:08:40,299 --> 00:08:43,100 It helps to prevent some of the if the injury that happened as a 168 00:08:43,100 --> 00:08:45,800 consequence of that instability due to the high permeability 169 00:08:46,000 --> 00:08:47,900 that other hypermobile patients struggle with. 170 00:08:47,900 --> 00:08:50,700 So if it's possible for a patient to build muscle mass, 171 00:08:51,000 --> 00:08:53,400 they need to be supported in that in every way. 172 00:08:53,400 --> 00:08:56,500 Because this is a way that we really establish a positive and 173 00:08:56,500 --> 00:08:59,300 hugely beneficial tissue change. And although it's not possible 174 00:08:59,300 --> 00:09:02,700 for everyone, for those patients who it's possible for, we need 175 00:09:02,700 --> 00:09:04,500 to make sure that they're getting that really good 176 00:09:04,500 --> 00:09:06,500 clinical outcome because it is life-changing. 177 00:09:06,500 --> 00:09:09,500 Long-term. Now, before we go any further, I 178 00:09:09,500 --> 00:09:13,000 do want to mention again. There will be some people 94 and 179 00:09:13,000 --> 00:09:14,600 not possible for. And if you want other people 180 00:09:14,600 --> 00:09:15,900 listening to this, I want to tell you. 181 00:09:15,900 --> 00:09:18,700 That's okay. We will talk in future episodes 182 00:09:18,700 --> 00:09:21,500 about what can be done in your situation and looking at ways of 183 00:09:21,500 --> 00:09:23,900 improving quality of life and protecting function. 184 00:09:24,200 --> 00:09:27,100 But this episode today is particularly targeted at the 185 00:09:27,100 --> 00:09:29,600 people who've been told it's safe for them to exercise and 186 00:09:29,600 --> 00:09:32,100 they just they're hitting a wall and they're not sure what to do 187 00:09:32,100 --> 00:09:35,600 and they're not making progress. So, speaking of hitting walls, 188 00:09:35,600 --> 00:09:37,400 let's, uh, let's talk about my journey. 189 00:09:38,100 --> 00:09:41,300 So I started as a swimmer growing up because we were told 190 00:09:41,300 --> 00:09:42,800 that. So mean Was like the safest and 191 00:09:42,800 --> 00:09:46,600 best thing I could do. So I was swimming and I started 192 00:09:46,600 --> 00:09:49,800 to have shoulder pain like a lot of swimmers and that shoulder 193 00:09:49,800 --> 00:09:53,000 pain led to chronic neck pain as someone who was I was in my 194 00:09:53,000 --> 00:09:56,100 early teens when I was having those symptoms I was maybe 13, 195 00:09:56,100 --> 00:09:59,600 maybe even younger and chronic neck pain in children. 196 00:09:59,600 --> 00:10:02,100 We should not be normalizing that but anyways, I was told it 197 00:10:02,100 --> 00:10:04,100 was, you know, stop complaining. Stop being so sensitive 198 00:10:04,100 --> 00:10:06,000 etcetera. And he got worse and worse, and 199 00:10:06,000 --> 00:10:07,900 worse. And eventually I saw a 200 00:10:07,900 --> 00:10:11,000 physiotherapist when I was about 16 or so, and the 201 00:10:11,000 --> 00:10:13,000 physiotherapist ride. Tell me did some treatment. 202 00:10:13,000 --> 00:10:15,500 It didn't work, you know, people were not aware that my shoulders 203 00:10:15,500 --> 00:10:18,000 are really high from about the time the Physiotherapy and 204 00:10:18,000 --> 00:10:19,400 exercise. I was given and they made my 205 00:10:19,400 --> 00:10:21,000 shoulders feel worse, not better. 206 00:10:21,500 --> 00:10:24,900 So I was eventually told by the exasperated physiotherapist that 207 00:10:24,900 --> 00:10:27,500 my that I had simply worn my shoulders out. 208 00:10:27,500 --> 00:10:29,600 I will never forget those words. I was told I had worn my 209 00:10:29,600 --> 00:10:33,200 shoulders out and that I needed to just not raise my arm above 210 00:10:33,200 --> 00:10:35,200 90 degrees anymore because that was where I had pain. 211 00:10:35,200 --> 00:10:36,600 It's a really common presentation. 212 00:10:36,600 --> 00:10:39,800 Patients will have pain raising their arm above 90 degrees, and 213 00:10:39,800 --> 00:10:41,700 I was told just to stop doing that. 214 00:10:41,900 --> 00:10:45,000 So, at the age of 16, I quit. So I mean and I stopped raising 215 00:10:45,000 --> 00:10:48,200 my arms above 90 degrees. I didn't realize that this at 216 00:10:48,200 --> 00:10:50,700 the time. But that was a very, very 217 00:10:50,700 --> 00:10:54,200 problematic thing for me to do because I lost the muscle mass 218 00:10:54,200 --> 00:10:57,400 that I had, which wasn't that much to begin with and my joints 219 00:10:57,400 --> 00:11:02,100 became even more unstable. My low point was in my early 20s 220 00:11:02,100 --> 00:11:04,600 and it's I always thought 20 want to be the best year of my 221 00:11:04,600 --> 00:11:06,000 life. It was the absolute worst. 222 00:11:06,000 --> 00:11:07,800 So if you're someone you're early 20s and you're listening 223 00:11:07,800 --> 00:11:11,300 to this you couldn't pay me to be 21 again. 224 00:11:11,400 --> 00:11:15,800 It's But I was in, I was in my early 20s and the low point was 225 00:11:15,800 --> 00:11:19,200 going home from Christmas in the car with my family and going 226 00:11:19,200 --> 00:11:22,700 over speed bumps and literally trying not to cry as we went 227 00:11:22,700 --> 00:11:25,300 over a speed bump every time because of the agony in my 228 00:11:25,300 --> 00:11:28,500 shoulder, just from the, the Jocelyn motion of the car going 229 00:11:28,500 --> 00:11:31,000 over the speed bumps. So that was the low point for 230 00:11:31,000 --> 00:11:33,500 me. I also had headaches that had me 231 00:11:33,500 --> 00:11:36,000 in bed for days at a time. I would have a pillow over my 232 00:11:36,000 --> 00:11:39,400 face, and I would just lie in the dark, just hoping it would 233 00:11:39,400 --> 00:11:42,300 end and not sure when we're gif, It would. 234 00:11:42,300 --> 00:11:44,600 And that if you're someone who gets those headaches, they 235 00:11:44,600 --> 00:11:48,800 really really suck. Anyways, through some trial and 236 00:11:48,800 --> 00:11:50,900 error. My degree studying all these 237 00:11:50,900 --> 00:11:52,100 things. I talked a little bit in episode 238 00:11:52,100 --> 00:11:55,500 one about that, but I started to kind of try to figure out what I 239 00:11:55,508 --> 00:11:58,300 could do to improve my shoulder on my own because I was done 240 00:11:58,400 --> 00:11:59,800 with physiotherapy at that point. 241 00:11:59,800 --> 00:12:01,600 And I was, I was done with manual therapy in general. 242 00:12:02,400 --> 00:12:06,100 So, I went to the gym, I couldn't afford a personal 243 00:12:06,100 --> 00:12:08,500 trainer, I couldn't afford more treatment, to be honest, I was 244 00:12:08,500 --> 00:12:11,600 just on my own and I made these little programs and I was trying 245 00:12:11,600 --> 00:12:15,500 to find Is to move safely and not feel pain and do something. 246 00:12:15,500 --> 00:12:18,300 Because I felt like I wanted more muscle mass because I would 247 00:12:18,300 --> 00:12:21,400 make my shoulders feel more stable, and more safe, and 248 00:12:21,400 --> 00:12:24,000 eventually and very carefully over time. 249 00:12:24,100 --> 00:12:28,600 I managed to exercise without injury which that that's the 250 00:12:28,600 --> 00:12:30,700 trick here, right? So for all of you who've been 251 00:12:30,700 --> 00:12:33,900 told, oh yeah, just build muscle mass, there's nothing just about 252 00:12:33,900 --> 00:12:35,300 it. If you're a hypermobile person 253 00:12:35,300 --> 00:12:37,800 and you're at a high risk of injury and on top of that, 254 00:12:37,800 --> 00:12:39,700 you're not gonna be able to feel your body in space, probably 255 00:12:39,700 --> 00:12:41,000 that. Well, so it's really hard to 256 00:12:41,000 --> 00:12:42,900 move with good technique. Technique, especially if you're 257 00:12:42,900 --> 00:12:47,200 on your own, it's so hard to exercise and not get injured. 258 00:12:47,200 --> 00:12:50,900 Like it's hard for the average person to build muscle mass, let 259 00:12:50,900 --> 00:12:53,300 alone a hypermobile person. So if you've struggled with 260 00:12:53,300 --> 00:12:58,000 this, you're not alone in that, but I managed to achieve that 261 00:12:58,000 --> 00:13:02,700 magic combination of not getting injured and exercising and I 262 00:13:02,700 --> 00:13:04,300 built up some muscle mass over time. 263 00:13:04,300 --> 00:13:07,800 And the point where I felt better, the point where I felt 264 00:13:07,800 --> 00:13:10,300 like my life had changed and you know what it would have been 265 00:13:10,300 --> 00:13:11,700 okay? If I just stayed here forever. 266 00:13:11,900 --> 00:13:13,400 This is the point. I felt like I made a big 267 00:13:13,400 --> 00:13:17,400 Improvement was when I was able to run for 10 minutes without 268 00:13:17,400 --> 00:13:19,600 shoulder pain. I remember I was on the 269 00:13:19,600 --> 00:13:21,800 treadmill at a mall in West London. 270 00:13:21,900 --> 00:13:24,700 I remember looking down at the screen and watching it Go nine 271 00:13:24,700 --> 00:13:27,300 minutes, 46 seconds, nine minutes, 47 seconds. 272 00:13:27,300 --> 00:13:30,100 You know, getting into that nine minutes, 52 seconds and then 273 00:13:30,300 --> 00:13:33,000 nine minutes 59 seconds and 10 minutes. 274 00:13:33,000 --> 00:13:36,200 And I couldn't believe that I had run ten minutes without my 275 00:13:36,200 --> 00:13:38,800 shoulder hurting, because I was literally listening to my 276 00:13:38,800 --> 00:13:41,700 shoulders waiting for them to have that horrible horrible. 277 00:13:41,800 --> 00:13:45,100 In Spain, they would have and they didn't hurt and I couldn't 278 00:13:45,100 --> 00:13:47,400 believe it. And actually I didn't Instagram 279 00:13:47,400 --> 00:13:51,200 post that day talking about how thrilled I was because that was 280 00:13:51,200 --> 00:13:53,300 a life-changing Improvement for me. 281 00:13:54,100 --> 00:13:56,800 Now, if you've looked any of the other content online you'll know 282 00:13:56,800 --> 00:13:59,200 I've gone to a lot more sporty things. 283 00:13:59,400 --> 00:14:02,000 Some of them have different degrees of risk and that is risk 284 00:14:02,000 --> 00:14:05,900 that I've chosen to take on because I decided it was safe 285 00:14:05,900 --> 00:14:07,800 for me. And I've gone on to do things 286 00:14:07,800 --> 00:14:10,300 like for example, developer really heavy snatch, so that's 287 00:14:10,300 --> 00:14:11,600 the type of Olympic weightlifting move. 288 00:14:11,800 --> 00:14:14,700 Where you left the bar overhead. And I got up to 52 and a half 289 00:14:14,700 --> 00:14:17,800 kilograms, which is, I think it's around like 115 pounds, 290 00:14:18,300 --> 00:14:21,400 which is huge. Like, I have a video of doing 291 00:14:21,400 --> 00:14:23,400 that lift and it's probably one of the happiest moments of my 292 00:14:23,400 --> 00:14:25,700 life because I never thought that would be possible for me. 293 00:14:26,200 --> 00:14:29,000 And I've gone on to do things like for example, long-endurance 294 00:14:29,900 --> 00:14:33,000 pieces like a half marathon row on a rowing machine. 295 00:14:33,000 --> 00:14:35,100 Holding a pretty fast pace on that too. 296 00:14:35,600 --> 00:14:38,800 So because I love sports and because my body lets me I have 297 00:14:38,800 --> 00:14:42,500 gone on to do a bit of an overcorrection and What I want 298 00:14:42,500 --> 00:14:46,100 to say to anyone out there is if you're someone who wants to, you 299 00:14:46,100 --> 00:14:48,600 have those big dreams and you want to do the sporty things, 300 00:14:49,000 --> 00:14:51,700 keep them find a find a qualified healthcare provider 301 00:14:51,700 --> 00:14:53,600 who can help you talk in realistic terms but what's 302 00:14:53,600 --> 00:14:57,700 possible for you or what's not possible and find the the 303 00:14:57,700 --> 00:15:01,000 smallest steps. First you have to find those 304 00:15:01,000 --> 00:15:04,100 little steps along the way. So for me, step one was 305 00:15:04,100 --> 00:15:06,500 literally just being able to raise my arm overhead without 306 00:15:06,500 --> 00:15:10,300 shoulder pain. So you have to find the steps in 307 00:15:10,300 --> 00:15:12,900 your journey. I promised you get into some 308 00:15:12,900 --> 00:15:15,200 really useful information today and the first thing I want to 309 00:15:15,208 --> 00:15:18,600 get into is how I think about exercise. 310 00:15:18,600 --> 00:15:22,300 I actually called My Philosophy of exercise, I'm half Greek and 311 00:15:22,300 --> 00:15:23,900 I maybe I've always wanted to philosophy, I don't know. 312 00:15:23,900 --> 00:15:26,100 But this is how this is my mental framework of how I think 313 00:15:26,100 --> 00:15:30,000 about exercise or My Philosophy. So there are three reasons why 314 00:15:30,000 --> 00:15:34,100 people exercise people exercise, either to look a certain way. 315 00:15:34,200 --> 00:15:37,700 So they exercise for Aesthetics, they exercise for the body to be 316 00:15:37,700 --> 00:15:40,800 able to do certain things. So it's exercising for fitness 317 00:15:41,400 --> 00:15:44,600 and And there's that third reason, which is exercising for 318 00:15:44,600 --> 00:15:47,000 tissue Health. They want their body to feel a 319 00:15:47,000 --> 00:15:50,000 certain way and most of the patients that I'm working with 320 00:15:50,000 --> 00:15:52,900 these days, they are patients who are looking to exercise for 321 00:15:52,900 --> 00:15:56,600 tissue Health. Now, if we look in that category 322 00:15:56,600 --> 00:15:59,400 in particular, there are three ways that people can exercise 323 00:15:59,400 --> 00:16:02,300 for tissue Health. You can do strength training, 324 00:16:02,300 --> 00:16:04,700 and of course, within each of these broad categories or 325 00:16:04,700 --> 00:16:06,300 subcategories. So, for strength training, you 326 00:16:06,300 --> 00:16:09,100 can do free weights, you can do resistance training, etcetera, 327 00:16:09,400 --> 00:16:11,600 you can do balance or proprioceptive training. 328 00:16:11,900 --> 00:16:13,500 And there are, of course, different ways of doing that. 329 00:16:13,800 --> 00:16:16,600 Or you can do cardiovascular training and there are kind of 330 00:16:16,600 --> 00:16:19,900 two main ways you can do that. You can do an anaerobic 331 00:16:20,200 --> 00:16:22,000 cardiovascular program, where you're kind of doing those 332 00:16:22,200 --> 00:16:25,200 Sprint pieces, you're out of breath, it's short, it's intense 333 00:16:25,700 --> 00:16:28,300 or you can do more aerobic style training where your heart is 334 00:16:28,300 --> 00:16:30,900 going to be a little bit lower it slightly longer sessions. 335 00:16:31,100 --> 00:16:33,200 I like to think of it like different gears in a car. 336 00:16:33,300 --> 00:16:34,500 So it is working in a different gear. 337 00:16:34,500 --> 00:16:36,600 That's all it is but it's still affecting your cardiovascular 338 00:16:36,600 --> 00:16:39,000 system. Now, this standard advice 339 00:16:39,000 --> 00:16:42,200 typically What hypermobile patients are told is that That 340 00:16:42,200 --> 00:16:44,900 they have to firstly. Safety is important, which it 341 00:16:44,900 --> 00:16:46,300 is. You have to do it safe for you? 342 00:16:46,300 --> 00:16:48,800 I'm not saying it's not but they're told that they have to 343 00:16:48,800 --> 00:16:50,700 do certain things. So they'll be told oh, you can 344 00:16:50,800 --> 00:16:53,300 you have to do resistance training only? 345 00:16:53,600 --> 00:16:55,400 And I've always found that recommendation, really weird 346 00:16:55,400 --> 00:16:57,900 because the world is made of free weights. 347 00:16:58,200 --> 00:17:00,700 So although there's nothing wrong with their bands. 348 00:17:01,000 --> 00:17:04,700 I think that any program needs to whenever possible support the 349 00:17:04,700 --> 00:17:08,500 patient in being able to safely navigate free weights, because 350 00:17:08,500 --> 00:17:10,300 that's what the world is made of a coffee. 351 00:17:10,300 --> 00:17:13,099 Weight is a free weight. Phone is free weight. 352 00:17:13,099 --> 00:17:16,099 So that's my brief thought on strike 3 will have a separate 353 00:17:16,099 --> 00:17:18,200 episode on all of these different types of exercise, but 354 00:17:18,200 --> 00:17:21,800 that's my quick little thought there when it comes to, you 355 00:17:21,800 --> 00:17:23,099 know, bounce proprioceptive training. 356 00:17:23,099 --> 00:17:27,300 Again, that is hugely valuable. I like to think of it as you're 357 00:17:27,300 --> 00:17:30,800 making the, you're making the race car driver, better able to 358 00:17:30,800 --> 00:17:33,200 drive the car. So if the hyperbole body is not 359 00:17:33,200 --> 00:17:36,500 the best car, it's not working. So well maybe those ankles are 360 00:17:36,500 --> 00:17:39,400 rolling all the time, it might make sense to start with balance 361 00:17:39,400 --> 00:17:41,600 and proprioceptive training because you're working. 362 00:17:41,700 --> 00:17:45,100 With that person to make them a better driver of their body. 363 00:17:45,100 --> 00:17:47,500 So even if the the ligaments have been injured and they're 364 00:17:47,500 --> 00:17:49,500 not behaving the same way and we have some hyper building the 365 00:17:49,500 --> 00:17:51,300 ankle. If you can make that person 366 00:17:51,300 --> 00:17:54,800 better able to balance on that on that tissue on that joint and 367 00:17:54,800 --> 00:17:58,300 to avoid those ankle sprains, then you're going to prevent 368 00:17:58,300 --> 00:17:59,700 injury. So sometimes balance and 369 00:17:59,700 --> 00:18:02,000 proprioceptive training is the right place to start. 370 00:18:02,200 --> 00:18:05,400 However, I tend to have my patients, start whenever 371 00:18:05,400 --> 00:18:09,200 possible and safe on something called a low-intensity steady 372 00:18:09,200 --> 00:18:11,600 state training program for my patients with an athletic 373 00:18:11,600 --> 00:18:13,300 background. And it may be a steady state 374 00:18:13,300 --> 00:18:15,800 training program, but typically it's going to be a low-intensity 375 00:18:15,800 --> 00:18:19,900 steady state training program. And I do this simply because it 376 00:18:19,900 --> 00:18:23,400 gets them feeling better. Faster, we're getting some as we 377 00:18:23,400 --> 00:18:26,100 talked about at the start of the episode about those dysautonomia 378 00:18:26,100 --> 00:18:28,100 issued, so way you can address some of those. 379 00:18:28,100 --> 00:18:30,300 So you're getting some blood flow, to those tissues, you're 380 00:18:30,300 --> 00:18:32,900 getting some endorphins and for patients who are stressed about 381 00:18:32,900 --> 00:18:35,500 going to the gym, it can be nice sometimes to not have to worry 382 00:18:35,500 --> 00:18:38,400 about doing all these different movements using these different 383 00:18:38,400 --> 00:18:39,600 weights or finding these machines. 384 00:18:39,600 --> 00:18:41,600 It's a way that I can almost control. 385 00:18:41,700 --> 00:18:44,800 Variables more precisely. Even for example, if you're 386 00:18:44,800 --> 00:18:47,300 doing a strength program with the patient and they're having 387 00:18:47,300 --> 00:18:51,300 to jump from a 6 kilo dumbbell to an a kilo, that's a huge 388 00:18:51,300 --> 00:18:52,900 jump. Whereas, if you're doing a 389 00:18:52,900 --> 00:18:56,300 steady-state style program or something that's, you know, 390 00:18:56,300 --> 00:18:59,400 reusing a Time domain, you can be a lot more precise in how you 391 00:18:59,400 --> 00:19:01,000 scale it. You can say, Okay, instead of 392 00:19:01,000 --> 00:19:03,400 doing three rounds of three minutes, we're going to do three 393 00:19:03,400 --> 00:19:05,300 rounds of three minutes and 10 seconds. 394 00:19:05,300 --> 00:19:08,100 So it gives you a much smaller increments you can work with but 395 00:19:08,100 --> 00:19:10,500 again I want to stress at the end of the day it comes down to 396 00:19:10,500 --> 00:19:12,000 the individual patient. Patients. 397 00:19:12,000 --> 00:19:13,600 Who see me? We start with strength training, 398 00:19:13,800 --> 00:19:16,000 I've patients who see me and we start bouncing preceptor 399 00:19:16,000 --> 00:19:19,700 training and this leads into the 8 things. 400 00:19:19,700 --> 00:19:22,100 You must make sure your healthcare provider is 401 00:19:22,100 --> 00:19:24,500 considering when they're making an exercise program for you. 402 00:19:25,000 --> 00:19:28,100 The first thing, it's a tie for first. 403 00:19:28,400 --> 00:19:30,800 So you've heard me say safety a million times in this episode, 404 00:19:30,800 --> 00:19:33,800 safety is important. We don't want people having bad 405 00:19:33,800 --> 00:19:35,700 things happen to them when they're exercising and stop. 406 00:19:35,700 --> 00:19:38,000 His diaper will people time. So I guess we'll put safety at 407 00:19:38,000 --> 00:19:40,300 number one, but coming in very, very close. 408 00:19:40,300 --> 00:19:43,200 At number two, is Stability. And I'm talking about 409 00:19:43,200 --> 00:19:47,100 accessibility in terms of money. So for example, say that 410 00:19:47,100 --> 00:19:50,900 reformer pilates is this? Perfect cure all for hydro all 411 00:19:50,900 --> 00:19:53,200 patients, say all of them should be doing reformer pilates, 412 00:19:53,600 --> 00:19:55,900 that's not possible. We've a cost-of-living crisis in 413 00:19:55,900 --> 00:19:58,800 the UK there are people struggling to afford food, and 414 00:19:58,800 --> 00:20:00,800 their homes. And for some patients, they're 415 00:20:00,800 --> 00:20:03,500 not going to be able to afford that type of training. 416 00:20:03,500 --> 00:20:05,300 So, you have to look at what's possible. 417 00:20:05,500 --> 00:20:09,200 In terms of financial ability for that individual. 418 00:20:09,900 --> 00:20:12,500 We also need to look at accessibility Terms of time, 419 00:20:12,700 --> 00:20:14,600 everyone has different commitments, some people, our 420 00:20:14,600 --> 00:20:17,600 parents, some people have jobs where they have to be there for 421 00:20:17,600 --> 00:20:20,100 a certain amount of hours, we need to look at what's possible 422 00:20:20,100 --> 00:20:22,800 in terms of time, for individuals, because even if I 423 00:20:22,800 --> 00:20:26,300 make the most perfect amazing program, if it's not impossible 424 00:20:26,300 --> 00:20:28,700 in terms of time or money, it's absolutely pointless and it's 425 00:20:28,700 --> 00:20:30,400 just going to lead to the patient feeling bad. 426 00:20:30,800 --> 00:20:32,200 So that's really, really important. 427 00:20:32,600 --> 00:20:34,200 Of course, in terms of accessibility also need to 428 00:20:34,208 --> 00:20:36,100 think, you know, geographical location. 429 00:20:36,100 --> 00:20:37,900 We just think of just literal ability. 430 00:20:37,900 --> 00:20:40,700 That can the patient like get to the place that were talking 431 00:20:40,700 --> 00:20:41,500 about. Are they able? 432 00:20:41,600 --> 00:20:43,700 All to use their body in that space. 433 00:20:43,700 --> 00:20:45,600 Is it a place where they feel safe and comfortable? 434 00:20:45,600 --> 00:20:48,100 So accessibility even in in that almost literal sense is 435 00:20:48,100 --> 00:20:51,200 important as well. So accessibility is a is almost 436 00:20:51,200 --> 00:20:53,500 number one and it's certainly number two, in terms of things. 437 00:20:53,500 --> 00:20:56,900 I think people should consider. Number three is, what does the 438 00:20:56,900 --> 00:21:01,300 patient want to do? I've seen patients where I would 439 00:21:01,300 --> 00:21:04,700 have preferred in some ways for them to begin with low intensity 440 00:21:04,700 --> 00:21:07,400 steady-state style training program, or some cardiovascular 441 00:21:07,400 --> 00:21:09,500 exercise. But the patient's told me, you 442 00:21:09,508 --> 00:21:13,000 know, what I love have lifting I want to get back into it. 443 00:21:13,000 --> 00:21:14,600 Lifting weeks, me. So, you know, I want to be 444 00:21:14,600 --> 00:21:16,900 strong. It makes me feel happy and I 445 00:21:16,900 --> 00:21:19,700 will take that into consideration when helping them 446 00:21:19,700 --> 00:21:22,400 make that clinical decision about what exercise program is 447 00:21:22,400 --> 00:21:25,100 right for them. It's important, especially when 448 00:21:25,100 --> 00:21:27,800 people feel down and they're tired and most chronic pain, 449 00:21:27,800 --> 00:21:30,300 hyper will help patients, feel exhausted and sad. 450 00:21:30,400 --> 00:21:33,800 It's important to think of what makes that person feel happy and 451 00:21:33,800 --> 00:21:36,000 incorporate it into their program. 452 00:21:36,200 --> 00:21:38,700 I cannot stress how important this is. 453 00:21:38,700 --> 00:21:40,100 I think it's something that's overlooked. 454 00:21:40,100 --> 00:21:43,100 We're always looking for what What's best for, what does the 455 00:21:43,100 --> 00:21:45,600 research say, or what, protocol, what you know, what does it say 456 00:21:45,600 --> 00:21:47,200 for this? This type of person what's best 457 00:21:47,200 --> 00:21:49,400 for them. You know what, they're an 458 00:21:49,400 --> 00:21:52,600 individual with thoughts and feelings and preferences and we 459 00:21:52,600 --> 00:21:55,100 need to think of what's best for them as individuals. 460 00:21:55,600 --> 00:21:58,200 I actually had a patient. This was, this was quite a while 461 00:21:58,200 --> 00:22:01,500 ago, but this patient really wanted to rollerblade 462 00:22:01,500 --> 00:22:04,500 rollerblading made her heart. Sing is rollerblading, High 463 00:22:04,500 --> 00:22:06,600 injury risk. Absolutely. 464 00:22:06,700 --> 00:22:09,300 We re starting from the bottom with this patient where this was 465 00:22:09,300 --> 00:22:10,300 there. A lot of stuff going on. 466 00:22:10,300 --> 00:22:13,100 Yes, there was You know what? I told the patient you want to 467 00:22:13,100 --> 00:22:14,600 rollerblade. These are all the things we need 468 00:22:14,600 --> 00:22:16,700 to get to do that. I'm not sure if it'll be 469 00:22:16,700 --> 00:22:19,700 possible, but we can try and that patient ended up getting to 470 00:22:19,700 --> 00:22:23,200 the point where through, you know, they I made sure that they 471 00:22:23,200 --> 00:22:25,700 acknowledge the risks and we did everything we could to reduce 472 00:22:25,700 --> 00:22:28,200 them, they were able to rollerblade. 473 00:22:28,600 --> 00:22:31,500 So again, it's about thinking of individual patients, and doing 474 00:22:31,500 --> 00:22:33,700 that risk assessment, but always making the decision and 475 00:22:33,700 --> 00:22:35,700 supporting the patient and making the decision. 476 00:22:35,700 --> 00:22:39,400 That's right for that patient. When it comes to risk, a quick 477 00:22:39,400 --> 00:22:41,500 note, there are risks with exercise. 478 00:22:41,600 --> 00:22:43,600 Eyes of all kinds there, different risks. 479 00:22:43,900 --> 00:22:46,300 There are also risks, though, from not exercising. 480 00:22:46,400 --> 00:22:49,600 So again, it's about taking out a holistic risk assessment, 481 00:22:49,700 --> 00:22:53,200 people will say, like, Pilates is safe, and yoga is bad, and 482 00:22:53,200 --> 00:22:55,600 that's simply not true. It's all about how it's done. 483 00:22:55,800 --> 00:22:57,600 It's all about the individual patient. 484 00:22:57,700 --> 00:22:59,500 So, again, there are, there are patients, I know of who get 485 00:22:59,500 --> 00:23:02,300 injured doing Pilates, because they struggle with lifting 486 00:23:02,300 --> 00:23:05,000 their, their head off the mat. Even if they're in a really 487 00:23:05,000 --> 00:23:07,500 using perfect technique that happy one-to-one coaching their 488 00:23:07,500 --> 00:23:10,300 neck is just too long to hypermobile and it injures them. 489 00:23:10,300 --> 00:23:11,500 So for them, they would have to do it. 490 00:23:11,700 --> 00:23:14,500 Pilates program or just avoid that kind of crunch type 491 00:23:14,500 --> 00:23:17,900 position and there may be another form of exercise that's 492 00:23:17,900 --> 00:23:20,800 safer for that patient. So it's always about what's 493 00:23:20,800 --> 00:23:23,600 right for that patient. We look at principles here. 494 00:23:23,600 --> 00:23:26,100 We don't just look at arbitrary. This is good or this is bad 495 00:23:26,100 --> 00:23:27,500 because it doesn't achieve anything. 496 00:23:28,000 --> 00:23:32,100 Now, we also want to look at the patient and think of what their 497 00:23:32,100 --> 00:23:35,000 primary symptoms are or what do they wish to address. 498 00:23:35,900 --> 00:23:38,900 So, for my patients who are having issues with dysautonomia, 499 00:23:38,900 --> 00:23:40,700 you're having issues with fatigue or lightheadedness. 500 00:23:40,700 --> 00:23:43,100 If it's safe. For them to do some form of 501 00:23:43,100 --> 00:23:46,100 cardiovascular exercise and they want to, that's a fantastic 502 00:23:46,100 --> 00:23:48,200 place to start. We cannot get them wearing a 503 00:23:48,200 --> 00:23:49,400 chest. Our part rate monitor, they can 504 00:23:49,400 --> 00:23:51,500 get that real-time feedback on their heart, we can train a 505 00:23:51,500 --> 00:23:54,800 different parameters that are individualized to them and how 506 00:23:54,800 --> 00:23:56,400 their cardiovascular system works. 507 00:23:56,800 --> 00:23:58,800 And that's a really, really cool place to begin. 508 00:23:59,700 --> 00:24:02,900 However, for a patient who, for example, they want to stop 509 00:24:02,900 --> 00:24:04,700 rolling their ankle. We're going to start with 510 00:24:04,700 --> 00:24:05,800 balance of proprioceptive training. 511 00:24:05,800 --> 00:24:09,200 So again, it's looking at that patient's individual, physical 512 00:24:09,200 --> 00:24:11,500 self and thinking. Okay, what does this one? 513 00:24:11,600 --> 00:24:13,500 This patient want from their body right now. 514 00:24:13,500 --> 00:24:15,900 What are they trying to achieve, how can I help them achieve 515 00:24:15,900 --> 00:24:17,300 that? So that's a really important 516 00:24:17,300 --> 00:24:22,100 point to consider as well, and of course, we want to think of 517 00:24:22,100 --> 00:24:25,100 what is the goal. So it's kind of goes back to its 518 00:24:25,100 --> 00:24:26,900 kind of similar to, what does the patient want to do? 519 00:24:26,900 --> 00:24:28,800 What makes their hearts saying, what makes them happy? 520 00:24:29,200 --> 00:24:30,400 But we want to think of what is the goal. 521 00:24:30,400 --> 00:24:32,600 So sometimes I'll patients for example, at a patient once who 522 00:24:32,600 --> 00:24:35,800 was struggling to hold his daughter and that was a goal 523 00:24:35,800 --> 00:24:38,500 that we work towards in a very particular way with weights and 524 00:24:38,500 --> 00:24:42,000 specific exercises. We wanted to help support him in 525 00:24:42,000 --> 00:24:46,400 exercising in a way that would result in him being able to hold 526 00:24:46,400 --> 00:24:49,000 his child. So we always want back exercise 527 00:24:49,000 --> 00:24:51,900 program to be tailored, not only to the individual patient but to 528 00:24:51,900 --> 00:24:54,600 what that individual patient needs to do in their life. 529 00:24:54,600 --> 00:24:56,700 Maybe that patient needs to work to pay rent. 530 00:24:56,700 --> 00:24:59,300 So again we're thinking of the exercise program and finding a 531 00:24:59,300 --> 00:25:02,300 way to make sure that it's tailored to what that patient 532 00:25:02,300 --> 00:25:04,500 needs to do with her body and that's why when I do a medical 533 00:25:04,500 --> 00:25:06,500 history, I ask a patient. What's going on? 534 00:25:06,500 --> 00:25:09,100 We get the whole picture, but I usually at somewhere near the 535 00:25:09,108 --> 00:25:11,400 end of it, I'll say, what do you need? 536 00:25:11,600 --> 00:25:14,300 Body to do for you and they'll tell me, you know, I need to 537 00:25:14,300 --> 00:25:16,200 look after my child, I need to walk my dog, I need to pay my 538 00:25:16,200 --> 00:25:19,000 rent, I need to, you know, see my friends or whatever. 539 00:25:19,000 --> 00:25:21,100 They'll tell me what they what they need their body for to do 540 00:25:21,100 --> 00:25:22,700 for them what they want their body to do. 541 00:25:22,700 --> 00:25:27,500 So again thinking of those goals is key and and what that patient 542 00:25:27,500 --> 00:25:29,500 really wants the outcome of the program to be. 543 00:25:30,200 --> 00:25:33,700 Because if the patient feels motivated and feels inspired, 544 00:25:33,700 --> 00:25:35,600 they're going to follow an exercise program perfectly. 545 00:25:35,600 --> 00:25:39,100 And if it's a program that's been made in a way which is 546 00:25:39,100 --> 00:25:42,600 informed by physiology and By what we know about tissue 547 00:25:42,600 --> 00:25:45,500 Remodeling and giving that right stimulus to get those changes 548 00:25:45,500 --> 00:25:47,300 and you're going to have a successful outcome for the most 549 00:25:47,300 --> 00:25:49,700 part. And of course, we always want to 550 00:25:49,708 --> 00:25:52,600 think, too. How will progress, be measured? 551 00:25:52,600 --> 00:25:55,300 How are we going to know if the ship is heading in the right 552 00:25:55,400 --> 00:25:57,700 direction? Emerson has a really lovely 553 00:25:57,700 --> 00:26:00,500 essay on called self-reliance and he uses this image of a 554 00:26:00,500 --> 00:26:02,900 sailboat and its trying to get to its end destination and I 555 00:26:02,900 --> 00:26:05,100 don't know if any of you can saline but it's salable doesn't 556 00:26:05,100 --> 00:26:08,000 go in a straight line from point A to point B attacks it goes a 557 00:26:08,008 --> 00:26:10,600 bit to the right, a bit to the left and we get this almost mini 558 00:26:10,600 --> 00:26:13,500 zigzag. And that's what this exercise 559 00:26:13,500 --> 00:26:16,100 program for anyone is going to look like long-term, we're going 560 00:26:16,100 --> 00:26:18,100 to we're going to use information that we gain from 561 00:26:18,100 --> 00:26:21,100 that program to inform how we can improve it and make it 562 00:26:21,100 --> 00:26:23,100 better for that patient and whatever their bodies. 563 00:26:23,100 --> 00:26:25,900 Like in four weeks, or two months, or three months, or 564 00:26:25,900 --> 00:26:28,200 whatever, going to be having regular check-ins to see how do 565 00:26:28,200 --> 00:26:30,900 we tweak it, how do we make it more challenging or how do we 566 00:26:30,900 --> 00:26:33,000 address this new symptom that's come up or whatever. 567 00:26:33,000 --> 00:26:37,500 So that's extremely important again for patients. 568 00:26:37,500 --> 00:26:40,200 It's nice sometimes to have some type of objective feedback so 569 00:26:40,200 --> 00:26:42,800 that could be of course looking at At things like, are we able 570 00:26:42,800 --> 00:26:44,900 to lift more weight? Are we able to do more 571 00:26:44,900 --> 00:26:46,700 repetitions? Do we just simply feel better 572 00:26:46,700 --> 00:26:49,100 doing the movement, and it can certainly be things. 573 00:26:49,100 --> 00:26:52,200 Like, for example, biomarkers like a heart rate monitor and 574 00:26:52,200 --> 00:26:54,500 getting that heart rate feedback in real time. 575 00:26:54,500 --> 00:26:57,200 And seeing, you know, is that heart rate a little bit more 576 00:26:57,200 --> 00:26:59,600 steady, are we able to keep it here with more control? 577 00:27:00,500 --> 00:27:02,100 Is that, you know, how is that behaving? 578 00:27:02,100 --> 00:27:04,500 So, I'm a big fan of data collection and looking at that, 579 00:27:04,500 --> 00:27:08,200 in the context of exercise, also, because it feeds into 580 00:27:08,200 --> 00:27:11,700 supporting patients, in developing body literacy and In 581 00:27:11,700 --> 00:27:14,100 able to read and interpret the signs of your body. 582 00:27:14,500 --> 00:27:16,700 So I've had so many patients who when they start, their 583 00:27:16,700 --> 00:27:18,900 low-intensity steady state training program. 584 00:27:19,200 --> 00:27:21,500 They're doing they're typically I'll start around like three 585 00:27:21,500 --> 00:27:25,000 rounds of three minutes. It's a very low starting point. 586 00:27:25,000 --> 00:27:27,200 That's I try to make exercise programs hard for people to 587 00:27:27,200 --> 00:27:28,500 enjoy themselves. So it's kind of it's a 588 00:27:28,508 --> 00:27:32,600 programmer trying to pitch the ball at the right speed and they 589 00:27:32,600 --> 00:27:35,800 will find it. So interesting to how their 590 00:27:35,800 --> 00:27:38,200 heart rate is entirely different on a day where they haven't 591 00:27:38,200 --> 00:27:41,400 slept, or they've had like, five cups of coffee or they're just, 592 00:27:41,500 --> 00:27:43,800 Really, really stressed. We're seeing how their body 593 00:27:43,800 --> 00:27:46,400 copes with the heat right now. We have a heat wave in the UK 594 00:27:46,600 --> 00:27:49,100 and people's heart rates. If they're exercising, are going 595 00:27:49,100 --> 00:27:52,600 to be affected by that. So it's a way that you can get 596 00:27:52,600 --> 00:27:54,800 patients, really involved in what's going on. 597 00:27:54,800 --> 00:27:58,500 And you can also help put that limit on their training. 598 00:27:58,500 --> 00:27:59,600 So if they're at a certain point, you're going to say, you 599 00:27:59,600 --> 00:28:02,000 know what, if you're seeing this type of data, you're going to 600 00:28:02,000 --> 00:28:04,200 call it a day, you're going to leave the gym we're done or get 601 00:28:04,200 --> 00:28:06,700 off your bike while you're on at home or whatever you're done. 602 00:28:07,400 --> 00:28:09,900 Because long-term we want to help these patients develop 603 00:28:09,900 --> 00:28:11,400 Independence, you want them to be able. 604 00:28:11,600 --> 00:28:14,900 All to support themselves in their health as much as possible 605 00:28:15,000 --> 00:28:17,100 and this leads into kind of my final Point. 606 00:28:17,100 --> 00:28:18,600 Well, of how will good and bad days? 607 00:28:18,600 --> 00:28:21,400 Be handled. Good and bad days are so 608 00:28:21,500 --> 00:28:23,700 challenging when you're working with hypermobile patients, 609 00:28:23,700 --> 00:28:26,500 because you'll have a patient who seems to be doing great and 610 00:28:26,500 --> 00:28:29,200 then something will happen, and they will feel awful and we've 611 00:28:29,200 --> 00:28:31,600 talked in previous episodes, but kind of the interaction between 612 00:28:31,600 --> 00:28:34,500 inflammation and fibrosis, which is the technical term for Scar 613 00:28:34,500 --> 00:28:36,400 Tissue. But we may have a patient who, 614 00:28:36,400 --> 00:28:38,400 for example, eat something, which really irritates their gut 615 00:28:38,400 --> 00:28:40,900 and that causes Mass cell reaction, or they have a 616 00:28:40,900 --> 00:28:42,400 histamine, and Tolerance or whatever. 617 00:28:42,800 --> 00:28:46,700 And that will make that patient feel potentially just really bad 618 00:28:46,700 --> 00:28:48,800 on a day, and it will seem random unless, you know what's 619 00:28:48,800 --> 00:28:54,600 going on, but having a promotion or demotion system built into 620 00:28:54,600 --> 00:28:57,600 the program is key. So I, when I program for 621 00:28:57,600 --> 00:28:59,500 patients off certain rules, and I'll say, look, if you're able 622 00:28:59,500 --> 00:29:03,200 to do this, this exact exercise, this work, this work out. 623 00:29:03,300 --> 00:29:05,100 Let's call to work out this workout, this training session. 624 00:29:05,100 --> 00:29:07,500 If able to do this many times and you get this type of 625 00:29:07,500 --> 00:29:10,300 biomarker feedback and we're looking, it's looking in this 626 00:29:10,300 --> 00:29:13,400 way, then you're allowed. How to change this parameter? 627 00:29:13,400 --> 00:29:16,000 You're allowed to add like 30 seconds or whatever you're 628 00:29:16,000 --> 00:29:19,000 allowed to progress the program in this way, but I'll say to the 629 00:29:19,000 --> 00:29:21,300 patient. However, if you go in and you're 630 00:29:21,300 --> 00:29:23,600 feeling poorly and you're getting, you know, you can just 631 00:29:23,600 --> 00:29:27,400 tell your body's not quite feeling its best, then you have 632 00:29:27,400 --> 00:29:29,300 to make that call to demote yourself. 633 00:29:29,300 --> 00:29:31,400 And you don't feel bad about it. You just say, you know what, I'm 634 00:29:31,400 --> 00:29:33,300 not feeling good. Today we're going to change this 635 00:29:33,300 --> 00:29:36,400 program or I'm just going to leave and I'm going to call it a 636 00:29:36,408 --> 00:29:38,700 day. So patients, really need to be 637 00:29:38,700 --> 00:29:41,100 supported in navigating good days and bad days. 638 00:29:41,600 --> 00:29:45,000 And it's not easy, it's a skill. It takes time to learn over 639 00:29:45,000 --> 00:29:47,000 time. But with the right support, this 640 00:29:47,000 --> 00:29:49,300 is something that can really help a patient in so many 641 00:29:49,300 --> 00:29:52,200 aspects of their lives. So, learning, how to cope with 642 00:29:52,200 --> 00:29:54,600 a, how to cope with that almost. It's like a changeable weather. 643 00:29:54,600 --> 00:29:57,500 If you think of the weather on a Caribbean Island how it can go 644 00:29:57,500 --> 00:29:59,900 from, really sunny to thunderstorms all of a sudden, 645 00:30:00,200 --> 00:30:02,900 that's like a hypermobile body, that's what it's like. 646 00:30:02,900 --> 00:30:05,500 So patients need to become equipped. 647 00:30:05,500 --> 00:30:06,700 They need their umbrella. Ready. 648 00:30:06,700 --> 00:30:08,700 They need their sunglasses. They need everything with them 649 00:30:08,700 --> 00:30:11,300 so that they feel in control and they're able to deal with. 650 00:30:11,500 --> 00:30:14,500 These changes and have successful outcomes simply 651 00:30:14,500 --> 00:30:18,400 through being able to deal with their body at an incredibly high 652 00:30:18,400 --> 00:30:20,900 level, they almost become experts in their own body. 653 00:30:20,900 --> 00:30:23,000 That's the outcome I want for my patients, at least. 654 00:30:23,500 --> 00:30:28,400 Now, speaking of experts, being able to distinguish between the 655 00:30:28,400 --> 00:30:32,400 pain of re-injury and the pain in quotation marks of healthy 656 00:30:32,400 --> 00:30:35,100 muscular. Fatigue is incredibly hard. 657 00:30:35,400 --> 00:30:38,500 It took me a very, very long time to be able to do this and I 658 00:30:38,500 --> 00:30:41,900 think back and I cringe to when I was swimming and I I had such 659 00:30:41,900 --> 00:30:44,600 intense shoulder pain and my coach was saying, push through 660 00:30:44,600 --> 00:30:47,300 the pain or pain is fear, leaving the body and I was 661 00:30:47,300 --> 00:30:50,000 trying so hard to push through it, but I wasn't pushing through 662 00:30:50,000 --> 00:30:54,100 healthy muscular fatigue, I was pushing through pain of injury 663 00:30:54,100 --> 00:30:58,300 and of re-injury and if you don't have someone to there to 664 00:30:58,300 --> 00:31:00,600 support you and being able to distinguish the two, it can be 665 00:31:00,600 --> 00:31:03,500 really, really hard. So I'm going to break down my 666 00:31:03,500 --> 00:31:08,000 tips on how I help my patients and how I actually myself 667 00:31:08,000 --> 00:31:12,700 distinguish between the pain of re-injury and the Pain or the 668 00:31:12,700 --> 00:31:15,700 feeling of healthy muscular fatigue. 669 00:31:16,000 --> 00:31:19,100 Now, if you're not aware exercise is traumatic. 670 00:31:19,100 --> 00:31:21,000 Even for people who are going to the gym and they're doing, 671 00:31:21,000 --> 00:31:22,200 they're you know, they're healthy. 672 00:31:22,200 --> 00:31:25,800 They're perfect gym session. They are subjecting their tissue 673 00:31:25,800 --> 00:31:28,300 to micro trauma and they're doing that because they're 674 00:31:28,300 --> 00:31:32,100 trying to stimulate it to grow back in a healthier better way 675 00:31:32,100 --> 00:31:35,800 that is how Exercise Works. So you are supposed to feel a 676 00:31:35,800 --> 00:31:39,100 little bit like like you've worked on something after an 677 00:31:39,100 --> 00:31:42,200 exercise program, that's okay. But the Problem with hypermobile 678 00:31:42,200 --> 00:31:44,700 patients is because they are often people who had chronic 679 00:31:44,700 --> 00:31:48,700 pain their whole lives, they don't know what pain feels like, 680 00:31:48,700 --> 00:31:51,900 it's incredibly hard, it's not talked about enough, and on top 681 00:31:51,900 --> 00:31:54,100 of that, we often do see different kinds of neurological 682 00:31:54,100 --> 00:31:56,700 changes would make it hard for that person to even really feel 683 00:31:56,700 --> 00:31:58,500 pain. So you will hear people who 684 00:31:58,500 --> 00:32:00,800 like, walked home with a fracture and you're just like 685 00:32:00,800 --> 00:32:04,200 what how would you do that? So so we see these two, this 686 00:32:04,200 --> 00:32:07,100 type of altered pain processing. So working in the way that I do, 687 00:32:07,100 --> 00:32:10,000 I like to make everything very systematic and very precise here 688 00:32:10,000 --> 00:32:14,700 is how I distinguish In the pain of of injury and pain of healthy 689 00:32:14,700 --> 00:32:19,600 muscular fatigue. So firstly pain of re-injury is 690 00:32:19,600 --> 00:32:23,400 typically going to feel focal. It'll feel like a point, it'll 691 00:32:23,400 --> 00:32:25,500 feel precise, it'll feel intense. 692 00:32:25,700 --> 00:32:28,900 Someone on a tick tock video, I made described it as feeling a 693 00:32:28,900 --> 00:32:30,900 high, they described him pitch and they said the pain of 694 00:32:30,900 --> 00:32:33,600 re-injury is a high pitch and the pain of healthy muscular 695 00:32:33,600 --> 00:32:35,400 fatigue is a low pitch. So I don't know if that'll make 696 00:32:35,400 --> 00:32:37,000 sense to you but that's how they described it. 697 00:32:37,200 --> 00:32:41,100 Also, if it feels that all like any of these words, if it feels 698 00:32:41,100 --> 00:32:45,400 like Like ripping tearing. If it feels like grinding 699 00:32:45,500 --> 00:32:48,900 pinching catching. That's not pain. 700 00:32:48,900 --> 00:32:52,200 Have healthy muscular fatigue, that's pain of re-injury. 701 00:32:52,700 --> 00:32:55,200 Additionally. It should make sense given the 702 00:32:55,200 --> 00:32:57,300 exercise. So if you're someone who, for 703 00:32:57,300 --> 00:33:00,500 example, is finding your neck is sore, when you're doing like 704 00:33:00,500 --> 00:33:03,800 crunches or whatever. That's not the, that's not the 705 00:33:03,800 --> 00:33:05,900 intended stimulus like of the exercise. 706 00:33:05,900 --> 00:33:06,900 That's not what you're trying to achieve. 707 00:33:06,900 --> 00:33:08,800 You're trying to maybe work on your core. 708 00:33:08,800 --> 00:33:10,700 If you're doing conscious again, they're not something that I 709 00:33:10,708 --> 00:33:12,500 would really do. Whatever let's say you're doing 710 00:33:12,500 --> 00:33:15,500 that. Now, if you're feeling neck pain 711 00:33:15,500 --> 00:33:17,700 there you will see. There are personal trainers and 712 00:33:17,700 --> 00:33:18,900 coaches. Who will argue that you building 713 00:33:18,900 --> 00:33:21,100 a strong neck? No, it's not that. 714 00:33:21,100 --> 00:33:25,000 If you feel pain every injury during a movement, don't do it. 715 00:33:25,300 --> 00:33:27,300 You can find different ways to strengthen tissues. 716 00:33:27,300 --> 00:33:30,700 Just don't do that, okay? And it doesn't make sense in the 717 00:33:30,700 --> 00:33:33,100 context of the exercise, because it's not the aim of the 718 00:33:33,100 --> 00:33:35,300 exercise. So if, if what you're feeling 719 00:33:35,300 --> 00:33:37,300 doesn't make sense. So you're feeling your neck when 720 00:33:37,300 --> 00:33:39,500 you should feel your core or you're feeling your back when 721 00:33:39,500 --> 00:33:42,300 you should feel your thighs, then, It doesn't, it's not 722 00:33:42,300 --> 00:33:44,500 right, you're injuring something don't do it, find a different 723 00:33:44,500 --> 00:33:47,800 movement, just try something else on that note as well. 724 00:33:47,800 --> 00:33:51,300 If you're doing a two-legged exerciser to arm exercise and 725 00:33:51,300 --> 00:33:53,900 you're only feeling pain on one side. 726 00:33:54,100 --> 00:33:58,200 Then you're probably having a re-injury occur because you 727 00:33:58,200 --> 00:34:01,700 should be physically exhausting your causing physical fatigue to 728 00:34:01,700 --> 00:34:03,700 both sides. You're using both sides. 729 00:34:03,700 --> 00:34:06,100 Why are you only feeling your left shoulder when you should be 730 00:34:06,100 --> 00:34:08,600 feeling both? So again, that's another way you 731 00:34:08,600 --> 00:34:11,300 can think about it. Additionally, you'll find that 732 00:34:12,100 --> 00:34:15,199 The pain of re-injury. It's not going to typically 733 00:34:15,199 --> 00:34:17,699 improve through training. So if you're doing the same 734 00:34:17,699 --> 00:34:20,100 shoulder strengthening program and you're feeling intense pain, 735 00:34:20,100 --> 00:34:22,600 in your right shoulder over time, it's not going to go away. 736 00:34:22,600 --> 00:34:25,400 If anything, it's going to get worse, whereas, if it is quote 737 00:34:25,400 --> 00:34:28,500 unquote, that sensation of pain, or that feeling of healthy 738 00:34:28,500 --> 00:34:32,199 muscular fatigue, you would expect it to lessen over time. 739 00:34:32,199 --> 00:34:34,199 If you're going back and doing those sessions that you did four 740 00:34:34,207 --> 00:34:36,600 months ago, it shouldn't feel. You should be able to feel it 741 00:34:36,600 --> 00:34:38,699 because you've become fitter, your muscles are able to cope 742 00:34:38,699 --> 00:34:41,500 with that increase load. Now for thinking of what the And 743 00:34:41,500 --> 00:34:44,000 of healthy muscular fatigue. Feels like typically will be 744 00:34:44,000 --> 00:34:46,400 across a muscle group. It's not going to be just one 745 00:34:46,400 --> 00:34:47,800 point. It's going to feel kind of 746 00:34:47,800 --> 00:34:51,400 diffuse, people who are hypermobile, who have gone on to 747 00:34:51,400 --> 00:34:54,000 be able to exercise safely and to experience the pain of 748 00:34:54,000 --> 00:34:56,699 healthy muscular fatigue. They often report that it feels 749 00:34:56,699 --> 00:34:59,600 actually Pleasant. It feels nice which goes to show 750 00:34:59,600 --> 00:35:02,000 how pain processing. Alterations can really change 751 00:35:02,000 --> 00:35:04,600 how you experience the world around you but they report that 752 00:35:04,600 --> 00:35:07,800 it feels nice. So it'll feel kind of it will 753 00:35:07,800 --> 00:35:11,200 feel exhausting, it will feel fatiguing but it's not. 754 00:35:11,300 --> 00:35:16,000 Going to feel like that white-hot, intensity, painful, 755 00:35:16,000 --> 00:35:18,100 re-injury. It's going to just feel like a 756 00:35:18,100 --> 00:35:20,400 diffuse healthy muscular fatigue. 757 00:35:20,900 --> 00:35:24,200 Now, what I like to say is if you're ever in doubt, err on the 758 00:35:24,207 --> 00:35:26,900 side of caution and assume it's pain of reinjure, if you're in 759 00:35:26,900 --> 00:35:31,200 doubt, err on the side of caution but learning to 760 00:35:31,200 --> 00:35:33,500 distinguish between those two. Things is probably the most 761 00:35:33,500 --> 00:35:36,600 essential skill that anyone who's hypermobile and trying to 762 00:35:36,600 --> 00:35:38,300 exercise and trying to build Fitness can have. 763 00:35:38,300 --> 00:35:41,300 And if I was a fairy godmother, it's something I would give to 764 00:35:41,300 --> 00:35:44,400 to every single hypermobile person because it becomes 765 00:35:44,400 --> 00:35:46,300 confusing. When you injure yourself from 766 00:35:46,300 --> 00:35:48,500 things you shouldn't and you don't know how to feel and you 767 00:35:48,508 --> 00:35:51,600 have coaches who are saying push through the pain and it's 768 00:35:51,600 --> 00:35:54,300 important that we work on improving that patients, 769 00:35:55,000 --> 00:35:58,900 internal assessment skills of what they're feeling in their 770 00:35:58,900 --> 00:36:01,100 bodies. So listening to your body and 771 00:36:01,100 --> 00:36:04,000 being kind to, your body is important and it's something 772 00:36:04,000 --> 00:36:06,700 that can be improved with the right support. 773 00:36:22,100 --> 00:36:24,400 We have reached the end of today's episode, it's certainly 774 00:36:24,400 --> 00:36:25,600 not the last. We're going to be talking about 775 00:36:25,600 --> 00:36:28,900 exercise, I have so much more to say on the topic but if you have 776 00:36:28,900 --> 00:36:31,700 any questions, if you have any feedback, please write in. 777 00:36:31,700 --> 00:36:34,500 I love hearing from you. And if you do want to take a 778 00:36:34,508 --> 00:36:36,800 minute to leave a review, if you can leave a 10 star review, of 779 00:36:36,800 --> 00:36:38,800 course, I'd love it. But if you want to leave a five 780 00:36:38,800 --> 00:36:41,200 star review, of course, that's fine too or whatever review you 781 00:36:41,300 --> 00:36:43,400 Feel suits the show so far, please do that. 782 00:36:43,400 --> 00:36:46,500 I would be so grateful for that type of feedback from you as 783 00:36:46,500 --> 00:36:48,400 well. And I do want to stress. 784 00:36:48,400 --> 00:36:50,400 Keep an eye out for the hyperbola. 785 00:36:50,400 --> 00:36:54,100 THQ membership. Launch is happening this Friday 786 00:36:54,100 --> 00:36:57,000 at 5:00 p.m. BST, if you're not on my mailing 787 00:36:57,000 --> 00:36:58,600 list, please make sure to sign up for that. 788 00:36:58,600 --> 00:37:01,700 You can find that in the link in my social media profiles because 789 00:37:01,700 --> 00:37:04,000 there will be more information being released about that over 790 00:37:04,000 --> 00:37:06,500 the coming days. But I'm so excited to be 791 00:37:06,500 --> 00:37:08,900 beginning that and I'm so excited, of course to have had 792 00:37:08,900 --> 00:37:12,800 you with me for today's episode. I wish you all the best and I'll 793 00:37:12,800 --> 00:37:14,500 catch up with you next time. Take care.