Welcome And Why Recovery Matters

SPEAKER_04 0:00

So you're thinking about running, but not sure how to take the first step? My name is Brian Patterson, and I'm here to help. Welcome to Brian's ROM pod. We're continuing our chat with Dr. Michael Bettler, a surgeon who has moved his expertise into lifestyle medicine and incorporates more osteopathic principles. His aim is to provide not only more preventative techniques to avoid injuries, but also to treat patients so they can return to their favorite sport as quickly as possible. In the second part of our discussion, I'll be talking about how recovery is a key part of any training plan. So these episodes are a bit shorter than usual, but they are still packed with valuable advice. So without further ado, let's dive into our conversation with Dr. Bettler. And if you haven't had a chance to listen to the first part, please do go back and check it out in our catalogue.

SPEAKER_02 1:21

Yeah.

SPEAKER_04 1:21

And is that do you think that's something that people are kind of tend to neglect, the recovery part of it? Um sort of like the sleep and recovery.

SPEAKER_03 1:31

Yeah, I think it it is. Um I guess it's person to person. In my experience with with telehealth, um, you definitely see variation. Um that is is job related, some of it is social related, but um the people that tend to do very well from a strength training and and cardiovascular standpoint, um, definitely focus on sleep, same sleep and wake times, um, like routines before bed, the blue light blocking glasses, yeah. If they are have to be on the phone or something like that.

SPEAKER_02 2:03

Yeah.

SPEAKER_03 2:03

Um to to make sure that their brain is not overactive so that they can get that good rest and recovery.

SPEAKER_04 2:09

So in a way, sometimes, you know, less is more to make sure that you're getting the benefits of the training that you're, you know, that you're doing.

SPEAKER_02 2:19

Right.

Shockwave Therapy Explained Clearly

SPEAKER_02 2:20

Yeah.

SPEAKER_04 2:20

So now I've got down here certain therapies, um, and I've heard of them before, um, shock shockwave therapy. Now, what is it?

SPEAKER_03 2:32

So there's two types of things that that people say call shockwave therapy. One of them is actually pressure wave therapy called extracorporeal pulse activated technology, which is um basically sound waves converted into pressure, and that pressure goes on the tissues. So it's really good for muscle healing, clearing lactic acid, um, getting the sore muscles, it can do superficial things like shin splints, um, and and it can treat that. The real shock wave is something called ESWT or extracorporeal shockwave therapy. Also takes down, converts it through isoelectric technology into energy, and that energy goes through a medium, goes through a lens, and that lens concentrates that energy to a focus point. And that focus is where you want the energy directed. If someone has like a hip issue, for instance, or amphilly's tendonitis. You want to hit as much energy as possible when you're doing that treatment in those areas so that that area will ramp up blood blood vessel growth factors, um, bone growth factors, and tendon growth factors um to the max and some other things in there as well.

Dry Needling For Muscle Spasm

SPEAKER_04 3:35

And dry needle.

SPEAKER_03 3:37

Yeah, dry needling.

SPEAKER_04 3:39

Dry needling, okay, dry needling, yeah.

SPEAKER_03 3:41

So you hear about needles, I think a lot of people think about accuracy, yeah.

SPEAKER_04 3:44

That's what I was thinking about, yeah.

SPEAKER_03 3:46

Um so but the dry needling is a little bit different. So dry needling, we look at sore muscles, um, and we're looking at spasm. So muscle spasm, you kind of find the muscle, the the middle of it, and you take the needle in and you put the needle kind of right in the middle, and you can adjust it back and forth until you get to the area where it's kind of maximally overloaded, and then that basically you leave that in for a little while and it kind of calms down in reaction to that. Um, you can also do something called East M, which you can attach electrodes to those wires that are in there and send it to the code.

SPEAKER_04 4:17

Oh, right. Okay.

SPEAKER_03 4:18

Sounds a bit accelerate that, yeah. So a lot of people like the East M actually.

SPEAKER_04 4:23

All right. So could

Glute Medius Tendon Injury Fixes

SPEAKER_04 4:25

these be um because I um I as I as a running theme sometimes on my podcast, is I had uh was last year I had a glutus medius injury tendon. Uh could some of those sort of therapies uh be used for uh for that kind of injury? Yeah. And it's quite a common injury for forerunners as well.

SPEAKER_03 4:49

Yeah. So so glute medius is a big balance muscle. Yeah, of course. So so one of the things uh as far as realignment is making sure that everything is even on both sides, so you're not stretching one side, stressing one side over the other side. Um shockwave is great for accelerating the healing from the tendon or where the attachments are on the bone. Um dry needling helps if there's any spasm in the area, but also can attract some of the healing factors. So um shockwave increases the growth factors for about 12 weeks after even just one treatment. So it accelerates your body's healing process, basically, is the goal of that one. Um but yeah, balancing and accelerating healing process, uh, magnet is another thing that we could use. And magnet in conjunction with shockwave, basically magnet kind of pushes out all the inflammatory cells to leave the cells with what they need to get better. Right. The things that are stopping them from getting better.

SPEAKER_04 5:41

Yeah. I mean, I th uh and these aren't would this be over like a period of time, maybe four to six weeks sort of thing? Um obviously it depends on the severity of the injury.

SPEAKER_03 5:56

Correct. It depends on the severity, but the the studied amount of courses for the shockwave is three courses. So we do a combination of the pulse activated technology and the focus shockwave on that. And then the magnet, you're supposed to do two sessions a week for eight weeks. Um, but I've had good success with the magnet, sometimes with just doing it with the shockwave as as a singular therapy um at the time and not doing the full course.

SPEAKER_02 6:19

Yeah.

SPEAKER_03 6:19

Um, but yeah, if you ideally it's about four weeks, and and usually, I mean, people do pretty well. Um the shockwave gives immediate pain relief as far as inflammation, but usually like a month to two months is where you experience the reconstruction part and the and the main healing part of it.

SPEAKER_04 6:36

All

Osteopathic Treatment And Realignment

SPEAKER_04 6:37

right. Now I've also got here osteopathic treatment. So are these very different to the other two treatments that you talked about?

SPEAKER_03 6:46

Yeah, so the osteopathic manipulative treatment is the realignment part of it.

SPEAKER_02 6:50

Right. Okay.

SPEAKER_03 6:51

Basically, we put our hands on and feel the tissue and see if there's any muscle spasm to get everything calmed down. We check and see if there's any imbalances in the system to make sure that everything is balanced from one side to the other and and kind of make things even. So um, one of the things as far as imbalance is if people bend over and touch their toes, sometimes they're limited. And a lot of times if you get everything balanced out, you'll be able to get another two to six inches on that because everything is a little bit more even. Um in doing yoga and kind of seeing that, you can actually you can see it very well in people that know their body and and have tried to do the yoga twists and things like that, where you balance it out and you'll you'll be able to do those things a little bit easier.

SPEAKER_04 7:29

Right.

Modern Sports Recovery Goes Mainstream

SPEAKER_04 7:31

So um now obviously from what you've been doing, um obviously you've you know created your own business over the last um I don't know how many years, but have you seen a change over the last 20 years in terms of how maybe how therapies used to be um for people who are recreational runners or just recreational athletes compared to what is you know on offer now? And how's and how's that changed? And is it got obviously it must have got better. Uh are the old ways the bad ways, or maybe some of the treatments that you were doing in the old days? Was that out um was some of that um could be um could be used still today?

SPEAKER_03 8:18

Yeah, I think one of the uh biggest things is for my clinic, what I'm trying to do is bring treatments that were really available to mostly elite athletes mainstream. So, like there's a lot of professional teams in the US that have access to shockwave magnet and things like that. So, so I'm trying to bring them out, um, put them at a reasonable price for people and not try to again make money off people.

SPEAKER_02 8:40

Yeah.

SPEAKER_03 8:41

But balance everything so that the kind of an everyday person that has an injury can come in and get treated and get better a little bit faster. I think in general, um, athletes that are um like 40s and up probably were not taken seriously if they were not in a major sport or something like that. So I think it was really just kind of rest, ice, elevation, splint it, and then let it heal. Yeah. So there's definitely more of an active recovery response now as we move forward. We understand that ice is not necessarily good for long-term treatment. It's really good for the first 24 to 48 hours to prevent swelling. And then heat is really what you want to do because heat helps with blood flow. Anything that helps with blood flow is really what gets the healing factors there and everything. And if you think of like a stagnant puddle where you see like mold and mosquitoes and things like that versus a river, and you don't see anything and it's nice and clean, like those that's the difference between things moving through and things being stagnant.

SPEAKER_02 9:35

Yeah.

SPEAKER_03 9:36

You want to make sure there's good blood flow so that you can get the healing factors there and have everything get better. Um, and I really think it's just like an everyday person now has more access to what the athletes of 20 years ago had access to. Yeah. Um, so that we can function at a higher level. And and again, we don't have to kind of languish and and you lose like hip fractures. The reason hip fractures are so bad is people miss out on the activity over 12 weeks. And it's not that the fracture was bad,

Ageing Well With Strength And Balance

SPEAKER_03 10:04

it's that the deconditioning that happens after the hip fracture was bad.

SPEAKER_02 10:07

Right.

SPEAKER_03 10:07

So trying to prevent hip fractures in aging people is extremely important because you don't want them to end up with that deconditioning. So bone strengthening becomes important, which is where the strength training comes in for that stuff too.

SPEAKER_04 10:18

I mean, my um uh my my father had dementia. So I mean he's um he passed away last year. But I mean, I know um just going into a home, um, you see how important it is to have you know a very strong base, strong legs, because you you you can be very susceptible to to falling um, you know, for for whatever reason, you know, or either you're gonna be you're gonna have to have a frame or something like that.

SPEAKER_03 10:45

So yeah, and that's where the balance training comes in for people too. It's very important. Um, and even one of the things that I've been working on with my trainer, I don't have any balance issues, but strengthening those like unilateral gluteus medias, for instance, yeah. Doing single leg squats, even body weight, just strengthens that um each side so that you can make sure that you're using that muscle. Yeah. Whereas if you're doing kind of all the typical stuff and not working on the balance, that it'll decondition a little bit. So understanding that what you strengthen today will get a little bit worse as you age. So you want to strengthen it so that you can do certain things when you get older that will help with that balance and put you in a position to be where you want to be at that point. So kind of like over-training that today. Um, and this is a kind of a Peter Atya um principle is is training, designing a training program now so that you can attain goals that you want to attain when you're in your 70s and 80s, for instance.

Diet Inflammation And Cancer Risk

SPEAKER_04 11:43

Can I get your opinion on this? This is a bit a little bit off topic in terms of the outline. Um, because over here there was a study. Oh, there was a study done about why younger people get cancers, and they did a study on various cancers, and they were trying to break it down as to, you know, what are the sort of like the root root causes are. Um one of the things is is kind of obesity, um, which I know is a big thing in the US and also maybe in is over in the UK that maybe it may be a cause of bowel cancer. I mean, what what are your what are your thoughts on that? Um I don't know if that's something you've come across.

SPEAKER_03 12:25

Yeah, so I I about five years ago now I went plant-based because I I see the associations, whether it's a cause or not, with yeah, and meat-based diets and obesity. I mean, anytime you have inflammation, cells will not like it.

SPEAKER_02 12:40

Right.

SPEAKER_03 12:41

If you're replicating with inflammation, that makes you more likely to have cancer. So throw fat, that only makes you a lot more susceptible to inflammation and cancer. Um, and these are the things, and obviously, like the foods you're putting in your body to get obese, you're eating high dense calorie foods that are processed.

SPEAKER_01 12:56

Yeah.

SPEAKER_03 12:56

So you're eating things that may have preservatives or something like that that really shouldn't be putting in our body. Um, so so really the best study or the best studied diet to prevent chronic disease and and cancer is anti-inflammatory diets. So, like Mediterranean diet is one of the best ones. Um lot of vegetables, a lot of good oils, um, chicken and fish mostly, not a whole lot of red meat. Um, and I'm not against people kind of eating whatever they eat, but it's important to eat as close to nature as possible. Yeah. And and understand that there are associations with like sugar sweetened beverages and processed meats. Um bacon, unfortunately, is as good as these things taste.

SPEAKER_02 13:36

Yeah.

SPEAKER_03 13:37

The nitrates and bacon, a lot of times they're not not good for you. So it's just important to be aware of it and understand the risk. And for me, because I'm a physician and I'm trying to set an example, I this kind of a little bit extreme and make sure we do it. And there's other reasons to weakless point-based. My son has a lot of allergies.

SPEAKER_02 13:57

Oh, right. Okay. Yeah.

SPEAKER_03 13:59

So we are our kids are actually pan-plant-based, also, and there's no growth differences in pipe-based kids or anything like that. Yeah. Um, trying to kind of almost do a study and see going forward and and where the cancer risks really are, you know.

SPEAKER_04 14:14

Yeah. Um, and and and another question is basically is,

Health Inequality And Food Deserts

SPEAKER_04 14:18

and and we do, I do hear this a lot. I mean, I know this is running podcasts, but obviously they are very relatable um themes here in terms of nutrition um and also the injury prevention. But people, I uh something I always come across is about how um becoming either you know, for injury prevention, it is kind of let's say if you are sort of of a demographic where you're quite wealthy or not not wealthy, but you know, you're you're quite affluent or and you're kind of that middle class, then you do have the ability to have the have access to all these particular resources. Where if you're not, and if you you know, if you come from a sort of lower class background, you don't have access to all these different resources or have the nutrition or being able to do things. And then maybe you are susceptible to to injuries, cancers, and all these different diseases. Um is that sort of the same situation you um or you've witnessed in the in the US?

SPEAKER_03 15:18

Yeah, absolutely. So what's one of the biggest things we studied in in ethics, um, you know, is access to food, access to healthy water and things like that. You look at cities in cities where there are poorer populations that don't have grocery stores that don't have farmers markets, for instance. So you're not getting all the fresh foods that they really they should be getting. And it's a lot cheaper to get the processed foods than it is to get the other stuff. Um they they may have mold in their apartment, but they can't do anything about it because they can't move out because they can't use to.

SPEAKER_02 15:47

Yeah.

SPEAKER_03 15:48

So there are a lot of various things that the that people have to deal with when they don't have the money to get out of those situations that do unfortunately lead to things like that. Um and it's something that people are working on to improve access and and find the food deserts. But it comes from a very altruistic um volunteer run, uh, you know, not funded and mostly grants and donations. Yes. Make sure that these things are available.

SPEAKER_04 16:16

Well, food, food banks, that kind of thing, or right.

SPEAKER_03 16:19

Yeah. Well, and and bringing fresh food. So you know it's not profitable for big businesses to put a grocery store where there's fresh food where people can't afford it. So you know, big businesses are not gonna say, let's do that. Um you're just gonna not have the things that and the access that people really should have access to from even just based human levels.

Best Injury Prevention Advice For Runners

SPEAKER_04 16:38

Do you do you I mean, as um uh just moving back on topic, is that um from let's say for recreational runners, is there any one thing that people that use that you one piece of advice that you can give them to help them with preventing injuries? It could be as limpill as maybe just get a couple of extra hours of sleep, sort of thing, or cut back on the stress in your life, you know, don't do the the overtime or spend more time with your family, or it could be change your training regime or something like that.

SPEAKER_03 17:13

Yeah. So so those are a good suggestion.

SPEAKER_04 17:16

Yeah. I've answered my own question.

SPEAKER_03 17:19

So so sleep is definitely one of the most important ones. Like I said, your growth factors go up at night. So the the healing really occurs when you're sleeping, not while you're awake and moving around. If you don't get those growth hormone spikes, your your body's not going to repair itself. Um the other thing that I think a lot of people end up is is footwear, is another big thing. So sleep and footwear is probably the two biggest areas that you want to hit. Like and myself have put too many miles on a shoe, and you definitely notice as long as footfalls and things like that, like you definitely get off and you start feeling things a lot more, like you don't have the cushions that are gonna prevent knee issues, for instance, for me is is where that I feel that. So making sure I change my shoes about every 150 to 200 miles, um, which ends up being maybe once a year. Yeah for for a recreational runner is something that is important, very important to injury prevention.

SPEAKER_04 18:11

And is there um is there something that runners can do if they're suddenly they they feel that they've maybe done a run and they've had a bit of a nickel, is it worth just you know resting

Niggles Pain Rules And When To Seek Help

SPEAKER_04 18:31

that? And if it happens again, then maybe go and see a professional.

SPEAKER_03 18:36

Yeah, I think it's the process I would suggest. If if you have one little twist or something like that that causes a problem, then you know, ice it right after the run, heat it for a couple of days, go back at it again. Um, and depending on your level of how hard you're going at it. Um like like a recreational runner, like you said, it may not cause as many issues. I had shin splints for a long time and kind of ran through them, probably not what I would advise anybody to do. And I and I just, you know, I I tried a lot of different things, but the footwear really was what ended up helping me in the end for that one. Um my my sister-in-law actually, on the other hand, uh, was training for a marathon, right? Um, ended up with a pelvic fracture because she was just going too hard. So she instantly had to stop. She found the fracture and couldn't continue her training. So there's there's a level of pain that you just, you know, it's important to listen to your body, and everybody deals with pain at different levels as far as feeling it. Um, but if there's anything that causes a small tweak and then it goes away, I think you're okay. But it's always if you have access to someone like me, I think it's good to see them and just get some advice if you want to get it looked at. If and then for someone like my sister-in-law who really had just kind of pain all the time, and even after that happened, just walking in the house, you're obviously not going to want to challenge that. You should go get it evaluated and see if there's anything major. And she had to adjust her nutrition and make sure that she got the right nutrients in her to make sure that her bone strength was was better because she had osteopenia after with all the running and calories that it took up from her body.

SPEAKER_04 20:10

I know you we kind of touched on it earlier on in terms of the AI. Um, and I know there is a danger of self-diagnosis. I'm sp I'm sure you you see that. Uh, would you advise the audience in terms of self-diagnosis, um, in terms of you know, AI or looking online um for particular treatments?

SPEAKER_03 20:33

Yeah, I I think it's just important to have someone that knows how to translate that um specifically. So if it's anything that's concerning to you, um, you know, get an x-ray to confirm. If it's something that that could be found on x-ray, that's okay. I mean, they have over here at least they have um urgent care orthopedic centers now. So you can go and say the therts, and a lot of times they'll do the x-ray and tell you what's going on right away. Um but see a podiatrist

AI Self Diagnosis And Getting It Checked

SPEAKER_03 21:00

or someone like that, if it's foot issue or running issue, some podiatrists can do all the way up to the knee. So someone that that can help you interpret that, um, even if it's a family member, you know, take it to someone that might have a medical lien or if if you know someone that's a physiotherapist within the family, it's it's okay to have them kind of look at it and get their advice. But um self-diagnosis, well, I don't think there's an inherent problem with it. I think that there's obviously rabbit holes that can be gone down that that are good to you know bounce off of people.

SPEAKER_04 21:30

Yeah. Yeah. Um I think, well, I've Dr. Bedler, um, Michael, you've been a fantastic fountain of knowledge uh for us today. But I can see that one of the main themes here is to make sure you've got the right shoe. Um, because uh that can obviously uh you know uh having the wrong shoe can obviously lead to a multitude of of of issues. Is there anything else that you feel that from our discussion today that basically um you know, we should be thinking about whenever we are going out, you know, on our run and then um hopefully um maybe preventing um any future injuries.

Recovery Routine And Where To Find Dr Bettler

SPEAKER_03 22:10

Yeah I think just having some sort of recovery routine. I mean sleep obviously is important. Epsom salt bath so that the magnesium salts can get in and replenish your muscles and bones. Um good nutrition, make sure you get the protein you need so your body can rebuild when it needs to um just all the hit all the basic things and and have a recovery routine. Don't not recover. Sleep is not the only thing if you're doing marathon training or long run training or ultramarathons. Like you need to make sure you get the nutrition and you need to make sure that you have a recovery program in place because without recovery you can't rebuild you can't get stronger you can run as much as you want but if your body doesn't make muscles stronger, make the bone stronger, you're not going to be able to push the envelope. Yeah and obviously as one gets older I remember um listening to an interview of Matt Damon when he was doing one of um his uh uh one recent action films uh the Bourne films and he said I think the last one he said he said it as because he was a lot older from the first time he did it he said that he he just didn't find you know he needed to recover a lot more because um you know yeah yeah absolutely it gets harder your your body doesn't push the things like it like it used to as far as having the growth hormone having the testosterone um and that's another thing that's okay to do get your blood work tested if you want to see if everything's in the right place because if your testosterone's low or something else there's options um dietary and otherwise that you can get in um with advice to make sure that you get um well well thank you very much Dr.

SPEAKER_04 23:46

uh Michael Bentler um before we go is where can we we reach you or you know sort of can where are you on uh online?

SPEAKER_03 23:56

Yeah so ctsportsrecovery.com is my website we're in Connecticut if anybody's ever over there come visit if you'd like to um we try to add information on there on our blog um we have some videos on there for posture and core strengthening and and pelvic floor exercises um we're always trying to add options to remote because you know people definitely like remote so yeah um I'm working on getting someone for nutrition counseling and fitness counseling at some point um I have I have a guy here but he's gonna go through some education so we're always gonna do things to try and advance what we have as far as offerings uh both in person and remote.

SPEAKER_04 24:31

Right. Okay. So I think thank you very much. I'd just like to say a big thank you to um Dr. Bentle for coming on the podcast and um I'd like to say goodbye from him and also goodbye from me until next week. Thank you very much. Cheers. Bye bye