Hot Topics in Health

In this week’s episode of the Get Better, Not Older Podcast, Dr. Rob Jones and his wife Shannon, a dietitian, dive deep into the most searched topics in their fields—weight loss and physical health. The discussion centers on GLP-1 drugs like Ozempic and Mounjaro, shedding light on their intended uses, history, and the reasons behind their recent surge in popularity for weight loss. Shannon emphasizes the necessity of coupling these medications with lifestyle changes to prevent weight regain and maintain long-term health benefits. Dr. Rob discusses the importance of proper exercise, particularly focusing on glute strengthening over hip flexor exercises and the benefits of strategic movement for pain relief and overall health. Both highlight the importance of adopting a holistic approach to health that includes proper diet, sustained exercise, and long-term behavior change.

Full Episode Transcript
https://heydrrob.com/episode-22-hot-topics-in-health/

Further Reading: 

https://heydrrob.com/episode-22-hot-topics-in-health/#further-reading

GBNO Weight Loss Protocol for Injectable Weight Loss Medications  

Intro Music:
“Got A Feelin’” (Album Version) by Albert Donaldi.

About the Hosts
Dr. Rob Jones 
25 years in chiropractic care specializing in spine, joint, and soft-tissue disorders. Expert in Active Release Therapy and functional rehabilitation to keep you moving pain-free.

Shannon Jones 
31 years as a clinical dietitian focused on obesity prevention, functional nutrition, and integrative medicine. She tailors nutrition strategies to prevent disease and support whole-body health.
Together, they bring over 50 years of combined clinical experience and share a passion for promoting foundational health so you can truly Get Better, Not Older.

Transcript

Intro

Dr. Rob: Welcome back to another episode of The GBNO Show, The Get Better, Not Older Show episode 22. I am Dr. Rob Jones, my awesome wife Shannon, the dietician.

Shannon: Hi.

Dr. Rob: Say hi Shannon.

Shannon: Hi Shannon.

Dr. Rob: You did it again. Nice. Alright, so, um. Why are you gonna listen to us?

Because we know a few things. We've been around a little while. The gray shows it. Over 50 years of combined experience. Clinically, I've been seeing patients. I'm in my 26th year. You are in your...mmmth year and...

Shannon: 32.

Dr. Rob: 32. Wow. We've learned some stuff. So, I am your outside in guy Shannon is your inside out girl. So today, what are we talking about, babe?

Shannon: The top searched categories.

Dr. Rob: Okay.

Shannon: In both of our expertise, our realms. So weight loss and diet. And for you, pain, injury, physical health. Mm-hmm. I did kind of a deep dive in trying to figure out what are the hot topics in each of our expertise. What are people really talking about?

What are they wanting to know more about? And I thought. Today I mean, this is gonna be a really great day for Dr. Jones because I'm just letting you talk.

Dr. Rob: Yes.

Shannon: And, um, but you gotta wait your turn.

Dr. Rob: Ah, that sucks.

Shannon: And you don't get to interrupt me.

Dr. Rob: I don't interrupt that much.

Shannon: Okay.

Dr. Rob: Only when's pertinent.

Shannon: Um, anyway, so, uh, if I, it's okay with you.

Weight Loss & Diet

Shannon: I'm gonna start in the weight loss and diet. Topic.

Dr. Rob: What is it in baseball terms? There's the color. Oh yeah. You're the color. I'm the play. No, you're the play by play. I'm the color analyst.

Shannon:

I don't know what that means.

Dr. Rob: Play by play.

And then I just, I just add filler.

Shannon: Okay. Whether it's interesting or not is yet to be determined. Okay? So the first category for me is the number one, which this will not surprise anyone, I don't think, are GL-1 drugs, um, like Ozempic, um, those continue to be heavily searched.

Dr. Rob: Okay, so can, can I ask a question?

Shannon: See, you're doing it already, but yes you can.

Dr. Rob: I always forget, and I, it always pops up in the car when we're together, but remind me of the name of the drug. I know one of them's a semaglutide and one of them is a tirzepatide. Just stop.

Shannon: I was getting there.

Dr. Rob: Oh, see, I'm ahead of the game. Sorry. Okay. Okay,

Shannon: So what I was going to first do is explain because I think a lot of people get confused between all the names, what they were indicated for and the release of them.

GLP-1 Drugs

Shannon: We have been using GLP-1 agonists in the clinical setting for diabetes for 20 years. These are not new medications. They just took off when a few movie stars started taking them and showing weight loss and then they went crazy because of that.

Dr. Rob: Is that what it was?

Shannon: Yeah, for sure. So the history of this is, especially like back when I was the director of a large weight loss program, pretty much everybody was on these GLP-1s. Now these, this was like six years ago, we were using Saxenda, which was semaglutide then too. It just was a once a day injection. So everybody used to have to give their injections once a day.

What they started to notice with these diabetic patients is that they were losing a lot of weight in addition to it being great blood sugar control. So that is really where the weight loss interests started. So then what launched after Saxenda was Ozempic, which was semaglutide the same molecule still.

However, it was now a once a week injection, and that really caught traction because to get people to give themselves shots every single day, compliance was a major issue.

Dr. Rob: Mm-hmm.

Shannon: So that's really where it started getting its traction. It was launched with, you had to have a diagnosis of diabetes.

Okay? So you couldn't get Ozempic if you didn't have the right diagnosis. Once it was gaining traction for losing weight, that's when they launched the same exact molecule, but they launched it as Wegovy, and that was with the indication of weight loss. Okay, so. Wegovy and Ozempic are the same thing, just two different indications.

Dr. Rob: Gotcha.

Shannon: Because to get the indication you have to go through all the FDA's, um, process to getting it indicated for that particular disease state. So then came tirzepatide, which is not only the GLP-1 peptide, but also a second, what we call GIP, GIP peptide. So it was a two peptide medication and that launched as Mounjaro for diabetes, and then launched as Zepbound for weight loss.

Dr. Rob: Gotcha.

Shannon: Okay. So you've got really two different molecules, four different indications, I will say between the two semi semaglutide and tirzepatide, the molecules. We are seeing much better results with tirzepatide up in like to the levels that we would see with bariatric surgery, which is pretty impressive.

So that is like in the realm of like 35 plus pounds or more, which is really kind of unheard of for weight loss drugs.

What is Bariatric Surgery?

Dr. Rob: Okay. Rewind. What's I mean? I know you and I know it is just for the audience, what is bariatric surgery?

Shannon: That's where people actually go in and have a surgery to change. There's numerous different types of bariatric surgeries, but it's where.

People have their stomach size changed surgically.

Dr. Rob: Yeah.

Shannon: Okay.

Dr. Rob: And the impact

of that is your stomach sack, if you will, is now smaller. So you're fuller way quicker. So instead of eating a whole steak, you're eating an eighth of a steak and you're stuffed.

Shannon: The first drug of its, you know, kind truly that is matching the level of weight loss that we have gotten historically with bariatric surgery.

Dr. Rob: And that is the tirzepatide, the two peptides.

Shannon: Yeah, we're just finding a lot

better acceptance as far as side effects, as well as the total number of pounds lost. Um, is quite a bit higher.

Dr. Rob: And that is Mounjaro?

Shannon: Honey.

Dr. Rob: I can't get it.

Shannon: That's Mounjaro and Zepbound.

Dr. Rob: Zepbound. Okay. I can.

Shannon: Surely, hopefully everybody else 'cause this. He literally asks this.

Dr. Rob: I can't get it.

Shannon: Almost every other day in our house.

Dr. Rob: It's

like calculus to me. I can't get that. For some some reason.

Shannon: I just think you need to write it down.

Dr. Rob: I think I need to write it down.

Shannon: Yeah. Okay. It's very, very interesting. You can remember a lot about cars and it's just interesting how that happens. Well, anyway, okay, so we digress. So that, that.

Dr. Rob: I always digress. Let's remember that.

Shannon: There we are with our two different molecules, four different drug names, and hopefully that was clear. So why is there so much controversy over these drugs? Well, quite honestly, I don't know. I feel like it has more to do with the person and not really the actual drug. I am a huge proponent of them.

I have used them for a very long time in my career. And I think if a person is doing it right, which to me as a clinician who specializes in obesity prevention and weight loss, it, it, it makes them good students. While they are learning the lifestyle that needs to match, being that smaller size. So if you have something that works this well, that is taking an edge off of your appetite, helping you feel fuller faster for longer.

Physiology of Weight Loss

Shannon: That way you can stop a minute and think about what you're doing and you're not fighting with your physiology on willpower and you know. Some people just don't experience satiety. Satiety is that feeling of fullness, and when I say you've been satiated, it just means you feel content. Like imagine how you feel after a Turkey dinner.

At Thanksgiving, most people have eaten enough and all their favorite things that they feel satiated. And so that's what these drugs are doing is helping people feel full. Quicker for longer and satiated where they're not even really thinking of food, which is a big deal for a lot of people who struggle with their weight.

Dr. Rob: Because that's not historically how their brain is wired. So it gives their brain a chance to rewire, it gives them time to work with an expert who can help them learn the lifestyle. But what is happening is we have a lot of people prescribing these. Med spas, um, you know, pharmacies, not only medical offices, but doctors that didn't even specialize in weight management. And they're not coupling the, the prescription with mandating, hey listen, there is a lifestyle change that needs to go with this. Because what's gonna happen? And now you know, a lot of what people are Googling is, you know, weight regain. This is a big one. The other big topic is, oh my gosh, you lose muscle when you are on these medications.

Shannon: Well, I've got news for everybody. If you lose weight quickly, it does not matter what diet. You are gonna lose muscle if you don't eat enough protein and work your muscles.

Dr. Rob: Mm-hmm.

Shannon: That is just how weight loss works. So it really has nothing to do with the particular drug. The drug's not causing any of that.

That's the person who is not properly educated and not learning the proper, you know, lifestyle to go with the medications. I have written some video. Instructed, I guess, libraries that are specific for people who don't wanna take medication and people who are actually on these medications because it's important to learn that lifestyle and learn how you do not regain.

So what's the purpose? Like, why would anyone want to spend the time and money on these medications? Um, if they're gonna just gain it back. It actually makes zero sense. So, so then, okay, so here you are and you're living this lifestyle, and you're eating what you're eating and you're, you know, living the way you're living and it is creating this outcome and you're obese and you don't like that outcome.

It's kind of crazy to think that you can still do this. And make this change.

Dr. Rob: Well, that's been the conundrum with weight loss since Fen-phen in the seventies. Right?

Shannon: It it requires lifestyle change.

Dr. Rob: Yeah.

Shannon: What the drugs do is take an edge off so you have the time to learn, and my goal is by the time you've mastered the lifestyle, that's where we start talking about, okay, you are to your goal weight.

Let's talk about what it is to maintain that, because. You know, I think people forget physiologically, we store fat as a protective mechanism for starvation. They, you know, we haven't had enough years of evolution where we've changed evolution where your body does not think we're hanging out in caves to go hunting.

Dr. Rob: Mm-hmm.

Shannon: For food. It doesn't understand that we have largely calorically dense foods, readily available at all times. That you don't have to move for. That's a big problem. And so what I feel like the drugs do is gives, gives everybody a chance to learn, okay, well I can't just eat these ultra processed foods and not move at all and not be obese.

Like that's not the way it works. So let me learn a new lifestyle. Let me learn how to do this. Let me learn how to mimic what the drug is helping me do, which is feel fuller faster for longer. And. You know, I have to mention this too, it's also helping to control your blood sugar. That's the reason why it was, you know, launched for diabetes initially.

So all of that is part of the picture, but there is a way to do that with lifestyle.

Dr. Rob: Mm-hmm.

Shannon: Okay. So I think I was making a point and then I got off on another point.

Dr. Rob: You totally Rob'd that. You, Dr. Rob'd, that you went off.

Shannon: I do get on my soap box.

Dr. Rob: That was great.

Shannon: A little bit.

Dr. Rob: That was a good soap box. But, but again, this is,

"Ozempic Face"

Dr. Rob: you and I talk about this a lot because we know people who are on it.

You can almost tell when people are on it now because the change is immediate. I, you know, I've seen some people professionally that I haven't seen in a month. And they look completely different a month later because they tend to lose a lot of weight in their face. I don't know why that is, but you can almost tell when somebody's on one of these GLP-1s, and again, I'm not judging people, I don't care if you wanna lose weight, lose weight, it's great if it makes you feel better.

But the biggest thing is, and this is what you know, we learned back in university in the early nineties when I was in school, the whole yo-yo thing, right?

Shannon: Yeah.

Dr. Rob: Like the whole,

 Yo-Yo Dieting

Dr. Rob: what yo-yo dieting means is you basically. Starve yourself of certain nutrients. And then like Shannon said, your body goes, oh, we haven't had a lot of nutrients.

So...

Shannon: You just reminded me what I was saying.

Dr. Rob: Oh, can I finish?

Shannon: Oh, please do.

Dr. Rob: Or, I don't want it to leave your brain. You want to go?

Shannon: Well, please. By all means.

Dr. Rob: Okay.

But, but again, so you, you've lost all this weight. Awesome. Great. Now your body goes, okay. The little bit we have left. We better conserve that and we better slow the engine down because we don't know when those calories are coming back.

Shannon: So further to that is, you know, it's what you know, I teach in my module on how you not regain. We are very primal when it comes to you are born with so many fat cells. Okay. We all are born with probably based on genetics, how many you have. At which point those fat cells grow to four times their size, they max out, and then you add fat cells After that.

Those fat cells you've added can grow to four times their size. Once you've added those fat cells, you can't ever get rid of those. I want you to think about this for childhood obesity and what that means.

Dr. Rob: Mm-hmm.

Shannon: Very sad. But you can shrink that fat. But if you've taught your fat cell that this is protective and normal because I've been this size for so long and then all of a sudden you lose that weight quickly, you have said to yourself, your body, oh my gosh, I just starving.

I am now going to lower my metabolism so that I am not burning as much fuel while I'm out hunting for food 'cause it's protecting you. And I'm gonna double your appetite. So that you. Are very motivated even though you're starving

Dr. Rob: Mm-hmm.

Shannon: to get out and hunt for food.

Dr. Rob: Yeah. You taught me something maybe six months ago.

That is, is it a year to 18 months to reset the metabolism of the fat cell?

Shannon: It can be three years. That's what I think is the biggest problem with these medications is because they're so expensive, people are trying to get off them too quickly.

Dr. Rob: Okay.

Shannon: And that is part of what I recommend is that people stay on the medication long enough to give your body a chance to reset.

It needs to feel comfortable at long enough at that weight where it doesn't feel threatened. How in the world are you gonna go from losing all of that weight if you had not done anything to change your behavior? You're eating crap food, but you're losing weight because you're decreasing the calories, but you're not giving your body anything that it needs.

All of a sudden you go off the medication, your appetite has doubled and your metabolism's slowing down.

Like how, how are you not going to regain that weight that, you know, if people just stop and think about it realistically, it makes really good sense. So what I recommend, Nope.

What I recommend is that people. Get on lower doses. And what I mean by that is I really do, when you find a good pharmacy, a trusted pharmacy that compounds these molecules so that we can microdose. The medications for maintenance give people's bodies and physiology a chance to adapt, and then all of a sudden they've had a chance to adapt their lifestyle.

They've stayed at that weight for a long time. This is really how we reverse this epidemic of obesity is it doesn't have to include these drugs, but you have to take into consideration fat metabolism and how the regain portion of that happens.

Dr. Rob: So do you think we are at almost like a, I don't wanna say breaking point, that's wrong phrase. Are we at a conundrum where we're gonna have a whole generation of people, yo-yoing back. Like when this trend calms down, which they always do.

Shannon: Yeah.

Dr. Rob: Are we gonna, in two years, are we gonna see all these people who dropped 40, 50 pounds?

Are they gonna be not only back up to where they were at that point, but are they gonna be heavier?

Shannon: The statistics aren't great.

Dr. Rob: And, and sicker.

Shannon: Yeah. The statistics aren't great, truly. But here is what I'm going to say. Without a doubt. If you eat Whole Foods. Real foods that actually one, think about this one ingredient food, if you eat real foods

that actually nourish and not are, are not a bunch of chemicals and you learn a lifestyle that is healthy, kind of like our Get Better, Not Older lifestyle. And you learn how to control your blood sugar and your insulin levels. Metabolically a little plug for me. I teach you how to do this in my modules.

I lost 75 pounds, what was that, 30 years ago? And I've stayed at this weight even through two pregnancies. It can be done, but he can attest to this. I work at it every day. I mean, I, I'm not ever gonna go back to doing what I was doing before. 'cause guess what? You get that same result.

Dr. Rob: Mm-hmm.

Shannon: So if people can learn that healthier lifestyle, and it's different for everybody, what works for me doesn't work for everybody. But that's what I do, is I help people find what works for them and what they can do long term. And that's really how we're gonna turn this around. Yes. This will be exactly like everything else.

If people do not learn that maintenance component, okay, people can lose, all of us can lose. Everybody can do something for a finite amount of time. But if you don't learn to do it properly mm-hmm. You will. As humans, we will not continue to do that long term.

Dr. Rob: Yeah. Okay. That's just not sustainable.

Shannon: Kind of ties right into the second category, which is,

Obesity as a Disease vs. Lifestyle Issue

Dr. Rob: obesity as a disease state or is it a behavioral issue? I don't really care for this question quite honestly, because any disease state is the, just the same. You may have a genetic predisposition for heart disease or hypertension or whatever you behaviorally choose to live your life, how you deem to live your life.

Shannon: Whether that's conducive to controlling that or not, obesity is no different. I mean. Why is it that we're, it's why is it okay? Like I have people all the time, I'll see them and I go, oh my gosh, you look so great. I mean, you've lost a lot of weight. And, uh, my whole, my first thing I always say is that is.

Hopefully it's healthy 'cause you don't want anyone to ever tell you that they've been sick or something negative, which is the reason why they've lost weight. Most everybody says, well, I, I'd hate to tell you this, but I started Ozempic or I started whatever, and I'm like, good for you. Like, why are we making people feel badly about this?

If you have heart disease and you go on medication, if you have hypertension and you go on medication. We know those can be controlled with lifestyle, almost all of them. And it's for some reason we've made it okay for everybody else to be on medication, but not people who have problems with their weight.

Dr. Rob: I'm okay with it.

Shannon: Yeah. So I, I don't like that stigma and I think we've got, get away from that. The second somebody sees somebody who's had success with weight loss, oh, they're for sure on Ozempic. Okay. Who cares? Like why are we making healthcare? Yeah. A negative that a negative thing?

Dr. Rob: Mm-hmm.

Well, it comes down to psychology, right? So I'm sure people who are on it feel like they're cheating in some sort of way because they're having some sort of aid.

Help them with weight loss versus just grinding it out in the gym and eating chicken and rice and broccoli or whatever. So there's that, you know, there's the self-deprecating part and then there's the judgment. Oh, look at Jane Doe. She's lost weight. I bet she's on Ozempic. You know, and you know what I mean?

Like, and it's probably because they feel crappy about themselves 'cause they're not doing it. So it's just, it's the human condition. Right. But what.

Shannon: Well, I think too, there are a, a large number of people who are giving. The medication and, and you know, like for instance, some of these movie stars who wanna go from a size four to a size zero. Give me a break.

Dr. Rob: Yeah.

Shannon: I mean, that is not what I'm talking about here.

Dr. Rob: Mm-hmm.

Shannon: And I'm not talking about the people who are doing it and saying, oh yeah, I eat three snicker bars all day, and, and I'm losing weight on Ozempic. I mean, that's not what this is all about.

Dr. Rob: No.

Shannon: So, um, let's just move forward from that. I don't think.

Dr. Rob: Well, you're looking at aesthetics versus health at that point, and that's when you're gonna start seeing the bottom dropout. I mean.

Shannon: Yeah. But you will always have that. You know, especially with social media and everything else, but, um, I've even seen some things recently where women who are not very big at all are saying, oh, this is helping me during perimenopause and all of that. That's great if it's being done properly.

Dr. Rob: Mm-hmm.

Shannon: I mean, microdosing and all of that has to be with an educated person and it's, it's not a regulated industry, so you have to make sure you're getting it from a good source. Who knows what they're doing.

Dr. Rob: You know, I'm always looking for takeaway number one.

If you're gonna get on it, get on it with somebody who knows how to titrate you down or lower the dosage as you get to your ideal weight, talk to somebody or get on your program, who knows how to educate you on nutrition and proper exercise while you're on it. So it doesn't just end up being another grapefruit 45 from 1984.

Shannon: Mm-hmm.

Dr. Rob: Okay. Where it's just lose, lose, lose. Done. I'm at my ideal weight. Gain, gain, gain.

Shannon: Okay.

Dr. Rob: Is that, is that a good summary?

Shannon: Yeah. And I mean.

Microdosing Weight Loss Drugs

Shannon: I do believe in, in microdosing. This is a controversial subject, but quite honestly, if you want my opinion from doing this for a very long time, I believe the prefilled pins, so anything that's been prescribed as a like Ozempic, Mounjaro with that name comes in prefilled pins. And I do believe we are overdosing people with the prefilled pins. I think we can get very good outcomes with lower doses. And I feel like that's where the majority of the side effects are coming from is overdosing. Um, we are going to include citations from the most common side effects from these drugs.

I'm not here to tell anyone that they should be on it. That is a discussion for you and your medical doctor who knows your, your medical history. This conversation today was about the person who is on the fence. Who's been given the okay medically and wonders how they're going to do that.

So I do believe there is a world where we can get to lower dosing microdosing that can be used at a lower cost for longer periods of time to get better outcomes.

Dr. Rob: Didn't you also say that there were some other health indications with them that you're seeing from microdosing?

Shannon: Some positives, like lower dosing microdosing.

I mean, I liken it a lot to the Naltrexone. Like we, we learned that. Even though Naltrexone was launched for very specific reason, we started to notice a lot of health benefits at a much lower dose, like microdoses.

Dr. Rob: Mm-hmm.

Shannon: Same thing. That's what's happening is we're seeing cardiovascular benefits, we're seeing cognition benefits with Alzheimer's and dementia.

The molecule itself is awesome. I just feel like where we get into the contraindications and the side effects comes with our dosing. And you also have to have the medical history to, for it to be conducive. So.

Dr. Rob: Understood.

Shannon: Okay. It's your turn.

Dr. Rob: I thought I was gonna get to talk a lot during this podcast. Because once I take over it's it's game on.

Shannon: Mark, set, go.

Dr. Rob: I'm running downhill. Okay. So a lot of things, again, social media being what it is,

"Doctor Google"

Dr. Rob: Doctor Google being what it is. You know, as I said, I've been practicing a quarter century and I wish I could remember exactly when this happened, but 2000 5, 6, 7, 8. Somewhere in through there. It used to be people came in and went, Dr. Rob, I hurt here. What is it? And then I would do my assessment, diagnose, treat, whatever.

Now it's people are coming in and going. Dr. Rob, I hurt right here and it's my infrapertanious and my exterior rotator of the meniscus and people are trying to sound, and God bless 'em I'm not trying to make fun of people, but, but I, I try to stay in my lane with what I know. I don't go to the mechanic and go, yeah, the aspirator of the carburetor's injection system is spilling out oil onto my pan of my stopper machine. And I mean, 'cause it's kind of, that's what it would be, right? Like so, and, and I guess people wanna be educated on it, but what, what has happened is Dr. Google, it, it, it's, it's now become, I hurt here Google symptoms. Everybody comes in now with symptoms being Googled. Everybody.

Shannon: Yeah.

Dr. Rob: And some people, and it's great. Like I want people to be educated, but some people are actually getting it right. But a lot of people are getting steered in the wrong direction. And there's a lot of, I need to be a louder voice so I can grow my social media and I can make money and yeah, and help a lot of people, but there's a lot of information in there that needs to be weeded through.

Instead of going down a path of talking to somebody who's a professional, who really can help direct you in the right direction to get better. Um, it's a lot of, you know,

Social Media Influencers

Dr. Rob: I'm gonna go on TikTok and talk to my favorite influencer who looks great in a bikini but doesn't have any clinical experience.

So we get, we get a lot of questions. Okay. So here's, here's the thing that's been trending a lot and it's hip flexor strengthening. We know, and we've known this a long time, that we sit too much. Okay? We're at computers, we're at desks, we're doing whatever. We're during the pandemic. Everybody was sitting at home.

And really research shows that if you sit on your tookus on your buttocks for more than about 20, 30 minutes. Your brain goes, oh, you're not using them. Let's just shut them off. And your glutes are hip extensors. they pull your leg back and they help you stand upright when they are shut off the antagonist, which is the opposing muscle group, which is your hip flexors, they get short and tight.

That's why a lot of people, when you go to stand up, you'll kind of go, ugh. And you have to kind of fight to stand up because you're literally taking a shortened hip flexor that's like a rubber band and you're trying to lengthen it out.

Shannon: That's gotten worse as I've gotten older.

Dr. Rob: Yeah. It happens to all of us.

Hip Flexors

Dr. Rob: There's a lot of stuff online now where people are talking about, oh, you've got a strengthen your hip flexors because they're short and weak. The problem with that, and I'm not saying don't train your hip flexors, you need to train your hip flexors. Okay. Because they're like any other muscle group.

But if you've been sitting on your butt and it's shut off, it doesn't matter how strong your hip flexors are, it's, it's a weak butt issue. Okay.

Shannon: This is. This comes up a lot.

Dr. Rob: What? Glutes?

Shannon: Yes.

Dr. Rob: Well that's why I've been saying to patients for over a decade the I call the glutes, the center of the universe.

Because if your glutes aren't firing, your, most likely your back isn't working right, because your hips aren't working right. Most likely your knees hurt because your hips aren't working right, because your glutes aren't firing. If your glutes aren't firing. Femurs not gonna sit in the right position, which is your upper leg bone, which is gonna make your knee track properly, which guess what?

Your ankle's now gonna drop in. I mean, it's, it's connected to so many things and if you go in there and start just getting into the gym and strengthening your hip flexors, you're already strengthening a shortened muscle that has a lot of tone to it. Okay? So you want to actually go to the gym and strengthen your glutes.

So. Doing hip thrusters, like Brett Contreras invented one of the best moves you can do for your butt because there's no load on the spine. You do bridges. You can stand in a tall position, take your leg back behind you. If you do that, you will normalize the pulley between the glute and the hip flexor. So if you just go in and strengthen the hip flexor.

Let's say this is your butt back here, and this is your hip flexor. If you have a strong hip flexor, it's gonna kind of pull you into what we call an anterior pelvic tilt, and that's gonna shut off the glute even more. So we wanna regulate that by having strong glutes, and I've seen tons of patients where I test their hip flexor and their hip flexor tests weak, which it kind of gives way to a hip flexion test.

I do glute strengthening with them, and then I come back and retest the hip flexor. The hip flexor test strong again. It's because the pelvis position, okay? Joints control what muscles do. If you have a really strong muscle or a really weak muscle, and the joint is not sitting in the right position, your brain, which is controlling everything, specifically peripheral nervous system for what we're talking about.

If the brain thinks the joint is not in a good position, it will kill power to said muscle. Okay, so if your glute is shut off neurologically, doesn't matter if you strengthen a hip flexor. So to answer that question, hip flexor strengthen routines.

Shannon: Well, it's just very, um, popular. It's a very, uh. It's a hot topic right now.

Dr. Rob: It is a hot topic and it's...

Shannon: And you wanna know why? Because of Jennifer Aniston's Pvolve and all the, it's always has to do with...

Dr. Rob: What the heck is Pvolve?

Shannon: It's this mat, she, have you not seen it?

Dr. Rob: No. Thank God.

Shannon: Yeah,

it is. You know it. A lot of that stuff, it's just always, uh, what our movie stars are doing.

Dr. Rob: Well, it's because it helped them with their one specific problem, right? So everybody must do it now and again, this is another thing like. It's like me search, right? Like all these influencers who are, who are, oh, I had one client who had X, Y, Z. It worked for them. Now everybody must do this.

Shannon: Mm-hmm.

Dr. Rob: When you've seen thousands of patients.

Call me. Okay. Because, and again, I'm not trying to say I'm smarter than anybody, but I've seen literally thousands of patients over the years, thousands. Like if when I sold my practice, the guy who bought my practice couldn't believe I saw that many people, and it's just. Because I was in business for a while.

But when you see that many people, you start to recognize patterns and you start to see what people have that do certain things and there's all...

Shannon: And that's the benefit of clinical experience is

Dr. Rob: Exactly.

Shannon: that It's one thing to be a PhD and start throwing stuff out there, but if you've not actually seen patients and learned

Dr. Rob: A hundred percent.

Shannon: for years, it's, it's a big difference.

Dr. Rob: I get comments all the time on the social media, well, do you have a study to support this? Well, well, of course there's studies to support everything, but, but there's also clinical experience that that expands upon studies that we have.

Shannon: It's called an n of one study. N of one. That person.

Dr. Rob: Oh yeah. Yeah. Me search.

Shannon: Usually in a study it's n of whatever, however many participants. Yeah. Yeah. I always call it an n of one.

Dr. Rob: Yeah. I call it me search. Yeah. Okay.

Strategic Exercise for Pain Relief

Dr. Rob: So another one is strategic exercise for pain relief. Okay. Back pain, knee pain, arthritis and all that. This is really trending. Um, and it's reversing the rest is best thing.

Yeah. And that's been going on since the late nineties. When I entered chiropractic school in 1997, we were talking, well, profe, I didn't know I was a dumb freshman, I didn't know anything. But you know, we had professors then saying, you gotta get your back pain patients moving. You've gotta get your neck pain patients moving.

It's no more. Take ibuprofen and go to bed. We know that atrophy sets in within 24 to 48 hours. And I'm talking not just like weakness, I'm talking atrophy where like, like the muscles literally shrink from disease.

Shannon: So I think that's normal for people when they're in pain to think, Ooh, I've gotta go to bed.

Dr. Rob: A hundred percent. Yeah. It's the worst thing you can do. I always tell everybody, if you can walk, at least you can walk. If you have the type of back pain or knee pain where you can't walk, but you can ride a bike. Ride a bike because your body is designed to move. This is the cool thing too. The guy.

Um, I believe it was from Harvard who came up with the rest Ice compression elevation. He's recanted that and he's showing now, if you put ice on an injury or you take anti-inflammatories, you actually interrupt the healing process and you stop the initial cascade of events

 that needs to happen when you damage tissue. If you have a small tear or a strain or even a large tear, you, you want an inflammatory response because that's what signals healing and that's what signals fibroblasts to go to the area, which are the molecules that help collagen reform to heal said tissue.

If you put ice on that and halt it, and then you take ibuprofen to halt the pain and then elevate it so you don't move it, now we have no exchange of the fluid and the constituents of metabolism that need to happen to create the healing. The recommendation now is mild pain-free movement.

So even on an acute ankle sprain. I mean, I don't recommend anybody, unless it's a fracture or something where you need to, like, you blew your ACL and you need to have surgery. I mean, yeah, that's, you gotta go with what your orthopedist says. But, but on, you know, on an ankle sprain that's acute, that's, you know, that's not totally blown.

You don't need surgery. We are recommending now mild pain-free movement. Move the ankle around and like an alphabet, put it, if there's no open lesion, put it in a pool and move it around. Walk around in a pool. If you're pain free and the outcomes are getting better that way. So, so yes, we're moving towards this model of, you know, this kind of strategic exercising for injury and it's, it's important we follow it.

But also it's important we know what to do. That's the other thing. So I had a patient recently who I still am still working with him and. He, I sent him to somebody who I thought was gonna, 'cause he lives in another city. I thought he was gonna be able to get what I would give him here if he lived here.

But he lived on the west coast and they had the idea of strategic exercise for his pain relief. But the problem was they thought it was strategic exercise, but they weren't addressing the problem. They just said, well, let's just get strong and your body will heal itself naturally. Well, he was already strong.

I felt bad because I, I referred him to this clinic thinking they were gonna do a really good job, and, and he had one injury and they had him doing pushups. It wa it wasn't a shoulder injury, but he called me one day and he was like, I just want to let you know, do you think this is okay?

Like, they had me like maxing out on pushups. And then they had me doing like bounding where I was jumping to get my explosiveness back.

Shannon: And what was this injury?

Dr. Rob: It was a lower back injury.

Shannon: Oh.

Dr. Rob: And so he kept saying to me. Like, why are they having me do this? And I'm in my mind going, I see this.

They're wanting to do some strengthening for his system, but he's already strong. He just has an injury in that area. So again, strategic exercise for pain relief. Very important, but he ended up, we ended up working again via distance, like via video, and I've since fixed him up, but he had hip imbalances and hip weaknesses and stiffness that was affecting his lower back.

So I gave him strategic exercise to move the hip better and stabilize the spine. So you have to be careful what said exercise is. So yes, you want to, you wanna move strategically if you're hurt, but you also have to work with somebody who knows how to address the problems specifically. Not just some, oh, you hurt your knee, let's get you stronger everywhere.

Well, not opposed to getting stronger everywhere, but you still have to address the dysfunction and that's what wasn't done. So again, this, this is, there's. I know I'm really confounding the answer here, but there's a right way and a wrong way. The right way is always motion is lotion. Okay. It's better to move than not to move, but you also have to do it in an educated fashion and weeding through that quagmire is really hard nowadays.

Shannon: Would you say that you've filmed a lot of videos? Yeah. Um, and you have a huge video library mm-hmm. Of. Uh, helping people.

Dr. Rob: Yeah.

Shannon: Where would they find help?

Dr. Rob: Well, I mean, again, like he, he's somebody I know. If he was somebody I didn't know and I get messages all the time, Dr. Rob, what do I do about this? And I say, just go to my website, Hey Dr rob.com.

And if you, if you've been told you have tennis elbow or if you have paint out here, buy the tennis elbow program. And I don't know what, I think it's on sale right now. They're not very much. Um, but basically. Like we talked about before in our Q&A this morning, or our table talk this morning for the community, you know, I had a professor who used to say he who treats at the site of pain is lost.

So in all of my protocols, we address the joints adjacent to the area. So if you have pain here in your elbow, it may be from there, but it also may be from lack of stability and mobility in the shoulder. If you're gonna get a tennis elbow protocol from me, you're gonna get some shoulder mobility and some wrist mobility and then some elbow mobility and strength.

So I'm trying to cover it all basically, so it's really tailored to that injury.

Shannon: We just recently launched a, a revamp of our website and it's awesome because everything is in one place.

Dr. Rob: Yeah.

Shannon: Easy to find. And, um, so Hey Dr. Rob.com.

Dr. Rob: Yeah. Mm-hmm.

Shannon: Awesome.

Exercise as Medicine

Dr. Rob: So this one is the concept of exercises. Medicine is gaining traction with studies linking activity to better outcomes across cardiovascular cancer and mental health domains.

I mean. Listen, if if, if you wanna be healthier, move more. I mean, that's just the bottom line like...

Shannon: Well, I always say this, and this kind of is between you and I here. That between, like if I'm talking exercise for weight loss, honestly exercise isn't great for weight loss. That will surprise a lot of people.

But a lot of the times we eat because our appetite goes up because we've just burned through the exercise. It's really quick to

Dr. Rob: Mm-hmm.

Shannon: burn 250 calories and walk in the kitchen and eat 250 calories. Exercise really in my mind physiologically is about disease prevention.

Dr. Rob: Mm-hmm.

Shannon: Um, however, we gotta do both, you know, for both situations.

Dr. Rob: If somebody said to me right away. What do I need to do, number one, to get healthier and to lose weight? What, what? What do I need to do right away? And most people who don't know anything about exercise do what they did when they were a kid. They start running.

Shannon: Mm-hmm.

Dr. Rob: And then they go to the gym and they get on their back and they do sit ups and crunches.

You Can't Out Exercise a Poor Diet

Dr. Rob: Do you remember me telling you about the older couple in our neighborhood, at our neighborhood gym?

Shannon: Yep.

Dr. Rob: I overheard this older gentleman talking to a friend of mine about how he's gotta get into a, he actually said the word cummerbund, which I haven't heard since the eighties, but he, he said, I've gotta, I've gotta get into a cummerbund in two months, so I'm, I gotta work on my stomach.

So he went immediately over to that stupid slanted abdominal board and started doing sit ups. Again, we know spot reduction is a myth. But again, this is, this is, I hate to say it, it's the lack of proper education in the system.

Shannon: Yeah.

Dr. Rob: And then too much bad information out there. If you wanna lose weight, don't go for a jog.

Okay, 'cause most people's mechanics aren't good enough. Yeah. And you're gonna burn glycogen, which is your stored glucose in your muscle and liver, you're not gonna burn fat, you're not gonna lose weight. If you wanna lose weight, go to the gym and lift weights three, four days a week safely. Okay. Tons of programs on, on our website and then walk, walk more.

Shannon: Mm.

Dr. Rob: Go for a 30 minute walk every single day or a 40 minute walk every single day. And you will, you will lose weight, you'll get healthier

Shannon: And...

Dr. Rob: and you'll not break basically.

Shannon: But you can't out exercise a poor diet.

Dr. Rob: No, of course not.

Shannon: So I would say one of my number one things I would recommend is. Get more towards a single ingredient type of intake.

Dr. Rob: Mm-hmm. Like I said earlier, steak, chicken, eggs, fish, what? What am I missing? What other meat?

Shannon: Apple.

Dr. Rob: Apple banana. That's...

Shannon: Strawberry.

Dr. Rob: Yeah. I mean, pretty simple.

Shannon: Yeah.

Dr. Rob: Rice. Yeah. I mean, it's pretty simple. Yeah. Like yeah, you can use some sauces and stuff, but it's pretty simple.

Shannon: Yeah. Okay.

Dr. Rob: What, what do you, hold on, I'm gonna say one more thing.

Outro

Dr. Rob: What did you always used to say? Of course. I'm gonna say one more thing. You always to say if my, if my great grandmother, what did you used to say?

Shannon: If your great grandmother doesn't recognize it, you probably shouldn't be eating it.

Dr. Rob: Exactly.

Shannon: Yeah.

Dr. Rob: That's the ingredient list anyways, right? Yeah.

Shannon: Well, there's, I prefer no ingredient list.

Dr. Rob: Well...

Shannon: Like honestly, if you wanna go on the simplest diet, I don't believe in diets, but diet should be how you nourish go on a single ingredient diet.

Dr. Rob: Mm-hmm.

Shannon: I just started a trend.

Dr. Rob: Nice.

Shannon: Alright.

Dr. Rob: Single ingredient diet

Shannon: For episode 22. That's a wrap.

Dr. Rob: Get Better, Not Older.