Episode 1: Having confidence In your body at any age

Michael Dermansky:

Hi everyone and welcome to our first episode of the Confident Body Show. Where we aim to give you practical, scientific advice from health professionals to help you build a confident body. So our aim of the show is to really help you get the best out of life, no matter how complicated your issues are. And we want you to have the best life possible. So if you want to be able to track the Himalayas, you can do that. If you want to be able to snowboard or even bike ride down Mount Buller, whether it’s summer or winter, we want you to be able to do that. Or if you want to just enjoy your trip overseas and really have a great time, that’s what we want you to do. So our aim today is to really help you start to build the foundations of a confident body.

Michael Dermansky:

And we have a guest star today. His name’s Will Ryan. He’s our senior physiotherapist and branch manager at MD Health in Paddington. And he’s going to be helping us talk about the foundations of a confident body. So Will, do you want to say hello and we’ll get started with having a chat about this.

William Ryan:

Hello, yeah. Let’s get into it. I’m excited.

Michael Dermansky:

Fantastic. So first question I have for you from your perspective and your experience as well, what’s the foundation, what are the basics needed to help you build a confident body?

William Ryan:

It’s an interesting question, because you got to look at everyone from their own individual perspective, but if you really break it down to the simple things, I guess you want to be strong. You want to be active. You want to have good nutrition habits, and you want to have good sleeping habits. I think those four sort of things, if you do all that, it probably allows you to have the confidence in your body to be able to really do whatever you put your mind to I guess.

Michael Dermansky:

I mean, what you’ve seen in your clients as well, and even for I guess yourself, what have you seen people being able to do and not being able to do if they do or don’t have a confident body?

William Ryan:

Well, not being able to do it puts a lot of limitations on… People who’ve got, say like active injuries and things and have just been struggling with them and haven’t been able to get on top of them, that really dents their confidence in a lot of ways. Even the fact that some people can’t go out for a 20 minute walk during the day to get out of the house and get moving. That really dents their confidence. I think just walking is one of the most underrated forms of exercise there is and if you can’t go out and do that straight away, it’s a bit of an issue. So that’s a really struggling one, a real one that I find a lot of clients can struggle with if they do have active pain and aren’t confident in their body. But you know all that stuff can change.

William Ryan:

I’ve seen someone recently who he’s coaching his son’s footy team and he wasn’t able to run and kick the footy. And he wanted to be able to do that at training and through making some certain lifestyle changes and getting strong and getting active again, he now can do that and it’s not a worry for him. So he can remain confident in his body that he can do that at training, which is great.

Michael Dermansky:

Well, let’s go break down this process in a few steps as well. But what I wanted to start with first is assessment. So from my perspective, as a physiotherapist, the first place I usually start assessing people as well. What about your perspective? Where does assessment fit into the process?

William Ryan:

The assessment’s really important. It’s really important to get a gauge of someone’s starting point. So when someone first comes in to see me, the actual diagnosing of their issue or injury is actually the easy part as a physio, really. The hard part is figuring out how to fix it and that’s where the assessment comes into it. So by being really thorough with finding out what their deficits are, whether it’s strength related or stability related or control related. Or even motion related, like if they’ve got a stiff joint or something, if we can really hone in on any of those areas, write up a solid treatment plan and follow it consistently. That’s when we start to get good results with people. So the assessment is really important, particularly at the start.

Michael Dermansky:

With this dad you talked about as well, do you remember when you did an assessment on him, what was the picture that you got out of it?

William Ryan:

So I guess one of his big issues, he’d had multiple knee surgeries across his life and he was really reluctant to do much running because of the load it placed on his knees and his knees never felt comfortable with that. But in his assessment, his quadriceps, which are your thigh muscles, which are the main part of… working on quadriceps are the main part of working on any sort of knee pain, really, when you break it down. But his quadriceps were really weak. I’m talking less than 20 kilos on our dianometry testing, which ideal world for someone that size? Would love to see over 40 and on his most recent assessment, we’ve got that up to around 38 now. So it’s getting there, yeah.

Michael Dermansky:

Wow. Any other findings? You’ve got an assessment as well that fitted together with that picture. Because you talked about his knees.

William Ryan:

Well, his knees are the big one, but he also had some hip stiffness issues and some lower back pain from that as well. So once he got better motion in his hips, started doing a little bit of mobility work and strength work around that area too his back pain started to get a lot better. He also couldn’t take load very well through his hips or his knees at all when they were inflection. So he couldn’t squat very well. Couldn’t lunge very well. So working on that technique early was something we did quite a fair bit of too.

Michael Dermansky:

Okay. Interesting. Well, At our center, we do a lot of clinical parties and exercise as well for both people that haven’t got problems or do have problems. Where does that fit in your picture? You do that as well. So where does that fit in in someone’s program?

William Ryan:

I find a great starting point to be able to isolate specific muscle groups or teach certain movement patterns. I know Michael you’d know that we have our reformers nice and low on the floor.

Michael Dermansky:

Yeah.

William Ryan:

So we’re not often doing exercises with legs in the arm straps or legs in the straps of like frog kicks or anything like that. We’re often doing a steaming hip extension exercise where they’ve got one foot on the ground, other foot on the carriage in it using the resistance of the carriage to press back and hold it there. That way you get that good ground reaction force through that standing leg as well.

Michael Dermansky:

Yep.

William Ryan:

So you’re sort of forcing them to stabilize on that standing leg and hold it back with the muscles on the pushing leg. So I find that as a starting point is really, really helpful. And I think it’s a lot better than just doing all exercises on the Pilates reformer on your back, because how often are we on our back doing demanding physical tasks? You know?

Michael Dermansky:

Really not very often. No. From my perspective as well, basically there’s elements of that, those reformers that were great in terms of the way the brain likes to learn your activities. So it’s got a balance component. It’s got a direction component too, because you do that on a Swiss ball, there’s multiple directions. So it’s harder for your brain to get that concept where this is one direction. So it’s easier to isolate control with the reformer. And the last thing it’s what’s called task orientated. So that means that you’re actually doing a movement. So your brain doesn’t remember whether you put your arm forward, sideways, whatever. It remembers I have pushed this, I have pulled this. And these are one of the elements that allow you to work on the stability muscles really well. Personally, I find if someone does have an injury, if those stabilizing muscle groups don’t do their job properly, it’s very, very hard to build strength on top of that too because the control’s just not there.

William Ryan:

Yeah. I agree with that. Definitely. I think we get that really good initial neuromuscular change by using the Pilates reformers, which is exactly what you just spoke about. Basically the brain can tell the muscles we’ve done this before, you can do this pain free. I think that’s what the Pilates reformers… And the way we are using in particular, I think that’s where we get the most benefit for sure.

Michael Dermansky:

What’s the difference between someone who doesn’t have an injury or does have an injury? How would you use the Pilates reformers differently or is there a difference?

William Ryan:

For someone who does have an injury I generally tend to give them exercises that don’t aggravate their pain. The exercises are often… the basis of the exercise is often the same though. So it might be like a hip extension exercise or a hip production exercise or a lunging exercise or a squatting exercise. So the exercise stays the same, but we just really change the load and probably the way the exercise is done as well. So instead of… So for someone who’s injured, we might say, right, push this back slowly, hold for three seconds, control back in. For someone who’s uninjured, we might load it up a bit more and then go push it back quick, hold it there And then come back in. We’re just changing the demand on the body a little bit more that way. And they get that further adaptation from that. But you know, we try to build people up to that heavier, faster point as quickly as we can, as pain permits so for that person who is in pain.

Michael Dermansky:

I identify the same thing, but also even people who don’t have an injury as well. They’ll usually have poor control around the hips. It’s the most common one I see. And so getting that stability first before I load them up on heavier exercises just means I can take them to the next level. And if I haven’t done that, they’re going to lose control and it puts strain on other areas that makes the whole process a lot harder.

William Ryan:

Yeah I think that lumbopelvic control is something that… A lack of that is something we see quite a lot, particularly in the injured person and then we work on it and it helps get people better for sure.

Michael Dermansky:

Yeah, I see that every day, just lack of control in hips and back, and being able to differentiate and use both muscles at the same time, which you should be able to do. It’s just one of the first things I see for most people.

William Ryan:

Yeah.

Michael Dermansky:

Where does treatment come to it too? So the classical perception of physiotherapy or osteo or chiro treatment is hands on treatment. Where does it fit into the picture? So you’ve talked about doing clinical Pilates or clinical exercise to help promote stability, that basic level of strength, where does treatment come into it? If someone has, or doesn’t have an injury?

William Ryan:

Treatment definitely has a role, but it depends on each person. A lot of people, if their real underlying issues are just caused by weakness and they’ve got good range of motion around everything else, we don’t really need to do a lot of treatment. Whereas like someone might have… A good example is maybe like an early onset arthritic hip or something. They might have some hip stiffness, some sort of pinching around the joint area. That’s where some of the treatment that we can try and do… We try and create a better range of motion in that joint, whether it lasts for a long period of time or not is a separate argument.

William Ryan:

But if we can create even a short term effect with a bit of manual treatment, whether it’s some soft tissue work if that’s indicated or more of a joint glide mobilization, which we do a lot of with seatbelts on hips, if we can create a little bit more room in the joint there and then train the muscles in that extra range of motion that we just created, I think that’s where the real gold is in manual therapy and the combination of the two as we do it in clinic, having it like right there can do. Do the treatment straight away, and then straight into the exercise and properly loaded exercise and making sure they’re doing a properly right technique. I think the combination is really important.

William Ryan:

And I think with manual therapy too, it’s also important not to overlook the sort of pain modulation effect it can have as well.

Michael Dermansky:

Right. What do you mean by that?

William Ryan:

Patients feel better when they get manual treatment, whether it actually does any change to the tissues or the joint or not, people like that feeling. And if we get a better result because they do like that feeling, that’s okay. Whether or not we’ve done any change to the joint or the muscle or whatever it is, if they feel better after it and are able to better do their exercises in clinic, that’s still a win.

Michael Dermansky:

I think the literature’s really something that shows as well that it’s not either or, it’s both. So the hands on treatment just allows those extra bits. So for example, someone does have hip arthritis like you said as well, if we don’t get that glide in the hip going as well, it’s just going to mean limitation and that pinching sensation and your brain’s going to say, I don’t like to do this. So if you can add that extra movement and then strengthen it at the same time, that’s where the real benefits are. So, I mean, I can do all the hands on treatment I like, but if I’m not making the area stronger, it’s not going to last. But then again, if I do the strengthening work as well and I don’t… The limitations because of scar tissue, because of changes happening over time, I’m going to be restricting the effect I’m going to have. I think at one stage I wasn’t doing any hands on treatment and just not getting the same benefit if when the two were combined together.

William Ryan:

Yeah, definitely. We get a lot of students through clinics. And one thing I used to say to them when I was teaching them a few manual techniques was look, the main aim for this is we’re trying to create an extra range of movement or extra movement in the joint. And then we’re trying to strengthen the area in that extra range of movement and that’s where we get the long term change. And that’s an easy way to explain to patients as well and people tend to understand that.

Michael Dermansky:

So the big one is strength training. So the difference in, from your perspective, what’s strength training and what the difference is, what you do with the clinical party in exercise and that classical strength, conditioning width, are they the same? Are they different? How do the two fit into each other?

William Ryan:

Strength training, loosely defined is just doing any movement under resistance. So I guess the clinical exercise and Pilates arm of what we do is strength training in a way. But when someone does progress to a pain free sort of level, I do like to load them up more by using things like Olympic barbells. Doing movements such as dead lifts and things. They target a lot of big muscle groups and it’s easy to load up the exercise and it requires a fair bit of control. So that whole combination of that gets a really good strengthening effect. And I like to say it sort of gives you more bang for your buck than some of the other exercises because you’re working heaps and muscle groups all in one big exercise, it’s nice and heavy. You get stronger and it doesn’t take as long.

Michael Dermansky:

But when you say nice and heavy. Why? What’s the big deal about making it nice and heavy? What’s the benefit?

William Ryan:

Well, the real benefit is we’re putting those muscle fibers under stress and that’s how we improve our strength over time. You got to put muscles under stress, let them recover. That’s how they grow. That’s how they get stronger. I feel like the exercises we do from a strengthening perspective, whether it’s with the barbells or with other weight machines or resistance bands or whatever, we want to work people to that point where it is really difficult, like an 80% of their maximum capacity. That’s where the research suggests that’s where the muscles are going to be at that stage where they’re not overworked that you’re going to be too sore. You’re not underworked that you’re not getting much benefit from it that you’re in that sweet spot. So the load is important and monitoring that load for each person is important too.

Michael Dermansky:

That’s the biggest thing that loading is really, really important. And I think, again, coming out of the research in the last, probably last year or two that this load management and actually loading people up is probably the key to really getting better… people getting the confident body and getting performance changes. Where for a long time, I think we’re guilty of underloading people and not giving their body the stimulus they need to grow. It’s a really big deal. Personally, in my experience, in terms of clinical exercise versus classical strength training, if you asked me seven, eight years ago, would I give classical strength training? I would have said no way, it’s dangerous. You can’t do that. Where now it’s like, this has to be a part of what we do. So if we’re going to get people to the next level and actually get them to get the most out of their life, we have to load them up so that they actually have a reason to build their muscle strengths.

Michael Dermansky:

And the clinical exercise and Pilates is our first step, but I learned a few years ago that just wasn’t enough. We can’t take people to that next level and really get them to have the most out of life if we’re not loading them up and there’s classical strength training and Olympic lifts, like you talked about as well. It is great. I mean, that’s that next level where people can really take that next step in their life. And from my experience, I know my experience as well, have you seen any limitation in age being a barrier, people doing this kind of strength work?

William Ryan:

Oh, not at all. It’s probably more important to do it as you get older. It’s when you take into account things like bone density, balance, all that sort of stuff. Strength training helps with all that stuff. Old people think, oh, that barbell stuff, that’s just for young people. You can modify it so that they can do it. You can bring the height of the barbell up. If you’re doing like a rapid pull movement from their knees instead of from the floor. And the low doesn’t have to be 60, 70, 100 kilos. It can be 20 and they still get a really good benefit from it. It just needs to be challenging and just needs to be done in the right way.

Michael Dermansky:

I think that if we do that classic strengthening work with people that are older, younger as well, but definitely older the maintenance and muscle mass, which is so, so, so important as you get older for diabetes management and the big one is bone density. So I’ve known for many, many years, I kept reading that we can only stop the decline of… we use the rate of decline of bone density and now we have actually a way of preserving if sometimes even improving bone density. If we load people up the right way on the classical strength training, it’s just great to see. You can actually make a difference in bone density. It’s not just, well, hopefully we’ll minimize the damage over time, but we can’t guarantee any of that stuff. So it’s really nice to see that through. And I’ve seen people in their 60s who can lift up and say, I can lift up 70 kilos, not everyone, but there are people that do that regularly and they have this great life as they should.

William Ryan:

I agree with all those points. I think the thing with the strength training aspect too that shouldn’t be overlooked as well. And you just touched on it then is people get very empowered by lifting heavy things. People lift that much weight and go back home and tell their kids or tell their friends. They’re like, Hey, I’m deadlifting 70 kilos at the moment. And people are like, wow, that’s awesome. Lie how did you get there, but it’s just a matter of starting isn’t it? And finding someone to coach you through it and coach you up to that point. But yeah, the mental empowering aspect of it is such… I think it’s a massive thing. I think it shouldn’t be discounted at all.

Michael Dermansky:

I couldn’t agree with you more. I’ve heard that story as well, where I’ve had clients come and say I’ve told my child I deadlifted up 60 kilos or 70 kilos. And they said, whoa, so we had to film it to prove that they could actually do it, but they were very proud. Can you give us an example? I mean, you gave us example before. If you want to continue that one, you can, otherwise another one as well, where you’ve seen someone go through those different stages of having and injury. They’re scared of the early stages, you’ve found some particular things, and when they get to that strength stage and what they’ve had been able to do with their lives from there.

William Ryan:

I think a massive one that really sticks in my mind a lot is a girl who saw me when I was working at the Melbourne clinic who had like quite a severe lumbar disc bulge that was impinging on her nerve root and she was one that was very close to going down that surgical path.

Michael Dermansky:

Right.

William Ryan:

But she was really willing to give 12 weeks of physio, at least if not… For anything to prepare for surgery. Which one: that’s a really good attitude to have. And she was young. She was a younger girl. I think she was only like early thirties. But they had pretty severe pain, worked at a bank so it was either sitting for long periods or standing for long periods. Which are those aggravating factors for that and she just wanted to be able to be stronger to be able to one, just be able to go to work and not be in pain. And then she wanted to go back to the gym. That was a long term goal. So a lot of early muscular strengthening work, particularly around her Lumbar spine in particular, her symptoms probably took about eight or nine weeks to really start to abate.

William Ryan:

And I was thinking at probably the week seven mark, look, maybe this isn’t working and we should go the surgical route. She was like, no, I’m happy with how everything’s going, despite not having much improvement yet. Which for her was quite a good attitude to have. And she was like, I’m pretty committed to sticking out this 12 weeks. And I was like, that’s awesome. So yeah, lots of clinical exercise and Pilates work with her initially, really strengthening the muscles around where that disc bulge was and where the nerve root was affected. So she had very weak hamstrings, could barely do a single leg bridge, which is quite significant but just built her up slowly to that. And I think around the probably 10 or 11 week mark, I was like, hey, let’s just get you doing a modified dead lift with the barbell. Let’s give it a go.

William Ryan:

And she loved it. She felt so good from it because she could do it and be pain free. She found that so empowering and from there we just built up her load gradually, we gradually lowered the barbell height as her lumber control got a lot better, her hip hinge movement, which basically is how straight you can keep your back as you bow forwards from your hips.

Michael Dermansky:

Yep.

William Ryan:

And now she’s back at the gym fully independently. She gets the odd flare up and comes in, but she doesn’t need that invasive back surgery anymore which is awesome. And I’m not sure if she’s had another MRI on her spine, but I would love to see it to see if there was any change to the disc itself or at least to see if the disc is retracted slightly from that nerve root. But it would be interesting to see.

Michael Dermansky:

Yeah we always see the before, we don’t always get that after shot. That’s a great story and that’s exactly the kind of story we want to hear where people are worried they can’t do what they want to do. And through patience and persistence and just slowly loading up as they’re able to do things, they get the life back and more than life back, the life they should have. That’s the way it should be. So to finish up, Will, what take home message or is there something you want people to do? What’s one or two things that you want them to think this is what I really… The first step you should take.

William Ryan:

Look, it’s really, really straightforward. It’s written in black and white on the Australian government, the health department’s website, the exercise guidelines for adults aren’t there as just a nice to have thing. We all should be trying to do 20 to 30 minutes of some form of exercise every day. Walking is exercise. Don’t discount walking, but we also should be trying to do strength work one to two times a week. And if you are scared of starting the strength work, go see someone who can help you with it. See whoever is in your circle that you trust, see your exercise physiologist or your physio or your personal trainer or whoever you’ve worked with before. Someone you trust, go see them, get started, try doing strength training twice a week.

William Ryan:

Do some aerobic exercise on top of that, whether it’s riding a bike or just going for a walk. I think that’s a great starting point for most people. And it’s not drummed into us enough, I don’t think, those exercise guidelines, as a society. I think we definitely should be really, really drilling it into people these days. But that’s our challenge is health professionals, I guess. It’s our role to do that as well.

Michael Dermansky:

Yeah, I think it’s underestimate. My biggest personal one is lack of strength training, like how important strength training is like one or twice a week, ideally twice a week.

William Ryan:

And that only got added to the exercise guidelines really recently.

Michael Dermansky:

Really. I thought it’s been around for a while. I think at least 2009.

William Ryan:

But that’s fairly recently this day and age isn’t it?

Michael Dermansky:

Yeah.

William Ryan:

It’s something we knew was working way back in the ages ago, eighties and onwards, but yeah, the strength training thing, I think it almost used to be a bit of a footnote at the bottom of it, but now it’s actually included in the main guidelines too, so…

Michael Dermansky:

Well the interesting thing is also about diabetes management as well. That before it was just about cardio, cardio, cardio, and now it’s like, no, no, no, you need strength because if you want to manage your insulin, this is the stuff that makes a difference. So yeah, I think it’s just way underestimated. Last thing to end this question part as well is that how long for… so realistically, if I did strength training exercise today, or I looked at these guidelines and wanted to implement it. How long is a real time frame to make a difference?

William Ryan:

Ah, well don’t expect to get stronger in three weeks or a month even. It’s a journey. It’s all about the journey I think more than anything else. So you can’t just get strong and then just expect that you’re going to stay strong. You’ve got to stay consistent with it. I think the biggest thing we probably see, Michael, is the people that stay consistent with their exercise and their training twice a week, they improve every single time.

William Ryan:

And people that will come in for like two weeks and then stop and then come back a month later and then stop again. They tend to sort of stagnate. So I think really to get maybe some change where you start to feel better is definitely around that seven week mark where you feel like your muscles are working better and you might not be much stronger yet, but you feel like your muscles are working better. And then it’s the six, seven, eight, depending on the person even longer sometimes. It’s the period after that where your strength really starts to improve. But like I said, you got to stay consistent and you got to just keep at it, keep doing it, make it a part of your life.

Michael Dermansky:

My magic number I think is about three months. I really see a big change of people’s lives at about three month mark where their muscle strength actually physically changed at that stage. And I think the other thing is you said is that consistency it’s gold. I mean, we’ve had people coming here consistently for 15 years now, too. And they for the whole time all the sudden they have great life because they’ve done the work and they’ve been consistent about it. That’s the real kicker, the consistency as well.

William Ryan:

Yeah.

Michael Dermansky:

Well Will, that’s been a great interview. Thank you very much. Next week, we’re going to go deeper into what an assessment is and what all the different parts are and what we really get out of it to make a difference in people’s bodies. So thank you very much for helping us and hopefully the listers would’ve gotten some great advice from your advice. Thanks a lot, Will.

William Ryan:

No problems at all.