Transcript for:
Overview of Monthly Case Study Calls

so these case study calls that we do once a month um there's usually a little bit of variance in in what I do either I present I directly present a client that I am working with and I just kind of go through my clinical reasoning the assessment we did you know what I was looking for and why I was looking for and what we did um but sometimes I'll also dot in you know every now and then we'll do a case study on all of you so you know questions that you have or presentations or a family member or partner or yourself and we can just kind of like tease that apart and work through it in real time um what we're going to do today because this is kind of like new cohort jumping in is rather than present a specific client I want to kind of walk through how I formulate you know an assessment because again this is something I've had to unlearn over the years rather of the the kind of formalized assessment I was taught to do as a physio again falls into this kind of reductionist um specific symptom based model um that I don't think takes into account this big picture so over the years I've kind of had to adapt what I assess and and what I look for particularly through the lens of breathing and the respiratory system and so today I I just kind of want to walk you through what I do right and so what I'm kind of looking for independent of what the person is presenting with now obviously there's a big component of let's say someone comes to me with chronic pain or specific anxiety or panic attacks like that's going to factor in to what we're looking at so today is more of a general like here are the pillars or here are the foundational aspects that I'm going to make sure that I cover because I understand the influence that they have on this person's presentation and so again what we spoke about yesterday in terms of zooming out from the specific pathology the specific presentation or the disease or the disorder and kind of more looking at like how is this human engaging in the world um particularly based around right if I were just said how is this person engaging in the world you know we would have endless things to look at um and sometimes we do need to kind of refine and and kind of cut back some of the noise to get to what are the factors that are actually driving this person um whether it's good things or bad things per se you know so we're going to kind of you'll notice that the layout of this program right we start with biomechanics physiology nervous system emotions um performance and then safety and then we move into the more therapeutic aspects and when I assess someone and when I work with someone I follow the exact same kind of model and this is done very intentionally this isn't coincidence so during an assessment I'm looking at biomechanics physiology nervous system emotions and throughout the treatment program that I'll put someone through right when I put together a plan for someone we tend to not all the time but we tend to start with biomechanics and then we work on physiology and then nervous system and emotions and that's done for a very specific reason when we think of this kind of what I'm going to start introducing to all of you you know is this idea of second order thinking or even relational thinking what is a relationship between someone's movement and posture and what that does to their physiology what that does to their nervous system what that does to their emotional state when we can start looking at that kind of like relationship I think it gives us far more number one understanding and number two opportunity to impact change and so the reason you're learning in this order is the same way I'm going to teach you to assess in this order and same way I'm going to teach you to treat in this order um and so you'll find just almost doesn't matter I just want to give an example because I was talking about this with someone yesterday whether you're working with a postpartum mom with anxiety a CEO with burnout an athlete you know that wants to improve their performance if you target mechanics physiology nervous system emotions doesn't matter who you're working with and it doesn't matter what they're presenting with because you're looking at these core aspects of their performance or their function and so again we've kind of separated ourself from me managing a set of symptoms that you've presented with you have this which means I do this no right I look at these core foundational aspects because I know the influence they have on functioning of human biology you know if we want to make it very Grand like that so we're going to start with kind of biomechanic and I just want to talk you through number one why you know like why are we looking at biomechanics what influence does it have um the common things that we tend to see in terms of problems and then what we look at kind of trying to address that so this is part assessment and also kind of dotting in you know some treatment ideas if you will um we can spend a little bit more time that on another call and obviously I can kind of I'll put all this up with a little bit more info that backs it um so biomechanics FY word for movement of the body right bio biology mechanics movement when we're looking at this sometimes people think well I'm not a physio or I'm not a movement coach I'm not a you know movement based practitioner and to me that is less relevant than you understanding what influence it can have and what are some simple things you can do about it what is someone's posture right there's you don't even need me to tell you this but you can kind of like if everyone just kind of like drops their head down and rounds their shoulders a little bit and lets their back kind of roll down as if you're looking down into your lap at a phone um you know a typical posture that you see a lot of people in and try and take a deep breath in that position and you'll just notice like where it moves in your body feels a little bit different to now if you kind of you know unroll the pelvis like let the spine grow tall draw the shoulders back and perhaps even just look up a little bit right and then try and take a big breath and you'll notice hm bit more room to move there you know like the change in the position of my body has automatically influenced my breathing now extrapolate that over 25,000 times a day for 20 years you know or a year or three weeks you know it doesn't need to be that grand but 20 upwards of 20,000 times a day if we remove some capacity for the body to breathe there is going to be an impact of that and we'll talk about what that is in terms of the relationship but the first thing I want understanding just in terms of volume right like our lungs are these two big balloons and my breathing will always conform to the shape of my body you know I want to kind of highlight and underscore and double exclamation point that you know breathing will always conform to the shape of my body so if I have a habitual posture that impacts my breathing right my breathing has to compensate like it can't fight against the rib cage my musculature my fasher and all this stuff like it's like okay this is the room I have available to me this is what I'm going to have to work with today but because of environment you'll hear me knock a lot on Modern culture and society and the problems that it's given us today but because you know if you look at the statistics people are spending upwards of five hours on their smartphone every day right and you don't see anyone on their phone like this do you right you see them like this even when they're standing their heads down and they're looking down like a recent study came out that showed a reduction of lung capacity of about 30% when people are in that position on their smartphones 5 hours a day you know so like we're not necessarily talking about you assessing someone's movement patterns and doing biomechanics it's like oh you know are you a human in today's world you probably spend a couple hours on your phone if you're like most people or if not your phone on your computer if not your computer driving your car if not your car sitting at a desk right like all of these things are going to orient the body in a certain way that is likely to negatively impact Brea because it's reducing available space so the first thing to remember is like if my breath has less room to move in my body then I reduce right that volume and so that reduction in volume is now going to start to impact physiology which will come back to um Trace I'll definitely link that study because it's a really interesting one um so it's not necessarily about you having to do right this formal movement assessment it's you understanding hey what do you do as a day job oh you drive an hour to work you at work at a desk for 8 hours you drive an hour Home you have dinner you watch a bit of TV all right you're probably sitting upwards of 10 11 hours a day what does that do to the diaphragm right well there's this beautiful relationship in the body called a length tension relationship basically the length of your muscle dictates the amount of tension that you can produce um a simple example that most people understand right is if I have my elbow bent at 90 degrees and I can Flex that muscle it's quite strong but if my elbows straight right the muscle got longer it's not as strong you can test it to yourself and if I pulled my fist all the way to my shoulder it's not as strong because the muscle is short at about 90° the length of the muscle is optimal to produce the most amount of tension we are strongest at about that position because of the length of my biceps the diaphragm is a muscle right so when I'm kind of like caved over and my everything's organs are compressed like the length of my diaphragm is different and it's not always just saying this rounded position if I'm like pled out right and I've kicked my back my ribs are forward the length of my diome is different so I'm unable to produce the same amount of tension or Force based on the position that I'm in and so often we'll see right people develop this breathe with their neck strategy how much is of that is because your body is making this decision and saying this is better in terms of how much energy it's requiring because initially you know like using my diaphragm it's kind of hard because I'm trying to push my organs out of the way and my rib cage is all compressed and I'm in the wrong orientation so the body chooses and says okay maybe using these muscles on my neck is better right now but I'm in that position all day every day week in week out and so I become a little bit more kind of I become better at breathing in effectively right and we see this strategy of using the neck and the shoulders and this kind of vertical breathing pattern how much of that initially came right from this stimulus which was my position has changed and so the the next kind of like aspect of that right because there's less room available we change the amount of oxygen carbon dioxide less right so if you just think of how much air you breathe in if we just like let's say cut that off by 20 or 30% I now have 20 or 30% less right of that interaction between oxygen and carbon dioxide because I'm just not moving as much right they shown just with three breaths right if I take three big breaths my chemistry is going to change right and so if I can't take big breaths right or my breaths have been reduced because of my position it's kind of keeping that buffer zone of my physiology which we're talking about this week like I'm going to have less of that fluctuation oxygen carbon dioxide my set point on my comfort zone gets smaller and smaller and smaller and so now we've got this kind of like almost sensitization to CO2 or air hunger that's coming because I'm not actually exposing myself to more or less because my breath is just this shallow little thing that happens the same volume because of the same position day in day out so that role of breathing mechanics on physiology the next one I want to kind of like just introduce there is when I do start to breathe with this more kind of neck based or vertical pattern of breath I like to call it as I'm using my accessory respiratory muscles my nervous system responds differently right right this is a very sympathetic breathing pattern right we're kind of pulling the air into the upper loes of the lungs we're using the sternomastoid the scalin these muscles that are kind of more associated with right like if you watch someone Sprint up a hill and then see how they breathe they do have that quite vertical pattern that's appropriate because they're sprinting up a hill right it's about moving the air as quickly as they can in and out right that's very different into taking this slow lateral low to top kind of expansion with my diaphragm right why there's a few reasons but one of the biggest one is my diaphragm when it moves there's a big hole in the diaphragm and straight through the middle of that hole goes the Vegas nerve and so it's this kind of mechanical influence of the diaphragm when it's moving effectively that gives us this the stimulation of the vagus nerve or stimulation of the parasympathetic response but if I'm not using my diaphragm because I've learned to breathe with my neck and I'm breathing far shallower than I should be then I lose that kind of foot on The Brak aspect of breathing which is like me touching the parasympathetic nervous system so kind of inhale is a bit sympathetic and I exhale is a bit parasympathetic but that's due to the movement of the diaphragm right I can extend my exhale I can breae in a way where the pattern of the breath should be theoretically parasympathetic but if I'm doing doing it like this right and I'm breathing up and down I'm not going to get that parasympathetic response because the diap is not what's driving that movement and just for those of you that are you know are less familiar with you know the anatomical side of things right the diaphragm is all the way down here so when it contracts and relaxes it cannot lift my shoulders you know a muscle that's down here cannot make my shoulders go up and so when we see that kind of up and down pattern of breath we know someone is using other muscles right namely these accessory respiratory muscles um in addition to the diaphragm and I just want to kind of pause here for a moment because even when we say something like diaphragmatic breathing I I try and do this less and less um it kind of in it almost suggests that if I'm not doing diaphragmatic breathing my diaphragm doesn't work the diaphragm is always working it's just that how well is it working right like unless someone has a neur I ological injury like the diaphragm it's still contributing to breathing you know that's this kind of brain body relationship it's not that my diaphragm just turned off and now I'm using these other muscles but these other muscles might be contributing more to breathing than the diaphragm and that's an issue so we want the diaphragm to be this driver of breath and often times when someone's breathing shallow up into their chest that's not the case so now we've got right just the movement side of things how it's influencing physiology and how it's influencing nervous system system that's the relationship that I really want you to kind of like grasp that it's not just about oh let me help you change your posture or let me help you have a better breathing pattern it's when we change that it influen these other huge factors right the physiological function of your body and the state of the nervous system right the nervous system is always responding to information and it's deeming what is the appropriate state for me to be in and when I'm taking 20 shallow vertical breaths a minute the nervous system is going to respond to that and say maybe something scary is happening out there right like why am I breathing shallow and up into my neck when all of evolution has suggested that that breathing pattern is associated with something threatening right so let me engage the stress response let me get prepared for a possible threat like this is the sympathetic nervous system and so it gets really interesting when we think of this and we'll talk more about this in a moment but just to kind of introduce this concept even when someone's relaxing they're stressing themselves out because the breathing partner is not now saying we're safe right we're good to engage systems of recovery it's still saying even though I'm sitting on the couch I've got this vertical shallow breath right at a high respiratory rate which is indicative of something threatening happening out there so I've had a crazy day I went through crappy traffic I got home I'm just going to take a minute and sit on the couch and I keep pushing my nervous system thing with still under threat right and so the nervous system doesn't switch off and go into recovery it's like something's still looming out there you know keep these systems engaged and that could be happening 24 hours a day for some people um and so if we kind of like I just want to reverse this for a moment someone comes to us and we go I'm not confident with biomechanics or Potter or movement I'm going to jump straight to trying to help them with their physiology or their nervous system we're going to have far less impact right because we haven't addressed how they breathe 22 to 25,000 times every day so I want to really just like I'm saying this because people students have said it in the past they're like but I'm not a physio or I'm not a personal trainer I don't understand the body as well as other people like I don't feel confident in talking to someone about posture and I want to kind of like knock that little doubt on the head right now because it's so so important that you can at least recognize oh this person that's got their head down their shoulders when they're sitting in front of me on Zoom or in the you know in person you have to be able to give them some strategies to help open up the diaphragm and open up their posture because it's going to allow me to impact their physiology and their nervous system so even if someone's only goal and they come to you is like I want to you know better regulate my nervous system we still need to be able to be like yeah but that's based on the how of breathing that's based on how you're moving air in and out of your body it's based on how you hold your body and so this is why we're going to start here rather than me telling you about extended exhales or coherence breathing or these things that are going to impact the nervous system but they're going to do it far less effectively if we don't build a top right functional mechanics or movement of breathing itself so the biggest problem I tend to see as a driver of dysfunctional breathing is posture right it's how I hold my body U because we adapt to the positions we put ourselves in frequently and a lot of people are sitting a lot more than they ever have and they're on their phone or they're on their devices right and that is impacting breathing so we have to you know it's important that we can kind of like take a look at that and have a conversation with someone about well what can we do so what can we do and again I'm not going to spend too much time on the treatment per se but just to kind of plant some seeds here we can look at strengthening and lengthening the diaphragm right so we can mobilize we can stretch we can also do some strengthening based exercises so the diaphragm is getting stronger and more effective we can actually look at improving the rib cage Mobility right A lot of people are very stiff through their rib cage and it's it's easier to pick a stiff C rib cage up and down than it is to expand it outwards but that's because a lot of people don't actually address their rib cage so doing you know foam rollers and and even just like rolling over a towel and actually side bending and rotating and just making sure hey does my rib cage open and close effectively because if it doesn't my body has to compensate once more and then finally is this kind of breath patterning how can we you know we talked about someone becoming a little bit more dominant with their accessory muscles how can we flip that and get the diaphragm to be driving the movement as our primary aspect and we can do that in lots of different positions and lots of different strategies you'll find there's some exercis in the biomechanics of using a th band you can get people laying down on their stomach their back their sides and just kind of like using their own hands or a weight right to give them a bit more feedback and just practicing how do I make this area of my body move but this not and it's so interesting it's hard excuse me it's it's hard until it isn't and I know that's kind of like a a nothing statement but I love it because people will be like I don't know how to do what you're telling me to do you know I'm trying to breathe in my belly or breathe into my rib and it's just not happening not happening it happened and they're like oh you know that was really oh now I know how to do it you know it's like this almost rewiring that happens and so we expect it to be really difficult it's not just tell someone here's how you fix your breathing pattern and they go oh thanks and it's better they have to work through that challenge of re you know relearning in a way and helping the right muscles engage at the right time so it it we expect people to be like I don't know what you're talking about like this is really hard for me to do until they get to the point like that feels normal now right like I've been doing that and it seems to be working per se um so it's hard until it isn't hard and I tell that to my patients they're like this is really hard I'm like it should be you've been breathing this way for five years and I'm trying to get you to breathe this way I don't expect you just to click your fingers and it's different now you know it's to be hard until you kind of learn that new pattern of your breath right so we're going to move from mechanics to the next thing I tend to look at is is physiology um so we spoke a little bit yesterday about kind of CO2 tolerance or air hunger tolerance and as we point out it's not just this assessment of physiology it does give us some information about physiology but I tend to to see it more as a internal thermostat if you will right um Andrea pointed out beautifully use as a kind of load tolerance like how much load am I ready for right now can I drive a car can I go into the meeting can I go and exercise am I ready to sleep whatever it might be in that moment and so what are the things that impact our physiology well we already touched on our mechanics so if someone's got shallow breathing or they've got vertical breathing they're going to have a reduction in how much CO2 they like to tolerate because they're just not used to it but what I want to kind of drop in here is the other very common things that do impact physiology that people don't talk about one is what I'm doing right now talking um talking is mouth breathing bull stop end of story we have this little you know just try it if you're having a conversation you have to stop to try and you know close off the glotus breath through the you can't hold a conversation if you're trying to breathe nasly you you sound a bit silly because it's like stop and then talk to you know it's like great it just breaks conversation so we have this coordination that's happening in the brain brain stem that allows vocalization and respiration to be occurring at the same time and so we take these little shallow breaths in between certain words you know to allow us to talk now what if you talk all day what if you're in sales you're answering phone calls you're a teacher you're a clinici right like I talk all day when I'm in clinic um I'm a chatty physio I don't like to sit in silence and you know my clients have got used to that um but if I think about it right if I go in and I see 10 or 12 clients in a day like I've probably been talking straight for 7 hours that's mouth breathing for S hours you know and when this big wide hole is open and I breathe through my mouth I remove more CO2 than when I'm breathing through my nose and that's just the velocity of air right it's pretty hard to breathe quickly out of your nose because there's resistance but it's very easy to breathe quickly out of your mouth you know there's no resistance to that air so just talking and breathing through my mouth for prolonged periods of time in the day is going to impact My overall physiology picture okay and so I ask people what do you do for work you know oh I do this I'm like well does that involve you talking a lot and you're like yes I'm backtack meetings for like four hours in a day and I got to call these people like okay so I've even had you know clients that are like very familiar with breath work and they're doing all the right things but they hadn't realized that oh wait I mouth breathe for 7 hours a day even though I'm doing all my stuff right and I'm doing all the correc I'm still a big chunk of my day is breathing in a way that is kind of taking me in a different direction to what I'm trying to do and so we want to kind of like use that as a do you need to do some slow nasal breathing before you get on the sales go before you start your meetings right when you get off have you got a couple of minutes so what I started to do when I have backtack clients is I'll take that two or three minutes between calls to really slow down My Breath Right which allows the co true to build back up I'll breathe two or three times a minute for a couple of minutes and I allow that CO2 to reaccumulate in a way and I push back right that kind of boundary that we all have or that set point so I've gone through a period of time with low CO2 because I've been mouth breathing and then I want to build it back up and if I do that a couple of times a day that's going to help prevent me staying in that hypo cinic low CO2 state for a prolonged period and kind of push back on some of the adaptation that's always occurring you know and again just a little point that I want to remind people of here adaptation is not always positive you know evolution is not always positive like we adapt to the environment we ad adapt to the things we do sit on a couch every day for a month and you get better at sitting on the couch you know like actual length of certain muscles lengthens and others shorten and your body is orienting because it's trying to become more efficient at what you do consistently and so if I talk day and day out right like my body's kind of of adapting to that and so talking can be this like little sneaky um impact on someone's physiology the other thing that often happens is people hold their breath you know there's a whole field of research emerging right now called email apneia where they've discovered people open up their inbox and they hold their breath while they're like looking at all the fires they're going to have to put out today or oh my God there's an email from my boss and I'm holding my breath the key that I want everyone to remember is they don't know they're holding their breath this isn't a conscious decision of let me hold my breath while I do this this is an autonomic response that says here's something threatening let me shut down this little process so I can focus on this but how often am I doing that you know maybe I notice I do it when I'm logging out of my email or after 10 seconds where I go you know but how many times do I not notice it you know do I hold my breath when I put the key in the door I found a lot of people do right it's like oh you know it's like usually it comes with cogn load I'm focusing on doing something that requires fine motor skills or balance skills or demand and I stop breathing to allow me to better attend to whatever it is that I'm doing but if I'm doing that all of the time what is holding my breath do right it usually this is where it gets tricky I'm not going to spend too much time on this because we will talk about it more but even breath holders right the the kind of like habitual breath holders can often fall into the hyperventilation category because what they do is they hold their breath and then they over breathe to try and compensate right so I'm holding my breath CO2 is building up my brain goes oh crap too much CO2 right and I take a few of these really big breaths and I offload that CO2 and I hold my breath again you know and it's not always immediate but this could be happening a number of times in a day right so sighing is a really good indicator most people notice oh yeah I sigh a lot what's that telling us right if I sigh a lot it's usually what happens a sigh is at the end of a breath hold usually I'm holding holding holding holding holding brain notices too much CO2 right so if someone notices I sigh all the time we can be thinking you probably are holding your breath and you're not knowing right you're noticing the Sigh but what's proceeding the S is a breathhold um another as I mentioned yesterday the ACO framework awareness control optimization another one I'll introduce this week or next week will be the the walking up stream right so like the Sigh I've noticed that I took a side but I didn't notice that prior to that I was holding my breath but prior to holding my breath something was going on as well right let's use the example of I was check my emails and so this idea of walking up from the thing that I noticed the Sigh to the activity that I'm doing check my email allows us then to build the awareness of when I check my email I need to pay more attention to my breath and not let me go offline so maybe I set a Cadence right and I count and I breathe really nice and regularly while I'm checking my email and I'm going to break that habit it's not immediate but here are the strategies that we'll talk about over time of like okay you've noticed you hold your breath what can you do about it the other thing that I always like to talk about in terms of physiology or Lookout is exercise right and so I'm always asking people what do you do for exercise if you do any and it's not just not exercise bad exercise good I want us to have a little bit more depth in that um if they are exercising what are they doing are they doing high-intensity interval are they breathing through their mouth are they pushing them cell you know really really hard are they overtraining you know how are they breathing during that or what I often see is this I was exercising and then I stopped because I hurt my back because I had this you know medical issue that come up and I was actually really fit and then I stopped exercise is interesting because it creates what's called demand ventilation we all know this run up a hill and what happens you breathe heavy you you're not deciding to do that body is demanding it of you right there's an increase in metabolic demand your body is saying we are producing more output we need more input and we automatically crank up our breathing and so if I've always done that and then it stops suddenly I lose the demand that window that I have shrinks and it gets more narrow and so I always want to kind of like if someone says to me you know I was super fit and I was training for this and then I got really sick and I stopped or I hurt my back and I stopped or I changed jobs and I just didn't have time that my exercise just stopped I'm always like hm you know this this is probably going to be reflected in your physiology because exercise is not just to get fit it's not just for Aesthetics it's really important in terms of this physiological flexibility right it puts us into a different physiological State we'll talk a lot about kind of homeostasis right returning to balance and hormesis pushing us out of balance but exercise serves that purpose beautifully because it puts us into a different state because my breathing ch es um and so if that was occurring and then it stopped we want to kind of think about maybe they've lost that buffer of their CO2 because they were getting it now they didn't or they've told me they do high-intensity interval training we could probably assume they're doing that mouth breathing because most people that do CrossFit Etc they're not doing at nasal breathing right on top of they talk all day at their job we start to put together this picture of like all right you've got mouth breathing all day because you're talking and then your exercise is actually mouth breathing as well hard and fast hm you know maybe we need to look at some strategies to help mitigate the fact that you're offloading a lot of carbon dioxide consistently and if we don't mitigate that right if we don't kind of like push back against that with some strategies we're going to see an overall change in your CO2 set point right and that relates really intimately to states of anxiety and arousal and stress and panic and performance as we talked about yesterday in terms of energy production and so asking about exercise what do you do how often do you do it were you doing it and you stopped you know is really really important for us to understand this picture of physiology not just hey exercise is good and I want to help you exercise more more what's it doing to your physiology we're going to come back to exercise because it's something else that I I think you know we we do talk about in terms of performance and recovery and it's really really important um but again the kind of what can I do if someone is a mouth breather and they mouth breathe during exercise and perhaps we've investigated their CO2 tolerance is low starts with awareness notice you're holding your breath notice your mouth breather notice what type of excise and how you're breathing when you exercise um and then start to do more of the opposite do slow breathing do nasal breathing do some breath holds intentionally even if you're you know as you get a little bit more kind of understanding this you can do it while you're exercising like breath holds while exercising a really great way to increase the CO2 pretty dramatically um I always often give people for what I call breath breaks or breath snacks as well you know you're on sales calls all day you're in meetings all day can you take that one minute between calls and you take that two minutes between meetings to do what I just described earlier is Stop close your mouth breathe really slowly right let the CO2 build back up stretch out that buffer zone again and then you're into the next meeting but you're talking talking you can't tell someone hey I want you to talk less or I want you to try and breathe through your nose whilst you're talking it's not it's not effective it's not appropriate it's not going to happen you need to give give them some bookends right or these little like snacks in between because we know you have to talk all day how can we kind of push back against the impact of that rather than tell you you have to change that behavior because it's their job you know or it's it's some part of what they're doing so we need to be a little bit more tactful in like how we're going to push back against that the next thing I spend a big chunk of time on with any client that I see is the nervous system um the nervous system is It's tricky to assess in a way we don't have a formal assessment of just saying like oh here's a a snapshot of your nervous system and it's healthy or it's not right there is some technology coming out when we look at heart rate variability um and some other kind of Bio feedback but I more want to present to you what I'm taking in terms of a subjective assessment that you know the questions that I ask and how I can kind of use that in addition to the objective like the measurements that I'm doing right so I can look at someone's breathing pattern and I can assess their CO2 tolerance and I can ask them some questions and put together a picture of their nervous system so the things that I look for in terms of the nervous system is language I can't switch off I struggle to fall asleep I'm tired and wired the can't switch off is often times the one that I hear the most right it's a language that we're all probably familiar with what they're literally saying is I can't switch between my aroused state or my active State and my calm and relaxed State I can't switch off my nervous system I can't flip between sympathetic and parasympathetic um similar you know there's many things that can impact sleep I'm not going to say it's only nervous system regulation but it's a big component right like it's hard to sleep in a sympathetic State it's just they are the Opposites to each other right sympathetic is threat detection it's arousal it's alertness and sleep is the opposite so if I'm not good at being able to transition from an alert state to a calm state I'm going to find it hard to fall asleep and that tired and wired right my body is exhausted but my mind is still alert you know my nervous system hasn't switched years my body's tied because there's only so much energy you know in the day and I've done all this stuff but my nervous system is still in this kind of like what's going on go go go State I always look to what is their morning look like um it gives us a lot of an indication as what the rest of their day looks like you know if someone wakes up and they grab their phone and they're in their workin box putting out fires within 5 minutes of waking up they're going to be in that state all day you know we can look at this through a few different lenses but number I'm just going to present two here because I think they're fascinating number one is there kind of like Z to 60 or Z to 100 depending on where you live um immediately I've gone from the most calm State the most relaxed state which is asleep to arguably a state of high arousal stress I'm in my work inbox I'm in social media right that is not a smooth transition that is not how we evolved right we wake up most people are in this slower brain waves slower heart ratees slower respiratory rate and it gently picks itself up part of this is tied to our circadian biology right as the light comes and it stimulates my body to start to wake up it's meant to be a smooth transition likewise when I go to bed it's meant to be a smooth transition but if someone's scrolling social media at 10 p.m. in bed and then they log off and they go now it's time for sleep like that is not a smooth transition that person's going to struggle moving between these states of their autonomic nervous system the second thing is how we get our dopamine is how we will seek our dopamine right so this is more of a a poke at the phone but if I wake up and the first thing I do is grab my phone and get a little doam mean hit because I went in and I saw a couple of notifications or a few emails I'm going to unconsciously seek that phone out to get more do me throughout the day this thing is very arousing in terms of my notice system because it's this far away from my face right it is a little jackpot of dopamine um and it pushes us more into that state of alertness and arousal and so the behaviors that someone has right I ask people what's this what does it look like when you wake up and people like what what do you mean I'm like just tell me from when you wake up talk to me through the first hour of your day and if it's like oh I woke up and I check my inbox and I got to rush and get the kids ready and then it's like through traffic and I get to work a couple minutes late and then I'm straight it's like what they're describing is sympathetic sympathetic sympathetic syp it's like no transition and then just straight right Red Zone all day and then I get home and it's I'm late and I got to put the kids to bed it's like and then I switch up and then I crash and then I you know it's like never in evolution has that existed that we just stay in this prolonged state of sympathetic arousal we are meant to take moments of stress and recovery and something stimulates us and then we recover and this up and down and up and down today most people go up and they stay up all because they have a stressful job and there hustle culture and there's all the influences that keep people in that more sympathetic State and so us kind of recognizing hey how you move through the day is a big influence on your nervous system if you're in a constant stimulated stress State you know that is going to impact your nervous system being on social media as soon as you wake up or before you go to bed is going to impact your nervous system these are questions we should be asking and I I'm hypothesizing here but I work with enough people that tell me like oh you're the first person that's asked me that like I don't think people are being asked hey how are you using your phone you know is it on your bedside table it's the first thing you look at and the last thing you look at every day let's instead of just bastardizing the phone which I think that's people think that's what we're doing oh I know I've got to you know it's like no I want you to understand the impact that your phone has on your nervous system because your nervous system impacts everything else you know and it's just helping someone have a conversation and develop a more constructive relationship with tech technology because I don't you know it's like these things are pretty useful right and they're not going anywhere so we have to develop a better relationship with them and that starts with having an awareness of what do they do to us right and so that immediate onto my phone into my work inbox or into social media or whatever it is has a direct impact on the state of my nervous system I'm creating a set point that is quite high and that's what I'm going to return to every day instead of what if I woke up and I spent 10 minutes in bed doing some slow breathing my phone's outside in the kitchen you know I went outside and got some sunlight had a glass of water a cup of tea I wrote my journal I did some meditation I CED my day and then I intentionally turn my phone on ready right in a state that's more appropriate to deal with the stimulus that's coming my way very different you know it sets you up for a very different day and so when I look at the nervous system I look at right how do you move through the world are you go go go always been on you know like the typ a or you know and not even an all it's it's is that influencing your nervous system is that something we need to talk about less of that is about breathing and it's more about habits and lifestyle and just like how we engage with the world but it's a a part of the conversation that needs to be had I always kind of look also sorry also look at not just like what your day looks like today but what has your days looked like in your life tell me about childhood you know I grew up in a very stressful environment you know I grew up in an abusive household I grew up moving moving from school to school to school to school you know it's like I ask people you know when again I just want to stress that I'm going to give you you know an outline of the assessment that I use in terms of the questions that I ask but I ask people tell me what a 24-hour day looks like right from the moment you wake up walk me through your day I ask them what does the last kind of 12 to 18 months look like um just as a more recent what's going on what could be kind of influencing where you're at today and then tell me about your life tell me about your childhood you know because someone comes to you you know with some issues today they didn't start yesterday ever right they've built up and there there's all of these influences that again when someone goes to see the GP and they get a seven minute appointment they don't have time to ask them about their upbringing and you know their work environment what their day looks like and how they use their phone but we perhaps have the opportunity to do that and honestly I think one of the reasons I get such great results my CLI I spend a ton of time talking to them about what they do on a day-to-day basis and like a lot of it's not just like I gave you this magical strategy I gave you this magical breath work tool it's I helped you understand how your environment is influencing your health and let's have a conversation about what changes we can make to do that um I don't I often don't think it's this like magic pill it's these tiny little incremental changes and pushing back against a lot of the technological advancements that are influencing how well our body works um and being able to do that in a way that doesn't just kind of like all right you got to throw your phone in the ocean and you got to live in a monastery it's like that's not effective or appropriate it's never going to work for people so we got to kind of find this like how can we start to work with the stuff in our life um in a way that allows me to still engage in society and be connected and do all the stuff but also it not be the thing that causes me to stay in this constant state of stress and stimulus because I would argue that we've never been a more disregulated people um as where we are today and I think a big component of that is technology and social media and lack of connection to Nature and each other and the social influence that we can have like we're more connected than ever yet I would argue we're more isolated than ever our nervous systems perceive that right like this isn't woo woo Ary fairy it's very well grounded look at things like poly vagel Theory and neuroception it's like the nervous system knows you know when it's getting this like overload of stimulus and lack of connection I don't go outside I don't get sunlight and I don't touch the ground yeah I'm disregulated and that's going to express itself in a set of symptoms um maybe there's not all of these different pathologies maybe there's this core disconnection um from self from others and from the greater right nature um that is the root cause of this disruption and when we can start to put those pieces back together let's let's redevelop your relationship with yourself right let's help you reconnect with sun line right and this Arcadian Rhythm of the world that's always been Let's help you reconnect with other people or with nature magical stuff starts to happen when we respect the needs of human biology that are not being met you know and I it sounds you know so often it's like well that sounds so simple and it is um we're just not doing it and we don't do it um and so we look for the magic pill instead of being like Oh wait I should probably go outside every day and maybe hug a tree or take measures off and you know look at the ocean or the River or the lake or the park whatever it is like these things aren't like luxuries they're Necessities um when we look at how well the nervous system responds to these things it's like oh wait you know this should be a prescription that is given as much as a prescription for some pill um so kind of looking at the nervous system again how do we look at addressing that um I talk about right morning and evening routines right can we get the phone out of the bedroom can we give you something to do in that first 10 20 30 or even 60 Minutes of the day that's going to support this gentle transition in and out of a state of arousal 5 to 10 minute practices throughout the day that help push someone back towards a parasympathetic State you know extended exhales or even just slowing respiratory rate is really impactful to just bring the nervous system down a notch nasal breathing you know or even just breathing patterning in terms of if I'm mouth breathing versus nasal breathing if I'm chest breathing vers going to low dimatic breathing if it's faster slow all these things influence the nervous system so instead of making everything about we have to change all the environment it's also what you're doing the internal State you're creating um that we can start to Target through these little strategies right that don't take a lot of time next step before I kind of wrap all this up is emotions um emotions are or emotional state or yeah I guess emotional state is probably the the word I use most and capsules this best um is such an untapped driver of people's Health in my opinion you know if I live in a state of fear that's very different in terms of my immune system my inflammation my nervous system everything than living in a state of appreciation you know and it's not about being a monk and in this Blissful State all the time but it's recognizing you know the language that I use how I look at you know the things that I have to do in terms of like I'm scared I'm apprehensive I'm anxious never nothing ever goes my way of course I had to flare up you know I'll never get better when we can pick up the language that someone uses it gives us a good read of like what is your kind of like consistent emotional state because people use language that reflects their state like there's not a that they are not separate things and so I'm always kind of listening you know if someone says like oh I've tried all these things like nothing's really work no I I just think I've got to live with this I've been told I have to live with this there is a reflection of certain emotional state you know and there's a whole Workshop I did called from chaos to coherence which I'll I'll kind of Link within the datab base but kind of looks at how we can have more influence over emotional state and this isn't about just like feeling happy when you're feeling sad right it's far deeper in terms of the impact that it has on the functioning of the body like there's fascinating research from the heart math Institute um that kind of show you know when we're in this state of physiological or emotional coherence right versus incoherence and and so they show these examples of like someone in a state of frustration or anger versus someone in a state of appreciation or gratitude and the impact that that has in their cardiovascular system their brain their immune system their memory their attention like it's wild how much of a performance-enhancing drug it is to be able to tap into and shift my emotional state to one that is a little bit more renewing we all know this right like you get good news you're excited to go on holiday you're excited to see someone you haven't seen in a while you feel differently you think differently you talk differently your internal narrative is different and so this is something that we can reliably shift ourselves but most of us I would argue all of us aren't taught this you know no one's taught here's some strategies that you can use here's a step-by-step framework you can use to actually change your emotional state from frustration to appreciation right from Fear to calm whatever might be for that person and the flow on impact that that has on just Health outcomes I'm going to keep that very general is really kind of mindboggling so I'm always kind of listening for language um in terms of a reflection of this person's emotional state again it's very hard to objectively assess assess someone's emotional state like there's no numbers that we can write down to say like oh you're predominantly in this state this is subjective right this is me gathering information like a detective you know and putting together a story or puzzle to help someone kind of understand this big picture and this is where we're going to come kind of end with this relationship between mechanics physiology nervous system and emotions and again just to kind of Zoom back to where we started it almost doesn't matter who it is that walks in your door that jumps on the other end of that call if you look at mechanics physiology Nova System and emotions I guarantee you can help that person um because we're not trying to manage set of symptoms we're not trying to cure a specific pathology we're looking to support a person and here is the way that we do that right here's the questions that we can ask the things that we can look at that may be disrupting this person's system and here are the things that we can change and introduce that are going to support this person's system and so it's not about what symptoms they present with it's really about us addressing these core pillars that are necessary for human biology to work um you know and I know that's a very kind of like Grand and almost very broad general statement but that's just how I've kind of like come to this over the years that you support these things and the system right this innate capacity we all have kind of kicks back into gear like I have no Illusions as to who's doing the healing when I work with someone it's not me it's them right I'm removing the irritance and the disturbance and the disruptions and I'm helping them get rid of the stuff that's preventing them from tapping into this capacity that we all have right that we've always had of this regenerative state that we can get into um you know I I use this simple example sometimes and it's a little bit strange it often works you cut your finger today right you're chopping some cheese or something you cut your finger you don't know how you don't have to know how to heal the cup right there is such complex processes happening to heal a cut on your finger you watch it over a couple of days right there's this cut and it's bleeding and then a few days later there's a scab and then before and then all of a sudden there's no evidence of it whatsoever the processes that had to happen to heal that cut in terms of sending in white blood cells managing the inflammation response laying down collagen and fibrinogen and weaving the skin back together it's so far beyond our comprehension but we just like take yeah my body I can heal from a cut why would anything else be any different like we get in our head about well I've got back pain or I've got some autoimmune thing like we don't have to know how to heal the thing I think that's often the problem we have to support the body in its own healing and regenerative capacity and a lot of that is removing the stuff that prevents that and supporting right that regenerative capacity and that can be done through lots of different ways but without supporting movement posture physiology nervous system and emotional state I think we're going to fall short you know you can give someone all the adaptogens and you know supplements in the world but if again they're moving through the world in a way that continues to disregulation thinking between someone's posture their physiology their nervous system and their emotions is what I'm looking for when I assess someone so when someone comes to me it's like here's my little like road map that I'm going to kind of work through and I'm going to gather as much information about these core pillars as I can to formulate a plan which then allows me to say this is what we're going to do over the next 6 weeks or the next 10 weeks or whatever it might be um it's not oh here are the symptoms and we're going to try and manage those it's like here's how we're going to support and give you the missing pieces and take away the things that shouldn't be there so that your system right can come back into this regenerative State the final two things or three things um that are are less of a I guess they start to move Beyond breath you know and how breath interacts with you know our functioning um as sleep stress and exercise again I had a question recently from one of the previous students it's it's like well I'm not a sleep scientist you know I can't diagnose the apne and treat it I'm like neither can I you know that's not what I'm talking about but most people the 99% right that don't sleep well don't have some mystery sleep pathology they have shitty habits they don't wake up they don't get sunlight they're on their phone late at night they don't regulate throughout the day they exercise too late they eat too late whatever it might be and their sleep's impacted so we're not trying to you cure sleep apnea we're not trying to treat sleep apnea or or some other sleep pathology this is about like what are the lwh hanging fruit that we can help someone with that is likely to improve their sleep because sleep is one of these you know the tide that raises all boats in terms of if someone is sleeping poorly it is going to impact everything else full stop and if someone starts to sleep better it is going to impact everything else so asking people how do you sleep do you wake up at night what time do you go to bed how long does it take you to go to bed how many times do you wake up if you do wake up are you getting straight back to sleep or are you tossing and turning for a couple hours right it allows us to then be like yes I need to provide you with some information you know and some support that maybe help you sleep better and I'm by no means a sleep scientist right or a sleep specialist but I talk to all my clients about sleep because I've had shitty sleep for a lot of my life and I had to solve that problem and the strategies that I use seem to be effective for everyone else because they're General right don't be on your phone before you go to bed make sure you get sunlight in the morning don't exercise too late don't eat too late cool down the room make it dark right like so these things you don't have to be this specific specialist to talk to someone about this right you have to understand the small you know incremental changes that you can have that are going to impact everything else next one is stress um do someone the biggest part here and I'm going to introduce this a few times over the next couple of months the biggest thing with stress is D does someone see it as good or bad right do they feel they have the capacity to deal with it or does it feel like it's outside of them and they just don't know what's going on you know the main determining factor for a positive or A negative outcome of stress is their perception of stress right how much stress are they under do they need more or do they need less you know they need different types of stress how do they currently navigate feeling stress right do they seek it out do they avoid it is it constructive is it destructive I always have a conversation with someone about how they feel about stress um and I said that intentionally because how I feel about stress and how someone else does could be completely different so it doesn't matter the only thing that matters is how someone perceives it and if they're like stress is bad um they're going to have a more negative outcome based on the stress that they're under but if I can educate them as to a lot of the research on stress and the perception of stress and how stress is actually a positive thing if you are resourced and you have the capacity to deal with it and start to introduce some information that is counter to their belief system then we can start to shift their belief and their perception of stress and that's going to have a huge impact on everything else and then the final thing is exercise um I'm not talking about exercise to get fit I'm talking about exercise just to move the body um again we've got a whole module on this but humans invented exercise we didn't have a couple hundred years ago we just moved right we picture it up we were in the garden we chased stuff like we've engineered exercise out of our world as modern humans so now we're trying to reintroduce it through you know a studio on the corner that I can go to a couple times a week I think it's fascinating you know but it's also very very strange um we've always moved we've always expressed ourselves through movement until very recently where we now sit at desks for really long periods of day and then we go and sit on a treadmill for 20 minutes and we kill ourselves or what you know I know that's a a small slice of the example but it's really interesting how our relationship with exercis has changed and exercise is so Paramount to the body in terms of the stress that it gives us and a positive way in terms of you know what it does muscles that release these anti-depressant hormones and molecules blood flow to the brain like there's so much fat leing stuff coming out about lifting heavy stuff and getting your heart rate up that is far beyond I want my body to look good and I want to be able to run far it's like oh this is actually a critical piece as well and so not just like you should exercise more how can I help you redevelop a relationship with exercise that is consistent and positive so you can keep doing this over time not so that you can run a 10K so that you can start to re-engage with this system right that is so beneficial to everything else in your body so you know just to kind of wrap that big picture up movement posture physiology nervous system emotions are these kind of like core pillars that I'm going to look at in addition to I want to chat to someone about how you sleeping are there any strategies we can give you there what's your stress levels are the strategies we can give you there and and what's your relationship with movement and exercise um and if I can do all those things over a period of time I think it's very unlikely that someone isn't going to see massive positive change um and again and I know I'm kind of sounding like a parrot here in myself but it's because we're not trying to manage set of symptoms that this works it's because we're trying to support a set of systems right we're not managing a problem we're managing a person and that's what's missing for so many people is they are seen as a diagnostic label they're seen as a set of symptoms right and instead we're going to look at them and be like you're a human that has this expression of symptoms what can we do to support the system to alleviate that and help you tap back into this more regenerative restorative state that we all have access to um but is missing because of external and internal disruption if we can just keep it nice in general um so I'll pause there otherwise I'll just talk for another hour um and I'll just quickly jump into the questions here Hannah can you remind us if increasing CO2 tolerance is best come by extended exal or intentional breathholds technically both um and in addition to that just slow breathing the the extended exhales I just want to kind of like point to for a moment if I extend my exhale it's always hard for me to wear this because it's so interesting um you know if I just think of my normal respiratory cycle if I just slightly increase my exhale it depends or not even slightly if I increase my exhale it depends on how I do it right I can extend my Exhale by blowing out more air that is reducing CO2 right because I'm blowing harder I'm pushing the air out but to continue to extend my exhale at some point I have to stop blowing and I have to start resisting right if I'm going to Exhale for 20 seconds I can't blow blow the air out for 20 seconds I have to reduce the amount of air that's escaping from my lips right and so at some point it's different forever and there's no way we can say this is the point that it changes but extended exhales I always just want to point to is like yeah I could I could do an extended exhale which longer than usual but I can do it by forcing the air out that is not going to increase CO2 because I'm pushing it out but at some point if it gets longer and longer and longer at some point I start to slow it down rather than push it out and that's when it starts to increase the CO2 so slow nasal breathing breath holds um yes extended exhales I would just put that under slow nasal breathing are kind of the the fastest way that we can start to impact CO2 um Andrea is there research demonstrating that helping people regulate their nervous system improves response to treatment poor health conditions I would dare say no because like spoke about yesterday ain't no money in that um you know and this is also the case when someone says is there is there research to show how breath work supports X Y or Zed and it's so kind of like Niche at the moment that we're not there's no funding for someone to explore how does breath work impact X Y or Zed the Wim Hoff method's actually getting a little bit they've done a couple of autoimmune conditions theyve done spond AR spond thesis no sponding alcoh so an autoimmune condition of the spine similar to rheumatoid arthritis so the Wim Hof method theyve actually you know done a couple of these like pilot studies on very specific inflammatory conditions um and so but what we're looking at there is like what is the impact there's this in between like what is breath work doing to the nervous system and nervous system doing to the condition that I find that that piece is more of a hypothesis it's like okay well we understand that you know slow breathing does this to the nervous system the nervous system being in this state does this to inflammation and so we can kind of draw those threads between A and B but I don't think there's any direct research to say nervous system regulation and impact on certain health conditions um I'll do a bit of digging to see if maybe I can make myself wrong because it would be great to see that research my guess is no um and Hannah I'll just type the five pillars [Music] in um and if anyone else has questions I got a couple of minutes um if anyone wants to chime in with anything so the core pillars would be the five movement physiology nervous system emotions um and then that addition when we're looking at kind of stress sleep and exercise and so I'll pop this recording up with a little bit more um text based information as to kind of like here's the tools that I'm talking about here's the you know just so you've got both I know some people are visual Learners and others like to write and read so I always like to just put this up and so I'll just link this once it's uploaded to YouTube um on a private Channel and just kind of like direct you to it um but if any other questions do come up I'm really a message away um it's nice to see some old faces and and lovely to see the new faces as well hopefully this kind of just paints a little bit of a picture and what I'd encourage you to do you know is like how am I going to apply this right you know Andrew you're on my screen for a moment right now so I'm just going to point to you it's like if you're thinking of like if I was chatting to you know those with f&d like what would this conversation look like you know how would we frame it because it's going to be different to to Spina you might be thinking about students in your class right and so this is a framework it is not necessary like I have to take this word for word and apply it there should be some adaptation and and some some kind of like personalization to like if I'm talking athletes if I'm talking to moms if I'm talking to CEOs like I'm probably going to adjust the language a little bit in terms of the questions that I'm asking but the framework won't change right if I look at these pillars you know and ask these questions I'm going to get some very very valuable information which I can use to then formulate a plan to take forward and help this person um so I just want to kind of add that but hope it makes sense for everyone and if any questions do come up fire on my way thank you so much Campbell it was so fantastic as always thanks cell really enjoyed that yeah cheers everybody'll see bye byebye bye