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June 07, 2023

Run Forever - Keeping Endurance Athletes Healthy with ultramarathoner Sean Greenspan

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Dr. Yoni Rosenblatt: Welcome to the true sports physical therapy podcast, this one is gonna be super different because I'm gonna play the role of guest, and I've got my buddy Shawn Greenspan, who is an elite level endurance athlete. Can we call you an ultra marathoner?

Sean Greenspan:
For the show. We can call. [laughter]

Dr. Yoni Rosenblatt: Okay, would you call yourself an ultra marathon on the weekends when you're out of the bar? Depends who's asking, okay.

Dr. Yoni Rosenblatt: Depends who is asking.

Dr. Yoni Rosenblatt: So, we got Sean Greenspan, who is himself really an ultra marathoner by day and a media mogul by night. He's gonna be asking me a bunch of questions.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: I think that's what we're doing, and hopefully there's some knowledge in here for the audience. Admittedly I'm used to being the one asking the questions, but, I'm happy to do my best trying to answer some questions.

Sean Greenspan: Feeling good. I feel like we're gonna get a little... [laughter]

Dr. Yoni Rosenblatt: As long as you feel good. Deal.

Sean Greenspan: I thought I was gonna get the intro.

Dr. Yoni Rosenblatt: Sean, you intro... Go ahead. How would you do it if this was your pod.

Sean Greenspan: This is... Well, this is my true sports podcast...

Dr. Yoni Rosenblatt: There you go.

Sean Greenspan: This is a true sports podcast, we got Yoni here today. I get to pick his brain as a pseudo ultra marathoner, a wanna be NFL player, NBA player, really, what I'm excited about Yoni is trying to uncover some of just like the basic things. Right now I'm an ultra marathoner, but I know that running and hiking are things that I love, and I think a lot of people enjoy. I know that lifting weights is really good for you, and I wanna be able to do that without you know bad back and shoulders for like the rest of my life, and I want to learn a lot on this because I think as a 29-year-old who stayed active, I'm getting away with a lot. Versus just like doing what I should be doing.

Dr. Yoni Rosenblatt: Sure.

Sean Greenspan: And Kelly Starrett, who was on your pod, he told me one time that the body is really resilient, and when people run for 40 years with bad form and don't take care of their joints, and then it breaks down there, like why that happened? It's the other way, it's like, No, your body has been amazing for 40 years...

Dr. Yoni Rosenblatt: Yeah.

Sean Greenspan: And it's like finally breaking down.

Dr. Yoni Rosenblatt: Yeah, like I always say, we're okay until we're not and so like how do you either kick that can down the road, of that point to you not being okay, or how do we avoid it? 

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: Right? And that's the way I kinda look at helping people achieve their goals, whether it be ultra marathoning in like the lunatic that you are, or playing pick up basketball on the weekend, it's just about kicking that can down the road.

Sean Greenspan: Absolutely. And I think where I wanna start is with running. I think a lot of, running is... I think it's a natural human movement, even whether it's like power walking or whatever, I feel like it's great for the brain, it's great for cardio, great musculoskeletal, a lot of people are either afraid of it or try and can't, right? What are some ways to get into running if you feel like you can. And you wanna do it safely.

Dr. Yoni Rosenblatt: Yeah, so you wanna think about... And this goes towards any athletic endeavor, you wanna think about the necessary needs your body has to go through in order to accomplish that activity, so when I break down running, and this comes up a lot post-surgery, so this isn't such a foreign thing, how do we get that athlete back to running? Well, we know that athlete has to be able to do what they have to be able to hopefully produce force somewhat symmetrically from their legs right? So that you can stay in a straight line. You hope that happens. You have to be able to do it repetitively now that the endurance of the ability to do that is variable... Yeah, go ahead and raise that.

Sean Greenspan: I got you.

Dr. Yoni Rosenblatt: So you wanna put together a program that forces or encourages symmetry and forces and encourages the ability to do something repetitively, which would be an endurance model, and then you wanna think about the structures at play, so the first thing is your foot hits that ground then that force travels up, so you wanna start from the ground up, so how is the ankle doing, or if you don't wanna talk joints, how are the muscles in your foot doing, how's the calf doing, how is the hamstring quad doing, how's your glut doing, how is your low back doing. And I would start working my way up there to create strength to support the activity of running.

Sean Greenspan: Gotcha. So different strength exercises for each individual.

Dr. Yoni Rosenblatt: So... Yeah, no, I would like to ideally put those together because that's the way we function as an athlete, right? It's important that as we identify weaknesses, if we need to isolate great, and if you have the time and ability to do that, then yes. Hey, here's your calf work, but if you can string those together and allow the body to act like a chain, that's where Kelly Stareet's genius comes into play when he talks about how amazing the human body is, it's our ability to function like a fine-tuned machine working together.

Sean Greenspan: Yeah, wonderful... You're talking about that we need to produce force somewhat evenly.

Dr. Yoni Rosenblatt: Yeah.

Sean Greenspan: Right? Is that like where single leg work would come in...

Dr. Yoni Rosenblatt: Yeah, exactly. That's exactly where that comes in, you wanna make sure that you're not just laying down poor habits and biases, so very often I see this a lot in the basketball population, where the opposite leg to the dominant hand will be that athletes stronger limb, 'cause they're just used to jumping off the left to go up, right? And so you wanna make sure that those legs somewhat catch up, so you're gonna use kinda that right leg in that instance in that example, to be the throttle, like you wanna keep that leg working as hard as possible without giving up and then match it with the left, and I love working, we call it unilaterally on the BIs, make sure you're working one leg at a time to make sure that they're each progressing accordingly.

Sean Greenspan: I really like that. You also mentioned... You talked about the feet, the muscles in the feet. I can tell you again, as someone who's been playing sports their whole life, never did I think about muscles in our feet or strengthening the feet. Now it's a trend. Some Instagram Ad got me to buy these vivo barefoot. Everyone's walking around with barefoot shoes. Talk about the importance of the feet in running, really in like a lot of activities.

Dr. Yoni Rosenblatt: Yeah. I like to train with shoes on, with shoes off. I think it makes a lot of sense to train in the environment that you're gonna be competing. That's not always barefoot. We know there are benefits to training barefoot, and that's what we call intrinsic muscle recruitment or strengthening. And those are the muscles that run from your toes to your heels to make sure that those don't go to sleep and get really weak. The trends in and out of shoes and running shoes, they continue to vacillate and it's really this ugly underbelly of the shoe world where the shoe... Let's say New Balance. The company will come out and call the local runner running store and say, "Hey, we're gonna give you this amount of merchandise. You gotta sell this. Make sure you're pushing this or that."

Dr. Yoni Rosenblatt: And so don't necessarily trust the shoe salesman that you walk in to find, but understanding that you want those muscles to be robust, to be strong, to be able to handle consistent force. And that's the way you train them. By pulling them out of shoes and getting the muscles that run from your toes to your heel to kick on, get stronger, get more resilient to the forces you're gonna put through. Another thing that I love to do, and really credit to Schlesinger or schlesstrength on Instagram, is to float the heel and get the posterior chain being, I love throwing the foot into that, but the bottom of the foot, the heel cord being your achilles tendon, your calf, and then your hams and glutes. And so if you can isolate that and load that and get pressure off your heel and more to towards your forefoot by doing what's called a heel float where we have the athlete just balance on the fore foot and keep that heel up in the air. Like if you're standing on a step. And do exercises there and train like that.

Sean Greenspan: What type of exercises like?

Dr. Yoni Rosenblatt: So that would be things like, my favorite is a single leg RDL, so just hinging over that planted leg, but also squat work from that position. Also hydrants and glute work and things of that nature. And sometimes it's just balancing to encourage all of those muscles to kick on. That combats the disease, which has occurred from these massively padded shoes. Like you'll see. Like the Hokas or the New Balance beasts and stuff like that.

Sean Greenspan: What do you think about when you just see the normal person walking around in the Hoka ones or whatever like...

Dr. Yoni Rosenblatt: I just think they're getting weak.

Sean Greenspan: Yeah. Oh, I actually... Here's something that I've encountered is... This is actually... I encountered this with my dad who's 64 years old and has foot pain and wears shoes in the house. Wouldn't come into my house. [laughter] Wears shoes around the house and says, do like, and they're... They're juiced up. And says, "Doing anything barefoot hurts." What would you recommend for someone like that?

Dr. Yoni Rosenblatt: I think you gotta train through that. By the way, that used to be me. There...

Sean Greenspan: Train through that.

Dr. Yoni Rosenblatt: You gotta train through that pain, unfortunately. And I rarely say that, but two pathologies that used to keep me up at night in treating them. One was heel pain, plantar fasciitis. The other was lumbar stenosis, which is a narrowing of the spinal column. The only way that I really got decent at helping patients with heel pain and foot pain is barefoot training and balance training and understanding what the mechanics of the foot should be and how to train that. That is not in shoes, because what... And it's not, by the way, in heavy orthotics necessarily. And you're talking to a guy who studied for a long time to learn how to make custom orthotics for people to put in their shoes. It's just the literature doesn't support it. For sure, the literature does not support custom versus over the counter. But secondarily and anecdotally, although maybe there's literature on it, you gotta train barefoot to get those muscles stronger.

Dr. Yoni Rosenblatt: It's crazy how we start changing our outlook depending upon the body part, whether we're gonna train through pain and hope that it helps versus just run away from it and put them in, essentially, cast like orthotics. I think as a whole, we've come around to being intelligent with our dosages, getting the tissue to respond and become stronger or more robust or more resilient, and the pain goes away. I don't know why we have trouble saying, "Oh, it's in your shoulder, so we shouldn't do that." Or, "It's your hip, so we shouldn't do that." I think it's really applicable to the entire human system. Again, it comes back to Starets' comment, which is we are unbelievably resilient and we will learn to adapt if we intelligently dose those interventions.

Sean Greenspan: Yeah. I enjoy hearing that. And what do you think when you... You keep saying train barefoot, train barefoot. What do you think about training in barefoot shoes or minimalist shoes? 

Dr. Yoni Rosenblatt: I think it's great. I think it gives you the ability to be on different types of train and not cause damage to the foot. So that's a good thing. One thing I encourage you to get away from however, is say you're a basketball player, I think you need to spend time with those high tops on in training. If you're a football player and you're working on field work and cutting, it's one thing to be barefoot and get the muscles used to it. It's nice. And I think it's an intelligent add-on to say, "Okay, you're good barefoot. Let's strap up some cleats and put you on the field." Mimic what you're about to do. Make sure you can handle that, because invariably muscles are gonna respond differently. So let's make sure you're strong there.

Sean Greenspan: So I heard two things there. One with the barefoot shoes. It sounds like they're fine if maybe your only surface is concrete, where there might be something your stepping on, but if you're on a clean turf, you would prefer barefoot, it sounds like.

Dr. Yoni Rosenblatt: I would do both.

Sean Greenspan: Yeah...

Dr. Yoni Rosenblatt: I think you gotta do both.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: You have to be barefoot because that's gonna help the intrinsic muscles. You have to be sports specific or activity specific.

Sean Greenspan: Wonderful. Yeah. That's cool. It's funny 'cause I play a lot of basketball. Never think about doing my plyometrics in basketball shoes. Why not though? It's like...


Dr. Yoni Rosenblatt: Why not? Outside, yeah... Outside of time, why not? It's the way you're gonna compete. I always laugh because I give baseball players a harder time because like, they just can't take their flat brims off. Like they're in the weight room and they're just wearing flat brims. But it's the same thing with basketball players. They're caught, they're training in high top basketball shoes. That doesn't make sense to always be in there. But Sean, if you're a basketball player, train in high tops once in a while.

Sean Greenspan: Yeah. Okay. Thank you.

Dr. Yoni Rosenblatt: Yeah.

Sean Greenspan: And I can't take the label basketball player. I already took a label. I feel guilty about it.

Dr. Yoni Rosenblatt: You shouldn't.

Sean Greenspan: An ultra marathoner.

Dr. Yoni Rosenblatt: But it's important to realize you've run how... What kind of distance races? 

Sean Greenspan: A 100 mile.

Dr. Yoni Rosenblatt: Okay. That makes you an ultra marathoner, doesn't it? 

Sean Greenspan: I think so.

Dr. Yoni Rosenblatt: Okay. Yeah. So own that.

Sean Greenspan: It's run it, run something about a little tangent or something about the ultra-marathons. Like it just, I don't know, like I said before, like running feels like the human movement and like I never thought I'd be an ultra m... I never thought I'd run a marathon.

Dr. Yoni Rosenblatt: How'd you get there?

Sean Greenspan: My buddy called me and said... COVID. That's how everything started, right? I don't think there was a world before COVID.

Dr. Yoni Rosenblatt: There was not. There wasn't.

Sean Greenspan: My buddy called me and said, "Hey, I'm signing up for a 100 marathon... Or I signed up for a 100 mile marathon and I need you to pace me." And I was like, "Cool, I'm there." And I was like, "What's that entail?" But I'm in either way. And he's like... He goes, "Well you could pace up to the last 50 miles and I don't have another pacer." I'm like, "Just say what you mean, man. Like I'm running 50 miles." And this was like... My knowledge of running was very, very low. And I was like, "I'm young, I'm in shape. Yeah. Easy." So I trained hard for a month and went out and did it. And at 2:30 in the morning in Utah, it was 15 degrees. He was dry heaving, having an asthma attack. And we were about 25 miles in and I quit on him. I left him there. I was like, we got back like near the cars where I could just tangent off. I was like, "Dude, my feet hurt. Like I'm dying." And he was like, "No, I really need you." I was like, "No, no, no, I'm dying." Like I've been struggling with this for hours. So I went back to the car. I kinda like drove the course and like helped him finish, but definitely wasn't there with him most of the time. And something was clicking in my head that just like, it was like one of the first times, like, I'd just been like severely humbled and I quit like on something.

Dr. Yoni Rosenblatt: Not something, a guy. Quit on a guy.

Sean Greenspan: A guy, a very good friend.

Dr. Yoni Rosenblatt: Who almost died.

Sean Greenspan: Who almost died. [laughter] Good thing he didn't.

Dr. Yoni Rosenblatt: But he didn't.

Sean Greenspan: And then, yeah, I signed up for a 50K race and I told myself, " I'm just gonna train super hard for it." And then right after that, like I was in pretty good shape and he asked me to pace him on another one. I don't know why he asked me again. But then I did a 50 miler and like, that's actually... It's not that like a 50 mile runs a training run, but like, if you look back at a 100, that's how people trained. They signed for a 50k, a 50 miler, a 100k, a 100 miler. So I was like... And now these were on the math and I was like, you know what? This is the best time to train for it. So I signed up for one, a couple months out and trained... I really, really trained hard for it. And it was interesting because even that like 25 miles, my feet hurt. Like my body ached for like two weeks. And I overall, if I look back at the training for this 100 miler, I trained for about 10 months. And you were talking about the body adapting. I'd get to a place where I'd run a marathon like two or three days in a row and I wouldn't like... It felt like maybe I lifted a little harder, but like, just like a little sore.

Dr. Yoni Rosenblatt: I love that. Okay. But to start this story, you're like, "I don't really think I should be called an ultramarathon... " Dude, you're a freaking ultra marathoner. Also what's interesting is I feel like I met you like right around that time.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: I think like right before you completed.

Sean Greenspan: Yeah. Yeah.

Dr. Yoni Rosenblatt: But you look like you're healthier and in better shape today than then. What do you attribute that to?

Sean Greenspan: Really, really...

Dr. Yoni Rosenblatt: The true sports podcast.

Sean Greenspan: The true sports podcast.

Dr. Yoni Rosenblatt: Other than that.

Sean Greenspan: I've just been listening to this and... It's funny that you say that because I was playing a lot of sports and lifting a lot of weights. I think that's an extremely healthy combination. Lot of basketball, lot of weight lifting. Running ultra marathons, my big issue with it is I don't think it's the healthiest way to train right? I lost 20 pounds and I couldn't have been eating more. I mean I got my testosterone check plummeted. Like my testosterone was like in the two's and they're like, "Do you sleep?" I'm like, "Yeah." Like, "Do you eat animal products? Do you lift heavy?" I'm like, "Yeah, yeah, yeah." And it's over-training, right? It is over-training, so I don't... If I had to guess my cortisol was probably high. And that... And I do feel more energized. Now you might ask why I just signed up for one last weekend. Another one.

Dr. Yoni Rosenblatt: I was going to ask that. Yeah.


Sean Greenspan: And it's because there's something about having like a big massive goal that's also makes you feel good. I noticed that when I was training for this 100, I... Was the first time in my life I was able to build and maintain a meditation practice. I didn't have a cheat meal for nine months. I don't think I was in bed past 8:30 PM but one day, and it was my friend's wedding. Everything kind of fell in line 'cause I was scared as shit. I was like, "Dude, if I don't do everything right, I'm not finishing." So it's kind of like both sides of it. I do feel holistically more healthy now, but again, I don't feel like I have some huge goal at all, I didn't.

Dr. Yoni Rosenblatt: Yeah. Listen, that fear thing that you just referenced is a real thing. I remember talking about on the business side. Like what the number one predictor that I thought was, or the number one thing that I could pinpoint in the success of our business, True Sports. And I think it was fear. I was just freaking terrified when I started and I just really felt like, if I didn't stay extra to see that patient or come in early to see that patient or spend the night on that treatment table so I could see the patient the next day, if I didn't do those things, I was so scared it would fail. And that's... Man, what a motivator that is. Right? And so it's like, it sounds similar to you with the ultra, like you were probably terrified that mile 26 you were gonna feel like you did in mile 25. And when you bailed. And so that fear, man, that'll get you in bed early, it'll get you outta bed early. It'll make you do everything. Right?

Dr. Yoni Rosenblatt: And so I think sometimes having those goals, like starting your own business or staring down the barrel of an ultra-marathon is enough to get you rolling.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: Right? 

Sean Greenspan: And that's really interesting. I like that correlation to business. And for those that don't know, how many locations do you have with true sports?

Dr. Yoni Rosenblatt: About 13.

Sean Greenspan: 13. So, I mean, you've built a pretty impressive business. I mean, 13 location.

Dr. Yoni Rosenblatt: But like I always say, anyone can sign leases.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: You gotta fill them.

Sean Greenspan: Yeah. [laughter]

Dr. Yoni Rosenblatt: But we're doing okay.

Sean Greenspan: Yeah. I mean, you have 13 locations. I know there's a lot of things that people don't see that you do that, whether it's how much time you're giving each patient. The fact that you've partnered it up with the gym experience I think is huge. I mean, you do a lot. And I think for those out there, it sounds like chasing any goal, business, fitness, relationship, whatever, fear's not maybe always such a bad thing.

Dr. Yoni Rosenblatt: Yeah.

Sean Greenspan: Don't you say?

Dr. Yoni Rosenblatt: Yeah. I mean, I think it gets your cortisol level up, right?

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: And I think it might be a problem for longevity, but when you're getting rolling or when you're laser focused on a specific goal, I think it's important.

Sean Greenspan: Yeah. Alright. Now we're gonna roll into something that hits home for me because, everywhere you see on the Internet, people that have enough money in the bank to retire and multiple houses talking about how we shouldn't be working too hard, right? I feel like life ebbs and flows a bit. And they all are, Hey, I did that, and now I'm at, I did that hard work. I was living in fear. I was living in stress. I built this amazing thing just to realize that's not gonna solve all my problems. You can't live like this forever. And then I kind of either automated it or stepped away or pivoted. What do you think about that? Because I almost feel like yes, to their point of like, it is, you can't live like that forever, and it is good step away, but I feel like that part one needs to happen. [chuckle]

Dr. Yoni Rosenblatt: I think that's true. I don't know how to get to part two without part one. And I think, I learned from one of my mentors and really good friends who you'll hear from on the pod soon enough, a guy named Dan Rautenberg, dude, he owns like a billion practices in the tri-state area. He said, and he probably got it from somewhere else, which is, "What got us here is not gonna get us there." And I think it's important to have that fear or that hunger and that balls to the wall mentality to start. It'll help you see what's next. And no, I don't think it's sustainable necessarily, but I don't know how to do it without that coming first.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: Play devil's advocate though. Do you think it's possible? You think it's possible to have like a awesome work life balance? Like play it slow and eventually you'll get to whatever level you want to get to?

Sean Greenspan: I think it's possible. I don't think it's that realistic. I also don't know if it's how we want to get there, because I haven't built anything like you. But I've, on a micro scales, it's like look at the ultra-marathon, right? Being able, like the depth that I was at at some points, training for that race and during the race allows me to see the other side and get the human experience. And if someone was like, "Yeah, that spike in your cortisol took 23 days out of your life, alright." [chuckle] Yeah.

Dr. Yoni Rosenblatt: Sign up for that.

Sean Greenspan: Yeah, I'll sign up for that. Someone actually, Peter Attia talks about how he believes emotions are similar to how we feel speed on an airplane. Like when you're coasting on an airplane, you don't feel it, but take off, you're like, head goes back against the plane and that's how he thinks about emotions, right? And he said he loves those endurance events. He's a swimmer because he's like, "You're like literally at the bottom of the barrel and then you finish the race." And that's like, you're at that the bottom and then the top, and it's like that acceleration of emotions feels amazing. And I think it's like a similar thing, whether it's with business or whatever, that you are, you need one to see the other better, right? You wouldn't really feel like you needed that work balance if you didn't put in the work and earn it, right?

Dr. Yoni Rosenblatt: You gotta earn your Mondays, right? So like you gotta, so comedians say, right? You gotta put in that grind over the weekend in the comedic world to earn your Mondays to just sit around. I think this struggle becomes, and really transparently, this is my struggle, is how do you shift gears, dude? 'Cause when you've spent years running at a certain pace and there are people that work way harder than me, I've never met them.


Dr. Yoni Rosenblatt: But I'm sure they're out there who are working way harder than me. How do you shift gears to say like, "Oh, let me smell the roses." By the way, are people gonna be there with you to share the smell of the roses if you're grinding for too long?

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: You gotta think about like, who do I want there? Who do I want to be a part of this journey, and how am I feeding those relationships? By the way, that doesn't mean like, when I use that analogy, I'm not necessarily just talking about family. I'm also talking about coworkers and teammates and people there with you. Are you building an environment? Are you building a team where people wanna be with you, wanna want to help you the whole time because they see a similar mission? Or are they just gonna start peeling off? And I think that can affect how far you go. And that's why when I say, and when Dan says, Dan Rautenberg says, "What got us here won't necessarily get us there." You gotta figure out where is it that I want to go and who do I need around me?

Sean Greenspan: Yeah. Yeah. You're shifting gears question. I don't know if anyone has just solved that. Look at Brett Favre. [laughter] Right? I mean, I retire, I'm back. I retire, I'm back Right. I think a lot of like, that's even why these people are out there on social media and podcasts talking about that because they're struggling with it. And that's like almost their form of like talk therapy. Like they're working through it then. And that's just your next challenge. I can say something that I've really started to try to shift in my head is to understand that things that might support the work life balance or the balance in general here. 'Cause we're talking about really everything. That is also work, right? Again, I built that meditation habit, which meditation's like, I think as relaxing as it gets. [laughter]

Sean Greenspan: From this... From the training for this ultra, I've been able to keep it. Some might say, "Oh, I don't have time for that. I'm on the grind." That's work. I woke... So last night I got in very late, which is super, super rare for me. Woke up early or woke up early, but still later than I usually do. And was like feeling kind of pressured. I gotta get to work. I got emails I gotta get to, I gotta get my morning training session in. And to just sit there for like 15 minutes, like that was also work. But work that's gonna like allow me to work longer. So...

Dr. Yoni Rosenblatt: No, I think... But you're making a good point, which is when you look at the ability to train for long term or you look at the ability to be successful in business for the long term, you have to work at the recovery side of things. And we're starting to see that with elite level athletes. There's no question about it. One, you've learned from here a guy named Mike Burton who takes his recovery. He's a fullback now with the Broncos. He takes his recovery as seriously as he takes his back squat. And it's the same level of effort that he's putting in because without one doesn't come the other.

Sean Greenspan: Yeah. Active recovery.

Dr. Yoni Rosenblatt: Active recovery.

Sean Greenspan: Yeah. Not.

Dr. Yoni Rosenblatt: Or being active in your recovery. Sometimes it should be passive like Boots.

Sean Greenspan: Yeah. Boots.


Sean Greenspan: It's a good time for a Boots commercial.


Dr. Yoni Rosenblatt: It's a good time for a Boots commercial.

Sean Greenspan: Well that was a great tangent. I wanna bring it back to something that does hit home for me personally and with a lot of people around me while we're talking about like physically training and it's back pain.

Dr. Yoni Rosenblatt: Yep.

Sean Greenspan: Back pain. Everyone has back pain.

Dr. Yoni Rosenblatt: Yep.

Sean Greenspan: And I think there's... We're not... I don't want to talk about acute back pain, like I slipped the disc. Right? I wanna talk about chronic back pain that makes people feel like they're scared to enter the gym, scared to even start running. What are some of the common causes of chronic back pain?

Dr. Yoni Rosenblatt: Okay. So there are a ton of things that can affect the feeling of pressure or achiness or pain within the low back. Just like with any pathology when you walk into that room, I always educate the therapist to try to say, "Okay, what is my list of things that could be causing this low back pain?" So when I think about low back pain, it is, if it's not that slipped disc, I'm trying to think like what could possibly be causing excessive force to be running through those joints or through that low back. Tight hip flexors is number one. Where hip flexors attached, they actually attach to the anterior portion of your transverse processes. That means the front portion of the side part of your spine. Okay. So that means when they're tight, it's pulling forward and almost like overarching the back.

Sean Greenspan: Okay.

Dr. Yoni Rosenblatt: Very often patients hate bending backwards when they have low back pain. They hate standing for long periods of... All of that is what we call an extension moment or bending backwards of the spine. If your hip flexors are tight, it keeps that spine extended always. That's one thing.

Sean Greenspan: Let's talk about hip flexors.

Dr. Yoni Rosenblatt: Okay.

Sean Greenspan: If you can imagine having a desk job and running an ultramarathon.

Dr. Yoni Rosenblatt: It's horrible.

Sean Greenspan: I know what tight hip flexors is.

Dr. Yoni Rosenblatt: Yeah. But you're always standing when we're on calls.

Sean Greenspan: That's 'cause I'm trying to impress you.

Dr. Yoni Rosenblatt: Okay. [laughter] It's working.

Sean Greenspan: It's 'cause you're a PT. I'm like, "Oh Yoni, I stand all day every day.


Sean Greenspan: But what are some things that get tight hip flexors. Sitting right, 'cause it shorten them.

Dr. Yoni Rosenblatt: No questions. No question. Yep.

Sean Greenspan: And then running, right? 'Cause it is...

Dr. Yoni Rosenblatt: So running can keep them tight, but it really depends upon like the way you're using your muscles. I think a better tie-in would be, if you're doing excessive amounts of abdominal work, but you're not using your abdominals, you're using your hip flexors, that will overwork them and tighten them. Yeah. So that's another thing where you think you're doing going good. And you're kind of missing stuff like that. And I think those hip flexors are just one to get tight because so much of what we do is seated. Even if it's like you're driving excessively. That... It's a seated position, but that'll tighten them up.

Sean Greenspan: Yeah.

Dr. Yoni Rosenblatt: There's an interesting study looking at the correlation between tight hip flexors and weak glutes. We don't really know what causes which, but oftentimes they occur in tandem. And so I would say another thing that causes tight hip flexors is weak glutes.0:31:13.2 Sean Greenspan: Yeah. So you obviously has been studying this for a while so you're saying the first thing that at least came to your mind when we're talking about pain is tight hip flexors, which again for those that don't know, that's like the front. It has nothing to do...

Dr. Yoni Rosenblatt: Correct.

Sean Greenspan: With the back. Right? And stretching those out. Weak glut. So I've never heard that. That's... It makes sense 'cause that's kind of like supportive. I've also heard that sometimes glutes are like not necessarily active if you're sitting a lot. What is that just like?

Dr. Yoni Rosenblatt: Yeah. So there's something called a length tension curve and that means every muscle has its ideal amount of stretch in which it can work efficiently. So if a muscle is all stretched out, picture like a rubber band that's overstretched, it's not gonna be able to snap back. It's not gonna be able to do its job. That's a job of the muscles, to snap back and encourage movement. So if you're sitting all day, your femur, your thighbone is closer to your belt buckle, which means the glute muscle is being stretched around that backside. It's gonna get to make it gross, purposely, like a stretched out ass. And it's gonna get weak and it's gonna get insufficient. That's gonna one, tighten up your hip flexors potentially, but two...

Dr. Yoni Rosenblatt: Pull away from some of that support the glutes can provide to your low back. You wanna picture the low back has this thick band of fascia that kinda goes around it, and that's a God-given weight belt, and muscles attach and send fibers up into that weight belt, and you want those taught to give yourself that support through your mid-section, that's where the idea of core stability comes from, glutes are a big piece of that. So you want to glutes to be in the right position, not too stretched out and strong, and that's where they will become, "deactivated" if they're too long.

Sean Greenspan: Got you. Two things, sounds like sitting, not ideal...

Dr. Yoni Rosenblatt: Sitting...

Sean Greenspan: So let's get up now. [laughter] And then strengthening them, are those the two biggest things? I think most people that I come across, right? When they hear, when they say back pain, oh, I have to stretch. And then you generally see them do a hamstring stretch.

Dr. Yoni Rosenblatt: I hate that.


Dr. Yoni Rosenblatt: Where the F, I don't know where that comes from, if someone knows where it comes from...

Sean Greenspan: I think it feels good.

Dr. Yoni Rosenblatt: Yeah, it's great. I'm glad that feels good, but...


Dr. Yoni Rosenblatt: It's far harder for me to jump to the hamstrings when there's so much to tackle, more close or proximal to the issue, and that's why I get frustrated when therapists start deviating from the source of issue, there's an issue at the back please just don't start looking at the neck unless you have done things directly around it, I just think you're getting ahead of yourselves and being too fancy. So yes, stretching, I encourage stretching with caution. You need to be a sniper when you're identifying that which is causing a pathology, don't just assume low back pain, they gotta stretch their Hamis, by the way, their hip flexors are tight. They feel tight. Well, are they tight or are they weak? And I would look through that lens as it pertains to everything that attaches right around that lower back.

Sean Greenspan: Got you. It sounds like you're saying, 'cause it could be the neck or it could be the feet or whatever, but let's start at the low back and then the hip flexures or the core. Core is one that interests me, so I was in Houston Texas last week, and I went to a handstand class, and they were like, all right, cool, we're gonna do overhead shoulder press to warm up, and I was like, oh, give me the big heavy weights. Right? They were like, we're gonna give you these tiny weights. I was like, cool. They said, go up, and once I got up, full extension shoulder to ear, kinda this, ribs came out. And they're like, again, it was a bunch of yogis in the class, not a lot of football players. Right? And one was like, oh, your cores weak. I was like, no, my core is not weak, neither are my shoulders. They're like, oh, no, they're both actually pretty weak and immobile, and what do you think about... And they're like, that's gonna put a lot of pressure on your back when you're arching, what do you think about the lack of core strength with back issues?

Dr. Yoni Rosenblatt: So sometimes it's strength, sometimes it's control, right? Your ability for your brain to really isolate and hone in on that which it's trying to do. And so that's why I say, when I talk core, I make sure that the athlete knows, where is the rectus abdominis? What is the job of the rectus abdominis while it runs from your xiphoid process, which is right under your sternum, all the way down to your belt buckle? And so its job is to really pull on that pills and pull it into what we call a posterior tilt, When you're pressing up overhead, if you don't have control of those abdominals, that's what they're saying is transpiring at your hips, is, it's jumping forward, arching the back, and that's what we were talking about before, which will just crush the joints in the back of the lower back, right? So how good are you at activating and controlling, and can you do that and still have the freedom to reach overhead with the other things? That's really what they're getting at.

Sean Greenspan: 'Cause you said crush the joints, 'cause I'm hearing like... It's funny, I know a lot of my lack of mobility comes from the shoulder, so when I go overhead, if I'm engaging the core, I'm more at this angle than this. But really with back squat where it's not too much on your shoulders, it actually doesn't, it doesn't hinder me too much. And because I have a friend that he's like, I have back pain, I heard you should just never back squat again, and to me, that feels wrong, it's more like just learn how to engage your core so you're using...

Dr. Yoni Rosenblatt: Well, I think it's learn how to get through the movement appropriately. And you gotta see a professional that, like I said, is able to hone in on exactly what could be limiting that, sometimes its shoulders, sometimes it's hip mobility, sometimes it's ankle mobility, right? That could be anywhere when looking at, it's such a global movement. So you gotta be able to identify that which are the limiting factors, and then cross them off and say, hey, that's not limiting, or that's limiting, how do I fix it? PT is so freaking simple. Sport performance training is so simple, it's just a matter of, is it weak? How do we test that? Let's strengthen it. Is it tight? How do we test that? Let's loosen it.

Sean Greenspan: Yeah, simple.

Dr. Yoni Rosenblatt: Super simple.

Sean Greenspan: But it's funny 'cause I was talking to, I was talking to a friend recently who was trying to lose weight, and they jumped to, what supplements they should be on, should they enter in all this stuff?

Dr. Yoni Rosenblatt: What would Peter at TA say about that?

Sean Greenspan: Yeah, he [laughter] would say, until you're sleeping eight hours, you exercising 10 hours and eating whole foods, we can't even talk about this stuff here. He actually had something on Haberman's podcast, where he said, if you don't exercise for 10 hours a week, you can't post anything on Instagram... [laughter] That was genius.

Dr. Yoni Rosenblatt: He's really a genius.

Sean Greenspan: He is, 'cause of how simple he makes it. I think one of my... Really my last question is, as a business owner, a busy man, a podcast host, everything, not like your training, what do you do for daily maintenance on your body to practice what you preach?

Dr. Yoni Rosenblatt: Yeah, I think it starts with, what are your goals? Is your goal an upcoming race? Well, you gotta deconstruct that and train appropriately. Is your goal to just be consistent and be able to complete your job, like in my world, coach athletes and teach athletes? Well, that's gonna look a little bit different. And then once you deconstruct that, it's like, what can I really commit to, and is that enough to get the effects that I want, like you said, the 10 hours, or where am I gonna find those 10 hours, let's say, to commit to this endeavor and then once you have those lined up...

Dr. Yoni Rosenblatt: Someone who's as busy as you describe, they're gonna wanna just plan that appropriately. And once that's planned, now you're not walking into the gym or lacing 'em up and then figuring out, "Hey, here's gonna be my workout." It's the work's already been done, now you just gotta do it.

Sean Greenspan: Yeah. Yeah. Gotcha. Do you have... I actually, I like the way that you took that, because I don't think a lot of people go in with a plan, even admittedly like people, like I've had big goals run a 100. I winged it much more than I should have. I was more curious about your daily like practice of like of assuming the goal is just to feel good, to be able to continue to do your job and to not worry about bending down to pick up groceries, like the basic stuff. What type of things do you do daily to keep your body in tune?

Dr. Yoni Rosenblatt: Yeah. So I've learned my own movement fault. One of them is I have a propensity to allow my hip flexors to get tight. So understanding how to keep them loose. Kelly was a major proponent of that couch stretch and really being able to teach that, educate that, breathe through that so that it becomes a piece of my movement pattern. That's always something that I will revisit. So keeping my hip flexors mobile and keeping my hips overall mobile, knowing my own personal injury history with torn labrums, with Tommy John ligament tear, stuff like that. Keeping those solid because my goal is to be able to continue to do what I'm doing for as long as I want to do. And that means being able to show these plyometric exercises, and show these movement patterns appropriately. I always say no one wants a fat out of shape physical therapist.

Dr. Yoni Rosenblatt: I don't say that on interviews, but they don't, and so how do I keep that consistent? The other piece is my own mental health and the way I go about that. I'm really lucky and blessed. I was raised in a religious environment that promotes prayer, which at this point to me really means a meditative practice. And so that's baked into my DNA three times a day, so I'm really blessed in terms of that. And just in consistency man, like that's what it's about and having that plan. So that's the way I go about it. So I wake up I pray or meditate, I make sure I pay attention to my mobility world. I've gotten more into the aerobic conditioning as I've gotten older, so I have my own cycling routines and goals there that I know I'm consistent with three to four days a week, and I know my strength and conditioning plans and environments.

Dr. Yoni Rosenblatt: Lke I have very little balance to begin with. I want to continue to train that balance so I can show a single leg plyo activity which is tough. I look at 60 year old coaches and they have trouble doing that. That's not gonna be me. And so I encourage myself to just keep up with some type of athletic training endeavor, that's different than like your seated chest presses.

Sean Greenspan: Yeah [chuckle] They're fun though.

Dr. Yoni Rosenblatt: They're fun. They're fun. But that is my least favorite topic is talking about me. So thanks so much for making me do that.

Sean Greenspan: For coming back with the second part of the question to make sure. No, I really love what you said about consistency and that you said like, you look at like prayers, meditation. The person who teaches me meditation says meditation's the highest form of prayer, and I think it just kind of goes to like a fact that we're all looking for the same thing. We're all doing like... Everyone's talking about this the same thing. And it's a little off topic for what we're talking about, but like I've just... I've realized that so much. It's like everyone's looking to be healthy physically, mentally in a place where they're not just making money. They're doing good things on the world, but it's not killing their soul and killing their health. And I have loved working with you. Full disclosure, man, you only work together on his business. And I love what you're continuing to just put out and I think it's like, yeah, you teach physical therapy but you also teach like other lessons to it, and it's pretty cool to be a part of.

Dr. Yoni Rosenblatt: Yeah. Well, thank you for that. Thank you for the kind words. It's obviously, I'm super passionate about it. And so are you saying I need to tone that down? But I am passionate about it and I want to keep doing it as long as I'm passionate about it. And I think there's so many lessons that come out of understanding a good strength and conditioning, or health routine that are applicable to so many different things. It's crazy how the pods that I started, the conversations that I start center around something clinical and then evolve into life lessons. It's pretty amazing.

Sean Greenspan: It is. It is. Thank you for it and thanks for having me.

Dr. Yoni Rosenblatt: Yeah, no problem. Well, Sean, thanks for being on the True Sports Physical Therapy podcast. I appreciate you interviewing me, I'll be at times uncomfortable, but you've taught me a ton through this process. You've taught me ways to get to the core and to the root of what it is we're trying to accomplish and you did that here. So thank you for bringing that to my audience. Sean, tell everyone, tell my audience where they can find you.

Sean Greenspan: Hey, you could find me on Instagram. Sean Greenspan at Sean Greenspan. S-E-A-N G-R-E-E-A-N. No. Oh, hey. From the top.

Dr. Yoni Rosenblatt: Mike. Edit that out.


Sean Greenspan: You could find me on Instagram at Sean Greenspan. S-E-A-N G-R-E-E-N-S-P-A-N, and on YouTube, same channel name.

Dr. Yoni Rosenblatt: And tell me what your company does.

Sean Greenspan: Greenspan Consulting, so we actually work with businesses in the fitness and wellness industry to help them really grow their impact on the world. So it was about two years ago when I realized that I want to work with brands that like I could feel a part of and I really care about. So whether it's through social media, email marketing, or partnerships and yeah, that's what we do.

Dr. Yoni Rosenblatt: And you do really well. So thank you so much. This was a great idea. I had a great time. I look forward to keeping...

Sean Greenspan: Thanks.

Dr. Yoni Rosenblatt: Keep learning from you.


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