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Back Pain Relief with Foundation Training
Episode 4816th May 2022 • Back Talk Doc • Sanjiv Lakhia - Carolina Neurosurgery & Spine Associates
00:00:00 00:51:49

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Sometimes, the greatest struggles can bring forth the greatest innovations. 

That is certainly true for Dr. Eric Goodman, DC, the founder of Foundation Training. As a young man in chiropractic school, his severe back pain from multiple disc herniations became unbearable.

“I had about a year left of chiropractic school when my back got bad to the point that I was like, ‘I don't want to be a chiropractor,’” Dr. Goodman tells Dr. Lakhia. “Driving hurt, standing hurt, sitting hurt, and laying hurt. You're just out of options.” 

It was in experimenting with his own pain in motion that he was able to develop Foundation Training, a combination of exercises and breathing techniques that helps with anything from basic daily movements to athletics.

Josh Brigham became a devotee of Foundation Training from his own spinal issues. Now a trainer and owner of Adapt CLT, he uses Foundation Training to bring others the same relief he’s experienced. 

He says a video about decompression breathing that he saw at his first Foundation Training event changed how he thought about breath. “It was just real easy to make that concept live inside of you,” Josh said. “And that's how it was introduced to me. And it never went away.” 

In this episode, Dr. Lakhia, Dr. Goodman, and Josh discuss all things Foundation Training — how to get started, and why changing how you bend and breathe can change your pain. 

 

💡 Featured Experts 💡

Name: Dr. Eric Goodman, DC

What he does: As a trained (but not practicing) chiropractor, Dr. Goodman used his education as a springboard to understanding how to strengthen the spine. He developed his series of Foundation Training exercises as a way for people to take their spine health into their own hands. 

Company: Foundation Training

Words of wisdom: “The ability to understand what your body is doing, as it's doing it, is probably the most important skill of chronic pain relief through lifetimes.”

Connect: LinkedIn | Foundation Training Streaming | Instagram | YouTube

Name: Josh Brigham

What he does: Josh found Foundation Training following a cervical spine injury that was treated with an artificial disc replacement. He now trains others in restoring their own spinal health at his Charlotte-based Adapt CLT. 

Company: Adapt CLT

Words of wisdom: “We want people to move and to do the things that they enjoy, whatever that movement looks like. But if you're not doing it connected, you're not going to be doing it well.” 

Connect: LinkedIn | Instagram


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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode, Back Pain Relief Through Posture and Movement, With Esther Gokhale. 

🔎 For more information on Dr. Sanjiv Lakhia and the podcast, visit BackTalkDoc.com.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Transcripts

Voiceover (:

Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your back talk doc, Dr. Sanjiv Lakhia.

Sanjiv Lakhia (:

Over the last several months for those that have been listening to the podcast you've and able to hear so many different viewpoints on how to effectively rehabilitate back injuries. I've had the pleasure of interviewing different authors, scientists, guest lecturers, physicians, and today I'm really excited to be interviewing two guests on the show. And again, if you're listening to this, there's also going to be a video version of this on YouTube, most likely. So feel free to watch that as well. But today I'm going to be interviewing two guests who seemingly might be able to put all of this together that we've been talking about on this podcast for the last several months, where we integrate the whole idea of exercise and breathing and movement and figure out a new system to move our bodies without pain. And I'm very excited to welcome Dr. Eric Goodman and his, I guess, disciple Josh Brigham to the show and talk about what they call foundation training. So welcome guys.

Eric Goodman (:

Oh man. Nice to be here, doc. And Josh. I'm sorry for that disciple statement.

Sanjiv Lakhia (:

Yeah.

Josh Brigham (:

No, no, no. Fair enough. I tell everybody about it. So it's not necessarily untrue.

Sanjiv Lakhia (:

Yeah.

Eric Goodman (:

That's awesome. Thank you for having us on here, doc.

Sanjiv Lakhia (:

Absolutely. I'm always thinking about who else can I get on the show to further the knowledge base of the audience. Those that listen to my podcast, I'm going to assume, have issues with their spine or someone in their family, and they're looking for answers. And as you guys know, I work at Carolina Neurosurgery and Spine Associates, and we're the largest neurosurgical practice in the country and I'm one of numerous physiatrists who specialize in nonsurgical care. And Eric, I actually got introduced to work via an online course I took that was put out by Ben Greenfield, where they talked about foundation training as a fundamental daily flow that you could do to help preserve your back and move pain free. And then it had been quite interesting how I got connected with you, Josh, literally just looking on whose was here in Charlotte and I found you.

Sanjiv Lakhia (:

And then as you guys both recall serendipitously, Eric ends up in Charlotte and I end up taking a class with both of you guys. And before I know it, I'm doing a woodpecker and a founder and I'm not sure what I got myself into. So I feel like it's been a little bit of fate that we got connected here. Eric, before we jump into this method that you call foundation training, I'd love for you to give people who don't know you a little bit of an introduction about your background, your training, and then maybe step into your story about how you went down this path. And then we'll open up the door for Josh to do the same.

Eric Goodman (:

So anybody that's interested in understanding a long term, sort of self-fulfilling fix to back pain, should consider foundation training as a really good tool and a really good consideration in their tool belt. Our work is all about doing it yourself ultimately, you're going to learn how to strengthen very specific parts of the spine that often are miscommunicating with the rest of the body. And that miscommunication leads to structural integrity breakdown of the spine and hips. So what we've done over the years, and over the years is I've been doing this for 13 years now. And what we've done over the 13 year period is we've created these body [weight 00:04:12] exercises that provide the support, stability, strength, range of motion and patterning for the rest of the body to feel very supportive. And with that support comes a lot of relief. My background is both as a chiropractor, though I've never practiced chiropractic.

Eric Goodman (:

I've got a wonderful education as a doctor of chiropractic that I've had since I graduated in 2008. And by the time I was out of school, I was very gung-ho on the path of trying to understand my own pain in the spine. And that led me to creating this protocol, this series of about 25 exercises that follow a very specific path of decompression breathing at the torso and pelvic anchoring from the feet to the pelvis. And those two principle are very [accessorizeable 00:05:03] in the sense that they can be added to most movements once you learn how to do them, and provide you with a less painful range of motion through your ordinary ranges of motion. Like you're not hacking them, the hack is the wrong word, and it's a shortening, this is a lifelong endeavor once you get into it. So don't think of it as a hack. Think of it as a skill of supporting yourself as naturally as possible through breathing and asymmetric exercises.

Sanjiv Lakhia (:

Yeah. And on your website, you have quite the MRI, so talk to the listeners a little bit about your own journey and if that is what really compelled you to look at this and create this sort of approach.

Eric Goodman (:

I didn't have a choice. It compelled me in the sense that it was truly compulsory. I had about a year left of chiropractic school when my back got bad to the point that I was like, "I don't want to be a chiropractor. I'm just in pain. When my back goes out, it goes out for... Geez man, three, four weeks at a time. Sometimes at this stage of my life and driving hurt, standing hurt, sitting hurt and laying hurt." You're just out of options. You can move around a little, "Okay. I don't hurt right there." But other than that, you feel the shooting pain. For me, it was L4-L5, L5-S1 compression that led to a pretty serious... My L5 and my S1 are almost like crushing into each other. And it's created a very, very uncomfortable lower back disc herniations, take those out of you. My discs are herniated. You know what I mean? It's not, "Oh, I've got an L5-S1 herniations." It's like, "No, I've got lumbar disc herniations."

Sanjiv Lakhia (:

Have multiple-

Eric Goodman (:

A few thoracic disc herniations and a mild cervical disc herniation. And none of them impact me any longer. They are all still there. The compressions in my lower spine are very prevalent. The bony protrusions, the osteophyte formations, the little bridges, the little degenerative changes that happen to all of us naturally, have happened significantly at my low back. And the difference between 2008, 9, 10, and now, is strength and range of motion and integration of that range of motion into more or less anything I do reaching, bending, squatting, kneeling. And those integrations have led me to really understand how the body breaks down physically. And if you look at my MRI, my MRI sucks, but my muscle tone, my nerve conduction, those are excellent because I work extremely hard on the nerve pathways and on the muscle pathways.

Sanjiv Lakhia (:

And I think it's somewhat of a similar story for you, Josh, about how you found your path. You're now a trainer or certified and foundation training, and you teach it in the Charlotte area. And that's how I've got to meet you and actually take a one on one lesson with you just a few days ago, but you also have an experience with my group. So whatever you're comfortable with sharing, I think your story is extremely valuable, because it illustrates that there really is probably a place for all of us in this path, surgical, nonsurgical. And I really feel like your story's compelling. So I'll open up the floor a little bit for you to share your journey.

Josh Brigham (:

Yeah, I'd be happy to. I did 31 years of age. I rolled over a sleep in bed and the C6-C7 discs ruptured as slid into the neural canal and compressed the nerve there. And I woke up screaming and I couldn't feel my hand that great. And I had limited range of motion. I thought something was wrong with my shoulder. I was trying to press my shoulder into a corner of the wall to see if my muscle would release, but went to the emergency room. Eventually ended up with one of your doctors Dom Coric and he literally saved my neck, putting an artificial disc in there between C6 and C7 and cleaning up that disc material. And after the surgery and the postop, he is like, "Well, I got good news and bad news, Josh." And I was like, "Well, let's hit me with the good news."

Josh Brigham (:

He's like, your neck's going to be fine. You're going to rehab this. You're going to be fine. The bad news is that you have the spinal health of an 80 year old masonry worker and you have all kinds of degeneration. You have 90% disc loss in the lumbar spine and you're going to need multiple fusion surgeries in the future, probably four or five years out. And he's scared me straight. He's like "Your job now is to put that off as long as you can." And he's like, "We're going to get you started on physical therapy." And he just asked me simple questions like, "What do you like to do?" And I was like, "I like to run." He's like, "Yeah, you can't afford a compression event. You can't even go over speed bumps fast without like being mindful of what you've got going on in your body.

Josh Brigham (:

Because if that disc ruptures, it finally gives out on you and you have to have this surgery, it's going to take a long time to heal." So that set me on the path to trying to figure out what I was supposed to do. I went through physical therapy. I did chiropractic, I did acupuncture, body work, traction therapy was my favorite part of the day, just going to Carolina Neurosurgery and Spine and laying on that table and being pulled apart. And it was like the ultimate release and relief. Yeah, so I had a pretty messed up spine and I saw this guy on YouTube one night with a Ted Talk and I was like, "Well, all right, I got 20 by let me buy that book." And that's how I got into foundation training.

Sanjiv Lakhia (:

Rust as history. And we're going to link, is foundationtraining.com. Correct. That's Eric, your website?

Eric Goodman (:

Yes.

Sanjiv Lakhia (:

We're going to link to that. I'm going to link in our show notes. I did a great podcast interview with Dr. [Coric 00:11:14] regarding artificial disc placement surgery. And just you know, you looked into really the world renowned expert you lucked into, and I'm so glad you did. And you are illustrating though that it doesn't stop with surgery. The story has to continue and you have to figure a way forward. So I want to jump into some questions, Eric, that I have for you. And then we'll, we'll bounce off each other our thoughts as we introduce this to the listeners. So you talk about Foundation Training and you just touched on it a little bit on your intro, but if you were stuck in an elevator and you had 30 seconds to explain it to someone you notice who was grabbing their back, what would be your elevator pitch? Of course you can elaborate beyond that, but define Foundation Training for people who don't understand it, or know what it's about.

Eric Goodman (:

So the quickest descriptor that I use when teaching and it used to be a long descriptor, but I've shortened. It is we have two basic stability features in the human body. One of them is elastic and contractile and it can move us into positions. And that's the primary stability of muscles and tendons, where they lock into joints and move them. And it goes all the way from the ribcage and the feet to the head, to the neck, to the spine, to everywhere. We're a elastic mechanical contractile being. And then we have our secondary, fail safe stability, which is ligaments and bones, the non contractile, non elastic boundaries of our body.

Eric Goodman (:

And Foundation Training pulls us out of those boundaries into primary stability. And it uses the pulleys, the muscles, the joints that are being pulled by those muscles to actively align the body so much so that if you repetitively do it strengthens those patterns to a point they become the dominant pattern of your body's ranges of motion. Many chronic pains are found along the head to the toes as you decompress the body. And many of them go away with Foundation Training during that active alignment and decompression.

Sanjiv Lakhia (:

Yeah, and I really resonate with that. Just in osteopathic medical school, we talk a lot about the fascial connections of the body, and this is why, and I was telling Josh is why some patients would come in, let's say with shoulder pain. And when I was working with my old profs and mentors, we would start by working on their contra later ankle and doing some unwinding and things and-

Eric Goodman (:

Awesome.

Sanjiv Lakhia (:

The whole body's integrated. And Josh, you brought a really nice book in when I saw you recently, I think it was called Anatomy Trains.

Eric Goodman (:

Right.

Sanjiv Lakhia (:

And I've seen that before. I don't own it, but I'm going to link to that as well in the show notes for people to look at, if you're trying to understand this concept about how the whole body's integrated and connected. I think that's a really good reference to potentially have.

Eric Goodman (:

I ask all of my students to read that book. Because it helps them understand the philosophy of anatomy. Anatomy is a science that's taught in a very compartmentalized piecemeal, origin, insertion action, teaching style. But really our anatomy is very alive. And Thomas Myers in Anatomy Trains does in a world class job of helping you to see the philosophy of anatomy.

Sanjiv Lakhia (:

It was a running joke in medical school. That fascia is a stuff you cut through to get to the good stuff in dissection class. And of course, obviously now we know it's not, it's where everything lives. And in fact, I do acupuncture as well and tons of research coming out about the importance of the fascial connections in the body and integration.

Eric Goodman (:

Have you seen what's coming out about it where it doesn't contract wholly in the direction of needed contraction or movement, but it sets this tone, this directional beacon and inertia for the muscles to continue. It's very interesting now. It's kind of alien level. It's very interesting.

Sanjiv Lakhia (:

Well, any articles or things you guys come across, send them to me and we'll definitely put them in our show notes for the listeners. One obvious question that's going to come up is going to be, can you help people understand maybe the difference between doing this type of... And I'm going to call Foundation Training a rehabilitative approach for injury, and I hope that's okay. Doing this type of rehabilitative approach versus let's say traditional physical therapy, which we have in our group. We have amazing physical therapist and we do get really good outcomes, but how would you look at this a little bit differently?

Eric Goodman (:

That's a good question. So I don't want to look at physical therapy as a thought process, more as individual practitioners. Most practitioners of anything in the rehabilitation field... you start to realize the standard limitations of status quo rehabilitation, and it will stabilize somebody very often, but it doesn't get them to the next level of be a performance or tone or power. You have to find other avenues to get there. And most rehabilitative specialists, be it physical therapist, chiropractor, medical doctor, DO, the acupuncturist, yogi, personal trainer, strength... They tend to start to lean towards the same systems. The ones that don't, the ones that go very by the book and that they're still clam shelling, glute problems, and sciatic problems, they're still having you trace letters with your toes for ankle mobility. They're still doing these external rotated leg lifts and different things.

Eric Goodman (:

They're still having these basic, basic, basic movements instead of integrated whole body movements that help the whole system learn to cooperatively, move together while stabilizing the problematic area, while cooperatively moving the problematic area. And I don't want to say it's the difference of found ankle therapy, but it's the difference of a practitioner who looks at an integrated approach to the body where, like you said, you used to untangle the ankles to get to the opposite shoulder. It's because you guys spot on and you are experienced in what really happens in the body versus what we learn happens in the body. And a good physical therapist is going to be able to look at any patient and say, here's the protocol for this and now here's what I'm going to add and subtract from that protocol to make sure that your outcome is for you and what you need.

Eric Goodman (:

Even in Foundation Training, I don't hand these guys a "This is what we do every time protocol." I do everything in my power and my team does everything in our power to give them a perspective from which they can view the body and as many tools to then treat or teach the body out of its patterns. And that's foundation training versus PT. Is we are very, very... The homework is the most important part of this. The at homework that you are doing is by far the most important time, even our time together, it's what you do at home what's going to biggest impact. It's what you're practicing, what you're learning.

Eric Goodman (:

There are very unique movements in our work. We have intellectual property on this process of decompressing the torso because it's not elsewhere. It's unique. And it's something we've been developing for many, many, many years, same on the pelvic anchoring. So we have a style and we have entry points that are unique and a little bit different, but they're not necessarily better. They're just unique. And I believe that a good therapist looks at the body through a good therapist's lens. It's not the skill they bring in the specific thing that makes them good or bad.

Sanjiv Lakhia (:

I really like that. And I would agree with that. In our group, we have some amazing therapists and I think what really makes them stand out is their passion for learning and going from that foundational teaching and expanding upon that, understanding how it all fits together. Like when I had my radiculopathy a year ago, my PT, Jay, who's just amazing, he had me doing something, he called toe yoga and I was like, "What's I going to do for my back?" And darn it, didn't it work? Like it really shut down some neural tension and it was really cool.

Eric Goodman (:

Well, just while you're on that for one second. You work in this field so much and you see this, we very often only look at symptoms as a downstream process, but what you just experienced with your spine is the upstream regulation of neural symptoms.

Sanjiv Lakhia (:

Yeah.

Eric Goodman (:

The distal coordination ranges of motion can absolutely program upstream into the proximal leaders of range of motion. The hips, the back, the groin, those are the leaders of your motion. But they're limiting step, they're lagging strand. If this was a chemical reaction, the lagging strand, and the ability of those hips and the powerful muscles to do their job is those little distal ranges of motion. So by practicing those, by cooperating those with the bigger movements, you are literally telling your body not only is this safe, but this is how you work. This is what you do. And it tends to listen very nicely.

Sanjiv Lakhia (:

Yeah. It's fascinating. I think the more that I think I know, the less I actually do. So

Eric Goodman (:

All of us.

Sanjiv Lakhia (:

Yeah. That's why I love having conversations like this. There's a good segue into this idea that you call your breathing technique. I'm sorry. It's slipping my mind. The decompression [crosstalk 00:20:26], right? Yes. Josh, let me let you run with that. Because you walked me through decompression breathing in our workout. I thought you great job. Share with the audience. What exactly is a decompression breath? And then maybe Eric can clean it up with his superior knowledge of anatomy.

Eric Goodman (:

Oh no. I'm not going to lie. Josh is a phenomenal instructor. And he's a curious instructor. So he'll probably say it better than I will.

Josh Brigham (:

I appreciate that. But I can talk on the decompression breathing because the very first time that I went to a Foundation Training event, back in 2015, it was Gail and Bryan. They played the art of breathing video, which is a one minute and six second video. And it just shows the ribcage expansion. And I saw that video, I was like, "I don't do that. I've never felt that in my body, is that what's supposed to be happening?" And they're like, "It's not that it has to happen all the time, but it can happen." And if you go and find that and chase those expansive ranges there, muscularly get yourself to the depth of your inhale, you get bigger and you not only decompress the spine, but the everything inside of you, the whole torso is responding to this. And it's just this space creating protocol that anyone can learn.

Josh Brigham (:

If you have the power of your breath, you have the power to change how you hold yourself. And they made that abundantly clear to me. So when I try to describe it to people, I'm trying to say, "It's like you're using your air like you're filling up two balloons inside of you to push everything out of the way, front to back, side to side, top to bottom, it's all there. And then you learn how to hold that space by hollowing out your abdomen and getting the transverse abdominals to hold you up here." And when you see that video, it's just real easy to make that concept live inside of you. And that's how it was introduced to me. And it never went away.

Eric Goodman (:

We are not the authors of that video. Mind you, that is the accurate way that the human body breathes, it's completely independent to us.

Sanjiv Lakhia (:

Why is the decompression breath critical to what you're trying to accomplish with Foundation Training?

Eric Goodman (:

That's a very good question. So the decompression breath came in starting around 2010, about three years after my initial development of this process. And it changed everything. The initial years of Foundation Training was a very low back extension based protocol and it was not closed kinetic chain yet. Closing the kinetic chain makes the body sort itself out in space, instead of an open kinetic chain, which makes that a much harder process. It leads to more challenges in proprioception and in somato sensation, both translations of what your body is doing at any given time. My back was very good from about 2008, until about 2010. And then it started getting extension problems because I was extending so much. So I started pulling my floating ribs. And if you look at the sous muscle, you see that the big meaty part of the sous is just around the kidneys and it attaches to the multi levels of the spine.

Eric Goodman (:

And I started looking at the sous much like I do the legs where it's like, well, where we always look at it down here, is just this skinny little muscle. You can't stretch that skinny little muscle, but what if you pull the big end away from the small end? And I started breathing my ribs bigger, especially the back low ribs where I was always extending, flattening out the curvature of my spine, especially the thoracic curvature. If you want to make the spine long, you don't straighten it, you broaden the ribcage at the back. You pull the ribs away from center, along the thoracic vertebra, the longest curvature of the spine. Mind you, I have learned this by reverse engineering, the process of decompression breathing for about 10 years. When you widen the back ribs, you don't lose height at the sternum, you gain height at the sternum. And it increases your lung volume, especially by spreading these back ribs into a subtle rib.

Eric Goodman (:

So you're decompressing the spine at the disc level by widening the ribcage during the inhalation, not just the front of the ribcage, particularly the back of the ribcage. That's a very important denote there. Upon widening it, you're improving lung volume, you're improving the capacity of the serratus muscles that surround the ribcage to communicate with the diaphragm, which is so important. We hear about it all the time for a million reasons. But the diaphragm is only as contract dial and is as useful as the abilities of the ribcage to pull away from center. So it wasn't like all of a sudden it was like, "Oh, we've got to put this thing together called decompression breathing." It was, my back is starting to hurt again, I'm going to play, I'm going to keep playing. I'm going to keep lifting. I'm going to keep lifting. I'm going to keep lifting. Boy. That's starting to feel surprisingly good.

Eric Goodman (:

What's half happening in there? What if I take it to these other positions? What if I do it laying down? What if I do it in a plank? What if I do it in a squat? What if I do it in a deeper hinge? What if I do it in a lunge with a spiral? And all of a sudden you start to see decompression breathing as a central expansion of the axial skeleton, coupled against tightness, and isometric contractions throughout the rest of the body. So while the whole body is tight and holding, we're actively trying to pull the ribcage away from center, creating sort of a counterbalancing perpetuating strength between the two.

Sanjiv Lakhia (:

And to keep it simple, correct me if I'm wrong, the decompression breath is, first you take this huge massive in-home where you're trying to expand the ribs front and back top and bottom. But the key difference is the exhalation part where you're trying maintain that container volume and don't let the entire thing collapse. Is that how you're coaching people?

Eric Goodman (:

Yeah. That's very reasonable. So the idea is, you're taking a breath into the lung, and the lungs only take up the rib. There's no lung in the belly. The lungs are particularly voluminous at the back of the rib cage, but only if the front of the cage is maintained. So you don't, this is not a big breath. But this is, and you want to really create that back to front density and depth. The exhale, like you said, very well, is where the magic happens. It's the eccentric, the negative, your diaphragm is at its contractile point. The serratus muscles are contracted and holding and the intercostals are expanded. Now as you exhale, your ribcage is trying to come down, trying to come down, trying to come down. And your effort is not to let it.

Eric Goodman (:

Instead, pushing the air out, not from the ribcage, but from the lower abdomen, heightening, pulling away from those centers of the ribs that you're pulling apart towards the lower abdomen. And that transversus abdominous contraction forces the residual air out of the lungs and keeps the ribcage leaned towards expansion, towards a learning absorption of what it's able to do. Muscles learn, not by generating force, but by learning to absorb the force, they then are meant to generate. So it's sort of a teacher to the inhalation muscles by not letting them come down during the exhalation.

Sanjiv Lakhia (:

And for those of you that are listening right now, or even watching us, this is really meant to just be an intro to these concepts. I would say that this is more of an experiential thing. You just have to do it. And Eric and his team, you guys have put out numerous demonstrating videos [crosstalk 00:28:07] people through routines, and they're like 10 minute routines. So I encourage anyone. And we'll definitely add some links to that in our show notes as well for people. But I'm just trying to get people who are curious a little bit of background knowledge on what this approach is and we're like the foundational basis for it comes. One thing I wanted to touch on with both of you, as I have been talking with my colleagues, some of my most trusted physical therapists, and then even some of the thought leaders in the field, such as Esther Gokhale.

Sanjiv Lakhia (:

And she's the author of the Gokhale method, who I interviewed recently, and that actually just released last week. And then, I had a great interview with Dr. Stewart McGill. One of the common themes is this concept of doing a proper hip hinge. And your TedTalk where you had just a few minutes to introduce such a complex topic, you chose to talk about how fundamentally a lot of our problems start by our inability to bend over properly and it's just got this domino chain reaction. So I just want to open the floor for both of you to share your thoughts on why it's important that we learn how to hip hinge, what is a safe hip hinge and just your experience in coaching people up on that at.

Eric Goodman (:

Josh, why don't you start on this one?

Josh Brigham (:

Okay. Yeah. One of the things that we're always talking about is hip driven movement. Like that the movement has to start its center and that the hips have to move first and then the spine responds to the movement in hips and not the other way around. One of the common problems that we see when people are trying to do a hip hinge is that they're so externally rotated already, their glutes are so tight and short that when they go to hip hinge, the iliums literally compress into each other, into the sacrum. And there's nowhere for that to go to pass through and then you start to flex and start to move it to lumbar spine. So a proper hip hinge has to have some degree of internal rotation. Correct me if I'm wrong, Eric, but it's like the hips moving almost further around the femur, so the butt can go back and the spine stays nice and long and I'll pass it to you from there.

Eric Goodman (:

That's one way, yeah. I like what you're saying. It's a hard concept to understand the pelvis moving around the femurs. But what you think of is the femur sits within a deep cave on each side, where the head of the femur articulates meets a up with the acetabulum, the hip joint, the actual socket in the pelvis on either side where the hip's going in. And it's a 270 degree rotation because you can't pull it all the way out. You know what I mean? Like there is a head of the femur and a neck of the femur that will block excessive external, excessive internal rotation. But they do need healthy internal rotation and healthy external rotation, just like they need healthy flexion and extension, but it's a circle. It's not a lock and key hinge. The hip is a circle.

Eric Goodman (:

It's a very nice circle, in fact, in most people, and it has the capacity to go through a lot of ranges of motion that tend to be hindered by steady chronic contractions. The most frequent place that hinders the hip joints ability to move as it naturally needs to within its socket is the butt muscles tightening and shortening, so that they're trying to turn the femurs away from center, even though a hip hinge requires that the hip joints internally circumduct to center in order for the sacrum to pass behind the femurs in a hip hinge. Because a hip hinge is passing the pelvis through the femurs, it's not bending the spine. A quick analogy or a quick illusion or a figure to think of in your head here is, imagine you have two planks, one of them is a diving board, and one of them is a seesaw.

Eric Goodman (:

On the diving board, you're going to hit the end of that plank and you're going to feel major flexion in the board because it is wrapping over a fixed spot. And that's how it's getting its elasticity and it's rebound. Makes sense?

Sanjiv Lakhia (:

Yeah.

Eric Goodman (:

That's the spine when the gluts are contracted. On a seesaw, you have a fulcrum of movement that allows one end to come while the other goes down and one end to come down while the other comes up, but you don't see flexion over that fulcrum. Now it is not that simple, but it is that simple. If your spine is required to flex, not optional, if you choose to flex your spine, that's different. If your spine is required to flex in order for you to move your torso forward to grab something, or move to the floor to grab something. If the spine is required to flex, it better be happening at a thoracic spine and not the lumbar spine, if you want to have a healthy hip hit.

Eric Goodman (:

If that contraction leads to flexion required at the lumbar spine, it's because the lumbar muscles are not strong enough to communicate with the hamstring and glute muscles during a hip hinge. Those muscles are dominant, they're too strong, they're too tight. And when they meet their end range of motion, where the spine should be strong here, it gives and that diving board flexes over the fixed point. And too much flexing makes a very unhappy spine. You can flex your spine and you can extend your spine. You can have wonderful ranges of motion segment to segment, to segment, to segment. But as Josh really eloquent stated, those inertias, those directions, those forces have to be generated initially below the spine from the pelvis. And that's how you save the spine and make sure that it's not overdoing any of its role.

Sanjiv Lakhia (:

Probably the most common presentation in my office for people who injure a lumbar disc, let's say L5-S1, is some sort of bending over maneuver. It could be as simple as bending over to tie your shoes. I was getting ready for work, put my socks on, and it was like "Someone stabbed me in the back with a knife." And I've asked all my guests this, is there a path forward for people through Foundation Training who have flexion sensitive back pain, flexion sensitive radiculopathy?

Eric Goodman (:

I'll tell you what, more important than a path forward, there's a path backward too. We're going to teach you how to go both directions. Left, right, up, down, backward, forward, all of it. We're going to teach you from the toes, through the ankles, through the hips, through the shoulders, through the neck, through the ears, through the jaw. Because you're going to know where to position yourself, and the first month, I don't care how much you know about mechanics, how much you know about your body, how much you know about movement, it's going to be a little awkward for the first month or so of learning this. Because you're paying attention to making sure if my right arm goes forward, my left hip is drawing back. You're making sure that as my hips go back, I'm subsequently doing these little rotations. I'm keeping... There's so much to think about in each of these motions initially. And that obsessive compulsive desire to make sure everything is accurate leads to very accurate movement down the line.

Eric Goodman (:

And once it's sort of embedded in your neurology, which is something that happens through frequency and intent, not through duration and intensity, it's frequency and intent, that patterns these neurological patterns in your movements, in your nerves, in your muscles, in your bones, and you get this really interesting process. All of a sudden, you have pain, you have symptoms, you have a problem that you're trying to address, and without even thinking of the pain or the symptoms of the problem, you grab something and you come up out of it. And you're like, "There it is. That's what I was waiting for. It's starting to get embedded into my movement patterns. It's there." And then you go harder. You work harder. You want it more. I've seen it with a lot of people. We have over 1200 instructors now, like Josh is one of over 1200 instructors in the Foundation Training community, through the word of mouth relief that other people have received.

Eric Goodman (:

That's how we've grown. We have three books on the subject, we have technically four books on the subject. My wife wrote a book for babies and how parents can help their babies really, really meet the physical milestones of the first year of life. She's a pediatric specialist, physical therapist and wrote a wonderful book called Shaping Your Baby's Foundation that helps parents. And then we have three specific books on the biomechanics and process of this work. We're still learning, still going to put more out. But there's one thing I know, the ability to understand what your body is doing as it's doing it, is probably the most important skill of chronic pain relief through lifetimes.

Sanjiv Lakhia (:

Yeah. And I think what you just touched on there is very important. Josh, you had talked to me about as you advanced through things, and you're starting to feel better that this is a precursor to being able to do exercises like deadlifts and other things. So how do you think about Foundation Training in the concept of physical fitness? Is this something that you would have your clients want to do as a daily thing, that sets them up to succeed in other activities? Is it done in place of? What's kind of your viewpoint on that and how do you have you integrated into your life since you've had your disc done and had your back looked at?

Josh Brigham (:

So look at it as like the ultimate accessory. We want people to move and to do the things that they enjoy, whatever that movement looks like. But if you're not doing it connected, you're not going to be doing it well. Foundation Training gets you connected, so when I have people that are trying to get back into the gym or trying to get back into a sport, I'm like, "Listen, you don't have to do this for an hour before you go and do the thing you like. Instead of you just stretching, warm up that you're used to doing where you just hold the stretch for a long time and passively sink into it. Let's light up all of the neurology and get everything to start communicating together. Let's breath into it, make more space, let's get you feeling yourself and feeling powerful and then send you to do the thing that you like to do.

Josh Brigham (:

It's not supposed to replace anything, it's supposed to make you better at everything that you do. If you get better at you, you get better at your sport, you get better at lifting. That's the way I explain it to people.

Sanjiv Lakhia (:

Yeah. And then, Eric, you just touched on and you were giving a little example actually with the video, about how then this concept can translate into daily activities. Because most of us and the people I see, they just want to be able to get their groceries out of the trunk without reaching for their back or give their young kid a shower or play little hoops in the driveway with their son.

Josh Brigham (:

Yeah.

Sanjiv Lakhia (:

So do you see that? Do you see that translate into... Is that more a matter of the more you do the better, it gets and it just becomes a program pattern that's actually healthy for you versus destructive?

Eric Goodman (:

I've had the really remarkable good fortune of listening to that story every day of my life for the past 10 years. Somebody, sometimes multiple people a day, will send me an email. They have my number they'll say they'll give me a phone call. "I just played with my kids, man. I just swung a bat with my kid. That's insane, that would've put me out. I just never would've thought to do that last year."

Eric Goodman (:

Grandparents picking up their kids, professional athletes playing their sports. We have a tagline. We have a couple taglines now, but the one that resonates for the longest that's been there since about 2008 is, from pain to performance. We have many people that have found our work. And now to be clear, what I teach in Foundation Training is a pain relief protocol. It is a chronic pain, that's my arena, that's my world, is pain management. However, I've also spent about 50% or more of my time working with professional athletes on performance. Specific, using those same pain management tools to accelerate their knowledge of biomechanics through feeling, like you said, through experience. Very often I'll take my stronger athletes, especially completely off of weights for between one and three months, work 100% on body weight movement patterns, reintroduce the weights a couple months later and they're stronger, because they're connected, as Josh was saying.

Eric Goodman (:

The ability to integrate muscle chains is significantly more impactful and powerful to the body than the ability to strengthen a compartmentalized or specific pattern in anybody. So if you can work on the integration of biomechanical chains, the posterior chain, the anterior chain, the spiral chain, this is where The Anatomy Trains becomes very interesting, that book. If you can integrate those chains, your body is simply better at dispersing, absorbing and providing force, either of those. So your reactivity improves, your athleticism improves, your ability to get through injuries improves and your force production improves. So we have a really interesting list of humans from the worst pains in their seventies and eighties to the best athletes in their twenties and thirties, that have chosen our work and these very specific breathing tools in biomechanics to enhance themselves legitimately. And to answer your question, yeah, man, every day I get to hear from people that have had their lives directly improve through these movements and the release that they've offered them.

Sanjiv Lakhia (:

That's really what it's all about.

Eric Goodman (:

Yeah.

Sanjiv Lakhia (:

For those people who have similar athleticism to me, the pinnacle of my career is just playing with my kids and being able to perform my job as a physician, feeling good, healthy and strong. And I think that's what people want to do on a day to day basis. I think we've covered quite a bit of information. I had a few other things, but you really checked all the boxes on our initial... My interview outline for you guys. One thing that people may be wondering, are there back conditions that you would say like, "If someone's interested in this," are there situations with, let's say low back where you'd be like, Make sure you get yourself checked out first" or are there any sort of contraindications?

Eric Goodman (:

Every one of them.

Sanjiv Lakhia (:

all Of them.

Josh Brigham (:

Yeah.

Eric Goodman (:

That's a great question. If anybody is experiencing a symptom they're coming to us for the first time and they don't know what it is, you got to get diagnosed, plain and simple. And to be clear, I'm the closest thing to a diagnostician in our community, and I'm not a diagnostician. I want somebody that's very capable at understanding the breakdown in pathology to help me understand what's happening. And then I will help them understand from the mechanics standpoint, how we can create a framework around that and build the patient up using breath mechanics. And then look, there's a million forms of medicine and all of them are important. And no one thing works all the time for everybody. But this is a very important accessory for those patients, for sure. Stenosis, post laminectomy, especially, I've probably had between one and two dozen post laminectomy, multilevel laminectomy patients, where we get a re really powerful result in neuropathy relief for about a year.

Eric Goodman (:

And then it seems like there's... I don't know if it's a scar. I don't know what happens in the laminectomy, but it seems it's by far the most challenging symptom I work with, is radicular neuropathies treated with laminectomies that get better for a year or two and then get bad again. That is so hard to figure that out. And very often I can't and I have to surrender. And we look at other pain relieving methods, but sometimes I can't. I'm just going to say this, I used to say the same thing about central canal stenosis, up until about six years ago. And now it's one of my favorite patients to treat. Because I've learned the things that do and don't help with it from our side of things. So I'm very hopeful that I'll get to treat more laminectomies over the next coming years and try to address the problems that I have with it and try to really find a better way in there.

Sanjiv Lakhia (:

Yeah. And again, like he's said, this is for informational purposes. If you're listening this or watching, start with a good medical evaluation, that's why I do what I do in my community. And find a healthcare professional in your community as well. And then you can go from there and look at ways to address it. Yeah, when you get those tough cases, let us know. We work those up quite a bit. There are some things that can develop after laminectomies that you have to keep an eye on from a medical spine lens, for sure.

Eric Goodman (:

I appreciate that. And I will take you up on that. And I feel that my end of the serendipity for this was getting to meet you, because I want to have as many options for... In my career, I've been getting more and more challenging patients. And I want to really have a network around us that I can offer the best pathways for them.

Sanjiv Lakhia (:

Absolutely.

Eric Goodman (:

Because, Foundation Training is not a cure all, there is no such thing. I wish it was, I'd be rich and famous, but I'm not, and it's not. It's a really nice tool that accessorizes those who are willing to do the work.

Sanjiv Lakhia (:

Yeah. That's fantastic. Now you guys, you mentioned the books you've put out in the video series, is your organization planning on collecting any data like outcomes data or research?

Eric Goodman (:

We have some, and we want to partner with third party organizations that can do it the best way possible so that we are involved in the teaching and training, but we are not involved in the study if that makes sense.

Sanjiv Lakhia (:

Right. Yeah. That's certainly...

Eric Goodman (:

When we did that with Los Angeles County Fire Department and we had a very powerful result with them. If you actually go on our streaming site, we have a first responder program that is a full program for first responders using Foundation Training that we filmed at and with Los Angeles county at their headquarters with their captains and fires, really fun. It's a great program for people to follow. While we were doing that, we did some basic studies on grip strength, on lung volume, on mental wellbeing and on the reported incidents of pain and injuries during many recruitment classes with Los Angeles County Fire. And we took the research from one recruitment class that was in this process. One of our instructors, Evan Halquist is a captain at Los Angeles County Fire Department, he's one of our core educators on the main team and he trains, for the past six or seven years now, every recruit that goes through Los Angeles County Fire.

Eric Goodman (:

So they've all had Foundation Training for a long time, but we finally did the actual study on eight weeks at 10 minutes a day. And the results were astounding.

Sanjiv Lakhia (:

Wow.

Eric Goodman (:

They were remarkable. And the test that we tested, all of the range of motion on, we had a third party come in and use the McGill spinal stability test assessment to govern whether or not we did well. And we also did the FRC functional range. Is it FRC? Did I say that right? Functional range... No, FRC is Andreo Spina's stuff. Functional movement screens, FMS is the one I'm thinking of.

Sanjiv Lakhia (:

Okay.

Eric Goodman (:

Functional movement screens is kind of the granddaddy of physical assessment and it's got nothing to do with us. And it's actually a really hard one to improve upon. And we showed, I think it was a 20% or more improvement across the board using only foundation training principles, 10 minutes a day for eight weeks from this study. And if you go to foundationtraining.work, you can see those case results studies on that page.

Sanjiv Lakhia (:

Yeah. One of the things, if I didn't have a full-time practice with three kids, podcast and everything else I'm into, one of the things I'd love to see happen someday is to integrate into the high school, physical education curriculum, learning how to bend properly. It sounds really silly, but while I feel like the disability, the suffering that could be prevented, if we would just simply slowly drip that into the curriculum of our youth would pay massive dividends.

Sanjiv Lakhia (:

Because, if you told me tomorrow, if I woke up tomorrow and someone had waved a magic wand and there would be no more back pain in the world, I would honestly be thrilled and go sell ice cream for a living because it's just not... The suffering that we see sometimes it's just overwhelming for people in spite of all we do. But today's focus is to show that there's a lot of hope, there's many different ways out there to approach it, and I think the work you guys are doing is compelling. If someone wants to get ahold of you, Eric, I'll let you start, share with people maybe your contact information or what you recommend, how they start with this concept.

Eric Goodman (:

So initially for foundation training, just go to our site. We have two websites, foundationtraining.com is our overall site. And from there you can get to our streaming site, which is stream.foundationtraining.com, where we have an app. It's a really nice spot to learn the basics, to learn the very basic understanding of this. We have 1200 plus instructors around the world in very interesting places from Australia, New Zealand, Canada, China, India, many in America, really, really wild actually where they all come from. And they're an excellent resource. We have a map on the website where you can see that. My personal stuff is... Just go to our social media and that's the easiest way they'll get to me from there. So Foundation Training on Instagram or on Facebook or on YouTube. And then if you have a very specific question for our group, K E V I N, kevin@foundationtraining.com is the one who filters all of those questions.

Eric Goodman (:

And if you have one for me, he'll make sure that it gets to me and that I see it. So we've got a lot of ways to learn this. I recommend everybody before you give us a dollar, go on YouTube, use our free stuff and try it, just try it. If you have instructors in your area and you see that they're putting on a workshop or a free class, go try it. It's very hard to understand what this work is or can do unless you experience it in your own body. And I hope that anybody listening takes the chance to go ahead and do that.

Sanjiv Lakhia (:

Awesome. Now for those who are in the Charlotte area where you and I live, Josh, how do people reach out to you?

Josh Brigham (:

So through Instagram, it's Adapt Charlotte, but just Adapt CLT. And then the website is the same www.adaptclt.com. And yeah, I'm hoping to see more instructors get certified in this area and see this practice grow and become just more accessible to more people. It gave me my life back and I was just like, people need to know about this and I appreciate the opportunity to come on and talk with you gentlemen, and get to share that little bit of it. So thanks for having me.

Sanjiv Lakhia (:

All right guys. Well, well done, thanks again for your time. It's been really cool connecting with both of you. I look forward to watching the work that you're doing and let's definitely stay in touch.

Eric Goodman (:

Thank you, doc. Thank you, Josh, for sharing with us on here and just for having me on, thank you for letting me share Foundation Training with your world and for being a really open-minded practitioner. I hope this helps you for the rest of your life. I really do.

Sanjiv Lakhia (:

Awesome. Thank you.

Josh Brigham (:

Thanks Sanjiv.

Voiceover (:

Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in north and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for about issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health, on the next episode of back talk doc. Additional information is also available at carolinaneurosurgery.com.

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