E45 | Dr. Jacob Harden: Are Chiropractors Quacks? - Art Of Coaching™

Posted November 27, 2019

TRANSCRIPTION

Brett Bartholomew 0:13

Welcome to another episode of The Art of coaching podcast guys. I’m here with Dr. Jacob Harden. Dr. Jacob Harden is a doctor specifically of chiropractic. And he owns and is the director of rehab at Orlando sports rehab in Orlando, obviously, Jacob, thanks for joining us, man. I really appreciate you.

Jacob Harden 0:35

Thanks for having me on, Brett.

Brett Bartholomew 0:36

Yeah, no doubt, like it’s not, you know, on this show, we try to have a wide variety of practitioners, from a wide variety of professions, I always say that it’s from the weight room, to the boardroom, to the classroom and everywhere in between. Talk to us a little bit about how you got started in chiropractic, and give our listeners a little bit of a springboard and insight into your journey, if you wouldn’t mind. ,

Jacob Harden 0:54

Yeah so I always tell everybody, like I just kind of fell into it, honestly. So I went to the University of Texas, and was a pre med there, getting my bio degree. And then, you know, through a series of events just kind of got burnout with school and couldn’t quite imagine doing enough during the rest of that schooling that would go through that. So took a little time off from that took about a year actually. And I’ve always had a bit of an athletic background, played sports growing up and all that. And so when I moved out to Florida, it just so happened that I was right next to one of the best chiropractic schools in the country.

And I was totally that guy that had never even been to Chiro before. So like I went and took the tour of the school and everything and just kind of heard how you can work with, I started envisioning, I guess how you can work with athletes how, you know, I could kind of have this kind of sports medicine based practice that I kind of wanted from a medical perspective anyway. So it seemed like a good fit for me. And so you know, the type of person I am, I knew that if I didn’t jump right on that, then I would talk myself out of it. So I actually filled up my application that afternoon. The rest is kind of history. But my wife and I opened up practice in Orlando, straight out of school about five years ago now and have been running private practice ever since.

Brett Bartholomew 2:29

That’s perfect. I appreciate that like, and here’s the thing, right? This is what I want to ask you like a lot of times when it’s trained coaches or performance professionals in general, it’s always tricky to know what our field really wants to call itself half the time. When we think of an integrated profession, you’ll hear people talking about sports medicine, Sports, Science, performance, nutrition, obviously, strengthen conditioning stuff, although sometimes I feel like chiropractic is met with a fair bit of skepticism, sometimes even way more so than, you know, traditional, like more physical therapy, massage therapy, although that’s got its critics as well.

You know, I want to start this off right off the bat, give us an overview of what you think of some of that criticism of the field. You know, people have some, there’s people that think it’s illegitimate that you guys aren’t regulated and all this other stuff. I mean, obviously, every field has its quacks, right, I tell everybody this, like you can be a doctor or a medical doctor go through, it can go through med school, the go through the license procedure, and there’s still, no matter what, right? Like at the highest level of anything, there’s going to be quack. So I’ll start that off with that. But give us a little bit about what you think about the criticism fair and unfair about chiropractic and whether that really like what you have to do to navigate that perception?

Jacob Harden 3:41

So I think I definitely think, I think some of it is fair. In all honesty, I think some of the criticism out there is completely fair as far as where the perception is that the public has of the field. And yeah, I’m, you know, take it all on you, like you have to own your stuff. So I think that the perception that has that the public has of us is our own doing, we’ve created that, and it’s up to us to you know, change that. So there definitely is a different subsets of the profession. And unfortunately, the one that we might call a little more like a quack, or, you know, the pseudo science aspect of it tends to be more vocal, and they tend to make the news more they tend to get the articles written about them.

Because as we know, the more negative side of things kind of just tends to spread a bit easier than just saying that oh, well, evidence based practice, you know, no one wants to read articles about that. So, that side of the profession doesn’t really get talked about nearly as much but it actually is a very large portion of the profession. And so, while I do think that, you know, the criticism as far as to the side to the profession that is saying that, you know, they can treat all these, you know, internal diseases, and really anything outside of the neuro musculoskeletal realm. You know, that criticism is warranted, because as far as what we do, we really should be more of a musculoskeletal specialist.

That’s how I view the profession. And that’s how the more evidence based side of the profession views itself as well. And you know, it goes so high, even to the regulatory bodies, I mean, we very much are regulated, you know, at the state level, at the national level, we have organizations and everything else. And we have scopes of practice. And unfortunately, there’s just a lot of gray areas in that, and some leeway in that, that some people can take advantage of. But you know, even at our national organizations, those are split, we have two of them, the American Chiropractic Association, and the International Chiropractic Association, and one tends to be more towards what we call the vitalistic side of things.

And one tends to be more towards the evidence based side of things. So we kind of have this divide right down the middle of the profession. And we’re really working on it internally to try and shift that towards more of a more towards that evidence based side and more towards that, you know, primary musculoskeletal care. And I always tell everybody, that the, you know, when you look at a good physical therapist, a good orthopedic physical therapist, I should say, and a good Chiro, you really shouldn’t be able to tell the difference between degrees, because we’re all seeing the same populations. We’re all reading the same literature, we have the same scope of practice. So therefore, our treatments should look basically the same, too.

Brett Bartholomew 6:51

Yeah. And that helps. I mean, you brought up a couple good jump off points there. One, it’s knowing that you’re regulated at the state and national level, I think it’s worth noting, you know, there’s a lot of people that still, and these aren’t new, right, but there’s a lot of people that get really excited about stem cell treatments, and those aren’t regulated, right? Like, there’s still a lot of ambiguity about that. And so, I always just find it fascinating, since I study a lot about human behavior and perception, how we sometimes, you know, judge or assign kind of this value to something that’s arbitrary, on one end, and then the same end of the spectrum, we feel like, we’re totally justified in saying, no, no, no, yeah, this is legit. But that’s not legit.

And especially in strength and conditioning. This is a big argument right? Now, we’ve talked about it several times in the show, is how do you define what is a qualified professional and you said, Listen, you might not be able to tell, you know, at face value, but as you get into that, like, if you were to evaluate, right, when this is just metaphorical, it’s okay, if like a year back, you listen to this, and you’re like, Oh, my God, Brett, I don’t like the answer I gave you. But like, just off the top of your head, if you were to create some kind of an evaluation, on what quality a truly qualified chiropractor is, what would that look like? Or at least what categories would it entail? Both on the technical side, and, you know, on the interpersonal side,

Jacob Harden 8:14

I think that, from a skill set perspective, the focus of treatment should be on exercise and education. First, it should be on active therapy and patient empowerment, and taking steps towards helping the patient have more self efficacy, and having more control over their own condition and their own injury and being able to find self management strategies toward and ways to help themselves. You know, from a business perspective, we shouldn’t be promoting lifelong care, you know, especially like the three times a week see me all the time, kind of care. You should not be promoting anything about bones being out of place spinal misalignments leading to internal disorders, because that’s just not where the evidence is pointing us.

It really should look a lot more like, it should look like a blend of what you would think health care and strength conditioning should be like, good exercise promotes health in the body. And, like, take steps to be unhealthy that we all know. And, you know, kind of it. I hate to say if it quacks like a duck, you know, but

Brett Bartholomew 9:35

Oh, no, that’s fine.

Jacob Harden 9:37

Like, there’s some stuff that you know it when you see it, right. You know, when you read, if you go on somebody’s website and you’re reading about how, you know, you always should get your spine checked. And because spinal misalignments somehow lead to like your liver not functioning well.

Brett Bartholomew 9:55

Yeah

Jacob Harden 9:55

Like, you have to just look at that and be like, huh rail Really, that’s kind of that sounds a bit far fetched,

Brett Bartholomew 10:03

right. And I don’t mean to interject, but I just want to make sure like, you know, because this is something that you do extremely well, when you’re talking about the, you know, patient empowerment, self management, we’re gonna get into that in a moment. Because that’s what drew me to you. Like, I think that you do that better than most like you’re like this lighthouse. And that’s kind of what we envision ourselves at art of coaching. I tell people listen, if you can explain what your company is in one paragraph, one sentence, one word in one image, you don’t have it.

And to me a lighthouse is something that like, it empowers other people to go through the journey, but it’s so kind of guides them but so let’s say somebody’s listening to this on the same train of thought you’re getting into, and they are somebody that are like, you know, what, I’ve seen a chiropractor, and he made a couple adjustments. And you’ve heard crazy shit, right? Like, people are like, I swear I’m breathing more easily. And I can taste strawberries with more, you know, like, and my visions better, you know, and all this stuff. So that’s a little bit of the placebo effect, is it not? Although, you know, there’s things that improve no doubt, because of adjustment. But what is it about that process that converts people into these evangelists where they really think, yeah, my livers functioning better now that I got, you know, that I got cracked a couple of times a week? What? Like, what fascinates you about that? And where do you think that comes from?

Jacob Harden 11:16

I think people are, I mean, people are naturally seeking out help. And when you have a problem, and you’ve had a problem for a while I no one’s been able to help you, you kind of start grasping the solution, like you start looking for things. And, you know, I treat a lot of people that have dealt with chronic pain. And, you know, as an example, I treated somebody just last week, who was told that the knee pain they were getting from squatting was caused by their elbow, and that by doing soft tissue mobilization of the elbow, it would free up their knee pain, due to cross body fascial slings and stuff.

And it’s just, I mean, that’s not– I mean, that’s even in the realm of musculoskeletal care still. Right? But it’s just like, it makes you raise an eyebrow, like, What in the world? What how? So, but you know, if it helps you, our natural tendency, is to believe that what you were told was true. It is the post hoc fallacy, right. So if you did this, therefore, it was caused by what I told you, the problem was, and so, unfortunately, like, it’s just there’s a lot of placebo out there, there’s a lot of things that work because we either we believe it to work, or maybe time just happened to align itself, right with, when you got that treatment.

Maybe it gave you more confidence to get yourself moving. And maybe it reduced your stress around that area, and you started to kind of expect it to get better, you started to, you know, not focus on it as much, you know, an example that I like to give there, and I like to just have these kind of talking points of people is, we’ve all probably woken up with that kind of achy knee, you walked around on it, you’re like, Oh, what the heck is that. And then you went to work, and it wasn’t there about the end of the day. Like, you distract yourself away from some things, and you stop thinking about some things, and they kind of let themselves fade.

So you know, sometimes with these treatments, you’re expecting them to get better. So you start to not necessarily focus on the burden of them as much, and therefore, they start to kind of fade. So I mean, there’s so many factors at play with pain, we can never just say it’s one thing. But a lot of why people just jump on these things are they’ve been, they’ve gone through an elaborate education process. And then they’re given a treatment, it helps for one reason or another, and therefore, it’s been anchored to that education they were provided.

Brett Bartholomew 14:09

Yeah, I think, you know, one thing I want to highlight that you said, there’s great as this focusing illusion, right? There’s cognitive bias that occurs when people place way too much importance or even significance on one aspect of an event. Right? And that causes an error in predicting, alright, well, what’s the utility of this future outcome? And I think there’s also this anchoring effect, right? Where like, sometimes people hear oh, I went to this guy, or this gal, and they did this and everything was better. And now it’s a dualistic nature where it’s kind of like somebody tells you, man, you need to go see this movie. It was hilarious.

Well, one, you’re either primed to also think that movie is hilarious if you share, on average the same views as that individual, or you’re gonna be super disappointed, you know, and so, either way, they have strong emotions tied to an outcome and you know, pain As you said, pain is almost like an emotion. It really is like, yeah, right. Like in people, they attach this, this significance, even though we know it’s a warning sign, and it’s a teacher on my friend, David Joyce, where he says it’s got many layers and like nociceptors are just one part of the story. There’s so much like, individual context associated with it. How many, be honest, you have more than 600,000 followers on Instagram? How many messages do you get? They’re like, Hey, doctor Harden, why does my knee hurt? And what stretch can I do for it?

Jacob Harden 15:34

It’s about 99% of them.

Brett Bartholomew 15:37

I’m always interested, like, how do you respond to that? Walk me through this?

Jacob Harden 15:40

It depends on the mood I’m in. You know? The number one thing, I’d have to say there is just hey, I don’t have you know, off a very limited information, no exam, no background, it’s impossible for me to tell you exactly why it hurts or what the best thing is, as I can then sometimes, you know, maybe say, in general, you know, I’ve done this with a patient, and it’s helped, you know, yeah, sometimes somebody tells me, you know, I’m having pain with XYZ movement, whenever I get to XYZ load, and you’re like, Oh, well, maybe you should back that down a little bit to a controllable level, and then rebuild off of that. But, you know, the number one answer always has to be Hey, without more information, anything I give you is just a shot in the dark. And I don’t know how useful that really is for anybody. ,

Brett Bartholomew 16:40

Yeah, yeah. And I think what always gets me about it. I love what you said about it depends on the mood I’m in. It’s is the same way for me, because inherently where I go, is well, I always try to be respectful. I’m just like, Hey, have you checked out like, I got one today this morning. It was, hey, what advice do you have for a coach today? And like if like literally have you started in 2019? What would you do? Well, like we have previous podcast episodes on that, like obstacles early in your career. I have like a free ebook download.

That’s like 50 pages, it talks about that, you know, I got a book and then the product. So what I’ll say to them is I’m like, Hey, I’m happy. You asked that here are these resources. You know, I also have a book that’s like 300 pages that took me like three years, right? That’ll tell you every damn mistake I made. And then like, so I leave that conversation feeling like alright, I hopefully answered their question. I gave them resources. The vast majority are free. And then like, 10 minutes later, Dr. Harden, I’ll get hey man, Where can I find your book then? And I’m like, do you even check Amazon?

Jacob Harden 17:39

I have zero tolerance for that kind of stuff.

Brett Bartholomew 17:41

Right? It’s learned helplessness, right? Like for you like looking at I encourage everybody listening to this, you have to go to Dr. Harden’s Instagram and his other resources. I mean, you’ve made it idiot proof, which like I don’t think people appreciate the amount of work that goes into this, which is where I’m going next, Dr. Harden. But like, you look at the amount of work you put into these posts, whether it’s ankle mobility routines, pinching hit, and I appreciate that you also put it in like common vernacular. I think there’s some purists that would be like pinching hips. That’s not what we call on you’re like, Yo, dude, I’m not talking to other practitioners here, right?

Like, I’m talking to the average Instagram person. But you’ve made it almost like just super easy for them to be empowered to manage that. Like, what goes into that, how many hours you spend a week creating this kind of content? And where do you still find, like, you know, where do you still find like that people really, like just don’t understand it enough. Because I know you sometimes think like, alright, this is self evident. And then somebody’s like, Yeah, but you forgot this picture. Can you just walk us through this?

Jacob Harden 18:44

Yeah, it’s, I mean, the hours per week, I kind of have no system now. So it’s not too bad. But I would say is that anytime I make a post, it’s probably going to be two hours of work for that one minute video. That’s from developing an idea what I’m going to say, filming it, then going into post and you know, getting all that done getting the subtitles put on excite caption every video that I talk in, because I found out I kind of have I have a large deaf audience, and I wanted to make sure that they get that information. Yeah, that was actually really interesting.

I started doing it on just one or two videos just because I thought it would be a good idea from an algorithm perspective that the majority of people watch videos with the sound off so captions would help but then like I got this like influx of messages from be like, Hey, I’m deaf or partially deaf and I can’t you know, I thank you so much for doing this. So that was really cool.

And then putting the titles on it, you know, coming up with the title that I think is going to grab someone’s attention so that they will watch it all that takes about two hours per post and then it just depends then how frequently am I posting I did that for three years straight, I did a video every single day. And just like in the past, probably four months have back that off to every other day to maybe having two days in between just more for my own longevity, and not getting burnout with it.

Brett Bartholomew 20:20

And this is something I’m always fascinated by too, is as somebody that you know, I’ve created a lot of content over the past five, six years and probably nowhere near the the layer of depth, right like that you have what you do is phenomenal, I think. And I’m still in that struggle phase where like, I do all my own stuff, I answer all my own comments, answer all my own DMS. And I don’t have like a video crew, right? Like, it just there’s a lot of nuances to it. But like, one thing I’m always freaked out about is one day you and I know that Instagram and all these other things are going bye bye, right and suddenly new take their place.

And so I am one of those doomsday people in regards to like, holy shit, I need to like back this up or make sure that I own it on my own native site, or whether it you know, like all saved captions and Google docs in case Instagram like boom is gone. Because some of my captions are huge, right? Like, they can almost be like books, just like some of your videos like you spent a lot of time on that. What’s your process? If you don’t mind me asking for like backing this up making sure that like if Instagram or any of these things went down today, you’re not like, Oh, shit.

Jacob Harden 21:23

I have everything on terabyte drives. Yeah, so everything, basically every video, whatever the title of the video is on the page has a folder on a terabyte drive. And that’s what every video, picture gallery post, whatever I did that day is it’s sitting inside that folder. And it’s you know, it has the date that it was made on. So if I need to, that makes it really easy for me to find it if I ever want to repost it, as well, because for quality purposes, in that, you know, I can just scroll down, see the date and then go find it. But it’s one of the things you just got to like, it has to be automated, where you just you do it, it’s then part of the process you go, you put it into the terabyte drive, it’s done. And you know, you’re kind of you’re good. .

Brett Bartholomew 22:10

Yeah and this is simply my own curiosity as well. Are you for most things, are you Google Drive, Dropbox guy, OneDrive, What’s your preferred method? Do you use a combination?

Jacob Harden 22:21

Google Drive is my number one. And that’s probably because I have like five different email accounts. I have ones that serve different purposes like because rather than having things go to folders, I just have like my personal email, I have kind of my professional email, I have my clinic email, I have my seminar email. And then I actually created one purely for whenever I sign up for promo stuff to get free, free downloads for email lists that I kind of don’t necessarily want to be on. But I do want to see what that free download is.

Brett Bartholomew 22:57

Yeah, better not include mine, Jacob, you better yeah.

Jacob Harden 23:02

You’re right there in the professional email. I look forward to those.

Brett Bartholomew 23:05

Damn right. I appreciate it. So I think going back to what we were talking about, a moment ago, and I loved this quote that you had when I was brushing up on you and just learning more about everything that you’re doing. You said, I feel like the movement world is really paralleling the nutrition world from about a decade ago. I feel like this is a huge, there’s a lot packed into that. And I would agree. Just and I want to hear your thoughts on this. But for me, like I see this in regards to almost like this obsession with perfection too

Like, there are people that still think perfect movement patterns exist. And I used to be one of them. Like I used to think, oh, that squat. There’s a little bit of valgus here. Now that’s not pure like this. We see this the big toe pinky toe aren’t staying on the ground on the unilateral RDL did it and they just realized no, no, no, it’s everybody’s got their own movement signature, like so when I look at that I think this obsession with perfection is so misplaced, but what do you mean by that comment?

Jacob Harden 24:10

Yeah, so that’s basically along the lines of what I mean, if we look at the nutrition world from about a decade ago, we saw like the Clean Eating craze that came in where everyone was Ultra obsessed with quality, and kind of ignored quantity for a little while. So it’s like focusing on the wrong things. Then the whole macro tracking thing kind of came in and you kind of threw quality out the window for a little while in terms of food quality, and we would see people that well if it fits in your macronutrient profiles, then eat whatever you want. And you know it’s all about numbers because body composition is all that matters.

And you would see people trying to get like all their daily calories and by cooking a cheesecake or something, you know, just to show that they could. So we went from this focus on pure focus on quality to then almost a pure focus on quantity. And now you we kind of see this, they’ve balanced out like, oh, yeah, you should eat fruits and vegetables, you should have most of your diet be nutritious Whole Foods, but you also shouldn’t fret about going out and having some pizza and a beer with your with your buddies, you know, so, quantity and quality kind of matter, you just need to prioritize.

And so from the movement side of things, I think we’ve gone, and we’re probably still in different phases, is that you have one camp that is still very, very quality focused, and it’s like that, you know, that miniscule amount of valgus, or you see that arch, you know, go down just a little bit, and all of a sudden, you know, you’re setting yourself up for injury, which kind of negates the whole adaptive process of the body, and the whole uniqueness of it. So they’re kind of our quality camp. And then, you know, on the other side of that, you have people that, you know, when the pendulum swings, one way, we know it’s gonna swing back the other way, too.

So we have another camp, that’s kind of, quality doesn’t really matter move however you want to there’s no good and bad. And I think eventually, we’re going to get to that balance point where, you know, there’s probably is a best way whenever things get really difficult. And biomechanically, there’s probably a less injurious way, a lower risk way to do things, not that your body is not adaptable. And not that you can’t perform things on a one off every now and again. But there’s probably a best way to train. And it’s probably the best way to deadlift versus there’s probably not a best way to go and pick up your wallet off the ground.

Brett Bartholomew 26:41

Sure, it’s a dimensional scale, right, like not necessarily categorical. Like, it’s not always as binary as we want to make it. I remember, before I even became a strength coach, when I was probably like 16, or 17. You know, I would always try to mimic whether I was squatting or doing something else, I’d try to mimic what I saw on you know, in magazines, or videos, and I’m somebody that has very limited ankle mobility, like, I’m not a natural squatter, despite my size, I’m about five, eight. And you know, I would try to go this narrow, because you’d read Oh, you don’t want your, you only want your feet about hip or shoulder width apart all this and then I noticed that, you know, my feet would stagger just slightly.

I mean, I may be talking an inch, and it was funny with what you said earlier about how people will draw these crazy conclusions I had ptsb Like, you listen, like you lack big toe extension. And because you’re staggered, there’s gonna be so much more shear, and you’re going to have this, but I chased perfect movement for so long. And then I thought about, like, how many people actually line up. And if we literally got everything out and measured, like, nope, the right foot and the left foot are directly proportional, everything’s perfect. There’s no compensation whatsoever. Like, that’s not reality. And once I quit, you know, obsessing about it, which didn’t mean that I didn’t pay attention to it didn’t mean that I didn’t strive to make it better, but quit obsessing about it,

You know, like, it’s like, Okay, now, like, I actually feel better, where sometimes when I tried to force myself into these quote, unquote, perfect patterns, I either would not feel stable, or it would have led to an injury that was like, when the big thing was PRI, I definitely have a little bit of an anterior tilt. So I literally had a therapist, and this was before I knew much about this stuff, say, hey, when you get under the bar, you know, posterior, tilt your pelvis, and I’m like, Huh? And then you know, so I’m like, fuck it, they know more than I do at this point in my career. So I’m going to try it and wouldn’t you know it, like back ended up getting jacked up, you know.

And so, as a strength coach, like I was really grateful, like, for any other opportunity I could like later on in my career, I’d always try to integrate as much as possible because I met so many people is like, you’re telling me that the reason I feel like you said pain in my elbow or shoulder is because I lacked big toe extension, and that I should posterior Lee tilt my pelvis when I have 400 pounds on my back? Probably not, you know what I mean? If you want me to be mindful of your posture throughout, but like, it just never ends does it? And that’s where I totally agree and love that line with you is like, with the nutrition side of things. And with this, it’s like we just go so off base, because we want to create our own world and playground where all these rules apply. And that’s just not how movement always is. Is that clean and clear. Always is it?

Jacob Harden 29:20

I Know, exactly. I mean, isn’t that the way it goes? With most things, though, when a new topic kind of becomes the hot topic, we get kind of hyper obsessed with it.

Brett Bartholomew 29:30

Yeah, especially in our field. That’s just the nature of it, you will get the person and the archetypes in our field. We gravitate to things that because we want to make a difference. So we’re like, holy shit, this is it now. I mean, you see it now with sleep, quote, unquote, sleep hygiene. You know, it’s funny like since all of this whether you know what you do with chiropractic care, myself as a strength coach and other people in their professions, their arts that are guided by science, and so we’re always going to gravitate towards like alright, now we’ve got the nutrition lined up. They’re a little bit about better about self care.

They’re lifting, but they’re still not getting all the results we want. What can we go to now? Oh, sleep? How many hours of sleep again? 78. Yeah, but are you looking at screens 30 minutes before, like, we create this world of meaning, that is not all that indifferent than when, like, you know, early man looked up at the stars. And we’re like, yep, that’s definitely the spirit of our ancestors shining. Like, No, those are actually flaming balls of gas. And it’s not that it’s wrong. I don’t want anybody listening to get all like, I’m not saying that the pursuit of these things isn’t great. It’s just like, where’s the tipping point? Where is it the breaking point of bullshit, where it’s like, we just got to be okay, knowing that, like, we don’t know everything, and we just gotta keep trying.

Jacob Harden 30:44

And I think it’s also I agree with you there. I think another thing there is just like, you have to realize that you’re never going to be in control of everything.

Brett Bartholomew 30:53

Yep.

Jacob Harden 30:54

You know, to do kind of pivot off of that to something one of those topics where, like, myself, I became very, very interested in a very invested in in the past two years training load, and measuring training loads and ratios, and you know, the metrics of keeping people, you know, from getting injured, because that’s a big hot topic right now is, how much can that help us? If we have variability in stress levels, and sleep levels, and hydration, and nutrition, and all these other factors? Do all the metrics actually mean anything for us, if we’re being variable, and all the other aspects of our life, because there’s so many things going on.

So which I still think that I still think it matters, I still thinking that we should be tracking things, I really think that we should be having some sort of bead on some sort of framework as to what we do. And we probably shouldn’t be doubling our workloads every other week. But we also need to realize it’s probably not in this tight knit range that if you go beyond, you know, X amount of increase on your workload, oh, you’re gonna get hurt. Or if you’re under, you’re gonna get hurt. Because, you know, when you manage on four hours of sleep for three weeks back here, and now you’re doing really well. So you know, your body just kind of is going to figure it out, too. And you probably just need to look at extremes and just put things into kind of a checklist and say, All right, am I doing pretty good on this, this, this, this? Alright, I’m doing the best I can here. Let’s follow the process.

Brett Bartholomew 32:42

Yeah, yeah. When you say just for our audience, because you’re right, training load. And all that is a very hot topic right now. Can you give us an idea of how you look at load, how you measure it, how you manage it, and give everybody a little bit of insight on training load? in case somebody listening is not familiar?

Jacob Harden 33:02

Sure. So training load is basically trying to find some sort of quantification of how much work you’re doing. And how hard was it for you. So different metrics out there, and I use different ones based around who I’m working with. For some of my higher level athletes, we use the session RPE, which is just the board category ratio, 10 scale, where it’s going to be a zero to 10 scale, ask where zero is basically no effort at all. 10 is a maximal effort. And you can multiply that by the minutes of activity that they used. And the basic gist of it is track that and then we want to see, we don’t want to see huge spikes in that workload.

So don’t double your workload, every other week, like I said, and depending on the population you’re in, we have data that says, okay, it should fall between, you know, point eight to 1.3 units, if you were to divide your acute by your chronic workloads. So I use that with some of my higher level guys. I think that for the Gen pop that that’s a little bit more, it gets into a little bit more detail than probably they need for their adherence levels. And so there I still will use that session RPE. But we look very much more so at just okay, well how hard was that workout?

You know, because if we go by, like if we want to have a on paper, a hard workout, it should fall within the top end of that range. If we want to have if we have a program to light workout, it should fall within the lower end of that range. But if you’re coming in a light day and you’re telling me it’s really hard, well we should probably adjust something. And I think that that’s typically how I use, that scale. With more of my averaged training clients, and more of my gen pop clients is looking more so at that internal load that response of okay, how hard was that for you? How hard did we plan for that to be for you? And then how are you feeling in response to that?

Brett Bartholomew 35:19

And with that, it’s and I know, there’s some people chomping at the bit because the acute chronic workload stuff has come under some fire lately. And that’s beyond the scope of this episode, I hope that people are taking what you said, you know, at understanding really the context behind it is, regardless of what you believe, are the methods you use, whether it’s the Borg scale anything else, right, because everybody wants, I’ve almost feel like we started to commodify evaluations and measurements and quantification. Like in the past, it was like, Oh, you’re a good and ethical, incredible professional, you’re you’re getting there if your your treatment practices match up with the fact that you’re at least testing people, right?

Because there’s a lot of people that don’t even test, reassess, keep proper records, whatever. Now, it’s like almost elitist, I find this, it’s like when people are like, Oh, you’re using a nintendo? Well, you know, you could buy a force plate, oh, you’re using this Brower timing system, you know, you could use this I’m like, bro, like, every day, something new is gonna come out. Like the important thing is that it’s reliable method, and it’s consistent, and that you’re doing it. And so I love that you have a process.

And you’re right, like, what matters is that you use things that are easy to understand for your population, and that they can be implemented. We had an episode, Jacob that was like, What’s the best exercise for performance? Because I get asked that question probably as often as you get, why does my knee hurt? So we did a whole thing on context and breaking that down? And what I tell people is, anytime you get into this best, what’s the best way to monitor to measure I say, like, listen, like, who are you? What do you have access to? What’s your budget? What’s your population? What’s your end goal, and what’s your knowledge of the subject and your ability to communicate it? Because that all outweighs this Boldin best bullshit, that we’re constantly fed out there, like use something consistently stick with it, and don’t have FOMO of like evaluation? Would you agree, feel free to shoot that down if you don’t think so?

Jacob Harden 37:13

No, I would agree to some extent on that. I think that, like you said, you have to fit it to the population. Right? And like you said, you know, what do you have access to? How can you communicate that at cetera, depending on the population, you might also need to step back and be like, okay, this person actually really needs to have this sort of testing done. And if I can’t do that, maybe I don’t need to work with that client either. And we see that in the rehab world, an easy example there is ACL testing, after somebody’s had an ACL reconstruction, is, you know, a lot of clinicians are still using manual muscle testing, to determine the like, quad strength.

It’s like, that’s not good enough at all. And if you don’t have at least some sort of force gauge handheld dynamometer, then you probably just don’t need to be seeing that client, or you need to be referring them out for better testing. You know, and that’s just doing the right service to the person. But whenever I have my 35 year old lawyer come in, who’s having a little bit of patellar, tendinopathy. You know, I can probably just get a rep max for him, and one, his split squat, and say, Alright, well, he got stopped at, you know, 100 pounds at 16 reps, that’s when pain stopped him.

So if we ended, whenever we went up to 120 pounds, he got stopped at eight reps. All right, we have some checkpoints that we can then, we have objective data. And whenever he can do this, and he can surpass that benchmark that we’ve established, then we know he is objectively better. And so as long as you’d have some sort of objective measure there to that you’re not just relying on your own subjectivity of saying, oh, yeah, I think you’re better. Yeah, I kind of feel better. You know, it can scale. And it scales with the level of the injury, it scales with the level of the athlete, it scales with the demand of the person. And you just have to make sure that you’re putting on your critical thinking hat to determine when are you using the right thing.

Brett Bartholomew 39:37

Yeah, and making sure that you’re not running wild with the information it gives you, right, because we know that like, again, any data we collect is context dependent, and it’s always going to be I mean, I found it fascinating. I know. You know, Mike Boyle was talking about his thoughts on you know, good exercises and bad exercises. That’s how he turns on. And he was talking about, you know, a leg extension and then therapist was like, actually like extensions can be really good for these purposes and evaluative measures. And then that started to cascade Oh, arguments about like, well, what are those measurements worth?

If it’s isolating like that, and we don’t isolate it in sport? And then, you know, the rabbit hole, this shit goes down, right? Like,

Jacob Harden 40:15

Oh yeah.

Brett Bartholomew 40:15

So what what are your thoughts on that? In general, like, and I know we can go super deep here. So I’m not asking you to write a manifesto. I don’t want to like monopolize your time. But I do think that people are drawn to the polemic. And I mean, I know how I feel when all of a sudden something comes out in the Journal of Strength and Conditioning research, where it’s like, yeah, we use a leg press for this. And like, I mean, yeah, I get it. Like, you can control some variables in it. But like, you can only extrapolate the meaning of that so much, what are your thoughts in terms of quote unquote, good exercises, bad exercises? What’s used in the research? How applicable that is? Could you just talk about that for a moment?

Jacob Harden 40:53

Yeah, so I think that the label of good and bad is probably not an appropriate label. And optimal and suboptimal for your goals is probably a better label. appropriate and inappropriate, would be a good label for that, as well. So to take like something, because the test can only tell you what the test tells you. Like it tests what it tests. So if we use a leg press as a test, it tells us what you can do on the leg press, it doesn’t really necessarily tell us what your sprinting is gonna look like. It doesn’t tell us what your deceleration is going to look like. It really doesn’t even tell us what your quad strength is.

There was a study done, because the gold standard for say, quad strength, post ACL reconstruction, is it isn’t isokinetic dynamometer testing. And, you know, there’s been studies that looked at the leg extension, the leg press, even handhelds as a proxy, to the isokinetic. And really like the leg press is not good. Like it doesn’t match up at all, there can still be good, there can still be big deficits, side to side, even with the leg extension, there can be big deficit side to side, even whenever it looks normal. On they’ll say the leg press, because you can use the glute, you can use other stuff to help.

Brett Bartholomew 42:31

I think like, you know, and that’s what Coach Boyle was saying is like, even when we quote unquote, isolate things, like he was trying to say, like, you’re not really isolating things, right? There’s co contraction, there’s co contraction there. And so when people are like what you’re saying you shouldn’t isolate, yada, yada, yada. But yeah, keep going. I like where you’re going with this.

Jacob Harden 42:48

Right. So if you want to look at the athlete’s ability to perform a skill, then test that skill. If you want to look at the capacity of a specific muscle, you need to isolate it to the best of your ability, where other stuff can’t help. So a leg press is not going to be a good proxy for something like quad strength, I like extension would probably be better, because you could strap the thigh down, make it to where they can’t move, and the only thing you can do is leg extension, right. And if you could find some sort of one RM or rep max on that, then you have a better objective measure. If you can use some sort of force gauge, you have an even better objective measure, you know, and the more that you can isolate out that specific thing, the more you’re going to be able to say, okay, that thing is meeting the baselines that we’re looking for that thing is improving?

If and so you just have to ask, do you need that level of isolation? Or do you need to look at a pattern as a whole? So going back to my example of if I have my lawyer, if we have that guy, and he’s telling me that he’s getting his knee pain whenever he squats? Well, I should probably just look at it squat, because I know that that is touching it at some sort of load. And it probably wouldn’t be the only test that we do. Because what if we have him go through it, and we build up his load over six weeks, but now he’s shifting back into his hips and not actually using his quads as much. So he’s not actually loading his knee as much and he’s found a workaround.

So if we’re going to use that test, we need to be filming it to look at okay, well biomechanically, is he doing it the same way as he was doing it before. And if he’s not, then we need to adjust something. And we need to look at it with the same qualitative aspects as well as quantitative too. And so it just gets into reproducibility. Whatever you do, you want to make sure that it is looking at what you’re trying to look at. And you need to make sure that you can reproduce it in the same manner over and over again.

Brett Bartholomew 45:03

Yeah. And from a communication standpoint, what role does that play, you know, with everything that you guys emphasize at Orlando sports rehab, because obviously, you know, no matter how analytical we get on that side, you know, the measurement and the assessment, and, you know, or evaluation, whatever term anybody wants to use. And those are obviously a little bit different in the education realm formal assessment and evaluation, but like, what role, what are some things that you learned in your journey of like, Alright, now I have this technical knowledge related to my trade craft, specifically around chiropractic and other elements of physiology, biomechanics, everything like that. What role does communication play in this process for you and everything you guys espouse there

Jacob Harden 45:48

It is, I would say, at the very top of our priority list, is being able to communicate effectively, why we are making the decisions we are making, and why we are making the recommendations we’re making. Because if a patient does not understand why you’re having them do things, then their adherence is likely to be much lower. And they’re likely to leave with a lot more confusion, and they’re likely to go have to start looking things up on their own. And I trust me more than I trust the internet to give them that information. So our ability to communicate with them is vital, I think, for our outcomes, and not necessarily like oh, well if we communicate better outcomes, just dramatic, all of a sudden, better, but it leads to a cascade effect of better understanding. Better if you’re,

Brett Bartholomew 46:56

It’s kind of when I’ve heard of fighters I trained other boxers in exchange for my training. And you know, still having worked with UFC fighters and professional boxers and stuff like that, you know, I remember one time having a conversation with Andre Berto, you know, he’s like, hey, you know, lifting weights can make me slow this or whatever. And he ended up me, he was awesome to work with. But I said, Listen, Andre, like getting stronger. One, is he going to do that shit, but I mean, I go getting stronger, does not guarantee you’re gonna win the fight. But being weaker, will absolutely increase your chances of losing it. And I say the same thing with communication. Because our motto is kind of, you know, it’s more successful interventions are the results of more successful interactions. And like you said, is there a direct quote, like. Can you prove that just because you can communicate better than somebody is gonna have a more successful outcome?

Well, no, not in every circumstance, but I can prove that if you communicate like shit, and really unclearly and in a really biased way, that it will absolutely like degrade the outcome, right? And so it’s like, it always fascinates me when people want to kind of like, I’m like, What’s your argument here that you don’t need to communicate? Okay, well, then I guess we’ll all be like, replaced by AI, like some other professions, you know, within that doctor Harden? Because we talked about evaluation on the technical side of what you do from a chiropractic standpoint, what do you guys do, if anything, from an evaluative measure on like, the way you guys communicate and a formal process of upgrading that are working on that formally, as a staff? Do you guys have a process there?

Jacob Harden 48:38

To be honest with you, no, we don’t, it’s probably something that we should have is evaluating our own ability to communicate. You know, just we do send out patient questionnaires, asking about their, you know, how was your experience here? What did you like? And I guess one thing that we do ask there is, you know, did you feel that you came away with a good understanding of your condition, and what you needed to do to move forward? And so we can look then at, you know, oh, well, this person said, you know, saying that, you know, they don’t have a very good understanding.

Well, let’s talk about that. Why do they feel that way? What did you say to them? We’ll kind of talk it out, as you know, between us, you know, or if somebody comes in, and it seems like they just didn’t get everything you said, then we have to be like, we’ve kind of stepped back and like, Well, what did we say there? Why, there? So it’s not necessarily a formal process in evaluating that. It’s something

Brett Bartholomew 49:41

Yeah, no, 100% and I asked that for a totally bias question. I mean, it’s just, you know, one thing I worked a large percentage of the last couple years on is creating more education around these things, because that’s what I realized, like at a time where I wanted more evaluation on the non technical skills related directly to strength and conditioning, I was like, Where else can I improve as a coach and you look around. And there’s stuff in the literature about Coach evaluation, but all of it is like, I mean, you know how it goes, right? A little bit of research is phenomenal, a little bit more is even better. But then sometimes it goes so crazy, where I found any kind of evaluative tool out there for coaches, specifically on the communication side was like, insane or non, it just wasn’t there.

And so that’s something that we do in our apprenticeships, and a lot of them are improv based. And I feel like you’d kill it, which by the way, you have a comp spot anytime you want to come. But we put coaches or practitioners in in improv based scenarios, some of them goofy, some of them serious, and they’ve got to create something from nothing, and we evaluate them on, hey, when you were in this situation of uncertainty, and where you were maybe even a little bit uncomfortable, because there’s a heightened reality, you know, what did we look at? How did we score you in terms of verbal nonverbal, your ability to navigate conflict, your ability to personalize and individualize the messaging, your ability to do all these things? And I think that’s where it’s funny, right? Like, it doesn’t need to be perfect to be helpful. And so even you saying, like, oh, yeah, we send out questionnaires. I mean, man, that there’s so many people that don’t even do that. So I applaud you on that front, is there anything else you want to add on that piece?

Jacob Harden 51:16

I think that you have to be self reflective. With that, too. Like, I think that the people that are gonna grow the most are the ones who are very self reflective. And you just naturally ask yourself, like, you know, how did I feel coming out of that conversation too did I feel like they got what I was trying to say there. Which, because none of us are perfect at all. I had a patient two weeks ago, that I had an initial assessment with, and I came away from it like, yeah, no, I think I said a lot of stuff that maybe you didn’t need to be said, one. And I don’t know that I necessarily got across the point that I was actually trying to get across for this person. They were someone who was, you know, they’re dealing with some shoulder pain.

And they had had injections in their shoulder, and they wanted to go and get repeat injections for that shoulder. And I don’t think I initially got my message across as to why maybe that hasn’t helped them so far, and what they needed to do to move forward. And so, you know, I’ve reflected on that, and I’ve been looking forward to our follow up, which I had earlier this week. And so, earlier this week, you know, I made that a talking point of like, because it came up again, and got to have a better conversation, because I reflected on the previous one. And kind of you know, I criticize myself. And it’s like asking myself, okay, just how can I be better? Because my gut tells me I didn’t get this. Right.

Brett Bartholomew 52:51

Right. No, and that’s the fun of it. I’m glad you said that. Because that’s almost the most fun I have with my own workshops is, you know, if you were to put me into these scenarios, and I jump in and do it just as much as anybody. And the nice thing is I’m like, yo, I’ll make mistakes, there’ll be exercises where you’ll end. But that’s so much fun in your career, when you get to the point where like, I find that there’s a direct correlation between somebody who says like, yeah, if you’re really dedicated, though, being a lifelong learner, then you’re also not somebody who is supremely risk averse, right? Because you don’t go into self preservation mode to sit there and rationalize your way out of like, well, I did it this way. Because of that, you know

And that’s part of the reason we make some of the improv exercises borderline not ridiculous, but just unrealistic in terms of time constraints, or, you know, did they have to say something with, do they have to begin a sentence with the last word that the previous person said, is because we’ve got to get them out of that defensive mechanism of trying to sit down and equivocate? Why they said something a certain way, it’s like, no, no, no, man, like, you don’t get it. We’re stacking the deck. So you fail in these exercises. So you have to be reflective. So you can’t sit there and try to like, be like, Well, I did it this week. No, man, it’s okay. You failed, you messed up.

And that’s we’re all going to do that in communication. And so, yeah, I think you’re spot on your heart and like you have to be reflective. Is there a way that you feel like you can cultivate that and somebody that isn’t, you know, say you hire a new member of your staff today and man, like he’s prodigious in his technical skills and his knowledge of chiropractic care in the body, but he’s just not very reflective. How do you approach that conversation with him?

Jacob Harden 54:33

I think if it’s in your business, it probably has to be a part of your culture. That and I think a lot of it comes down to your locus of control. Like I think a lot of that speaks to what is your locus of control? Are you an external locus of control person, that it’s always like they didn’t understand because it’s on them. They didn’t adhere to their program because of them, or is it an internal locus of control of what could I have done better and one, I don’t know how that’s gonna be, that’s tough to change in the first place. But the way that I would approach it is, I would speak on my own failures, first, I would put, I would try and meet them in that reality and say, so here’s where I, here’s where I’ve needed to improve this week, here’s where I’ve needed to improve over my last 10 encounters.

And so it doesn’t come across as like an attack on them and their skill set and how somehow they failed, because none of us want to be a failure. And say, it’s not a failure, it’s room for improvement. It’s room for growth. And we’re all sitting here trying to grow, myself included. And here’s where I’m coming from, here’s what I need to do. And I might ask them, based on what I’ve told you about this encounter with this patient, what do you think I could have done better there? And we might start the conversation that way, before we then jump into their visit with their patient, and I then give them feedback based on where I think they could improve to.

Brett Bartholomew 56:04

Yeah, that’s a great answer. Listen, you have been more than gracious, I haven’t exactly giving you easy questions to answer. And I appreciate the fact that you don’t dip duck dive what is the other seven to one of, of dodgeball there? I mean, the the information is tremendous, the breadth of the discussion and topics we covered and your transparency. And guys, I can’t say it enough, I make it a point to vet the people that are on this podcast pretty hard. You know, like, if they’re not people that are transparent, and have not put in countless hours trying to provide you with useful, helpful content. And they’re also just, you know, good quality, high character people. So you know, make sure that you check out all of Dr. Harden’s stuff, Dr. Harden, what are the best ways for them to support you, and to find you on social media and elsewhere.

Jacob Harden 56:56

So my main platform is going to be my Instagram platform, Dr. Jacob Harden, I’m on every social platform that you can find out there too. I mean, YouTube, Facebook, all that. So you can find me anywhere. But you’ll see the most majority of my content on that platform. If anybody wants to come out, I do teach continuing education for health and fitness professionals. And we get into a lot of these topics about testing and load management and exercise prescription and how we kind of put all this together into a plan that we can actually help people with. And so we try and simplify things. So if anybody wants to come out, I teach a course called prehab. One on one, and I’m all around the world with that one too.

Brett Bartholomew 57:40

Yeah. And guys, you can find that again, please do your due diligence, don’t email him and say, hey, where’s the next free one on one he’s got that LinkedIn is Instagram, it’s on his site. It’s on all that. I mean, not that Jacob wouldn’t be happy to answer that question for you. But I guess I’m just really big and most of the listeners can tell right now Dr. Harden, through a lot of my previous episodes, like I just think that the worst thing we can do is spoon feed people. I think like you said, we got to empower them. They got to do the due diligence. And, you know, I think that leads to you know, a higher quality individual coming to those things as well because people don’t want the easy route aren’t going to engage anyway. Well, listen, I can’t thank you enough. Hopefully this was valuable to you as well and know that you’re welcome back on. Anytime.

Speaker 1 58:20

Thanks very much, man. I look forward to chatting to you again.

Brett Bartholomew 58:24

Yeah, my pleasure. Alright guys, until next time, thanks for joining us on the podcast.

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